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AIM: To investigate associations between Body Image concerns (BICs) measured by the ICD Body Image Concerns Questionnaire (ICD-BICQ) and other Patient-Reported-Outcomes (PROs), in a cohort of patients with an Implantable Cardioverter Defibrillator (ICD). METHODS AND RESULTS: In a cross-sectional survey, we included patients >18 years implanted with a first-time ICD (VVI, DDD and CRT-D) who had lived with their ICD from 3-24 months. They completed the 39-item ICD-BICQ together with the Generalized Anxiety Disorder-scale, Patient Health-Questionnaire, Type D-Scale, Health Status-Questionnaire and the Florida Patient Acceptance-Survey. Data were analyzed using linear regression to compare personality constructs between patients with and without BICs. Logistic repression and receiver operating characteristic curves were used to predict patients with BICs based on other PROs.A total of 330 patients completed the survey. Five patients were excluded due to re-operations leaving 325 patients in the analyses. A total of 20% reported BICs at the recommended cut-off at 36-points. Patients with BICs reported higher anxiety and depression levels, lower device acceptance and health status, had a Type D personality as compared to patients without BICs. FPAS was moderately able to predict BICs, while other PROs only had limited ability to predict BICs. CONCLUSION: Patients with BICs reported poorer PROs. The PRO instruments were not able to predict patients with BICs, indicating that the ICD-BICQ provides independent relevant clinical information. In clinical practice, healthcare professionals can use the ICD-BICQ to identify and obtain information on possible BICs. The ICD-BICQ can also be used to evaluate new operation techniques.

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Objective: Firstly, the study explores the association between timely initiation of rehabilitation and 90-day and 365-day all-cause acute readmission and secondly, 90-day and 365-day all-cause mortality in a cohort of Odense Municipality residents. Methods: The registry-based observational cohort study investigates acute contacts at Odense University Hospital from 2015 to 2020. Descriptive statistics, Cox regression and cumulative incidence rates were used for analysis. Subjects: The study utilizes initiated rehabilitation referrals within 60 days from Odense Municipality residents. Results: In total, 7,377 rehabilitation plans were initiated, including 5051 (68.5%) within the legal timeframe. Overall, timely initiation of rehabilitation within the legal timeframe was associated with a significantly reduced risk of 90-day all-cause acute readmission (Adjusted HR 0.82, 95% CI 0.74-0.90).In the adjusted analysis, timely initiation was also significantly associated with reduced risk in 365-day all-cause acute readmission (HR 0.90, 95% CI 0.83-0.97). Each week of delay in initiation of rehabilitation was associated with an increased risk of readmission (HR 1.05, 95% CI 1.02-1.07). Further, timely initiation of rehabilitation was associated with a significant reduction in the risk of 365-day all-cause mortality (HR 0.74, 95% CI 0.61-0.89). Conclusion: Timely initiation of rehabilitation within the legal timeframe of 7 or 14 days was associated with significantly reduced risk of 90-day and 365-day all-cause acute readmission. Timely initiation of rehabilitation was also associated with significant reduction in the risk of 365-day all-cause mortality.

Most patients can benefit from rehabilitation after hospital admission. Early rehabilitation has shown to be useful for specific patient groups. This study explores the association between timely rehabilitation and readmission and early mortality in a cohort of Odense Municipality residents. Findings show that timely initiation of rehabilitation is associated with fewer acute readmissions. For each week the rehabilitation is delayed the risk of readmission increases. Furthermore, timely initiation of rehabilitation was significantly associated with a reduction of all-cause mortality within 365 days.

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BACKGROUND: Health-related quality of life (HRQoL) is highly valued among older adults with cancer. The Geriatric 8 screening tool identifies individuals with frailty, but its association with HRQoL remains sparsely investigated. Herein, we evaluate whether Geriatric 8 frailty is associated with short-term and long-term HRQoL in older patients with cancer. METHODS: In this Danish single-centre, prospective cohort study, patients aged 70 years and older, referred to oncological assessment for solid cancers, were screened with the Geriatric 8. Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality-of-Life Core 30 (QLQ-C30) and Elderly 14 (ELD14) questionnaires at baseline, 3 months, 6 months, 9 months, and 12 months. Patient characteristics were obtained from medical records. Differences in mean global health status and QoL (GHS), measured using the two seven-point Likert scale questions from the EORTC QLQ-C30 regarding overall health and QoL during the past week, between patients with frailty (defined as a Geriatric 8 score of ≤14) and without frailty within 12 months were the primary outcome. Secondary outcomes were differences in the mean EORTC Summary Score comprised of all questions from the QLQ-C30 except for those included in the GHS and a question concerning financial difficulties, and five functional (physical, role, and social functioning, maintaining purpose, and family support from the EORTC QLQ-C30 and the EORTC-QLQ-ELD14), and five symptom scales (fatigue, pain, mobility, future worries, and burden of illness from the EORTC-QLQ-C30 and the EORTC-QLQ-ELD14). Analyses were done using linear mixed models. All primary and secondary outcomes were adjusted for gender, treatment intent, and cancer type and the primary outcome was also assessed by means of a responder analysis. FINDINGS: Between June 1, 2020 and Oct 15, 2021, 1398 eligible patients were screened with the Geriatric 8 (908 [65%] with frailty and 490 [35%] without frailty) and provided medical record data. Of these patients, 707 (51%) also provided HRQoL data (437 [62%] with frailty and 270 [38%] without frailty). When adjusted, patients with frailty had poorer GHS (-15·1, 95% CI -18·5 to -11·6; p<0·0001) at baseline and throughout follow-up (3 months -7·4, -11·0 to -3·7, p=0·0001; 6 months -11·7, -15·5 to -7·9, p<0·0001; 9 months -10·4, -14·3 to -6·5, p<0·0001; 12 months -10·4, -14·6 to -6·2, p<0·0001) compared to patients without frailty. Adjusted summary scores were also poorer for patients with frailty (-9·9, 95% CI -12·1 to -7·6; p<0·0001) compared to patients without frailty at baseline and throughout follow-up (3 months -8·2, -10·5 to -5·8, p=0·0001; 6 months -9·0, -11·4 to -6·6, p<0·0001; 9 months -9·2, -11·7 to -6·8, p<0·0001; 12 months -8·9, -11·5 to -6·3, p<0·0001). Patients with frailty had significantly worse physical and role functioning, mobility, and fatigue outcomes, with no differences in family support within 12 months, at all timepoints. INTERPRETATION: Older patients with cancer and frailty have significantly poorer HRQoL than those without frailty within the 12 months following an oncology referral. Thus, by identifying and treating frailty, we can ultimately improve patient HRQoL. FUNDING: The Danish Cancer Society, Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, University of Southern Denmark, Dagmar Marshalls Fond, and Agnes and Poul Friis Fond.

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BACKGROUND: The distinction between complicated and uncomplicated acute appendicitis (AA) is important as it guides postoperative antibiotic treatment. A diagnosis based on intraoperative findings is imprecise and standard cultivation of peritoneal fluid is generally time-consuming with little clinical benefit. The aim of this study was to examine if cultivation of peritoneal fluid in acute appendicitis could reliably detect bacteria within 24 h. METHODS: Patients older than 18 years undergoing laparoscopic appendectomy were prospectively enrolled at two surgical departments after informed consent was obtained. Periappendicular fluid was collected prior to appendectomy and sent for cultivation. Sensitivity, specificity and positive and negative predictive values were calculated with 95% confidence intervals (CIs) using 72-hour cultivation results as the gold standard. Patients with complicated AA as determined by the surgeon, received a three-day course of oral antibiotics. Postoperative infectious complications within 30 days after surgery were registered. RESULTS: From July 2020 to January 2021, 101 patients were included. The intraoperative diagnosis was complicated AA in 34 cases. Of these patients, six (17.6%) had bacteria cultured within 24 h after surgery, leading to a sensitivity of 60% and a specificity of 100%. The positive and negative predictive values were 1.00 and 0.96, respectively. Seven patients developed a postoperative infection (five superficial wound infections and two intra-abdominal abscess). In all cases with a positive cultivation result, the intraoperative diagnosis was complicated appendicitis and a postoperative course of antibiotics prescribed. CONCLUSION: Twenty-four-hour cultivation of the peritoneal fluid in acute appendicitis is a valid indicator for peritoneal bacterial contamination. Randomized studies are necessary to determine if this approach is suitable for targeting postoperative antibiotic treatment as a means to prevent overtreatment without increasing the risk of infectious complications.

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BACKGROUND: In aging populations, understanding predictors of cognitive decline is essential. We aimed to investigate the risk of cognitive decline and dementia by sensory impairments across sex, age, and European regions, and examined the mediating role of activities of daily living (ADL), physical activity, and depressive symptoms. METHODS: A cohort study of 72,287 Europeans aged 50+ participating in at least two waves of the Survey of Health, Ageing and Retirement in Europe. We employed mixed-effects and time-to-event models, incorporating sex interactions, and adjusting for socio-demographic factors and medical history. RESULTS: Compared to individuals with good vision and hearing, lower cognitive function was found for people with vision impairment (VI) (males: coef. -0.70, 95 % CI -0.95; -0.46; females: coef. -1.12, 95 % CI -1.33; -0.92), hearing impairment (HI) (males: coef. -0.64, 95 % CI -0.93; -0.35; females: coef. -0.96, 95 % CI -1.27; -0.65) and dual sensory impairment (DSI, i.e. VI and HI) (males: coef. -1.81, 95 % CI -2.16; -1.46; females: coef. -2.71, 95 % CI -3.05; -2.38), particularly among females. Moreover, higher dementia risk was observed among participants with VI (hazard ratio (HR) 1.29, 95 % CI 1.17; 1.43), HI (HR 1.18, 95 % CI 1.05; 1.34), and DSI (HR 1.62, 95 % CI 1.45; 1.81) with no sex-interactions. Findings were overall consistent across age and European regions. CONCLUSION: The results suggest the necessity of preventing sensory impairments to maintain good cognitive function. Mitigating depressive symptoms, ADL limitations, and physical inactivity could potentially reduce a significant portion of the total effect of sensory impairments on cognitive decline.

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PURPOSE: This study aimed to investigate the effect of remote ischemic preconditioning (RIPC) on the healing of small intestinal anastomoses, evaluated by tensile strength and histologic wound healing on postoperative day 5. METHODS: A total of 22 female pigs were randomized 1:1 into either an intervention or control group. The intervention group received 5 cycles of 3-minute ischemia followed by 3-minute reperfusion on the right forelimb. Two end-to-end anastomoses, a distal and a proximal, were created in the small intestine 30 and 60 min after RIPC, respectively. On postoperative day 5, the anastomoses were harvested and underwent a maximal anastomotic tensile strength (MATS) test (MATS 1-3) followed by histologic analyses. RESULTS: MATS 1, when a tear became visible in the serosa, was significantly increased in the proximal anastomoses of the RIPC group compared with the control group (4.91 N vs 3.83 N; P = .005). No other significant differences were found when comparing these 2 groups. CONCLUSION: Our study showed no convincing results of RIPC on intestinal anastomotic healing to recommend its use in a general clinical setting. Further animal studies on RIPC's effect after relative or absolute intestinal ischemia may be recommended.

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OBJECTIVE: To investigate if a combination of an online and onsite implementation strategy was superior to an online-only strategy in enhancing the use of an injury prevention exercise programme (IPEP) and in reducing the risk of shoulder, knee and ankle injuries in youth community handball players (age 11-17) over a handball season. METHODS: In this 30-week hybrid effectiveness-implementation cluster randomised type 3 study, 20 youth handball clubs were randomly assigned 1:1 to either a combined online and onsite implementation strategy (coach workshop using the health action process approach behaviour change model and health service provider (HSP) support) or an online-only strategy (control group). The primary implementation outcome was coach-reported adherence, measured as the average IPEP exercise usage by the team over 30 weeks. The primary effectiveness outcome was player-reported handball playing time to any new handball-related shoulder, knee and ankle injuries, reported weekly using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. RESULTS: We enrolled 63 coaches (27% women) and 945 players (mean age 14.5 years, 55% girls). Intention-to-treat analyses showed no statistically significant difference between implementation strategies in adherence (between-group difference 1.4, 95% CI -0.5 to 3.4) or in cumulative injury risk (between-group difference 5.5% points, 95% CI -2.2 to 13.1). CONCLUSION: Our findings demonstrate that in youth community handball, a combined online and onsite implementation strategy, including a coach workshop and HSP support, was not superior to an online-only strategy regarding adherence to an IPEP or in reducing shoulder, knee and ankle injury risk. TRIAL REGISTRATION NUMBER: NCT05294237.

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BACKGROUND: Gestational diabetes mellitus (GDM) is glucose intolerance first detected during pregnancy. Twin pregnancies have a higher risk of GDM, likely due to increased placental mass and elevated placental lactogen levels. OBJECTIVE: The aims of this study were 1) to assess the impact of chorionicity on the development of GDM in twin pregnancies and 2) to assess a possible association between placenta weight and the development of GDM. METHODS: We conducted a prospective cohort study of all women with twin pregnancies (N = 819) at the department of Obstetrics and Gynecology, Lillebaelt University Hospital, Kolding, Denmark, between January 1, 2007 and April 30, 2019. Information on chronicity was determined at the first visit with ultrasonic imaging, during weeks' gestation 11-13. Oral glucose-tolerance test was performed to diagnose gestational diabetes mellitus. RESULTS: Among 819 twins, 17.8 % were monochorionic twins and 82.2 % were dichorionic twins. There were no statistically significant difference of GDM prevalence between monochorionic twins group 7.4 % and dichorionic twins group 9.8 % (P = 0.42). Placenta's weight in dichorionic twins was larger compared with monochorionic twins. No association was found between the weight of placenta and the prevalence of GDM (P = 0.21), even after adjustment for body mass index, gestational age, and fertility treatment (P = 0.87). CONCLUSIONS: Our study could not find an association between chorionicity, placental weight, and GDM. It is, therefore, possible that twin pregnancies, regardless of chorionicity and placental weight, have the same risk for GDM.

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Materials applied in nuclear environments such as fission or fusion power-plants face severe conditions. The irradiation by neutrons induces thermal loads and irradiation damage. Furthermore, coolants in contact with the materials induce corrosion, which is particularly challenging for liquid salts intended for the next generation of fission reactors. A new device (DICE) is installed at the 3.5 MV accelerator at DIFFER for the accelerated testing of such materials under combined irradiation and corrosion conditions. The DICE enables irradiation of samples at temperatures of up to 1050 K and in contact with liquid salts. An integrated shielding and a low power temperature control concept based on radiation cooling enables high-duty cycle application in a standard accelerator laboratory. Ion currents of up to 30 µA are possible with continuous irradiation. This work outlines the technical concept of the device and presents the first data.

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AIM: This study aimed to investigate the short-and long-term effect on diabetic retinopathy (DR) in individuals with type 1 diabetes treated with continuous subcutaneous insulin injections (CSII) compared to those using multiple daily injections (MDI). METHODS: We conducted a register-based matched cohort study utilizing data from the Danish Registry of Diabetic Retinopathy as well as several other national Danish health registers. Our cohort consisted of all individuals with type 1 diabetes who attended the Danish screening program for DR from 2013 to 2022. We included individuals registered with CSII treatment, and compared them to individuals using MDI, matched by age, sex, and DR level. Cox regression analysis was performed to evaluate the outcomes. RESULTS: The study included 674 individuals treated with CSII and 2006 matched MDI users. In our cohort 53.4 % were female and median age was 36 (IQR 27-47). Average follow-up risk-time was 4.8 years. There was no difference in the risk of DR worsening between the CSII group and MDI group (HR 1.05 [95%CI 0.91; 1.22], p = 0.49). However, an increased risk of focal photocoagulation was observed in the CSII group (HR 2.40 [95%CI 1.11; 5.19], p = 0.03). CONCLUSIONS: Our findings indicate that CSII treatment does not confer a significant difference in the overall short- and long-term risk of DR worsening or ocular intervention compared to MDI treatment. These results provide insights into the DR outcomes of CSII treatment in individuals with type 1 diabetes.

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BACKGROUND: Vitamin D status in pregnancy may affect offspring neurodevelopment. OBJECTIVE: The objective was to investigate the association between serum 25-hydroxyvitamin D in cord blood and pregnancy and symptoms of attention-deficit hyperactivity disorder in 5-year-old offspring. METHOD: In Odense Child Cohort, Denmark, 944 mother-child pairs had data on pregnancy or cord serum 25-hydroxyvitamin D and parent-rated attention-deficit hyperactivity disorder symptom score by Child Behavior Checklist for ages 1.5-5 years. Adjusted multiple linear regression and two-stage exposure analyses were performed for serum 25-hydroxyvitamin D associations to the attention-deficit hyperactivity disorder symptom score. RESULTS: The mean (standard deviation) serum 25-hydroxyvitamin D in cord blood was 48.0 (21.8) nmol/L; early pregnancy was 65.5 (20.2) nmol/L and late pregnancy was 79.3 (25.7) nmol/L. The median (interquartile range) age of child at examination was 5.2 (5.1-5.4) years and median (interquartile range) attention-deficit hyperactivity disorder symptom score was 2 (0-3) points. In adjusted analyses, serum 25-hydroxyvitamin D of <25 nmol/L and <32 nmol/L in cord blood and <25 nmol/L in early pregnancy was associated with 0.9 [95% confidence interval: 0.4, 1.3], 0.5 [0.1, 0.9] and 2.1 [0.8, 3.4] points higher attention-deficit hyperactivity disorder symptom score vs reference. In the two-stage exposure analysis, attention-deficit hyperactivity disorder symptom score decreased by 0.4 points per 25 nmol/L increase in serum 25-hydroxyvitamin D. Moreover, serum 25-hydroxyvitamin D of <25 nmol/L in early pregnancy and cord was associated with a five-fold and a two-fold risk of attention-deficit hyperactivity disorder symptom score ⩾90th percentile, adjusted odds ratio [95% confidence interval] = 4.9 [1.3, 19.0] and 2.2 [1.2, 3.9]. CONCLUSION: In this cohort, serum 25-hydroxyvitamin D <25 nmol/L in cord blood and early pregnancy were risk factors for higher attention-deficit hyperactivity disorder symptom score in 5-year-old children, suggesting a protective effect of vitamin D on attention-deficit hyperactivity disorder traits at preschool age.

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Ion Beam Analysis (IBA) utilizing MeV ion beams provides valuable insights into surface elemental composition across the entire periodic table. While ion beam measurements have advanced towards high throughput for mapping applications, data analysis has lagged behind due to the challenges posed by large volumes of data and multiple detectors providing diverse analytical information. Traditional physics-based fitting algorithms for these spectra can be time-consuming and prone to local minima traps, often taking days or weeks to complete. This study presents an approach employing a Mixture Density Network (MDN) to model the posterior distribution of Elemental Depth Profiles (EDP) from input spectra. Our MDN architecture includes an encoder module (EM), leveraging a Convolutional Neural Network-Gated Recurrent Unit (CNN-GRU), and a Mixture Density Head (MDH) employing a Multi-Layer Perceptron (MLP). Validation across three datasets with varying complexities demonstrates that for simple and intermediate cases, the MDN performs comparably to the conventional automatic fitting method (Autofit). However, for more complex datasets, Autofit still outperforms the MDN. Additionally, our integrated approach, combining MDN with the automatic fit method, significantly enhances accuracy while still reducing computational time, offering a promising avenue for improved analysis in IBA.

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BACKGROUND: The BODY-Q is a widely used patient-reported outcome measure for comprehensive assessment of treatment outcomes specific to patients undergoing body contouring surgery (BCS). However, for BODY-Q to be meaningfully interpreted and used in clinical practice, minimal important difference (MID) scores are needed. A MID is defined as the smallest change in outcome measure score that patients perceive important. OBJECTIVES: The aim of this study was to determine BODY-Q MID estimates for patients undergoing BCS to enhance the interpretability of the BODY-Q. METHODS: Data from an international, prospective cohort from Denmark, Finland, Germany, Italy, the Netherlands, and Poland were included. Two distribution-based methods were used to estimate MID: 0.2 standard deviations of mean baseline scores and the mean standardized response change of BODY-Q scores from baseline to 3 years postoperatively. RESULTS: A total of 12,554 assessments from 3,237 participants (mean age; 42.5±9.3 years; body mass index; 28.9±4.9 kg/m2) were included. Baseline MID scores ranged from 1 to 5 in the health-related quality of life (HRQL) scales and 3 to 6 in the appearance scales. The estimated MID scores from baseline to 3 years follow-up ranged from 4 to 5 in HRQL and from 4 to 8 in the appearance scales. CONCLUSIONS: The BODY-Q MID estimates from before BCS to 3 years postoperatively ranged from 4 to 8 and are recommended for use to interpret patients' BODY-Q scores, evaluate treatment effects of different BCS procedures, and for calculating sample size for future studies.

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BACKGROUND: The natural history of symptomatic uncomplicated gallstone disease is largely unknown. We examined the risk of progressing from symptomatic uncomplicated to complicated gallstone disease in a large regional cohort of patients, where disruptions in elective surgical capacities have led to the indefinite postponement of surgery for benign conditions, including cholecystectomies. METHODS: Patients with radiologically diagnosed incident symptomatic and uncomplicated gallstone disease were identified from outpatient clinics and emergency departments on the Island of Funen, Denmark. The absolute risk of complications (cholecystitis, cholangitis, pancreatitis, acute cholecystectomy for unremitting pain) was calculated using death and elective cholecystectomies as competing risks using the Aalen-Johansen method. Cox proportional hazards regression analysis was used to estimate hazard ratios (HRs) of gallstone complications associated with patient and gallstone characteristics. RESULTS: Two hundred eighty-six patients diagnosed with incident symptomatic, uncomplicated gallstone disease from 1 January 2020 to 1 July 2023 were identified. During 79,170 person-years of observation, 176 (61.5%) patients developed a gallstone-related complication. The 6-, 12- and 24-month risk of developing gallstone-related complications were 36%, 55% and 81%. The risk of developing complications related to common bile duct stones was lowest with larger stones (aHR per millimeter increase = 0.89 (0.82-0.97), p < 0.01), while no covariates were statistically significantly associated with the risk of cholecystitis. Eighty-five (30%) patients underwent elective laparoscopic cholecystectomy, with one patient (1.2%) developing a gallstone-related complication afterward. CONCLUSIONS: The risk of developing complications to symptomatic gallstones in a general Scandinavian population is high, and prophylactic cholecystectomy should be considered.

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Importance: Patients with atrial fibrillation (AF) can have an ischemic stroke (IS) despite oral anticoagulant (OAC) treatment. Knowledge regarding the association between OAC discontinuation and the subsequent risk of recurrent IS in patients with AF is limited. Objectives: To determine the risk of recurrent IS in patients with AF receiving OAC and to evaluate the association between OAC discontinuation and the risk of recurrent IS. Design, Setting, and Participants: This is a nationwide cohort study of patients aged 50 years or older in Denmark who had AF and an IS (entry IS) and were initiating or restarting subsequent OAC treatment after being discharged between January 2014 and December 2021. Patients were followed up for recurrent IS until June 2022. Within this study cohort, a nested case-control analysis was performed in which patients with recurrent IS were matched to patients receiving OAC who had not yet experienced a stroke. Data were analyzed from May 25, 2023, to April 18, 2024. Exposure: Use of OAC at the time of recurrent IS or the equivalent date in matched controls based on redeemed prescriptions. Main Outcomes and Measures: The primary outcome was recurrent IS. Crude and adjusted cumulative incidences of recurrent IS and all-cause mortality were calculated in cohort analyses, and adjusted odds ratios (aORs) were determined for recurrent IS associated with OAC discontinuation in nested case-control analyses. Results: The study cohort included 8119 patients (4392 [54.1%] male; mean [SD] age, 78.4 [9.6] years; median (IQR) CHA2DS2-VASc score, 4.0 [3.0-5.0]). Over a mean (SD) follow-up of 2.9 (2.2) years, 663 patients had a recurrent IS, of whom 533 (80.4%) were receiving OAC at the time of their recurrent IS. The crude cumulative incidence of recurrent IS at 1 year was 4.3% (95% CI, 5.9%-7.1%), and the crude cumulative incidence of all-cause mortality was 15.4% (95% CI, 14.7%-16.2%). Adjusted analysis showed similar results. Patients who discontinued OACs had a higher risk of recurrent IS (89 cases [13.4%], 180 controls [6.8%]; aOR, 2.13; 95% CI, 1.57-2.89) compared with patients still receiving OAC. Conclusions and Relevance: The risks of recurrent IS and mortality were high in patients with AF despite secondary prevention with OAC, and OAC discontinuation doubled the risk of recurrent IS compared with patients who continued OAC. This finding highlights the importance of OAC continuation and the need for improved secondary stroke prevention in patients with AF.

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PURPOSE: The Region of Southern Denmark has recently established four late effects clinics to help cancer survivors suffering from complex and severe late effects. This study aimed to capture and analyze the full range of physical, mental, and psychosocial issues using patient-reported outcomes. Moreover, we aimed to describe demographic data and the type and severity of the late effects. METHODS: A prospective cohort study was conducted among cancer survivors referred to a late effects clinic. Before their first appointment, patients completed the European Organization for Research and Treatment of Cancer Quality of Life cancer survivorship core questionnaire (EORTC QLQ-SURV100). We compared mean scores of the EORTC QLQ-SURV100 scales that were comparable to the scales/items from the EORTC QLQ-C30 questionnaire with norm data for the Danish population and EORTC reference values. RESULTS: All patients referred to the clinic within its first 2 years were included (n = 247). The mean age was 57 [23-85] years and 74% were females. The most common cancer diagnoses was breast cancer (39%). The five most commonly reported late effects were fatigue (66%), pain (51%), cognitive impairment (53%), sleep problems (42%), and neuropathy (40%). A total of 236 of the patients entering the clinic completed QLQ-SURV100. They reported significantly worse mean scores on all scales compared to the Danish norm population and EORTC reference values for pretreatment cancer patients, p < 0.001. Effect sizes were moderate or large for all scales. INTERPRETATION: In this study, we collected demographic data and described the late effects presented by the patents referred to the clinic. Moreover, we captured and analyzed the full range of physical, mental, and psychosocial issues using QLQ-SURV100. Patients referred to the Late Effects Clinic (LEC) had a number of late effects and reported a significantly lower health-related quality of life compared to the general Danish population and patients who have just been diagnosed with cancer, suggesting the aim of helping patients suffering from late effects gain a better quality of life is in dire need.

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PURPOSE: Non-response (NR) to patient-reported outcome (PRO) questionnaires may cause bias if not handled appropriately. Collecting reasons for NR is recommended, but how reasons for NR are related to missing data mechanisms remains unexplored. We aimed to explore this relationship for intermittent NRs. METHODS: Patients with multiple myeloma completed validated PRO questionnaires at enrolment and 12 follow-up time-points. NR was defined as non-completion of a follow-up assessment within seven days, which triggered contact with the patient, recording the reason for missingness and an invitation to complete the questionnaire (denoted "salvage response"). Mean differences between salvage and previous on-time scores were estimated for groups defined by reasons for NR using linear regression with clustered standard errors. Statistically significant mean differences larger than minimal important difference thresholds were interpreted as "missing not at random" (MNAR) mechanism (i.e. assumed to be related to declining health), and the remainder interpreted as aligned with "missing completely at random" (MCAR) mechanism (i.e. assumed unrelated to changes in health). RESULTS: Most (7228/7534 (96%)) follow-up questionnaires were completed; 11% (802/7534) were salvage responses. Mean salvage scores were compared to previous on-time scores by reason: those due to hospital admission, mental or physical reasons were worse in 10/22 PRO domains; those due to technical difficulties/procedural errors were no different in 21/22 PRO domains; and those due to overlooked/forgotten or other/unspecified reasons were no different in any domains. CONCLUSION: Intermittent NRs due to hospital admission, mental or physical reasons were aligned with MNAR mechanism for nearly half of PRO domains, while intermittent NRs due to technical difficulties/procedural errors or other/unspecified reasons generally were aligned with MCAR mechanism.

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OBJECTIVES: To investigate the associations between sensory impairments and the development of depressive symptoms across sex, age, and European regions, and to examine the mediating role of cognitive function, activities of daily living (ADL), and physical activity. METHOD: A cohort study including 56,847 Europeans aged 50+ participating in at least two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). Associations were analyzed using mixed effects logistic regression models considering several confounders. RESULTS: Overall, 17.8% developed depressive symptoms. Compared to participants with good vision and hearing, those with vision impairment (VI) (odds ratio (OR) = 1.35, 95% confidence interval (CI) 1.27-1.44), hearing impairment (HI) OR = 1.32, 95% CI 1.21-1.43, and dual sensory impairment (DSI, i.e. VI and HI) (OR = 1.93, 95% CI 1.75-2.13) had increased odds of depressive symptoms. The associations were consistent across sex and European regions but became stronger with advancing age among men. Dose-response relationships were found for all associations. Mediation analyses revealed that preventing cognitive decline, ADL limitations, and physical inactivity would eliminate 15.0%, 11.5%, and 21.4% of the total effect for VI, HI, and DSI, respectively. CONCLUSION: Our findings emphasize the importance of preventing sensory impairments to avoid depressive symptoms.

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OBJECTIVES: The objective of this study was to investigate associations between knowledge of health issues and healthcare satisfaction and propensity to complain including the association between knowledge and greater patient involvement. DESIGN: The present study is a secondary analysis of a larger cross-sectional case vignette survey. SETTING: Survey conducted in adult Danish men. PARTICIPANTS: Participants included 6755 men aged 45-70 years. INTERVENTIONS: Participants responded to a survey with scenarios illustrating prostate-specific antigen (PSA) testing and different information provision. PRIMARY AND SECONDARY OUTCOME MEASURES: Using Likert scales (scored 1-5), participants rated their satisfaction with the care described and their inclination to complain and responded to a short quiz (scored 0-3) assessing their knowledge about the PSA test. RESULTS: Satisfaction with healthcare increased with better quiz performance (Likert difference 0.13 (95% CI .07 to 0.20), p <0.001, totally correct vs totally incorrect responders) and correspondingly, the desire to complain significantly decreased (Likert difference -0.34 (95% CI 0.40 to -0.27), p <0.001). Respondents with higher education performed better (mean quiz score difference 0.59 (95% CI 0.50 to 0.67), p <0.001, most educated vs least educated). Responders who received information about the PSA test generally performed better (quiz score difference 0.41 (95% CI 0.35 to 0.47), p<0.001, neutral vs no information). Overestimation of PSA merits was more common than underestimation (7.9% vs 3.8%). CONCLUSIONS: Mens' knowledge of the benefits of screening varies with education, predicts satisfaction with care and the desire to complain, and may be improved through greater involvement in decision-making.

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BODY-Q is a patient-reported outcome measure for comprehensive assessment of outcomes specific to patients undergoing bariatric surgery. The clinical utility of BODY-Q is hampered by the lack of guidance on score interpretation. This study aimed to determine minimal important difference (MID) for assessment of BODY-Q. Prospective BODY-Q data from Denmark and the Netherlands pre- and post-bariatric surgery were collected. Two distribution-based methods were used to estimate MID by 0.2 standard deviations of baseline scores and the mean standardized response change of scores from baseline to 3-years postoperatively. In total, 5476 assessments from 2253 participants were included of which 1628 (72.3%) underwent Roux-en-Y gastric bypass, 586 (26.0%) sleeve gastrectomy, 33 (1.5%) gastric banding, and 6 (0.03%) other surgeries. The mean age was 45.1 ± 10.9 with a mean BMI of 46.6 ± 9.6. Baseline MID ranged from 1 to 4 in health-related quality of life (HRQL) and from 2 to 8 in appearance scales. The mean change of scores ranged from 4 to 5 in HRQL and from 4 to 7 in the appearance scales. The estimated MID for the change in BODY-Q HRQL and appearance scales ranged from 3 to 8 and is recommended for use to interpret BODY-Q scores and assess treatment effects in bariatric surgery.