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Klusmann H, Eisenlohr-Moul T, Baresich K, Schmalenberger KM, Girdler S, Andersen E. Analyzing the atypical - Methods for studying the menstrual cycle in adolescents. Psychoneuroendocrinology 2023; 158:106389. [PMID: 37769538 PMCID: PMC10843271 DOI: 10.1016/j.psyneuen.2023.106389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 08/08/2023] [Accepted: 09/10/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The female pubertal transition is characterized by a rapidly changing hormone milieu, which is heavily influenced by the first menstrual cycle - menarche. The first year following menarche is associated with menstrual cycles that are irregular and anovulatory. Peripuberty also marks the beginning of a female-biased risk for suicidality and depression, suggesting some influence by the menstrual cycle and ovarian hormone fluctuations. However, there are limited methods and guidelines for studying the menstrual cycle and related affective symptoms in this developmental window. Thus, this study's objective was to identify the most accurate methods for detecting ovulation in irregular cycles (Part 1) and develop guidelines based on these methods for determining menstrual cycle phases. These methods were applied to investigate hormones and affective symptoms based on cycle phase and ovulation status in a sample of peripubertal females (Part 2). METHODS Thirty-two peripubertal females (ages 11-14) provided daily urine samples of estrogen (E1G) and progesterone (PdG) metabolites and luteinizing hormone (LH), and ratings of affective symptoms for one menstrual cycle. Ten literature-derived methods for determining the presence of an LH-peak or PdG rise were compared, focusing on their feasibility for psychological research. RESULTS Methods by Sun et al. (2019) and Park et al. (2007) most accurately detected PdG rises and LH peaks in this sample, identifying 40.6% of cycles as ovulatory. As expected, ovulatory participants showed greater LH in the periovulatory phase (p = .001), greater PdG in the mid-luteal phase (p < .0001), and greater E1G in the periovulatory phase (p = .001) compared with anovulatory participants. Exemplary methods to compare psychological symptoms between both groups are provided. CONCLUSIONS Recommendations and guidelines for studying the menstrual cycle in irregular cycling adolescents are offered. Novel methods for ovulation detection identified phase-specific hormonal patterns in anovulatory and ovulatory adolescent cycles.
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Affiliation(s)
- Hannah Klusmann
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Tory Eisenlohr-Moul
- Department of Psychiatry, University of Illinois at Chicago College of Medicine, Department of Psychiatry (MC 913), 60612 Chicago, USA.
| | - Kayla Baresich
- School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Carolina Crossings Building B, 2218 Nelson Highway, 27517 Chapel Hill, USA.
| | - Katja M Schmalenberger
- Department of Psychiatry, University of Illinois at Chicago College of Medicine, Department of Psychiatry (MC 913), 60612 Chicago, USA.
| | - Susan Girdler
- School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Carolina Crossings Building B, 2218 Nelson Highway, 27517 Chapel Hill, USA.
| | - Elizabeth Andersen
- School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Carolina Crossings Building B, 2218 Nelson Highway, 27517 Chapel Hill, USA.
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Andersen E, Prim J, Campbell A, Schiller C, Baresich K, Girdler S. Biobehavioral mechanisms underlying testosterone and mood relationships in peripubertal female adolescents. Dev Psychopathol 2023:1-15. [PMID: 37529837 PMCID: PMC10834847 DOI: 10.1017/s0954579423000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
The pubertal transition is characterized by pronounced sex hormone fluctuation, refinement of affective neural circuitry, and an increased risk of depression in female adolescents. Sex hormones, including testosterone, exert modulatory effects on frontal-limbic brain networks and are associated with emotion dysregulation and depressive symptoms. Weekly changes in hormones predict affective symptoms in peripubertal female adolescents, particularly in the context of stress; however, the biobehavioral mechanisms underlying hormone change and mood relationships during the pubertal transition have yet to be determined and was the objective of the present study. Forty-three peripubertal female adolescents (ages 11-14) collected 8-weekly salivary hormone (estrone, testosterone) samples and mood assessments to evaluate hormone-mood relationships, followed by a biobehavioral testing session with psychosocial stress and EEG. Within-person correlations between weekly hormone changes and corresponding mood were performed to determine individual differences in mood sensitivity to weekly hormone change. Increased frontal theta activity indexing emotion reactivity, reduced cortisol reactivity, and reduced vagal efficiency predicted the strength of the relationship between testosterone and mood. Further, testosterone-sensitivity strength was associated with the enhancement of negative affect following stress testing. Results identify divergent frontal theta and stress responses as potential biobehavioral mechanisms underlying mood sensitivity to peripubertal testosterone fluctuation.
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Affiliation(s)
- Elizabeth Andersen
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Julianna Prim
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Alana Campbell
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Crystal Schiller
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Kayla Baresich
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Susan Girdler
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
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Andersen E, Klusmann H, Eisenlohr-Moul T, Baresich K, Girdler S. Life stress influences the relationship between sex hormone fluctuation and affective symptoms in peripubertal female adolescents. Dev Psychopathol 2023:1-13. [PMID: 36876646 PMCID: PMC10480354 DOI: 10.1017/s095457942300010x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Female adolescents have a greatly increased risk of depression starting at puberty, which continues throughout the reproductive lifespan. Sex hormone fluctuation has been highlighted as a key proximal precipitating factor in the development of mood disorders tied to reproductive events; however, hormone-induced affective state change is poorly understood in the pubertal transition. The present study investigated the impact of recent stressful life events on the relationship between sex hormone change and affective symptoms in peripubertal female participants. Thirty-five peripubertal participants (ages 11-14, premenarchal, or within 1 year of menarche) completed an assessment of stressful life events, and provided weekly salivary hormone collections [estrone, testosterone, dehydroepiandrosterone (DHEA)] and mood assessments for 8 weeks. Linear mixed models tested whether stressful life events provided a context in which within-person changes in hormones predicted weekly affective symptoms. Results indicated that exposure to stressful life events proximal to the pubertal transition influenced the directional effects of hormone change on affective symptoms. Specifically, greater affective symptoms were associated with increases in hormones in a high stress context and decreases in hormones in a low stress context. These findings provide support for stress-related hormone sensitivity as a diathesis for precipitating affective symptoms in the presence of pronounced peripubertal hormone flux.
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Affiliation(s)
- Elizabeth Andersen
- University of North Carolina, Department of Psychiatry. CB #7167, Chapel Hill, NC 27617
| | - Hannah Klusmann
- University of North Carolina, Department of Psychiatry. CB #7167, Chapel Hill, NC 27617
- Freie Universität Berlin, Division of Clinical Psychological Intervention, Department of Education and Psychology. Schwendenerstraße 27, 14195 Berlin, Germany
| | - Tory Eisenlohr-Moul
- University of Illinois at Chicago, Department of Psychiatry, MC 913, Chicago, IL 60612
| | - Kayla Baresich
- University of North Carolina, Department of Psychiatry. CB #7167, Chapel Hill, NC 27617
| | - Susan Girdler
- University of North Carolina, Department of Psychiatry. CB #7167, Chapel Hill, NC 27617
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Baek A, Coots L, Andersen E, Lele S, Juan H, Mountziaris P. Effect of Enhanced Recovery After Surgery (ERAS) on racial disparities in prescribing practices for autologous breast reconstruction. Clin Nutr ESPEN 2022. [DOI: 10.1016/j.clnesp.2022.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Andersen E, Fiacco S, Gordon J, Kozik R, Baresich K, Rubinow D, Girdler S. Methods for characterizing ovarian and adrenal hormone variability and mood relationships in peripubertal females. Psychoneuroendocrinology 2022; 141:105747. [PMID: 35398750 PMCID: PMC9149069 DOI: 10.1016/j.psyneuen.2022.105747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
Peripubertal females are at elevated risk for developing affective illness compared to males, yet biological mechanisms underlying this sex disparity are poorly understood. Female risk for depression remains elevated across a woman's reproductive lifespan, implicating reproductive hormones. A sensitivity to normal hormone variability during reproductive transition events (e.g., perimenopause) precipitates affective disturbances in susceptible women; however, the extent of hormone variability during the female pubertal transition and whether vulnerability to peripubertal hormone flux impacts affective state change in peripubertal females has not been studied. 52 healthy peripubertal females (ages 11-14) provided 8 weekly salivary samples and mood ratings. 10 salivary ovarian and adrenal hormones (e.g., estrone, testosterone, dehydroepiandrosterone (DHEA)) were analyzed weekly for 8 weeks using an ultrasensitive assay to characterize the female peripubertal hormone environment and its association with affective state. Hormone variability indices, including standard deviation, mean squared and absolute successive differences of the 8 weekly measurements were analyzed by menarche status. Within-person partial correlations were computed to determine the strength of the relationship between weekly change in hormone level and corresponding mood rating for each participant. As expected, results indicated that hormone variability was greater for post- relative to pre-menarchal females and with advancing pubertal development, yet pregnenolone-sulfate and aldosterone did not differ by menarche status. Mood sensitivity to changes in estrone was exhibited by 57% of participants, whereas 37% were sensitive to testosterone and 6% were sensitive to DHEA changes. The present results offer novel evidence that a substantial proportion of peripubertal females appear to be mood sensitive to hormone changes and may inform future investigations on the biological mechanisms underlying hormone-induced affect dysregulation in peripubertal females.
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Affiliation(s)
- Elizabeth Andersen
- Department of Psychiatry, University of North Carolina-Chapel Hill, CB 7160, Chapel Hill, NC 27517, United States.
| | - Serena Fiacco
- Department of Psychiatry, University of North Carolina-Chapel Hill, CB 7160, Chapel Hill, NC 27517, United States; Clinical Psychology Behavioral Analytics Lab, Department of Psychology, University of Zurich, Binzmuehlestrasse 14, Box 1, 8050 Zurich, Switzerland.
| | - Jennifer Gordon
- Department of Psychology, University of Regina, 3737 Wascana Parkway Regina, Saskatchewan S4S 0A2, Canada.
| | - Rachel Kozik
- Department of Psychiatry, University of North Carolina-Chapel Hill, CB 7160, Chapel Hill, NC 27517, United States.
| | - Kayla Baresich
- Department of Psychiatry, University of North Carolina-Chapel Hill, CB 7160, Chapel Hill, NC 27517, United States.
| | - David Rubinow
- Department of Psychiatry, University of North Carolina-Chapel Hill, CB 7160, Chapel Hill, NC 27517, United States.
| | - Susan Girdler
- Department of Psychiatry, University of North Carolina-Chapel Hill, CB 7160, Chapel Hill, NC 27517, United States.
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Klusmann H, Schulze L, Engel S, Bücklein E, Daehn D, Lozza-Fiacco S, Geiling A, Meyer C, Andersen E, Knaevelsrud C, Schumacher S. HPA axis activity across the menstrual cycle - a systematic review and meta-analysis of longitudinal studies. Front Neuroendocrinol 2022; 66:100998. [PMID: 35597328 DOI: 10.1016/j.yfrne.2022.100998] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/09/2022] [Accepted: 05/07/2022] [Indexed: 12/29/2022]
Abstract
Differential HPA axis function has been proposed to underlie sex-differences in mental disorders; however, the impact of fluctuating sex hormones across the menstrual cycle on HPA axis activity is still unclear. This meta-analysis investigated basal cortisol concentrations as a marker for HPA axis activity across the menstrual cycle. Through a systematic literature search of five databases, 121 longitudinal studies were included, summarizing data of 2641 healthy, cycling participants between the ages of 18 and 45. The meta-analysis showed higher cortisol concentrations in the follicular vs. luteal phase (dSMC = 0.12, p =.004, [0.04 - 0.20]). Comparisons between more precise cycle phases were mostly insignificant, aside from higher concentrations in the menstrual vs. premenstrual phase (dSMC = 0.17, [0.02 - 0.33], p =.03). In all included studies, nine samples used established cortisol parameters to indicate HPA axis function, specifically diurnal profiles (k = 4) and the cortisol awakening response (CAR) (k = 5). Therefore, the meta-analysis highlights the need for more rigorous investigation of HPA axis activity and menstrual cycle phase.
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Affiliation(s)
- Hannah Klusmann
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Lars Schulze
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany.
| | - Sinha Engel
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Elise Bücklein
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Universität Ulm, Lise-Meitner-Str. 16, 89081 Ulm, Germany.
| | - Daria Daehn
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany.
| | - Serena Lozza-Fiacco
- School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Carolina Crossings Building B, 2218 Nelson Highway, 27517 Chapel Hill, USA.
| | - Angelika Geiling
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Caroline Meyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Elizabeth Andersen
- School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Carolina Crossings Building B, 2218 Nelson Highway, 27517 Chapel Hill, USA.
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany; Clinical Psychology and Psychotherapy, Department of Psychology, Faculty of Health, HMU Health and Medical University, Olympischer Weg 1, 14471 Potsdam, Germany.
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Andersen E, Juhl CR, Kjøller ET, Lundgren JR, Janus C, Saupstad M, Ingerslev LR, Jensen SBK, Holst JJ, Stallknecht BM, Madsbad S, Torekov SS, Barrès R. O-018 Sperm count is increased by diet-induced weight loss and maintained by exercise or GLP-1 analogue treatment: a randomised controlled trial. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Does diet-induced weight loss improve semen parameters, and are these possible improvements maintained with sustained weight loss?
Summary answer
An 8-week low-calorie diet-induced weight loss was associated with improved sperm count, which was maintained after one year in men who maintained weight loss.
What is known already
Obesity is associated with impaired semen parameters. Weight loss improves metabolic health in obesity, but there is a lack of knowledge on the acute and long-term effects of weight loss on semen parameters.
Study design, size, duration
This is a substudy of men with obesity enrolled in a randomised, controlled, double-blinded trial (the S-LITE trial). The trial was conducted between August 2016 and November 2019. A total of 56 men was included in the study and assigned to an initial 8-week low-calorie diet (800 kcal/day) followed by randomisation to 52 weeks of either: placebo, exercise training, and placebo (exercise), the GLP-1 analogue liraglutide (liraglutide) or liraglutide in combination with exercise training (combination).
Participants/materials, setting, methods
Inclusion criteria were men who delivered semen samples, 18 to 65 years of age and a body mass index between 32 to 43 kg/m2, but otherwise healthy. The study was carried out at Hvidovre Hospital and at the University of Copenhagen, and the participants were from the Greater Copenhagen Area. We assessed semen parameters, anthropometrics and collected blood samples before (T0) and after the 8-week low-calorie dietary intervention (T1) and after 52 weeks (T2).
Main results and the role of chance
The men lost on average 16.5 kg (95% CI: 15.2-17.8) bodyweight during the low-calorie diet, which increased sperm concentration 1.49 fold (95% CI: 1.18-1.88, P<0.01) and sperm count 1.41 fold (95% CI: 1.07-1.87, P<0.01). These improvements were maintained for 52 weeks in men who maintained the weight loss but not in men who regained weight. Semen volume, sperm motility and motile sperm count did not change.
Limitations, reasons for caution
The S-LITE trial was a randomised controlled trial of weight loss maintenance. Analysis of semen was preregistered to explore the effects of weight loss and weight loss maintenance on semen parameters. Due to the small sample size, definite inferences cannot be made.
Wider implications of the findings
This study shows that sperm concentration and sperm count were improved after a diet-induced weight loss in men with obesity. Our findings indicate that both liraglutide and exercise as weight maintenance strategies may be used to maintain the improvements in sperm concentration and count.
Trial registration number
H-16027082
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Affiliation(s)
- E Andersen
- Novo Nordisk Foundation Center for Basic Metabolic Research- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen , Denmark
| | - C R Juhl
- Department of Biomedical Sciences- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen , Denmark
| | - E T Kjøller
- Novo Nordisk Foundation Center for Basic Metabolic Research- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen , Denmark
| | - J R Lundgren
- Department of Biomedical Sciences- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen , Denmark
| | - C Janus
- Department of Biomedical Sciences- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen , Denmark
| | - M Saupstad
- Novo Nordisk Foundation Center for Basic Metabolic Research- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen , Denmark
| | - L R Ingerslev
- Novo Nordisk Foundation Center for Basic Metabolic Research- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen , Denmark
| | - S B K Jensen
- Department of Biomedical Sciences- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen , Denmark
| | - J J Holst
- Department of Biomedical Sciences- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen , Denmark
| | - B M Stallknecht
- Department of Biomedical Sciences- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen , Denmark
| | - S Madsbad
- Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre , Denmark
| | - S S Torekov
- Department of Biomedical Sciences- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen , Denmark
| | - R Barrès
- Novo Nordisk Foundation Center for Basic Metabolic Research- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen , Denmark
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Maroof S, Henkel R, Osmundson M, Andersen E, Lodge Y, Carroll M, Campbell A. P-038 Comparison of three methods of semen analysis: A novel at-home sperm test kit, a computer-assisted assessment and an embryologist. Hum Reprod 2022. [PMCID: PMC9384434 DOI: 10.1093/humrep/deac104.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
How does computer-assisted semen analysis (CASA) (Lenshooke, LOGIXX) and at-home sperm testing (ExSeed) compare with manual methodology assessment of male fertility based on WHO criteria (5thEdition); a three-method comparison study.
Summary answer
All methods showed good agreement for concentration and limited agreement for motility highlighting the need for further development of alternatives to manual assessment.
What is known already
Several studies have shown good correlation between CASA systems and laboratory-based manual semen analysis, but only a few have carried out a three-way comparison study. One of which showed positive correlation with motility and concentration between a smartphone-based semen analysis and laboratory-based CASA system and positive correlation between concentration and motility between the smartphone-based CASA system and microscopic-based results. The at-home sperm test kit may play a role in motivating infertile males to visit clinics for early diagnosis and also reducing the need for multiple visits to the fertility clinic for repeat semen analyses.
Study design, size, duration
Fifty patients (between 29 and 56 years) attending a fertility clinic were included in the study between September 2021 to December 2021. Semen samples were split into 3 aliquots and evaluated using manual semen assessment (MSA) according to the WHO 5th Edition (2010) guidelines, the ExSeed Home Sperm Test (HST) and the LensHooke® X1 PRO Semen Quality Analyzer (CASA).
Participants/materials, setting, methods
The semen samples were collected from fifty participants at CARE Fertility Tunbridge Wells. The samples were placed in an incubator at 37°C for 30 minutes to liquefy. After liquefaction, sperm concentration, total motility, total motile sperm count (TMSC) and normal morphology were evaluated. Spearman’s Rank correlations (>0.7) and Chi-squared tests were used and the p-value < 0.05 was considered as statistically significant.
Main results and the role of chance
All variables were highly significantly (p < 0.0002) positively correlated between all 3 methods.
The greatest correlations were obtained for sperm concentration (CASA/HST: r = 0.826; MSA/HST: r = 0.870; MSA/CASA: r = 0.871) and TMSC (MSA/CASA: p = 0.792; CASA/HST: r = 0.800; MSA/HST: r = 0.854). Correlations for motility were markedly lower (MSA/HST: r = 0.611; CASA/HST: r = 0.717; MSA/LCASA: r = 0.750). The lowest correlation was found for morphology (MSA/CASA: r = 0.500). The HST device does not determine morphology.
As compared to MSA, using the HST device agreement for normal or low sperm concentration (≥15 × 106/mL or < 15 × 106/mL respectively) was identified in 84.3% of the cases, whereas 94.0% with CASA. The agreement between CASA and HST was 82.0%. For total motility ≥ or < 40%, the agreements were 68.0% (CASA/HST), 56.9% (MSA/HST) and 82.0% (MSA/CASA), respectively.
For the identification of patients with normal morphology >4%, the agreement between MSA and CASA was 30%.
Limitations, reasons for caution
The small sample size was 50 cases. The home testing device does not assess morphology. Furthermore, it is difficult to ascertain whether a consumer would carry out the analysis with this device with the same accuracy as an embryologist.
Wider implications of the findings
The need for repeated semen analyses, the effect of the COVID-19 pandemic and the discomfort some patients feel in a clinical setting, necessitate the need for evaluation of novel semen analysis approaches. These emerging technologies have potential to be more patient friendly, convenient and efficient than standard semen assessment methods.
Trial registration number
not applicable
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Affiliation(s)
- S Maroof
- CARE Fertility, Embryology , Tunbridge Wells, United Kingdom
| | - R Henkel
- Logixx Pharma, Scientific Research , London, United Kingdom
| | - M Osmundson
- Logixx Pharma, Business Development , London, United Kingdom
| | - E Andersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences , Copenhagen, Denmark
| | - Y Lodge
- CARE Fertility, Embryology , Tunbridge Wells, United Kingdom
| | - M Carroll
- Manchester Metropolitan University, Cellular Science , Manchester, United Kingdom
| | - A Campbell
- CARE Fertility, Embryology , Nottingham, United Kingdom
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Zukauskaite R, Grau Eriksen J, Andersen E, Johansen J, Samsøe E, Long Krogh S, Overgaard J, Grau C, Rønn Hansen C. MO-0480 Risk of acute mucositis following an increase in high dose CTV1 in HNSCC patients. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02374-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Nowicka-Matus K, Friborg J, Hansen C, Andersen E, Bernsdorf M, Elstrøm U, Farhadi M, Grau C, Eriksen J, Johansen J, Nielsen M, Petersen J, Samsøe E, Sibolt P, Smulders B, Jensen K. OC-0089 Acute toxicities in proton therapy of head-neck cancer – a matched analysis of DAHANCA 35 pilot data. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02465-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shen MR, Tzioumis E, Andersen E, Wouk K, McCall R, Li W, Girdler S, Malloy E. Impact of Mentoring on Academic Career Success for Women in Medicine: A Systematic Review. Acad Med 2022; 97:444-458. [PMID: 34907962 DOI: 10.1097/acm.0000000000004563] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE Research has shown that barriers to career success in academic medicine disproportionately affect women. These barriers include inadequate mentoring, which may perpetuate the underrepresentation of women in senior leadership positions. The purpose of this review was to summarize the qualitative and quantitative evidence of the impact of mentoring on women's career outcomes and to inform future interventions to support the promotion and retention of women in academic medicine. METHOD The authors conducted a systematic review of original research published in English-language, peer-reviewed journals through March 20, 2020. Search terms related to mentorship, women, and academic medicine. The authors searched MEDLINE, Embase, Scopus, Current Contents Connect via Web of Science, Cochrane Library, and PsycINFO. They excluded studies not specifically addressing women and those without gender-stratified outcomes. They extracted and analyzed the following data: study design, population, sample size, response rate, participant age, percentage of women, mentoring prevalence, and outcomes. RESULTS Of 2,439 citations identified, 91 studies met the inclusion criteria, including 65 quantitative and 26 qualitative studies. Mentoring was associated with objective and subjective measures of career success. Women perceived mentorship to be more valuable to their career development yet were more likely to report having no mentor. Additionally, women were more likely to report lower levels of research productivity, less career satisfaction, and greater barriers to promotion. Qualitative results indicated that women had less access to informal mentoring and family responsibilities had a greater effect on their career outcomes. Professional networking, female mentors, and relational aspects of mentoring were common themes. CONCLUSIONS This review examined gender disparities in mentoring and the impact on research productivity, promotion success, and career satisfaction for women in academic medicine. Institution-supported mentoring programs are needed to facilitate identification of appropriate mentors and promotion of a more equitable academic career environment for women.
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Affiliation(s)
- Mary R Shen
- M.R. Shen is a resident, Department of Surgery, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-8923-4174
| | - Emma Tzioumis
- E. Tzioumis is assistant professor, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elizabeth Andersen
- E. Andersen is assistant professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathryn Wouk
- K. Wouk is a postdoctoral research fellow, Carolina Global Breastfeeding Institute, and adjunct associate professor, Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rebecca McCall
- R. McCall is clinical librarian, Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Winston Li
- W. Li is assistant professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susan Girdler
- S. Girdler is professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erin Malloy
- E. Malloy is professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Song Y, Mohamed Nassur A, Rupasinghe V, Haq F, Boström AM, Reid C, Andersen E, Wagg A, Hoben M, Goodarzi Z, Squires JE, Estabrooks CA, Weeks LE. Factors associated with residents’ responsive behaviours towards staff in long-term care homes: A systematic review. The Gerontologist 2022; 63:674-689. [PMID: 35094085 PMCID: PMC10167766 DOI: 10.1093/geront/gnac016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Objectives
When staff experience responsive behaviors from residents, this can lead to decreased quality of work-life and lower quality of care in long-term care homes. We synthesised research on factors associated with resident responsive behaviours directed towards care staff and characteristics of interventions to reduce the behaviours.
Research Design and Methods
We conducted a mixed-methods systematic review with quantitative and qualitative research. We searched 12 bibliographic databases and “grey” literature, using two keywords (long-term care, responsive behaviours) and their synonyms. Pairs of reviewers independently completed screening, data extraction, and risk of bias assessment. We developed a coding scheme using the ecological model as an organising structure and prepared narrative summaries for each factor.
Results
From 86 included studies (57 quantitative, 28 qualitative, 1 mixed methods), multiple factors emerged, such as staff training background (individual level); staff approaches to care (interpersonal level); leadership and staffing resources (institutional level); and racism and patriarchy (societal level). Quantitative and qualitative results each provided key insights, such as qualitative results pertaining to leadership responses to reports of behaviours, and quantitative findings on the impact of staff approaches to care on behaviours. Effects of interventions (n=14) to reduce the behaviours were inconclusive.
Discussion and Implications
We identified the need for enhanced understanding of the interrelationships among factors associated with resident responsive behaviours towards staff and processes leading to the behaviours. To address these gaps and to inform theory-based effective interventions for preventing or mitigating responsive behaviours, we suggest intervention studies with systematic process evaluations.
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Affiliation(s)
- Yuting Song
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | | | | | - Fajr Haq
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anne-Marie Boström
- Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Colin Reid
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Elizabeth Andersen
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Calgary Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary Alberta, Canada
| | - Janet E Squires
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Lori E Weeks
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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Hansen C, Friborg J, Skyt P, Smulders B, Sibolt P, Nielsen M, Samsøe E, Petersen J, Johansen J, Zukauskaite R, Andersen E, Andersen M, Farhadi M, Eriksen J, Overgaard J, Grau C, Jensen K. Photon-proton dose plan comparison in the pilot phase of the randomized clinical DAHANCA 35 trial. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00106-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Lassen P, Huang S, Su J, O’Sullivan B, Waldron J, Andersen M, Primdahl H, Johansen J, Andrup Kristensen C, Andersen E, Eriksen J, Rønn Hansen C, Alsner J, Lilja-Fisher J, Bratman S, Ringash J, Kim J, Hope A, Spreafico A, de Almeida J, Xu W, Overgaard J. PH-0051 Outcomes after definitive (C)RT in HPV+ OPC: Largescale comparison of two population-based cohorts. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07233-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Zukauskaite R, Grau Eriksen J, Andersen E, Johansen J, Samsøe Hinsby E, Long Krogh S, Overgaard J, Grau C, Rønn Hansen C. OC-0516 Local control in HNSCC after introduction of geometric margins in DAHANCA radiotherapy guidelines. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06942-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Andersen E, Geiger P, Schiller C, Bluth K, Watkins L, Zhang Y, Xia K, Tauseef H, Leserman J, Gaylord S, Girdler S. Effects of Mindfulness-Based Stress Reduction on Experimental Pain Sensitivity and Cortisol Responses in Women With Early Life Abuse: A Randomized Controlled Trial. Psychosom Med 2021; 83:515-527. [PMID: 33259351 PMCID: PMC8164640 DOI: 10.1097/psy.0000000000000889] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Early life abuse (ELAb) initiates pathophysiological cascades resulting in long-term maladaptive stress responsivity, hyperalgesia, and an increased risk of psychopathology. Mindfulness-based stress reduction (MBSR) is effective in modifying psychological and somatic symptoms; thus, we predicted that MBSR would be particularly efficacious for women with ELAb. METHOD Medically healthy women (mean age = 31 years) with or without a history of early (≤13 years) physical or sexual abuse provided self-report measures and were tested in the laboratory before and after randomization to standard MBSR (n = 52) or social support (SSG) (n = 60) for 8 weeks. The laboratory procedure involved pain testing using the cold pressor and temporal summation of heat pain (indexing central sensitization) procedures, and exposure to the Trier Social Stress Test. Plasma cortisol in response to the experimental protocol was assessed as area under the curve (AUC). RESULTS The interventions differentially impacted pain sensitivity and cortisol AUC for women with ELAb, as MBSR increased the temporal summation of heat pain intensity ratings (p = .024) and reduced cortisol AUC (p = .004). For women without ELAb, MBSR decreased cold pressor tolerance (p = .045) and decreased the temporal summation of heat pain intensity ratings relative to SSG (p = .024). Both MBSR and SSG improved depression symptoms and emotion regulation abilities (p values < .001); however, MBSR was associated with greater benefits in describing emotions (p = .008) and impulse control (p = .017) for women with ELAb. CONCLUSIONS Women with ELAb benefited from MBSR-specific improvements in central sensitization, mindfulness skills, and emotion regulation abilities. This is the first study to examine the efficacy of MBSR in modifying affective and somatic symptoms based on ELAb status and provides evidence for considering ELAb in tailoring treatment approaches.Trial Registration: ClinicalTrials.gov Identifier: NCT01995916; https://clinicaltrials.gov/ct2/show/NCT01995916.
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Affiliation(s)
| | - Paul Geiger
- Department of Psychiatry, University of North Carolina-Chapel Hill
| | - Crystal Schiller
- Department of Psychiatry, University of North Carolina-Chapel Hill
| | - Karen Bluth
- Department of Psychiatry, University of North Carolina-Chapel Hill
| | - Lana Watkins
- Department of Psychiatry and Behavioral Sciences, Duke
University
| | - Ying Zhang
- Department of Biostatistics, University of North Carolina- Chapel
Hill
| | - Kai Xia
- Department of Psychiatry, University of North Carolina-Chapel Hill
| | - Hafsah Tauseef
- Department of Psychiatry, University of North Carolina-Chapel Hill
| | - Jane Leserman
- Department of Psychiatry, University of North Carolina-Chapel Hill
| | - Susan Gaylord
- Department of Physical Medicine and Rehabilitation, University of
North Carolina-Chapel Hill
| | - Susan Girdler
- Department of Psychiatry, University of North Carolina-Chapel
Hill
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17
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Onofre J, Geenen L, Cox A, Van Der Auwera I, Willendrup F, Andersen E, Campo R, Dhont N, Ombelet W. Simplified sperm testing devices: a possible tool to overcome lack of accessibility and inconsistency in male factor infertility diagnosis. An opportunity for low- and middle- income countries. Facts Views Vis Obgyn 2021; 13:79-93. [PMID: 33889864 PMCID: PMC8051200 DOI: 10.52054/fvvo.13.1.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Manual semen assessment (MSA) is a key component in a male’s fertility assessment. Clinicians rely on it to make diagnostic and treatment decisions. When performed manually, this routine laboratory test is prone to variability due to human intervention which can lead to misdiagnosis and consequently over- or under- treatment. For standardisation, continuous training, quality control (QC) programs and pricy Computer-Assisted Sperm Analysis (CASA) systems have been proposed, yet, without resolving intra- and inter-laboratory variability. In response, promising simplified sperm testing devices, able to provide cost-effective point-of-care male infertility diagnosis are prospected as a plausible solution to resolve variability and increase access to sperm testing. Materials and methods A throughout literature research for semen testing, sperm analysis, smart-phone assisted semen analysis, ‘at-home’ semen testing, male infertility, infertility in developing countries, infertility in low- and middle-income countries (LMIC) and quantitative sperm analysis was performed. A total of 14 articles, specific to ‘at-home’ simplified sperm assessment, were included to treat the core subject. Results Continuous training and consistent QC, are sine qua none conditions to achieve accurate and comparable MSA. Compliance does not rule-out variability, nevertheless. Emerging simplified sperm assessment devices are an actual alternative to resolve the lack of standardisation and accessibility to sperm analysis. YO ® , SEEM ® , and ExSeed ® are commercially available, user-friendly smartphone-based devices which can accurately measure volume, sperm concentration (millions/ml) and total motile sperm count. More broadly, by cost-effectiveness, availability, accuracy and convenient application, these devices could effectively select patients for first-line artificial reproduction treatments such as intrauterine insemination. Conclusions Accuracy and cost-effectiveness make smart-phone based sperm testing devices a practical and realistic solution to overcome variability in MSA. Importantly, these tools represent an actual opportunity to standardise and improve male subfertility diagnosis and treatment, especially in LMIC. However, before clinical application is possible, guidelines, further testing with special attention on accuracy in washed sperm, availability, cost-benefit and reliability are required.
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Affiliation(s)
- J Onofre
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - L Geenen
- University of Hasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - A Cox
- Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - I Van Der Auwera
- Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | | | | | - R Campo
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - N Dhont
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - W Ombelet
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
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18
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Jensen K, Vogelius I, Andersen M, Overgaard J, Eriksen J, Farhadi M, Andersen E, Johansen J, Friborg J. PO-0798: Early mortality after radical radiotherapy in head and neck cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00815-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Kaplan L, Hansen C, Jensen K, Friborg J, Samsøe E, Johansen J, Andersen M, Smulders B, Andersen E, Nielsen M, Eriksen J, Petersen J, Elstrøm U, Holm A, Skyt P, Vestergaard A, Lorenzen E, Nielsen M, Marseguerra R, Morthorst M, Grau C, Korreman S. OC-0107: Quantitative metrics to analyze variations and support best practices in head and neck dose plans. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Ginsburg LR, Hoben M, Easterbrook A, Andersen E, Anderson RA, Cranley L, Lanham HJ, Norton PG, Weeks LE, Estabrooks CA. Examining fidelity in the INFORM trial: a complex team-based behavioral intervention. Implement Sci 2020; 15:78. [PMID: 32938481 PMCID: PMC7493316 DOI: 10.1186/s13012-020-01039-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/31/2020] [Indexed: 11/11/2022] Open
Abstract
Background Fidelity in complex behavioral interventions is underexplored. This study examines the fidelity of the INFORM trial and explores the relationship between fidelity, study arm, and the trial’s primary outcome—care aide involvement in formal team communications about resident care. Methods A concurrent process evaluation of implementation fidelity was conducted in 33 nursing homes in Western Canada (Alberta and British Columbia). Study participants were from 106 clinical care units clustered in 33 nursing homes randomized to the Basic and Enhanced-Assisted Feedback arms of the INFORM trial. Results Fidelity of the INFORM intervention was moderate to high, with fidelity delivery and receipt higher than fidelity enactment for both study arms. Higher enactment teams experienced a significantly larger improvement in formal team communications between baseline and follow-up than lower enactment teams (F(1, 70) = 4.27, p = .042). Conclusions Overall fidelity enactment was associated with improvements in formal team communications, but the study arm was not. This suggests that the intensity with which an intervention is offered and delivered may be less important than the intensity with which intervention participants enact the core components of an intervention. Greater attention to fidelity assessment and publication of fidelity results through studies such as this one is critical to improving the utility of published trials.
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Affiliation(s)
- Liane R Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, Toronto, Ontario, M3J 1P3, Canada.
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Adam Easterbrook
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Elizabeth Andersen
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, V2C 0C8, Canada
| | - Ruth A Anderson
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, 27599-7460, USA
| | - Lisa Cranley
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, M5T 1P8, Canada
| | - Holly J Lanham
- University of Texas Health Science Center San Antonio, University of Texas, San Antonio, Texas, 78229, USA
| | - Peter G Norton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4 N1, Canada
| | - Lori E Weeks
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
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21
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Henjum S, Kjollesdal MKR, Flaaten MO, Andersen E, Hjellset VT, Morseth MS. Prevalence of type 2 diabetes and associated risk factors among Saharawi refugees in Algeria. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The Saharawi refugees have been living in refugee camps in the Algerian desert since 1975 and are dependent on food aid. A double burden of malnutrition by the coexistence of undernutrition among children and overweight and obesity among adults has been observed in the Saharawi refugee camps. Limited knowledge about the prevalence of type 2 diabetes (T2D) and associated risk factors exists in this population. The aim of this study was, therefore, to address this gap in the literature.
Methods
A cross-sectional survey was carried out in five Saharawi refugee camps in Algeria in 2014. A total of 180 women and 175 men were included. HbA1c was used to assess the prevalence of T2D and prediabetes. The Finnish Diabetes Risk Score (FINDRISC) was used to estimate the risk of developing T2D. Multiple logistic regressions were performed to assess risk factors associated with T2D and prediabetes.
Results
Median (min, max) HbA1c among the Saharawi refugees was 35 (4, 135) mmol/mol. The prevalence of T2D and prediabetes was 7% and 10%, respectively. The prevalence of overweight and obesity combined was 45%, and higher in women than in men. According to FINDRISC, 9% of participants had high risk of developing diabetes and 10% had moderate risk. In adjusted models, significant predictors for T2D were age, waist circumference and having a first-degree relative with T2D. Significant predictors for prediabetes were age, body mass index (BMI), waist circumference and a history of high blood glucose.
Conclusions
We found moderate prevalence of diabetes and prediabetes and a relatively high prevalence of overweight and obesity among the Saharawi refugees, especially the women. Given the fragility of the Saharawi health care system, screening for diabetes should be conducted in a cost-effective manner and high-risk individuals should receive advice about lifestyle changes (e.g. diet and physical activity).
Key messages
We found moderate prevalence of diabetes and pre-diabetes among the Saharawi refugees, and a high proportion were classified as overweight or obese. In light of this, the rates of T2D are likely to increase in the near future. The Saharawi health authorities should pay attention to the increased risk of diabetes in this vulnerable population.
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Affiliation(s)
- S Henjum
- Public Health Nutrition, Oslo Metropolitan University, Oslo, Norway
| | - M K R Kjollesdal
- Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
| | - M O Flaaten
- Public Health Nutrition, Oslo Metropolitan University, Oslo, Norway
| | - E Andersen
- Faculty of Humanities, Sports and Educational Science, University of South-Eastern Norway, Horten, Norway
| | - V T Hjellset
- Public Health Nutrition, Oslo Metropolitan University, Oslo, Norway
| | - M S Morseth
- Public Health Nutrition, Oslo Metropolitan University, Oslo, Norway
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22
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Jensen KH, Vogelius I, Kristensen CA, Andersen E, Overgaard J, Eriksen JG, Primdahl H, Johansen J, Farhadi M, Andersen M, Friborg J. Early Mortality after Radical Radiotherapy in Head and Neck Cancer - A Nationwide Analysis from the Danish Head and Neck Cancer Group (DAHANCA) Database. Clin Oncol (R Coll Radiol) 2020; 33:57-63. [PMID: 32698963 DOI: 10.1016/j.clon.2020.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/08/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022]
Abstract
AIMS Curative-intent radiotherapy (RT) or chemoradiation (CRT) of squamous cell carcinoma of the head and neck (HNSCC) produces high survival rates, but is associated with substantial toxicity. However, there are no commonly accepted quality metrics for early mortality in radiation oncology. To assess the applicability of early mortality as a clinical quality indicator, this study investigated the temporal distribution, risk factors and trends of 90- and 180-day overall and non-cancer mortality in a nationwide cohort of HNSCC patients treated with RT/CRT. MATERIALS AND METHODS Information on all HNSCC patients treated with curative-intent RT/CRT in Denmark between 2000 and 2017 was obtained from the national Danish Head and Neck Cancer Group clinical database. Deaths in patients with residual or recurrent disease after RT/CRT were classified as cancer-related. Possible risk factors were investigated using logistic regression analysis. RESULTS Data from 11 419 patients were extracted. In total, 90- and 180-day mortality risks were 3.1% and 7.1%, respectively. There was a uniform temporal distribution of 180-day mortality. In multivariable analysis, increasing age, stage, performance status, earlier treatment year and hypopharyngeal cancer were significantly associated with an increased risk (P < 0.05). Risk factor estimates were comparable for 90- versus 180-day mortality as well as for overall versus non-cancer mortality. Between 2000 and 2017 there was a significant decrease in 180-day mortality, which was driven by a reduction in cancer-related events. CONCLUSION The distribution of 180-day overall and non-cancer mortality did not indicate a well-defined early high-risk period. Moreover, risk factor estimates were highly similar across risk periods and groups. Taken together, our findings question the applicability of early mortality as a standard metric for treatment-associated toxicity.
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Affiliation(s)
- K H Jensen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - I Vogelius
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C A Kristensen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - E Andersen
- Department of Oncology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - J Overgaard
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - J G Eriksen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - H Primdahl
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - J Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - M Farhadi
- Department of Oncology, Zealand University Hospital, Zealand, Denmark
| | - M Andersen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - J Friborg
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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23
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Carlander A, Zamani M, Larsen C, Hellelstrup D, Agander T, Kiss K, Olsen C, Baandrup L, Nielsen F, Andersen E, Friborg J, Buchwald C. Survival and characteristics of 772 patients with oropharyngeal cancer and specific human papillomavirus genotypes: A Danish population-based study from 2011-2017. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Wormgoor MEA, Indahl A, Andersen E, Egeland J. Effectiveness of Briefer Coping-Focused Psychotherapy for Common Mental Complaints on Work-Participation and Mental Health: A Pragmatic Randomized Trial with 2-Year Follow-Up. J Occup Rehabil 2020; 30:22-39. [PMID: 31222615 DOI: 10.1007/s10926-019-09841-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The aim of this study was to assess short and long-term effectiveness of brief coping-focused psychotherapy (Brief-PsT) compared with short-term psychotherapy (Short-PsT) on work-participation (WP) and mental health. Both treatments were preceded by group education. Methods All participants were on, or at risk of, sick leave due to common mental complaints. Patients were selected for inclusion in this study based on levels of self-reported symptoms ('some' or 'seriously affected') of anxiety and depression. They were randomized to Brief-PsT (n = 141) or Short-PsT with a more extended focus (n = 143). Primary outcome was the transition of WP-state from baseline to 3 months follow-up. In addition, WP at 12 and 24 months follow-up were assessed. The secondary outcome, clinical recovery rate (CR-rate) was obtained from the Beck Depression and Beck Anxiety Inventories, at 2-year follow-up. In addition, self-reported mental health symptom severity, self-efficacy, subjective health complaints and life satisfaction were assessed. Results At 3 months follow-up, the increase in WP was significantly greater in Brief-PsT than in Short-PsT (p = 0.039). At 3 months, 60% in Brief-PsT and 51% in Short-PsT was at work, partial or full. Thereafter, these differences diminished, 84% and 80% were at work at 2-year follow up. The 2-year follow-up of the secondary outcome measurements was completed by 53% in Brief-PsT and 57% in Short PsT. CR-rate was significantly greater in Brief-PsT compared with the Short-PsT (69% vs. 51%, p = 0.024). Furthermore, there was a greater reduction in the number of subjective health complaints in Brief-PsT (4.0 vs. 1.9 p = 0.012). All other measurements favoured Brief-PsT as well, but did not reach statistical significance. Conclusions Brief coping-focused psychotherapy added to group education for persons with depression or anxiety complaints seemed more effective in enhancing early work participation compared with additional short-term psychotherapy of standard duration with more extended focus. Clinical recovery rate and decline of comorbid subjective health complaints at 2-year follow-up were also in favour of the brief coping-focused program.
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Affiliation(s)
- M E A Wormgoor
- Division Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway.
| | - A Indahl
- Division Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway
| | - E Andersen
- Division of Mental Health & Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - J Egeland
- Division of Mental Health & Addiction, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
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25
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Howard M, Robinson CA, McKenzie M, Fyles G, Sudore RL, Andersen E, Arora N, Barwich D, Bernard C, Elston D, Heyland R, Klein D, McFee E, Mroz L, Slaven M, Tan A, Heyland DK. Effect of an Interactive Website to Engage Patients in Advance Care Planning in Outpatient Settings. Ann Fam Med 2020; 18:110-117. [PMID: 32152014 PMCID: PMC7062494 DOI: 10.1370/afm.2471] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 05/12/2019] [Accepted: 05/24/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Online programs may help to engage patients in advance care planning in outpatient settings. We sought to implement an online advance care planning program, PREPARE (Prepare for Your Care; http://www.prepareforyourcare.org), at home and evaluate the changes in advance care planning engagement among patients attending outpatient clinics. METHODS We undertook a prospective before-and-after study in 15 primary care clinics and 2 outpatient cancer centers in Canada. Patients were aged 50 years or older (primary care) or 18 years or older (cancer care) and free of cognitive impairment. They used the PREPARE website over 6 weeks, with reminders sent at 2 or 4 weeks. We used the 55-item Advance Care Planning Engagement Survey, which measures behavior change processes (knowledge, contemplation, self-efficacy, readiness) on 5-point scales and actions relating to substitute decision makers, quality of life, flexibility for the decision maker, and asking doctors questions on an overall scale from 0 to 21; higher scores indicate greater engagement. RESULTS In total, 315 patients were screened and 172 enrolled, of whom 75% completed the study (mean age = 65.6 years, 51% female, 35% had cancer). The mean behavior change process score was 2.9 (SD 0.8) at baseline and 3.5 (SD 0.8) at follow-up (mean change = 0.6; 95% CI, 0.49-0.73); the mean action measure score was 4.0 (SD 4.9) at baseline and 5.2 (SD 5.4) at follow-up (mean change = 1.2; 95% CI, 0.54-1.77). The effect size was moderate (0.75) for the former and small (0.23) for the latter. Findings were similar in both primary care and cancer care populations. CONCLUSIONS Implementation of the online PREPARE program in primary care and cancer care clinics increased advance care planning engagement among patients.
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Affiliation(s)
- Michelle Howard
- CORRESPONDING AUTHOR: Michelle Howard, PhD, Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main St W, 5th Fl, Hamilton, Ontario, Canada L8P 1H6,
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Lassen P, Huang S, Su J, O’Sullivan B, Waldron J, Andersen M, Primdahl H, Johansen J, Kristensen C, Andersen E, Alsner J, Lilja-Fischer J, Bratman S, Spreafico A, de Almeida J, Xu W, Overgaard J. Treatment Outcomes and Survival Following Primary (chemo) Radiotherapy in HPV+ Oropharynx Cancer: A Largescale Comparison of Two Institutions. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gauthier R, Andersen E, Reid C, Taylor D. The information-seeking patterns of care aides who work in nursing homes. J Nurs Manag 2019; 27:1604-1613. [PMID: 31419352 DOI: 10.1111/jonm.12840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Abstract
AIM To explore the information-seeking patterns of care aides who work in nursing homes. BACKGROUND Under the direction and supervision of nursing professionals, care aides provide the majority of direct care to nursing home residents. Understanding how, why, when and where they seek information to perform their duties is important for managers, policymakers and stakeholders. METHOD Semi-structured interviews with eight care aides employed in three Canadian nursing homes were analysed using the Braun and Clarke method of thematic analysis. RESULTS Five prominent information-seeking patterns emerged as themes. CONCLUSIONS Care aides were motivated to seek information for personal and job-based reasons that included wanting to avoid mistakes and preparing physically, mentally and emotionally for the work ahead. They described depending on a social hierarchy of verbal information and using personal time (before/after work) to seek the information they needed. Due to time constraints, they relied on established patterns, accessed online information once a day at most and preferred paper-based sources. IMPLICATIONS FOR NURSING MANAGEMENT Programs to enhance care aide communication skills to include the importance of information-seeking are warranted. Time for formal information-seeking during working hours should be provided and encouraged. When care aides initiate information-seeking to improve care this should be recognized and respected by others on the team. Programs to enhance care aide communication skills to include the importance of information-seeking are warranted. Time for formal information-seeking during working hours should be provided and encouraged. When care aides initiate information-seeking to improve care this should be recognized and respected by others on the team.
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Affiliation(s)
- Renée Gauthier
- School of Nursing, Ringgold Standard Institution, The University of British Columbia - Okanagan, Kelowna, BC, Canada
| | - Elizabeth Andersen
- School of Health and Exercise Science, The University of British Columbia - Okanagan, Kelowna, BC, Canada
| | - Colin Reid
- School of Health and Exercise Science, The University of British Columbia - Okanagan, Kelowna, BC, Canada
| | - Deanne Taylor
- School of Health and Exercise Science, The University of British Columbia - Okanagan, Kelowna, BC, Canada
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Saksø M, Andersen E, Bentzen J, Andersen M, Johansen J, Overgaard J, Eriksen J. OC-0388 A prospective multicenter DAHANCA study of hyperfractionated accelerated RT for head and neck cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30808-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rasmussen JH, Grønhøj C, Håkansson K, Friborg J, Andersen E, Lelkaitis G, Klussmann JP, Wittekindt C, Wagner S, Vogelius IR, von Buchwald C. Risk profiling based on p16 and HPV DNA more accurately predicts location of disease relapse in patients with oropharyngeal squamous cell carcinoma. Ann Oncol 2019; 30:629-636. [PMID: 30657857 DOI: 10.1093/annonc/mdz010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In the era of precision medicine and HPV-related oropharyngeal squamous cell carcinoma (OPSCC), it is relevant to assess the risk of not only survival, but also the risk of local, regional, or distant treatment failure. The UICC 8th edition uses the surrogate marker p16 to stratify for HPV association but discordance between p16 status and HPV association has been shown. The purpose of this study was to develop a prognostic model to predict the risk of local, regional, and distant metastases and non-cancer-related death for patients with OPSCC, test the prognostic relevance of adding HPV DNA and p16 status, and validate the findings in an independent external dataset. PATIENTS AND METHODS Consecutive patients diagnosed with OPSCC and treated with curative radiotherapy with or without cisplatin in eastern Denmark from 2000 to 2014 were included. Characteristics included age, gender, TNM stage, smoking habits, performance status, and HPV status assessed with p16 and HPV DNA. The information was used to develop a prognostic model for first site of failure with four competing events: recurrence in T-, N-, and M-site, and death with no evidence of disease. RESULTS Overall 1243 patients were eligible for the analysis. A prognostic model with the four events was developed and externally validated in an independent dataset with a heterogeneously treated patient population from another institution. The individual prognostication from the competing risk analysis is displayed in a user friendly online tool (https://rasmussen.shinyapps.io/OPSCCmodelHPV_p16/). Replacing p16 status with the combined variable HPV/p16 status influenced the HR and patients with HPV-/p16+ had significantly higher HR of M-site recurrence than HPV+/p16+ with a HR = 2.56; CI [1.30; 5.02]; P = 0.006 (P = 0.013 in the validation cohort). CONCLUSION Patients with HPV-/p16+ have significantly higher risk of M-site recurrence and could potentially be relevant candidates for clinical trials testing systemic treatments in combination with conventional treatments.
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Affiliation(s)
- J H Rasmussen
- Departments of Otorhinolaryngology, Head and Neck Surgery and Audiology.
| | - C Grønhøj
- Departments of Otorhinolaryngology, Head and Neck Surgery and Audiology
| | - K Håkansson
- Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen
| | - J Friborg
- Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen
| | - E Andersen
- Department of Oncology, Herlev Hospital, University of Copenhagen, Copenhagen
| | - G Lelkaitis
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J P Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne
| | - C Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - S Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - I R Vogelius
- Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen
| | - C von Buchwald
- Departments of Otorhinolaryngology, Head and Neck Surgery and Audiology
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Gill M, Andersen E, Hilsmann N. Best practices for teaching pharmacology to undergraduate nursing students: A systematic review of the literature. Nurse Educ Today 2019; 74:15-24. [PMID: 30554030 DOI: 10.1016/j.nedt.2018.11.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 10/15/2018] [Accepted: 11/23/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE In this systematic review we describe best practices for teaching pharmacology to undergraduate baccalaureate nursing students based on the available evidence. Numerous teaching strategies employed in undergraduate pharmacology courses for nursing students have been summarized and compared for their impact on pharmacology knowledge retention, application of pharmacology theory to practice, and student satisfaction. Future directions for research are discussed. DESIGN The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses. DATA SOURCES The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Academic Search Complete, Education Resources Information Center (ERIC), and Education Source and Health Reference Centre Academic were searched using key search terms and phrases. Twenty studies, conducted between 2001 and 2017, met the inclusion criteria. METHOD Quality assessment was made in accordance with two appraisal tools: Kirkpatrick's framework and the Medical Education Research Quality Instrument (MERSQI) for quantitative studies. RESULTS Online, simulation, and integrated methods of teaching pharmacology were most beneficial for pharmacology knowledge acquisition and student satisfaction. Traditional lecture, problem-based learning, and a flipped classroom were least effective strategies for teaching pharmacology to undergraduate students. CONCLUSIONS This systematic review will contribute to the body of knowledge used by nurse educators who teach in undergraduate nursing programs, may be particularly useful for undergraduate nursing program directors/administrators who are considering undergoing curricular changes, and may be a conduit for future researchers who wish to design studies aimed at improving teaching and learning within undergraduate nursing education.
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Affiliation(s)
- Manu Gill
- Faculty of Nursing, School of Health Sciences, British Columbia Institute of Technology, Burnaby, BC, Canada.
| | - Elizabeth Andersen
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Kelowna, BC, Canada
| | - Norma Hilsmann
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Kelowna, BC, Canada
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Andersen PS, Andersen E, Graversgaard M, Christensen AA, Vejre H, Dalgaard T. Using landscape scenarios to improve local nitrogen management and planning. J Environ Manage 2019; 232:523-530. [PMID: 30503898 DOI: 10.1016/j.jenvman.2018.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/14/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Abstract
Scenario-building is a widely used tool to initiate discussions on future land uses. In scenarios possible futures can be explored and peoples' ideas as well as societal trends can be visualized by the use of maps, pictures and figures. With focus on agricultural nitrogen management, and point of departure in the farmers' decisions-regarding fertilizer inputs, crop rotations, land use, and drainage, landscape scenarios are formulated based on local ideas for future nitrogen management and general prospects for local development. The key research question addressed in this paper is how landscape scenarios can guide farmers to improve nitrogen management in smaller catchments dominated by farming. Participatory modelling was used to develop landscape scenarios, depicting the change of nitrogen emission as a result of changes in landscape management and agricultural practices. In the development of the scenarios we used an ArcMap based tool combining statistical data, experimental knowledge, nitrate leaching modelling and input from local stakeholders on biophysical as well as land use and farm management issues. The scenarios presented are the result of a collaborative planning experiment within the frames of the dNmark research alliance on nitrogen. Three different types of scenarios are presented and discussed and their effects in terms of N reduction are estimated. The three scenarios were called: River valley set-aside, constructed wetlands, and land zonation. All the modelled scenarios are estimated to have a positive effect i.e. a reduction of the level of N leached to the root zone. Based on the experience gathered in the project, the feasibility of using scenarios for future environmental planning in the agricultural landscapes is discussed. Further, this is related to the current discussion in Denmark on geographically targeted nitrogen regulation. It is concluded that the co-creative approach to formulation of scenarios can be an effective way of increasing the knowledge and ownership of possible future solutions, however the cost associated with this planning approach is likely to substantially higher that more traditional planning approaches. Consequently, the estimated transactions costs should be weighed against the expected benefits in terms of more successful implementation.
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Affiliation(s)
- P S Andersen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, DK-1958, Frederiksberg, Denmark.
| | - E Andersen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, DK-1958, Frederiksberg, Denmark
| | - M Graversgaard
- Department of Agroecology, Aarhus University, DK-8830, Tjele, Denmark
| | - A A Christensen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, DK-1958, Frederiksberg, Denmark
| | - H Vejre
- Department of Geosciences and Natural Resource Management, University of Copenhagen, DK-1958, Frederiksberg, Denmark
| | - T Dalgaard
- Department of Agroecology, Aarhus University, DK-8830, Tjele, Denmark
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Friesen L, Andersen E. Outcomes of collaborative and interdisciplinary palliative education for health care assistants: A qualitative metasummary. J Nurs Manag 2018; 27:461-481. [PMID: 30194886 DOI: 10.1111/jonm.12714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 08/30/2018] [Accepted: 09/04/2018] [Indexed: 11/29/2022]
Abstract
AIM To explore collaborative and interdisciplinary palliative educational strategies and corresponding outcomes for health care assistants. BACKGROUND Health care assistants are frontline staff who provide almost all hands-on care to seniors. Health care managers are responsible to provide ongoing support and a working environment conducive to health care assistants' abilities to provide quality, safe, evidence-based care. EVALUATION A Qualitative metasummary of collaborative and interdisciplinary teaching strategies was conducted following guidelines developed by Sandelowski et al. (). KEY ISSUES The gold standard of palliative care is interdisciplinary delivery of care, yet education is often monodisciplinary. Furthermore, evaluation of interdisciplinary continuing education is most often subjective via self-report questionnaires. CONCLUSIONS Findings from 16 articles representing 15 studies conducted between 2007 and 2017 were grouped thematically and summarized. Collaborative or interdisciplinary palliative interventions offer health care assistants opportunities to debrief, build their confidence, and critically reflect on the importance of psychosocial care for patients, family and colleagues. IMPLICATIONS FOR NURSING MANAGEMENT The metasummary provides six suggestions for managers who are considering implementing a collaborative palliative educational workshop and draws attention to the need to create contextual changes that support health care assistants to enact newly acquired knowledge and skills.
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Affiliation(s)
- Lynnelle Friesen
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada
| | - Elizabeth Andersen
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada
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Andersen E, Campbell A, Girdler S, Duffy K, Belger A. Acute stress modifies oscillatory indices of affective processing: Insight on the pathophysiology of schizophrenia spectrum disorders. Clin Neurophysiol 2018; 130:214-223. [PMID: 30580244 DOI: 10.1016/j.clinph.2018.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/28/2018] [Accepted: 10/24/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The current study evaluated the differential impact of acute psychosocial stress exposure on oscillatory correlates of affective processing in control participants and patients with schizophrenia spectrum disorders (SCZ) to elucidate the stress-mediated pathway to psychopathology. METHODS EEG was recorded while 21 control participants and 21 patients with SCZ performed emotional framing tasks (assessing a key aspect of emotion regulation (ER)) before and after a laboratory stress challenge (Trier Social Stress Test). EEG spectral perturbations evoked in response to neutral and aversive stimuli (presented with positive or negative contextual cues) were extracted in theta (4-8 Hz) and beta (12-30 Hz) frequencies. RESULTS Patients demonstrated aberrant theta and beta oscillatory activity, with impaired frontal theta-mediated framing and beta-derived motivated attention processes relative to controls. Following stress exposure, controls exhibited impaired frontal theta-mediated emotional framing, similar to the oscillatory profile observed in patients before stress. CONCLUSIONS The acute stress-induced oscillatory changes observed in controls were persistently present in patients, indicating an inefficiency of fronto-limbic adaptation to stress exposure. SIGNIFICANCE Results provide novel insight on the electrophysiological correlates of arousal and affect regulation, which are core homogeneous symptom dimensions shared across neuropsychiatric disorders, and shed light on putative mechanisms in the translation of stress into psychopathology.
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Affiliation(s)
- Elizabeth Andersen
- Department of Psychiatry, CB# 7160, University of North Carolina, Chapel Hill, NC 27599-7160, USA.
| | - Alana Campbell
- Department of Psychiatry, CB# 7160, University of North Carolina, Chapel Hill, NC 27599-7160, USA.
| | - Susan Girdler
- Department of Psychiatry, CB# 7160, University of North Carolina, Chapel Hill, NC 27599-7160, USA.
| | - Kelly Duffy
- Department of Psychiatry, CB# 7160, University of North Carolina, Chapel Hill, NC 27599-7160, USA
| | - Aysenil Belger
- Department of Psychiatry, CB# 7160, University of North Carolina, Chapel Hill, NC 27599-7160, USA; Brain Imaging and Analysis Center, CB# 3918, Duke University, Durham, NC 27710, USA.
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Andersen E, Olsen L, Denison J, Zerin I, Reekie M. "I will go if I don't have to talk": Nursing students' perceptions of reflective, debriefing discussions and intent to participate. Nurse Educ Today 2018; 70:96-102. [PMID: 30172986 DOI: 10.1016/j.nedt.2018.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/24/2018] [Accepted: 08/16/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND/OBJECTIVES The ability to be a reflective practitioner is recognized by nursing regulatory bodies as a component of professional competence and becoming a reflective practitioner is an essential part of learning to become a nurse. In this multi-site study, we explored undergraduate nursing students' beliefs, capacities and intentions to participate in reflective, debriefing discussions facilitated by clinical instructors. At the same time, we tested the effectiveness of a period of rest and an intervention designed to refresh and inspire them. DESIGN A randomized crossover design. SAMPLE Our analyzed sample consisted of 106 students; 87.7% were female and 65.1% were less than 20 years old. METHOD This study was guided by the Theory of Planned Behaviour and consisted of five steps: instrument development, recruitment, random assignment to intervention, data collection at two time points using four tools, and data analysis. One hundred and forty-one first year nursing students used a learning management system to sign up to one of 15 potential clinical groups; maximum 10 students per group. Eight groups were randomly assigned to an intervention during post-clinical discussions; seven groups participated in the usual post-clinical discussions for the same length of time. After six weeks, the groups 'crossed-over' (switched). RESULTS Students had a negative attitude towards routine discussions that occur after clinical practice experiences which did not significantly improve despite a period of rest and an intervention. Most did not feel in control and felt social pressure to participate. Additional results revealed that most students arrived at reflective post-clinical discussions with an underlying intent not to talk. Intent to remain silent (not participate) did not significantly improve despite a period of rest and intervention. CONCLUSIONS The context and timing of the routine discussions may dramatically influence students' decision-making regarding intent to participate. Reflective processes require time and routine reflective debriefing discussions could be delayed until later in the week after students have had a chance to absorb and assimilate their experiences.
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Affiliation(s)
- Elizabeth Andersen
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Okanagan Campus, Arts Building - Art 142, 1147 Research Road, Kelowna, British Columbia V1V 1V7, Canada.
| | - Lise Olsen
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Okanagan Campus, Arts Building - Art 164, 1147 Research Rd., Kelowna, British Columbia V1V 1V7, Canada.
| | - Jacqueline Denison
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Okanagan Campus, Arts Building - Art 143, 1147 Research Rd., Kelowna, British Columbia V1V 1V7, Canada.
| | - Ismat Zerin
- Sindi Ahluwalia Hawkins Center for the Southern Interior, 399 Royal Ave, Kelowna, British Columbia V1Y 5L3, Canada.
| | - Manuela Reekie
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Okanagan Campus, Arts Building - Art 342, 1147 Research Rd., Kelowna, British Columbia V1V 1V7, Canada.
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Samsøe E, Grau C, Johansen J, Andersen E, Petersen J, Jensen K, Smulders B, Friborg J, Sand H, Andersen M, Logadóttir A, Ujmajuridze Z, Hansen C. PO-0922: Implementation of swallowing organs in national radiotherapy guidelines for H&N cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31232-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zukauskaite R, Hansen C, Johansen J, Grau C, Samsøe E, Andersen E, Petersen J, Overgaard J, Eriksen J. PV-0430: Localisation of recurrences in the neck after IMRT for HNSCC in relation to the elective CTV. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30740-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Overgaard J, Hoff C, Hansen H, Specht L, Overgaard M, Lassen P, Andersen E, Johansen J, Andersen L, Evensen J, Alsner J, Grau C. OC-0536: Darbepoetin alfa and radiotherapy in the treatment of SCCHN – the DAHANCA 10 randomized trial. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30846-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
PROBLEM The aim of this concept analysis was to clarify failure to rescure as a nurse-sensitive indicator. Although the concept of failure to rescue as a nurse-sensitive outcome has appeared in the nursing literature for over a decade, conceptual clarity is needed to address its variable and ambiguous use in health care. METHODS Walker and Avant's eight-stage method of concept analysis was used to explore the concept of failure to rescue in nursing practice. Twenty-one papers were retrieved from Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE databases and selected for review and synthesis. RESULTS Failure to rescue as a nurse-sensitive indicator was found to be a "failing to rescue" process characterized by a cascade of events, including four key attributes: (1) errors of omission in care, (2) failure to recognize changes in patient condition, (3) failure to communicate changes, and (4) failures in clinical decision making. CONCLUSIONS Nurses have a pivotal role in "failing to rescue" through early recognition, escalation, and intervention of subtle changes signaling complications. Upstream strategies, such as the use of early warning sign indicators, structured communication, and teamwork, shift the discourse from failure to rescue, to processes in nursing practice of good catch events.
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Affiliation(s)
- Jane Mushta
- Emergency Department, Interior Health Authority, Kelowna, Canada
| | - Kathy L Rush
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada
| | - Elizabeth Andersen
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada
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van de Glind I, Bunn C, Gray CM, Hunt K, Andersen E, Jelsma J, Morgan H, Pereira H, Roberts G, Rooksby J, Røynesdal Ø, Silva M, Sorensen M, Treweek S, van Achterberg T, van der Ploeg H, van Nassau F, Nijhuis-van der Sanden M, Wyke S. The intervention process in the European Fans in Training (EuroFIT) trial: a mixed method protocol for evaluation. Trials 2017; 18:356. [PMID: 28750673 PMCID: PMC5531072 DOI: 10.1186/s13063-017-2095-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 07/11/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND EuroFIT is a gender-sensitised, health and lifestyle program targeting physical activity, sedentary time and dietary behaviours in men. The delivery of the program in football clubs, led by the clubs' community coaches, is designed to both attract and engage men in lifestyle change through an interest in football or loyalty to the club they support. The EuroFIT program will be evaluated in a multicentre pragmatic randomised controlled trial (RCT), for which ~1000 overweight men, aged 30-65 years, will be recruited in 15 top professional football clubs in the Netherlands, Norway, Portugal and the UK. The process evaluation is designed to investigate how implementation within the RCT is achieved in the various football clubs and countries and the processes through which EuroFIT affects outcomes. METHODS This mixed methods evaluation is guided by the Medical Research Council (MRC) guidance for conducting process evaluations of complex interventions. Data will be collected in the intervention arm of the EuroFIT trial through: participant questionnaires (n = 500); attendance sheets and coach logs (n = 360); observations of sessions (n = 30); coach questionnaires (n = 30); usage logs from a novel device for self-monitoring physical activity and non-sedentary behaviour (SitFIT); an app-based game to promote social support for physical activity outside program sessions (MatchFIT); interviews with coaches (n = 15); football club representatives (n = 15); and focus groups with participants (n = 30). Written standard operating procedures are used to ensure quality and consistency in data collection and analysis across the participating countries. Data will be analysed thematically within datasets and overall synthesis of findings will address the processes through which the program is implemented in various countries and clubs and through which it affects outcomes, with careful attention to the context of the football club. DISCUSSION The process evaluation will provide a comprehensive account of what was necessary to implement the EuroFIT program in professional football clubs within a trial setting and how outcomes were affected by the program. This will allow us to re-appraise the program's conceptual base, optimise the program for post-trial implementation and roll out, and offer suggestions for the development and implementation of future initiatives to promote health and wellbeing through professional sports clubs. TRIAL REGISTRATION ISRCTN81935608 . Registered on 16 June 2015.
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Affiliation(s)
- I van de Glind
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - C Bunn
- Institute of Health and Wellbeing, College of Social Sciences, 27 Bute Gardens, University of Glasgow, Glasgow, G12 8RS, UK.
| | - C M Gray
- Institute of Health and Wellbeing, College of Social Sciences, 27 Bute Gardens, University of Glasgow, Glasgow, G12 8RS, UK
| | - K Hunt
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, 200 Renfield St, University of Glasgow, Glasgow, G2 3QB, UK
| | - E Andersen
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - J Jelsma
- Department of Public and Occupational Health, and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
| | - H Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - H Pereira
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Estrada da Costa, 1495-688, Cruz Quebrada, Portugal
| | - G Roberts
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - J Rooksby
- School of Computing Science, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Ø Røynesdal
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - M Silva
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Estrada da Costa, 1495-688, Cruz Quebrada, Portugal
| | - M Sorensen
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - S Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - T van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - H van der Ploeg
- Department of Public and Occupational Health, and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
| | - F van Nassau
- Department of Public and Occupational Health, and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
| | - M Nijhuis-van der Sanden
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - S Wyke
- Institute of Health and Wellbeing, College of Social Sciences, 27 Bute Gardens, University of Glasgow, Glasgow, G12 8RS, UK
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Hansen C, Johansen J, Samsøe E, Andersen E, Petersen J, Jensen K, Sand H, Andersen L, Grau C. PO-0613: Effect of geometric GTV-CTV margins in national contouring guidelines. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31050-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Zukauskaite R, Hansen C, Brink C, Grau C, Samsøe E, Johansen J, Andersen E, Petersen J, Overgaard J, Eriksen J. OC-0329: Does margin matter? Distribution of locoregional failures after primary IMRT for Head & Neck cancer. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Engh J, Andersen E, Martinsen E, Egeland J, Holmen T, Bigseth T, Bang-Kittilsen G. Metabolic health in patients with schizophrenia – CVD risk in a Norwegian outpatient population. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The mortality of schizophrenia patients is approximately twice that of the general population and there is a 20% reduction in life expectancy in this patient group. Cardiovascular disease (CVD) is responsible for as much as 50% of the excess mortality associated with schizophrenia. One important source of the high CVD prevalence is the cluster of metabolic characteristics defining the metabolic syndrome (MetS: 3 or more of the following features: abdominal obesity, high blood pressure, elevated levels of triglycerides and fasting glucose and low levels of high-density lipoproteins). Patients with schizophrenia seem to be undertreated for these vascular risk factors relative to the general population. More knowledge is needed concerning broadened risk factors of cardiovascular disease in a representative sample of schizophrenia patients. We conducted preliminary cross sectional analyses in a sample of 64 consecutive outpatients with schizophrenia with a mean age of 37 years consisting of 59% men, who were enrolled in a treatment study. All used antipsychotics, and 71% were smokers. We found that (percentage of patients under treatment for the respective somatic condition in parenthesis) 82% were overweight, 49% had hypertonia (17%), 24% hyperglycemia (3%), 48% hypertriglyceridemia and 13% hyperlipidemia (10% triglycerid or cholesterol lowering medication). Forty percent had metabolic syndrome compared to 11% in the normal population (Norway, age corrected). Additionally, estimates of insulin resistance will be conducted. We found that the prevalence of MetS components was high in outpatient schizophrenia. A substantial discrepancy was found between metabolic ill health and medication treatment of such conditions.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Giannopoulou C, Andersen E, Demeurisse C, Cimasoni G. Neutrophil Elastase and its Inhibitors in Human Gingival Crevicular Fluid during Experimental Gingivitis. J Dent Res 2016; 71:359-63. [PMID: 1372921 DOI: 10.1177/00220345920710020301] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The relative concentrations and absolute amounts of neutrophil elastase and its two inhibitors, α2-macroglobulin (α2-M) and alantitrypsin (α1-AT), were determined in gingival crevicular fluid (GCF) collected from six dental students who refrained from brushing the upper left or right quadrant during three weeks. Plaque and gingival indices and flow of GCF were measured before, during, and after the three weeks of no brushing. Functional elastase, representing the enzyme complexed with a2-M, was measured by use of a low-molecular-weight fluorogenic substrate. Elastolytic activity in GCF was also assayed by use of elastin as substrate. Antigenic elastase, representing the enzyme complexed with a 1-AT, as well as the inhibitors a2-M and al-AT were measured by ELISA. After three weeks of plaque accumulation, the concentrations of both functional and antigenic elastase increased by a factor of about 3, whereas the concentrations of the inhibitors increased in a much higher proportion. No free elastase could be detected in GCF, as evidenced by the Sephadex G-75 elution profile of GCF, by the negative results obtained when elastin was used as substrate, and by the demonstration that pure enzyme kept its activity against the low-molecular-weight substrate after being saturated by a2-M.
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Affiliation(s)
- C Giannopoulou
- Division of Physiopathology and Periodontology, School of Dentistry, Medical Faculty, University of Geneva, Switzerland
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Wulff NB, Kristensen CA, Andersen E, Charabi B, Sørensen CH, Homøe P. Risk factors for postoperative complications after total laryngectomy following radiotherapy or chemoradiation: a 10-year retrospective longitudinal study in Eastern Denmark. Clin Otolaryngol 2016; 40:662-71. [PMID: 25891761 DOI: 10.1111/coa.12443] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine the rates of and risk factors for postoperative complications following total laryngectomy in patients treated with radiotherapy or chemoradiation. DESIGN Retrospective longitudinal study. SETTING Tertiary medical centres. PARTICIPANTS A total of 143 patients undergoing total laryngectomy for squamous cell carcinoma of the larynx or hypopharynx. MAIN OUTCOME MEASURES Overall postoperative complications and fistula formation. RESULTS Overall postoperative complications, fistula formation, wound infection, bleeding and wound necrosis within one year after total laryngectomy occurred in 56.6%, 42.3%, 31.0%, 11.3% and 9.2% of patients, respectively. Stenosis of the pharynx/oesophagus and stoma shrinkage within five years after surgery were each seen in 18.2% of cases. In 66.7% of cases, conservative treatment of the fistulas was chosen. Rehospitalisations within five years occurred for 44.8% with a median rate of 1.5 (range 1-11). Smoking status (P = 0.005 and 0.013) and chronic obstructive pulmonary disease (COPD) (P = 0.013 and 0.011) were significant risk factors for both overall postoperative complications and fistula formation in uni- and multivariate analysis. Tumour localisation in the hypopharynx was associated with overall postoperative complications (P = 0.036). Residual tumour or cancer recurrence was associated with late-onset fistulas (P < 0.001). CONCLUSION The frequencies of postoperative complications after total laryngectomy were comparable with similar international studies, although fistula formation rate is increasing in Denmark. We suggest optimising treatment of COPD and to further encourage to smoking cessation. We propose that development of fistulas >2 months after surgery prompts immediate biopsies. Additionally, we suggest standardised registration of surgical techniques to identify variables affecting the frequency of postoperative complications.
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Affiliation(s)
- N B Wulff
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Denmark
| | - C A Kristensen
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Denmark
| | - E Andersen
- Department of Oncology, Herlev Hospital, University Hospital of Copenhagen, Denmark
| | - B Charabi
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Denmark
| | - C H Sørensen
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Denmark
| | - P Homøe
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Denmark.,Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, Denmark
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Cabrera M, Ravenscroft G, Andersen E, McLean C, Azmanov D, Stark Z, Davis M, Kornberg A, Ryan M, Laing N. Severe autosomal recessive congenital hypomyelinating neuropathy causing death in the first four months of life. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wulff N, Andersen E, Kristensen C, Sørensen C, Charabi B, Homøe P. Prognostic factors for survival after salvage total laryngectomy following radiotherapy or chemoradiation failure: a 10-year retrospective longitudinal study in eastern Denmark. Clin Otolaryngol 2016; 42:336-346. [DOI: 10.1111/coa.12726] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 12/15/2022]
Affiliation(s)
- N.B. Wulff
- Department of Otolaryngology, Head & Neck Surgery and Audiology; Rigshospitalet; University Hospital of Copenhagen; Copenhagen
| | - E. Andersen
- Department of Oncology; Herlev Hospital; University Hospital of Copenhagen; Herlev
| | - C.A. Kristensen
- Department of Oncology; Rigshospitalet; University Hospital of Copenhagen; Copenhagen
| | - C.H. Sørensen
- Department of Otolaryngology, Head & Neck Surgery and Audiology; Rigshospitalet; University Hospital of Copenhagen; Copenhagen
| | - B. Charabi
- Department of Otolaryngology, Head & Neck Surgery and Audiology; Rigshospitalet; University Hospital of Copenhagen; Copenhagen
| | - P. Homøe
- Department of Otolaryngology, Head & Neck Surgery and Audiology; Rigshospitalet; University Hospital of Copenhagen; Copenhagen
- Department of Otorhinolaryngology and Maxillofacial Surgery; Zealand University Hospital; Køge
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Engstroem K, Casares-Magaz O, Roervik J, Andersen E, Muren L. WE-AB-202-12: Voxel-Wise Analysis of Apparent Diffusion Coefficient and Perfusion Maps in Multi-Parametric MRI of Prostate Cancer. Med Phys 2016. [DOI: 10.1118/1.4957753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Lyhne N, Primdahl H, Kristensen C, Andersen E, Johansen J, Andersen L, Overgaard J. OC-0449: Pattern of failure and disease control in patients treated for glottic cancer in Denmark 1971-2011. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31698-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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McIntosh L, Andersen E, Reekie M. Conservative Treatment of Stress Urinary Incontinence In Women: A 10-Year (2004-2013) Scoping Review of the Literature. Urol Nurs 2015; 35:179-203. [PMID: 26402992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Stress urinary incontinence is a serious threat to the well-being of women world-wide. In this scoping review of the literature, we examined the most prominent research foci between the years 2004 and 2013. In this article, conservative treat-ment is operationalized as any non-surgical or non-pharmacological treatment modalities that could be carried out by specially trained nurses, physiotherapists, or physicians to treat stress urinary incontinence in women. The two most frequently described or systematically investigated treatment options identified in our review were 1) strengthening pelvic floor muscles with pelvic floor muscle training, including biofeedback and weighted vaginal cones; and 2) the use of intravaginal support devices, such as incontinence pessaries. Other treatment modalities were also explored in the literature review, such as intraurethral devices, behavioral and lifestyle interventions, products, and alternative therapies, such as acupuncture and acupressure. However, the focus of this article is on the two most frequently described options.
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Samsøe E, Andersen E, Hansen C, Johansen J, Sand H, Andersen L, Petersen J, Jensen K, Smulders B, Kristensen C, Grau C. PO-0944: Radiotherapy QA of the DAHANCA 19 protocol. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40936-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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