Validation of the type 1 diabetes distress scale (T1-DDS) in a large Danish cohort: Content validation and psychometric properties.

Aim: To validate the Type 1 Diabetes Distress Scale (T1-DDS) in a large sample of adults with Type 1 diabetes (T1D) from diabetes clinics in Denmark. Methods: Altogether 40 adults with T1D were interviewed to explore the content of T1-DDS in a Danish setting and to validate the translation of the T1-DDS into Danish. Subsequently, a survey including T1-DDS, the Problem Areas In Diabetes scale (PAID-20), fear of hypoglycemia, social support, and diabetes duration was answered by 2201 people with T1D. Other person characteristics were collected from the National Patient Register. HbA1c was obtained from the Clinical Laboratory Information System. Data distribution, internal consistency, convergent and construct validity, factor structure, three weeks retest, and cut-points were explored. Results: Interview data supported the relevance of all T1-DDS items for the assessment of diabetes distress among adults with T1D. The T1-DDS showed good content and acceptable construct validity, and the ability to detect high diabetes distress levels. A high correlation between T1-DDS and PAID-20 (rho = 0.91) was found. The retest scores showed a good reliability (all rho ≥0.68) with the highest variability in the Friends/Family Distress and Physician Distress subscales and the lowest variability in the Powerlessness and Eating Distress subscales of the T1-DDS. Qualitative findings pointed out relevant concerns of people with T1D, which were not included in the T1-DDS. Conclusion: The study supports the use of the Danish T1-DDS, but also highlights that existing diabetes distress questionnaires including T1-DDS do not cover all potential diabetes stressors and worries.

Impact of patient-centred diabetes self-management education targeting people with type 2 diabetes: an integrative review.

AIMS: To synthesize primary research into the impact of person-centred diabetes self-management education, and support that targets people with type 2 diabetes, on behavioural, psychosocial and cardiometabolic outcomes and to identify effective mechanisms underlying positive outcomes of person-centred diabetes self-management education and support. METHODS: Using Whittemore and Knafl's integrative review method, we conducted a systematic search of peer-reviewed literature published between January 2008 and June 2019 using PubMed, Scopus and CINAHL. After article selection according to established criteria, study quality was assessed using Critical Appraisal Skills Programme checklists for cohort studies, randomized controlled trials and qualitative research. RESULTS: From 1901 identified records, 22 (19 quantitative, two qualitative, and one mixed methods) were considered eligible for inclusion. Interventions were categorized by content, medium of delivery, and outcomes. Qualitative studies, quantitative cohort studies and randomized controlled trials demonstrated positive outcomes, with no differences in success rates across study design. Interventions were largely successful in improving HbA1c and patient-reported outcomes such as quality of life but had limited success in lowering cholesterol and weight, or initiating long-term improvements in lifestyle behaviours. Primary objectives were achieved more often than secondary objectives, and studies with fewer outcomes appeared more successful in achieving specific outcomes. CONCLUSIONS: Person-centred diabetes self-management education and support has demonstrated a considerable impact on desired diabetes-related outcomes in people with type 2 diabetes. To advance the field further, new studies should take advantage of systematic and transparent approaches to person-centred diabetes self-management education.

Discrimination and stigma among people with type 2 diabetes in the workplace: prejudice against illness or obesity?

OBJECTIVES: Both obesity/overweight and type 2 diabetes (T2D) have been independently identified as being the basis for stigma and discrimination in the workplace. The study sought to test the hypothesis that people with T2D are at increased risk of discrimination and adverse self-reported psychosocial work environment. STUDY DESIGN: This study was based on survey data from 2415 working Danes with T2D (n = 586) and without T2D (n = 1829) recruited from online panels. Single self-reported items were used to obtain information about diabetes status, exposure to discrimination and other individual factors. METHODS: Descriptive statistics and linear regression were used for the data analysis. RESULTS: Six percent of the participants with T2D had experienced some type of discrimination at work, which was ascribed to their diabetes. People with diabetes had higher levels of effort-reward imbalance. When adjusting for body mass index, differences in relation to effort-reward imbalance were accounted for. CONCLUSIONS: People with T2D reported relatively poor psychosocial working environment compared with the general working population, but the difference was removed by adjusting for overweight/obesity. This indicates that T2D alone is not a source of stigma and discrimination in the context of work. Levels of perceived discrimination were notably lower than expected among people with diabetes as a whole, but a number of people, nonetheless, continue to be exposed to the destructive effects of discrimination in the context of work.

Reliability and validity of self-reported questionnaires to measure pain and disability in adults with neck pain and its associated disorders: part 3-a systematic review from the CADRE Collaboration.

PURPOSE: To determine the reliability and validity of self-reported questionnaires to measure pain and disability in adults with grades I-IV neck pain and its associated disorders (NAD). METHODS: We updated the systematic review of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and systematically searched databases from 2005 to 2017. Independent reviewers screened and critically appraised studies using standardized tools. Evidence from low-risk-of-bias studies was synthesized according to best evidence synthesis principles. Validity studies were ranked according to the Sackett and Haynes classification. RESULTS: We screened 2823 articles, and 26 were eligible for critical appraisal; 18 were low risk of bias. Preliminary evidence suggests that the Neck Disability Index (original and short versions), Whiplash Disability Questionnaire, Neck Pain Driving Index, and ProFitMap-Neck may be valid and reliable to measure disability in patients with NAD. We found preliminary evidence for the validity and reliability of pain measurements including the Body Pain Diagram, Visual Analogue Scale, the Numeric Rating Scale and the Pain-DETECT Questionnaire. CONCLUSION: The evidence supporting the validity and reliability of instruments used to measure pain and disability is preliminary. Further validity studies are needed to confirm the clinical utility of self-reported questionnaires to assess pain and disability in patients with NAD. These slides can be retrieved under Electronic Supplementary Material.

Health Literacy and self-care among visually impaired people with type 1 diabetes in Denmark.

AIMS: The aim of this study was to investigate health literacy and self-care among visually impaired people with type 1 diabetes in Denmark. METHODS: Survey data from 1425 Danes with type 1 diabetes were categorised in two groups according to visual status: visually impaired ( n = 38) and sighted ( n = 1387). Using the Health Literacy Questionnaire and the Summary of Diabetes Self-Care Activities Scale, health literacy and self-care activities were assessed. Visually impaired respondents were compared to sighted respondents using t-tests and chi-squared tests. RESULTS: Visually impaired people were older, had higher diabetes duration and were more likely to live alone. Also they had a significant lower level of health literacy on two key dimensions of health literacy ('Ability to find good health information' and 'Understanding health information well enough to know what to do'), they monitored blood sugar less frequently than people that were sighted but had better self-care regarding feet examination. CONCLUSIONS: Visually impaired people with type 1 diabetes are less able to find and understand health information than sighted people with type 1 diabetes. Our findings indicate need for interventions to promote better self-care and health literacy among visually impaired people with diabetes.

Correction: W.C. Mak, et al. Controlled Delivery of Human Cells by Temperature Responsive Microcapsules. J. Funct. Biomater. 2015, 6, 439-453.

Recently, we found a mistake in Figure 4D in our previously published paper[...].

Willingness to pay for flexible working conditions of people with type 2 diabetes: discrete choice experiments.

BACKGROUND: The increasing number of people with chronic diseases challenges workforce capacity. Type 2 diabetes (T2D) can have work-related consequences, such as early retirement. Laws of most high-income countries require workplaces to provide accommodations to enable people with chronic disabilities to manage their condition at work. A barrier to successful implementation of such accommodations can be lack of co-workers' willingness to support people with T2D. This study aimed to examine the willingness to pay (WTP) of people with and without T2D for five workplace initiatives that help individuals with type 2 diabetes manage their diabetes at work. METHODS: Three samples with employed Danish participants were drawn from existing online panels: a general population sample (n = 600), a T2D sample (n = 693), and a matched sample of people without diabetes (n = 539). Participants completed discrete choice experiments eliciting their WTP (reduction in monthly salary, €/month) for five hypothetical workplace initiatives: part-time job, customized work, extra breaks with pay, and time off for medical consultations with and without pay. WTP was estimated by conditional logits models. Bootstrapping was used to estimate confidence intervals for WTP. RESULTS: There was an overall WTP for all initiatives. Average WTP for all attributes was 34 €/month (95% confidence interval [CI]: 27-43] in the general population sample, 32 €/month (95% CI: 26-38) in the T2D sample, and 55 €/month (95% CI: 43-71) in the matched sample. WTP for additional breaks with pay was considerably lower than for the other initiatives in all samples. People with T2D had significantly lower WTP than people without diabetes for part-time work, customized work, and time off without pay, but not for extra breaks or time off with pay. CONCLUSIONS: For people with and without T2D, WTP was present for initiatives that could improve management of diabetes at the workplace. WTP was lowest among people with T2D. Implementation of these initiatives seems feasible and may help unnecessary exclusion of people with T2D from work.

Validation of static and dynamic radiostereometric analysis of the knee joint using bone models from CT data.

OBJECTIVES: Static radiostereometric analysis (RSA) using implanted markers is considered the most accurate system for the evaluation of prosthesis migration. By using CT bone models instead of markers, combined with a dynamic RSA system, a non-invasive measurement of joint movement is enabled. This method is more accurate than current 3D skin marker-based tracking systems. The purpose of this study was to evaluate the accuracy of the CT model method for measuring knee joint kinematics in static and dynamic RSA using the marker method as the benchmark. METHODS: Bone models were created from CT scans, and tantalum beads were implanted into the tibia and femur of eight human cadaver knees. Each specimen was secured in a fixture, static and dynamic stereoradiographs were recorded, and the bone models and marker models were fitted to the stereoradiographs. RESULTS: Results showed a mean difference between the two methods in all six degrees of freedom for static RSA to be within -0.10 mm/° and 0.08 mm/° with a 95% limit of agreement (LoA) ranging from ± 0.49 to 1.26. Dynamic RSA had a slightly larger range in mean difference of -0.23 mm/° to 0.16 mm/° with LoA ranging from ± 0.75 to 1.50. CONCLUSIONS: In a laboratory-controlled setting, the CT model method combined with dynamic RSA may be an alternative to previous marker-based methods for kinematic analyses.Cite this article: K. Stentz-Olesen, E. T. Nielsen, S. De Raedt, P. B. Jørgensen, O. G. Sørensen, B. L. Kaptein, M. S. Andersen, M. Stilling. Validation of static and dynamic radiostereometric analysis of the knee joint using bone models from CT data. Bone Joint Res 2017;6:376-384. DOI: 10.1302/2046-3758.66.BJR-2016-0113.R3.

Characteristics associated with non-disclosure of Type 2 diabetes at work.

AIM: To explore factors associated with non-disclosure of Type 2 diabetes to employers among Danish workers with Type 2 diabetes. METHODS: A total of 705 workers with Type 2 diabetes completed a Danish cross-sectional survey. Logistic regression models were used to estimate the associations between background characteristics and probability of non-disclosure of diabetes to the employer. The models were mutually adjusted for background characteristics, socioeconomic-, diabetes- and work-related factors. RESULTS: Among the participants, 23% had not disclosed their Type 2 diabetes to their current employer. Non-disclosure was associated with more sickness absence, more years with diabetes, greater use of diabetic medication, higher educational level and a perception of not being respected by superior. Personal traits such as gender, age and well-being were not associated with disclosure. CONCLUSIONS: Among the feasible targets for interventions, good psychosocial work environment was associated with disclosure.

Risk of depressive disorder following disasters and military deployment: systematic review with meta-analysis.

BACKGROUND: Numerous studies describe the occurrence of post-traumatic stress disorder following disasters, but less is known about the risk of major depression. AIMS: To review the risk of depressive disorder in people surviving disasters and in soldiers returning from military deployment. METHOD: A systematic literature search combined with reference screening identified 23 controlled epidemiological studies. We used random effects models to compute pooled odds ratios (ORs). RESULTS: The average OR was significantly elevated following all types of exposures: natural disaster OR = 2.28 (95% CI 1.30-3.98), technological disaster OR = 1.44 (95% CI 1.21-1.70), terrorist acts OR = 1.80 (95% CI 1.38-2.34) and military combat OR = 1.60 (95% CI 1.09-2.35). In a subset of ten high-quality studies OR was 1.41 (95% CI 1.06-1.87). CONCLUSIONS: Disasters and combat experience substantially increase the risk of depression. Whether psychological trauma per se or bereavement is on the causal path is unresolved.

Controlled Delivery of Human Cells by Temperature Responsive Microcapsules.

Cell therapy is one of the most promising areas within regenerative medicine. However, its full potential is limited by the rapid loss of introduced therapeutic cells before their full effects can be exploited, due in part to anoikis, and in part to the adverse environments often found within the pathologic tissues that the cells have been grafted into. Encapsulation of individual cells has been proposed as a means of increasing cell viability. In this study, we developed a facile, high throughput method for creating temperature responsive microcapsules comprising agarose, gelatin and fibrinogen for delivery and subsequent controlled release of cells. We verified the hypothesis that composite capsules combining agarose and gelatin, which possess different phase transition temperatures from solid to liquid, facilitated the destabilization of the capsules for cell release. Cell encapsulation and controlled release was demonstrated using human fibroblasts as model cells, as well as a therapeutically relevant cell line-human umbilical vein endothelial cells (HUVECs). While such temperature responsive cell microcapsules promise effective, controlled release of potential therapeutic cells at physiological temperatures, further work will be needed to augment the composition of the microcapsules and optimize the numbers of cells per capsule prior to clinical evaluation.

Psychosocial work conditions associated with sickness absence among hospital employees.

BACKGROUND: Meaningfulness of the job, collaboration among colleagues, trustworthiness of the closest superior and bullying have previously been shown to be major covariates of intention to quit the job. AIMS: To test if these elements of the psychosocial work environment are also the most essential covariates of sickness absence. METHODS: A cross-sectional questionnaire study of hospital employees which sought information on elements of the psychosocial work environment, general health status, life style, age, gender and profession. Data on sickness absence were obtained from the employer's salary database. RESULTS: A total of 1809 hospital employees took part with a response rate of 65%. The mean age was 43 (range: 20-69) and 75% were female. Totally, 363 study participants (20%) had at least 14 days sickness absence (defined as high absence) during the preceding year. Associations between high sickness absence and 29 psychosocial work elements were analysed, adjusting for relevant confounders. Following multiple logistic regression analysis, three elements had an independent statistically significant association with high sickness absence: no exposure to bullying (odds ratio (95% confidence interval) 0.50 (0.33-0.77)), high meaningfulness of the job (0.71 (0.52-0.97)) and high trustworthiness of the closest superior (0.70 (0.54-0.92)). CONCLUSIONS: Elements of the psychosocial work environment which have previously been shown to have a significant independent association with intention to quit the job were also the most essential covariates of high sickness absence.

Job satisfaction and intention to quit the job.

BACKGROUND: Negative psychosocial work conditions may influence the motivation of employees to adhere to their job. AIMS: To elucidate the perception of psychosocial work conditions among Danish hospital employees who would quit their job if economically possible and those who would not. METHODS: A cross-sectional questionnaire study of hospital employees. The questionnaire gave information on elements of the psychosocial work environment (job demands, job influence, job support, management quality, exposure to bullying), general health status, sick-leave during the preceding year, life style (leisure time physical activity, alcohol intake and smoking habits), age, sex and profession. RESULTS: There were 1809 participants with a response rate of 65%. About a quarter (26%) reported that they would quit their job if economically possible; this rose to 40% among the 17% who considered their health mediocre or bad. In a final logistic regression model, six factors were identified as independently associated with the wish to quit or not: self-assessed health status, meaningfulness of the job, quality of collaboration among colleagues, age, trustworthiness of closest superior(s) and exposure to bullying. Based on these factors it was possible to identify groups with fewer than 15% wishing to quit, and similarly, groups where 50% or more would quit if this was economically possible. CONCLUSIONS: Psychosocial work conditions, in particular meaningfulness of the job, were independently associated with intention to quit the job if economically possible and relevant within different job categories.

Non-invasive assessment of equine muscular function: A case study.

Assessment of muscle function after an injury or during recovery is of great importance in the veterinary field. Accelerometry, bioimpedance analysis and mechanomyography/acoustic myography have been used to assess human muscular problems, but have not been applied to the veterinary clinic. We report the clinical use of these techniques in a 12-year-old Danish Warmblood horse presenting with recurring and shifting lameness. Acoustic myography, assessing both the amplitude and frequency of active muscles, was employed to locate the specific area of muscle injury, the right hip, which exhibited minimal fibre recruitment giving rise to considerable weakness. This specific region was assessed by accelerometry which revealed a normal step interval for the injured leg when compared with the contralateral, but a weaker acceleration and strike force. Finally, an assessment of muscle resistance (R) and reactance (Xc) using bioimpedance confirmed a regional loss of muscle mass and a loss of cellular integrity compared with the contralateral limb.

Brain sex differences and the organisation of juvenile social play behaviour.

Juvenile social play behaviour is one of the earliest forms of non-mother directed social behaviour in rodents. Juvenile social play behaviour is sexually dimorphic, with males exhibiting higher levels compared to females, making it a useful model to study both social development and sexual differentiation of the brain. As with most sexually dimorphic behaviour, juvenile play behaviour is organised by neonatal steroid hormone exposure. The developmental organisation of juvenile play behaviour also appears to be influenced by the early maternal environment. This review will focus briefly on why and how rats play, some brain regions controlling play behaviour, and how neurotransmitters and the social environment converge within the developing brain to influence sexual differentiation of juvenile play behaviour.

Regulation of progestin receptor expression in the developing rat brain by a dopamine d1 receptor antagonist.

Steroid receptors within the developing brain influence a variety of cellular processes that endure into adulthood, altering both behaviour and physiology. Therefore, it is important to understand how steroid receptor expression is regulated during early brain development. Most studies indicate that oestradiol, by acting upon oestrogen receptors, increases the expression of progestin receptors in the developing brain. We have recently observed an additional mechanism by which dopamine can increase the expression of progestin receptors in developing female rat brain. That is, we found that a dopamine D1 receptor agonist can further increase progestin receptor expression by activating oestrogen receptors in a ligand-independent manner within restricted areas of female brain; however, it is unclear whether dopamine D1 receptors are involved in the normally occurring expression of progestin receptors in developing male and female brain. To investigate this, we examined whether a dopamine D1 receptor antagonist can disrupt the normal developmental expression of progestin receptors in both male and female rat brain. We report that treatment with a dopamine D1 receptor antagonist reduces progestin receptor expression within some, but not all, regions of the developing rat brain in a sex-specific manner. Some of the current findings also suggest that dopamine might be acting to prevent sex differences in progestin receptor expression in some areas while contributing to a sex difference in other areas.

Sex differences in Fos protein expression in the neonatal rat brain.

Sex differences in the brain and behaviour are mostly a result of transient increases in testosterone during the perinatal period. Testosterone influences brain development primarily through aromatization to oestradiol and subsequent binding to oestrogen receptors. Although some studies report that steroid hormones regulate the expression of the inducible transcription factor, Fos, in developing brain, it is not known if there is a sex difference in Fos expression. Changes in Fos protein can be used as an indicator of neuronal/genomic activity. Thus, it provides a useful tool to identify brain regions responding directly or indirectly to steroid hormones. In a first experiment, we examined Fos protein expression in the developing male and female rat brain using western immunoblotting. Dissections were taken from male and female rat pups on the day of birth (postnatal day 0; PN 0), PN1, PN5, PN11 or PN20. Although there was no difference on PN 0, males expressed significantly greater levels of Fos protein on PN1, PN5 and PN20. In a second experiment, we localized the sex difference in Fos protein expression using immunocytochemistry. We found that males expressed significantly higher levels of Fos within a variety of brain regions. These data indicate a sex difference in Fos protein expression during brain development, suggesting a potential role for Fos in differentiating male from female rat brain.

Maximal prime subgraph decomposition of Bayesian networks.

The authors present a method for decomposition of Bayesian networks into their maximal prime subgraphs. The correctness of the method is proven and results relating the maximal prime subgraph decomposition (MPD) to the maximal complete subgraphs of the moral graph of the original Bayesian network are presented. The maximal prime subgraphs of a Bayesian network can be organized as a tree which can be used as the computational structure for LAZY propagation. We also identify a number of tasks performed on Bayesian networks that can benefit from MPD. These tasks are: divide and conquer triangulation, hybrid propagation algorithms combining exact and approximative inference techniques, and incremental construction of junction trees. We compare the proposed algorithm with standard algorithms for decomposition of undirected graphs into their maximal prime subgraphs. The discussion shows that the proposed algorithm is simpler, more easy to comprehend, and it has the same complexity as the standard algorithms.

Practical modeling of Bayesian decision problems - exploiting deterministic relations.

The widespread use of influence diagrams to represent and solve Bayesian decision problems is still limited by the inflexibility and rather restrictive semantics of influence diagrams. We propose a number of extensions and adjustments to the definition of influence diagrams in order to make the practical use of influence diagrams more flexible and less restrictive. In particular, we describe how deterministic relations can be exploited to increase the flexibility and efficiency of representing and solving Bayesian decision problems. The issues addressed in the paper were motivated by the construction of a decision support system for mission management of unmanned underwater vehicles (UUVs).

A method for diagnosing multiple diseases in MUNIN.

A new method for diagnosing multiple diseases in large medical decision support systems based on causal probabilistic networks is proposed. The method is based on characteristics of the diagnostic process that we believe to be present in many diagnostic tasks, both inside and outside medicine. The diagnosis must often be made under uncertainty, choosing between diagnoses that each have small prior probabilities, but not so small that the possibility of two or more simultaneous diseases can be ignored. Often a symptom can be caused by several diseases and the presence of several diseases tend to aggravate the symptoms. For diagnostic problems that share these characteristic, we have proposed a method that operates in a number of phases: in the first phase only single diseases are considered and this helps to focus the attention on a smaller number of plausible diseases. In the second phase, pairs of diseases are considered, which make it possible to narrow down the field of plausible diagnoses further. In the following phases, larger subsets of diseases are considered. The method was applied to the diagnosis of neuromuscular disorders, using previous experience with the so-called MUNIN system as a starting point. The results showed that the method gave large reductions in computation time without compromising the computational accuracy in any substantial way. It is concluded that the method enables practical inference in large medical expert systems based on causal probabilistic networks.