Tailoring a complex intervention to reduce antidepressants in institutionalized older persons with dementia

INTRODUCTION: First-line treatment for behavioral and psychiatric symptoms of dementia is non-pharmacological. Still, psychotropic medication is widely used, despite its limited effect and harmful side-effects. More than half of all nursing home residents with dementia receive antidepressants, even though deprescribing is safe and feasible. Interventions to promote deprescribing of antidepressants in nursing homes are few and complex. To optimize the deprescribing process through an intervention, transparency for the development of the intervention is needed. We aim to describe the steps in the development and tailoring of an intervention targeting GPs, nursing home staff, and relatives to enhance collaboration on reducing the use of antidepressants in institutionalized older persons with dementia in Denmark. METHOD: A step-wise process guided by the core elements in the Medical Research Council constituted the tailoring process. Five steps were included; 1) a literature search, 2) interviews with stakeholders, 3) drafting the intervention prototype, 4) professionals’ assessment of the intervention, and 5) refinement of the intervention. The steps were conducted from June 2020 to June 2022. RESULTS: Based on the literature search, interviews with stakeholders, and professionals’ assessment of the intervention, four main themes were identified; 1) focusing on antidepressants, 2) importance of professional qualifications, 3) collaboration and communication, and 4) patient and relative involvement. They guided intervention development and refinement of the final intervention, which included 1) a case-based training course and 2) a dialog tool including a symptom assessment scale to be used in a structured consultation at the nursing home. CONCLUSION: This study presents a detailed account of the tailoring process for a complex intervention to optimize deprescribing of antidepressants for older persons with dementia at nursing homes. By presenting a thorough development process, we expect to achieve increased adherence to the intervention which is currently being tested in an ongoing cluster randomized controlled trial. The transparency of the process will also increase the future development of other similar complex interventions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08961-9

Intake of Dairy Products in Relation to Periodontitis in Older Danish Adults

This cross-sectional study investigates whether calcium intakes from dairy and non-dairy sources, and absolute intakes of various dairy products, are associated with periodontitis. The calcium intake (mg/day) of 135 older Danish adults was estimated by a diet history interview and divided into dairy and non-dairy calcium. Dairy food intake (g/day) was classified into four groups: milk, cheese, fermented foods and other foods. Periodontitis was defined as the number of teeth with attachment loss ≥3 mm. Intakes of total dairy calcium (Incidence-rate ratio (IRR) = 0.97; <em>p</em> = 0.021), calcium from milk (IRR = 0.97; <em>p</em> = 0.025) and fermented foods (IRR = 0.96; <em>p </em>= 0.03) were inversely and significantly associated with periodontitis after adjustment for age, gender, education, sucrose intake, alcohol consumption, smoking, physical activity, vitamin D intake, heart disease, visits to the dentist, use of dental floss and bleeding on probing, but non-dairy calcium, calcium from cheese and other types of dairy food intakes were not. Total dairy foods (IRR = 0.96; <em>p</em> = 0.003), milk (IRR = 0.96; <em>p</em> = 0.028) and fermented foods intakes (IRR = 0.97; <em>p</em> = 0.029) were associated with reduced risk of periodontitis, but cheese and other dairy foods intakes were not. These results suggest that dairy calcium, particularly from milk and fermented products, may protect against periodontitis. Prospective studies are required to confirm these findings

Incidence of COVID-19 hospitalisation in patients with systemic lupus erythematosus:A nationwide cohort study from Denmark

Background: Patients with systemic lupus erythematosus (SLE) have an increased risk of infections due to impaired immune functions, disease activity, and treatment. This study investigated the impact of having SLE on the incidence of hospitalisation with COVID-19 infection. Methods: This was a nationwide cohort study from Denmark between 1 March 2020 to 2 February 2021, based on the linkage of several nationwide registers. The adjusted incidence of COVID-19 hospitalisation was estimated for patients with SLE compared with the general population in Cox-regression models. Among SLE patients, the hazard ratio (HR) for hospitalisation was analysed as nested case-control study. Results: Sixteen of the 2533 SLE patients were hospitalised with COVID-19 infection. The age-sex adjusted rate per 1000 person years was 6.16 (95% CI 3.76–10.08) in SLE patients, and the corresponding hazard ratio was 2.54 (95% CI 1.55–4.16) compared with the matched general population group after adjustment for comorbidities. Among SLE patients, hydroxychloroquine treatment was associated with a HR for hospitalisation of 0.61 (95% CI 0.19–1.88), and 1.06 (95% CI 0.3–3.72) for glucocorticoid treatment. Conclusion: Patients with SLE were at increased risk of hospitalisation with COVID-19

Lektier Online - didaktisk design af et uformelt online læringsrum?

I denne artikel undersøger vi det didaktiske design i Lektier Online; et online lektiehjælpstilbud for folkeskole- og gymnasieelever baseret på frivillige universitetsstuderende som lektiehjælpere. Vi identificerer fire betydninger af ’didaktisk design’, som alle behandles for Lektier Online. Vi opstiller en hypotese om Lektier Online-konceptet som frembydende et forholdsvis uformelt læringsrum samt tre eksplorative forskningsspørgsmål, der adresserer brugen af Lektier Online-platformens forskellige medier, deres virkemåde i læringskommunikationen mellem lektiehjælper og elev, samt muligheder for at kvalificere denne læringskommunikation didaktisk. Hypotese og forskningsspørgsmål undersøges gennem et eksplorativt observationsstudie, hvor lektiehjælpssessioner analyseres vha. positionerings- og affordanceteori. Vi konkluderer, at lektiehjælper og elev i samarbejde forhandler læringskommunikationen med anknytning til et lærer-elev narrativ og peger på, hvordan de primære kommunikationsmedier, tale og chat, samt de primære arbejdsmedier, digital tavle og Google Docs, bidrager i denne forhandling

Humanities for the environment—A manifesto for research and action

Human preferences, practices and actions are the main drivers of global environmental change in the 21st century. It is crucial, therefore, to promote pro-environmental behavior. In order to accomplish this, we need to move beyond rational choice and behavioral decision theories, which do not capture the full range of commitments, assumptions, imaginaries, and belief systems that drive those preferences and actions. Humanities disciplines, such as philosophy, history, religious studies, gender studies, language and literary studies, psychology, and pedagogics do offer deep insights into human motivations, values, and choices. We believe that the expertise of such fields for transforming human preferences, practices and actions is ignored at society’s peril. We propose an agenda that focuses global humanities research on stepping up to the challenges of planetary environmental change. We have established Environmental Humanities Observatories through which to observe, explore and enact the crucial ways humanistic disciplines may help us understand and engage with global ecological problems by providing insight into human action, perceptions, and motivation. We present this Manifesto as an invitation for others to join the “Humanities for the Environment” open global consortium of humanities observatories as we continue to develop a shared research agenda