Vitamin D Depletion in Pregnancy Decreases Survival Time, Oxygen Saturation, Lung Weight and Body Weight in Preterm Rat Offspring

Animal studies suggest a role of vitamin D in fetal lung development although not studied in preterm animals. We tested the hypothesis that vitamin D depletion aggravates respiratory insufficiency in preterm rat offspring. Furthermore, the effects of vitamin D depletion on growth and lung surfactant were investigated. Female Sprague-Dawley rats were randomly assigned low vitamin D (VDL) or control diet before mating and followed with serum 25-hydroxyvitamin D (s-25(OH)D) determinations. After cesarean section at gestational day 19 (E19) or day 22 (E22), placental weight, birth weight, crown-rump-length (CRL), oxygenation (SaO2) at 30 min and survival time were recorded. The pup lungs were analyzed for phospholipid levels, surfactant protein A-D mRNA and the expression of the vitamin D receptor (VDR). S-25(OH)D was significantly lower in the VDL group at cesarean section (12 vs. 30nmol/L, p<0.0001). Compared to the controls, E19 VDL pups had lower birth weight (2.13 vs. 2.29g, p<0.001), lung weight (0.09 vs. 0.10g, p = 0.002), SaO2 (54% vs. 69%, p = 0.002) as well as reduced survival time (0.50 vs. 1.25h, p<0.0001). At E22, the VDL-induced pulmonary differences were leveled out, but VDL pups had lower CRL (4.0 vs. 4.5cm, p<0.0001). The phospholipid levels and the surfactant protein mRNA expression did not differ between the dietary groups. In conclusion, Vitamin D depletion led to lower oxygenation and reduced survival time in the preterm offspring, associated with reduced lung weight and birth weight. Further studies of vitamin D depletion in respiratory insufficiency in preterm neonates are warranted

Shared decision-making in general practice from a patient perspective. A cross-sectional survey

AbstractObjectives We aimed to assess patient involvement in terms of shared decision-making in general practice from the perspectives of patients with chronic obstructive pulmonary disease (COPD) or type 2 diabetes (T2DM) (or both).Design A cross-sectional survey using the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) ranging from 0 to 5 (best).Setting and subjects Patients diagnosed with either T2DM and/or COPD were asked to focus on their most recent consultation in general practice concerning their T2DM or lung disease. Responders were approached through the Danish Diabetes Association and Danish Lung Association.Results The sample included 468 responders. Mean scores for the total sample were between 3.3 and 4.2. The overall mean score for all items was 3.7. The highest overall mean score was for patients with T2DM, whereas the lowest overall mean score was for patients having both T2DM and COPD. Furthermore, we observed a slightly lower overall mean score for women compared to men and for those younger than 65 years compared to those aged 65 years or older.Conclusion Overall, patients are involved in shared decision-making in general practice Minor nuances were found because patients with COPD were less involved in shared decision-making compared to patients with T2DM. Similarly, younger patients and women were less involved than older patients and men

General practitioners’ perceptions of treatment of chronically ill patients managed in general practice: An interview study

Background Patients with chronic conditions pose a major challenge to the Danish healthcare system. Since 2018, disease management programmes for patients with chronic obstructive pulmonary disease (COPD) and type 2 diabetes (T2D) were introduced in Denmark. Treatment in hospitals should be reserved for those patients who require specialised treatment. Hence, more patients with COPD and T2D fall within the general practitioners’ (GPs) responsibility. Objectives This study explores GPs’ perceptions of their role as physicians responsible for the disease management programmes on COPD and T2D and their perceptions of the quality of care provided to these patient groups. Methods Between November 2019 and January 2020, we conducted semi-structured interviews with 14 GPs from the five regions of Denmark. We analysed the interviews using systematic text condensation inspired by Malterud’s thematic analysis. Results The GPs stated that they have been managing the care of COPD and T2D patients for over a decade, and they considered the quality of care to be high. They believed that managing patient treatment pathways in general practice settings contributes to a heightened sense of security for the patient, mainly because of the long-standing and trusting relationship between the patient and GP. Conclusion According to the GPs, they continue to play an important role as treatment coordinators to ensure coherence and high quality in treating patients with COPD and type 2 diabetes

Fertility awareness and attitudes towards parenthood among Danish university college students

Background: Postponing parenthood has steadily increased during the past decades in Western countries. This trend has affected the size of families in the direction of fewer children born per couple. In addition, higher maternal age is associated with an increased risk of pregnancy-related complications such as prematurity and foetal death, while higher paternal age increases the risk of miscarriage and affects time-to-pregnancy. Hence, understanding the circumstances and reflections that influence the decision is greatly needed and little is known about potential gender difference influencing the choice. The aim was to investigate attitudes towards parenthood, intentions for childbirth and knowledge about fertility issues among men and women. Methods: We conducted a cross-sectional study based on a validated 49-item questionnaire among students, who attended selected mandatory lectures at a Danish university college in February to April 2016. The participation rate was 99%, and 517 completed the questionnaire. Results: Though the majority of all participants wished to have children in the future (&gt; 86%), there was significant difference between the genders (p = 0.002). Women rated having children to be more important than men did (p &lt; 0.001), while men rated higher the likelihood of abstaining from having children if faced with infertility (p = 0.003). Knowledge about fertility issues was similar between genders including poor knowledge about the age-related decline in female fertility. While women found it more important to have children before being 'too old' (p = 0.04), still more than 40% of all respondents intended to have their last child after the age of 35 years. For both genders the most important prerequisite for parenthood was having a partner to share responsibility with. Perceived or experienced life changes related to parenthood were generally positive such as personal development. Conclusion: The majority of respondents wished to have children, but many desired to have these after the biological decline in female fertility. The moderate knowledge level among both genders uncovered in this study is of concern. Future research should address the potential link between fertility knowledge and planning of parenthood. We may benefit from intervention studies examining the effect of routine preconception care

Survival-rate in hours after birth.

<p>Kaplan-Meier survival analysis of both A) E19 (VD_L group (n = 58); control group (n = 28)) and B) E22 (VD_L group (n = 38); control group (n = 31)) pups. Comparison of survival curves using log-rank (Mantel-Cox) test.</p

Offspring data.

<p>Offspring data.</p