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Physical fitness and cognitive function: a cross-sectional study among adults in Qatar

Por: Alabdulrazzak · A. · Al-louzi · T. · Rahhal · M. O. · Albaloshi · A.-J. · Al-Emadi · R. · Al Mohannadi · M. · Abdulrahman · J. · Hasan Farooqui · H. · Pedersen · S. · Mahmood Al Saady · R.
Objective

This study aims to investigate the association between physical fitness and markers of cognitive function in adults aged 40 and above in Qatar.

Design

A cross-sectional study.

Setting

The Qatar Biobank, data of 1000 adults aged 40 and above.

Participants

A population of 1000 adults aged 40 years and older was included. Available data comprised measures of physical fitness including cardiorespiratory fitness, muscular strength, body composition and physical fitness capacity, as well as cognitive function assessed through tests of short-term visual memory and psychomotor coordination.

Primary and secondary outcomes

This paper investigated the physical fitness effect on cognitive functioning through short-term visual memory and psychomotor coordination testing. Logistic regression was used to measure the association between physical fitness and cognitive functioning tests.

Results

Our study showed that lower physical fitness capacity was significantly associated with lower psychomotor coordination in females (OR=1.57, p=0.040) and showed no significant association in males (OR=1.65, p=0.062). For short-term visual memory, the association was significant in females (OR=1.68, p=0.042) unlike in males (OR=1.58, p=0.062). Males with greater muscle strength were about half as likely to have lower psychomotor coordination (OR=0.48, p=0.04). In females, a higher body fat percentage was associated with poorer cognitive function, with each 1% increase in body fat being linked to 6% higher odds of low short-term visual memory (p=0.02) and low psychomotor coordination (p=0.006). Cardiorespiratory fitness showed no statistically significant association with short-term visual memory and psychomotor coordination level in either sex.

Conclusion

Our findings suggest that overall physical fitness capacity is associated with better cognitive function in Qatari adults. The relationship between specific fitness measures and cognitive function varied by sex, with muscle strength having a stronger effect for males and body composition for females. These results highlight the potential importance of maintaining physical fitness for cognitive health in adulthood.

Intravenous immunoglobulin and prednisolone to women with unexplained recurrent pregnancy loss after assisted reproductive technology treatment: a randomised, double-blind, placebo-controlled trial

Por: Norgaard-Pedersen · C. · Kesmodel · U. S. · Jorgensen · M. M. · Christiansen · O.
Objective

To investigate whether treatment with oral corticosteroids and intravenous immunoglobulin (IVIg) improves pregnancy outcomes in women with unexplained recurrent pregnancy loss (RPL) following assisted reproduction technology (ART) treatment.

Design

A randomised, double-blinded, parallel-group, placebo-controlled trial conducted from January 2021 to February 2024.

Setting

A single-centre trial at a Danish tertiary clinic for RPL management.

Participants

80 women with at least two consecutive early pregnancy losses following ART, age 18–41 years, body mass index below 35, and no identified cause of RPL. Forty participants were allocated to each group, with 37 fulfilling the protocol criteria in each group.

Interventions

Participants were randomised to receive either a combination of low-dose oral prednisolone starting on the first day of menstruation and IVIg given the first time around the time of embryo transfer; or matching placebo tablets and albumin infusions. Treatment continued until gestational week 8+4 in those who conceived with a total of four infusions.

Primary and secondary outcome measures

The primary outcomes were the ongoing pregnancy rate (OPR) defined as a living fetus in gestational week 13 among all randomised participants and in those who conceived after embryo transfer, respectively, based on intention-to-treat (ITT) and per-protocol (PP) analyses. Secondary outcomes included safety outcomes related to pregnancy complications and neonatal health.

Results

OPR was equal to live birth rate. Among all randomised participants (ITT), the OPR was 25.0% in the treatment group and 15.0% in the placebo group (relative risk 1.67; 95% CI 0.67 to 4.15; p=0.26). Among participants without major protocol deviations (PP), OPRs were 21.6% and 16.2%, respectively (relative risk 1.33; 95% CI 0.51 to 3.47; p=0.55). Among participants who became pregnant following embryo transfer, ongoing pregnancy occurred in 83.3% of the treatment group and 42.9% of the placebo group (relative risk 1.94; 95% CI 1.01 to 3.75; p=0.05). No differences in adverse events or neonatal outcomes were observed between the two groups.

Conclusions

The combination of oral corticosteroids and IVIg did not improve overall pregnancy rates in women with RPL after ART. However, among those who achieved pregnancy after embryo transfer, the risk of pregnancy loss appeared reduced. Larger randomised trials are needed to confirm these findings.

Trial registration number

ClinicalTrials.Gov: NCT04701034. Registration date: 5 January 2021

EudraCT number: 2020-000256-35; Registration date: 11 November 2020

The North Denmark Region Committee on Health Research Ethics: N-20200066, Registration date: 16 December 2020

The Data Protection Agency: 2020-156; Registration date: 4 November 2020

WHO universal trial number: U1111-1273-8585

Date of first patient’s enrolment: 28 January 2021.

Peer‐Mentor Support for Older, Vulnerable Patients With Ischemic Heart Disease: A Mixed Methods Process‐Outcome Evaluation

ABSTRACT

Aim

To achieve a deeper understanding of the results of a primary randomised controlled trial to clarify the potential effective mechanisms and barriers of a peer-mentor intervention.

Design

Mixed methods process-outcome evaluation of the intervention.

Method

Qualitative and quantitative data were collected during the intervention in a during-trial set-up, that is, a convergent design.

Results

The qualitative and quantitative findings mostly confirmed and expanded each other, identifying several mechanisms that facilitate the effectiveness of peer-mentor support during cardiac rehabilitation, such as mentors' experience-based knowledge and motivation. However, barriers related to lifestyle changes among older, vulnerable patients (e.g., mentee concerns about heart-healthy diets) and psychological outcomes (e.g., mentees' resilience) may minimise the effectiveness.

Conclusion

Peer-mentoring holds potential for supporting older, vulnerable patients during cardiac rehabilitation. However, ensuring that peer-mentors are well-suited for their role and capable of providing motivational, experience-based support is crucial, as is the need for tailored mentorship and consideration of specific patient populations needing mentor-supported cardiac rehabilitation.

Implications and Impact

Cardiac rehabilitation faces challenges due to high drop-out rates, particularly among older individuals, females, and vulnerable patients. Peer mentoring, a low-cost intervention, holds promise for supporting these groups in cardiac rehabilitation programmes.

Reporting Method

The study adheres to the ‘Systematic Development of Standards for Mixed Methods Reporting in Rehabilitation Health Sciences Research’, ‘Good Reporting of A Mixed Methods Study’ and ‘Template for Intervention Description and Replication’.

Patient and Public Contribution

A group of patients with cardiovascular disease actively contributed to developing and implementing the intervention.

Trial and Protocol Registration

ClinicalTrials.gov Identifier: NCT04945486—prospectively registered before the first participant was recruited

Perceived Capability, Opportunity and Motivation to Deliver Fundamental Nursing Care: A Cross‐Sectional Survey in Neurological Settings

ABSTRACT

Background

Delivering nursing care to patients' fundamental needs in neurological settings is challenging due to complex needs such as long-term care, physical disability and cognitive or communicative impairment.

Aim

To examine how registered nurses and nurse assistants perceive their capability, opportunity and motivation to deliver fundamental nursing care and use this insight to inform implementation strategies based on the Fundamentals of Care framework.

Design

Cross-sectional survey.

Methods

The questionnaire, grounded in the Capability–Opportunity–Motivation (COM-B) model and the Fundamentals of Care framework, was distributed to all nursing staff (n = 404) in four neurological departments at a university hospital in Denmark. Level of agreement was calculated as the proportion of responses in the top two Likert categories (‘to some extent agree’ and ‘completely agree’) and categorised as low (< 60%), medium (60%–85%) or high (> 85%). Quantitative results were analysed descriptively and inferentially; open-text answers were examined using deductive content analysis.

Results

The response rate was 63%. Agreement was high for capability (90.6%), motivation (89.2%) and addressing physical needs (85.2%), while opportunity (75.3%) and relational care (69.1%) were lower. The relational domain scored notably high for taking time to listen (95.8%) and low for evaluating the nurse–patient relationship (43.5%). Nurse assistants showed significantly higher agreement in the physical care domain than registered nurses. Variation across departments highlighted higher agreement in spinal cord injury and neurology compared to anaesthesia, pain, respiratory and traumatic brain injury units.

Conclusion

Nursing staff show strong internal drive and perceived competence—particularly in physical care—but face structural barriers in relational nursing and continuity. Implementation strategies should leverage high motivation, strengthen leadership engagement, ensure resource allocation and systematically integrate relational care into practice.

Patient or Public Contribution

No patient or public contribution.

Trial Registration

Danish Data Protection Agency (P20231246)

Advanced Practice Nurses' Roles and Responsibilities in Advance Care Planning for Older Persons—A Mixed Methods Systematic Review

ABSTRACT

Aim

To systematically identify, evaluate and synthesise the research literature about (a) the roles and responsibilities of advanced practice nurses (APNs) in the context of advance care planning (ACP) for older persons, (b) the characteristics of APNs' ACP practices and (c) the facilitators and barriers influencing APNs' involvement in ACP.

Design

Mixed-methods systematic review.

Methods

Followed the mixed methods systematic review guidelines outlined by the Joanna Briggs Institute. Three researchers independently screened studies for eligibility using the Covidence Screening Application. The screening involved two stages: titles and abstracts, followed by full-text evaluation. The Mixed Methods Appraisal Tool was used for quality assessment. A convergent integrated synthesis combined quantitative and qualitative data by ‘qualitising’ quantitative findings into text, enabling integration and thematic analysis to synthesise the results.

Data Sources

Medline, CINAHL and Embase were searched from 2012 to 2024 for original research in English, focusing on APNs involved in ACP for individuals aged 65 or older, using qualitative, quantitative or mixed method designs.

Results

The review included 19 studies: seven qualitative, nine quantitative and three mixed method designs. Thematic analysis revealed that APNs play a key role in ACP, aligning care with patient preferences through discussions and documentation. Studies from the United States (12), United Kingdom (4), Canada (2) and Australia (1) show varying APN roles and responsibilities.

Conclusion

APNs are crucial to ACP, but barriers limit their impact. Overcoming these is key to improving outcomes.

Implications for the Profession and Patient Care

APNs clinical expertise and close patient relationships are crucial for aligning care with patient preferences and needs in ACP. However, to fully maximise their contribution, it is essential to overcome barriers such as time constraints, lack of role recognition and insufficient training. Addressing these challenges will enhance the effectiveness of APNs in providing person-centred care.

Reporting Method

This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Patient or Public Contribution

No patient or public contribution.

Protocol for the SUPPORTED study: a Danish multicentre complex intervention for first-time fathers of preterm infants

Por: Holm · K. G. · Hägi-Pedersen · M.-B. · Haslund-Thomsen · H. · Nilsson · I. · Aagaard · H. · Maastrup · R. · Ejlertsen · C. · Petersen · M. · Feenstra · M. M. · Kristensen · I. · Brodsgaard · A.
Introduction

Fathers of preterm infants wish to be actively involved and attentive in caring for their children. The positive impacts of paternal caregiving on preterm infants’ cognitive and social development have been recognised. Awareness of the need to support fathers during early parenthood is increasing, but fathers may feel excluded when their infants are in the neonatal intensive care unit. Here, we present the protocol for a study involving the development and national implementation of a complex intervention supporting first-time fathers of preterm infants in early parenthood.

Methods and analysis

The study adheres to the Medical Research Council framework for complex interventions. A multicentre, prospective, non-blinded, quasi-experimental design will be applied to evaluate the effect of a clinical and technology-based intervention targeting both nurses and the fathers. Outcomes from participants enrolled during the control (2023–2024) and intervention (2025–2026) periods, comprising 295 fathers and their partners, will be compared. Effects on parental confidence, stress, depression and mood and family and reflective functioning as well as infants’ emotional and social development will be assessed. A comprehensive process evaluation will be applied using both qualitative and quantitative methods.

Ethics and dissemination

The study has been registered at Clinicaltrials.org [no. NCT0 6 116 747 (The SUPPORTED study – First-time Fathers of Preterm Infants), approved on 3 November 2023]. The Danish Data Protection Agency has approved the study (P-2022–792). The findings will be disseminated through peer-reviewed publications.

Trial registration number

NCT06116747.

Diabetes self-management observational study investigating how CGM use impacts diabetes distress, glycaemia and functions as a technological substitute for hypoglycaemia awareness: a study protocol

Por: Nitschke · M. J. · Demir · C. · Brosen · J. M. B. · Tapager · I. W. · Norgaard · K. · Kristensen · P. L. · Pedersen-Bjergaard · U.
Introduction

Continuous glucose monitoring (CGM) provides real-time glucose data for people with diabetes. However, detailed knowledge of its use in daily life remains limited. We aim to investigate the interaction between people with type 1 diabetes (T1D) and their CGM data and the impact of the interaction on glycaemia and diabetes distress.

Methods and analysis

This is a two-centre observational study of adults (n=500) with T1D using FreeStyle Libre 2. Over a period of 14 days, participants will continue their regular CGM use, record insulin doses and timing with smart insulin pens, track activity and sleep with an activity tracker, log all food intake in the LibreLink app and answer questions about quality of life and hypoglycaemia two times per day. Before the study period, the participants will complete a survey of 11 validated questionnaires assessing diabetes distress, hypoglycaemia awareness and other patient-reported outcomes (PROs). After the study period, the participants will complete two additional questionnaires assessing diabetes distress and health literacy.

The collected data will be used in two substudies with the overall aims of:

Substudy 1: to investigate how CGM is used in practice and the impact of the interaction on diabetes distress and glycaemia.

Substudy 2: to investigate whether and how CGM functions as a technological substitute for impaired awareness of hypoglycaemia, focusing on alarm data.

Endpoints will include CGM metrics, alarm data and PROs.

Ethics and dissemination

The Danish Data Protection Agency approved the study (P-2024–15985), and the regional committee on health research ethics has granted an ethical waiver (H-24014662). All participants have signed written informed consent forms before participating. The results will be published in an international peer-reviewed scientific journal by the study investigators and shared via www.clinicaltrials.gov. Participants who agreed to receive information about the study will be sent the results after publication.

Trial registration number

ClinicalTrials.gov (NCT06453434).

BREATHEIN: Better understanding obstructive REspiratory Airway disease Treatment and HEalth: a nationwide INvestigative survey in Denmark--a study protocol

Por: Hansen · K. K. · Pedersen · L. L. · Lokke · A. · Hilberg · O.
Introduction

Understanding patient perspectives on asthma and chronic obstructive pulmonary disease (COPD) is limited, with no prior studies employing such a large-scale, proactive survey to systematically target individuals with a confirmed prescription for inhalation medication. This study aims to explore how patients with asthma or COPD manage their lives, including treatment experiences, symptoms and impacts on daily life.

Methods and analysis

A nationwide survey will be launched in January 2025, targeting adults (≥18 years) in Denmark diagnosed with asthma or COPD and prescribed or dispensed inhalation medication between 1 October 2023 and 30 September 2024. Data from the Danish Health Data Authority’s Register of Medicinal Product Statistics will identify eligible individuals. The electronic survey will be distributed via e-Boks to approximately 450 000 individuals.

The questionnaire integrates validated tools—COPD Assessment Test, Modified Medical Research Council scale, EuroQol 5-Dimension 5-Level and Asthma Control Test—alongside expert-developed questions on symptoms, diagnosis, disease control, treatment and patient experiences. Questionnaire development included 10 cognitive interviews with patients from the Outpatient Clinic at Vejle Hospital.

Descriptive statistics will be used to analyse both continuous and categorical data, with sensitivity analyses conducted as well. Data management will be handled in Research Electronic Data Capture, and statistical analyses will be performed using Stata V.18.0.

Ethics and dissemination

The study is registered with the Danish Data Protection Agency (24/5229) and Open Patient Data Explorative Network (OP_2094) and follows the Declaration of Helsinki. Results will be published in peer-reviewed journals, presented at national and international conferences and shared through patient associations.

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