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While measures to detect psychophysical olfactory ability are a crucial part of clinicians' assessment of potential olfactory loss, it gives no indication of how olfaction is experienced by the patient and these different aspects often deviate substantially. To ensure quality and reproducibility of subjectively reported olfactory experience and significance, the Importance of Olfaction Questionnaire (IO-Q) was introduced around a decade ago, and while initial validations have produced promising results, important aspects remain nearly unexamined. For example, the test-retest reliability has rarely been examined and the difference of online versus pen-and-paper administration remains unexplored. Here, we translated IO-Q to Danish and examined its validity, test-retest reliability and mode of administration. A cohort of 179 younger, Danish participants with a high level of English proficiency took the test twice with varying time in-between. The first test was taken digitally and in English, while the second was taken using pen-and-paper and in Danish. The distribution of scores and the relationship between the IO-Q and subscale scores were nearly identical between tests, indicating little to no influence of language/test modality in the sampled population. The internal consistency was comparable to previously published results. Likewise, an acceptable test-retest reliability was observed for the full IO-Q and slightly lower for subscales. No significant effect of time was found across several weeks. In conclusion, the IO-Q performed satisfactorily in all examinations and could therefore serve as a valuable clinical measure of subjective olfactory experience, and its Danish translation shows highly similar characteristics to the original, English version. [ABSTRACT FROM AUTHOR]

In composing multi-thematic questionnaires for the Lolland-Falster Health Study (LOFUS), we faced a range of challenges, for which we found limited guidance in the literature. LOFUS is a household-based population study covering multiple medical and social research areas and targeting the mixed rural-provincial population of 103,000 persons on the Danish islands Lolland and Falster. Households were randomly selected for invitation. In this paper, we describe and discuss challenges in developing the questionnaires related to stakeholders, content of the questionnaire, and the process itself. The development process was characterised by loops of learning and can be described as an iterative and incremental process. We propose recommendations to researchers and administrators involved in similar development processes, including awareness of the non-linearity and complexity of the process, a need for negotiations and navigation among multiple stakeholders, and acknowledgement of pragmatism as an inherent part of decisions made in the process. [ABSTRACT FROM AUTHOR]

Background: Patient reported outcomes and experience measures (PROM and PREM) provide an opportunity to prioritize patients' health goals in care decisions and quality improvement. In perinatal care, the use of PROM and PREM is scarce and limited to research and quality purposes. The International Consortium of Health Outcomes Measurement (ICHOM) published an outcome set for pregnancy and childbirth (PCB set), including PROM and PREM. In the Netherlands, the PCB set was implemented in a pilot project with the primary goal to integrate its PROM and PREM in clinical practice over the full course of pregnancy and postpartum care. To ensure continuity of care, the project was explicitly organized within integrated obstetric care networks (OCN): collaborating with all care professionals and organizations involved. Objectives: This study aimed to report first outcomes, experiences, and practice insights of implementing the PCB set in clinical practice of perinatal care. We assessed compliance to the PROM and PREM questionnaires, outcomes per domain, and clinical use of threshold values. Methods: Seven OCN across the Netherlands, each consisting of one or two hospitals and multiple community midwifery practices (2 - 18), implemented the PROM and PREM of the PCB set as part of clinical routine. This observational study included all women participating in the clinical project who gave informed consent for research purposes. The PROM and PREM were assessed with questionnaires at five timepoints: two during pregnancy and three postnatally until six months postpartum. Clinical threshold values (alerts) supported physicians interpretating the answers, indicating worrisome outcomes per domain. Data collection took place from February 2020 till September 2021. Questionnaires were assessed mostly digital - in one site on paper. Data analysis included missing (pattern) analysis, sum scores, alert rates, and sensitivity analysis. Results: In total 1923 questionnaires were collected across the five timepoints: 816 at T1 (first trimester), 793 at T2 (third trimester), 125 at T3 (maternity week), 170 at T4 (6 weeks postpartum) and 19 at T5 (6 months postpartum). Of these, 84% were filled out completely. Missing items per domain ranged from 0 to 13%, with highest missing rates for depression, pain with intercourse and experience with pain relief at birth. No notable missing patterns were found. Relatively high alert rates were found for urine incontinence (27%), pain with intercourse (25%), breastfeeding selfefficacy (23%) and mother-child binding (45%). Regarding PREM domains, most alerts were found for birth experience (23%), shared decision making (11%) and discussing pain relief antepartum (41%). Some domains showed very little clinical variation: mother role and satisfaction with care. Conclusions: The PCB set is a useful and acceptable tool to assess patient reported outcomes that need to be addressed over the whole course of pregnancy and childbirth. Our findings reveal a window of opportunity to improve and personalize perinatal care. Furthermore, based on our findings we could propose several recommendations about the methods and timeline of PROM and PREM measurement based. This study supports further implementation of the PCB set in clinical practice and the transformation towards patient centred value driven care. [ABSTRACT FROM AUTHOR]

Background: Pregnant women with depression and/or anxiety prior to pregnancy are at higher risk of preterm birth, breastfeeding problems, postpartum depression, and disruption of the mother-infant attachment. It is well documented that exercise improves psychological well-being in nonpregnant subjects with symptoms of depression. However, in only a few small studies have researchers examined the effect of exercise on symptoms of depression among pregnant women. We hypothesize that physiotherapist-supervised group exercise for pregnant women at risk of antenatal depression increases their psychological well-being. This paper describes the study protocol of a randomized controlled trial (RCT) on a supervised group exercise intervention for pregnant women with a current or previous history of depression and/or anxiety.Methods/design: The RCT is being carried out at the Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, in the period 2016-2019. The inclusion criteria are pregnant women ≥18 years of age with depression and/or anxiety requiring treatment by a psychiatrist or a psychologist within the last 10 years and/or intake of antidepressants in the 3 months prior to conception and/or during pregnancy. The women must have appropriate Danish language skills, be pregnant with a single fetus, give written informed consent, and be at 17-22 gestational weeks when the intervention begins. The primary outcome is psychological well-being (the five-item World Health Organization Well-being Index). Secondary outcomes are symptoms of depression (Edinburgh Postnatal Depression Scale), functional ability (General Health Questionnaire), clinical symptoms of anxiety (State-Trait Anxiety Inventory), sleep quality and sleep disturbances (Pittsburgh Sleep Quality Index), and pregnancy and delivery outcomes. The intervention is supervised group exercise twice weekly for 12 weeks. The control group will receive standard antenatal care. On the basis of sample size calculation, a total of 300 women will be randomly assigned to either the intervention or the control group in a ratio of 1:1.Discussion: The trial is expected to contribute to the body of knowledge used in planning antenatal care for pregnant women at risk of depression.Trial Registration: ClinicalTrials.gov, NCT02833519 . Registered on 19 May 2016. [ABSTRACT FROM AUTHOR]

Background: It is currently unknown if school-based social norms interventions are effective in preventing harmful alcohol consumption and other drug use among adolescents in Denmark. This paper describes the social norms-based programme The GOOD life and the design of a cluster-randomized controlled trial to test its effectiveness.Methods/design: The intervention The GOOD life is composed of three social norms components representing three different communication channels, namely face-to-face communication (normative feedback session), print communication (posters) and interactive media (web application). The intervention period of 8 weeks is preceded and followed by data collection, with the follow-up taking place 3 months after baseline. Public schools in the Region of Southern Denmark with grades 8 and 9 are invited to participate in the study and participating schools are randomly allocated to either intervention or control schools. The aim is to recruit a total of 39 schools and a sample of 1.400 pupils for the trial. An online questionnaire is conducted to examine the use of alcohol, tobacco and marijuana as well as the perceived frequency of use among peers of their own grade, which is measured before and after the intervention. Baseline data is used to develop social norms messages which are included in the three intervention components. Primary outcomes are binge drinking (more than 5 units at one occasion) and perceived frequency of binge drinking among peers, while smoking, marijuana use and alcohol-related harm will be assessed as secondary outcomes.Discussion: The GOOD life study will provide necessary insights on descriptive and injunctive norms regarding alcohol and other drug use among Danish adolescents. In addition, it will provide new knowledge and insight on the feasibility, implementation context and effectiveness of a newly developed social norms intervention in the Danish school context.Trial Registration: Date of registration: 17 February 2016 (retrospectively registered) at Current Controlled Trials with study ID ISRCTN27491960. [ABSTRACT FROM AUTHOR]

Background: Integration of physical activity (PA) into the classroom may be an effective way of promoting the learning and academic achievement of children at elementary school. This paper describes the research design and methodology of an intervention study examining the effect of classroom-based PA on mathematical achievement, creativity, executive function, body mass index and aerobic fitness.Methods: The study was designed as a school-based cluster-randomized controlled trial targeting schoolchildren in 1st grade, and was carried out between August 2012 and June 2013. Eligible schools in two municipalities in the Region of Southern Denmark were invited to participate in the study. After stratification by municipality, twelve schools were randomized to either an intervention group or a control group, comprising a total of 505 children with mean age 7.2 ± 0.3 years. The intervention was a 9-month classroom-based PA program that involved integration of PA into the math lessons delivered by the schools' math teachers. The primary study outcome was change in math achievement, measured by a 45-minute standardized math test. Secondary outcomes were change in executive function (using a modified Eriksen flanker task and the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire filled out by the parents), creativity (using the Torrance Tests of Creative Thinking, TTCT), aerobic fitness (by the Andersen intermittent shuttle-run test) and body mass index. PA during math lessons and total PA (including time spent outside school) were assessed using accelerometry. Math teachers used Short Message Service (SMS)-tracking to report on compliance with the PA intervention and on their motivation for implementing PA in math lessons. Parents used SMS-tracking to register their children's PA behavior in leisure time.Discussion: The results of this randomized controlled trial are expected to provide schools and policy-makers with significant new insights into the potential of classroom-based PA to improve cognition and academic achievement in children.Trial Registration: Clinicaltrials.gov: NCT02488460 (06/29/2015). [ABSTRACT FROM AUTHOR]

Background: Variation in prescription of antibiotics in primary care can indicate poor clinical practice that contributes to the increase of resistant strains. General Practitioners (GPs), as a professional group, are expected to have a fairly homogeneous prescribing style. In this paper, we describe variation in prescribing style within and across groups of GPs from six countries. Methods: Cross-sectional study with the inclusion of 457 GPs and 6394 sore throat patients. We describe variation in prescribing antibiotics for sore throat patients across six countries and assess whether variation in “prescribing style” - understood as a subjective tendency to prescribe - has an important effect on variation in prescription of antibiotics by using the concept of prescribing style as a latent variable in a multivariable model. We report variation as a Median Odds Ratio (MOR) which is the transformation of the random effect variance onto an odds ratio; Thus, MOR = 1 means similar odds or strict homogeneity between GPs' prescribing style, while a MOR higher than 1 denotes heterogeneity in prescribing style. Results: In all countries some GPs always prescribed antibiotics to all their patients, while other GPs never did. After adjusting for patient and GP characteristics, prescribing style in the group of GPs from Russia was about three times more heterogeneous than the prescribing style in the group of GPs from Denmark - Median Odds Ratio (6.8, 95% CI 3.1;8.8) and (2.6, 95% CI 2.2;4.4) respectively. Conclusion: Prescribing style is an important source of variation in prescription of antibiotics within and across countries, even after adjusting for patient and GP characteristics. Interventions aimed at influencing the prescribing style of GPs must encompass context-specific actions at the policy-making level alongside GP-targeted interventions to enable GPs to react more objectively to the external demands that are in place when making the decision of prescribing antibiotics or not. [ABSTRACT FROM AUTHOR]

Background Evidence suggests that sitting time is adversely associated with health risks. However, previous epidemiological studies have mainly addressed mortality whereas little is known of the risk of coronary heart disease. This study aimed to investigate total sitting time and risk of myocardial infarction, coronary heart disease incidence and all-cause mortality. Methods In the Danish Health Examination Survey (DANHES) conducted in 2007-2008 we tested the hypothesis that a higher amount of daily total sitting time is associated with greater risk of myocardial infarction, coronary heart disease and all-cause mortality. The study population consisted of 71,363 men and women aged 18-99 years without coronary heart disease. Participants were followed for myocardial infarction, coronary heart disease and mortality in national registers to August 10, 2012. Cox regression analyses were performed with adjustment for potential confounders and multiple imputation for missing values. Results During a mean follow-up period of 5.4 years 358 incident cases of myocardial infarction, 1,446 of coronary heart disease, and 1,074 deaths from all causes were registered. The hazard ratios associated with 10 or more hours of daily sitting compared to less than 6 hours were 1.38 (95% CI: 1.01, 1.88) for myocardial infarction, 1.07 (95% CI: 0.91, 1.27) for coronary heart disease and 1.31 (95% CI: 1.09, 1.57). Compared to sitting less than 6 hours per day and being physically active in leisure time, the hazard ratios of sitting more than 10 hours per day and also being physically inactive in leisure time were 1.80 (95% CI: 1.15, 2.82) for myocardial infarction, 1.42 (95% CI: 1.11, 1.81) for coronary heart disease, and 2.29 (95% CI: 1.82, 2.89) for all-cause mortality. Conclusions The results suggest that a higher amount of daily total sitting time is associated with all-cause mortality, particularly among inactive adults. In relation to coronary heart, disease results were less clear. This paper adds new evidence to the limited data on the evidence of sitting time and cardiovascular disease and mortality. [ABSTRACT FROM AUTHOR]

Background. According to the World Health Organization, depression ranks as a major contributor to the global burden of disease. A large proportion of adult depressions had their first appearance in adolescence.Aim. Because primary health care professionals lack valid instruments for early identification of depression, we sought to validate HSCL-10. The design of study is a GP multicentre study conducted in Norway and Denmark. The setting of the study is adolescents (14–16 years) responded by answering a questionnaire and later completed a Composite International Diagnostic Interview, which was used as the gold standard. Depression was defined by International Classification of Diseases-10 (ICD-10). Both internal and external validity were examined, the likelihood between pretest and posttest measured and a cut-off point for depression calculated by using the Youden index.Results. The Hopkins Symptom Checklist-10 test (HSCL-10) met the criteria for external and internal validity. When analysed separately, the criteria were met both in Denmark and in Norway and both for paper and web. The optimal cut-off point for the HSCL-10 test was 16 (HSCL-10 = 16/10 items = 1.6), with no gender differences. For girls and boys, respectively, it yielded a sensitivity of 87.5% and 87.5%, specificity of 72.4% and 87.9% and likelihood of 3.2 and 7.2.Conclusion. HSCL-10 is a suitable and valid instrument for detecting depression in young people in primary care. [ABSTRACT FROM PUBLISHER]

Green Public Procurement (GPP) has been considered as an important policy instrument in the context of sustainable consumption and production. The state and progress of GPP has earlier been measured by questionnaires and interviews, both methods being based on the assessment by the purchaser, and questionnaires having low response rates. Recently, a new method was developed, analyzing the existence of environmental criteria in the calls for tenders. However, the studies have dealt neither with the progress in GPP, nor the statistical evidence of differences between countries. Our aim was to analyze more thoroughly whether the differences in the proportions of ‘green’ calls for tenders between the three Nordic countries, Denmark, Finland and Sweden, in 2003 and 2005 were real, and whether there had occurred any progress between the years concerned. The paper also presents the ‘GPP-record’ method, which enables more valid measurement of the environmental soundness of public purchasing. The statistical analyses were done using logit models with country, year and product group as the explanatory factors. It proved to be relevant to take into account the variation that occurred from the random existence of product groups in the samples of calls for tender. There were less environmental criteria in the calls for tenders in Finland than in Denmark and Sweden in 2003, but in 2005 no significant difference between Finland and Denmark was observed. Both Finland and Sweden saw progress in this area between 2003 and 2005. [Copyright &y& Elsevier]

Simple Summary: In childhood cancer healthcare, interprofessional education involves multiple healthcare professionals with general and specific knowledge and skills. However, few interprofessional education programs exist in childhood cancer. This feasibility study assesses the acceptability, demand, practicality, and implementation of postgraduate interprofessional case-based learning for healthcare professionals from 13 different occupational groups working with children and adolescents with cancer. The study design is interventional, with subjective and objective assessment measures. Outcome measures provide sufficient information to inform a randomized controlled trial. Results from this feasibility study could be useful in the planning, design, and evaluation of postgraduate interprofessional education in other settings. This paper presents a feasibility study assessing the acceptability, demand, implementation, and practicality of postgraduate interprofessional case-based learning in childhood cancer at Copenhagen University Hospital—Rigshospitalet. Healthcare professionals included nurses, doctors, social workers, physiotherapists, occupational therapists, pharmacists, pharmacologists, dieticians, nursing assistants, and professionals with a supportive function (teachers, secretaries, priests, and daycare workers). All participated in a postgraduate interprofessional case-based learning session. Feasibility was assessed using Bowen's focus areas of acceptability, demand, implementation, and practicality. Before and after the intervention session, three measurement tools were used 2–3 weeks before participation and 3–4 weeks after participation to collect data: Assessment of Interprofessional Team Collaboration Scale, Readiness for Interprofessional Learning Scale, and Safety Attitudes Questionnaire. Representing 13 occupational groups, 49 participants completed the case-based learning sessions, indicating acceptability and practicality. The pre- and post-intervention questionnaires were completed by 79% of the participants, 88% of whom rated the professional content as good or very good. A change over time was detected on all three scales measuring mean difference post-intervention scores. The outcome measures can be used to assess the effect of the intervention. Postgraduate interprofessional case-based learning in childhood cancer is feasible in terms of acceptability, demand, implementation, and practicality. Implementation requires leadership commitment at all levels. [ABSTRACT FROM AUTHOR]

Background: Using paper questionnaires to measure quality of care from the perspective of the patient is a time consuming procedure resulting in very slow feedback. Response rates are low and patients who cannot read the local language are usually excluded.Objective: To investigate the applicability of an electronic questionnaire by evaluating the response rate. To study whether computer-based continuous monitoring could elucidate reasons for parents being less satisfied with care and treatment and to compare parent satisfaction with the results of a study performed in 2003.Methods: Parents were asked to assess the quality of care and treatment by answering questions on a touch-screen computer. The questions, which were translated into seven languages, corresponded to the indicators selected by the department for monitoring parents' satisfaction. The system was developed in cooperation with a software company.Results: A total of 780 parents answered (69%). Of these, 2% parents answered in a foreign language. The main reasons for being less satisfied were perceived difficulties in getting in contact with the staff, having experienced unnecessary long waiting time and having the impression that the nurses did not have enough time. Significant improvements in satisfaction had occurred as compared to a study from 2003.Conclusion: By using electronic questionnaires, it was possible to focus on the small percentage of parents not satisfied, to identify reasons for being less satisfied and to respond immediately to the feedback from the parents. Electronic surveys produce a satisfactory response rates. [ABSTRACT FROM AUTHOR]