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OBJECTIVE: to explore how contextual conditions influence midwives' relational competencies, ability and confidence to undertake psychosocial assessment of pregnant women and their partners during the first antenatal consultation that identifies expectant parents in vulnerable positions.DESIGN: a realist evaluation carried out through three phases: 1) development 2) testing and 3) refinement of programme theories. Data was generated through realist interviews and observations.SETTING: nine community-based and hospital-based midwife clinics in the North Region of Denmark.INTERVENTION: a dialogue-based psychosocial assessment programme in the the North Region of Denmark was evaluated.PARTICIPANTS AND DATA: 15 midwives were interviewed and 16 observations of midwives undertaking psychosocial assessment during the first antenatal consultation were conducted.FINDINGS: contextual conditions at multiple levels which supported midwives' relational competencies, autonomy and the power of peer reflection-and thus facilitation of a woman-centred approach and trust-were identified, i.e., being experienced, having interest, organisational prioritisation of peer reflection and flexibility. Where midwives lacked experience, competency development regarding psychosocial assessment, opportunities for peer reflection and autonomy to individualise care for expectant parents in vulnerable positions, the approach to assessment tended to become institution-centred which caused a distant dialogue and instrumental assessment which potentially harmed the midwife-woman/couple relationship.CONCLUSION: midwives' ability and confidence to undertake psychosocial assessment were affected by whether individual and organisational contextual conditions empowered them to assess and care for expectant parents within a philosophy of woman-centred care. Accordingly, development of trustful midwife-woman/couple relationships - which is essential for disclosure - was achievable. These conditions become fundamental for securing quality of antenatal care for expectant parents in vulnerable positions.

BackgroundWhile continuity of care is a core element of high-quality maternity care, it is potentially even more important for pregnant women and their partners who are at risk of adverse health outcomes because of psychosocial vulnerability. However, little is known about how a coherent care journey can be ensured for women and families who may require interdisciplinary and inter-sectoral services during pregnancy and the postnatal period.AimTo explore the role of continuity of care in creating a coherent care journey for vulnerable parents during pregnancy and the postnatal period.MethodsAn ethnographic study conducted in Denmark based on interviews with, and field observations, of 26 mothers and 13 fathers receiving services due to mental health problems, young age, past substance abuse and/or adverse childhood experiences.FindingsThree key findings emerged: 1). Developing relationships allowed parents to know and feel known by care providers, which helped them feel secure and reach out for support. 2). Handover of information allowed parents to feel secure as their need for support was recognised by care providers; some parents, however, felt exposed when information was shared 3). Receiving relevant services allowed parents to have their needs for support addressed, which requires easy referral pathways and coordination of services.ConclusionAll forms of continuity of care should be prioritised in the organisation of maternity care services for women and families in vulnerable positions. While relational continuity is important, continuity of care must also reach across providers, sectors and services to ensure coherent care journeys.

The production of renewable energy from solar panels and windmills is rapidly increasing these years. However, one of the biggest hurdles that need to be overcome in the green transition is cost-efficient energy storage to reach the full exploitation of their potential. A promising energy storage technology is redox flow batteries (RFBs), particularly using quinones as electron carriers. The prototypes of quinone batteries have been derived from crude oil, which unfortunately falls short of the ambition of sustainable energy production purely from renewable sources. It is well-known that filamentous fungi have a great capacity for quinone production. and the first RFB with a fungal-produced quinone was recently generated as a proof-of-concept. Here, we give our opinion and perspectives on which challenges need to be solved before an RFB with fungal-produced quinones can be applied in the green transition.

Aim To determine the effectiveness of despatching an electronic reminder of participation in screening for gestational diabetes. The reminder was sent to the women 1–8 years after delivery. Methods A registry-based, randomized controlled trial in the North Denmark Region among women with gestational diabetes. Randomization was made, which included seven groups stratified by the child’s birth year (2012–2018). The intervention group received standard care supplemented by an electronic reminder through a secure nationwide email system (n = 731), while the control group received only standard care (n = 732). The primary outcome was based on blood testing for diabetes (OGTT, HbA1c or fasting P-glucose). Results A total of 471 (32.1%) women participated in screening. The primary outcome was experienced by 257 women (35.1%) in the intervention group and 214 women (29.2%) in the control group. The effect of the reminder seemed to increase with recipient’s age, non-western origin, urban dwelling, and multiparity. Of those who participated in follow-up screening, 56 (3.8%) were diagnosed with type 2 diabetes. Conclusion Electronic reminders, based on the principles of informed choice and patient-centred care, to women have been shown to support life-long participation in follow-up screening. Attempts to further stimulation of coverage could however be considered. Trail registration ISRCTN registry (22/04/2022, ISRCTN23558707).

Aqueous organic redox flow batteries (AORFBs) have gained increased interest as a promising solution to store energy from sustainable energy sources. Inspired by naturally occurring bio-quinones, we here propose a new electrolyte based on the fungal compound phoenicin. Phoenicin was produced using the filamentous fungus Penicillium atrosanguineum at a concentration of 1.24 g L−1 liquid medium and extracted using ethyl acetate to a purity exceeding 95 %. The fungus may provide a benefit of high scalability of the biosynthesis-based production of the electroactive substance. Here, we demonstrate the performance of biologically produced phoenicin as a negative electrolyte in an RFB against ferro/ferricyanide, as a proof of concept, giving an initial capacity of 11.75 Ah L−1 and a capacity decay of 2.85 % day−1. For a deeper investigation of the battery setup, in situ attenuated total reflection infrared (ATR-IR) spectra of the phoenicin electrolyte were recorded. Symmetric cell cycling was performed to study the stability of this bio-based active material.

Senior centre staff members seemingly have an important organisational and administrative role, as well as engage in outreach activities, referral and follow-up in relation to health issues among senior centre users. However, their role in health promotion and illness prevention is easily overlooked and under researched. This study aimed to explore municipal senior centre staffs' awareness of and response to signs of deteriorating health or well-being among users. A multisite ethnographic field study was conducted at seven municipal senior centres in Denmark from November 2019 to February 2020. Data were obtained from participant observation and semi-structured individual interviews with 16 staff members. A thematic analysis strategy helped identify themes of importance. Senior centre staff followed a process of three steps when remaining aware of and responding to signs of deteriorating health and well-being among users: detecting, tracing and reacting. Three themes with corresponding subthemes were identified: Establishing close and trusting relationships, facilitating a community feeling and utilising joint collaboration. Each subtheme was linked to some or all of the three steps in the process. The municipal senior centre staff had a strong and explicit focus on detecting, tracing and reacting to signs of deteriorating health and well-being among senior centre users. This makes the senior centres a promising arena for illness prevention and health promotion.

As social technologies increase in popularity, there is a growing interest in incorporating them into mental health interventions. Research shows that the use of social technologies may support belonging and mental health. Findings, however, are contradictory and highlight the need to clarify the processes and mechanisms by which this technology may have positive effects. This study conducted a realist evaluation of a web-based citizen-to-citizen platform adopted within community care in a Danish Municipality. It focused on how, for whom and under what circumstances the web-based platform worked to promote belonging and mental health. The evaluation was structured in subsequent phases of development, testing, and refinement of programme theories. A purposeful sampling frame was developed based on the programme theories, and 27 interviews were conducted. With variations, the platform was found to support its users in meeting their social needs by (a) expanding their access to social networks; (b) allowing them to overcome barriers related to reaching out to new people in real life and (c) providing them with an improved starting point for identification of a relational match. Whether this resulted in improved belongingness and mental health was strongly affected by individual and relational circumstances. Findings suggest that web-based platforms that aim to enable citizens to locate friends and activity partners can serve as helpful tools in interventions striving to promote mental health in the community, as they may support people to fulfil a need for belongingness. However, the impact of such tools is highly dependent on the individual's abilities to use the initiatives to form relationships of sufficient quality to accommodate these needs. People with previous relational difficulties, and who have struggled to achieve feelings of belonging and citizens with limited digital literacy, may need support to realise the social opportunities provided by these technologies.

This paper presents a definition of volunteering that will help organizations and workers determine when U.S. organizations can legally draw on volunteer labor. By drawing on recent U.S. court cases, the intentions of the Fair Labor Standards Act (FLSA) to protect vulnerable workers and the wider literature on organizational logics, work, and volunteering, we demonstrate under which circumstances workers should be considered employees covered by the FLSA and therefore entitled to minimum pay, rather than volunteers. We show that in order to determine the legalities of work it is necessary, but not sufficient, to consider if activities are carried out for commercial purposes. What matters most to a legal definition is the role performed within organizations and the promises made to individual workers in terms of compensation.

Objectives Ischemic heart disease (IHD) displays wide social inequalities that are often explained with reference to lifestyle factors. However, research indicates that social support may also play an important role in social inequality in IHD. This study aims to explore the role of social support in the experience of life with IHD for socially disadvantaged patients. Methods The study was conducted as a critical hermeneutic qualitative study in Denmark between October 2018 and August 2019. Data consist of in-depth qualitative interviews with 30 socially disadvantaged patients with IHD. Results The findings showed a notable difference between the participants who were engaged in close and supportive social relationships and those who were not. Life with IHD for those who lacked supportive relationships tended to be marked by feelings of chaos, powerlessness and meaninglessness. Contrarily, those who were engaged in supportive relationships received help to navigate their life with illness, reconcile with what had happened to them, feel empowered, and gain a sense of meaning in their life. Discussion: Social support from close social relationships appears to be crucial for socially disadvantaged ischemic heart patients, and should be encouraged and facilitated in healthcare and interventions targeting this patient group.

Socially disadvantaged ischemic heart patients are more likely to report poor patient satisfaction and problematic patient-provider communication than patients without social disadvantages. These inequalities are often understood with the use of concepts emphasising the individual’s cognitive abilities, such as health literacy. This study aims to explore Danish socially disadvantaged ischemic heart patients’ lived experiences of healthcare interactions through the lens of cultural health capital, and thereby further our understanding of more underlying structural, social and interpersonal factors shaping social inequalities in cardiac treatment. The study was carried out as a nationwide critical hermeneutic study in Denmark between October 2018 and August 2019. Data consist of qualitative interviews with 30 participants and supplementary observations. The findings showed that the healthcare interactions were characterised by unequal power balances. The healthcare professionals dominated the norms of the clinical encounter and thereby what kind of cultural health capital that held the highest exchange value. Furthermore, the participants felt inferior compared to patients with a higher social status who managed to display valued parts of the cultural health capital, and thereby receive more attentive treatment. The findings indicate that treatment of this group of patients should acknowledge the patients’ habitus and life circumstances.

INTRODUCTION: Maternal mental health conditions have been shown to affect perinatal outcomes negatively. However, knowledge on the impact of different types and severities of maternal mental health conditions is needed. The objective of this study was to determine the association between maternal mental health status and perinatal health outcomes in the infant.MATERIAL AND METHODS: This register-based cohort study included all live-born infants in Denmark born between 2000 and 2016. Exposed infants were grouped based on whether the mothers received mental health care in primary care settings only (minor conditions) or required specialized psychiatric intervention (moderate-severe conditions) within 12 months before childbirth. Modified Poisson regression analyses were applied to produce adjusted risk ratios (aRRs) for each perinatal outcome of interest. The primary outcomes were neonatal mortality, 5-minute Apgar scores RESULTS: A total of 952 071 infants were included in the analysis; 4.0% had mothers with minor mental health conditions and 2.9% had mothers with moderate-severe conditions. The risk of neonatal death in exposed infants was aRR 1.08 (95% CI 0.93-1.27) for minor mental health conditions and aRR 0.93 (95% CI 0.78-1.11) for moderate-severe conditions. Both exposure groups had increased risks of 5-minute Apgar scores CONCLUSIONS: Infants of mothers with moderate-severe and minor mental health conditions were at increased risks of multiple adverse perinatal outcomes. Effective supportive interventions to improve outcomes in both groups are needed.

Background Inequality in preterm birth is a world-wide challenge that has proved difficult for maternity care services to meet. Reducing the inequality requires identification of pregnant women at particularly high risk of preterm birth in order to target interventions. Therefore, the aim was to estimate the risk of preterm birth in women with different combinations of socioeconomic position, mental health conditions, and age. Methods In this nationwide register-based cohort study, we included all first-time mothers that gave birth to a singleton liveborn infant in Denmark between 2000 and 2016. The absolute and relative risk of preterm birth ( Results Of the 415,523 included first-time mothers, 6.3% gave birth prematurely. The risk of preterm birth increased with decreasing educational level and increasing severity of mental health conditions in all age strata, but most in women aged ≥31 years. The highest absolute risk was 12.9% [95% CI: 11.2;14.8%] in women aged ≥31 years with low education and moderate/severe mental health conditions resulting in a relative risk of 2.23 [95% CI: 1.93–2.58] compared to the unexposed reference group in that age strata. We found positive additive interaction between low education and mental health conditions in women aged 24–30 and ≥ 31 years and between age ≥ 31 years and combinations of mental health conditions and educational levels. Conclusion The inequality in preterm birth increased with increasing age. To reduce inequality in preterm birth focused attention on women with higher age further combined with lower educational levels and mental health conditions is essential.

Objective Pregnant women with psychosocial vulnerability factors face a higher risk of preterm birth, a heavier burden of perinatal morbidity and mortality and less social health equity. Prevention of preterm birth in this group has proved difficult, and more knowledge is needed to ensure evidence-based care and improve prevention. This study aimed to determine the effectiveness of preventive interventions to reduce preterm birth among pregnant women with psychosocial vulnerability factors. Design A systematic review of preventive interventions was conducted, searching the databases Cinahl, Cochrane Library, Embase, ProQuest, PsycInfo, PubMed and Scopus to identify RCT's. The search was completed on October 14, 2019. Using the Cochrane Collaboration tools, quality assessments were made, and independent single-data extraction was conducted. Due to heterogeneity in, e.g., participant characteristics, intervention content and duration, the data were synthesised qualitatively. Included studies were ranked in evidence-based hierarchical order, elucidating the risk of bias of each individual study, all of which were ranked as having a medium or low level of evidence. Findings We identified 1,562 articles, of which five focused on prevention of preterm birth, met our predefined criteria for inclusion and quality assessment, and were therefore included. Interventions consisted of home visits in two studies, group meetings in one study, phone calls in one study, and physical massage in the last study. Four transverse themes arose: intervention intensity, initiation, continuity of care, and the healthcare professionals’ educational background. Key conclusions The evidence base for interventions aiming to prevent preterm birth among pregnant women with psychosocial vulnerabilities is limited. Interventions based on ten antenatal group meetings initiated during the second trimester and facilitated by the same midwife have the greatest likelihood of being effective. Continuity in intervention delivery and healthcare professional's educational background may positively impact the efficiency of the intervention. Further research is needed to address questions about the impact of intervention initiation and intensity and its degree of continuity and mode of delivery.

Background: Pregnant women and partners with psychological and/or social challenges are exposed to adverse health outcomes. It is therefore recommended that they receive targeted maternity care services. The relationship between parents and professionals is key to help parents engage with services and experience them as supportive. However, more knowledge is needed on parents’ care experiences during encounters with professionals to further understand when and how these are experienced as supportive. Objectives: This study aimed at identifying the key elements of supportive care practices by exploring how parents in vulnerable positions experience their relationship and encounters with the professionals involved in their pregnancy and postnatal care. Design: Ethnographic fieldwork was conducted in a Danish municipality, including 50 semi-structured interviews with parents and 51 field visits during parent-professional encounters, including informal interviews and participant observation. Using a purposive recruitment strategy, 26 women and 13 men were recruited, who varied in age, socioeconomic background and vulnerability factors. COREQ reporting guidelines were used. Results: The analysis identified five themes: (a) Having a voice: Feeling listened to, (b) Being met with empathy: Feeling understood, (c) Worthy of attention: Feeling taken seriously, (d) On equal terms: Feeling like a normal family and (e) Moving in the right direction: Feeling reassured. Conclusion: Positive care experiences facilitate engagement with services and professionals as this contribute to parents feeling included, respected and safe. Conversely, negative care experiences leave parents feeling excluded, judged and anxious, potentially reinforcing and adding to existing feelings of anxiety and stigma. This requires that professionals have good communication skills and are able to approach parents in an open and non-judgmental way. Relevance to clinical practice: Understanding the significance of supportive care practices is paramount for health visitors, midwives and other professionals involved in providing for parents in vulnerable positions during pregnancy and the postnatal period.

Background Women with previous gestational diabetes have an increased risk of developing type 2 diabetes later in life. Recommendations therefore urge these women to participate in follow-up screening, 4–12 weeks postpartum and every 1–3 years thereafter. We sought to theorize how reminder interventions to support early detection of diabetes work, for whom, and in what circumstances. Methods We used a method informed by realist review and synthesis. A systematic, iterative search in six electronic databases (PubMed, MEDLINE Ovid, The Cochrane Library, CINAHL, EMBASE) had a primary focus on experimental intervention studies and included additional information in relation to identified intervention studies. Analysis inductively identified context-mechanism-outcome configurations present in the evidence. Results We located 16 articles eligible for inclusion. A cross-case comparison identified seven grouped context-mechanism-outcome configurations leading to intervention mechanisms relating to changes in women’s reasoning and behavior. Configurations were thematically ordered in relation to Systems Resources, Women’s Circumstances, and Continuity of Care. These were mapped onto a socio-ecological model and discussed according to identified middle-range theories. Conclusion Our findings adds to the body of evidence, that reminders have the potential to be effective in increasing participation in the recommended follow-up screening. Our study may assist researchers and policy and decision makers to analyze and judge if reminders are feasible and/or likely to succeed in their specific context. Further research into the perspective of socially disadvantaged and overweight women is needed to avoid unintended consequences such as social inequality in service use and stigmatization in future programs.

Background Mental illness can have negative impact on pregnant women, their infants and their families, including adverse birth outcomes, as well as place children at risk of developing mental illness later in life. It is recommended to offer additional support in the ante - and postnatal period, but to be able to offer appropriate, timely and effective care, more knowledge is needed on women's own experiences. The aim of this paper is to explore women's experiences with mental illness in the context of pregnancy and early motherhood, and how they experience and engage with supportive services. Methods This paper presents selected findings from an ethnographic field study carried out in a Danish municipality. The findings are based on data from 22 women, who were recruited when they were pregnant or had a newborn baby. The women were currently facing or had previously suffered from one or multiple mental health conditions. Results Analysis found that women with current or prior mental illness experienced a high level of fear, worries and uncertainty during pregnancy and early motherhood, which shaped how they engaged with supportive maternity services. Some were deeply worried about their mental health and reached out for support to cope with this. Concerns about being a bad mother and about the potential influence of their mental illness on their infants were common. Furthermore, some women were scared of being judged as unfit mothers and losing custody of their children. Many experienced stigma surrounding mental illness, making some more hesitant about reaching out for support. Conclusions By providing new insight into women's own perspectives, this study contributes with in-depth knowledge on women's experiences with mental illness during pregnancy and early motherhood, and illustrates how engaging with supportive services may be an ambivalent experience.

Background Mounting evidence suggests that mental health problems in pregnant women may negatively affect the intra- and extrauterine health and development of the child. This is especially of concern as the prevalence of mental health problems in pregnant women is high and believed to be increasing. We set out to quantify the effect of maternal mental health status on the risk of adverse perinatal outcomes for the infant. Methods We undertook a nationwide register-based cohort study including children born alive in Denmark between 2000 and 2016. The exposed cohort was children born to mothers with mental health problems in the two years prior to childbirth that had been cared for in primary care settings only (Group 1, minor problems, n = 71 759) or had required psychiatric intervention (Group 2, moderate-severe problems, n = 41 099). All non-exposed children served as comparison group (n = 908 268). We calculated risk ratios (RRs) with 95% confidence intervals (CI) for each perinatal outcome of interest. Results Infants in Group 1 as well as Group 2 were at higher risk of neonatal death than infants born to unaffected mothers, although for Group 2 the trend was non-significant (Group 1: adjusted RR (aRR) 1.34, 95% CI 1.17-1.52; Group 2: aRR 1.11, 95% CI 0.94-1.32). Both exposure groups were furthermore at significantly increased risk of 5-minute Apgar scores Conclusions Infants born to mothers with moderate-severe as well as minor mental health problems were at increased risk of multiple adverse perinatal outcomes, thus calling for effective preventive strategies to improve outcomes in both groups.

Background User involvement in developing community-based public health services has been on the agenda for decades. User involvement refers to the variety of ways in which service users or public citizens participate in the development of health services: from proving information on their needs to actively being involved in decisions about future services. Former studies found that user involvement is meaningful to the people involved and could have a favorable impact on the quality of services. Thus, it is timely to systematically identify and provide a comprehensive overview of user involvement methods used in public health studies. The aim of this scoping review is to provide an overview of the current body of empirical research where user involvement methods have been used to develop community public health services and identify its possible impact on the individual as well as services. Methods A systematic scoping review of user involvement methods aiming to develop public health services followed Arksey and O'Malley, 2005 framework. Six databases: CINAHL, Cochrane Library, Embase, PsycINFO. PubMed, Scopus and ProQuest, were searched from October till November, 2019. Search terms were: user involvement, methods and health care with corresponding synonym. All hits were double screened. Results 6.044 studies were identified of which 38 studies lived up to the criteria. Preliminary findings from coding and synthesizing studies have identified a variety of user involvement Methods 19 of the studies used complex, multi-facetted packages of methods aiming to identify needs, prioritize and formulate recommendations for future services. 19 studies used different kinds of group meetings and some used certain techniques to facilitate the process. Many reported the impact, and 13 evaluated the methods. The impact of using the methods varied from impact on individual, group, or service/political level. Final results will be presented at the conference. Key messages Studies on user involvement methods in developing community public health services and its impact are sparse. User involvement is privotal in developing sustainable public health community services.

Background Inequality in preterm birth is a public health challenge requiring identification of pregnant women at particularly high risk of preterm birth. Therefore, the aim was to estimate the risk of preterm birth in women with different combinations of mental health conditions and socioeconomic position. Methods Based on Danish registries, we conducted a nationwide cohort study including all first-time mothers giving birth to a singleton liveborn infant in Denmark between 2000 through 2016. We examined the risk of preterm birth (30 years). The relative risk of preterm birth was estimated using Poisson regression with a robust error variance. We measured the attributable proportion to assess additive interaction between the effects of exposures. Results Of the 415,523 included first time mothers, 29,069 (7,0%) gave birth preterm. The risk of preterm birth increased in combinations of higher degree of mental health conditions, lower degree of educational level, and increasing age. Women aged>30 years with moderate/severe mental health conditions and low educational level had the highest risk of preterm birth (13.7%). The analysis of additive interaction revealed only a limited additional effect of being exposed to mental health conditions and lower educational levels in each age strata. However, positive additive interaction was found between age>30 year and combinations of mental health conditions and educational level. Conclusions Substantial inequality in preterm birth remains with increasing risk in women with combinations of higher degree of mental health conditions and lower degree of educational level. In the prevention of inequality in preterm birth special attention on women aged>30 years exposed to mental health conditions and lower educational levels is essential

Background Rapid infant weight gain (RIWG) is strongly related to childhood overweight and obesity, and prevention of RIWG is an approach to early years obesity prevention. This systematic review aimed to explore effectiveness, deliverers’ and recipients’ experiences of involvement, and key intervention components and processes of such prevention activities. Methods Key databases and websites were searched systematically for quantitative and qualitative studies covering intervention effectiveness, experiences with intervention involvement or process outcomes. After duplicate screening and quality assessment, papers were analyzed through narrative synthesis, thematic synthesis and intervention component analysis. Results Seven quantitative and seven qualitative studies were eligible for inclusion. Most intervention studies reported small, but significant results on infant weight gain. More significant results were measured on weight gain during the first compared with the second year of life. A weak evidence base made elaboration of the relationship between intervention effectiveness and content challenging. Home-delivered interventions may be more relevant for parents. Contextual factors, such as social norms, beliefs and professional identity should be considered during intervention development. Stakeholder involvement can be key to increase intervention acceptability and feasibility. Conclusions The field of RIWG prevention is new and evolving, but more research is needed before further conclusions about intervention effectiveness and intervention content can be drawn. Future interventions should take parents, health professionals and other contextual needs into account to improve chances of success. More research on long-term effects on overweight and obesity is needed.

Background Parental mental illness has been associated with a number of consequences for the health and use of healthcare services of the child. However, most research has focused on maternal depression. Research examining the impact of paternal mental vulnerability (MV) as well as different degrees of MV are needed to plan interventions. Therefore, the aim of this study was to examine the association between different categories of individual and combined parental MV and the child’s use of healthcare services the first year of life. Methods A population-based birth cohort study was conducted including all Danish children born from 2000-2016 using the Danish national registers. Exposure was parental MV of three categories according to the degree of MV: Group 1 “minor MV” with mental related contacts to primary healthcare and/or prescribed psychopharmaceuticals, group 2 “moderate MV” and group 3 “severe MV” both with contacts to psychiatric hospital. Outcome was contacts to GP the first year of life expressed as incidence-rate ratios (IRR) using Poission’s regression analyses. Results The analyses included 952,709 children. 21% of the mothers and 11% of the fathers were in the MV groups. Parental MV (any parent, any MV-group) was associated with an increased risk of GP contacts daytime and out-of-hour contacts. If both parents were classified as group 1 MV, IRR were 1.21 (CI95 1.20-1.22). IRR were 1.18 (1.17-1.18) resp. IRR 1.05 (1.04-1.06) if only the mother resp. father were in MV group 1. The same pattern were seen for out-of-hour contacts; IRR 1.28 (1.26-1.31) for both parents in group 1 and IRR 1.19 (1.18-1.20) resp. IRR 1.09 (1.08-1.11) for the mother resp. father. Conclusions Maternal and paternal MV were associated with an increased risk of GP contacts daytime and out-of-hour contacts although maternal MV had the highest risk. Even minor MV had an impact on healthcare contacts and the risk increased further if both parents were classified as minor MV. Key messages Both maternal and paternal mental vulnerability has an impact on the child’s healthcare contacts. Our results indicate the need for a focus also on minor mental vulnerability in the planning of interventions.

Background Social relations influence mental health through different pathways. To capture the complexity of social relations, it is beneficial to consider both the structural (e.g., reachability of social network and social integration) and functional (e.g., instrumental and emotional support) aspects of the concept. Both aspects are rarely investigated simultaneously. This study aimed to examine the association between the structural and functional aspects of social relations and poor mental health. Methods The study was designed as a cross-sectional register study. We used data on mental health and social relations from 15,839 individuals aged 16–92 years with a mean age of 49.0 years (SD 17.9) who responded to The North Denmark Region Health Survey 2013 among residents in Northern Jutland, Denmark. The 12-Item Short-Form Health Survey measured mental health; a cut-off point of 44.5 was used to dichotomize participants into poor and good mental health. The categorization of social relations was inspired by Berkman et al.’s conceptual model of social relations and health. The analyses were performed with survey logistic regression. Results We found that 21.6% (n = 3422) of participants reported poor mental health, and 59% (n = 2020) of these were women. Being in contact with family and friends less than once a month statistically significantly increased the risk for poor mental health (Family OR = 1.78, 95% CI = 1.51–2.10 and Friends OR = 2.65, 95% CI = 2.30–3.06). The individuals who were not in contact with their network as often as they liked had a significantly higher risk for poor mental health (OR = 2.40, 95% CI = 2.20–2.62). Lack of instrumental support was associated with a higher risk for poor mental health (OR = 2.81, 95% CI = 2.26–3.48). We found an interaction between age and emotional support; the youngest population had the highest risk for poor mental health when they did not have access to emotional support (Young OR = 5.26, 95% CI = 3.91–7.09; Adult OR = 3.69, 95% CI = 3.17–4.30; and Elderly OR = 2.73, 95% CI = 2.23–3.34). Conclusions Both structural and functional aspects of social relations were associated with poor mental health in our study. Rarely being in contact with friends and a lack of network reachability were associated with poor mental health. Likewise, low levels of emotional and instrumental support were associated with poor mental health. Electronic supplementary material The online version of this article (10.1186/s12889-017-4871-x) contains supplementary material, which is available to authorized users.

Health-risk behaviour like physical inactivity is more evident in deprived neighbourhoods than in nondeprived neighbourhoods, and in the former knowledge is lacking as to what causes effects in interventions on physical activity. A possible contribution to physical activity interventions is community engagement, which has been shown to be effective for changing health-risk behaviour, but more knowledge is needed on "the active ingredients" or mechanisms that make interventions work. The aim of this study was to give more insight into the possible mechanisms within an intervention on physical activity using community engagement. The study applied a theory-based evaluation approach using theory of change to uncover the underlying mechanisms of a community-based fitness centre in a deprived Danish neighbourhood. Data were gathered from documents about the intervention, semistructured interviews with three front-line workers on the intervention and ten residents participating in the centre as either volunteer instructors or members. The following mechanisms of the intervention to improve participation and health were anticipated by the front-line workers; the creation of meaningful communities through social interaction, the presence of relatable role models, residents taking responsibility and feeling co-ownership and the experience of being of value as an instructor. Interviews with members and volunteer instructors showed that the anticipated mechanisms did facilitate participation and improved health; however, with some individual variations and with the physical and mental benefits of the particular activities also functioning as mechanisms for participation and engagement. Furthermore, the study found potential unintended consequences related to engagement, such as difficulties in balancing the needs of others with own needs. Findings indicate that both the social aspect and the activities should be prioritised, as should a continued focus on the inclusion of different residents in the area. Furthermore, unintended consequences should be considered and prevented through support for volunteering residents.

Introduction: Current knowledge of the fetoplacental vasculature in fetal growth restriction (FGR) due to placental dysfunction focuses on the microvasculature rather than the macrovasculature. The aim of this study was to investigate the feasibility of computed tomography angiography to analyze the fetoplacental macrovasculature in normal and FGR pregnancies. Material and methods: We included 29 placentas (22–42 weeks of gestation) from normal birthweight pregnancies and eight placentas (26–37 weeks of gestation) from FGR pregnancies (birthweight

Background Frequent attendance to primary care constitutes a large use of resources for the health care system. The association between frequent attendance and illness-related factors has been examined in several studies, but little is known about the association between frequent attendance and individual social capital. The aim of this study is to explore this association. Methods The analysis is conducted on responders to the North Denmark Region Health Profile 2010 (n = 23,384), individually linked with information from administrative registers. Social capital is operationalized at the individual level, and includes cognitive (interpersonal trust and norms of reciprocity) as well as structural (social network and civic engagement) dimensions. Frequent attendance is defined as the upper-quartile of the total number of measured consultations with a general practitioner over a period of 148 weeks. Results Using multiple logistic regression, we found that frequent attendance was associated with a lower score in interpersonal trust [OR 0.86 (0.79–0.94)] and social network [OR 0.88 (0.79–0.98)] for women, when adjusted for age, education, income and SF12 health scores. Norms of reciprocity and civic engagement were not significantly associated with frequent attendance for women [OR 1.05 (0.99–1.11) and OR 1.01 (0.92–1.11) respectively]. None of the associations were statistically significant for men. Conclusion This study suggests that for women, some aspects of social capital are associated with frequent attendance in general practice, and the statistically significant dimensions belonged to both cognitive and structural aspects of social capital. This association was not seen for men. This indicates a multifaceted and heterogeneous relationship between social capital and frequent attendance among genders. Electronic supplementary material The online version of this article (10.1186/s12889-018-5230-2) contains supplementary material, which is available to authorized users.

Objective Roux-en-Y gastric bypass surgery and small-for-gestational-age births are known to be associated although the etiology is not fully understood. This study aimed to investigate pregnancy outcomes and maternal nutritional status among pregnant women with a history of Roux-en-Y gastric bypass using maternal anemia and gestational weight gain as indicators of micronutrient and macronutrient deficiency in pregnancy. Study design The study was designed as a retrospective matched cohort study. All Roux-en-Y-gastric-bypass-operated pregnant women (n = 151) who were followed in the outpatient obstetric clinic at Aalborg University Hospital in Denmark and gave birth between 1 January 2010 and 31 December 2013 were included. Each Roux-en-Y-gastric-bypass-operated woman was closely matched with a non-Roux-en-Y-gastric-bypass-operated woman. Primary outcomes were small-for-gestational-age birth, maternal anemia and gestational weight gain. The two groups (matched 1:1) were compared by paired tests on all measures, conditional logistic regression for paired binary data and the paired t-test or Wilcoxon signed-rank test for paired continuous data. Results The risk of small-for-gestational-age birth (odds ratio (OR) = 2.67, 95% confidence interval (CI); 1.04–6.82) and maternal anemia (OR = 3.0, 95% CI; 1.09–8.25) were significantly increased for the Roux-en-Y gastric bypass group compared to the non-Roux-en-Y gastric bypass group. No significant difference was found in gestational weight gain (p = 0.169) between women with a history of Roux-en-Y gastric bypass (11.51 kg ± 8.97 standard deviation (SD)) and non- Roux-en-Y-gastric-bypass-operated women (12.18 kg ± 6.28 SD). Conclusion A history of Roux-en-Y gastric bypass surgery increases the risk of small-for-gestational-age birth and anemia, while a finding of differences in gestational weight gain is uncorroborated. Our findings suggest a role of micronutrient deficiency rather than reduced gestational weight gain in the etiology of small-for-gestational-age birth among women with a history of Roux-en-Y gastric bypass surgery.

Objective to explore pregnant women's experience of being offered participation in a supportive intervention and how their experience influenced the outcome of the intervention. Design and setting a qualitative, phenomenological hermeneutic study based on semi-structured interviews with eight Danish first-time mothers. Findings the study revealed a divergence between the professional's and the women's perception of their vulnerability. The women typically felt the offer of participation as a stigma, which they met with anxiety and confusion. Insufficient information led to uncertainty and a feeling of being evaluated as inadequate mothers or parents. The information offered failed to provide the basis of informed choice. However, the development of a trusting, supportive and non-judgemental relationship with the health professionals ensured most women a positive outcome of the intervention. Key conclusion being invited to participate in an intervention targeting vulnerable women may induce unintended feelings in relation to stigmatization and judgement, leading to doubt about own ability to cope with motherhood. Inadequate information and explication about aims and contents of the intervention are likely to cause confusion and anxiety and a feeling of being judged as parents. Information combined with establishing a trusting and non-judgemental relationship between women and professionals appears to have significant impact on outcomes. Implications for practice care providers should be aware of the induced negative feelings and sense of judgement and stigmatization as a result of being categorized as vulnerable and perceived in need of help to cope with motherhood, and that they may play a key role in helping women cope with this. Furthermore, detailed information about the intervention and the background of the offer should be ensured as well as an informed choice of participation.