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The death toll and monetary damages from landslides continue to rise despite advancements in predictive modeling. These models' performances are limited as landslide databases used in developing them often miss crucial information, e.g., underlying movement types. This study introduces a method of discerning landslide movements, such as slides, flows, and falls, by analyzing landslides' 3D shapes. By examining landslide topological properties, we discover distinct patterns in their morphology, indicating different movements including complex ones with multiple coupled movements. We achieve 80-94% accuracy by applying topological properties in identifying landslide movements across diverse geographical and climatic regions, including Italy, the US Pacific Northwest, Denmark, Turkey, and Wenchuan in China. Furthermore, we demonstrate a real-world application on undocumented datasets from Wenchuan. Our work introduces a paradigm for studying landslide shapes to understand their underlying movements through the lens of landslide topology, which could aid landslide predictive models and risk evaluations. This study analyzes the 3d shapes of landslides and introduces a method to discern landslide movements, such as slides, flows and falls. [ABSTRACT FROM AUTHOR]

Modern veterinary medicine offers a level of care to cats and dogs similar to that available to their owners, including blood transfusions, chemotherapy and MRI scans. The potential benefits to the animals of owners who can afford such care are obvious, but there can also be negative consequences if owners with strong emotional attachments to their pets pursue treatments that significantly reduce the quality of the animal's life while attempting to prolong it. Moreover, caring for a chronically or seriously ill animal can lead to emotional distress and financial and practical challenges for the pet owner. A questionnaire was used to survey cat and dog owners from representative samples of citizens in the UK, Austria and Denmark, to investigate owners' expectations and attitudes towards advanced veterinary care, and the factors that might influence those views. Overall, 58.4% of the pet owners surveyed believed that their pets should have access to the same treatment options as humans, while 51.5% believed that they should have access to the same diagnostic tests as humans. Owners were most likely to be neutral on the question of whether advanced veterinary care has 'gone too far' (45.3%), and to disagree with the statement that advanced care is 'unnecessary' (40.1%). In all three countries, the level of attachment owners had to their pets was most strongly associated with attitudes towards advanced care, with owners scoring higher on Lexington Attachment to Pets Scale (LAPS) being more likely to expect advanced care to be available. Other factors such as owner age, living situation (alone or not), income or possession of pet insurance were less consistently with owner attitudes. Our findings will help inform veterinarians and other health care providers about pet owner expectations and attitudes towards advanced veterinary care, and contribute to the debate on increasing specialisation within the profession. [ABSTRACT FROM AUTHOR]

Background: Alcohol and cannabis use constitutes the major public health problems in Greenland. Thus, it is important to assess if Allorfik, a new national outpatient addiction treatment service introduced in 2016, was implemented successfully and how it is perceived. Allorfik introduced local treatment centers offering a treatment methodology (motivational interviewing and cognitive therapy) new to addiction treatment in Greenland with limited evidence from Indigenous populations such as the Greenlandic. The present study investigates the implementation of Allorfik from the perspective of those engaged in the process and the field. Methods: Data consisted of transcribed interviews with 23 individuals from both Allorfik and organizations collaborating with or supposed to collaborate with Allorfik. The theme of the interviews was their perspectives on the implementation process, enablers, and obstacles in the process and how Allorfik was performing at the time of the interview. The interview guide was informed by implementation theory. The transcribed material was analyzed using a general inductive approach. Results: The analysis resulted in three overall and interconnected themes, namely, implementation, collaborations, and challenges. The implementation was overall considered a success by the interviewees as all components were implemented as planned with a few adaptions, e.g., a treatment guideline update. The collaborations are considered challenging but important to all interviewees. Collaborations seem to rely on personal commitment as opposed to well-defined structures, making it unstable and vulnerable to changes in staff. One of the main challenges highlighted by the interviewees is the number of problems other than addiction among people in treatment, which makes addiction treatment and recovery difficult to achieve. Nevertheless, the high levels of other problems being treated in Allorfik highlights the need for easily accessible therapy as many find that Allorfik is the only place to turn to in times of crisis. Conclusion: Allorfik seems to have been implemented in accordance with original intentions and plans for addiction treatment service but has also become more than just a service for addiction treatment with easy access in a country with vast distances and limited resources. [ABSTRACT FROM AUTHOR]

Simple Summary: Pancreatic neuroendocrine tumors are a rare and heterogenous group of neoplasms. Surgical resection is the only curative option. However, there has been an increase in palliative medical options. The aim of this retrospective study was to investigate responses for the most commonly used medical treatments in 192 patients. The current results support the effectiveness of somatostatin analogues in low-grade tumors and showed that it might also be used in patients with Ki-67 ≥ 10%. Treatment with streptozocin and 5-floururacil as first-line treatment showed good efficacy for G2 disease. Due to good efficacy and generally good tolerability PRRT might be considered as first-line treatment for NET G2. The results confirmed poor prognosis in high-grade tumors treated with carboplatin/etoposide or temozolomide. The current results provide valuable knowledge as current treatment algorithms and sequencing are primarily guided by expert opinions with limited evidence. Background: Given the rarity and heterogeneity of pancreatic neuroendocrine neoplasms (pNEN), treatment algorithms and sequencing are primarily guided by expert opinions with limited evidence. Aim: To investigate overall survival (OS), median progression-free survival (mPFS), and prognostic factors associated with the most common medical treatments for pNEN. Methods: Retrospective single-center study encompassing patients diagnosed and monitored between 2000 and 2020 (n = 192). Results: Median OS was 36 (95% CI: 26–46) months (99 months for grade (G) 1, 62 for G2, 14 for G3, and 10 for neuroendocrine carcinomas). Patients treated with somatostatin analogues (SSA) (n = 59, median Ki-67 9%) had an mPFS of 28 months. Treatment line (HR (first line as reference) 4.1, 95% CI: 1.9–9.1, p ≤ 0.001) emerged as an independent risk factor for time to progression. Patients with a Ki-67 index ≥10% (n = 28) had an mPFS of 27 months. Patients treated with streptozocin/5-fluorouracil (STZ/5FU) (n = 70, first-line treatment n = 68, median Ki-67 10%) had an mPFS of 20 months, with WHO grade serving as an independent risk factor (HR (G1 (n = 8) vs. G2 (n = 57)) 2.8, 95% CI: 1.1–7.2, p-value = 0.031). Median PFS was 21 months for peptide receptor radionuclide therapy (PRRT) (n = 41, first line n = 2, second line n = 29, median Ki-67 8%), 5 months for carboplatin and etoposide (n = 66, first-line treatment n = 60, median Ki-67 80%), and 3 months for temozolomide-based therapy (n = 56, first-line treatment n = 17, median Ki-67 30%). Conclusion: (1) Overall survival was, as expected, highly dependent on grade; (2) median PFS for SSA was around 2.5 years without difference between tumors with Ki-67 above or below 10%; (3) STZ/5FU as first-line treatment exhibited a superior mPFS of 20 months compared to what has historically been reported for targeted treatments; (4) PRRT in G2 pNEN achieved an mPFS similar to first-line chemotherapy; and (5) limited treatment efficacy was observed in high-grade tumors when treated with carboplatin and etoposide or temozolomide. [ABSTRACT FROM AUTHOR]

Background: Most young children (0–3 years) attend formal childcare in Denmark, many of them fulltime. Yet recent reports of the quality of Danish childcare centers have shown that in more than one-third of nurseries, the interactions between caregivers and young children (0–3 years) are of "insufficient" quality, which constitutes a risk for affected children's well-being and development. Effective interventions to improve childcare providers' interactive skills are necessary. Methods: In this randomized controlled trial, we test the effectiveness of the Caregiver Interaction Profile training, which focuses on improving six core interactive skills: sensitive responsiveness, respecting children's autonomy, structuring and limit setting, verbal communication, developmental stimulation, and fostering positive peer interactions. We will recruit N = 200 childcare providers from nursery groups in Copenhagen (n = 100 training group, n = 100 waiting-list control group). Our primary outcomes are childcare providers' six interactive skills named above, observed from video-recorded interactions in the nursery groups. The secondary goal of our study is to test whether the training boosts children's social-emotional and linguistic development. To this end we aim to recruit N ≈ 500 children from participating childcare providers' nursery groups (n ≈ 250 training group, n ≈ 250 waiting-list control group). We measure social-emotional and linguistic development with various standardized questionnaires, filled out by parents and childcare providers. Discussion: If the training is effective at improving childcare providers' interactive skills, then this will be an important foundation for implementation efforts, such as offering the training as part of the educational program of childcare providers. Future research should also evaluate whether the Caregiver Interaction Profile training is effective for childcare providers of older children (3–5 years) in Danish kindergartens. Trial registration: This trial is registered at clinicaltrials.gov as "Testing the Effects of the Caregiver Interaction Profile Training on the Interactive Skills of Daycare Providers (CDP)" with registry ID NCT05654116. Registration date: 12/01/2022. [ABSTRACT FROM AUTHOR]

Extended working lives become important in aging populations. Yet, for a long time, increasing computer use pushed older individuals out of the workforce. Recently, older workers' computer skills have improved. This article investigates how computer use, experience, and training affect workforce participation in old age in countries with widespread computer use. It conducts regression analyses of Danish and Finnish survey data. Findings show that individuals who used computers had a higher chance of remaining in the workforce. Computer experience made older Finns marginally more likely to retire. However, computer training had no influence. Findings suggest that the relevance of computer use for extended working lives depends on a country's computerization level: the higher the level, the less of an obstacle to extended working lives computerization presents. Policymakers should facilitate older workers' computer use especially when computers are first introduced, and explore alternative means for extending working lives afterwards. [ABSTRACT FROM AUTHOR]

Background: Most adult smokers started smoking in their teenage years, which increases the risk of nicotine dependence. In Denmark, there is a high prevalence of youth smoking among students in Vocational Education and Training (VET). However, reducing and preventing smoking in this group is a major challenge. This article presents a needs assessment aimed to explore factors sustaining legitimacy of smoking in VET schools and consider the measures needed to prepare VET schools' implementation of smoking reduction and prevention interventions. Methods: Participant observations were conducted in four VET classes representing three VET schools in Denmark with a duration of four days each. Individual, semi-structured interviews were conducted with teachers, managers, and a student advisor, as well as four focus groups with a total of 20 students. Interviews were audio-taped, transcribed, and the data material was analyzed following Malterud's systematic text condensation. Findings: Factors that helped sustain legitimacy of smoking in VET schools included a positive and normalized attitude towards smoking at home and among friends, an understanding of smoking as an integral and expected practice in VET professions and schools, a perceived reliance on smoking as an icebreaker in new social relations and as a pedagogical tool, and smoking as a habit and a means to deal with boredom and stress relief. Conclusions: The factors sustaining legitimacy of smoking in VET schools are reciprocal and call for smoking reduction and prevention intervention efforts which consider and address social influence, habitual behavior, and psychological needs, as well as changes at the policy level. [ABSTRACT FROM AUTHOR]

Xanthoria ectaneoides , usually recognised by its secondary sublobules, is circumscribed in a strict sense using spore size and a molecular phylogeny based on ITS-sequences. The species, earlier considered a synonym of X. aureola , forms a subclade with X. coomae and the new species X. pylyporlykii , described here, whereas X. aureola is positioned in the Xanthoria calcicola subclade. The new species X. pylyporlykii is characterised by a combination of characters typical either for Xanthoria ectaneoides or X. coomae. [ABSTRACT FROM AUTHOR]

Background: The commitment of nurses to their profession and workplace is closely linked to the delivery of high-quality patient care. Existing literature highlights the positive impact of commitment on care quality and patient outcomes. Conversely, a lack of commitment can lead to nurse burnout and disengagement. However, it remains unclear whether and how cultural beliefs and practices influence newly graduated nurses' commitment to the nursing profession and their workplace. Aim: To explore the cultural beliefs and practices influencing newly graduated nurses' commitment to the profession and commitment to their workplace during their first year of employment. Design: A focused ethnographic study. Methods: Data consisted of field notes from 94 h of participant observations and 10 semi-structured interviews with newly graduated nurses working in acute care settings in Denmark. Data were analysed using ethnographic content analysis. Data were collected between March and June 2022. Results: The findings reveal a major theme, termed 'A State of Transience among Newly Graduated Nurses', consisting of two themes: 'Newly Graduated Nurses' Pursuit of Professional Development and Supportive Work Environments' and 'A Lack of Formal Agreements or Conditions to Meet Expectations for Professional Development.' Conclusion: Hospitals and nurse managers need to support newly graduated nurses in their first employment after registration by providing a range of clinical experiences through job rotation opportunities within the same organization, deliver on promises for onboarding support and foster a culture of trust. These strategies will help maintain the motivation, commitment and ability of newly graduated nurses to deliver high-quality patient care, thereby reducing the likelihood of turnover. Relevance for Clinical Practice: A trusting and supportive work environment is fostered by providing diverse clinical experiences and consistent support for newly graduated nurses. To address potential high turnover associated with job rotation, hospitals need to rethink how retention is defined and measured, moving beyond hospital unit-level models and measures. Reporting Method: This study reports to the SRQR guidelines. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

A series of studies have identified gender bias in teaching evaluations in higher education—with women being evaluated lower than men. However, other recent studies indicate that gender bias is not present across all contexts. Our study adds to the understanding of the role of gender in teaching evaluations by focusing on a Danish university—a national context with relatively high educational gender equality and support for egalitarian gender norms. Crucially, the study pays systematic attention to the role of students' gender in explaining evaluation outcomes. In a quantitative analysis of 125,000 evaluations in the social sciences at a Danish university, we identify a same-gender affinity. While there is no overall gender bias in the evaluations, students evaluate a teacher of their own gender best. To understand the mechanisms behind this pattern, we analyze comments provided by students in teaching evaluations and 20 interviews with students. Students are generally more positive in their descriptions of a teacher of their own gender. Moreover, we identify gendered patterns in the perceptions of teachers as well as in the aspects of teachers' behavior and characteristics appreciated by students. [ABSTRACT FROM AUTHOR]

The article takes its point of departure in an experiment conducted at Randers Art Museum, Denmark, in which museum visitors were asked to comment on their experiences with artworks from the museum's collection. Their comments that were subsequently shared by the museum in the exhibition space. By examining dialogue as a form of participation, the author analyses and discusses how this particular participatory experiment created a dialogical and polyphonic museum experience in which the institutional voice was complemented and even challenged. The article contributes to the field of research on participation by connecting theoretical and practical levels through an experimental methodological approach. It presents concrete recommendations for enhancing visitor-oriented and dialogical strategies in museum communication. Moreover, it demonstrates that the experimental approach can be very useful for both researchers and museum professionals, as long as they reflect on both the limitations and the possibilities of specific experiments like this one. [ABSTRACT FROM AUTHOR]

This article analyses the introduction of a mandatory learning management system (LMS) in Danish primary and lower secondary education. By thinking with Bourdieu's concepts of field, capital and habitus, the study analyses key policy texts to identify the embedded logics that structure the field of education, reflecting relationships of domination and struggle and explores how these logics and conflicts influence process of policy change. A historical analysis of the conflict between legislators and the Teachers' Union (TU) in Denmark is conducted based on 21 policy texts published between 2005 and 2020. The findings indicate that human capital is the predominant logic structuring the field of education. Legislators use the logics of other fields such as economics to support this predominance. Moreover, the findings suggest that changes in educational policy are the result of a protracted struggle between legislators and the TU, with legislators making ongoing adjustments to policies based on pressure from the TU. These modifications can be seen as a political concession. [ABSTRACT FROM AUTHOR]

Objectives Adrenocortical carcinoma (ACC) is a malignant tumor originating from the adrenal cortex. The aim of the study was to report the incidence of ACC and survival of ACC in Denmark. The secondary objective was to describe the impact of treatment with mitotane on survival. Design Retrospective population study of patients diagnosed with ACC between 2003 and 2019 in Denmark. Methods Individuals at risk for ACC were identified in the national Danish Health registries, and diagnosis of ACC was confirmed by review of the health records. Data on demographics, presentation, treatment, recurrence, and death was evaluated. Results 138 patients were included in the study with more females (59.4%) than males (40.6%). Incidence rate was 1.4 per million per year. The incidence rate ratio significantly increased only in females by 1.06 [95% confidence interval (CI): 1.02-1.12] per year. Overall median survival was 1.93 (95% CI: 1.24-3.00) years with no differences between males and females. The proportion of patients treated with mitotane (either as adjuvant treatment or as part of a chemotherapeutic regime) was 72.3%. Survival was significantly decreased in women not treated with mitotane compared to women treated with mitotane (either as adjuvant or as part of a chemotherapeutic regime) hazards ratio.30 (95% CI:.10-.89), adjusted for European Network for the Study of Adrenal Tumours score, age at diagnosis, and year of diagnosis, but survival was unaffected by mitotane treatment in men. Conclusion Incidence of ACC in Denmark was 1.4 per million per year and increased in women but not in males during the study period 2003-2019. [ABSTRACT FROM AUTHOR]

Physical activity is considered one of the most important components of daily activities and a healthy lifestyle for the older adult to achieve well-being. The purpose of this study is to explore older adults' views on physical activity in the neighborhood environment. This study is qualitative and interpretive in nature. In this research, thematic analysis was used to identify, analyze and report patterns in the qualitative data, employing Braun and Clarke's six-step inductive approach. Twenty-four active seniors in the Ekhtiarieh neighborhood of Tehran were interviewed in person. The purpose of the interview was to probe into the deep layers of the interviewees' mindset and obtain valid information. The analysis of the data yielded Hygge as the global theme, and the three main themes of joyful emotions and behavior (Wellness Hygge), perceived social support (Neighborhood Hygge), and safety and security, as well as eight sub-themes. Although Hygge derives Danish culture and its national identity, The creation of a Hygge subculture in the neighborhood through physical activity can be considered as a collective effort to deal with the contradictions in the society with happiness. The findings of this research have been chosen as inspiring concepts for a better and healthier life, to reproduce simple cultural elements that do not exist in the situation of the local culture, by borrowing from the the culture of Denmark, the happiest country in the world. [ABSTRACT FROM AUTHOR]

Species distribution models and maps from large‐scale biodiversity data are necessary for conservation management. One current issue is that biodiversity data are prone to taxonomic misclassifications. Methods to account for these misclassifications in multi‐species distribution models have assumed that the classification probabilities are constant throughout the study. In reality, classification probabilities are likely to vary with several covariates. Failure to account for such heterogeneity can lead to biased prediction of species distributions. Here, we present a general multi‐species distribution model that accounts for heterogeneity in the classification process. The proposed model assumes a multinomial generalised linear model for the classification confusion matrix. We compare the performance of the heterogeneous classification model to that of the homogeneous classification model by assessing how well they estimate the parameters in the model and their predictive performance on hold‐out samples. We applied the model to gull data from Norway, Denmark and Finland, obtained from the Global Biodiversity Information Facility. Our simulation study showed that accounting for heterogeneity in the classification process increased the precision of true species' identity predictions by 30% and accuracy and recall by 6%. Since all the models in this study accounted for misclassification of some sort, there was no significant effect of accounting for heterogeneity in the classification process on the inference about the ecological process. Applying the model framework to the gull dataset did not improve the predictive performance between the homogeneous and heterogeneous models (with parametric distributions) due to the smaller misclassified sample sizes. However, when machine learning predictive scores were used as weights to inform the species distribution models about the classification process, the precision increased by 70%. We recommend multiple multinomial regression to be used to model the variation in the classification process when the data contains relatively larger misclassified samples. Machine learning prediction scores should be used when the data contains relatively smaller misclassified samples. [ABSTRACT FROM AUTHOR]

This article traces the political process towards full formal integration of women in the military professions in Scandinavia and Finland, investigating the shifting roles played by military labour demands and politics of gender equality. It provides the first comparative overview of these developments in the Nordic region. The analysis demonstrates the importance of historical continuity in women's military participation. Due to military labour demands, women were throughout the post-war decades recruited into a range of auxiliary, voluntary and hybrid capacities in the Scandinavian armed forces. The reforms opening the military professions to women in Denmark, Norway and Sweden in the 1970s were the outcome of a double crisis, as military needs for the regulation of these women's organisational status coincided with new political demands for gender equality in the labour market. Corresponding reforms in Finland were delayed by the country's lack of continuity in women's military participation as well as its sufficient supply of male military personnel. A common Nordic model of gender and military work nonetheless emerged in the 1990s, marked by equal rights to military participation for women on a voluntary basis, combined with mandatory military conscription for men. [ABSTRACT FROM AUTHOR]

Background: Significant changes in Western populations' abdominal aortic aneurysm (AAA) epidemiology have been reported following the introduction of screening, endovascular AAA repair, and reduced tobacco consumption. We report incidence and mortality of AAA repair in Denmark from 1996 to 2018, where AAA screening was not implemented. Methods: Nationwide cohort study of prospective data from population-based Danish registries covering 1996 to 2018. We identified 15,395 patients undergoing first-time AAA repair using the Danish Vascular Registry. Comorbidity was assessed by Charlson's Comorbidity Index (CCI). Incidence rate (IR) ratios and mortality rate ratios (MRR) were estimated by multivariable Poisson and Cox regression, respectively. Results: Overall AAA repair IR decreased by 24% from 1996 through 2018, mainly reflecting a 53% IR reduction in ruptured AAA repairs in men. Overall, the IR decreased 52– 63% in age groups below 70 years and increased 81% among octogenarians. The proportion of intact AAAs repaired endovascularly increased from 2% in 1996– 1999 to 42% in 2015– 2018. For both ruptured and intact AAAs the CCI score increased by 0.9% annually independently of age and sex. The adjusted five-year MRR in 2016– 2018 vs.1996– 2000 was 0.46 (95% confidence interval (CI): 0.39– 0.54) following ruptured and 0.51 (95% CI: 0.44– 0.59) following intact AAA repair. Conclusion: In Denmark, overall AAA repair incidence decreased between 1996 and 2018, primarily reflecting a reduction among males and a shift to an older population requiring intervention. These trends mirror changes in tobacco consumption in Denmark. Regardless of age and comorbidity, AAA repair mortality decreased markedly during the study period. [ABSTRACT FROM AUTHOR]

Background: The Copenhagen General Practice Laboratory (CGPL) was founded in 1922 to provide paraclinical analyses to the primary health-care sector in Copenhagen. At the end of 2015, CGPL was closed and the CopLab database was established to make CGPL data available for research. Methods: We isolated tests performed at the CGPL with clinically relevant test results. The database was linked to national registers containing health, social, and demographic information. Results are presented with descriptive statistics showing counts, percentages, medians, and interquartile ranges (IQR). Results: The CopLab database includes 1,373,643 unique individuals from primary care with test results from laboratory analyses of blood/urine/semen as well as cardiac and lung function tests collected by CGPL from greater Copenhagen from 2000 to 2015. The CopLab database holds nearly all test results requested by general practitioners throughout years 2000 to 2015 for residents in the greater Copenhagen area. The median age of the individuals was 51 years and 59.7% were females. Each individual has a median of 4 requisitions. More than 1 million participants are currently alive and living in Denmark and may be followed in national registries such as the Danish National Patient Registry, Laboratory Database, National Prescription Database etc. [ABSTRACT FROM AUTHOR]

Tens of millions of people in the world are incarcerated, which may negatively affect them and their families. Visitation may mitigate the negative consequences, but there is little causally identified evidence on its efficacy. To generate plausibly causal estimates, we utilize the fact that incarcerated persons in Denmark are assigned to the prison with open capacity that is closest to their home. The distance-driven variation in visitation coupled with Danish registry data allow us to measure the effects of visitation on incarcerated persons and their families. We find little evidence that visitation affects incarcerated individuals or their family members. [ABSTRACT FROM AUTHOR]

Patients with psychiatric disorders are at risk of experiencing suboptimal cancer diagnostics and treatment. This study investigates how this patient group perceives the cancer diagnostic process in general practice. Cross-sectional study using questionnaire and register data. General practice in Denmark. Patients diagnosed with cancer in late 2016 completed a questionnaire about their experiences with their general practitioner (GP) in the cancer diagnostic process (n = 3411). Information on pre-existing psychiatric disorders was obtained from register data on psychiatric hospital contacts and primary care treated psychiatric disorders through psychotropic medications. Logistic regression was used to analyse the association between psychiatric disorders and the patients' experiences. Patients' experiences, including cancer worry, feeling being taken seriously, and the perceived time between booking an appointment and the first GP consultation. Box 1. Included survey items on the patients' experiences Items Response categories Combined in analysis Total respondents, n (%) Were you worried that you might have cancer when consulting a GP for the first time? Very much Very much/A great deal 1348 (44.6%)/909 (30.7%) A great deal A little A little/No 396 (13.1%)/334 (11.1%) No I do not know Omitted in analysis 36 (1.2%) Did you tell the GP about your concerns? No No 878 (44.6%) Yes Yes 1089 (55.4%) Did you feel taken seriously when consulting the GP for symptoms? No, not at all No, not at all/Not so much 135 (4.5%)/151 (5.0%) Not so much Yes, to some degree Yes, to some degree/Yes, very much 354 (11.8%)/2258 (75.0%) Yes, very much Not relevant for me Omitted in analysis 111 (3.7%) Are you confident that the GP made the best possible effort before your cancer was diagnosed? No, not at all No, not at all/Not so much 142 (4.3%)/192 (5.8%) Not so much Yes, to some degree Yes, to some degree/Yes, very much 376 (11.3%)/2,570 (77.3%) Yes, very much I was not in contact with [the GP] Omitted in analysis 45 (1.3%) How many times did you consult your GP before being referred to a medical specialist or hospital for diagnostic investigation? One time One time to three times 2212 (73.0%)/659 (21.7%) Two-three times Four times or more Four times or more 136 (4.5%) Was not referred Omitted in analysis 22 (0.7%) Was it clear to you what would happen after your visit(s) to your GP (e.g. whether you were to contact a medical specialist or would be contacted by the hospital staff)? Not at all Not at all/Not so much 164 (5.5)/118 (3.9%) Not so much Yes, to some degree Yes, to some degree/Yes, very much 471 (15.7%)/2210 (73.6) Yes, very much Not relevant for me Omitted in analysis 39 (1.3%) How do you assess the time interval from your first contact to the GP (when you called or used the online system to book an appointment) until the first time you were seen/examined by the GP? The time interval was suitable The time interval was suitable 2210 (79.5%) It took too long It took too long 209 (7.5%) It was too short It was too short 232 (8.35%) Not relevant for me Omitted in analysis 128 (4.6%) How do you assess the time interval from the first time you were seen/examined by the GP until referred to a medical specialist or hospital for diagnostic investigation? The time interval was suitable The time interval was suitable 2163 (76.5%) It took too long It took too long 313 (11.1%) It was too short It was too short 282 (10.0%) Not relevant for me Omitted in analysis 68 (2.4%) A total of 13% of patients had an indication of a psychiatric disorder. This group more often perceived the time interval as too short between the first booking of a consultation and the first GP consultation. Patients with primary care treated psychiatric disorders were more likely to worry about cancer at the first presentation and to share this concern with their GP compared with patients without psychiatric disorders. We observed no statistically significant association between patients with psychiatric disorders and perceiving the waiting time to referral from general practice, being taken seriously, trust in the GP's abilities, and the patients' knowledge of the process following the GP referral. The patients' experiences with the cancer diagnostic process in general practice did not vary largely between patients with and without psychiatric disorders. Worrying about cancer may be a particular concern for patients with primary care treated psychiatric disorders. It is unknown how patients with psychiatric disorders perceive the cancer diagnostic process in general practice. This study found an association between having a psychiatric disorder and more often perceiving the time interval as too short between the first booking of a consultation and the first GP consultation. An association was found between having a primary care treated psychiatric disorder and being worried about cancer and more often sharing these concerns with the GP. Experiences with the cancer diagnostic process in general practice did not differ between patients with a hospital treated psychiatric disorder and patients with no indication of psychiatric disorders. [ABSTRACT FROM AUTHOR]

To explore the Nordic municipal health and care services' ability to promote principal goals within care for older people during the COVID-19 pandemic. Two surveys were conducted among managers of municipal health care services for older people in Denmark, Finland, Norway and Sweden; the first around 6 months into the pandemic (survey 1), and the second around 12 months later (survey 2). Data were analysed through descriptive statistics, and multiple regression (OLS). 1470 (survey 1, 2020) and 745 (survey 2, 2021) managers. 32% in home care, 51% in nursing homes, 17% combined. In all countries the pandemic seems to have had more negative impact on eldercare services' ability to promote an active and social life, than on the ability to promote or enhance older people's mental and physical health. The regression analysis indicates that different factors influence the ability to promote these goals. Managers within nursing homes reported reduced ability to promote mental and physical health and an active social life to a significantly lower degree than managers of home care. The effect of three prevention strategies (lock down, testing, and/or organisational change), were explored. Organisational change (reorganize staff and practice, restrict use of substitutes) tended to impact the units' ability to promote a social life in a positive direction, while lock down (areas, buffets etc) tended to impact both the ability to promote mental/physical health and a social life in a negative direction. Measures that can improve opportunities for an active and social life during a pandemic should have high priority, particularily within home care. It is important to learn from how the COVID-19 outbreak in 2020 affected the municipal health and care services' ability to achieve principal goals within care for older people. The pandemic had a more negative impact on the services' ability to promote an active and social life, than on their ability to promote or enhance mental and physical health. Measures that can improve opportunities for an active and social life during a pandemic situation should have high priority, particularily within home-based care. [ABSTRACT FROM AUTHOR]

Introduction: The Good Life with osteoArthritis: Denmark (GLA:DTM) is an evidence-based program designed for individuals with symptomatic hip and knee osteoarthritis (OA). This program has reported improvement in pain, quality of life and self-efficacy, as well as delays in joint replacement surgery for adults with moderate to severe hip or knee OA. Evaluations of GLA:DTM implementation in several countries have focused on effectiveness, training, and feasibility of the program primarily from the provider perspective. Our objective was to examine how the GLA:DTM program was perceived and experienced by individuals with hip and knee OA to inform on-going program refinement and implementation. Methods: Thirty semi-structured telephone interviews were conducted with participants who completed the GLA:DTM program in Alberta. An interpretive description approach was used to frame the study and thematic analysis was used to code the data and identify emergent themes and sub-themes associated with participants' experience and perception of the GLA:DTM program. Results: Most participants had a positive experience of the GLA:DTM program and particularly enjoyed the group format, although some participants felt the group format prevented one-on-one support from providers. Three emergent themes related to acceptability were identified: accessible, adaptable, and supportive. Participants found the program to be accessible in terms of location, cost, and scheduling. They also felt the program was adaptable and allowed for individual attention and translatability into other settings. Finally, most participants found the group format to be motivating and fostered connections between participants. Conclusion: The GLA:DTM program was perceived as acceptable by most participants, yet the group format may not be useful for all individuals living with OA. Recommended improvements included adapting screening to identify those suited for the group format, providing program access earlier in the disease progression trajectory, modifying educational content based on participants' knowledge of OA and finally, providing refresher sessions after program completion. [ABSTRACT FROM AUTHOR]

The objective was to develop an interdisciplinary weaning protocol (IWP) for patients with tracheostomy tubes due to acquired brain injury, and to effect evaluate implementation of the IWP on decannulation rates and weaning duration. An expert panel completed a literature review in 2018 to identify essential criteria in the weaning process. Based on consensus and availability in clinical practice, criteria for guiding the weaning process were included in the protocol. Using the IWP, dysphagia is graded as either severe, moderate, or mild. The weaning process is guided through a protocol which specified the daily duration of cuff deflation until decannulation, along with recommendations for treatment and rehabilitation interventions. Data from 337 patient records (161 before and 176 after implementation) were included for effect evaluation. Decannulation rate during hospitalization was unchanged at 91% vs. 90% before and after implementation (decannulation rate at 60 days was 68% vs. 74%). After implementation, the weaning duration had decreased compared to before implementation, hazard ratio 1.309 (95%CI: 1.013; 1.693), without any increased risk of tube-reinsertion or pneumonia. Furthermore, a tendency toward decreased length of stay was seen with median 102 days (IQR: 73–138) and median 90 days (IQR: 58–119) (p = 0.061) before and after implementation, respectively. Scientific debate on weaning protocols for tracheostomy tubes are encouraged. [ABSTRACT FROM AUTHOR]

Background: The fraction of elderly people in the population is growing, the incidence of some cancers is increasing, and the number of available cancer treatments is evolving, causing a challenge to healthcare systems. New healthcare tools are needed, and wearable sensors could partly be potential solutions. The aim of this case report is to describe the Danish research experience with wearable sensors in oncology reporting from three oncological wearable research projects. Case studies: Three planned case studies investigating the feasibility of different wearable sensor solutions during cancer treatment are presented, focusing on study design, population, device, aim, and planned outcomes. Further, two actual case studies performed are reported, focusing on patients included, data collected, results achieved, further activities planned, and strengths and limitations. Results: Only two of the three planned studies were performed. In general, patients found the technical issues of wearable sensors too challenging to deal with during cancer treatment. However, at the same time it was demonstrated that a large amount of data could be collected if the framework worked efficiently. Conclusion: Wearable sensors have the potential to help solve challenges in clinical oncology, but for successful research projects and implementation, a setup with minimal effort on the part of patients is requested. [ABSTRACT FROM AUTHOR]

Implementation of a new European Union directive on energy renovation in Denmark can be expected to have a strong impact on the country's energy renovation requirements. Accordingly, an indicator framework has been developed with the aim of identifying and quantifying the energy renovation potential of a specific Danish municipality. We identified and selected four indicators—energy consumption, CO2 emissions, heating costs and current energy labels—specifically for detached dwellings. The physical renovation potential was then quantified based on the indicator results, and an average score for the four indicators was calculated for each of the 10,228 detached dwellings in the municipality. All four indicators were weighted equally in the calculations of the total renovation potential score. The methods used in this study can be applied more widely as they rank detached dwellings according to their renovation potential. However, we also found that more detailed data are necessary to determine the specific renovation potential of detached dwellings. A greater effort to collect more data on the part of the municipalities would improve the accuracy of analyses. [ABSTRACT FROM AUTHOR]

Background: Denmark was one of the few countries that experienced an increase in life expectancy in 2020, and one of the few to see a decrease in 2021. Because COVID-19 mortality is associated with socioeconomic status (SES), we hypothesize that certain subgroups of the Danish population experienced changes in life expectancy in 2020 and 2021 that differed from the country overall. We aim to quantify life expectancy in Denmark in 2020 and 2021 by SES and compare this to recent trends in life expectancy (2014–2019). Methods: We used Danish registry data from 2014 to 2021 for all individuals aged 30+. We classified the study population into SES groups using income quartiles and calculated life expectancy at age 30 by year, sex, and SES, and the differences in life expectancy from 2019 to 2020 and 2020 to 2021. We compared these changes to the average 1-year changes from 2014 to 2019 with 95% confidence intervals. Lastly, we decomposed these changes by age and cause of death distinguishing seven causes, including COVID-19, and a residual category. Results: We observed a mortality gradient in life expectancy changes across SES groups in both pandemic years. Among women, those of higher SES experienced a larger increase in life expectancy in 2020 and a smaller decrease in 2021 compared to those of lower SES. Among men, those of higher SES experienced an increase in life expectancy in both 2020 and 2021, while those of lower SES experienced a decrease in 2021. The impact of COVID-19 mortality on changes in life expectancy in 2020 was counterbalanced by improvements in non-COVID-19 mortality, especially driven by cancer and cardiovascular mortality. However, in 2021, non-COVID-19 mortality contributed negatively even for causes as cardiovascular mortality that has generally a positive impact on life expectancy changes, resulting in declines for most SES groups. Conclusions: COVID-19 mortality disproportionally affected those of lower SES and exacerbated existing social inequalities in Denmark. We conclude that in health emergencies, particular attention should be paid to those who are least socially advantaged to avoid widening the already existing mortality gap with those of higher SES. This research contributes to the discussion on social inequalities in mortality in high-income countries. [ABSTRACT FROM AUTHOR]

Background: Recruiting and securing primary care physician workforce has been the center of international attention for decades. In Denmark, the number of general practitioners has decreased by 8.5% since 2013. However, a rising population age and increasing prevalence of chronic diseases and multimorbidity place an even greater future need for general practitioners in Denmark. The choice of general practice as specialty has been associated with a range of both intrinsic and extrinsic factors, however, few studies have examined the recruitment potential that lies within medical trainees' who are undecided about general practice specialization. The aim of this study was, therefore, to explore how medical trainees who are undecided about general practice specialization (GP-positive/undecided) differ from medical trainees who are either committed (GP-committed) or not committed to a general practice career (GP-non-committed) regarding factors related to future work life. Methods: The present study concerns baseline findings from a longitudinal survey study. An online questionnaire was e-mailed to a national cohort of medical trainees during their transition from under- to postgraduate education. The associations between orientations towards general practice specialization and work-related factors and potential influencing factors, respectively, were analyzed using uni- and multivariable modified Poisson regression models. Results: Of 1,188 invited participants, 461 filled out key study variables concerning specialty preferences and rejections, corresponding to a response rate of 38.8%. We found significant positive associations between GP-positive/undecided orientation and valuing a good work/life balance and the opportunity to organize own working hours when compared to GP-non-committed respondents. Compared to the GP-committed orientations, the GP-positive/undecided orientation was associated with a positive attitude towards technology, working shift hours, and an openness towards several career paths. Across all orientations, undergraduate exposure to the specialties was found to be highly influential on the specialty preferences. Conclusion: GP-positive/undecided medical trainees value autonomy over their working hours more than the GP-non-committed, but less than the GP-committed. However, the GP-positive/undecided respondents present more openness to different career opportunities and the use of technology in daily work. We suggest using this knowledge in the planning of recruitment strategies aiming to increase interest in general practice specialization. [ABSTRACT FROM AUTHOR]

Background: Failing to comprehend risk communication might contribute to poor treatment adherence. Using hypertension as a case, we investigated how a risk communication tool for patients with an elevated risk of cardiovascular disease was perceived. Methods: As part of a large project featuring a randomised controlled trial in a general practice setting in the Region of Southern Denmark, we conducted a semi-structured individual interview study. The study included patients with hypertension who had used an intervention comprising a visual and dynamic cardiovascular risk communication tool, along with receiving recurring emails providing advice on a healthy lifestyle. The analyses were based on Malterud's Systematic Text Condensation. Results: This article focuses solely on the results of the interview study, which comprised a total of 9 conducted and analysed interviews. The IT setup had a major impact on adherence to the intervention. A positive impact was found when the IT setup was perceived as easy to use and accessible, while a negative impact was noted when it malfunctioned. The intervention increased patients' self-reported insight into risk of cardiovascular disease. Patients reported the intervention and their risk of cardiovascular disease to become less important to them when they had more severe comorbidities. The involved health professional was very important for treatment adherence when communicating risk visually. Patients expressed trust in their general practitioners, and the general practitioners' attitudes toward the intervention affected patients' perceptions of its usefulness. While the informants reported an increased awareness of their risk of cardiovascular disease, none of them felt more concerned. Conclusions: Patients reported an increase in their perceived insight into the risk of cardiovascular disease but not an increased concern. Our findings align with previous studies emphasizing the importance of patients' motivation as well as risk perception for adherence. General practitioners have an important role when implementing new tools for patients. [ABSTRACT FROM AUTHOR]

Background: Mental health disorders are common among people in prison, but their prevalence in the Scandinavian prison population remain unclear. In this multinational register study, we examined the prevalence of mental health disorders and the comorbidity of substance use disorders (SUDs) with other mental health disorders in this population. Further, we investigated how the prevalence of mental disorders at prison entry had changed in Norway, Denmark, and Sweden over the study period. Methods: The three study cohorts included all individuals, aged 19 or older, whom had been imprisoned in Norway (2010–2019), Denmark (2011–2018), and Sweden (2010–2013). Mental disorders were defined as ICD-10 diagnoses (F-codes) registered in the national patient registers. The study prevalence was estimated based on recorded diagnoses during the entire study follow-up period in each respective country. The one-year prevalence of mental disorders was estimated for each calendar year for individuals entering prison during that year. Results: The Scandinavian prison cohorts included 119 507 individuals released 191 549 times during the study period. Across all three countries a high proportion of both women (61.3%-74.4%) and men (49.6%-57.9%) had at least one mental health disorder during the observation period. The most prevalent disorders were SUDs (39.1%-44.0%), depressive disorder (8.1%-17.5%), and stress related disorder (8.8%-17.1%). Women (31.8%-41.1%) had higher levels of mental health and substance use comorbidities compared to men (20.8%-27.6%). The one-year prevalence of any mental health disorder increased over time with a 33% relative increase in Norway, 8% in Denmark, and 10% in Sweden. The proportion of individuals entering prison with a comorbid SUD and other mental disorder had also increased. Conclusions: While the incarceration rate has been decreasing during the past decade in the Scandinavian countries, an increasing proportion of people entering prison have a diagnosed mental health disorder. Our results suggest that prisons should provide adequate treatment and scale up services to accommodate the increasing proportion of people with complex health needs among incarcerated people. [ABSTRACT FROM AUTHOR]

In the near future, it is predicted that the natural distribution range of forest tree species will be reshaped due to the rapid changes in climate conditions. The assisted migration of species in favorable environmental conditions, as future solutions for sustainable forest management, could be supported by genetic tests. This study aims to evaluate the adaptive potential of European beech (Fagus sylvatica L.) and the opportunities for applying assisted migration practices in the Carpathian region of Romania. Growth and stability performances, as well as phenotypic plasticity of 31 international beech provenances, were assessed in two common garden experiments located in optimum growing conditions and at the eastern margin of the beech distribution range, respectively. For all analyses, trees height, breast height diameter, and survival were determined. Survival and growth traits were higher by 6–8% in the ecological optimum for beech. The highest mean plasticity was obtained by three provenances from France and one from Denmark. Three provenances performed better in both trials. Increasing the management sustainability of beech forests in a changing climate might be possible by using assisted migration practices, which include the promotion of the highest adapted and productive provenances only in the provenance region where they performed. [ABSTRACT FROM AUTHOR]

A change of government or minister constitutes a stress test for the relationship between ministers and bureaucrats. The new political masters may question the loyalty of incumbent bureaucrats and seek to replace them. However, the relationship between political changes and administrative turnover is poorly understood in meritocratic systems. This article analyses how changes of either government or minister affect the turnover of permanent secretaries in Denmark and Norway (1970–2020). Whereas ministers are completely reliant on career bureaucrats in pure meritocratic systems, they are supported by political appointees in hybrid meritocratic systems. The article investigates whether the effect of political changes on administrative turnover is mediated by the presence or absence of political appointees. Changes of government increase the risk of administrative turnover in Norway (hybrid system), but there are no such effects in Denmark (pure system), suggesting that political appointees potentially undermine the permanence of career bureaucrats. [ABSTRACT FROM AUTHOR]

This study was conducted to investigate the potential effects of natural polyphenol antioxidant (Cabanin® CSD provided by R2 Agro, Denmark)-supplemented diets on the growth performance and biochemical and antioxidant responses of Nile tilapia (Oreochromis niloticus). The fish were fed two control diets (low and high levels of vitamin C and vitamin E without added Cabanin® CSD) and two experimental diets with Cabanin® CSD supplementation for 10 weeks. After the trial, the specific growth rate, feed utilization, and survival rate were observed. The blood biochemical parameters, consisting of superoxide dismutase activity, malondialdehyde, cortisol, and glucose, were measured. The presence of malondialdehyde in the flesh meat of the tilapia was also evaluated during refrigerated storage. The fish was then challenged with 60 mg/L ammonia for 168 h. The survival rate and biochemical parameters of the blood (glucose and cortisol) were recorded after exposure to ammonia. The results show that the growth performance of tilapia was significantly improved by Cabanin® CSD supplementation (p < 0.05), while the survival rates were similar between control and Cabanin® CSD-supplemented diet groups. Superoxide dismutase activity and malondialdehyde levels in the blood serum were significantly different between the control and Cabanin® CSD-supplemented diet groups (p < 0.05). The malondialdehyde levels were significantly higher in the control group in comparison with the Cabanin® CSD-supplemented groups at day 1 and day 7 of refrigerated storage (p < 0.05). In the ammonia challenge test, the highest survival rate was observed in the Cabanin® CSD-supplemented diet groups compared to the control group. The fish serum glucose and cortisol levels increased in all the Cabanin® CSD-supplemented diet groups. In general, diets featuring Cabanin® CSD supplementation were found to exert beneficial effects on the growth performance, antioxidant capacity, and biochemical activity of tilapia under ammonia stress. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to systematically evaluate the validity of variables related to pregnancy, delivery, and key characteristics of the infant in the Danish National Patient Register using maternal medical records as the reference standard. Patients and Methods: We reviewed medical records of 1264 women giving birth in the Region of Southern Denmark during 2017. We calculated positive (PPV) and negative (NPV) predictive values, sensitivity, and specificity to estimate the validity of 49 selected variables. Results: The PPV was ≥ 0.90 on most pregnancy-related variables including parity, pre-gestational BMI, diabetes disorders, and previous cesarean section, while it was lower for hypertensive disorders, especially mild to moderate preeclampsia (0.49, 95% CI 0.32– 0.66). Sensitivity ranged from 0.80 to 1.00 on all pregnancy-related variables, except hypertensive disorders (sensitivity 0.38– 0.71, lowest for severe preeclampsia). On most delivery-related variables including obstetric surgical procedures (eg cesarean section and induction of labor), pharmacological pain-relief, and gestational age at delivery, PPV's ranged from 0.98 to 1.00 and the corresponding sensitivities from 0.87 to 1.00. Regarding infant-related variables, both the APGAR score registered five minutes after delivery and birthweight yielded a PPV of 1.00. Conclusion: Obstetric coding in the Danish National Patient Register shows very high validity and completeness making it a valuable source for epidemiologic research. Plain Language Summary: Danish register data are often used for epidemiological research in reproduction. The registers are based on coded information to the registers based on information from medical records. The quality of the register data is highly dependent of the validity of the codes. Yet there is a lack in our knowledge of the validity of data related to pregnancy, childbirth, and the characteristics of the newborn baby. We therefore aimed to validate the Danish National Patient Registry data related to pregnancy and childbirth by comparing the registered code with information from the medical records. We scrutinized medical records from 1264 women giving birth in the Region of Southern Denmark during 2017. We compared the registration in the medical record with the registered code in the Danish National Patient Registry by calculating how accurate the register data are according to 49 different variables. Results showed that registered codes in the Patient Registry for pregnancy- and childbirth-related conditions and key infant characteristics were to a high degree in agreement with the data from the medical report with few exceptions. In conclusion, the study revealed that the Danish National Patient Register provides highly accurate and comprehensive data for most pregnancy, delivery, and infant-related variables. This underscores the register's value as a reliable source for epidemiologic research in reproductive health. [ABSTRACT FROM AUTHOR]

The interest in the use of medical cannabis has increased in recent years in both human and veterinary fields. In Denmark, there are no veterinary-licensed medical cannabis or cannabinoid supplements, and it is illegal to prescribe or sell cannabinoids intended for the treatment of veterinary patients. This study aimed to explore the unlicensed cannabinoid use in Danish dogs, by questioning dog owners about usage, indication for use, way of purchase, and their perceived effect of the cannabinoid treatment. An anonymous online survey was distributed via social media. The total number of respondents were 2,002, of which 38% indicated using or having administered cannabinoids to their dog. The majority of the respondents confirming the use of cannabinoids (93%) had used cannabidiol drops/oil and only few (4%) reported using Δ9-tetrahydrocannabinol-based products. Most owners (67%) purchased the products online. The three most common indications for use were pain alleviation, behavioural issues, and allergy. When asked about the respondent-perceived effect the majority reported a good or very good effect. The indication with the highest percentage of owner-perceived positive effect (77%) was pain alleviation. This study shows that, despite no licensed veterinary cannabinoid products being available in Denmark, dog owners do supplement their dogs with cannabinoids and the majority of these perceive that the treatment had a positive effect. This supports the need for more evidence-based knowledge in veterinary cannabinoid therapy. [ABSTRACT FROM AUTHOR]

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative model of psychopathology. HiTOP proposes that trauma-related distress is a facet of Internalizing psychopathology, but recent evidence with young people suggests that it may reflect a unique dimension of psychopathology. This study assessed the latent structure of child and adolescent psychopathology to determine whether there is evidence of a unique 'Traumatic Stress' dimension, and how dimensions of psychopathology are associated with specific types of childhood adversity and trauma, and suicidal ideation and self-injurious behavior. Participants were children and adolescents aged 1–17 years (N = 1,800) who were in contact with the Danish child protection system due to suspected child abuse. Confirmatory factor analysis was used to determine the optimal latent structure of psychopathology, and structural equation modelling was used to determine how the dimensions of psychopathology were associated with different forms of trauma and adversity and suicidality/self-harm. The best fitting model included three factors of Internalizing, Externalizing, and Traumatic Stress. The Traumatic Stress dimensions was associated with older age, living outside of the family home, parental mental illness, higher levels of parental conflict, and the presence of domestic violence in the child's home. The Traumatic Stress dimension was not associated with suicidality/self-harm. This study provides additional evidence of a distinct dimension of Traumatic Stress among young people. Further studies are needed to determine if these findings are replicable, particularly in older participants. [ABSTRACT FROM AUTHOR]

Background: Conduct disorders (CD) are among the most frequent psychiatric disorders in children and adolescents, with an estimated worldwide prevalence in the community of 2–4%. Evidence-based psychological outpatient treatment leads to significant improvement in about two-thirds of cases. However, there seems to be considerable variation in rates of CD diagnoses and implementation of evidence-based interventions between nations. The aim of this study was to compare administrative prevalence and treatment patterns for CD in children and adolescents seen in health care systems across four Western countries (Denmark, Germany, Norway, and the USA). Methods: Cross-sectional observational study using healthcare data to identify children and adolescents (aged 0–19 years) with an ICD-10 code for CD within the calendar year 2018. Within each country's study population, the prevalence of CD, psychiatric comorbidity, psychopharmacological treatment, and psychiatric hospitalisation was calculated. Results: The prevalence of diagnosed CD differed 31-fold between countries: 0.1% (Denmark), 0.3% (Norway), 1.1% (USA) and 3.1% (Germany), with a male/female ratio of 2.0–2.5:1. The rate of psychiatric comorbidity ranged from 69.7 to 86.1%, with attention-deficit/hyperactivity disorder being most common. Between 4.0% (Germany) and 12.2% (USA) of youths with a CD diagnosis were prescribed antipsychotic medication, and 1.2% (Norway) to 12.5% (Germany) underwent psychiatric hospitalisation. Conclusion: Recognition and characteristics of youths diagnosed with CD varied greatly by country. In some countries, the administrative prevalence of diagnosed CD was markedly lower than the average estimated worldwide prevalence. This variation might reflect country-specific differences in CD prevalence, referral thresholds for mental health care, diagnostic tradition, and international variation in service organisation, CD recognition, and availability of treatment offers for youths with CD. The rather high rates of antipsychotic prescription and hospitalisation in some countries are remarkable, due to the lack of evidence for these therapeutic approaches. These findings stress the need of prioritising evidence-based treatment options in CD. Future research should focus on possible reasons for inter-country variation in recognition and management of CD, and also address possible differences in patient-level outcomes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine the Coronavirus disease 2019(COVID-19) vaccine policies disparities and effectiveness in Germany, Denmark and Bulgaria, with a view to providing lessons for global vaccination and response to possible outbreak risks. Methods: This study analyzed big data through public information on the official websites of the Ministries of Health of the European Union, Germany, Denmark and Bulgaria and the official websites of the World Health Organization. We systematically summarized the COVID-19 vaccine policies of the three countries, and selected the following six indicators for cross-cutting vaccination comparisons: COVID-19 vaccine doses administered per 100 people, COVID-19 vaccination rate, the share of people with fully vaccinated, the share of people only partly vaccinated, cumulative confirmed COVID-19 cases per million, cumulative confirmed COVID-19 deaths per million. Meanwhile, we selected the following four indicators for measuring the effectiveness of COVID-19 vaccine policy implementation: daily cases per million, daily deaths per million, the effective reproduction rate (Rt), the moving-average case fatality rate (CFR). Results: Although these three EU countries had the same start time for vaccination, and the COVID-19 vaccine supply was coordinated by the EU, there are still differences in vaccination priorities, vaccination types, and vaccine appointment methods. Compared to Germany and Denmark, Bulgaria had the least efficient vaccination efforts and the worst vaccination coverage, with a vaccination rate of just over 30% as of June 2023, and the maximum daily deaths per million since vaccination began in the country was more than three times that of the other two countries. From the perspective of implementation effect, vaccination has a certain effect on reducing infection rate and death rate, but the spread of new mutant strains obviously aggravates the severity of the epidemic and reduces the effectiveness of the vaccine. Among them, the spread of the Omicron mutant strain had the most serious impact on the three countries, showing an obvious epidemic peak. Conclusions: Expanding vaccination coverage has played a positive role in reducing COVID-19 infection and mortality rates and stabilizing Rt. Priority vaccination strategies targeting older people and at-risk groups have been shown to be effective in reducing COVID-19 case severity and mortality in the population. However, the emergence and spread of new variant strains, and the relaxation of epidemic prevention policies, still led to multiple outbreaks peaking. In addition, vaccine hesitancy, mistrust in government and ill-prepared health systems are hampering vaccination efforts. Among the notable ones are divergent types of responses to vaccine safety issue could fuel mistrust and hesitancy around vaccination. At this stage, it is also necessary to continue to include COVID-19 vaccination in priority vaccination plans and promote booster vaccination to prevent severe illness and death. Improving the fairness of vaccine distribution and reducing the degree of vaccine hesitancy are the focus of future vaccination work. [ABSTRACT FROM AUTHOR]

Publicly funded pension systems are facing the challenge of remaining financially sustainable without lowering pensions. Raising the statutory retirement age gradually in line with the increase in life expectancy has been a key measure to solve the problem. The implicit assumption is that the additional years of life are lived in good health, or as a minimum that health status is compatible with work. However, some individuals may not have the ability to work. Furthermore, a uniform retirement age ignores the different exposures to morbidity and mortality risks across social groups. Consequently, it is important to examine whether the health of older individuals will allow them to continue working and whether there is significant heterogeneity in the ability to work. Combining the Survey of Health, Ageing and Retirement in Europe (SHARE) with data from the Danish registers enables us to create a composite health index that includes an extensive range of health indicators. Utilising the health capacity to work approach, we estimate the health capacity to work among Danes aged 55 and above. We divide health capacity into physical and mental health. We investigate heterogeneity in health capacity across educational and occupational attainment. Substantial additional work capacity is found for older Danes. Depending on the type of health index applied, the health capacrk varies. There is evidence of a socio-economic gradient in work capacity. Results thereby show that policies that intend to utilise the additional work capacity should consider heterogeneity in health. Highlights We provide new evidence of the health capacity work in Denmark. The combination of survey and register data allow for comprehensive health indices. There is substantial additional health capacity to work. There is variation across health indices. There is variation across educational and occupational attainment. [ABSTRACT FROM AUTHOR]

Background: Cancer is a major global health concern. Unfortunately, Indigenous populations such as Greenlanders living in Denmark, face significant disparities in cancer risk, incidence, diagnosis, care quality, and outcomes. In Denmark, vulnerable Greenlanders face challenges accessing cancer screening. The aim of this study was to explore their perceptions of cancer, barriers to participation in cancer screening, and potential for developing a tailored intervention. Methods: This qualitative study was based on participant observations and qualitative interviews. The sample comprised 46 participants from four distinct drop-in centres. Of these, 28 were vulnerable Greenlanders (19 women and 9 men), 9 were staff members (6 women and 3 men), and 6 were relatives (4 women and 2 men). The data were analysed through inductive content analysis. Results: Vulnerable Greenlanders in Denmark believed they were responsible for their own health and were generally satisfied with the healthcare system. However, they found it challenging to manage their own health and many depended on support from others. Fear of cancer and death shaped their attitudes towards screening. Conclusion: For vulnerable Greenlanders in Denmark participation in cancer screening programmes was positively viewed for most but could be challenging. Different intervention ideas raised by the vulnerable Greenlanders, relatives and staff members could guide the development of strategies to increase participation rates. [ABSTRACT FROM AUTHOR]

Background: A low incidence of eosinophilic esophagitis (EoE) in children in the North Denmark Region (NDR) were measured in 2007–2017. Few of the children diagnosed before 2017 were treated to remission suggesting a lack of awareness. While there currently are no guidelines for treating EoE in Denmark, a new English guideline was published in 2022 renewing focus on the disease. Objective: The aim of this study was to measure the difference of current Danish clinical practice for treatment and follow-up of EoE children in the NDR with the new English guideline from the British Society of Gastroenterology (BSG) and the British Society of Pediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN). Methods: This retrospective, register-based DanEoE cohort study included 31 children diagnosed with EoE between 2007 and 2021 in NDR. Medical records were reviewed and information about treatment and follow-up were collected. Results: In 32% of the children with EoE in the NDR, first-line treatment corresponded with the new English guideline. One in 6 children were never started on any treatment even though treatment always is recommended. Histologic evaluation within 12 weeks as recommended was performed in 13% of the children. Conclusions: In Denmark focus on improving EoE treatment and follow-up for children is needed, as there is a significant difference between current clinical practice and the recommendations in the new English guideline. [ABSTRACT FROM AUTHOR]

Objective: Few patients achieve full control of their coronary artery disease (CAD) risk factors. Follow-up, such as cardiac rehabilitation, is important to increase adherence to lifestyle changes and treatment, to improve the patient's risk profile, and to treat established complications of CAD clinical events. However, the type of follow-up patients receive varies. Therefore, the aim of this research note was to describe and compare patients' self-reported use of health services, the type of follow-up patients reported to prefer, and the type of information patients reported to be important, in two countries with different follow-up practices after PCI. Results: We included 3417 patients in Norway and Denmark, countries with different follow-up strategies after PCI. The results showed large differences between the countries regarding health services used. In Denmark the most frequently used health services were consultations at outpatient clinics followed by visits to the general practitioner and visits to the fitness centre, whereas in Norway visits to the general practitioner were most common, followed by rehospitalisation and no follow-up used. However, patients found the same type of follow-up and information important in both countries. Patients' perceived need for follow-up and information decreased over time, suggesting a need for early follow-up when the patients are motivated. Trial registration: NCT03810612 (18/01/2019). [ABSTRACT FROM AUTHOR]

Background: Preterm birth (PTB) is a leading cause of child morbidity and mortality. Evidence suggests an increased risk with both maternal underweight and obesity, with some studies suggesting underweight might be a greater factor in spontaneous PTB (SPTB) and that the relationship might vary by parity. Previous studies have largely explored established body mass index (BMI) categories. Our aim was to compare associations of maternal pre-pregnancy BMI with any PTB, SPTB and medically indicated PTB (MPTB) among nulliparous and parous women across populations with differing characteristics, and to identify the optimal BMI with lowest risk for these outcomes. Methods: We used three UK datasets, two USA datasets and one each from South Australia, Norway and Denmark, together including just under 29 million pregnancies resulting in a live birth or stillbirth after 24 completed weeks gestation. Fractional polynomial multivariable logistic regression was used to examine the relationship of maternal BMI with any PTB, SPTB and MPTB, among nulliparous and parous women separately. The results were combined using a random effects meta-analysis. The estimated BMI at which risk was lowest was calculated via differentiation and a 95% confidence interval (CI) obtained using bootstrapping. Results: We found non-linear associations between BMI and all three outcomes, across all datasets. The adjusted risk of any PTB and MPTB was elevated at both low and high BMIs, whereas the risk of SPTB was increased at lower levels of BMI but remained low or increased only slightly with higher BMI. In the meta-analysed data, the lowest risk of any PTB was at a BMI of 22.5 kg/m2 (95% CI 21.5, 23.5) among nulliparous women and 25.9 kg/m2 (95% CI 24.1, 31.7) among multiparous women, with values of 20.4 kg/m2 (20.0, 21.1) and 22.2 kg/m2 (21.1, 24.3), respectively, for MPTB; for SPTB, the risk remained roughly largely constant above a BMI of around 25–30 kg/m2 regardless of parity. Conclusions: Consistency of findings across different populations, despite differences between them in terms of the time period covered, the BMI distribution, missing data and control for key confounders, suggests that severe under- and overweight may play a role in PTB risk. [ABSTRACT FROM AUTHOR]

This article makes a case for understanding International Sign (IS) as a distributed practice. IS, a translingual practice, arose from interactions among individuals from diverse linguistic backgrounds, integrating signs from multiple national sign languages and leveraging iconic and transparent features of sign language lexicons and grammars. At the heart of IS is the principle of calibration, an adaptive process aimed at aligning signs to foster mutual understanding. This study delves into the use of IS in an adult education classroom in Denmark, where IS includes not only the use of signs but also their interplay with technology and writing. The discussed examples suggest that IS is a fluid process in which people shift between conventional and adaptive signing. Furthermore, the examples showcase an intricate relationship between signing and forms of writing, suggesting that the latter should not be seen as separate from IS. [ABSTRACT FROM AUTHOR]

Introduction: Educators require focused training to foster the development of intercultural competence in nurses. Training programs for educators need to be based on a comprehensive profile with a focus on intercultural learning. This study aims to define and validate a profile of the Intercultural Nursing Educator (INE). Method: The Delphi method was used with an iterative, multi-stage process to transform opinions into group consensus. A total of 46 European, African, and American experts from the nursing and intercultural field participated. Inclusion criteria required English at a level of B2, expertise in the field of intercultural competence, experience in teaching intercultural competence in the nursing context, and publications focused on intercultural topics. Results: The INE profile was developed and all 126 competencies were validated. Discussion and conclusion: The profile is freely available on the project website and provides the basis for curricula, training programs and assessment of the required competences. [ABSTRACT FROM AUTHOR]

This article explores processes of place knowledge formation based on an ethnographic study among highly specialized international work migrants on two islands in the so-called 'Peripheral Denmark.' The article investigates the internationals' expectations and motivations for relocating to Denmark and their experiences of settling into daily life. The analysis shows that their work and workplace are central arenas for the formative knowledge process during which the internationals gradually become aware of the 'peripheral conditions' of the islands. I unpack this dawning periphery awareness and show how it influences re-evaluations of the islands as places of opportunity. [ABSTRACT FROM AUTHOR]

The International Ocean Discovery Program (IODP) Expedition 396 to the mid-Norwegian margin recovered > 1300 m of pristinely preserved, volcanic-ash-rich sediments deposited during the late Paleocene and early Eocene from close to the centre of the North Atlantic Igneous Province (NAIP). Remarkably, many of these cores contain glendonites, pseudomorphs after the purported cold-water mineral ikaite, from sediments dated to the late Paleocene and early Eocene. These time intervals span some of the hottest climates of the Cenozoic, including the Paleocene–Eocene Thermal Maximum (PETM). Global deep-ocean temperatures are not thought to have dropped below 10 ∘ C at any point during this time, making the occurrence of supposedly cold-water (near-freezing temperature) glendonite pseudomorphs seemingly paradoxical. This study presents a detailed sedimentological, geochemical, and microscopic study of the IODP Exp. 396 glendonites and presents an updated model for the ikaite-to-calcite transformation for these glendonites. Specifically, we show that early diagenesis of basaltic ashes of the NAIP appear to have chemically promoted ikaite growth in the sediments in this region. Together with existing knowledge of late Paleocene and early Eocene glendonites from Svalbard to the north and early Eocene glendonites from Denmark to the south, these new glendonite finds possibly imply episodic, short-duration, and likely localized cooling in the Nordic Seas region, which may have been directly or indirectly linked to the emplacement of the NAIP. [ABSTRACT FROM AUTHOR]

This article draws on two in-depth stories of an Arab-Danish Muslim woman and an Arab-Danish Muslim man to explore how they 'do gender' when 'doing care' for their elderly parents in their everyday lives. Analysis of ethnographic material reveals that for the Arab-Danish Muslim woman, 'doing care' is regarded as a right which provides her with the opportunity to become irreplaceable and enables her to realize herself. In her self-realization, it is argued, lies a reproduction of gendered understanding of caregiving that seems to prevent the Muslim man from performing the desired role as caregiver, leaving him to struggle with the entrenched gender norms and structured ideals of masculinity. [ABSTRACT FROM AUTHOR]

The role of street-level bureaucracy in social policy has been taken up by two relatively distinct streams of research, based on Lipsky's foundational work (2010). One group of literature has focused on the organizational working conditions, practices and coping mechanisms of street-level bureaucrats, their impact on the implementation of political programs and reforms, and the scope for discretion in the face of political pressures and institutional demands (Brodkin and Marston, 2013; Jessen and Tufte, 2014; Breit et al., 2016; Van Berkel et al., 2017; van Berkel, 2020). Starting from a focus on interaction with clients and the direct impact of discretionary decisions 'on people's lives' (Lipsky, 2010, 8), a second group of studies has focused more on differences in allocation of benefits caused by perceived 'deservingness' and discrimination among street-level bureaucrats (Altreiter and Leibetseder, 2014; Terum et al., 2018; Jilke and Tummers, 2018). [ABSTRACT FROM AUTHOR]

Many recent legislative reforms concerning children have emphasized the importance of involving children and adolescents in accordance with the principles of Article 12 in the UN Convention on the Rights of the Child. This article deals with the rights of youths to express their opinions, feelings, and views in parent-teacher conferences in lower secondary education in Denmark. Both international and Danish research on parent-teacher conferences has shown that students are often objectified and are not provided with real opportunities to participate with their own voices and perspectives. Based on the sociology of Hartmut Rosa, the article explores students' experiences of parent-teacher conferences as zones of alienation or spaces of resonance. In addition, we draw on Gert Biesta's concept of subjectification to analyze how the current organization of the conferences largely displaces students' opportunities to bring themselves into play as subjects of their own lives. The analysis is based on observations and interviews carried out in 2021 and 2022. [ABSTRACT FROM AUTHOR]

Community-acquired pneumonia is a serious public health problem, and more so in older patients, leading to high morbidity and mortality. However, this problem can be reduced by optimising in-hospital nursing care. Accordingly, this study describes a systematic process of designing and developing a tailored theory- and research-based implementation strategy that supports registered nurses (RNs) in delivering evidence-based and person-centred care for this patient population in a hospital setting. The implementation strategy was developed by completing the six steps of the Intervention Mapping framework: (1) developing a logic model of the problem and (2) a logic model of change by defining performance and change objectives, (3) designing implementation strategy interventions by selecting theory-based change methods, (4) planning the interventions and producing materials through a co-design approach, (5) developing a structured plan for adoption, maintenance and implementation and (6) developing an evaluation plan. This method can serve as a guide to (1) target behavioural and environmental barriers hindering the delivery of nursing care in local clinical practice, (2) support evidence uptake, (3) support RNs in the delivery of nursing care according to individual patient needs and thereby (4) optimise health-related patient outcomes. [ABSTRACT FROM AUTHOR]