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Introduction: This study investigates the effectiveness of the segmentation principle from the cognitive theory of multimedia learning as well as the effectiveness of the generative learning strategy of summarization in immersive virtual reality (IVR) within a sample of preadolescents. Although previous research has supported the effectiveness of these instructional methods in multimedia learning, it remains unclear whether segmentation, summarization or the combination of both are superior to a stand‐alone IVR lesson in facilitating learning. Methods: To address this gap, 190 sixth to seventh grade students learned about the human body in an IVR lesson. Students were randomly assigned to one of four experimental conditions: (a) an IVR lesson divided into four segments (segmentation condition); (b) an IVR lesson, where students summarized after the entire lesson (summarizing condition); (c) an IVR lesson presented in four segments, where students summarized after each segment (combined condition); and (d) an IVR lesson without any manipulation (control condition). Results: Results indicated that, compared to the control condition, adding segmentation or summarization to an IVR lesson leads to better transfer, but not to acquiring more factual knowledge. Combining the two methods did not improve learning. Conclusion: The findings support the evidence that choosing appropriate instructional methods for IVR lessons can foster transfer. Lay Description: What is currently known about the subject matter: The use of immersive virtual reality (IVR) in classroom settings is increasing rapidlyThere are mixed results related to the efficiency of using IVR for learning facts and conceptsFew studies have investigated if efficient instructional design guidelines generalize to IVRFew studies have investigated the efficiency of IVR within a children sample What their paper adds: A class‐room investigation of the value of using different instructional design methods for designing IVR lessons within a children sampleResults indicated that, compared to the control condition, adding segmentation or summarization to an IVR lesson leads to better transferAdding segmentation or summarization did not lead to more factual knowledge Implications of study findings for practitioners: Choosing appropriate instructional methods for IVR lessons can foster transferStudents profit most from IVR lessons when they are given opportunities for refection during or following the immersive experience [ABSTRACT FROM AUTHOR]

This paper investigates different uses of the Journal Impact Factor (JIF) in national journal rankings and discusses the merits of supplementing metrics with expert assessment. Our focus is national journal rankings used as evidence to support decisions about the distribution of institutional funding or career advancement. The seven countries under comparison are China, Denmark, Finland, Italy, Norway, Poland, and Turkey—and the region of Flanders in Belgium. With the exception of Italy, top‐tier journals used in national rankings include those classified at the highest level, or according to tier, or points implemented. A total of 3,565 (75.8%) out of 4,701 unique top‐tier journals were identified as having a JIF, with 55.7% belonging to the first Journal Impact Factor quartile. Journal rankings in China, Flanders, Poland, and Turkey classify journals with a JIF as being top‐tier, but only when they are in the first quartile of the Average Journal Impact Factor Percentile. Journal rankings that result from expert assessment in Denmark, Finland, and Norway regularly classify journals as top‐tier outside the first quartile, particularly in the social sciences and humanities. We conclude that experts, when tasked with metric‐informed journal rankings, take into account quality dimensions that are not covered by JIFs. [ABSTRACT FROM AUTHOR]

This paper investigates and quantifies the impact of parallel trade in markets for pharmaceuticals. The paper develops a structural model of demand and supply using data on price, sales, and the characteristics of statins in Denmark and simulates outcomes under a complete ban of parallel imports, keeping other regulatory schemes unchanged. There are two sets of key results. The first set focuses on price effects. On average, prices increase more in markets where the molecule has lost patent protection; wholesale prices for both generic and original products increase after competition from parallel importers is removed, but the final price paid by consumers (after deducting reimbursement) increases more for original products than for generics because most changes in wholesale prices are absorbed by the prevailing reimbursement rules. The second set of results reports the effects on market participants. My model takes into consideration consumers' preferences, allowing them to substitute between products. Prohibiting parallel imports induces consumers to substitute towards original products for which they have stronger preferences. In sum, banning parallel imports leads to (a) an increase in variable profits for original producers and a decrease for generic firms, (b) an increase in governmental health-care expenditures, and (c) a decrease in the welfare of Danish patients and firms. [ABSTRACT FROM AUTHOR]

Introduction: Induction of labor (IOL) is used to improve the outcome of pregnancy for mother and child. Since 2013, oral misoprostol has been used for IOL at Aarhus University Hospital, Denmark. The purpose of the present paper is to describe our experience of the use of a new, 25-µg misoprostol tablet commercially manufactured for the purpose of IOL regarding efficacy and outcome for mother and neonate in both an inpatient and an outpatient regimen.Material and Methods: We performed an audit from 1 April 2016, including data on all IOL in women with singleton pregnancies until 1000 consecutive women were registered. Data from 976 consecutive women with gestational age ≥37+0  weeks induced in accordance with the "Aarhus protocol" were included in the present analyses. All inductions were by oral misoprostol. Outpatient induction is standard procedure in low-risk pregnancies, that is, pregnancies with a healthy mother and no signs of placental insufficiency. In the outpatient IOL, the first dose of misoprostol is administered after a normal cardiotocography registration at the hospital. Subsequent doses are taken at home according to a predefined regimen. Following delivery, data on baseline variables and outcome variables for the mother and neonate were retrieved from the medical records.Results: In 71.9% of cases, the women were induced in an outpatient regimen. Delivery within 24 hours was achieved in 38.8% of women (nulliparous 32.3%, multiparous 50.9%) and within 48 hours in 70.1% (nulliparous 66.2%, multiparous 77.2%). Hyperstimulation during induction occurred in 0.6%. The mode of delivery was spontaneous vaginal in 75.5% of cases. The cesarean section rate was 14.9% (nulliparous 20.7%, multiparous 4.1%). Apgar <7 at 5 minutes and pH <7.0 in the umbilical artery was seen in 0.9% and 0.7%, respectively.Conclusions: Induction of labor by a commercially produced low-dose (25 µg) misoprostol tablet for oral induction according to the "Aarhus protocol" is feasible in an outpatient as well as an inpatient regimen. Delivery was achieved within 48 hours for 70.1% of women. Few adverse events were seen; however, the audit was underpowered for safety. [ABSTRACT FROM AUTHOR]

Are individuals willing to intervene in public violence? Half a century of research on the "bystander effect" suggests that the more bystanders present at an emergency, the less likely each of them is to provide help. However, recent meta-analytical evidence questions whether this effect generalizes to violent emergencies. Besides the number of bystanders present, an alternative line of research suggests that pre-existing social relations between bystanders and conflict participants are important for explaining whether bystanders provide help. The current paper offers a rare comparison of both factors-social relations and the number of bystanders present-as predictors of bystander intervention in real-life violent emergencies. We systematically observed the behavior of 764 bystanders across 81 violent incidents recorded by surveillance cameras in Copenhagen, Denmark. Bystanders were sampled with a case-control design, their behavior was observed and coded, and the probability of intervention was estimated with multilevel regression analyses. The results confirm our predicted association between social relations and intervention. However, rather than the expected reversed bystander effect, we found a classical bystander effect, as bystanders were less likely to intervene with increasing bystander presence. The effect of social relations on intervention was larger in magnitude than the effect of the number of bystanders. We assess these findings in light of recent discussions about the influence of group size and social relations in human helping. Further, we discuss the utility of video data for the assessment of real-life bystander behavior. [ABSTRACT FROM AUTHOR]

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This paper investigates whether self-rated health (SRH) covaries with individual hospital records. By linking the Danish Longitudinal Survey on Ageing with individual hospital records covering all hospital admissions from 1995 to 2006, I show that SRH is correlated to historical, current, and future hospital records. I use both measures separately to control for health in a regression of mortality on wealth. Using only historical and current hospitalization controls for health yields the common result that SRH is a stronger predictor of mortality than objective health measures. The addition of future hospitalizations as controls shows that the estimated gradient on wealth is similar to one in which SRH is the control. The results suggest that with a sufficiently long time series of individual records, objective health measures can predict mortality to the same extent as global self-rated measures. [ABSTRACT FROM AUTHOR]

Introduction: Currently fetal nuchal translucency (NT) ≥3.5 mm is an indication for invasive testing often followed by chromosomal microarray. The aim of this study was to assess the risks for chromosomal aberrations in fetuses with an NT 3.0-3.4 mm, to determine whether invasive prenatal testing would be relevant in these cases and to assess the residual risks in fetuses with normal non-invasive prenatal test (NIPT) results.Material and Methods: A retrospective study and meta-analysis of literature cases with NT between 3.0 and 3.4 mm and 2 cohorts of pregnant women referred for invasive testing and chromosomal microarray was performed: Rotterdam region (with a risk >1:200 and NT between 3.0 and 3.4 mm) tested in the period July 2012 to June 2019 and Central Denmark region (with a risk >1:300 and NT between 3.0 and 3.4 mm) tested between September 2015 and December 2018.Results: A total of 522 fetuses were referred for invasive testing and chromosomal microarray. Meta-analysis indicated that in 1:7.4 (13.5% [95% CI 8.2%-21.5%]) fetuses a chromosomal aberration was diagnosed. Of these aberrant cases, 47/68 (69%) involved trisomy 21, 18, and 13 and would potentially be detected by all NIPT approaches. The residual risk for missing a (sub)microscopic chromosome aberration depends on the NIPT approach and is highest if NIPT was performed only for common trisomies-1:21 (4.8% [95% CI 3.2%-7.3%]). However, it may be substantially lowered if a genome-wide 10-Mb resolution NIPT test was offered (~1:464).Conclusions: Based on these data, we suggest that the NT cut-off for invasive testing could be 3.0 mm (instead of 3.5 mm) because of the high risk of 1:7.4 for a chromosomal aberration. If women were offered NIPT first, there would be a significant diagnostic delay because all abnormal NIPT results need to be confirmed by diagnostic testing. If the woman had already received a normal NIPT result, the residual risk of 1:21 to 1:464 for chromosome aberrations other than common trisomies, dependent on the NIPT approach, should be raised. If a pregnant woman declines invasive testing, but still wants a test with a broader coverage of clinically significant conditions then the genome-wide >10-Mb resolution NIPT test, which detects most aberrations, could be proposed. [ABSTRACT FROM AUTHOR]

Background: Relatives are recognised as important for older patients' care and treatment. Variations in relatives' opportunities to negotiate the quality and continuity of older people's care and treatment can potentially lead to inequality in older people's access to care and treatment. Aim: This study aimed to examine relatives' opportunities and strategies for negotiation with health care professionals (HCPs) during the admission of older people to emergency departments in Denmark. Materials and Methods: We planned a qualitative ethnographical study employing a hermeneutic approach. Observations focused on social situations and interactions between relatives and HCPs. The analysis was guided by qualitative content analysis. Results: The analysis derived one main theme, attitude to action, containing three subthemes: frustration obtaining access, presenting the case and a powerful relationship. Being active appeared to be essential to achieving possibilities for negotiation with HCPs. Discussion: Inspired by Bourdieu, habitus, doxical values and institutional logics of relatives seem to affect their opportunities to negotiate with HCPs during older people's admission to an emergency department. Conclusion: Active and proactive relatives seem to have better opportunities to negotiate with HCPs during older people's acute hospital admission than reactive, passive and hesitant relatives. The logic of public management and the medical profession seem to dominate and influence doxa in the EDs and put special demands on the relatives. This imbalance constitutes a risk of inequality in older people's access to health. [ABSTRACT FROM AUTHOR]

Government responses to the Covid‐19 pandemic in the Nordic states—Denmark, Finland, Iceland, Norway, and Sweden—exhibit similarities and differences. This article investigates the extent to which crisis policymaking diverges from normal policymaking within the Nordic countries and whether variations between the countries are associated with the role of expertise and the level of politicization. Government responses are analyzed in terms of governance arrangements and regulatory instruments. Findings demonstrate some deviation from normal policymaking within and considerable variation between the Nordic countries, as Denmark, Finland, and to some extent Norway exhibit similar patterns with hierarchical command and control governance arrangements, while Iceland, in some instances, resembles the case of Sweden, which has made use of network‐based governance. The article shows that the higher the influence of experts, the more likely it is that the governance arrangement will be network‐based. [ABSTRACT FROM AUTHOR]

Summary: Background: Knowledge of COVID‐19 and the pandemic's effects on Danish children's body weight is limited. Objective: Objectives were to investigate (I) risk of weight changes among Danish children with and without SARS‐CoV‐2, (II) associations between weight changes, psychological symptoms, and long COVID symptoms, and (III) weight distribution pre‐ and post‐pandemic. Methods: A national survey was administered to all Danish children aged 0–18 years, with prior COVID‐19 (cases) and matched references including questions on weight, weight changes during the pandemic and long COVID‐related symptoms. Descriptive statistics and logistic regression were used. Weight distribution was compared with a pre‐pandemic database. Results: In all, 17 627 cases and 54 656 references were included. The 4–18‐year‐old cases had lower odds of unintended weight gain. The 2–3‐year‐old cases had higher odds and the 15–18‐year‐old cases lower odds of weight loss compared to references. Regardless of COVID‐19 status, any reported long COVID‐related symptom was associated with a change in body weight. No sign of increasing obesity rates was found among Danish children post‐pandemic. Conclusion: COVID‐19 was associated with higher odds of weight loss in 2–3‐year‐olds and lower odds of unintended weight gain in 4–18‐year‐olds. Any long COVID‐related symptom was associated with higher odds of weight changes regardless of COVID‐19 status. [ABSTRACT FROM AUTHOR]

Aims: Diabetes is associated with a higher risk of colorectal cancer (CRC) and inferior survival after CRC. Screening may enable the early detection of CRC. We aimed to assess the impact of diabetes on cancer detection and disease stage during the prevalence round of a national CRC screening program. Methods: We performed a register‐based cohort study based on the randomized procedure for inviting Danish residents aged 50–74 years to the prevalence round of national CRC screening program in 2014–2017. By comparing the random half of the population who had been invited by 1 May 2016 with the not yet invited half, the effect of screening was assessed by the detection of CRC and disease stage among individuals with and without diabetes. Further, the impact of diabetes on the screening participation rate was calculated. Results: By randomisation, 504,673 individuals had been invited to the CRC screening by 1 May 2016, and 549,359 individuals had not yet been invited. The diabetes prevalence was 10% in both groups. When comparing those not yet invited to those invited, the effect of screening on the number of detected cancers per 100,000 individuals was higher in those with diabetes (from 207 to 494 cancers) than in those without diabetes (from 147 to 364 cancers), and screening resulted in overall higher proportions of stage I cancer. Among those invited to screening, the participation rate was 9.1% lower (95% CI: 8.7%–9.5%) in individuals with versus without diabetes. Conclusions: Despite a lower participation rate, the effect of CRC screening was higher in individuals with diabetes. [ABSTRACT FROM AUTHOR]

This article scrutinizes national political parties' organizational linkages with the European level. Such linkages not only provide parties with information from the European level, but also provide the EU with a source of democratic legitimacy. By applying an inductive research design and qualitatively reconstructing the organizational linkages of 15 parties in Flanders, the Netherlands and Denmark, this article shows that not only national parties' concrete organizational practices, but also their underlying strategies for engaging the European level differ notably. Importantly, parties' multilevel organizational strategies differentiate between an 'internal' dimension (linkages with their 'own' EU‐level agents) and an 'external' dimension (linkages with their Europarty). Building on these case studies, the article presents an original typology of multilevel party organization in an EU context, providing researchers with an empirically grounded and ideal‐typical benchmark for understanding the organization and behaviour of national parties in the EU. [ABSTRACT FROM AUTHOR]

Aim: To investigate if acupuncture reduces nausea and vomiting in terminally ill patients. Design: A comparative effectiveness research design was used to generate evidence‐based knowledge close to practice for the use of clinicians. The sample size was calculated to 136 patients randomised into an intervention and a control group, respectively. Nausea and vomiting were measured using the EORTC QLQ‐c15‐PAL (European Organisation for Research and Treatment of Cancer, Quality of Life Questionnaire, core 15, Palliation). Location: The trial was conducted among terminally ill patients admitted to three in‐bed hospices in Demark. Participants: Terminally ill patients suffering from nausea and/or vomiting; 95% of patients had cancer. Intervention: The intervention group received acupuncture in addition to usual care for three days. We used the acupuncture spots: Pericardium‐6, Stomach‐36, Liver‐3 and Yin Tang. The control group received usual care only. Results: In total, 136 patients were randomised, 24 patients withdrew resulting in a total sample of 112 patients: 52 patients in the intervention group and 60 patients in the control group. In the intervention group, 75% of the patients experienced a reduction of their nausea score after the intervention compared to 55% in the control group. The statistical difference was p = 0.028. In the intervention group, 52% of the patients did not experience nausea at all after the intervention compared to 30% in the control group. In the intervention group, 31% of the patients were still vomiting after the intervention compared to 34% in the control group; no statistically significant difference was found. Conclusion: Acupuncture reduced the experience of nausea among terminally ill patients but did not reduce vomiting. Thus, acupuncture is recommended to reduce nausea among terminally ill patients. [ABSTRACT FROM AUTHOR]

Background and purpose: Social engagement is an important active aging strategy to promote older adults' mental health. The purposes of this study were to compare social engagement in older populations around the world and explore associations with mental health outcomes. Materials and methods: An international cross‐sectional survey was conducted from 2017 to 2019. Data were retrieved from The International Social Survey Programme for a secondary data analysis across 30 countries. This study applied the Taxonomy of Social Activities and its six levels as operational definitions for a consistent concept of social engagement for international comparisons. Results: In total, 9403 older adults with a mean age of 72.85 ± 6.40 years responded. The highest levels of older adults' social engagement were found in Switzerland, Thailand, and New Zealand. Older adults of a higher age, with a lower educational level, who were permanently sick or disabled, who had no partner, who were widowed or whose civil partner had died, who lived alone, and who had lower self‐placement in society had significantly lower social engagement than did their counterparts. In the regression model, older adults' social engagement positively predicted general health, self‐accomplishment, and life satisfaction, but negatively predicted loneliness and depression. Conclusions: In aging societies worldwide, encouraging older adults' social engagement would be beneficial to promote mental health. Implications for nursing practice and health policies: Community professional nurses can develop strategies of social engagement based on the needs and sociodemographic factors of older adults to improve their mental health. Developing efficient strategies and local policies by learning from successful experiences in other countries is important to promote social engagement in aging societies. [ABSTRACT FROM AUTHOR]

In response to societal demands, democratic governments constantly adopt new policies. As existing policies are rarely abandoned, policies accumulate over time. Policy accumulation bears the challenge of overburdening implementation bodies, hence undermining policy effectiveness. Any escape from this situation requires democratic governments to strike a balance between policy responsiveness and effectiveness. We posit that the extent to which countries are able to achieve this depends on the vertical integration of processes of policy formulation and implementation. We provide a novel conceptualization of vertical policy‐process integration (VPI) that is based on two channels. While bottom‐up integration captures the extent to which policy implementers can communicate reasons for potential policy failure from the bottom up, top‐down integration indicates the degree to which the policy formulation level has to cover the implementation costs of the policies they produce. We illustrate our argument by an empirical analysis of VPI patterns in Denmark and Italy. [ABSTRACT FROM AUTHOR]

Makerspaces are places for construction and creative expression using tools such as 3D printers, laser cutters, and sewing machines. In this study, we investigate how makers obtain information for their makerspace projects. The study focuses on four sources of information: people, documents, experimentation, and prior knowledge. On the basis of interviews with 13 makers, we analyze their use of these information sources in relation to different knowledge areas, creative‐process stages, and relevance criteria. Our main findings are that (a) experimentation is a prime source of information, (b) ease and pleasure are the dominant relevance criteria, (c) process and situation receive little attention, and (d) information sources vary across process stages. Specifically, experimentation is the dominant information source during the construction stage. In addition, the relevance criteria show that the makers turn to people because it is pleasurable, to documents because it is easy, and to experimentation because it results in quality products. These results emphasize the importance of experimentation and suggest that it warrants closer attention in studies of the information behavior of makers and, more broadly, creative professionals. [ABSTRACT FROM AUTHOR]

Previous research suggests that young adults from out‐of‐home care (OHC) are at high risk of low education and unemployment. However, there are no studies on their risk of long‐term NEET (Not in Employment, Education or Training). This study compared the risk of NEET at age 21–23 among OHC youth across Denmark, Finland and Sweden, using register data for an entire birth cohort born in 1987. The Nordic countries share many features, but there are differences in the provision of after‐care support and in the linkage between the educational system and the labour market. The results show that about a fourth in Denmark and Sweden and a third in Finland were NEET, suggesting that the welfare systems were not able to compensate for the OHC youth's childhood disadvantages. To a significant extent, the excess risk of NEET was attributed to poor school performance. Implications for research, policy and practice are discussed. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to conduct a cross‐cultural comparison of the level of critical thinking of Danish and Spanish psychology students (N = 788) attending innately different bachelor‐level courses; personality psychology and introductory statistics/research methods. Several instruments are available for the assessment of critical thinking (CTh), but most are, however, unsuitable for use in large surveys with many constructs, due to length or single‐person administration formats. One brief and much‐used scale is the CTh scale in the Motivated Strategies for Learning Questionnaire (MSLQ), used in this study. To ensure unbiased comparisons across countries and courses, our secondary aim was to investigate the content validity, as well as the psychometric properties, of the CTh scale to ensure the most accurate and unbiased comparison. For this purpose, Rasch and graphical loglinear Rasch models were used. After reducing the number of items due to content validity issues, the CTh scale fitted Rasch models within each national sample, and was measurement invariant relative to age group, gender, course and university. In the cross‐cultural item analysis, two items functioned differentially relative to nationality, and the scale fitted a graphical loglinear Rasch model. CTh scores related to introductory statistics/research methods courses differed significantly from scores related to personality psychology, for Danish students only. [ABSTRACT FROM AUTHOR]

Introduction: Human papillomavirus (HPV) testing as the primary cervical cancer screening method is implemented in several countries. We report data from the first round of a large Danish pilot implementation of HPV-based screening. Our aim was to compare colposcopy referrals, detection of high-grade cervical intraepithelial neoplasia (CIN) and cervical cancer, and positive predictive value (PPV) of colposcopy referral in HPV vs cytology-based screening.Material and Methods: From May 2017 to October 2018, women aged 30-59 years attending cervical cancer screening in the uptake area of the Department of Pathology, Vejle Hospital, Region of Southern Denmark were screened by primary HPV testing (n = 16 067) or primary cytology (n = 23 981) depending on municipality of residence. In the HPV group, women with HPV16/18, or other high-risk HPV types and abnormal cytology, were referred to immediate colposcopy. Women with other high-risk HPV types and normal cytology were invited for repeat screening with HPV test and cytology after 12 months. From a nationwide pathology register, we obtained information on screening results and subsequent histological diagnoses during up to 2.9 years after the first screen. PPVs included diagnoses within 1 year after referral.Results: In the HPV group, 3.7% were referred to immediate colposcopy and 2.8% were referred at the 12-month repeat screening. The total referral to colposcopy was higher in the HPV (6.6%) than cytology group (2.1%) (age-adjusted relative referral = 3.05, 95% confidence interval [CI] 2.75-3.38). The detection of CIN3+ was higher in the HPV (1.5%) than the cytology group (0.8%) (age-adjusted relative detection = 1.88, 95% CI 1.56-2.28). The probability of CIN3+ among women referred to colposcopy (= PPV) was lower in the HPV (21.1%; 95% CI 18.7%-23.7%) than the cytology group (34.6%; 95% CI 30.7%-38.9%). In the HPV group, the PPV was lower among women referred at repeat screening (12.1%) than among women referred immediately (27.8%).Conclusions: Compared with cytology-based screening, HPV-based screening provided a 90% increased CIN3+ detection at the cost of a threefold increase in colposcopy referrals, when considering complete data from the prevalence round. Our findings support implementation of HPV-based screening in Denmark, but modifications of screening algorithms may be warranted to decrease unnecessary colposcopy referrals. [ABSTRACT FROM AUTHOR]

High infant weight increases the risk of childhood overweight, while breastfeeding may reduce the risk. However, some infants have a very high weight gain even though they are exclusively breastfed. We examined the risk of a high body mass index (BMI) and overweight in childhood for infants ≥2.5 SD above the median weight‐for‐age (WAZ) at age 5 months according to duration of exclusive breastfeeding (≤2, >2 to <4 or ≥4 months). The study is based on 13,401 7‐year‐old and 9,819 11‐year‐old children enrolled into the Danish National Birth Cohort (born 1997–2003). Linear and logistic regression analyses were used to examine the associations while adjusting for presumed confounders including birth weight. The results showed that infants ≥2.5 SD at 5 months, breastfed exclusively ≤2, >2 to <4 or ≥4 months had adjusted odds ratios (ORs) for overweight at age 7 at 3.67 (95% confidence interval [CI] [2.10, 6.43]), 3.42 (95% CI [2.32, 5.04]) and 3.19 (95% CI [1.90, 5.36]) respectively, when compared with infants <2.5 SD WAZ exclusively breastfed ≥4 months. The corresponding results for BMI z‐scores were 0.82 (95% CI [0.60, 1.04]), 0.63 (95% CI [0.48, 0.78]) and 0.57 (95% CI [0.38, 0.77]). For the ≥2.5 SD infants, the differences in risk of overweight and BMI according to duration of exclusive breastfeeding were neither significantly different among the 7‐year nor among the 11‐year‐old children. A high infant weight increases the odds of overweight and is associated with a higher BMI in childhood. Whereas the odds and BMI z‐scores tended to be lower for those exclusively breastfed longer, the differences were not statistically significant. [ABSTRACT FROM AUTHOR]

To study the context dependence of the impact of goal activation on sustainable consumer choices in an online survey, 1,031 participants in Denmark and 1,028 in Brazil were randomly allocated to three different goal‐activation manipulations, which were set up to activate a normative goal, a hedonic goal, and a gain goal, respectively. Goal‐activation impacts were measured with a choice experiment consisting of six repeated choices of tomatoes. The importance for consumer choices of each of the varied product attributes for consumer choices can be linked to characteristics that differ between countries. Therefore, it was predicted that the importance of attributes differs between Denmark and Brazil. This was confirmed for one of the three attributes (appearance), but not for the other two (organic and price). Still, as predicted, the goal‐activation manipulation influenced the impact of varied product attributes (two out of three) on choices. The activation of a normative goal made participants in both countries more likely to choose organic tomatoes and less focused on the appearance of the tomatoes. However, the goal‐activation manipulation did not influence the importance of the price. The findings suggest that the situational activation of a normative goal can be an effective means to promote sustainable consumer choices in very different national contexts. [ABSTRACT FROM AUTHOR]

Introduction: Emergency contraceptive pill (ECP) use is reported to have increased in several countries over time. In this multi-country population-based questionnaire study, we aimed to describe the patterns of ECP use and identify factors associated with its use.Material and Methods: In 2011-2012, women aged 18-45 years were randomly selected from national registers in Denmark, Norway and Sweden and invited to respond to questions related to lifestyle and contraceptive use. We used generalized logistic models to estimate odds ratios (ORs) and 95% confidence intervals (CI) comparing women who had used ECP with women who had never used ECP.Results: Of the 45 445 women, 33.9% (Denmark = 32.3%, Norway = 35.1%, Sweden = 34.6%) had used ECP at least once in their lifetime. Among ECP users, 15.8% had used ECP within the last year and 50.0% had used ECP more than once in their life. After adjusting for country, age at response and response type, ECP use was associated with higher education (OR 2.09, 95% CI 1.54-2.84) and being single, divorced or widowed (OR 3.17, 95% CI 2.87-3.49). Binge drinking and smoking increased the odds of ECP use. Furthermore, early age at first intercourse (OR 1.29, 95% CI 1.08-1.55), having a new partner in the last 6 months (≥3 partners: OR 6.44, 95% CI 5.46-7.60) and lack of condom use with a recent new partner (OR 1.42, 95% CI 1.22-1.66) were found to be associated with ECP use.Conclusions: Our study shows that ECP use is common among Scandinavian women. Higher education and being single were associated with increased odds of ECP use. Risk behaviors such as smoking and early age at first sex were also associated with increased odds of ECP use. Since ECP use is not protective against sexually transmitted infections, our findings highlight the need to encourage awareness and regular use of condoms to prevent sexually transmitted diseases in women. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing emergency abdominal surgery are at high risk of post-operative complications. Although post-operative treatment at an intermediate care unit may improve early outcome, there is a lack of studies on the long-term effects of such therapy. The aim of this study was to assess the long-term effect of intermediate care versus standard surgical ward care on mortality in the Intermediate Care After Emergency Abdominal Surgery (InCare) trial.Methods: We included adult patients undergoing emergency major laparoscopy or laparotomy with an Acute Physiology and Chronic Health Evaluation (APACHE) II score of 10 or more, who participated in the InCare trial from October 2010 to November 2012. In the InCare trial, patients were randomized to either post-operative intermediate care or standard surgical ward care. The primary outcome was time to death within 6 years after surgery. We assessed mortality with Coxregression analysis.Results: A total of 286 patients were included. The all-cause 6-year landmark mortality was 52.8% (76 of 144 patients) in the intermediate care group and 47.9% (68 of 142 patients) in the ward care group. There was no statistically significant difference in mortality risk between the two groups (hazard ratio 1.06 (95% confidence interval 0.76-1.47), P = .73).Conclusion: We found no statistically significant difference in 6-year mortality between patients randomized to post-operative intermediate care or ward care after emergency abdominal surgery. However, we detected an absolute mortality risk reduction of 5% in favour of ward care, possibly due to random error. [ABSTRACT FROM AUTHOR]

Background: Neuromuscular monitoring is recommended whenever a neuromuscular blocking agent is administered, but surveys have demonstrated inconsistent monitoring practices. Using qualitative methods, we aimed to explore barriers and aids to routine neuromuscular monitoring and consistent reversal practice.Methods: Focus group interviews were conducted to obtain insights into the thoughts and attitudes of individual anaesthetists, as well as the influence of colleagues and department culture. Interviews were conducted at five Danish and one US hospital. Data were analysed using template analysis.Results: Danish anaesthetists used objective neuromuscular monitoring when administering a non-depolarizing relaxant, but had challenges with calibrating the monitor and sometimes interpreting measurements. Residents from the US institution used subjective neuromuscular monitoring, objective neuromuscular monitoring was generally not available and most had not used it. Danish anaesthetists used neuromuscular monitoring to assess readiness for extubation, whereas US residents used subjective neuromuscular monitoring, clinical tests like 5-second head lift and ventilatory parameters. The residents described a lack of consensus between senior anaesthesiologists in reversal practice and monitoring use. Barriers to consistent and correct neuromuscular monitoring identified included unreliable equipment, time pressure, need for training, misconceptions about pharmacokinetics of neuromuscular blocking agents and residual block, lack of standards and guidelines and departmental culture.Conclusion: Using qualitative methods, we found that though Danish anaesthetists generally apply objective neuromuscular monitoring routinely and residents at the US institution often apply subjective neuromuscular monitoring, barriers to consistent and correct use still exist. [ABSTRACT FROM AUTHOR]

Background: Cardiac surgery is associated with a risk of complications, including post-operative cognitive dysfunction (POCD). In the randomized Perfusion Pressure Cerebral Infarcts (PPCI) trial, we allocated cardiac surgery patients to either a low-target mean arterial pressure (40-50 mm Hg) or a high-target pressure (70-80 mm Hg). The study found no difference in the volume of new ischemic cerebral lesions nor POCD, but 30-day mortality tended to be higher in the high-target group. In the present study we did a long-term 3-year follow-up to assess survival and level of cognitive functioning. The primary hypothesis was that patients allocated to a high-target blood pressure had a higher long-term mortality at 3-year follow-up.Methods: We determined long-term mortality of patients included in the PPCI trial at 3-year follow-up using national registries and we assessed POCD using a cognitive test battery. Subjective level of functioning was assessed with questionnaires. POCD and subjective functioning at follow-up were evaluated in logistic regression models.Results: Among the 197 patients who participated in the original study, there was no significant difference in mortality over a median of 3.4 years according to blood pressure target during cardiopulmonary bypass (hazards ratio 1.23 [high vs low] 95% confidence interval: 0.50-3.02, P = .65). POCD was found in 18.9% and 14.0% in the high-target and low-target groups, respectively adjusted odds ratio 1.01 (CI 95% 0.33-3.12). No differences were found for subjective functioning between groups.Conclusions: No difference in mortality nor in the level of cognitive functioning was found according to blood pressure target during cardiac surgery long-term at 3-year follow-up. [ABSTRACT FROM AUTHOR]

Introduction: Applying whole-exome sequencing (WES) for the diagnosis of diseases in children has shown significant diagnostic strength compared with chromosomal microarray. WES may also have the potential of adding clinically relevant prenatal information in cases where a fetus is found to have structural anomalies. We present results from the first fetal exomes performed in a tertiary center in Denmark.Material and Methods: Couples/expectant parents were included in Central Denmark Region from July 2016 to March 2019. Inclusion was not systematic, but where one or more fetal malformations or severe fetal hydrops were detected, and a specific diagnosis had not been obtained by chromosomal microarray. WES was performed in ongoing pregnancies (N = 11), after intrauterine demise (N = 5), or after termination of pregnancy based on ultrasound findings (N = 19). In most cases, a trio format was applied comprising fetal and parental DNA.Results: WES was performed in 35 highly selected fetal cases. Pathogenic variants, or variants likely to explain the phenotype, were detected in 9/35 (26%). Variants of uncertain significance were detected in 7/35 (20%) and there was one secondary finding (3%). Out of the 11 ongoing pregnancies, four reached a genetic diagnosis (36%). Detection rate was highest in cases of multisystem anomalies (7/13, 54%). WES was completed in all three trimesters and both autosomal dominant, autosomal recessive and X-linked inheritance were revealed.Conclusions: We present data from 35 cases of exome sequencing applied in a setting of fetal malformations. Importantly, though, we wish to share our personal experiences with implementing WES into a prenatal setting. As a medical society, we must continue to share what we do not understand, what went wrong, what is difficult, and what we do not agree upon. A common understanding and language are warranted. We also advocate that more research is needed concerning the clinical value, as well as costs and patient perspectives, of using WES in pregnancy. We believe that WES will lead to improved prenatal and perinatal care. [ABSTRACT FROM AUTHOR]

Background: In Europe 700.000 new cases of sepsis occur annually and more than 100.000 of these patients die due to multiorgan failure (MOF). We have identified shock-induced endotheliopathy (SHINE) to be associated with development of MOF and mortality. Furthermore, in patients with septic shock those with circulating levels of thrombomodulin (TM) above 10 ng/mL have twice the mortality (56% vs 28%) than those with levels below this level. Pilot studies indicate that infusion of iloprost (1 ng/kg/min) is associated with improved endothelial function in patients with septic shock.Material and Methods: This is a multicenter, randomized, blinded, investigator-initiated, adaptive phase 2B trial in up to 384 patients with septic shock-induced endotheliopathy defined by TM > 10 ng/mL who are allocated 1:1 to 72 hours continuous infusion of iloprost 1 ng/kg/min or placebo (equal volume of saline). The primary outcome is the mean daily modified Sequential Organ Failure Assessment (SOFA) score in the ICU up to day 90. Secondary outcomes include 28- and 90-day all-cause mortality, days alive without vasopressor in the ICU within 90 days, days alive without mechanical ventilation in the ICU within 90 days, days alive without renal replacement therapy in the ICU within 90 days, numbers of serious adverse reactions, and the number of serious adverse events within the first 7 days.Discussion: This trial tests the safety and efficacy of iloprost vs placebo for 72 hours in patients with septic shock and SHINE. The outcome measures focus on the potential effect of the intervention to mitigate organ failure.Trial Registration: COMBAT-SHINE trial-EudraCT no. 2019-001131-31-Clinicaltrials.gov: NCT04123444-Ethics Committee no. H-19018258. [ABSTRACT FROM AUTHOR]

Prophylactic antibiotics in caesarean delivery before or after cord clamping - protecting the mother at the expense of the infant's microbiota? To prevent postoperative infections after caesarean deliveries, most obstetric guidelines recommend intravenous antibiotic prophylaxis before skin incision as opposed to after cord clamping.[1] However, the clinical reality may have changed since this procedure was recommended. The primary outcome was defined as postpartum infections with either endometritis, surgical-site infection or sepsis within 30 days after caesarean delivery. 2 Smail F, Grivell R. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section (Review). [Extracted from the article]

Introduction: We aimed to describe the cervical cancer mortality rates after correcting for hysterectomy and to evaluate trends over calendar time and by age.Material and Methods: Using data from nationwide registries, we calculated uncorrected and hysterectomy-corrected cervical cancer mortality rates among women age ≥20 years in Denmark during 2002-2015. We calculated hysterectomy-corrected rates by subtracting post-hysterectomy person-years from the denominator, unless hysterectomy was performed due to cervical cancer.Results: The age-standardized hysterectomy-corrected cervical cancer mortality rate of 5.8/100 000 was 18.4% higher than the corresponding uncorrected rate. The hysterectomy-corrected cervical cancer mortality rate increased significantly with age, particularly in women aged 65+ (annual percent change +4.57), peaking at 26.1/100 000 person-years in women aged ≥85. The hysterectomy-corrected cervical cancer mortality declined significantly over calendar time, from 6.3/100 000 person-years in 2002 to 4.5/100 000 person-years in 2015 (annual percent change -0.22). This was mainly due to a significant decline in women aged 60 years and older, from 20.4/100 000 person-years in 2003 to 9.3/100 000 person-years in 2015 (annual percent change -0.75).Conclusions: The mortality of cervical cancer increased significantly by age, particularly among women aged 65 years and older for whom routine cervical cancer screening is not recommended. Understanding reasons for the high mortality rate in older women is critical, as this may help identify interventions needed to ensure a continued decline in cervical cancer mortality in older Danish women. [ABSTRACT FROM AUTHOR]

Aim: The study aims to investigate secular changes in adult height among Nordic reference populations during the last four decades and in parents of Swedish study participants, and to study during which growth phase(s) infancy, childhood or puberty changes in height and tempo occurred.Methods: Length and height data were obtained from publications on populations used as current and previous national height references in Denmark, Finland, Norway and Sweden. Measurements from birth until adult height and original parental heights of participants in Swedish reference populations born 1956, 1974, and 1990 were used.Results: Adult height has increased progressively in Nordic populations born in 1950s-1990s; for females by 6 mm/decade Norway, 4 mm; Sweden, 6 mm; Finland and Denmark, 7 mm; for males by 9 mm/decade, in Sweden, 5 mm; Finland, 7 mm; Denmark 8 mm; Norway, 15 mm. This was due to more growth during childhood despite earlier timing of mid-puberty. Heights of Swedish parents born 1920s-1960s increased 11 mm/decade for mothers, 14 mm/decade for fathers.Conclusion: The Nordic countries comprise some of the tallest populations in the world yet continue to show a positive secular change in adult height alongside a faster tempo of growth by earlier timing of puberty, highlighting the need to regularly update national height references. [ABSTRACT FROM AUTHOR]

Addiction to work is defined as a compulsion or an uncontrollable need to work incessantly. Only few measures exist to identify work addiction and the health consequences are sparsely explored. The Bergen Workaholic Scale (BWAS) measures seven core elements of work addiction and has been used in Norway, Hungary, Brazil, Italy, USA and Poland. The aim of this study was to validate the BWAS in a Danish sample and to investigate if high risk of work addiction was associated with stress and reduced quality of life. We conducted an online screening survey with 671 participants aged 16–68 years with the Danish translation of the BWAS. We added the perceived stress scale (PSS) and the quality of life scale EQ‐5D‐5L. Those with high risk of work addiction reported significantly higher mean PSS scores (20.0 points) compared to those with low risk of addiction (12.5 points) and poorer quality of life (61.9) compared to the low risk group (81.3). Furthermore, work addiction was associated with more weekly working hours (44.0 vs. 35.6 hours/week) and having more leadership responsibility. A preliminary estimate of work addiction prevalence was 6.6%. The BWAS demonstrated good reliability (α = 0.83), and factor analyses pointed at a single factor structure. Work addiction seems to be associated with health problems in terms of stress and poorer quality of life. The BWAS is recommended as a reliable and valid tool to identify work addiction in Danish. [ABSTRACT FROM AUTHOR]

Background: The prevalence of iron depletion is high among premenopausal women who donate blood frequently. Studies in nondonor populations indicate that iron deficiency anemia is associated with an increased risk of low birth weight. This prompts concerns that iron deficiency induced by frequent blood donation might impair subsequent fetal development.Study Design and Methods: The aim of this study was to assess whether prepregnancy donation intensity affects the birth weight of singletons born at term (gestational week 38 or later) to nulliparous female donors in Denmark. We identified 293,897 first live singleton births to Danish women between 1997 and 2012 with complete information on gestational age, birth weight, child sex, parental age, maternal smoking status during pregnancy, and parental education length and annual income. Linear regression analysis was applied, with birth weight as outcome, number of donations within the 3 years before pregnancy as the explanatory variable, and confounding variables as described.Results: Birth weight among children of low-intensity donors (n = 22,120) was 12.6 g (95% confidence interval, 6.7-18.6) higher than nondonors (n = 268,253) after controlling for the above-mentioned factors. The higher birth weight among low-intensity donors can be explained by the healthy donor effect. In fully adjusted analyses, birth weight among children of high-intensity donors (n = 3,524) was 20.2 g (95% confidence interval, 5.1-35.3 g) lower compared with low-intensity donors. This reduced birth weight among high-intensity donors compared to low-intensity donors may reflect blood donation-induced iron deficiency.Conclusions: Our results show that high prepregnancy donation intensity is inversely associated with birth weight of singletons born at term to nulliparous women. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to explore how patient participation is constructed in social interaction processes between nurses, other health professionals and service users, and which structures provide a framework for the participation of service users in a psychiatric context? Methodological design: Ten tape‐recorded interviews of nurses and observations of interactions between nurses, other health professionals and service users reflected differing constructed views of patient participation. Charmaz's interpretation of the grounded theory method was used, and the data were analysed using constant comparative analysis. Ethical issues and approval: The study was designed in accordance with the ethical principles of the Helsinki Declaration (1) and Danish law (2). Each study participant in the two psychiatric departments gave informed consent after verbal and written information. Findings: The articulation of patient participation emphasises the challenge between, on the one side, orientations of ethical care, and, on the other, paternalism and biomedicine. The core category was generated from four inter‐related categories: (i) taking care of the individual needs; (ii) the service user as expert; and (iii) biomedicine, and (iv) paternalism, and their 13 subcategories. Conclusions: This study illuminates the meaning of patient participation in a psychiatric context based on social interaction between nurses, other health professionals and service users. This can contribute to dealing with the challenges of incorporating patient participation as an ideology in all service users in a psychiatric context and is therefore important knowledge for health professionals. [ABSTRACT FROM AUTHOR]

There are few data available that describe the current anaesthetic management of children. We have analysed anaesthetic practice and peri-operative complications for children in Denmark aged less than two years. We conducted a population-based observational cohort study using the Danish Anaesthesia Database to identify children who received anaesthesia in hospital from 1 January 2005 until 31 December 2015. Data were combined with that from the Danish National Patient Registry and the Danish Civil Registration System. Age, sex, height, weight, ASA physical status, days in hospital before anaesthesia, number of anaesthetics per child, indications for anaesthesia, methods of anaesthesia, airway management and complications were all recorded. A total of 17,436 children (64% of whom were male) received 27,653 anaesthetics during the study period. In 58% of cases, the child had an ASA physical status score of 1. Thirty-seven percent had a previous anaesthetic episode. Seventy-nine percent were anaesthetised at a university hospital. The indications for anaesthesia were surgery (70%), diagnostic radiology (16%), non-surgical care (11%) and other indications (3%). General anaesthesia combining intravenous and inhalational agents was the most common approach for surgery (68%) and diagnostic radiology (47%). For non-surgical care, general anaesthesia using inhalational agents was the most common method (42%). Neuraxial blocks were used infrequently. The most common regional anaesthetic nerve block was an infraclavicular brachial plexus block (11%). Peri-operative complications occurred in 1.71% of cases. A large proportion of anaesthetics were conducted in children with comorbidities. Non-surgical indications for anaesthesia were frequent and peri-operative complications were rare. [ABSTRACT FROM AUTHOR]

Background: The association between socio-economic status (SES) and headache among adolescents is an understudied issue, and no study has examined whether such an association changes over time. The aim was to examine trends in socio-economic inequality in frequent headache among 11- to 15-year-olds in Denmark from 1991 to 2014, using occupational social class (OSC) as indicator of SES.Methods: The study applies data from the Danish part of the international Health Behaviour in School-aged Children (HBSC) study. HBSC includes nationally representative samples of 11-, 13- and 15-year-olds. This study combines data from seven data survey years from 1991 to 2014, participation rate 88.6%, n = 31,102. We report absolute inequality as per cent difference in frequent headache between high and low OSC and relative inequality as odds ratio for frequent headache by OSC.Results: In the entire study population, 10.4% reported frequent headache. There was a significant increase in frequent headache from 8.0% in 1991 to 12.9% in 2014, test for trend, p < 0.0001. This increasing trend was significant in all OSCs. The prevalence of frequent headache was significantly higher in low than high OSC, OR = 1.50 (95% CI: 1.34-1.67). This socio-economic inequality in frequent headache was persistent from 1991 to 2014.Conclusion: There was a significant and persistent socio-economic inequality, i.e. increasing prevalence of frequent headache with decreasing OSC. The association between socio-economic position and headache did not significantly change over time, i.e. the statistical interaction between OSC and survey year was insignificant.Significance: The prevalence of frequent headache among adolescents increases with decreasing SES. This socio-economic inequality has been persistent among adolescents in Denmark from 1991 to 2014. Clinicians should be aware of this social inequality. [ABSTRACT FROM AUTHOR]

Objectives: To perform a neurophysiological follow-up at 48 or 60 months of age in children exposed prenatally to progesterone compared with a placebo and evaluate their medical histories up to 8 years of age.Methods: In this study, Danish participants of the PREDICT study, including 989 surviving children from 498 twin pregnancies, were followed-up. PREDICT was a placebo-controlled randomized clinical trial examining the effect of progesterone for prevention of preterm delivery in unselected twin pregnancies. Medical histories of the children were reviewed and neurophysiological development was evaluated by the parent-completed Ages and Stages Questionnaire (ASQ) at either 48 or 60 months after the estimated date of delivery. We used the method of generalized estimating equation to account for the correlation within twins.Results: A total of 492 children had been exposed prenatally to progesterone and 497 to placebo. There was no difference in the number of admissions to or length of stay in hospital between the treatment groups, and we found no overall difference in the rates of diagnoses made. However, the odds ratios (ORs) for a diagnosis concerning the heart was 1.66 (95% CI, 0.81-3.37), favoring placebo, among all children, 2.38 (95% CI, 1.07-5.30) in dichorionic twins and 8.19 (95% CI, 1.02-65.6) in all children when excluding diagnoses made at outpatient clinic visits. ASQ scores were available for 437 children (progesterone, n = 225; placebo, n = 212). Mean ASQ score was slightly higher in the progesterone group compared with the placebo group (P = 0.03). In dichorionic twins, the risk of having a low ASQ score (< 10(th) centile) was decreased in the progesterone group (OR, 0.34 (95% CI, 0.14-0.86)).Conclusion: Second- and third-trimester exposure of the fetus to progesterone does not seem to have long-term harmful effects during childhood, but future studies should focus on cardiac disease in the child. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

This study extends research on the relations between social representations and social identities through an exploration of how Muslim women manage the stigma of veiling. Based on analysis of individual and group interviews among Muslim women in Denmark and the UK, the study highlights the dialectical nature of social identity as constructed through and against others' representations of social groups and the norms of valuing they impose. It shows how, for the women here, the reinforcement of a shared sense of Muslim identity goes together with re-evaluation of aspects of that identity, principally in response to representations of the veil that deny Muslim women agency and cast them as oppressed. It shows how norms of gender and agency are in this process variously resisted and affirmed, resulting in the reframing of gendered religious values. Theoretically, the study argues that an account of the role of representations in the construction of identity challenges the inter-group framework of existing approaches to threatened social identity and sheds light on intersectional dynamics of identity. [ABSTRACT FROM AUTHOR]

Background: Chronic pain has serious consequences for individuals and society. In addition, opioid prescription for chronic non-cancer pain (CNCP) has become more frequent. This study aims to examine the trends regarding the prevalence of CNCP, dispensed opioids, and concurrent use of benzodiazepine (BZD)/BZD-related drugs in the Danish population.Methods: Data from the cross-sectional national representative Danish Health and Morbidity Surveys (2000, 2005, 2010, and 2013) were combined with The Danish National Prescription Registry at an individual level. The study populations varied between 5000 and 13,000 individuals ≥16 years (response rates: 51-63%). Respondents completed a self-administered questionnaire, which included the analyzed items on identification of chronic pain (≥6 months).Results: From 2000 to 2013, the prevalence of CNCP increased and subsequently the annual prevalence of opioid use from 4.1% to 5.7% among CNCP individuals. Higher CNCP prevalence was related to female gender, no cohabitation partner, short education, non-Western origin, and overweight/obesity. In addition, women with CNCP, especially >65 years, became more frequent users of opioids and used higher doses than men. Concurrent use of BZD/BZD-related drugs decreased (13%) from 2010 to 2013, still one-third of long-term opioid user were co-medicated with these drugs.Conclusions: The use of opioids has increased in Denmark, especially among elderly women. The concurrent use of BZD/BZD-related drugs has decreased from 2010 to 2013, but still one-third of long-term opioid users were co-medicated. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether discontinuation of oxytocin infusion increases the duration of the active phase of labour and reduces maternal and neonatal complications.Design: Randomised controlled trial.Setting: Department of Obstetrics and Gynaecology, Regional Hospital of Randers, Denmark.Population: Women with singleton pregnancy in the vertex position undergoing labour induction or augmentation.Methods: Two hundred women were randomised when cervical dilation was ≤4 cm to either continue or discontinue oxytocin infusion when cervical dilation reached 5 cm.Main Outcome Measures: The primary outcome was duration of the active phase of labour, defined as the time period from 5 cm of cervical dilation until delivery. Secondary outcomes were mode of delivery, uterine tachysystole, hyperstimulation, abnormalities in fetal heart rate, postpartum haemorrhage rate, perineal tears, and neonatal outcomes.Results: The active phase of labour was longer by 41 minutes (95% confidence interval 11-75 minutes) in the discontinued group (median 125 minutes in 85 women who had reached the active phase and delivered vaginally) versus the continued group (median 88 minutes in 78 women). The incidence of fetal heart rate abnormalities (51 versus 20%) and uterine hyperstimulation (12 versus 2%) was significantly greater in the continued than the discontinued oxytocin group. The incidence of tachysystole, caesarean deliveries, postpartum haemorrhage, third degree perineal tears and adverse neonatal outcomes was higher in the continued group, but did not reach significance.Conclusions: Discontinuation of oxytocin infusion in the active phase of labour may improve some labour outcomes but has the disadvantage of increasing the duration of the active phase of labour.Tweetable Abstract: Stopping oxytocin in the active phase seems to make labour less complicated but lengthens duration. [ABSTRACT FROM AUTHOR]

The debate about the future of universal social programmes has been raging for years, both in social-democratic and in liberal welfare states. The objective of this article is to contribute to the literature on universality by analyzing the evolution of universal social programmes in two social-democratic and two liberal countries: Denmark, Sweden, Canada and the UK. This choice of countries provides the opportunity to investigate whether the principle and practice of universality has fared differently both within and between countries. The analysis focuses primarily on the national level while exploring three policy areas: pensions, healthcare and family policy, specifically child benefits and day care. The main conclusion of our comparative analysis is clear: among our two liberal and two social-democratic countries, the institutional strength of universality varies greatly from one policy area and one country to another. Considering this, there is no such a thing as a universal decline of universality. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2012; 26; 615-623 Danish version of 'The COPD self-efficacy scale': translation and psychometric properties The aim of the study was to translate 'The COPD self-efficacy scale' (CSES) into Danish and to evaluate the psychometric properties of the Danish version (CSES-DK). CSES enables assessment of self-efficacy in individuals with chronic obstructive pulmonary disease (COPD). The scale consists of 34 items, describing situations which may cause dyspnoea in patients with COPD. The CSES was translated into Danish using a standard forward-backward translation procedure. To estimate the reliability, measurements of internal consistency and repeatability were applied. The validity of the Danish version was evaluated by examining the associations between the CSES-DK score and socio-demographic variables (age, gender, education, disease severity and self-rated health). Factor analysis was conducted to compare the internal structure of the Danish version and the American source version. The study included 151 patients with COPD, recruited from three outpatient clinics. Estimates of reliability were in accordance with the original version of CSES (Cronbach's α = 0.97, test-retest r = 0.82, p < 0.001). Significant correlations were obtained between the CSES-DK total score and vocational training and education ( r = 0.27, p = 0.001), disease severity ( r = −0.27, p = 0.001) and self-rated health ( r = −0.41, p < 0.001), indicating construct validity. Five factors were extracted from both versions of CSES. However, in the CSES-DK, only one factor concerns emotions, whereas two factors describing emotions were obtained for the original scale. Furthermore, important discrepancies exist with respect to the direction of the scoring of CSES. In some studies, a high score indicates high self-efficacy, whereas it indicates low self-efficacy in other studies, which complicates the comparison of studies. The Danish version of CSES showed acceptable measurements of reliability and validity. Potential limitations of the scale were identified, and discrepancies exist between the factor structure of the original and Danish version. Consequently, more studies of the factor structure should be conducted on both the original CSES and the translated versions of the instrument. [ABSTRACT FROM AUTHOR]

Most studies of late Holocene sea-level changes generally assume stable tectonic conditions. However, unrecognized neotectonic 'noise', even the small rates of passive continental margins, can severely distort sea-level reconstructions of the late Holocene. The detailed sea-level curve proposed here is reconstructed by identification of an area ( Læsø archipelago in the Kattegat Sea) where small neotectonic level changes and other kinds of 'background noise' can be precisely quantified by advanced Li DAR techniques. We show that the absolute ('eustatic') sea level of Kattegat has risen by 110±14 cm since AD 1300 and that the Little Ice Age lowstand occurred between 1250 and 1750. Thereafter, four oscillations with a cyclicity of ∼70 years peaked around 1790, 1860, 1920-1950 (double peak), and at the present. We discuss the global implications of the curve, for example that the acceleration in the present sea-level rise may be part of this 70-year cyclicity, and that the non-anthropogenic sea-level rise between 1700 and 1790 seems faster than the present and projected sea-level rise for the 21st century. Moreover, the conspicuous sea-level fall at the beginning of the Little Ice Age confirms that ice-cap growth can be faster than ice-cap melting. By comparison with 29 long-term tide gauge measurements of the region we show that the isostatic implications of the sea-level curve are in nearly perfect agreement with Peltier's global isostatic VM2 model (applied by IPCC and PSMSL) and yield a 3-4 times smaller spread of isostatic rates. Owing to this higher precision it is possible to produce a reliable isostatic map of SW Scandinavia, Denmark, N Germany and NW Poland. This new map identifies an isostatic jump by ∼0.6 mm a−1 at the Ringkøbing- Fyn Basement High, separating the isostatic pattern of the North German Basin from the isostatic pattern of the Danish Basin and the Scandinavian Peninsula. [ABSTRACT FROM AUTHOR]

EGEROD I, STORLI SL and ÅKERMAN E. Nursing Inquiry 2011; 18: 235-246 Intensive care patient diaries in Scandinavia: a comparative study of emergence and evolution Critical illness and intensive care therapy are often followed by psychological problems such as nightmares, hallucinations, delusions, anxiety, depression, and symptoms of posttraumatic stress. Intensive care patient diaries have been kept by nurses and the patients' family since the early 1990s in the Scandinavian countries to help critically ill patients come to terms with their illness after hospital discharge. The aim of the study was to describe and compare the emergence and evolution of intensive care patient diaries in Denmark, Norway, and Sweden. The study had a comparative international design using secondary analysis of qualitative data generated by key-informant telephone interviews with intensive care nurses ( n = 114). The study showed that diaries were introduced concurrently in the three Scandinavian countries as a grass-roots initiative by mutual cross-national inspiration. The concept has evolved from a pragmatic practice to an evidence-based domain of inquiry propelled by academically prepared nurses. Several schools of thought were identified in our study: diaries as (i) a therapeutic instrument, (ii) an act of caring, (iii) an expression of empathy, and (iv) a hybrid of the above. Diaries have the potential to fulfill the existential needs of patients who struggle to make sense of their experiences and construct their own illness narrative. [ABSTRACT FROM AUTHOR]

Objective To explore the empirical support for a reclassification of the eating disorders NOS (EDNOS) category. Methods In a cross-sectional design eight specific subgroups of EDNOS were compared to anorexia nervosa (AN) and bulimia nervosa (BN) on interview-based data and questionnaire measures. The sample consisted of 965 patients in the age 13-54 years admitted to treatment for an eating disorder. Results According to the DSM-IV 176(18%) presented with AN, 290(30%) with BN and 499(52%) with EDNOS. Of all EDNOS cases 34% could be reclassified as AN or BN. Three specific subgroups emerged as separate diagnostic entities. A heterogeneous subgroup of 122 patients (13% of all) was proposed as 'true' EDNOS. Implications of the results on the DSM-V are discussed. Conclusions The results support a broader definition of AN and BN and suggest subgroups of EDNOS as separate diagnostic entities. This results in a substantial reduction of the heterogeneous EDNOS group. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective: To evaluate an immunofluorescence antibody test (IFAT) for diagnosis of schistosomiasis in nonimmune travellers and immigrants from endemic areas.Methods: 65 patients (48 Danes and 17 immigrants) with schistosomiasis were included. The diagnosis of schistosomiasis was based on the presence of schistosome eggs in faeces, urine, sperm, rectal or bladder biopsies and/or the presence of specific antibodies determined by the serological immunofluorescence antibody test (IFAT). Egg excretion was detected using conventional methods and the IFAT performed on whole S. mansoni schistosomula worms, harvested after 8 weeks from mice. Two patterns of immunofluorescence were observed: Fluorescence in the gut of the schistosome called 'Gut Associated Antigen, GAA', and fluorescence of the surface of the schistosomula called 'Membrane Bound Antigen, MBA'.Results: Eggs were found in 44% of the Danish patients and in 76% of immigrants. The diagnosis was based on a positive IFAT in 48% of the patients. In patients from nonendemic areas, the finding of antibodies against GAA was diagnostic while optimal sensitivity in the immigrants was reached by measuring antibodies against both GAA and MBA.Conclusion: In patients from nonendemic areas GAA is a sensitive marker of acute infection with schistosomiasis. In patients from endemic areas the demonstration of both GAA and MBA is necessary to properly identify long-lasting, nonacute infections. Egg-detection and/or measurement of CAA and CCA remain the methods of choice to monitor treatment as the immunofluorescence assay may remain positive for several years after treatment. [ABSTRACT FROM AUTHOR]