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Purpose: Most patient-reported outcome (PROs) used in thrombosis research and clinical practice are delivered using technology like online questionnaires. However, only few have undergone formal electronic adaptation from paper to digital versions, threatening the validity and reliability of the PROs. The present study aimed to perform an electronic adaption and cross-cultural translation of two PROs measuring health-related quality of life in a Danish cohort of patients with venous thrombosis (VTE), specifically the VEINES-QoL/Sym questionnaire and the PEmb-QoL questionnaire. Methods: The electronic adaption and cross-cultural translation processes followed the international guidelines recommended by ISPOR. The migration of the questionnaires from paper to electronic versions was conducted in the Research Electronic Data Capture (REDCap). Following approval of the electronically adapted and translated versions, a pretest of the questionnaires was performed by cognitive interviewing patients with VTE recruited from a hospital setting. Results: Nine men and ten women between the age of 19 and 73 years participated in cognitive interviews. The questionnaires were successfully adapted from paper to electronic versions, and during the migration process only a few modifications to the content and format were made. Most comments were related to technicalities, e.g. touch functions and checkboxes. The cross-cultural translation of both questionnaires was satisfactory, as only minor rephrasing was required. Conclusions: The original and Danish version of VEINES-QoL/Sym and PEmb-QoL were successfully adapted into electronic versions and are ready to share for REDCap users. Furthermore, the Danish versions of the two questionnaires have shown satisfactory face validity. [ABSTRACT FROM AUTHOR]

Aims: To explore how parents experienced their child with delirium and how parents viewed our delirium management bundle. Design: We conducted a qualitative exploratory descriptive study using semi‐structured individual or dyad interviews. Methods: Twelve semi‐structured interviews with 16 parents of 12 critically ill children diagnosed with delirium in a paediatric intensive care unit were conducted from October 2022 to January 2023 and analysed through a reflexive thematic analysis. Findings: We generated five themes: (1) knowing that something is very wrong, (2) observing manifest changes in the child, (3) experiencing fear of long‐term consequences, (4) adding insight to the bundle, and (5) family engagement. Conclusion: The parents in our study were able to observe subtle and manifest changes in their child with delirium. This caused fear of lasting impact. The parents regarded most of the interventions in the delirium management bundle as relevant but needed individualization in the application. The parents requested more information regarding delirium and a higher level of parent engagement in the care of their child during delirium. Impact: This paper contributes to understanding how parents might experience delirium in their critically ill child, how our delirium management bundle was received by the parents, and their suggestions for improvement. Our study deals with critically ill children with delirium, their parents, and staff working to prevent and manage paediatric delirium (PD) in the paediatric intensive care unit. Reporting Method: The consolidated criteria for reporting qualitative research guidelines were used to ensure the transparency of our reporting. Patient or Public Contribution: No patient or public contribution to the research design. What does this Paper Contribute to the Wider Global Community?: ‐ It increases awareness of the parent's perspective on PD in critically ill children.‐ It shows how PD might affect parents, causing negative emotions such as distress, frustration, and fear of permanent damage.‐ It shows that the parents in our study, in addition to the care bundle, requested more information on delirium and more involvement in the care of their delirious child. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject: Treatment groups in Mental Health Service is cost‐effective, increases patients´ self‐understanding and stimulate changeResearch shows that people with mental illness have different barriers to attend group sessions which often originates from a lack of trust in other people, but it is known that the possibility to build gradual trust among the participants encourages attendance. What the paper adds to existing knowledge: This study is based on the experience from outpatients and illuminates how discovery groups from the Tidal Model can be used as introductory sessions to build gradual trust among people with mental illness before engaging in a person‐centred group intervention.The study fills a research gap in methods to create a safe and trusting environment in treatment groups for people with mental illness working with recovery‐oriented person‐centred interventions. What are the implications for practice: This study emphasizes the importance of meeting concerns about social interactions in persons with mental illness when joining treatment groups. It presents a recovery‐oriented method which meets this requirement and is easy to implement in practice. Introduction: Recovery‐oriented interventions delivered individually or in groups are more and more common within mental health nursing. However, persons with mental illness may be cautious about engaging in groups. Therefore, it is important to provide a trusting basis in the group to allow for the best opportunities to promote engagement, attendance and impact of treatment. Aim: The aim was to explore how discovery group sessions were experienced as introductory sessions from the perspectives of participants and facilitators before engaging in a person‐centred group intervention. Method: A qualitative interview study was conducted, involving four group facilitators and 16 participants with mental illness from five completed groups. Data were analysed with Ricoeur's theory of interpretation. Results: The findings showed that the two discovery group sessions were experienced as useful and meaningful to all and created a safe atmosphere and a trusted relationship among group participants and facilitators. Discussion: Feeling safe and sharing experiences and emotions contribute to the relational climate in a group. Implication for practice: Addressing concerns about social interactions in persons with mental illness is important in group treatment. This study proved that engaging patients in designing or adapting interventions for mental health services is important to improve quality. [ABSTRACT FROM AUTHOR]

The present paper explores how aging bodies of middle-aged women can enable and constrain participation in physical activity. The study is inspired by the process sociology of Norbert Elias and builds on qualitative empirical material from passive observations (N = 57), focus groups (N = 51), and individual follow-up interviews (N = 21) with middle-aged Danish women who participated in a 3-month research project with exercise intervention. The qualitative study found that awareness of bodily aging enabled the taking up of exercise in the intervention. Additionally, taking up regular exercise in midlife can be understood as a highly rationalized leisure-time activity in relation to societal moral norms of self-responsibility for own physiological health. Furthermore, the qualitative material indicates that participation enabled a self-realization among the middle-aged women, as strong and capable bodies counter to the biomedical view of decline in the aging body. [ABSTRACT FROM AUTHOR]

Patients previously examined for cancer with a negative result may present in general practice with ongoing or new symptoms or signs suggestive of cancer. This paper explores the potential existence of a relatively safe period for cancer occurrence after receiving negative examination results for specific types of cancer, including lung (CT thorax), upper gastrointestinal (gastroscopy), colorectal (colonoscopy), bladder (cystoscopy), and breast (clinical mammography). Register-based time-to-event analyses. Denmark. All 3.3 million citizens aged 30–85 years who on January first, 2017, had not previously been diagnosed with the specific type of cancer were categorized based on the time since their most recent examination. Using 1-year follow-up, we calculated the age- and sex-adjusted hazard ratios of being diagnosed with the related cancer, with non-examined individuals as reference. Negative examination results were defined as the absence of a cancer diagnosis within 6 months following the examination. Previous negative examination results were common, also among those diagnosed with cancer during follow-up. For 10 years after a negative colonoscopy the risk of diagnosing a colorectal cancer was nearly halved. However, already 1 year after a clinical mammography and 2 years after a CT thorax the risk of diagnosing the related cancers was significantly higher among those with a previous negative result compared to non-examined individuals. This study did not identify a post-examination period in which the cancer risk, compared to non-examined individuals, was sufficiently low to confidently rule out any of the investigated cancers. What should one expect when considering re-examining a patient with a negative result of a previous examination for cancer? We found that previous negative examination results are common in the general population and among those subsequently diagnosed with cancer. We did not find a safe period after any of the examinations in which a negative result alone could safely rule out the presence of cancer. [ABSTRACT FROM AUTHOR]

In this paper, we view health strategies in the field of personalised medicine as performative actions which articulate the development desired for a given society and demonstrate and affirm values and visions for that society. Based on a qualitative study in Denmark, we show how political actors and policy documents articulate visions for personalised medicine through a distinct sociotechnical imaginary. This sociotechnical imaginary mobilises the distinction between non-profit public and for-profit private organisations, placing personalised medicine in the public domain as the self-evidently desirable future for Danish health care In the Danish case, the issue of implementing personalised medicine becomes an opportunity to revisit the vision for the welfare state and verify public institutions as a shared space for state and citizens. While Danish political actors see personalised medicine as transformative, they articulate this transformation as being steered by public actors, at the same time downplaying the role of private companies. Where public health studies have focused on how political investments into personalised medicine may marginalise specific groups and populations, the Danish case shows that also powerful transnational players may be excluded from political discourse. It teaches us not to treat personalised medicine as one phenomenon, but to pay direct attention to the local contexts in which it operates and shapes what 'public' and 'health' become. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to describe the study design and respondent characteristics (including non-response analyses) of the Danish Health and Wellbeing Surveys in 2015 and 2019 and a follow-up survey that was carried out during the COVID-19 pandemic in 2020. Methods: The Danish Health and Wellbeing Survey is the Danish part of the European Health Interview Survey (EHIS). The samples in 2015 (N =12,000) and 2019 (N =14,000) were both based on a simple random selection of individuals aged ⩾15 years from the Danish Civil Registration System. All individuals from the sample in 2019 who were still alive and living in Denmark were reinvited for a follow-up survey in 2020 (N =13,474). Data in all surveys were collected via self-administered questionnaires (web or paper based). The questionnaires in 2015 and 2019 included the EHIS model questionnaire as well as national questions, whereas the questionnaire in 2020 mainly focused on physical and mental health, employment and working lives, and health behaviour. Results: The overall response proportion declined slightly between 2015 (48.4%) and 2019 (47.4%) but went up to 49.8% in the follow-up survey in 2020. Unit non-response was associated with, for example, male sex, younger age, being unmarried and lower educational level but not with degree of urbanisation. In all, 5000 individuals completed the questionnaire in both 2019 and 2020. Conclusions: The results are in line with most previous research on non-response in health surveys. However, an association between degree of urbanisation and non-response has been suggested in previous studies. This association was not found in our study. [ABSTRACT FROM AUTHOR]

Objectives: To investigate response rates for online and paper versions of an identical questionnaire and the differences between respondents to each and between respondents and non-respondents among a population with type 2 diabetes.Methods: We mailed letters containing an invitation to complete an online questionnaire to 2045 individuals, followed by two reminders; the second included a paper version of the questionnaire.Results: In total, 1081 people responded to either version of the questionnaire, yielding a response rate of 54%. Compared to total respondents, respondents completing the online version were more likely to be male, better educated, and younger, and have had diabetes for a shorter period of time. Compared to non-respondents, respondents were more likely to be male and have a lower hemoglobin A1c level.Conclusion: Web-based surveys are capable of delivering a substantial number of responses cost-effectively. However, disadvantages related to selection bias should be taken into account, and mixed-mode methods should be considered when surveying populations with type 2 diabetes. [ABSTRACT FROM PUBLISHER]

Aim: This article aims to describe the study design, including descriptive statistics on changes in response rates, characteristics associated with response and response mode distribution, in the Danish National Health Survey (DNHS) in 2010, 2013 and 2017. Methods: Each survey was based on five regional stratified random samples and one national random sample drawn from the Danish Civil Registration System. The subsamples were mutually exclusive. Around 300,000 individuals (aged ⩾16 years) were invited to participate in each survey using a mixed-mode approach (paper/web). A questionnaire with a minimum of 52 questions was used in all subsamples. In 2010 and 2013, invitations were sent via the regular postal service, whereas a secure electronical mail service was used to invite the majority (around 90%) in 2017. Weights accounted for survey design and non-response. Results: Participation decreased from 59.5% in 2010 to 54.0% in 2013 after which it increased to 58.7% in 2017. The proportion answering the web questionnaire increased from 31.0% to 77.4% between 2013 and 2017 and varied from 73.8% to 79.7% between the subsamples in 2017. Overall, the response rate was low among young men and old women and among individuals who were unmarried, had low sociodemographic status, were from ethnic minority backgrounds or were living in the eastern part of Denmark. Conclusions: The survey mode, response mode distribution as well as response rate have changed over time. Weights to handle non-response can be applied to accommodate possible problems in generalising the results. However, efforts should continuously be made to ensure that response is missing at random. [ABSTRACT FROM AUTHOR]

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]

Difficulties in recruiting newly bereaved families and following them over time present a major barrier in grief research following the death of a spouse/parent. We established FALCON—the first prospective nationwide cohort of families with children below age 18 years whose parent died in Denmark between April 2019 and July 2021. Data from parents and children were collected within 2 months of death with ongoing follow-up assessments up to 18 months post-death. A total of 992 families were invited. The final cohort consisted of 250 families (250 widowed parents, 134 adolescents, 120 children aged 6–12 years and 63 children aged 0–5 years). In this paper, we describe the rationale for the cohort's creation, the challenges of researching grief in families, the methods used and future plans to utilize this unique family-level dataset. [ABSTRACT FROM AUTHOR]

BACKGROUND: Digital applications have been vital to ensuring business continuity during the COVID-19 pandemic. Indeed, digital transformation is considered key to shaping Europe's future, including the opportunity for hybrid work. Consequently, a central issue is the experience and perception of workers and the effect on their mental well-being. OBJECTIVE: Building on the assumption that the more 'digitalized' and 'experienced with working from home (WFH),' the more positive peoples' perceptions are, this paper explores how workers in Italy and Denmark perceived WFH during the first COVID-19 lockdown from a psychosocial perspective and what lessons could be drawn for policy and industry. METHODS: Ranking top and bottom respectively on the European Digital Economy and Society Index (DESI) and different pre-pandemic experiences of WFH, data about WFH perceptions and mental well-being were collected among Danes and Italians via a survey from March to May 2020. The data were analyzed using descriptive statistics, t-tests, and ANOVA. RESULTS: The combination of high rank and pre-experience of WFH did not result in a positive perception of WFH. Mental well-being of Danes were mostly affected and they experienced WFH to be more challenging than the Italians, where the key disadvantages were related to "Home office constraints" and the isolation that followed. CONCLUSION: When digitalizing Europe and workplaces are likely to offer people the opportunity to have hybrid work, the results highlight how national conditions affect the prospects of the new ways of working including people's mental well-being and where actions are most needed for policy and industry. [ABSTRACT FROM AUTHOR]

Coercive measures are a major infringement of the autonomy of psychiatric patients and no medical justification exists for applying mechanical restraint (MR) to these patients currently. Knowledge regarding how preventive strategies affect the use of MR is limited. This paper aimed to understand the link between the initiatives taken by national authorities and the practical implications to MR reduction. Policy texts and the number of coercive measures used in two decades were reviewed. Trends were discussed with five experts with real-life experience and suggestions were obtained regarding how to end the use of mechanical restraint in mental health care settings. [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]

Summary: This paper demonstrates a large post-fracture anti-osteoporosis treatment gap in the period 2005 to 2015. The gap was stable in Denmark at around 88–90%, increased in Catalonia from 80 to 88%, and started to increase in the UK towards the end of our study. Improved post-fracture care is needed. Introduction: Patients experiencing a fragility fracture are at high risk of subsequent fractures, particularly within the first 2 years after the fracture. Previous studies have demonstrated that only a small proportion of fracture patients initiate therapy with an anti-osteoporotic medication (AOM), despite the proven fracture risk reduction of such therapies. The aim of this paper is to evaluate the changes in this post-fracture treatment gap across three different countries from 2005 to 2015. Methods: This analysis, which is part of a multinational cohort study, included men and women, aged 50 years or older, sustaining a first incident fragility fracture. Using routinely collected patient data from three administrative health databases covering Catalonia, Denmark, and the United Kingdom, we estimated the treatment gap as the proportion of patients not treated with AOM within 1 year of their first incident fracture. Results: A total of 648,369 fracture patients were included. Mean age 70.2–78.9 years; 22.2–31.7% were men. In Denmark, the treatment gap was stable at approximately 88–90% throughout the 2005 to 2015 time period. In Catalonia, the treatment gap increased from 80 to 88%. In the UK, an initially decreasing treatment gap—though never smaller than 63%—was replaced by an increasing gap towards the end of our study. The gap was more pronounced in men than in women. Conclusion: Despite repeated calls for improved secondary fracture prevention, an unacceptably large treatment gap remains, with time trends indicating that the problem may be getting worse in recent years. [ABSTRACT FROM AUTHOR]

This paper aims to provide knowledge on medical trainees' considerations about specialisation as they move from undergraduate to postgraduate medical education; especially their interest in general practice compared to other specialities. We developed and content-validated a questionnaire to examine medical trainees' speciality considerations and conducted a descriptive, cross-sectional study. All medical trainees initiating their internship in Denmark in 2022 (N = 1,188) were invited to participate in the study. Medical specialities were categorised as hospital service specialities, internal medicine specialities, primary care, psychiatry specialities and surgery and emergency specialities. Descriptive statistics were used to describe the cohort and examine the participants' speciality considerations by assigning them to one of the following three orientations: committed, undecided or non-committed to a speciality. The response rate was 38.8% (n = 461), and participants' mean age was 27.4 years with a majority of females (68.1%). Nearly 25% of the participants had general practice as speciality preference, and only 13.9% had excluded general practice for future specialisation. Overall, around half of the participants had general practice as a first, second or third preference for specialisation. Danish medical trainees show considerable interest in general practice at the time of their transition from undergraduate to postgraduate education. However, to meet future demands on the primary care, further recruitment of general practitioners is still needed. This knowledge of the specialities' recruitment potential will likely be of interest to medical educators and healthcare planners alike. [ABSTRACT FROM AUTHOR]

Aim: This paper describes the design of the 'Move More' study, which aims to develop and assess the feasibility of a social-prescribing intervention to increase physical activity among physically inactive Danes. Background: Physical inactivity constitutes a public-health challenge in Denmark. Social prescribing may be a promising tool to tackle physical inactivity by linking physical activity support from general practitioners with community-based activities in sports clubs, as this may help physically inactive citizens become more physically active. Given the range of stakeholders and behaviours required for social prescribing of physical activity, an intervention that harnesses this approach may constitute a complex intervention. The methods and decisions made in the stages of developing complex interventions are seldom reported. The present study enabled us to describe how co-creation can be used in a pragmatic development process for a complex intervention that considers the needs of stakeholders and the conditions of the delivery context. Methods: The study is based on the core elements of the development and feasibility phases of the Medical Research Council Framework for Developing and Evaluating Complex Interventions. Additionally, it is informed by a framework for the co-creation and prototyping of public-health interventions, drawing from a scoping review, stakeholder consultations and co-creation workshops. Ultimately, a feasibility study will be conducted to refine the programme theory by introducing the proposed intervention in case studies. Perspectives: The study will result in a prototype intervention manual and recommendations for implementation of an adapted social-prescribing intervention targeting physical inactivity in Denmark. [ABSTRACT FROM AUTHOR]

Background: Immersive virtual reality (VR) is increasingly used in organizational training interventions. However, few studies have systematically investigated VR compared to standard training methods in actual organizational contexts. Objectives: The focus of this study was to evaluate the effectiveness of a VR simulation for training professionals in the biotech industry. Aligning training needs to unique media affordances, the study designed an immersive story‐based VR simulation for training customer‐facing employees on a new product and tested it in an international biotech company. Methods: The system was evaluated by comparing its effectiveness to a traditional video presentation with the same content in a randomized between subjects experiment. The sample consisted of 95 employees across three locations: Brazil, Denmark, and USA. Results: The VR simulation group performed better than the video presentation group on the outcomes of conceptual knowledge (d = 0.41) spatial knowledge (d = 0.61), transfer intentions (d = 0.57), enjoyment (d = 1.74), self‐efficacy (d = 0.68), perceived learning (d = 0.89), personal value (d = 0.83), and organizational value (d = 0.82), but no significant difference was found for factual knowledge (d = −0.10). Implications: Results suggest that VR simulations can be effective across cultures in organizational training interventions. VR is specifically effective when the goals of the training are to increase conceptual and spatial understanding as well as enjoyment, and self‐efficacy, but not factual knowledge. Furthermore, employees report higher levels of perceived learning, personal and organizational value and transfer intentions after VR training compared to standard video‐based training. Lay Description: What is currently known about the subject matter: Immersive virtual reality (VR) is increasingly used in organizational training interventions. This interest has especially surged amid recent global challenges, and the sudden need for companies and employees to adapt to the new remote working conditions.However, few studies have systematically investigated VR compared to standard training methods in actual organizational contexts that include a real‐world scenario and a representative testing sample.Applied research that assesses the outcomes of VR based training in realistic learning and training settings is needed. What their paper adds: We propose and test an interdisciplinary approach that links unique features of VR with training needs and multidimensional outcome measures in an organizational training context within the biotech industry in Brazil, Denmark and USA.The findings suggest that a specifically designed VR tool is superior to a comparable video presentation for the outcomes of spatial and conceptual knowledge acquisition and transfer intentions, but not factual knowledge acquisition.The VR group also reported significantly higher personal value, organizational value, self‐efficacy, perceived learning, and enjoyment compared to the video group. Implications of study findings for practitioners: The results support the value of using VR simulations in organizational training, specifically related to affective outcomes as well as spatial and conceptual knowledge and transfer intentions.The study suggests that it is not the medium of VR, but rather the alignment between the training goals with the instructional methods and the unique affordances of VR that will contribute to better or worse learning outcomes.The article describes how to evaluate the effectiveness of VR tools in applied contexts, suggesting that we have to evaluate the effectiveness of tested content with respect to different outcome variables, which coincide with the training outcomes of a particular organizational context.The project as a whole, can be used as a blueprint for future applied research efforts, exemplifying how to bridge gaps between small‐medium‐enterprises, international corporate companies and academic institutions. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate whether implementing the Modified Early Warning Scoring system impacts nurses' free text notes related to Airway, Breathing, Circulation and Pain in general ward medical and surgical patients. Background: The quality of nursing documentation in patient health records is important to secure patient safety, but faces multiple challenges whether being paper‐based or electronic. Nurses' ability to draw a complete picture of the patient situation is thereby compromised. Structured use of the Modified Early Warning Score, found to reduce unexpected death, might affect nurses' free text documentation of clinical observations. Design: A prospective, pre‐ and postinterventional, nonrandomised study adhering to the EQUATOR guideline TREND. Methods: Data on nurses' free text notes were obtained in 1,497 patient records during one preinterventional (March–June 2009) and two postinterventional study periods (September–December 2010 and March–June 2011) in a Danish university hospital. Data were organised by the Airway, Breathing and Circulation principles and by nurses' working shifts in the 56 hr surrounding the first recording of deviating vital parameters or a Modified Early Warning Score ≥ 2. Preinterventional free text notes were compared with notes from the two postinterventional periods, respectively. Results: In the 8‐hr working shift where deviations in vital parameters were recorded for the first time, nurses' free text notes related to patients' breathing (B) increased significantly, comparing 2009 with 2010 and 2011, respectively. In the 24 hr following initial deviations in vital parameters, a significant increase in free text notes was identified concerning Airway, Breathing and Circulation‐related symptoms or problems. Conclusion: Mandatory use of the Modified Early Warning Score and related implementation activities significantly impacts nursing documentation of free text notes. Relevance to clinical practice: Nurses' practice of communicating observed clinical symptoms by documenting free text notes should be supported through measures to enhance situation awareness. [ABSTRACT FROM AUTHOR]

The outbreak of COVID-19 in early 2020 created dangerous public health conditions which pressured governments and health systems to respond in a rapid and effective manner. However, this type of rapid response required many governments to bypass standing; bureaucratic structures of health sector administration and political governance to quickly take; essential measures against a rapidly evolving public health threat. Each government's particular; configuration of governmental and health system decision-making created specific structural and functional challenges to these necessary centrally developed and coordinated strategies. Most East Asian governments (except Japan) succeeded relatively quickly in centralizing essential disease control and treatment initiatives in a timely manner. In contrast, a number of European countries, especially those with predominantly tax-based financing and politically managed health delivery systems, had greater difficulty in escaping bureaucratic governance and management constraints. Drawing on data about these governments' early stage COVID-19 control experiences, this article suggests that structural changes will be necessary if low-performing governments are to better respond to a pandemic. This paper also summarizes other relatively successful strategies. By adopting such strategies, nations can help overcome structural bureaucratic and administrative obstacles in responding to further waves of COVID-19 or similar future pandemic events. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding a study on the monetary costs and cost of illness analysis of bullying in the workplace among social care workers in the sector of elder care.

Background/objectives: Sedentary behavior (SB), defined as sitting (nonexercising), reclining, and lying down (posture), or by low energy expenditure, is a public health risk independent to physical activity. The objective of this systematic literature review was to synthesize the available evidence on amount of SB reported by and measured in older adults. Data source: Studies published between 1981 and 2014 were identified from electronic databases and manual searching. Large-scale population studies/surveys reporting the amount of SB (objective/ subjective) in older adults aged ≥ 60 years of age were included. Appraisal and synthesis was completed using MOOSE guidelines. Results: 349,698 adults aged ≥ 60 within 22 studies (10 countries and 1 EU-wide) were included. Objective measurement of SB shows that older adults spend an average of 9.4 hr a day sedentary, equating to 65-80% of their waking day. Self-report of SB is lower, with average weighted self-reports being 5.3 hr daily. Within specific domains of SB, older adults report 3.3 hr in leisure sitting time and 3.3 hr watching TV. There is an association with more time spent in SB as age advances and a trend for older men to spend more time in SB than women. Conclusion/ implications: Time spent sedentary ranges from 5.3-9.4 hr per waking day in older adults. With recent studies suggesting a link between SB, health, and well-being, independent of physical activity, this is an area important for successful aging. Limitations: Different methodologies of measurement and different reporting methods of SB made synthesis difficult. Estimated SB time from self-report is half of that measured objectively; suggesting that most self-report surveys of SB will vastly underestimate the actual time spent in SB. [ABSTRACT FROM AUTHOR]

This paper investigates the epidemiology and public health response of novel coronavirus infection (COVID-19) in the Nordic region. The data on cases and deaths due to COVID-19 were drawn from the European Centre for Disease Prevention and Control. The data on age- and sex-wise cases, deaths and intensive care unit (ICU) admissions, and public health interventions in the Nordic region through November 10, 2020, were obtained from respective countries' health ministries. Sweden accounted for 60.59% of cases (162 240 of 267 768 cases) and 81% of deaths (6057 of 7477 cases) in the Nordic region. The incidence rate for the Nordic region was 989.59 per 100 000, varying from 327.30 per 100 000 in Finland to 1616.51 per 100 000 in Sweden, and the mortality rate for the region was 27.63 per 100 000, ranging from 5.3 per 100 000 in Norway to 60.35 per 100 000 in Sweden. The case–fatality ratio of the Nordic region was 2.79%. Females were more susceptible to COVID-19 infection than males (52.30% vs 47.66%), while males had a greater proportion of deaths (54.7%) and ICU need (71.99%) than females. It is imperative to continue with social distancing, mandatory masks, testing, prohibition of mass gatherings, isolation of confirmed cases, and preventing the importation of cases from other countries to avoid the further resurgence of cases. [ABSTRACT FROM AUTHOR]

Purpose: Few papers have described results after periacetabular osteotomy (PAO) and risk factors for conversion to total hip arthroplasty (THA). The aim of the present paper was to analyse clinical and radiographic outcome, survival of the hip joint and risk factors of early conversion to THA in patients with PAO. Basic procedures: In the period 1999-2008, 93 patients (127 hips, median patient age 31, range 13-49 years) were operated on with PAO. Median follow-up was 7 (SD 2.1) years. Analyses of clinical and radiographic examinations, including WOMAC, were performed. Osteoarthritis was measured using Tönnis grade. Survival was assessed by the Kaplan-Meier method and predictors of conversion to THA were calculated using Cox regression analysis with THA as defined endpoint. Main findings: Centre-edge angle improved significantly with a mean of 8.7 (95% CI: 7.1; 10.3) preoperatively to a mean of 24.6 (95% CI: 22.6; 26.6) at follow-up. Likewise the acetabular roof obliquity angle improved significantly with a mean of 21.2 (95% CI: 19.7; 22.6) preoperatively to 8.7 (95% CI: 7.1; 10.4) at follow-up. Eleven out of 127 hips had conversion to THA. The 11.7 years cumulated hip joint survival rate was 85% (95% CI: 0.753; 0.945). Significant predictors of converting to THA were preoperative high grade of OA and postoperative high degree of acetabular roof obliquity angle. An improvement was found in Harris Hip Score pain score after receiving a PAO (p = 0.01). Conclusions: Our results, with almost 12 years survival data, are comparable with the literature. PAO is considered as an effective treatment for young adults with painful hip dysplasia, especially when preoperative criteria for conversion to THA are highlighted. [ABSTRACT FROM AUTHOR]

The paper examines the proposition from the law of 1 over n (Weingast et al. ) that project size tends to increase with common pool size. Comparable studies have tended, firstly, to focus on assets and debt rather than on expenditures and, secondly, on district population rather than on the number of districts as in the original formulation of the law. Both issues are sought to be remedied in this paper. The proposition is examined on Danish municipal expenditures from 1996 to 2006, using municipal mergers towards the end of this period as a quasi-experiment. A difference-in-difference identification strategy and a subsample strategy are used to identify the effect of the availability and size of a common pool on municipal expenditures. The paper finds positive, statistically and economically significant effects of the availability and size of a common pool in the final year of the treatment period. The importance of the number of districts over district population suggests a reappraisal of the law of 1 over n as originally formulated. [ABSTRACT FROM AUTHOR]

Introducing continental European approaches to UK child welfare practice raises a problem of comparison: to what extent are the problems and issues similar to or different from one country compared to another. Social pedagogues trained in continental Europe and working in English residential care services often encountered the phrase ‘our young people are worse’ from their English colleagues, with the implication that the social pedagogic approach was not suitable for the client group. This paper examines two propositions: (1) that in the context of introducing the continental European approach of social pedagogy into children's residential care services in England, young people are ‘different’ in England compared to other European countries and (2) that the placement options and practices for young people living away from their birth parents in continental European countries differ from those in England. Using data from a five nation study of young people from public care backgrounds, the paper argues that while family backgrounds are remarkably similar there are marked differences in the child welfare systems that might account for the perception that young people in care are ‘worse’ in England. [ABSTRACT FROM AUTHOR]

In emergencies, such as the COVID-19 pandemic, there is an increased need for contact with emergency medical services (EMS), and call volume might surpass capacity. The Copenhagen EMS operates two telephone line the 1-1-2 emergency number and the 1813 medical helpline. A separate coronavirus support track was implemented on the 1813 medical helpline and a web-based self-triage (web triage) system was created to reduce non-emergency call volume. The aim of this paper is to present call volume and the two measures implemented to handle the increased call volume to the Copenhagen EMS. This is a cross sectional observational study. Call volume and queue time is presented in the first month of the COVID-19 pandemic (27th of February 2020 to 27th of march) and compared to the equivalent month from the year before (2019). Descriptive statistics are conducted on call volumes and queue times and spearman's rank correlation test are performed to test correlation between web triage and call volume. Total EMS call volume increase by 23.3% between 2019 and 2020 (92.670 vs. 114,250). The 1-1-2 emergency line total call volume increase by 4.4% (8,4942 vs. 8,870) and the 1813 medical helpline increased by 25.1% (84.176 vs. 105.380). The coronavirus support track handled 21,063 calls. The 1813 medical helpline queue time was a mean of 02 minutes and 23 seconds (CI: 2.22-2.25) in 2019 and 12 minutes and 2 seconds (CI 11:55-12:09) in 2020 (P < 0.001). The web triage was used 10,894 times. No correlation between call volume and web triage usage was seen. In the first month of the ongoing COVID-19 pandemic a significant increase in call volume was observed in the 1813 medical helpline compared to 2019. A large number of calls were handled by the additional coronavirus track and diverted away from the regular tracks of the 1813 medical helpline. This likely contributed to mitigating increased call volumes and queue times. The web triage was widely used but no significant correlation was seen with 1813 medical helpline call volume. Other EMS organizations can learn from this to enhance capacity in a future epidemics. [ABSTRACT FROM AUTHOR]

This paper reports on a case study within an engineering consultancy firm, where engineering designers and ergonomists were working together on the design of a new hospital sterile processing plant. The objective of the paper is to gain a better understanding of the premises for integrating ergonomics into engineering design processes and how different factors either promote or limit the integration. Based on a grounded theory approach a model illustrating these factors is developed and different hypotheses about how these factors either promote and/or limit the integration of ergonomics into design processes is presented along with the model. [ABSTRACT FROM AUTHOR]

Introduction: Regular moderate‐to‐vigorous physical activity (MVPA) is associated with improved mental health, but the evidence for the effect of reducing sedentary behavior (SB) or increasing light PA (LPA) in older adults is lacking. Using isotemporal substitution (IS) models, the aim of this paper was to investigate the effect of substituting SB with LPA or MVPA on associations with mental health in older adults. Methods: Data from 1360 older adults (mean age 75.18 years) in four countries were utilized. PA and SB was measured using ActiGraph wGT3X‐BT + accelerometers worn for 7 days. Self‐rated mental health was measured using the Hospital and Anxiety Depression Scale (HADS). IS models estimated cross‐sectional associations when 30 minutes of one behavior was substituted with another. Models were adjusted for age, sex, marital status, and educational attainment. Results: Substituting 30 minutes of SB with LPA (β −.37; 95% CI −0.42, −0.32) or MVPA (β −.14; 95% CI −0.21, −0.07) and substituting LPA with MVPA (β −.11; 95% CI −0.18, −0.04) were associated with improvements in anxiety. However, substituting 30 minutes of SB with LPA (β.55; 95% CI 0.49, 0.62) was associated with increased depression. Conclusion: Replacing 30 minutes of SB with LPA or MVPA was associated with improved anxiety symptoms in older adults. Greater benefits were observed when shifting SB and LPA to MVPA. [ABSTRACT FROM AUTHOR]

Aim: To present the content, data quality, and research potential of the West Jutland Tele-Electrocardiogram Registry (WEJU-tECG). Methods: Danish patients reporting symptoms indicating heart disease in the prehospital setting are subjected to a 12-lead tele-electrocardiogram (ECG) in the ambulance, which is digitally sent to a local tele-centre. WEJU-tECG is a newly established Danish registry containing information from the individual tele-ECGs received at the Regional Hospital West Jutland tele-centre. Results: WEJU-tECG holds extracted information from all tele-ECGs with a valid Civil Personal Register number between 2011 and 2020. WEJU-tECG contains information on patient characteristics, tele-ECG data (including a computerised tele-ECG interpretation), vital signs, and time information. A unique Civil Personal Register number allows individual-level linkage between WEJU-tECG and other Danish registries and enables complete follow-up. WEJU-tECG contains 43,696 tele-ECGs from 29,489 different patient contacts among 20,280 different patients. WEJU-tECG contains 5566 patients with ST-segment deviations. The median age is 67 years and 45% are women. Completeness is highest for time information (100% for all variables), tele-ECG data (99% for heart rate, the specific intervals and axes, and QRS duration, and 86% for J-point deviation), and patient characteristics (100% for all variables). Completeness is lowest for vital signs (13% for systolic, diastolic, and mean arterial blood pressure, and 12% for blood oxygen saturation). The computerised tele-ECG interpretation had a negative predictive value of 80% for ST-segment elevation myocardial infarction and 94% for non-ST-segment elevation myocardial infarction and a positive predictive value of 45% for ST-segment elevation myocardial infarction and 32% for non-ST-segment elevation myocardial infarction. Conclusions: WEJU-tECG is a novel population-based tele-ECG registry with high research potential. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is a powerful public health intervention that produces long-term health benefits. However, in high-income countries such as Denmark, breastfeeding rates are suboptimal and unequally distributed across socio-economic positions. The 'Breastfeeding – a good start together' intervention, to promote longer duration of exclusive breastfeeding and reduce social inequity, was implemented in a cluster-randomised trial during 2022–2023 across 21 municipalities in two Danish regions. A process evaluation was conducted to assess the implementation, mechanisms of impact, and possible contextual factors affecting the intervention. Methods: The study was guided by the Medical Research Council's guidance for conducting process evaluations and employed a mixed-methods approach in a convergence design. Quantitative data: contextual mapping survey (n = 20), health visitor survey (n = 284), health visitor records from 20 clusters and intervention website statistics. Qualitative data: dialogue meetings (n = 7), focus groups (n = 3) and interviews (n = 8). Results: Overall, the intervention was delivered as planned to intended recipients, with few exceptions. Health visitors responded positively to the intervention, noting that it fitted well within their usual practice and enhanced families' chances of breastfeeding. Mothers expressed having received the intervention with few exceptions, and reacted positively to the intervention. Although health visitors were concerned about the potential stigmatisation of mothers receiving the intensified intervention, none of the interviewed mothers felt stigmatised. Contextual factors impacting the intervention implementation and mechanisms included staff and management turnover, project infrastructure and mothers' context, such as resources, social networks and previous experiences. The overall fidelity of the intervention delivery was high. Conclusions: Health visitors and families responded well to the intervention. Interventions aimed at enabling health care providers to deliver simplified and structured breastfeeding support, in alignment with support provided in other sectors of the health care system, may increase breastfeeding rates and reduce social inequity in breastfeeding, even in international contexts. Trial registration: Clinical Trials: NCT05311631. First posted April 5, 2022. [ABSTRACT FROM AUTHOR]

Background Rising global temperatures due to climate change pose a health risk. Mortality and morbidity increase during heat events affects various organ systems. While warmer countries face higher risks, even colder regions show elevated mortality during hot periods. This study examines physiological responses to heat exposure using data from the general Danish population cohort Lolland–Falster Health Study (LOFUS) during the summers of 2016–2019. Methods In this cross-sectional study, we analysed health data from 3804 individuals aged ≥15 years. Data were analysed across organ systems: cardiovascular system, lung function, renal system, inflammation, coagulation, and liver function. Meteorological data from the Danish Meteorological Institute provided information on temperature and humidity. Heat exposure was defined as one day ≥28°C heat index the day prior to examination. Adjusted multiple linear regression was applied to analyse differences between the two groups. Results There were 46 of 368 days with temperatures ≥28°C heat index. In total, 396 participants were heat-exposed (exposure group), while 3408 constituted the unexposed group. Heat exposure was associated with lower systolic blood pressure (−3.82 mm Hg [−5.72; −1.93]), higher heart rate (1.71 beats/min [0.45; 2.98]), lower oxygen saturation (−0.28% [−0.45; −0.10]), higher sodium (0.56 mmol/l [0.33; 0.79]), and higher urine albumin (0.14 mg/l [0.02; 0.27]). No significant differences were observed in inflammation, coagulation, or liver function. Conclusion This study reveals early physiological responses to heat with one day of heat exposure ≥28°C, particularly in the cardiovascular, pulmonary, and renal systems. These findings underline the need for tailored strategies to mitigate health risks associated with rising temperatures. [ABSTRACT FROM AUTHOR]

Simple Summary: Targeted therapies with BRAF- and MEK-inhibitors have significantly improved outcomes for patients with metastatic melanoma, but they come with a risk of heart-related side effects. This study included 108 real-world patients with metastatic melanoma from Eastern Denmark from 2019–2022 treated with encorafenib and binimetinib. Heart function was monitored with MUGA scans at baseline and every three months. While 18% of the patients experienced minor heart issues without symptoms, only 6% faced major problems, some needing medical intervention. However, no severe heart issues occurred beyond six months of starting the treatment. This suggests that it might be safe to reduce heart monitoring after six to nine months if no issues appear early on. Modern therapies targeting the BRAF gene mutation in advanced melanoma have significantly improved patient outcomes but pose cardiovascular risks. This retrospective study in Eastern Denmark (2019–2022) assessed 108 melanoma patients treated with encorafenib and binimetinib. Patients were monitored for heart function using multigated acquisition (MUGA) scans. The study defined major cardiotoxicity as a decline in left ventricular ejection fraction (LVEF) by more than 10 percentage points to below 50%, and minor cardiotoxicity as a decrease in LVEF by more than 15 points but remaining above 50%. Results showed that 19 patients (18%) developed minor cardiotoxicity and were asymptomatic, while 7 (6%) experienced major cardiotoxicity, with two requiring intervention. Notably, no significant declines in LVEF were observed after six months of treatment. The study concluded that significant cardiotoxicity occurred in 6% of cases, mostly asymptomatic and reversible, and suggests that monitoring LVEF could potentially be reduced after 6–9 months if no early signs of cardiotoxicity are detected. This provides valuable insights into the cardiac safety of these treatments in real-world settings. [ABSTRACT FROM AUTHOR]

Objectives: This study compares the follow-up rates of non-normal cervical screening samples between Denmark and Flanders (Belgium) to illuminate whether organizational differences between the health systems might affect the follow-up rates, e.g. sending of reminders in Denmark since 2012 compared to Flanders with no such system in place. Methods: The study population included 48,082 Danish women and 22,271 Flemish women who received abnormal or inadequate primary screening results from 2014 to 2016. The participants were followed for 24 months, and the timeliness and appropriateness of the recommended follow-up, according to national guidelines, were evaluated. Results: After 18 months over 90% of the Danish women had received some form of follow-up, while in Flanders, this level is achieved only for those who test positive for human papillomavirus. The analysis also revealed that 10–28% of follow-ups were performed too early, with Danish women showing the highest proportions. In both regions, general practitioners (GPs) exhibited better follow-up rates compared to gynaecologists, with gynaecologists displaying a tendency towards earlier re-testing than recommended. Conclusions: An important factor influencing the follow-up rate may be the sending of reminders in Denmark since 2012, as the follow-up rates in general were higher in this period. It is noteworthy that a reminder system is currently being implemented in Flanders and further studies on the potential effects should be studied. Additionally, the organization of the health system might influence the follow-up rate, as engaging the GP for screening in Denmark may have had a positive effect. [ABSTRACT FROM AUTHOR]

Background The Nordic countries represent a unique case study for the COVID-19 pandemic due to socioeconomic and cultural similarities, high-quality comparable administrative register data and notable differences in mitigation policies during the pandemic. We aimed to compare weekly excess mortality in the Nordic countries across the three full pandemic years 2020–2022. Methods Using data on weekly all-cause mortality from official administrative registers in Denmark, Finland, Norway and Sweden, we employed time series regression models to assess mortality developments within each pandemic year, with the period 2010–2019 used as reference period. We then compared excess mortality across the countries in 2020–2022, taking differences in population size and age- and sex-distribution into account. Results were age- and sex-standardized to the Danish population of 2020. Robustness was examined with a variety of sensitivity analyses. Results While Sweden experienced excess mortality in 2020 [75 excess deaths per 100 000 population (95% prediction interval 29–122)], Denmark, Finland and Norway experienced excess mortality in 2022 [52 (14–90), 130 (83–177) and 88 (48–128), respectively]. Weekly death data reveal how mortality started to increase in mid-2021 in Denmark, Finland and Norway, and continued above the expected level through 2022. Conclusion Although the Nordic countries experienced relatively low pandemic excess mortality, the impact and timing of excess mortality differed substantially. These estimates—arguably the most accurate available for any region in capturing pandemic-related excess deaths—may inform future research and policy regarding the complex mortality dynamics in times of a health crisis such as the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

In recent years, website aesthetics has received a fair amount of attention from the HCI community. This has led to the creation of a variety of multi-item questionnaires aimed at capturing users' aesthetic judgments. Researchers have used these questionnaires in several HCI studies to investigate the relationship between aesthetics and other evaluative constructs such as usability. However, their usefulness as evaluation tools in visual design practice remains underexplored. Lengthy multi-item questionnaires can be particularly problematic especially in studies where participants must evaluate multiple designs or when they are required to give responses repeatedly in predefined time intervals. Despite the criticism, single-item scales have been used in many past studies in which questionnaire length could be problematic. Another alternative available to practitioners/researchers are short versions of standardised multi-item questionnaires that have been created for the aesthetic evaluations of websites. In this paper, we present a study in which we compare the performance of three such condensed aesthetic questionnaires (i.e. aesthetics scale, AttrakDiff, VisAWI) during a website redesign project. The short versions of those questionnaires were used by 187 users during an evaluation of 7 alternative website designs. The questionnaires were compared on performance criteria such as reliability, validity, and predictive ability. Data analysis showed that although AttrakDiff's overall performance was better, a considerable amount of variance in aesthetic judgment could not be accounted for by any of the questionnaires. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on this subject?: There is a need to shed light on healthcare professionals' reactions to the use of the Guided Self‐Determination method in a mental health hospital to better understand and adjust the implementation process of evidence‐based practice.Healthcare professionals´ values and beliefs play an important role when implementing evidence‐based practice in real‐world healthcare settings. What this paper adds to existing knowledge?: The study identifies opposite positions in mental healthcare professionals: being ready or resistant to change when implementing an evidence‐based intervention. The positions are elaborated in four thematic dynamic continuums describing reactions to using the intervention.In addition, this is the first study to explore mental healthcare professionals´ reactions to using the Guided Self‐Determination method in a mental health context. What are the implications for practice?: When preparing implementation of an evidence‐based intervention, it is important to consider adaptation of the intervention, the mental healthcare professionals' acceptability, support from management and participation in supervision.In future research, it is important to consider collecting data from mental healthcare professionals trained in using an evidence‐based intervention, however not using it in clinical practice, to understand barriers towards evidence‐based practice. Introduction: Evidence‐based interventions are required in mental health nursing to improve quality and outcome for patients. However, there is a need to shed light on professionals' reactions to the use of evidence‐based interventions to better understand and adjust the implementation process. Aim: To explore mental healthcare professionals´ reactions to using the evidence‐based intervention Guided Self‐Determination method in the care of inpatients with severe mental illness. Method: A qualitative study conducted in relation to an 8 months implementation program. Data collection: 9 qualitative interviews and field notes generated from supervision of the intervention. Results: Four themes emerged from a thematic analysis: "The expert becomes novice," "Theory used as a looking glass," "Guided Self‐Determination perceived as an interruption" and "Becoming an informer of the impact of GSD." Discussion: Using the themes may help leaders or researchers predict or discover the support needed by individual professionals. Implications for practice: When preparing implementation of an evidence‐based intervention, it is important to consider adaptation and acceptability, as well as support from management and participation in supervision. Finally, it is worth to consider collecting data from trained professionals, who did not use the intervention in practice to understand barriers towards evidence‐based practise. [ABSTRACT FROM AUTHOR]

This paper explores the manner in which two hospices - one located in Denmark and one in Australia - negotiate and determine the boundaries of volunteer workers vis-à-vis paid staff. A comparative case study approach was used to juxtapose organisations with similar activity fields located in different welfare state systems, i.e. a social democratic welfare state and a liberal welfare state. This study involved non-participant observation of volunteers at work and unstructured interviews with volunteers, staff and management in the hospices ( n = 41). Data were collected between August 2012 and February 2013. Data were managed using NVivo and analysed thematically. A key finding is that volunteers in the Danish hospice were excluded from all direct care work due to the effective monopoly of the professional care providers, whereas the Australian volunteers participated in the provision of care to the extent that risk could be eliminated or mitigated to an acceptable level. The findings suggest two different models of the roles of volunteers in tension with professional care providers. Both models recognise that volunteers add to the level of care delivered by the organisations and allow for a discussion that moves away from the normative discussions of 'not taking somebody's job', while also recognising that volunteers must be more than just the 'nice extra' if they are to be of any real value to the organisation and to care receivers. [ABSTRACT FROM AUTHOR]

Background: Recognition of homogeneous subgroups of patients can usefully improve prediction of their outcomes and the targeting of treatment. There are a number of research approaches that have been used to recognise homogeneity in such subgroups and to test their implications. One approach is to use statistical clustering techniques, such as Cluster Analysis or Latent Class Analysis, to detect latent relationships between patient characteristics. Influential patient characteristics can come from diverse domains of health, such as pain, activity limitation, physical impairment, social role participation, psychological factors, biomarkers and imaging. However, such ‘whole person' research may result in data-driven subgroups that are complex, difficult to interpret and challenging to recognise clinically. This paper describes a novel approach to applying statistical clustering techniques that may improve the clinical interpretability of derived subgroups and reduce sample size requirements. Methods: This approach involves clustering in two sequential stages. The first stage involves clustering within health domains and therefore requires creating as many clustering models as there are health domains in the available data. This first stage produces scoring patterns within each domain. The second stage involves clustering using the scoring patterns from each health domain (from the first stage) to identify subgroups across all domains. We illustrate this using chest pain data from the baseline presentation of 580 patients. Results: The new two-stage clustering resulted in two subgroups that approximated the classic textbook descriptions of musculoskeletal chest pain and atypical angina chest pain. The traditional single-stage clustering resulted in five clusters that were also clinically recognisable but displayed less distinct differences. Conclusions: In this paper, a new approach to using clustering techniques to identify clinically useful subgroups of patients is suggested. Research designs, statistical methods and outcome metrics suitable for performing that testing are also described. This approach has potential benefits but requires broad testing, in multiple patient samples, to determine its clinical value. The usefulness of the approach is likely to be context-specific, depending on the characteristics of the available data and the research question being asked of it. [ABSTRACT FROM AUTHOR]

Background: Approximately 30–40% of heart patients develop anxiety and/or depression, which might influence recovery and long-term survival. Research has suggested that support from relatives may decrease anxiety and depression among heart patients; however, the results are inconsistent and often based on small study populations. Aim: The paper aimed to investigate the association between having supportive relatives and the occurrence of anxiety and depression in heart patients. Methods: A population-based cross-sectional study among Danish patients diagnosed with ischemic heart disease, atrial fibrillation, heart failure, or heart valve disease. Presence of supportive relatives was measured as the degree to which the patients felt that they had relatives they could count on, while symptoms of anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). Multiple logistic regression analyses accounting for confounders were used to examine the association between supportive relatives and anxiety/depression. Results: The questionnaire was answered by 2496 heart patients, corresponding to 50% of the invited population. Patients with low or some degree of supportive relatives had a higher odds ratio (OR) of anxiety than patients with a high degree (OR = 2.20, 95% confidence interval (CI): 1.28–2.37; OR = 1.75, 95% CI: 1.57–3.08, respectively). Likewise, patients with low or some degree of supportive relatives had a higher OR of depression than patients with a high degree (OR = 1.96, 95% CI: 1.40–2.66; OR = 1.93, 95% CI: 1.37–2.60, respectively). Conclusions: The presence of supportive relatives was found to be associated with lower occurrence of anxiety and depression. Health professionals should focus on including relatives in the treatment and rehabilitation of heart patients. [ABSTRACT FROM AUTHOR]

Background: Vocational rehabilitation programs (VRP) developing and improving work ability are used in Denmark to assist long-term unemployed citizens with complex problems. The aims of this study were to (1) describe VRP-participants in relation to general health, well-being, work ability and self-efficacy at baseline and one-year follow-up, (2) obtain an understanding of VRP-participants' personal development towards improving work ability, and (3) explore VRP-participants' hopes and thoughts about their future.Methods: In a mixed methods approach, data from a longitudinal survey and semi-structured interviews were collected. In the quantitative longitudinal survey, all participants completed paper questionnaires at baseline and one-year follow-up. For the qualitative semi-structured interviews, VRP participants were recruited with a maximum variation sampling strategy through VRP coordinators and personal contact. Data were analysed by descriptive statistics and systematic text condensation. Following analysis, data were merged and presented in combination according to identified themes.Results: At baseline and one-year follow-up 146 (response rate 34%) and 74 participants (response rate 52%) respectively, responded to the questionnaire. Seven participants were interviewed. The analysis revealed four themes: 1) Individual explanations of life situation and health; 2) Finding the path; 3) Work as giving meaning to life; 4) Hope for the future. Despite self-reported scores indicating poor general health, lack of well-being, low work ability and low self-efficacy, VRP-activities seemed to have assisted participants in finding meaning in life. VRP-components that may be drivers of successful recovery processes were identified.Conclusions: VRP-participants experienced life situations that include multifactorial burdens, and low levels of general health, well-being, work ability, and self-efficacy at baseline and 1 year later. From the outset, most did not have a clear goal of employment, but over time, new goals were set as realistic opportunities for re-developing their work ability were explored. Successful core components of VRP were individually tailored programs and support, development of new relationships, and accommodated flexible internships and jobs.Trial Registration: ClinicalTrials.gov Identifier: NCT02641704 , date of registration December 29, 2015. [ABSTRACT FROM AUTHOR]

Background: Inequity in healthcare utilisation refers to differences between groups that remain after adjustment for need for health care. To our knowledge, no previous studies have aimed to assess social inequity in chiropractic utilisation in a general population. Therefore, the objective of this study was to evaluate social inequity in chiropractic utilisation in the general Danish population adjusted for health status as a proxy of need for chiropractic care. Methods: A population-based repeated cross-sectional study design was used based on the Danish National Health Survey in 2010 and 2017. Overall, we included 288,099 individuals aged 30 years or older in 2010 or 2017. For each individual, information on chiropractic utilisation, socioeconomic status, and health status as a proxy of need for chiropractic care was retrieved from nationwide registers using the unique personal identification number. Measures of health status included demographics, poor self-rated physical health, activity limitations, musculoskeletal pain, number of musculoskeletal conditions, and number of chronic diseases. We investigated social inequity in chiropractic utilisation (yes, no) using logistic regression adjusted for health status, stratified by sex and year. Three characteristics of socioeconomic status (educational level, employment status and income) were investigated. To further quantify the degree of social inequity in chiropractic utilisation, we estimated the concentration index of inequity for each of the three characteristics of socioeconomic status. Results: We found significantly higher odds of chiropractic utilisation among individuals with short or medium/long education compared with individuals with elementary education, and among employed individuals compared with individuals who were unemployed, receiving disability pension or retired. Furthermore, the odds of chiropractic utilisation increased with higher income. The concentration index indicated social inequity in chiropractic utilisation in favour of individuals with higher socioeconomic status, with income and employment status contributing more to inequity than educational level. Conclusion: The study demonstrated social inequity in chiropractic utilisation in Denmark beyond differences in health status as a proxy of need for chiropractic care in the general population. The results suggest that new strategies are required if equal treatment for equal need is the goal. [ABSTRACT FROM AUTHOR]

Introduction: Holistic rehabilitation approaches addressing the numerous complex challenges in young persons with acquired brain injury are required. The purpose of this study was to describe and evaluate the holistic person-centered youth mentoring intervention program, which is based on occupational therapy. Methods: Prospectively collected data were extracted from a national clinical quality database (n = 59). Proportions of young persons receiving different aspects of support and proportions rating the intervention as meaningful were calculated. One-year changes in occupation, work ability, and social interactions were calculated. Results: The young persons most frequently received support for energy management (75%) and structuring of everyday life (61%). Seventy-three percent rated the intervention as meaningful. One year post-inclusion, occupation and work ability had increased by 35% and 58%, respectively, and it had declined by 10% and 26%, respectively. The 1-year increase and decrease in social interactions were less clear (15% and 25%, respectively). One-year changes did not differ between those who entered the program early or late after injury indicating the potential beneficial effect of the program. Conclusion: The findings could indicate that the program has a unique value in supporting young persons with acquired brain injury to create a meaningful everyday life through occupation, work ability, and social interaction. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, general practices in Denmark rapidly introduced video consultations (VCs) to prevent viral transmission. Aim: To study the use of VCs in daytime general practice by describing the rate of VCs, and the patient characteristics associated with having VCs. Design & setting: Register-based study of consultations in daytime general practice in Denmark. Method: We included all consultations in daytime general practice from 1 January 2019–30 November 2021. We calculated the rate of video use and categorised the general practices into no, low, and high use. Logistic regression was used to calculate adjusted odds ratios (aOR) for having a VC for different patient characteristics when contacting a video-using practice, stratified for low- and high-using practices. Results: A total of 30 148 478 eligible consultations were conducted during the pandemic period. VCs were used mostly during the early stage pandemic period, declining to about 2% of all clinic consultations in the late-stage period. Patients having more VCs were young, had a long education, were employed, and lived in big cities. In low-using practices, native Danes and 'western' immigrants had higher odds of receiving a VC than 'non-western' immigrants, and patients with ≥2 comorbidities had lower odds than those without comorbidities. Conclusion: Patients of a younger age, with long education, or employment had higher odds of receiving a VC, while patients of an older age and patients who had retired had lower odds. This difference in the access to VCs warrants further attention. [ABSTRACT FROM AUTHOR]

Background: The Good Life with osteoArthritis: Denmark (GLA:D™), an evidence-based education and exercise program designed for conservative management of knee and hip osteoarthritis (OA), has been shown to benefit participants by reducing pain, improving function, and quality of life. Standardized reporting in the GLA:D databases enabled the measurement of self-reported and performance-based outcomes. There is a paucity of qualitative research on the participants' perceptions of this program, and it is important to understand whether participants' perceptions of the benefits of the program align with reported quantitative findings. Methods: We conducted semi-structured telephone interviews with individuals who participated in the GLA:D program from January 2017 to December 2018 in Alberta, Canada. Data were analyzed using an interpretive description approach and thematic analysis to identify emergent themes and sub-themes associated with participants perceived benefits of the GLA:D program. We analyzed the data using NVivo Pro software. Member checking and bracketing were used to ensure the rigour of the analysis. Results: 30 participants were interviewed (70% female, 57% rural, 73% knee OA). Most participants felt the program positively benefited them. Two themes emerged from the analysis: wellness and self-efficacy. Participants felt the program benefited their wellness, particularly with regard to pain relief, and improvements in mobility, strength, and overall well-being. Participants felt the program benefited them by promoting a sense of self-efficacy through improving the confidence to perform exercise and routine activities, as well as awareness, and motivation to manage their OA symptoms. Twenty percent of participants felt no benefits from the program due to experiencing increased pain and feeling their OA was too severe to participate. Discussion: The GLA:D program was viewed as beneficial to most participants, this study also identified factors (e.g., severe OA, extreme pain) as to why some participants did not experience meaningful improvements. Early intervention with the GLA:D program prior to individuals experiencing severe OA could help increase the number of participants who experience benefits from their participation. Conclusion: As the GLA:D program expands across jurisdictions, providers of the program may consider recruitment earlier in disease progression and targeting those with mild and moderate OA. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to explore the expectations of and experiences with the public healthcare system of domestic partners of people with Parkinson's disease (PD) in Denmark and Norway. Methods: A qualitative exploratory design was applied. The sample consisted of 14 people from Denmark (n = 9) and Norway (n = 5) living with a partner with PD. Semi-structured individual interviews were conducted between June and September 2020, digitally recorded, transcribed verbatim and analysed using a reflexive thematic analysis approach combining inductive and deductive approaches. Results: The main themes were 'negotiating systems of support' and 'balancing being both a partner and a family carer'. Partners take responsibility for the people with whom they live and attempt to fill gaps in the public healthcare system. The most frequently described needs were more information, service coordination as the illness progressed and acknowledgement of the complex role. Discussion: A recommendation for practice is recognition of the complex roles of partners to people with PD and reaching out to both regularly to determine needs. This may enhance the collaboration between partner carers, people with PD and healthcare providers, ensure sustainability of the system and optimise living with PD in the family. [ABSTRACT FROM AUTHOR]

One of the core principles of providing care in general practice is giving more to those who need it most. We investigate some of the complexities of this ambition in the context of cancer care for patients defined as socially disadvantaged by their general practitioner (GP). We do this by exploring how care is sought, how it is offered, and what expectations patients and GPs carry with them when receiving and providing cancer care in the Danish welfare state. We carried out semi-structured interviews with eight GPs and seven socially disadvantaged cancer patients living with different types and stages of cancer. The interviews focused on needs and challenges in cancer follow-up in general practice and were thematically coded. Drawing on theoretical concepts of morality and Nordic individualism, we point to how one of the main challenges in cancer care and follow-up is to figure out how the doctor-patient relationship should be established, practiced, and maintained. Both GPs and patients stressed the importance of the relationship, but how it should be practiced amidst social norms about being a patient, a citizen and how care-seeking should unfold seems less clear. In conclusion we argue that giving more to those who need it the most is a difficult and ill-defined task that is shaped by the cultural, social, and political expectations of both GPs and patients. [ABSTRACT FROM AUTHOR]

Volunteer interventions play a vital role in supporting families by offering accessible and community-based resources outside the formal professional sector. This study examines the impact of the volunteer intervention known as Family Club Denmark (FCD) on the well-being of parents and children. FCD aims to provide families with positive experiences and support relationship building. The intervention, open to families from diverse social backgrounds, comprises volunteer-led family clubs where parents and children aged 2–12 years engage in activities and meals. We allocated 510 families (363 vulnerable families) to FCD or placed them on a waiting list based on a first-come, first-served principle. We conducted baseline, post-intervention, and follow-up assessments through questionnaires, observations, and interviews. On average, families participated in 5.8 sessions, with both families and volunteers reporting high satisfaction. When compared to control families, we find that vulnerable FCD parents feel more confident playing with their children (p = 0.04, [0.01; 0.40], d = 0.25), require less assistance in playing with their children (p = 0.01, [−0.34; −0.05], d = 0.33), and report that their children have a more challenging time forming friendships (p = 0.01, [−0.51; −0.09], d = 0.29). However, we did not find significant effects on mental health, parenting stress, self-efficacy, self-worth, family routines, or child well-being. We observed similar results for the full sample. The discovery that parents feel more confident playing with their children after participating in FCD highlights the vital role of volunteer-based interventions in enhancing parental engagement and fostering positive parent–child interactions. Trial registration: ClinicalTrials.gov NCT03657888 (registered 29 August 2018). [ABSTRACT FROM AUTHOR]

Background: Person-centred medicine is recommended in the care of older patients. Yet, involvement of care home residents and relatives in medication processes remains limited in routine care. Therefore, we aimed to develop a complex intervention focusing on resident and relative involvement and interprofessional communication to support person-centred medicine in the care home setting. Methods: The development took place from October 2021 to March 2022 in the Municipality of Aarhus, Denmark. The study followed the Medical Research Council guidance on complex intervention development using a combination of theoretical, evidence-based, and partnership approaches. The patient involvement tool, the PREparation of Patients for Active Involvement in medication Review (PREPAIR), was included in a preliminary intervention model. Study activities included developing programme theory, engaging stakeholders, and exploring key uncertainties through interviews, co-producing workshops, and testing with end-users to develop the intervention and an implementation strategy. The Consolidated Framework for Implementation Research and the Interprofessional Shared Decision Making Model were used. Data were analysed using a rapid analysis approach. Results: Before the workshops, six residents and four relatives were interviewed. Based on their feedback, PREPAIR was modified to the PREPAIR care home to fit the care home population. In total, ten persons participated in the co-producing workshops, including health care professionals and municipal managerial and quality improvement staff. The developed intervention prototype was tested for three residents and subsequently refined to the final intervention, including two fixed components (PREPAIR care home and an interprofessional medication communication template) delivered in a flexible three-stage workflow. Additionally, a multi-component implementation strategy was formed. In line with the developed programme theory, the intervention supported health care professionals´ awareness about resident and relative involvement. It provided a structure for involvement, empowered the residents to speak, and brought new insights through dialogue, thereby supporting involvement in medication-related decisions. The final intervention was perceived to be relevant, acceptable, and feasible in the care home setting. Conclusion: Our results indicate that the final intervention may be a viable approach to facilitate person-centred medicine through resident and relative involvement. This will be further explored in a planned feasibility study. [ABSTRACT FROM AUTHOR]

Introduction: Chronic non-cancer pain (CNCP) is a lifelong condition with radical consequences, calling for management involving patients' families. Interventions based on the family systems nursing framework by Wright and Leahey have proved beneficial in other populations but require investigation in a CNCP population. This trial assumed that family nursing conversations (FNCs) based on the family systems nursing framework would increase patients' and family members' self-efficacy concerning CNCP management. Objective: To investigate whether an intervention with FNCs as an add-on to the usual multidisciplinary treatment of CNCP would have an effect on patients' and family members' self-efficacy. Additionally, to investigate any impact on family function, health-related quality of life, anxiety, and depression. Methods: The trial applied a prospective non-blinded quasi-experimental design with two comparable groups of patients and family members: a historical control group (HCG) and an intervention group (IG). The intervention was executed by nurses employed at a multidisciplinary pain center in the Capital Region of Denmark. HCG data were collected before the nurses' intervention training. The primary outcome was self-efficacy. Secondary outcomes were family function, health-related quality of life, anxiety, and depression. Results: In total, 58 patients and 85 family members were included. The primary outcome, self-efficacy, detected no statistically significant between-group differences in mean change for patients, p =.990, or family members, p =.765. A statistically significant effect in favor of the IG was found in between-group differences in mean change in patients' behavioral family function, p =.034, and anxiety, p =.031. No statistically significant between-group differences were detected in family members' secondary outcomes. Conclusion: The intervention had no effect on patients' or family members' self-efficacy but a positive effect on patients' behavioral family function and anxiety. The intervention was deeply affected by the COVID-19 pandemic. Hence, any results should be interpreted with caution. [ABSTRACT FROM AUTHOR]