Search

Background: Type 2 diabetes (T2D) treatment has changed markedly within the last decades. We aimed to explore whether people with severe mental illness (SMI) have followed the same changes in T2D treatment as those without SMI, as multiple studies suggest that people with SMI receive suboptimal care for somatic disorders. Methods: In this registry‐based annual cohort study, we explored the T2D treatment from 2001 to 2015 provided in general practices of the Greater Copenhagen area. We stratified the T2D cohorts by their pre‐existing SMI status. T2D was defined based on elevated glycated hemoglobin (≥48 mmol/mol) or glucose (≥11 mmol/L) using data from the Copenhagen Primary Care Laboratory Database. Individuals with schizophrenia spectrum disorders (ICD‐10 F20–29) or affective disorders (bipolar disorder or unipolar depression, ICD‐10 F30–33) were identified based on hospital‐acquired diagnoses made within 5 years before January 1 each year for people with prevalent T2D or 5 years before meeting our T2D definition for incident patients. For comparison, we defined a non‐SMI group, including people who did not have a hospital‐acquired diagnosis of schizophrenia spectrum disorders, affective disorders, or personality disorders. For each calendar year, we assembled cohorts of people with T2D with or without SMI. We used Poisson regression to calculate the rates per 100 person‐years of having at least one biochemical test (glycated hemoglobin, low‐density lipoprotein cholesterol, estimated glomerular filtration rate, and urine albumin‐creatinine ratio), having poor control of these biochemical results, taking glucose‐lowering or cardiovascular medications, or experiencing a clinical outcome, including all‐cause mortality and cardiovascular mortality. Three outcomes (cardiovascular events, cardiovascular mortality, and all‐cause mortality) were additionally examined and adjusted for age and sex in a post hoc analysis. Results: From 2001 to 2015, 66,914 individuals were identified as having T2D. In 2015, 1.5% of the study population had schizophrenia spectrum disorder and 1.4% had an affective disorder. The number of people who used biochemical tests or had poor biochemical risk factor control was essentially unrelated to SMI status. One exception was that fewer LDL cholesterol tests were done on people with affective disorders and schizophrenia spectrum disorders at the beginning of the study period compared to people in the non‐SMI group. This difference gradually diminished and was almost nonexistent by 2011. There was also a slightly slower rise in UACR test rates in the SMI groups compared to other people with T2D during the period. Throughout the study period, all groups changed their use of medications in similar ways: more metformin, less sulfonylurea, more lipid‐lowering drugs, and more ACEi/ARBs. However, people with schizophrenia disorder consistently used fewer cardiovascular medications. Cardiovascular events were more common in the affective disorder group compared to the non‐SMI group from 2009 to 2015 (rate ratio 2015: 1.36 [95% CI 1.18–1.57]). After adjustment for age and sex, all‐cause mortality was significantly higher among people with a schizophrenia spectrum disorder each year from 2003 to 2015 compared to the non‐SMI group (rate ratio 2015: 1.99 [95% CI 1.26–3.12]). Conclusion: Persons with schizophrenia or affective disorders demonstrated the same treatment changes for T2D as those without SMI in general practice. The lower use of most types of cardiovascular medications among people with schizophrenia disorders indicates potential undertreatment of hypertension and dyslipidemia and remains throughout the study period. Cardiovascular events were most common among people with affective disorders, but this was not reflected in a higher proportion using cardiovascular preventive medications. This knowledge should be considered in the management of this vulnerable patient group. [ABSTRACT FROM AUTHOR]

It has been argued that persons with severe mental illness (SMI) receive poorer treatment for somatic comorbidities. This study assesses the treatment rates of glucose-lowering and cardiovascular medications among persons with incident type 2 diabetes (T2D) and SMI compared to persons with T2D without SMI. We identified persons ≥30 years old with incident diabetes (HbA1c ≥ 48 mmol/mol and/or glucose ≥ 11.0 mmol/L) from 2001 through 2015 in the Copenhagen Primary Care Laboratory (CopLab) Database. The SMI group included persons with psychotic, affective, or personality disorders within five years preceding the T2D diagnosis. Using a Poisson regression model, we calculated the adjusted rate ratios (aRR) for the redemption of various glucose-lowering and cardiovascular medications up to ten years after T2D diagnosis. We identified 1,316 persons with T2D and SMI and 41,538 persons with T2D but no SMI. Despite similar glycemic control at diagnosis, persons with SMI redeemed a glucose-lowering medication more often than persons without SMI in the period 0.5–2 years after the T2D diagnosis; for example, the aRR was 1.05 (95% CI 1.00–1.11) in the period 1.5–2 years after the T2D diagnosis. This difference was mainly driven by metformin. In contrast, persons with SMI were less often treated with cardiovascular medications during the first 3 years after T2D diagnosis, e.g., in the period 1.5–2 years after T2D diagnosis, the aRR was 0.96 (95% CI 0.92–0.99). For people with SMI in addition to T2D, metformin is more likely to be used in the initial years after T2D diagnosis, while our results suggest potential room for improvement regarding the use of cardiovascular medications. [ABSTRACT FROM AUTHOR]

Background Long-term preventive treatment such as treatment with statins should be reassessed among patients approaching end of life. The aim of the study was to describe the rate of discontinuation of statin treatment and factors associated with discontinuation in the 6 months before death. Methods This study is a retrospective cohort study using national registers and blood test results from primary health care patients. Patients in the Copenhagen municipality, Denmark who died between 1997 and 2018 and were statin users during the 10-year period before death were included. We calculated the proportion who remained statin users in the 6-month period before death. Factors associated with discontinuation were tested using logistic regression. Results A total of 55,591 decedents were included. More patients continued treatment (64%, n = 35,693) than discontinued (36%, n = 19,898) the last 6 months of life. The 70 and 80 age groups had the lowest odds of discontinuing compared to the 90 (OR 1.59, 95% CI 0.93–2.72) and 100 (OR 3.11, 95% CI 2.79–3.47) age groups. Increasing comorbidity score (OR 0.89, 95% CI 0.87; 0.90 per 1-point increase) and use of statins for secondary prevention (OR 0.89, 95% CI 0.85; 0.93) reduced the likelihood of discontinuation as did a diagnosis of dementia, heart failure, or cancer. Conclusion A substantial portion of patients continued statin treatment near end of life. Efforts to promote rational statin use and discontinuation are required among patients with limited life expectancy, including establishing clear, practical recommendations about statin discontinuation, and initiatives to translate recommendations into clinical practice. [ABSTRACT FROM AUTHOR]

Nordic cities are often perceived as frontrunners of urban sustainability and their planners increasingly embrace and combine environmentalist ideas with communicative planning approaches. We argue that how corporatist networks promote green growth strategies that can undermine sustainability targets is often overlooked. In this article, we examine how the City of Copenhagen is failing in its efforts to become the world's first carbon-neutral capital by 2025 partly because of corporatist capture of the decarbonisation agenda. Taking a phronetic social science approach we shed light on the production of knowledge and counter-knowledge in planning conflicts over energy infrastructure, in particular the iconic €530 million Copenhill waste-to-energy plant in Denmark. On one side of the conflict was a green coalition that initially blocked the proposed energy megaplant to defend the city's ambitious climate targets. On the other side was a corporatist coalition who subsequently succeeded in strong-arming the city council to accept the plant, even though that meant carbon emissions would increase significantly, instead of decreasing. We focus on this U-turn in the planning process as a case of dark planning and a knowledge co-creation fiasco. Our findings reveal how the sustainability concept can be utilised as an empty vessel to promote private sector export agendas. We suggest that environmentalist ideals may stand stronger in planning conflicts if they link up with a broader alternative socio-economic agenda capable of attracting coalition partners. The lesson to be learned for green coalitions is that it is crucial to combine expert, local, and political knowledge to be able to "read' the power configuration and develop strategic and tactical capacity to challenge dominant discourses. [ABSTRACT FROM AUTHOR]

The article argues that the present Danish urban policy and urban democracy can be characterized by a striking duality and tension between: (1) Participatory empowering welfare oriented community strategies, which targets deprived districts and neighbourhoods, which are based on notions of the inclusive city. This trend is founded on priorities of radical democracy, social justice, inclusion and citizens empowerment; (2) Neo-elitist/corporative market driven strategic regional and global growth strategies, which are based on notions of the Entrepreneurial Globalized City and where urban policy becomes a question of facilitation of the "growth machine" and neo-liberalized urban authoritarianism. The article discusses dilemmas for overcoming the growing tension between elitist neo-corporate growth regimes, which are in operation via "Quangoes" and closed elite networks, and community empowerment and welfare oriented policy in the age of globalization. Taking the stand of community empowerment and welfare policy, the article conclusively discusses ways to shape a new inclusive politics of difference including using "positive selectivism" as part of an empowerment strategy. [ABSTRACT FROM AUTHOR]

The Orestad project is representative of large-scale changes in urban planning and governance in Copenhagen. Until the seventies urban policy was characterised by top-down rational planning. The post-war «golden age of the Welfare City" rested on a strong centralised City Hall administration which had remained in the hands of a powerful Social Democratic regime since the beginning of the century. During the seventies the effectiveness and legitimacy of the regime was challenged by i) a weakening of the urban economy due to industrial decline and demographic changes, which eroded the tax-base, and ii) powerful leftist forces and successful mobilisation on the part of new urban movements. The latter challenged the top-down style of planning and governance and pushed for community-based participatory, urban regeneration. In the beginning of the eighties the political and institutional dislocation of the regime combined with a financial crisis of the municipality. This in turn led in the mid and late eighties to more severe conflicts with the state (from 1982-92 in the hands of a Liberal-Conservative coalition) over additional grants. From the late eighties on, state- initiated pressure for a Metropolitan strategic growth policy contributed to the shift in urban policy in the nineties towards an «Entrepreneurial City» strategy linked to the emerging cross-border regional strategy. The Orestad project was the result the formation of a strategic growth partnership between the state and the city of Copenhagen. In this strategy the project is the flagship-project of the Oresunds region. At the start of the millennium the urban policy orientation and governance can be characterised by a duality between 1) Participatory, empowering welfare-oriented strategies, which target deprived districts and neighbourhoods and are based on notions of the diverse and solidaristic City, and 2) Neoelitist/corporative market driven growth strategies, which are based on notions of the Entrepreneurial City. The tension and possible mediation between the two orientations represents a major challenge for a system of urban governance wishing to confront social polarisation in the urban space. [ABSTRACT FROM AUTHOR]