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Research Infrastructures (RI) and Core Facilities (CF) are strong drivers for generating research results and, thus, knowledge at European Universities. In this paper, we provide insight into different features of RI and CF, their organisational structure and governance, funding mechanisms, critical factors for success, and challenges and opportunities associated with implementing and operating these research support structures. Our results are based on a comparative analysis across six European universities from the 4EU + University Alliance. Due to the lack of a clear definition of RI and CF, we provide a variety of indicators and criteria attributed to such facilities and highlight differences between CF and RI in terms of goals and objectives. If establishing Core Facilities is seen as a response to the evolving needs and challenges of researchers, a centralised management and collaborative governance model can provide a practical solution. We explore the legal framework, organisation, access, users and charge rate models at Core Facilities. We also identify several challenges in setting up and maintaining Core Facilities. Special attention is directed towards staff challenges, including introducing the staff category of 'scientific technical experts'. Finally, we present a Core Facility Manifesto and share our conclusions.

In Danish universities, like elsewhere, there is an increased concern for students' mental health and well-being. In 2018 the Danish government implemented a new biannual national student survey that focuses on well-being as a new indicator in the performance-based funding model. In this article we explore the survey, which is similar to surveys from other national contexts, and discuss the possible effects on students and universities. We draw on a Foucauldian post-disciplinary conceptual framework that asks us to consider how the "psy-disciplines" play out in educational institutions and contexts. We show how the survey mobilises psychometrics based on positive psychology and argue that the survey, as a new form of governing at a distance, normalises a figure of the "positive" student, which may counteract the intention of addressing the lack of well-being. Further it responsibilises universities for how students "feel" rather than what they learn, which constitutes a significant change.

Inquiry-based science education (IBSE) has made a massive entry in science education classes. Students work with their competence development through inquiry. Such an approach calls for new strategies from the teachers to help students learn through inquiry. This study takes a descriptive approach to teachers' understanding and usage of such strategies. Through classroom observations, video analysis, and teacher interviews, three cases are identified to hold teacher practice against a theoretical framework on scaffolding strategies where focus is on the means and intentions of scaffolding. The findings show that teachers use different scaffolding strategies according to the students' level of inquiry understanding, and that scaffolding takes place in short sequences, but the findings also show that the teachers themselves are not aware of such differentiated usage of strategies. This calls for a both better understanding of teachers' usage of scaffolding strategies and for professional development in being aware of how to use such strategies for best practice with students.

The article focuses on Petersen Tegl, one of the six brickworks that remain in Nybølnorvej, Denmark. It notes that brick has been produced in the area since 1791, when King Christian VII granted the founder of the family business, smallholder Peter Andresen, permission to build a brickworks. Christian A. Petersen and his daughters are currently running the company. It also describes the unique Kolumba that Petersen has been producing and cites the reasons why the company fared so well.

Based on philosophical reflections on the concepts of place, place-based education, wild pedagogies and outdoor schooling in Denmark, the article presents and reflects upon selected results from a three-year accompanying qualitative research conducted in connection with a project for underserved young people and students. Approximately 40 participants aged 14-29 with social, personal, relational and/or substance abuse problems were enrolled as crewmembers on a schooner in periods ranging from a few weeks to six to eight months during the project's three-year duration. The results indicate that place, nature, an extended stay and the relationship competency of the crew are all factors that can have a positive and transformative impact on participants, supporting their efforts to get "on an even keel" - to use a maritime expression that alludes to keeping a vessel's keel steady, assuring smooth sailing.

The paper explores the challenges of designing personalised learning paths in SPOCs (Small Private Online Courses). It opens with a discussion on different approaches to tailoring teaching to individual needs and moves on to introduce a SPOC that was developed for Continuing Professional Development (CPD) for primary and lower-secondary teachers in Denmark. The SPOC, which performs adaptation using a recommendation system, allows for students to create a personalised learning path on the basis of three components: a learner profile, a content model and an adaptation model. Using the three components as a starting point, the SPOC is analysed in order to identify differences between the intended design (what the SPOC set out to do), the implemented design (how the SPOC is used by its users) and the attained design (the outcome of the SPOC). The analysis draws on data from a series of semi-structured interviews with SPOC students and their lecturers. We find that the implemented design deviates from the intended design in several respects, most notably in relation to how the personalised learning paths are created and how decisions as to curriculum contents are made. Moreover, it is suggested that differences between the intended design and the implemented design are rooted in differences in the learning perspectives of the students, the lecturers and the educational designers of the SPOC. Despite the fact that the implemented design deviates from the intended design, the attained design is nevertheless successful in that a high percentage of the students enrolled succeeded in passing their examinations and thus obtained the formal qualifications in the subjects they teach. It is concluded that further research in adaptive learning designs for online platforms such as MOOCs (Massive Open Online Course) and SPOCs is needed to minimise the gap between intended designs and implemented designs in order to create a more personalised learning experience for the students involved.

Designing teaching in an era of educational technology calls for new models for designing learning opportunities. The 7Cs framework developed by Professor Gráinne Conole and her colleagues provides a tool for discussing learning designs for online learning environments. In this paper, we introduce the 7Cs framework put forward by Conole and colleagues and discuss it in relation to the concept of personalized learning paths and 'schooling' as a discourse. The article is mainly theoretical, but as empirical support for our theoretical arguments, we discuss examples from a MOOC developed for the teacher education program at University College Absalon, Denmark. On this background, we propose a number of revisions for the 7Cs framework in order to adapt it for designing MOOCs that are used in blended contexts.

Denmark has persistent challenges with an unacceptably large 'residual group' of young people with no upper secondary education. Vocational education and training programs continue to suffer low enrollment and high dropout rates. Far too many ethnic minority boys drop out of school and educational system in Denmark. At the same time, there is a growing shortage of labor within science, technology, engineering, and mathematics (STEM). In this article, we introduce and discuss an educational approach, invented in the Pathway-to-Technology (P-Tech) schools in the US, as a reflection model for Denmark and Scandinavia and for teacher educators. P-Tech is the concerted pedagogical efforts of various educational institutions, businesses, and political initiatives aimed specifically at the large marginalized and vulnerable residual youth groups in the US.

Most European Union countries and members of the Organization of Economic Co-operation and Development (OECD) are facing increasing learner diversity in schools and are accommodating increasing numbers of children from ethnic minority and/or migrant backgrounds. International surveys from OECD indicate that teachers are in need of professional training to better prepare them for working in multicultural and multilingual classroom settings. The aim of this article is to briefly investigate how curriculum in the 2013 reform of Danish teacher education suggests that student teachers address classroom diversity.

Questionnaire design is routinely guided by classic experiments on question form, wording, and context conducted decades ago. This article explores whether two question order effects (one due to the norm of evenhandedness and the other due to subtraction or perceptual contrast) appear in surveys of probability samples in the United States and 11 other countries (Canada, Denmark, Germany, Iceland, Japan, the Netherlands, Norway, Portugal, Sweden, Taiwan, and the United Kingdom; N = 25,640). Advancing theory of question order effects, we propose necessary conditions for each effect to occur, and found that the effects occurred in the nations where these necessary conditions were met. Surprisingly, the abortion question order effect even appeared in some countries in which the necessary condition was not met, suggesting that the question order effect there (and perhaps elsewhere) was not due to subtraction or perceptual contrast. The question order effects were not moderated by education. The strength of the effect due to the norm of evenhandedness was correlated with various cultural characteristics of the nations. Strong support was observed for the form-resistant correlation hypothesis.

In the past decades, the importance of developing and validating informal and nonformal learning processes has been launched by several international organizations including UNESCO and the OECD, originally mostly focusing on adult learning experiences. Meanwhile, in recent years an increased focus has been evidenced on introducing informal and non-formal learning environments for learners at primary and secondary school levels as means of re-engaging in particular school-leavers, drop-outs, and disadvantaged learners in the formal educational system. Educational policy, empirical studies, projects, and various pedagogical interventions carried out in Europe, the United States, and other countries evidence this development. Based on empirical data and research from an European project "Anholt 2013" aimed at empowering disadvantaged and disengaged young European school-leavers, and motivating them to take responsibility for their own need for education, this article sets out to reflect whether informal and non-formal learning environments should be considered in teacher education and teaching.

This article focuses on the leadership used by the principal in a collaborative ICT project. The case study chosen was a school project conducted within the NCCE project (Nordic Cross Country Education). The EU funded project ran for three years in grades 5-9 in Sweden, Denmark and Norway. The goal of the project was to develop cross-border education models between the national education systems in the three countries. The project was based on virtual communication using digital technology. The study focuses on how the Swedish teachers from two schools involved in the NCCE project experienced the leadership of the principals in ICT related matters. A qualitative method was used by interviewing the teachers in order to inquire about what kind of support they had received from the school leadership on pedagogical issues, technical equipment and ICT competence. The ICT leadership was analyzed by Dexter's three basic features: "setting direction," "developing people" and "making the organization work." The result showed two kinds of leadership. The first one resembled a "distributed leadership," where the principal worked closely with teachers and ICT managers, almost like being one of the team. The second one resembled more a formal leadership where principals had a positive attitude towards ICT development but did not participate personally in the project work.

For decades foreign and second language teachers have taken advantage of the technology development and ensuing possibilities to use e-learning facilities for language training. Since the 1980s, the use of computer assisted language learning (CALL), Internet, web 2.0, and various kinds of e-learning technology has been developed and researched comprehensively to extend predominantly communicative language teaching approaches focusing on training language skills. While international, in the 2000s the use of web 2.0 technologies in particular has been introduced for developing reading and writing skills in Denmark with special attention towards the development of web-based materials for Danish pronunciation. This paper sets out to introduce differences between the international and Danish use of web-based language learning and teaching. Finally, dilemmas and challenges for the use of CALL, IT, and web 2.0 in L2 teaching and learning and in particular the teachers' key role in e-learning will be addressed.

It is often discussed whether dyslexics show a deviant pattern of reading and spelling development when compared to typically developing students, or whether they follow the same pattern as other students, only at markedly slower rate. The present cross-sectional study investigated phonological encoding skills in dyslexic Danish students. We compared dyslexic and non-dyslexic students from grades 3, 5, 7, and 9 and examined whether effects of item length were stronger in the dyslexic groups. Mixed between-within subjects analyses of variance revealed significant interactions between dyslexia status and item length as the dyslexics at all grade levels were more affected by item length than their non-dyslexic peers. A marked developmental delay was apparent as the dyslexic group from grade 9 performed on approximately the same level as the non-dyslexic group from grade 3. Although the overall difference between these two groups was not significant, a significant interaction between dyslexia status and item length remained because the grade 9 dyslexics were more affected by item length than the younger non-dyslexic students. This difference in error profiles suggests a difference in the developmental patterns of dyslexic vs. non-dyslexic students.

The third-person belief ascription, "Marie believes that the contract is in the cabinet," may engender two interpretations: (1) It neutrally describes what is on Marie's mind and (2) it offers indirect evidence about reality, committing the speaker to the cabinet as the most likely location. The circumstances that lead to the evidential interpretation are at present not well documented in the case of belief verbs. In the case of belief-dependent verbs with and without embedding clause syntax, for example, "Marie "says" that the contract is in the archive," and "Marie 'is looking for' the contract in the archive," it has been claimed that they eschew the evidential interpretation altogether. We explore the influence of the pragmatic context on the third-person, present tense and first-person, past tense use of the verbs, "believe," "say," and "look for." In three experiments that manipulated the discourse context, 258 adults rated written vignettes. Regardless of the verb and the tense, when presented in discourse contexts without prior shared knowledge of the location of the object in question, the belief ascription was interpreted as indirect evidence. The results illuminate the border area between semantics and pragmatics, particularly regarding evidential uses of belief and belief-dependent verbs.

The aim of this ethnographic field study was to investigate the influence of school-day social interactions on the well-being and social inclusion of children diagnosed with ADHD. The empirical data consisted of participant observations and informal interviews over a three-month period at a Danish primary school. Two ADHD-diagnosed 11-year-old boys in the fourth and fifth grades were followed on an alternating basis. The field notes were analysed using a qualitative content analysis that incorporated Etienne Wenger's concepts of social identity and participation. The results revealed that the effects of school-day social interactions are complex and situation dependent. Medication, friendships and relationships with teachers and other adults strongly influence how children diagnosed with ADHD participate in social interactions and, consequently, how they thrive. We argue that it is important to emphasise the mediation of these children's participation in the classroom community throughout an entire school day to ensure their social inclusion and well-being.

This study explores the incidence of poor comprehenders, that is, children identified as having reading comprehension difficulties, despite age-appropriate word reading skills. It supports the findings that some children do show poor reading comprehension, despite age-appropriate word reading, as measured with a phonological coding test. However, the proportion of poor comprehenders was smaller than the frequently reported 10-15%, and smaller yet, when average sight word recognition, measured with an orthographic coding test, was also set as a criterion for word reading skill. Compared to average comprehenders, the poor comprehenders' orthographic coding and daily reading of literary texts were significantly below those of average readers. This study indicates that a lack of reading experience, and likewise, a lack of fluent word reading, may be important factors in understanding 9-year-old poor comprehenders' difficulties.

In this paper we present a matrix-organised implementation of an experimental course in the history of the concept of a function. The course was implemented in a Danish high school. One of the aims was to bridge history of mathematics with the teaching and learning of mathematics. The course was designed using the theoretical frameworks of a multiple perspective approach to history, Sfard's theory of thinking as communicating, and theories from mathematics education about concept image, concept definition and concept formation. It will be explained how history and extracts of original sources by Euler from 1748 and Dirichlet from 1837 were used to (1) reveal students' meta-discursive rules in mathematics and make them objects of students' reflections, (2) support students' learning of the concept of a function, and (3) develop students' historical awareness. The results show that it is possible to diagnose (some) of students' meta-discursive rules, that some of the students acted according to meta-discursive rules that coincide with Euler's from the 1700s, and that reading a part of a text by Dirichlet from 1837 created obstacles for the students that can be referenced to differences in meta-discursive rules. The experiment revealed that many of the students have a concept image that was in accordance with Euler's rather than with our modern concept definition and that they have process oriented thinking about functions. The students' historical awareness was developed through the course with respect to actors' influence on the formation of mathematical concepts and the notions of internal and external driving forces in the historical development of mathematics.

The psychometric function of single-letter identification is typically described as a function of stimulus intensity. However, the effect of stimulus exposure duration on letter identification remains poorly described. This is surprising because the effect of exposure duration has played a central role in modeling performance in whole and partial report (Shibuya & Bundesen, 1988). Therefore, we experimentally investigated visual letter identification as a function of exposure duration. We compared the exponential, the gamma, and the Weibull psychometric functions, all with a temporal offset included, as well as the ex-Gaussian, the log-logistic, and finally the squared-logistic, which is a psychometric function that to our knowledge has not been described before. The log-logistic and the squared-logistic psychometric function fit well to experimental data. Also, we conducted an experiment to test the ability of the psychometric functions to fit single-letter identification data, at different stimulus contrast levels; also here the same psychometric functions prevailed. Finally, after insertion into Bundesen's Theory of Visual Attention (Bundesen, 1990), the same psychometric functions enable closer fits to data from a previous whole and partial report experiment. (Contains 8 figures.)

Drawing on material collected amongst Danish and Australian humanities and social science academics, the article illustrates and problematises a particular and recurring discursive practice amongst academics: "the conduct of concern". Conceptualising the conduct of concern as an exclusionary and de-legitimising discursive practice, the article offers a (mis)reading of some of the storylines and constructions it could be seen to invoke and reproduce--amongst others, the idea of the autonomous, rational academic subject. The author discusses the conduct of concern, as a particular kind of subject position and positioning, in terms of Donna Haraway's figure "the modest witness". The author suggests that the conduct of concern as a readily available exclusionary discursive practice in academia "smuggles in" and naturalises constructions and positionings associated with the autonomous rational subject, and participates in masking the discourse mobiliser's subjective and political investments. In that way, by appropriating the ubiquitous discursive practice academics might contribute to upholding constructions and practices they otherwise seek to disrupt.

Aim: To identify and discuss the contextual characteristics requisite for improving the use of evidence-based knowledge in a locally rooted clinical practice in Denmark. Background: In order to assist nurses to understand and use evidence-based knowledge in practice, an understanding of the clinical context is required. Methods: A survey was conducted to understand how clinical nurses experienced assessing and using evidence- based knowledge in their daily context. Data were generated from an open-ended question. Thematic content-analysis was conducted. Results: 349 nurses responded. Three themes were developed: 1) A supportive culture for evidence-based practice in nursing; 2) Leadership with visible goals, and 3) Facilitators for knowledge sharing. Conclusions: Cultural change, leadership and knowledge sharing were identified as essential factors in clinical nurses' access to and utilization of evidence-based practice. Future research needs to measure the impact of these factors on creating a learning culture and building knowledge networks between knowledge producers and users. [ABSTRACT FROM AUTHOR]

The ability to recognize and diagnose acid-base disorders is of the utmost importance in the clinical setting. However, it has been the experience of the authors that medical students often have difficulties learning the basic principles of acid-base physiology in the respiratory physiology curriculum, particularly when applying this knowledge to the analysis of arterial blood gases. Collaborative teaching strategies may enhance student performance in quizzes in undergraduate physiology courses. In particular, the so-called peer instruction technique has been reported to enhance both the transfer and retention of learned material in a time-efficient fashion. The Harvard professor Eric Mazur originally developed peer instruction for teaching physics to undergraduate students. In this teaching approach, specific questions are integrated in the conventional lecture format; in an initial "individual phase," students mark down their answer and rate how confident they are about the correctness of their answer, and this is followed by a "pair phase," where students are asked to convince their neighbor of their answer. After this, they may revise the answer and again rate their confidence in their second answer. This teaching approach may differ substantially from conventional group work, where students typically discuss questions in small groups and mark down their answer during the lecture. The present study attempts to implement and compare conventional group work and Mazur's peer instruction technique for teaching second-year medical students to diagnose common acid-base disorders by arterial blood gas analysis.

Presents results from a longitudinal study of Danish children of dyslexic and normally reading parents. Follows children from beginning of kindergarten to the beginning of grade 2. Finds children of dyslexics have an increased risk of dyslexia when dyslexia was defined as poor phonological recoding. Notes that all language measures in kindergarten were predictors of dyslexia. (PA)

The article presents the discussion on gymnasts in both retrospective and prospective injury surveillance studies. Topics include training culture and repression of female gymnasts making headlines and given rise to considerations in gymnastic federations worldwide; and Olympic Games in artistic gymnastics chosing to line up in suits with long legs for dissociatign themselves from sexualization.

Importance: Onset of mental disorders during childhood or adolescence has been associated with underperformance in school and impairment in social and occupational life in adulthood, which has important implications for the affected individuals and society.Objective: To compare the educational achievements at the final examination of compulsory schooling in Denmark between individuals with and those without a mental disorder.Design, Setting, and Participants: This population-based cohort study was conducted in Denmark and obtained data from the Danish Civil Registration System and other nationwide registers. The 2 cohorts studied were (1) all children who were born in Denmark between January 1, 1988, and July 1, 1999, and were alive at age 17 years (n = 629 622) and (2) all children who took the final examination at the end of ninth grade in both Danish and mathematics subjects between January 1, 2002, and December 31, 2016 (n = 542 500). Data analysis was conducted from March 1, 2018, to March 1, 2019.Exposures: Clinical diagnosis by a psychiatrist of any mental disorder or 1 of 29 specific mental disorders before age 16 years.Main Outcomes and Measures: Taking the final examination at the end of ninth grade and mean examination grades standardized as z scores with differences measured in SDs (standardized mean grade difference).Results: Of the total study population (n = 629 622; 306 209 female and 323 413 male), 523 312 individuals (83%) took the final examination before 17 years of age and 38 001 (6%) had a mental disorder before that age. Among the 542 500 individuals (274 332 female and 268 168 male), the mean (SD) age was 16.1 (0.33) years for the females and 16.2 (0.34) years for the males. Among the 15 843 female and 22 158 male students with a mental disorder, a lower proportion took the final examination (0.52; 95% CI, 0.52-0.53) compared with individuals without a mental disorder (0.88; 95% CI, 0.88-0.88). Mental disorders affected the grades of male individuals (standardized mean grade difference, -0.30; 95% CI, -0.32 to -0.28) more than the grades of their female peers (standardized mean grade difference, -0.24; 95% CI, -0.25 to -0.22) when compared with same-sex individuals without mental disorders. Most specific mental disorders were associated with statistically significantly lower mean grades, with intellectual disability associated with the lowest grade in female and male students (standardized mean grade difference, -1.07 [95% CI, -1.23 to -0.91] and -1.03 [95% CI, -1.17 to -0.89]; P = .76 for sex differences in the mean grades). Female and male students with anorexia nervosa achieved statistically significantly higher grades on the final examination (standardized mean grade difference, 0.38 [95% CI, 0.32-0.44] and 0.31 [95% CI, 0.11-0.52]; P = .54 for sex differences in the mean grades) compared with their peers without this disorder. For those with anxiety, attachment, attention-deficit/hyperactivity, and other developmental disorders, female individuals attained relatively lower standardized mean grades compared with their male counterparts.Conclusions and Relevance: Results of this study suggest that, in Denmark, almost all mental disorders in childhood or adolescence may be associated with a lower likelihood of taking the final examination at the end of ninth grade; those with specific disorders tended to achieve lower mean grades on the examination; and female, compared with male, individuals with certain mental disorders appeared to have relatively more impairment. These findings appear to emphasize the need to provide educational support to young people with mental disorders. [ABSTRACT FROM AUTHOR]

Discusses three issues related to day care in Denmark: (1) the tension women experience between work and home; (2) the ability of day care to nurture children; and (3) the monopolization of children's free time through organized activities. (RJC)

Introduction: Hyperglycaemia during hospitalisation is associated with a longer and more complicated admission and with increased mortality. Therefore, guidelines suggest that blood glucose should be less than 10 mmol/l. In this audit, we aimed to describe the prevalence of diabetes patients at four orthopaedic departments in the Capital Region of Denmark and to measure the quality of in-hospital diabetes management., Methods: We conducted audits of medical records in the electronic health record system for two months in 2019. All patients admitted were included in the audit. We gathered information on diabetes status, orthopaedic diagnosis, glycosylated haemoglobin and diabetes management., Results: Among 2,463 included patients, 10% had diabetes. The three most frequent diagnosis groups were infection, fracture of lower extremity and hospitalised for alloplastic surgery. The number of blood glucose measurements during 24-hour perioperative care was 6.5. Among patients analysed, 10-20% did not have their blood glucose measured in the days following surgery. Among patients, 64% received insulin 1-50% of the required times., Conclusion: We demonstrated that 10% of hospitalised patients suffer from diabetes. The audit also showed that blood glucose is generally measured according to guidelines, whereas the treatment of an elevated blood glucose is far from being given according to guidelines. This may potentially delay recovery and prolong hospitalisation., Funding: none., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Importance: Infections are recognized as playing a critical role in the risk of psychiatric disorders and suicidal behavior; however, few studies have evaluated the risk of eating disorders.Objective: To evaluate the association of hospitalization for infections and treatment with anti-infective agents with the risk of an eating disorder diagnosis.Design, Setting, and Participants: A nationwide, population-based, prospective cohort study of 525 643 girls born from January 1, 1989, to December 31, 2006, and followed up until December 31, 2012, was conducted using individual-level data drawn from Danish longitudinal registers. Data were analyzed from January 15 to June 15, 2018, using survival analysis models and adjusted for age, calendar period, parental educational level, and parental history of psychiatric illness.Exposures: Hospital admission for infections and prescribed anti-infective agents for infections.Main Outcomes and Measures: The main outcome of interest was diagnosis of an eating disorder (anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified) in a hospital, outpatient clinic, or emergency department setting. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and accompanying 95% CIs.Results: The study population consisted of 525 643 adolescent girls: 2131 received a diagnosis of anorexia nervosa (median [range] age, 15.2 [8.6-21.3] years), 711 received a diagnosis of bulimia nervosa (median [range] age, 17.9 [13.4-22.7] years), and 1398 received a diagnosis of an eating disorder not otherwise specified (median [range] age, 15.6 [8.6-21.6] years). A total of 525 643 adolescent girls were followed up for 4 601 720.4 person-years until a mean age of 16.2 years (range, 10.5-22.7 years). Severe infections that required hospitalization were associated with an increased risk of a subsequent diagnosis of anorexia nervosa by 22% (HR, 1.22; 95% CI, 1.10-1.35), bulimia nervosa by 35% (HR, 1.35; 95% CI, 1.13-1.60), and eating disorder not otherwise specified by 39% (HR, 1.39; 95% CI, 1.23-1.57) compared with adolescent girls without hospitalizations for infections. Infections treated with anti-infective agents were associated with an increased risk of a subsequent diagnosis of anorexia nervosa by 23% (HR, 1.23; 95% CI, 1.10-1.37), bulimia nervosa by 63% (HR, 1.63; 95% CI, 1.32-2.02), and eating disorder not otherwise specified by 45% (HR, 1.45; 95% CI, 1.25-1.67) compared with adolescent girls without infections treated with anti-infective agents.Conclusions and Relevance: The findings suggest that hospital-treated infections and less severe infections treated with anti-infective agents are associated with increased risk of subsequent anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified and that future studies should investigate whether these associations are causal and identify the exact mechanisms between infections and subsequent inflammatory processes with eating disorders. [ABSTRACT FROM AUTHOR]

Children of immigrants in Denmark have excess risk for some of the most well-established risk factors for cerebral palsy (CP). To study differences in risk of CP between children of immigrants and children of Danish-born mothers, and explore whether socioeconomic status drives any potential association. A register-based cohort study including 1,274,616 children born in Denmark between 1981 and 2007. Of these, 2807 had a validated CP diagnosis in the Danish CP Register. We estimated the risk of CP as odds ratios (OR) using logistic regression and assessed mediation through socioeconomic status using natural effect models. In children of Danish-born mothers, 2.2/1000 had CP overall and the prevalence was similar for children of immigrants. However, children of immigrants had lower risk of unilateral spastic CP than children of Danish native-born mothers; OR = 0.59 (95% CI:0.38–0.91) for Western and OR = 0.79 (95% CI:0.61–1.03) for Non-Western immigrants. By contrast, the risk of bilateral spastic CP was higher in children of Non-Western immigrants (OR = 1.27 (95% CI:1.05–1.53)), especially from Turkey and Pakistan compared with children of Danish native-born mothers. The mediation analysis revealed an indirect effect (through maternal educational level and household income) with an OR of 1.06 (95% CI:0.99–1.14) for children of Non-Western immigrants. While children of immigrants had lower risk of unilateral spastic CP than children of Danish-born mothers, the risk of bilateral spastic CP was increased in children of Non-Western immigrants. Socioeconomic status did not appear to be a significant contributor to the increased risk of bilateral spastic CP. • Ethnic inequality exist in the risk of cerebral palsy in Denmark. • Children of immigrants have a reduced risk of unilateral spasticity. • Children of Non-Western immigrants have an increased risk of bilateral spasticity. • Socioeconomic status does not contribute to the inequality in bilateral spasticity. [ABSTRACT FROM AUTHOR]

Importance: Infections have been associated with increased risks for mental disorders, such as schizophrenia and depression. However, the association between all infections requiring treatment and the wide range of mental disorders is unknown to date.Objective: To investigate the association between all treated infections since birth and the subsequent risk of development of any treated mental disorder during childhood and adolescence.Design, Setting, and Participants: Population-based cohort study using Danish nationwide registers. Participants were all individuals born in Denmark between January 1, 1995, and June 30, 2012 (N = 1 098 930). Dates of analysis were November 2017 to February 2018.Exposures: All treated infections were identified in a time-varying manner from birth until June 30, 2013, including severe infections requiring hospitalizations and less severe infection treated with anti-infective agents in the primary care sector.Main Outcomes and Measures: This study identified all mental disorders diagnosed in a hospital setting and any redeemed prescription for psychotropic medication. Cox proportional hazards regression was performed reporting hazard rate ratios (HRRs), including 95% CIs, adjusted for age, sex, somatic comorbidity, parental education, and parental mental disorders.Results: A total of 1 098 930 individuals (51.3% male) were followed up for 9 620 807.7 person-years until a mean (SD) age of 9.76 (4.91) years. Infections requiring hospitalizations were associated with subsequent increased risk of having a diagnosis of any mental disorder (n = 42 462) by an HRR of 1.84 (95% CI, 1.69-1.99) and with increased risk of redeeming a prescription for psychotropic medication (n = 56 847) by an HRR of 1.42 (95% CI, 1.37-1.46). Infection treated with anti-infective agents was associated with increased risk of having a diagnosis of any mental disorder (HRR, 1.40; 95% CI, 1.29-1.51) and with increased risk of redeeming a prescription for psychotropic medication (HRR, 1.22; 95% CI, 1.18-1.26). Antibiotic use was associated with particularly increased risk estimates. The risk of mental disorders after infections increased in a dose-response association and with the temporal proximity of the last infection. In particular, schizophrenia spectrum disorders, obsessive-compulsive disorder, personality and behavior disorders, mental retardation, autistic spectrum disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder and conduct disorder, and tic disorders were associated with the highest risks after infections.Conclusions and Relevance: Although the results cannot prove causality, these findings provide evidence for the involvement of infections and the immune system in the etiology of a wide range of mental disorders in children and adolescents. [ABSTRACT FROM AUTHOR]

Cervical intraepithelial neoplasia grade 2 has historically been the threshold for surgical excision, but because of high regression rates, many countries are transitioning to active surveillance. However, estimates for regression rates are based on small studies with heterogeneous definitions of regression and progression. This study aimed to describe regression and progression rates of cervical intraepithelial neoplasia grade 2 using nationwide healthcare registry data. This was a nationwide population-based cohort study on women aged 18 to 40 years who had undergone active surveillance for cervical intraepithelial neoplasia grade 2 in Denmark from 1998 to 2020. This study excluded women with a previous record of cervical intraepithelial neoplasia grade 2 or worse or surgical excision. Cumulative incidence functions were used to estimate the rates of regression and progression at 6, 12, 18, and 24 months after diagnosis. In addition, a modified Poisson regression was used to estimate the crude and adjusted relative risks of progression within 24 months stratified by index cytology and age. During the study period, 11,056 women underwent active surveillance, 6767 of whom regressed and 3580 of whom progressed within 24 months. This corresponded to regression rates of 62.9% (95% confidence interval, 61.9–63.8) and progression rates of 33.3% (95% confidence interval, 32.4–34.2) at 24 months of follow-up. Most women regressed (90%) or progressed (90%) within the first 12 months. Women with high-grade index cytology had a higher risk of progression than women with normal index cytology (adjusted relative, 1.58; 95% confidence interval, 1.43–1.76), whereas there was no difference in the risk of progression between women aged 30 and 40 years and women aged 23 to 29 years (adjusted relative risk, 0.98; 95% confidence interval, 0.88–1.10). The observed high regression rates of cervical intraepithelial neoplasia grade 2 supported the transition in clinical management from surgical excision to active surveillance, particularly among women with low-grade or normal index cytology. [ABSTRACT FROM AUTHOR]

Objective: To describe study design and procedures for a prospective randomized trial investigating whether radical prostatectomy (RP) ± radiation improves cause-specific survival in comparison with primary radiation treatment (RT) and androgen deprivation treatment (ADT) in patients with locally advanced prostate cancer (LAPC). Materials and methods: SPCG-15 is a prospective, multi-centre, open randomized phase III trial. Patients are randomized to either standard (RT + ADT) or experimental (RP with extended pelvic lymph-node dissection and with addition of adjuvant or salvage RT and/or ADT if deemed necessary) treatment. Each centre follows guidelines regarding the timing and dosing of postoperative RT and adjuvant treatment such as ADT The primary endpoint is cause-specific survival. Secondary endpoints include metastasis-free and overall survival, quality-of-life, functional outcomes and health-services requirements. Each subject will be followed up for a minimum of 10 years. Results: Twenty-three centres in Denmark, Finland, Norway and Sweden, well established in performing RP and RT for prostate cancer participated. Each country's sites were coordinated by national coordinating investigators and sub-investigators for urology and oncology. Almost 400 men have been randomized of the stipulated 1200, with an increasing rate of accrual. Conclusions: The SPCG-15 trial aims to compare the two curatively intended techniques supplying new knowledge to support future decisions in treatment strategies for patients with LAPC The Scandinavian healthcare context is well suited for performing multi-centre long-term prospective randomized clinical trials. Similar care protocols and a history of entirely tax-funded healthcare facilitate joint trials. [ABSTRACT FROM AUTHOR]

Triplet pregnancies are high risk for both the mother and the infants. The risks for infants include premature birth, low birthweight, and neonatal complications. Therefore, the management of triplet pregnancies involves close monitoring and may include interventions, such as fetal reduction, to prolong the pregnancy and improve outcomes. However, the evidence of benefits and risks associated with fetal reduction is inconsistent. This study aimed to compare the outcomes of trichorionic triplet pregnancies with and without fetal reduction and with nonreduced dichorionic twin pregnancies and primary singleton pregnancies. All trichorionic triplet pregnancies in Denmark, including those with fetal reduction, were identified between 2008 and 2018. In Denmark, all couples expecting triplets are informed about and offered fetal reduction. Pregnancies with viable fetuses at the first-trimester ultrasound scan and pregnancies not terminated were included. Adverse pregnancy outcome was defined as a composite of miscarriage before 24 weeks of gestation, stillbirth at 24 weeks of gestation, or intrauterine fetal death of 1 or 2 fetuses. The study cohort was composed of 317 trichorionic triplet pregnancies, of which 70.0% of pregnancies underwent fetal reduction to a twin pregnancy, 2.2% of pregnancies were reduced to singleton pregnancies, and 27.8% of pregnancies were not reduced. Nonreduced triplet pregnancies had high risks of adverse pregnancy outcomes (28.4%), which was significantly lower in triplets reduced to twins (9.0%; difference, 19.4%, 95% confidence interval, 8.5%–30.3%). Severe preterm deliveries were significantly higher in nonreduced triplet pregnancies (27.9%) than triplet pregnancies reduced to twin pregnancies (13.1%; difference, 14.9%, 95% confidence interval, 7.9%–21.9%). However, triplet pregnancies reduced to twin pregnancies had an insignificantly higher risk of miscarriage (6.8%) than nonreduced twin pregnancies (1.1%; difference, 5.6%; 95% confidence interval, 0.9%–10.4%). Triplet pregnancies reduced to twin pregnancies had significantly lower risks of adverse pregnancy outcomes, severe preterm deliveries, and low birthweight than nonreduced triplet pregnancies. However, triplet pregnancies reduced to twin pregnancies were potentially associated with a 5.6% increased risk of miscarriage. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Multi-resistant bacteria (MRB) are an emerging problem. Early identification of patients colonized with MRB is mandatory to avoid in-hospital transmission and to target antibiotic treatment. Since most patients pass through specialized emergency departments (EDs), these departments are crucial in early identification. The Danish National Board of Health (DNBH) has developed exposure-based targeted screening tools to identify and isolate carriers of meticillin-resistant Staphylococcus aureus (MRSA) and carbapenemase-producing Enterobacteriaceae (CPE)., Aim: To assess the national screening tools for detection of MRSA and CPE carriage in a cohort of acute patients. The objectives were to investigate: (i) if the colonized patients were detected; and (ii) if the colonized patients were isolated., Methods: This was a multi-centre cross-sectional survey of adults visiting EDs. The patients answered the DNBH questions, and swabs were taken from the nose, throat and rectum. The collected samples were examined for MRSA and CPE. Screening performances were calculated., Findings: Of the 5117 included patients, 16 were colonized with MRSA and four were colonized with CPE. The MRSA screening tool had sensitivity of 50% [95% confidence interval (CI) 25-75%] for carrier detection and 25% (95% CI 7-52%) for carrier isolation. The CPE screening tool had sensitivity of 25% (95% CI 1-81%) and none of the CPE carriers were isolated., Conclusion: The national screening tools were of limited use as the majority of MRSA and CPE carriers passed unidentified through the EDs, and many patients were isolated unnecessarily., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: The aim of this study was to describe the carrier prevalence and demographic variation of four different multiresistant bacteria (MRB) among acute patients in Danish emergency departments (EDs): methicillin-resistant Staphylococcus aureus (MRSA), carbapenemase-producing enterobacteria (CPE), extended-spectrum beta-lactamase-producing enterobacteria (ESBL) and vancomycin-resistant enterococci (VRE), and to analyse the association of MRB carriage to a range of potential risk factors., Design: Multicentre descriptive and analytic cross-sectional survey., Setting: Eight EDs and four clinical microbiology departments in Denmark., Participants: Adults visiting the ED., Main Outcome Measures: Swabs from nose, throat and rectum were collected and analysed for MRSA, ESBL, VRE and CPE. The primary outcome was the prevalence of MRB carriage, and secondary outcomes relation to risk factors among ED patients., Results: We included 5117 patients in the study. Median age was 68 years (54-77) and gender was equally distributed. In total, 266 (5.2%, 95% CI 4.6 to 5.8) were colonised with at least one MRB. No significant difference was observed between male and female patients, between age groups and between university and regional hospitals. Only 5 of the 266 patients with MRB were colonised with two of the included bacteria and none with more than two. CPE prevalence was 0.1% (95% CI 0.0 to 0.2), MRSA prevalence was 0.3% (95% CI 0.2 to 0.5), VRE prevalence was 0.4% (95% CI 0.3 to 0.6) and ESBL prevalence was 4.5% (95% CI 3.9 to 5.1). Risk factors for MRB carriage were previous antibiotic treatment, previous hospital stay, having chronic respiratory infections, use of urinary catheter and travel to Asia, Oceania or Africa., Conclusion: Every 20th patient arriving to a Danish ED brings MRB to the hospital. ESBL is the most common MRB in the ED. The main risk factors for MRB carriage are recent antibiotic use and travel abroad., Trial Registration Number: NCT03352167;Post-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Supervision via tele-ultrasound presents a remedy for lacking on-site supervision in focused cardiac ultrasound, but knowledge of its impact is largely absent. We aimed to investigate tele-supervised physicians' cine-loop quality compared to that of non-supervised physicians and compared to that of experts., Methods: We conducted a single-blinded cluster randomized controlled trial in an emergency department in western Denmark. Physicians with basic ultrasound competence scanned admitted patients twice. The first scan was non-supervised, and the second was non-supervised (control) or tele-supervised (intervention). Finally, experts in focused cardiac ultrasound scanned the same patient. Two blinded observers graded cine-loops recorded from all scans on a 1-5 scale. The outcome was the mean summarized scan gradings compared with a linear mixed-effects model., Results: In each group, 10 physicians scanned 44 patients. From the mean summarized gradings, on a scale from 4 to 20, the second non-supervised scan grading was 10.9 (95% CI 10.2-11.7), whereas the tele-supervised grading was 12.6 (95% CI: 11.8-13.3). From the first to the second scan, tele-supervised physicians moved 9% (1.09; 95% CI: 1.00-1.19; P = 0.041) closer to the experts' quality than the non-supervised physicians., Conclusion: Tele-supervised physicians performed scans of better quality than non-supervised physicians. The present study supports the use of tele-supervision for physicians with basic focused ultrasound competence in a setting where on-site supervision is unavailable., (© 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Background: Postoperative delirium (PD) is a well-known complication among elderly surgical patients and associated with increased morbidity, mortality and length of stay (LOS). In elective orthopedic surgery, including hip and knee arthroplasty (THA/TKA), most studies report incidences between 5% and 10%. The multimodal optimization of perioperative care (fast-track) aims to enhance recovery and reduce morbidity and LOS, but limited data are available on the effect on PD. Consequently, the study investigated signs of PD associated with LOS > 4 days.Methods: Prospective risk assessment study with retrospective analysis of discharge notes or medical records of signs of PD in 6331 elective primary unilateral THA and TKA patients ≥ 70 years, and LOS > 4 days. Preoperative patient characteristics collected from eight high volume centers with similar standardized fast-track protocols from January 2010 to November 2013.Results: We identified 43 (0.7%) cases of PD symptoms mentioned as a reason for LOS > 4 days among the 789 patients with LOS > 4 days (12.5% of all THA and TKA). PD patients had a mean age of 80.7 [[95% CI] 79.3-82.1] years, being 4.0 [[95% CI] 2.5-5.5] years older compared to patients without PD (P < 0.001). LOS was median 10 [[Q2-Q3] 7-14] days in the PD group vs. 3 [2-3] days in the non-PD group (P < 0.001), without differences in gender or site of arthroplasty (P = 0.139 and 0.499, respectively).Conclusion: Postoperative delirium symptoms contributing to LOS > 4 days in fast-track THA and TKA are rare in elderly patients. [ABSTRACT FROM AUTHOR]

Greenhouse gas (GHG) emissions from agriculture are a significant contributor to total Danish emissions. Consequently, much effort is currently given to the exploration of potential strategies to reduce agricultural emissions. This paper presents results from a study estimating agricultural GHG emissions in the form of methane, nitrous oxide and carbon dioxide (including carbon sources and sinks, and the impact of energy consumption/bioenergy production) from Danish agriculture in the years 1990–2010. An analysis of possible measures to reduce the GHG emissions indicated that a 50–70% reduction of agricultural emissions by 2050 relative to 1990 is achievable, including mitigation measures in relation to the handling of manure and fertilisers, optimization of animal feeding, cropping practices, and land use changes with more organic farming, afforestation and energy crops. In addition, the bioenergy production may be increased significantly without reducing the food production, whereby Danish agriculture could achieve a positive energy balance. [Copyright &y& Elsevier]

Introduction: With the increasing use of recreational trampolines, more injuries are seen in emergency depart-ments (ED). Little is known about the relationship between adherence to safety precautions and injuries. This retro-spective study aims to describe the types of injuries and the precautions taken when using trampolines, and to investigate the relationship between injuries and safety precautions., Methods: We reviewed patient lists and the medical records of children younger than 18 years who were treated between 1 April and 30 September 2014 at the ED of Hospital Unit West, Denmark. Demographic data and type of injury were recorded. Patients or guardians were contacted for a structured telephone interview to describe the safety precautions they had taken before the injury occurred. A total of 113 patients were identified, and 100 patients were included in the phone interviews. A total of 13 patients were excluded due to incorrect/missing phone numbers or lack of a Danish home address., Results: 6% of all children treated in the ED had trampoline-related injuries. A total of 58 (51.3%) patients had fracture injuries, and 55 (48.7%) patients had non-fracture injuries. 4% had complied with all five recommended safety precautions., Conclusions: This study describes types of injuries and safety precautions related to trampoline use. 6% of all children in the ED had an injury related to trampoline use. 4% complied with all five recommended safety precautions., Funding: none., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Background: Multiresistant bacteria (MRB) is an increasing problem. Early identification of patients with MRB is mandatory to avoid transmission and to target the antibiotic treatment. The emergency department (ED) is a key player in the early identification of patients who are colonized with MRB. There is currently sparse knowledge of both prevalence and risk factors for colonization with MRSA, ESBL, VRE, CPE and CD in acutely admitted patients in Western European countries including Denmark. To develop evidence-based screening tools for identifying carriers of resistant bacteria among acutely admitted patients, systematic collection of information on risk factors and exposures is required. Since a geographical variation is suspected, it is desirable to include emergency departments across the country. The aim of this project is to provide a comprehensive overview of prevalence and risk factors for MRSA, ESBL, VRE, CPE and CD colonization in patients admitted to Danish ED's. The objectives are to describe the prevalence and demography of resistance, co-infections, to identify risk factors for carrier state and to develop and validate a screening tool for identification of carriers., Methods: Multicenter descriptive and analytic cross-sectional survey from January-May 2018 of around 10.000 acutely admitted patients > 18 years in 8 EDs for carrier state and risk factors for antibiotic resistant bacteria. Information about the background and possible risk factors for carrier status together with swabs from the nose, throat and rectum is collected and analyzed for MRSA, ESBL, VRE, CPE and CD. The prevalence of the resistant bacteria are calculated at hospital level, regional level and national level and described with relation to residency, sex, age and risk factors. A screening model for identification of carrier stage of resistant bacteria is developed and validated., Discussion: The study will provide the prevalence of colonized patients with resistant bacteria on arrival to the ED and variation in demographic patterns, and will develop a clinical tool to identify certain risk groups. This will enable the clinician to target antibiotic treatments and to reduce the in-hospital spreading of resistant bacteria. This knowledge is important for implementing and evaluating antimicrobial stewardships, screening and infection control strategies., Trial Registration: Clinicaltrials.gov : NCT03352167 (registration date: 20. November 2017).

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub-elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score ( HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1-4) were included. Players completed in the beginning of the new season (July-Sept 2011) a self-reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45-52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26-36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub-elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season. [ABSTRACT FROM AUTHOR]

Biodiversity conservation efforts in Europe have traditionally focused on farmland and open nature areas such as grasslands, heathlands and meadows, while little attention has been devoted to conservation actions in forest. Using detailed information on the geographical distribution of about 900 terrestrial species in Denmark we apply systematic conservation planning techniques to identify how to protect biodiversity at the lowest cost to society. The results suggest that conservation actions in forest should be given a higher priority. Thus, three to four times the number of forest species are protected per million € compared with species living in open land natural areas. Furthermore, a gap analysis finds the current designation of Natura 2000 and other protected areas is skewed toward open land natural areas, and insufficient to meet the conservation targets on forest species. [ABSTRACT FROM AUTHOR]

Promotion of bioenergy production is an important contemporary topic around the world. Vast amounts of research are allocated towards analysing and understanding bioenergy systems, which are by nature multi-faceted. Despite a focus on the deployment of multi-criteria decision-making (MCDM) methods for planning of bioenergy systems, only little research has addressed the location component of bioenergy facility planning. In this paper the authors develop a model for sustainable capacity expansion of the Danish biogas sector allowing for an identification and prioritization of suitable locations for biogas production. The model builds on a framework for spatial planning and decision making through the application of spatial multi-criteria evaluation (SMCE). The paper is structured around a case study including four Danish municipalities in order to demonstrate the power of the spatial multi-criteria evaluation model. The model allows a two level comparison of suitability, within municipalities as well as between municipalities. Criteria weights for generation of alternatives are obtained through an analytical hierarchy process (AHP) analysis, carried out among a group of Danish central governmental decision makers. We find that resource and production economic criteria are given highest priority followed by environmental and social criteria. In all four case study municipalities, the identified alternatives are compared through incorporating economic, environmental and social criteria. It is found that 4–6% of the municipal area is suitable for biogas facility location and among the best performing sustainable locations the potential of reducing overall production costs is 3% as compared with current biogas plants. The results of this paper can provide support to central governmental decision makers, regarding regional allocation of subsidies in the country. Likewise local decision makers can obtain important information for planning and decision support, allowing for a more inclusive and transparent planning procedure. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between tobacco smoking and disease activity, treatment adherence and treatment responses in patients with AS treated with their first tumour necrosis factor-alpha inhibitor (TNFi) therapy in routine care., Methods: Observational cohort study based on the Danish nationwide DANBIO registry. Kaplan-Meier plots, Cox and logistic regression analyses by smoking status (current/never/previous) were calculated for treatment adherence and BASDAI 50%/20 mm-response. Additional stratified analyses were performed for gender and TNFi-type., Results: Of 1576 AS patients included in the study, 1425(90%) had known smoking status (current/never/previous: 43%/41%/16%). The median follow-up time was 2.02 years (IQR 0.69-5.01). At baseline, current smokers compared with never smokers had longer disease duration (4 years (1-12)/2 years (0-10)), higher BASDAI (61 mm (47-73)/58 mm (44-70)), BASFI (53 mm (35-69)/46 mm (31-66)) and BASMI (40 mm (20-60)/30 mm (10-50)) scores (all P < 0.01). Current and previous smokers had shorter treatment adherence than never smokers (current: 2.30 years (1.81-2.79) (median (95% CI)); previous: 2.48 years (1.56-3.40), never: 4.12 years (3.29-4.95)), P < 0.0001). Similar results were found in multivariate analyses (current versus never smokers, HR 1.41 (95% CI 1.21-1.65), P < 0.001), most pronounced among men. Current smokers had poorer 6 months' BASDAI50%/20 mm-response rate than never smokers (42%/58%, P < 0.001). In multivariate analyses, current smokers had lower odds of achieving BASDAI50%/20 mm-response than never smokers, both overall (OR 0.48 (95% CI 0.35-0.65), P < 0.0001) and for the different TNFi-types (adalimumab 0.45 (0.27-0.76)/etanercept 0.24 (0.10-0.61)/infliximab 0.57 (0.34-0.95))., Conclusion: In this study of TNFi-treated AS patients in clinical practice, current and previous smokers had significantly poorer patient-reported outcomes at baseline, shorter treatment adherence and poorer treatment response compared with never smokers., (© The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

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