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Background: The COVID‐19 pandemic was a global health and economic crisis. In the early phase of the pandemic, studies found that populations were reporting lower levels of mental well‐being and high levels of distress and worry. This study investigated potential protective and risk factors such as sociodemographics and psychological factors such as adaptation/coping. Methods: Two convenience samples from Norway and Denmark were recruited during the early phase of the first lockdown in May 2020 using snowball sampling primarily by social media. Measures included the Patient Health Questionnaire‐4 (PHQ‐4) for screening anxiety and depression, COVID‐19 distress, and coping strategies applied during the lockdown. Descriptive analyses were applied as well as bivariate correlations for associations between coping and mental health measures. Results: Levels of anxiety and depression were not alarmingly high, but being young, single, and female constituted a higher risk for poorer mental health. Applying positive reframing strategies was negatively associated with poor mental health and high COVID‐19 stress, whereas distraction coping strategies were positively correlated with poor mental health and high COVID‐19 stress. Conclusion: Applying positive reframing as a coping strategy may constitute a protective factor for mental health in the early phase of a crisis such as a pandemic. This knowledge may inform public health agencies on how to promote mental health in similar situations in the future. However, longitudinal and qualitative studies are needed to investigate the long‐term effects of the different coping strategies applied. [ABSTRACT FROM AUTHOR]

Objective: Timely diagnosis of cancer is important for prognosis. Patients' health literacy (HL) may impact differences of diagnostic delays. Thus, we aim to explore the association between HL and diagnostic intervals in cancer. Methods: Questionnaire data were obtained from patients with cancer diagnosed in 2016 and their general practitioner (n = 3890). The primary care interval (PCI) and the diagnostic interval (DI) were calculated using dates from national registries and questionnaires. A long PCI and DI were defined as ≥75th percentile. HL was assessed using scales from the Health Literacy Questionnaire: engaging with healthcare providers (scale 6:Engagement, n = 3008), navigating in healthcare (scale 7:Navigation, n = 2827) and understanding health information (scale 9:Knowledge, n = 3002). Low HL was defined as a score ≤3. Results: Low HL was reported by 12.2% (Engagement), 27.0% (Navigation) and 9.3% (Knowledge) of the patients and associated with a long PCI after adjustment of socio‐economic factors: Engagement (prevalence rate ratio [PRR] 1.27 [95% CI 1.01–1.60]), Navigation (PRR 1.41 [95% CI 1.10–1.80]) and Knowledge (PRR 1.32 [95% CI 1.03–1.68]). No association was found between HL and DI. Conclusion: HL may interfere with the diagnostic processes in general practice. Efforts to manage low HL include GPs' awareness of patients' ability to explain and respond to bodily changes and use of corresponding safety‐netting strategies. [ABSTRACT FROM AUTHOR]

The EU Water Framework Directive (WFD) aims to protect the ecological status of coastal waters. To establish acceptable boundaries between good and moderate ecological status, the WFD calls for reference conditions practically undisturbed by human impact. For Denmark, the nitrogen (N) concentrations present around year 1900 have been suggested to represent reference conditions. As the N load of coastal waters relates closely to runoff from land, any reduction in load links to agricultural activity. We challenge the current use of historical N balances to establish WFD reference conditions and initiate an alternative approach based on parish-level land-use statistics collected 1896/1900 and N concentrations in root zone percolates from experiments with year 1900-relevant management. This approach may be more widely applicable for landscapes with detailed historic information on agricultural activity. Using this approach, we find an average N concentration in root zone percolates that is close to that of current agriculture. Thus, considering Danish coastal waters to be practically unaffected by human activity around year 1900 remains futile as 75% of the land area was subject to agricultural activity with a substantial potential for N loss to the environment. It appears unlikely that the ecological state of coastal waters around year 1900 may serve as WFD reference condition. [ABSTRACT FROM AUTHOR]

Background: To explore and compare safety, efficiency, and health-related quality of telephone triage in out-of-hours primary care (OOH-PC) services performed by general practitioners (GPs), nurses using a computerised decision support system (CDSS), or physicians with different medical specialities. Methods: Natural quasi-experimental cross-sectional study conducted in November and December 2016. We randomly selected 1294 audio-recorded telephone triage calls from two Danish OOH-PC services triaged by GPs (n = 423), nurses using CDSS (n = 430), or physicians with different medical specialities (n = 441). An assessment panel of 24 physicians used a validated assessment tool (Assessment of Quality in Telephone Triage - AQTT) to assess all telephone triage calls and measured health-related quality, safety, and efficiency of triage. Results: The relative risk (RR) of poor quality was significantly lower for nurses compared to GPs in four out of ten items regarding identifying and uncovering of problems. For most items, the quality tended to be lowest for physicians with different medical specialities. Compared to calls triaged by GPs (reference), the risk of clinically relevant undertriage was significantly lower for nurses, while physicians with different medical specialties had a similar risk (GP: 7.3%, nurse: 3.7%, physician: 6.1%). The risk of clinically relevant overtriage was significantly higher for nurses (9.1%) and physicians with different medical specialities (8.2%) compared to GPs (4.3%). GPs had significantly shorter calls (mean: 2 min 57 s, SD: 105 s) than nurses (mean: 4 min 44 s, SD: 168 s). Conclusions: Our explorative study indicated that nurses using CDSS performed better than GPs in telephone triage on a large number of health-related items, had a lower level of clinically relevant undertriage, but were perceived less efficient. Calls triaged by physicians with different medical specialities were perceived less safe and less efficient compared to GPs. Differences in the organisation of telephone triage may influence the distribution of workload in primary and secondary OOH services. Future research could compare the long-term outcomes following a telephone call to OOH-PC related to safety and efficiency. [ABSTRACT FROM AUTHOR]

We investigated the interacting effects of inorganic nitrogen and the main inorganic phosphorus form in dairy manure (dicalcium phosphate, CaHPO4) on growth, nutrient uptake, and rhizosphere pH of young maize plants. In a pot experiment, three levels of CaHPO4 (0, 167, and 500 mg P pot−1) were combined with nitrogen (637 mg N pot−1) applied at five NH4‐N : NO3‐N ratios (0 : 100, 25 : 75, 50 : 50, 75 : 25, and 100 : 0) and a nitrification inhibitor in a concentrated layer of a typical acid sandy soil from Denmark. 15N‐labeled NH4‐N was applied to differentiate the role of nitrification and to partition nitrogen uptake derived from NH4‐N. Among treatments including nitrogen, shoot biomass, rooting and phosphorus uptake were significantly higher at the five‐leaf stage when CaHPO4 was applied with NH4‐N : NO3‐N ratios of 50 : 50 and 75 : 25. In these treatments, rhizosphere pH dropped significantly in direct proportion with NH4‐N uptake. The fertilizers in the concentrated layer had a root‐inhibiting effect in treatments without phosphorus supply and in treatments with pure NO3‐N or NH4‐N supply. Increased nitrogen uptake as NH4‐N instead of NO3‐N reduced rhizosphere pH and enhanced acquisition of applied CaHPO4 by young maize plants, which may have positive implications for the enhanced utilization of manure phosphorus. [ABSTRACT FROM AUTHOR]

Objective: To develop a valid and reliable assessment tool able to measure quality of communication, patient safety and efficiency in out-of-hours (OOH) telephone triage conducted by both general practitioners (GP) and nurses. Design: The Dutch KERNset tool was translated into Danish and supplemented with items from other existing tools. Face validity, content validity and applicability in OOH telephone triage (OOH-TT) were secured through a two-round Delphi process involving relevant stakeholders. Forty-eight OOH patient contacts were assessed by 24 assessors in test-retest and inter-rater designs. Setting: OOH-TT services in Denmark conducted by GPs, nurses or doctors with varying medical specialisation. Patients: Audio-recorded OOH patient contacts. Main outcome measures: Test-retest and inter-rater reliability were analysed using ICCagreement, Fleiss' kappa and percent agreement. Results: Major adaptations during the Delphi process were made. The 24-item assessment tool (Assessment of Quality in Telephone Triage - AQTT) measured communicative quality, health-related quality and four overall quality aspects. The test-retest ICCagreement reliability was good for the overall quality of communication (0.85), health-related quality (0.83), patient safety (0.81) and efficiency (0.77) and satisfactory when assessing specific aspects. Inter-rater reliability revealed reduced reliability in ICCagreement and in Fleiss' kappa. Percent agreement revealed satisfactory agreements when differentiating between 'poor' and 'sufficient' quality). Conclusion: The AQTT demonstrated high face, content and construct validity, satisfactory test-retest reliability, reduced inter-rater reliability, but satisfactory percent agreement when differentiating between 'poor' and 'sufficient' quality. The AQTT was found feasible and clinically relevant for assessing the quality of GP- and nurse-led OOH-TT. KEYPOINTS: Comparative knowledge is sparse regarding quality of out-of-hours telephone triage conducted by general practitioners and nurses. The assessment tool (AQTT) enables assessment of quality in OOH telephone triage conducted by nurses and general practitioners AQTT is feasible and clinically relevant for assessment of communication, patient safety and efficiency. AQTT can be used to identify areas for improvement in telephone triage [ABSTRACT FROM AUTHOR]

Background: Malignant melanoma (MM) is increasing rapidly in Northern Europe. To reduce incidence and mortality through earlier diagnosis, public awareness of MM is important. Thus, we aim to examine awareness of risk factors and a symptom of MM, and how awareness varies by country and socio-demographic factors in Denmark, Northern Ireland (NI), Norway and Sweden. Methods: Population-based telephone interviews using the 'Awareness and Beliefs about Cancer' measure were conducted in 2011 among 8355 adults ≥50 years as part of the International Cancer Benchmarking Partnership Module 2. Prevalence ratios (PRs) with 95% confidence intervals were calculated. Results: In these four countries, lowest awareness was found for 'sunburn in childhood' (63%), whereas awareness was high for 'use of sunbeds' (91 %) and 'mole change' (97%). Lack of awareness of 'sunburn in childhood' was more prevalent among respondents from Norway [PR = 1.38 (1.28-1.48)] but less prevalent among respondents from Northern Ireland (NI) [PR = 0.78 (0.72-0.85)] and Sweden [PR = 0.86 (0.79-0.93)] compared with respondents from Denmark. Lack of awareness of 'use of sunbeds' was more prevalent among respondents from Norway [PR = 2.99 (2.39-3.74)], Sweden [PR = 1.57 (1.22-2.00)], and NI [PR = 1.65 (1.30-2.10)] compared with respondents form Denmark. Being a man, age ≥70, living alone, and having lower education, were each independently associated with lack of MM-awareness. Conclusions: The results indicate relatively low awareness of 'sunburn in childhood' as a risk factor for MM, and important disparities in MM-awareness across countries and socio-demographic groups. Improved and more directed initiatives to enhance public MM-awareness, particularly about 'sunburn in childhood', are needed. [ABSTRACT FROM AUTHOR]

Background: Chronic diseases and multimorbidity are common in western countries and associated with increased breast cancer mortality. This study aims to investigate non-participation in breast cancer screening among women with chronic diseases and multimorbidity and the role of time in this association.Method: This population-based cohort study used regional and national registries. Women who were invited to the first breast cancer screening round in the Central Denmark Region in 2008-09 were included (n = 149,234). Selected chronic diseases and multimorbidity were assessed up to 10 years before the screening date. Prevalence ratios (PR) were used as an association measure.Results: The results indicated that women with at least one chronic condition were significantly more likely not to participate in breast cancer screening. In adjusted analysis, a significantly higher likelihood of non-participation was found for women with cancer (PR = 1.50, 95% CI: 1.40-1.60), mental illness (PR = 1.51, 95% CI: 1.42-1.60), chronic obstructive pulmonary disease (PR = 1.51, 95% CI: 1.42-1.62), neurological disorders (PR = 1.24, 95% CI: 1.12-1.37) and kidney disease (PR = 1.70, 95% CI 1.49-1.94), whereas women with chronic bowel disease (PR = 0.75, 95% CI 0.65-0.88) were more likely to participate than women without these disease. Multimorbidity was associated with increased non-participation likelihood. E.g. having 3 or more diseases was associated with 58% increased non-participation likelihood (95% CI: 27-96%). Higher non-participation was also observed for women with severe multimorbidity (PR = 1.53, 95% CI: 1.23-1.90) and mental-physical multimorbidity (PR = 1.54, 95% CI: 1.36-1.75).Conclusion: In conclusion, we found a strong association between non-participation in breast cancer screening for some chronic diseases and for multimorbidity. The highest propensity not to participate was observed for women with hospital contacts related to the chronic disease in the period closest to the screening date. [ABSTRACT FROM AUTHOR]

Background: A cost-effective identification of HLA- DQ risk haplotypes using the single nucleotide polymorphism (SNP) technique has recently been applied in the diagnosis of celiac disease (CD) in four European populations. The objective of the study was to map risk HLA- DQ haplotypes in a group of Danish CD patients using the SNP technique. Methods: Cohort A: Among 65 patients with gastrointestinal symptoms we compared the HLA- DQ2 and HLA- DQ8 risk haplotypes obtained by the SNP technique (method 1) with results based on a sequence specific primer amplification technique (method 2) and a technique used in an assay from BioDiagene (method 3). Cohort B: 128 patients with histologically verified CD were tested for CD risk haplotypes (method 1). Patients with negative results were further tested for sub-haplotypes of HLA- DQ2 (methods 2 and 3). Results: Cohort A: The three applied methods provided the same HLA- DQ2 and HLA- DQ8 results among 61 patients. Four patients were negative for the HLA- DQ2 and HLA- DQ8 haplotypes (method 1) but were positive for the HLA- DQ2.5-trans and HLA- DQ2.2 haplotypes (methods 2 and 3). Cohort B: A total of 120 patients were positive for the HLA- DQ2.5-cis and HLA- DQ8 haplotypes (method 1). The remaining seven patients were positive for HLA- DQ2.5-trans or HLA- DQ2.2 haplotypes (methods 2 and 3). One patient was negative with all three HLA methods. Conclusions: The HLA- DQ risk haplotypes were detected in 93.8% of the CD patients using the SNP technique (method 1). The sensitivity increased to 99.2% by combining methods 1 - 3. [ABSTRACT FROM AUTHOR]

The aim of this study was to validate the measurement properties of the Danish version of the Illness Perception Questionnaire–Revised adapted to measure symptom representations among patients with colorectal cancer symptoms. A total of 488 colorectal cancer patients completed a questionnaire derived from the Illness Perception Questionnaire–Revised to retrospectively assess cognitive and emotional representations of experienced symptoms. A confirmatory factor analysis indicated no good comparative fit with the Illness Perception Questionnaire–Revised. Using exploratory factor analysis, a 7-factor structure was conducted, which fairly supported the Illness Perception Questionnaire–Revised. The modified Illness Perception Questionnaire–Revised is a promising tool for measuring symptom representations among Danish colorectal cancer patients. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the impact of groundwater abstraction on stream discharge and physical habitat conditions for brown trout (Salmo trutta) in a small Danish stream. Stream discharge was simulated using a lumped hydrological model (NAM) and a scenario was set up for stream discharge reference conditions. Stream physical habitat conditions (WUA) were simulated for four life stages of trout using a hydraulic habitat model (RHYHABSIM). The impact of groundwater abstraction on WUA for trout was assessed by combined simulations from the NAM model and the RHYHABSIM model. The model predicted that groundwater abstraction reduced median annual discharge by 37% and mean annual 90th percentile discharge by 82%. Summer discharge was relatively most affected by groundwater abstraction and WUA was therefore particularly affected by groundwater abstraction during summer. WUA for adult trout was mainly controlled by suitable water depths (>40 cm) even under conditions without abstraction. On an annual basis WUA for fry and juvenile trout was most affected by abstraction. Future modelling should consider improving simulation of low discharges and preferably not use general hydrological models. [ABSTRACT FROM AUTHOR]

Sargassum muticum (Fucales: Sargassaceae) has been present in Scandinavia since 1984. In Limfjorden, a shallow Danish sound, it has invaded the habitat of the indigenous Halidrys siliquosa (Fucales: Cystoseiraceae). Studies have suggested a displacement of indigenous relatives by Sargassum muticum and that this could be due to differences in life history strategies. Our study is the first to document the phenology of S. muticum at the northern part of its European distribution range (Scandinavia) and the first to document the phenology of Halidrys siliquosa. Thallus height and weight, species cover and tissue carbon, nitrogen and phosphorus were measured. For Sargassum muticum a strong seasonality with midsummer maxima, similar to previously published results from other European sites, was found. Halidrys siliquosa only exhibited moderate seasonality, if any. Hence, the two species were found to be functionally different and have different life histories. Our results support the idea that the competitive success of Sargassum muticum is caused by its pseudo-perennial life history compared to the truly perennial life histories of many indigenous relatives. Conversion factors between commonly used biometric measures were derived from the phenological data. [ABSTRACT FROM AUTHOR]

Row-injection of cattle slurry in combination with a nitrification inhibitor (NI) or slurry acidification (SA) has the potential to replace the use of mineral phosphorus starter fertiliser in maize cropping. N: Nitrogen, P: Phosphorus. Filled blue circle: Mineral NP starter fertiliser, open circle: seed. • DMPP or acid added to row-injected slurry increased initial leaf P concentration. • High initial leaf P concentrations did not always turn into higher harvest yields. • Broad-banded slurry placement combined with DMPP resulted in highest yields. • The P surplus in maize cropping was reduced when mineral P fertiliser was omitted. Accumulation of phosphorus (P) in soil can be a problem on intensive livestock farms with maize cropping, when mineral P starter fertilisers are applied in combination with evenly injected liquid manure before sowing. We examined the possibilities of replacing mineral P starter fertiliser with placement of cattle slurry close to the maize row before sowing in a two-year field study. The study was carried out on a sandy loam (pH of 6.1 and Olsen-P content of 44 mg P kg−1) and a coarse sandy soil (pH of 5.9 and Olsen-P content of 34 mg P kg−1) in Denmark. Slurry was row-injected at 10 cm depth in a broad-band with a 26-cm wide goosefoot tine or in a narrow-band. These two row-injection methods were combined with a nitrification inhibitor and/or slurry acidification. Treatments with evenly injected slurry at random lateral positions relative to the maize row (non-placed slurry) with increasing amounts of mineral starter P (0, 10 and 30 kg P ha−1, respectively) were included as reference treatments. Slurry placement in narrow or broad bands combined with slurry acidification or a nitrification inhibitor resulted in leaf P concentrations at the five-leaf stage that were significantly higher than the reference treatment with non-placed slurry and no mineral starter P. However, increased leaf P concentrations at the early growth stage did not always turn into higher yields at harvest. The highest dry matter yields (up to +1.9 Mg dry matter yield ha−1 compared to the reference treatment with non-placed slurry and no mineral starter P) were obtained when slurry was applied in a broad band below the maize row, but on the sandy loam only in combination with a nitrification inhibitor or slurry acidification. The P uptake at harvest did not differ among treatments (averaged 37 and 28 kg P ha-1 on the sandy loam and coarse sandy soil, respectively), and consequently the P surplus could be markedly reduced by omitting the use of mineral starter P fertiliser. We conclude that placement of cattle slurry in broad bands below the row can substitute the use of mineral P starter fertiliser and thus reduce farm P surpluses in silage maize cropping. [ABSTRACT FROM AUTHOR]

The article discusses the reports within the issue, which were presented at the fifth international symposium on cell volume regulation and its physiological and pathophysiological implications, held in September 2005 in Copenhagen, Denmark. Major themes of the articles include sensors and transducers of the cell volume signal, effectors in cell volume regulations and the relation between cellular and extracellular volume and signal transduction in the brain.

Cancer survivors may be struggling to re‐create meaning in life. Addressing their personal sources of meaning can support them in this process. The sources of meaning card method (SoMeCaM) aims to map and explore personal sources of meaning in a 1‐h session. It includes 26 cards, each with a statement on a source of meaning. The purpose of this study was to validate the statements on the sources of meaning cards for use among participants in cancer rehabilitation by examining whether participants attribute the same meaning to the statements as intended. The three step test interview method was used to assess response processes to the sources of meaning cards among 12 participants in a 5‐day cancer rehabilitation program in Denmark. The interviews were transcribed verbatim and analyzed using framework analysis. Nineteen of the 26 statements were interpreted congruently, that is, in line with the underlying theory, by all participants. Issues of incongruency, ambiguity and confusion were observed in participants' interpretations of the statements on religiosity (n = 6), spirituality (n = 10), and reason (n = 6). Minor issues were observed for the statements on practicality, achievement, knowledge, and attentiveness. In most statements, cancer survivors' interpretation aligned with the underlying theory. Problems were apparent regarding the sources of meaning religiosity, spirituality and reason, and a reconsideration of the wording of the statements is recommended. These problems may be due to cultural and linguistic interpretations rather than to being a cancer survivor. Future studies could focus on these issues in other target populations. Despite these minor issues, the SoMeCaM has proven useful in addressing the important topic of meaning in life in the cancer rehabilitation setting. Clinicians should pay attention to nuances in participants' understanding of the cards. [ABSTRACT FROM AUTHOR]

Background: Older patients with cancer have poorer prognosis compared to younger patients. Moreover, prognosis is related to how cancer is identified, and where in the healthcare system patients present, i.e. routes to diagnosis (RtD). We investigated whether RtD varied by patients' age., Methods: This population-based national cohort study used Danish registry data. Patients were categorized into age groups and eight mutually exclusive RtD. We employed multinomial logistic regressions adjusted for sex, region, diagnosis year, cohabitation, education, income, immigration status and comorbidities. Screened and non-screened patients were analysed separately., Results: The study included 137,876 patients. Both younger and older patients with cancer were less likely to get diagnosed after a cancer patient pathways referral from primary care physician compared to middle-aged patients. Older patients were more likely to get diagnosed via unplanned admission, death certificate only, and outpatient admission compared to younger patients. The patterns were similar across comorbidity levels., Conclusions: RtD varied by age groups, and middle-aged patients were the most likely to get diagnosed after cancer patient pathways with referral from primary care. Emphasis should be put on raising clinicians' awareness of cancer being the underlying cause of symptoms in both younger patients and in older patients., (© 2022. The Author(s).)

Background: In population-based breast cancer screening programmes, the geographical distance to the screening site may influence a woman's propensity to participate. The aim of this study was to analyse the effect driving distance to the screening unit had on women's participation in a breast cancer screening programme., Methods: All women invited to the first round of breast cancer screening in the Central Denmark Region were eligible for inclusion (n = 149,234). Information on participation was collected from a regional administrative database. The shortest road distance between each woman's residence and her affiliated screening site was assessed using Network Analyst, ArcGIS., Results: The unadjusted association between distance and non-participation formed a J-shape curve. Adjustment for socio-demographic characteristics caused the J-shape to disappear, and the probability of non-attendance rose with longer distance to the screening site but flattened after ~45 km. Women without access to a vehicle had a higher risk of non-participation than women with access to a vehicle., Conclusions: A long road distance to the screening site was associated with an increased risk of non-participation. Women without access to a vehicle were at higher risk of non-participation than women who had access to a vehicle., (© The Author 2013. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The purpose of this study was to examine the relationship between perceived social support and patient delay (PD) among female and male cancer patients., Methods: A population-based study with register-sampled cancer patients was designed. Patient delay was defined as the time interval between the patient's experience of the first symptom and the first contact with a health-care professional. Both dates were provided by the patients (n=910). The patients completed a purpose-designed questionnaire, which assessed the patient's perceptions of how the partner reacted ('Partner Avoidance' and 'Partner Support') and how others in the social network responded ('Other Avoidance' and 'Other Support') to the patient's worries about the symptoms. The associations between the social support subscales and PD were analysed separately for men and women., Results: In female patients, Partner Support and Other Support were associated with shorter PD, whereas Other Avoidance was associated with longer PD. In the multivariate analysis, Other Avoidance remained associated with longer PD. Moreover, disclosure of symptoms to someone reduced the likelihood of a long PD in female patients. In male patients, none of the social support scales significantly increased or decreased the risk of a long PD in the univariate analysis, but Partner Support significantly decreased risk of a long PD in the multivariate analysis., Conclusions: The results of this study suggest that social support and avoidance from network members influence length of PD differently in male and female cancer patients. This gender difference may explain previous mixed findings obtained in this field.