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The work of early childhood educators is conducted in highly regulated environments in many Western nations. This is due to managerialism, the right arm of neoliberal-inspired policies. To explore educators' work within these contexts, our international study highlights the impacts of these systems on educators and the children they teach. This paper presents findings from five countries, namely, Australia, Canada, Denmark, Georgia and Italy. The results reveal the experiences of educators in these countries, impacted by neoliberal-inspired policies that are manifested in two different ways. They are dealing with increased managerial regulation or with the neglect of the sector in the pursuit of higher profits. Educators' job satisfaction is impacted when they perceive they are not able to adequately educate and support children due to these constraints. Using a critical neoliberal framework, we employed a mixed-method approach. The participants were educators with various roles and qualifications in a variety of service types. To analyse the numerical/closed answer data we used cross tabulation. Thematic analysis was used to analyse the qualitative data. Despite their difficulties, educators provided many ideas on the ways their government can better support their work so that they can focus on supporting children's learning through play. This study will be of interest to researchers, educators, policymakers and teacher educators.

The implementation of large-scale intervention and development projects is often problematic, and the impacts of such projects usually fall somewhat short of what was expected. Additionally, the rationalities of intervention projects are not carried over into classroom teaching as directly as expected. This problem is generally known, but comprehensive explanations continue to elude the research community at large. Using the theory of cultural-historical activity theory (CHAT), we propose that the heart of the problem lies in the "expansive learning process" that teachers undergo. This process is driven by unrecognised contradictions in terms of cultural and historical origin, which are fundamentally different from the processes governing the projects. We analyze two cases taken from two large Danish professional development projects. In each case, we focus on a teacher as part of two activity systems ('the project' and 'the classroom') and how the contradictions within and between these shape learning through epistemic actions. The results indicate the importance of making these contradictions apparent and accessible to everyone in the activity systems. Because of these various contradictions, the agency conferred upon teachers leads to unintended outcomes.

In this paper, we present and discuss an explorative study on the use of a social 360° virtual reality (360VR) for supporting case-based Problem Based Learning (case-PBL) in clinical medical education. In the context of case-PBL, we argue that our social 360VR learning space extends the design and application of cases in medical education by including elements from project-PBL. Three groups tested the learning design as a part of the clinical exercises in their 5. Semester bachelor course. After the social 360VR activity, the students performed a physical examination of the collateral and cruciate ligaments of the knee like the one in the training material. Our preliminary findings indicate that the students immersed in social 360VR collaboratively establish a mutual understanding of how to perform the examination through identifying problems related to the examination and by taking responsibility for their own and the other group members learning.

Many universities throughout the world apply student-centered approaches. Common to these is that projects, problems, challenges etc. stem from "real life". Mathematics is an effective tool to solve problems, but in this paper, we discuss how we reconcile the fact that mathematics is both a pure and an applied discipline with problem-based learning (PBL) which builds on such authentic real-life problems. How can the learning of pure mathematics benefit from these education approaches? We present a taxonomy to classify types of problems encountered discussing the notion of the problem context -- it can be internal or external to mathematics, or both.

Citizenship education in Denmark is considered as having a long history, not least as an important part of the folk high school tradition. More recently, it has become an important ingredient in the process for immigrants to obtain Danish citizenship. The focus of this paper is to analyse how the above types of citizenship education build on a particular imagining of the nation by engaging with the tradition and content of citizenship education as linked with the folk high schools and the preparation for the citizenship test. This is analysed within a critical interculturalist perspective and with Denmark as case.

The aim of this article is to review the psychometric properties of the psychological tests that are being used in the Nordic countries during pregnancy and the child's first two years of life. A systematic literature search was performed for 33 identified tests routinely used in health care, using specific review databases as well as PsycInfo, Embase and Medline. The trained authors conducted an overall assessment of quality for each test which was then verified by the editors. A total of 12% of the tests were rated at Level 1 'Low level of quality', 61% at Level 2 'Some evidence of Quality', 15% at level 3 'Good level of Quality' and 12% at Level 4 'High level of quality'. This indicates that the evidence for the psychometric properties is insufficient for many tests used in the Nordic countries for this purpose

This study explores how experienced Danish caseworkers who work with young people at municipal job centres justify and make decisions regarding referring young clients to psychosocial interventions. Twelve caseworkers and a line manager from two municipalities were interviewed. A thematic analysis was conducted. Key themes were: in-house and out-of-house collaboration; referral as an ongoing process; matching the young person with the service provider based on information about the service providers' target groups, and information about personal factors and individual contextual factors; dealing with regional gatekeepers; and the role of financial constraints and bureaucratic procedures. The caseworkers experienced a high degree of autonomy and were pragmatic in their approach to referring their young clients to service providers.

For several years, Danish and other European countries have had political objectives for promoting higher education and research. As a result of this, there has been an increased supply of PhD graduates in all disciplines. From a socio-economic point of view, investment in the development of a highly educated work force is considered necessary to ensure competitiveness in the global knowledge economy. It is assumed that PhD graduates are requested outside of academia and that they will contribute to the dissemination of knowledge and skills outside of academia. However, within the social sciences and humanities, most PhD raduates are employed within academia and employment in other branches appears less frequent. This has led to an increased research interest in the strategies and competences of these PhD graduates vis-à-vis the structures of the labour market. The focus tends to be more on individualist perspectives of employability than on structuralist perspectives of social background and knowledge discourses, which constitute the focus of this article. Our focus is on analysing narratives of PhD graduates from the social sciences and humanities as to which career strategies they follow and how they apply competences and refer to knowledge acquired through their PhD. Based on data from universities in Denmark, we have analysed the implications of the policy discourses of employability and transferability and how they result in different knowledge discourses.

The 'Programme for the International Assessment of Adult Competencies' (PIAAC), developed and managed by the OECD, is an important source of knowledge about adult skills as well as an intervention in the field of education policy. One level of the intervention is the presence of PIAAC results in public media and debate. This article presents a comparative analysis of the way major newspapers in Italy and Denmark presented and used PIAAC over the period 2013-2019. The press contributes to constructing knowledge and setting agendas for education by presenting information structured from criteria of news value and from ideological stances. The analysis, done as part of the ENLIVEN research project (Milana et al., 2020), traces how PIAAC results were covered in Italian and Danish newspapers and used in the construction of themes, angles and 'truths' on skills and adult learning.

The purpose of this paper is to examine how adult education institutions have developed in close connection with the Danish welfare state and how structural reforms since the 1990s have changed the institutional structure and impacted accessibility. This involves analyses of the main functions linked to the different types of adult education institutions (VUCs) in Denmark and their development in relation to welfare state policies in the first instance and to globalization and competition state policies in the second. Thus, the paper provides a historical outline of the development of adult education institutions in two main areas, a vocational and a general, followed by an analysis of selected policy documents on structural reforms. Focusing on the reforms of 2000, 2007, and 2018, the analysis identifies external and internal limitations to accessing general adult education. In conclusion, the market orientation of the VUC entails limitations to both external and internal accessibility.

Like other Nordic countries, Denmark is a mixed-economy welfare society, where capitalist production and market logics coexist with public policy having social cohesion and equality as important priorities. Educational and pedagogical research, which is a main knowledge base for policy and practice in schools and the education system, is also seen as a field of public responsibility, carried out mainly in universities and other public research institutes. In recent years, however, a number of private actors have engaged in funding research related to education and learning. The actors include private organizations doing research in connection with product development and privately established foundations initiating research and development projects. The interplay between public and private funding and management can promote quality research combining new general knowledge with societal relevance; but it can also lead to narrow criteria for topics and methods, unsettling important balances in the field of educational research. The article examines and discusses these developments, especially the role of private foundations, as well as the conditions for fruitful interaction between the public sector and private actors in educational research.

In 2020, Denmark buried approximately four million culled, farmed mink in mass graves treated with slaked lime due to widespread SARS-CoV-2 infections. After six months, environmental concerns prompted the exhumation of these cadavers. Our analysis encompassed visual inspections, soil pH measurements, and gas emission assessments of the grave environment. Additionally, we evaluated carcasses for decay status, cadaverine content, and the presence of various pathogens, including SARS-CoV-2 and mink coronavirus. Our findings revealed minimal microbial activity and limited carcass decomposition. Although viral RNA from SARS-CoV-2 and mink coronavirus, along with DNA from Aleutian mink disease virus, were detected, the absence of infectious SARS-CoV-2 in cell culture assays suggests slow natural degradation processes. This study provides critical insights for future considerations in managing mass burial scenarios during outbreaks of livestock-associated zoonotic pathogens. [ABSTRACT FROM AUTHOR]

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) not only caused the COVID-19 pandemic but also had a major impact on farmed mink production in several European countries. In Denmark, the entire population of farmed mink (over 15 million animals) was culled in late 2020. During the period of June to November 2020, mink on 290 farms (out of about 1100 in the country) were shown to be infected with SARS-CoV-2. Genome sequencing identified changes in the virus within the mink and it is estimated that about 4000 people in Denmark became infected with these mink virus variants. However, the routes of transmission of the virus to, and from, the mink have been unclear. Phylogenetic analysis revealed the generation of multiple clusters of the virus within the mink. Detailed analysis of changes in the virus during replication in mink and, in parallel, in the human population in Denmark, during the same time period, has been performed here. The majority of cases in mink involved variants with the Y453F substitution and the H69/V70 deletion within the Spike (S) protein; these changes emerged early in the outbreak. However, further introductions of the virus, by variants lacking these changes, from the human population into mink also occurred. Based on phylogenetic analysis of viral genome data, we estimate, using a conservative approach, that about 17 separate examples of mink to human transmission occurred in Denmark but up to 59 such events (90% credible interval: (39–77)) were identified using parsimony to count cross-species jumps on transmission trees inferred using Bayesian methods. Using the latter approach, 136 jumps (90% credible interval: (117–164)) from humans to mink were found, which may underlie the farm-to-farm spread. Thus, transmission of SARS-CoV-2 from humans to mink, mink to mink, from mink to humans and between humans were all observed. Author summary: In addition to causing a pandemic in the human population, SARS-CoV-2 also infected farmed mink. In Denmark, after the first identification of infection in mink during June 2020, a decision was made in November 2020 to cull all the farmed mink. Within this outbreak, mink on 290 farms (out of about 1100 in the country) were found to have been infected. We showed, by analysis of the viruses from the mink, that the viruses on the farms were mainly of three different, but closely related, types (termed Clusters 2, 3 and 4) that shared certain distinctive features. Thus, we found that many outbreaks in mink resulted from transmission of the virus between mink farms. However, we identified that new introductions of other virus variants, presumably from infected humans, also occurred. Furthermore, we showed that spread of the virus from infected mink to humans also happened on multiple occasions. Thus, transmission of these viruses from humans to mink, mink to mink, from mink to humans and between humans were all observed. [ABSTRACT FROM AUTHOR]

Focusing on the school corridor, this article explores the coming into being of Danish school space through shifting architectural designs, teaching practices, and volumes and organisations of pupils' bodies. The analysis shows a transformation of the corridor itself: from primarily being a disciplining and potentially dangerous space for moving across and between different contexts, school corridors become stimulating spaces for active learning. Thereby, the child's schooling and bodily movements, as well as meaning-making about where and how school is supposed to take place, are altered. The article draws on Karen Barad's theory of agential realism to analyse guidance material on how to design, decorate, and use school buildings and a number of spearhead schools at the cutting edge of various trends within school architecture from the second half of the twentieth century until the present day. Through this theoretical lens, the article explores the material and discursive coming into being of the corridor as a space of potential, the transformations of the relationship between the corridor and the classroom, and, finally, the emergence of the corridor as a learning space.

This article addresses schoolteachers' spatial work in the process of inhabiting and using a new school building. The study focuses on a historical case of a Danish open-plan school built in the early 1970s and shows how the teachers' spatial work engages with questions of the organisation of bodies, sound, furniture and teaching aids. The article uses Tim Ingold's notion of making -- stressing the making of architecture, as well as pedagogy, as a continuous and never-ending process -- and Karen Barad's theory of agential realism to explore the teachers' spatial work as part of the intra-actions of and mutual coming into being of school space, pedagogical ideas, teachers and pupils. Finally, the article analyses the transnational entanglements of the teachers' spatial work through a discussion of the open-plan school as an architectural and pedagogical model found across the globe.

Familiarity and distance is an issue that is much discussed in ethnographic fieldwork. This paper focuses on the topic of balancing familiarity and distance when the researcher is directly or indirectly part of the field, which in the study consists of an adult education context of two different teacher-training courses for upper secondary teachers. The fieldworker is also a teacher at one of the courses in the study, which is thus in a double sense framed by the challenge of an adult education study. The analysis is based on Bourdieu's concept of participant objectification and Gold's categorising of roles in ethnographic fieldwork. It illustrates how different contexts depending on the prior familiarity of the fieldworker provide access to different degrees of participation. The particular adult education context and fieldworker relations complicate the fieldwork relations and the act of balancing familiarity and distance.

Objective: To estimate the costs and cost-effectiveness of introducing highly active antiretroviral therapy (HAART) in Denmark based on real-world evidence for the three treatment eras pre-HAART (1985–1995), early HAART (1996–2005), and late HAART (2006–2017). Methods: We performed a cohort study using Danish clinical and administrative registries to estimate costs, quality-adjusted life-years (QALYs), and life-years (LY) gained per person living with human immunodeficiency virus (PLHIV) in three treatment eras. The study utilized Markov modeling for a health economic evaluation, which summarized inputs from real-world evidence and estimated the cost-effectiveness in 2017 prices of the introduction of HAART in Denmark. We performed deterministic and probabilistic sensitivity analyses to assess the robustness of the results. Results: The total annual costs per PLHIV increased with the introduction of HAART for the index year but decreased in the incremental years and the last year of life. The total lifetime discounted (and undiscounted) cost for an average PLHIV was €91,010 (€128,981) in pre-HAART, €103,130 (€199,062) in early HAART, and €126,317 (€254,964) in late HAART. The estimated incremental cost-effectiveness ratios showed that early HAART was cost-effective compared with pre-HAART with an incremental cost-effectiveness ratio (ICER) of €1378 per QALY, and that late HAART was cost-effective compared with early HAART with an ICER of €7385 per QALY. Sensitivity analyses confirmed cost-effectiveness in all scenarios. Conclusions: The introduction and implementation of HAART in Danish healthcare was cost-effective, and in some scenarios, even disruptive, i.e., led to both cheaper and more effective care of PLHIV. [ABSTRACT FROM AUTHOR]

Aims: In hospitals, 15%–20% of patients have diabetes. Therefore, all healthcare professionals (HCPs) must have a basic knowledge of in‐hospital diabetes management. This survey assessed the knowledge of diabetes among HCPs in Denmark. Methods: A 27‐item questionnaire was developed and reviewed independently before the survey was distributed. The questionnaire contained seven baseline questions on the HCPs' current workplace, educational level, usual shift routines and years of experience, 18 multiple‐choice questions and 2 cases. Results: A total of 252 completed questionnaires were returned by 133 (52.8%) physicians, 101 (40.1%) nurses and 18 (7.1%) healthcare assistants. HCPs answered 50% of the questions correctly. Having experience from endocrinological departments increased the correct response score (0%‐100%) by 6.2% points (95% CI 0.3‐12.1) (p = 0.039) and 3.1% points (95% CI 1.5–4.7) for every increase in confidence level on a scale from 1 to 10 (p < 0.001). HCPs scored 8 out of 10 on a confidence level scale on average. In a fictive case, 50% of HCPs administered the correct bolus insulin dose. Hyperglycaemia (>10.0 mmol/L) and hypoglycaemia (<3.9 mmol/L) were correctly identified by around 40% of HCPs. Hypoglycaemia was rated more important than hyperglycaemia by most HCPs. Conclusion: Significant gaps in identifying hypo‐ and hyperglycaemia and correct administration of bolus insulin have been identified, which could be targeted in future education for HCPs. HCPs answered 50% of questions related to in‐hospital diabetes management correctly. Experience from endocrinological departments and self‐rated confidence levels are associated with HCPs' in‐hospital diabetes competencies. [ABSTRACT FROM AUTHOR]

Nontuberculous mycobacteria (NTM) are emerging as notable causative agents of opportunistic infections. To examine clinical significance, species distribution, and temporal trends of NTM in Denmark, we performed a nationwide register-based study of all unique persons with NTM isolated in the country during 1991–2022. We categorized patients as having definite disease, possible disease, or isolation by using a previously validated method. The incidence of pulmonary NTM increased throughout the study period, in contrast to earlier findings. Mycobacterium malmoense, M. kansasii, M. szulgai, and M. avium complex were the most clinically significant species based on microbiologic findings; M. avium dominated in incidence. This study shows the need for surveillance for an emerging infection that is not notifiable in most countries, provides evidence to support clinical decision-making, and highlights the importance of not considering NTM as a single entity. [ABSTRACT FROM AUTHOR]

Background: The rationale for screening for cardiovascular disease (CVD) is debated as a prevention strategy. However, research shows that when preventive medication is initiated after screening for CVD, mortality rates decrease, especially among men. When implementing screening programmes, facilitating citizens' informed decisions and empowering their autonomy in the decision‐making process are crucial. We therefore aimed to explore citizens' perspectives on and decisions regarding initiating cardiovascular preventive medication for screen‐detected CVD. Methods: We employed an exploratory qualitative design using semi‐structured interviews to investigate participants' perspectives on and decisions regarding initiating cardiovascular preventive medication for screen‐detected CVD. Twelve interviews were conducted and analysed using thematic analysis following Braun and Clarke's six‐step approach. Findings: We found one overall theme, Being on a continuum between wellness and illness, with two underlying sub‐themes. Sub‐theme (1) Navigating mixed feelings and pathways reflects participants' perspectives on CVD preventive medication, which were positioned on a continuum with shifting perspectives. The state between wellness and illness was experienced as liminal and characterised by uncertainty and concerns about CVD risk. (2) Navigating medication decisions: a negotiated process. Pivotal medical decisions hinged on trust in authorities or own judgement, influenced by attitudes towards the need for medication, perception of meaningfulness, asymptomatic condition, age, family responsibility and predisposition. Participants' medical decisions were supported and impacted by significant others. Conclusion: We uncovered a continuum of shifting perspectives ranging from feeling improved health to experiencing fear of CVD. For certain citizens, it is like navigating between these contrasting feelings. The perceived necessity and meaningfulness, in particular, shape medical decisions. Providing support for informed decisions is crucial and includes significant others. Shared decision‐making with healthcare professionals as facilitators is needed. Future research is warranted to investigate how to embrace the various perspectives on initiating CVD preventive medication in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Noncommunicable diseases (NCDs) constitute a massive global burden and are the leading cause of death and disability worldwide. In Greenland, the prevalence of NCDs has historically been low. However, during the past approximately 70 years, life circumstances have changed dramatically resulting in increased life expectancy. Today, the proportion of inhabitants in Greenland ≥65 years has nearly tripled since the 1980s, and the prevalence of obesity and diabetes has increased rapidly within the past decades. The aim of this study was to describe the burden of selected NCDs in a primary care setting in Nuuk and compare it to a modern westernized suburban general practice in Denmark. Methods: The study was performed as a cross sectional register-based study using data extracted from the electronic medical records (EMR) based on diagnosis codes from inhabitants living in Nuuk, Greenland, and a suburb in Denmark. Estimates of prevalence were age-standardized to the WHO world standard population. Results: In both Nuuk and the Danish suburb, the highest prevalence was observed for hypertension (13.2% for both populations), followed by asthma (4.4 and 9.5%, respectively) and diabetes (4.3 and 2.9%, respectively). The age-standardized prevalences of diabetes, COPD, atrial fibrillation, and heart failure, were significantly higher in Nuuk, while seven NCDs including asthma, ischemic heart disease, arthritis urica, psoriasis, hyperthyreosis, hypothyreosis and osteoporosis were significantly higher in the Danish suburb. Conclusion: In contrast to the disease pattern observed in Greenland in the last century, the prevalence of diagnosed NCDs in Nuuk is no longer rare. Thus, the overall prevalence of NCDs in the population of Nuuk is now comparable to or even higher than in the suburb in Denmark. This calls for increased focus on all NCDs in the primary healthcare system in Greenland and adaption of the primary healthcare services to a changed disease spectrum. [ABSTRACT FROM AUTHOR]

Background: Standing frames are commonly used by healthcare professionals in their practice with children with cerebral palsy (CP) who do not have an independent standing function. A better understanding of healthcare professionals' attitudes and experiences with standing frames may impact practice and rehabilitation. Therefore, this study aimed to investigate the standing frame practice among healthcare professionals and expand their attitude and experience with the use of standing frames for children with CP. Methods: This is an explanatory sequential mixed methods study. A cross‐sectional survey was conducted, providing quantitative data on 210 healthcare professionals' use of standing frames. The quantitative data were descriptively analysed. Subsequently, the results from the survey were followed up with five focus group interviews of healthcare professionals (n = 14). The qualitative data were analysed using thematic analysis, enabling integration between the quantitative and qualitative data. Results: When quantitative and qualitative data are integrated, expansion between the two datasets occurred. The quantitative dataset emphasised the use of GMFCS levels as a guideline for recommending standing frames, whereas the qualitative data showed that the healthcare professionals' recommendations were based on individual needs. Furthermore, the healthcare professionals expanded the quantitative data, showing that the healthcare professionals' considerations regarding age and dosage were based on clinical experience, and saw the standing frame as having many benefits. Conclusion: The healthcare professionals had a child‐centred approach, where the child's need for using a standing frame was assessed based on the functional level, stage of development, cognitive level and clinical assessment. All of these considerations showed that the use of standing frames for children with CP was individualised, thereby making it difficult to make unified descriptions. [ABSTRACT FROM AUTHOR]

This paper presents a case study of didactic infrastructures to direct Study and Research Paths (SRP) in teacher education within the context of interdisciplinary inquiry. The disciplines of school mathematics and school biology, and their didactics, are made to interconnect through the investigation of a generating question concerning the illness diabetes. The resulting interdisciplinary knowledge as evidenced through students written diaries is analysed using the Anthropologic Theory of the Didactic and shows the challenge of combining two disciplines and their didactics at the same time. Two particular forms of didactic infrastructure to guide the self-sustained process of SRP are proposed and scrutinized: "Selective picking" and "Side questions." Selective picking is shown to be a promising, yet indirect, infrastructure to steer the SRP without taking away the desired autonomy of the students. Side questions, initially proposed by Ives Chevallard, are considered in light of the case, and a number of suggestions for their characteristics and use are put forward.

Entrepreneurship Education often emphasizes the practical applications of competencies. This article aims to collect findings on entrepreneurship education linked to democratic formation in primary education as experienced by teacher students. Based on a model from the Danish Foundation for Entrepreneurship and theories on democratic formation and active citizenship, the authors analyze what entrepreneurship and democratic formation have in common. Entrepreneurship education will also be linked to education for sustainable development. By following a group of teacher students in two different cases, the authors discuss how a potential synergy is visible, when the teacher students learn by reading, discussing and solving concrete tasks connected to social entrepreneurship education. The teacher students' personal attitudes and understanding of authentic practical experiences turns out to be important to their learning from entrepreneurial education tasks. The structural organization of teacher education is a challenge to the organization of teaching entrepreneurship education.

In recent decades, the concept of accountability has attracted more and more attention in public governance and management. The management of education is no exception. This article presents and discusses the evolution and current status of educational accountability in two different national contexts, China and Denmark. Two main sectors of education are covered, general school education and higher education. It is shown that both countries are marked by an increasing concern with educational accountability, that differences in history and culture between the two countries are reflected in the approaches to accountability, but that there are still considerable similarities in the types of accountability pursued. Under the influence of a transnational regime of policy development both countries seem to be moving towards output-based accountability, but more traditional inspection continues to have a role.

Background A small share of patients account for a large proportion of costs to the healthcare system in Denmark as in many Western countries. A telephone-based self-management support, proactive health support (PaHS), was suggested for prevention of hospitalisations for persons at risk of hospital admission. These persons have chronic diseases, unplanned hospitalisations and age ≥ 65 years. However, evidence is limited on whether this type of intervention is cost-effective. Aim The aim of this study was to assess the incremental cost-utility ratio (ICER) of PaHS, compared with standard care. Methods The economic evaluation was nested within a randomised controlled trial, and was based on a health system perspective, with follow-up and time horizon of 12 months. We measured incremental costs per quality-adjusted life years (QALY) gained. Total average costs per patient included PaHS programme costs, and costs in hospitals, primary care and municipalities. We analysed differences by generalised linear models with Gamma distribution for costs and mixed models for QALY. Results We analysed data on 6,139 patients, where 3,041 received PaHS and 3,098 received usual care. We found no difference in healthcare costs, and programme costs were on average €1,762 per patient, providing incremental costs of €2,075. Incremental effects on QALY were 0.007, resulting in an ICER of €296,389 per QALY gained. Conclusion We found no evidence of PaHS being cost-effective in this study, but the results will be used to identify new ways to organise similar interventions and identify patients with the objective to reduce health system costs per patient. [ABSTRACT FROM AUTHOR]

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]

Denmark has a strong and versatile tradition of adult education. Over a long historical period, adult education for public enlightenment and leisure, for continuing study and for vocational and professional competence have been developed, been made part of state policy and been used by citizens. But in recent years the public and political presence of Danish adult education has changed. While education policy issues generally abound in public and political debates, adult education is given much less attention than earlier. In this article, we trace the causes of this and conclude that it reflects a turn towards focusing on vocational types of adult education and a relocation of adult education policy to networks linking the state and the social partners. Drawing on theories of policy streams, policy networks and the competition state, we provide a historical analysis of Danish adult education reforms during the past two decades and document how the vocational turn has manifested itself.

The focus of this article is Faroese children's early vocabulary acquisition using a Faroese adaptation of the MacArthur-Bates Communicative Development Inventories (MBCDI) parental report. The study is a population-based cross-sectional study including 1135 children aged 8-36 months. The article has two objectives: the first is to describe the Faroese adaptation of the MBCDI, and the second is to examine Faroese children's early vocabulary acquisition. Selected percentile levels for vocabulary comprehension and production are presented, as well as gender differences and developmental trends. The study finds evidence for a spurt in productive vocabulary in the second year of life, and that vocabulary comprehension preceded production, with both showing increases with age similar to those described in the literature for other languages. Girls had an advantage in vocabulary production over boys, resulting in a significant gender difference. Finally, the early lexical composition of Faroese children is notable in that it contains a substantial number of baby-word forms.

Background and Purpose. Occult breast cancer (OBC) is a rare condition. Due to the small number of patients in previous studies, the benefits of treatment with mastectomy are still discussed. This study aims to determine the clinicopathological characteristics, treatment, and prognosis of OBC presenting with locoregional lymph node metastasis (LNM). Materials and Methods. This study included patients registered in the national Danish Breast Cancer Group (DBCG) database between 2001 and 2015, with locoregional LNM as well as a bilateral negative mammography, ultrasonography, and physical examination of the breasts. Overall survival (OS) and invasive disease‐free survival (IDFS) were compared by treatment groups, ALND + RT (axillary lymph node dissection and radiotherapy) or ALND + MAST ± RT (axillary lymph node dissection, mastectomy with or without radiotherapy). Results. In total, 56 patients were included in the study, of which 37 were treated by ALND + RT, 16 by ALND + MAST ± RT, and the remaining three patients receiving different treatments. The median follow‐up for the 53 OBC patients sorted by treatment group was 12.2 years (interquartile range: 10.1 years; 15.3 years). There was no significant difference in OS or IDFS between the treatment groups, except for a subgroup of 46 (out of 53) patients without verified in situ lesions before treatment, where ALND + RT treatment showed an improved OS (log‐rank p = 0.05). Conclusion. Treating OBC patients with ALND and radiotherapy resulted in a similar outcome as treatment with ALND and mastectomy. This supports omission of mastectomy in favor of radiotherapy of the breast in these patients. [ABSTRACT FROM AUTHOR]

Background: The 15-method is an opportunistic screening and brief intervention tool for alcohol-related problems in primary healthcare. A Danish feasibility study of the 15-method indicated that adjustments were needed to improve its contextual fit to Danish general practice. This adjustment process was conducted in two parts. The first part focused on identifying barriers, facilitators, and user needs for addressing alcohol using the 15-method. The second part will address the identified barriers and user needs to finalize a Danish version of the method. This study reports on part one of the adjustment process. Methods: Semi-structured individual interviews and focus group interviews with healthcare professionals (n = 8) and patients (n = 5) from general practice in Denmark. Data analysis was conducted using thematic content analysis. The results were condensed into two focus areas that will form the basis for user workshops in part two of the adjustment process. Results: The main barriers for addressing alcohol using the 15-method were patients and healthcare professionals not having the same agenda, having difficulty opening a conversation on alcohol, and workflow in the practices. Main facilitators included high interpersonal skills, taking the patient's perspective, and good routines and interdisciplinary work. Suggested adjustments and additions to the method included digitalization, visual icebreakers, quotes and examples, and development of a quick guide. The identified focus areas for user workshops were Communication and Material, and Integration to Workflows. Conclusion: Healthcare professionals found the opportunistic screening approach exemplified by the 15-method to be beneficial in identifying and addressing alcohol-related problems. They appreciate the method's structured framework that assists in presenting treatment options. Identified adjustment areas to the 15-method will lay the groundwork for future efforts to develop a finalized Danish version of the 15-method. [ABSTRACT FROM AUTHOR]

Background Examining regional variation in acute kidney injury (AKI) and associated outcomes may reveal inequalities and possibilities for optimization of the quality of care. Using the Danish medical databases, we examined regional variation in the incidence, follow-up and prognosis of AKI in Denmark. Methods Patients with one or more AKI episodes in 2017 were identified using population-based creatinine measurements covering all Danish residents. Crude and sex-and-age-standardized incidence rates of AKI were estimated using census statistics for each municipality. Adjusted hazard ratios (aHR) of chronic kidney disease (CKD), all-cause death, biochemical follow-up and outpatient contact with a nephrology department after AKI were estimated across geographical regions and categories of municipalities, accounting for differences in demographics, comorbidities, medication use, lifestyle and social factors, and baseline kidney function. Results We identified 63 382 AKI episodes in 58 356 adults in 2017. The regional standardized AKI incidence rates ranged from 12.9 to 14.9 per 1000 person-years. Compared with the Capital Region of Denmark, the aHRs across regions ranged from 1.04 to 1.25 for CKD, from 0.97 to 1.04 for all-cause death, from 1.09 to 1.15 for biochemical follow-up and from 1.08 to 1.49 for outpatient contact with a nephrology department after AKI. Similar variations were found across municipality categories. Conclusions Within the uniform Danish healthcare system, we found modest regional variation in AKI incidence. The mortality after AKI was similar; however, CKD, biochemical follow-up and nephrology follow-up after AKI varied across regions and municipality categories. [ABSTRACT FROM AUTHOR]

Psychopharmacological treatment may be an independent risk factor for increased length of stay and readmission after hip and knee replacement. Thus, temporary perioperative discontinuation may be beneficial. However, little is known regarding the treatments, and not all are feasible to discontinue. Therefore, the aim of this study was to describe the treatments in terms of type, dose, duration, indication and initiating physician to assess the feasibility of temporary perioperative discontinuation. We included 482 patients planned for hip or knee replacement in psychopharmacological treatment for psychiatric disorders from 2021 to 2023 at five orthopaedic departments in Denmark. Most patients were treated with antidepressants (89%); most frequently, either selective serotonin reuptake inhibitors (SSRIs; 48%) or serotonin‐norepinephrine reuptake inhibitors (SNRIs; 21%). The majority received monotherapy (70%); most frequently, an SSRI (36%) or an SNRI (12%). Most antidepressants were initiated by general practitioners (71%), and the treatments had lasted for more than a year (87%). The doses of SSRIs/SNRIs were moderate, and the most frequent indication for antidepressants was depression (77%). These results imply that temporary perioperative SSRI/SNRI discontinuation may be feasible in hip and knee replacement patients and support a future randomized controlled trial investigating the potential benefits of temporary discontinuation. [ABSTRACT FROM AUTHOR]

Introduction: Cryoballoon ablation is a safe and efficient rhythm control strategy in atrial fibrillation (AF) patients. The impact of time from diagnosis to ablation is unclear. The aim of this study was to examine the impact of timing of first‐time cryoballoon ablation on AF recurrence in a nationwide cohort of AF patients. Methods and Results: From nationwide registers, all AF patients ≥18 years of age who underwent first‐time AF cryoballoon ablation in Denmark from 2012 to 2018 were included. The AF patients were stratified by ablation timing: Early group (≤1 year after AF diagnosis), intermediate group (1–3 years after AF diagnosis), and late group (≥3 years after AF diagnosis). By adjusted Cox regression models, the effect of timing on AF recurrence was examined. This study included 1064 AF patients with a median age of 63 years. Most patients were male (66%) and had paroxysmal AF (67%). The 1‐year risk of AF recurrence increased from 31% in the early group to 41% and 44% in the intermediate and late group. The hazard ratios (95% confidence intervals) were 1.28 (0.95, 1.74) in the intermediate group and 1.42 (1.09, 1.86) in the late group when compared to the early group. Continuous diagnosis‐to‐ablation time seemed to have the greatest impact on AF recurrence within the first 2 years. Conclusion: In AF patients undergoing cryoballoon ablation, late timing of ablation was associated with a significantly higher AF recurrence rate when compared to early timing of ablation. These findings support early cryoballoon ablation to improve the outcomes after ablation. [ABSTRACT FROM AUTHOR]

Background: The 15-method is a targeted screening and treatment approach for alcohol problems in primary care. The 15-method used in primary care has proven as effective as specialized treatment for mild to moderate alcohol dependence in Sweden. A feasibility study of the 15-method in Danish primary care found the method acceptable and feasible. Aims: To evaluate the effectiveness of the 15-method in a Danish primary care setting in (1) lowering the proportion of patients exceeding the Danish low-risk alcohol consumption limit of ten standard units per week and a maximum of four standard units on a single day for men and women, and (2) increasing the likelihood of alcohol use being addressed during a consultation in general practice. Further, the rate of prescribed pharmacological treatment for alcohol problems (Disulfiram, Naltrexone, Acamprosate, and Nalmefene) will be measured along with the use of the biomarkers Alanine Transaminase and Gamma-Glutamyl Transferase. Methods: Stepped wedge cluster randomized controlled trial in sixteen general practices in the Region of Southern Denmark. Following a three-month baseline, the practices are randomly assigned to launch dates in one of four clusters. General practitioners and nurses receive three hours of training in the 15-method before launch. Patient questionnaires will collect data on alcohol consumption levels among patients affiliated with the practices. The healthcare professionals will register consultations in which alcohol is addressed in their patient filing system. Pharmacological treatment rates and the use of biomarkers will be collected through Danish national registries. The study follows the Medical Research Council's guidelines for developing and evaluating complex interventions. Discussion: From the patient's perspective, the 15-method may help identify alcohol-related problems at an earlier stage with flexible treatment offers in a familiar setting. For healthcare professionals, it addresses a traditionally challenging topic by equipping them with concrete tools, communication training, and clear treatment directives. From a societal perspective, primary care holds a unique position to identify hazardous and harmful alcohol use across different age groups, with potential public health and economic benefits through early identification and intervention. Trial registration: Clinicaltrials.gov NCT05916027. Retrospectively registered 22 June 2023. [ABSTRACT FROM AUTHOR]

Background: Worldwide visitor restrictions forced nurses to separate patients from their relatives. However, the experience of implementing shifting restrictions from the frontline nurses' perspectives in a Danish context has yet to be assessed. Aim: The aim of this descriptive qualitative study was to explore frontline nurses' experiences of managing shifting visitor restrictions in a Danish somatic university hospital during the COVID‐19 pandemic. Methods: An online questionnaire, including open‐ended questions, was developed. Data were analysed using descriptive statistics and content analysis. Findings: 116 nurses from 29 departments participated; they were informed about restrictions primarily by their charge nurses and hospital intranet. Shifting visitor restrictions compelled the nurses to constantly adjust and negotiate their practices. When deciding to suggest deviating from the restrictions, they shared their decision‐making with colleagues. Visitor restrictions left the hospital environment quieter, but they also created a lack of overview and predictability, an emotional burden, and a negative impact on the quality of care. Conclusion: Restricting relatives' access challenged the nurses' professional values, and it seems to have affirmed their appreciation of relatives' role as important partners in contemporary hospital‐based health care. [ABSTRACT FROM AUTHOR]

Objectives: To validate an AI system for standalone breast cancer detection on an entire screening population in comparison to first-reading breast radiologists. Materials and methods: All mammography screenings performed between August 4, 2014, and August 15, 2018, in the Region of Southern Denmark with follow-up within 24 months were eligible. Screenings were assessed as normal or abnormal by breast radiologists through double reading with arbitration. For an AI decision of normal or abnormal, two AI-score cut-off points were applied by matching at mean sensitivity (AIsens) and specificity (AIspec) of first readers. Accuracy measures were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and recall rate (RR). Results: The sample included 249,402 screenings (149,495 women) and 2033 breast cancers (72.6% screen-detected cancers, 27.4% interval cancers). AIsens had lower specificity (97.5% vs 97.7%; p < 0.0001) and PPV (17.5% vs 18.7%; p = 0.01) and a higher RR (3.0% vs 2.8%; p < 0.0001) than first readers. AIspec was comparable to first readers in terms of all accuracy measures. Both AIsens and AIspec detected significantly fewer screen-detected cancers (1166 (AIsens), 1156 (AIspec) vs 1252; p < 0.0001) but found more interval cancers compared to first readers (126 (AIsens), 117 (AIspec) vs 39; p < 0.0001) with varying types of cancers detected across multiple subgroups. Conclusion: Standalone AI can detect breast cancer at an accuracy level equivalent to the standard of first readers when the AI threshold point was matched at first reader specificity. However, AI and first readers detected a different composition of cancers. Clinical relevance statement: Replacing first readers with AI with an appropriate cut-off score could be feasible. AI-detected cancers not detected by radiologists suggest a potential increase in the number of cancers detected if AI is implemented to support double reading within screening, although the clinicopathological characteristics of detected cancers would not change significantly. Key Points: • Standalone AI cancer detection was compared to first readers in a double-read mammography screening population. • Standalone AI matched at first reader specificity showed no statistically significant difference in overall accuracy but detected different cancers. • With an appropriate threshold, AI-integrated screening can increase the number of detected cancers with similar clinicopathological characteristics. [ABSTRACT FROM AUTHOR]

Aim: To explore registered nurses' perspectives on challenges and facilitators to implementing a telephone‐based self‐management support (SMS) intervention (Proactive Health Support) as an everyday healthcare practice, during the early stages of implementation. Design: Data were collected using a qualitative research design involving focus‐group interviews and participant observations. Methods: We conducted participant observation following nine nurses and four focus group interviews with 14 nurses. Data were analysed using thematic analyses. Results: Proactive Health Support was implemented in units organized independently of the existing organizational units within healthcare services. This independent organization, along with the intervention's generic (non‐disease specific) design, empowered nurses to become autonomous practitioners capable of prioritizing the operationalization of SMS as an everyday healthcare practice. However, unlearning already embedded medical practices and establishing new nursing roles necessary to accommodate the intervention in practice was experienced a challenge. Education and supervision were identified as valuable tools for successful implementation. Conclusion: Our study highlights the significance of organizational context and autonomy in successful SMS implementation. Balancing external factors like organizational context, priority and time is vital, but navigating the internal shift in professional practice is equally crucial. Role transition processes can constitute challenges demanding accommodation. Implications for the Profession: From a nursing perspective, this study highlights that practising SMS requires substantial training and education. Generic SMS interventions can introduce higher levels of contingency due to their versatile nature. Thus, equipping nurses with competencies that enable them to navigate this unpredictability flexibly is crucial. Impact: Policymakers and administrators should allocate resources and support implementation processes in ways that accommodate both internal and external conditions to facilitate nurses in delivering effective SMS. Reporting Method: This study adheres to the SRQR guideline. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Objectives: The aim was to determine the association between self-reported health (SRH), allostatic load (AL) and mortality. Methods: Data derived from the Lolland-Falster Health Study undertaken in Denmark from 2016-2020 (n = 14,104). Median follow-up time for death was 4.6 years where 456 participants died. SRH was assessed with a single question and AL by an index of ten biomarkers. Multinomial regression analysis were used to examine the association between SRH and AL, and Cox regression to explore the association between SRH, AL and mortality. Results: The risk of high AL increased by decreasing level of SRH. The ratio of relative risk (RRR) of having medium vs. low AL was 1.58 (1.11-2.23) in women reporting poor/very poor SRH as compared with very good SRH. For men it was 1.84 (1.20-2.81). For high vs. low AL, the RRR was 2.43 (1.66-3.56) in women and 2.96 (1.87-4.70) in men. The hazard ratio (HR) for all-cause mortality increased by decreasing SRH. For poor/very poor vs. very good SRH, the HR was 6.31 (2.84-13.99) in women and 3.92 (2.12-7.25) in men. Conclusion: Single-item SRH was able to predict risk of high AL and all-cause mortality. [ABSTRACT FROM AUTHOR]

Globally, education policy reforms are increasingly aimed at attending to excellence in education. This is mainly expressed as attempts at raising educational standards generally, but also of identifying intellectual elites and making special provisions for them. Denmark, which is otherwise considered an exponent of an equality-oriented tradition in education, is now pursuing strategies of developing talent throughout the educational system, which is to cater more to the needs of so-called gifted and talented students. This policy is claimed to have found inspiration from Australia, where some of the states have been pursuing such policies for several years and where we find a more developed tradition for this. The paper is focused on understanding what concept of excellence such education policies imply; we aim to analyse the targeted groups with respect to means of identification and development, and to analyse the wider implications of such policies. The analysis is empirically focused on education policy documents on gifted and talented educational provisions at national/state level. Beginning with the political discourse of talent development in education as it has appeared in Denmark, we analyse this in relation to the policies and curricular provisions for the gifted and talented in England and Australia.

This paper explains how engineering students at a Danish university acquired the necessary skills to become emergent facilitators of organisational development. The implications of this approach are discussed and related to relevant viewpoints and findings in the literature. The methodology deployed for this paper is empirical and conceptual. A specific facilitation project carried out by six international engineering students is presented. The importance of combining cognitive, emotional and synergistic skills is highlighted on the basis of this example, the authors' extensive experience in teaching facilitation and the literature. These types of skills are most effectively acquired by combining conceptual lectures, classroom exercises and the facilitation of groups in a real-life context. The paper also reflects certain 'shadow sides' related to facilitation observed by the students and discussed in the literature. The educational process description and reflections presented in this paper can help university staff and mentors in public and private organisations to adopt interactive methods for education and training. A brief overview of the methods used is included in the Appendix. By connecting the literature, the authors' and engineering students' reflections on facilitator skills, this paper adds value to existing academic and practical discussions on learning facilitating leadership.

The Nordic countries are often perceived as a coherent group representing the Nordic model of welfare states, with a strong emphasis on the public provision of universal welfare and a strong concern with social equality. But today we see a change in the Nordic model as part of a global knowledge economy. The aim of this article is to examine education in the five Nordic countries utilising three dimensions of political change: deregulation, marketisation and privatisation. We also analyse the parallel changes in relation to segregation and differentiation in education. The analysis shows that the themes related to deregulation seem to show fairly similar patterns and structures in all contexts. The emerging differences were discovered mainly in the themes of marketisation and privatisation. Institutional segregation emerges in all Nordic countries to different extents along the lines of these three processes, and we observe a simultaneous social segregation and differentiation with an ambiguous connection to them. Based on these findings, the question of what is left of the "Nordic model" could be raised.

Background: The Danish cardiovascular screening (DANCAVAS) trial, a nationwide trial designed to investigate the impact of cardiovascular screening in men, did not decrease all-cause mortality, an outcome decided by the investigators. However, the target group may have varied preferences. In this study, we aimed to evaluate whether men aged 65 to 74 years requested a CT-based cardiovascular screening examination and to assess its impact on outcomes determined by their preferences. Methods and findings: This is a post hoc study of the randomised DANCAVAS trial. All men 65 to 74 years of age residing in specific areas of Denmark were randomised (1:2) to invitation-to-screening (16,736 men, of which 10,471 underwent screening) or usual-care (29,790 men). The examination included among others a non-contrast CT scan (to assess the coronary artery calcium score and aortic aneurysms). Positive findings prompted preventive treatment with atorvastatin, aspirin, and surveillance/surgical evaluation. The usual-care group remained unaware of the trial and the assignments. The user-defined outcome was based on patient preferences and determined through a survey sent in January 2023 to a random sample of 9,095 men from the target group, with a 68.0% response rate (6,182 respondents). Safety outcomes included severe bleeding and mortality within 30 days after cardiovascular surgery. Analyses were performed on an intention-to-screen basis. Prevention of stroke and myocardial infarction was the primary motivation for participating in the screening examination. After a median follow-up of 6.4 years, 1,800 of 16,736 men (10.8%) in the invited-to-screening group and 3,420 of 29,790 (11.5%) in the usual-care group experienced an event (hazard ratio (HR), 0.93 (95% confidence interval (CI), 0.88 to 0.98; p = 0.010); number needed to invite at 6 years, 148 (95% CI, 80 to 986)). A total of 324 men (1.9%) in the invited-to-screening group and 491 (1.7%) in the usual-care group had an intracranial bleeding (HR, 1.17; 95% CI, 1.02 to 1.35; p = 0.029). Additionally, 994 (5.9%) in the invited-to-screening group and 1,722 (5.8%) in the usual-care group experienced severe gastrointestinal bleeding (HR, 1.02; 95% CI, 0.95 to 1.11; p = 0.583). No differences were found in mortality after cardiovascular surgery. The primary limitation of the study is that exclusive enrolment of men aged 65 to 74 renders the findings non-generalisable to women or men of other age groups. Conclusion: In this comprehensive population-based cardiovascular screening and intervention program, we observed a reduction in the user-defined outcome, stroke and myocardial infarction, but entail a small increased risk of intracranial bleeding. Trial registration: ISRCTN Registry number, ISRCTN12157806https://www.isrctn.com/ISRCTN12157806. In this post-hoc analysis of the DANCAVAS trial, Axel Diederichsen and colleagues explore how cardiovascular screening impacts on outcomes as defined by patients themselves. Author summary: Why was this study done?: Stroke and heart attack remain a prevalent cause of decreased quality of life and premature death. Coronary atherosclerosis serves as an important risk modifier and is easily identifiable by cardiac imaging. Despite this, screening for cardiovascular disease by cardiac CT in the Danish cardiovascular screening (DANCAVAS) trial did not lead to a decrease in death from cardiovascular causes. However, it is essential to recognise that patients may have preferences other than death, and these preferences play a critically important role in informed and shared decision-making between caregivers and patients. What did the researchers do and find?: The DANCAVAS trial included men aged 65 to 74 from specific areas of Denmark, with some receiving invitations to screening (16,736 men) and others receiving usual care (29,790 men). Patients with significant atherosclerosis were treated with atorvastatin, aspirin, and underwent surveillance or surgery in case of aneurysms. Here, the study outcomes were determined based on patient preferences, which were assessed through a survey of a random sample of 9,095 men aged 65 to 74. The surveyed men expressed a preference for preventing stroke and heart attack over death. Screening reduced the absolute risk of stroke and heart attack by 0.7%, but it also increased the risk of intracranial haemorrhage by 0.2%. What do these findings mean?: The DANCAVAS trial met patient preferences, but the benefits were modest and accompanied by a slight increase in the risk of intracranial haemorrhage. These data suggest that there is limited benefit to the widespread implementation of cardiovascular screening programmes. The trial specifically targeted men aged 65 to 74, meaning the findings cannot be generalised to women or men outside this age group. Future cardiovascular screening programs should encompass both sexes and accommodate patient preferences. Additionally, they might consider excluding aspirin from the intervention arm. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the nationwide incidence of Salmonella infections in Denmark from 2013 to 2022. Methods: Confirmed cases of Salmonella enterica subsp. enterica were examined using the National Register of Enteric Pathogens during 2013–2022. Proportions, incidence rates (IR), relative risk (RR), and 95% confidence intervals (CI) were calculated to assess differences in serotypes, invasiveness, age, sex, and travel exposure. Results: We identified 9,944 Danish Salmonella enterica subsp. enterica cases, with an average annual incidence rate of 16.9 per 100,000 inhabitants, declining during the COVID-19 pandemic. Typhoidal cases totaled 206, with an average annual IR of 0.35 per 100,000 inhabitants. Enteric fever patients had a median age of 24 years (IQR:17–36). Leading non-typhoid Salmonella (NTS) serotypes were S. Enteritidis (26.4%), monophasic S. Typhimurium (16.5%), and S. Typhimurium (13.5%). Median age for NTS cases was 42 (IQR: 18–62), with even sex distribution, and a third reported travel prior to onset of disease. The overall percentage of invasive NTS (iNTS) infection was 8.1% (CI: 7.6–8.7). Eleven serotypes were associated with higher invasiveness, with S. Dublin and S. Panama having the highest invasiveness with age and sex-adjusted RR of 7.31 (CI: 6.35–8.43) and 5.42 (CI: 3.42–8.60), respectively, compared to all other NTS serotypes. Increased age was associated with higher RR for iNTS infection. Conclusion: During the decade, there was a limited number of typhoidal cases. The dominant NTS serotypes were S. Enteritidis and monophasic S. Typhimurium, whereas S. Dublin and S. Panama exhibited the highest invasive potential. [ABSTRACT FROM AUTHOR]

Introduction. Little is known about how shifting hospital visitor restrictions issued by national health authorities were communicated, managed, and adapted by hospital charge nurses during the COVID-19 pandemic. Aims. To describe the shifting visitor restrictions and the passing on of restrictions from the national authority level to charge nurses and secondly describe charge nurses' management of the restrictions and their challenges when enforcing them. Methods. The study consisted of a document analysis and a cross-sectional survey including open-ended questions. Descriptive statistics and qualitative content analysis were used. The survey was distributed online to 88 charge nurses in somatic units in a Danish university hospital from March 2020 to April 2021. Results. Restrictions were communicated from national authority level in an effective administrative cascade. The charge nurses led their enforcement in each unit. In total, 71 charge nurses (81%) responded to the survey. For 70%, the wording of the restrictions was clear, while 31% found them challenging to handle. On a weekly or daily basis, 68% of the charge nurses deviated from the restrictions. They identified both upsides and downsides to the absence of relatives. Communication, collaboration, and leadership were experienced as key tools in the ongoing processes of adapting to shifting restrictions. Conclusion. During this severe health crisis, essential information was passed on through well-defined management levels in an effective communication pathway. Charge nurses and their professional values were challenged when balancing shifting national restrictions against individual needs of patients and relatives. Implications for Nursing Management. Charge nurses serve as vital intermediaries between national authorities and frontline nursing practice in managing shifting visitor restrictions during a pandemic. Their experiences can contribute to further qualifying nurse managers' considerations when designing family-centred hospital visitor policies for the future. Also, they may strengthen the handling of future sudden major organizational changes. [ABSTRACT FROM AUTHOR]

Background: To investigate factors associated with risk for rebleeding and 30-day mortality following prophylactic transarterial embolization in patients with high-risk peptic ulcer bleeding. Methods: We retrospectively reviewed medical records and included all patients who had undergone prophylactic embolization of the gastroduodenal artery at Rigshospitalet, Denmark, following an endoscopy-verified and treated peptic Sulcer bleeding, from 2016 to 2021. Data were collected from electronic health records and imaging from the embolization procedures. Primary outcomes were rebleeding and 30-day mortality. We performed logistical regression analyses for both outcomes with possible risk factors. Risk factors included: active bleeding; visible hemoclips; Rockall-score; anatomical variants; standardized embolization procedure; and number of endoscopies prior to embolization. Results: We included 176 patients. Rebleeding occurred in 25% following embolization and 30-day mortality was 15%. Not undergoing a standardized embolization procedure increased the odds of both rebleeding (odds ratio 3.029, 95% confidence interval (CI) 1.395–6.579) and 30-day overall mortality by 3.262 (1.252–8.497). More than one endoscopy was associated with increased odds of rebleeding (odds ratio 2.369, 95% CI 1.088–5.158). High Rockall-score increased the odds of 30-day mortality (odds ratio 2.587, 95% CI 1.243–5.386). Active bleeding, visible hemoclips, and anatomical variants did not affect risk of rebleeding or 30-day mortality. Reasons for deviation from standard embolization procedure were anatomical variations, targeted treatment without embolizing the gastroduodenal artery, and technical failure. Conclusions: Deviation from the standard embolization procedure increased the risk of rebleeding and 30-day mortality, more than one endoscopy prior to embolization was associated with higher odds of rebleeding, and a high Rockall-score increased the risk of 30-day mortality. We suggest that patients with these risk factors are monitored closely following embolization. Early detection of rebleeding may allow for proper and early re-intervention. [ABSTRACT FROM AUTHOR]

Background National colorectal cancer screening commenced in Denmark in 2014. Little is known about the effects of organized colorectal cancer screening on intraoperative and postoperative events. The aim of this nationwide cohort study was to evaluate the difference in intraoperative and postoperative outcomes between patients with screen-detected colorectal cancer and non-screen-detected colorectal cancer within the first 90 days after surgery. Methods National register data were collected for Danish residents diagnosed with colorectal cancer between January 2014 and March 2018. Outcomes for the two cohorts were reported as relative risk or weighted mean difference. Intraoperative outcomes were blood loss, blood transfusion, tumour perforation, and organ lesion. Postoperative outcomes were complications (surgical and non-surgical) and 90-day mortality. Discrete data estimates were calculated from a general linear model. Analyses were adjusted for potential healthy user bias with respect to sex, age, location of the cancer (colon/rectum), and Charlson co-morbidity index. Results In total, 10 606 patients were included. Compared with patients in the non-screen-detected colorectal cancer group (4497 patients), patients in the screen-detected colorectal cancer group (6109 patients) had reduced intraoperative blood loss (−52 mL, 95% c.i. −67 to −37, P < 0.001), a shorter duration of hospitalization (−2.3 days, 95% c.i. −2.8 to −1.8, P < 0.001), and reduced rates of intraoperative organ lesion (0.76, 95% c.i. 0.59 to 0.99, P = 0.042), surgical complications (0.79, 95% c.i. 0.73 to 0.87, P < 0.001), non-surgical complications (0.68, 95% c.i. 0.60 to 0.78, P < 0.001), and 90-day mortality (0.29, 95% c.i. 0.21 to 0.39, P < 0.001). Conclusion In comparison with non-screen-detected colorectal cancer, surgery for screen-detected colorectal cancer remains associated with improvement in several intraoperative and early postoperative outcomes after considering healthy user bias. [ABSTRACT FROM AUTHOR]