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Our main goal was to investigate if and how using multiple immersive virtual reality (iVR) simulations and their video playback, in a science course, affects student learning over time. We conducted a longitudinal study, in ecological settings, at an undergraduate field-course on three topics in environmental biology. Twenty-eight undergraduates were randomly assigned to either an iVR-interaction group or a video-viewing group. During the field-course, the iVR group interacted with a head-mounted device-based iVR simulation related to each topic (i.e. total three interventions), while the video group watched a pre-recorded video of the respective simulation on a laptop. Cognitive and affective data were collected through the following checkpoints: a pre-test before the first intervention, one topic-specific post-test immediately after each intervention, a final post-test towards the end of the course, and a longitudinal post-test deployed approximately 2 months after the course. Through a descriptive analysis, it was found that student performance on the knowledge tests increased considerably over time for the iVR group but remained unchanged for the video group. While no within- or between-group differences were noted for intrinsic motivation and self-efficacy measures, students in the iVR group enjoyed all the simulations, and perceived themselves to benefit from those simulations.

This article analyses the ways in which notions of student diversity and student voice are defined in five European countries, two terms directly related to notions of inclusion. In so doing, it examines links between the two terms, noting that, often, they are used in international research without acknowledging the ways that they are defined within particular national contexts. Using literature and policy documents from five countries (i.e. Austria, Denmark, England, Portugal and Spain), the article highlights similarities as well as differences in the various contexts. Through the analysis of these texts, the paper concludes that diversity is conceptualised in five ways, although there is occasionally overlap of different conceptualisations in some of the countries. Meanwhile, the term 'student voice' is a term that is not used in some of the countries' policies. Instead, other terms that relate to student voice, such as 'participation', are used. The paper discusses the implications of these varied understandings for the promotion of the inclusion of all students in schools.

This paper contributes with elements of an emerging designs for learning-methodology and takes as its starting point the concept of Students as Learning Designers, which was developed by Sørensen and Levinsen and based on more than a decade of research-and-development projects in Danish primary schools (first to 10th grade). The research focussed on the integration of information and communication technology (ICT) in learning situations framed by the Scandinavian tradition of Problem Oriented Project Pedagogy (POPP), Problem Based Learning (PBL) and students' production. In recent years, the research projects that provide the theory's grounding have focussed specifically on designs for learning that constitute students as learning designers of digital subject related productions aimed at peers. These may be both multimodal communication productions and coded/programmed productions such as games and robots. This includes designs for learning that contribute to students' empowerment, involvement and autonomy within the teacher-designed frameworks that simultaneously scaffold students' subject-related inquiry, agency, reflection and learning. Research have documented that this approach constitutes arenas that support students' deep learning and mastery of both transdisciplinary and subject matter, along with acquisition of digital literacy and 21st-century competencies. As this theory and its operationalization in practice have proven useful, it makes sense to move from researching the WHY of students as learning designers to look into HOW, that is the methodology of teachers practicing designs for learning. For this purpose, we use the lens of the concepts metaphor and metonymy and interaction design theory to explore our empirical studies and previous findings and identify aspects of designs for learning practice that teachers can apply as methods when creating designs for learning aimed at students as learning designers.

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

Introduction: Prone position ventilation (PPV) of patients with adult respiratory distress syndrome (ARDS) supported with veno-venous extracorporeal membrane oxygenation (V-V ECMO) may improve oxygenation and alveolar recruitment and is recommended when extensive dorsal consolidations are present, but only few data regarding adverse events (AE) related to PPV in this group of patients have been published. Methods: Nationwide retrospective analysis of 68 COVID-19 patients admitted from March 2020 – December 2021 with severe ARDS and need of V-V ECMO support. The number of patients treated with PPV, number of PPV-events, timing, the time spent in prone position, number and causes of AE are reported. Causes to stop the PPV regimen and risk factors for AE were explored. Results: 44 out of 68 patients were treated with PPV, and 220 PPV events are evaluated. AE were identified in 99 out of 220 (45%) PPV events and occurred among 31 patients (71%). 1 fatal PPV related AE was registered. Acute supination occurred in 19 events (9%). Causes to stop the PPV regimen were almost equally distributed between effect (weaned from ECMO), no effect, death (of other reasons) and AE. Frequent causes of AE were pressures sores and ulcers, hypoxia, airway related and ECMO circuit related. Most AE occurred during patients first or second PPV event. Conclusions: PPV treatment was found to carry a high incidence of PPV related AE in these patients. Causes and preventive measures to reduce occurrence of PPV related AE during V-V ECMO support need further exploration. [ABSTRACT FROM AUTHOR]

Changing learning objectives was the beginning of rethinking the pedagogical frame of my courses within a traditional law study program. The objectives were changed in order to aim for students becoming better at reflecting on the curriculum. I chose to work within a workshop frame incorporating some of the Aalborg PBL principles. The two courses conducted within this frame are Danish Consumer Law (in Danish) and EU Consumer Law (in English). They are both electives at master level (8th semester) at the Law School at Aalborg University. This case description gives an insight into the structure of the workshops and gives examples of what tasks the students are assigned to work on in the group work in order to achieve the learning objectives.

Entrepreneurship has revealed a new way of considering learning in educational institutions; but it presents a challenge to most schools. Entrepreneurial learning is asking the teachers to allow pupils to see new possibilities, take initiatives and be self-directed. However, this is difficult for teachers, since they are used to being in control of the teaching and are fixated on conventional curricula, teaching methods, use of knowledge, teaching styles, teacher-student relations, culture, habitat and assessments [1]. In entrepreneurship education, we tend to have a single focus, e.g. "motivation", "self-directed learning", "learning goals" etc., but maybe we need to broaden our focus and look at the bigger picture. The main question in this paper is: how can we understand the challenge that entrepreneurial learning poses to the teacher's role and the learning culture in schools and additionally, how can we develop entrepreneurial education that meets these challenges? The paper refers to our research in a public school. Based on this research and additional literature review [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11] we suggest adding a design approach to entrepreneurship education. Additionally, we present a design approach that also takes the student's personal and inner focus into account.

Purpose: Post-stroke sequelae among elderly often lead to a more inactive life while carrying a risk of overburdening close relatives. The objective of the present study was to determine if a novel self-management neuro-rehabilitation intervention added to usual treatment for people with stroke over the age of 65 years improved their self-efficacy. Methods: This randomised controlled trial included participants two weeks before discharge from subacute rehabilitation. All participants received usual treatment. The intervention entailed an add-on of six to eight self-management sessions lasting 45–60 min within a period of nine months after discharge. This novel neuro-rehabilitation intervention focused on promoting growth, development and self-efficacy by facilitating the participants' self-management strategies regarding their activities and social network. All participants were assessed at baseline, three months and nine months after discharge. The primary outcome was self-efficacy measured by the Stroke Self-Efficacy Questionnaire. Results: Sixty-nine individuals with stroke aged > 65 years were randomised. Their mean(SD) age was 76(6) years; 32 (46%) were female. No significant difference was found between the groups at baseline. Improvement recorded in the intervention group did not significantly differ from that of the control group with regard to primary outcome or secondary outcomes. Conclusions: This novel self-management intervention had no significant effect measured by the primary outcome self-efficacy or quality of life. Furthermore, no impact was observed on participation and autonomy compared with usual treatment. Clinical trial registration—URL: ClinicalTrials.gov, NCT03183960. Registered on 12 June 2017. IMPLICATION FOR REHABILITATION: The present study testing a novel self-management neuro-rehabilitation intervention for people with stroke aged more than 65 years failed to improve self-efficacy, quality of life, and impact on participation and autonomy. Post hoc analyzes showed a lower caregiver burden at three and nine months in the intervention group as compared to the control group. The approach of perceiving the stroke individual and the informal caregiver as one unit (dyad), involving both in decisions regarding everyday activities and roles in everyday life especially within their shared part of life, appears important and warrants further development. [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]

Persons with intellectual disabilities (ID) face pronounced health disparities. The aim of this study was to describe premature mortality by causes of death and avoidable mortality among persons with ID compared to the general Danish population. This study is based on a Danish nationwide cohort of adults (aged 18–74 years) with ID (n  = 57 663) and an age- and sex-matched reference cohort (n  = 607 097) which was established by linkage between several registers. The cohorts were followed in the Register of Causes of Death between 2000 and 2020. Causes of death were categorized into preventable, treatable, or unavoidable deaths using the OECD/Eurostat classification and furthermore categorized into specific interventions. We compared the observed and expected number of deaths by calculating standardized mortality ratio (SMR). Among persons with ID the number of deaths was 9400 whereof 5437 (58%) were avoidable. SMR for preventable deaths, e.g. by reducing smoking and alcohol intake or by vaccination, was 2.62 (95% CI, 2.51–2.73), and SMR for treatable deaths, e.g. by earlier diagnosis and treatment, was 6.00 (5.72–6.29). Unavoidable mortality was also six-fold increased (SMR = 6.03; 5.84–6.22). Preventable deaths were higher for persons with mild ID compared to severe ID, while treatable and unavoidable mortality were highest for persons with severe ID. The study confirmed that persons with ID have an amplified risk of mortality across all categories. There is a need for competence development of social care and healthcare personnel and reasonable adjustment of health promotion programs and healthcare services for people with ID. [ABSTRACT FROM AUTHOR]

Simple Summary: Soft-tissue sarcomas (STSs) are rare cancers that are difficult to diagnose and treat due to their variability. In 2009, Denmark introduced the Cancer Patient Pathways for sarcomas (CPPs) to improve the survival of sarcoma patients by accelerating the diagnosis and treatment processes. This study examined whether the CPPs improved survival in patients with high-grade STSs. Our findings show that survival has improved since the CPPs were introduced and treatment delays have been reduced. This research highlights the importance of streamlined cancer care in improving patient outcomes. Background: Soft-tissue sarcomas (STSs) are rare and challenging to diagnose due to their heterogeneous presentation. In 2009, Denmark introduced the Cancer Patient Pathways for sarcomas (CPPs) to improve sarcoma treatment by streamlining diagnostic and therapeutic processes. The primary objective of this study is to evaluate the impact of the CPPs on the overall survival of patients with deep-seated, high-grade STSs, comparing outcomes from before and after CPP implementation. Methods: A retrospective cohort study was conducted using data from 712 patients diagnosed with high-grade STSs in the extremities or trunk wall between 2000 and 2018. Patients were grouped into pre-CPP (2000–2008) and post-CPP (2010–2018) cohorts. Overall survival was analyzed using Kaplan–Meier estimates. Results: The five-year overall survival improved from 43% in the pre-CPP cohort to 52% post-CPP (p = 0.05). Time-to-treatment was significantly reduced in the post-CPP cohort, with a median decrease of 3 days (18 vs. 15 days, p < 0.001). We found only a very weak tendency toward larger tumor sizes in the pre-CPP cohort and no difference regarding the percentage of patients that had distant metastases at diagnosis between cohorts. In the post-CPP cohort, the percentage of whoops operations decreased and the use of oncological services increased. Conclusions: After the introduction of the CPPs for the sarcoma patients, overall survival improved and time to treatment was reduced. This study highlights the importance of efficient referral pathways in improving cancer outcomes but cannot exclude that other factors could also have contributed. [ABSTRACT FROM AUTHOR]

Departing from discussions at Research in Management Learning & Education (RMLE) Unconferences, we identify the problem of practical deliberation: When faced with multiple, relevant theories that all demand to be given weight in a process of deliberation, how do management students, while drawing on these theories, justify their choice? Based on contemporary practical philosophy, we claim that students must aim for rational necessitation when practically deliberating about such decisions. Using the example of our teaching on a Master of Public Governance program at a major European business school, we delineate how we have employed a philosophical pedagogy to teach MBA students to practically deliberate in order to reach rational necessitation. With our theoretical and practical research, we aim to show how contemporary practical philosophy offers a distinct, original contribution to management learning and education in contrast with the traditional philosophies of education We end the article by suggesting and motivating five avenues of further research into the problem of practical deliberation in management learning and education.

The present paper is based on two empirical research studies. The "Netbook 1:1" project (2009-2012), funded by the municipality of Gentofte and Microsoft Denmark, is complete, while "Students' digital production and students as learning designers" (2013-2015), funded by the Danish Ministry of Education, is ongoing. Both projects concern primary and lower secondary school and focus on learning design frameworks that involve students' agency and participation regarding digital production in different subjects and cross-disciplinary projects. Within these teacher-designed frameworks, the students perform as learning designers of learning objects aimed at other students. "Netbook 1:1" has shown that digital and multimodal production especially facilitates student-learning processes and qualifies student-learning results when executed within a teacher-designed framework, which provides space for and empowers students' agency as learning designers. Moreover, the positive impact increases when students as learning designers participate in formative evaluation practices. Traditionally, the Danish school has worked hard to teach students to verbalise their own academic competencies. However, as our everyday environment becomes increasingly complex with digital and multimodal technologies, formative evaluation as a learning practice becomes central, requiring the students to develop a digital and multimodal literacy beyond the traditional, language-centred type. In order to clarify these practices, we address the various understandings of evaluation and assessment that may blur our arguments. "Students' digital production and students as learning designers" is a large-scale project that follows up on the findings of "Netbook 1:1." It experiments further with various evaluation practices in a digitalised learning environment that focuses on different phases of the learning processes and includes feed-forward and feedback processes. Evaluation as a learning practice in a digitalised learning context focuses on students as actors, addressing their self-reflections, responses to feedback from peers and feedforward processes, and responses to feedback from teachers and feed-forward processes. We find that apart from teacher initiated and planned evaluations, the teachers find it useful to initiate ad-hoc evaluations in order to grab interesting aspects on the fly. At the same time we see students initiate ad-hoc peer-evaluations and make appointments for swopping their work for peer-evaluation.

For the past decade, philosophers of mathematical practice have examined the nature and function of proofs in mathematical practice, most often in mathematical research practice. More recently they have examined how mathematicians assess and get to know a proof not just by reading it, but through active engagement with the proof. For example, mathematicians traverse gaps in the proof by filling in details. This paper examines the relevance of this literature to the teaching of mathematics. In particular, it examines how reader engagement can be taught as an aspect of proofs in the context of upper-secondary mathematics education, and the argument is illustrated by teaching material on Hero's formula, which was developed for and tested in Danish upper-secondary mathematics teaching.

Background: To meaningfully understand outcomes of gender-affirming care, patient-reported outcome measures (PROMs) that are grounded in what matters to individuals seeking care are urgently needed. The objective of this study was to develop a comprehensive PROM to assess outcomes of gender-affirming care in clinical practice, research, and quality initiatives (the GENDER-Q). Methods: Internationally established guidelines for PROM development were used to create a field test version of the GENDER-Q. In-depth interviews were conducted from December 2018 to March 2020 with youth and adults aged 16 years and older who were seeking or had received gender-affirming care at outpatient clinics providing gender-affirming care located within tertiary care centers or communities in Canada, Denmark, the Netherlands or the US. Data were analyzed and used to develop a conceptual framework and an item pool, which was used to develop preliminary scales. Between February 2021 to November 2021, iterative feedback was sought from clinicians and patient participants on the scales and used to refine or develop new scales. The revised scales were pilot-tested using a crowd-sourcing platform between February 2022 and April 2022. Results: Data from interviews with 84 participants (aged 34 ± 14 years) resulted in a conceptual framework of the GENDER-Q with 13 domains measuring health-related quality of life, sexual, urination, gender practices, voice, hair, face and neck, body, breasts, genital feminization, chest, genital masculinization, and experience of care. Preliminary versions of 44 scales were developed covering most concepts in the conceptual framework. Iterative feedback was obtained from clinician experts (4 to 37 experts per scale; response rate, 67%) and 7–14 patient participants (depending on scale). All scales were refined, and 15 new scales were developed, resulting in 55 scales in the field test version of the GENDER-Q. In total, 601 transgender and gender diverse (TGD) people (aged 25 ± 6 years) participated in the pilot field test and the data were used to make changes to the field test survey. Conclusion: The GENDER-Q was developed using extensive input from TGD individuals and clinician experts and represents the most comprehensive set of independently functioning scales that are available to date. An international field test of the GENDER-Q was completed in 2024 and the GENDER-Q is available for use in patient care, clinical research and quality improvement efforts. [ABSTRACT FROM AUTHOR]

To provide an overview of the information recorded in the DHMR and to highlight its strengths and limitations as a pharmacoepidemiological research tool. Methods: We reviewed the registry´s geographic and clinical specialty coverage and medications recorded according to the main groups of the Anatomical Therapeutic Chemical classification system. Results: From May 2018 through December 2023, the DHMR recorded data on more than 1.9 million unique patients from all approximately 50 public hospitals and associated hospital outpatient clinics, totaling 105.3 million recordings of hospital medication use. The registry records detailed data on the indication for medication, medication type, pharmaceutical form, dosage, and administration time, collected through electronic medical record systems. Although the data quality has not yet been evaluated in a scientific context, some potential limitations are known. These include regional differences in the data collection and a lack of data from certain clinical specialties. Due to its recent establishment in 2018, the registered number of patients treated may still be limited for some rarely used medications. Conclusion: The DHMR is an important new resource for research in Denmark. Combined with the Danish National Prescription Registry, which covers all community pharmacies, it offers access to accurate data on medication exposure in the Danish population. Users should be aware of potential issues with lack of information before 2018. [ABSTRACT FROM AUTHOR]

Purpose: Evidence on rehabilitation after revision total hip replacement (THR) is inadequate and development of rehabilitation interventions is warranted. Even so, little is known about patients' experiences with revision THR rehabilitation. This study aimed to explore patients' rehabilitation exercise experiences after revision THR. Materials and methods: Using constructivist grounded theory, we conducted semi-structured qualitative interviews with twelve patients with completed or almost completed rehabilitation exercise after revision THR. Data collection and analysis were a constant comparative process conducted in three phases; initial, focused, and theoretical. Findings: From the data, we generated a substantial theory of the participant's circumstances and ability to integrate rehabilitation exercise into their everyday life after revision THR. Four categories were constructed based on patients' experiences in different contexts: hesitance, fear avoidance, self-commitment, and fidelity. Conclusions: This study highlighted that patients' expectations, past experiences, attitudes, trusts, and circumstances interact to influence engagement and adherence to rehabilitation exercise and described four categories relating to the integration of revision THR rehabilitation exercise into their everyday life. Clinicians should be aware of and account for these categories during rehabilitation exercise. Tailored individual rehabilitation exercise interventions and clinician approaches to optimize engagement and adherence are needed among patients with revision THR. IMPLICATIONS FOR REHABILITATION: Patients' rehabilitation exercise experiences after revision total hip replacement may serve as guidance for clinicians. A need exists to tailor individual rehabilitation interventions and clinicians' approaches to optimize patients' engagement and rehabilitation exercise adherence following revision total hip replacement. Clinicians can tailor rehabilitation exercise for patients with revision total hip replacement by focusing on therapeutic relationships, support needs, and physical function while incorporating insights from previous rehabilitation exercise experiences. An important goal of rehabilitation exercise is to enhance patient engagement, thereby facilitating the integration of rehabilitation exercises into the patients' everyday life. [ABSTRACT FROM AUTHOR]

While left-handers have been overrepresented among 7-meter shooters in handball, previous investigators have not found success from the 7-meter line to be related to handedness. Drawing on previous handedness research in sport, we performed two studies to examine possible negative frequency-dependent advantages to left-handedness during 7-meter throws among elite players. In Study I, we analyzed the records of 974 7-meter shooters from Danish and Norwegian elite divisions (485 males and 489 females) and found that left-handed males were overrepresented compared to the prevalence of left-handers in these two leagues, but left-handed females were not. An analysis of covariance showed no statistically significant associations between throwing arm or sex, and success from the 7-meter line. In Study II, we analyzed the records of 899 7-meter shooters at 41 major championships for both males and females between 2007-2023 (442 males and 457 females). We again found left-handed males to be overrepresented compared to their prevalence at the championships, but left-handed females were not. Also, in alignment with Study I, an analysis of covariance found no associations between throwing arm or sex, and success from 7-meter throws. These findings further underline the complexities associated with lateral biases in sports, where there appear to be benefits for left-handed males in the selection process that are not evident during performance execution. [ABSTRACT FROM AUTHOR]

Objective: To examine the combined impact of migraine and gestational diabetes mellitus (GDM) on the risks of premature (persons aged ≤60 years) major adverse cardiovascular and cerebrovascular events (MACCE) based on a composite endpoint of fatal and non‐fatal myocardial infarction (MI) and stroke. Background: Migraine and GDM are risk factors for cardiovascular disease. It is unknown how the combination of migraine and GDM may affect cardiovascular disease risk. Methods: In a Danish population‐based cohort longitudinal study, we established four cohorts among women with at least one pregnancy during 1996–2018: women with migraine, women with GDM, women with both migraine and GDM, and women free of migraine and free of GDM. Risks of premature MACCE and component endpoints were assessed for each cohort. Results: We included 1,307,456 women free of migraine and free of GDM, 56,811 women with migraine, 24,700 women with GDM, and 1484 women with migraine and GDM. The 20‐year absolute risk of MACCE was 1.3% (MI: 0.4%, ischemic stroke: 0.6%, hemorrhagic stroke: 0.3%) among women free of migraine and free of GDM, 2.3% (MI: 0.8%, ischemic stroke: 1.2%, hemorrhagic stroke: 0.5%) among women with migraine, 2.2% (MI: 1.0%, ischemic stroke: 1.0%, hemorrhagic stroke: 0.4%) among women with GDM, and 3.7% (MI: 1.7%, ischemic stroke: 1.7%, hemorrhagic stroke: 0.3%) among women with both migraine and GDM. The 20‐year adjusted hazard ratio of premature MACCE was 1.65 (95% confidence interval [CI] 1.49–1.82) for women with migraine; 1.64 (95% CI 1.37–1.96) for women with GDM; and 2.35 (95% CI 1.03–5.36) for women with both GDM and migraine when compared with women free of migraine and free of GDM. Conclusions: Migraine and GDM were each independently associated with an increased risk of MACCE. Risk of premature MACCE was greatest among women with both migraine and GDM, although this risk estimate was imprecise. Plain Language Summary: Migraine and gestational diabetes are both risk factors for cardiovascular disease, but it is unknown how the combination of migraine and gestational diabetes affects cardiovascular disease risk. In this study, we found an increased risk of cardiovascular disease among women with migraine only and among women with gestational diabetes only. The risk of cardiovascular disease was greatest among women with both migraine and gestational diabetes. [ABSTRACT FROM AUTHOR]

Purpose: This paper provides an overview of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort and biobank, including baseline characteristics of participants enrolled up to 2023, and post-enrollment rates of cardiovascular disease outcomes and mortality. Methods: Since 2010, the DD2 project has enrolled individuals with type 2 diabetes mellitus (T2DM) recently diagnosed by general practitioners and by hospital-based clinicians across Denmark. Data from questionnaires, clinical examinations, and biological samples are collected at enrollment. Additional baseline and longitudinal follow-up data are accessed via linkage to health registries. Results: Between 2010 and 2023, the DD2 project enrolled 11,369 participants (41.3% women, median age 61.4 years). Median T2DM duration at enrollment was 1.3 years, and median BMI was 31.6 kg/m2 for women and 30.5 kg/m2 for men. 18.3% were smokers, 5.7% consumed more than 14/21 units of alcohol weekly (women/men), and 17.9% reported leisure-time physical inactivity. Original midwife records dating back > 80 years revealed that 20.2% of cohort participants had birth weights < 3000 g. Based on complete hospital contact history 10 years before enrollment, 20.7% of cohort participants had macrovascular complications, 17.0% had microvascular complications, and 21.7% had kidney disease based on eGFR or urine albumin-creatinine measurements. At enrollment, statins were used by 68.2%, antihypertensive drugs by 69.9%, and glucose-lowering drugs by 86.5% of individuals. Median HbA1c was 48 mmol/mol and median LDL cholesterol 2.2 mmol/L. Genome-wide genotyping and biomarker data have been analyzed for over 9000 individuals. During the current follow-up time from the enrollment date (median 7.9 years), incident cardiovascular disease rate has been 13.8 per 1000 person-years and the mortality rate has been 17.6 per 1000 person-years. Conclusion: The DD2 cohort, with its detailed information and long-term follow up, can improve our understanding of the progression and prevention of complications among individuals with newly diagnosed T2DM. [ABSTRACT FROM AUTHOR]

Osgood Schlatter's disease (OSD) is characterized by pain at the tibial tuberosity provoked during knee‐loading activities, and is common in adolescent athletes. The aim of this study was to characterize clinical, pain and ultrasound imaging characteristics in participants with OSD compared to controls. This cross‐sectional study included adolescents diagnosed with OSD and matched controls. Following baseline evaluation including ultrasound, participants completed the following aggravating activities in a randomized order: single‐leg isometric knee hold, single‐leg squat, single‐leg vertical jump, hopping, running, cutting, lunges, and walking. Participants rated pain intensity on a numeric rating scale (0–10; no pain to worst pain imaginable) and localization during activities. We included 35 participants with OSD (48.5% females, age 13.0 [SD 1.5]) and 21 controls (47.6% females, age 13.4 [SD1.4]). Doppler signal was more prevalent in OSD participants at the tendon (77% vs. 30%) and tuberosity (29% vs. 10%). Tendon thickness was greater in OSD at distal (mean difference = 4.5 mm 95% CI 1.5–7.5) and proximal sites (mean difference = 4.2 95% CI 0.1–8.3). Aggravating activities induced higher pain in OSD. The greatest differences between OSD and control were the dynamic single‐leg squat (mean difference = 4.2 (95% CI 3.22–5.1)). Pain was localized at the tibial tuberosity and patellar tendon during activities. Sex, sports participation, bilateral pain, and Doppler were associated with greater pain during aggravating activities. Single‐leg activities loading the tibial tuberosity through the tendon appear to provoke OSD‐related pain more than other sports specific movements. This may be useful to guide adolescents on which activities are likely to aggravate pain. [ABSTRACT FROM AUTHOR]

Introduction: It remains unclear why 17% of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in Danish hospitals are readmitted within 30 days. Hospital discharge is multifaceted. However, the preparation process and nurses' efforts may be essential in ensuring a successful discharge. Aim: To explore the process of preparing discharge for patients with COPD in a hospital setting. Method: Using constructivist grounded theory, we observed 11 nurses' work at two pulmonary medical wards using participant observation. Data collection and analysis were conducted using a constant comparative process encompassing three phases: initial, focused and theoretical. Results: We identified important perspectives influencing nurses when patients with COPD are discharged from two pulmonary medical wards. We generated a substantial theory of how nurses integrate various perspectives into their handling of hospital discharge. The theory contains three discharge approaches: co‐creating, hesitating and socialising. The co‐creating approach focuses on patient and relative involvement and systematic task solution, embedded in a biopsychosocial process, aiming to achieve a safe and sustainable discharge. In contrast, the hesitating approach focuses on discharging patients in line with system requirements and colleagues' expectations. Finally, the socialising approach focuses on creating a pleasant discharge experience for patients and colleagues alike. Conclusion: This study illuminates three distinct approaches adopted by nurses when discharging a patient with COPD. The co‐creating process encompasses patient involvement and systematic task resolution, incorporating a biopsychosocial process. In contrast, the other approaches are more limited in scope: the hesitating approach aims for harmony and collegial consensus, while the socialising approach focuses on ensuring a pleasant discharge experience for everyone. Nurses should therefore be mindful of the approach they adopt and the values associated with it in order to optimise their management of hospital discharge processes. [ABSTRACT FROM AUTHOR]

The aim of this paper is to investigate the organization of research in high-performing research groups in an age of increasing competition and pressure from outside and within higher-education institutions. To explore how researchers navigate such pressures and demands, the practice and perceptions of four high-performing research groups in Denmark and the Netherlands are examined, and the extent to which these groups can be understood as "communities of practice" or if they are displaying "team"-like characteristics is discussed. Previous studies have shown the benefits of communities of practice for organizational performance, and the present study demonstrates that the successful groups do indeed share many characteristics with such communities. A central argument of the paper is, however, also that incentive structures, inherent in many new policy initiatives that are meant to foster excellence in science, are more directed at "team-like" organization by focusing on, e.g., formally organized work processes, predefined goals, milestones, work packages, and hierarchically organized consortia. The potential implications of this are discussed.

This paper will introduce a master program in ICT and Learning (MIL) and present some of the experiences we have gained so far. MIL is a result of a collaborative initiative taken by five Danish universities, and it is an accredited part-time 2-year master program. It is unique in the sense that it builds on the pedagogical framework of project pedagogy and is based on online collaboration. The paper will describe MIL, the universities involved, the administrative organization, and the profile of the students. We will discuss the pedagogical framework and the project collaboration in relation to the modularity and flexibility that characterize the study and allow admission of part-time students, full-time students and students who only sign up for one accredited module. The methodology will be illustrated through empirical snapshots from selected modules in the start-up phase, and the focus will be directed towards problems experienced by the students. From an analytical perspective, the paper will identify and discuss fundamental problems related to the organization, flexibility, and implementation of project pedagogy online. MIL is organized around ICT and Learning and the study theme focuses on ICT and Learning. In addition, MIL provides a learning space where practice is under constant negotiation and reconstruction as an inherent, integrated part of the learning process. Consequently, we argue that MIL may be seen as an example of best practice in blended learning.

Background: Psychological research about meaningfulness is concerned with a subjective sense of meaning of one's own life, that is, meaning in life. Empirical research in this field is attracting interest, as meaning in life has wide‐ranging positive implications for mental health and well‐being. Aim: The aim of this article is to test the validity of the Finnish translation of the Sources of Meaning and Meaning in Life (SoMe) questionnaire. In the article, meaningfulness and crisis of meaning are correlated with sources of meaning, and results are compared with other validation studies in Norway, Denmark, and Brazil as well as with the original German questionnaire. Methods: To meet our aim, 551 participants were recruited to answer the Finnish questionnaire. The internal and construct validity of the Finnish questionnaire were tested with reliability analysis, confirmatory factor analysis, exploratory factor analysis, and analysis of intercorrelations of items in the questionnaire. Results: The analysis demonstrated similar reliability to other validation studies of the questionnaire and results highly comparable to the Norwegian study regarding the internal structure of the questionnaire. Results of intercorrelations of items within the questionnaire were also comparable to the other validation studies. [ABSTRACT FROM AUTHOR]

To describe staff experiences with the use of videoconferences with forensic psychiatric outpatients during the COVID-19 pandemic. Semi-structured interviews with staff at forensic community services in the Region of Southern Denmark. Nine semi-structured staff interviews were conducted. Two main themes were identified through thematic analysis: Challenges due to technical uncertainty and the Use of videoconferences as support in clinical assessment and treatment. The second main theme also included a number of subthemes: Lack of opportunity for observation of a patient's overall situation; Compromise of nurses' professionalism; Limitation of disturbing stimuli means more focus on the conversation; Telephone contact vs. video contact—pros and cons; Expectations reflect attitudes; and Will professionalism be changed based on organizational and political perspectives? Staff opinions on use of videoconferences in psychiatric patients differed. The nurses in particular were concerned about whether professionalism could be maintained. Others experienced patients focusing more on the conversation when it took place via video because there were fewer disturbing elements. In general, expectations seem to influence attitudes toward using videoconferences. [ABSTRACT FROM AUTHOR]

Over the last 30 years, non-pharmacological treatment with ear acupuncture, including National Acupuncture Detoxification Association (NADA) acupuncture, has become popular in Western society to relieve cancer-related symptoms. This study aim is to explore whether NADA acupuncture plays a role in relieving suffering experienced by patients hospitalized in a specialized palliative care ward and their family caregivers and whether it contributes to their coping skills. A qualitative study with a hermeneutic approach utilizing inductive thematic content analysis. Purposeful sampling took place in a specialized palliative care ward in Denmark and all data were collected through semi-structured interviews with patients and family caregivers as either individual or family interviews. A total of 10 patients and 15 family caregivers participated in interviews. Four themes emerged: (1) communication about treatment with NADA acupuncture, (2) relief of suffering generates extra energy and inner strength, (3) sharing the experience with the family is beneficial, and (4) physical and psychological effects after receiving NADA acupuncture. Patients in palliative care and their family caregivers experienced relief of suffering after receiving NADA acupuncture, as well as improved well-being, and extra energy and inner strength to cope with their life situation. The ability to share NADA acupuncture gave family caregivers the feeling of being cared for and contributed to feelings of fellowship and togetherness within the family, strengthening their ability to communicate and cope. [ABSTRACT FROM AUTHOR]

Background: Poor male fecundity is of concern and warrants the identification of potential modifiable risk factors. Short and long sleep duration might be risk factors for poor male fecundity although evidence in this research field is inconsistent. Objectives: To investigate the association between sleep duration and biomarkers of male fecundity in young men. Materials and methods: We conducted a cross‐sectional study of 1,055 young men from the Fetal Programming of Semen Quality (FEPOS) cohort, Denmark, 2017–2019. Sleep duration was obtained from an online survey answered by the participants prior to the clinical visit, where semen and blood samples were obtained, and testis volume was self‐assessed using an Orchidometer. Percentage differences in semen characteristics, testes volume, and reproductive hormone levels were analysed according to sleep duration using multivariable negative binomial regression models. Sleep duration was dichotomised (recommended (6–9 h/night) versus deviant sleep) and visualised continuously as restricted cubic spline plots. Results: Deviation from recommended sleep duration was associated with higher high DNA stainability (HDS) of 5% (95% CI: −1%; 13%), higher testosterone of 3% (95% CI: 0%; 7%) and higher free androgen index (FAI) of 6% (95% CI: 0%; 13%). The spline plots overall supported these results, suggesting u‐shaped associations between sleep duration and HDS, testosterone and FAI, a linear association between sleep duration and semen volume and sex hormone binding globulin (SHBG) and an inverse u‐shaped association with normal morphology. Discussion: Information on sleep duration was obtained by self‐report in broad categories with at least 3 h intervals. We were not able to investigate short or long sleep duration separately, since only few participants reported this. Conclusion: Sleep duration was associated with some biomarkers of fecundity in young men. Maintaining a recommended sleep duration may thus be beneficial for young men with regard to reproductive health. [ABSTRACT FROM AUTHOR]

In Denmark, 12,000 people live with Parkinson's disease. Parkinson's disease is a chronic neurodegenerative disease that requires specialized interventions based on a coordinated interdisciplinary and intersectoral approach. This study aims to illuminate challenges experienced by professionals related to creating coordinated pathways for people with Parkinson's disease and their relatives in a Danish context. The study is based on ten qualitative interviews with healthcare professionals from different professional backgrounds; the interviews were analyzed using qualitative content analysis. The analysis revealed four themes: Collaboration happens by coincidence; Geography dictates treatment offers; Professionals have no influence over treatment offers; and, Achieving new knowledge can be a challenge.These barriers challenge health care professionals to create a coordinated individualized pathway. Consequently, people living with Parkinson's disease and their relatives must seek and coordinate activities themselves, and ultimately interventions may not target individual needs, risking inequality in treatment and care. [ABSTRACT FROM AUTHOR]

Background: Preclinical animal studies have suggested that myeloid cell–synthesized coagulation factor X dampens antitumor immunity and that rivaroxaban, a direct factor Xa inhibitor, can be used to promote tumor immunity. This study was aimed at assessing whether patients with atrial fibrillation taking direct factor Xa inhibitors have lower risk of cancer and cancer-related mortality than patients taking the direct thrombin inhibitor dabigatran. Methods and findings: This nationwide population-based cohort study in Denmark included adult patients with atrial fibrillation and without a history of cancer, who started taking a factor Xa inhibitor or dabigatran between 2011 and 2015. Data on medical history, outcomes, and drug use were acquired through Danish healthcare registries. The primary outcome was any cancer. Secondary outcomes were cancer-related mortality and all-cause mortality. Outcome events were assessed during 5 years of follow-up in an intention-to-treat analysis. The propensity score-based inverse probability of treatment weighting was used to compute cumulative incidence and subdistribution hazard ratios (SHRs) and corresponding 95% confidence intervals (CIs), with death as a competing event. Propensity scores were estimated using logistic regression and including in the model sex, age group at index date, comorbidities, and use of comedications. A total of 11,742 patients with atrial fibrillation starting a factor Xa inhibitor and 11,970 patients starting dabigatran were included. Mean age was 75.2 years (standard deviation [SD] 11.2) in the factor Xa cohort and 71.7 years (SD 11.1) in the dabigatran cohort. On the basis of the propensity score-weighted models, after 5 years of follow-up, no substantial difference in the cumulative incidence of cancer was observed between the factor Xa inhibitor (2,157/23,711; 9.11%, 95% CI [8.61%,9.63%]) and dabigatran (2,294/23,715; 9.68%, 95% CI [9.14%,10.25%]) groups (SHR 0.94, 95% CI [0.89,1.00], P value 0.0357). We observed no difference in cancer-related mortality (factor Xa inhibitors cohort 1,028/23,711; 4.33%, 95% CI [4.02%,4.68%]. Dabigatran cohort 1,001/23,715; 4.22%, 95% CI [3.83%,4.66%]; SHR 1.03, 95% CI [0.94,1.12]), but all-cause mortality was higher in the factor Xa inhibitor cohort (factor Xa inhibitors cohort 7,416/23,711; 31.31%, 95% CI [30.37%,32.29%]. Dabigatran cohort 6,531/23,715; 27.56%, 95% CI [26.69%,28.45%]; HR 1.17, 95% CI [1.13,1.21]). The main limitations of the study were the possibility of residual confounding and the short follow-up period. Conclusions: In this population based cohort study, factor Xa inhibitor use was not associated with an overall lower incidence of cancer or cancer-related mortality when compared to dabigatran. We did observe an increase in all-cause mortality in the factor Xa inhibitor cohort. Floris Bosch and colleagues investigate whether patients with atrial fibrillation taking direct Factor Xa inhibitors have a lower risk of cancer and cancer-related mortality than patients taking dabigatran. Author summary: Why was this study done?: A preclinical study in mice with breast cancer and fibrosarcoma showed that factor X dampens antitumor immunity and that factor Xa inhibitor promote tumor immunity. Whether factor Xa inhibition is associated with decreased cancer incidence and cancer-related mortality in humans is unknown. What did the researchers do and find?: We assessed cancer incidence during 5 years of follow-up in patients with atrial fibrillation in Denmark using a factor Xa inhibitor (n = 11,742) or a thrombin inhibitor (dabigatran) (n = 11,970) for stroke prevention. No substantial difference in the cumulative incidence of cancer was observed between the factor Xa inhibitor (9.11%, 95% CI [8.61%,9.63%]) and dabigatran (9.68%, 95% CI [9.14%,10.25%]) groups (SHR 0.94, 95% CI [0.89,1.00]. No difference in cancer-related mortality (SHR 1.03, 95% CI [0.94,1.12]) was observed, but all-cause mortality was higher in the factor Xa inhibitor cohort (HR 1.17, 95% CI [1.13,1.21]). What do these findings mean?: Factor Xa inhibitor use for atrial fibrillation did not appear to significantly reduce cancer risk compared to dabigatran use. The main limitations of the study were the possibility of residual confounding and the short follow-up period. [ABSTRACT FROM AUTHOR]

Yellow rust caused by Puccinia striiformis f. sp. tritici (Pst) is one of the most important wheat diseases. Adult plant resistance (APR) genes have gained the attention of breeders and scientists because they show higher durability compared to major race-specific genes. Here, we determined the effect of the APR genes Yr18, Yr29 and Yr46 in North-West European field conditions against three currently important Pst races. We used three pairs of sibling wheat lines developed at CIMMYT, which consisted of a line with the functional resistance gene and a sibling with its non-functional allele. All APR genes showed significant effects against the Pst races Warrior and Warrior (–), and a race of the highly aggressive strain PstS2. The effects of Yr18 and Yr46 were especially substantial in slowing down disease progress. This effect was apparent in both Denmark, where susceptible controls reached 100 percent disease severity, and in United Kingdom where disease pressure was lower. We further validated field results by quantifying fungal biomass in leaf samples and by micro-phenotyping of samples collected during early disease development. Microscopic image analyses using deep learning allowed us to quantify separately the APR effects on leaf colonization and pustule formation. Our results show that the three APR genes can be used in breeding yellow rust resistant varieties of spring wheat to be grown in North-West European conditions, and that deep learning image analysis can be an effective method to quantify effects of APR on colonisation and pustule formation. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association between women's health literacy and attendance in the Danish national breast cancer screening programme. Methods: In a population-based cross-sectional study, information on two health literacy subscales, measured using the Health Literacy Questionnaire (HLQ), and sociodemographic factors was obtained from the 'How are you? 2017' survey in the Central Denmark Region. Information on screening attendance was obtained from register data from 2016–2017. Data were linked based on individual civil registration numbers. To account for missing data, multiple imputation by chained equations was implemented to fill in missing values on all variables. Unadjusted and adjusted logistic regression analyses were performed separately for two HLQ subscales to estimate odds ratio (OR) of screening attendance. Both multiple imputation analyses and complete case analyses were performed. Results: A total of 6012 women were included in multiple imputed statistical analyses. Generally, women had high health literacy levels. In multiple imputed analyses, the unadjusted OR of the primary HLQ subscale, understanding, was 1.32 (95% confidence interval (CI): 1.10–1.59), indicating higher odds for screening attendance with higher health literacy level. However, after adjustment no significant association between the HLQ subscale of understanding and screening attendance was found (OR 1.09 (95% CI: 0.90–1.33)). Similar results were found for the secondary HLQ subscale of engaging (insignificant association in adjusted analysis). No effect modification from sociodemographic characteristics was found. Similar results were found in complete case analyses. Conclusions: No significant association was found between health literacy and attendance in the Danish breast cancer screening programme. [ABSTRACT FROM AUTHOR]

Background: The Movethehip trial investigates the effectiveness of an exercise and patient education intervention for adults with acetabular dysplasia. The intervention involves eight tailored one-to-one sessions with trained providers who employ supportive feedback tools. The present protocol reports a planned process evaluation, which aims to determine how the intervention functions by examining the implementation of the intervention (process, dose and reach), its acceptability, mechanisms of change and the influence of contextual factors. Methods: Two hundred trial participants aged 18–50 years will be recruited from a University Hospital in Denmark and randomised to the intervention or control group. Approximately ten providers will deliver the intervention. The process evaluation adopts a concurrent mixed-methods design. The implementation will be assessed using self-report questionnaires (at baseline and 6-month follow-up), training records and semi-structured focus group interviews with intervention providers (n = 10) and healthcare managers (n = 4–6). The mechanisms of change will be explored through semi-structured one-to-one interviews (at baseline and 6-month follow-up) with 15–20 purposefully sampled participants and by measuring changes in health outcomes (self-reported pain, physical functioning and quality of life completed at baseline and at 3- and 6-month follow-up). Additionally, change will be measured through an explorative examination of associations between dose and change in health outcomes, applying simple linear regression models. The acceptability of the intervention and the influence of contextual factors will be explored through one-to-one participant interviews and focus group interviews with 4–6 healthcare managers. The interviews will focus on expectations, experiences, events, personal understandings and interaction with interpersonal and organisational aspects. Interview data will be analysed using theoretical thematic analyses, and findings will be merged with quantitative data and reported jointly on a theme-by-theme basis. Discussion: The process evaluation conducted as part of the MovetheHip trial will illuminate how the intervention functions, and if the intervention is proven effective, the findings of the evaluation will contribute to pinpoint how the intervention may be optimised to facilitate future up-scaling and implementation. Trial registration: The MovetheHip protocol was approved by the Committee on Health Research Ethics in the Central Denmark Region. ClinicalTrials, NCT04795843. Registered on 20 March 2021. [ABSTRACT FROM AUTHOR]

Aim: To investigate the challenges and barriers in Danish care professionals' work in relation to elderly citizens who use substances. Method: The study draws on data from a "going along" study of care professionals' encounters with citizens as well as interviews with professionals. This was conducted in two smaller, rural municipalities in Denmark. Findings: Providing adequate care for elderly citizens who use substances can be highly challenging. This is due to a multitude of factors, especially (1) the complexity of their health conditions, (2) contradictory logics of care (autonomy vs. healthy living), (3) citizens often unpredictable behaviours, (4) lack of cooperation between welfare systems and, not least, (5) lack of knowledge and education among healthcare professionals. Conclusions: There is a need for more specialised procedures locally, the appointment of local "experts", better cooperation between sectors and easier accessible training and information on the group on a national level. [ABSTRACT FROM AUTHOR]

Aim: Linking information on family members in the Danish Civil Registration System (CRS) with information in Danish national registers provides unique possibilities for research on familial aggregation of diseases, health patterns, social factors and demography. However, the CRS is limited in the number of generations that it can identify. To allow more complete familial linkages, we introduce the lite Danish Multi-Generation Register (lite MGR) and the future full Danish MGR that is currently being developed. Methods: We generated the lite MGR by linking the current version of the CRS with historical versions stored by the Danish National Archives in the early 1970s, which contain familial links not saved in the current CRS. We describe and compare the completeness of familial links in the lite MGR and the current version of the CRS. We also describe planned procedures for generating the full MGR by linking the current CRS with scanned archived records from Parish Registers. Results: Among people born in Denmark in 1960 or later, the current CRS contains information on both parents. However, it has limited parental information for people born earlier. Among the 732,232 people born in Denmark during 1950–1959, 444,084 (60.65%) had information on both parents in the CRS. In the lite MGR, it was 560,594 (76.56%). Conclusions: The lite MGR offers more complete information on familial relationships than the current CRS. The lite and full MGR will offer an infrastructure tying together existing research infrastructures, registers and biobanks, raising their joint research value to an unparalleled level. [ABSTRACT FROM AUTHOR]

Studies have highlighted the potential importance of modeling interactions for suicide attempt prediction. This case-cohort study identified risk factors for suicide attempts among persons with depression in Denmark using statistical approaches that do (random forests) or do not (least absolute shrinkage and selection operator regression [LASSO]) model interactions. Cases made a nonfatal suicide attempt (n  = 6032) between 1995 and 2015. The comparison subcohort was a 5% random sample of all persons in Denmark on January 1, 1995 (n  = 11 963). We used random forests and LASSO for sex-stratified prediction of suicide attempts from demographic variables, psychiatric and somatic diagnoses, and treatments. Poisonings, psychiatric disorders, and medications were important predictors for both sexes. Area under the receiver-operating characteristic curve (AUC) values were higher in LASSO models (in men, 0.85, 95% CI, 0.84-0.86; in women, 0.89, 95% C, 0.88-0.90) than random forests (in men, 0.76, 95% CI, 0.74-0.78; in women, 0.79, 95% CI = 0.78-0.81). Automatic detection of interactions via random forests did not result in better model performance than LASSO models that did not model interactions. Due to the complex nature of psychiatric comorbidity and suicide, modeling interactions may not always be the optimal statistical approach to enhancing suicide attempt prediction in high-risk samples. This article is part of a Special Collection on Mental Health. [ABSTRACT FROM AUTHOR]

This article reports on a Danish study on interprofessional collaboration between child psychiatrists and educational psychologists concerning children who are categorised as being at risk. Methodologically, the analysis is grounded in qualitative interviews with psychologists. A Foucauldian approach is applied to narratives and experiences that occur within these interviews concerning external collaboration with child psychiatrists. The article is informed by the research tradition that has problematised the significance of psychiatry and diagnoses in the field of special needs education and social pedagogy. We thus enquire into how the rise of diagnostics and medicalisation affects our understanding of children's difficulties. We discuss a paradox that is present in Denmark and other countries. As educational policies emphasise inclusion, the field of schooling experiences a huge rise in children with medical diagnoses. We argue that diagnostic knowledge is itself an insufficient basis for action and must be considered in relation to teachers' overall training and teachers' situated professionalism.

The emphasis on competitiveness and the knowledge-based economy in European policymaking has resulted in a heightened focus on monitoring and steering the science system, particularly through metric-based instruments. Policymakers' general aims of fostering excellent research and breakthroughs are shared by researchers as well; however, below the surface is a paradox that is rarely discussed. The political system and the science system understand and pursue these concepts and objectives differently. Through two case studies on high-performing university-based research environments in Denmark and Sweden, this article uncovers the ways in which highly successful researchers often behave in ways that run counter to policy steering attempts. They do this by shielding themselves and their research group from steering pressures originating in the political system. Using Luhmann's systems theory, the cases demonstrate why the relationship between the science system and the political system needs to be understood as a horizontal rather than a vertical relationship, and using concepts from organizational theory, provides a model and terminology for identifying and analyzing the types of mechanisms and strategic responses that the science system uses to shield itself from political steering pressures.

Problem-based learning (PBL) has proven to be highly effective for educating students in an active and self-motivated manner in various disciplines. Student projects carried out following PBL principles are very dynamic and carry a high level of uncertainty, both conditions under which agile project management approaches are assumed to be highly supportive. The paper describes an empirical case study carried out at Aalborg University Copenhagen involving students from two different semesters of a Bachelor of Science programme. While executing the study, compelling examples of how PBL and the agile project management method Kanban blend could be identified. A final survey reveals that applying Kanban produces noticeable improvements with respect to creating, assigning and coordinating project tasks. Other improvements were found in group communication, knowledge about the work progress with regards to both the individual and the collective and the students' way of continuously improving their own teamwork.

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

Socioeconomic differences in overall survival from childhood cancer have been shown previously, but the underlying mechanisms remain unclear. We aimed to investigate if social inequalities were seen already for early mortality in settings with universal healthcare. From national registers, all children diagnosed with cancer at ages 0–19 years, during 1991–2014, in Sweden and Denmark, were identified, and information on parental social characteristics was collected. We estimated odds ratios (OR) and 95% confidence intervals (CI) of early mortality (death within 90 days after cancer diagnosis) by parental education, income, employment, cohabitation, and country of birth using logistic regression. For children with acute lymphoblastic leukaemia (ALL), clinical characteristics were obtained. Among 13,926 included children, 355 (2.5%) died within 90 days after diagnosis. Indications of higher early mortality were seen among the disadvantaged groups, with the most pronounced associations observed for maternal education (ORadj_Low_vs_High 1.65 [95% CI 1.22–2.23]) and income (ORadj_Q1(lowest)_vs_Q4(highest) 1.77 [1.25–2.49]). We found attenuated or null associations between social characteristics and later mortality (deaths occurring 1–5 years after cancer diagnosis). In children with ALL, the associations between social factors and early mortality remained unchanged when adjusting for potential mediation by clinical characteristics. In conclusion, this population‐based cohort study indicated differences in early mortality after childhood cancer by social background, also in countries with universal healthcare. Social differences occurring this early in the disease course requires further investigation, also regarding the timing of diagnosis. [ABSTRACT FROM AUTHOR]

Aims 3D echocardiographic (3DE) assessment of the left atrium (LA) is a new modality of potential clinical value. Age- and sex-based normative values are needed to benchmark these parameters for clinical use. Methods and results Of 4466 participants in the 5th Copenhagen City Heart Study, a prospective longitudinal cohort study on the general population, 2082 participants underwent 3DE of the LA. Healthy participants were included to establish normative values for LA strain, volume, and function by 3DE. The effects of age and sex were also evaluated. After excluding participants with comorbidities, 979 healthy participants (median age 44 years, 39.6% males) remained. The median and limits of normality (2.5th and 97.5th percentiles) for functional and volumetric measures were as follows: LA reservoir strain (LASr) 30.8% (18.4–44.2%), LA conduit strain (LAScd) 19.1% (6.8–32.0%), LA contractile strain 11.7% (4.3–22.2%), total LA emptying fraction (LAEF) 61.4% (47.8–71.0%), passive LAEF 37.7% (17.4–53.9%), active LAEF 37.4% (22.2–52.5%), LA minimum volume index (LAVimin) 10.2 (5.9–18.5) mL/m2, and LA maximum volume index (LAVimax) 26.8 (16.5–40.1) mL/m2. All parameters changed significantly with increasing age (P value for all <0.001). Significant sex-specific differences were observed for all parameters except active LAEF and LAVimax. Sex significantly modified the association between age and LASr (P for interaction < 0.001), LAScd (P for interaction < 0.001), LAVimin (P for interaction = 0.037), and total LAEF (P for interaction = 0.034) such that these parameters deteriorated faster with age in females than males. Conclusion We present age- and sex-specific reference material including limits of normality for LA strain, volume, and function by 3DE. [ABSTRACT FROM AUTHOR]

Purpose: Uterine sarcomas are a rare group of uterine malignancies. Due to the low incidence and changes in uterine sarcoma classification, risk factors are not well characterized. Our objective was to evaluate risk factors for uterine sarcoma and compare risk factors between uterine sarcoma, malignant mixed Mullerian tumors (MMMTs), and type I endometrial carcinomas. Methods: This nested case–control study utilized linked data from population-based medical birth and cancer registries in Denmark, Finland, Norway, and Sweden. Up to 10 controls were matched on country and birth year for each uterine cancer case. Using multivariable adjusted multinomial logistic regression, estimates of the associations between pregnancy-related factors and risk of uterine sarcoma, MMMTs, and type I endometrial carcinomas were determined. Results: Having a very-low-birth-weight infant (< 1500 vs. 2500–3999 g: OR [95% CI] 2.83 [1.61–4.96]) was associated with an increased risk of uterine sarcoma. Whereas, having a more recent pregnancy was associated with reduced risks of MMMT (< 10 vs. ≥ 30 years: 0.66 [0.20–2.23]) and type 1 endometrial carcinomas (0.35 [0.30–0.41]) but not uterine sarcomas (1.33 [0.90–1.98], p-heterogeneity < 0.01). Conclusion: Our study provides evidence that risk factors for uterine sarcoma and MMMT, previously grouped with uterine sarcomas, vary substantially. Additionally, MMMT and type I endometrial carcinomas are more similar than uterine sarcoma in that pregnancy complications like gestational hypertension and preeclampsia were associated with reduced risks of both but not uterine sarcoma, suggesting different etiologies. [ABSTRACT FROM AUTHOR]

Background: Vaginal bleeding (VB) before 20 gestational weeks of a viable pregnancy is a manifestation of a threatened miscarriage. VB is associated with increased levels of pro‐inflammatory cytokines such as interferon‐gamma, tumour necrosis factor‐alpha and interleukin‐6. Increased levels of these cytokines and oxidative stress are risk factors for cancer. The risk of cancer following a VB‐affected pregnancy that ended in childbirth is unknown. Objectives: To investigate the associations between VB in pregnancy that resulted in delivery and risk of incident cancer. Methods: We conducted a cohort study (1995–2018) in Denmark using administrative and healthcare registries. We included 37,082 VB‐affected deliveries, 1,363,614 VB‐unaffected deliveries, 324,328 pregnancies ending in terminations, and 137,104 miscarriages. We computed the absolute risk of cancer and hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, calendar year, morbidities, and socio‐economic factors using Cox proportional hazards regression. Multiple pregnancies to the same woman were accounted for in the analysis. Results: The median (25th–75th percentile) follow‐up in the study was 12.6 (6.9, 18.2) years. The prevalence of VB in the present study was 3%. At the end of the follow‐up, there were 1320 cancer cases among the VB‐affected delivery cohort, 40,420 among the VB‐unaffected delivery cohort, 10,300 among the termination cohort and 4790 among the miscarriage cohort. HRs for any cancer among VB‐affected deliveries were 1.03 (95% CI 0.97, 1.08) compared with VB‐unaffected deliveries, 1.03 (95% CI 0.97, 1.09) compared with terminations and 0.90 (95% CI 0.84, 0.95) compared with miscarriages. There were no increased risks of premenopausal breast cancer, cervical cancer, ovary and fallopian tube cancer or uterine cancer following VB‐affected deliveries vs. comparison cohorts. Conclusions: We found no evidence of an association between vaginal bleeding in pregnancy and an increased risk of cancer. [ABSTRACT FROM AUTHOR]

Background. Testing and titration of the right levodopa equivalent dose are usually performed during a hospital admission. However, optimal dose titration in people with Parkinson's disease (PwPs) may depend on home environment, emotional stress, and physical activity of everyday life. Objective. Firstly, to evaluate the feasibility and safety of a home-based LCIG titration program and patients'/caregivers' satisfaction. Secondly, to identify barriers and facilitators for home-based titration. Method. This study assesses the feasibility and safety of home-based titration of levodopa duodenal infusions with the use of self-reported evaluation questionnaires with open-ended questions included, registration of total time used, and number of contacts/visits. A telemedicine solution was used to remotely monitor the patients, adjust treatment, and provide support and guidance to patients and caregivers. Results. Ten of 12 PwPs (5 females and 7 males) completed the total titration program. Eight of the 12 PwPs were dependent on help. These 8 PwPs also had a high burden of nonmotor symptoms (NMS). Cognitive impairments varied in severity (range 16–30). Time spent with home visits was on average 93.4 minutes (ranging from 35 to 180 minutes), and the length of the total titration (LCIG initiation to termination of titration) was on average 3.4 days with 2–5 (mean 3.2) contacts/visits with PD team members. The average score on the satisfaction evaluation questionnaires was lower in the caregiver group (mean 31.8) than the PwP outcome (mean 36.2). Conclusions. Telehealth-assisted home-based titration programs are feasible due to the length of the titration period, number of contacts, and time spent in PwPs' private homes, are rated satisfactory and safe by PwPs and caregivers, and may be a substitute for in-hospital treatment. Clinical recommendations including facilitators and barriers from a patient/caregiver perspective are displayed. This trial is registered with NCT4196647. [ABSTRACT FROM AUTHOR]

Introduction: Alopecia areata (AA) is an autoimmune skin disease presenting as nonscarring hair loss. Information on the epidemiology of AA, especially the occurrence of AA and its subtypes within the general population, is scarce. The study aimed to estimate the incidence rates and prevalence of hospital-treated AA and its subtypes in Denmark and to examine the demographic and clinical characteristics of patients with AA, including comorbidities and use of prescription medications. Methods: This was a cohort study based on data from administrative and health registers in Denmark in 1995–2016. The study included individuals who were (1) registered with a hospital inpatient or hospital-based outpatient clinic diagnosis of AA between 1995 and 2016 in the Danish National Patient Registry covering encounters at all Danish hospitals, (2) alive and resided in Denmark anytime between 1995 and 2016, (3) aged ≥ 12 years, and (4) resided uninterrupted in Denmark during the 12 months before the first AA diagnosis during the study period. Results: During the study period, 2778 individuals with an incident hospital-based diagnosis of AA were identified; 63.1% were female and 28.7% of the patients were aged ≥ 50 years. Over the study period, the overall incidence rate for any hospital-treated AA per 100,000 person-years was 2.62 (95% confidence interval [CI], 2.53–2.72), and the overall prevalence in 2016 was 71.7 (95% CI 69.4–74.1) per 100,000 persons. Both incidence rate and prevalence increased over time. Prevalence of most hospital-treated comorbidities or history of medication use was below 10% and was similar in the alopecia totalis (AT)/alopecia universalis (AU) and non-AT/AU subtypes of AA. Conclusion: This cohort study reported incidence rates and prevalence over time and characteristics of individuals with hospital-treated AA in Denmark, which are in agreement with those previously reported in this population. [ABSTRACT FROM AUTHOR]

Background Long-term use of aspirin has been shown to reduce colorectal cancer risk, but the association remains inconclusive for individual noncolorectal cancers. We examined the association between long-term aspirin use and cancer risk in Denmark. Methods Using nationwide registries, we followed individuals aged 40-70 years at baseline (January 1, 1997) for cancer diagnoses through 2018. We assessed low-dose (75-150 mg) aspirin use according to continuity, duration, and cumulative amount. In addition, we explored associations with consistent high-dose (500 mg) aspirin use. Using Cox regression, we estimated multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) with aspirin use for overall and site-specific cancer. Results Among 1 909 531 individuals, 422 778 were diagnosed with cancer during mean follow-up of 18.2 years. Low-dose aspirin use did not reduce the hazard ratio for cancer overall irrespective of continuity and duration of use (continuous use: HR = 1.04, 95% CI = 1.03 to 1.06). However, long-term (≥5 or ≥10 years) use was associated with at least 10% reductions in hazard ratios for several cancer sites: colon, rectum, esophagus, stomach, liver, pancreas, small intestine, head and neck, brain tumors, meningioma, melanoma, thyroid, non-Hodgkin lymphoma, and leukemia. Substantially elevated hazard ratios were found for lung and bladder cancer. In secondary analyses, consistent high-dose aspirin use was associated with reduced hazard ratios for cancer overall (HR = 0.89, 95% CI = 0.85 to 0.93) and for several cancer sites. Conclusion Long-term low-dose aspirin use was associated with slight to moderately reduced risks for several cancers but not for cancer overall owing to increased risk for some common cancers. Similar or slightly stronger inverse associations were observed for consistent use of high-dose aspirin. [ABSTRACT FROM AUTHOR]

Purpose: A surge in the use of semaglutide injection (Ozempic®) approved to treat type 2 diabetes (T2D) has led to a global supply shortage. We investigated contemporary user rates and clinical characteristics of semaglutide (Ozempic®) users in Denmark, and the extent of "off-label" prescribing for weight loss. Patients and Methods: Nationwide population-based cross-sectional study based on linked health registries January 2018 through December 2023. All adults who received a first prescription of semaglutide once weekly (Ozempic®) were included. We examined quarterly rates of new users and total user prevalences, using other glucagon-like peptide-1 receptor agonists and weight loss medications as comparison. We also investigated user characteristics including T2D, glucose control, comedications, and cardiorenal disease. Results: The new user rate of semaglutide (Ozempic®) remained stable at approximately 4 per 1000 adult person-years between 2019 and 2021 and then accelerated, peaking at 10 per 1000 in the first quarter of 2023 after which it declined sharply. User prevalence increased to 91,626 users in Denmark in 2023. The proportion of semaglutide (Ozempic®) new users who had a record of T2D declined from 99% in 2018 to only 67% in 2022, increasing again to 87% in 2023. Among people with T2D who initiated semaglutide (Ozempic®) in 2023, 52% received antidiabetic polytherapy before initiation, 39% monotherapy, and 8% no antidiabetic therapy. Most T2D initiators had suboptimal glucose control, with 83% having an HbA1c ≥ 48 mmol/mol and 68% ≥ 53 mmol/mol despite use of antidiabetic medication, and 29% had established atherosclerotic cardiovascular disease or kidney disease. Conclusion: The use of semaglutide (Ozempic®) in Denmark has increased dramatically. Although not approved for weight loss without T2D, one-third of new users in 2022 did not have T2D. Conversely, most initiators with T2D had a clear medical indication for treatment intensification, and "off-label" use can only explain a minor part of the supply shortage. [ABSTRACT FROM AUTHOR]