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Background: Social inequality in ischaemic heart disease has been related to socioeconomic position in childhood, early adulthood and late adulthood. However, the impact of relative level of accumulated income periods across adult life course and the potential gender and age differences have not been investigated. The aim was to investigate the association between relative level of accumulated income across the life course and acute myocardial infarction (AMI) from age 60+ years and to study if the associations differ by gender and in different age groups (30-39 years, 40-49 years and 50-59 years). Methods: All Danes born 1935-1954 (N=1 235 139) were followed up in registers for incident AMI (42 669 cases). The accumulated proportional deviation from median equivalised income (APDMEI) for each gender/age/calendar year strata was constructed and divided in quartiles. The associations were analysed by means of Cox's proportional hazard models. Results: Among men, those in the lowest APDMEI quartile had an HR 1.40 (1.35-1.45) of AMI compared with the highest quartile. Those in the second and third highest quartiles had HR of 1.24 (1.20-1.28) and 1.14 (1.10-1.18), respectively. Among women, the lowest quartile had an HR of 1.78 (1.69-1.88), the second 1.45 (1.37-1.53) and the third 1.19 (1.13-1.26). The social gradient was similar across the different age groups. Conclusion: The risk of AMI increased with lower levels of relative accumulated income across the life course. While men generally had a higher risk of AMI, the social gradient was steeper in women. There was no indication of a specific sensitive age period for exposure to relative level of accumulated income.

BACKGROUND: Denmark and Sweden have implemented reforms that narrowed disability benefit eligibility criteria. Such reforms in combination with increasing work demands create a pincer movement where in particular those with moderate health problems might be unable to comply with work demands, but still not qualify for permanent disability benefits, ending up with temporary means-tested or no benefits. This paper examines whether this actually happened before and after the reforms.METHODS: The Survey of Health, Ageing and Retirement in Europe (SHARE) study waves 1-2 and 4-6 in Denmark and Sweden for the age group 50-59 years (N=5384) was used to analyse changes in employment rates and benefits among people with different levels of health before, during and after disability benefit reforms. Interaction between time and health in relation to employment versus permanent or temporary benefits was used as a criterion for whether our hypotheses was confirmed.RESULTS: Overall, employment rates have increased in the age group, but only among the healthy. The OR for receiving temporary or no benefits increased from 1.25 (95% CI: 0.81 to 1.90) before to 1.73 (95% CI: 1.14 to 2.61) after policy reforms for the 29% with moderate health problems and from 2.89 (95% CI: 1.66 to 5.03) to 6.71 (95% CI: 3.94 to 11.42) among the 11% with severe health problems. The interaction between time and health was statistically significant (p<0.001).CONCLUSION: People with impaired health and workability are forced into a life with temporary means-tested or no benefits when pressed by rising work demands and stricter disability benefit eligibility criteria.

Aims: Most previous prospective studies have examined workplace social capital as a resource of the individual. However, literature suggests that social capital is a collective good. In the present study we examined whether a high level of workplace aggregated social capital (WASC) predicts a decreased risk of individual-level long-term sickness absence (LTSA) in Danish private sector employees. Methods: A sample of 2043 employees (aged 18–64 years, 38.5% women) from 260 Danish private-sector companies filled in a questionnaire on workplace social capital and covariates. WASC was calculated by assigning the company-averaged social capital score to all employees of each company. We derived LTSA, defined as sickness absence of more than three weeks, from a national register. We examined if WASC predicted employee LTSA using multilevel survival analyses, while excluding participants with LTSA in the three months preceding baseline. Results: We found no statistically significant association in any of the analyses. The hazard ratio for LTSA in the fully adjusted model was 0.93 (95% CI 0.77–1.13) per one standard deviation increase in WASC. When using WASC as a categorical exposure we found a statistically non-significant tendency towards a decreased risk of LTSA in employees with medium WASC (fully adjusted model: HR 0.78 (95% CI 0.48–1.27)). Post hoc analyses with workplace social capital as a resource of the individual showed similar results. Conclusions: WASC did not predict LTSA in this sample of Danish private-sector employees.

Background: The Danish public healthcare system provides comprehensive care based on the principle of equal access. However, it is well documented that patients with low socioeconomic position are less likely to participate in cardiac rehabilitation. More knowledge is needed to understand this phenomenon. The aim of the study was to explore the patient experience of barriers to completion of phase II cardiac rehabilitation, and to investigate the impact of socioeconomic factors on completion of cardiac rehabilitation. Methods: The study had a qualitative explorative design using semi-structured individual or dyadic interviews with patients (n = 24) and close relatives (n = 12). Informants were sampled from a quantitative prospective study of 302 patients with acute coronary syndrome and data were analyzed using the framework method. Results: Patients in different socioeconomic groups were challenged by a rigid and non-individualized rehabilitation program. A total of five themes were identified that might explain non-participation in cardiac rehabilitation: exclusion by time and place, exclusion by health beliefs, exclusion from counseling, exclusion by alienation, and exclusion of relatives. The themes were described in a matrix of socioeconomic factors of age, sex, education and employment. Conclusions: Patients in various socioeconomic subgroups felt excluded from cardiac rehabilitation for different reasons. This study supports earlier findings and provides examples of real-life issues that need to be addressed to prevent attrition and encourage participation. Equal access to cardiac rehabilitation can only be reached if the physical and psychological needs of patient and family are met by tailoring therapy to consider age, sex, education and employment groups.

We investigate the association between pre-cancer job dissatisfaction and return-to-work probability 3 years after a cancer diagnosis. We use a Danish data set combining administrative data and a survey to breast and colon cancer survivors. We find that the return-to-work probability has a negative correlation with pre-cancer job dissatisfaction with mental demands (where the correlation is driven by the high-educated) and with physical demands and the superior (where the correlation is driven by the low-educated). Educational gradients in the probability of returning to work after cancer are not significantly affected by controlling for pre-cancer job dissatisfaction and pre-cancer ability to work.

Background: Alcohol-related mortality is more pronounced in lower than in higher socioeconomic groups in Western countries. Part of the explanation is differences in drinking patterns. However, differences in vulnerability to health consequences of alcohol consumption across socioeconomic groups may also play a role. We investigated the joint effect of alcohol consumption and educational level on the rate of alcohol-related medical events.Methods: We pooled seven prospective cohorts from Denmark that enrolled 74,278 men and women age 30–70 years (study period, 1981 to 2009). We measured alcohol consumption at baseline using self-administrated questionnaires. Information on highest attained education 1 year before study entry and hospital and mortality data on alcohol-related medical events were obtained through linkage to nationwide registries. We performed analyses using the Aalen additive hazards model.Results: During follow-up (1,085,049 person-years), a total of 1718 alcohol-related events occurred. The joint effect of very high alcohol consumption (>21 [>28] drinks per week in women [men]) and low education on alcohol-related events exceeded the sum of their separate effects. Among men, we observed 289 (95% confidence interval = 123, 457) extra events per 100,000 person-years owing to education–alcohol interaction (P < 0.001). Similarly, among women, we observed 239 (95% confidence interval = 90, 388) extra events per 100,000 person-years owing to this interaction (P < 0.001).Conclusions: High alcohol consumption is associated with a higher risk of alcohol-related medical events among those with low compared with high education. This interaction may be explained by differences in vulnerability and drinking patterns across educational groups.See video abstract at, http://links.lww.com/EDE/B267

BACKGROUND: Scandinavian welfare states, despite having better population oral health than less egalitarian societies, are characterized by ubiquitous social gradients and large relative socioeconomic inequalities in oral health. However, trends in these inequalities among Scandinavian children and adolescents have not been studied in detail.OBJECTIVES: To describe the associations between socioeconomic position (SEP) and oral health in adolescents and to investigate the trends in these associations between 1995 and 2013.METHODS: Nationwide repeated cross-sectional studies (using individual-level data) were conducted on 15-year-olds in Denmark from 1995, 2003, and 2013 (N=154,750). Dental data were obtained from the national dental register of the Danish Health Authority (Sundhedsstyrelsens Centrale Odontologiske Register [SCOR]) and data on social variables from administrative registers at Statistics Denmark. SEP measures included previous year's parental education (highest attained educational level by either of the parents), income (equivalized household disposable income), and occupational social class (highest recorded occupational class between the parents). Covariates were immigration status, country of origin, number of children and persons in the family, and household type. The outcome was dental caries experience, represented by the decayed, missing, and filled surfaces (DMFS) index. Negative binomial regression models were used to examine the association between DMFS count and each of the explanatory variables separately while accounting for cluster-correlated family data. Furthermore, hierarchical multiple regressions of DMFS on SEP indicators-using the zero-inflated negative binomial (ZINB) distribution as the outcome distribution-were estimated while successively adjusting for the potential effects of the included covariates.RESULTS: Caries prevalence declined from 71% in 1995 to 63% in 2003 and 45% in 2013. Separate assessment

Objectives: This study examines the geographic variation and trends in the distribution of dental caries among adolescents in Danish municipalities between 1995 and 2013. Moreover, the study explores the trends in the association between childhood socioeconomic position (SEP) and dental caries experience between 1995 and 2013. Methods: Nationwide repeated cross-sectional studies were conducted on 15-year-olds in Denmark from 1995 (n=49173), 2003 (n=50512), and 2013 (n=51214). Data on the outcome, dental caries experience (represented by the decayed, missing, and filled surfaces [DMFS] index), were obtained from the national dental register of the Danish Health Authority. Data on individual-level social variables (childhood SEP, immigration status, country of origin, number of children and persons in the family, and household type) were obtained from administrative registers at Statistics Denmark. Municipality deprivation data (GINI coefficient; proportion of poor, unemployed, low educated, and unmarried/non-cohabiting individuals; proportion of household overcrowding and single parent households) were obtained from Statistics Denmark’s Statbank (Statistikbanken). Measures of childhood SEP included previous year’s parental education, occupational social class, and household equivalized disposable income. Geo-mapping of trends in dental caries experience was undertaken for the 275 Danish municipalities. Multilevel Bayesian conditional autoregressive models with the zero-inflated negative binomial (ZINB) distribution as the outcome distribution were used to evaluate the association between childhood SEP and dental caries experience, hierarchically adjusting for individual and contextual covariates, while also assessing the spatial autocorrelation between neighboring municipalities using a neighborhood adjacency matrix.Findings-to-date: Caries prevalence among Danish adolescents declined from 71% in 1995 to 63% in 2003 and 45% in 2013. In single-level multivariable

PURPOSE: One established risk factors for testicular cancer is cryptorchidism. However, it remains unclear whether cryptorchidism is a risk factor in itself or whether the two conditions share common causes in early life (estrogen hypothesis), such as birth weight and birth order. The objective of this study is to utilize data from the Copenhagen School Health Records Register (CSHRR) to evaluate cryptorchidism, birth weight and birth order as risk factors for testicular cancer.METHODS: The study population consisted of 408 cases of testicular cancer identified by a government issued identification number linkage of the entire CSHRR with the Danish Cancer Registry and a random subsample of 4819 males from the CSHRR. The study design was case-cohort and the period of follow-up between 2 April 1968 and 31 December 2003.RESULTS: Cryptorchidism was significantly associated with testicular cancer in crude analyses [hazard ratio (HR) = 3.60, 95% CI 2.79-4.65]. Birth weight was inversely associated with testicular cancer and no clear association with birth order was observed. The positive association between cryptorchidism and testicular cancer was only slightly attenuated controlling for birth weight and birth order and stratified on birth cohort (HR = 3.46, 95% CI 2.67-4.48).CONCLUSION: This study confirmed the robustness of the association between cryptorchidism and testicular cancer even after adjustment for birth weight and birth order. Furthermore, the study showed an inverse association between birth weight and testicular cancer.

Although research suggests that project collaboration supports deep learning, facilitators frequently face participation and engagement challenges – particularly in 100% online courses and/or courses with students from diverse geographical/cultural backgrounds. We present our experiences with learning designs featuring online project collaboration by examining student evaluation of the group work component in the course ‘Climate Change Impacts and Adaptation’ and reviewing specific process reports from the course ‘Environmental Management in the Tropics’. For the CCIAM we discern positive trends over the 2009-2012 period with ‘collaborative dynamics’, ‘organisation/coordination’, ‘burden sharing’ and practical knowledge’ showing significant improvements following revision. We provide experience from revising the CCIAM course (responding to evaluations) - and reflect on the results that such revisions engender. Determining specific factors that contribute to improvements in student evaluations are not always clear but we offer suggestions for facilitating online project collaboration to circumnavigate the four above-mentioned major issues identified on the CCIAM course: these suggestions are peer assessment, mandatory participation, and grading (as a contribution to the overall final grade). For EMiT ‘communication’ showed the strongest issue-signal – with organization/coordination ‘cultural issues’ and ‘learning outcomes’ also indicating issue-relevance.. We propose that learning designs for online project collaboration can be improved via teacher-facilitated interventions without undermining the socialisation pathways that students can find motivating and that promote online team building.

This paper explores the application of learning designs featuring formalised and structured technology enhanced peer learning. These include student produced learning elements, peer review discussions and peer assessment in the BSc/MSc level summer course Restoration of European Ecosystems and Freshwaters (REEF), the Master thesis preparation seminars for the Master of Public Health (MPH) and the MOOC course Global Environmental Management (GEM). The application of student produced learning elements and peer review discussions is investigated by analyzing quotes from course evaluations and performing focus group interviews. The application of peer assessment is investigated by analyzing the agreement of peer assessment between students assessing the same assignment. Our analyses confirm previous research on the value of peer learning and peer assessment and we argue that there could also be a huge benefit from developing learning design patterns that facilitate informal peer learning and reinforce knowledge sharing practices.

This paper explores the application of learning designs featuring formalised and structured technology enhanced peer learning. These include student produced learning elements, peer review discussions and peer assessment in the BSc/MSc level summer course Restoration of European Ecosystems and Freshwaters (REEF), the Master thesis preparation seminars for the Master of Public Health (MPH) and the MOOC course Global Environmental Management (GEM). The application of student produced learning elements and peer review discussions is investigated by analyzing quotes from course evaluations and performing focus group interviews. The application of peer assessment is investigated by analyzing the agreement of peer assessment between students assessing the same assignment. Our analyses confirm previous research on the value of peer learning and peer assessment and we argue that there could also be a huge benefit from developing learning design patterns that facilitate informal peer learning and reinforce knowledge sharing practices., This paper explores the application of learning designs featuring formalised and structured technology enhanced peer learning. These include student produced learning elements, peer review discussions and peer assessment in the BSc/MSc level summer course Restoration of European Ecosystems and Freshwaters (REEF), the Master thesis preparation seminars for the Master of Public Health (MPH) and the MOOC course Global Environmental Management (GEM). The application of student produced learning elements and peer review discussions is investigated by analyzing quotes from course evaluations and performing focus group interviews. The application of peer assessment is investigated by analyzing the agreement of peer assessment between students assessing the same assignment. Our analyses confirm previous research on the value of peer learning and peer assessment and we argue that there could also be a huge benefit from developing learning design patterns that facilitate informal peer learning and reinforce knowledge sharing practices.

Background: Scandinavian welfare states, despite having better population oral health when compared to less egalitarian societies, are characterized by ubiquitous social gradients and large relative socioeconomic inequalities in oral health. However, time trends in these inequalities among Scandinavian children and adolescents have not been studied in detail.Objectives: To analyze the associations between socioeconomic position (SEP) and dental caries experience in adolescents and to investigate the time trends in these associations between 1995 and 2013. Methods: Nationwide repeated cross-sectional studies using individual-level data were conducted on all adolescents in Denmark who became 15 years old in 1995, 2003, and 2013 (N=154,750). Dental data were obtained from the SCOR register of the Danish Health Authority while data on social variables were acquired from administrative registers at Statistics Denmark. SEP measures included previous year’s parental education (highest attained educational level between the parents), income (equivalized household disposable income), and occupational social class (highest recorded occupational class between the parents). Covariates were immigration status, country of origin, number of children and persons in the family, and household type. The outcome was dental caries experience, determined by the decayed, missing, and filled surfaces (DMFS) index. Negative binomial regression models were used to examine the association between DMFS count and each of the explanatory variables separately, while accounting for cluster-correlated family data. Furthermore, hierarchical multiple regressions of DMFS on SEP indicators—using the zero-inflated negative binomial (ZINB) distribution as the outcome distribution—were estimated while successively adjusting for the potential effects of the included covariates. Results: Caries prevalence declined from 71% in 1995 to 63% in 2003 and 45% in 2013. Separate assessment of each covariate

BACKGROUND: High intake of whole grains has been associated with lower risk of coronary heart disease; however, the research that has been used to evaluate different effects of different whole-grain cereals (e.g., wheat, rye, and oats) has been sparse.OBJECTIVE: We investigated the association between whole-grain intake in terms of total intake and intakes of different cereals and myocardial infarction.DESIGN: This prospective study included 54,871 Danish adults aged 50-64 y, of whom 2329 individuals developed myocardial infarction (13.6 y of follow-up). Detailed information on daily intake of whole-grain products was available from a self-administered food-frequency questionnaire, and intakes of total whole grain and whole-grain species (wheat, rye, and oats) were estimated. The association between intake of whole grains and risk of myocardial infarction was examined with the use of a Cox proportional hazards model adjusted for potential confounders.RESULTS: For both men and women with total whole-grain intake in the highest quartile, lower risks of myocardial infarction were shown [HRs: 0.75 (95% CI: 0.65, 0.86) and 0.73 (95% CI: 0.58, 0.91), respectively] than for individuals with intake in the lowest quartile. When the specific cereal species were considered, rye and oats, but not wheat, were associated with lower myocardial infarction risk in men. No significant associations were seen in women. For total whole-grain products, significantly lower myocardial infarction risks were seen with higher intakes in both men and women. Rye bread (in men and women) and oatmeal (in men) were associated with significantly lower risk of myocardial infarction, whereas no significant association was shown for whole-grain bread, crispbread, and wheat.CONCLUSION: In this study, we provide support for the hypothesis that whole-grain intake is related to lower risk of myocardial infarction and suggest that the cereals rye and oats might especially hol

Background: Several studies have documented an association between socioeconomic position and survival from gynaecological cancer, but the mechanisms are unclear. Objective: The aim of this study was to examine the association between level of education and survival after endometrial cancer among Danish women; and whether differences in stage at diagnosis and comorbidity contribute to the educational differences in survival. Methods: Women with endometrial cancer diagnosed between 2005 and 2009 were identified in the Danish Gynaecological Cancer Database, with information on clinical characteristics, surgery, body mass index (BMI) and smoking status. Information on highest attained education, cohabitation and comorbidity was obtained from nationwide administrative registries. Logistic regression models were used to determine the association between level of education and cancer stage and Cox proportional hazards model for analyses of overall survival. Results: Of the 3638 patients identified during the study period, 787 had died by the end of 2011. The group of patients with short education had a higher odds ratio (OR) for advanced stage at diagnosis, but this was not statistically significant (adjusted OR 1.20; 95% CI 0.97–1.49). The age-adjusted hazard ratio (HR) for dying of patients with short education was 1.47 (CI 95% 1.17–1.80). Adjustment for cohabitation status, BMI, smoking and comorbidity did not change HRs, but further adjustment for cancer stage yielded a HR of 1.36 (1.11–1.67). Conclusion: Early detection in all educational groups might reduce social inequalities in survival, however, the unexplained increased risk for death after adjustment for prognostic factors, warrants increased attention to patients with short education in all age groups throughout treatment and rehabilitation.

Background/Objectives: Metabolic deregulations and development of metabolic syndrome may be an important pathway underlying the relationship between stress and cardiovascular disease. We aim to estimate the effect of a comprehensive range of psychosocial factors on the risk of developing metabolic syndrome in men and women. Methods: The study population consisted of 3621 men and women from the Copenhagen City Heart Study who were free of metabolic syndrome at baseline and reexamined after 10 years. The data was analyzed by multivariable logistic regression models adjusted for age, education, income, menopausal status and life style factors. Results: We found major life events in adult life (OR 1.48, 95% CI 0.93 to 2.36) and major life events at work (OR 2.75, 95% CI 1.38 to 5.50), lacking a confidant (OR 1.94, 95% CI 1.07 to 3.53) and dissatisfaction with social network (OR 1.53, 95% CI 1.11 to 2.11) to be risk factors for developing the metabolic syndrome in women, while vital exhaustion (OR 2.09, 95% CI 0.95 to 4.59) and intake of sleep medications (OR 2.54, 95% CI 0.92 to 5.96) may play a more important role in men. Conclusions: Experiencing major life events in work and adult life and/or dysfunctional social networks is a risk factor for metabolic syndrome in women, and stress reactions such as vital exhaustion and intake of sleep medications may play a more important role in the development of metabolic syndrome men.