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Vitamin D deficiency increases the risk of developing several chronic diseases. Sufficient vitamin D levels in reproductive age women are important not only for women’s but also for their offspring’s health. However, vitamin D deficiency in non-western ethnic minorities in Denmark is prevalent, despite specific national recommendations for vitamin D supplementation. This study aimed to explore attitudes towards vitamin D supplementation in Turkish women of childbearing age living in Denmark. A qualitative interview study was conducted. Women were recruited using the personal network of one of the authors. Interviews were analyzed using inductive content analysis. The interview guide was inspired by the Knowledge –Attitudes - Behaviors model. Nine telephone interviews, lasting about half an hour, were conducted. Age of the women varied from 22 to 37 years; all reported being vitamin D deficient; vitamin D status was obtained from their general practitioners. The analysis revealed two main themes: (1) vitamin D supplements were perceived as medication, where the condition for which it was supposed to be used (i.e. vitamin D deficiency) had to be diagnosed and followed-up; (2) vitamin D was preferred to be received naturally, and the concrete information on what to eat and how long to be in the sun to be vitamin D sufficient was desired. The findings suggest that Turkish women may lack trust in vitamin D supplementation. There is a need to raise women’s awareness of the benefits of vitamin D supplements, and motivate them to take these supplements regularly and confidently.

Introduction The use of oral retinoids during pregnancy is associated with teratogenic effects and malformations in newborn babies. The European Medicine Agency (EMA) provided recommendations regarding the restrictive use of oral retinoids during pregnancy in 2003, and updated these recommendations in 2018 by introducing a pregnancy prevention program (PPP). This study aimed to investigate the awareness of oral retinoid teratogenicity and the adherence to the PPP by physicians, pharmacists and patients in Denmark. Method. As part of the EMA initiated multi-country survey, web-based questionnaires were distributed among Danish dermatologists and general practitioners, community pharmacists, and women of childbearing age, who were not pregnant and were using or had used oral retinoids within the past five years.Results. A total of 62 physicians, 96 pharmacists, and 50 oral retinoid using women responded to the questionnaires; 95%, 100%, and 98%, respectively, were aware of the teratogenic risks of oral retinoids. For physicians, the most applied PPP measures were the usage of the patient (44%) and the healthcare professional (19%) guides, while the least applied measure was signing medication risk form (3%). The majority of the physicians discontinued oral retinoids in women who wanted to become pregnant (90%). Performing pregnancy tests and monthly follow-ups with women using oral retinoids were practiced by appr. two thirds of the physicians. Among the pharmacists, the warning sign on the outer medication package was the most used measure (45%), the other measures showed a use of 12.0% or lower; 79% of the pharmacists often or always provided information about the importance of effective contraception when dispensing oral retinoids, and 74% advised women to contact their prescriber if they suspected being pregnant. Among the women, a majority (90%) had read the patient information leaflet included in the medication package and 72% discussed the use of contraception with their healthcare provider, while risk awareness forms and patient cards were seen by only few. Conclusion. The study showed that in Denmark physicians, pharmacists and medicine users are aware about the teratogenic effects of oral retinoids. Adherence to pregnancy prevention measures varied considerably for different measures, indicating a lack of access or unwillingness to use the measures that require patients’ signatures. Feasibility and accessibility of the PPP measures need to be improved to help increase their adherence and improve the safety of oral retinoid prescribing, dispensing, and use. Introduction The use of oral retinoids during pregnancy is associated with teratogenic effects and malformations in newborn babies. The European Medicine Agency (EMA) provided recommendations regarding the restrictive use of oral retinoids during pregnancy in 2003, and updated these recommendations in 2018 by introducing a pregnancy prevention program (PPP). This study aimed to investigate the awareness of oral retinoid teratogenicity and the adherence to the PPP by physicians, pharmacists and patients in Denmark. Method. As part of the EMA initiated multi-country survey, web-based questionnaires were distributed among Danish dermatologists and general practitioners, community pharmacists, and women of childbearing age, who were not pregnant and were using or had used oral retinoids within the past five years.Results. A total of 62 physicians, 96 pharmacists, and 50 oral retinoid using women responded to the questionnaires; 95%, 100%, and 98%, respectively, were aware of the teratogenic risks of oral retinoids. For physicians, the most applied PPP measures were the usage of the patient (44%) and the healthcare professional (19%) guides, while the least applied measure was signing medication risk form (3%). The majority of the physicians discontinued oral retinoids in women who wanted to become pregnant (90%). Performing pregnancy tests and monthly follow-ups with women using oral retinoids were practiced by appr. two thirds of the physicians. Among the pharmacists, the warning sign on the outer medication package was the most used measure (45%), the other measures showed a use of 12.0% or lower; 79% of the pharmacists often or always provided information about the importance of effective contraception when dispensing oral retinoids, and 74% advised women to contact their prescriber if they suspected being pregnant. Among the women, a majority (90%) had read the patient information leaflet included in the medication package and 72% discussed the use of contraception with their healthcare provider, while risk awareness forms and patient cards were seen by only few. Conclusion. The study showed that in Denmark physicians, pharmacists and medicine users are aware about the teratogenic effects of oral retinoids. Adherence to pregnancy prevention measures varied considerably for different measures, indicating a lack of access or unwillingness to use the measures that require patients’ signatures. Feasibility and accessibility of the PPP measures need to be improved to help increase their adherence and improve the safety of oral retinoid prescribing, dispensing, and use.

Objective: In 2021, thrombocytopenia syndrome (TTS) was confirmed by the European Medicines Agency (EMA) as a rare side effect of the COVID-19 adenovirus vector vaccines from AstraZeneca or Janssen. This study aimed to describe the public’s knowledge of TTS and how it affected the willingness to be vaccinated with COVID-19 and other vaccines.Methods: In 2022, a multi-country cross-sectional online survey was conducted in Denmark, Greece, Latvia, Netherlands, Portugal and Slovenia. The minimum target of participants to be recruited was linked to the country’s population. The results were analysed descriptively. Results: In total, 3794 respondents were included in the analysis. Many (33.3% to 68.3%) reported being aware about TTS and its association with the vaccines from AstraZeneca and Janssen, though most were not familiar with the exact symptoms. Changes in willingness to be vaccinated with COVID-19 and other vaccines varied by country. The largest change in the willingness to be vaccinated with AstraZeneca and Janssen vaccines was in Denmark (61.2%), while the largest change in the willingness to be vaccinated with other COVID-19 vaccines was in Slovenia (30.4%).Conclusion: Information about TTS seemed to be considered by the public in the European countries resulting in changed willingness to be vaccinated with the COVID-19 vaccines from AstraZeneca and Janssen. Willingness to be vaccinated against other COVID-19 vaccines and vaccines in general seemed to be determined by the approaches of the national health authorities to react to and communicate about the COVID-19 vaccination risks. Further investigation of risk communication strategies is warranted.

Background and Objectives. Major Depressive Disorder (MDD) is a global health concern and one of the most common comorbidities among patients with somatic diseases. Mapping of prescription drugs for somatic diseases could differentiate MDD patients in terms of somatic burden. This study aimed to identify and characterize the somatic drug profiles among MDD patients at diagnosis and over time.Methods. A nationwide register-based study including all Danish patients with an incident MDD diagnosis between 2011 and 2015 was performed. Latent Class Analysis (LCA) was used to sub-group the population according to somatic drug use (drug profiles). The changes between somatic drug profiles were depicted in four different time intervals from 3 years prior MDD diagnosis to 3 years after the MDD diagnosis.Results. The study population comprised 37,080 MDD patients (mean age 41.5 years, 62% women). The LCA identified five somatic drug profiles: 1) limited drug use (74.3%), 2) drugs for pain management (7.6%), 3) cardiovascular drugs (10.7%), 4) drugs for obstructive airway diseases (2.3%), 5) high drug burden (5.1%). The limited drug use profile included 96% of the population younger than 35, the other drug profiles mainly included patients older than 35. The majority of the population continued in the same drug profile during all time intervals. Movement between drug profiles over time was most common in the population older than 35. Conclusions. Using data driven methods on prescription drugs for treatment of somatic diseases, five somatic drug profiles, generally stable over time, were identified in patients with MDD.

Background: Medication beliefs can predict medication adherence. Vaccines may not be perceived as medications, and therefore medication beliefs may not predict vaccination status. The aim was to investigate the association between beliefs about medications, as opposed to attitudes towards vaccines (vaccine hesitancy), and COVID-19 vaccination status in the general public.Methods: An online questionnaire survey using social media was conducted in Denmark. The validated Beliefs about Medicines Questionnaire (BMQ) was used to measure beliefs about medications. The newly validated Danish translation of the Vaccination Attitudes Examination scale (VAX) was applied to measure vaccine hesitancy. Independent t-test compared medication beliefs and vaccination hesitancy between COVID-19 vaccinated and not vaccinated respondents. Results: Among in total 211 respondents, 83% were female; mean (SD) age was 49.9 (18.0) years; 83%, 6% and 11%, respectively, were fully, partly and not COVID-19 vaccinated. Fully vaccinated compared to not vaccinated respondents had more positive beliefs about medications and lower hesitancy towards vaccines: respective mean (SD) BMQ scores (scale range 1-5) were 3.7 (0.60) and 2.3 (0.59), pConclusion: Even though beliefs about medications and attitudes towards vaccines were correlated, attitudes towards vaccines seem to be more strongly associated with COVID-19 vaccination status than were beliefs about medicines. The findings should be further confirmed in regression analysis.

Background: This article presents the results of the evaluation of a mentalising education programme for staff at community pharmacies as to whether it had made counselling more patient-centred.Methods: A mixed-methods design was chosen, combined with Kirkpatrick’s four levels of evaluation. Twenty-eight participants from 11 community pharmacies participated. Data comprised qualitative reports at the end of the programme and measurements of Level of Emotional Awareness, Job Satisfaction, and Course Experience questionnaires.Results: The qualitative evaluation revealed three themes: “Awareness of emotions and communication skills is an important element when mentalising is the goal”, “It’s far more than a dispensing situation – I now tune into the patient”, “I don’t have to hide behind the screen any longer”. The quantitative evaluation showed a significant increase in awareness of mental states, improvement in job satisfaction, and satisfaction with the programme.Conclusion: The results show promise in supporting the pharmacy workforce to adopt a patient-centred approach during counselling.

Background . One of the core activities at community pharmacies is counselling patients about medication to support implementation of correct use and to contribute to health promotion. Dialogue is known to be the key to ensure patient-centered counselling, but studies show that pharmacy staff rarely seem to include patients’ perspectives in counselling especially if they sense the patient or themselves get emotionally affected. A theory-driven education program was developed, with the aim to increase pharmacy workforce’s mentalizing abilities for them to attend to and navigate their own and patients’ emotions during counseling. The topics in the education are the mentalizing mindset, mentalizing communication and pharmacy practice. The education was developed in Denmark by researchers from The University of Copenhagen and Pharmakon and tested in both Denmark and the Netherlands. The development was done in a user-driven workshop format, including perspectives from patients, pharmacy workforce and proprietors. The extent of the education is 2.5 ECTS. Purpose. The aim was to evaluate participants’ knowledge of mentalizing in a pharmacy practice context and their competencies in transferring this to knowledge about how to communicate in mentalizing ways in pharmacy encounters with the potential of establishing patient-centered counseling.Methods. 28 participants from 11 community pharmacies participated. A mixed methods design based on Kirkpatrick levels of evaluation inspired the evaluation. Data comprised written reports comprising 36 qualitative questions completed after ending the education, and quantitative measure of Level of Emotional Awareness, Job Satisfaction Measure and Course Experience Questionnaire before and after the education. Findings. The qualitative evaluation revealed three themes 1) Awareness of emotions and communication skills are important elements when mentalizing is the goal, 2) It’s far more than just an expedition – I tune into the patient, 3) Don’t have to hide behind the screen any longer. The quantitative evaluation showed 1) a significant increase in awareness of mental states (pConclusion. The education promoted the participants awareness of mental states and mentalizing communication skills making them able to center the interaction around the patient’s perspectives. The results are promising to support pharmacy workforce to act truly patient-centered in counselling desk meetings and to prevent or reduce job related stress and burnout.

Background Little is known about how pharmacists think and act in the situation when they need to prioritize patients without prioritization tools. Aim To understand the individual pharmacist professional’s analytic processes when prioritizing patients for medication review in an emergency department.Method A mixed-methods study with pharmacists working in one emergency department in Denmark. Qualitative participant observations of all seven pharmacists who work at the emergency department were carried out. Semi-structured interviews with six of the pharmacists were held closely in time to the observations. Observations for each pharmacists’ patients were analysed inductively looking for patterns and themes. The interviews were audiotaped, transcribed verbatim and analysed inductively seeking to understand pharmacists’ analytic processes when prioritizing patients for medication review. Results Observations showed that non-clinical prioritization rules had been implemented according to the wishes of the ward management, which affected how the pharmacists prioritized patients. The ways pharmacists prioritized was more targeted with more clinical experience. In the interviews, pharmacists told how they used the rules set out by ward management, how their collaboration with physicians was vital to prioritization, and how the pharmacy profession could better contribute to the ward team.Conclusion Although the ward-established rules increased efficiency, it was not deemed the best way to detect the clinically meaningful patients for the pharmacists working at the Emergency Department. A prioritization tool and sitting closer to the physicians at the ward would help pharmacists be further integrated into patient care and improve prioritization of patients for medication reviews.