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Background: Migrant and ethnic minority populations in Europe are growing, leading to a demand for health systems and health educations to accommodate the growing diversity. Research indicates that health professionals feel inadequately prepared to care for diverse populations, and medical education has gaps in addressing these issues. The aim of the study is to explore whether Danish medical students and newly graduated physicians feel prepared to meet the needs of the increasingly diverse populations., Methods: An online survey was emailed to students in the four medical Master's programs in Denmark and to newly graduated physicians in clinical internships. Data was collected spring 2023. Descriptive statistics reported overall numbers, and multivariate logistic regression was used to model the association between survey answers and the background variables: semester, gender/sex, parent's education, self-identified ethnicity., Results: Many medical students and newly graduated physicians feel unprepared to care for patients of backgrounds different from their own. For all items women reported feeling more unprepared than men. Among the medical students and newly graduated physicians with enough clinical experience to answer the question, 34.2% reported feeling helpless at times or often in the past year when treating culturally different patients. Men were less likely than women to report feeling helpless (OR = 0.42; 95% CI 0.28 to 0.64); and self-identified ethnic minorities were 2.59 times more likely than Danish/European medical students and newly graduated physicians to report feeling helpless (95% CI 1.32-5.07)., Conclusion: Our findings indicate shortcomings in medical students and newly graduated physicians feeling of preparedness to provide care to patients of backgrounds different from their own. These findings can assist medical education management with identifying curriculum gaps., Competing Interests: Declarations. Ethics approval and consent to participate: The study was reported to the Data protection committee at the University of Copenhagen (514–0814/23-3000). The study was conducted in accordance with general ethical codes within the field of research, cf. the Declaration of Helsinki. Data was handled in full accordance with the requirements defined by the Danish Data Protection Agency. According to the Danish Act on the Biomedical Ethics Committee System and the Processing of Biomedical Research Projects, the study was not notifiable to the Danish Research Ethics Committee System, as it did not include biological material. Consent was obtained by asking participants to check a box in the questionnaire. The participants were informed that their participation was voluntary and that they could revoke their consent at any time. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: This scoping review aims to summarize and synthesize research findings on the disparities between audiometrically diagnosed and aided hearing loss versus the individual's own experience of hearing loss., Methods: A systematic search strategy was employed across multiple databases to identify studies published between 1990 and October 2023 focusing on the experiences of hearing problems among individuals with aided hearing loss. The selected studies underwent screening based on predetermined inclusion and exclusion criteria. These criteria revolved around including papers featuring a population of adult (+18) individuals with audiometrically measured hearing loss who had undergone technological rehabilitation. Data charting was employed to provide an overview of the studies and was additionally utilized to identify key themes. Narrative analysis was used to identify subthemes within the data set., Results: A total of 11 articles met the inclusion criteria. The analysis identified five themes: "disability experience and discrepancy between measured and self-perceived hearing loss"; "listening effort"; "mental burden/psychological consequences"; "factors that alleviate the consequences of HL"; and "sociodemographic factors.", Conclusions: The scoping review shows that, despite the proliferation of technological options, there is a pressing need for a more concentrated effort to identify and scrutinize the supplementary facets of hearing loss that remain inadequately addressed by current hearing technology. This includes subjective experiences associated with hearing loss that may not be effectively treated solely with hearing aids., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Objective: This study uses capital theory to investigate survivors' investments in their bodies and the resources they accumulate during their rehabilitation trajectory, and how these factors impact their perception of recovery from their impairments., Methods: Qualitative interviews were conducted with 20 patients of working age and their relatives, with audio recordings transcribed verbatim. Data analysis utilized an abductive approach informed by Bourdieu's capital theory., Findings: During the initial phases of rehabilitation (acute and subacute), survivors invest in their physical bodies and acquire physical capital. However, they encounter a range of complex barriers when attempting to convert this capital into the resources necessary for re-entering the workforce or pursuing education. These difficulties are linked to the lack of specialized community services in the later phases of their rehabilitation trajectory., Discussion and Conclusion: Present-day Danish healthcare rehabilitation focuses on restoring physical function and recovering physical capital. However, comprehensive rehabilitation to enhance mental and cognitive abilities and increase levels of emotional capital, which is crucial for working-age individuals, is inadequately addressed within community services. This results in unequal treatment and care, contradicting the stated goal of equality in the Danish healthcare system., Patient or Public Contribution: This study incorporated the perspectives of 20 individuals who have survived severe traumatic brain injury, as well as their relatives, to gain insights into their experiences throughout the rehabilitation process, the resources they have accumulated and how these factors contribute to their sense of recovery., (© 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Introduction: Research indicates that social networks and roles are disrupted throughout the entire trajectory of someone living with a brain tumour. Young adults aged 18-35 years are particularly vulnerable to such disruption because they are in a process of establishing themselves. Pre-existing social roles and support networks of young adults living with a primary brain tumour may change. This study aims to identify the social networks of young adults aged 18-35 years diagnosed with a primary brain tumour and to map how the diagnosis and disease course affects the social network in relation to changes in relationships and roles over time., Methods and Analysis: The study adopts a longitudinal design with a convergent mixed methods approach to describe the social network of young adults. The study utilizes a quantitative approach to social network analysis to measure network size, composition and density and a qualitative approach with interviews to gain insight into young adult's narratives about their network. Network maps will be produced, analysed and all the findings will then be compared and integrated. Interviews and network drawing will take place at the time of the diagnoses, with follow-up interviews 6 and 12 months later. This will shed light on transformations in network compositions and network support over time., Ethics and Dissemination: The study has been approved by the Danish Data Protection Agency (ID P-2022-733). Written informed consent will be obtained from all patients. The results will be disseminated through a peer-reviewed journal and reported at local, national and international conferences on brain cancer., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This article suggests a conceptual framework for choice of target populations for public health interventions. In short, who should benefit? Taking the seminal work of Geoffrey Rose on "individuals at risk" versus the "whole population approach" as a point of departure, we explore later contributions. Frohlich and Potvin introduced the notion of "vulnerable populations" applying relevant social determinants as the defining selection criterion. Other interventions focus on a "physical space" (spatial demarcations) such as a neighborhood as a means to define intervention populations. As an addition to these criteria, we suggest that the life-course perspective entails an alternative means of selecting target populations based on a "temporal" perspective. A focus on the various age phases ranging from fetal life and infancy to old age may guide selection of population segments for targeted public health interventions. Each of the selection criteria has advantages and disadvantages when used for primary, secondary, or tertiary prevention. Thus, the conceptual framework may guide informed decisions in public health planning and research regarding precision prevention versus various approaches to complex community-based interventions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Aagaard-Hansen, Hindhede and Terkildsen Maindal.)

Purpose: This paper explores the perception of "relatives" during the rehabilitation of young adults with severe acquired brain injury (SABI)., Methods: This longitudinal qualitative study followed eight young adults with a SABI from hospital discharge to a year and a half after discharge. The design encompassed professional records, interviews, and surveys, including a name generator list completed by the young adults and focus group interviews with both their families and professionals. We apply a sociological theoretical framework concerning friendship, and we employ social network analysis (SNA) methodology to capture, visualise, and analyse the young adults' significant social relations., Results: Social relations engaged as relatives during rehabilitation are to a large extent determined by the perceptions of professionals and the parents of the young adult. These perceptions contain a limited number of social relations, with priority given to biological and juridical ties. This might reflect the reduced social support available for the young adult, who initially had a much larger social network., Conclusion: The authors suggest a professional rethinking of who "relatives" are as well as considering these social ties as dynamic. Implications for rehabilitationRehabilitation professionals must be aware of and pay attention to differing perceptions that exist as to who qualifies as significant social relations in order to reconsider the practical implementation of relative involvement.The perception of who relatives are during the rehabilitation process should be reconsidered and extended to include who the young adult perceive as significant social relations.Relatives are not a fixed entity and should be considered dynamically throughout the rehabilitation process.Social relations of the young adult must to a larger extent be considered during rehabilitation to prevent social isolation in the long run.

Purpose: In this study, we investigate the nature and strength of the social relations of working-age individuals who have survived a severe traumatic brain injury., Materials and Methods: Fifty-three survivors diagnosed with severe traumatic brain injury completed the social network analysis questionnaire, enabling us to map their social networks using the software program EgoNet.QF. This was combined with interviews with four survivors and their significant members of their network and constructed narrative cases of the resources gained from their network., Results: Half the survivors lost friends because of the brain injury. The most common social network post injury comprised parents followed by spouses. Close relatives experienced a dramatic change in the nature of their relationships with the survivor. They also struggled greatly with the rehabilitation health system, which in many cases affected their own careers., Conclusion: Persons with severe traumatic brain injury and their close relatives predominantly learn to manage the new situation, with functionality driving social interaction. However, as social networks often are limited to the close family, these individuals are placed in a vulnerable position.IMPLICATIONS FOR REHABILITATIONExisting networks (whether few or many) are of major importance for individuals with traumatic brain injury in the rehabilitation process.Close social relations possess knowledge about the survivor with traumatic brain injury that is important for the rehabilitation process.To support individuals and their families who lack strong resources and social networks, health care professionals should systematically identify these persons from admission to hospital and primary care.When these persons have been identified, individual plans for how to strengthen their network can be developed in collaboration with the individuals and their existing social network.

Inequalities in illness, service provision, and outcomes are well documented in the Nordic universal welfare state. The ways in which inequalities are produced during illness recovery trajectories remain largely unknown. Long-term brain injury rehabilitation in this context provides a window into veiled aspects of inequality and the underlying mechanisms. We examine inequality empirically by combing framing field structures with the classed abilities of families to mobilise capital after a severe acquired brain injury (severe ABI). Using a Bourdieuan theoretical framework, informed by the concepts of field, doxa, cultural health capital (CHC), and rehabilitation capital (RC), we designed a longitudinal case study encompassing professional records, observations, and interviews that tracked and analysed subjects' trajectories. We found that families' consistent accumulation and conversion of capital was crucial after a severe ABI because of the multifaceted rehabilitation process involving many different field specific agendas and doxas. This study supplements previous concepts (CHC and RC) developed in a health care context by including other rehabilitation contexts. These disparities in forms of capital amongst social classes result in winners and losers and were reflected in the rehabilitation trajectories of the young adults, characterised by continuity on one extreme and broken trajectories on the other.

When a person experiences a severe stroke, their relatives must assume the role of partners in the rehabilitation process. Drawing on Bourdieu's field theory, we investigated the potential gap between the subjective expectations of relatives in terms of the assistance and care they can offer patients with severe brain injuries and the objective constraints of a healthcare field. Using data from observations, as well as interviews with relatives and official documents, our study shows how some relatives, reliant on their habitus, bring to their collaboration with healthcare professionals an expectation that the healthcare field will be able to take care of their multiple individual needs. However, due to hysteresis - a gap between their dispositions and the objective possibilities of the transformed healthcare field - these relatives are not equipped to recognise, grasp and occupy their new field position. We conclude that Bourdieu's theoretical concept of hysteresis may help to understand how changes in the healthcare field may lead to a mismatch between the field and the habitus manifested in interactions between patients, relatives and healthcare professionals, so that the ill-adjusted habitus of relatives leads to missed chances in relation to the opportunities objectively offered by the field.

This article provides an example of the application of social network analysis method to assess community participation thereby strengthening planning and implementation of health promotion programming. Community health promotion often takes the form of services that reach out to or are located within communities. The concept of community reflects the idea that people's behavior and well-being are influenced by interaction with others, and here, health promotion requires participation and local leadership to facilitate transmission and uptake of interventions for the overall community to achieve social change. However, considerable uncertainty exists over exact levels of participation in these interventions. The article draws on a mixed methods research within a community development project in a vulnerable neighborhood of a town in Denmark. It presents a detailed analysis of the way in which social network analysis can be used as a tool to display participation and nonparticipation in community development and health promotion activities, to help identify capacities and assets, mobilize resources, and finally to evaluate the achievements. The article concludes that identification of interpersonal ties among people who know one another well as well as more tenuous relationships in networks can be used by community development workers to foster greater cohesion and cooperation within an area.

Aim The aim was to explore the extent to which a Danish prevention centre catered to marginalised groups within the catchment area. We determined whether the district's socio-economic vulnerability status and distance from the citizens' residential sector to the centre influenced referrals of citizens to the centre, their attendance at initial appointment, and completion of planned activities at the centre., Background: Disparities in access to health care services is one among many aspects of inequality in health. There are multiple determinants within populations (socio-economic status, ethnicity, and education) as well as the health care systems (resource availability and cultural acceptability)., Methods: A total of 347 participants referred to the centre during a 10-month period were included. For each of 44 districts within the catchment area, the degree of socio-economic vulnerability was estimated based on the citizens' educational level, ethnicity, income, and unemployment rate. A socio-economic vulnerability score (SE-score) was calculated. Logistic regression was used to calculate the probability that a person was referred to the centre, attended the initial appointment, and completed the planned activities, depending on sex, age, SE-score of district of residence, and distance to the centre. Findings Citizens from locations with a high socio-economic vulnerability had increased probability of being referred by general practitioners, hospitals, and job centres. Citizens living further away from the prevention centre had a reduced probability of being referred by their general practitioners. After referral, there was no difference in probability of attendance or completion as a function of SE-score or distance between the citizens' district and the centre. In conclusion, the centre is capable of attracting referrals from districts where the need is likely to be relatively high in terms of socio-economic vulnerability, whereas distance reduced the probability of referral. No differences were found in attendance or completion.

Background: Individual-based interventions aim to improve patient self-management of chronic disease and to improve lifestyle among people at high risk, to reduce the prevalence of diseases contributing to health inequality. The present study investigates risk factors for uncompleted health interventions, via a combination of quantitative and qualitative methods., Methods: From a health centre in Copenhagen, questionnaire data on educational level, gender, age, and cohabitation status from 104 participants in health interventions were used to examine risks for dropout. Qualitative telephone interviews further investigated risk factors among 17 participants who were registered as uncompleted., Results: Our findings show that there is a significantly higher prevalence of uncompleted courses among participants below age 60 (OR 3.38, 95 % CI 1.08; 10.55) and an insignificantly higher prevalence among people with low education (OR 1.82, 95 % CI 0.66; 5.03). Qualitative elaboration of these findings points to low self-control in jobs and a higher degree of comorbidity and treatment of diseases among the lower educated as determinants for not completing, but not lower motivation or less positive attitude toward the intervention itself., Conclusions: This study indicates a social difference in dropout, and if dropout is to be prevented, there is a need to acknowledge factors such as organization of the intervention, lack of job flexibility, and comorbidity. If these factors are not addressed, people with low socioeconomic status will most likely have reduced opportunities for making healthy choices, in this case, completing the intervention, and this may increase health inequality.

Focusing on the largest and, arguably, the least visible disability group, the hearing impaired, this paper explores present-day views and understandings of hearing impairment and rehabilitation in a Danish context, with particular focus on working-age adults with late onset of hearing impairment. The paper shows how recent changes in perception of the hearing impaired patient relate to the introduction of a new health care reform that turns audiological rehabilitation into a consumer issue. Ethnographic and interview data from hearing clinics provides evidence that the hearing technologies that are on offer stabilise in specific forms through processes of negotiation among a variety of social actors representing the interests of science, industry, government, and hearing-impaired people. The discussion critically considers the emergence of an "informed consumer" in audiological practices.

Motivational interviewing is a counseling method used to bring about behavior change; its application by school nurses for preventing obesity in children is still new. This study, based on in-depth interviews with 12 school nurses, shows how school nurses adapted motivational interviewing and integrated it into their daily practice along with other methods they knew from the past. Three dilemmas for school nurses were revealed: when the child was severely overweight and the parents did not perceive this as a problem, when the child and the parents were at different stages of motivation to change, and when applying an individualized approach such as motivational interviewing for preventing a complex societal problem, in this instance obesity. The study raises an important issue to consider, with implications for school nursing and obesity prevention: motivational interviewing as either a counseling method or a prevention strategy., (© The Author(s) 2014.)

Using disability theory as a framework and social science theories of identity to strengthen the arguments, this article explores empirically how working-age adults confront the medical diagnosis of hearing impairment. For most participants hearing impairment threatens the stability of social interaction and the construction of hearing disabled identities is seen as shaped in the interaction with the hearing impaired person's surroundings. In order to overcome the potential stigmatization the 'passing' as normal becomes predominant. For many the diagnosis provokes radical redefinitions of the self. The discursively produced categorization and subjectivity of senescence mean that rehabilitation technologies such as hearing aids identify a particular life-style (disabled) which determines their social significance. Thus wearing a hearing aid works against the contemporary attempt to create socially ideal bodily presentations of the self, as the hearing aid is a symbolic extension of the body's lack of function.

Purpose: It has been argued by researchers from the Anglo-Saxon nations that the rationality of the market has increasingly infiltrated the medical field. This paper seeks to enquire via policy analysis to what extent these principles have affected the prototypical welfare state of Denmark in relation to Danish hearing health policies., Design/methodology/approach: The paper is based on qualitative methods comprising observations and interviews in two hearing clinics., Findings: The paper shows that rather than a "withdrawal" of the state there has been a process of reform. The data suggest that a distinguishing mark of the consumer role on offer in Denmark is that, along with a free hearing aid, the Danish health consumer enjoys a range of rights and reciprocal responsibilities. The paper concludes that few of the hearing-impaired patients were able to embrace the consumer ethos, and those who chose not to wear their prescribed hearing aids experienced the added burden of moral reproach., Originality/value: It makes little sense to analyse abstracted rationalities without proceeding to analyse how they actually function in practice. This paper demonstrates empirically how and to what degree governmentality is embedded in social practice in two public hearing clinics in Denmark.