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Integration of vocational rehabilitation and mental healthcare has shown some effect on work participation at 1-year follow-up after sick leave with depression and anxiety. We aimed to study the effect on work and health outcomes at 2-year follow-up, why we performed a randomized trial was conducted to study the effectiveness of integrated intervention (INT) compared to service as usual (SAU) and best practice mental healthcare (MHC). We included 631 participants, and at 24-month follow-up, we detected no differences in effect between INT and SAU. Compared to MHC, INT showed faster return-to-work (RTW) rates (p = 0.044) and a higher number of weeks in work (p = 0.024). No symptom differences were observed between the groups at 24 months. In conclusion, compared to SAU, INT was associated with a slightly higher work rate reaching borderline statistical significance at 12-month follow-up and lower stress levels at 6-month follow-up. The disappearance of relative effect between 12 and 24 months may be explained by the fact that the intervention lasted less than 12 months or by delayed spontaneous remission in the SAU group after 12 months. Despite the lack of effect at long-term follow-up, INT still performed slightly better than SAU overall. Moderate implementation difficulties, may partly explain the absence of the hypothesized effect. Integrated intervention, as implemented in this trial, showed some positive effects on mid-term vocational status and short-term stress symptom levels. However, these effects were not sustained beyond the duration of the intervention.

Background In 2013, Denmark implemented a reform that tightened the criteria for disability pension, expanded a subsidized job scheme (‘flexi-job’) and introduced a new vocational rehabilitation scheme. The overall aim of the reform was to keep more persons attached to the labour market. This study investigates the impact of the reform among persons with chronic disease and whether this impact differed across groups defined by labour market affiliation and chronic disease type. Methods The study was conducted as a register-based, nationwide cohort study. The study population included 480 809 persons between 40 and 64 years of age, who suffered from at least one of six chronic diseases. Hazard ratios (HR) and 95% confidence intervals (CI) of being awarded disability pension or flexi-job in the 5 years after vs. the 5 years prior to the reform were estimated. Results Overall, the probability of being awarded disability pension was halved after the reform (HR = 0.49, CI: 0.47–0.50). The impact was largest for persons receiving sickness absence benefits (HR = 0.31, CI: 0.24–0.39) and for persons with functional disorders (HR = 0.38, CI: 0.32–0.44). Also, the impact was larger for persons working in manual jobs than for persons working in non-manual jobs. The probability of being awarded a flexi-job was decreased by one-fourth (HR = 0.76, CI: 0.74–0.79) with the largest impact for high-skilled persons working in non-manual jobs. Conclusion Access to disability pension and flexi-job decreased after the reform. This impact varied according to labour market affiliation and chronic disease type.

Background Findings about the relationship between individuals’ social relations and general practitioner (GP) contact are ambiguous as to whether weak social relations are associated with an increased or decreased consultation pattern. Furthermore, social relations may affect GP contact differently for men compared to women, between socioeconomic groups and according to perceived need. The overall aim of the study is to examine the association between functional aspects of social relations, perceived emotional and instrumental social support, the tendency to consult a GP and the frequency of GP contact. Methods The study comprised 6911 individuals aged 49–61 at baseline from the Copenhagen Aging and Midlife Biobank (CAMB). We conducted a two-part regression to explore the association between perceived emotional and instrumental social support and GP contact (tendency and frequency), controlling for age, sex, occupational social class, cohabitation status and number of morbidities. Results Results show no overall effect of the perceived social support aspects of social relations on GP contact independent of health-related needs. Conclusions Our results do not support that perceived social support, reflecting functional aspects of social relations, are associated with general practitioner contact among middle-aged people. Trial registration The study has been registered and approved by the Danish Data Protection Agency and the local ethical committee (approval No.H-A-2008-126 and No. 2013-41-1814).Keywords: social relations, perceived social support, healthcare utilisation, general practitioner, middle-aged

We investigated the contribution of physical and psychosocial work factors to social inequalities in self-rated health (SRH) in a sample of Danish 40 and 50 years old occupationally active women and men. In this longitudinal study, the study population consisted of 3338 Danish women and men. Data were collected by postal questionnaires in 2000 (baseline) and 2006 (follow-up). The independent variable, socioeconomic position (SEP), was assessed by the highest achieved educational level at baseline. We conducted gender-stratified parallel multiple mediation analyses. In the mediation analyses, SEP was categorised as SEP I, II, III, VI and V among men. Among women, SEP was dichotomised into SEP I–IV and V. The outcome, SRH, was assessed at baseline and follow-up. A wide range of physical and psychosocial work factors were included as potential mediators. We found a social gradient in SRH across all levels of SEP among men. Among women, we only found a poorer SRH among those with the lowest SEP. Mediation analyses showed that work factors together accounted for 56% of the social inequalities in SRH among men and 44% among women. In both genders, ergonomic exposures and job insecurity seemed to play the major role for social inequalities in SRH. For women only, we also found noise to contribute to the social inequalities in SRH. Physical and psychosocial work factors partially explained social inequalities in SRH among both genders. Improvement of the working environment can potentially contribute to the reduction of social inequalities in health.

Background Despite an increasing use and positive effects of peer support interventions, little is known about how the outcomes are produced. Thus, it is essential not only to measure outcomes, but also to identify the mechanisms by which they are generated. Using a realist evaluation approach, we aimed to identify the mechanisms generating outcomes in a Danish peer support intervention for socially vulnerable people with type 2-diabetes (peers). By investigating the participating peers’ interactions, we furthermore examined how their individual contextual factors either facilitated or hindered the mechanisms in operation. Methods We used a multi-method case-study design (n = 9). Data included semi-structured interviews with four key groups of informants (peer, peer supporter, project manager, and a diabetes nurse) for each case (n = 25). Furthermore, we collected survey data from peers both before and after participation (n = 9). The interview data were analysed using a systematic text condensation, and the Intervention-context-actor-mechanism-outcome framework was used to structure the analysis. Results We identified 2 groups of mechanisms that improved diabetes self-management and the use of healthcare services (outcomes): ‘perceived needs and readiness’ and ‘encouragement and energy’. However, the mechanisms only generated the intended outcomes among peers with a stable occupation and financial situation, a relatively good health condition, and sufficient energy (all defined as contextual factors). Independent of these contextual factors, ‘experience of social and emotional support’ was identified as a mechanism within all peers that increased self-care awareness (defined as output). Dependent on whether the contextual factors facilitated or hindered the mechanisms to generate outcomes, we categorised the peers into those who achieved outcomes and those who did not. Conclusions We identified two groups of mechanisms that improved the peers’ diabetes self-management and use of healthcare services. The mechanisms only generated the intended outcomes if peers’ individual contextual factors facilitated an active interaction with the elements of the intervention. However, independent of these contextual factors, a third group of mechanisms increased self-care awareness among all peers. We highlight the importance of contextual awareness of the target groups in the design and evaluation of peer support interventions for socially vulnerable people with type 2-diabetes. Trial registration ClinicalTrials.gov, Retrospective Registration (20 Jan 2021), registration number NCT04722289.

Aim: To document the challenges of developing and executing an interviewer-driven survey questionnaire in an ethnically diverse and deprived social housing area undergoing reconstruction in Denmark. Methods: The survey was initially planned to be conducted in three waves (before, during and after reconstruction of the housing area), based on a questionnaire covering health, wellbeing and social relations. The first two waves took place in 2018 and 2019 (invited n=~600 per wave) and the third wave will be conducted once the reconstruction is finalised. The approach to the third wave is under revision by the research team. The questionnaire was translated from Danish into the seven most common languages in the housing area. A bilingual interview team went door to door interviewing residents. Field notes were collected systematically during each wave to document the process. Results: The response rates were 35% ( n=209) and 22% ( n=132) for waves 1 and 2, respectively. There was an overall decrease in response rates between waves 1 and 2 for all language groups, but particularly for Arabic and Turkish-speaking men. The most frequently stated reasons for non-participation included illness and language barriers. The key lessons learnt were that overcoming linguistic and cultural barriers to conducting research among residents in this social housing area requires time and resources. Conclusions: Several challenges are associated with conducting a survey in ethnically diverse and deprived social housing areas. Documenting the challenges and learning from experience are both important, in order to include this hard-to-reach population in health research.

Previous research has shown social inequality in type 2 diabetes prevalence and that socially vulnerable type 2 diabetes patients benefit less than average from health services. Based on ethnographic fieldwork carried out between February 2017 and March 2018 in a Danish specialized outpatient clinic, this article focuses on patient work among socially vulnerable type 2 diabetes patients. Through attending to the border zone between formal health care and self-care, we show that patients do a lot of work requiring skills, resources, and initiative, to access and benefit from formal care. This work is complex and implicit in the organization of care. Patients’ social situations, especially their employment situation, complicate getting patient work done. Attending to patient work and implicit tasks in care organization may help us to see how social inequality in type 2 diabetes outcomes develops, and may be combated.

Background Type 2 diabetes cluster in lower social groups and people with type 2 diabetes from lower social groups experience more complications, benefit less from health services and live shorter lives than people with type 2 diabetes from higher social groups. Different logics govern diabetes care and potentially influence the possibility of socially vulnerable type 2 diabetes patients to access and benefit from health services. In order to understand which practice and underlying logic enable socially vulnerable type 2 diabetes patients to access and benefit from diabetes care we aim to describe what professionals at a specialized diabetes clinic do to adjust services to patient’s needs and make the tasks involved in diabetes care doable for socially vulnerable patients and how this work is embedded in an organizational and moral context. Methods Ethnographic fieldwork combining participant observation and interviews was carried out between February 2017 and March 2018 in a specialized diabetes clinic located in a socially deprived area in the capital region of Denmark. Sixteen patients (9 male, 7 female, aged 35-73 years) and 12 professionals (7 doctors, 4 nurses, 1 secretary) participated in the study. We used Annemarie Mol’s concept of “the logic of care” to guide our analysis. Results Our analysis shows that the logic of care and the care practices in this clinic are characterized by a needs-based approach to treatment involving adjustment of services (permeability, timing, and content) and seeing the patient as a person with many needs. Throughout our description of selected care practices, we both characterize how health professionals practice this particular logic of care and the organizational and normative conditions that this logic is entangled with. Conclusions Practicing diabetes care based on patients’ needs involves individualization, something often described as an element of patient centred care. Our study shows that this ideal of individualization and adjustment of treatment is possible in practice. Organizational flexibility and an organizational culture that values patient needs enable needs-based care. In order for socially vulnerable type 2 diabetes patients to benefit from health services it is necessary to create conditions under which professionals can attend to these patients’ multiple and complex needs. Adjusting care to these needs demand a variety of professional efforts some of which are hardly predictable or standardisable.

The MAMAACT intervention aimed to address ethnic and social disparity in stillbirth and infant health by improving management of pregnancy complications. This process evaluation of the intervention was guided by the British Medical Research Council’s framework. We examined implementation through dose, reach, and fidelity, important mechanisms and the influence of contextual factors. The intervention included a six-hour training session for antenatal care (ANC) midwives in intercultural communication and cultural competence, two follow-up dialogue meetings, and health education materials (leaflet and app) on warning signs of severe pregnancy complications and how to respond for pregnant women. A mixed-methods approach was applied. Cross-sectional survey data and administrative data were used to assess intervention reach and dose. Qualitative data (records from dialogue meetings with midwives, participant observations and field notes from ANC visits, focus group interviews with midwives, and individual interviews with non-Western immigrant women) evaluated intervention fidelity, mechanisms, and contextual barriers. More than 80% of women received the MAMAACT leaflet and many found the content useful. The app was used more selectively. Midwives described being more aware and reflective in their communication with women from various cultural backgrounds. Organizational factors in ANC (time pressure, lack of flexibility in visits, poor interpreter services), barriers in women’s everyday life (lack of social network, previous negative experiences/lack of trust and domestic responsibilities), and habitual interaction patterns among midwives served as contextual barriers. The reach of the intervention was high and it was evaluated positively by both pregnant women and midwives. Organizational factors hindered changes towards more needs-based communication in ANC potentially hindering the intended mechanisms of the intervention. When interpreting the intervention effects, attention should be drawn to both organizational and interpersonal factors in the clinic as well as the pregnant women’s life situations.

Introduction: Flexible Assertive Community Treatment (FACT) is a model of integrated care aiming to increase continuity of care for individuals with severe mental illness. FACT teams have been implemented in many countries by merging Assertive Community Treatment (ACT) and standard care from Community Mental Health teams (CMHTs). However, there has been little research on how practitioners experienced the fusion of these teams. Aim: This study explores how former ACT and CMHT practitioners perceived the implementation of FACT. Method: Perceptions of the FACT model, implementation strategies and adaptations of the model were investigated through 17 semi-structured interviews with FACT practitioners. Results: Perceived positive contributions of FACT included the recognition that FACT addressed a service gap for a group of patients who could benefit from increased support and improved integration of outpatient and hospital care. Perceived disadvantages of FACT included the experience that FACT drew away resources from ACT patients with the highest psychiatric needs. The findings also describe barriers to implementation, such as lack of perceived benefit of FACT, the maintenance of traditional work culture and insufficient organisational capacity. These challenges required the negotiation of local implementation strategies and adaptations. Conclusion: FACT increases access to intensive care for a broader group of patients with severe mental illness. However, findings from this study also suggest that the increased caseload in FACT compared with ACT and a changed mindset may not reflect the needs of the smaller group of patients who find it difficult to engage with mental health care services.

Well-being at work is important to quality of life. However, reconciling work and diabetes management is often challenging; failing to do so threatens the well-being of people with type 1 diabetes (T1D). We explored the mechanisms underlying diabetes-specific challenges at work using theories of logics, involvement, and action space. Thematic analyses of two data sets, consisting of interviews with adults with T1D ( n = 22) showed that people with T1D experience a conflict between two logics linked to diabetes and work, owing to the contradictory demands of work life and diabetes management. Individuals’ ability to lower the priority of work tasks—shifting them from their main to a side involvement so as to properly manage T1D—helps resolve the conflict, as does being able to create an enabling action space for diabetes management at work. These insights can inform interventions targeting the well-being of workers with T1D.

Gestational diabetes mellitus (GDM) increases the risk of adverse outcomes during and after pregnancy, including a long-term risk of type 2 diabetes. Women with GDM are treated by numerous healthcare professionals during pregnancy and describe a lack of preventive care after pregnancy. We aim to investigate healthcare professionals’ perspectives on the cross-sectoral treatment pathway for women with GDM—during and after pregnancy. A qualitative study was conducted using systematic text condensation. Nine healthcare professionals (two general practitioners, four midwives, two obstetricians and one diabetes nurse) were interviewed and eight health visitors participated in two focus group discussions., Three major themes emerged: 1) “professional identities”, which were identified across healthcare professionals and shaped care practices, 2) ”unclear guidelines on type 2 diabetes prevention after GDM”, which contributed to uncertainty about tasks and responsibilities during and after pregnancy, and 3) “cross-sectoral collaboration”, which relied heavily on knowledge transfers between hospitals, general practice and the local municipality. The findings implicate that clear, transparent guidelines for all sectors should be prioritized to strengthen cross-sectoral care to women with GDM during and after pregnancy. As a result, strong cross-sectoral care throughout the GDM care pathway may improve maternal health by supporting healthy behaviors, facilitate weight loss and reduce the risk of subsequent GDM and early onset diabetes.

Introduction Immigrant women have an increased risk of negative pregnancy and birth outcomes compared to women from European host populations. Similar trends are seen in Denmark, where especially some groups of non-Western immigrant women have an increased risk of stillbirth and infant mortality. This study reports on an implementation analysis of The MAMAACT Intervention, which was developed to increase midwives' and women's responses to pregnancy complications (trial registration number: NCT03751774). The intervention consisted of a training session and two dialogue meetings for midwives, and a leaflet and mobile application for women. Objective To explore midwives' and non-Western immigrant women's attitudes towards and experiences of using the MAMAACT intervention to enhance mutual interactions and improve responses to potential pregnancy complications. Design A multi-method qualitative study was used to collect data. Data consisted of non-participant observations of midwifery visits, field notes, focus group interviews with midwives and in-depth interviews with non-Western immigrant women. Data were initially analysed using systematic text condensation according to Malterud. Subsequently, Shim's concept of cultural health capital was applied to the data analysis. Setting Data were collected from ten Danish antenatal care facilities affiliated with five maternity care wards. Participants Twenty-three midwives participated in observations of 40 midwifery visits, and 27 midwives participated in nine focus group interviews. Twenty-one non-Western immigrant women each participated in one in-depth interview. Findings Two main themes were identified: ‘the MAMAACT intervention as a tool to build knowledge and skills’ and ‘intervention experiences’. Training sessions and dialogue meetings promoted midwives’ reflection on practice, however, at the visits, habitual ways of interacting impacted encounters between midwives and non-Western immigrant women. Among midwives, informing was a more dominant communication strategy than the use of dialogue, and competing tasks affected their follow-up on women's use of the information material. Women seemed hesitant to use the MAMAACT leaflet and app to actively engage with midwives at the visits although they used this material to distinguish between normal and abnormal conditions in pregnancy and to contact emergency maternity care services when at home. Conclusions and implications for practice The acceptability and usability of the intervention were high among participants. The leaflet and app showed potential in prompting women to contact emergency care maternity services. Despite midwives’ increased reflections on immigrant women's care provision, this did not appear to increase their use of a needs-based dialogue at the antenatal visits. Institutional structures, especially power relationships between midwives and non-Western immigrant women, affected mutual interactions. Attention to midwives’ task loads and time resources are needed if midwives are to have the necessary space to adapt their interactional styles to immigrant women's individual needs.

The main purpose of the study is to examine the development in health, wellbeing and social relations among middle-aged and older residents during a four-year period from 2018-2021 in a Danish multi-ethnic social housing area undergoing large structural changes in the built environment. In addition, to develop two interventions with a focus on ensuring social cohesion in the area during the study period. This presentation will provide an overview of the study outline. The presentation will include a description of the study area, the political decisions that have led to the structural changes, the study population and a short overview of the aims and planned sub-studies. To prepare for the workshop discussion of the challenges, advantages and possibilities with the multi-methods approach this is followed by a short introduction to the different methods applied (a three-wave survey and qualitative data as well as two co-created interventions). The study is furthermore including a 'natural experiment' (N∼6.000) with a neighbouring non-profit social housing area not undergoing structural changes as the control area based on register data. The user-engagement in the design of study will be shortly described for example by their involvement in intervention development and by the involvement of citizen representatives and representatives from the Municipality and local non-governmental organizations in the design and execution of the study. Finally, the inclusion of graphical facilitation as a communication tool will be introduced.

Differential incidence and severity of pregnancy complications are likely important contributing factors to the increased risk of poor pregnancy outcomes among ethnic minority women in Europe. To address this issue, the MAMAACT trial has been developed based on a thorough mixed methods needs assessment and co-creation process, feasibility tested, now implemented in a nationwide complex intervention. The overall aim of the Danish MAMAACT trial is to reduce ethnic and social disparity in stillbirth and newborns' health by improved management of pregnancy complications. The overall target group is all pregnant women, and the specific target group is women of non-Western origin. The hypothesis of MAMAACT is that improved communication between pregnant women and midwives regarding body symptoms that need prompt reaction will improve perinatal health among these vulnerable groups. The intervention consists of postgraduate training of midwives in intercultural communication and a smart phone application and a leaflet, both in six different languages. The app and leaflet target the women and explain the most serious warning signs of pregnancy complications and how to respond to them. MAMAACT is implemented and evaluated in a randomized controlled cluster trial and 10 maternity wards consist the intervention groups, while nine maternity wards are the control groups. The evaluation is a mixed method evaluation focusing on understanding the mechanisms of change, how context at both maternity ward level as well as in the everyday life of women affects the implementation, and finally if effects on health literacy of the women and perinatal health of the children can be documented.

Emerging evidence points towards lower quality of life, more fragile social relations and suboptimal health behaviour and health status of residents living in social housing areas characterized by ethnic diversity and socioeconomic disadvantage. Residents from social housing areas are less likely to engage in health promotion interventions compared to the rest of society. Community-based health promotion interventions developed in collaboration with the target group and adjusted to local context can affect the acceptance of and engagement in such interventions. However, few studies have investigated the potential of community-based interventions in social housing areas. This study explores resident perspectives on engagement in a community-based health promotion intervention focusing on enhancing social relations. Engagement was the key foundation for the designing and implementation of the intervention by the use of graphic facilitation. The intervention consisted of social outings to different sights and historical landmarks in Denmark. The study builds on qualitative methods including participant observations combined with pre- and post-intervention interviews with a selected group of residents (n = 9). Data were thematically analysed with a focus on participation in an everyday life context and by concepts of othering and territorial stigmatization. Engagement in the intervention was motivated by a need for establishing and enhancing social relations, and exploring the world outside the housing area. However, barriers including cultural and language differences among residents and competing contextual factors challenged engagement. We conclude that participatory community-based interventions have a potential to enhance social relations in social housing areas. Nevertheless, it is necessary to understand the motives and barriers to ensure feasible and relevant health promotion interventions and future engagement among residents living in social housing areas.

Melatonin is a commercially attractive tryptophan-derived hormone. Here we describe a bioprocess for the production of melatonin using Escherichia coli to high titers. The first engineered strain produced 0.13 g/L of melatonin from tryptophan under fed-batch fermentation conditions. A 4-fold improvement on melatonin titer was further achieved by (1) protein engineering of rate-limiting tryptophan hydroxylase to improve 5-hydroxytryptophan biosynthesis and (2) chromosomal integration of aromatic-amino-acid decarboxylase to limit byproduct formation and to minimize gene toxicity to the host cell. Fermentation optimization improved melatonin titer by an additional 2-fold. Deletion of yddG, a tryptophan exporter, exhibited an additive beneficial effect. The final engineered strain produced ∼2.0 g/L of melatonin with tryptophan supplemented externally and ∼1.0 g/L with glucose as the sole carbon source for tryptophan supply. This study lays the foundation for further developing a commercial melatonin-producing E. coli strain.

In a disadvantaged rural area in Denmark, severe challenges have been identified concerning overweight and obesity in families with preschool-age children. The present paper examines how families with young children and emerging obesity issues perceive 'healthy living' and barriers to practising it. Using data from qualitative workshops with families and professionals working with them, we reveal health perceptions and related family dynamics. Drawing on P. Bourdieu's theory of habitus and 'tastes of necessity', K.L. Frohlich et al.'s notion of 'collective lifestyles' and E. Lindbladh and C. H. Lyttken's theory of preconditions for health behaviour change and reactions to risk-related information, we analyse how risk perceptions and related health practices within the families are influenced by the local contexts in the disadvantaged area under study. Despite shared perceptions of 'healthy living', we found that diverse health-risk perceptions created family dynamics in which parents performed opposed health behaviours, which became a huge barrier to becoming a healthier family. Based on our theoretical approach, we propose that risk perceptions and reactions are highly context dependent, as illustrated in both micro-contexts (family dynamics) and the macro-context (the disadvantaged area).

Emerging evidence points towards a lower quality of life, fragile social relations and suboptimal health behavior and status of residents living in social housing areas characterized by ethnic diversity and socioeconomic deprivation. Community-based health promotion interventions developed in collaboration with the target group and adjusted to the local context can affect the acceptance of and engagement in such interventions. However, few studies have investigated the potential of community-based interventions in deprived social housing areas. This study explores residents&rsquo, perspectives on engagement in a community-based health promotion intervention focusing on enhancing social relations. The study builds on qualitative methods including participant observations combined with pre- and post-intervention interviews with a selected group of residents (n = 9). Data were thematically analyzed with focuses on participation in an everyday life context, concepts of othering, and territorial stigmatization. Engagement in the intervention was motivated by the need to establish and enhance social relations, and to explore the world outside the housing area. However, barriers including cultural and language differences among residents, and competing contextual factors, challenged engagement. We conclude that participatory community-based interventions have a potential to enhance social relations in deprived social housing areas. However, adequate support and efforts to overcome the identified barriers are needed.

In western countries, immigrant women have an increased risk of negative birth outcomes. Immigrant women&rsquo, s and maternity care system&rsquo, s delayed response to pregnancy complications contribute to ethnic inequities in reproductive health. The MAMAACT intervention was developed to improve midwives&rsquo, and women&rsquo, s response to pregnancy complications in Denmark. The study examines the context of the implementation of the MAMAACT intervention and investigates how the intended intervention mechanisms regarding response to pregnancy complications were affected by barriers in non-Western immigrant women&rsquo, s everyday life situations. Twenty-one interviews with non-Western immigrant women were undertaken. Systematic text condensation and the situational-adaptation framework by Alonzo were used to analyze data. Four main categories were identified: &lsquo, Sources of knowledge during pregnancy&rsquo, &lsquo, Containment of pregnancy warning signs&rsquo, Barriers during the onset of acute illness&rsquo, and &lsquo, Previous situations with maternity care providers&rsquo, Attention to potential pregnancy complications may conflict with immigrant women&rsquo, s everyday life situations and result in the containment of symptoms as well as causing delays in seeking medical assistance. It is probable that barriers in women&rsquo, s everyday life will impact the intended intervention mechanisms and thus the full potential of the intervention may not be reached.

Family interventions to treat childhood obesity are widely used, but knowledge about how family dynamics are affected by these interventions is lacking. The present study aims to understand how a family intervention impacts the context of family dynamics, and how different contexts affect the families&rsquo, implementation of the intervention. Based on qualitative interviews, we studied families with a child between 9&ndash, 12 years enrolled in a family intervention to treat childhood obesity at a pediatric outpatient clinic. We conducted 15 family interviews including 36 family members. We found that the family intervention created a new context for the enrolled children. They had to navigate in different contexts and non-supportive environments and push for change if they needed more supportive environments in their attempt to adhere to healthy habits. We show the complexities experienced by parents and grandparents when trying to comply with siblings&rsquo, and/or grandchildren&rsquo, s different needs. The enrolled children were often indirectly blamed if others had to refrain from unhealthy preferences to create supportive environments. These findings are significant in understanding the important role of contexts in family-obesity interventions. This knowledge is relevant to health professionals, researchers, and policymakers.

Background In Europe, the number of children born by non-Western immigrant women is rising and these women have an increased risk of negative pregnancy and birth outcomes, compared to the host populations. Several individual and system barriers are associated with immigrant women's access to maternity care. Scientific evaluations of interventions to enhance the health of immigrant women in the maternity setting are lacking, and there is a need for further development of the evidence base on how health care system initiatives may mitigate ethnic inequities in reproductive health. In Denmark, the MAMAACT intervention was developed to improve midwives’ as well as non-Western immigrant women's response to pregnancy complications and to promote midwives' intercultural communication and cultural competence. The intervention included a training course for midwives as well as a leaflet and a mobile application. This study focuses on the significance of the antenatal care context surrounding the implementation of the MAMAACT intervention (Id. No: SUND-2018–01). Objectives To explore the main organisational barriers, which impacted the intended mechanisms of the MAMAACT intervention in Danish antenatal care. Design A qualitative study design was used for data collection and analysis. Setting Midwifery visits at ten antenatal facilities affiliated to five Danish maternity wards formed the setting of the study. Participants and methods Data consisted of nine focus group interviews with midwives (n = 27), twenty-one in-depth interviews with non-Western immigrant women, forty observations of midwifery visits, and informal conversations with midwives at antenatal care facilities (50 h). Data were initially analysed using systematic text condensation. The candidacy framework was applied for further interpretation of data. Results Analysis of data revealed three main categories: ‘Permeability of antenatal care services’, ‘The interpreter as an aid to candidacy´, and ‘Local conditions influencing the production of candidacy’. Conclusions Several organisational barriers impacted the intended mechanisms of the MAMAACT intervention. Major barriers were incomplete antenatal records, insufficient referrals to specialist care, inadequate interpreter assistance, and lack of local time resources for initiating a needs-based dialogue with the women. Immigrant targeted interventions must be understood as events within complex systems, and training midwives in intercultural communication and cultural competence cannot alone improve system responses to pregnancy complications among immigrant women. Changes in the legal, social, and political context of the health care system are needed to support organisational readiness for the MAMAACT intervention.

PurposeTo treat childhood obesity, health education interventions are often aimed at the whole family. However, such interventions seem to have a relatively limited effect on weight loss. The purpose of this paper is to examine how families enrolled in a family-based health education intervention manage the intervention in their daily lives and to understand how and why intra-familial conflicts may occur.Design/methodology/approachData consist of 10 in-depth semi-structured family interviews with 25 family members (10 children, 15 parents), who were enrolled in a family-based health education intervention for families with an obese child.FindingsActively involving all family members in the intervention proved difficult in many families. Often, the children experienced inconsistent family support, which led to intra-familial conflicts. When parents were unsuccessful in changing unhealthy habits, the responsibility for healthy living was often passed on to the obese child. Thus, several families managed the intervention by making specific rules that only the obese child was required to adhere to. This resulted in several children feeling stigmatized in their own family.Practical implicationsProfessionals working with family-based health education interventions should understand that, in order to minimize the risk of intra-familial conflicts and stigmatization of the obese child, all family members must be equally committed to the lifestyle intervention.Originality/valueThe study contributes to the existing literature by adding specific knowledge about how and why conflicts occur in these families and what the consequences of these conflicts are.

Background The prevalence of multimorbidity is increasing, creating challenges for patients, healthcare professionals, and healthcare systems. Given that chronic disease management increasingly involves eHealth, it is useful to assess its perceived value among people with multimorbidity. Objective To explore challenges related to multimorbidity and patients’ perspectives on eHealth. Design Ten semi-structured interviews with adults, living with multimorbidity in Copenhagen, Denmark. Interviews focused on patient-experienced challenges, from challenges related to self-management to challenges experienced in the healthcare sector, as well as perceptions of eHealth. During interviews, participants were presented with pictures of different eHealth technologies. Data analysis followed the systematic text condensation approach. Results Participants experienced challenges in their daily lives, e.g. when practicing self-management activities, when navigating the healthcare sector, and when interacting with healthcare professionals. Patient-perceived value of eHealth varied, depending on their burden of illness and treatment: those with a greater burden had more positive perceptions of eHealth, and expressed more intention to use it. Participants with less complex disease patterns and less burdensome treatment regimens were more likely to perceive eHealth as something worthless and undesirable. Participants stressed that eHealth should only be introduced as an optional supplement. Conclusions eHealth can potentially address some patient-experienced challenges related to multimorbidity by promoting self-management, patient-centeredness, and access. However, patients’ needs and preferences vary and eHealth cannot substitute the personal interaction between patient and healthcare professionals. Our findings point to the importance of patient assessment and stratification to ensure appropriate use of eHealth.

Cytochromes P450 (CYP) are attractive enzyme targets in biotechnology as they catalyze stereospecific C-hydroxylations of complex core skeletons at positions that typically are difficult to access by chemical synthesis. Membrane bound CYPs are involved in nearly all plant pathways leading to the formation of high-value compounds. In the present study, we systematically maximize the heterologous expression of six different plant-derived CYP genes in Escherichia coli, using a workflow based on C-terminal fusions to the green fluorescent protein. The six genes can be over-expressed in both K- and B-type E. coli strains using standard growth media. Furthermore, sequences encoding a small synthetic peptide and a small bacterial membrane anchor markedly enhance the expression of all six genes. For one of the CYPs, the length of the linker region between the predicted N-terminal transmembrane segment and the soluble domain is modified, in order to verify the importance of this region for enzymatic activity. The work describes how membrane bound CYPs are optimally produced in E. coli and thus adds this plant multi-membered key enzyme family to the toolbox for bacterial cell factory design.

Problem Despite free universal healthcare, Copenhagen is challenged by inequality in the prevalence and implications of type 2-diabetes (T2D). To address the problem, the Municipality of Copenhagen has initiated a city action plan including a peer support program for socially vulnerable citizens with T2D. Such programs have shown to be an essential supplement to the established health system to reach groups, who have limited contact with the health system. However, research on the implementation of the programs is generally limited. Description of the problem This 6-months peer support program is based on an initial analysis, showing social vulnerability to be associated with co-morbidity, low level of education, unemployment, living in a disadvantaged district and living alone. The peers are matched with a volunteer peer supporter with T2D, who helps out every 14. day with social-, practical- or bridging activities to health services or the municipality. We aim to evaluate the implementation with focus on contextual factors. We conduct in-depth qualitative interviews with peers (N = 12), peer supporters (N = 12), and relevant stakeholders (N = 6). Further, surveys with the peers and peer supporters (N = 45). Results Our preliminary results indicate how the peer supporters can bridge the gap between socially vulnerable citizens with T2D and the health system. However, contextual factors regarding the recruitment of peers have challenged the implementation process as the municipality has difficulty reaching them. Lessons To ensure a successful implementation, it is important to prioritize resources to ensure good collaboration with local stakeholders, who can be gatekeepers in the recruitment and get in contact with this group of citizens. Key messages The program has potential to bridge the gap between socially vulnerable citizens and the health system. The group is hard to reach without collaboration with local stakeholders.

Initiatives to improve maternal and child health among non-Western immigrant populations in Western countries are still sparse. So far, interventions within antenatal care have primarily focused on doula support and group-based antenatal care. A qualitative evaluation of the implementation of the intervention was undertaken to explore midwives and non-Western immigrant women’s attitudes towards and experiences of using the MAMAACT intervention. The evaluation also investigated key contextual factors impacting the interventions utilization. Data consisted of focus group interviews with midwives (n = 9) and in-depth interviews with non-Western immigrant women (n = 15), as well as observations of midwifery visits (n = 42). Data were collected at five intervention sites across Denmark and it was analyzed using systematic text condensation. Findings show that midwives found the MAMAACT intervention to be a relevant tool, which was easy to implement in antenatal care. Several organizational factors such as task load, interpreter services and lack of cooperation with general practitioners impacted the implementation of the intervention. Non-Western immigrant women found the leaflet and app to be useful tools in distinguishing between normal and abnormal pregnancy symptoms. The degree to which the intervention was used by the women varied between the participants, and women also used other sources of information during their pregnancy. Contextual factors such as lack of social network and material resources as well as language proficiency impacted how women responded to their pregnancy symptoms. Findings show that in addition to targeting the intervention to midwives and non-Western immigrant women’s informational needs, structural factors such as the organization of antenatal care and women’s socioeconomic conditions need to be addressed in order to reduce ethnic disparity in reproductive health.