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When they discuss the Danish academic situation, Szulevicz, Lund and Lund (2021) address three questions about the academic training of psychology researchers: (a) why do Danish master's students in psychology more frequently choose the qualitative method for their research?; (b) what are psychology students working on?; and (c) what are they interested in? These three questions have led us to reflect on researcher training and the political and educational model universities adopt for psychology master's courses, not only in the Danish context, but also in other general contexts. In this commentary, we will discuss one strictly normative issue: what should the scientific ideal be for training researchers in psychology? Or more accurately: how can psychology contribute to discussions about the scientific ideal of researcher training in this knowledge area?, (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

A popular notion refers to laughter as “the best medicine,” and a stream of psychological research encourages treatment providers to use humour as a therapeutic tool. However, remarkably few studies have investigated client perspectives on professionals' use of humour in everyday practice. Drawing on ethnographic data from fieldwork in two Danish drug treatment institutions for young people, this paper begins to fill this gap in the existing research. Analyzing the use of humour in naturally occurring, informal situations wherein professionals joke, use irony and tell funny stories, this paper suggests that the use of humour by professionals – despite their allegedly good intentions – may at times be problematic, even offensive for clients. Furthermore, as the young people who turn to drug treatment are socially vulnerable and dependent on the professionals, the paper illuminates how they find their opportunities for objecting to the professionals' use of humour limited. The paper concludes that professionals should handle humour with care, rather than viewing it as a benign, risk-free addition to treatment, and that future research must tackle the methodological challenges of exploring client perspectives with respect to how professionals use humour in institutional settings characterized by asymmetrical power relations. [ABSTRACT FROM PUBLISHER]

The aim of this paper is to reflect critically on the current health promotion initiatives targeting overweight individuals in Western countries. The paper’s methodological approach is to draw on analytical findings from my and other sociologists’ empirical work on how the problems of overweight people are being defined in various settings in Denmark, England, Australia and the US. I try to illustrate how health promotion targeting overweight individuals can not only be seen as a project aimed at securing longer lives and fewer illnesses for people carrying excess fat but also a moral project that, in a more general sense, aims to tell people how they ought to live their lives. I link this moral aspect of health promotion to a) the medicalization tendency in current Western society (e.g. a growing pharmaceutical industry and its economic interest in transforming the human condition of being overweight into a treatable disorder) and b) the strong focus on individual risk today. One of the main arguments in the paper is that health in relation to overweight is primarily defined from a biomedical perspective that praises certain physical measurements of the body, as well as dominant societal values such as  self-responsibility and self-control, and that a combination of biomedicine and these dominating values can lead to health promotion becoming a problematic moral endeavour. [ABSTRACT FROM PUBLISHER]

This paper explores the moral implications of treatment of young people with functional somatic symptoms. Based on an ethnographic field study at a Danish pain clinic for youngsters (age 8 to 18), the paper seeks to unearth the cultural, moral values that clinical practice steers by and upholds, and the implications this has for the assessment and management of ill body-selves. Through an exposition of the general practice of the clinic and an investigation of two specific cases of youngsters, it is found that the assessment of symptoms and selves and the goals of treatment are informed by cultural ideals of 'the good self' and 'the good life' in which agency and work ethic – both pertaining to the notion of individual responsibility – figure as prevalent virtues. The study underpins the findings of other researchers who have found that ideals of individual autonomy and responsibility for own life and health permeate the Western health care system and the discourses of ill individuals. The contribution of this article is to portray in ethnographic detail how such a cultural ethics manifests in practice and what implications this have for the treatment of young people with functional symptoms at a specific location and in specific cases. The two cases illustrate that the underlying norms and values can give rise to very different moral assessments of symptoms and selves within the same diagnostic category. [ABSTRACT FROM AUTHOR]

In this article the authors seek to describe state responses to figures showing that the rates of physical and/or sexual violence against women in Denmark are among the highest in Europe. The authors do so by investigating the representations of intimate partner sexual violence, framing contemporary political developments of the Danish field of welfare work addressing violence in intimate relationships as well as the dominating knowledge production substantiating these. Theoretically, Slavoj Zizek and his concept objective violence inform the paper, in order to analyze authoritative representations of "intimate partner sexual violence" in two areas: Danish research on sexual violence and Danish policy-papers. On the basis of a descriptive analysis we conclude that intimate partner sexual violence is essentially an unexplored problem in a Danish research context and we show that an incident-oriented conceptualization of rape and sexual assault dominates most of the research on sexual violence. Furthermore, in the political context we identify strong tendencies toward de-gendering violence as an outcome of strategies working to mainstream the field of welfare work addressing violence. This means that in a Danish context working with violence is now taking place within an ideological environment where the idea that equality between the sexes has been achieved dominates. [ABSTRACT FROM AUTHOR]

Purpose Studies have shown that mental health professionals find working with patients with dual diagnosis challenging, and the purpose of this paper is to examine some of these challenges.Design/methodology/approach In total, 85 mental health professionals from 8 different mental health centres in Denmark were interviewed. The data analysis was inspired by a grounded theory approach.Findings Different challenges in the dual diagnosis treatment were identified and they suggested that the focus of treatment was mainly on the mental illness rather than the substance use disorder. The single focus of the treatment made it challenging to treat patients with dual diagnosis sufficiently. While several studies explain the single focus by inadequate competencies among professionals, the present study suggests that the single focus is also explained by the way that the treatment is organised. For instance, standardized treatment packages and insufficient guidelines on substance abuse treatment make it challenging to treat patients with dual diagnosis.Originality/value This paper suggests that a more flexible, and a longer period of, treatment, together with more sufficient guidelines on dual diagnosis treatment and a more formalized collaboration with the substance abuse treatment centres, will make it a less challenging issue to treat patients with dual diagnosis. [ABSTRACT FROM AUTHOR]

Risk-assessment models are widely used in casework involving vulnerable children and families. Internationally, there are a number of different kinds of models with great variation in regard to the characteristics of factors that harm children. Lists of factors have been made but most of them give very little advice on how the factors should be weighted. This paper will address the use of risk-assessment models in six different Danish municipalities. The paper presents a comparative analysis and discussion of differences and similarities between three models: the Integrated Children's System (ICS), the Signs of Safety (SoS) model and models developed by the municipalities themselves (MM). The analysis will answer the following two key questions: (i) to which risk and protective factors do the caseworkers give most weight in the risk assessment? and (ii) does each of the different models ensure a holistic assessment (which is required by law in Denmark)? The study contributes to the discussion about the use of risk-assessment models and whether these newer models have actually made a difference in what is assessed when looking at families at risk. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide insight into teachers’ practice in implementing school-based health promotion. Design/methodology/approach – This qualitative research was designed as a multiple case study. The study involved five schools, 233 pupils in the age 12-16 and 23 teachers. The primary data generation method were focus groups. Findings – According to the national guidelines the health education in primary schools in Denmark should be based on the critical approach to health education developed within the European Network of Health Promoting Schools. However, the study showed that teachers’ implementation of the guidelines in practice was closer to traditional health education, which focuses only lifestyle change, than to critical health education which also explores the underlying conditions for health. Research limitations/implications – The study explored teachers’ implementation practices, and the individual and institutional factors that influence the practice. This paper restricts itself to examining teachers’ practice against the national curriculum guidelines. Practical implications – The teachers were not sufficiently familiar with the curriculum guidelines or the critical approach to health education. The inclusion of the national curriculum and the principles of critical health education in the initial and in-service professional development of teachers is an urgent priority if this gap is to be reduced. Originality/value – This paper contributes to the debate related to the potentials and barriers for implementing of health promotion interventions in a school context. [ABSTRACT FROM AUTHOR]

Research has shown an increase in the experience of educational pressure among students in contemporary Western societies and also, in their use of pharmaceuticals, for enhancement purposes. Based on qualitative interviews with 60 Danish students conducted in 2016, this article analyses student narratives about their use of pharmaceuticals to meet the expectations they experience in the educational settings. Though many students find pharmaceuticals useful, interesting gender differences exist regarding their motives and legitimations of use, and regarding pharmaceuticals of choice. By using two paradigmatic, narrative cases the article suggests that a 'male strategy' of augmentation is more in accordance with the overall requirement to perform and succeed in the 'performance society' than a 'female strategy' of normalisation. The article argues that there may be a parallel between the increasing numbers of women in Danish society diagnosed with stress and anxiety, the media representations of achieving women being more vulnerable than men, and the gender differences in pharmaceutical use. The paper aims to contribute to a nuanced discussion of the relations between educational pressure, gender and use of pharmaceuticals for enhancement purposes in contemporary Western societies. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on this subject?: There is a need to shed light on healthcare professionals' reactions to the use of the Guided Self‐Determination method in a mental health hospital to better understand and adjust the implementation process of evidence‐based practice.Healthcare professionals´ values and beliefs play an important role when implementing evidence‐based practice in real‐world healthcare settings. What this paper adds to existing knowledge?: The study identifies opposite positions in mental healthcare professionals: being ready or resistant to change when implementing an evidence‐based intervention. The positions are elaborated in four thematic dynamic continuums describing reactions to using the intervention.In addition, this is the first study to explore mental healthcare professionals´ reactions to using the Guided Self‐Determination method in a mental health context. What are the implications for practice?: When preparing implementation of an evidence‐based intervention, it is important to consider adaptation of the intervention, the mental healthcare professionals' acceptability, support from management and participation in supervision.In future research, it is important to consider collecting data from mental healthcare professionals trained in using an evidence‐based intervention, however not using it in clinical practice, to understand barriers towards evidence‐based practice. Introduction: Evidence‐based interventions are required in mental health nursing to improve quality and outcome for patients. However, there is a need to shed light on professionals' reactions to the use of evidence‐based interventions to better understand and adjust the implementation process. Aim: To explore mental healthcare professionals´ reactions to using the evidence‐based intervention Guided Self‐Determination method in the care of inpatients with severe mental illness. Method: A qualitative study conducted in relation to an 8 months implementation program. Data collection: 9 qualitative interviews and field notes generated from supervision of the intervention. Results: Four themes emerged from a thematic analysis: "The expert becomes novice," "Theory used as a looking glass," "Guided Self‐Determination perceived as an interruption" and "Becoming an informer of the impact of GSD." Discussion: Using the themes may help leaders or researchers predict or discover the support needed by individual professionals. Implications for practice: When preparing implementation of an evidence‐based intervention, it is important to consider adaptation and acceptability, as well as support from management and participation in supervision. Finally, it is worth to consider collecting data from trained professionals, who did not use the intervention in practice to understand barriers towards evidence‐based practise. [ABSTRACT FROM AUTHOR]

Commercialization of emotions is not a new phenomenon but in Denmark there is a new general trend to tell and sell personal stories in the media. Personal deprivation and crises are also major topics in sports media. This paper focuses on sports biographies as a book genre that is reviving in popularity. The paper approaches the topic through the biographies of one Danish athlete: the former professional cyclist, Jesper Skibby, who writes about his doping disclosure and shares his personal dilemmas as a former elite sportsman. The thematic text analysis orientates around social interactions, emotions, and personality constructions. Inspired by microsociology with a Durkheimian flavor of Goffman and Hochschild, themes including 'face work,' 'interaction rituals,' and 'emotions management' are discussed. The analysis claims that sharing personal information in the media is not only a means of confession and reclaiming status but is also business and management - on an intimate level. Telling the story of the corrosion of a sporting character has become a hot issue, an entertainment, and not least a commercial commitment. [ABSTRACT FROM AUTHOR]

Hunters in the Western world today do not need to hunt to obtain food and other animal products. So why do they hunt? This paper examines the motives of hunters, the motives ascribed to hunters by members of the general public, and the role motives play for the moral acceptability of hunting among members of the general public. It draws on a nationally representative survey of the general public (n = 1,001) and hunters (n = 1,130) in Denmark. People with a negative attitude to hunting are more likely to take motives into account when they consider the acceptability of hunting. Three clusters of motives defining distinctive hunting motivational orientations were identified:action/harvest, management/care,andnatural and social encounters. The general public ascribedaction/harvestmotives to hunters more than hunters did. In a policy perspective, if hunters’ motives are misperceived, improved dialog may be needed to protect the legitimacy of recreational hunting. [ABSTRACT FROM PUBLISHER]

Aims: Nordic welfare states have achieved admirable population health profiles as a result of public policies that provide economic and social security across the life course. Denmark has been an exception to this rule, as its life expectancies and infant mortality rates since the mid-1970s have lagged behind the other Nordic nations and, in the case of life expectancy, behind most Organisation for Economic Co-operation and Development nations. Methods: In this review paper, we identify a number of new hypotheses for why this may be the case. Results: These hypotheses concern the health effects of neo-liberal restructuring of the economy and its institutions, the institution of flexi-security in Denmark’s labour market and the influence of Denmark’s tobacco and alcohol industries. Also of note is that Denmark experienced higher unemployment rates during its initial period of health stagnation, as well as its treatment of non-Western immigrants and high wealth inequality and, until recently, the fact that Denmark did not systematically address the issue of health inequalities. Conclusions: These hypotheses may serve as covering explanations for the usually provided accounts of elevated behavioural risks and psychosocial stress as being responsible for Denmark’s health profile. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the challenges women with neuromuscular disease face when having to urinate when away from home. The design for this study was qualitative using the interpretive description methodology and the Sense of Coherence theory. The method was three semi-structured focus group interviews with 12 women (3 ambulant and 9 non-ambulant) with neuromuscular diseases at a specialized rehabilitation hospital. We found that physical and functional barriers hampered the opportunity to urinate when away from home due to lack of accessibility and impaired physical functioning. Psychosocial impacts were related to inconvenience and dependency on relatives, fear of stigmatization and impacted dignity, and the constant social sacrifices. The challenge of access to adequate and equitable sanitation for women with neuromuscular diseases is not at always met in society, and these women consequently often must resort to repressing the fundamental need to urinate. [ABSTRACT FROM AUTHOR]

Aims: A central paradigm of global anti-doping policy is detection-based deterrence, i.e. the risk of testing and exclusion from sport are effective doping deterrents. This paper investigates how elite athletes perceive the deterrent effect of the testing strategy in their sport and explores whether and how specific factors such as the frequency of testing influence athletes’ perceptions of testing as a deterrent.Methods: 645 Danish elite athletes completed a web-based questionnaire about their perceptions of testing efforts in their sport.Findings: 75% of the athletes considered the likelihood that a test would prove positive to be a deterrent. By contrast, only 40% found the risk of being selected for testing to be a deterrent. Athletes tested frequently and athletes from doping-risk sports were more likely to perceive testing as a deterrent. In total, 24% regarded neither the likelihood of testing nor detection as deterrents. 8% did not consider the likelihood of testing and detection nor the ban from sport as deterrents.Conclusions: Testing programmes – as a strategy to detect and deter doping – are no great deterrent for many athletes. The results highlight the limitations of detection-based deterrence and emphasise a need to give higher priority to additional prevention-orientated strategies. Recommondations are outlined. [ABSTRACT FROM PUBLISHER]

This qualitative study explores the structural barriers to preventive interventions targeting childhood obesity in the Danish health care system. Based on interviews with relevant health care professionals, the paper reports on the problems which are experienced by general practitioners and health visitors and which complicate implementation of the policies of the Danish health authorities. Findings show that the current system is not well equipped to treat early overweight. A gap in primary preventive health care for children at age 3–5, indistinct lines of responsibility, inadequate cooperation, and lack of resources together make it difficult for health care professionals to initiate interventions and reach the children in need of support. By analyzing the policy implementation process in a theoretical framework that discloses the discursive allocation of responsibilities, the study is able to provide a deeper description and analysis of the problem. The study makes it clear how preventive health care for overweight children rests on the negotiation of formal and performed responsibilities among health practitioners within a framework of scarce resources and communication deficit. [ABSTRACT FROM PUBLISHER]

This paper is based on ethnographic fieldwork at an obstetric ultrasound unit in Denmark and explores the few, intense minutes of clinical interaction following a high-risk screening result for Down's syndrome. The category of high-risk transforms the routine ultrasound into a situation of inescapable choice, where the health of the foetus is questioned and decisions must be made. The clinical interactions following a high-risk result are investigated as processes of production, and the concepts oflogic of choiceandthe logic of careare employed as analytical tools for identifying different rationales at play in the situation. The analysis shows that sonographers and women/couples collaboratively engage in logics of choice and care. Their mutual aim is to make the high-risk results meaningful and manageable so that a decision can be made. In this process initiative is shifted back and forth. Through a logic of care, complexity is reduced and statistics transformed by emphasising certain interpretations and leaving others unspoken. However, the logic of choice is also collectively maintained by positioning the women/couples as decision-makers. It is argued that in the obstetric ultrasound unit, the logic of choice provides a powerful frame, with the logic of care filling in the gaps and discontinuities to facilitate decisions. In this context, the logics are complementary rather than competing, and thus the analysis add new perspectives to the original concepts. In sum, the logics of choice and care provide a valuable analytical tool for interpreting and understanding the complex and collaborative practices of clinical interaction. [ABSTRACT FROM AUTHOR]

Background: Death of a close family member such as a parent or a sibling can cause prolonged stress and changes in the family structure that may have extensive social and health effects on a young child. The aim of this paper is to examine the rate of type 1 diabetes following bereavement due to death of a first-degree family member in early life.Methods: We used data from the Danish Civil Registration System (CRS) to identify singleton births in Denmark born 1 January 1980 through 31 December 2005, n = 1 740 245 and their next of kin. We categorised children as exposed to bereavement if they lost a mother, father or sibling from age 5 years onwards, the remaining children were considered unexposed. Children were followed until first diagnosis of diabetes, death, emigration, or 31 December 2010. We estimated incidence rate ratios (IRRs) from birth using log-linear Poisson regression models with person-years as an offset variable. Exposed children were followed up for an average of 9.1 years [standard deviation (SD) 6.7] and unexposed children were followed up for an average of 12.3 years (SD 7.3).Results: In our sample 94 943 children were exposed to bereavement, and 6110 cases of type 1 diabetes were identified. Bereavement was associated with an increased rate of type 1 diabetes when exposure onset began after 11 years of age (adjusted IRR 1.28, 95% confidence interval 1.08, 1.51).Conclusion: We found some evidence to indicate an increase in the rate of type 1 diabetes among children exposed to bereavement when exposure occurred after 11 years of age. [ABSTRACT FROM AUTHOR]

Career decisions are amongst the most important we make. Unsurprisingly, much published research exists on this particular aspect of career behaviour. However, the overwhelming majority of studies have been carried out on young people making initial career decisions. This paper extends our understanding by examining how mid-career adults in three European countries (Denmark, France and Italy) actually make career decisions. Characteristic patterns of behaviour recur when individuals approach points of transition or of crisis; each of these transitioning styles is illustrated by an iconic case. Emergent findings support the growing body of evidence that challenges the dominant policy and practice orthodoxy, which places rationality at the centre of the process, by recognising the importance of emotion and context. [ABSTRACT FROM PUBLISHER]

The term convenience food is subject to diversification, lack of clarity and moral ambiguity. In this paper we address these issues and critically discuss convenience food by using empirical findings from a Danish study that deals with practitioners' uses of meal box schemes. The methodological design consists of thirteen individual interviews, four focus groups and some observations of cooking practices. We combine the empirical findings with a particular definition of convenience food by Brunner et al. (2010) and selected practice theoretical concepts. This particular combination enables us to categorize meal box schemes as a new form of convenience food called convenient food. In addition, results suggest that meal box schemes reduce leftovers from dinner. Meal boxes also influence dinner related activities such as planning ahead in time and grocery shopping, which require less physical and mental effort. [ABSTRACT FROM AUTHOR]

This paper approaches institutionalized dementia care as a site of societal disposal, valuation, and care for human life. Drawing upon six weeks of ethnographic fieldwork and ten qualitative interviews carried out in a Danish dementia nursing home in 2014, we analyze how nursing home staff, through everyday care, uphold the value of life for residents in severe mental and physical decline. We argue that life's worth is established when residents gain qualities of personhood and agency through substitution processes carried out by staff. Yet the persistent absence of conventional personhood and autonomous agency in residents (i.e. capacities for memory, consciousness, language, and mobility) evokes experiences of ambiguity in staff and relatives of residents. We close the article with a discussion of this ambiguity and the significance of the nursing home as care institution in the welfare state. Dementia care, we propose, is not only about preserving the lives of people with dementia. At stake in the daily care practices around severely disabled residents in the nursing home is the very continuance of the main principles of the welfare society. [ABSTRACT FROM AUTHOR]

Farmers are accustomed to coping with year-to-year changes in climate, but climate change is expected to accelerate the need and magnitude of farmers’ adaptation ( Wheeler and Tiffin, 2009 ). Based on a survey of farmers across Denmark (1053 responses), this paper assesses how farmers’ perceive climate change, weigh its attendant risks, and envision the barriers to adaptation as these factors stand to affect their likelihood to undertake adaptive action in the Global North. Descriptive statistics and an ordered probit model were used to disentangle the magnitude and direction of the cognitive factors underpinning farmers’ likelihood to adapt. We also differentiate between adaptation to positive and negative potential impacts of climate change and provide important new insights on loss aversion and, more specifically, the conditions under which loss aversion may give way to a preference for gains. Our results indicate that Danish farmers are not terribly concerned about climate change impacts and perceive many barriers to adaptation, yet they indicate a moderate likelihood to undertake adaptive action in the future, particularly to potential opportunities from climate change impacts. However, we also find that the more concerned a farmer is about climate change, the more he is likely to adapt in response to negative climate impacts − the balance between loss aversion and gain preferences appears to depend on context. In either case, Danish farmers appear to prefer incremental and flexible adaptations in the face of uncertain future climate change impacts. [ABSTRACT FROM AUTHOR]

Excessive alcohol consumption is one of the most important lifestyle factors affecting the disease burden in the Western world. The results of treatment in daily practice are modest at best. The aim of the RESCueH programme is to develop and evaluate methods, which are as practice-near as possible, and therefore can be implemented quickly and easily in everyday clinical practice. It is the first clinical alcohol programme to be transatlantic in scope, with implementation in treatment centers located in Denmark, Germany and the US. The RESCueH programme comprises 5 randomized controlled trials, and the studies can be expected to result in (1) more patients starting treatment in specialized outpatient clinics, (2) a greater number of elderly patients being treated, (3) increased patient motivation for treatment and thus improved adherence, (4) more patients with stable positive outcomes after treatment and (5) fewer patients relapsing into harmful drinking. The aim of this paper is to discuss the rationale for the RESCueH programme, to present the studies and expected results. [ABSTRACT FROM AUTHOR]

People with type 2 diabetes (T2D) live with several challenges, which may enhance the risk of poor mental and physical health. However, despite living with a chronic illness, some individuals manage to achieve a life with positivity and well-being. The objective of this study is to explore the potential of Positive Psychology and Salutogenesis when analyzing how families with one or more members with T2D experience having resources leading to thriving. Data consist of 18 semi-structured family interviews with 38 participants. Data were analyzed using systematic text condensation with the concepts of sense of coherence and upward/downward spirals as the analytical framework. The analysis revealed three overall findings: (i) T2D is perceived as manageable due to general optimism despite living with a chronic illness; (ii) establishing supportive social relations means having the opportunity to share the burden of diabetes; and (iii) achieving an open dialogue and communicating the difficulties of diabetes without straining surroundings with negative illness communication. The three overall findings may reinforce each other in an upward spiral and enhance the sense of coherence. These findings have implications for diabetes management research and our understanding of psychological health in chronic illness. The overall goal is to help people with diabetes create meaning with their illness and make use of their social environment through dialogue and communication in order to increase positivity, optimism and mental health. [ABSTRACT FROM AUTHOR]

Objective: To present the theoretical foundation and methodological considerations for a group-based pain management programme for patients with persistent non-specific low back pain and psychosocial risk factors. Method: The Template for Intervention Description and Replication (TIDieR) checklist was used as a framework for describing the content, structure and context of the program. The theoretical rationale underlying the pain management programme was described using the first three steps of the Intervention Mapping framework. The Fear-avoidance model and the Self-efficacy Theory were identified as the two main theories. These were used to establish specific factors addressed by the pain management programme as well as expected outcomes. Intervention description: A multidisciplinary, group-based programme using a cognitive-behavioural approach was developed. The programme consisting of six sessions of two hours duration, took place at a spine clinic at a regional hospital in Denmark. Psychoeducation and cognitive restructuring were specific strategies hypothesised to induce changes in outcome measures. The outcomes expected to change as a result of the intervention were disability, quality of life, sick leave and physical activity. A pilot study was performed, subsequent adjustments made and the final content and educational materials completed by January 2017. Conclusion: The theoretical foundation and underlying evidence for the hypothesised change mechanisms in the use of a cognitive-behavioural approach was presented. A theoretically sound and practically feasible intervention has been developed and its effectiveness is being determined in a randomised controlled trial, including 130 low back pain patients, which is currently underway. [ABSTRACT FROM AUTHOR]

Objective: Even when medical treatments are limited, supporting patients' coping strategies could improve their quality of life. Greater understanding of patients' coping strategies, and influencing factors, can aid developing such support. We examined the prevalence of coping strategies and associated variables.Methods: We used sociodemographic and baseline data from the ACTION trial, including measures of Denial, Acceptance, and Problem-focused coping (COPE; Brief COPE inventory), of patients with advanced cancer from six European countries. Clinicians provided clinical information. Linear mixed models with clustering at hospital level were used.Results: Data from 675 patients with stage III/IV lung (342, 51%) or stage IV colorectal (333, 49%) cancer were used; mean age 66 (10 SD) years. Overall, patients scored low on Denial and high on Acceptance and Problem-focused coping. Older age was associated with higher scores on Denial than younger age (β = 0.05; CI[0.023; 0.074]), and patients from Italy (β = 1.57 CI[0.760; 2.388]) and Denmark (β = 1.82 CI[0.881; 2.750]) scored higher on Denial than patients in other countries.Conclusions: Patients with advanced cancer predominantly used Acceptance and Problem-focused coping, and Denial to a lesser extent. Since the studied coping strategies of patients with advanced cancer vary between subpopulations, we recommend taking these factors into account when developing tailored interventions to support patients' coping strategies. [ABSTRACT FROM AUTHOR]

Aims: To gain knowledge about families' experiences while staying in a hospital family house during their child's hospitalisation. Background: When a child is hospitalised with a chronic, serious or life‐threatening disease, the entire family is stressed as normal everyday life is disrupted. In Denmark, accompanying the ill child to the paediatric wards is often possible only for one of the parents. Design: This qualitative study takes a phenomenological–hermeneutical approach, exploring the lived experience of families' everyday life in a hospital family house. Method: The study comprised semi‐structured interviews with 33 family members from 15 families who stayed in a hospital family house. The interviews were made in the summer of 2017. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline "see Appendix S1." Results: The families experienced the house as a home or a haven where they could stay together as a family. The house provided a quiet and peaceful environment with space for family life and playing. Overall, this gave the families a feeling of togetherness. Conclusion: The families who stayed in the hospital family house experienced the house as a place to breathe freely, that is, as a safe haven. A place with peace and quietness, without "activity efficiency." In the house, the volunteers offered a very caring and supportive environment including all families in the house and embracing everyday activities. Providing accommodation for the whole family at the hospital family house afforded the family a place where they could stay together and maintain everyday life even though everything around them was, at times, chaotic. Relevance to Clinical Practice: Healthcare professionals should use knowledge about the healing environment to help create havens for families to a hospitalised child. Hospitalised children need safe places where no treatment takes place—therefore, family houses should stay treatment free. [ABSTRACT FROM AUTHOR]

Aims: There is evidence that young people are less satisfied with their lives when they are unemployed or working in precarious conditions. This study aims to shed light on how the life satisfaction of unemployed and precariously employed young people varies across welfare states with different labour market policies and levels of social protection. Methods: The analyses are based on representative cross-sectional survey data from five European countries (Denmark, the UK, Germany, Spain and the Czech Republic), corresponding to five different welfare state regimes. For economically active young adults (N =6681), the prevalence ratios of low life satisfaction were estimated through multivariate logistic regressions. Results: In all five countries, unemployed young adults presented a higher prevalence of low life satisfaction. When we compared employees with people with permanent and temporary contracts, the former were more satisfied with their lives only in Germany and the UK, examples of conservative and liberal welfare regimes, respectively. Experience of unemployment decreased young adults' life satisfaction only in Germany and the Czech Republic, examples of a conservative and an eastern European welfare regime, respectively. In almost all countries, young adults with low economic self-sufficiency presented a higher prevalence of low life satisfaction. Conclusions: There are nuanced patterns of employment type and life satisfaction across European states that hint at welfare state regimes as possible moderators in this relationship. The results suggest that the psychological burdens of unemployment or work uncertainty cannot be overlooked and should be addressed according to different types of social provisions. [ABSTRACT FROM AUTHOR]

Aims and objectives: To elucidate the lived experience of how patients with alcohol use disorders experience being cared for when admitted to acute medical units. Background: Alcohol use is health damaging and is identified as one of the major avoidable risk factors, and alcohol use disorder is classified among the most harmful, debilitating disease categories. Patients suffering from alcohol use disorders are characterised by complex problems and health pictures spawned by chaotic lifestyles. However, the experience of the hospitalisation from patients' perspective is poorly documented. Design: The present study has a qualitative research design and is anchored in phenomenological and hermeneutical methodology, as described in reflective lifeworld research. Methods: The data set consists of 15 in‐depth interviews with patients suffering from alcohol use disorders admitted to an acute medical unit. A purposive sampling strategy was used, and the interviews were conducted as open dialogues. The study was reported in accordance with the consolidated criteria for reporting qualitative research. Results: Being cared for when hospitalised was experienced as a two‐stage process that changed throughout the hospitalisation from an experience of scheduled care experienced as caring to an experience of scheduled care experienced as non‐caring. Four constituents further described the variable experiences: being in a safe haven, sharing a tacit but mutual goal, being in a chaotic space and being on your own. Conclusions: The study showed that being met in an authentic presence by nurses was a powerful tool that helped ease the hospitalisation. Patients suffering from alcohol use disorders call for an intentional and distinctive attentiveness and authentic presence from the nurses throughout their hospitalisation. Relevance to clinical practice: Our findings highlight that patients suffering from alcohol use disorders call for an intentional and distinct attentiveness from nurses throughout the hospitalisation, where a possible transfer of attention is noticed and responded to in the care provided. [ABSTRACT FROM AUTHOR]

Background: Accreditation is a widely adopted tool for quality control and quality improvement in health care, which has increasingly been employed for general practice. However, there is lack of knowledge of how accreditation is received and experienced by health professionals in general practice. This study explores how general practitioners (GPs) and their staff experienced the comprehensibility of accreditation standards and how they worked to increase their understanding of the standards. The study was conducted in Denmark where accreditation was mandatory in general practice from 2016 to 2018. Methods: The study consists of qualitative interviews with general practitioners and staff from 11 general practices that were strategically sampled among practices set to receive their survey visit in 2017. Participants were interviewed twice; once during the preparation phase and once after the survey visit. GPs and staff were interviewed separately. The interviews were analysed inductively using thematic analysis. Results: Understanding the requirements of the accreditation standards was a major challenge for the professionals when preparing for the accreditation survey visit. The participants attempted to increase their understanding of the standards in several ways including the use of regional support options and seeking out experts and colleagues. However, participants had mixed experiences with the various support options and many found the sense making work frustrating and time consuming. Conclusion: The results point to the importance of considering the level of specificity in accreditation standards and how to ensure an organisational set-up that can offer appropriate support to primary care clinics in terms of understanding what is required to meet the standards. [ABSTRACT FROM AUTHOR]

Background Noise exposure is a well-known risk factor for multiple adverse health effects. Annoyance is the most prevalent response to environmental noise and may result in negative emotional responses, including poor mental health and high levels of perceived stress. The aim of this study was to investigate the association between neighbour and traffic noise annoyance, and mental health and perceived stress. Methods Data were derived from the Danish Health and Morbidity surveys in 2010 and 2013. The study was based on a random sample of the adult population in Denmark living in multistorey housing (n = 7090). Information on neighbour and traffic noise annoyance during the past 2 weeks, and mental health and perceived stress, using Short Form-12 and Perceived Stress Scale instruments, respectively, was obtained by means of self-administered questionnaires. Multiple logistic regression models were used to examine the associations between noise annoyance and poor mental health, and high perceived stress levels, respectively. Results Those who reported being very annoyed by neighbour noise had 2.34 [95% confidence interval (CI): 1.83–2.99] times higher odds of having poor mental health and 2.78 (95% CI: 2.25–3.43) times higher odds to experience a high level of perceived stress than individuals not annoyed by noise from neighbours. Similar associations were observed with traffic noise annoyance. Conclusion The results from this study indicate that there is a strong relationship between noise annoyance and poor mental health and high levels of perceived stress among individuals living in multistorey housing in Denmark. Future studies are needed to determine the direction of causality. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify and describe patients’ experiences and care needs throughout the diagnostic phase of an integrated brain cancer pathway. Background: A malignant brain tumour is a devastating diagnosis, which may cause psychical symptoms and cognitive deficits. Studies have shown that the shock of the diagnosis, combined with the multiple symptoms, affects patients’ ability to understand information and express needs of care and support. Unmet needs have been reported within this group of patients; however, the experiences and care needs of patients going through the diagnostic phase of a standardised integrated brain cancer pathway have not previously been explored. Design: A case study design was used to provide detailed information of the complex needs of patients being diagnosed with a malignant brain tumour. Methods: Research interviews and direct participant observation of four patients during hospital admission, brain surgery and discharge were conducted in a Danish university hospital. Systematic text condensation was used to analyse the data material. Results: Four major themes were identified: information needs, balancing hope and reality while trying to perceive the unknown reality of brain cancer, not knowing what to expect and participants’ perceptions of the relationship with the healthcare providers. The analysis revealed that participants were in risk of having unmet information needs and that contextual factors seemed to cause fragmented care that led to feelings of uncertainty and loss of control. Conclusions: Brain tumour patients have complex care needs and experience a particular state of vulnerability during the diagnostic phase. Through personal relationships based on trust with skilled healthcare providers, participants experienced an existential recognition and alleviation of emotional distress. Relevance to clinical practice: Patients receiving a brain tumour diagnosis experience unmet care needs in several areas during their hospital stay. There is a need for interventions from healthcare providers. [ABSTRACT FROM AUTHOR]

Background and purpose — Using patient-reported health-related quality of life (HRQoL), approximately 10% of patients report some degree of dissatisfaction after a total hip arthroplasty (THA). The preoperative comorbidity burden may play a role in predicting which patients may have limited benefit from a THA. Therefore, we examined whether gain in HRQoL measured with the EuroQol-5D (EQ-5D) at 3 and 12 months of follow-up depended on the comorbidity burden in THA patients Patients and methods — 1,582 THA patients treated at the Regional Hospital West Jutland from 2008 to 2013 were included. The comorbidity burden was collected from an administrative database and assessed with the Charlson Comorbidity Index (CCI). The CCI was divided into 3 levels: no comorbidity burden, low, and high comorbidity burden. HRQoL was measured using the EQ-5D preoperatively and at 3 and 12 months’ follow-up. Association between low and high comorbidity burden compared with no comorbidity burden and gain in HRQoL was analyzed with multiple linear regression. Results — All patients, regardless of comorbidity burden, gained significantly in HRQoL. A positive association between comorbidity burden and gain in HRQoL was found at 3-month follow-up for THA patients with a high comorbidity burden (coeff: 0.09 (95% CI 0.02 - 0.16)) compared with patients with no comorbidity burden. Interpretation — A comorbidity burden prior to THA does not preclude a gain in HRQoL up to 1 year after THA. [ABSTRACT FROM AUTHOR]

The long-term reactions, experiences and reflections of simulation educators have not been explored. In a semistructured, exploratory interview study, the experiences of simulation educators in either Advanced Life Support (ALS) or Crisis Resource Management (CRM) courses in Denmark, Norway and the USA were analyzed. Three overarching themes were identified: (1) general reflections on simulation-based teaching, (2) transfer of knowledge and skills from the simulation setting to clinical settings and (3) more overarching transformations in simulation educators, simulation participants, and the healthcare system. Where ALS was deemed as high on the efficiency dimension of learning, CRM courses were described as high on the innovation dimension. General reflections, transfer and transformations described were related to differences in course principles. The results are relevant for career planning, faculty development and understanding simulation as social practice. [ABSTRACT FROM AUTHOR]

Abstract: The growth in the numbers of older adults needing long‐term care has resulted in rising costs which have forced the Dutch government to change its long‐term care system. Now, the local authorities have greater responsibility for supporting older adults and in prolonging independent living with increased support provided by the social network. However, it is unclear whether these older adults have such a network to rely upon. The objective of this study was to gain insight into the providers of formal and informal care to older adults, and to assess possible differences between older adults who are frail and those who are not. In addition, we investigated their care and support needs. We used data from a quantitative survey using a cross‐sectional design in different regions of the Netherlands from July until September 2014 (n = 181). Frailty was measured using the Tilburg Frailty indicator. To analyse the data chi‐square tests, crosstabs and odds ratios were used for dichotomous data and the Mann–Whitney U‐Test for nominal data. The number of formal care providers involved was significantly higher (median = 2) for those deemed frail than for those not deemed frail (median = 1), U = 2,130, p < .005. However, more than one‐third of the respondents deemed frail did not get the care or support they needed (33.7%). There was a significant positive association between being frail and having an informal care provider (χ2 = 18.78, df = 1, p < .005). However, more than one‐third of those deemed frail did not have an informal care provider (36.8%). One‐third of older adults deemed to be frail did not have their needs sufficiently addressed by their care network. For a substantial part of this group of older adults, the informal network seems to be unable to support them sufficiently. Additional attention for their needs and wishes is required to implement the policy reforms successfully. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To explore from the perspective of women the nature of basic existential conditions while living with systemic lupus erythematosus. Background: Systemic lupus erythematosus has an unpredictable disease course and is documented to cause an existential rearrangement of life. The significance of changes in existential conditions and related experiences are unclear in the context of nursing and women with systemic lupus erythematosus. Design: A qualitative design guided by Van Manen's hermeneutic‐phenomenological methodology. Method: Individual in‐depth interviews with 15 women diagnosed with systemic lupus erythematosus and of various ages, disease durations and severities were undertaken from September 2013 ‐ October 2015. Data were analysed following van Manen's phenomenological approach and using drawing as an interpretive tool. Findings: The main existential experience was interpreted as a person “moving with the waves of systemic lupus erythematosus” constituted by the themes “oscillating between presence and absence of systemic lupus erythematosus,” “recognizing space and bodily possibilities and limitations” and “being enriched through relationships and activities.” When systemic lupus erythematosus was flaring, well‐being was threatened and a laborious time to escape the feeling of a setback‐in‐life persisted long after the disease was medically under control. Conclusion: Daily life with systemic lupus erythematosus is conditioned by a prominent need to be in existential motion, related to the absence and presence of systemic lupus erythematosus. The experience of a setback‐in‐life by illness might challenge well‐being and indicates that periods of disease flares or disturbing symptoms are critical time points to provide support. [ABSTRACT FROM AUTHOR]

Study Question: Are couples initiating ART treatment at higher risk for future union dissolution compared to other couples?Summary Answer: There is no effect of ART treatments in future marital dissolution over a period of 16 years when adjusting for all confounders.What Is Known Already: Findings regarding marital stability and infertility treatments have been sparse and controversial. While there is data showing higher divorce rates among women who go through infertility treatments, there is also some evidence of this experience bringing couples closer by forcing them to communicate more and to deal with the surrounding stigma. Using a population-based study and couple-level data, we investigated the extent to which ART treatment increases the risk for divorce/marital dissolution during up to 16 years of follow-up.Study Design Size, Duration: Register-based national cohort study including all women registered with ART treatment in Denmark between 1 January 1994 and 30 September 2009 (n = 42 845). Marital/cohabiting status was confirmed by matching these women to partners who they were married to or shared an address with. To account for having a significant relationship at baseline (2 years), marital/cohabiting status was confirmed by accessing this variable before the establishment of the cohort back to 1 January 1992.Participants/materials, Setting, Methods: A comparison group from the background population including five controls per case and matched to female age at baseline was prospectively sampled. Participants could change status during follow-up if they entered ART. The final sample had 148 972 couples, followed until marital dissolution, death of self/spouse, migration or until 31 December 2010. We used Cox regression models adjusting for female and male age, education, marriage, common child at baseline and live-born child during follow-up.Main Results and the Role Of Chance: At baseline, the majority of couples were married (69%). More non-ART couples opted for marriage (70% versus 64%; P < 0.0001) and already had common children at study entry (43% versus 9%; P < 0.0001). During the 16 years of follow-up the majority of couples had children with their baseline partners (56% non-ART versus 65% ART), and 22% ended up separated or divorced (20% ART versus 22% non-ART). Findings revealed a lower risk of break-up among ART couples (crude HR 0.84, 95% CI 0.82-0.86), even after adjusting for both partners' age, education, partnership status and having a common child at baseline (adj HR 0.83, 95% CI 0.80-0.86). However, when subsequent common children (time-dependent) was added to the model, no difference in the risk of dissolution was found (adj HR 1.00, 95% CI 0.99-1.01). A significant interaction between ART status and common children showed that the risk of break-up was attributed to childlessness regardless of having gone through ART treatment.Limitations Reason For Caution: This study did not control for involuntary childlessness, non-ART fertility care (ovulation induction, IUI) and biological parenthood. Additionally, there are important predictors of divorce that were not considered. We were unable to adjust for religion, existence of previous marital relationships, income, employment, health status of parents and child(ren), and quality of relationship.Wider Implication Of Findings: The finding that going through ART does not increase the risk of break up per se is reassuring for couples who underwent ART and have children or are contemplating to start ART.Study Funding/competing Interest(s): This work was supported by FCT (Portuguese Foundation for Science and Technology), grant ref. SFRH/BPD/85789/2012. The authors have no conflicts of interest.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Background: Delirium in the intensive care unit (ICU) has received more attention in the past decade. Early detection, prevention and treatment of delirium are important, and the most commonly used tool for delirium assessment is the Confusion Assessment Method for the ICU (CAM-ICU). Aim: The aim of this study was to identify nurses' and physicians' perceived professional barriers to using the CAM-ICU in Danish ICUs. Methods: This study uses a qualitative explorative multicentre design using focus groups and a semi-structured interview guide. Five focus groups with nurses (n=20) and four with physicians (n=14) were conducted. Strategic sampling was used to include participants with varying CAM-ICU experience at units, with variable implementation of the tool. Results: Using a hermeneutical approach, three main themes and nine sub-themes emerged. The main themes were (1) Professional role issues: CAM-ICU screening affected nursing care, clinical judgment and professional integrity; (2) Instrument reliability: nurses and physicians expressed concerns about CAM-ICU assessment in non-sedated patients, patients with multi-organ failure or patients influenced by residual sedatives/opioids; and (3) Clinical consequence: after CAM-ICU assessment, physicians lacked evidence-based treatment options, and nurses lacked physician acknowledgment and guidelines for disclosing CAM-ICU results to patients. Conclusion: In this study, ICU nurses and physicians raised a number of concerns regarding the use of the CAM-ICU for delirium detection. It might be necessary to revalidate the instrument as ICU care has changed in recent years, with lighter sedation and early mobilization of patients. We recommend that nurses and physicians receive more training in the use of the CAM-ICU to address some of the issues identified in our study. Relevance to clinical practice: There is a need for ongoing training and clearer guidelines on how to proceed with the delirium screening of non-sedated patients. [ABSTRACT FROM AUTHOR]

Background: Little evidence exists on whether cardiac rehabilitation is effective for patients after heart valve surgery. Yet, accepted recommendations for patients with ischaemic heart disease continue to support it. To date, no studies have determined what heart valve surgery patients prefer in a cardiac rehabilitation programme, and none have analysed their experiences with it. Aims: The purpose of this qualitative analysis was to gain insight into patients’ experiences in cardiac rehabilitation, the CopenHeartVR trial. This trial specifically assesses patients undergoing isolated heart valve surgery. Methods: Semi-structured interviews were conducted with nine patients recruited from the intervention arm of the trial. The intervention consisted of a physical training programme and a psycho-educational intervention. Participants were interviewed three times: 2–3 weeks, 3–4 months and 8–9 months after surgery between April 2013 and October 2014. Data were analysed using qualitative thematic analysis. Results: Participants had diverse needs and preferences. Two overall themes emerged: cardiac rehabilitation played an important role in (i) reducing insecurity and (ii) helping participants to take active personal responsibility for their health. Despite these benefits, participants experienced existential and psychological challenges and musculoskeletal problems. Participants also sought additional advice from healthcare professionals both inside and outside the healthcare system. Conclusions: Even though the cardiac rehabilitation programme reduced insecurity and helped participants take active personal responsibility for their health, they experienced existential, psychological and physical challenges during recovery. The cardiac rehabilitation programme had several limitations, having implications for designing future programmes. [ABSTRACT FROM AUTHOR]

Psoriasis is a long-term condition with a possibly cumulative life course impairment. Young people struggle to minimize its effects on appearance and functioning. To date, the self-management needs of adolescents suffering from psoriasis have been underinvestigated. Using focus groups and individual interviews, we present an interpretive description of young people’s experiences of living with psoriasis, the challenges they face, and the support they need to relieve suffering and come to terms with their condition. This process is characterized by loneliness, the self-imposition of limitations, and the lack of personalized knowledge and communication skills to manage the impact of disease and society’s reactions. Our study provides insight into needs of early interventions tailored to address condition, role, and emotional management, involving parent education, peer support, storytelling, and roles for professionals. We argue that further research should involve young people, their parents, and professionals in the development and evaluation of interventions. [ABSTRACT FROM AUTHOR]

Monitoring and managing customers’ satisfaction are key features to benefit from today’s competitive environment. In higher education context, only a few studies are available on satisfaction and loyalty of the main customers who are the students, which signifies the need to investigate the field more thoroughly. The aim of this research is to measure the strength of determinants of students’ satisfaction and the importance of antecedents in students’ satisfaction and loyalty in Denmark. Our research model is the modification of European Performance Satisfaction Index (EPSI), which takes the university’s image direct effects on students’ expectations into account from students’ perspective. The structural equation model of student satisfaction and loyalty has been evaluated using partial least square path modelling. Our findings confirm that the EPSI framework is applicable on student satisfaction and loyalty among Danish universities. We show that all the relationships among variables of the research model are significant except the relationship between quality of software and students’ loyalty. Results further verify the significance of antecedents in students’ satisfaction and loyalty at Danish universities; the university image and student satisfaction are the antecedents of student loyalty with a significant direct effect, while perceived value, quality of hardware, quality of software, expectations, and university image are antecedents of student satisfaction. Eventually, our findings may be of an inspiration to maintain and improve students’ experiences during their study at the university. Dedicating resources to identified important factors from students’ perception enable universities to attract more students, make them highly satisfied and loyal. [ABSTRACT FROM AUTHOR]

Background: Identifying older adults with reduced physical performance at the time of hospital admission can significantly affect patient management and trajectory. For example, such patients could receive targeted hospital interventions such as routine mobilisation. Furthermore, at the time of discharge, health systems could offer these patients additional therapy to maintain or improve health and prevent institutionalisation or readmission. The principle aim of this study was to identify predictors for persisting, reduced physical performance in older adults following acute hospitalisation.Methods: This was a prospective cohort study that enrolled 117 medical patients, ages 65 or older, who were admitted to a short-stay unit in a Danish emergency department. Patients were included in the study if at the time of admission they performed ≤8 repetitions in the 30-s Chair-Stand Test (30s-CST). The primary outcome measure was the number of 30s-CST repetitions (≤ 8 or >8) performed at the time of follow-up, 34 days after admission. Potential predictors within the first 48 h of admission included: age, gender, ability to climb stairs and walk 400 m, difficulties with activities of daily living before admission, falls, physical activity level, self-rated health, use of a walking aid before admission, number of prescribed medications, 30s-CST, and the De Morton Mobility Index.Results: A total of 78 (67%) patients improved in physical performance in the interval between admission and follow-up assessment, but 76 patients (65%) had persistent reduced physical performance when compared to their baseline (30s-CST ≤ 8). The number of potential predictors was reduced in order to create a simplified prediction model based on 4 variables, namely the use of a walking aid before hospitalisation (score = 1.5), a 30s-CST ≤ 5 (1.8), age > 85 (0.1), and female gender (0.6). A score > 1.8 identified 78% of the older adults who continued to have reduced physical performance following acute hospitalisation.Conclusion: At the time of admission, the variables of age, gender, walking aid use, and a 30s-CST score ≤ 5 enabled clinicians to identify 78% of older adults who had persisting reduced physical performance following acute hospitalisation.Trial Registration: ClinicalTrials.gov Identifier: NCT02474277 . (12.10.2014). [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate experienced symptoms of parastomal bulging in relation to an ileostomy or colostomy. Background Parastomal bulging is a common complication of stoma formation that can affect patients' physical, psychological and social function. Symptom burdens reported by health professionals vary from asymptomatic to high symptom load; however, patients' experiences of symptoms are lacking. Design and method A qualitative design with focus group interviews was chosen for data collection. Twenty patients participated in five semi-structured interviews. Analysis was performed using a phenomenological-hermeneutic approach. Findings The bulge caused different unfamiliar bodily sensations that interacted with patients' everyday lives. Some but not all of these sensations were modifiable. As the bulge and the ostomy changed size and shape, patients had to adjust and readjust stoma care continuously. The physical change called for patients' awareness and posed a threat to patients' control of the ostomy and challenged stoma self-care. The bulge caused a bodily asymmetry that deformed the patients' bodies in a way that exceeded the perceived alteration already caused by the stoma. To cover the physical disfigurement, new clothing solutions, garment wear and creativity were essential in everyday life. Patients gradually adapted to the bulge over time. Easy access to professional help was crucial in order to find the best appliance and garment solution in relation to the bulge. Conclusions Various symptoms related to the parastomal bulge affected patients' everyday lives in different ways and underpinned that an individualised approach is important when addressing patients' problems and complaints. Research into nonsurgical treatments and patient perspectives is limited and highly warranted to improve clinical outcome. Relevance to clinical practice The ever-changing bulge posed a threat to patients′ control of the ostomy and required specific care from the stoma therapist. Needs-based access to counselling, advice and supplementary materials is important. [ABSTRACT FROM AUTHOR]

The article contributes to the growing literature on framing of deservingness as an alternative to ‘blame avoidance’ strategies in the politics of welfare retrenchment. In particular, the article focuses on the interplay between political framing and media framing. Based on an analysis of two major welfare reforms involving reductions of social benefits in Denmark in 2005 and 2013, the article analyses the frames used by politicians supporting and opposing reform, as well as the frames used by the media. The article shows, first, that political reforms reducing social benefits are followed by increased framing of recipients as undeserving. The article finds a strong correlation between the political objective of reducing benefits and the reliance on frames that position recipients as undeserving. Second, the article shows that media framing remains significantly different from political framing in both years. However, the results also show that the media become less critical and more prone to frame recipients as undeserving along with the changes in political framing. Third, the article shows that media coverage of retrenchment reforms will be more critical under conditions of political conflict than in the case of political consensus. However, this result is also qualified by the observation that the media increasingly seek outside sources in order to find alternative voices under conditions approximating political consensus. [ABSTRACT FROM AUTHOR]

Background A dominant context for pregnant women in the Western world is medical technologies such as ultrasound and screening. It has been argued that such technologies may result in tentative pregnancies, which may be particularly prominent in the first trimester. However, little is known about how women experience early pregnancy. Objective To explore the everyday experiences and expectations of first trimester pregnant women in a medicalized context of comprehensive and routine prenatal screening. Design Qualitative, semi-structured interviews analysed using thematic analysis. Setting Between May 2015 and January 2016, participants were recruited from two general practices and one obstetric ultrasound unit in Aarhus, Denmark. Participants Twenty, first trimester pregnant women (15 primiparae, five multiparae) aged 21-39 years. Results Early pregnancy is often kept secret in the first trimester due to a higher risk of miscarriage. However, the pregnancy is very real in the lives of the pregnant women who make it meaningful through practices of information seeking, listening to the body and anticipating the different milestones in pregnancy. First trimester screening represents one such milestone that is expected to mark a new and more certain phase in the pregnancy. A majority expects to terminate following a prenatal diagnosis, but this does not seem to influence their engagement with the pregnancy. Conclusions The pregnant women use medical technologies to mark a milestone in pregnancy but do not expect all concerns to disappear upon a normal screening result. The majority of women acknowledge that pregnancy involves simultaneous feelings of happiness and worry. [ABSTRACT FROM AUTHOR]

Background: Vaccination is used worldwide to prevent infectious diseases. However, vaccination programmes in western countries face challenges in sustaining high coverage rates. The aim of this study was to explore how parents in Denmark make a decision about whether to allow their child to receive a Bacille Calmette Guerin vaccine at birth for the purpose of achieving non-specific effects on the immune system.Methods: A total of five focus groups were conducted with expectant mothers and fathers. Written information about the vaccine and information about the hypothesis of non-specific effects of the vaccine were delivered in order to discuss considerations and determinants of parents' decisions.Results: Heritable factors and the possibility of stimulating the immune system of the child to achieve less atopic diseases and fewer infections were identified as arguments in favour of receiving the BCG vaccine. Arguments against receiving BCG mainly focused on concerns about its described and non-described side effects. Both arguments for and arguments against the vaccine were seen as parents attempt to make an individual risk evaluation for their child. Attitudes and beliefs in the local network were identified as important for parents' decisions.Discussion: It is discussed how "lay epidemiology" characterizes parents' risk evaluation as an individual addition to the population-based risk declaration. It is furthermore discussed how health professionals should engage with both the empirical element and the value element of "Lay epidemiology".Conclusion: "Lay epidemiology" forms the basis for the parental decision of whether to allow their child to receive a BCG vaccination. Attitudes and beliefs about the causes and distribution of illnesses in the family or local network influence parents' risk evaluations. It would be ideal for parents if health professionals focused their communication about the BCG vaccine on individual risk evaluations. [ABSTRACT FROM AUTHOR]

Background: While previous research establishes an association between social relations, health and use of healthcare services among older people, how to implement this knowledge in real-life settings has received much less attention. This study will explore the relationship between social relations, health and use of healthcare services in a Danish mid-life population sample. In addition, the study will explore individual and contextual factors affecting the implementation of a group-based life story intervention aimed at establishing and strengthening social relations among older people at nursing homes in Denmark.Methods/design: A combined quantitative register-based approach and a qualitative implementation approach will be applied in this study. First, we will quantitatively analyse the relationship between social relations, health status and use of healthcare services among middle-aged people in Denmark by linking survey data on social relations, loneliness, self-perceived health and disease status from the Copenhagen Aging and Midlife Biobank (CAMB) (n = 7191) with national registries through the Public Health Database on use of healthcare services and demographic and socioeconomic factors. Second, we will qualitatively analyse individual and contextual factors affecting the implementation process of the group-based life story intervention based on semi-structured interviews (n = 16), observations and field notes with and among intervention stakeholders, i.e., participants and group leaders facilitating the intervention.Discussion: The results of this study are expected to improve knowledge about mechanisms through which social relations are associated with health status and use of healthcare services and to inform the implementation of future interventions targeting social relations among older people at nursing homes.Trial Registration: The study has been registered and approved by the Danish Data Protection Agency. Seperate approvals have been attained for the qualitative data (Approval No. SUND-2016-08), and for the quantitative data in the CAMB database which has also received approval from the local ethical committee (approval No.H-A-2008-126 and No. 2013-41-1814, respectively). [ABSTRACT FROM AUTHOR]

It is often discussed whether dyslexics show a deviant pattern of reading and spelling development when compared to typically developing students, or whether they follow the same pattern as other students, only at markedly slower rate. The present cross-sectional study investigated phonological encoding skills in dyslexic Danish students. We compared dyslexic and non-dyslexic students from grades 3, 5, 7, and 9 and examined whether effects of item length were stronger in the dyslexic groups. Mixed between-within subjects analyses of variance revealed significant interactions between dyslexia status and item length as the dyslexics at all grade levels were more affected by item length than their non-dyslexic peers. A marked developmental delay was apparent as the dyslexic group from grade 9 performed on approximately the same level as the non-dyslexic group from grade 3. Although the overall difference between these two groups was not significant, a significant interaction between dyslexia status and item length remained because the grade 9 dyslexics were more affected by item length than the younger non-dyslexic students. This difference in error profiles suggests a difference in the developmental patterns of dyslexic vs. non-dyslexic students. [ABSTRACT FROM AUTHOR]

Background: Supplemental health insurances (SHI) cover 38% of the Danish population. SHI can give faster access to, and additional treatment from, private health providers. However, this is contingent on a referral from the general practitioner (GP), further complicating clinical decision-making.Objectives: To describe GPs' attitudes to SHI and their experiences with patients holding SHI. Moreover, we analysed associations between different GP characteristics; e.g. gender, age, practice type, own SHI status and their attitudes to and experiences with SHI.Methods: A questionnaire was mailed to 3321 GPs focusing on three issues: (i) Attitudes towards the public health care system. (ii) Perceptions of the impact of SHI. (iii) Experiences with patients holding SHIs.Results: The response rate was 64%. Overall, GPs found that SHIs contribute to inequality (83%) and overtreatment (90%). However, 46% often feel under pressure to refer SHI patients to specialist care, even though not medically indicated, while 11% always or often refer SHI patients unconditionally. Both groups perceive SHI patients more insistent on getting referrals than patients without SHI.Conclusion: Even though a majority of GPs associate SHI with overtreatment and inequality in health, many GPs feel under pressure to refer patients holding SHI for treatments or examinations that are not medically warranted. Some GPs even refer these patients without further examination or questioning. Insistent SHI patients may partly explain this paradox. Future research should illuminate SHI patients' courses in the private as well as the public healthcare system with regards to medical indications and health outcome measures focusing on inequality and overtreatment. [ABSTRACT FROM AUTHOR]