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In this paper, we view health strategies in the field of personalised medicine as performative actions which articulate the development desired for a given society and demonstrate and affirm values and visions for that society. Based on a qualitative study in Denmark, we show how political actors and policy documents articulate visions for personalised medicine through a distinct sociotechnical imaginary. This sociotechnical imaginary mobilises the distinction between non-profit public and for-profit private organisations, placing personalised medicine in the public domain as the self-evidently desirable future for Danish health care In the Danish case, the issue of implementing personalised medicine becomes an opportunity to revisit the vision for the welfare state and verify public institutions as a shared space for state and citizens. While Danish political actors see personalised medicine as transformative, they articulate this transformation as being steered by public actors, at the same time downplaying the role of private companies. Where public health studies have focused on how political investments into personalised medicine may marginalise specific groups and populations, the Danish case shows that also powerful transnational players may be excluded from political discourse. It teaches us not to treat personalised medicine as one phenomenon, but to pay direct attention to the local contexts in which it operates and shapes what 'public' and 'health' become. [ABSTRACT FROM AUTHOR]

This paper aims to provide knowledge on medical trainees' considerations about specialisation as they move from undergraduate to postgraduate medical education; especially their interest in general practice compared to other specialities. We developed and content-validated a questionnaire to examine medical trainees' speciality considerations and conducted a descriptive, cross-sectional study. All medical trainees initiating their internship in Denmark in 2022 (N = 1,188) were invited to participate in the study. Medical specialities were categorised as hospital service specialities, internal medicine specialities, primary care, psychiatry specialities and surgery and emergency specialities. Descriptive statistics were used to describe the cohort and examine the participants' speciality considerations by assigning them to one of the following three orientations: committed, undecided or non-committed to a speciality. The response rate was 38.8% (n = 461), and participants' mean age was 27.4 years with a majority of females (68.1%). Nearly 25% of the participants had general practice as speciality preference, and only 13.9% had excluded general practice for future specialisation. Overall, around half of the participants had general practice as a first, second or third preference for specialisation. Danish medical trainees show considerable interest in general practice at the time of their transition from undergraduate to postgraduate education. However, to meet future demands on the primary care, further recruitment of general practitioners is still needed. This knowledge of the specialities' recruitment potential will likely be of interest to medical educators and healthcare planners alike. [ABSTRACT FROM AUTHOR]

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One of the core principles of providing care in general practice is giving more to those who need it most. We investigate some of the complexities of this ambition in the context of cancer care for patients defined as socially disadvantaged by their general practitioner (GP). We do this by exploring how care is sought, how it is offered, and what expectations patients and GPs carry with them when receiving and providing cancer care in the Danish welfare state. We carried out semi-structured interviews with eight GPs and seven socially disadvantaged cancer patients living with different types and stages of cancer. The interviews focused on needs and challenges in cancer follow-up in general practice and were thematically coded. Drawing on theoretical concepts of morality and Nordic individualism, we point to how one of the main challenges in cancer care and follow-up is to figure out how the doctor-patient relationship should be established, practiced, and maintained. Both GPs and patients stressed the importance of the relationship, but how it should be practiced amidst social norms about being a patient, a citizen and how care-seeking should unfold seems less clear. In conclusion we argue that giving more to those who need it the most is a difficult and ill-defined task that is shaped by the cultural, social, and political expectations of both GPs and patients. [ABSTRACT FROM AUTHOR]

Purpose: It can be challenging to research aspects of people's health behaviour, attitudes, and emotions due to the sensitive nature of these topics. We aimed to develop a novel methodology for discussing sensitive health topics, and explore the effectiveness in focus groups using prostate cancer and screening as an example. Method: We developed a fictitious case and employed it as a projective technique in focus groups on prostate cancer and screening. The participants were men and their partners who lived in Denmark. Results: The technique encouraged emotional and cognitive openness in focus group discussions about the risk of prostate cancer, the benefits and harms of screening, and decision-making about screening. It appeared that using the fictitious case allowed the participants to personally distance themselves from the topic, project emotions onto the case, and thereby openly talk about their emotions. Conclusion: This article presents a methodological contribution to communication about sensitive topics in focus groups, using prostate cancer screening as an example. Further refinement of the methodology is needed to enable participants to transfer improvements in knowledge to their own decision about screening. [ABSTRACT FROM AUTHOR]

People with inflammatory arthritis (IA) often experience low work ability, and up to 38% lose their jobs during the initial years after the diagnosis of IA. We explore the perceived challenges at work and identify the need for professional support among Danish people with IA. Individual explorative interviews based on a hermeneutic approach. We used Graneheim and Lundman's qualitative content analysis. Eleven women and four men with IA (aged 36–68 years) who worked full or part time, or were on short-term sick leave, participated. The analysis revealed one main theme, Balancing work as part of everyday life, and four sub-themes: 1) Working despite challenges, 2) Prioritising energy for work, 3) Fatigue leading to lack of control, and 4) Need for flexibility and recognition. People with IA prioritise staying at work despite experiencing challenges with fatigue and balancing their work and energy in everyday life. They need recognition, support and flexibility at work to be able to continue in their jobs. The study highlights the need to be aware of occupational balance and, thus, to include other aspects in life apart from just work. It points at occupational therapists as relevant partners in vocational rehabilitation. [ABSTRACT FROM AUTHOR]

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

This study explored women's lived experience of making fertility decisions six years after attending the Fertility Assessment and Counselling (FAC) clinic in Copenhagen, Denmark, which is a personalised fertility awareness intervention. We conducted a qualitative interview study with 24 women who attended the FAC clinic 6 years earlier. Interviews were semi-structured and broadly examined the women's perceptions and experience of the intervention during follow-up. Data was analysed using a phenomenological framework and themes were identified related to women's experience of making fertility decisions after attending the FAC clinic. The overarching theme regarding the women's lived experience of making fertility decisions after attending the FAC clinic was: Fertility decisions were guided by the 'family clock'. There were four themes: (i) Deciding to 'get started' by attending the FAC clinic; (ii) Sense of making informed and empowered decisions; (iii) Influence of partner status on fertility decisions; and (iv) Decisions dictated by circumstance over preference and knowledge. At follow-up, the majority (21 women, 88%) had become parents. More than half of the women said that they had not achieved their desired family size. Consideration of women's 'family clock' is necessary in personalised fertility awareness interventions to enable women to achieve their family goals. [ABSTRACT FROM AUTHOR]

To translate and cross-culturally adapt the Challenge, and investigate the reliability and minimal detectable change (MDC) of the Danish Challenge in children with cerebral palsy (CP). A Danish version of the Challenge was created through a standardized translation process. Four physiotherapists evaluated face validity. Independently ambulatory children with CP were tested. Live performance rating was conducted by assessors independently scoring the Challenge. Video-rating was undertaken for a subset of assessments. Same day assessment test–retest reliability was estimated. The Challenge's Best Score Total was of primary interest. Forty-five children (5–18 years: mean 10 years 9 months; 19 girls) in Gross Motor Function Classification System levels I and II were tested. Inter-rater reliability was excellent for live assessments (n = 45) ICC = 0.998 (95% CI 0.998–0.999) and video assessments (n = 15) ICC = 0.991 (95% CI 0.963–0.997) and intra-rater reliability was excellent for live versus video-recorded assessments (n = 10) ICC = 0.977 (95% CI 0.895–0.994). Test–retest reliability (n = 22) was excellent with ICC = 0.991 (95% CI 0.979–0.996) and minimal detectable change (MDC90) of 4.7 points. The Danish Challenge showed excellent reliability in this testing context when physiotherapists scored from live- or video-recorded assessments. The Challenge's ability to detect 4.7 points change seems a clinically realistic target for progress. Clinical trial registration: This trial has been approved by the Data Protection Agency, Central Region Denmark, Ref nr.: 615216, Case nr.: 1-16-02-46-16. Registration date: 01-01-2016. The Challenge remained reliable and maintained a promising minimal detectable change of less than five points after translation and cultural adaptation. The Danish version of the Challenge 20-item version can be used to measure advanced motor skill performance in children with cerebral palsy, GMFCS level I and GMFCS level II. Challenge live scoring is as reliable as the more time-consuming video-recorded scoring, meaning that physiotherapists can choose the method that fits best with their clinical context and preference. [ABSTRACT FROM AUTHOR]

This study aims to investigate the experienced and measured development in physical capacity in people with Chronic Obstructive Pulmonary Disease (COPD) undergoing a standard pulmonary rehabilitation programme with a focus on the diverging experiences of responders and non-responders. Twenty-one participants in standard pulmonary rehabilitation were included in the study. We measured the participants' change in the six-minute walk test (6MWT) during rehabilitation participation. We investigated their experiences of the changes in their physical capacity by combined participant observations and interviews. A convergent mixed analysis was conducted of the coherent data. Standard pulmonary rehabilitation had a different physical impact on people with COPD. Responders were delighted by a positive physical change, which improved their daily functioning and capability of fulfilling personal priorities. However, non-responders experienced decreased capacity and a lack of trust in their future. All participants found it challenging to exercise and achieve sustainable exercise habits. In this qualitative study, we found that absence of expected improvement to pulmonary rehabilitation seems to confer distress and feelings of hopelessness. The achievement of sustainable change in daily exercise behaviour appears yet to be insufficient. Thus, new and more individualized models of physiotherapists' guidance in exercise are imperative. It is vital to acknowledge differential response to people with the chronic obstructive pulmonary disease following eight-week standard pulmonary rehabilitation. Especially noteworthy feelings of distress and hopelessness are prominent to non-responders because of the absence of the promised improvements. Both responders and non-responders require intensive physiotherapist guidance to exercise. It is recommended to ensure individualised support to people with chronic obstructive pulmonary disease in rehabilitation programmes. [ABSTRACT FROM AUTHOR]

Across rehabilitation fields, rehabilitees and professionals meet to set rehabilitation goals. Portrayed as an ordinary, yet foundational practice in rehabilitation, participants often find goal-setting meetings challenging; ideal and real seem to clash. Based on a long-term fieldwork in Danish Parkinson's disease rehabilitation, we explore goal-setting and its rationale to gain insight into why goal-setting qualifies as challenging. We find that challenges relate to disease, organizational matters and an imbalance in institutional knowledge, but also that different logics, of choice, interdependence, and accountability, entangle and affect goal-setting. A competitive aspect between goal-setting logics appears pivotal to understand the challenges in goal-setting. [ABSTRACT FROM AUTHOR]

Most previous studies about fertility knowledge and attitudes among men have been based on quantitative methods using questionnaires with fixed-choice response options. The aims of this qualitative study were to explore childless young men's reflections on fertility and infertility through semi-structured interviews. Danish (n = 17) and Swedish (n = 12) young childless men aged between 20 and 30 years in their last year of education were interviewed. Data were analysed using qualitative content analysis. Few informants had considered their own fertility, and most were positive towards fertility treatment. The young men had inadequate knowledge about factors that can potentially impair male and female fertility. On average, the young men each mentioned three different factors they believed influence male and female fertility: (i) health behaviour; (ii) factors beyond personal control; and (iii) age. None mentioned sexual transmitted infections (STIs) but most appeared aware of the effect of increasing age on fertility. The results of this study highlight the need for educational strategies to improve young men's knowledge about fertility and the factors that influence it, particularly about the potential adverse effect of STIs on fertility. [ABSTRACT FROM AUTHOR]

To translate and cross-culturally adapt the ABILHAND-Kids questionnaire into Danish and assess its psychometric properties in children with cerebral palsy (CP). A Danish version of the parent-reported ABILHAND-Kids questionnaire was created through a standardized translation process. Dimensionality (confirmatory factor analysis), reliability, smallest detectable change, floor and ceiling effects, and Rasch analysis were carried out. One-hundred-and-fifty children diagnosed with CP were included. No parent had difficulty completing the ABILHAND-Kids (DK). Psychometric testing demonstrated a unidimensional scale, excellent test-retest reliability (ICC2.1A = 0.97) and internal consistency (α = 0.96). A smallest detectable change of 5.15 points was considered acceptable. One item showed Differential Item Functioning, four pairs of items showed signs of local dependence and one item had disordered thresholds. Nevertheless, analyses did not lead to the removal of any items. Item thresholds covered most levels of person abilities. Lastly, 24.7% scored within measurement error at the ceiling of the scale, indicating that it was not possible to measure further improvement. ABILHAND-Kids (DK) seems to be a valid, reliable and comprehensive measurement scale to assess manual ability in children with CP. It can be used in goal setting and to inform future interventions and rehabilitation evaluation. Impaired hand function leads to limited participation in activities of everyday life in children with cerebral palsy. Adequate outcome measures of hand function are crucial for the planning and evaluation of interventions. The Danish version of ABILHAND-Kids is a valid and reliable measure of manual ability in children with cerebral palsy, and it can be used in clinical practice and for research purposes. [ABSTRACT FROM AUTHOR]

Purpose: To deepen the understanding of how survivors' experience and give meaning to the embodied phenomenon of chronic sensory disturbances in everyday life after oxaliplatin treatment for colorectal cancer. Methods: Data was generated by means of a semi-structured interview guide and drawings with the aim to explore eight survivors' lifeworld experiences. Data was analyzed through a phenomenological approach. Results: The essential meaning of sensory disturbances emerged in two main themes and four sub-themes. Theme A: 'A peculiar experience that is difficult to logically understand' with the subthemes; 'An ambiguous perception in hands and feet' and 'Being alienated from one's own body'. Theme B: Losing touch with the world' with the subthemes: 'A lack of sensory contact with physical surfaces' and 'Breakdown of sensitivity in hands hampers fine motor skills and social contact'. Conclusion: Sensory disturbances contributed to an ambiguous and discordant perception of an alienated body that was difficult to describe and affected the ability to act and connect to things and other people. Metaphors and drawings were valuable as means to verbalize and illustrate the changed body perception where the 'I can' changed into 'I cannot'. To support the embodied connection to the world new usage patterns were required. [ABSTRACT FROM AUTHOR]

Purpose: Becoming widowed is a stressful health-threatening event causing major life changes. We explored how widowed people experience becoming widowed and examined if these experiences are quantitatively associated with widowhood. Methods: A multi-methods study using an exploratory sequential mixed-methods approach including a qualitative descriptive study with widowed people from Denmark and a Swedish cohort study. Qualitative interviews (n = 9) were analysed using qualitative content analysis, describing experiences as explained by the widowed people. The quantitative association of the experiences was examined by identifying proxies for the qualitative experiences of widowhood in the cohort study and examining the occurrence in widowed people compared to married people (n = 1,095). Results: Six categories of experiences emerged: the circumstances around spousal death, mental health and well-being, physical health, social relations, activities and practicalities. The quantitative examination showed a significant association with widowhood regarding mental and physical health problems. Conclusion: The circumstances around spousal death and the time before spousal death, in general, were important to how participants felt being widowed. Being ill negatively affected mental health and well-being, partly because of the inability to participate in activities and social relations. This is important, as health problems are more common among widowed people than married people. [ABSTRACT FROM AUTHOR]

Mental health care professionals are at risk of experiencing burnout. This cross-sectional study aims to investigate burnout in two settings: open and closed psychiatric wards, and two professions: registered nurses and social healthcare assistants in eight psychiatric wards in Denmark. A total of 114 professionals completed the Copenhagen Burnout Inventory and a demographic questionnaire. No statistically differences in burnout in professionals working in closed and open wards were found. However, we found professionals to score highest on personal and work-related burnout and lowest on client-related burnout. This indicates that patients may only play a minor role in burnout in health professionals. [ABSTRACT FROM AUTHOR]