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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]

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]

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]

Purpose – The main aim of the paper is to explore whether health theatre as a school-based health promotion initiative communicates relevant health knowledge to children and the interrelated processes of identity development, knowledge acquisition and participation. Development of the definition of "health identity" was a subsidiary objective of the study. Design/methodology/approach – This was a qualitative study based on observation of five health theatre performances, with 20 focus group interviews with a total of 98 children and 22 individual interviews with teachers and parents. Findings – Three themes emerged from the qualitative analysis: children's varying capacities for participation affect knowledge acquisition and identity development; health knowledge acquisition is enhanced when information is made relevant by linking health to everyday life; and acquisition of health information and children's health identities are closely related. Coherent information and environments are conducive to knowledge acquisition, and health promotion efforts must be careful to avoid reinforcing negative health identities and furthering perceived divisions between "healthy" and "unhealthy" children. Originality/value – The paper provides important foundational information for school-based health theatre initiatives. It presents knowledge for practitioners working with knowledge-based health promotion for children and explores the connection between identities, health knowledge acquisition and participation within an alternative theoretical framework. [ABSTRACT FROM AUTHOR]

The analysis presented in this paper is part of a larger study, the aim of which is to describe the GPs’ everyday taken-for-granted working life. The study is based on multi-sited anthropological fieldwork in Danish general practices. This paper analyses consultations where children are vaccinated and the analysis shows the way these consultations differ from other consultations in relation to flow and communication. Neither parents nor doctors question the value of the vaccination, but the manner in which they talk about it and handle it in the flow of the consultation points to them experiencing it as being problematic. Taking inspiration from Mary Douglas’ theory on cultural classification the injection is interpreted as ‘matter out of place’. The analysis identifies the infliction of pain and the discomfort this brings to the doctor and the parent as problematic as well as a breach of the doctor–patient relationship. The aim of vaccination is to prevent potential diseases in the future, but its function in the consultation, besides being fulfilment of national guidelines, is not immediately apparent. It has no real function in the consultation and this makes it problematic in the present, causing the ambiguity that both doctors and parents express. [ABSTRACT FROM PUBLISHER]

The aim of the present paper is to investigate the relationships of stressful events with self-reported mental health problems in the general population, comparing non-western immigrants with Danish nationals. 11.500 individuals aged 18-64 years from eight ethnic groups were invited to participate in a bilingual telephone survey on health among ethnic minorities in Denmark in 2007. Overall response rate is 52.1%. 3.997 individuals were selected for the present study. Self-reported mental health problems is twice as high among immigrants from Ex-Yugoslavia (24.6%), Iraq (30.2%) Iran (20.5%), Lebanon (27.2%) and Pakistan (19.9%), as among Danish nationals (9.7%) χ (7, n = 3.997) = 21.57, P > 0.00. Non-western immigrants report twelve out of thirteen types of stressful events more frequently compared to Danish nationals. The most frequently reported stressful event among non-western immigrants is 'personal disease'. Immigrants perceive the perils of daily life as more stressful in comparison with host nationals probably because of the additional challenges of adjusting to a new environment. [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]

Objective. Approximately 98% of Danish citizens are listed with a general practice which they consult for medical advice. Although 85% of the population contact their general practitioner (GP) every year, little is known about these contacts. The aim of the present paper is to gain updated knowledge about patients' reasons for encounter and the GP activities and to make comparisons with a similar study from 1993. Methods. All GPs in the Central Denmark Region were invited to register all contacts during one randomly chosen day within a year. The registration included questions about patients' reasons for encounter, the types and contents of the contacts, referrals, and distribution between new episodes and follow-up contacts. Aggregated data were compared with the results from 1993. Results. A total of 404 (46%) GPs participated. The number of contacts per 1000 inhabitants had risen by 19.7%. The reasons for encounter and final diagnoses resembled those in 1993. Musculoskeletal, psychological, and respiratory problems were the most common reasons for encounter, psychological problems being the only type to increase over the period. Interestingly, the proportion of diagnoses within the ICPC 'A' chapter rose from 13.5 to 19.7%. The referral rate rose by 2% (relative: 18.7%) from 10.7% to 12.7% and the share of follow-up contacts rose from 45.9% to 50.4% (relative: 8.7%). Conclusion. Quite small changes were seen in the patterns of reasons for encounter and diagnoses from 1993 to 2009. However, an increase was found in contacts with general practice and referrals and in the proportion of follow-ups. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study investigating the association between the support experienced by supervisors from superiors and from fellow supervisors, on the one hand, and the support experienced by subordinates from their supervisors, on the other hand, in organizations under external pressure. Background. It is known from studies in other sectors that supervisors' support of workers is important for retaining them in the organization. From the literature on social exchange in the workplace it can be hypothesized that support from managers is one way to generate supervisor supportiveness towards their subordinates. Methods. A survey was conducted in 15 Danish local government services providing care for senior citizens. The data were collected in 2006. Results. Multilevel analyses revealed that the more supervisors felt supported by fellow supervisors, the more their subordinates felt supported by them. There was no statistically significant association between how much supervisors felt supported by their immediate superiors and how much supervisors' subordinates felt supported by them. Conclusion. Under conditions comparable to those of Danish elder care today, more is to be gained in terms of generating supportive behaviour towards subordinates from supervisors by empowering them to support each other rather than by increasing support from their superiors. Research is needed to identify methods and structures of mutual support between supervisors in the healthcare sector that will aid them in supporting their subordinates. [ABSTRACT FROM AUTHOR]

This paper concerns the prevalence of mental health problems among children in family foster and residential care within a Danish context. All children, born in Denmark in 1995, who are or formerly have been placed in out-of-home care ( n= 1072), are compared with a group of vulnerable children of the same age, subjected to child protection interventions but living at home ( n= 1457, referred to as the ‘in home care children’), and to all contemporaries who are not child protection clients ( n= 71 321, referred to as the ‘non-welfare children’). Prevalence data are established on the basis of national administrative register data, including data on psychiatric diagnoses of the children, and on survey data scoring children in out-of-home care, in home care children, and non-welfare children by means of the Strengths and Difficulties Questionnaire (SDQ). Results show that 20% of children in out-of-home care have at least one psychiatric diagnosis compared to 3% of the non-welfare children. Almost half of the children in care (48%) are, furthermore, scored within the abnormal range of SDQ, compared to 5% of the non-welfare children. [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]

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]

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]

Aim: To investigate the personality in very preterm individuals (VPT; gestational age, GA, <32 weeks) at adult age in two cohorts born in 1974–76 and 1980–82, respectively, and to illuminate the effect of increased survival rates and the clinical implications of deviations in personality. Method: Demographic data were extracted for all individuals born in Denmark in 1974–76 and 1980–82. From each period one index-group each comprising 150 individuals with the lowest gestational age was selected. Thereafter two control groups born at term were matched by gender, age and residential area. Personality was assessed with the short version of NEO PI-R, and psychiatric diagnoses were obtained from the Danish Psychiatric Central Research Register. Results: Of all the individuals born <32 weeks of gestation in 1980–82 67% were alive in 2006 vs. 43% of those born in 1974–76 (p<0.0001). A total of 433 individuals participated in the study, 76% of the VPT groups (n = 227, mean GA = 27.9) and 69% of the control groups (n = 206). There were no significant differences on personality scores between the two VPT groups. Compared to the control groups, the combined VPT groups scored higher on neuroticism (p = 0.005) and agreeableness (p = 0.012), but lower on extraversion (p = 0.002). Psychiatric disorder was strongly associated with higher scores on neuroticism and lower scores on extraversion. Interpretation: Improved survival of VPT infants was not associated with increased deviances in the personality as adults. The personality traits in VPT individuals differ moderately from those of term born controls. High scores in neuroticism and low scores in extraversion were associated with increased risk psychiatric disorders. VPT adults also showed signs of positive adaptation in the form of an agreeable and confident attitude towards others. What this paper adds: The much improved survival rate in very preterm infants during the early years of active neonatology was not associated with increased risk of personality deviation. There are signs of positive adaptation in the form of increased agreeableness in young adults born very preterm. [ABSTRACT FROM AUTHOR]

Introduction. This paper deals with secular, spiritual, and religious existential concerns during severe illness. Materials and Methods. Qualitative research interviews were made before and after surgery with women who underwent final diagnostics, surgery, and chemotherapy for ovarian cancer. By applying a phenomenological-hermeneutic text interpretation methodology the findings were systematically identified, placed into meaning structures, interpreted, and critically discussed. Results. The analysis offered insight into the complexity of challenges and personal development over time in being a woman with ovarian cancer during her first treatment period. Although the women experienced their health to be seriously threatened, they also felt hope, will, and courage. The diagnostic procedures and treatment had comprehensive impact on their lives. However, hope and spirituality were important resources of comfort and meaning. Conclusion. Hope and courage to face life represent significant personal resources that are created not only in the interplay between body and mind but also between patients and their healthcare professionals. The women dealt with this in a dialectical manner, so that hope and despair could be present simultaneously. In this process secular, spiritual, and religious existential meaning orientations assisted the women in creating new narratives and obtain new orientations in life. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this paper is to describe how the process of developing and maintaining trust is related to how and if smoking cessation advice is given in general practice consultations. Methods: The study consisted of interviews with six Danish GPs and with 11 of their patients, on the basis of observations of their consultations. Results: According to the findings of this study, both the GPs and the patients expected GPs to demonstrate in interaction with the patients their intent to evaluate and possibly resolve the patient''s health problem. The GPs were also expected to show that they recognized the patient''s health problem. Both GPs and patients felt that this would help to develop patients’ trust in their GPs. Smoking cessation advice during consultations could negate these demonstrations of GPs intents. Smoking cessation advice, however, could demonstrate interest and a desire to help and so develop trust. Conclusion: Smoking cessation advice has the potential both to put trust under strain and to strengthen trust. The outcome depends on whether the advice conforms to what both patients and GPs expect from the interaction in general practice consultations. Practice implications: To develop and maintain patients’ trust GPs should consider the specific expectations from the interaction with patients during consultations when giving smoking cessation advice. [Copyright &y& Elsevier]

The purpose of the present paper is to investigate and explore why education organised around production may seem meaningful to youngsters who are at risk with leaving the traditional school and educational system. Education organised around production is here defined as educational activities organised by the state authorities or other educational providers which take outset in producing goods to be sold to real customers outside the school. It is becoming increasingly important to consider learning arrangements for youth "at risk" because access to training and education is acknowledged as a key to ensuring social inclusion and increased labour market participation. This is particularly relevant for groups that have traditionally been excluded from, or marginalised in the labour market (Piercy, Murray & Abernethy, 2006). Based on a broader project conducted in Northern Jutland, Denmark, for "Youth at Risk", the case-stories of three young people (Ivan, Daniella and Lisa) are presented, evaluated and discussed. Their experiences of dropping out of secondary and vocational school, and in the cases of Ivan and Lisa, of taking part in production-oriented education, are analysed. The results indicate the importance of closely monitored teacher and/or adult support for students "at risk". Furthermore, the students' perceptions that problems are real, self-owned and authentic facilitate a more general theoretical discussion of learning opportunities. [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]

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]

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]

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: 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]

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]

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: 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]