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Abstract Background The aim of this study was to compare and describe different professionals’ experiences of workplace psychological and social factors in occupational health (OH) organizations in Sweden. Methods This cross-sectional study with a descriptive and comparative design included 472 respondents with common professions in the occupational health service (OHS) in Sweden. Data were collected with “The General Nordic Questionnaire for Psychological and Social Factors at Work” (QPSNordic). The professions have been compared pairwise using the Independent Samples Kruskal-Wallis test, adjusted by Bonferroni correction for multiple tests on subscales and single items and these are presented descriptively. Results The experience of the psychological and social work environment on job task measurement level differed between the professionals. Experiences on social and organizational as well as on individual measurement levels are similar between the professionals who perceive them as satisfactory. Out of the 472 respondents, 7% reported that they had seen someone being subjected to harassment and bullying at the workplace during the last six months. Conclusions The experience among the professionals differs most in the Job task measurement level. The results indicate that although different OH professionals experience psychological and social factors at work in different ways, their experiences are generally satisfactory even though harassment and bullying do exist. The research about occupational health professionals and their work environment is sparse. Further applied research is needed for the planning and development of occupational health services in Sweden.

Abstract Background Chest pain is a frequent cause of health care contacts. We examined the prehospital management, in-hospital discharge diagnoses, and mortality of patients calling a non-emergency and emergency medical service with chest pain. Methods The Copenhagen Emergency Medical Services (EMS) consists of a non-emergency medical helpline (calls to 1813) and emergency medical service (1-1-2 calls). We included all calls to the Copenhagen EMS with a primary complaint of chest pain from 2014 to 2018 in Copenhagen, Denmark. The outcomes were: emergency response (ambulance dispatch, other transports/self-transport/home visits, self-care, and unknown/cancelled response), in-hospital diagnosis within 7 days after the call (cardiovascular, pulmonary, or other non-cardiovascular/pulmonary) and 30-day mortality. Results Among 4,834,071 calls, 91,671 were registered with chest pain at the Copenhagen EMS. The first call for each patient was kept for analysis (n = 66,762). In total, 91.4% were referred to the hospital, 75.8% (n = 50,627) received an ambulance and 15.6% (n = 10,383) received other transport/self-transport/home visits. Overall, 26.9% (n = 17,937) were diagnosed with a cardiovascular disease, 5.2% (n = 3,490) a pulmonary disease, 52.8% (n = 35.242) other non-cardiovascular/pulmonary disease, and 15.1% (n = 10,093) received no diagnosis. Among ambulance-transported patients, the prevalence of cardiovascular discharge diagnoses was higher (32.1%) and fewer received no diagnosis (11.0%). Cardiovascular disease was less prevalent among patients not transported by ambulance and patients not referred to hospital at all (2-13.4%) and in patients ≤ 40 years of age (

Abstract Background Disaster responders are exposed to several physical and mental health risks. This study aimed to describe self-care strategies used by disaster responders after the earthquake in Syria and eastern Turkey in February 2023. Methods A study specific web-based questionnaire survey was used to collect quantitative and qualitative data according to a convergent mixed methods approach. Data from 252 disaster responders responding to the earthquakes in Turkey and Syria were analyzed using both descriptive and analytical statistics and summative content analysis of free-text answers. Data were collected in March to July, 2023. Results The most used self-care strategies included resting, social support from colleagues in the field, extra intake of food or drink, and intake of medicines. The recovery strategies varied due to previous disaster response experience, indicating that supportive self-care strategies can be developed or learned. Conclusion Given the extreme conditions and limited possibilities of external support, sufficient self-care is an essential competence among disaster responders. Self-care strategies can be both external processed such as intake of medicines, social support from others, and internal processes such as personal reflection. Providing oneself with self-care activities seems to be a skill developed with increasing experience supported by pre-deployment training. Therefore, to enhance resilience, self-care strategies should be encompassed in pre-disaster response training.

Abstract Background The worldwide market for continuing medical education (CME) was severely affected by the COVID-19 pandemic, which precipitated an increase in web-based CME course attendance. Virtual education methods may be effective for engaging learners and changing behaviors. However, more information is needed about physician preferences for in-person vs. livestreamed CME courses in the postpandemic era. Because of the paucity of data regarding this topic, the current study was designed to evaluate CME participant characteristics, preferences, engagement, and satisfaction with traditional in-person vs. virtual educational methods. Methods A cross-sectional study was performed of attendees of two large internal medicine CME courses held in 2021. Both CME courses were offered via in-person and livestream options, and were taught by Mayo Clinic content experts. Participants, who consisted of practicing physicians seeking CME, completed a 41-question survey after CME course completion. Statistical comparisons were performed by using Fisher exact tests for all survey items, except for those with ordinal response sets, which were compared with Cochran-Armitage trend tests. Results A total of 146 participants completed the survey (response rate, 30.2%). Among the 77 respondents who attended in-person courses, the most frequent reasons indicated were the opportunity to travel (66%) and collaboration/networking with others (25%). Among the 68 respondents who attended the livestream courses, the most frequent reasons indicated included COVID-19–related concerns (65%), convenience (46%), and travel costs (34%). The percentage of respondents who indicated that they would choose the same mode of attendance if given the option again was higher for those who attended in person than for those who attended via livestream (91% vs. 65%, P

Abstract Background Trauma systems are crucial for enhancing survival and quality of life for trauma patients. Understanding trauma triage and patient outcomes is essential for optimizing resource allocation and trauma care. Aims The aim was to explore prehospital trauma triage in Region Zealand, Denmark. Specifically, characteristics for patients who were either primarily admitted or secondarily transferred to major trauma centers were described. Methods A retrospective descriptive study of severely injured trauma patients was conducted from January 2017 to December 2021. Results The study comprised 744 patients including 55.6% primary and 44.4% secondary patients. Overall, men accounted for 70.2% of patients, and 66.1% were aged 18–65 years. The secondary patients included more women—34.2% versus 26.3% and a higher proportion of Injury Severity Score of ≥ 15—59.6% versus 47.8%, compared to primary patients. 30-day survival was higher for secondary patients—92.7% versus 87%. Medical dispatchers assessed urgency as Emergency level A for 98.1% of primary patients and 86.3% for secondary patients. Physician-staffed prehospital units attended primary patients first more frequently—17.1% versus 3.5%. Response times were similar, but time at scene was longer for primary patients whereas time from injury to arrival at a major trauma center was longer for secondary patients. Conclusions Secondary trauma patients had higher Injury Severity Scores and better survival rates. They were considered less urgent by medical dispatchers and less frequently assessed by physician-staffed units. Prospective quality data are needed for further investigation of optimal triage and continuous quality improvement in trauma care.

Abstract Background The ankle–brachial index (ABI) is the ratio of the ankle and brachial systolic blood pressures. In the clinical setting, low ABI ( 1.4) is a sign of arterial stiffness and calcification. The purpose of the current study was to investigate the association between ABI and physical activity levels, measured by accelerometer. Methods The Swedish CArdioPulmonary bioImage Study (SCAPIS) is a Swedish nationwide population-based cross-sectional cohort for the study of cardiovascular and pulmonary diseases, in which individuals aged 50–64 years were randomly invited from the general population. The study population with data on ABI, physical activity, and sedentary time based on accelerometry was 27,737. Differences between ABI categories and associations to sedentary behavior, moderate to vigorous physical activity (MVPA), and other metabolic characteristics were compared. ABI was categorized as low, ABI ≤ 0.9, borderline, ABI 0.91–0.99, normal, ABI 1.0-1.39, and high, ABI ≥ 1.4. Results Prevalence of low ABI was higher in the most sedentary quartiles compared to the least sedentary (0.6% vs. 0.1%, p 1.4 (0.069 ± 0.001; p 1.4 (0.534 ± 0.002; p = 0.004). Conclusion This population-based study shows that middle-aged individuals with ABI > 1.4 have the highest level of physical activity, while individuals with a lower ABI, especially those with ABI

Abstract Background The majority of palliative care patients express a preference for remaining at home for as long as possible. Despite progression of disease there is a strong desire to die at home. Nonetheless, there are transfers between care settings, demonstrating a discrepancy between desired and actual place of death. Aim To map the prevalence of patients near death undergoing specialized palliative home care and being transferred to inpatient care in Sweden. Methods A national retrospective cross-sectional study based on data from the Swedish Register of Palliative Care. Patients ≥ 18 years of age enrolled in specialized palliative home care with dates of death between 1 November 2015 and 31 October 2022 were included (n = 39,698). Descriptive statistics were used. Results Seven thousand three hundred eighty-three patients (18.6%), approximately 1,000 per year, were transferred to inpatient care and died within seven days of arrival. A considerable proportion of these patients died within two days after admission. The majority (73.6%) were admitted to specialized palliative inpatient care units, 22.9% to non-specialized palliative inpatient care units and 3.5% to additional care units. Transferred patients had more frequent dyspnoea (30.9% vs. 23.2%, p

Abstract Background Changes in demographics with an older population, the illness panorama with increasing prevalence of non-communicable diseases, and the shift from hospital care to home-based care place demand on primary health care, which requires multiprofessional collaboration and team-based organization of work. The COVID-19 pandemic affected health care in various ways, such as heightened infection control measures, changing work practices, and increased workload. Objectives This study aimed to investigate the association between primary care practices’ organization, and quality and safety changes during the COVID-19 pandemic. Design Data were collected from 38 countries in a large online survey, the PRICOV-19 study. For this paper, the participating practices were categorized as “Only GPs”, comprising practices with solely general practitioners (GPs) and/or GP trainees, without any other health care professionals (n = 1,544), and “Multiprofessional,” comprising practices with at least one GP or GP trainee and one or more other health professionals (n = 3,936). Results Both categories of practices improved in infection control routines when compared before and during the COVID-19 pandemic. A larger proportion of the multiprofessional practices changed their routines to protect vulnerable patients. Telephone triage was used in more “Multiprofessional” practices, whereas “Only GPs” were more likely to perform video consultations as an alternative to physical visits. Both types of practices reported that the time to review new guidelines and scientific literature decreased during the pandemic. However, both had more meetings to discuss directives than before the pandemic. Conclusions Multiprofessional teams were keener to introduce changes to the care organization to protect vulnerable patients. However, practices with only GPs were found to be more aligned with video consultations, perhaps reflecting the close patient-doctor relationship. In contrast, telephone triage was used more in multiprofessional teams.

Abstract Background One of the potential dimensions on which exclusion and injustice may occur in energy transitions is age. Age-based patterns of exclusion—ageism—has recently been conceptualized in the context of decarbonization as energy ageism. This paper offers a comparative empirical analysis of the senior citizens’ outlook towards an imminent energy transition as well as the impact of energy poverty in two European countries: Norway and Poland. Results Drawing on interviews and focus groups with Polish and Norwegian seniors, we present the differences and similarities between the two countries, and the determinants of energy ageism, as well as the concept’s overall applicability and empirical usefulness. We find that socioeconomic conditions outweigh ageism, that is, the resilience of senior citizens in dealing with energy poverty during a transition is conditioned by their material standing and welfare state robustness rather than age based. An important factor is household heating technology, combined with economic vulnerability can push some individuals into energy poverty, while others using alternative sources of heat can navigate through energy crises unscathed. Conclusions We note the importance of mainstreaming social inclusion considerations in energy policy and of targeted digital competence building which can enhance senior citizen integration in the energy transition. Lower levels of digital competences among senior citizens certainly play a role and need to be addressed with education programs to increase participation. In both countries, household heating is a major issue and heating sources are strong predictors of energy poverty and regulatory measures and subsidies should be designed at national, regional, and municipal level to assist vulnerable groups in this area.

Abstract Purpose To report a case of endogenous endophthalmitis caused by the dematiaceous fungus Cladophialophora devriesii. Methods Observational case report and literature review. Case presentation A 73-year-old female with a history of chronic obstructive pulmonary disease presented with a red and painful left eye. Examination revealed anterior segment inflammation and vitritis, indicative of endophthalmitis. She underwent core vitrectomy and intravitreal injection of vancomycin and amphotericin B. The vitreous sample showed inflammatory cells and fungal hyphae, and systemic amphotericin B and itraconazole were commenced for fungal endophthalmitis. Targeted amplification of the sample for bacterial DNA (V2-V3 region of 16 S rDNA) was negative, but fungal DNA targets (ITS1 and ITS2) were present, and their sequences were consistent with Cladophialophora devriesii. Phenotypic characterisation and sequencing of ITS1 and ITS2, carried out on cultured fungus from the sample, also revealed Cladophialophora devriesii. She received repeated intravitreal injections of voriconazole, and based on the antifungal susceptibility results, her systemic medication was changed to posaconazole. After 12 months, the eye showed no signs of inflammation, and posaconazole therapy was discontinued. After 3 months without antifungal medication, the inflammation recurred, and she was restarted on antifungal therapy for an additional 20 months. Another recurrence occurred 3 months after discontinuation of treatment, and a repeat vitreous sample confirmed the presence of Cladophialophora devriesii. She was started on isavuconazole, but developed seclusio pupillae and painful secondary glaucoma. Due to the duration and severity of the infection, the eye was enucleated. Histopathology revealed persistent fungal elements at the ciliary processes and the posterior lens surface. Conclusions This second reported case of endogenous endophthalmitis caused by Cladophialophora devriesii illustrates the role of vitreous sampling and molecular methods in diagnosis and treatment of fungal endophthalmitis. Despite early diagnosis and prolonged local and systemic antifungal therapy, it was not possible to achieve long-term control of the fungal infection.

While people's proclivity toward congenial partisan media has been well documented, methods of resistance are less researched. This study explores the congenial media effect, the phenomenon of our gravitation to and acceptance of like-minded media, and whether a media literacy intervention can mitigate people's acceptance of ideologically congruent partisan media. In an online experiment (N = 199), conservatives and liberals were exposed to differing media literacy interventions, one reviewing the traits of objectivity and bias, another which combined the former with an opportunity to reflect on participants' own political beliefs. All were then exposed to amenable partisan content on the Supreme Court nomination of Brett Kavanaugh. Results demonstrated that neither intervention affected participants' perceptions of bias toward the material, however, liberals were more critical in their evaluations, deeming the partisan content as less credible than conservatives. Additionally, for liberals exposed to the objectivity and bias intervention, lower perceptions of credibility were seen compared to liberals who received no intervention.

Introduction Data suggest that micronised progesterone (mP) in menopausal hormone therapy is safer for the breast than synthetic progestins, while protection of the endometrium appears to be less effective. However, comparative randomised trial data are lacking. The objective of the Progesterone Breast Endometrial Safety Study is to investigate breast and endometrial safety of mP versus norethisterone acetate (NETA) in continuous combination with oral oestrogen.Methods and analysis This multicentre trial, conducted at three University Hospitals in Stockholm and Uppsala, Sweden, consists of two phases: part 1 focuses on breast safety and is designed as a double-blind, randomised controlled trial. 260 postmenopausal women will be randomised to 100 mg mP or 0.5 mg NETA per day in continuous combination with 1 mg oestradiol. The primary objective is to compare the treatments with respect to percentage change in mammographic breast density after 12-month treatment. Secondary outcomes are breast proliferation, endometrial histology and proliferation, bleeding pattern, gut and vaginal microbiome, hormone levels and coagulation and metabolic factors, mood, and health-related quality of life. Part 2 features an open, single-arm design to study endometrial safety of 1-year treatment with mP in continuous combination with oestradiol on endometrial pathology (hyperplasia and cancer). We will treat 260 additional women with 100 mg mP/1 mg oestradiol resulting in an endometrial safety population of 390 women. The total number of participants in part 1 and part 2 will be 520.Ethics and dissemination The study protocol was approved by the Swedish Ethical Review Authority (2021-03033) on 29 June 2021 with amendment (2023-01480-02, protocol version 3.1) on 14 March 2023. Results of the study will be published in peer-reviewed journals and presented at scientific meetings.Trial registration number NCT05586724.

ABSTRACT We previously demonstrated that the lungs of deceased COVID-19 patients were filled with a clear hydrogel consisting of hyaluronan (HA). In this translational study, we investigated the role of HA at all stages of COVID-19 disease to map the consequences of elevated HA on morbidity and identify the mechanism of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced HA production. A reduced alveolar surface area was observed in the lungs of deceased COVID-19 patients compared to healthy controls, as visualized by a 3D rendering of lung morphology using light-sheet fluorescence microscopy. We confirmed the presence of HA in lung biopsies and found large quantities of proinflammatory fragmented HA. The association of systemic HA in blood plasma and disease severity was assessed in patients with mild (WHO Clinical Progression Scale, WHO-CPS, 1–5) and severe COVID-19 (WHO-CPS, 6–9) during the acute and convalescent phases and related to lung function. We found that systemic levels of HA were high during acute COVID-19 disease, remained elevated during convalescence, and were associated with a reduced diffusion capacity. In vitro 3D-lung models, differentiated from primary human bronchial epithelial cells, were used to study the effects of SARS-CoV-2 infection on HA metabolism, and transcriptomic analyses revealed a dysregulation of HA synthases and hyaluronidases, both contributing to increased HA in apical secretions. Furthermore, corticosteroid treatment reduced the inflammation and downregulated HA synthases. Our findings demonstrate that HA plays a role in COVID-19 morbidity and that sustained elevated HA concentrations may contribute to long-term respiratory impairment.IMPORTANCEThis study provides insights into the role of hyaluronan (HA) in the severity and long-term impact of COVID-19 on lung function. Through extensive morphological examination of lung tissues and a multicenter study, we identified that HA levels are significantly elevated in COVID-19 patients, correlating with a reduced lung diffusion capacity during convalescence. Using a 3D-lung model, we further uncovered how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 infection causes a dysregulated HA metabolism, leading to increased HA production. Our findings provide valuable insights into the pathogenesis of SARS-CoV-2 and suggest that targeting HA metabolism could offer new therapeutic avenues for managing COVID-19, particularly to prevent long-term lung impairment. Additionally, HA holds potential as a biomarker for predicting disease severity, which could guide personalized treatment strategies.

Background: Ongoing opioid treatment can potentially modify symptoms of myocardial infarction (MI) and cause a lack of recognition and treatment delay. Objectives: The purpose of this study was to examine MI symptoms and the time to hospitalization for patients in ongoing opioid treatment compared to patients without ongoing opioid treatment. Methods: We evaluated calls to the Copenhagen Emergency Medical Services in Denmark from 2014 to 2018. Calls were included when followed by hospitalization and a diagnosis of MI. Symptoms of MI and the time from call to hospitalization in patients in ongoing opioid treatment initiated prior to the onset of MI were compared to a control group of MI patients without opioid treatment. Results: In total, 6,633 calls were included; 552 calls from patients in opioid treatment and 6,081 calls from controls. Patients in opioid treatment were older and had more comorbidities than controls. Chest pain was less prevalent in MI patients in opioid treatment compared to controls (adjOR: 0.70; 95% CI: 0.57-0.85). The median time from the call to hospitalization was longer in patients in opioid treatment than in controls (50 vs 47 minutes; P = 0.006). Conclusions: In calls to the Emergency Medical Services, opioid treatment initiated prior to the onset of MI was associated with less frequent chest pain in MI. Therefore, awareness of ongoing opioid treatment may improve telephone triage of patients with MI, as symptom presentation in opioid-treated patients may differ and potentially challenge and delay the emergency response.

Objectives: Booster COVID-19 vaccinations are used to protect the elderly, a group vulnerable to severe disease. We compared humoral and cellular immunity in older versus younger adults up to eight months after administering a BNT16b2 booster vaccine dose. Next, we analyzed the plasma levels of soluble T cell activation/exhaustion markers. Methods: Home-dwelling older adults (n = 68, median age 86) and younger healthcare workers (n = 35, median age 39), previously vaccinated with two doses of BNT162b2, were given a booster dose at ten months after the initial dose. Our analysis consisted of spike-specific IgG, neutralizing antibodies, memory B cells, IFN-γ and IL-2 secreting T cells and soluble T cell exhaustion/activation markers. Results: Following the initial two doses, the elderly cohort exhibited lower humoral and IFN-γ responses compared to younger adults. The booster dose increased the humoral responses in both older and younger adults. At two months after the booster dose, older and younger vaccinees had comparable levels of antibodies and the responses were maintained up to 18 months. The younger cohort elicited an increase in the cellular response, while no increase was detected in the elderly. The elderly had higher plasma levels of soluble forms of the T cell activation/exhaustion markers CD25 and TIM-3, which inversely correlated with age and T-cell cytokine responses. This suggests that these markers may be related to the observed dysfunctional cellular cytokine response in older adults. However, both elderly and younger adults who experienced breakthrough infections after booster vaccination, elicited more robust humoral and IFN-γ responses. Conclusions: The booster dose elicited neutralizing and spike-specific antibody responses in the elderly that were comparable with that of the younger cohort. However, the lack of a strong cellular cytokine response to the third dose in the elderly may explain their vulnerability to severe infection and may be a consequence of exhausted or senescent T cell responses. (https://clinicaltrials.gov/study/NCT04706390).

Background: Infertility affects millions of couples globally, with up to 40–50 % of cases linked to impaired semen quality. Insemination or in vitro fertilization are used frequently, regardless of the cause of infertility due to the lack of specific medical interventions for male infertility. Denosumab, an antibody blocking RANKL signaling, may enhance semen quality in infertile men. This randomized controlled trial evaluates if denosumab improves spermatogenesis in men with severely impaired semen quality identified by serum AMH levels as a predictive marker. Methods: NAPO is a single-center, sponsor-investigator-initiated, placebo-controlled, double-blinded randomized trial. Subjects will be randomized in a 2:1 fashion to receive either denosumab 60 mg subcutaneously or a placebo. The study will be carried out at the Division of Translational Endocrinology, Copenhagen University Hospital, Herlev, Denmark. The primary outcome of the study is defined as the difference in sperm concentration (millions/mL) at one spermatogenesis (80 days) after inclusion. Discussion: An important step in addressing infertility is establishing a viable treatment option for male infertility. With this study, we describe the protocol for a planned RCT aimed at evaluating whether treatment with denosumab can improve sperm concentration in men with severely impaired semen quality. The results of this study will provide evidence crucial for future treatment in a patient group where treatment options are minimal at best. Trial registration: Clinical Trials: NCT06300229. Registered on March 12, 2024. Clinical Trials Information System (CTIS): 2023-508325-27-00. Approved on December 19, 2023.

Gjennomføring av videregående opplæring er avgjørende for tilknytning til og deltakelse i arbeidslivet. Likevel fullfører en av fem elever i Norge ikke videregående skole. I denne studien undersøkte vi hvordan helsesykepleiere kan legge til rette for tverrprofesjonelt arbeid for å motvirke skolefrafall. Basert på tre fokusgruppeintervjuer med 13 helsesykepleiere i videregående skole, ble kvalitative utsagn analysert ved hjelp av en stegvis-deduktiv-induktiv metode. Funnene indikerer at helsesykepleierne tilstreber å se hele eleven for å forstå fraværsårsaker, men har utfordringer med å synliggjøre sin egen kompetanse for samarbeidspartnere. Implisitte maktstrukturer, inkludert skoleledelsen, spiller en betydelig rolle i helsesykepleiernes inkludering i tverrprofesjonelle team. For å fremme tverrprofesjonelt samarbeid og styrke sin egen rolle, bør helsesykepleierne aktivt synliggjøre seg selv og sin kompetanse.