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With the outbreak of the COVID-19 pandemic, Denmark and Sweden's governments and health authorities implemented social distancing measures as the main strategy to limit the spread of the coronavirus. In Denmark, these were mostly mandatory, whereas in Sweden they were primarily voluntarily based. The aim of this study was to explore how young adults in Denmark and Sweden retrieved and perceived information during the COVID-19 pandemic and what their experiences of everyday life were with the implemented social distancing measures. To this end, 30 Danish and Swedish young adults between 18 and 25 years were interviewed. The participants considered themselves informed and reflected on multiple sources of information. However, social distancing measures were translated in different ways and had both negative and positive implications for their everyday lives. Many participants felt that their youth - as a significant phase in life - became restricted., Funding Agencies|Innovation Fund Denmark [0211-00026B]

This chapter uses the neo-Weberian and neo-institutionalist frameworks to analyse developments in the Danish health system. Developments are presented and discussed with reference to the main stakeholder groups in the health sector, in particular healthcare professionals, state, regional and local governments, patients and the medical–industrial complex. The chapter shows that historical ambitions and political compromises have created a system that is not only state regulated, largely funded by taxation and dominated by public ownership of hospitals but also subject to gradual ongoing reform – some of which have been influenced by the New Public Management. The system also has significant private components in terms of voluntary supplementary insurance to cover co-payments, and reliance on outpatient general and specialist practices that are privately owned and managed, but tightly integrated into public planning and regulation and largely funded by public means. Such features are shown to be rooted in political responses to specific historical conditions that provide a specific hybrid flavour to the Danish version of the Nordic National Health Service. The system performs relatively well in terms of population health – and its resilience is highlighted by its positive response to the Covid-19 pandemic.

The Danish universal tax-based health system has effective provision of quality care and high patient satisfaction with low levels of unmet health needs. However, it faces coordination and fragmentation challenges due to its decentralized structure and the provision of care by three different sectors: regions, municipalities, and the private sector, including general practitioners and specialists. Ensuring coordination and continuity of care has been an ongoing focus area for policy discussions and reforms; however, it remains an issue of concern.

With the outbreak of the COVID-19 pandemic, Denmark and Sweden’s governments and health authorities implemented social distancing mea-sures as the main strategy to limit the spread of the coronavirus. In Denmark, these were mostly mandatory, whereas in Sweden they were primarily voluntarily based. The aim of this study was to explore how young adults in Denmark and Sweden retrieved and perceived informa-tion during the COVID-19 pandemic and what their experiences of every-day life were with the implemented social distancing measures. To this end, 30 Danish and Swedish young adults between 18 and 25 years were interviewed. The participants considered themselves informed and reflected on multiple sources of information. However, social distancing measures were translated in different ways and had both negative and positive implications for their everyday lives. Many participants felt that their youth – as a significant phase in life – became restricte, With the outbreak of the COVID-19 pandemic, Denmark and Sweden’s governments and health authorities implemented social distancing measures as the main strategy to limit the spread of the coronavirus. In Denmark, these were mostly mandatory, whereas in Sweden they were primarily voluntarily based. The aim of this study was to explore how young adults in Denmark and Sweden retrieved and perceived information during the COVID-19 pandemic and what their experiences of everyday life were with the implemented social distancing measures. To this end, 30 Danish and Swedish young adults between 18 and 25 years were interviewed. The participants considered themselves informed and reflected on multiple sources of information. However, social distancing measures were translated in different ways and had both negative and positive implications for their everyday lives. Many participants felt that their youth–as a significant phase in life–became restricted.

Background Falls cause 58% of injury-related Emergency Department (ED) attendances. Previous research has highlighted the potential role of cardiovascular risk factors for falls. This study investigated the impact of cardiovascular disease (CVD) risk on three-year incident falls, with presentation to the ED, and mortality. Methods A matched cohort study design was employed using national registry data from 82,292 adults (33% male) aged ≥ 65 years living in Denmark who attended the ED in 2013. We compared age and gender matched ED attendees presenting with a fall versus another reason. The cohort was followed for three-year incident falls, with presentation to the ED, and mortality. The impact of falls-related CVDs was also examined. Results Three-year incident falls was twofold higher among age and gender matched ED attendees aged ≥ 65 years presenting with a fall versus another reason at baseline. A presentation of falls with hip fracture had the highest percentage of incident falls in the 65–74 age group (22%) and the highest percentage mortality in all age groups (27–62%). CVD was not a significant factor in presenting with a fall at the ED, nor did it contribute significantly to the prediction of three-year incident falls. CVD was strongly associated with mortality risk among the ED fall group (RR = 1.81, 95% CI: 1.67–1.97) and showed interactions with both age and fall history. Conclusion In this large study of adults aged ≥ 65 years attending the ED utilising data from national administrative registers in Denmark, we confirm that older adults attending the ED with a fall, including those with hip fracture, were at greatest risk for future falls. While CVD did not predict incident falls, it increased the risk of mortality in the three-year follow up with advancing age. This may be informative for the provision of care pathways for older adults attending the ED due to a fall., Background: Falls cause 58% of injury-related Emergency Department (ED) attendances. Previous research has highlighted the potential role of cardiovascular risk factors for falls. This study investigated the impact of cardiovascular disease (CVD) risk on three-year incident falls, with presentation to the ED, and mortality. Methods: A matched cohort study design was employed using national registry data from 82,292 adults (33% male) aged ≥ 65 years living in Denmark who attended the ED in 2013. We compared age and gender matched ED attendees presenting with a fall versus another reason. The cohort was followed for three-year incident falls, with presentation to the ED, and mortality. The impact of falls-related CVDs was also examined. Results: Three-year incident falls was twofold higher among age and gender matched ED attendees aged ≥ 65 years presenting with a fall versus another reason at baseline. A presentation of falls with hip fracture had the highest percentage of incident falls in the 65–74 age group (22%) and the highest percentage mortality in all age groups (27–62%). CVD was not a significant factor in presenting with a fall at the ED, nor did it contribute significantly to the prediction of three-year incident falls. CVD was strongly associated with mortality risk among the ED fall group (RR = 1.81, 95% CI: 1.67–1.97) and showed interactions with both age and fall history. Conclusion: In this large study of adults aged ≥ 65 years attending the ED utilising data from national administrative registers in Denmark, we confirm that older adults attending the ED with a fall, including those with hip fracture, were at greatest risk for future falls. While CVD did not predict incident falls, it increased the risk of mortality in the three-year follow up with advancing age. This may be informative for the provision of care pathways for older adults attending the ED due to a fall.

IntroductionDenmark and Sweden initially adopted different responses to the COVID-19 pandemic although the two countries share many characteristics. Denmark responded swiftly with many mandatory restrictions. In contrast, Sweden relied on voluntary restrictions and a more "relaxed" response during the first wave of the pandemic. However, increased rates of COVID-19 cases led to a new approach that involved many more mandatory restrictions, thus making Swedens response similar to Denmarks in the second wave of the pandemic. AimThe aim was to investigate and compare the extent to which the populations in Denmark and Sweden considered the COVID-19 restrictions to be acceptable during the first two waves of the pandemic. The study also aimed to identify the characteristics of those who were least accepting of the restrictions in the two countries. Materials and methodsCross-sectional surveys were conducted in Denmark and Sweden in 2021. The study population was sampled from nationally representative web panels in the two countries, consisting of 2,619 individuals from Denmark and 2,633 from Sweden. The questionnaire captured key socio-demographic characteristics. Acceptability was operationalized based on a theoretical framework consisting of seven constructs and one overarching construct. ResultsThe respondents age and gender patterns were similar in the two countries. The proportion of respondents in Denmark who agreed with the statements ("agree" alternative) that captured various acceptability constructs was generally higher for the first wave than the second wave of the pandemic. The opposite pattern was seen for Sweden. In Denmark, 66% in the first wave and 50% in the second wave were accepting of the restrictions. The corresponding figures for Sweden was 42% (first wave) and 47% (second wave). Low acceptance of the restrictions, defined as the 25% with the lowest total score on the seven acceptability statements, was associated with younger age, male gender and l, Funding: Innovation Fund Denmark [0211-00026B]

Health systems internationally face demands to deliver care that is better coordinated and integrated. The health system financing and delivery model may go some, but not all the way in explaining health system fragmentation. In this paper, we consider the road to care integration in two countries with Beveridge style health systems, England and Denmark, that are both ranked as highly Integrated systems in Toth's health integration index. We use the SELFIE framework to compare the policies and reforms that have affected care integration over the past 30 years in the two countries. The countries both started their reform path by reforming to introduce choice and competition, but did so in different ways that set them on different pathways. Nevertheless, after two decades, the countries ended the period with largely similar structures that emphasised the creation of a cross-sectoral governance structure. In the relatively centralised England, by introducing decentralised Integrated Care Systems, and in the relatively decentralised Denmark with a centralising element in the form of new Health Clusters.

INTRODUCTION: Denmark and Sweden initially adopted different responses to the COVID-19 pandemic although the two countries share many characteristics. Denmark responded swiftly with many mandatory restrictions. In contrast, Sweden relied on voluntary restrictions and a more "relaxed" response during the first wave of the pandemic. However, increased rates of COVID-19 cases led to a new approach that involved many more mandatory restrictions, thus making Sweden's response similar to Denmark's in the second wave of the pandemic.AIM: The aim was to investigate and compare the extent to which the populations in Denmark and Sweden considered the COVID-19 restrictions to be acceptable during the first two waves of the pandemic. The study also aimed to identify the characteristics of those who were least accepting of the restrictions in the two countries.MATERIALS AND METHODS: Cross-sectional surveys were conducted in Denmark and Sweden in 2021. The study population was sampled from nationally representative web panels in the two countries, consisting of 2,619 individuals from Denmark and 2,633 from Sweden. The questionnaire captured key socio-demographic characteristics. Acceptability was operationalized based on a theoretical framework consisting of seven constructs and one overarching construct.RESULTS: The respondents' age and gender patterns were similar in the two countries. The proportion of respondents in Denmark who agreed with the statements ("agree" alternative) that captured various acceptability constructs was generally higher for the first wave than the second wave of the pandemic. The opposite pattern was seen for Sweden. In Denmark, 66% in the first wave and 50% in the second wave were accepting of the restrictions. The corresponding figures for Sweden was 42% (first wave) and 47% (second wave). Low acceptance of the restrictions, defined as the 25% with the lowest total score on the seven acceptability statements, was associated wit

We assessed challenges that the COVID-19 pandemic presented for mental health systems and the responses to these challenges in 14 countries in Europe and North America. Experts from each country filled out a structured Healthcare systems questionnaire with closed- and open-ended questions between January and June 2021. We conducted thematic Health policy analysis to investigate the qualitative responses to open-ended questions, and we summarized the responses closed-ended survey items on changes in telemental health policies and regulations. Findings revealed that many countries grappled with the rising demand for mental health services against a backdrop of mental health provider shortages and challenges responding to workforce stress and burnout. All but one country in our sample implemented new policies or initiatives to strengthen mental health service delivery – with more than two-thirds investing to bolster their specialized mental health care sector. There was a universal shift to telehealth to deliver a larger portion of mental health services in all 14 countries, which was facilitated by changes in national regula- tions and policies; 11 of the 14 participating countries relaxed regulations and 10 of 14 countries made changes to reimbursement policies to facilitate telemental health care. These findings provide a first step to assess the long-term challenges and re-organizational effect of the COVID-19 pandemic on mental health systems in Europe and North America., We assessed challenges that the COVID-19 pandemic presented for mental health systems and the responses to these challenges in 14 countries in Europe and North America. Experts from each country filled out a structured questionnaire with closed- and open-ended questions between January and June 2021. We conducted thematic analysis to investigate the qualitative responses to open-ended questions, and we summarized the responses to closed-ended survey items on changes in telemental health policies and regulations. Findings revealed that many countries grappled with the rising demand for mental health services against a backdrop of mental health provider shortages and challenges responding to workforce stress and burnout. All but one country in our sample implemented new policies or initiatives to strengthen mental health service delivery – with more than two-thirds investing to bolster their specialized mental health care sector. There was a universal shift to telehealth to deliver a larger portion of mental health services in all 14 countries, which was facilitated by changes in national regulations and policies; 11 of the 14 participating countries relaxed regulations and 10 of 14 countries made changes to reimbursement policies to facilitate telemental health care. These findings provide a first step to assess the long-term challenges and re-organizational effect of the COVID-19 pandemic on mental health systems in Europe and North America. Keywords Mental healthhealthcare systemshealth policyhealthcare reformtelehealth

The debate on accountability within the public sector has been especially lively over the past decade. Significant progress has been made in developing conceptual frameworks and typologies for characterizing different features and functions of accountability. At the same time, however, there has been a lack of sector-specific adjustment of such frameworks. In this chapter we present a framework for analyzing accountability within healthcare. The chapter makes use of the concept of “accountability regime” to signify the combination of different accountability forms, directions, and functions in operation at any given point in time. We show that reforms can introduce new forms of accountability, change existing accountability relations, or change the relative importance of different accountability forms. They may also change the dominant direction and shift the balance between different functions of accountability. We further suggest that developments in accountability regimes are best analyzed with a combination of top-down and bottom-up perspectives and that there is a need to develop research strategies to support this aim., The debate on accountability within the public sector has been especially lively over the past decade. Significant progress has been made in developing conceptual frameworks and typologies for characterizing different features and functions of accountability. At the same time, however, there has been a lack of sector-specific adjustment of such frameworks. In this chapter we present a framework for analyzing accountability within healthcare. The chapter makes use of the concept of “accountability regime” to signify the combination of different accountability forms, directions, and functions in operation at any given point in time. We show that reforms can introduce new forms of accountability, change existing accountability relations, or change the relative importance of different accountability forms. They may also change the dominant direction and shift the balance between different functions of accountability. We further suggest that developments in accountability regimes are best analyzed with a combination of top-down and bottom-up perspectives and that there is a need to develop research strategies to support this aim.

Background The COVID-19 pandemic highlighted the fragmented nature of governmental policy decisions in Europe. However, the extent to which COVID-19 vaccination policies differed between European countries remains unclear. Here, we mapped the COVID-19 vaccination policies that were in effect in January 2022 as well as booster regulations in April 2022 in Austria, Denmark, England, France, Germany, Ireland, Italy, the Netherlands, Poland, and Spain. Methods National public health and health policy experts from these ten European nations developed and completed an electronic questionnaire. The questionnaire included a series of questions that addressed six critical components of vaccine implementation, including (1) authorization, (2) prioritization, (3) procurement and distribution, (4) data collection, (5) administration, and (6) mandate requirements. Results Our findings revealed significant variations in COVID-19 vaccination policies across Europe. We observed critical differences in COVID-19 vaccine formulations authorized for use, as well as the specific groups that were provided with priority access. We also identified discrepancies in how vaccination-related data were recorded in each country and what vaccination requirements were implemented. Conclusion Each of the ten European nations surveyed in this study reported different COVID-19 vaccination policies. These differences complicated efforts to provide a coordinated pandemic response. These findings might alert policymakers in Europe of the need to coordinate their efforts to avoid fostering divergent and socially disruptive policies., Background: The COVID-19 pandemic highlighted the fragmented nature of governmental policy decisions in Europe. However, the extent to which COVID-19 vaccination policies differed between European countries remains unclear. Here, we mapped the COVID-19 vaccination policies that were in effect in January 2022 as well as booster regulations in April 2022 in Austria, Denmark, England, France, Germany, Ireland, Italy, the Netherlands, Poland, and Spain. Methods: National public health and health policy experts from these ten European nations developed and completed an electronic questionnaire. The questionnaire included a series of questions that addressed six critical components of vaccine implementation, including (1) authorization, (2) prioritization, (3) procurement and distribution, (4) data collection, (5) administration, and (6) mandate requirements. Results: Our findings revealed significant variations in COVID-19 vaccination policies across Europe. We observed critical differences in COVID-19 vaccine formulations authorized for use, as well as the specific groups that were provided with priority access. We also identified discrepancies in how vaccination-related data were recorded in each country and what vaccination requirements were implemented. Conclusion: Each of the ten European nations surveyed in this study reported different COVID-19 vaccination policies. These differences complicated efforts to provide a coordinated pandemic response. These findings might alert policymakers in Europe of the need to coordinate their efforts to avoid fostering divergent and socially disruptive policies.

Background and Aims The aim of the SCIENCE trial was to investigate whether a single treatment with direct intramyocardial injections of adipose tissue derived mesenchymal stromal cells (CSCC_ASCs) was safe and improved cardiac function in patients with chronic ischemic heart failure with reduced ejection fraction (HFrEF). Methods The study was a European multi-centre double-blinded placebo-controlled phase II trial using allogeneic CSCC_ASCs from healthy donors or placebo (2:1 randomization). Main inclusion criteria were NYHA II-III, left ventricular ejection fraction (LVEF) < 45%, and NT-ProBNP levels>300 pg/mL. CSCC_ASCs or placebo (isotonic saline) were injected directly into viable myocardium. Primary endpoint was change in left ventricular end-systolic volume (LVESV) at 6 months follow up measured by echocardiography. Results A total of 133 symptomatic HFrEF patients were included. The treatment was safe without any drug-related severe adverse events or difference in cardiac related adverse events during a 3-years follow-up period. There were no significant differences between the groups during follow up in LVESV (0.3 ± 5.0 ml, P = 0.945), nor in secondary endpoints left ventricular end-diastolic volume (−2.0 ± 6.0 ml, P = 0.736) and LVEF (−1.6 ± 1.0%, P = 0.119). The NYHA classification improved slightly within the first year in both groups without any difference between groups. There were no changes in 6-Minute Walk Test, NT-ProBNP, CRP or quality-of-life the first year in any of the two groups. Conclusion The SCIENCE trial demonstrated safety of intramyocardial allogeneic CSCC_ASC therapy in patients with chronic HFrEF. However, it was not possible to improve the predefined endpoints and induce restoration of cardiac function or clinical symptoms, Aims The aim of the SCIENCE trial was to investigate whether a single treatment with direct intramyocardial injections of adipose tissue-derived mesenchymal stromal cells (CSCC_ASCs) was safe and improved cardiac function in patients with chronic ischaemic heart failure with reduced ejection fraction (HFrEF). Methods and results The study was a European multicentre, double-blind, placebo-controlled phase II trial using allogeneic CSCC_ASCs from healthy donors or placebo (2:1 randomization). Main inclusion criteria were New York Heart Association (NYHA) class II–III, left ventricular ejection fraction (LVEF) <45%, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels >300 pg/ml. CSCC_ASCs or placebo (isotonic saline) were injected directly into viable myocardium. The primary endpoint was change in left ventricular end-systolic volume (LVESV) at 6-month follow-up measured by echocardiography. A total of 133 symptomatic HFrEF patients were included. The treatment was safe without any drug-related severe adverse events or difference in cardiac-related adverse events during a 3-year follow-up period. There were no significant differences between groups during follow-up in LVESV (0.3 ± 5.0 ml, p = 0.945), nor in secondary endpoints of left ventricular end-diastolic volume (−2.0 ± 6.0 ml, p = 0.736) and LVEF (−1.6 ± 1.0%, p = 0.119). The NYHA class improved slightly within the first year in both groups without any difference between groups. There were no changes in 6-min walk test, NT-proBNP, C-reactive protein or quality of life the first year in any groups. Conclusion The SCIENCE trial demonstrated safety of intramyocardial allogeneic CSCC_ASC therapy in patients with chronic HFrEF. However, it was not possible to improve the pre-defined endpoints and induce restoration of cardiac function or clinical symptoms.

This contribution examines the responses of five health systems in the first wave of the COVID-19 pandemic: Denmark, Germany, Israel, Spain and Sweden. The aim is to understand to what extent this crisis response of these countries was resilient. The study focuses on hospital care structures, considering both existing capacity before the pandemic and the management and expansion of capacity during the crisis. Evaluation criteria include flexibility in the use of existing resources and response planning, as well as the ability to create surge capacity. Data were collected from country experts using a structured questionnaire. Main findings are that not only the total number but also the availability of hospital beds is critical to resilience, as is the ability to mobilise (highly) qualified personnel. Indispensable for rapid capacity adjustment is the availability of data. Countries with more centralised hospital care structures, more sophisticated concepts for providing specialised services and stronger integration of the inpatient and outpatient sectors have clear structural advantages. A solid digital infrastructure is also conducive. Finally, a centralised governance structure is crucial for flexibility and adaptability. In decentralised systems, robust mechanisms to coordinate across levels are important to strengthen health care system resilience in pandemic situations and beyond, This contribution examines the responses of five health systems in the first wave of the COVID-19 pandemic: Denmark, Germany, Israel, Spain and Sweden. The aim is to understand to what extent this crisis response of these countries was resilient. The study focuses on hospital care structures, considering both existing capacity before the pandemic and the management and expansion of capacity during the crisis. Evaluation criteria include flexibility in the use of existing resources and response planning, as well as the ability to create surge capacity. Data were collected from country experts using a structured questionnaire. Main findings are that not only the total number but also the availability of hospital beds is critical to resilience, as is the ability to mobilise (highly) qualified personnel. Indispensable for rapid capacity adjustment is the availability of data. Countries with more centralised hospital care structures, more sophisticated concepts for providing specialised services and stronger integration of the inpatient and outpatient sectors have clear structural advantages. A solid digital infrastructure is also conducive. Finally, a centralised governance structure is crucial for flexibility and adaptability. In decentralised systems, robust mechanisms to coordinate across levels are important to strengthen health care system resilience in pandemic situations and beyond.

Chronic diseases are major causes of death and reduction in the quality of life worldwide, and their prevalence is expected to rise due to changing demographics. Disease management programmes (DMPs) have been presented as a policy response to challenges of care coordination for such chronic diseases. This paper investigates the implementation of DMPs in a National Health Care system in the Nordic region using type II diabetes as an example. DMPs are detailed descriptions of the sequence and responsibilities for diagnostic, treatment, rehabilitation and prevention procedures. The paper applies a systemic implementation perspective to provide detailed analysis of implementation progress, issues and concerns. The implementation analysis shows that the framework of DMP has facilitated the development of new practices and attention to the roles that each of the stakeholders are playing within the service delivery. Many new initiatives contribute to improved coordination and overall management of the Type 2 diabetes (T2DB) population. Yet, there are also several cross-cutting challenges that are affecting the implementation process.