Danish Program Research Articles

Relapse detection in the Danish surveillance program of patients with clinical stage I seminoma: a nationwide study.

Active surveillance is a recommended management strategy for patients with clinical stage I (CSI) seminoma. This study aims to identify patterns of relapse detection methods in an unselected population-based cohort of CSI patients and provide evidence for a risk-adapted follow-up program. A total of 924 patients with CSI seminoma were identified in the prospective Danish Testicular Cancer database. Retrospectively collected clinical data were used for descriptive analyses of patterns in detection methods. Additionally, we explored a risk-adapted surveillance approach based on recently identified risk factors for relapse, classifying patients into low- and non-low-risk groups. At 60 months, the 5-year cumulative relapse risk was 16%, with 146 relapses during surveillance. Relapses were detected by imaging alone in 71% of cases, imaging combined with elevated serum tumor markers (STMs) in 18%, isolated elevation of STMs in 8%, and by self-referral due to symptoms in 3%. No relapses were detected by abnormal findings at a physical examination. In total, 134 (92%) relapses were localized to retroperitoneal lymph nodes, primarily without additional spread. The 5-year relapse risk in patients with low risk of relapse was 9% compared to 28% in patients in the non-low-risk group. This study highlights that the surveillance program can detect relapses at an early stage. Reduction of visits and omission of routine physical examinations can safely be considered for patients with a low risk of relapse, while further research is needed to optimize follow-up and treatment for patients at higher risk of relapse.

Motivation or Inconvenience—What matters most? Understanding recycling behavior of healthcare waste

Recycling programs are widely used to address global environmental challenges, with the active participation of end users being crucial for the successful return of products at the end of use. However, individuals have different motivations for recycling and face various obstacles in doing so. We lack an understanding of these motivations and the inconveniences of engaging in this behavior, especially within the healthcare industry. By drawing insights from the take-back program ReturpenTM, which was introduced in Denmark and the UK, this study addresses how different types of motivation influence end-user participation in take-back programs and the extent to which motivation offsets the inconveniences. The results showed that individuals' underlying motivations vary, with altruism emerging as the primary motivator, followed by social norms, while direct personal benefits play a relatively minor role. While 92% of respondents indicated their intention to engage in the take-back program, the actual return rate in the Danish program was approximately 22%, which points to a clear intention-behavior gap.

The effect of periodic vehicle inspection on road traffic crash risk

In the European Union (EU), periodic inspection of motor vehicles is mandatory. In Denmark, cars and vans are inspected for the first time four years after the first registration and subsequently every two years, while lorries and buses are inspected annually. Denmark follows the EU minimum requirements, but there have been considerations to increase the frequency of inspections. However, based on previous research, the positive effects on crash risk are questionable. The aim of this study was to investigate the association between time since the most recent inspection and crash risk using nationwide Danish registry data. The hypothesis is that crash risk increases proportional with time since latest inspection. Methodologically, we used a case-control design. In total, 72 089 cars, 11 289 vans, 3 101 lorries and 1 575 buses involved in crashes were included as cases. Five controls were randomly selected per case and matched by age, brand and total weight. The analyses were controlled for odometer reading and the number of brake defects at the latest inspection. The study found no association between periodic inspections and crash risk in separate analyses of each vehicle type. There were no specific effects of inspections of older vehicles aged 10 years or more. This study does not provide evidence for expanding the current Danish inspection programme with more frequent checks of vehicles. The study also indicates that vehicles that are subject to the inspection programme are in good condition such that defects have a small (not negligible) impact on crash risk.

Azithromycin resistance in Escherichia coli and Salmonella from food-producing animals and meat in Europe.

To characterize the genetic basis of azithromycin resistance in Escherichia coli and Salmonella collected within the EU harmonized antimicrobial resistance (AMR) surveillance programme in 2014-18 and the Danish AMR surveillance programme in 2016-19. WGS data of 1007 E. coli [165 azithromycin resistant (MIC > 16 mg/L)] and 269 Salmonella [29 azithromycin resistant (MIC > 16 mg/L)] were screened for acquired macrolide resistance genes and mutations in rplDV, 23S rRNA and acrB genes using ResFinder v4.0, AMRFinder Plus and custom scripts. Genotype-phenotype concordance was determined for all isolates. Transferability of mef(C)-mph(G)-carrying plasmids was assessed by conjugation experiments. mph(A), mph(B), mef(B), erm(B) and mef(C)-mph(G) were detected in E. coli and Salmonella, whereas erm(C), erm(42), ere(A) and mph(E)-msr(E) were detected in E. coli only. The presence of macrolide resistance genes, alone or in combination, was concordant with the azithromycin-resistant phenotype in 69% of isolates. Distinct mph(A) operon structures were observed in azithromycin-susceptible (n = 50) and -resistant (n = 136) isolates. mef(C)-mph(G) were detected in porcine and bovine E. coli and in porcine Salmonella enterica serovar Derby and Salmonella enterica 1,4, [5],12:i:-, flanked downstream by ISCR2 or TnAs1 and associated with IncIγ and IncFII plasmids. Diverse azithromycin resistance genes were detected in E. coli and Salmonella from food-producing animals and meat in Europe. Azithromycin resistance genes mef(C)-mph(G) and erm(42) appear to be emerging primarily in porcine E. coli isolates. The identification of distinct mph(A) operon structures in susceptible and resistant isolates increases the predictive power of WGS-based methods for in silico detection of azithromycin resistance in Enterobacterales.

Presence and development of diabetic retinopathy in 16 999 patients with type 1 diabetes in the Danish Registry of Diabetic Retinopathy.

To evaluate the five-year incidence of diabetic retinopathy (DR) and associated risk markers in patients with type 1 diabetes in the national Danish DR-screening programme. Based on national data, we included all 16 999 patients with type 1 diabetes in the Danish Registry of Diabetic Retinopathy, who attended the national screening programme in the period 2013-2018. According to the worse eye at first screening, DR was classified (levels 0-4) and linked with various national health registries to retrieve information on diabetes duration, systemic comorbidity, and medication. At first screening, median age and duration of diabetes were 45.0 and 16.7 years, and 57.5% were males. The prevalence and five-year incidences for DR and progression to proliferative DR (PDR) were 44.2%, 8.9% and 2.0%, respectively. In multivariable Cox models, the incidence endpoints were associated with duration of diabetes (hazard ratio [HR] 1.76, 95% confidence interval [CI] 1.63-1.89, and HR 2.04, 95% CI 1.73-2.40 per 10 years), moderately low Charlson Comorbidity Index score (HR 1.27, 95% CI 1.10-1.47, and HR 2.80, 95% CI 2.23-3.51), and use of blood pressure lowering medication (HR 1.20, 95% CI 1.05-1.36, and HR 1.98, 95% CI 1.53-2.57). In a study of all patients with type 1 diabetes from the Danish DR-screening programme, we identified duration of diabetes, systemic disease and use of anti-hypertensive treatment as consistent risk markers for incident and progressive DR.

High risk of peripheral ischemia in patients on dialysis without diabetes mellitus.

Background: Patients on dialysis have an increased risk of peripheral arterial disease. This nationwide Danish cohort study describes the incidence of lower extremity amputation or revascularization in patients treated with dialysis and explores influence of diabetes mellitus and dialysis modality over time. Methods: By individual-linkage between nationwide registries, risk of lower extremity amputation or revascularization was compared between two time periods and groups of patients treated with hemodialysis or peritoneal dialysis, with or without diabetes mellitus. Results: We assessed risk of lower extremity amputation or revascularization in 75 419 patients with diabetes not on dialysis and 10 908 dialysis patients. Compared with the background population, hazard ratio for lower extremity amputation or revascularization associated with diabetes or treated with peritoneal dialysis without diabetes was equal, hazard ratio 12. Patients with diabetes on hemodialysis had hazard ratio 117(104-131) in the period 1997-2004 with lower hazard ratio in the later period, hazard ratio 68(60-77). For patients treated with hemodialysis with no diabetes, hazard ratio was not lower in the second time period; hazard ratio 15(13-18) vs hazard ratio 17(14-20). Hazard ratios of lower extremity amputation or revascularization were not significantly lower in patients with peritoneal dialysis and diabetes in the later period, hazard ratio 38(30-48) vs 30(23-37). For patients on hemodialysis with diabetes a lower hazard ratio was found in the later period. Patients without diabetes had almost the same risk of lower extremity amputation or revascularization over time. Patients on peritoneal dialysis had, compared to patients treated with hemodialysis, lower risk of lower extremity amputation or revascularization. Conclusions: Patients on dialysis without diabetes had an equal or increased risk of lower extremity amputation or revascularization compared to patients with diabetes not on dialysis. Patients on dialysis with diabetes had higher risk compared to those without diabetes. Risk was higher in patients on hemodialysis compared to patients on peritoneal dialysis. Over time there was a trend towards decreased risk in dialysis patients with diabetes. The Danish programme for yearly evaluation of peripheral ischemia by podiatricians in patients with diabetes may be one of the reasons for the differences seen in risk reduction.

Hip displacements and correctable scoliosis were prevalent in children with cerebral palsy registered in a Danish follow-up programme from 2010 to 2020.

We need a better understanding of non-surgical interventions for hip dislocations and scoliosis. This study estimated the cumulative incidence of problems among children with cerebral palsy and described the type and frequency of therapist-led interventions. The study comprised 1482 children (58% male) aged 0-15 years, with a mean age of 3.6 years, who were registered in the Danish Cerebral Palsy Follow-up Programme from 2010 to 2020. We used the Kaplan-Meier estimator to examine the cumulative incidence of hip displacement, hip dislocation, correctable scoliosis and non-correctable scoliosis. The type and frequency of therapist-led interventions are reported descriptively. The cumulative incidence of hip displacement and hip dislocation were 15.8% and 3.5%, respectively, and 39.0% and 13.9% for correctable and non-correctable scoliosis. The most frequently reported type of therapist-led intervention was a joint range of motion exercise. We found that 60.5% with hip displacements and 43.8% with correctable scoliosis used a standing aid. A further 5.4% used a spinal orthosis to prevent deformity and 8.1% for stabilisation. Hip displacement and correctable scoliosis were prevalent in children with cerebral palsy, whereas the occurrence of hip dislocations and non-correctable scoliosis was low. The use of assistive aids was low.

Danish community pharmacies supporting self-care for patients

In Denmark, self-care has been a part of the health care professional and health political discourse since the middle of the 1970s particularly in relation to prevention. However, the concept has become more visible in connection with the Danish government's public health programme “Healthy throughout life” from 2002 to 2010, where patients' self-care was highlighted as an important element in preventing disease progression and complications. Self-care in Denmark is seen as a partnership between the patient and the health care professional. Some self-care activities in Danish community pharmacies are mentioned in national and municipal guidelines for better prevention and self-care regarding obesity, sexual health, smoking cessation, teaching patients/relatives and vaccination. This paper describes self-care activities and services delivered by Danish community pharmacies gathered from survey results at 33 community pharmacies, oral communication with the Association of Danish Pharmacies and published papers on Danish community pharmacy services.Self-care activities in Danish community pharmacies include counselling (about health, self-care, prescription medication, and OTC medication), health campaigns, collaborations with other health care professionals and patient associations and community pharmacy services, all with the purpose to support correct medication use, medication safety and to contribute to health promotion and prevention. These cover activities on prevention, detection, minor ailments, and chronic disease. Six of ten future community pharmacy contributions to medication safety and prevention in future health care, described by the Association of Danish Pharmacies, are related to community pharmacies' support of patients towards better self-care. In the future, Danish community pharmacies should consider offering self-care activities by expanding existing counselling, community pharmacy services and collaborations. Remuneration also needs to be aligned for the activities to succeed and become an integrated part of prevention packages and national initiatives that support patient self-care.

Supporting Families with Breast Cancer: Insights from the Danish Nurse-Led Program “The Children's Tour” for Families with Parental Cancer

PurposeThis study explores how a Danish nurse-led program designed to provide support to families where mothers are affected by breast cancer is experienced by the women attending the program and the nurses organizing it. Their experiences provide insights into the program's impact and potential areas of improvement and inform future interventions targeting the well-being of this specific population. Data SourcesThe study involved data collected through qualitative research. An observational study of the intervention was conducted to inform the development of an interview guide for semistructured individual interviews and a focus group interview. Five women with breast cancer and children aged 5 to 16 years were interviewed, and four nurses involved in the nurse-led program took part in the focus group interview. Data were audio recorded, transcribed verbatim, and thematically analyzed. ConclusionFamilies participating in the nurse-led program reported it helpful in many ways. Three themes emerged from the analysis of the interviews: 1) “How to talk about parental cancer with school-aged children,” 2) “Setting up the room,” and 3) “Exchanging imagination for reality.” Getting familiar with the treatment room and nurses, playing with hospital gear (syringes, bandages, and the treatment chair), and watching a movie together indicate that the visit to the ward is important and cannot be entirely replaced by digital solutions. With the need for support and limited resources at the hospital, it is pivotal to identify the families most in need. Implications for Nursing PracticeWomen with breast cancer parenting adolescent children need family-based care based at the hospital. Further research is needed to refine the program to cover the concerns of the whole family, including fathers and grandparents, and to apply the program to other families with parental cancer of other types.

Antimicrobial resistance monitoring in the Danish swine production by phenotypic methods and metagenomics from 1999 to 2018.

BackgroundIn Denmark, antimicrobial resistance (AMR) in pigs has been monitored since 1995 by phenotypic approaches using the same indicator bacteria. Emerging methodologies, such as metagenomics, may allow novel surveillance ways.AimThis study aimed to assess the relevance of indicator bacteria (Escherichia coli and Enterococcus faecalis) for AMR surveillance in pigs, and the utility of metagenomics.MethodsWe collated existing data on AMR and antimicrobial use (AMU) from the Danish surveillance programme and performed metagenomics sequencing on caecal samples that had been collected/stored through the programme during 1999-2004 and 2015-2018. We compared phenotypic and metagenomics results regarding AMR, and the correlation of both with AMU.ResultsVia the relative abundance of AMR genes, metagenomics allowed to rank these genes as well as the AMRs they contributed to, by their level of occurrence. Across the two study periods, resistance to aminoglycosides, macrolides, tetracycline, and beta-lactams appeared prominent, while resistance to fosfomycin and quinolones appeared low. In 2015-2018 sulfonamide resistance shifted from a low occurrence category to an intermediate one. Resistance to glycopeptides consistently decreased during the entire study period. Outcomes of both phenotypic and metagenomics approaches appeared to positively correlate with AMU. Metagenomics further allowed to identify multiple time-lagged correlations between AMU and AMR, the most evident being that increased macrolide use in sow/piglets or fatteners led to increased macrolide resistance with a lag of 3-6 months.ConclusionWe validated the long-term usefulness of indicator bacteria and showed that metagenomics is a promising approach for AMR surveillance.

Cognitive assessment of literacy learning difficulties in adult non- or low-literate second language learners.

The population of non- or low-literate adult immigrants studying a new language is large and growing in many countries. The aim of this study was to develop and validate a new instrument for theassessment of cognitive impairment that may hinder literacy learning in adult non- or low-literate L2 learners, the Cognitive Assessment of Literacy Learning Difficulties (CALL), in a language center setting. This was a case-control study in which the CALL was validated in adult non- or low-literate students, or students who were not literate in the Latin alphabet, in nine Danish language centers. Educator classification of students with very slow progression in learning basic Danish literacy was used asa benchmark for literacy learning difficulties. Classification was further based on the number of lessons participants had required to pass tests during Danish language program levels. An acceptable discriminative validity (AUC 0.76; specificity 0.94, sensitivity 0.64) for literacy learning difficulties (n=32) versus schooling and sex matched control participants (n=28) was found. In comparison, years of formal schooling had an AUC of 0.58. Age had a small effect on the ability of the CALL to predict literacy learning difficulties (OR=1.097, p=0.013), whereas sex and years of schooling did not. CALL was found to be a valid instrument for identification of cognitive impairment that may hinder literacy learning in adult non- or low-literate L2 learners in a Danish language center setting.

Using public procurement of organic food to promote pesticide-free farming: A comparison of governance modes in Denmark and Sweden

Promoting organic farming is the ultimate strategy to reduce the use of synthetic pesticides. Denmark and Sweden have introduced measures to increase organic consumption as a policy strategy to expand the organic farm sector. Both countries have introduced public procurement programmes for organic food in public sector institutions. While the Danish procurement programme relied on a set of central government policy instruments, the Swedish programme used a national organic consumption goal for the public sector as the main measure. In a Nordic context, both programmes were successful as they reached significantly higher organic consumption levels than those of the other Nordic countries. However, the Swedish procurement programme performed better than the Danish. The article undertakes a comparative analysis of the governance modes in the two programmes. These developed differently. In Denmark, governance was characterised by centrally governed programme initiatives whereas the Swedish governance mode limited the role of central government to setting direction and leaving it to local and regional government to adopt specific measures. The comparative analysis does not allow drawing firm conclusions about the effect of governance modes on programme success as the institutional context was most conducive for success in Sweden. Nonetheless, the analysis does highlight that the Swedish governance mode resulted in a high level of local engagement in increasing organic food procurement. Despite the differences, the cases suggest two pathways for successfully increasing public procurement of organic food as a measure to expand pesticide-free farming.

Bidirectional 5-year risks of diabetic retinopathy, glaucoma and/or ocular hypertension: Results from a national screening programme.

We aimed to investigate if diabetic retinopathy (DR), glaucoma and/or ocular hypertension (OHT) are prospectively linked, as previous studies have proposed cross-sectional associations, but longitudinal data from larger cohorts are lacking. We performed a bidirectional 5 years prospective, registry-based cohort study. We extracted data from national registers, including the Danish Registry of Diabetic Retinopathy, the Danish Civil Registration System, the Danish National Patient Register and the Danish National Prescription Registry. DR level was defined by the highest level of the two eyes. Glaucoma and/or OHT was defined by diagnostic codes (H40*) or at least three redeemed prescriptions of glaucoma medication (S01E*) within 1 year. We included 205 970 persons with diabetes and 1 003 170 age- and gender-matched non-diabetes controls. Exposures were level-specific DR (i) and glaucoma and/or OHT (ii), and outcomes were hazard ratios (HRs) for 5 years incident glaucoma and/or OHT (i) and DR (ii). Persons with diabetes were more likely to develop glaucoma and/or OHT (multivariable adjusted HR 1.11, 95% CI 1.06-1.15), but this did not depend on the level of DR. In persons with diabetes, those with glaucoma and/or OHT were more likely to develop DR (multivariable adjusted HR 1.12, 95% CI 1.03-1.23) within 5 years. In a national cohort, diabetes associated with a little higher risk of upcoming glaucoma and/or OHT, and, inversely, the presence of the latter predicted a higher risk of incident DR. Nevertheless, our data do not seem to justify including glaucoma evaluation in the national Danish DR-screening programme.

Undergraduate students' experiences of participating in a Danish respite programme for young carers-A mixed methods study.

Age-appropriate communication and interaction are essential when meeting young carers, requiring in-depth knowledge and experience. Volunteer programmes may enhance undergraduate students' competencies in this regard. This pilot study evaluated undergraduate students' perceptions of volunteering on the Buddies for Children and Youngsters (BCY) programme by assessing the extent to which students experienced an improvement in their relational and communication competencies and/or felt better equipped for their future work. The researchers conducted a mixed methods study with a parallel design, focussing on undergraduate students from the University College of Northern Denmark within the field of nursing, teaching, pedagogy, physiotherapy, and occupational therapy. The students participated in the programme for at least 4months. Forty-two students responded to a questionnaire, and 17 students were selected to participate in four focus groups. The results showed that participation in the programme improved the students' communication and relational competencies to some degree. The programme provided the students with experience of age-related communication on both informal and difficult topics, and of building relationships and solving relational challenges. Also, the programme generally equipped students for future work with young carers and children. In conclusion, the BCY programme is a relevant supplement to regular educational activities. Decision makers within politics of health, health planning and management, should therefore consider implementation of such programmes in relevant educational areas.

Barriers for Participation in the Danish Colorectal Cancer Screening Program: a Qualitative Study.

The participation rate in the Danish National Screening Program for Colorectal Cancer is around 60%. Since early detection of cancer through the colorectal cancer screening program (CRCS) reduces mortality rates, it is important to understand why people do not participate. The aim of this study was therefore to examine in depth why some people do not participate in the Danish CRCS program. Individual semi-structured interviews were conducted with 18 people who had not participated in the national CRCS program. Data was analyzed using an inductive hermeneutic approach. The analysis uncovered three main themes describing barriers to screening: (a) the accountability for ensuring personal health covered the following sub-themes: (i) when invitation is out of sight it is out of mind, (ii) aversion against own stool sample collection, and (iii) the perceived risk of getting colorectal cancer (CRC); (b) attitudes towards the healthcare system and its organization covered the following sub-themes: (i) positivity towards CRCS, (ii) trust in the healthcare system, (iii) lack of internal communication in the healthcare system, and (iv) wish for involvement of the general practitioner (GP); (c) knowledge about disease and screening covered the following sub-themes: (i) knowledge about CRC and CRCS, (ii) wish for information via new channels, and (iii) CRC is rarely something you talk about. Among the informants included in this study, lack of participation in the CRCS program was not due to an active opt-out, as most informants had intentions of participating. The informants thought it would motivate them to participate if their GP would remind them of the screening program.

Universal screening for postpartum depression? Inequalities and barriers among immigrant mothers

Abstract Background Postpartum depression (PPD) is a serious public health concern affecting 12% of women globally. Early detection is necessary to provide timely support. In Scandinavian countries, universal screening is recommended. However, migrant women, who are at increased risk of PPD, seem to be screened less often. Still, there is limited knowledge about 1) how acculturation relates to screening, and 2) how healthcare providers navigate PDD screening with migrant women. Aims and methods We used a mixed-methods approach to explore whether and why inequalities in PPD screening using the Edinburgh postpartum depression scale (EPDS) may exist in the context of universal PPD screening within the free home-visiting program in Denmark. Data from 77,694 infants and their mothers participating in the Danish home-visiting program (2015-2018) was used to examine the prevalence of participation in PPD screening and its association with migrant status and acculturation factors. We interviewed 16 health visitors to examine qualitatively challenges and strategies used when assessing PPD among immigrant mothers. Results Immigrant women were 80% more likely to lack screening (adj. RR 1.81-1.90). All factors indicating lower acculturation, such as shorter length of residence, older age at migration, and having studied abroad were independently associated with increased risk of lack of screening. Thematic analysis of qualitative data showed how cultural and linguistic differences and organizational constraints limit health visitors’ ability to assess immigrant women's mental health needs. Although health visitors often used EPDS as an opener to talk about mental health, they did not use it as an ‘assessment’. Conclusions This study shows inequalities in PPD screening than may result in reduced use of mental health services among immigrant women. The experiences of health visitors shed light on how to improve the identification of PPD among immigrant mothers. Key messages • Migrant women in Denmark, even those who have migrated as children, are at risk of being left out of PPD screening programs. • Limited organizational support and cultural competences makes PPD screening among immigrant women not feasible for maternal health visitors.

Measuring social marginalisation: using SEM to uncover essential social factors underlying social marginalisation in public schools

ABSTRACT This study aimed to uncover key variable relationships underlying social marginalisation of students in public schools. Structural equation modelling was conducted on a large subset of the Danish Programme for Learning Management survey (2017) containing both student (Grades 4–10, ages 10–16) and parent responses (N = 42,702). The Social Marginalisation Scale (SMS) was utilised. The results indicate that teacher support is vital for securing a positive classroom environment and for protecting students against social marginalisation. Moreover, a stronger parental community was associated with a more supportive classroom environment and lower social marginalisation in school.

Student conceptions of problem and project based learning in engineering education: A phenomenographic investigation

AbstractBackgroundProblem‐oriented project work, also known as problem and project‐based learning (PBL), is a popular educational approach in engineering education. However, the focus of the literature on the implementation of PBL has been at the course and institutional levels. Scant attention has been paid to the student experience, especially regarding student conceptions of PBL.PurposeThis is a phenomenographic study of student conceptions of PBL in a Danish engineering program that uses a systemic PBL model.Design/methodThis study follows a phenomenographic qualitative design. Sixteen participants from four different engineering disciplines were asked to share their views and experiences with PBL. The interview transcripts were analyzed to identify emerging variations in the student conceptions of PBL.ResultsThe outcome space suggests three levels of students' conceptions of PBL: individual, group and society levels. Within the categories of description, sublevel variations appear: PBL as an unsupportive process and environment, PBL as a supportive process and environment, and PBL as a structured education method. These conceptions were organized hierarchically from a narrow individual to a broader society level.ConclusionsStudent conceptions of PBL as a structured education method echo the literature on the intended learning outcomes of PBL. However, our study shows that conceptions of PBL as personal and social processes fall outside of the scope of current scholarly discussions on PBL. Issues of societal relevance, while prominent in the literature on PBL, do not feature in students' thinking about PBL at this stage. Introducing broader reflection practices informed by exemplarity could address some of these discrepancies.

Who Should Get Vaccinated First? Limits of Solidarity during the First Week of the Danish Vaccination Programme

AbstractThe coronavirus disease 2019 (COVID-19) pandemic resulted in several acute shortages of healthcare provision and thereby posed a challenge to solidarity among citizens of welfare states. One example was the limited number of vaccine batches at the outset of European COVID-19 vaccination campaigns. This resulted in a rare constellation in which citizens faced both a unifying collective threat but also a scarcity of healthcare resources that necessitated the prioritization of certain groups for an early vaccination. On that premise, we conducted a survey experiment during the first week of the Danish vaccination programme. Our results demonstrate that citizens judged who deserves early access to preventive healthcare along established lines of welfare chauvinism. Fictitious diabetes patients with a Muslim name and those who recently immigrated were regarded as less deserving of an early vaccination. That said, concerns over responsibility for one’s hardship and anti-social free-rider behaviour drive citizens considerations, too. Contra our hypotheses, we find only weak evidence that immigrants or Muslims are penalized more harshly for an irresponsible lifestyle or free-rider behaviour. Compared with previous research, we study a unique moment in history and are the first to disentangle minority status from stereotypes about their anti-social free-riding behaviour and irresponsibly unhealthy lifestyles.

A national needs assessment to identify technical procedures in plastic surgery for simulation-based training

Medical simulation is not developed and integrated into plastic surgery unlike other surgical specialties despite the procedures being complex and require practice. First step in enhancing simulation in plastic surgery is to clarify the need among peers. The objective of the study was to identify and prioritize the technical procedures that should be included in a simulation-based curriculum for residency training in plastic surgery. A panel of participants with key roles in the Danish plastic surgery specialist training program was appointed. Participation was voluntary. A national need assessment study was performed using a three-round Delphi process to collect information from the participants. In round 1, participants reported all the procedures that a newly qualified specialist in plastic surgery should be able to perform. In round 2, participants replied to a survey exploring the frequency of the procedures, the number of surgeons performing the procedure, the risk or discomfort for patients treated by an inexperienced surgeon and the feasibility of training the procedure in simulation, resulting in a preliminary ranking of procedures. In round 3, participants eliminated and reprioritized the identified procedures according to importance. Thirty-five of 37 agreed to enter the expert panel. The response rate was 97%, 86% and 86% for rounds 1, 2 and 3, respectively. Twenty-nine of 136 procedures identified in round 1 reached the final prioritized list of procedures relevant for simulation training in plastic surgery.