Danish Setting Research Articles

Management of Patients with Type 2 Diabetes with Once-Weekly Semaglutide Versus Dulaglutide, Exenatide ER, Liraglutide and Lixisenatide: A Cost-Effectiveness Analysis in the Danish Setting.

IntroductionOnce-weekly semaglutide is a novel glucagon-like peptide-1 (GLP-1) analog for the treatment of type 2 diabetes (T2D) that has been associated with greater reductions in glycated hemoglobin (HbA1c) and body weight versus GLP-1 receptor agonists dulaglutide, exenatide extended-release (ER), liraglutide and lixisenatide in the SUSTAIN trial program and a network meta-analysis (NMA). The aim of the present study was to assess the long-term cost-effectiveness of semaglutide versus all available GLP-1 receptor agonists in Denmark, using a clinically orientated treatment approach.MethodsOutcomes were projected over patient lifetimes using the IQVIA CORE Diabetes Model. Baseline characteristics and treatment effects were sourced from the corresponding SUSTAIN trials and the NMA. Patients were assumed to initiate GLP-1 receptor agonist therapy and subsequently treatment-intensify according to clinical treatment guidelines, with addition of basal insulin and switching to basal-bolus insulin occurring when HbA1c exceeded recommended targets. Patients were assumed to receive a GLP-1 receptor agonist plus basal insulin therapy once HbA1c levels reached 7.5% and a basal-bolus insulin regimen once HbA1c exceeded 8.0%. Costs were captured in 2017 Danish kroner (DKK), with future costs and outcomes discounted at 3% per annum.ResultsPrimary analyses indicated that semaglutide 0.5 mg and 1 mg were associated with improvements in quality-adjusted life expectancy of 0.11 and 0.34 quality-adjusted life years, respectively, versus dulaglutide, achieved at cost savings of DKK 289 and DKK 13,416, respectively. Supporting analyses indicated that both doses of semaglutide were either cost-effective or dominant versus exenatide ER, liraglutide 1.2 mg and 1.8 mg and lixisenatide.ConclusionSemaglutide represents a cost-effective alternative to other GLP-1 receptor agonist therapies available in Denmark, demonstrating clinical benefits versus dulaglutide, exenatide ER, liraglutide and lixisenatide for the treatment of patients with T2D.FundingNovo Nordisk A/S.Plain Language SummaryPlain language summary available for this article.Electronic supplementary materialThe online version of this article (10.1007/s13300-019-0630-6) contains supplementary material, which is available to authorized users.

Narrative Complexity and Cultural Relevance in the Name of Public Service Broadcasting: The Cases of Borgen and Herrens Veje

Abstract Danish television has been able to produce a remarkable number of successful primetime dramas over the last years from Forbrydelsen (The Killing, DR 2007-12) to Herrens Veje (Ride upon the Storm, DR 2017-). Many of them are Nordic Noir crime dramas, yet the list also includes political thrillers and family dramas. This article briefly summarizes main reasons for the prolific production environment at public service broadcaster Danmarks Radio (DR). Some of the exceptional circumstances of Danish television demonstrate why the relatively small country was able to produce shows that found devoted audiences around the world. While the DR production framework has received much attention, this article takes a closer look at narrative composition, issues of characterization and the presentation of themes. Analyzing the first episodes of Borgen (DR 2010-13) and Herrens Veje, the article proposes that it is specifically the combination of multiperspectivity of the leading protagonists and how their life is linked to wider cultural, social and political debates, that can be identified as one main outcome of the fruitful collaboration between DR and various creative personnel. While both shows adhere to the main characteristics of complex serial drama as identified by Jason Mittel and Trisha Dunleavy, there are also some noticeable differences, including their strong public service ethos, their unusual Danish settings, the avoidance of transgressive protagonists, character-centred storylines and their slow, indulgent pace.

The Cornell Assessment of Pediatric Delirium: Translation and inter-rater reliability in a Danish pediatric intensive care unit.

Delirium is a serious medical problem and recognized as a common syndrome in critically ill children. Without routine screening, delirium diagnosis is often missed by the medical providers. Internationally, there are tools to assess pediatric delirium (PD), but none currently available in Danish. The aim of this project was to translate the Cornell Assessment of Pediatric Delirium (CAPD) into Danish and determine its feasibility and reliability in a Danish clinical setting. Translation was done in accordance with WHO guidelines. Linguistic and cultural differences were reconciled with the original developers of the instrument. The Danish CAPD was then tested in a prospective cohort of children admitted to a single pediatric intensive care unit at a university hospital in Denmark. Inter-rater reliability was determined using weighted Kappa statistics. Thirty children were enrolled, and 92 delirium assessments were completed. Inter-rater reliability (n=84) revealed that inter-observer agreement among the nurses was high (κ 0.85). The Danish version of the CAPD was successfully administered in all children. Standardized assessment tools are a pre-requisite to identify PD. A Danish version of the CAPD now exists, and preliminary testing has demonstrated it as feasible and reliable for use in a Danish clinical setting. A multi-institutional study is needed to determine the prevalence of PD in Denmark.

Cross-cultural adaptation of the medical engagement scale into Danish general practice setting

Introduction: The need to involve doctors in healthcare leadership has long been recognized by clinical staff and policymakers. A Medical Engagement Scale has been designed in England to evaluate levels of medical engagement in leadership and management.Objective: The aim of this study was to translate and adapt the scale and to test the translated version for comprehension and suitability in Danish general practice setting.Design and method: The process involved forward translation, backward translation, and field tests. The field tests included cognitive debriefing interviews. In all 30 general practitioners and 5 non-general practitioners participated in the process of translation. After using the scale among 1652 general practitioners statistical analysis was carried out to test internal consistency.Setting: The study was carried out in general practice in Denmark.Results: Several changes made during the process in order to achieve a Danish version that is acceptable, understandable and still capable of measuring medical engagement comparable of the original English version. Analysis of scale internal consistency using Cronbach’s alpha revealed acceptable reliability for all three meta-scales, which ranged from 0.69 to 0.81. The overall tool achieved a Cronbach’s alpha of 0.89.Conclusion: The Danish version of the Medical Engagement Scale is a valid and reliable tool that is acceptable and relevant for general practice in Denmark.Key pointsThis study describes the cross-cultural adaptation of the Medical Engagement Scale from a UK primary healthcare setting to a Danish primary healthcare setting.The process produced a relevant and acceptable questionnaire measuring medical engagement.Internal consistency revealed acceptable reliabilityThe translation of the scale provides the possibility to use this scale for practical and academic purposes.

Community reinforcement and family training (CRAFT) - design of a cluster randomized controlled trial comparing individual, group and self-help interventions

BackgroundAround 585,000 people in Denmark engage in harmful use of alcohol with 140,000 suffering from outright alcohol dependence. The concerned significant others (CSOs) are affected by the drinking, often suffering almost as much as the person with alcohol use disorder. Community Reinforcement and Family Training (CRAFT) is aimed at CSOs who struggle unsuccessfully, in an effort to motivate their loved ones to stop drinking and seek treatment. The aims of this study are 1) To implement CRAFT interventions into the daily routine of operating Danish alcohol treatment centers 2) To investigate whether 6-week-individual CRAFT, 6-week-open group-based CRAFT or CRAFT based on self-help material, is efficient in getting problem drinkers to seek treatment for their alcohol problems 3) To investigate which of the three interventions (individual, group or self-directed CRAFT) is the most effective and in which group of population.MethodsThe study is a three-arm, cluster randomized controlled trial: A: individual CRAFT, group CRAFT, and CRAFT as a self-help intervention. A total of 405 concerned significant others to persons with alcohol abuse will be recruited from 24 alcohol outpatient clinics. The participants will fill out a questionnaire regarding i.e. life quality, if the drinking person entered treatment (main outcome) and satisfaction with the intervention, at baseline and after 3 and 6 months.DiscussionWe expect to establish evidence as to whether CRAFT is efficient in a Danish treatment setting and whether CRAFT is most effective at individual, group or self-help material only.Trial registrationClinical trials.gov ID: NCT03281057. Registration date: September 13th, 2017.

Time from referral to ovarian tissue cryopreservation in a cohort of Danish women.

Young women with a cancer diagnosis often have very little time to decide whether or not to commence fertility-preserving strategies before initiating potentially sterilizing cancer treatment. Minimizing the interval from opting for fertility preservation to completion of the procedure will reduce the potential risk of delaying cancer treatment. In the current study, we have evaluated the period of time from referral to ovarian tissue cryopreservation (OTC) to actual freezing of the tissue in a cohort of Danish women. The study population comprised 277 consecutive patients with both malignant and nonmalignant diseases referred for OTC from four centers in the Danish network. Statistical analysis was conducted to analyze the impact of age, diagnosis, and referring center on the time from OTC-referral to OTC. A literature search for "random start" protocols for controlled ovarian stimulation (COS) for fertility preservation in cancer patients was performed. The time from OTC-referral to OTC was significantly influenced by diagnosis, age, and referring center. Women with malignant diseases other than breast cancer, such as sarcomas, pelvic cancers, and hematological cancers, experienced a significantly shorter interval to OTC (5days) than women with breast cancer (7days) and nonmalignant diseases including systemic, ovarian, and hereditary conditions (13-17.5days). Women over the age of 30years experienced a significantly longer time to OTC (P<0.03), and the diagnosis determined the length of the interval (P<0.001). According to the literature, fertility preservation by oocyte vitrification requires 13-14days, as the average time for 1 round of COS was 11days and oocyte collection can be performed 2days later. It is in the interest of both cancer patients and clinicians to perform fertility preservation as quickly and safely as possible. In a Danish setting, OTC provides a short interval of around 6days from the patient choosing this option to completion of the procedure. This is considerably less time than what is needed to perform COS and oocyte vitrification, and therefore OTC might be considered the preferred choice of fertility preservation when urgency is needed.

Efficacy of Internet-Delivered Acceptance and Commitment Therapy for Severe Health Anxiety: Results from a Randomized, Controlled Trial

Background: Health anxiety is common, disabling and costly due to patients' extensive use of health care services. Internet-delivered treatment may overcome barriers of accessibility to specialized treatment. We aimed to evaluate the efficacy of internet-delivered Acceptance and Commitment Therapy (iACT). Methods: A randomized, controlled trial of iACT versus an internet-delivered discussion forum (iFORUM), performed in a Danish university hospital setting. Patients self-referred and underwent video-diagnostic assessment. Eligible patients (≥18 years) with health anxiety were randomized to 12 weeks of intervention. The randomization was blinded for the assessor. The primary outcome was between-group unadjusted mean differences in health anxiety symptoms measured by the Whiteley-7 Index (WI-7, range 0-100) from baseline to 6-month follow-up (6-MFU) using intention to treat and a linear mixed model. Outcomes: 151 patients self-referred, and 101 patients were randomized to iACT (n=53) or iFORUM (n=48). A mean difference in change over time of 19*0 points (95% CI 10*8-27*2, p<0*001) was shown on the WI-7. The number needed to treat was 2*8 (CI 95% 1*8-6*1, p<0*001), and twice as many patients in iACT were no longer clinical cases (35% vs 16%; RR 2*17, 95% CI 1*00-4*70, p=0*050). Adverse events were few and insignificant. Interpretation: iACT for health anxiety led to sustained effects at 6-MFU. The study contributes to the development of easily accessible treatment options and deserves wider application. Trial Registration: The study is registered at clinicaltrials.gov, number NCT02735434. Funding Statement: The Danish Foundation, Trygfonden, (grant no. 102644). Declaration of Interests: The Research Clinical for Functional Disorders at Aarhus University Hospital, Denmark received funding from the Danish foundation TrygFonden for this project. DH, CUR, JSJ and LF declares no competing interests. EHL is shareholder of DahliaQomit Inc, a company specializing in online psychiatric symptom assessment. Ethics Approval Statement: The study was approved by the Ethical Committee in Central Region Denmark, January 2016 (ID no. 1-10-72-321-15) and by the Danish Data Protection Agency, February 2016 (ID no. 1-16-02-51-16).

Labour outcomes in caseload midwifery and standard care: a register-based cohort study

BackgroundResearch on caseload midwifery in a Danish setting is missing. This cohort study aimed to compare labour outcomes in caseload midwifery and standard midwifery care.MethodsA historical register-based cohort study was carried out using routinely collected data about all singleton births 2013–2016 in two maternity units in the North Denmark Region. In this region, women are geographically allocated to caseload midwifery or standard care, as caseload midwifery is only available in some towns in the peripheral part of the uptake areas of the maternity units, and it is the only model of care offered here. Labour outcomes of 2679 all-risk women in caseload midwifery were compared with those of 10,436 all-risk women in standard midwifery care using multivariate linear and logistic regression analyses.ResultsCompared to women in standard care, augmentation was more frequent in caseload women (adjusted odds ratio (aOR) 1.20; 95% CI 1.06–1.35) as was labour duration of less than 10 h (aOR 1.26; 95% CI 1.13–1.42). More emergency caesarean sections were observed in caseload women (aOR 1.17; 95% CI 1.03–1.34), but this might partly be explained by longer distance to the maternity unit in caseload women. When caseload women were compared to women in standard care with a similar long distance to the hospital, no difference in emergency caesarean sections was observed (aOR 1.04; 95% CI 0.84–1.28).Compared to standard care, infants of caseload women more often had Apgar ≤7 after 5 min. (aOR 1.57; 95% CI 1.11–2.23) and this difference remained when caseload women were compared to women with similar distance to the hospital.For elective caesarean sections, preterm birth, induction of labour, dilatation of cervix on admission, amniotomy, epidural analgesia, and instrumental deliveries, we did not obseve any differences between the two groups. After birth, caseload women more often experienced no laceration (aOR 1.17; 95% CI 1.06–1.29).ConclusionsFor most labour outcomes, there were no differences across the two models of midwifery-led care but unexpectedly, we observed slightly more augmentation and adverse neonatal outcomes in caseload midwifery. These findings should be interpreted in the context of the overall low intervention and complication rates in this Danish setting and in the context of research that supports the benefits of caseload midwifery. Although the observational design of the study allows only cautious conclusions, this study highlights the importance of monitoring and evaluating new practices contextually.

Student and staff perceptions of alcohol as part of student life in Denmark: A Q methodology study.

IntroductionIntervening effectively to prevent students’ harmful use of alcohol remains a challenge. Harmful alcohol use has been noted as the most dominant public health problem facing universities today. This study sought to investigate the diversity in staff and student perceptions of the contribution alcohol makes to student life in a Danish university setting. Increasing understanding of staff and students’ perceptions of how alcohol fits into student life is required to amend future public health intervention for this population.Materials and methodsThis Q methodology study included 38 staff members and 105 students from Aarhus University, Denmark. Participants used online Q sorting software, to rank 40 statements about the contribution alcohol makes to the university student experience from strongly agree to disagree. To support the interpretation of the factors, self-reported alcohol consumption and demographic data were collected. In addition qualitative data was collected on the participant’s reasons for the ranking of the items they most strongly agreed or disagreed with.Results and discussionUsing principal components analysis, five statistically independent viewpoints for students and four for staff were identified.The findings provide evidence to inform approaches to prevent harmful alcohol use. Some viewpoints suggest a need for tailored secondary and tertiary prevention and intervention that focusses on individuals and/or sub-groups who are at risk of consuming alcohol at harmful levels. Other viewpoints suggest the need for primary universal prevention to support the maintenance of healthy norms which can prevent harmful alcohol behaviour. Public health campaigns need to ensure that interventions targeting harmful alcohol use at universities challenge problematic perceptions and attitudes while also bolstering exposure to positive norms.

Maternal Antibiotic Use During Pregnancy and Type 1 Diabetes in Children—A National Prospective Cohort Study

Prenatal prescription of antibiotics is common but may perturb the composition of the intestinal microbiota in the offspring. In childhood the latter may alter the developing immune system to affect the pathogenesis of type 1 diabetes (1). Previous epidemiological studies reported conflicting results regarding the association between early exposure to antibiotics and childhood type 1 diabetes (2,3). Here we investigated the association in a Danish register setting. The Danish National Birth Cohort (DNBC) provided data from 100,418 pregnant women recruited between 1996 and 2002 and their children born between 1997 and 2003 ( n = 96,840). The women provided information on exposures during and after pregnancy. Antibiotic prescription during pregnancy was obtained from the Danish National Prescription Registry (anatomical therapeutic chemical code J01), and type 1 diabetes diagnoses (diagnostic codes DE10 and DE14) during childhood and adolescence were obtained from the Danish National Patient Register. The children were followed until 2014 (mean follow-up time 14.3 years [range 11.5–18.4 years, SD 1.4]). We excluded ( n = 4,828) twins and triplets, children born before gestational week 26, children weighing <500 g at birth, and stillbirths, leaving 92,012 children for unadjusted analyses. Socioeconomic status, parity, maternal diabetes, smoking …

A cost analysis of intensified vs conventional multifactorial therapy in individuals with type 2 diabetes: a post hoc analysis of the Steno-2 study

Aims/hypothesisLong-term follow-up of the Steno-2 study demonstrated that intensified multifactorial intervention increased median lifespan by 7.9 years and delayed incident cardiovascular disease by a median of 8.1 years compared with conventional multifactorial intervention during 21.2 years of follow-up. In this post hoc analysis of data from the Steno-2 study, we aimed to study the difference in direct medical costs associated with conventional vs intensified treatment.MethodsIn 1993, 160 Danish individuals with type 2 diabetes and microalbuminuria were randomised to conventional or intensified multifactorial target-driven intervention for 7.8 years. Information on direct healthcare costs was retrieved from health registries, and the costs in the two groups of participants were compared by bootstrap t test analysis.ResultsOver 21.2 years of follow-up, there was no difference in total direct medical costs between the intensified treatment group, €12,126,900, and the conventional treatment group, €11,181,700 (p = 0.48). The mean cost per person-year during 1996–2014 was significantly lower in the intensified treatment group (€8725 in the intensive group and €10,091 in the conventional group, p = 0.045). The main driver of this difference was reduced costs associated with inpatient admissions related to cardiovascular disease (p = 0.0024).Conclusions/interpretationOver a follow-up period of 21.2 years, we found no difference in total costs and reduced cost per person-year associated with intensified multifactorial treatment for 7.8 years compared with conventional multifactorial treatment. Considering the substantial gain in life-years and health benefits achieved with intensified treatment, we conclude that intensified multifaceted intervention in high-risk individuals with type 2 diabetes seems to be highly feasible when balancing healthcare costs and treatment benefits in a Danish healthcare setting.

Knowledge and behaviour management in the multi-ethnic classroom: an ethnographic study of teachers’ classroom-management strategies and minority pupils’ participation in different school subjects

ABSTRACTWithin the tradition of ethnographic classroom research, this paper studies how pupils with a minority background are disciplined and participate in different school subjects such as Danish, English, math and science in Danish primary and lower secondary school settings. Whereas most research on minority children in classroom contexts focuses either on classroom social norms or effectiveness of teaching methods, this paper aims to understand how classroom behavioural norms and the norms for legitimate participation in the knowledge practices of different subjects impact each other. On one hand, our principal findings indicate that the teacher's foregrounding of behavioural norms in the classroom seems to displace knowledge practices, producing power struggles between pupils and their teachers. On the other hand, the teacher's foregrounding of knowledge practices tends to make schooling more meaningful for pupils, thereby reducing power struggles.

Children centered care: Minimizing the need for anesthesia with a multi-faceted concept for MRI in children aged 4–6

PurposeTo evaluate the need for general anesthesia (GA) in MRI in children aged 4–6 years, using a multi-faceted concept, Children Centered Care (CCC), compared to a standard setup. Materials and MethodsIn this prospective study of 81 children, we developed and tested a multi-faceted concept, CCC, for MRI in children aged 4–6 without GA, comparing it to a standard setup. The CCC included: 1) an interactive app, 2) a trained pediatric team, 3) a children’s lounge with a toy-scanner, and 4) a child-friendly multimedia environment in the MRI room. Patients were included from February-September 2016 and 2017. The use of GA was evaluated, image quality was assessed and a cost-benefit analysis was done. ResultsWe included 40 children in the control group and 41 in the CCC group. Mean age was 5.8 years and 48 (59%) were males. Neuro and orthopedic imaging accounted for 58 (72%) and 22 (27%), respectively. With the CCC setup 39/41 (95%) completed a diagnostic MRI without GA compared to 17/40 (43%) in the control group (p < 0.001). Image quality was not different between the groups (p = 0.37). The setup proved cost-effective with a payback time of two years in a Danish setting with 250 eligible patients per year. ConclusionWith the multi-faceted concept CCC, the use of GA for MRI in children aged 4–6 was markedly reduced to 5%, image quality was maintained and the setup was cost-effective.

A Cost Analysis of Intensified vs. Conventional Multifactorial Therapy of Patients with Type 2 Diabetes—The Steno 2 Study

Introduction: Follow-up at 21.2 years after the initiation of the Steno-2 study, demonstrated that intensified multifactorial intervention increases median life-span with 7.9 years and delays incident cardiovascular disease (CVD) with a median of 8.1 years compared to conventional multifactorial intervention. Here we aimed to analyse the direct medical costs in the two original treatment groups during 21.2 years of follow-up. Methods: In 1993, 160 Danish patients with type 2 diabetes and microalbuminuria were randomised to receive either conventional or intensified and target-driven multifactorial intervention for 7.8 years. Information on direct health costs was gathered from health registers and any difference of costs in the two groups was assessed by non-parametric bootstrap t-test analysis. Results: Intensified treatment was on average more expensive regarding drug prescriptions, but less expensive in primary health sector services (both p&amp;lt;0.0001) and in-patient admission costs (p=0.02), specifically related to CVD (p&amp;lt;0.0001) during the entire follow-up period. There was no significant difference in total costs between the intensified treatment group, $13.0M and the conventional treatment group, $12.3M (p=0.19). When further assessing the cost per patient year there was no significant difference between the intensified group, $9,648, and the conventional treatment group, $10,681 (p=0.13). Conclusion: Over an average follow-up of 21.2 years we found no significant increase in total costs or in costs per person year associated with intensified multipronged treatment for 7.8 years when compared to conventional multipronged treatment. Considering the substantial gain of years of life and health benefits achieved with intensified treatment we conclude that intensified multifaceted intervention in high-risk patients with type 2 diabetes is highly cost-effective in a Danish health care setting. Disclosure J. Gaede: None. J. Oellgaard: None. R. Ibsen: None. P. Gæde: None. E. Noertoft: Employee; Self; Novo Nordisk A/S. J. Kjellberg: None. O. Pedersen: None.

Danish translation, cultural adaption and initial psychometric evaluation of the patient feedback form

AimNo suitable Danish questionnaire exists to evaluate patient satisfaction with various patient reported outcome measures. Thus, the aim of this research project was to conduct a study on the translation and cultural adaption of an American patient reported experience measures questionnaire, “Patient Feedback Form”, among Danish patients, and to examine selected psychometric properties within reliability.Material and methodsIn the first phase of the study, the Patient Feedback Form was forward and backward translated following the methodology of existing guidelines. Subsequently, cognitive interviewing was performed with seven cancer patients and seven healthy persons (19–86 years old/6 men and 8 women) to ensure that questions were easy to understand and made sense to Danish interviewees.In the second phase, phone interviews were carried out with 95 prostate cancer patients after they had responded to the same Patient Feedback Form. Missing data was imputed using the Expectation-Maximization technique. To examine the structure of the questionnaire, an exploratory factor analysis was conducted. Cronbach’s alpha was calculated to investigate internal consistency.ResultsThere were only minor disagreements in the translation process, and the reconciliation went smoothly (phase 1). With regard to one item, however, it was difficult to reach a consensus. Through the qualitative validation process, the right solution was found. The results from the psychometric testing (phase 2) showed that four factors had an Eigen value > 1, but only one factor was extracted as the Scree plot had a clear “elbow”, showing a one factor structure that explained 46.1% of the variance. The internal consistency was high as Cronbach’s alpha was 0.89.ConclusionThe translated, culturally adapted, and validated version of the Patient Feedback Form seems to be suitable for measuring satisfaction with patient reported outcome measures in a Danish setting. While the results should be treated with caution due to the small sample size, psychometric testing indicates that the questionnaire is a valid instrument. However, additional psychometric testing such as hypotheses testing, responsiveness, and test-retest on a larger and more diverse sample size is required to further verify the validity of the instrument.

Ways of ‘appealing to the institution’ in interprofessional rehabilitation team decision-making

Making decisions in interprofessional team meetings about clients' employability and entitlements to welfare benefits is a balancing act between institutional resources and constraints on the one hand and professional expertise and responsibility on the other. Despite a growing focus, only a handful of discourse and communication oriented studies engage focally on decision-making processes involving different professionals. We specifically address the following research question: how do professionals appeal to the existing institutional norms and frameworks in a contingent manner while processing client cases to arrive at decisions? Our study context is the rehabilitation team meetings in the Danish social work setting. Based on 18 recordings of rehabilitation team meetings we adopt the framework of activity analysis to identify the distributional patterns of appeals to the institution vis-à-vis professional expertise and role-responsibility. Our findings suggest that appeals to the institution can be differentiated at the level of five sub-types depending on what is at stake, e.g. (i) the legal/institutional framework; (ii) the institutional criteria for eligibility; (iii) the institutional categories; (iv) the institutional procedures for case-processing; and (v) anticipating future institutional scenarios. Despite this differentiation, these sub-types of appeal to the institution are interwoven in any stretch of decisional team talk and point to an inherent tension between the so-called institutional order and (inter)professional order.

Is TWEAK a valid screening questionnaire to identify alcohol risk drinkers among pregnant women in Denmark?

Identification of pregnant alcohol risk drinkers is crucial to prevent adverse birth outcomes. The TWEAK screening instrument has shown promising results for identifying risk drinkers. However, as the effectiveness of the screening questionnaire has only been investigated among American women with mainly low socioeconomic status, we aimed to investigate the ability of TWEAK to identify alcohol risk drinkers among pregnant Danish women. During 2000, Danish-speaking women referred to the Midwife Center at Aarhus University Hospital (n = 1554) and Fredericia Hospital (n = 499) for routine antenatal care were invited to participate in the study at their first visit. The women were interviewed about their periconceptional and current drinking habits including average weekly alcohol consumption and binge drinking. Additionally, the women were also asked the questions related to the TWEAK questionnaire. We found that the sensitivity of TWEAK to identify periconceptional risk drinking was quite low, but its ability to identify risk drinkers during pregnancy was marginally higher. Our results suggested that older age (odds ratio 1.46, 95% confidence interval 0.95-2.23), current smoking (odds ratio 2.33, 95% confidence interval 1.63-3.33), being single (odds ratio 2.38, 95% confidence interval 1.38-4.11) and a TWEAK score with a cut-off score of ≥1 (odds ratio 2.75, 95% confidence interval 2.02-3.76) increased the risk of high-risk drinking during pregnancy. In a Danish setting, TWEAK does not seem as an optimal screening tool to identify periconceptional risk drinkers but it may be useful in identifying high-risk drinking during pregnancy.

Importance of implementation level when evaluating the effect of the Hi Five Intervention on infectious illness and illness-related absenteeism

There is limited research on the importance of implementation when evaluating the effect of hand hygiene interventions in school settings in developed countries. The aim of this study was to examine the association between an implementation index and the effect of the intervention. The Hi Five Intervention was evaluated in a 3-armed cluster randomized controlled trial involving 43 randomly selected Danish schools. Analyses investigating the association between implementation of the Hi Five Intervention and infectious illness days, infectious illness episodes, illness-related absenteeism, and hand hygiene were carried out in a multilevel model (school, class, and child). The level of implementation was associated with hand hygiene and potentially associated with number of infectious illness days and infectious illness episodes among children. This association was not found for illness-related absenteeism. Classes that succeeded in achieving a high level of implementation of the Hi Five Intervention had a lower number of infectious illness days and infectious illness episodes, suggesting that the Hi Five Intervention, if implemented adequately, may be relevant as a tool to decrease infectious illness in a Danish school setting.

From Implicit Norms to Explicit Skills – Focusing on Danish Academic Vocabulary

Research shows that L1 as well as L2 and L3 students in Danish tertiary education struggle with acquiring the necessary academic language skills for studying in Danish. Research also shows a tendency for educators in the Danish setting to treat academic language norms as implicit norms, making it much harder for students to grasp the language-related demands of academia. This article argues that in order to make the demands and norms of academic language explicit to the students, irrespective of linguistic background, we need more research-based knowledge about Danish academic language. Furthermore, focussing on one particular aspect of academic language, namely academic vocabulary, can be a step towards more explicit approaches to academic language norms. Academic vocabulary is here defined as a non-technical, general purpose vocabulary with distinct academic functions used across a range of academic disciplines. To come nearer an understanding of how we can make the academic language norms more tangible and accessible to both students and staff, the article begins with a review of existing research on Danish academic language and academic vocabulary with a particular focus on Danish SLA research. This is followed by an analysis of Danish guidance literature on academic writing for students. The article concludes with suggestions for further research in relation to teaching Danish academic vocabulary.

Small scale entrepreneurship – understanding behaviors of aspiring entrepreneurs in a rural area

PurposeNetworking and being a part of an established business network supports the process of translating new ideas into marketable solutions and acquiring customers. The purpose of this paper is to investigate how aspiring entrepreneurs in a Danish rural area setting manage to get embedded into relevant business networks. Before the literature background on social capital and regional development, the authors use the embeddedness approach in explaining whether weak or strong ties are most beneficial to get the business started and how lacking strong ties can be compensated.Design/methodology/approachThis paper takes an economic sociology perspective on social capital and is empirically based on a case study. The sample consists of a group of young aspiring entrepreneurs, living in the rural area of Southern Jutland, who are all committed to an organization which supports regional start-ups.FindingsThe authors found that aspiring entrepreneurs have different needs depending on their development status and type of innovation. Founders, who are developing or have developed new product innovations, seem to have an increased need for “strong ties” with consultants and those with knowledge about building up a professional network. Founders, who are developing or have developed a significantly improved service, have strong ties with former fellow students and researchers at the university.Originality/valueThis study illustrates that aspiring entrepreneurs connected to a regional entrepreneurship center gained access to a wider relevant network. Depending on their level of embeddedness, they could build new strong relationships and exploit information stemming from new “weak ties” and as such harness more benefits. The study shows that less privileged start-ups can substitute strong ties, especially through the support of professional managers of startup-supporting organizations. Finally, a model explaining the impact of social capital on the entrepreneurial sphere of regional business networks and on its innovativeness is deduced.