Danish Users Research Articles

Adapting to New Hearing Aids and Hearing Aid Adjustments in Adult Danish Users.

This study was aimed at understanding the effect of time taken to adapt to the new hearing aids (HAs) and the timeline of HA adjustments performed over more than a year of rehabilitation on self-reported HA outcomes. A self-report of the time it took to get accustomed to the new HAs and adjustment of the HAs during a year of rehabilitation collected from 690 HA users using a nonstandardized questionnaire were analyzed. The abbreviated version of the Speech, Spatial, and Quality of Hearing questionnaire and the International Outcome Inventory for Hearing Aids were used as the self-reported HA outcome. Out of 690 participants, 442 (64%) got accustomed to HAs within 2 months. Ninety-one participants (13%) did not get accustomed to the HAs at all, out of which 74 (81%) were first-time HA users. Eighty-four participants (12%) did not receive any HA adjustments after their initial fitting, and 49 (7%) had their HAs adjusted four or more times during the 1 year of rehabilitation. Three hundred ninety (57%) participants got their HA adjusted only at the 2-month follow-up visit, showing the intent to adjust given an opportunity. The stepwise multiple linear regression results showed the significant impact of getting accustomed to the HA and having HA adjusted at multiple instances on the self-reported HA outcomes. This study showed the importance of getting accustomed to the HA and having a minimal number of adjustments to have a better long-term self-reported HA outcome.

Visual thinking strategies as a pedagogical tool: initial expectations, applications, and perspectives in Denmark

This paper examines the introduction of Visual Thinking Strategies (VTS) in Denmark and its potential as a pedagogical tool used throughout Danish education culture and particularly in Danish primary schools. The first active Danish users of and trainers in VTS in the country provide purposive qualitative interview data through structured e-mail interviews focused on their experiences with VTS and their impressions of this pedagogical tool in the Danish education culture context. The analysis of this qualitative data indicates that VTS is highly and widely adaptable to Danish education culture which, like other Scandinavian education systems, is based on bildung didactic principles. In their contemporary manifestation, these principles value the emancipation of the individual and the promotion of democratic learning processes. The introduction of VTS is still a work in progress in the Danish context and is not yet formally used in the school system. However, it is precisely there that a rich vein of opportunities exists for VTS in Denmark.

From the history of Danish-Russian bilingual lexicography. Ivan Stscelkunoff (1870–1966) and his dictionary

The first Danish-Russian dictionary (Dansk-Russisk Ordbog) was published in Denmark in 1949. Author Ivan Stchelkunoff was born in Copenhagen to a family that moved from Russia. He received a good education, studied at the prestigious Metropolitan School, then at the University of Copenhagen, majoring in Latin, Greek and English. In 1901–1910 he was an Orthodox deacon in Athens. The years after returning to Denmark until 1917 were very successful. He was priest of the Imperial Diplomatic Mission of Russia, priest of the Alexander Nevsky Church in Copenhagen. He implemented several projects related to Russia. He published a book based on the history of Russia, Letters of Empress Catherine to the Dowager Queen Juliane Maria, a translation of I. S. Turgenev’s novel The Day Before, Russian Textbook for Beginners, Russian Commercial Correspondence, and two pocket dictionaries: Danish-Russian and Russian- Danish. In the early 1920s he moved from Copenhagen to Bornholm, where he became a teacher. He told about his life in the book Fifty years under the golden domes. Denmark, Greece, Russia. The publication of translations of L. N. Tolstoy’s novel Anna Karenina and two Ehrenburg books belongs to this period. In 1945, after the surrender of Germany, Soviet soldiers had to liberate the island due to the ridiculous orders of the German command. In 1945–1946, when they were on the island, Stchelkunoff was “an interpreter for Russian soldiers.” The Danish-Russian dictionary was created for a long time, from 1934 to 1946. In the preface, the author expresses gratitude to professor Holger Pedersen, who helped him. The dictionary was published in 1949 shortly after the adoption of changes in Danish spelling, but they could not be taken into account. Danish-Russian Dictionary is aimed at Danish users “who want to learn Russian, but it can be useful for Russians who want to get directly acquainted with Danish literature while reading.” Therefore, the author made do with minimal grammatical explanations. There are no lists of abbreviations and geographical names that are given in the corpus. The dictionary is satisfactory for this volume (about 30.000 words), although there are non-obvious lexemes for this pair of languages. In general, the dictionary can be assessed as reliable, conscientiously made and very timely appeared.

Risk of Major Adverse Cardiovascular Events, Severe Hypoglycemia, and All-Cause Mortality for Widely Used Antihyperglycemic Dual and Triple Therapies for Type 2 Diabetes Management: A Cohort Study of All Danish Users.

The vast number of antihyperglycemic medications and growing amount of evidence make clinical decision making difficult. The aim of this study was to investigate the safety of antihyperglycemic dual and triple therapies for type 2 diabetes management with respect to major adverse cardiovascular events, severe hypoglycemia, and all-cause mortality in a real-life clinical setting. Cox regression models were constructed to analyze 20 years of data from the Danish National Patient Registry with respect to effect of the antihyperglycemic therapies on the three end points. A total of 66,807 people with type 2 diabetes were treated with metformin (MET) plus a combination of second- and third-line therapies. People on MET plus sulfonylurea (SU) had the highest risk of all end points, except for severe hypoglycemia, for which people on MET plus basal insulin (BASAL) had a higher risk. The lowest risk of major adverse cardiovascular events was seen for people on a regimen including a glucagon-like peptide 1 (GLP-1) receptor agonist. People treated with MET, GLP-1, and BASAL had a lower risk of all three end points than people treated with MET and BASAL, especially for severe hypoglycemia. The lowest risk of all three end points was, in general, seen for people treated with MET, sodium-glucose cotransporter 2 inhibitor, and GLP-1. Findings from this study do not support SU as the second-line treatment choice for patients with type 2 diabetes. Moreover, the results indicate that adding a GLP-1 in people treated with MET and BASAL could be considered, especially if those people suffer from severe hypoglycemia.

Facebook use as a communicative relation: exploring the relation between Facebook users and the algorithmic news feed

ABSTRACT This study examines how young Danish adults between 18 and 26 engage in a communicative relation with Facebook's news feed as algorithmic technology and to what extend they are aware of this relation. The empirical analysis is based on theoretical concepts related to media use and everyday life as well as a recent development within the field of Human-Machine Communication. Drawing on 20 in-depth interviews, the qualitative thematic analysis was organized in relation to the following themes: (1) critical reflection; (2) everyday use; and (3) communicative agency. We find that young Danish users lack critical awareness of how their own everyday media use is communicating with the Facebook algorithm. We argue that the concept of ‘use’ needs to be re-examined on a theoretical as well as a practical level in relation to algorithmic media use. We finally propose that future research should approach social media use from the perspective of communicative relations between everyday media use and algorithmic personalization.

Use of phthalate-containing prescription drugs and the risk of gastric cancer: a Danish nationwide case-control study

Background: Phthalates are used as excipients in some drug products, and up to a 50-fold increased urinary excretion of phthalate metabolites compared to non-users has been demonstrated in users of such products. In vitro studies have demonstrated that phthalates stimulate mechanisms involved in gastric cancer development. We therefore examined the association between cumulative phthalate exposure from drug products and the risk of gastric adenocarcinomas.Methods: Using the Danish Cancer Registry, we identified all patients with incident gastric adenocarcinoma from 2008 to 2015 (n = 1525). Cancer cases were matched to 10 controls. Linking information retrieved from nationwide Danish registries, we determined individual cumulative phthalate exposure to the ortho-phthalates diethyl phthalate (DEP), dibutyl phthalate (DBP) and enteric phthalate polymers from prescription drugs. The association between cumulative phthalate exposure and gastric adenocarcinoma was estimated using conditional logistic regression, adjusting for socioeconomical status and drugs or comorbidities known or suspected to modify the risk of gastric adenocarcinoma.Results: No association was seen for the risk of gastric adenocarcinomas among individuals with high cumulative exposure to ortho-phthalates (exceeding 500 mg) (ORadj 1.22, 95% CI: 0.84–1.77). Likewise, no associations were observed individually for DEP (ORadj 1.06 95% CI: 0.63–1.76) or DBP (ORadj 1.32 95% CI: 0.78–2.23). Cumulative exposure to enteric phthalate polymers exceeding 10,000 mg, did not reveal an association with gastric adenocarcinoma (ORadj 0.79, 95% CI: 0.54–1.16) and no association was seen for individual compounds. Additionally, no dose-response pattern was observed across exposure strata (p = .39, test for trend).Conclusion: We did not find an increased risk of gastric adenocarcinoma among Danish users of phthalate-containing drug products. Our study is limited by a low number of cases exposed to high cumulative doses of phthalates.

Striving for self-improvement: alternative medicine considered as technologies of enhancement

The notion of medical enhancement technologies has drawn attention to optimization techniques within the health area. However, this notion has evolved at the level of governmental programmes, with very little attention directed towards people’s own practices. Using a social scientific body of knowledge about enhancement technologies and a Foucauldian analytical framework, this article explores how users engage with alternative medicine. Drawing on in-depth interviews with Danish users and observations of their treatment sessions, the article demonstrates how they embark on a voyage of discovery with the body to enhance their own selves and bodily resources. The discussion centres on Rose’s approach to medical enhancement technologies and Foucault’s notion of ‘technologies of the self’. A wider field of tension is outlined in which embodied alternative treatment practices play a role in various modalities of transforming and controlling bodies and selves. It is argued that such practices can be conceived of as enhancement technologies at the users’ level by showing how they not only concentrate on treatment and body maintenance, but also foster the enabling processes of changing habits, preferences, and attitudes, and creating a subjective sense of their bodies.

Wired to freedom: Life science, public politics, and the case of Cochlear Implantation.

Cochlear Implantation is now regarded as the most successful medical technology. It carries promises to provide deaf/hearing impaired individuals with a technological sense of hearing and an access to participate on a more equal level in social life. In this article, we explore the adoption of cochlear implantations among Danish users in order to shed more light on their social and political implications. We situate cochlear implantation in a framework of new life science advances, politics, and user experiences. Analytically, we draw upon the notion of social imaginary and explore the social dimension of life science through a notion of public politics adopted from the political theory of John Dewey. We show how cochlear implantation engages different social imaginaries on the collective and individual levels and we suggest that users share an imaginary of being "wired to freedom" that involves new access to social life, continuous communicative challenges, common practices, and experiences. In looking at their lives as "wired to freedom," we hope to promote a wider spectrum of civic participation in the benefit of future life science developments within and beyond the field of Cochlear Implantation. As our empirical observations are largely based in the Scandinavian countries (notably Denmark), we also provide some reflections on the character of the technology-friendly Scandinavian welfare states and the unintended consequences that may follow in the wake of rapid technology implementation of life science in society.

Using Speech Recall in Hearing Aid Fitting and Outcome Evaluation Under Ecological Test Conditions

In adaptive Speech Reception Threshold (SRT) tests used in the audiological clinic, speech is presented at signal to noise ratios (SNRs) that are lower than those generally encountered in real-life communication situations. At higher, ecologically valid SNRs, however, SRTs are insensitive to changes in hearing aid signal processing that may be of benefit to listeners who are hard of hearing. Previous studies conducted in Swedish using the Sentence-final Word Identification and Recall test (SWIR) have indicated that at such SNRs, the ability to recall spoken words may be a more informative measure. In the present study, a Danish version of SWIR, known as the Sentence-final Word Identification and Recall Test in a New Language (SWIRL) was introduced and evaluated in two experiments. The objective of experiment 1 was to determine if the Swedish results demonstrating benefit from noise reduction signal processing for hearing aid wearers could be replicated in 25 Danish participants with mild to moderate symmetrical sensorineural hearing loss. The objective of experiment 2 was to compare direct-drive and skin-drive transmission in 16 Danish users of bone-anchored hearing aids with conductive hearing loss or mixed sensorineural and conductive hearing loss. In experiment 1, performance on SWIRL improved when hearing aid noise reduction was used, replicating the Swedish results and generalizing them across languages. In experiment 2, performance on SWIRL was better for direct-drive compared with skin-drive transmission conditions. These findings indicate that spoken word recall can be used to identify benefits from hearing aid signal processing at ecologically valid, positive SNRs where SRTs are insensitive.

Information on risk of constipation for Danish users of opioids, and their laxative use

While it is well known that use of opioids often cause constipation, little is known about the information given to patients regarding this potential side-effect and their use of laxatives to prevent it. To assess the degree of information provided by the prescriber to users of opioids by the time of the first prescription regarding the risk of constipation. Interviews with patients filling an opioid at a community pharmacy were performed by the dispensing pharmacist or pharmaconomist at the pharmacy. Information collected concerned the patient, the opioid, information received regarding constipation, current constipation and current laxative treatment. A total of 286 interviews were completed. Overall, 28.3 % remembered having received information about the risk of constipation by the time of the first prescription. Excluding 49 first-time opioid users, we found 91 laxative users and 146 non-laxative users, of whom 73.6 and 4.8 %, respectively, currently experienced constipation. Only a small proportion of patients with a prescription for opioids remembered having had information on potential constipation caused by opioids and having received any recommendation on how to use laxatives to prevent constipation. Interventions should focus on whether constipation is present and on rational use of laxatives.

‘It can do no harm’: Body maintenance and modification in alternative medicine acknowledged as a non risk health regimen

This article proposes the notion of a non-risk health regimen as a mode of recognising more dynamic aspects of risk-awareness in health care, in this case alternative medicine in Denmark. Danish users of alternative medicine are in an ambivalent position. They are responsible citizens who care about their own health. On the other hand, they are doing this by paying out of their own pockets for attending non-authorised treatments with very limited scientific evidence for their effects. This article draws on 138 qualitative in-depth interviews conducted in 2006–07 with 46 Danish users of different forms of session-based alternative medicine. A recurring theme throughout users' accounts is found to be that the treatments ‘at least can do no harm’. Many of the users regard pharmaceuticals or surgery as an artificial impediment and a threat to overall health, whereas the energy-stimulating processes initiated by the alternative practitioner are not considered risky. The no harm discourse constitutes a sophisticated lay-explanation that brings together a wide range of explanations within which three themes are identified: responsibility; optimization; desperation. By informing these findings with the concept of reflexive body techniques, it is shown that use of alternative medicine is a process of working on the self and body in a spectrum between transition (i.e. pain relief or self-development) and continuity (i.e. well-being or prevention of illness) and not only a quest for cure. In this process ‘non-risk’ emerges as a lay explanation in the efforts of users to construct coherent self-narratives as agents in a risk-aware environment. The development of the notion of a non-risk health regimen invites and facilitates further studies on various lay motives within health care in general and contributes to explaining the popularity of alternative medicine in particular.

The use of medication against attention deficit/hyperactivity disorder in Denmark: a drug use study from a patient perspective

Our aim was to characterize utilization patterns for drugs used to treat attention deficit/hyperactivity disorder (ADHD) on the level of the individual patient among Danish users, focusing on treatment duration, doses used, and concurrent use of ADHD and non-ADHD drugs. Using the Danish Registry of Medicinal Product Statistics, we extracted data on 1,085,099 prescriptions for ADHD drugs issued to a total of 54,024 persons in the study period 1 January 1995 to 30 September 2011. For users in the final year of the study period, we further extracted 315,365 prescriptions for non-ADHD drugs. Drug utilization was characterized using descriptive statistics. The mean duration of ADHD treatment was highest (3.6-4.2 years) for patients initiating therapy at a young age (age<13). Dropout rate after receiving only one prescription was highest among off-label users (age<6 and age >17). All age categories showed an increase in the average daily dosage of methylphenidate used from 2003 to 2010. Concomitant treatment with methylphenidate and atomoxetine was rare, as only 2 % of methylphenidate treatment overlapped with atomoxetine treatment. Nineteen percent of methylphenidate instant-release treatment overlapped with methylphenidate controlled-release treatment. Users of ADHD drugs across all age categories had an increased use of drugs related to the nervous system, especially antipsychotics [standardized morbidity rate (SMR), 6.4-19.5] and antiepileptics (SMR, 4.0-5.5). We found certain traits that warrant further investigation: the apparent increase in average daily doses, the low adherence to treatment among off-label users, and the increased use of other psychotropic medication.

Drug utilization and asthma control among young Danish adults with asthma – analyses of trends and determinants

UNLABELLED This PhD thesis was performed during my employment at the Research Unit of General Practice in Odense, University of Southern Denmark. It comprises an overview of three papers, all published or submitted for publication in international peer-reviewed scientific journals. BACKGROUND Observational studies have revealed inadequate use of inhaled corticosteroids (ICS) among asthmatics. However, only limited data exist on whether ICS usage has changed over time. In addition, improved knowledge is needed on factors associated with ICS use and asthma control in order to identify subjects at risk of being inadequately treated. AIMS Among young adult Danish asthmatics we aimed: To investigate trends in ICS use and factors associated with ICS use during 1997-2006 (Study I). To investigate associations between socioeconomic status (education and income) and ICS use, and whether these associations were consistent over time during 1997-2005 (Study II). To investigate whether particular prescribing patterns of anti-asthmatic drugs were associated with clinically uncontrolled asthma (Study III). METHODS Three studies were carried out among Danish users of anti-asthmatic drugs aged 18-44 years. Study I (N = 106 757) and Study II (N = 97 665) were longitudinal studies based on repeated annual cross-sectional analyses on national register data. Study III (N = 357) was a cross-sectional study based on register and clinical data from a municipal cohort from Odense, Denmark. RESULTS Study I: We observed an annual increase in one year prevalence of ICS use from 67% in 2001 to 77% in 2006, occurring concurrently with the introduction of fixed dose combination therapy with ICS and inhaled long-acting beta-2-agonists. Still some 20-30% of subjects with a massive annual IBA consumption were not prescribed ICS. Factors associated with ICS use were high annual use of inhaled beta-2-agonists (IBA), female gender, age 18-24 years, use of leukotriene receptor antagonists, and use of drugs for rhinitis and specific immune therapy. Study II: High levels of education (OR 1.46, 95% CI 1.40-1.51) and income (OR 1.10, 95% CI 1.06-1.14) were found to be positively associated with ICS use with the most pronounced impact among 35-44 year-olds. Higher education showed an almost constant association with ICS use each year throughout the entire observation period, but high income did not demonstrate any statistically significant association with ICS use before 2001 (OR 1.10, 95% CI 1.02-1.18) with increasing ORs observed each year hereafter (OR 1.30, 95% CI 1.20-1.40 in 2005). Study III: A total of 96 of the clinically assessed subjects (26.9%) had uncontrolled asthma. An increasing association between uncontrolled asthma and an increasing annual quantity of inhaled short-acting beta-2-agonists (SABA) usage was demonstrated. Due to a substantial overlap in levels of SABA use among controlled and uncontrolled asthmatics this association was not strong enough to allow conclusions on individual asthma patients. CONCLUSION The results support previous findings by demonstrating a continuing inadequate use of ICS among young adult asthmatics with a consistent and high use of reliever therapy, which was associated with uncontrolled asthma. This apparent over-reliance on reliever therapy and possible non-adherence to ICS may indicate inefficient guideline implementation among patients and physicians, leaving room for further improvement. The clear indications of a socioeconomic gradient in ICS use further emphasizes that knowledge of patient-related factors associated with asthma treatment and asthma control is imperative for health care professionals to be able to identify subjects deserving special attention.

Exploring perceptions and use of mobile services: user differences in an advancing market

This paper reports results on the evolution of m-services' market in a Western European context. We investigate Danish users' perceptions on a set of attributes similar to those utilised in an empirical research conducted during 2001, in what we expect to constitute a more mature market for m-services. Our objective is twofold: to confirm or reject the impact of the set attributes on consumer behaviour, and to highlight differences, which are bound to market evolution, between 'basic' and 'advanced' users. The results provide indications of an evolutionary path of strategic importance for firms with a competitive stake in advanced m-service's use.

Some considerations on the choice of a field sprayer1

An analysis comparing conventional and air‐assisted sprayers indicates that even over relatively small areas air‐assisted spraying offers advantages of both economics and efficacy. An analysis of Danish meteorological data from 1989 to 1991 indicates that, without including any savings on plant protection products, air‐assisted sprayers proved most economic at total sprayed areas of over 600 ha, which with a typical Danish rotation equals a farm area of approx. 160 ha. Danish users of air‐assisted sprayers claim reduction in their use of plant protection products of 25‐30%. If more modest reductions of only 20 or 10% are considered, the break‐even occurs at total sprayed areas of only 300 or 200 ha, equalling typical farms of 77 or 52 ha, respectively.