Implementation of low-dose computed tomography (LDCT) screening for lung cancer is recommended. The Norwegian Lung Cancer Screening pilot (TIDL) has been conducted to explore recruitment strategy, detection rate and the value of a radiology-led screening program. This publication presents baseline results from the screened participants. Patient/material and methods: All 125,095 individuals aged 60-79 years in Akershus county, Norway were invited to participate. Ever-smokers completed a risk questionnaire based on the PLCOm2012NoRace model: those with ≥35 pack-years or a ≥2.6% 6-year lung cancer risk were eligible for inclusion. Of 2,499 eligible participants, 1,006 underwent baseline LDCT between August 2022 and May 2023, and up to two more rounds later. Nodules were categorized by Lung-RADS v2022. Follow-up and staging were managed by thoracic radiologists; High-suspicion cases were referred to pulmonologists. At baseline, lung cancer was diagnosed in 23 participants (2.3%), whereof 19 (83%) in stage I and 2 (9%) in stage II. Most underwent curative treatment, primarily robot-assisted surgery. Only 2.9% of the screened individuals were referred for further diagnostic evaluation. The false positive rate was 0.6% after pulmonologist referral and 1.7% after radiological staging. A total of 13.8% required 3- or 6-month imaging follow-up. Complication rates from diagnostic procedures were low. LDCT screening using combined risk-based eligibility and a radiology-led model is feasible and effective in the Norwegian context. The high detection rate and low clinical burden support its potential for national implementation. These findings may guide the development of future lung cancer screening programs in the Nordic countries and beyond.

Intensive care physicians often provide end-of-life (EOL) care in the intensive care units (ICUs). However, knowledge about the physicians' role and confidence in EOL care after the decision to withdraw life-sustaining therapy is unknown. This study aimed to explore the confidence and the self-perceived role of specialized ICU physicians in performing EOL care. Following criteria-based sampling, a questionnaire was sent to ICU physicians in Iceland, Sweden, Norway, Finland, and Denmark. Questions included: (1) Background information and existing guidelines, (2) Physicians' confidence in EOL care in ICUs, and (3) Self-perceived role in EOL care. The questionnaire collected both quantitative and qualitative data, which were subsequently analyzed separately. A total of 178 ICU physicians answered the questionnaire. Most physicians (66%) felt very confident performing EOL care. Responses to the open-ended qualitative questions emphasized that ICU physicians regarded EO care as a central professional responsibility, marked by personal presence, active support for patients and families, and attention to individual needs. They reported the value of transparent communication, thorough preparation for treatment withdrawal, and accommodation of personal, cultural, and religious preferences. Participants highlighted the importance of individualized transfer decisions while also emphasizing the need for adaptable EOL guidelines and enhanced training, particularly for residents. Our study showed that Scandinavian ICU physicians felt very confident in performing EOL care and recognized their unique role and responsibility in delivering ICU EOL care. This study surveyed ICU physicians in Nordic countries concerning perceptions and confidence for end care in their ICU clinical practice. The responses indicated that the survey responders were quite confident in how they manage this group of cases in the ICU.

Prevalence of self-reported sensitivities to various environmental factors in Germany, Sweden, and Finland based on multiple classification criteria.

ABSTRACTBackgroundHeadache caused by aneurysmatic subarachnoid hemorrhage (aSAH) is often severe and may persist long after the ictus. Pharmacological pain management can be challenging due to poor efficacy or adverse effects. Multimodal pharmacotherapy is often required. Lack of guidelines and good quality clinical studies on pain management has led to variation in pain management practices. Knowledge of current practice and goals of pain management in Nordic countries is lacking. We aimed to fill these knowledge gaps by conducting a survey targeting Nordic clinicians involved in aSAH treatment.MethodsAn electronic survey in English was sent to national coordinators in December 2023. The coordinators distributed the survey to intensivists, neurosurgeons, and other specialists treating aSAH patients in their respective countries. The survey contained 63 questions gathering background information, current aSAH pain management during the hospital stay and at hospital discharge, follow‐up, and preferred outcome measures regarding a clinical trial on pain management in aSAH. The results were analysed and presented descriptively.ResultsWe received 70 responses: 36 from Finland, 11 from Norway, 11 from Denmark, 5 from Sweden and 7 from Iceland. Respondents were intensivists (N = 46), neurosurgeons (N = 20), neurologists (N = 2), and others (N = 2). The most frequently used pain medications at ICUs were paracetamol, opioids, and non‐steroidal anti‐inflammatory drugs (NSAID). Most neurosurgeons (70%, N = 14) responded that they never prescribe opioids at hospital discharge for aSAH patients. The most preferred outcome for a clinical trial was patients' self‐reported quality of life.ConclusionsIn the Nordic countries, paracetamol, opioids, and NSAIDs were reported as the most frequently used analgesics in the management of aSAH related pain in the ICU. Use of gabapentinoids was commonly reported by Danish respondents, unlike respondents from other Nordic countries. Neurosurgeons reported that they rarely prescribe opioids at hospital discharge.Editorial CommentThis survey of Nordic clinicians involved in ICU and neurosurgical management of subarachnoid bleed (aneurysm) cases presents preferences for pain management in hospital and with discharge, as well as assessing clinician preferences for outcomes by which to assess pain management in these cases.

Ultrasound is increasingly used in anesthesia and intensive care medicine for procedural guidance and patient assessment. However, training and formal skills assessment vary, and there is limited knowledge about current ultrasound practices in the Nordic countries. This study aims to survey the availability, daily clinical use, and current state of ultrasound training and skills assessment among anesthesiologists across the Nordic countries. An online cross-sectional survey, designed according to the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) guidelines was distributed as a convenience sample across anesthesiology departments in Denmark, Finland, Iceland, Norway, and Sweden, covering a range of hospital types, including regional and university hospitals. The survey consisted of three sections: demographics, ultrasound availability, and procedural use, including skills development and assessment. Key measures included the frequency of ultrasound use, types of procedures where ultrasound was employed, training methods, self-assessed proficiency, and the frequency of formal skills assessments. An overall response rate of 38% (n = 412) was obtained. Ultrasound was used daily or weekly by 96% of respondents, and procedures where ultrasound was most frequently used were vascular access (97%) and peripheral nerve blocks (83%). Practical training was primarily acquired through clinical use under supervision from colleagues, with limited use of simulation-based training. Few respondents (27% across procedures) reported formal skills assessments, and self-assessed proficiency varied, with intermediate and beginner levels being the most common. Retention of skills was rarely assessed, with an average of 8% across procedures. Ultrasound is used almost daily by most anesthesiologists in the Nordic region, with equipment readily available in the departments. Despite its frequent use, training and skills assessments vary with limited focus on ensuring skills retention. EDITORIAL COMMENT: This article presents the results of a survey on ultrasound availability, usage and training for anesthesiologists working in the Nordic countries. Keeping in mind responder bias, the availability and usage is high, but there is a low level of reported formal training and skills assessment. This highlights a need for structured training and competency assessment for ultrasound, that could be offered via nordic collaboration.

Patterns and trends in sarcoidosis: an epidemiological perspective.

BackgroundA part of online gambling consumption takes place in offshore markets. Lack of regulatory control over offshore offers erodes many public policy and public health objectives. Channelling consumption from offshore markets to regulated markets is therefore used as justification in many gambling policy decisions. Yet, it is currently unknown how reliable existing estimates of the size of offshore markets are.MethodsThis scoping review investigates how offshore gambling markets are measured in the Nordic context and what kinds of uncertainties are involved in existing measures. We searched available estimates of offshore gambling markets from academic and grey literature in four Nordic countries (Denmark, Finland, Norway, Sweden). The final sample consists of 32 reports. To supplement the results, we conducted key informant interviews and our own analysis of available data.Results24 estimates concerned the monetary value of offshore gambling as a percentage of the full market. Nine estimates concerned the population prevalence of offshore gambling. In terms of methodologies, most studies reported figures from a private gambling intelligence company H2 gambling capital, either directly or combined with other data sources. Different methodological choices yielded different estimates. An important part of reports was funded by the gambling industry. Industry reports tended to have higher overall estimates of offshore gambling due to methodological choices.ConclusionsThe measurement of offshore gambling is a politically sensitive topic wrought with uncertainties. More reliable methods and figures are needed to better inform harm prevention and consumer protection in the online environment. Inaccurate offshore measures can be used as a tool for regulatory resistance. A transparent and scientifically validated measurement tool is needed to improve the evidence-base.

During the first year of the COVID-19 pandemic, reported cancer cases declined in the Nordic countries, potentially reflecting delays in cancer diagnosis. We compared 1-year relative survival (RS) and excess mortality of patients diagnosed with cancer in the Nordic countries in March-December 2020 with that expected based on patients diagnosed in 2011-2019. We used flexible parametric RS models, defining excess mortality as the difference in total mortality between patients with cancer and the national population without cancer. We report the ratio between the observed and expected excess mortality (EMR) and the difference in 1-year RS in percentage points (pp) by country, age, sex, and cancer site. Excess mortality of patients diagnosed during the pandemic was increased in all Nordic countries except Iceland. Swedish men had the highest EMR of 1.12 (95% CI 1.06, 1.17), corresponding to a 1.4 pp reduction in 1-year RS (87.1%-85.8%). In women, the highest EMR was 1.10 (95% CI 1.03, 1.18) in Norway, corresponding to a 1-year RS decrease of 1.2 pp (86.6%-85.5%). The largest site-specific decreases in 1-year RS were observed for liver cancer in Finnish and Swedish men, with decreases of 10.2 pp (45.3%-35.1%) and 7.2 pp (55.7%-48.5%), respectively. We found reduced 1-year RS among Nordic patients diagnosed with cancer during the COVID-19 pandemic in 2020, especially in older patients and those with aggressive cancers. These reductions coincided with restrictions and potential delays in seeking healthcare.

Separation related problems (SRPs) are common in companion dogs and give rise to serious problems for both dog welfare and owner quality of life. However, they are not well understood, making them difficult to prevent and treat. A so far underutilised source of knowledge is experience from professional behaviour practice. In this qualitative study, we explored professionally situated knowledge to identify factors that may contribute to the development of SRPs in dogs. The study is based on 15 semi-structured interviews with a diverse group of dog professionals (veterinarians, animal behaviourists, dog trainers) involved in the treatment of SRPs in Denmark, Sweden, and Norway. The transcripts were analysed using reflexive thematic analysis. Six central themes emerged from this analysis, which were labelled "co-occurring behavioural difficulties", "a body in flux", "dog training gone wrong", "breed type", "changes to routine and environment", and "psychological interplay between dogs and their owners". These themes reflect professional observations of recurring contexts in SRP cases, rather than empirically established risk factors. While some align with existing scientific findings (e.g. comorbidity with noise sensitivity), others highlight underexplored areas, such as effects of adolescence and owner stress. The findings serve to underpin a broad, context-aware view of SRPs.

ObjectiveTo help to clarify whether long term use of proton pump inhibitors is associated with an increased risk of gastric adenocarcinoma by designing a study that considered the existing literature’s methodological weaknesses.DesignPopulation based case-control study using prospectively collected data from multiple complete nationwide registries in five Nordic nations.SettingAll healthcare in five Nordic countries—Denmark, Finland, Iceland, Norway, and Sweden—between 1994 and 2000.ParticipantsCase patients with gastric adenocarcinoma, each matched for age, sex, calendar year, and country with 10 control participants randomly identified from each country’s entire population.ExposureThe exposure was long term (>1 year) proton pump inhibitor use, excluding the 12 months before the diagnosis date (cases) or inclusion date (controls). Long term (>1 year) use of histamine-2-receptor antagonists was analysed to assess the validity and specificity of the findings for proton pump inhibitor useMain outcomes measuresThe outcome was gastric non-cardia adenocarcinoma. Gastric cardia adenocarcinoma was excluded to avoid confounding by indication (that is, gastro-oesophageal reflux). As well as controlling for the matching variables, multivariable logistic regression provided odds ratios with 95% confidence intervals, adjusted for country, Helicobacter pylori treatment, peptic ulcer disease, smoking related diseases, alcohol related diseases, obesity or type 2 diabetes, and drug treatment with metformin, non-steroidal anti-inflammatory drugs, and statins.ResultsThe study included 17 232 cases of gastric (non-cardia) adenocarcinoma and 172 297 controls. Long term proton pump inhibitor use occurred in 1766 (10.2%) cases and 16 312 (9.5%) controls. No association was found between long term proton pump inhibitor use and gastric adenocarcinoma (adjusted odds 1.01, 95% confidence interval 0.96 to 1.07). The risk was similar for histamine-2-receptor antagonist use (adjusted odds ratio 1.03, 0.86 to 1.23). Multiple sources of error that led to a false positive association were identified—inclusion of proton pump inhibitor use shortly before the gastric adenocarcinoma diagnosis, short term use of proton pump inhibitors, cardia adenocarcinoma, and lack of adjustment for Helicobacter pylori related variables.ConclusionsLong term proton pump inhibitor use may not be associated with an increased risk of gastric adenocarcinoma.

Purpose In the Netherlands, there is a practice of entrepreneurs who buy land, fragment it into tiny parcels and sell it using aggressive marketing campaigns for extremely high prices to private people suggesting that this is a fine investment, because of expected planning gain. However, usually, this land has no prospect for development at all being often situated in areas that have no development perspective at all. Furthermore, the speculative shredding of land makes it unfit for future uses. This paper aims to explore whether the legal systems of Nordic countries (Denmark, Finland, Norway and Sweden) with regard to subdivision, can help to address this issue of speculative land fragmentation, and it explores the potential of Nordic experiences for including some of these principles in the legal system of the Netherlands. Design/methodology/approach The comparative study is based on study of relevant documents and legal materials, studies and expert interviews. Findings Denmark, Norway and Sweden have each a system that will not allow speculative land fragmentation in the ways it appears in the Netherlands. The way these systems are organised differs, with a central role of a private surveyor (Denmark), the municipality (Norway) or a national agency (Sweden). Finland has a system that will not prevent subdivision outside areas that are planned for construction. Practical implications Different alternative ways are discussed on how the experiences from the Nordic countries can be used to change the Netherlands system. Originality/value The speculative land fragmentation in the Netherlands is a rather new phenomenon and there is no previous publication on the ways how learning from Nordic countries may provide options to prevent it.

Background: Bladder cancer (BC) incidence in Greenland is lower than in other Nordic countries, yet mortality is disproportionately high, suggesting delayed detection. Cystoscopy is the diagnostic gold standard to detect BC, but access in Greenland is often limited by geographic and logistical challenges, underscoring the need for more accessible diagnostic tools. Objectives: This study evaluated the performance of the urinary biomarker test Xpert® Bladder Cancer Detection (XBCD) among patients referred for cystoscopy within the Greenlandic healthcare system. Methods: In this prospective observational study, 198 patients referred for urological evaluation due to hematuria or other urologic symptoms were recruited from five Greenlandic towns. All participants provided a urine sample for XBCD testing prior to cystoscopy, which served as the reference standard. Results: Among 194 patients with valid test results, seven BC cases were detected. XBCD identified five true positives and 166 true negatives, yielding a sensitivity of 71.4%, specificity of 88.8%, and a negative predictive value of 98.8%. Conclusions: In this low-prevalence setting, XBCD demonstrated potential as a triage tool to reduce the number of procedures and support earlier BC detection, although findings are limited by the small number of cancer cases.

Predicting the spatio-temporal risk of human tick-borne encephalitis (TBE) in Europe by combining hazard and exposure drivers

Emergency Radiology: Organizational Models in Swiss and Nordic Hospitals.

Multiple social positions and well-being among Nordic adolescents: An intersectional MAIHDA analysis of the interplay between gender, age, immigrant background, family structure, and perceived socioeconomic status.

Electric vehicle adoption and energy prices: Empirical evidence from four Nordic countries

As European societies face rising longevity rates and healthier ageing populations, a shift toward a “longevity society” is underway — one that values older adults’ active socio-economic participation. The Nordic countries provide a compelling case study, where the demographic ageing intersects with digitalisation, rural-urban divides, and regional integration. This paper explores how digital health innovations in the Nordics influence equality, quality, and access to healthcare, particularly within the context of the growing silver economy. Through policy analysis and review of empirical studies and strategic documents, it examines national and regional responses to ageing. Rural areas, especially in Finland and northern Sweden, where older populations are overrepresented due to youth outmigration, face particular challenges. In these settings, digital tools — telemedicine, care robots, and cross-border health data systems — are used to enhance accessibility and care standards. Findings reveal that Nordic countries have, over the past decade, advanced digital health and social care strategies responsive to real-time societal needs. These strategies increasingly address not only older adults but also vulnerable groups such as immigrants, Indigenous populations, and people with disabilities. There is also growing cooperation with the Baltic states to develop more resilient, inclusive, and interoperable healthcare systems. The 2025 meeting of the Nordic Council’s Committee for Welfare in Tromsø emphasized the need for a unified ageing strategy. This includes boosting digital inclusion, promoting culturally adaptive care, and supporting older adults in co-designing their care. A draft strategy, currently under consultation, will guide long-term cooperation and is expected to be adopted in late 2025. In conclusion, the Nordic experience demonstrates how inclusive, data-driven digital policies can effectively support ageing societies — offering lessons for broader regional and global application.

BackgroundThere is an urgent need for feasible and effective mental health promoting interventions from early childhood. High-quality music education carries the potential to promote school thriving, positive class community, and social relations, which are key prerequisites for children’s mental health. However, the implementation and potential benefits of this type of intervention have not yet been evaluated in the Nordic countries. The Everyone Can Sing intervention is a class-based singing intervention that integrates class choir into the regular school schedule, two lessons a week for primary school children in grades 0 to 3 (age 5–10 years). The lessons follow a manualised pedagogy, which combines co-teaching between the class teacher and an educated choir leader with enactive learning in a safe atmosphere, changing choir partners, musical arousal regulation, a song repertoire including movement and gestures, and choir performances in and outside school. The aim of this feasibility study is twofold: 1) To examine feasibility of the implementation of Everyone Can Sing in three Danish primary schools, and 2) to examine feasibility of the evaluation design.MethodsA non-randomized single-group feasibility trial will be conducted from January 2024 to March 2025 among approximately 900 primary school children in grades 0 to 3 in three Danish public primary schools. Six domains relating to feasibility of the intervention (barriers and facilitators of implementation, adaptability, implementation capacity, responsiveness, acceptability, and signs of benefit and harms) and three domains relating to feasibility of the study design (validity of questionnaire, uncertainties in data collection, and outcome measures) will be assessed. The study primarily employs a convergent mixed methods design, collecting quantitative data (baseline and follow-up questionnaires from students, parents, and teachers) and qualitative data (observations of choir and interviews with students, parents, teachers, choir leaders, Everyone Can Sing school coordinators, Everyone Can Sing management, and school management) in parallel. The design also incorporates elements of explanatory and exploratory sequential approaches. In the convergent phase, the two strands will be analyzed separately and then integrated through triangulation to assess both the feasibility of implementation and the feasibility of the evaluation design.DiscussionThe results of this non-randomised feasibility study will inform whether the intervention should proceed to a future, full-size effectiveness trial, return to refinement of the intervention or the evaluation design, or stop.Trial registrationClinicalTrials.gov, ID: NCT06204029, registered January 2nd, 2024. https://clinicaltrials.gov/study/NCT06204029?cond=NCT06204029&rank=1.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40814-025-01757-8.

Objective. This study analyzes international experiences in implementing the FAIR principles (Findability, Accessibility, Interoperability, Reusability) in research data management in university environments. Methods. A comprehensive methodological approach was used, including a systematic literature review of the publications of 2020-2024, case studies of best practices from leading European and American universities, expert interviews with university library data management specialists, and analysis of institutional policies and regulatory documents. Results. The analysis revealed significant variability in FAIR implementation levels depending on geographical location, institutional policies, cultural factors, technical infrastructure, and the specificities of scientific disciplines. Nordic countries and the UK demonstrate leadership in FAIR implementation, while Eastern European countries, including Ukraine, show significantly lower levels of implementation. Natural sciences demonstrate more developed data sharing practices compared to humanities and social sciences. The paper identifies main obstacles to the development of this area of activity in the library environment. Conclusions. Successful implementation of FAIR requires comprehensive approaches, including the development of institutional policies, the creation of specialized infrastructure, raising awareness among researchers, and the development of discipline-specific guidelines to ensure full compliance with FAIR principles.

This article aims to assess the local governments’ fiscal capacity and to determine the revenue decentralization impact on economic growth. The sample includes 27 national economies of the EU member-states and Ukraine over the period from 2011 to 2024. The level of own revenue decentralization in the sampled countries is evaluated, and the interrelation between that indicator and the dynamics of economic growth is highlighted. The institutional peculiarities of the local taxes and fees system, as the basis for ensuring the territorial communities' fiscal capacity, were investigated. Special attention is paid to the periodic real estate tax’s fiscal significance and administration features. The level of partial tax autonomy is evaluated. The highest revenue decentralization is recorded for the sub-sample of Nordic countries, while Ukraine belongs to the group of countries with a medium level of the above indicator. It is found that an increase in gross capital formation and in the Human Development Index has a positive impact on economic growth. In contrast, own revenue decentralization had a slightly negative effect. An optimal level of decentralization should be the main target for the fiscal space’s institutional transformation. The strengthening of the local taxes and fees' fiscal significance is identified as a prerequisite for an increase in the overall public governance effectiveness. Additionally, it is pointed out that the capacity of local governments to administer the local taxes and fees should be expanded. The priorities for the property taxation reform are systematized. The trend of digitalization in tax administration should be reinforced to ensure the de-shadowing of the economy. It is argued that a fiscal decentralization reform should be approached with foresight and deliberation.