North Denmark Research Articles

Subsistence and population development from the Middle Neolithic B (2800-2350 BCE) to the Late Neolithic (2350-1700 BCE) in Southern Scandinavia.

The present study aims to explore the hypothesis of a link between a population increase derived from intensified food production and the development from the widespread cultural diversity of the Middle Neolithic B (MNB) to the cultural unity towards the end of the Late Neolithic (LN) in Southern Scandinavia. We explore this through quantitative modelling of radiocarbon dates, aoristic time series of material culture and palynological data. On this basis, we propose three main results that may explain the transformation: (1) A supra-regional population increase, culminating in the middle of the LN (c. 2100 BCE). (2) A depopulation in Western Jutland at the transition from the MNB to the LN (c. 2400-2300 BCE) counterbalanced by a population increase in North and East Denmark. (3) A population boom in Southern Sweden around 2250-2000 BCE, possibly leading to migrations towards west. Furthermore, we propose an overall decline in population in the final LN (c. 1850 BCE).

Stimulating thyrotropin receptor antibodies in early pregnancy.

Thyrotropin-receptor antibodies (TRAb) are used to diagnose Graves' hyperthyroidism in pregnant women. Bioassays provide a measure of thyrotropin-receptor stimulatory antibodies (TSI) specifically. The objective was to measure TSI in pregnant women for establishment of a pregnancy-specific cut-off and comparison with immunoassay measurements of TRAb. The retrospective Danish study was performed within the North Denmark Region Pregnancy Cohort (2011-2015) that includes stored biobank samples from early pregnancy (median week 10) with immunoassay measurements of thyroid function parameters and TRAb. TSI were measured in the same samples using the Turbo TSI bioassay (Quidel/Ortho-Clinical Diagnostics) with a recommended cut-off of 0.0241 IU/L in non-pregnant adults. A pregnancy-specific TSI cut-off (95-percentile) was established using Regression on Order Statistics. The established TSI cut-off was 0.0418 IU/L (95 % CI: 0.0417-0.0419). Among women with early pregnancy hyperthyroidism (n=438), 43 women (9.8 %) were TSI positive using the established cut-off, and these women had lower TSH (median 0.008 mIU/L) compared to women with TSI levels below 0.0241 (median TSH 0.040 mIU/L) or in the range from 0.0241 to 0.0418 (median TSH 0.033 mIU/L). Among the 438 women with early pregnancy hyperthyroidism, 22 women were positive for TSI and TRAb, 388 were negative for both, and 28 women were positive for either TSI or TRAb. This is the first study on TSI measurements in a large cohort of early pregnant women. A pregnancy-specific cut-off for TSI was established and agreement in the classification with immunoassay measurements of TRAb was seen in 94 % of cases.

Maternal Thyroid Function and Biochemical Markers of Placental Function in Early Pregnancy.

A link between maternal thyroid function and the placental biomarkers, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF), has been brought forward. This study aimed to describe their association in early pregnancy. Retrospective cohort study. Eight hundred and fifty-eight pregnant women from the North Denmark Region, 2013, with blood samples drawn in early pregnancy. Thyroid-stimulating hormone (TSH), free thyroxine (fT4), thyroid-peroxidase antibodies (TPO-Ab), thyroglobulin antibodies (Tg-Ab) (ADVIA Centaur XPT, Siemens Healthineers), sFlt-1 and PlGF (Kryptor Compact, ThermoFisher Scientific) were measured. The association between maternal TSH and fT4 and percentile (pc) levels of sFlt-1 and PlGF (< 25th pc, 25-75th pc, > 75th pc) was evaluated using regression analysis and reported as adjusted beta coefficient (aβ). The frequency of maternal thyroid autoantibodies (TPO-Ab > 60 U/mL or Tg-Ab > 33 U/mL) by pc levels of sFlt-1 and PlGF was compared using chi-squared test. Higher levels (> 75th pc) of sFlt-1 associated with lower TSH (aβ 0.62, 95% CI: 0.51-0.76) and higher fT4 (aβ 1.03, 95% CI: 1.01-1.05). Higher levels of PlGF associated with lower TSH (aβ 0.82, 95% CI: 0.69-0.98), but not with levels of fT4 (aβ 1.00, 95% CI: 0.97-1.02). No association with maternal thyroid autoantibodies was found (TPO-Ab: sFlt-1: p-value 0.5 and PlGF: p-value 0.1; Tg-Ab: sFlt-1: p-value 0.7 and PlGF: p-value 0.1). In a large cohort of Danish pregnant women, higher levels of sFlt-1 and PlGF associated with maternal thyroid function in early pregnancy, while there was no association with maternal thyroid autoantibodies.

Regional CCUS strategies in the context of a fully decarbonized society

Global strategies to combat climate change must be implemented through actions at the local level. The complexity and interconnection of the global challenges are, however, difficult to interpret at the local level. This requires enhanced collaboration and coordination together with a shared understanding of the interconnected nature of our energy systems and the strategies that shape them. Global, international, and national strategies for carbon capture utilization and storage (CCUS) have emerged in recent years as carbon is increasingly outlined as a key element in the future energy system. This emphasizes CCUS strategies as an important part of a transition toward a fully decarbonized society. Therefore, principal strategies for CCUS and the energy system need to be coordinated and translated following a spatiotemporal assessment to enable meaningful actions at the local level. This article applies a regional perspective, in which a regional energy system model seeks to bridge the gap between national and local energy planning. The regional energy system is developed as part of an overarching national scenario for the transition towards a fully decarbonized society. This context provides a national boundary shaped by a global ceiling to provide a meaningful and adequate framework for regional and local development in the future. The overarching national scenario frames the potentials and constraints of the regional energy system and CCUS strategies as part of a global transition while enabling investigations of potential ramifications from changes in national objectives. The analysis in the article uses the North Denmark Region as a case and investigates scenarios in which the region assumes various roles as a contributor to the national transition. The results indicate a need for more interactive and dynamic energy planning and CCUS strategies to comprehend possible impacts from the various roles and changes in the national objectives. This article suggests that spatial and temporal awareness at the regional level of CCUS strategies as part of a future fully decarbonized society is key to creating a meaningful context for local actions today.

The optimal antibiotic treatment duration for community-acquired pneumonia in adults diagnosed in general practice in Denmark (CAP-D): an open-label, pragmatic, randomised controlled trial

BackgroundUse of antibiotics is the main driver of antimicrobial resistance which is considered one of the biggest threats to human health. In Denmark, most antibiotics are prescribed in general practice. Acute lower respiratory tract infections, including community-acquired pneumonia (CAP), are among the most frequent indications for antibiotic prescribing. Phenoxymethylpenicillin is established as first-line treatment in general practice in Denmark. However, the treatment duration with phenoxymethylpenicillin is mostly based on traditions. Both 5 and 7 days of treatment is recommended in Danish guidelines, and when asking the general practitioners about what treatment duration, they prescribe the variation is even bigger. Several hospital-based studies have proven short course (≤ 6 days) antibiotic treatment non-inferior to long course (≥ 7 days) treatment of CAP. No evidence exists on the optimal treatment duration for CAP in non-hospitalised patients.This randomised controlled trial aim to investigate the optimal treatment duration with phenoxymethylpenicillin for CAP in adults diagnosed in general practice in Denmark.MethodsThis is an open-label, pragmatic, randomised controlled, five-arm DURATIONS trial. Participants will be recruited from at least 24 general practices in Denmark. Eligible participants are adults, with no pre-existing lung disease, presenting with symptoms of CAP, and in whom the general practitioner finds it relevant to treat with antibiotics. The study will compare treatment with phenoxymethylpenicillin 1.2 MIE q.i.d. in 3, 4, 5, 6, and 7 days.DiscussionThis study will provide evidence for the optimal antibiotic treatment duration of CAP in general practice and inform future guidelines on CAP in all countries using phenoxymethylpenicillin for the treatment of acute respiratory tract infections in adults. The results of this study might also be used to guide treatment recommendations in other countries using phenoxymethylpenicillin.Moreover, a (potential) reduction in antibiotic use might lower the development of antimicrobial resistance, increase patient treatment adherence, reduce risks of adverse events, and lower the economical expTrial registrationClinicalTrials.gov: NCT06295120. Registered 28 February 2024. The Scientific Ethics Committee for the North Denmark Region: N-20230039.

Effectiveness of treatment with budesonide orodispersible tablets in 76 patients with eosinophilic oesophagitis – real-life experience from the population-based DanEoE cohort

Background Eosinophilic oesophagitis (EoE) is a chronic immune-mediated disease. In Denmark, the budesonide orodispersible tablet (BOT) is recommended as a second-line treatment for proton pump inhibitor-refractory EoE patients. Aims To evaluate the effectiveness of treatment with BOT in adult EoE patients in a population-based setting in Denmark. Methods This was a retrospective, registry-based, DanEoE cohort study of all 76 adult EoE patients treated with BOT and diagnosed between 2007 and 2021 in the North Denmark Region. After medical record revision, the EoE diagnosis was defined according to the AGREE consensus. Symptomatic response was based on the information found in the patients’ medical reports and histologic remission was defined as <15 eosinophils per high-power field (eos/hpf). Results Histologic remission was achieved in 89% of the patients treated with BOT who underwent histologic evaluation. Clinicohistologic remission was achieved in 71% of the patients who underwent both symptomatic and histologic evaluation. Despite histologic remission, 18% of patients still experienced symptoms. Non-responders were found in 7% of the patients. Complications were rare, with dilation of strictures performed in 7% and food bolus obstruction (FBO) occurring in 3%. Discontinuation of the treatment due to unacceptable side effects was observed in 11% of the treated patients. Conclusions Treatment with BOT effectively induced histologic remission in most of the EoE patients. Despite achieving histologic remission, approximately 1/5 of the patients were still symptomatic. Complications were rare. In non-responders and those with unacceptable side effects, alternative treatment options such as biologic agents might be needed.

Exploring general practice staff perspectives on a teaching concept based on instruction videos for diabetic retinopathy screening – an interview study

Objective The aim of this study is to explore general practice staff perspectives regarding a teaching concept based on instructional videos for conducting DR screenings. Furthermore, this study aims to investigate the competencies acquired by the staff through this teaching concept. Design and setting Qualitative cross-sectional study conducted in general practice clinics in the North Denmark Region. Method A teaching concept was developed based on instruction videos to teach general practice staff to conduct diabetic retinopathy screenings with automated grading through artificial intelligence. Semi-structured interviews were performed with 16 staff members to investigate their perspectives on the concept and acquired competencies. Results This study found no substantial resistance to the teaching concept from staff; however, participants’ satisfaction with the methods employed in the instruction session, the progression of learning curves, screening competencies, and their acceptance of a known knowledge gap during screenings varied slightly among the participants. Conclusion This study showed that the teaching concept can be used to teach general practice staff to conduct diabetic retinopathy screenings. Staffs’ perspectives on the teaching concept and acquired competencies varied, and this study suggest few adjustments to the concept to accommodate staff’s preferences and establish more consistent competencies.

Stimulating TSH-receptor antibodies in early pregnancy using the turbo TSI bioassay: a study of 3,028 pregnant women in the north denmark region

Stimulating TSH-receptor antibodies in early pregnancy using the turbo TSI bioassay: a study of 3,028 pregnant women in the north denmark region

Strategic management of CO2: A scalable model for CCS in decarbonised societies

In future decarbonised energy systems, residual carbon emissions require strategic planning and management. In environmental management, an evaluation of carbon removal considering local geographic frameworks is needed. This paper introduces a scalable and adaptable model for evaluating the economics and geography of future carbon capture and storage (CCS) configurations across geographical scales, covering capture, transport, and storage of carbon. The model is applied to the North Denmark Region, showing that future energy production carbon sources will be concentrated in Thisted and Jammerbugt, while industrial sources remain in Aalborg and Rebild municipalities. Carbon transport configurations, including truck, pipeline, and shipping are assessed, for the carbon to be stored in onshore and offshore geological storages. The regional scale findings suggest that pipelines and onshore storage provide the most economical configuration. However, a sensitivity study using a smaller geographical scope indicates potential for optimising carbon transport by evaluating both carbon volume and distance. The paper discusses how the model's flexibility and scalability enable the integration of alternate cost components, thereby supporting the calculation of the carbon repurposing potentials, including carbon capture, utilisation, and storage (CCUS) configurations.

Paving the Road While Walking – Perspectives from Flexible Assertive Community Treatment Managers on Preparing the Implementation of Peer Support Work (PSW) in Outpatient Services

This qualitative study explored the perspectives of Flexible Assertive Community Treatment managers on preparation and employment of peer support workers. The study was based on semi-structured interviews with managers (n = 5) in Outpatient Services in the North Denmark Region. The analysis was based on an inductive approach to content analysis which led to three themes: (1) An exploratory but energy-loaded process—deciding to employ peer support workers, (2) Paving the road while walking—preparing employment of peer support workers, and (3) Uncertainty about the “how” and the “what”—preparing mental health professionals for collaborating with peer support workers. Together these themes describe an exploratory and unstructured implementation process, revealing a lack of structure during implementation. Such circumstances are known to potentially compromise staff wellbeing, feeling insecure about own professional role, and lack of readiness to embrace peer support workers as colleagues. Applying an implementation framework and addressing the literature on barriers and facilitators may promote successful implementation of peer support worker employment.

Maternal hypothyroidism and the risk of preeclampsia: a Danish national and regional study

BackgroundMaternal hypothyroidism in pregnancy has been proposed to increase the risk of preeclampsia, but uncertainties persist regarding the underlying causal mechanisms. Thus, it remains unclear if an increased risk of preeclampsia in hypothyroid pregnant women is caused by the lack of thyroid hormones or by the autoimmunity per se.MethodsWe conducted a retrospective study of two pregnancy cohorts in the Danish population. The nationwide cohort (n = 1,014,775) was register-based and included all singleton pregnancies in Denmark from 1999–2015. The regional cohort (n = 14,573) included the biochemical measurement of thyroid stimulating hormone (TSH), thyroid peroxidase antibodies (TPO-Ab), and thyroglobulin antibodies (Tg-Ab) (ADVIA Centaur XPT, Siemens Healthineers) among pregnant women in The North Denmark Region from 2011–2015 who had a blood sample drawn in early pregnancy as part of routine prenatal screening for chromosomal anomalies. The associations between diagnosed and biochemically assessed hypothyroidism and a diagnosis of preeclampsia were evaluated using logistic regression (adjusted odds ratio (aOR) with 95% confidence interval (CI)) adjusting for potential confounders, such as maternal age, diabetes, and parity.ResultsIn the nationwide cohort, 2.2% of pregnant women with no history of hypothyroidism (reference group (ref.)) were diagnosed with preeclampsia, whereas the prevalence was 3.0% among pregnant women with hypothyroidism (aOR 1.3 (95% CI: 1.2–1.4)) and 4.2% among women with newly diagnosed hypothyroidism in the pregnancy (aOR 1.6 (95% CI: 1.3–2.0)). In the regional cohort, 2.3% of women with early pregnancy TSH < 2.5 mIU/L (ref.) were diagnosed with preeclampsia. Among women with TSH ≥ 6 mIU/L, the prevalence was 6.2% (aOR 2.4 (95% CI: 1.1–5.3)). Considering thyroid autoimmunity, preeclampsia was diagnosed in 2.2% of women positive for TPO-Ab (> 60 U/mL) or Tg-Ab (> 33 U/mL) in early pregnancy (aOR 0.86 (95% CI: 0.6–1.2)).ConclusionsIn two large cohorts of Danish pregnant women, maternal hypothyroidism was consistently associated with a higher risk of preeclampsia. Biochemical assessment of maternal thyroid function revealed that the severity of hypothyroidism was important. Furthermore, results did not support an association between thyroid autoimmunity per se and preeclampsia.

Clinical and microbiological characteristics of anaerobic bacteremia during 1994–2019: A Danish population-based cohort study

ObjectivesBacteremia with anaerobic bacteria is generally a marker of severe prognosis. However, population-based data is lacking. Our aim was to describe the epidemiology and the 30-day mortality rate of anaerobic bacteremia in a Danish population-based setting. MethodsIn this population-based cohort study, all first-time episodes of anaerobic bacteremia from the North Denmark Bacteremia Research Database during 1994–2019 were identified. Information on comorbidities, discharge diagnoses, and mortality was retrieved. 30-day mortality rates were calculated and a multivariate logistic regression analysis to identify risk factors for death was performed. Results1750 episodes with anaerobic bacteremia were identified, corresponding to an incidence rate of 12.5 per 100,000 inhabitants (increasing from 11.2 in 1994–2014 to 17.7 in 2015–2019). Of these episodes, a third were polymicrobial, and the majority (70 %) of patients had one or more comorbid conditions. Abdominal infection was the source of bacteremia in 61 % of patients, while it was unknown for 15 %. The most frequently isolated genera were Bacteroides (45 %), Clostridium (20 %) and Fusobacterium (6 %). The overall crude 30-day mortality rate was 27 %, but rates were even higher for patients of high age, with liver disease, and solid tumors. The odds ratio (OR) for 30-day mortality was 1.32 for Clostridium species, and 1.27 for polymicrobial bacteremia with aerobic bacteria. ConclusionsThe incidence rate of anaerobic bacteremia increased, and the 30-day mortality rate remained high during the study period. Multiple factors influence 30-day mortality rates, including high age, liver disease, solid tumor, polymicrobial bacteremia, and bacteremia with Clostridium species.

E-Methanol Production and Potential Export in the Northern Denmark Region for 2030 and 2045

Denmark has set a target of 4–6 GW electrolysis capacity by 2030, of which a part of the produced hydrogen is to be used for export, while the rest could be transformed further into electrofuels. The North Denmark Region has favourable conditions for the production of carbon-based fuels. The region has high availability of CO2 sources and a strategic position for establishing CO2 hubs in the local harbours that could support biogenic CO2 availability in the future. This paper investigates the potential of the region for exporting e-methanol through 22 energy system scenarios and the impacts on the energy system if this is to be realised by 2030 and 2045, when Denmark is expected to achieve its national climate goals. The analysis highlights the significant potential of this region to contribute to e-methanol production not only to meet the regional demand for methanol for marine transport and aviation but also for export to the rest of Denmark or beyond Danish borders.

Diagnostic accuracy of dipsticks for urinary tract infections in acutely hospitalised patients: a prospective population-based observational cohort study

ObjectiveTo determine the added diagnostic value of dipsticks for urinary tract infections (UTI) in acutely hospitalised individuals.DesignProspective population-based cohort study.SettingNorth Denmark.ParticipantsAll adults (≥18 years) examined with dipsticks at emergency departments...

Emergency Call versus General Practitioner Requested Ambulances - Patient Mortality, Disease Severity and Pattern.

Ambulance requests by general practitioners for primary care patients (GP-requested) are often omitted in studies on increased demand within emergency care but may comprise a substantial patient group. We aimed to assess acute severity, intensive care unit (ICU) admission, and diagnostic pattern, including comorbidity, and mortality among GP-requested ambulance patients, compared to emergency call ambulance patients. Our hypothesis was that emergency call patients had more severe health issues than GP-requested ambulance patients. Historic population-based cohort study of ambulance patients in the North Denmark Region, 2016-2020. Hospital contact data including diagnoses, ambulance data, vital signs and vital status was linked using each patient's unique identification number. Primary outcome measure was mortality within 1, 7, and 30 days. Secondary outcomes were disease severity expressed as modified National Early Warning Score (NEWS2), and ICU admission. Admission status and hospital diagnostic pattern, including comorbidity were described and compared. We included 255,487 patients. GP-requested patients (N = 119,361, 46.7%) were older (median years [IQR] 73 [58-83] versus 61 [37-76]) and more had moderate/severe comorbidity (11.9%, N = 13,806 versus 4.9%, N = 6145) than the emergency call patients. Prehospital mNEWS2 median scores were lower for GP-requested patients. For both groups, mNEWS2 was highest among patients aged 66+. GP-requested patients had higher 30-day mortality (9.0% (95% CI: 8.8-9.2), N = 8996) than emergency call patients (5.2% (95% CI: 5.1-5.4), N = 6727). Circulatory (12.0%, 11,695/97,112) and respiratory diseases (11.6%, 11,219/97,112) were more frequent among GP-requested patients than emergency call patients ((10.7%, 12,640/118,102) and (5.8%, 6858/118,102)). The highest number of deaths was found for health issues 'circulatory diseases' in the emergency call group and 'other factors' followed by "respiratory diseases" in the GP-requested group. GP-requested patients constituted nearly half of the EMS volume, they were older, with more comorbidity, had serious conditions with substantial acute severity, and a higher 30-day mortality than emergency call patients.

Potential medicine waste in the process of outpatients receiving cost-free medicines from medicine pick-up lockers in the North Denmark region

ObjectivesIn the Danish healthcare system, restructuring is an ongoing process to accommodate the rising number of patients and to optimise resource allocation. To ease departmental burdens at hospitals in the...

Adverse events reporting during the COVID-19 pandemic in a Danish region: a retrospective analysis.

The 2020 onset of the COVID-19 pandemic globally strained healthcare. Healthcare systems worldwide had to rapidly reorganize, impacting service delivery, patient care, and care-seeking behaviors. This left little time to assess the pandemic's effects on patient safety. This paper investigates COVID-19's influence on patient safety in a Danish region, using data from the national reporting system for adverse events during the initial COVID-19 surge in early 2020. This retrospective analysis investigated how the early phase of the COVID-19 pandemic (January-September 2020) affected the incidence of adverse events in a Danish Region, comparing it to the same period in 2019. Data were sourced from the Danish Patient Safety Database and regional systems. Adverse events were reported numerically. Descriptive statistics were employed to describe the percentage difference in adverse events and hospital activity, as well as the rate of adverse events per 1000 activities. Additionally, COVID-19-specific adverse events from April 2020 to March 2021 were identified and analyzed, categorizing them into seven risk areas across various healthcare sectors. During Denmark's initial COVID-19 surge in early 2020, the North Denmark Region's hospitals reported a significant decrease in adverse events, with a 42.5% drop in March 2020 compared to March 2019. From January to September 2020, the number of adverse events dropped 8.5% compared to the same period in 2019. In the same period, hospital activity declined by 10.2%. The ratio of reported adverse events per 1000 hospital activities thus decreased in early 2020 but showed only a minor difference overall for January-September compared to 2019. Between April 2020 and March 2021, out of 5703 total adverse events, 324 (5.7%) were COVID-19 related. COVID-19-related events were categorized into seven distinct risk areas, reflecting diverse impacts across healthcare sectors including hospitals, general practices, pre-hospital care, and specialized services. The initial decline in reporting of adverse events likely resulted from rapid healthcare changes and under-prioritization of the reporting system during the acute phase. However, a near return to pre-pandemic reporting levels suggests a resilient reporting system despite the crisis. The study's strength lies in the comprehensive data from Danish reporting systems, though it acknowledges potential underreporting and doesn't measure the pandemic's overall impact on patient safety.

Validity of obstructive sleep apnoea diagnoses

INTRODUCTION. Healthcare databases are a valuable source for epidemiological research in obstructive sleep apnoea, but accurately registered diagnoses are pivotal in contributing quality evidence. We examined positive predictive values (PPV) of the International Classification of Diseases, tenth version (ICD-10) diagnosis for “obstructive sleep apnoea” and “sleep apnoea” in the Danish National Patient Register. METHODS. Using the Danish National Patient Registry, we randomly sampled 100 patients from the North Denmark Region diagnosed with “obstructive sleep apnoea” (ICD-10 code DG4732) and 100 patients diagnosed with “sleep apnoea” (DG473*) during the year 2020. We calculated the PPV using a documented Apnea-Hypopnea Index (AHI) ≥ 5 to confirm the recorded diagnosis. A total of 70 patients were referred to the private sector for assessment of the AHI and excluded due to limited access to their data. RESULTS. The study population included 130 patients, among whom 64 were diagnosed with “obstructive sleep apnoea”, and 66 patients were registered with “sleep apnoea”. The PPV for “obstructive sleep apnoea” was 93.8% (95% confidence interval (CI): 85.0-97.5%), and the PPV for “sleep apnoea” was 80.3% (95% CI: 69.2-88.1%). CONCLUSIONS. Our findings indicated a high validity of the ICD-10 code DG4732 with a PPV of 93.8% and a lower PPV (80.3%) for the ICD-10 code DG473* for identifying patients with obstructive sleep. The “obstructive sleep apnoea” diagnosis is a suitable source of data for epidemiological research to identify patients with the disease. FUNDING. None. TRIAL REGISTRATION. Not relevant.

A telemonitoring intervention design for patients with poorly controlled type 2 diabetes: protocol for a feasibility study.

Maintaining optimal glycemic control in type 2 diabetes (T2D) is difficult. Telemedicine has the potential to support people with poorly regulated T2D in the achievement of glycemic control, especially if the telemedicine solution includes a telemonitoring component. However, the ideal telemonitoring design for people with T2D remains unclear. Therefore, the aim of this feasibility study is to evaluate the feasibility of two telemonitoring designs for people with non-insulin-dependent T2D with a goal of identifying the optimal telemonitoring intervention for a planned future large-scale randomized controlled trial. This 3-month randomized feasibility study will be conducted in four municipalities in North Denmark starting in January 2024. There will be 15 participants from each municipality. Two different telemonitoring intervention designs will be tested. One intervention will include self-monitoring of blood glucose (SMBG) combined with sleep and mental health monitoring. The second intervention will include an identical setup but with the addition of blood pressure and activity monitoring. Two municipalities will be allocated to one intervention design, whereas the other two municipalities will be allocated to the second intervention design. Qualitative interviews with participants and clinicians will be conducted to gain insight into their experiences with and acceptance of the intervention designs and trial procedures (e.g., blood sampling and questionnaires). In addition, sources of differences in direct intervention costs between the two alternative interventions will be investigated. Telemonitoring has the potential to support people with diabetes in achieving glycemic control, but the existing evidence is inconsistent, and thus, the optimal design of interventions remains unclear. The results of this feasibility study are expected to produce relevant information about telemonitoring designs for people with T2D and help guide the design of future studies. A well-tested telemonitoring design is essential to ensure the quality of telemedicine initiatives, with goals of user acceptance and improved patient outcomes. ClinicalTrials.gov, ID: NCT06134934 . Registered November 1, 2023. The feasibility trial has been approved (N-20230026) by the North Denmark Region Committee on Health Research Ethics (June 5, 2023).

Non-peer professionals' understanding of recovery and attitudes towards peer support workers joining existing community mental health teams in the North Denmark Region: A qualitative study.

Peer support is a collaborative practice where people with lived experience of mental health conditions engage in supporting like-minded. Peer support impacts on personal recovery and empowerment and creates value at an organisational level. However, the implementation of peer support into existing mental health services is often impeded by barriers embedded in organisational culture and support in role expectations. Non-peer professionals' recovery orientation and attitudes towards peer support workers (PSWs) are essential factors in the implementation of peer support, and this study explored non-peer professionals' understanding of recovery and their attitudes towards PSWs joining existing community mental health teams in one region of Denmark. In total, 17 non-peer professionals participated in three focus groups. Thematic analysis led to three themes: (1) Recovery is a process of "getting better" and balancing personal and clinical perspectives; (2) Realising recovery-oriented practice: a challenging task with conflicting values; and (3) Expectations and concerns about peer support workers joining the team. Recovery-oriented practice faces challenging conditions in contemporary mental health services due to a dominant focus on biomedical aspects in care and treatment. Implementation facilitators and barriers in the employment of PSWs point towards fundamental aspects that must be present when employing PSWs in an organisation. The issues described leading up to the employment of PSWs reflected in this study underpin the importance of preparing an organisation for the employment of PSWs based on the available knowledge.