Effective prevention of drowning and aquatic incidents requires timely and accurate surveillance supported by high-quality validated data. In Denmark, the use of the free-text fields in the Danish Prehospital Medical Record has proven effective in identifying potentially relevant cases for such surveillance. While these free-text fields contain rich contextual information, manual screening of all records is impractical. This study aimed to develop and internally validate a Danish natural language processing pipeline for identifying drowning and aquatic incidents (AquaAI) from routine prehospital records and prioritizing records for final manual validation by medical experts. This nationwide retrospective cohort study was conducted using Danish prehospital electronic medical records from 2016 to 2024. Medical records were first retrieved using the Danish Drowning Formula, an iteratively developed trigger-word search algorithm, and expert-labelled as Drowning, Aquatic incident, or Non-relevant. A Danish transformer-based language model was then fine-tuned for three-class sequence classification as the second-stage classifier in this workflow and embedded in a hybrid pipeline with rule-based safeguards. Model development used a temporal split with training data from 2016 to 2021 and validation data from 2022. Final performance was evaluated on a temporally separated hold-out dataset comprising records from 2023 to 2024. Primary outcomes were class-wise sensitivity and a binary Relevant (Drowning + Aquatic incident) versus Non-relevant analysis to quantify case finding and workload reduction. The dataset comprised 40,876 medical records retrieved with the Danish Drowning Formula. On the hold-out dataset, AquaAI identified 91% of relevant cases and correctly filtered 89% of non-relevant records from manual review. Overall, this reduced the number of records requiring manual review by 77.5%. In the three-class analysis, sensitivity was 84% for Drowning, 83% for Aquatic incident, and 89% for Non-relevant. Only one drowning case (0.3%) was classified as non-relevant. A hybrid transformer-based pipeline operating as a second-stage classifier within a two-step retrieval workflow can identify drowning and aquatic incidents from prehospital free-text narratives with high case finding and substantial reduction of manual review. This approach may support national surveillance and targeted prevention initiatives.
Psychologists are increasingly asked to assess intellectual functions in adults from diverse cultural and linguistic backgrounds. This study investigated the impact of acculturation and bilingualism on Wechsler Adult Intelligence Scale (WAIS)-IV performance among Arabic-Danish bilingual university students. Forty-eight academically high-achieving participants (69% female), fluent in Danish and educated entirely in Denmark, were recruited in Greater Copenhagen and completed a demographic questionnaire, the Danish version of the WAIS-IV, and self-report measures of acculturation and bilingualism. Several WAIS-IV indexes and subtests were significantly associated with degree of bilingualism and acculturation, even after controlling for educational variables. Despite being academically high-achieving university students, participants scored below the national mean on most indexes and subtests. In fact, only performances on the Processing Speed Index, and the Coding and Symbol Search subtests were at the expected level. Notably, the lowest scores were observed on Block Design, which showed a strong correlation with Arabic acculturation scores. Finally, participants had index profiles that were more uneven than predicted based on the norms. These findings underscore the influence of cultural and linguistic factors on WAIS-IV performance and suggest that WAIS-IV may not fully capture the intellectual abilities of bilingual individuals, even when they are fluent in the test language and have the same educational experience as the norm population.
The National Danish Injury Cohort (NDIC) is a nationwide, register-based cohort established to examine the incidence of total and specific injuries in Denmark and to provide insights into causes and consequences. Comprehensive individual-level information for this cohort is stored in the NDIC dataset, serving as a foundation for analyses of injury determinants and supporting the planning and evaluation of preventive measures aimed at reducing injury-related harm. Individuals registered in the Danish National Patient Register with an injury from 2010 onwards are included in the dataset. Additionally, it comprises persons in the Cause of Death Register whose deaths was attributed to accidents, violence, or suicide. The cohort is currently updated through 2022 and contains information on more than 7.2 million primary injury contacts and 26 thousand accident-related deaths. Analyses based on NDIC demonstrated substantial demographic and geographical disparities in the incidence rates of injuries. Overall, men exhibited higher rates of both injury incidents and injury‑related mortality compared with women. Marked differences were observed when stratifying by sex and age, as well as by region of residence. NDIC offers a solid data foundation facilitating research into injury trends, causes, and impacts, including disparities across social groups and geographic areas. It presents unique opportunities to explore novel research ideas to boost injury prevention, improve targeting of interventions, and reduce health inequalities. Strengthening this research area will help further reinforce NDIC's role in injury surveillance and evidence‑based policymaking.
Schizophrenia spectrum disorders (SSD) are complex illnesses influenced by genetic, biological and psycho-social factors, necessitating large clinical deep-phenotyped cohorts. Here, we describe the Region Midt Schizophrenia (RMS) Cohort, which aims to establish such a large, representative cohort with long-term follow-up, enabling large-scale studies on SSD etiology and prognosis. The RMS cohort includes patients aged ≥15 years diagnosed with a first-episode SSD recruiting at 6 Danish psychiatric hospitals. Baseline and follow-up assessments at 1, 2, 3, and 12 months and 2, 3, 5, and 10 years cover sociodemographic measures, psychotic and negative symptoms, adverse childhood experiences (ACEs), level of functioning, sleep, actigraphy, cognition, side effects, and medication adherence. Blood is collected at baseline and months 3 and 12 and at years 2, 3, 5 and 10 enabling comprehensive molecular analyses, e.g. genetics and omics. Age- and sex-matched healthy controls will complete a baseline assessment including blood draw. Participants give informed consent for linkage with Danish nationwide register-based data. By February 23rd, 2026, a total of 131 participants with SSD have been recruited (109 with schizophrenia, median age 25 years (IQR 8), 54% females). Retention rates at 1, 2, 3 and 12 months are 86%, 80%, 78%, and 75%, respectively. Our vision is continuous recruitment of 100 participants/year, establishing a large, deep-phenotyped, and representative clinical cohort with long-term follow-up. The RMS cohort will serve as the basis for several studies on etiological and prognostic factors and is designed to match with similar international cohorts enabling further collaborations. The protocol has been approved by the ethics committee of the Central Denmark Region (reference: 1-10-72-147-23). Study findings will be published in peer-reviewed journals independent of whether they are positive, negative, or inconclusive, and will be presented at national and international conferences.
Survivors of out-of-hospital cardiac arrest (OHCA) who remain comatose after return of spontaneous circulation are routinely sedated and mechanically ventilated during early post-resuscitation care. Although prolonged sedation has traditionally been considered necessary, contemporary normothermia-based temperature control allows earlier wake-up call. The optimal timing of an early wake-up call remains unknown and may influence overall mortality, neurological recovery, duration of mechanical ventilation, and length of hospital stay. The Danish Out-of-Hospital Cardiac Arrest (DANOHCA) trial (clinicaltrials.gov identifier: NCT05895838; and euclinicaltrials.eu, identifier: 2024-515,997-28-00) is an investigator-initiated, multicenter, randomized clinical trial using a 2 × 2 × 2 × 2 factorial design evaluating four interventions in patients resuscitated from OHCA. The present protocol describes the comparison of an early versus late wake-up call strategy. Adult patients (≥ 18 years) with presumed cardiac-cause of OHCA, sustained return of spontaneous circulation, and persistent unconsciousness on intensive care unit admission are randomized 1:1 to early wake-up call (≤ 6 h after randomization) or late wake-up call (28-36 h after randomization). Wake-up call includes interruption of sedation, assessment of neurology, and may be followed by extubation if predefined neurological and respiratory criteria are fulfilled. The primary endpoint is days alive and out of hospital within 30 days after randomization. Analyses will follow a modified intention-to-treat principle. Optimizing post-resuscitation care remains a cornerstone in managing comatose cardiac arrest survivors and improving outcomes. We hypothesize that sedation for 28-36 h leads to more days alive outside of the hospital in 30 days compared to sedation for ≤ 6 h. EudraCT number: 2016-003265-26; EU CTIS no 2024-515997-28-00; ClinicalTrials.gov identifier: NCT05895838.
A novel heterozygous missense variant in STAT3 (NM_139276.3: c.1250G > C, NP_644805.1: p.(Arg417Thr) was identified in a Danish family spanning five generations with diverse phenotypes consistent with autosomal dominant STAT3-Hyper-IgE-Syndrome (STAT3-HIES). Genetic analysis confirmed the absence of the variant in population databases, and computational predictions of pathogenicity were conflicting. Functional assessment revealed that the variant STAT3 Arg417Thr maintained normal DNA binding but exhibited reduced IL-6-induced transcriptional activity and no negative-dominance. Further, significantly impaired STAT3-dependent, IL-10-mediated suppression of TNF-α production were found in patient-derived monocytes, consistent with a partial loss-of-function effect. Clinically, affected individuals presented with recurrent staphylococcal skin abscesses, eczema, atopic or infectious complications, and characteristic facial features. There was a marked variability in extra-hematopoietic manifestations such as retained primary teeth, vascular anomalies, and psychiatric disorders. Laboratory findings included elevated serum IgE levels, but only slightly reduced or normal Th17 cell counts. NIH-HIES scores varied within the family (range: 12-34), highlighting the variability of clinical expression. Based on ACMG guidelines, the variant was classified as likely pathogenic due to absence from controls, co-segregation with disease, and supportive functional evidence. This report highlights the challenges in interpreting novel STAT3 variants and the critical need for functional validation in uncertain cases. The findings emphasize the importance of molecular diagnosis irrespective of clinical scoring and address the ethical complexities of genetic testing in familial disease.
暂无摘要（点击查看详情）
Use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) has increased rapidly following approval for obesity treatment, but data on their use in younger populations remain limited. We examined trends in GLP-1RA use among 12- to 24-year-olds in Denmark during 2018-2025. Using nationwide prescription, hospital, and laboratory registries, we conducted a drug utilization study including all 12- to 24-year-olds who filled a GLP-1RA prescription between January 2018 and December 2025. We described incidence of use, baseline characteristics, prescribing patterns, and treatment persistence. GLP-1RA use rose more than 50-fold across the study period, reaching 418 new users per 100,000 by 2025, driven by semaglutide for weight management. Uptake was steepest among individuals aged 18-24 years (from 13 to 686 per 100,000) and more modest among adolescents aged 12-17 years (from 1.7 to 72 per 100,000). Most users were female, few had diabetes, and 33% had psychiatric comorbidity, particularly emotional and neurodevelopmental disorders. By 2025, 78% of new treatments were initiated in general practice. Only 38% were covered by a prescription after 1 year. Findings demonstrate rapid uptake of GLP-1RAs in youth and the need for specialist involvement, long-term safety data, and careful evaluation of mental health in this population.
Stiff person syndrome is a rare and progressive neurological disorder, yet evidence on long term outcomes is limited. We examined the occurrence and mortality associated with stiff person syndrome in Denmark. We conducted a population based cohort study including all Danish citizens from 2001-2022. Individuals with a first time diagnosis of stiff person syndrome (N=30) were identified in the Danish National Patient Registry covering all Danish hospitals and matched 1:100 on sex and birth year with persons from the general population (N=3,000). Incidence, prevalence, cumulative mortality, and mortality rates were estimated, and Cox proportional hazards regression was used to compute hazard ratios (HRs) as an estimate of mortality rate ratios adjusted for sex, year of birth, and comorbidity with 95% confidence intervals (CIs). Thirty patients were diagnosed during the study period; 53.3% were male, and median age at diagnosis was 50 years. Incidence increased from 0.11 per 1,000,000 person years (2001-2008) to 0.43 (2017-2022). Prevalence rose from 1.32 per 1,000,000 in 2016 to 3.94 in 2022. The 10 year cumulative mortality in the stiff person syndrome cohort was 27.5% (95% CI: 13.8-50.1) (HR=4.1 [95% CI: 1.9-8.9). Stiff person syndrome is a rare disorder with increasing incidence and prevalence, and high mortality. .
The primary aim was to report available literature on antibiotic prophylaxis against open fracture-related infections, in populations with antimicrobial resistance patterns similar to Denmark's as reported by the European Antimicrobial Resistance Surveillance Network. Countries included: Denmark, Finland, Germany, Great Britain, Iceland, the Netherlands, Norway, and Sweden. A secondary aim was to compare Danish regional guidelines with these findings. PubMed, Medline, and Embase were searched for studies published between January 1998 and March 2024. Danish guidelines were retrieved on May 7th, 2024, through a systematic search. Out of 6492 studies, 120 were screened in full, and 19 were included for analysis. 9 studies recommended cephalosporins (primarily 1st and 2nd generations) for Gustilo-Anderson Grades I and II, while 10 studies supported further gram-negative coverage for Gustilo-Anderson grade IIIa-c fractures. One study found no significant benefit of antibiotic prophylaxis for reducing fracture-related infections. Danish guidelines varied: The Capital Region of Denmark recommends gram-negative coverage for all Gustilo-Anderson grades, whereas the Region of Southern Denmark and 10/19 studies only recommend it for Gustilo-Anderson grade IIIa-c fractures. This review identifies a lack of data on pathogens causing FRI in regions with similar antimicrobial resistance patterns according to the EARS-Net, complicating optimal antibiotic strategies. The variability of open fractures underscores the need for research to utilize the Gustilo-Anderson classification when planning the treatment regime, focusing on specific grades to improve targeted AP for preventing FRI. Furthermore, taking the cultures after sufficient surgical debridement. Future high-quality studies in populations with homogeneous antimicrobial resistance patterns are needed to optimize national AP protocols.
Thyroid diseases are common among women of reproductive age and may be related to childhood cancer among offspring, though the evidence is inconsistent. Using Danish registries, we conducted a population-based case-control study to investigate the relationship between maternal thyroid diseases and medication use and childhood cancer among offspring. Cases (N = 2521) diagnosed between 1973 and 2016 were ascertained from the Danish Cancer Registry, and controls (N = 63,014) were randomly selected from the Central Population Registry and matched on sex and date of birth. Information on diagnoses and prescriptions was obtained from the National Patient Register and the National Prescription Register, respectively. Conditional logistic regression was applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Goiter was associated with any cancer (OR = 2.08, 95% CI: 1.44, 3.00), leukemia (OR = 2.18, 95% CI: 1.13, 4.18), acute lymphoblastic leukemia (OR = 2.12, 95% CI: 1.02, 4.42), and lymphoma (OR = 3.06, 95% CI = 1.20, 7.82). There was no observed association between childhood cancer and maternal hypothyroidism or hyperthyroidism; however, these results were likely underpowered. No increased risk of cancer was observed for maternal thyroid medication use. Though the small sample size must be considered, the elevated risk of cancer with maternal thyroid diseases, especially goiter, was notable.
The increasing prevalence of inflammatory bowel disease (IBD) and constrained clinical resources necessitate a shift from fixed-interval outpatient visits towards patient-initiated, needs-based follow-up. Real-world evidence on whether such transitions maintain disease control and achieve patient acceptance remains limited. In 2024, Aalborg University Hospital (Denmark) transitioned all patients with IBD not receiving biological therapy to a digitally supported, patient-initiated monitoring model. We aimed to evaluate the quality of care and patient satisfaction after the transition. This pre-post quality improvement study included 966 patients with IBD (Crohn's disease (CD): n = 279; ulcerative colitis (UC): n = 687). Clinical data, disease activity scores, faecal calprotectin levels, and health-related quality of life were obtained from the GASTROBIO web-based regional database for two years before and up to two years after the transition. Patient satisfaction was assessed via a questionnaire adapted from the validated Danish "LUP survey". Entries of patient reported outcomes (PROs) and faecal calprotectin sampling increased following transition. The proportion of patients in faecal calprotectin-defined remission increased in both CD (63 % to 76 %; p = 0.01) and UC (62 % to 70 %; p = 0.04), while disease activity scores remained stable. Health-related quality of life improved in both CD (p = 0.02) and UC (p < 0.01). Of 966 eligible patients, 371 (38 %) completed the satisfaction survey; the majority preferred the new model over standard of care (CD: 77 %; UC: 84 %) and rated satisfaction as high or very high (CD: 66 %; UC: 71 %). Higher satisfaction correlated with better health-related quality of life in both groups (CD: Spearman's ρ =  - 0.22, p = 0.05; UC: ρ =  - 0.18, p = 0.01). A patient-initiated, digitally supported remote monitoring model maintained disease control, improved health-related quality of life, and achieved high patient satisfaction in a large real-world IBD cohort. These findings support the feasibility and scalability of needs-based IBD follow-up underpinned by an integrated digital infrastructure.
The risk of tuberculosis is increased after solid organ transplantation (SOT) and associated with morbidity and mortality. Pre-transplantation screening and treatment for tuberculosis infection (TBI) is recommended. Aims of this prospective cohort study were determining the prevalence of positive pre-transplantation interferon-gamma release assays (IGRAs), risk factors for a positive result, and describe TBI management. We included SOT candidates from 2020 to 2023 at Rigshospitalet, Denmark with a pre-transplantation IGRA. Data were collected from records and the Danish Microbiology Database. Of 586 patients, 564 (96%) had a pre-transplantation IGRA. Twenty-two (4%) had positive, 537 (95%) negative, and 5 (1%) indeterminate results. Risk factors for a positive IGRA were diabetes (14/480 (3%) without diabetes, 8/84 (10%) with diabetes, aOR 3.07, 95% CI 1.14-7.78), birth in other low-incidence countries (4/24 (17%) vs. 8/463 (2%), aOR 10.14, CI 2.48-35.95) or medium-/high-incidence countries (10/77 (13%), aOR 8.22, CI 3.11-22.43), and alcohol use (aOR 2.75, CI 1.04-7.15). Seventeen patients had TBI; 16 (94%) treated with isoniazid for 6 months, one (6%) with rifampicin for 4 months; treatment discontinued in one case. In conclusion, IGRA screening coverage was high. Positive IGRAs were associated with birth in other low- or medium-/high-incidence countries, diabetes, alcohol use. TBI treatment was well tolerated.
Occupational therapy interventions can improve the ability to perform activities of daily living (ADL) in individuals with chronic conditions. The group-based ADAPT program was developed as an alternative to usual one-to-one occupational therapy (UOT), aiming to enhance ADL ability through structured problem-solving processes and implementation of adaptational strategies. This pilot and feasibility study evaluated the feasibility of delivering ADAPT 3.0 in a municipal setting and informed the design of a future full-scale randomised controlled trial (RCT). A two-armed pilot RCT was conducted in a Danish municipality, comparing outcomes of ADAPT 3.0 to UOT. Eligible clients (≥ 18 years, chronic conditions, decreased ADL ability) were randomised to either intervention or control group. Outcomes included recruitment and retention, trial participation, impact on staff, access to UOT documentation, completion of outcome measures, and fidelity to the ADAPT manual. Descriptive statistics, logbook notes, and predefined progression criteria guided the evaluation. Twelve clients and four ADAPT-trained occupational therapists participated. ADAPT 3.0 was delivered with high fidelity and dose. Most progression criteria were met, including access to UOT documentation and successful delivery of ADAPT 3.0. However, recruitment was slower than anticipated, and clients in the UOT group reported to receive limited trial-related information. Completion rates of follow-up evaluations were acceptable in the ADAPT group but lower in the UOT group. Minor structural and procedural challenges were identified. The study supports the feasibility of delivering ADAPT 3.0 in a municipal setting and progressing to a full-scale RCT. To ensure robust trial conduct, key refinements are needed in recruitment procedures, participant information for the UOT group, and clarity of outcome measures. ClinicalTrials.gov Identifier: NCT05775653.
In situ simulation (ISS) enables healthcare teams to test systems, identify safety threats, and strengthen interprofessional practice. Compared with off-site simulation (OSS), ISS may promote greater fidelity and transfer of learning. Cross-training, where participants adopt roles outside their profession, is widely used in healthcare education but remains controversial, with little evidence on how participants perceive its impact. We conducted a qualitative study in a Danish teaching hospital intensive care unit, using ethnographic observations, field notes, and semi-structured interviews. Sixteen interviews with physicians and nurses, supported by audio recordings of debriefings, were thematically analysed using a phenomenological-hermeneutic approach with consensus coding. Four themes were identified: fidelity, psychological safety, transfer, and cross-training. Participants described fidelity as multidimensional, including environmental, team, scenario, time, and resource aspects. ISS was perceived as more realistic and immersive than OSS, supporting deeper engagement and learning. PS was enhanced by familiarity with colleagues and environment, limited observation, and absence of cross-training. Facilitator competence at facilitating politely and creating room for all participants to speak up strongly influenced PS. ISS was viewed as promoting greater transfer of technical and social-cognitive skills to clinical practice, with some learning leading to organisational change. Cross-training was met with mixed reactions. Most participants, especially junior staff, preferred training in authentic roles, citing negative effects on PS and learning. More experienced clinicians occasionally valued cross-training for its reflective potential, though often only in less advanced roles. In situ simulation promotes learning by aligning fidelity, psychological safety, and transfer within participants' authentic clinical roles and environments. Cross-training was frequently perceived as undermining both learning and psychological safety, particularly among less experienced staff, suggesting a misalignment between role substitution and learners' developmental needs. Careful scenario design emphasising authentic roles, realistic fidelity, and skilled facilitation may optimise simulation learning outcome, Cross-training should be applied selectively, with explicit attention to learners' experience levels, role authenticity, and potential impacts on psychological safety.
Accurate predictions of heathland plant species are crucial for ecological monitoring and assessing biodiversity. Previous research has predominantly utilised convolutional neural networks (CNNs), which process images arranged on a regular grid. Although CNNs are effective at extracting local visual features, they frequently do not capture the irregular spatial relationships characteristic of heathland vegetation. Earlier approaches employing graph neural networks (GNNs) for plant classification have generally relied on simple or dataset-wide graph constructions, with limited consideration for edges that represent the actual morphological structure of plants. This study presents PlantGraphNet, a hybrid CNN-GNN framework that integrates visual and structural information for heathland plant species classification. PlantGraphNet extracts image-specific keypoints and local descriptors to construct graphs, where nodes correspond to plant regions and edges encode spatial relationships. The resulting graphs are processed using graph convolution and graph attention layers to capture relational context, while a CNN backbone provides complementary appearance features. These two modalities are combined into a unified representation for classification. To ensure scalability, PlantGraphNet employs distributed data-parallel training, enabling efficient gradient synchronisation across devices and near-linear performance scaling. When evaluated on Danish aerial heathland datasets, PlantGraphNet achieves a precision of 98.98%, substantially outperforming CNN-only baselines. In addition to improved accuracy, the explicit graph construction increases interpretability by associating classification outcomes with specific plant structures. These findings indicate that integrating CNN-derived features with purposefully designed graph representations of plant morphology yields a robust and interpretable approach for fine-grained heathland plant species classification.
Lumbar spinal stenosis is a leading indication for spine surgery, but outcomes are heterogeneous. We aimed to develop and externally validate prediction models for 12-month disability and pain to inform shared decision-making. This registry-based multicentre cohort study used data from three national spine registries of patients (≥16 years) undergoing elective lumbar spinal stenosis surgery. Data from the Norwegian Registry for Spine Surgery (NORspine, 2007-2023) were used for model development and internal-external cross-validation (IECV). External validation was carried out in the Swedish Registry (SweSpine, 2016-2022) and Danish Registry (DaneSpine, 2009-2022) with data collected by the Spine Centre of Southern Denmark. The primary outcome was the Oswestry Disability Index (ODI) at 12 months, modelled as a continuous and binary measure (acceptable symptom state). Secondary outcomes were Numeric Rating Scale (NRS) back and leg pain at 12 months. Logistic regression, linear regression, and XGBoost models were applied with 16 predictors. Missing data were handled using multiple imputation. Performance was assessed by calibration, mean absolute error (MAE), adjusted R2, and C-statistics. This study is registered with Open Science Framework (https://osf.io/qz27b/). The development cohort included 31,908 patients (52.4% female, 47.6% male). The external validation cohorts included 30,700 from SweSpine (52.8% female, 47.2% male) and 4063 from DaneSpine (54.6% female, 45.4% male). Twelve-month outcome completeness was 77% in the development cohort and ranged from 66% to 80% across the external validation cohorts. For ODI, linear regression achieved a pooled MAE of 12.4 (95% CI 11.8-13.1) after IECV, and 13.3 (95% CI 13.2-13.4) and 12.3 (95% CI 12.0-12.7) at external validation. Adjusted R2 values ranged from 0.26 to 0.33. Calibration was acceptable, with slopes near 1 and calibration-in-the-large ranging from -0.47 after IECV to 1.28-1.54 at external validation, indicating minor systematic underprediction. The binary ODI model achieved C-statistics of 0.75 (95% CI 0.74-0.76) after IECV, and 0.78 (95% CI 0.78-0.79) and 0.76 (95% CI 0.74-0.77) at external validation. Pain models showed lower performance (MAE 2.2-2.6; C-statistics 0.64-0.73). XGBoost yielded similar results. Models predicting disability and pain were well calibrated and generalisable across Scandinavian countries, with the best overall performance for disability. These findings provide a foundation for prospective evaluation in future studies to determine the impact on decision-making and patient outcomes in clinical practice. Research Council of Norway.
To investigate the generalizability of the study population and treatment effects observed in a randomized controlled trial comparing a strategy of early surgery to a strategy of exercise therapy and patient education (with the option of later surgery) for young adults with meniscal tears, through comparison with a parallel clinical cohort. We compared patient characteristics of patients (n = 121) from the Danish RCT on Exercise versus Arthroscopic Meniscal Surgery for Young Adults (DREAM) to patients (n = 182) aged 18-40 years with a meniscal tear participating in a parallel clinical cohort (i.e., those who were screened for the RCT, but not participating for various reasons), to assess the generalizability of the DREAM study population. In addition, we compared observed treatment effects between the trial and cohort (Knee injury and Osteoarthritis Outcome Score, mean of 4/5 subscales-KOOS4) of surgery (trial [n = 60] vs. cohort [n = 52]) and exercise (trial [n = 61] vs. cohort [n = 51]). Patients participating in the DREAM trial and the clinical cohort were, on average, similar in most patient characteristics and level of patient-reported symptoms at baseline, except for symptom duration, symptom onset and KOOS symptom subscale scores, where statistically significant differences were observed. Similar baseline to 12-month average KOOS4 trajectories were observed for trial and cohort patients following surgery (time × group p = 0.98; adjusted mean difference in change 0.7, 95% confidence interval [CI] -7.1 to 8.5) and exercise therapy (time × group p = 0.62; adjusted mean difference in change 3.2, 95% CI -4.3 to 10.7). Overall, both baseline characteristics and observed improvements of surgery and exercise therapy observed in the DREAM trial were largely comparable to those observed in the clinical cohort, suggesting that the DREAM trial results were generalizable to patients aged 18-40 years with meniscal tears observed in daily clinical practice. Level II.
Parkinson's disease (PD) profoundly impacts the everyday lives and relationships of those affected. This is especially the case when the caregiver is a family member of the person with PD. With disease progression, caregiving needs increase, prompting its description as a family disease. While caregiving is frequently viewed as burdensome, the role of hope remains underexplored. Hope is vital in serious illness; understanding carers' hope across PD stages is essential. Drawing on ethnographic fieldwork in Danish PD support groups and interviews with 15 relatives, we explore the everyday life of PD relatives, sources of hope, and nuances of care across disease stages. We introduce the notion "evolving care" to illustrate how caregiving tasks, roles, and emotions change over time, requiring ongoing adaptation. Hope, too, was dynamic, assuming multiple forms. Psychotic episodes and dementia marked critical tipping points, where hope faltered and care became precarious. Our findings underscore how hope, deeply rooted in social relationships, offers vital strength but can become fragile when caregiving demands intensify. Furthermore, we show how an attention to hope may reveal to professionals specific situations where help is needed.
Cancer is increasingly relevant to ageing societies, yet progress in cancer control is difficult to assess when population years of life lost (YLL) to cancer appear stable. Using Danish registers, we followed 4.26 million residents aged ≥50 years (1980-2019) and estimated YLL under observed and counterfactual scenarios, separating demography and incidence from post-diagnosis outcomes. From the 1980s to the 2010s, YLL per individual changed little (men 2.3 to 2.1; women 2.5 to 2.2), while YLL per patient fell markedly (men 8.5 to 5.2; women 9.3 to 5.8). With 2010s incidence and background mortality but 1980s management, YLL per individual would have been 4.2 (men) and 3.9 (women), showing that cancer control averted about half of the life-years otherwise lost. YLL reductions were largest for localized and regional disease (~60 and ~40%) and modest for distant stage (~15%), highlighting persistent losses in advanced cancer and growing survivorship-care needs.