Family involvement in the intensive care unit (ICU) is recognized as important, yet its implementation is complex and varies across contexts, including Scandinavian settings. This integrative review aimed to synthesize and integrate the evidence on family involvement in Scandinavian ICUs across the perspectives of family members, patients, and healthcare professionals. Findings are presented thematically rather than by perspective to capture shared and contrasting dimensions within overarching concepts. An integrative review was conducted following Whittemore and Knafl's framework. A systematic search was conducted in five databases (PubMed, PsycINFO, and CINAHL) covering January 2010-October 2023, with an update in January 2025. A systematic search strategy was applied, and reporting adhered to PRISMA guidelines. Peer-reviewed studies published between 2013 and 2024 in English, Danish, Swedish, or Norwegian were included. Fourteen studies met the inclusion criteria: nine qualitative (including one case-oriented) and five cross-sectional surveys. The review highlights the critical role of family involvement in the ICU, emphasizing its positive impact on patient care and family wellbeing. Active participation by family members provides both practical assistance and emotional support, fostering a patient-centred approach that improves patient outcomes. However, integrating families into care also presents significant challenges. Healthcare professionals' attitudes and behaviours, along with institutional policies and resource limitations, strongly influence the experience of family involvement. Families often face emotional stress and uncertainty, which can affect their engagement and lead to varying levels of participation. These findings underscore the need for strategies that balance collaboration with sensitivity to contextual and individual factors. Family involvement in Scandinavian ICUs is a complex, context-dependent phenomenon shaped by relational, emotional, and organizational factors. It requires healthcare teams to balance challenges with the benefits for patients and families.
This comparative analysis explores the legal frameworks surrounding end-of-life issues in the Scandinavian countries. Despite their shared legal traditions, all four nations exhibit stringent restrictions on end-of-life practices. This paper highlights the specific legal provisions, limitations, and societal attitudes within each country, demonstrating a significant legislative rigidity that contrasts with the more progressive approaches observed in other countries. Notably, while Norway and Denmark maintain a conservative stance lacking substantial public movements advocating for change, Sweden displays elements of dialogue around end-of-life issues, albeit without formal legislation permitting euthanasia. By providing a detailed examination of the current state of laws and ethical considerations in Scandinavian countries, this work underscores the critical divergence between societal desires for autonomy in end-of-life decisions and the legal constraints. The findings suggest the necessity for legislative reflection and potential reform to align legal practices with evolving public sentiment regarding the right to die.
Total ankle replacement (TAR) has developed rapidly during the last decades, and there is solid evidence that this is a good treatment for end-stage ankle arthritis (ESAA). Whether these improved outcomes have translated into a higher utilization of TARs compared with ankle fusions (AFs) in Scandinavia is unknown. The aim of this study was to report the incidences of TAR and AF in the Scandinavian countries and to report any trends in these incidences during the last 8 years. Data were collected from the official patient registries of the three countries for the period 2016-2023, using NOMESCO codes for TAR and AF. To evaluate the capacity for highly specialized foot and ankle surgery, data about triple fusions and calcaneal osteotomies were also collected. Trends in incidence rates were evaluated with negative binomial regression. During the period, 5667 AFs and 2012 TARs were performed in the three countries, which gives an ankle replacement percentage (ARP) of 26% for the whole region. Denmark had a higher total procedure volume, a higher number of TAR, and a higher ARP than the other countries (38% vs 20% for the two other countries, P ≤ .001). There was an increasing incidence of TAR during the period in Denmark and Sweden, while there was a decrease in Norway. The incidence of TAR and the ARP vary between the Scandinavian countries, where Denmark has a much higher incidence of TARs than the other two countries. In the last 8 years, the incidence of TARs has been stable in Denmark, increasing in Sweden and decreasing in Norway.
Chronic illness negatively affects education due to school absence. Telepresence robots can be a valuable educational tool for reducing school absence among students with chronic illnesses. This study aimed to investigate the reflections of Scandinavian community care stakeholders on telepresence robots as a tool to reduce school absence for students with chronic illnesses in the education system. We conducted fifteen semi-structured interviews and four focus group interviews with 25 community care stakeholders. Our study used the interpretive description methodology and Edgar Schein's organizational culture as the theoretical lens. The analysis identified three categorical themes and six subthemes: The action of integrating telepresence robots into the education system, the telepresence robots as a pathway to educational opportunities, and the adoption and management of telepresence robots. Our findings showed that stakeholders had to motivate and communicate the purpose of telepresence robots to reduce skepticism among multiple people in the school environment. Our study provides insights into the barriers and challenges to integrating and adopting telepresence robots in the Scandinavian education systems, as well as how stakeholders should communicate with and support the education system during their implementation.
Paraesophageal hernia (PEH) repair is challenging, with high recurrence rates reported. Evidence suggests that anterior gastropexy may reduce the recurrence rate, but real-world data are lacking. We performed a retrospective multicenter study of adults undergoing PEH repair (2018-2023) at four Scandinavian centers. The primary outcome was a computed tomograpy (CT) verified recurrence defined radiologically as a ≥20 mm herniation above the diaphragm. Propensity score matching balanced patients with and without anterior gastropexy. Outcomes and predictors were analyzed using matched comparisons and Cox proportional hazards regression. A total of 395 patients underwent primary PEH repair during the study period. The median age was 70 (range 63-76) years, and the median follow-up was 1.8 (0.8-3.3) years. 297 (75%) patients received a gastropexy as part of the procedure, while 98 (25%) patients did not. The group without gastropexy had a significantly higher rate of recurrence, 33 out of 98 patients (34%) compared with the gastropexy group, 45 out of 297 patients (15%, P < 0.001). After propensity score matching and adjustment for confounding factors, the risk of recurrence remained higher for patients who did not receive gastropexy (HR: 2.5, 95% CI: 1.3-4.9; P = 0.007). Anterior gastropexy was associated with a significantly lower risk of recurrence following PEH repair. These findings indicate that this component of the surgical procedure might improve long-term outcomes.
Objectives: To test whether Scandinavian Red (SR) sires improve udder health (somatic cell score; SCS) in New Zealand crossbred dairy cows without compromising milk solids yield. Materials and Methods: Herd-test records (one test day per cow) from six pasture-based New Zealand herds were analyzed (n = 5,294). All cows were daughters of Friesian x Jersey dams and were sired by Friesian (F), Jersey (J), Friesian × Jersey (F × J), or SR bulls. SCS was calculated as ln (SCC/1,000). Linear models estimated sire-breed effects on SCS, adjusting for herd, cow age group, days in milk (linear and quadratic), and milk solids (fat + protein, kg/day). Tukey-adjusted comparisons were used. Results: Sire breed significantly affected SCS (p = 0.004). SR-sired cows had the lowest adjusted mean SCS and were significantly lower than F- and J-sired cows; F × J-sired cows were intermediate. Milk solids (kg/day) yield did not differ by sire breed (p = 0.12). Older cows, early/late lactation, and herds were associated with higher SCS. Conclusions: Under pasture-based New Zealand conditions, using SR sires on Friesian x Jersey dams was associated with improved udder health (lower SCS) without reducing milk solids yield, supporting SR genetics as a practical option to reduce mastitis risk and antimicrobial use.
75th Anniversary Congress of the Scandinavian Association of Plastic Surgeons (SCAPLAS) June 3-5th, 2026 Oslo, Norway.
Parascaris spp. commonly infects foals, and high burdens can cause fatal small intestinal impactions. Progressive anthelmintic resistance poses a risk for an increase of Parascaris spp. related disease in juvenile horses. To investigate Parascaris-related surgical intestinal lesions, with special emphasis on ascarid impactions, in Scandinavia by exploring (1) disease occurrence and (2) short-term survival rates after laparotomy in affected foals and yearlings. Restrospective case series. A retrospective clinical record search was conducted at six Scandinavian equine hospitals during a 7-15-year period. Horses older than 1 month but less than 2 years of age that had been surgically treated for colic were included. Age, breed, surgical diagnosis, presence of Parascaris spp. infection, immediate anthelmintic history and short-term survival, defined as survival to hospital discharge, were recorded. A total of 233 records were included and lesions involving the small intestine were observed in 52.8% (123/233). Fourteen foals were diagnosed with ascarid impaction at laparotomy, with an occurrence of 6.0% (14/233), encompassing 11.4% of surgical small intestinal lesions (14/123) and 9.7% of horses younger than 1 year of age (13/134). Six foals with ascarid impaction had been treated with an anthelmintic drug within 2 days of presentation. Four foals with ascarid impaction survived to discharge. Overall occurrence of Parascaris-associated intestinal lesions, including impactions, was 13.7% (32/233), encompassing 26.0% (32/123) of all small intestinal abnormalities, and with a short-term survival rate of 38% (12/32). Retrospective study design, hospital-dependent variations could not be controlled. No previous data to compare disease occurrence. Parascaris spp. related disease in juvenile horses comprises a substantial portion of small intestinal surgical lesions with a poor prognosis for survival. With the appearance of multi-drug-resistant parasite populations, it is important to develop management practices to reduce parasite infection burdens.
Clinical practice guidelines are intended to help with decision-making. However, their quality differs. Guidelines of low quality are a waste of resources and can cause patient harm. We compared the quality of the Danish, Norwegian, and Swedish guidelines on papillary thyroid cancer (PTC) with those of the American Thyroid Association (ATA, 2015 version). Three pairs of appraisers independently rated the guidelines using the AGREE II instrument, a validated tool for assessing the quality of guidelines. Furthermore, recommendations on the extent of surgery in low-risk PTC, prophylactic lymph node dissection, thyroxine suppression, radioiodine treatment, active surveillance, and the length of follow-up after treatment, along with the evidence cited to support these recommendations, were compared across the four guidelines. Overall, the ATA guidelines had the highest quality, with a score of over 70 % in four domains, and the highest score in five of six domains. The Danish and Swedish guidelines each reached a score of over 70 % in only one domain, while the Norwegian guidelines did not reach that score in any domain. The overall score was 83 % for the ATA guidelines, 50 % for the Danish, 44 % for the Swedish, and 28 % for the Norwegian. Recommendations varied widely, particularly regarding extent of surgery and indications for radioiodine treatment. The ATA guidelines had the highest number of references supporting the recommendations. The quality of clinical practice guidelines and recommendations on treatment for PTC differed between the Scandinavian countries and the ATA, with the ATA having the highest quality.
Evidence regarding the treatment of displaced, extraarticular lateral clavicle fractures is scarce. No study has shown clinically significant differences between surgical and nonsurgical treatment, but the sample sizes have been small, as it has been difficult to include enough patients with this relatively uncommon fracture type. This study aims to compare outcomes after surgical and nonsurgical treatment for displaced lateral clavicle fractures. This is a pragmatic, noninferiority, preference-tolerant, randomized controlled trial (RCT). A total of 100 patients between the ages of 18 and 65 with displaced lateral clavicle fractures will be randomly allocated on a 1:1 ratio to surgical or nonsurgical treatment with the option of early crossover after 6 weeks. An observational cohort will comprise patients not willing to be randomized. This is a multicenter Scandinavian RCT including hospitals in Sweden, Norway, Denmark, and Finland. The primary outcome is the Disabilities of the Arm, Shoulder and Hand (DASH) score at 1 year. Follow-up points will be 6 weeks, 3 months, 6 months, and 1 year. The secondary outcomes are the DASH score, the EQ-5D-5L score, the University of California, Los Angeles (UCLA) activity score, the Nottingham Clavicle Score (NCS), a visual analog scale (VAS) for pain, and anchor questions in the form of the Patient Global Impression of Change (PGIC) collected at all timepoints during the study. All complications, radiographic healing, and return to work will be reported. The optimal treatment for displaced Neer type II and V lateral clavicle fractures remains a topic of debate. This RCT may provide a better understanding of the differences in outcomes of nonsurgical and surgical treatment while reflecting real-world clinical practice and guiding the development of a treatment algorithm for the orthopedic community. ClinicalTrials.gov NCT06981065. Registered on 19 May 2025. https://clinicaltrials.gov/study/NCT06981065?term=Scandilac&rank=1.
Canine atopic dermatitis (AD) is a common allergic skin disease for which identifying allergen sensitization via IgE serological or intradermal testing is necessary to implement allergen-specific immunotherapy. Because serum IgE has a short half-life and circulating levels fluctuate with environmental allergen exposure, the timing of blood sampling may influence serological test outcomes. This cross-sectional study assessed seasonal variation in allergen-specific IgE concentrations and seropositivity rates across pollen and mite allergen categories in Scandinavian dogs suspected of allergic disease. PAX multiplex macroarray results from 5014 canine sera submitted by veterinarians across Denmark, Norway, and Sweden over one full year were retrospectively analyzed for 17 allergens, including tree, grass, and weed pollens, house dust mites, and storage mites. Mean sIgE levels showed statistically significant but relatively small seasonal variation. Seropositivity rates, however, showed clearer patterns: seropositivity for tree and weed pollen was highest in spring and summer, and that for house dust mite peaked in autumn and winter, while storage mite sensitization rates showed the opposite trend. These results confirm that IgE serological test results in dogs are affected by the sampling season and emphasize the importance of considering timing when collecting and interpreting IgE serological tests in atopic dogs.
To explore differences and similarities in paediatric stone treatment between hospitals in the Nordic countries. A retrospective review of the medical records was performed for children receiving stone treatment in nine Nordic hospitals between January 2014 and December 2023. Variables of interest included diagnostic imaging, treatment modalities, complication rates and stone free rates (SFR). Five hundred and sixty two treatments among 319 children were included; 117 girls and 202 boys with a median age of 10 years (interquartile range 5 - 14). Preoperative diagnostic imaging with computed tomography was performed in 442 cases (79%), and 120 patients (21%) were diagnosed with ultrasound, MRI or X-ray. In 150 cases (27%), stones treated were located in the ureter only and in 412 cases (73%) in the renal pelvis ± ureter. Ureteroscopic stone treatment (URS) was performed in 248 (44%), shock wave lithotripsy (SWL) in 242 (43%) and percutaneous lithotripsy (PCNL) in 72 cases (13%). The distribution of treatment modalities varied considerably between hospitals. URS treatments increased, and SWL procedures declined throughout the study period. A follow-up consultation was carried out in 505 cases (90%). Overall SFR after each session across treatment modalities and location was 49%. The SFRs after URS was 68%, SWL 30% and PCNL 61% and significantly higher after URS compared to SWL, p < 0.001. Postoperative complications leading to readmission occurred in 10% of patients. The study reveals differences in preferred treatment modalities and results between the hospitals. Standardising diagnostics, treatment and follow-up could improve outcomes for children with kidney stone disease.
During the Covid-19 pandemic, Nordic states were praised for leadership on global vaccine equity, notably through strong support for the Access to Covid-19 Tools Accelerator (ACT-A) and COVAX. At the same time, like other high‑income countries, they took decisive measures to secure priority access to vaccines for their own populations, contributing to global inequities. Scholarship on global health security and diplomacy often treats global solidarity and national self-interest as a binary and focuses on great powers and inter-state dynamics, overlooking how domestic drivers also shape global pandemic response. This article instead proposes the concept of "strategic solidarity" to analyse how solidarity and self‑interest were combined and justified in Norwegian and Danish global health diplomacy during the acute phase of the pandemic (2020-2022). Through analysis of three key policy debates - support for vaccine R&D; contributions to global vaccine distributions and positions on intellectual property reforms to boost vaccine supply - the article shows how Norway and Denmark simultaneously enabled and constrained multilateral efforts for vaccine equity. Domestic political pressures, public opinion, national identity narratives, and inter-ministerial tensions shaped how authorities practiced multi‑level diplomacy and managed trade‑offs between national protection and global commitments. Strategic solidarity operated both as a policy orientation distinct from purely security‑driven logics and as a justificatory frame used to reconcile apparent policy incoherence and sustain the countries' self‑images as solidaristic states. Strategic solidarity better captures the empirical reality of pandemic policymaking than a strict solidarity/self‑interest dichotomy and can inform the design of future mechanisms for more equitable global health responses.
In this first randomized controlled trial comparing bulbar urethroplasty techniques; transecting excision and primary anastomosis caused more penile complications, particularly penile shortening and reduced glans filling, than buccal mucosa graft urethroplasty, with similar recurrence rates. Corpus spongiosum transection should therefore be avoided whenever possible.
Target volume and organ of interest (OOI) contouring and treatment planning for IDH-mutated gliomas CNS WHO grades 2 and 3 are subject to interindividual variation. We aimed to assess this variation and heighten delineation awareness as a quality assurance measure in the PRO-GLIO trial. Five experts established consensus delineations for target volumes and defined OOI in two IDH-mutated gliomas cases. Next, target volumes and OOI were delineated by experts from 12 treatment centers participating in the PRO-GLIO trial, and by deep learning segmentation (DLS). These structures were compared to consensus contours based on predefined quantitative and qualitative parameters. Proton and photon treatment planning were performed on the consensus delineations by 11 centers. Median dice similarity coefficient (DSC) for clinical target volume (CTV) was 0.92 for both cases, whereas the median 95th percentile Hausdorff distance for CTV was 0.54 cm and 0.65 cm. Larger variability in DSC and volume size was seen for OOI, e.g., a median DSC of 0.47 and 0.64 for the optic chiasm and between 0.61 and 0.77 for the hippocampi. DSC-derived DLS-values were within the range of manual delineations for all OOI. Delineation variation between study centers was minor for target volumes, especially for DSC of CTV. Variability was considerably higher for several OOI, representing a potential hazard not least with new and more precise radiotherapy techniques. Interestingly, DLS performed OOI-segmentation within the range of manual experts and represents a reasonable OOI-segmentation alternative in the future.
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.
Climate change can alter species interactions by shifting phenology and species distributions. Batesian mimicry is one such interaction in which mimic protection is often assumed to depend on temporal and spatial overlap with defended models, although recent studies suggest strict synchrony may not always be required. To examine long-term mimic-model phenological dynamics, we compiled flight season data for bumblebee models and their hoverfly mimics across the Scandinavian Peninsula spanning a little over a century and a half. We estimated shifts in mean flight season and the relative order of emergence while accounting for variation in sampling effort among years. The flight periods of several bumblebee models advanced over time, whereas the hoverfly mimic remained largely unchanged. We found a marked shift in seasonal flight time within our bumblebee-hoverfly mimicry system. Historically, mimics flew earlier than their bumblebee models, but in recent decades the pattern has reversed, with models emerging earlier than mimics. This shift reduces temporal overlap between mimics and peak model activity and may alter the conditions under which mimicry provides protection.
The current study aimed at characterizing idiopathic epilepsy in a referral population of Golden Retrievers regarding signalment, seizure frequency, post-ictal signs, treatment response, survival time, and cause of death retrospectively. Data was extracted from medical records from two Scandinavian veterinary referral hospitals. Median survival time was calculated for the overall group and for male and female, respectively, using Kaplan-Meier survival curves and compared using the Log-rank (Mantel-Cox) test. The significance level was set at P value ≤ 0.05. In total, 32 Golden Retrievers were included. There was no statistical difference in prevalence between sexes overall (P value = 0.314), nor for dogs classified with 'moderate' seizure activity, defined as ≥ 1 episode of cluster seizures, or 'severe' seizure activity, defined as cluster seizures and ≥ 1 episode of status epilepticus (P value = 0.562). 21/32 dogs had cluster seizures, and 3/32 dogs had experienced status epilepticus and cluster seizures. Post-ictal aggression (n = 10/32), confusion (n = 10/32) and anxiety (n = 9/32) were most common. 21/32 dogs received ≥ 2 anti-epileptic drugs. Median survival time was 1361 days, with no statistical difference between sexes (P value = 0.992). The primary cause of death was unsatisfactory seizure control (n = 10/18). While our findings in this referral population may not be representative for all Golden Retrievers with idiopathic epilepsy, they underline a potential severe disease course in the breed, which calls for more effective treatment. Further, findings can aid clinicians in informing owners regarding expectations of disease progression.
BackgroundBurnout and emotional numbing-known in Scandinavian contexts as forråelse-pose critical challenges for psychiatric healthcare professionals. These phenomena are closely linked to moral distress, ethical dilemmas, and systemic pressures that complicate daily clinical practice. Understanding the interplay between organizational constraints, moral agency, and relational dynamics is essential for ethical and sustainable mental healthcare.Research aimThe study aims to examine how organizational and ethical pressures contribute to burnout and emotional numbing among psychiatric healthcare professionals, and how these professionals experience and respond to moral distress and relational challenges in daily clinical practice.Research designA qualitative ethnographic design was employed, combining prolonged field observation with semi-structured interviews to capture nuanced experiences of staff in real-world clinical settings. Reflexivity and iterative analysis ensured rich, contextually grounded insights.Participants and research contextEighteen psychiatric healthcare professionals were interviewed over 6 months in inpatient psychiatric units. Participants included nurses, social workers, medical doctors, and allied staff, representing a range of clinical roles.Ethical considerationsInformed consent, confidentiality, and participant well-being were prioritized. Reflexive practices were used to acknowledge researcher influence, and ethical approval was obtained from the relevant institutional review board.ResultsFour interrelated themes emerged: workplace dynamics, task management, patient collaboration, and emotional numbing. Systemic pressures-including understaffing, ethical strain, and limited institutional support-were central drivers of burnout. Emotional numbing appeared as an adaptive response to sustained moral distress and relational demands. Participants reported finding meaning through relational commitment, peer support, and small therapeutic successes, despite persistent ethical and organizational challenges.ConclusionsBurnout and emotional numbing are systemically produced phenomena rather than individual failings. Addressing these issues requires structural reforms, reflective supervision, and supportive workplace cultures that integrate ethical deliberation. Recognizing moral distress and fostering relational engagement are critical to safeguarding staff well-being and promoting ethical, patient-centered psychiatric care.