Opioid use after surgical treatment in the Danish population-Protocol for a register-based cohort study.

BACKGROUND: Over the past 25 years, global opioid consumption has increased. Denmark ranks fifth in opioid use globally, exceeding other Scandinavian countries. Postsurgical pain is a common reason for opioid prescriptions, but opioid use patterns after patient discharge from the hospital are unclear. This study examines trends in opioid prescription among Danish surgical patients over a year. METHODS: This register-based cohort study will use data from Danish governmental databases related to patients undergoing the 10 most frequent surgical procedures in 2018, excluding cancer-related and minor procedures. The primary outcome will be the dispensed postoperative opioid prescriptions at retail pharmacies over four quarters. Secondary analyses will include associations with sex, age, education attainment, and oral morphine equivalent quotient. Surgical treatments and diagnoses will be identified using NOMESCO procedure codes and ICD-10 codes. Opioids will be identified by ATC codes N02A and R05DA04. Subjects will be classified as preoperative opioid consumers or non-opioid consumers based on opioid prescriptions redeemed in the 6 months before surgery. DISCUSSION: The study will use extensive national register-based data, ensuring consistent data collection and enhancing the generalizability of the findings to similar healthcare systems. The study may identify high-risk populations for long-term opioids and provide information to support opioid prescribing guidelines and public health policies.

Social disparity is associated with an increased risk of acute and chronic pancreatitis.

AIM: To study social disparity in acute pancreatitis (AP) and chronic pancreatitis (CP).We also aimed at exploring whether an interaction exists between alcohol intake and socioeconomic factors. METHODS: Prospective cohort study based on data from 271 696 men and women participating in the Danish National Health Surveys 2010, and 2013. Information on alcohol and smoking parameters, body mass index (BMI), diet, and education, were self-reported and information on family income was obtained from administrative registers. Outcome variables (acute and chronic pancreatitis) were obtained from national health registers. RESULTS: The incidence rate ratio (IRR) of developing AP and CP increased with decreasing family income. Compared to participants in the highest income quintile, participants in the lowest income quintile had 43 (95% CI: 14-80%), 99 (95% CI: 26-214%), and 56% (95% CI: 26-94%) higher incidence rates of AP, CP, and all pancreatitis, respectively. The associations persisted after adjustment for alcohol intake, smoking, BMI, and diet.Likewise, participants with only primary school education had an IRR for an AP of 1.30 (95% CI: 1.06-1.59) compared to those with higher education after adjustment for baseline year, age, and sex. We found no interactions between alcohol intake and income or between alcohol intake and education in relation to neither AP, CP, nor all pancreatitis. CONCLUSION: This large prospective population study showed a significant social disparity in incidence rates of pancreatitis by family income, with higher rates among those with the lowest income and education independent of risk factors such as alcohol intake, smoking, BMI, and diet.

Self-reported mental and physical health is associated with not returning to work in patients with ischemic heart disease.

BACKGROUND: Ischemic Heart Disease (IHD) can lead to prolonged sick leave and loss of ability to work. This study aimed to describe non-return to work (non-RTW) across three IHD subgroups at 3 and at 12 months post discharge, and explore whether baseline characteristics, and patient-reported mental and physical health were associated with work detachment. METHODS: Data from the national cohort study DenHeart were used, including the patient-reported outcomes (PROs) Short-Form 12, Hospital Anxiety and Depression Scale, Edmonton Symptom Assessment Scale and HeartQoL measured at discharge and register-based follow-up at 3 and at 12 months. A total of 3873 patients with IHD ≤ 63 years old and part of the workforce prior to hospitalisation, were included in the analyses and divided into three groups: chronic IHD/stable angina, non-STEMI (non-ST-Elevation Myocardial Infarction)/unstable angina and STEMI (ST-Elevation Myocardial Infarction). A composite outcome of 'prolonged sick leave' and/or 'left the workforce' was defined as non-return to work (non-RTW). Adjusted logistic regression models were performed. RESULTS: Overall, the frequency of non-RTW was 37.7% and 38.0% at 3 and 12 months, respectively, thus not improving with time. The largest proportion of non-RTW was found in STEMI patients, followed by non-STEMI/unstable angina and IHD/stable angina patients. Several clinical and socio-demographic factors, as well as patient-reported mental and physical health were associated with non-RTW among the subgroups. CONCLUSION: The findings demonstrate a need for identifying IHD patients at risk of non-RTW after discharge based on their mental and physical health and a need for initiatives to minimize unwanted non-RTW.

The Danish Health Survey among Marginalized People: Study design and respondent characteristics.

AIM: The Danish Health Survey among Marginalized People is a nationwide health survey targeting people in marginalized life situations in Denmark. The aim of this paper is to present the study design, data collection methods and respondent characteristics of the survey, which was conducted in 2007, 2012, 2017 and 2022. METHODS: The survey applies an outreach data collection approach which entails reaching out to social services (public and private) asking for their help with distributing self-administered paper questionnaires among their users. Themes include self-rated health, mental health, morbidity, pain, oral health, health behaviours, gambling problems, social relations, violence, sexual harassment and assault, suicide, and source of income. RESULTS: The overall number of respondents has decreased slightly from 2007 (1290) to 2022 (1134). In all survey waves, men were overrepresented among the respondents. In 2007, women represented only 28%, which increased to 37% in 2022. There have been remarkable changes in the age distribution among respondents between 2007 and 2022. For example, the oldest age group (55-80 years) accounted for 15% of the respondents in 2007 and 40% in 2022. CONCLUSIONS: Conducting surveys among marginalized people entails methodological challenges and ethical considerations. However, continually attempting to reach marginalized people in surveys by tailoring data collection strategies to their specific life situation is essential to gain insight into their health and well-being.

Trends in the use of complementary and alternative medicine between 1987 and 2021 in Denmark.

BACKGROUND: Complementary and alternative medicine (CAM) has been widely and increasingly used worldwide during the past decades. Nevertheless, studies in long-term trends of CAM use are limited. The aim of this study was to assess long-term trends in the prevalence of CAM use (both overall and for specific CAMs) between 1987 and 2021 in the adult Danish population and to examine certain sociodemographic characteristics of CAM users. METHODS: Data derived from nationally representative health surveys in the general adult population (≥ 16 years) in Denmark (the Danish Health and Morbidity Surveys) conducted in 1987, 1994, 2000, 2005, 2010, 2013, 2017, and 2021. The response proportion declined from 79.9% in 1987 to 45.4% in 2021. CAM use was assessed by questions on ever use of specific types of CAMs and overall use within the past 12 months. Differences in use of CAMs across educational levels were assessed using the Slope Index of Inequality (SII). RESULTS: An overall increase in the prevalence of CAM use within the past 12 months was found between 1987 (10.0%) and 2021 (24.0%). However, a stagnation was observed between 2010 and 2017, after which the prevalence decreased in 2021. In all survey waves, the prevalence was higher among women than men. For both sexes, the prevalence tended to be highest among respondents aged 25-44 years and 45-64 years. The group with 13-14 years of education had the highest prevalence of CAM use compared to the other educational groups (< 10 years, 10-12 years, and ≥ 15 years). SII values for both men and women increased between 1987 and 2021, which indicates an increase in differences of CAM use across educational groups. In all survey waves the most frequently used CAMs included massage and other manipulative therapies, acupuncture, and reflexology. CONCLUSIONS: The use of CAM has increased markedly within the last decades and recently stagnated at high levels, which underlines the importance of securing high quality information and education for the public, health professionals, and legislators to ensure and promote safe use of CAMs.

Changes in co-use of alcohol and cannabis among Nordic adolescents in the 21st century: Results from the European School Survey Project on Alcohol and Other Drugs study.

INTRODUCTION: In the 21st century, there has been a decline in alcohol use among adolescents in most Nordic countries, while trends of cannabis use have diverged. We explore how alcohol and cannabis use, respectively, and co-use of the two substances, have changed among Nordic adolescents. Three hypotheses are used to frame the study: (i) cannabis use has substituted alcohol use; (ii) there has been a parallel decline in both substances; and/or (iii) there has been a 'hardening' of users, implying that alcohol users increasingly use cannabis. METHODS: Data from the European School Survey Project on Alcohol and Other Drugs, conducted among 15- to 16-year-olds in Denmark, Finland, Iceland, Norway and Sweden (N = 74,700, 49% boys), were used to explore trends of past-year alcohol and cannabis use in the period 2003-2019. RESULTS: The proportion of adolescents reporting alcohol use decreased significantly in all Nordic countries except Denmark. The proportion of those using cannabis only was low (0.0%-0.7%) and stable in all countries. The total number of substance use occasions declined among all adolescents in all countries but Denmark. Among alcohol users, cannabis use became increasingly prevalent in all countries but Denmark. DISCUSSION AND CONCLUSIONS: We found no support for the 'parallel decline hypothesis' in alcohol and cannabis use among Nordic adolescents. Partially in line with the 'substitution hypothesis', cannabis use accounted for an increasing proportion of all substance use occasions. Our results suggests that the co-use of alcohol and cannabis has become more common, thus also providing support to the 'hardening' hypothesis.

Quality of Life in the Danish Fontan Population is Unchanged Over the Past Decade-A Nationwide Longitudinal Study.

Knowledge about health-related quality of life (HRQoL) over time in Fontan patients is sparse. We aimed to describe HRQoL over a ten-year period in a population-based Fontan cohort. Further, we compared HRQoL in Fontan patients with the general population. In 2011, Danish Fontan patients were invited to participate in a nationwide study assessing HRQoL. Depending on age, 152 participants filled out either the Pediatric Quality of Life Inventory or the 36-Item Short Form Health Survey. After a decade, patients from the initial study were invited to participate in a follow-up study. All were given the same questionnaire as in the first study, plus the 12-Item Short Form Health Survey (SF-12) as part of the Danish National Health Survey. HRQoL over time was described, and SF-12 scores were compared with the general population. A total of 109 Fontan patients completed the questionnaires in both studies. The mean patient age was 14.9 ± 6.6 years and 25.6 ± 6.5 years respectively. Despite an increase in complications, HRQoL did not decrease during the study period. Physical HRQoL scores were lower than mental HRQoL scores at both time points. The SF-12 physical component score was significantly lower in Fontan patients than in the general population (median score 52 vs. 56, p < 0.001), while the SF-12 mental component score was comparable (median score 51 vs. 50, p = 0.019). HRQoL remained stable over a ten-year period in a contemporary Danish Fontan cohort. Still, the physical HRQoL remained significantly lower than that of the general population.

Association between educational level and self-reported musculoskeletal pain and physical functioning in Danes 60-70 years old from 2010 to 2017: a longitudinal analysis of trends over time on data from the Danish Health and Morbidity Survey.

OBJECTIVES: The aims of this study were to investigate the association between educational level and musculoskeletal pain and physical function, respectively, in persons 60-70 years old, and to investigate if the association changed from 2010 to 2017. DESIGN AND PARTICIPANTS: This is a sex-stratified, cross-sectional study based on data from the Danish Health and Morbidity Survey in 2010 (n=15 165) and in 2017 (n=14 022).Self-reported data from respondents who were 60-70 years old and reported data for pain or physical function, sociodemographic, education and behavioural factors were included. PRIMARY OUTCOME MEASURES: Prevalence of pain and physical limitations. RESULTS: Among men, a high educational level was associated with reduced odds of pain compared with low educational level (OR 0.56 (95% CI 0.41; 0.74)). Medium and high educational levels were associated with reduced odds of pain in women (0.74 (0.59; 0.92) and 0.64 (0.41; 1.00), respectively). High educational level was associated with reduced odds of physical limitations in men (0.35 (0.19; 0.65)) and women (0.33 (0.14; 0.78)). The interaction terms between time and education were not associated with pain and physical function, respectively. CONCLUSION: High education was associated with reduced musculoskeletal pain and reduced limitations of physical function. The association between education and musculoskeletal pain and physical function did not change significantly over time. Musculoskeletal pain during the past 14 days and chronic pain among old men and women 60-70 years and their level of physical function contribute to important knowledge of a group near the retirement age. The future perspectives illustrate trends and importance of focusing on adapting job accommodations for senior workers.

Arts and culture engagement for health: a Danish population-based study.

OBJECTIVES: Global health challenges are complex and new approaches are pivotal. Engagement in arts and cultural activities is commonplace across different cultures, and research shows associations with benefits for health and wellbeing. Using the arts for health promotion and prevention of illness has increased worldwide. STUDY DESIGN: A population-based study. METHODS: Data were obtained from the Danish Health and Wellbeing Survey in 2019. A self-administered questionnaire was sent to 14,000 randomly selected adults (aged ≥15 years). The questionnaire included items on self-rated health and frequency of participation in various cultural activities (concerts or musical events; participation in a choir, band, or orchestra; theatre show or other performing arts; cinema; art museum or exhibition; library). A cultural participation index was calculated based on the six questions on cultural activities. Logistic regression models were fitted to examine the associations between the index and good self-rated health, adjusting for relevant covariates. RESULTS: In total, 6629 individuals completed the questionnaire (47.4%). The most frequent activity, used at least once a month, was visiting a library. A strong association between the cultural participation index and self-reported health was observed. A one-point-higher index score was associated with a 10% higher likelihood of having good self-reported health (adjusted odds ratio: 1.10; 95% confidence interval: 1.08-1.12). CONCLUSIONS: This study supports the understanding that engagement in arts and cultural activities is beneficial for self-rated good health. Individuals with higher frequency of arts and culture engagement were more likely to report good health than those with lower engagement.

Psychometric Properties of the Kansas City Cardiomyopathy Questionnaire in a Surgical Population of Patients With Aortic Valve Stenosis.

The 12-item version of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) was originally developed for patients with heart failure but has been used and tested among patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation. Whether the instrument is suitable for patients with AS who underwent surgical aortic valve replacement (SAVR) is currently unknown. Thus, we aimed to investigate the psychometric properties of the KCCQ-12 before and after SAVR among patients with severe AS. We conducted a prospective cohort of 184 patients with AS who completed the KCCQ-12 and the EuroQol 5 Dimension 5 Levels before and 4 weeks after surgery. Construct validity was investigated with hypothesis testing and an analysis of Spearman's correlation between the two instruments. Structural validity was investigated with explorative and confirmatory factor analyses and reliability with Cronbach's α. All analyses were conducted on data from the two time points (preoperatively and four weeks after surgery). The hypothesis testing revealed how the New York Heart Association class was significantly correlated with the preoperative KCCQ-12 total score (higher New York Heart Association class, worse score). A longer length of hospital stay and living alone were significantly associated with poorer postoperative KCCQ-12 total score. KCCQ-12 and EuroQol 5 Dimension 5 Levels were moderately correlated in most domains/the total score/Visual Analogue Scale score. Principal component analyses revealed two 3-factor structures. The confirmatory factor analyses did not support the original model at any time point. Cronbach's α ranged from 0.22 to 0.84 in three preoperative factors and from 0.39 to 0.76 in the postoperative factors. The total Cronbach's α was 0.83 for the suggested preoperative 3-factor model and 0.83 for the postoperative model. In conclusion, the Danish version of the KCCQ-12 tested in a population of patients with AS who underwent SAVR appears to have acceptable construct validity, whereas structural validity cannot be confirmed for the original four-factor model. Overall reliability is good.

Cognitive impairment and psychopathology in sudden out-of-hospital cardiac arrest survivors: Results from the REVIVAL cohort study.

AIM: To investigate cognitive impairment and psychopathology in out-of-hospital cardiac arrest (OHCA) survivors using a screening procedure during hospitalisation and examine the evolution of these parameters at three-month follow-up. METHODS: This multicentre cohort study screened for cognitive impairment using the Montreal Cognitive Assessment (MoCA), for symptoms of anxiety, depression and traumatic distress using the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale-revised (IES-R) during hospitalisation. At three-month follow-up, we evaluated cognitive impairment with a neuropsychological test battery and symptoms of psychopathology were re-assessed using HADS and IES-R. Logistic regression models were applied to examine associations between screening results and outcomes. RESULTS: This study included 297 OHCA survivors. During hospitalisation, 65% presented with cognitive impairment, 25% reported symptoms of anxiety, 20% symptoms of depression and 21% symptoms of traumatic distress. At follow-up, 53% reported cognitive impairment, 17% symptoms of anxiety, 15% symptoms of depression and 19% symptoms of traumatic distress. Cognitive impairment during hospitalisation was associated with higher odds (OR (95% CI) 2.55 (1.36-4.75), p = .02) of an unfavorable cognitive outcome at follow-up, and symptoms of psychopathology during hospitalisation were associated with higher odds of psychopathology at follow-up across all three symptom groups; anxiety (6.70 (2.40-18.72), p < .001), depression (4.69 (1.69-13.02), p < .001) and traumatic distress (7.07 (2.67-18.73), p < .001). CONCLUSION: OHCA survivors exhibited both cognitive impairment and symptoms of psychopathology during hospitalisation comparable to previous studies, which were associated with unfavorable mental health outcomes at three-month follow-up.

Do animation videos increase participation in national health surveys? A randomised controlled trial.

BACKGROUND: Declining response proportions in surveys have been observed internationally. Improving response proportions is important for the generalizability of the outcome. The aim of this study was to examine the potential of animation videos to improve response proportions and sample composition in health surveys. METHODS: A randomized trial was embedded in the Danish National Health Survey 2021 (n = 186,113) where the use of animation videos in the digital invitation letter was tested as a mean to increase response proportion. The effect of both demographic-targeted videos and a general video was tested. The sample was stratified into four subsamples; (1) individuals with non-western background and a non-Danish citizenship (n = 9,956), (2) men aged 16-24 years (n = 12,481), (3) women aged 75 years or older (n = 7,815) and (4) the remaining individuals (n = 155,861). The fourth subsample was randomized into two equal sized groups; a group receiving the general video and a control group receiving no video. Each of the first three subsamples was subsequently randomized into three subgroups with 25% receiving the target group video, 25% receiving the general video and 50% receiving no video. A total of four reminders (one digital and three postal) were sent to the eligible population. RESULTS: The use of animation videos resulted in similar or slightly lower overall response proportion compared to the control group. The different animation videos were found to have heterogeneous effects on response proportions. A positive effect was found among men aged 16-24 years before the delivery of the postal reminder for the targeted animation video compared to no video (odds ratio: 1.13; 95% confidence interval: 1.02-1.26). Overall, the targeted animation videos tended to produce higher response proportions than the general animation video. CONCLUSIONS: The heterogeneous effects of the videos suggest that there is some potential for the use of animation videos to improve response proportions and sample composition. The content, target group and timing of evaluation seem to be important for the animation videos to be successful. This warrants further research to better identify in which contexts, in which subgroups and under which circumstances, animation videos are useful to increase response proportions. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT05520242, registered 08/26/2022.

Changes in loneliness prevalence in Denmark in the 21st century: Age-period-cohort analysis.

AIM: The aim of this study was to investigate changes in the prevalence of loneliness in Denmark from 2000 to 2021 by conducting age-period-cohort analysis. METHODS: Our study was based on a sample (N=83,437; age: ⩾16 years) of the Danish Health and Morbidity Surveys conducted in Denmark in 2000, 2005, 2010, 2013, 2017 and 2021. We used logistic regression models by gender to estimate the age-period-cohort effects, with loneliness as the dependent variable and age, survey year and birth cohort as independent variables, mutually adjusted. RESULTS: The prevalence of adult loneliness increased by each survey year over the entire period (from 13.2% in 2000 to 27.4% in 2021 among men and from 18.8% to 33.7% among women). Overall, a U-shaped curve, for the prevalence of loneliness among different age groups, was observed, which was most pronounced among women. The greatest increase in the prevalence of loneliness from 2000 to 2021 was observed among the youngest age group (16-24 years), with 28.4 and 30.7 percentage points for men and women. No significant cohort effect was observed. CONCLUSIONS: The observed increase in loneliness prevalence from 2000 to 2021 was driven by period and age effects rather than cohort effects. It should be noted that data from 2021 were collected during a national lockdown due to an outbreak of COVID-19, which could explain part of the large increase in loneliness from 2017 to 2021.

Sex Differences in Patient-Reported Outcomes in the Immediate Recovery Period After Resuscitation: Findings From the Cross-sectional DenHeart Survey.

BACKGROUND: A paucity of resuscitation studies have examined sex differences in patient-reported outcomes upon hospital discharge. It remains unclear whether male and female patients differ in health outcomes in their immediate responses to trauma and treatment after resuscitation. OBJECTIVES: The aim of this study was to examine sex differences in patient-reported outcomes in the immediate recovery period after resuscitation. METHODS: In a national cross-sectional survey, patient-reported outcomes were measured by 5 instruments: symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), illness perception (Brief Illness Perception Questionnaire [B-IPQ]), symptom burden (Edmonton Symptom Assessment Scale [ESAS]), quality of life (Heart Quality of Life Questionnaire), and perceived health status (12-Item Short Form Survey). RESULTS: Of 491 eligible survivors of cardiac arrest, 176 (80% male) participated. Compared with male, resuscitated female reported worse symptoms of anxiety (Hospital Anxiety and Depression Scale-Anxiety score ≥8) (43% vs 23%; P = .04), emotional responses (B-IPQ) (mean [SD], 4.9 [3.12] vs 3.7 [2.99]; P = .05), identity (B-IPQ) (mean [SD], 4.3 [3.10] vs 4.0 [2.85]; P = .04), fatigue (ESAS) (mean [SD], 5.26 [2.48] vs 3.92 [2.93]; P = .01), and depressive symptoms (ESAS) (mean [SD], 2.60 [2.68] vs 1.67 [2.19]; P = .05). CONCLUSIONS: Between sexes, female survivors of cardiac arrest reported worse psychological distress and illness perception and higher symptom burden in the immediate recovery period after resuscitation. Attention should focus on early symptom screening at hospital discharge to identify those in need of targeted psychological support and rehabilitation.

Alcohol Drinking Patterns and Risk of Developing Acute and Chronic Pancreatitis.

AIM: The aim was to analyze the effects of drinking pattern and type of alcohol on risk of acute and chronic pancreatitis. METHODS: Prospective cohort study based on data from 316,751 men and women participating in the Danish National Health Surveys 2010 and 2013. Self-reported questionnaire-based alcohol parameters and information on pancreatitis was obtained from national health registers. Cox regression models were used adjusting for baseline year, gender, age, smoking, Body Mass Index, diet and education. RESULTS: Development of acute and chronic pancreatitis increased with alcohol intake with a significant increase among abstainers and those drinking >14 drinks per week compared with individuals drinking 1-7 drinks per week. Frequent binge drinking and frequent drinking (every day) was associated with increased development of acute and chronic pancreatitis compared with those drinking 2-4 days per week. Problematic alcohol use according to the CAGE-C questionnaire was associated with increased development of acute and chronic pancreatitis.Intake of more than 14 drinks of spirits per week was associated with increased development of acute and chronic pancreatitis, and more than 14 drinks of beer per week were associated with increased development of chronic pancreatitis, whereas drinking wine was not associated with development of pancreatitis. CONCLUSION: This large prospective population study showed a J-shaped association between alcohol intake and development of pancreatitis. Drinking every day, frequent binge drinking and problematic alcohol use were associated with increased development of pancreatitis and drinking large amounts of beer and spirits might be more harmful than drinking wine.

Engagement with arts and culture activities in the Danish general population: Longitudinal associations with new onset or persistent depression and mental wellbeing.

OBJECTIVES: International literature suggests that arts and culture activities may benefit mental health, however, such survey studies conducted in the Danish population are scarce. Further, studies have investigated the associated risk for incident depression, but not for persistent depression. The objective of the current prospective study was to assess associations of engagement in arts and culture activities with incident/persistent depression and also mental wellbeing among Danish adults in the general population. DESIGN: Observational prospective study. METHODS: Data stem from a Danish nationally representative panel study of 5000 adults (aged 15+ years) conducted in 2019 and 2020, which was linked to Danish register data. An exposure variable was constructed for frequency of attending concerts, theatres, museums, and cinemas. Validated scales were used to assess the presence of depression (PHQ-8) and levels of mental wellbeing (SWEMWBS). Binary logistic regression analyses were conducted to assess the risk of incident depression (among participants free of depression at baseline), as well as the risk of persistent depression (among participants with depression at baseline), while multinomial logistic regression was used to assess odds for moderate and high mental wellbeing (low as base outcome) while adjusting for baseline values. RESULT: In terms of incident depression, quarterly engagement in arts and culture activities (compared to never) was associated with an OR of .43 (95%CI .23-.80), while 8 times or more was associated with an OR of .53 (.29-.97). In terms of persistent depression, quarterly engagement was associated with an OR of .30 (.10-.90), while 8 times per year or more was associated with an OR of .26 (.07-.92). Similar to the patterns for incident/persistent depression, associations with moderate mental wellbeing showed higher odds for quarterly engagement and 8 times per year or more. Quarterly engagement was also associated with higher odds for high mental wellbeing but did not reach statistical significance. CONCLUSIONS: The results support the involvement of the cultural and creative sectors in health strategies. Mental health promotion initiatives as well as arts and culture sectors may encourage the general public to engage in arts and culture activities with frequencies of at least once per quarter.

Changes in mental well-being during the COVID-19 pandemic: A longitudinal study among Danes from 2019 to 2021.

Numerous studies have shown that the COVID-19 pandemic had large influence on mental health during the first lockdown, but fewer studies have focused on the long-term influence on mental health. In a national longitudinal study, we examined mental well-being measured just before (fall 2019) and twice during (falls of 2020 and 2021) the COVID-19 pandemic. We utilized the Danish Health and Wellbeing Survey with questionnaires collected in 2019, 2020 and 2021 among the same study population consisting of 8179 persons. The outcome was mental well-being measured by the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). Linear regression models were conducted to evaluate change in SWEMWBS from 2019 to 2021. The SWEMWBS distribution was similar in 2019, 2020 and 2021, although the distribution moved to lower scores in 2020 compared to 2019 and moved slightly to higher scores in 2021 compared to 2020. Mean SWEMWBS decreased from 24.8 (95%CI 24.7-25.0) in 2019 to 24.1 (24.0-24.2) in 2020 and increased to 24.4 (24.3-24.6) in 2021 (p < 0.001). The mean decrease from 2019 to 2020 and increase from 2020 to 2021 was strongest among women, persons below age 75 years, persons without depression and among persons with higher education and with employment. In conclusion, we find that mental well-being decreased from 2019 to 2020 and slightly increased from 2020 to 2021 without reaching the pre-pandemic level. These changes are statistically significant but small and support that COVID-19 may only have had a small long-term influence on mental health in the general population.

Health and quality of life of patients with haemophilia: A national study of 124 Danish men.

PURPOSE: In the past decades, haemophilia treatment has greatly improved the health of persons with haemophilia (PWH). This study compares PWH to the general population on social conditions and health. METHODS: In December 2021, all Danes with moderate or severe haemophilia A or B, or von Willebrands disease type 3 were invited to participate in an online self-report survey concerning sociodemographic factors, self-rated health, teeth status, chronic health conditions, symptoms and loneliness. This study compares responses from the 124 adult male PWH with responses from a male general population sample (N = 4849). Analyses used logistic regression, controlling for age and highest completed education. RESULTS: Fewer PWH were in the oldest age group (65-84 years). Controlling for age, no significant differences were found regarding cohabitation status or education. Fewer PWH were employed (OR = .48, [.33-.71])-particularly in the 45-64 age group. PWH were less likely to report good health (OR = .49, [.31-.77]). The odds of joint disease was much higher (OR = 13.00, [8.37-20.28]). Also, hypertension (OR = 2.25, [1.13-5.65]) and previous stroke (OR = 2.51, [1.44-3.50]) were more frequent. PWH were more likely to report pain in the arms/hands/legs/hips (OR = 2.94, [1.92-4.52]), but less likely to report pain in the head/neck/shoulder (OR = .66, [.45-.96]). CONCLUSION: The disease burden of haemophilia has improved so PWH resembles the general population in areas such as marriage and education. However, even for young PWH, the disease still imposes a significant burden from hemophilia arthropathy and pain in extremities and joints. Middle-aged PWH also have poorer levels of employment than same-aged peers.

Factors related to COVID-19 vaccine hesitancy in Denmark: A national study in the autumn of 2021.

AIMS: The novelty of the COVID-19 pandemic and fast-developed vaccines may increase concerns about the safety and effectiveness of the COVID-19 vaccine and thereby influence vaccine hesitancy. The aims of this study were to examine (a) the main reasons for COVID-19 vaccine hesitancy and (b) factors associated with COVID-19 vaccine hesitancy. METHODS: A nationwide survey was conducted in the autumn of 2021 when most Danes had received at least one dose of a COVID-19 vaccine. The sample (N=13,570) was based on a random selection of individuals (⩾15 years), and data were collected via self-administered mailed questionnaires (digital and physical). The participants were asked whether they had been vaccinated against COVID-19, and if they had not, they were asked about their reasons for vaccine hesitancy. Logistic regression models were used to determine factors associated with vaccine hesitancy. RESULTS: In all, 5,384 (39.7%) individuals completed the questionnaire. The main reasons for vaccine hesitancy were worries about adverse effects (57.6%) and the belief that natural immunity is better than vaccination (43.8%). Factors associated with vaccine hesitancy included female sex, younger age, being divorced, a country of origin other than Denmark, lower educational level, being unemployed, previously infected with COVID-19 and being worried to a greater extent about oneself and others getting infected. Mental health indicators were not associated with vaccine hesitancy. CONCLUSIONS: COVID-19 vaccine hesitancy is likely to pose a challenge for population immunity. To reduce vaccine hesitancy and increase vaccination uptake, future vaccination programmes should focus on specific socio-demographic subgroups identified in this study.

Return to work and everyday life following out-of-hospital cardiac arrest. Results from the national survey, DenHeart.

BACKGROUND: With increasing survival rates following out-of-hospital cardiac arrest (OHCA), knowledge on return to everyday life, including return to work, should be getting increasing attention. OBJECTIVES: To i) describe patterns of labor market affiliation up to 12 months after discharge among a workforce population and to, ii) investigate the association between clinical and sociodemographic characteristics, self-reported health at discharge and a composite endpoint of prolonged sick leave and leaving the workforce after 3 and 12 months. METHODS: Data from the national survey, DenHeart, were used, including measures of self-reported health: HeartQoL and the Hospital Anxiety and Depression Scale (HADS), combined with register-based follow-up. RESULTS: During the study period, n = 572 OHCA patients were discharged from five Heart centres, n = 184 were part of the workforce. At discharge, 60% were on paid sick leave, and 20% at 12 months. Age (per one year older) increased the odds of experiencing the composite endpoint at 3 and 12 months (3 months: OR 1.06 95%CI 1.03-1.10, 12 months: OR 1.06 95%CI 1.03-1.09) among the total population (n = 184). Self-reported health at discharge was not associated with the endpoint. CONCLUSION: One-fifth of the OHCA survivors at a working-age prior to the OHCA was still on paid sick leave after 12 months. Increasing age was the only characteristic associated with a composite endpoint of prolonged sick leave or leaving the workforce at 3 and 12 months after discharge. With increasing survival rates, healthcare professionals need to support the population in resuming daily life, including returning to the workforce, when relevant.