Negative Acts in the Courtroom: Characteristics, Distribution, and Frequency among a National Cohort of Danish Prosecutors.

Danish prosecutors report exposure to negative acts from professional counterparts in courtrooms, which is associated with an increased risk of burnout. However, knowledge of the characteristics of these acts is limited. Based on existing theoretical frameworks, this study aims to characterize these negative acts. A nation-wide survey of Danish prosecutors (response rate: 81%) yielded 687 descriptions of experiences with negative acts from professional counterparts from a career perspective. These were analyzed using theory-directed content analysis based on the Stress-as-Offense-to-Self (SOS) theory by Semmer and colleagues and Cortina and colleagues' characterization of incivility in American courtrooms. We identified a total of 15 types of behavior within the three main themes: illegitimate tasks (n = 22), illegitimate stressors (n = 68), and illegitimate behavior (n = 612). Tentative differences in the distribution of experienced negative acts from a career perspective were found for gender and seniority. Women reported negative acts more frequently than men, and assistant prosecutors reported verbal abuse more frequently than senior prosecutors, who, conversely, more often reported a perceived lack of court management. More prospective research is needed on negative acts experienced by prosecutors to assess the scope of these in Danish courtrooms and how they impact the risk of burnout.

Adolescents' needs for information and psychosocial support during their mother's breast cancer trajectory: A systematic review.

OBJECTIVE: Breast cancer is the most common cancer diagnosis among women. The acute crisis and uncertainty that often follow diagnosis put the family at risk of exhaustion and dysfunction. Adolescents have been identified as a particularly vulnerable group of relatives. To investigate how to prevent distress in this group, we systematically reviewed research on adolescents' (11-21 years) needs for information and psycho-social support during their mothers' breast cancer trajectory. METHOD: Systematic searches were conducted in five bibliometric databases. Peer-reviewed, original research of adolescents aged 11-21 with a mother diagnosed with breast cancer was included. Two researchers conducted screening, quality assessment, and data extraction independently. Thematic synthesis was applied to the included studies. RESULTS: A total of 8066 studies were screened, and five quantitative and six qualitative studies were included. The results indicated that adolescents' information and psycho-social support needs were poorly met. Many were reluctant to share feelings with family and peers and experienced abandonment during the crisis. Adolescents who were not well informed experienced distress. Poor family functioning increased the level of adolescents' distress. CONCLUSIONS: Despite limitations regarding heterogeneity among the studies, eligibility criteria, and quality assessment, this review provides clear clinical implications. Encounter groups may support adolescents during their mother's breast cancer trajectory. Furthermore, healthcare professionals could provide more indirect support to adolescents by providing support and clearer guidelines to parents. Finally, adolescents from poor-functioning families need extra attention.

Regaining Autonomy in a Holding Environment: Patients' Perspectives on the Existential Communication with Physicians When Suffering from a Severe, Chronic Illness: A Qualitative Nordic Study.

Patients experience existential themes as pivotal in their lives, in order to be able to live with a severe, chronic illness; however, physicians report a hesitative approach to existential communication. The current study investigated Nordic patients' experiences of existential communication with their physicians related to the treatment of multiple sclerosis or chronic pain. Semi-structured interviews with 23 patients were analyzed following Interpretative Phenomenological Analysis. Physicians focusing on medical aspects at the expense of psychological and existential aspects of being ill was experienced by patients as challenging their treatment and well-being. For making a shared decision with the physician on their treatment, patients needed a transition from being dependent to being autonomous. A holding environment and existential communication about transitional objects such as relationships with something bigger than themselves, as nature or religion, supported this autonomy. The analysis showed that existential communication not only supported patients in developing and regaining autonomy but also functioned as a moderator for illness-related distress, as a prevention of withdrawal from treatment, and as significant for patients in relation to living with chronic illness. Further education in existential communication is desirable, to support physicians integrating existential dimensions in consultations and shared decision-making with patients suffering from a severe, chronic illness.

The effect of medical cannabis on cognitive functions: a systematic review.

BACKGROUND: Cannabis-based medicines are widely used in the treatment of a number of medical conditions. Unfortunately, cognitive disturbances are often reported as adverse events, although conversely, cognitive improvements have been reported. Hence, the objective of the present study was to identify, critically appraise and synthesise research findings on the potential impact of cannabis-based medicines on cognitive functioning. METHODS: Four databases (EMBASE, PsycINFO, PubMed and Scopus) were systematically searched. Studies were included if they provided findings on the impact of cannabis-based medicines in controlled settings on cognitive functioning measured by recognised cognitive tests in human adults. Study participants were required to be their own case-control, and neither studies on abuse, abstinences, patients with severe neurodegenerative diseases nor cancer-related pain conditions were included. Screening, risk of bias assessment and data extraction were conducted independently by two researchers. Findings were tabulated and synthesised by outcome. FINDINGS: Twenty-three studies were included, comprising a total of N = 917. Eight studies used Sativex as the cannabis-based medicine two used Epidiolex, two other studies used sprays, three studies used gelatine capsules, five smoked cannabis, two other and finally one studied cannabis withdrawal. Fifteen studies reported non-significant findings; six reported cognitive impairments; one study found cognitive improvement and a single study found improvement following withdrawal. Thirteen studies had cognitive or neuropsychological functioning as the primary outcome. CONCLUSIONS: Due to a large heterogeneity and methodological limitations across studies, it is not possible to make any definite conclusions about the impact of cannabis-based medicines on cognitive functioning. However, the majority of high-quality evidence points in the direction that the negative impact of cannabis-based medicines on cognitive functioning is minor, provided that the doses of THC are low to moderate. On the other hand, long-term use of cannabis based medicines may still adversely affect cognitive functioning. In the studies that found impaired cognitive functioning to be significant, all of the test scores were either within the normal range or below what would be characterised as a neuropsychologically cognitive impairment.

What do women at high risk of breast cancer request of a patient education day? Focus interviews with women before and after deciding about prophylactic interventions.

OBJECTIVE: At a Danish Hospital, we wished to establish a co-designed patient education day about prophylactic interventions for women at high risk of developing breast cancer. However, knowledge is lacking on the women's acceptability and requests for content. The objective of this study is to gain knowledge about the acceptability and requests of the content of a patient education day among women at high risk of breast cancer considering prophylactic mastectomy. METHODS: A user panel consisting of patients and health care professionals developed an interview guide for two focus interviews with two groups of women at high risk of breast cancer; one group had received a prophylactic mastectomy and one group considered it. Thematic analysis was used to explore the participants' acceptability and requests for content. RESULTS: Meaningful content was knowledge about prophylactic interventions, how to share knowledge with partners and children, and talking to equals in a safe forum. Not all participants wished to discuss own surgery in a group setting. CONCLUSION: An education day is an acceptable and supportive format for gaining knowledge about surgery, but since some topics may be vulnerable to discuss in a group setting to some women, we suggest the education day as a valuable supplement to the individual consultations.

Values-based cognitive behavioural therapy for the prevention of chronic whiplash associated disorders: A randomized controlled trial.

BACKGROUND: Whiplash is a common traffic-related injury with up to 50% of those affected continuing to experience symptoms one-year post-injury. Unfortunately, treatments have not proven highly effective in preventing and treating chronic symptomatology. The overall aim of this study was to test the effectiveness of an early values-based cognitive-behavioural therapeutic intervention (V-CBT) delivered within 6 months post-injury in preventing chronic symptomatology compared to wait list controls. METHODS: The study was a two-armed randomized controlled trial. Participants (n = 91) experienced pain, disability and at least one psychological risk factor (e.g. enhanced pain-catastrophizing) after a whiplash trauma no later than 6 months prior. Participants were randomized to 10 sessions of V-CBT starting 1 week (group A) or 3 months (group B) post-randomization. The primary outcome was pain-related disability, while secondary outcomes were pain intensity, neck-pain related disability, depression, anxiety, PTSD symptoms, pain-catastrophizing and kinesiophobia. These were evaluated at baseline and at 3, 6, 9 and 12 months post-randomization. RESULTS: At 3 months, group A demonstrated clinically important effects on all outcomes that were significantly better than group B (waitlist). When group B received the intervention at 6 months, they also demonstrated clinically important effects on all outcomes. However, there was a significant difference at 12 months for the primary outcome, in which group B increased their disability levels, while group A remained stable. CONCLUSIONS: While this indicates that an intervention window for early prevention of disability after whiplash injury may exist, this needs to be tested in a truly early intervention. SIGNIFICANCE: An early Values-based Cognitive Behavioural Therapeutic intervention delivered within 6 months post-injury (mean days 117) was effective in reducing pain-related disability and psychological distress compared to the control group that received the intervention later after a three months wait-list period. The effects were sustained at 12 months follow-up. The early intervention was significantly more effective in reducing pain-related disability compared to the control group, indicating that an intervention window for early prevention of disability after whiplash injury may exist.

Are Long-Distance Walks Therapeutic? A Systematic Scoping Review of the Conceptualization of Long-Distance Walking and Its Relation to Mental Health.

Long-distance walking is an ancient activity practiced across cultures for many reasons, including the improvement of one's health. It has even been suggested that long-distance walking may be considered a form of psychotherapy. This scoping review examined the relationship between long-distance walking and mental health among adults. Publication trends and definitions were also examined, and the reason why long-distance walking may have therapeutic effects was discussed. Systematic searches in three online databases were performed using a selection of long-distance walking terms. Both quantitative and qualitative studies were included if they examined associations between long-distance walking and mental health in an adult population. Mental health was conceptualized in broad terms, including descriptions of mental states as well as more specific measurements or notions of mental health. A total of 8557 records were screened and 26 studies were included, out of which 15 were quantitative, 9 were qualitative, and 2 were mixed. The findings showed that long-distance walking was positively related to mental health. This was most consistent with regard to emotional distress compared to somewhat inconsistent findings regarding well-being. Therefore, long-distance walking may be more appropriately used to counter some personal or emotional struggle rather than to achieve hedonic pleasure.

An existential support program for people with cancer: Development and qualitative evaluation.

PURPOSE: To describe the development process of an existential support program and to explore participants' evaluation of supportive/unsupportive processes of change. METHOD: A five-day existential support program called "Energy for life" was designed including three main elements: 1. existential group counseling, 2. art therapy and 3. interaction with nature and aesthetic surroundings. The program was implemented at two different study sites. Focus group interviews were conducted to evaluate the program. RESULTS: 40 subjects were recruited (20 for each one of the two study sites) and 36 completed the study (31 women, five men) in the age range from 31 to 76 years and living with cancer across all stages and types. The program resulted in supportive processes of "existential sharing". The existential group counseling included a sharing process which led to an increased awareness and acceptance of one's existential situation and a preparation for the next steps in one's life. Art therapy offered a respite from the illness or the opportunity to express and share difficult thoughts and feelings connected to the illness experience. The interaction with nature/surroundings induced feelings of calmness and peace, increasing self-worth and spiritual belonging. Unsupportive processes of change related to the organization of the existential counseling groups, feelings of discomfort with creative engagement and feelings of distress provoked by a hospital environment. CONCLUSION: Through "Energy for life" existential concerns and distress were shared, contained and transformed. Knowledge has been gained about how an existential support program can be designed that explicitly focuses on alleviating patients' existential distress.

The Wildman Programme. A Nature-Based Rehabilitation Programme Enhancing Quality of Life for Men on Long-Term Sick Leave: Study Protocol for a Matched Controlled Study In Denmark.

Many men have poor mental health and need help to recover. However, designing a rehabilitation intervention that appeals to men is challenging. This study protocol aims to describe the 'Wildman Programme', which will be a nature-based rehabilitation programme for men on long-term sick leave due to health problems such as stress, anxiety, depression, post-cancer and chronic cancer, chronic obstructive pulmonary disease (COPD), cardiovascular disease, or diabetes type II. The programme will be a nature-based rehabilitation initiative combining nature experiences, attention training, body awareness training, and supporting community spirit. The aim of the study will be to examine whether the 'Wildman Programme' can help to increase quality of life and reduce stress among men with health problems compared to treatment as usual. The study will be a matched control study where an intervention group (number of respondents, N = 52) participating in a 12-week nature-based intervention will be compared to a control group (N = 52) receiving treatment as usual. Outcomes are measured at baseline (T1), post-treatment (T2), and at follow up 6 months post-intervention (T3). The results of this study will be important to state whether the method in the 'Wildman Programme' can be implemented as a rehabilitation offer in the Danish Healthcare System to help men with different health problems.

The effect of exercise as adjunctive treatment on quality of life for individuals with alcohol use disorders: a randomized controlled trial.

BACKGROUND: A physically active lifestyle contributes to the prevention of lifestyle diseases, promotion of physical health, and reduction of pain, among other benefits. Being physically active also promotes mental health for many individuals, in the form of improved mood, increased self-efficacy and reduced risk of depression. Alcohol-dependent individuals may experience a better quality of life when supplementing their treatment with physical exercise. This study aimed to evaluate the effect of exercise on Quality of Life among patients with alcohol use disorder in a large randomized controlled trial. METHODS: The study had three arms: Patients were allocated to (A) treatment as usual, (B) treatment as usual and supervised group exercise two days a week of one hour each, (C) treatment as usual and individual physical exercise minimum two days a week. Duration of the intervention was six months. Data on values of Quality of Life were collected at baseline (before treatment start and at time of enrollment in the study), and at follow-up (at six months after enrollment in the study) using the EQ-5D questionnaire and the EQ-VAS. The sample consisted of 117 consecutive patients, and the follow-up rate was 66.6%. Intention-to-treat analyses were conducted to evaluate the effect of exercise on quality of life. RESULTS: Although not statistically significant, a substantial portion of the participants in the individual exercise condition reported that they had no pain or discomfort (one of the five quality of life dimensions measured by EQ-5D questionnaire) compared to the controls at follow-up. No difference was found between the groups regarding the EQ-VAS. CONCLUSION: The exercise intervention had no effect on quality of life for patients with alcohol use disorder, nor was quality of life improved across the total sample. More research in how to improve quality of life for patients with alcohol use disorder is needed. TRIAL REGISTRATION: ISRCTN74889852 (retrospectively registered, date: 16/05/2013).

Saying yes or no to physical activity - A comparative cohort analysis of patients seeking treatment for Alcohol Use Disorder.

INTRODUCTION: Engaging individuals, suffering from alcohol use disorder (AUD), in a physical activity can be a challenge, and often it is a limitation of the quality of studies on the topic. The aim of the present study is to investigate differences between participants and non-participants in a randomized controlled trial on the effect of physical exercise as add-on to treatment as usual (TAU) to treatment for alcohol use disorder, thereby identifying potential factors that may predict lack of willingness or ability to consider increasing the level of physical activity. METHOD: The Healthy Lifestyle Study was a randomized controlled trial with three arms, of which two included adding physical activities to treatment for AUD as usual. All patients from an outpatient alcohol treatment clinic were invited to participate in the study. 172 accepted participation, and 384 patients either did not show up for information about the study or declined to participate. All patients in the treatment clinic were assessed by means of European Addiction Severity Index (EuropASI). RESULTS: The only predictor of participation in the study was the drinking pattern. Patients, who had been drinking every day for the last 6 months were less likely to participate in the study (OR 0.7 CI 0.4-0.9). Neither somatic nor psychiatric health seemed to impact whether or not the patients participated in the study. CONCLUSION: Non-participants did not differ from participants in this study except in their drinking pattern.

Efficacy and safety of cannabidiol followed by an open label add-on of tetrahydrocannabinol for the treatment of chronic pain in patients with rheumatoid arthritis or ankylosing spondylitis: protocol for a multicentre, randomised, placebo-controlled study.

INTRODUCTION: Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic, systemic, inflammatory diseases, primarily in the musculoskeletal system. Pain and fatigue are key symptoms of RA and AS. Treatment presents a clinical challenge for several reasons, including the progressive nature of the diseases and the involvement of multiple pain mechanisms. Moreover, side effects of pain treatment pose an implicit risk. Currently, no well-controlled studies have investigated how medical cannabis affects pain and cognitive functions in RA and AS. The present study aims to evaluate the efficacy and safety of medical cannabis in the treatment of persistent pain in patients with RA and AS with low disease activity. METHODS AND ANALYSIS: A double-blinded, randomised, placebo-controlled study of cannabidiol (CBD), followed by an open label add-on of tetrahydrocannabinol (THC) with collection of clinical data and biological materials in RA and AS patients treated in routine care. The oral treatment with CBD in the experimental group is compared with placebo in a control group for 12 weeks, followed by an observational 12-week period with an open label add-on of THC in the primary CBD non-responders. Disease characteristics, psychological parameters, demographics, comorbidities, lifestyle factors, blood samples and serious adverse events are collected at baseline, after 12 and 24 weeks of treatment, and at a follow-up visit at 36 weeks. Data will be analysed in accordance with a predefined statistical analysis plan. ETHICS AND DISSEMINATION: The Danish Ethics Committee (S-20170217), the Danish Medicines Agency (S-2018010018) and the Danish Data Protection Agency approved the protocol. The project is registered in the European Clinical Trials Database (EudraCT 2017-004226-15). All participants will give written informed consent to participate prior to any study-related procedures. The results will be presented at international conferences and published in peer-reviewed journals.

A municipality-based vocational rehabilitation programme for occupationally marginalized citizens: a study protocol for a mixed methods study.

BACKGROUND: In 2013 vocational rehabilitation programmes (VRP) were given official and legal approval under Danish law to assist occupationally marginalized citizens in gaining general life skills, building their work ability, and increasing their chances of entering the work force. The project's aim is to develop a detailed understanding of the health, psychosocial and work circumstances of participating citizens, and of the important processes and mechanisms underlying the potential effects of participating in the VRP. METHODS: This study uses an exploratory mixed methods approach with sequential use of quantitative and qualitative methods. Participants are citizens assigned to an individually tailored VRP in the municipality of Sonderborg, Denmark. The quantitative part of the study consists of a longitudinal survey in which participants complete questionnaires at baseline and at follow-up one year later. Variables include demographic and personal characteristics, the latter ascertained through validated questionnaires on well-being, physical activity, interpersonal problems, general health, work ability, kinesiophobia, self-efficacy, depression and anxiety. The qualitative part of the study consists of semi-structured interviews and observations that explore experiences related to VRP. Participants will be recruited and data collected from questionnaires, interviews and observations in the period February 2016 - March 2018. DISCUSSION: This research will assemble a unique corpus of knowledge about the characteristics, experiences and outcomes of occupationally marginalized citizens participating in a VRP. It will identify potential enablers and barriers to a successful outcome, and ultimately this knowledge will help inform the future design of individually tailored VRP's. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02641704 , date of registration December 29, 2015.

Longer term follow-up on effects of Tailored Physical Activity or Chronic Pain Self-Management Programme on return-to-work: A randomized controlled trial.

OBJECTIVE: To evaluate the longer term efficacy of the interventions Tailored Physical Activity (TPA) and Chronic Pain Self-management Program (CPSMP) against a reference group on return-to-work for sick-listed subjects with pain in the back or upper body. DESIGN: A randomized controlled trial. SUBJECTS: A total of 141 sick-listed subjects with pain in the back or upper body. METHODS: All participants received health guidance for 1.5 h and were randomly assigned to TPA (n = 47), CPSMP (n = 47) or a reference group (n = 47). The primary end-point was the proportion of participants returning to work and the co-primary end-point was the duration of the sickness absence period retrieved 11 months after the first day on sick leave. Secondary outcomes were pain level, body mass index, aerobic capacity, work ability and kinesiophobia. RESULTS: TPA and CPSMP were no more effective than the reference group as regards return-to-work. Compared with the reference group no other benefits of TPA and CPSMP were evident regarding pain, work ability, kinesiophobia or physical capacity. CONCLUSION: After 11 months TPA, the reference group, and CPSMP show similar patterns of facilitating return-to-work. This is additional knowledge, compared with the 3-month findings reported previously, showing that TPA seems to facilitate a faster return-to-work.

The RESCueH Programme: Testing New Non-Pharmacologic Interventions for Alcohol Use Disorders: Rationale and Methods.

Excessive alcohol consumption is one of the most important lifestyle factors affecting the disease burden in the Western world. The results of treatment in daily practice are modest at best. The aim of the RESCueH programme is to develop and evaluate methods, which are as practice-near as possible, and therefore can be implemented quickly and easily in everyday clinical practice. It is the first clinical alcohol programme to be transatlantic in scope, with implementation in treatment centers located in Denmark, Germany and the US. The RESCueH programme comprises 5 randomized controlled trials, and the studies can be expected to result in (1) more patients starting treatment in specialized outpatient clinics, (2) a greater number of elderly patients being treated, (3) increased patient motivation for treatment and thus improved adherence, (4) more patients with stable positive outcomes after treatment and (5) fewer patients relapsing into harmful drinking. The aim of this paper is to discuss the rationale for the RESCueH programme, to present the studies and expected results.

Value-based cognitive-behavioural therapy for the prevention of chronic whiplash associated disorders: protocol of a randomized controlled trial.

BACKGROUND: Whiplash injury is the most common traffic-related injury affecting thousands of people every year. Conservative treatments have not proven effective in preventing persistent symptoms and disability after whiplash injury. Early established maladaptive pain behaviours within the first weeks after the injury may explain part of the transition from acute to chronic whiplash associated disorder (WAD). Hence, early targeting of psychological risk factors such as pain catastrophizing, fear-avoidance-beliefs, depression, and symptoms of posttraumatic stress disorder (PTSD) may be important in preventing the development of chronic WAD. Some evidence exists that targeting fear-avoidance beliefs and PTSD with exposure strategies and value-based actions may prevent development of persistent disability after whiplash injury. Yet, the results have to be tested in a randomized controlled trial (RCT). The primary objective of the present study is to test whether a specifically tailored value-based cognitive-behavioural therapy program (V-CBT) is able to prevent the development of persistent disability, pain, and psychological distress if delivered within the first three months after a whiplash injury. METHODS/DESIGN: The current study is a two-armed randomized controlled study with a crossover design. Group A is scheduled for V-CBT within one week of randomization and group B with a delayed onset 3 months after randomization. DISCUSSION: If the study detects significant effects of V-CBT as a preventive intervention, the study will provide new insights of preventive treatment for patients with WAD and thereby serve as an important step towards preventing the chronic condition. TRIAL REGISTRATION: Current Controlled Trials Registration September 19, 2014: NCT02251028.

Efficacy of Tailored Physical Activity or Chronic Pain Self-Management Programme on return to work for sick-listed citizens: A 3-month randomised controlled trial.

OBJECTIVES: The aim was to evaluate the efficacy of 'Tailored Physical Activity' (TPA) and a 'Chronic Pain Self-management Programme' (CPSMP) compared with a reference group (REF) on return to work after 3 months as sick-listed citizens with pain related to the back or the upper body. METHODS: Using a randomised controlled trial design all participants (n= 141) received health guidance for 1.5 hours and were randomised to TPA, CPSMP or REF. Characteristics of participants were collected from a questionnaire. The primary endpoint was proportion of participants returned to work as registered by the municipality and the co-primary endpoint was duration of the sickness absence period. Secondary outcomes consisted of pain, body mass index, aerobic capacity, grip strength, work ability and kinesiophobia. The trial was conducted in Sonderborg Municipality from March 2011 to October 2013. RESULTS: TPA was more effective on return to work than REF, while CPSMP only tended to be more effective than REF, and the primary outcome was the only between-groups significant difference. TPA participants also reached a highly significant reduction in pain from baseline to follow-up with no similar effect seen in CPSMP or REF. In contrast, no benefit of TPA and CPSMP was evident regarding work ability, kinesiophobia or physical capacity after 3 months of follow-up. CONCLUSIONS: The results suggest that TPA is a promising intervention to facilitate return to work and reduce pain among sick-listed citizens with pain related to the back or upper body compared to REF.

Efficacy of 'Tailored Physical Activity' on reducing sickness absence among health care workers: A 3-months randomised controlled trial.

AIM: The aim was to evaluate efficacy of "Tailored Physical Activity" (TPA) versus a reference group (REF) in reducing the number of self-reported days of sickness absence for health care workers in the Sonderborg Municipality. METHODS: In this randomised controlled trial, all participants (n = 54) received health guidance for 1.5 h and were randomised to TPA or REF. The primary aim was to make a comparison of participants' self-reported sickness absence due to musculoskeletal troubles measured three months after baseline. Secondary outcomes included anthropometric, health-related and physical capacity measures. RESULTS: A TPA intervention was not significantly more effective than REF in reducing sickness absence caused by musculoskeletal troubles. However, there were significant improvements for TPA participants compared to REF in reducing pain intensity from 47.9 mm to 21.8 mm (p < .01), increasing work ability from 7.3 to 8.1 (p = .04) and decreasing kinesiophobia from 26.7 to 22.5 (p < .01). A trend towards a significant improvement was seen for aerobic capacity while no effect of the intervention was found on productivity, BMI or grip strength. CONCLUSION: This physical activity intervention is a promising initiative for health care workers since participants achieved a substantial effect on their experience of pain, on their work ability and on their fear of physical movement relating to pain. Moreover, a difference in aerobic capacity was apparent between the sample groups. TPA however, had no significant effect in reducing sickness absence days.

[Quality of life of bariatric and body contouring]. / Patienttilfredshed efter bariatrisk og postbariatrisk kirurgi.

Surgical treatment of obesity has led to a large group of patients with massive weight loss. The massive weight loss results in excessive skin, which leads to pain, skin problems, cosmetic discomfort and psychosocial issues. The impact on quality of life of bariatric and body contouring surgery can be measured by patient-specific, well-constructed psychometrically validated patient-reported outcome measures. A new patient-reported outcome measure, the Body-Q, has been translated for use in Danish patients.

A qualitative study of citizens' experience of participating in health counseling.

Individual health counseling is a form of intervention designed to minimize the effects of chronic health disease and to offer a path towards good health practices. The aim of the present study was to explore the experiences of those persons who participated in health counseling in order to assess the psychosocial significance of the counseling upon their health behavior. In addition the study was concerned with the factors which underlay peoples' decision to sign up for health counseling. The research involved 11 semi-structured interviews with individuals who had participated in a municipality based health counseling program. Data was analyzed using Malterud's systemic text condensation and a theoretical framework around Bandura's social cognitive theory. Analysis revealed that an approach tailored to each individual with minor short-term goals accompanied by feeling supported by the counselor produced the greatest impact on behavior. Receiving feedback from the counselor and feeling positive about the relationship were seen as essential. These aspects were also crucial in the decision to undertake health counseling. The study indicates that whether individual's sign up on their own initiative or conversely are invited to join the program has no influence upon their motivation to change their behavior. Overall the respondents demonstrated improvement in their behavior and attitudes towards their health. However, the study also indicates that this form of intervention is less or even ineffective without the support of the individual's immediate family.