Denmark

This article shows the relationship between Saxo Grammaticus' "Gesta Danorum" (History of the Danes) (Saxo was a Danish historian and mythographer who composed a Latin work on the legendary past of Denmark as well as Scandinavian mythology) and J.R.R. Tolkien, mainly when he was a student of ancient language and literature.

Higher education institutions have been profoundly reshaped by processes associated with neoliberalism. In this chapter, Larsen outlines the ways in which Denmark has ushered in market-driven reforms to the Danish higher education system to enhance their institutional competitiveness over the past 30 years. Research on the impacts of neoliberal higher education reforms on faculty is reviewed and the author discusses her experiences (at a Canadian university) with market-driven, accountability reforms. The chapter shifts direction and provides the reader with an overview of the concept of hygge, an idealized Danish term that has connotations of coziness, safety, friendliness, and intimacy. Larsen recounts her experiences as a Canadian academic on sabbatical at a Danish university in 2017, illustrating the ways in which she experienced hygge in the Danish university setting. In the final section of the chapter, Larsen argues that hygge can be viewed as a retreat from the individualism, competition, market stratification and other challenges associated with neoliberalism. Hygge marks out the boundaries between the cold and heartless marketplace and the warm and cozy home, and despite critiques that is instantiates exclusions, hygge offers hope to resist the alienation associated with neoliberalism and provide an alternative ethos for close and safe social relations within academia.

Absiract. The compliance of practice to national guidelines on urethral catheter care has been examined. Questionnaires on the practices used with patients under their care were sent to 1350 nursing staff. Replies were received from 1153 individuals, 692 from hospitals, 345 from nursing homes and 116 from home care. While national guidelines stress the importance of maintaining a closed urine drainage system, the results revealed that 25.4% of respondents opened the drainage system to collect samples of urine for analysis, 57.9% to perform bladder washouts and 76% to change urine bags. 26% of respondents reported that they collected urine samples for routine bacteriological surveillance, a procedure considered unnecessary in the guidelines. 83% of staff reported that they washed their hands after emptying urine bags. Staff awareness of written guidelines for various aspects of catheter care ranged from 2 5 4 8 % in hospitals, 27-45% in nursing homes and 7-17% in home care. A marginal costs analysis was performed to estimate the economic consequences of non-compliance to the national guidelines.

We investigated whether spiders fed lipid-rich rather than protein-rich prey elevate metabolism to avoid carrying excessive lipid deposits, or whether they store ingested lipids as a buffer against possible future starvation. We fed wolf spiders (Pardosa prativaga) prey of different lipid:protein compositions and measured the metabolic rate of spiders using closed respirometry during feeding and fasting. After a 16-day feeding period, spider lipid:protein composition was significantly affected by the lipid:protein composition of their prey. Feeding caused a large and fast increase in metabolism. The cost of feeding and digestion was estimated to average 21% of the ingested energy irrespective of diet. We found no
difference in basal metabolic rate between dietary treatments. During starvation ˙VO2 and ˙VCO2 decreased gradually, and the larger lipid stores in spiders fed lipid-rich prey appeared to extend survival of these spiders under starvation compared to spiders fed protein-rich prey. The results show that these spiders do not adjust metabolism in order to maintain a constant body composition when prey nutrient composition varies. Instead, lipids are stored efficiently and help to prepare the spiders for the long periods of food deprivation that may occur as a consequence of their opportunistic feeding strategy.

Physical activity is considered an important and determining factor for the cancer patient's physical well-being and quality of life. However, cancer treatment may disrupt the practice of physical activity, and the prevention of sedentary lifestyles in cancer survivors is imperative. The current study aimed at investigating self-reported physical activity behaviour, exercise motivation and information in cancer patients undergoing chemotherapy. Using a cross-sectional design, 451 patients (18-65 years) completed a questionnaire assessing pre-illness and present physical activity; motivation and information received. Patients reported a significant decline in physical activity from pre-illness to the time in active treatment (p<0.001). Amongst the respondents, 68% answered that they believed exercise to be beneficial; and 78% claimed not exercising as much as desired. Exercise barriers included fatigue (74%) and physical discomfort (45%). Present physical activity behaviour wa...

Objective To assess the effect of virtual reality training on an actual laparoscopic operation. Design Prospective randomised controlled and blinded trial. Setting Seven gynaecological departments in the Zeeland region of Denmark. Participants 24 first and second year registrars specialising in gynaecology and obstetrics.

This exposure study addresses the validity of the exposure assessment method of an epidemiological study of traffic-related air pollution and childhood cancer. In particular, this paper concerns the question of whether the concentration of nitrogen dioxide (NO,) outside the front door is a valid marker of the exposure of the child living at the address. The study includes 100 children living on streets with dense traffic in central parts of Copenhagen and 100 children living in rural areas. Preliminary results, based on 25% of the study subjects, suggest that both the outdoor NO,-concentration and the exposure of the children are two to three times higher in Copenhagen than in the rural districts. Moreover, the results suggest that the NO,-concentration outside the front door is a poor marker of the exposure of the children in Copenhagen, but a marker of some relevance for the exposure of the children in rural districts. The preliminary results must be treated with caution, as among other things, the analysis did not consider seasonal changes and indoor NO,-sources such as passive smoking. candles, and gas appliances.

In this introductory essay, we build on the articles in this special issue to provide a novel theoretical framework for the understanding of current and future trends in the digitalisation of teaching and learning in Nordic higher education (HE). We highlight three key elements. Context is critical and should be systematically expanded to include not only the immediate context of the virtual and blended classroom, but also the broader organisational and national contexts within which digital learning takes place. The involvement of individual actors, higher education institutions and national policy-making agencies in the development and implementation of digitalisation policy ideas and practices is also shaped by multiple mediations, which include the mediating role of technology itself, but also of other human, organisational and policy actors, ideas and practices. Finally, digitalisation of HE teaching and learning can lead to a variety of gradual or more radical digital transformations, operating at multiple scales and with multiple potential positive or negative effects. This framework helps put into focus the key question of how to go about searching for a flexible set of "Nordic characteristics" that might affect digitalisation of teaching and learning in the Nordic region, albeit in uneven and diverse ways. While it is too early to provide a systematic analysis of the impact of the rapid digitalisation of Nordic HE teaching and learning spurred by the Covid-19 pandemic, we make some preliminary observations that offer this emerging theoretical framework as a way to assess these trends both before and after the pandemic.

Objective The aim was to examine risk factors for ovarian borderline tumors overall, and according to histological subtype (serous vs. mucinous), in a large Danish population-based case-control study. Methods Ovarian borderline cases and controls were recruited from 1995 to 1999, and personal interviews were conducted. In all, 202 cases and 1,564 randomly selected controls were included. The analysis was performed using multiple logistic regression models. Results The risk of ovarian borderline disease decreased with increasing parity (OR=0.79 per birth, 95% CI: 0.63-0.98) and older age at first birth (OR=0.67 per 5 years, 95% CI: 0.53-0.84). Both a history of breastfeeding and use of oral contraceptives reduced the risk of borderline tumor, the effect being most pronounced for serous tumors. Increasing body mass index (BMI) was associated with elevated risk of serous borderline tumor (OR=1.05 per BMI unit; 95% CI: 1.00-1.10), whereas current smoking was a strong risk factor only for mucinous tumors (OR=2.10; 95% CI: 1.22-3.60). Finally, increasing consumption of milk (all types) was found to increase the risk of borderline disease (OR=1.04 per glass milk per week; 95% CI: 1.02-1.06), and increasing intake of total lactose also increased the risk significantly (OR=1.16 per 50 gram lactose per week; 95% CI: 1.06-1.26). Conclusion The risk profile of ovarian borderline tumors is similar to that of ovarian carcinomas, and we observed significant etiological differences between serous and mucinous borderline tumors.

Deep-water oxygen concentrations in the Baltic Sea are influenced by eutrophication, but also by saltwater inflows from the North Sea. In the last two decades, only two major inflows have been recorded and the lack of major inflows is believed to have resulted in a long-term stagnation of the deepest bottom water. Analyzing data from 1970 to 2000 at the basin scale, we show that the estimated volume of water with oxygen, <2 mL L -1 , was actually at a minimum at the end of the longest so-called stagnation period on record. We also show that annual changes in dissolved inorganic phosphate water pools were positively correlated to the area of bottom covered by hypoxic water, but not to changes in total phosphorus load, thus addressing the legacy of eutrophication on a basinwide scale. The variations in phosphorus pools that have occurred during the past decades do not reflect any human action to reduce inputs. The long residence time and internally controlled variation of the large P pool in the Baltic Sea has important implications for management of both N and P inputs into this eutrophicated enclosed basin.

The purpose of the study was to assess the association of obstetric complications with risk for mental disorders resulting in hospitalization before the age of 15. Records from all births in Denmark from 1973 through 1993 were linked to records of all psychiatric hospitalizations. Diagnoses were grouped into seven broad categories. A reference population of 10% of births in Denmark from 1973 to 1990 was used for comparison. Obstetric complications were associated with the range of mental disorders occurring in childhood. The strongest predictors were a variable indicating the interaction of birth weight with speed of growth and the 5-minute Apgar score. There was no diagnostic group that stood out as different with respect to obstetric complications. These results are consistent with the hypothesis of the continuum of reproductive casualty.

Major depression is a mood disorder that is often accompanied by the impairment of cognitive functions. Although suggestive, the large range of existing neuropsychological, neuropsychiatric, and, lately, neuroimaging investigations have not yet given a consistent picture of the psychological and biological disturbances involved in this psychiatric disorder. The present study of the cognitive functions in depression was part of an extensive investigation, including neuropsychological testing, psychiatric examination, and neuroimaging. A representative sample of 40 severely depressed hospitalized patients and a group of 49 closely matched control subjects were tested with an extensive neuropsychological test battery. Results, corrected for various confounding factors, confirmed the current notion that depressed patients suffer from widespread cognitive impairments. The group analysis did not allow any hypothesis on a possible pattern to the dysfunctions, but heterogeneity in the test performances calls for further analysis of the data in patient subgroups in relation to neuroimaging results. psychological test battery. The neuropsychological test battery was composed to include a number of tests of attention, 240 B. Ravnkilde et al.

Age-related macular degeneration (AMD) is a degenerative disease of the human retina affecting individuals over the age of 55 years. This heterogeneous condition arises from a complex interplay between age, genetics, and environmental factors including smoking and diet. It is the leading cause of blindness in industrialized countries. Worldwide, the number of people with AMD is predicted to increase from 196 million in 2020 to 288 million by 2040. By this time, Asia is predicted to have the largest number of people with the disease. Distinct patterns of AMD prevalence and phenotype are seen between geographical areas that are not explained fully by disparities in population structures. AMD is classified into early, intermediate, and late stages. The early and intermediate stages, when visual symptoms are typically absent or mild, are characterized by macular deposits (drusen) and pigmentary abnormalities. Through risk prediction calculators, grading these features helps predict the ...

Objective: To compare the reproductive outcome of three protocols for frozen ET treatment. Design: Retrospective follow-up study. Setting: Two public clinics and one private clinic. Patient(s): Four thousand four hundred seventy frozen ET cycles between 2006 and 2010. Intervention(s): Thawing of embryos and ET. Main Outcome Measure(s): Pregnancy test rate, clinical pregnancy rate, and pregnancy loss rate. Result(s): The natural cycle followed by P (NC þ P) was used in 26% of cycles, the natural cycle with hCG (NC þ hCG) in 10%, and the substituted cycle with estrogen and P (E þ P) in 64% of cycles. The rate of transfers after thawing was similar in all groups (87.2%, 73.9%, and 87.2%, respectively). There was a significantly higher positive pregnancy test rate in the E þ P (34.3%) and NC þ hCG (35.5%) cycles as compared with the NC þ P cycles (26.7%). However, the clinical pregnancy rate was similar in all groups (27.7%, 29.1%, and 24.3%, respectively). Moreover, no differences were seen between groups regarding the live-birth rate (20.1%, 23.5%, and 20.7%, respectively). A logistic regression analysis showed that the type of protocol was the only predictor of pregnancy loss, while age, irregular cycles, endometrial thickness, number, and quality of embryos transferred did not correlate to pregnancy loss. Conclusion(s): A higher positive pregnancy test rate was obtained in E þ P frozen ET cycles in comparison with other protocols; however, due to an increased preclinical and clinical pregnancy loss, comparable clinical pregnancy, and delivery rates are reported for the three protocols. (Fertil Steril Ò 2012;98:1165-9. Ó2012 by American Society for Reproductive Medicine.

In the network society the boundaries between media, politics, economy and culture is put under pressure. The media is placed in an increasingly direct competition with the state, private companies, interest organisations etc. about the powers of definition within important spheres of society. This is illustrated by for instance “the Muhammad crisis” and the debate about the documentary “The secret war”. Both cases also show the importance of the legitimacy of the roles played by the media in the network society. This puts forward the old question about the objectivity of journalism, and makes this question important in the debate about the roles of journalism in the network society.

Objective At temperate latitudes, 1-5% of the population suffer from winter depression; during winter, mood difficulties tend to increase but may be alleviated by bright light therapy. Unlike indoor workers, outdoor workers are exposed to therapeutic levels of sunlight during winter. We hypothesized that outdoor work may protect against mood difficulties and depression. Method We studied this hypothesis among 2910 civil servants from Århus, Denmark, who participated in a survey in January-February 2009. Mental symptoms (N=422) defined a common case category that we broke down into two parts: depression (N=66) and mood difficulties but no depression (N=356). A total of 222 controls were also sampled from the study population. All 644 participants reported the extent of outdoor work. Results The confounder-adjusted odds ratio (OR) of mood difficulties showed a decreasing trend by increasing hours of outdoor work of borderline statistical significance. The OR was 0.63 [95% confidence interval (95% CI) 0.34-1.18)] for those working outdoors for >2 hours a day. No such effect was suggested for depression. Conclusion Our study is limited by its cross-sectional design and low statistical power but nevertheless suggests that outdoor work during winter may protect against mood difficulties. If this finding holds true it may have significant impact on workers' health as well as public health in general. Therefore, further studies are recommended.

An inverse association between allergic conditions and glioma risk has been reported previously. In this large population-based case-control study, the authors identified cases diagnosed with glioma or meningioma in Denmark, Norway, Finland, Sweden, and southeast England between 2000 and. Detailed information on self-reported physician-diagnosed allergic conditions was collected from 1,527 glioma cases, 1,210 meningioma cases, and 3,309 randomly selected controls. Logistic regression showed an odds ratio of 0.70 (95% confidence interval: 0.61, 0.80) for glioma associated with a diagnosis of any of asthma, hay fever, eczema, or other type of allergy. The risk estimates for glioma were around 0.65 for each allergic condition (asthma, eczema, hay fever, and food allergy), and the 95% confidence intervals were equally consistent, at around 0.55, 0.80. The reduced risks of glioma related to eczema, hay fever, and allergy overall, but not asthma, were confined to current rather than past conditions. Meningioma risk was not associated with allergic conditions, except for eczema (odds ratio ¼ 0.74, 95% confidence interval: 0.60, 0.91). Our results show a reduced risk for glioma associated primarily with current allergic conditions. If this is etiologic, it has implications for the understanding of how allergic conditions might reduce the tumor risk.

Mineralisation of the phenylurea herbicide isoproturon (3-(4-isopropylphenyl)-1,1-dimethylurea) and two of its known metabolites, 3-(4-isopropylphenyl)-1-methylurea (monodesmethyl-isoproturon) and 4-isopropylaniline, was studied in Danish agricultural soils with or without previous exposure to isoproturon. A potential for rapid mineralisation of isoproturon and the two metabolites was present in soils sampled from three plots within an agricultural field previously treated regularly with the herbicide, with 34-45%, 51-58% and 33-36% of the added [phenyl-U-14 C]isoproturon, [phenyl-U-14 C]monodesmethylisoproturon and [phenyl-U-14 C]4-isopropylaniline metabolised to [ 14 C]carbon dioxide within 30 days at 20 • C. In contrast, such extensive mineralisation of these three compounds was not observed within this period in soils sampled from two other agricultural fields without previous treatment with isoproturon. The mineralisation patterns indicated growth-linked metabolism of the three compounds in the previously exposed soils, and doubling times for [ 14 C]carbon dioxide production ranged from 1.6 to 3.2, 1.0 to 2.1 and 1.3 to 1.7 days for isoproturon, monodesmethyl-isoproturon and 4-isopropylaniline, respectively. The ability to mineralise [phenyl-U-14 C]isoproturon to [ 14 C]carbon dioxide was successfully sub-cultured to a fresh mineral medium which provided isoproturon as sole source of carbon and nitrogen. One of the soils sampled from an agricultural field not previously treated with isoproturon showed accelerated mineralisation of [phenyl-U-14 C]4-isopropylaniline toward the end of the experiment, with a doubling time for [ 14 C]carbon dioxide production of 7.4 days. This study indicates that the occurrence of rapid mineralisation of the phenyl ring of isoproturon to carbon dioxide is related to previous exposure to the herbicide, which suggests that microbial adaptation upon repeated isoproturon use may occur within agricultural fields.

The authors examined the relation between fish consumption during pregnancy and fetal growth among 44,824 women from the Danish National Birth Cohort (1996)(1997)(1998)(1999)(2000)(2001)(2002). They evaluated the associations between consumption of total fish, fatty fish, and lean fish in midpregnancy and birth weight, birth length, and head circumference among singleton full-term infants. Fish consumption was ascertained by food frequency questionnaire. The birth of infants classified below the 10th percentile for gestational age and gender was significantly increased among women who consumed more than 60 g of fish per day, as compared with women who consumed 5 g or less per day. Adjusted odds ratios were 1.24 (95% confidence interval (CI): 1.03, 1.49) for birth weight and 1.21 (95% CI: 1.01, 1.43) for head circumference. The adjusted odds ratio was borderline significant for birth length (odds ratio ¼ 1.20, 95% CI: 1.00, 1.45). These increases in risk were followed by small decreases in average values for these growth measures. Furthermore, the inverse association for total fish consumption could be explained by consumption of fatty fish, while no association was found for lean fish. These results indicate that consumption of fatty fish, a known route of exposure to persistent organic pollutants, could be associated with reduced fetal growth.

Patients with acute whiplash trauma were followed to examine if post-trauma ratings of pre-collision pain and psychological distress were associated with reduced work capability and neck pain at 12 months follow-up. The study included 740 consecutive patients (474 females, 266 males) referred from emergency departments or primary care after car accidents in four counties in Denmark. After the collision patients received a questionnaire on psychological distress, unspecified pain and socio-demographics and 12 months later a follow-up on work capability and neck pain was performed. Risk factors were identified by multiple logistic regression analysis. Factors associated with affected work capacity at the 12-month follow-up were pre-collision unspecified pain condition (OR = 2.4, p = 0.002) and socio-demographic characteristics: female gender, low educational level, unemployment and blue collar worker. Factors associated with considerable neck pain at follow-up were pre-collision unspecified pain (OR = 3.5, p < 0.000), pre-collision high psychological distress (OR = 2.1, p = 0.03) and socio-demographic characteristics: female gender and formal education >4 years. Pre-collision neck pain and severity of accident were not associated with poor outcome. In conclusion unspecified as opposed to specified pain (neck pain) before the collision is associated with poor recovery and high accumulation of pre-collision psychological distress is associated with considerable neck pain at follow-up. However, no conclusions on causality can be drawn. Personal characteristics before the collision are important for recovery and attention to pre-collision characteristics may contribute to the prevention of poor recovery after acute whiplash trauma. Ó

S everal studies have explored the impact of marital bereavement on mortality, while increasing emphasis has recently been placed on genetic factors influencing longevity -in this paper, we study the impact of losing the spouse and losing the co-twin, for twins aged 50 to 70. We use data from the Danish Twin Registry and the Population Register of Denmark for the period 1968 through 1999. Firstly, we use survival analysis to study mortality after the death of the spouse or the co-twin. We find that the risk of dying is highest in the first year after the death of the spouse, as well as in the second year after the death of the co-twin. We then use event history analysis techniques to show that there is a strong impact of the event 'losing the co-twin' even after controlling for age, sex and zygosity and that this effect is significantly higher in the second year of bereavement. The effect is similar for men and women, and it is higher for monozygotic twins. The latter confirms the influence of genetic factors on survival, while the mortality trajectory with a peak in the second year after the death of the co-twin is consistent with the existence of a twin bereavement effect.

In recent years, coaching, as a supplement to professional development, has received increased attention, especially in nursing. Still, only little is known about how health professionals experience participating in coaching sessions. The purpose of this pilot study was to describe and analyze health professionals' experiences from coaching-what coaching meant to them and how it influenced different aspects of their lives.

Objective. Couples with fertility problems may experience marital or sexual distress which could potentially result in dissolved relationships. We investigated the likelihood of ending a relationship among women who did not have a child after a fertility evaluation. Design. Longitudinal cohort study. Setting. Danish women ever referred for primary or secondary fertility problems to a public Danish hospital or private fertility clinic between 1990 and 2006. Population. A total of 47 515 women. Methods. The data were linked to Danish administrative population-based registries containing demographic and socioeconomic information. Discrete-time survival models were used with person-period data. Each woman was followed from the year of her initial fertility evaluation through to 2007. Main outcome measures. Effects of parity after a fertility evaluation on the likelihood of ending a marital or cohabitation relationship. Results. After up to 12 years of follow up, nearly 27% of the women were no longer living with the person with whom they had lived at the time of the fertility evaluation. Women who did not have a child after the evaluation had significantly higher odds ratios for ending a relationship up to 12 years after the evaluation (with odds ratios up to 3.13, 95% CI 2.88-3.41) than women who had a child, regardless of their parity before the evaluation. Conclusions. Parity after a fertility evaluation may be an important component in the longitudinal relationships of couples with fertility problems. Studies with detailed information on marital quality and relational well-being of couples with fertility problems are needed.

Testicular cancer is the most common type of cancer in young Caucasian men. It has been suggested that testicular microlithiasis (TML) is a premalignant condition. This study&#39;s objective was to investigate TML histology prevalence in testicular cancer patients in two European populations. We analysed archived histopathology orchiectomy specimens from 152 patients diagnosed with testicular cancer at Fredericia Hospital in Denmark from 2004 to 2014, and 106 patients diagnosed at St Thomas&#39; Hospital in London from 2011 to 2015. The Danish patients&#39; median age was 37 years (range: 16-74 years) and the English patients&#39; 36 years (range: 18-78 years). In the Danish patients, 29 (19.1%) had TML, and in the English patients, 43 (40.6%) had TML (p &lt; 0.001). Haematoxylin bodies were slightly more common in the English patients. Laminated calcification was more often seen in seminomas than in non-seminomas.
 CONCLUSIONS: The English testicular cancer patients had a statistic...

Background: Daily pain and multi-site pain are both associated with reduction in work ability and health-related quality of life (HRQoL) among adults. However, no population-based studies have yet investigated the prevalence of daily and multi-site pain among adolescents and how these are associated with respondent characteristics. The purpose of this study was to investigate the prevalence of self-reported daily and multi-site pain among adolescents aged 12-19 years and associations of almost daily pain and multi-site pain with respondent characteristics (sex, age, body mass index, HRQoL and sports participation). Methods: A population-based cross-sectional study was conducted among 4,007 adolescents aged 12-19 years in Denmark. Adolescents answered an online questionnaire during physical education lessons. The questionnaire contained a mannequin divided into 12 regions on which the respondents indicated their current pain sites and pain frequency (rarely, monthly, weekly, more than once per week, almost daily pain), characteristics, sports participation and HRQoL measured by the EuroQoL 5D. Multivariate regression was used to calculate the odds ratio for the association between almost daily pain, multi-site pain and respondent characteristics. Results: The response rate was 73.7%. A total of 2,953 adolescents (62% females) answered the questionnaire. 33.3% reported multi-site pain (pain in >1 region) while 19.8% reported almost daily pain. 61% reported current pain in at least one region with knee and back pain being the most common sites. Female sex (OR: 1.35-1.44) and a high level of sports participation (OR: 1.51-2.09) were associated with increased odds of having almost daily pain and multi-site pain. Better EQ-5D score was associated with decreased odds of having almost daily pain or multi-site pain (OR: 0.92-0.94). Conclusion: In this population-based cohort of school-attending Danish adolescents, nearly two out of three reported current pain and, on average, one out of three reported pain in more than one body region. Female sex, and high level of sports participation were associated with increased odds of having almost daily pain and multi-site pain. The study highlights an important health issue that calls for investigations to improve our understanding of adolescent pain and our capacity to prevent and treat this condition.

Background: Suicidal thoughts are common, causing distress for millions of people all over the world. However, people with suicidal thoughts might not access support due to financial restraints, stigma or a lack of available treatment offers. Self-help programs provided online could overcome these barriers, and previous efforts show promising results in terms of reducing suicidal thoughts. This study aims to examine the effectiveness of an online self-help intervention in reducing suicidal thoughts among people at risk of suicide. The Danish Self-help Online against Suicidal thoughts (SOS) trial is a partial replication of a previously conducted Dutch trial. Methods and design: A randomized, waiting-list controlled trial with 1:1 allocation ratio will be carried out. A total of 438 people with suicidal thoughts will be recruited from the Danish suicide hotline, The Lifeline's, website and allocated to the intervention condition (N = 219) or the control condition (N = 219). The intervention condition consists of a 6-week, Internet-based self-help therapy intervention. The format of the intervention is self-help, but the participants can be guided by the trial manager. The control condition consists of a waiting-list assignment for 32 weeks. The primary outcomes are frequency and intensity of suicidal thoughts. Secondary outcome measures include depressive symptoms, hopelessness, worrying, quality of life, costs related to health care utilization and production loss. Number of deliberate self-harm episodes, suicides and deaths will, as well as the participant's evaluation of the intervention and the experience of negative effects, be investigated. Assessments will be conducted over the intervention website through self-report questionnaires at baseline, 2 weeks, 4 weeks, 6 weeks and 32 weeks (6 months post intervention). Discussion: If we find the intervention to be linked to reductions in suicidal thoughts, this will strengthen the evidence that online self-help interventions are relevant tools for people with suicidal thoughts.

Objective-To investigate the effects on general practitioners' activities of a change in their remuneration from a capitation based system to a mixed fee per item and capitation based system. Design-Follow up study with data collected from contact sheets completed by general practitioners in one period before (March 1987) a change in their remuneration system and two periods after (March 1988, November 1988), with a control group of general practitioners with a mixed fee per item and capitation based system throughout. Setting-General practices in Copenhagen city (index group) and Copenhagen county (control group).-Subjects-265 General practitioners in Copenhagen city, of whom 100 were selected randomly from the 130 who agreed to participate (10 exclusions) and 326 general practitioners in Copenhagen county. Main outcome measures-Number of consultations (face to face and by telephone) and renewals of prescriptions, diagnostic and curative services, and specialist and hospital referrals per 1000 enlisted patients in one week. Results-Of the 75 general practitioners who completed all three sheets, four were excluded for incomplete data. Total contact rates per 1000 patients listed rose significantly compared with the rates before the change index in the city (100-0 before the change v 111-7 (95% confidence interval 106-4 to 117-4 after the change) and over the same time in the control group (100.0 v 106-0), but within a year these rates fell (to 104-2 (991to 109-6) and 104-0 respectively). There was an increase in consultations by telephone initially but not thereafter. Rates of examinations and treatments that attracted specific additional remuneration after the change rose significantly compared with those before (diagnostic services, 138-1 (118-7 to 160-5) and 159-5 (137-8 to 184-7) and curative services 194-6 (152-2 to 248.9) and 194-8 (152-3 to 249-2) for second and third data collections respectively) and with the control group (diagnostic services 105-3, 107*6 and curative services 106-0, 115-0) whereas referral rates to secondary care fell (specialist referrals 90-1 (80-7 to 100-6) and 77-0 (68-6 to 86.4) and hospital referrals 87-4 (71-1 to 107-5) and 68-4 (54.7 to 85.4)) in doctors in the city. Conclusions-Introducing a partial fee for service system seemed to stimulate the provision of services by general practitioners, resulting in reduced referral rates. The concept of a "target income" which doctors aim at, rather than maximising their income seemed to play a part in adjustment to changing the system of remuneration.

Chemical warfare agents (CWAs) have been disposed of in various fashions over the past decades. Significant amounts (∼11,000 tonnes) have been dumped in the Baltic Sea east of the island Bornholm following the disarmament of Germany after World War II, causing concerns over potential environmental risks. Absence of risk based on assumptions of extremely low solubility of CWAs cannot alone dismiss these concerns. Existing and modelled fate and effects data were used in the analysis to assess the fish community risk level. The most realistic and also conservative assessment result is the scenario describing 70 m water depth for the most realistic dump-site area with a focus on chronic toxicity, at 0-20 cm above the sediment, yielding a total mixture toxic unit (TU) of 0.62. Triphenylarsine is the CWA with the highest realistic risk profile at 0.2 TU for the fish community followed by Adamsite (0.17), Clark I (0.086) and Yperite (0.083) TU. Adamsite is more persistent and constitutes a potential risk for a longer period than triphenylarsine. The seawater volume potentially at risk is <4 m above sediment and <58 km down current of dump sites. Further risk assessment of dumped CWAs in the Baltic Sea is warranted.

Objectives: Health Technology Assessment (HTA) is defined as a policy research approach that examines the short-and long-term social consequences of the application or use of technology. Internationally different institutions have translated this definition to local contexts. In Denmark, HTA is comprehensive with focus on four aspects of the problem in question (technology [clinical evidence], economy, patient, and organization). The objective of this study is to study how the application of HTA differs across leading countries and to study the extent to which Danish HTA reports differ from foreign HTAs. Methods: A sample of 433 HTA reports published in the period 1989-2002 by eleven leading institutions or agencies in Denmark and eight other countries were reviewed. We looked at the characteristics of the HTA with respect to focus on the four main aspects and the manner in which each aspect has been approached. Results: The study shows health technology procedures to be the most common type of health technology assessed in HTAs and literature review to be the most often used method of analysis. Policy recommendations are only present in approximately half of the HTA reports. Conclusions: In the HTAs one generally sees a great focus on the clinical aspect of health technologies, leaving the economic, the patient-related, and the organizational aspect much more unanalyzed. The Danish HTAs generally have a wider scope than HTAs produced in other countries and tend to focus more frequently on patient-related and organizational dimensions.