Background: ICD-11 revised the diagnostic criteria for a depressive episode by adding hopelessness as a symptom, moving low energy from core to accompanying, merging low self-confidence with guilt, and raising the symptom threshold. The Major Depression Inventory (MDI) was built to screen for depression using ICD-10 and has no hopelessness item. We asked how the switch to ICD-11 would change who counts as a case. Methods: We scored ICD-10, ICD-11 and DSM diagnoses in a normative Danish population survey conducted in 2000, in which MDI and SCL-92 were administered to adults aged 18-80 (53% female, using established MDI algorithms and a co-administered hopelessness item (SCL-92 item 54) for ICD-11. Results: Among the 1130 respondents, the overall prevalence was identical: 43 cases, i.e., 3.81% [95% CI 2.84; 5.09] under both ICD-10 and ICD-11. Beneath that identical rate, cases churned: only 33 of the 43 cases overlapped between criteria; 10 dropped out, and 10 were new. Dropped cases fell out because ICD-11 raised the symptom threshold, while gained cases entered through the relaxed core-symptom rule and the new hopelessness symptom. Hopelessness drove 7 of 10 gains and 0 of 10 drops. DSM prevalence was lower (3.27% [2.38; 4.48]) but agreed almost perfectly with ICD-11 (kappa = 0.92), the gap reflects hopelessness counting independently only in ICD-11. Conclusions: An identical headline rate from ICD-10 to ICD-11 can conceal a substantial change in case membership. Studies that compare depression prevalence across ICD versions should examine case-level agreement, not just the aggregate rate.
The integration of the multitude of ultrasound techniques into a "one-stop" liver clinic model will revolutionize the management of liver diseases. This approach streamlines patient care by providing immediate imaging assessment, facilitating prompt diagnosis, and expediting treatment plans. The traditional ultrasound methods of B-mode imaging and Doppler techniques have been supplemented by the newer techniques of tissue elastography, fat quantification, and contrast-enhanced ultrasound-termed multiparametric ultrasound. The deployment of these techniques to establish in more detail the underlying status of liver disease has been profound. The encompassing ultrasound techniques have allowed the ultrasound practitioner to establish a comprehensive assessment of liver disease, allowing further accurate management, and negating the need for additional, often more expensive, imaging to establish the diagnosis. This paper explores the implementation, benefits, and challenges of ultrasound-based one-stop liver clinics, emphasizing their impact on patient outcomes and healthcare efficiency. A detailed assessment of the techniques and their position in the diagnostic armamentarium is reviewed with a comprehensive overview established. CRITICAL RELEVANCE STATEMENT: Multiparametric liver ultrasound integrating B-mode, Doppler, CEUS, elastography and fat quantification provides a practical, low-cost one-stop pathway for staging chronic liver disease, assessing portal hypertension surrogates and characterizing incidental lesions, thereby speeding up treatment. KEY POINTS: Ultrasound is the first-line imaging investigation for liver disease, with established criteria on B-mode imaging for steatosis and cirrhosis. Multiparametric ultrasound integrates morphology, hemodynamics, fibrosis, steatosis, and lesion assessment. A one-stop liver ultrasound clinic accelerates decisions and reduces additional imaging.
Growing evidence reveals relative stability in long-term clinical and functional outcomes of schizophrenia spectrum disorders (SSD), and links poor premorbid adjustment (PA) to worse prognoses. This study investigated associations between PA across developmental stages and long-term outcomes. Data on 496 participants (age 26.8 ± 6.5, male 58.5
Non-suicidal self-injury (NSSI) is common in inpatient mental health care and poses challenges for staff, patients, and organizations. While training programs can improve knowledge and attitudes, less is known about how staff collectively experience implementing new strategies for managing self-harm and how such strategies influence ward culture and professional practice. This qualitative study was part of a broader evaluation of implementing a regional self-harm strategy in a Danish inpatient mental health service. The strategy included staff training, clinical tools, and supervision. Four focus group interviews with 25 staff members from five inpatient units were conducted in 2024. Data were analyzed using reflexive thematic analysis. The analysis generated four interrelated themes: (1) Relational work as invisible yet essential: Staff valued listening and dialogue as crucial for preventing escalation but described these practices as undervalued and the first to be dropped under pressure. (2) Diagnostic hierarchies: psychosis as the legitimate inpatient diagnosis, self-harm as responsibility: Psychotic patients were viewed as genuinely ill and beyond control, while patients who self-harm were often framed as responsible, sustaining moralized hierarchies of care. (3) Cultural change – from control to dialogue: The strategy disrupted routines of restraint in relation to self-harm. Initially perceived as “doing nothing,” the new strategy was increasingly legitimized as staff witnessed calmer units, reduced coercion, and clearer professional roles grounded in relational practice. (4) Responsibility, guilt, and emotional distance — Staff struggled with the emotional and moral burden of refraining from coercion, negotiating professional boundaries, and managing feelings of guilt and emotional withdrawal. Implementing a self-harm strategy requires more than new clinical tools. It depends on staff integrating the approach into everyday practice, supported by structural and cultural change. Sustainable implementation relies on legitimizing relational care as skilled clinical work, creating space for reflection, and addressing the emotional demands placed on staff. The findings also show that diagnostic hierarchies continue to shape how legitimacy and responsibility are distributed within psychiatric care.
The purpose of this study is to objectively quantify physical activity and sedentary behaviour in children and adolescents during hospital admission using device-based monitoring and investigate the association between sedentary behaviour and pain, constipation, surgery status, movement restrictions, 30-day readmission, and length of stay. Children and adolescents aged 2 ≤ 17 years admitted between March and September 2025 to three paediatric departments at a Danish hospital were eligible for this prospective observational study. Children and adolescents scheduled for day surgery and wheelchair users were excluded. All participants wore two triaxial accelerometers throughout their hospital stay. In total, 103 hospitalised children and adolescents were included. The participants spent 45 min per day (interquartile range 20–125) in upright position (standing and walking time combined) and were sedentary (sitting and lying time combined) for 23.3 h per day (21.8–23.7). Adolescents undergoing spine surgery were sedentary for 23.6 h per day (23.5–23.7), of which 22.6 h (21.8–23.0) were spent lying in bed. Sedentary behaviour was significantly associated with higher age (p < 0.001), opioid consumption beyond standardised analgesia (p = 0.028), and orthopaedic procedures (p < 0.001). No associations between sedentary behaviour and length of stay (p = 0.391), 30-day readmission (p = 0.467), laxative use (p = 0.695), and postoperative movement restrictions (p = 0.637) were found. Conclusion: Hospitalised children and adolescents in this study exhibited high levels of sedentary behaviour. The findings highlight that mobilisation strategies are needed across all paediatric surgical procedures, but adolescents, patients undergoing orthopaedic or spine procedures, and those prescribed opioids beyond standardised analgesia require particular attention. There is a need for further evidence of the consequences of sedentary behaviour during hospitalisation among children and adolescents.
