INTRODUCTION:The transition from medical school to clinical practice is a demanding phase for junior doctors. This study examined associations between clinical work perceptions, mental health and pre-graduate clinical experience among Danish junior doctors, focusing on early training experiences and well-being. METHODS:A cross-sectional survey was sent to junior doctors in the North Denmark Region. The questionnaire was developed with input from junior doctor focus groups and included validated items from the Copenhagen Psychosocial Questionnaire, the WHO-5 Well-Being Index and the Major Depression Inventory. RESULTS:Overall, 297 junior doctors (38% response rate) completed the survey. Whereas the majority (66-79%) reported positive perceptions of the introduction, supervision and preparedness, 25% doubted their ability to remain in the profession. Approximately one-third reported exhaustion or stress more than half the time. Moreover, 13% scored below 35 on the WHO-5 Well-Being Index, indicating a high risk of stress-related disorders. Overall, 18% had a Major Depression Inventory score ≥ 20, consistent with depression. Pre-graduate locum experience was significantly associated with greater perceived preparedness and confidence, but not reduced stress or depressive symptoms. CONCLUSIONS:Substantial mental health concerns exist among Danish junior doctors. Pre-graduate experience enhances confidence but not emotional resilience. Institutional measures, such as structured supervision, mentorship and targeted well-being support, are needed in early medical careers. FUNDING:None. TRIAL REGISTRATION:Registration F2025-058.

Survival has improved substantially for patients with Hodgkin lymphoma (HL), but long-term quality of life (QoL) remains incompletely understood. This was a Danish, nationwide, cross-sectional study of QoL among persons with a diagnosis of HL matched 1:10 to general population comparators. Questionnaires included the HeartQoL, the European Organization for Research and Treatment of Cancer Quality of Life Core-30 (QLQ-C30), the Short Form-36 (SF-36), and the EuroQoL Health Questionnaire (EQ-5D). Mean differences (MD) were estimated using linear regression adjusted for sex and age, and stratified by time since diagnosis (0-5, > 5-10, and > 10 years). Overall, 1777 patients with HL (42% of 4156 invited) and 6166 matched comparators (14% of 41 558 invited) responded, and median age was similar (HL: 59, comparators: 61). Most had classical HL (92%). HL groups had consistently and significantly lower QoL than their respective comparators, with 0-5, > 5-10, and > 10 years post-diagnosis MDs of -0.27, -0.28, and -0.24 for the HeartQoL, -7.4, -7.6, and -5.6 points for the QLQ-C30 summary score, -4.5, -4.9, and -4.2 points for the SF-36 physical component summary, and -0.05, -0.05, and -0.04 for the EQ-5D index. The relative difference between the HL group and comparators decreased from baseline to > 10 years post-diagnosis, but differences remained clinically important. The most pronounced symptoms were fatigue and dyspnea. To summarize, persons with HL experience reductions in QoL compared with the general population, even > 10 years post-diagnosis. The observed differences were clinically relevant within several domains and emphasize the need for a multidisciplinary approach to survivorship care.

An altered level of consciousness (ALOC) in emergency patients is linked to poor outcomes. Glasgow Coma Scale (GCS), initially made for head injury patients, but often used in both trauma and other patients. GCS assesses consciousness, with scores ranging from 15 (fully aware) to 3 (deep coma). Assessing GCS is quickly done and does not require technical equipment, unlike other vital signs. This study aims to characterize unselected prehospital ALOC patients brought to a hospital and assess their mortality. Retrospective observational cohort study. Patients transported by ambulance to a hospital in the North Denmark Region between 2017 and 2021, with a first registered GCS of 3–14, were included. The reason for calling the emergency number, subsequent ICD-10 diagnoses given at hospital, and raw and adjusted mortality, were reported. Fifteen thousand two hundred thirty-five patients were included. One in eight ambulance patients had ALOC, most with a GCS score of 14. The primary reason for calling the emergency number was decreased consciousness or paralysis, except for those with a GCS score of 3–8, where the most common reason was unconsciousness/possible cardiac arrest. Most patients received non-specific diagnoses at hospital, which covers a wide range of symptoms and abnormal findings. Those with a GCS score of 3, most frequently were diagnosed with circulatory diseases, especially cardiac arrest and more diverse diagnostic picture among the others, including trauma, strokes, syncope, seizures and poisoning as the most frequent. Among patients with a GCS score of 3, 60

Critical Health Literacy (CHL) emphasizes that health-related action is shaped by power, inequality and structural conditions, not by individual skills alone. This study examines a more specific and under-theorized link in that process: how negative and ambivalent social ties affect whether health-related competencies are enacted as concrete action in everyday healthcare. Drawing on 12 semi-structured interviews with adults living with multimorbidity in contexts of social vulnerability, the study explores how health-related knowledge, intentions, and professional advice are converted, delayed, redirected, or blocked in concrete health-related episodes. Analysis was abductive and used Compensatory Network Capital (CNC) as a sensitizing framework. Participants often described knowledge, motivation, and awareness of recommended care, but action appeared to be constrained when support was difficult to mobilize, poorly matched to the task, insufficiently recognized in institutional encounters, or when no helper was available to act on the person's behalf. These patterns were analysed through four tie-level mechanisms: Activation, Function-specific Help, Recognition and Substitution. Negative and ambivalent ties appeared to operate not only as psychosocial stressors but also as practical barriers affecting help-seeking, follow-up, care coordination and digital navigation. The study contributes to CHL research by specifying a micro-meso relational layer through which health-related competencies may become actionable, partial or blocked in practice. It suggests that equity-oriented health promotion may need to address not only individual skills, but also the relational and organizational conditions that enable, constrain or block health-related action.

PurposeThere is social inequity in the distribution of digital health literacy (DHL), and patients with chronic disease have also been shown to have lower general health literacy. The study aimed to examine the associations between low socioeconomic status (SES) [measured by self-reported educational level], chronic disease and low DHL and whether chronic disease modifies the effect between SES and DHL.MethodsCross-sectional study from the Danish HLS19 survey, a stratified random sample of 3,644 respondents from the Danish population. A questionnaire collected information on educational level and the prevalence of 13 specific chronic diseases. The number of self-reported chronic diseases were counted. DHL was measured using the HLS19 digital health literacy scale from the WHO-Action Network M-POHL. Linear regression models were used to estimate the association between chronic disease and DHL and between education level and DHL, adjusted for sex and age. The potential effect modification between SES, chronic disease and DHL was analyzed.ResultsHaving two or more chronic diseases was associated with a lower level of DHL (beta (95%CI)) (-3.88 (-5.68; -2.08)) compared to having no chronic disease. Both bachelor-level education (6.49 (4.68; 8.30)) and master-level or above (9.39 (7.43;11.36)) were associated with a higher DHL than respondents with vocational education. No statistically significant interaction was found between chronic diseases and education level on the level of DHL.ConclusionsSES and the presence of chronic diseases were independently associated with DHL but did not interact.

Background Incidence and prevalence of atrial fibrillation (AF) is increasing worldwide, and the condition is associated with high risk of adverse clinical outcomes. Increasing global migration results in more diverse patient populations, and knowledge about AF-related outcomes in immigrants is warranted. Aim To examine clinical outcomes after AF diagnosis across migrant populations in Denmark. Method Patients with first-time AF and sex-, age- and country of origin matched non-AF population (ratio 1:5) were followed from age 45 from 1998 to 2017. Poisson regression was used and stratified by country of origin for the clinical outcomes: stroke, major bleeding, heart failure, and all-cause mortality. Analyses were adjusted for sex, age, comorbidity, contacts to general practitioners, and socioeconomic variables. Results The population contained 1,940,010 individuals of Danish origin and 47,952 with origin in one of the ten most represented countries. For all outcomes, the adjusted incidence rate ratio (IRR) was higher for individuals diagnosed with AF. For stroke, the lowest and highest IRR were observed for individuals from Pakistan (1.87 [95 %CI: 1.14; 3.07]) and Bosnia-Herzegovina (5.32 [95 %CI: 3.37;7.93]), for heart failure: Iraq (5.06 [95 %CI:3.07;8.34]) and Bosnia-Herzegovina (8.10 [95 %CI: 6.07;10.80]), for major bleeding: Finland (2.04 [95 %CI: 1.42;2.95]) and Yugoslavia (3.53 [95 %CI: 2.70;4.62]), and death: Germany (1.60 [95 %CI: 1.51;1.69]) and Pakistan (2.33 [95 %CI: 1.83;2.98]). Conclusion AF was associated with a substantially higher risk of adverse clinical outcomes among Danish-born, and all examined migrant populations. However, the impact of AF appeared to differ according to country of origin, which could indicate potential differences in AF care and compliance.

Objectives: To estimate and compare (1) how social support (SS) acts as a mediator for the association between health literacy (HL) and health outcomes, and (2) how HL acts as a mediator for the association between SS and health outcomes. Study design: Mediation analyses. Methods: Data from the Health Literacy Survey 2019 (HLS19) were analyzed including 42,445 participants in 17 European countries. Four mediation models were tested with two health outcomes: self-reported health (SRH) and health-related limitations (Global Activity Limitations Indicator, GALI). In two models, SS was the mediator between HL and SRH and in the other two models HL was the mediator between SS and GALI. Results: SS is a significant mediator of the association between HL and SRH in all countries and between HL and GALI in eight countries. Up to 25-30 % of the total effect was mediated by SS. In addition, HL is a significant mediator of the association between SS and SRH in 15 countries and between SS and GALI in eight countries. With regard to SRH, SS may be regarded as the more relevant mediator between HL and SRH; whereas for GALI, HL can be considered the mediating factor between SS and GALI, as the proportions mediated were higher in the respective models in most countries. Conclusions: Both HL and SS may serve as significant mediators in the models of both health measures, but to different extents. Planning interventions to mutually improve SS and HL may help communities improve health.

AIM:Inflammatory bowel disease (IBD) diagnosed in adolescence may have adverse effects on educational attainment. The study aims to examine post-secondary educational attainment in patients with IBD and how it is affected by disease severity and comorbid mental health disorders. METHODS:This cohort study used nationwide Danish registries. In a cohort of patients with IBD and matched references, the time to attainment of post-secondary education was examined using Cox regression. In the analysis for disease severity and mental health disorders, the relative risk of attainment of post-secondary education was evaluated using binomial regression. RESULTS:We identified 1136 patients with IBD and 8791 references. Overall, patients with Crohn's disease (CD) or ulcerative colitis (UC) attained a post-secondary education as often as references (CD: hazard ratio (HR) 1.10 (95% confidence interval (CI) 0.99-1.22); UC: HR 0.97 (95% CI 0.88-1.06)). Patients with both severe IBD and mental health disorders had a significantly lower chance of attaining a post-secondary education compared to patients with severe IBD without mental health disorders. CONCLUSIONS:Patients with IBD attained a post-secondary education at the same rate as references. Having both severe IBD and mental health disorder negatively affected post-secondary educational attainment.

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of mortality, and exercise has been shown to reduce both. Health conditions, environmental factors, and logistical challenges are often barriers for participation in pulmonary rehabilitation (PR). Given the barriers many individuals with COPD face when attending healthcare centers for PR, virtual home-based cycling exercise could be an option. This study aimed to explore the development of a home-based cycling exercise intervention for individuals with COPD, focusing on aspects as bicycle selection, app functionality and pilot testing. Furthermore, it aimed to explore participants and non-participants attitudes toward the intervention. Using a phenomenological-hermeneutic approach, data were gathered from 15 semi-structured interviews, including test pilots, participants, and non-participants. A thematic analysis was used to analyze the data. Thematic analysis identified eight key themes: bicycle selection, individual guidance needs, geographical and video quality, online connectivity, comfort and accessibility of home-based cycling, flexibility, energy levels, and practical limitations. Findings highlighted a preference for pedal bicycles with adjustable intensity, the importance of flexibility in scheduling, and the autonomy provided by a home-based setup. While most participants appreciated the virtual journey on videos, barriers such as lack of energy, stress, and limited space were reported by non-participants. Recommendations include enhancing app features and addressing individual needs to improve adherence. The study underscores the potential of tailored home-based exercise interventions in overcoming traditional pulmonary rehabilitation challenges. NCT06235502

IntroductionDigital health information sources are playing an increasingly prominent role in health promotion, public health and in healthcare systems. Consequently, digital health literacy skills are likewise becoming increasingly important.MethodsUsing a concept validation approach, the aim of the study was to validate a digital health literacy measure applied in the European Health Literacy Survey 2019–2021 (HLS19) of the WHO M-POHL Network, analyzing data from 28,057 respondents from 13 European countries.ResultsThe scale displayed high internal consistency. Confirmatory factor analysis (CFA) strengthened the hypothesized one-factor structure. In most countries, the data displayed acceptable fit to the unidimensional Rasch partial credit model (PCM). Pearson correlation with a measure of general health literacy showed sufficient discriminant validity, and a social gradient was found. Testing for predictive validity showed that the scale score predicts health-related outcomes.DiscussionThe study shows that considerable proportions of the general adult populations across countries in Europe have limited DHL skills. The level of DHL has direct potential consequences for some forms of health service utilization, in some countries. Implications of the study include recommendations for improving digital health literacy, promoting organizational health literacy and quality assurance for digital health information and resources.

BackgroundChronic obstructive pulmonary disease (COPD) is a leading cause of mortality, and exercise has been shown to reduce both. Health conditions, environmental factors, and logistical challenges are often barriers for participation in pulmonary rehabilitation (PR). Given the barriers many individuals with COPD face when attending health care centers for PR, virtual home-based cycling exercise could be an option. ObjectiveThis study aimed to explore the development of a home-based cycling exercise intervention for individuals with COPD, focusing on aspects such as bicycle selection, app functionality, and pilot testing. Furthermore, it aimed to explore participants' and nonparticipants' attitudes toward the intervention. MethodsUsing a phenomenological-hermeneutic approach, data were gathered from 15 semistructured interviews, including test pilots, participants, and nonparticipants. A thematic analysis was used to analyze the data. ResultsThematic analysis identified 8 key themes: bicycle selection, individual guidance needs, geographical and video quality, online connectivity, comfort and accessibility of home-based cycling, flexibility, energy levels, and practical limitations. Findings highlighted a preference for pedal bicycles with adjustable intensity, the importance of flexibility in scheduling, and the autonomy provided by a home-based setup. While participants appreciated the virtual journey on videos, barriers such as lack of energy, stress, and limited space were reported by nonparticipants. ConclusionsRecommendations include enhancing app features and addressing individual needs to improve adherence. The study underscores the potential of tailored home-based exercise interventions in overcoming traditional PR challenges. International Registered Report Identifier (IRRID)RR2-10.1136/bmjresp-2024-002573

Objectives:As the aging population grows, Alzheimer's disease and related dementias (ADRD) present a major public health challenge. Environmental noise, linked to stress and sleep disruption, may increase ADRD risk. We aimed to summarize the research literature on long-term noise exposure and ADRD. Methods:We conducted a systematic review and meta-analysis of studies investigating the association of long-term (≥1 year) noise exposure and ADRD assessed with standardized diagnostic criteria. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Eligible studies reported hazard ratios (HR) or similar effect estimates with confidence intervals. Results:A multilevel random-effects meta-analysis of six longitudinal studies using 13 effect sizes found a significant association between long-term noise exposure and incident ADRD (HR: 1.15, 95% CI: 1.03-1.28). Interaction effects between noise source and dementia subtype were not statistically significant. Conclusion:Long-term noise exposure may contribute to ADRD risk. Heterogeneity between studies highlights the need for standardized exposure assessment and consideration of other environmental factors. Future research should include the exposome approach for identifying environmental drivers of dementia.

AIMS:Sex differences in survival and short-term outcomes after out-of-hospital cardiac arrest (OHCA) are well documented, but its impact on long-term health-related quality of life (HRQoL) is unclear. METHODS AND RESULTS:This cross-sectional survey study used the EuroQol Health Questionnaire (EQ-5D), the 12-Item Short-Form Health Survey (SF-12), and the Hospital Anxiety and Depression Scale (HADS) to assess HRQoL among adult OHCA survivors in Denmark between 2001 and 2019 who were alive as of 1 October 2020. Survivors were grouped by time since cardiac arrest: 0-4, >4-8, >8-12, and >12 years post-arrest. Among 2552 respondents (56.1% response rate), 2075 were men (81.3%) and 477 were women (18.7%). The mean survey age was 60.2 years (SD 14.7) for women and 66.0 years (SD 11.8) for men. EuroQol Visual Analogue Scale and EuroQol Health Questionnaire index scores were both lower for women than for men [69 vs. 75 and 0.76 (SD 0.21) vs. 0.84 (SD 0.17), respectively; P < 0.001]. The SF-12 physical and mental health scores were also lower for women [40.3 (SD 12.9) and 50.9 (SD 8.8)] compared with men [44.0 (SD 12.1) and 53.3 (SD 8.1); P < 0.001]. Hospital Anxiety and Depression Scale scores for anxiety (5.4 vs. 3.5; P < 0.001) and for depression (4.0 vs. 3.2; P < 0.001) were higher among women. In multivariable logistic regression, female sex remained significantly associated with poorer long-term HRQoL outcomes. Trends remained consistent regardless of time since cardiac arrest. CONCLUSION:Female OHCA survivors reported less favourable long-term HRQoL outcomes compared with male survivors, irrespective of time elapsed since cardiac arrest.

We develop Compensatory Network Capital (CNC) as a sociological framework for understanding how social networks translate potential social support into actual capability within healthcare. Building on Bourdieu’s capital theory and Sen’s capability approach, we specify social conversion as a meso–micro process that links institutional rules, social network resources, and concrete health actions. Rather than proposing a competing construct, CNC refines social capital, Distributed Health Literacy, and related models by identifying four tie-level mechanisms: Activation, Function-specific Help, Recognition, and Substitution (A–F–R–S) that condition whether support becomes action at the point of need. Drawing on qualitative interviews and two small pilot surveys, we employ abductive analysis to illustrate how these mechanisms can be operationalised through event-level indicators (e.g., booking, attendance, follow-up) and to distinguish between positive, partial, and failed conversions, including harmful or misdirecting network influence. We argue that CNC offers a theoretically grounded and measurable account of when and for whom networks compensate for limited individual health literacy, and how organisational recognition of informal helpers shapes these outcomes. The model contributes to relational public health by identifying key points of intersection where people, social ties, and institutions intersect.

BackgroundConstruction workers in Europe are, like other employees in the future, expected to work until they are in their late sixties. Physically demanding work in the construction sector may challenge older workers. Still, little is known about their perspective on work participation, which could contribute to a deeper understanding of how to keep construction workers in the labour force.ObjectiveTo explore how older construction workers experience their work participation to gain a deeper understanding of their perspectives on work life and factors influencing their decision to remain or leave the labour market.MethodsTwenty semi-structured individual interviews with male construction workers between 56 and 66 of age were conducted, and thematic narrative analysis was performed to identify their perspectives on work participation.ResultsThree core narratives were identified, illustrating how former work life shaped construction workers' perspectives on current work participation and future work life. One narrative gave insight about a demanding work life, another narrative how they found ways to manage and lastly a narrative emphasised work ethics and economy. Years of hard labour and health risks had influenced their current work life and how they view future work, yet they had adapted and managed construction work while ageing.ConclusionsFindings emphasize how construction workers' continuing work participation depends on their physical capability, a supportive work environment and their financial situation. Future interventions targeting construction worker's work participation while ageing need to consider how employers and labour market policies can help retain construction workers in the workforce.

OBJECTIVES:Significant sociodemographic inequalities in participation in colorectal cancer (CRC) screening programmes across the globe are evident. We aimed to investigate the effect of introducing colon capsule endoscopy (CCE) as a filter test in faecal immunochemical test (FIT)-based CRC screening on overall FIT participation and social inequalities in FIT participation. STUDY DESIGN:We conducted a randomised controlled trial, randomising 368,452 individuals. METHODS:Both groups received an invitation to submit a FIT sample, which elicited a follow-up investigation if ≥ 20 μg haemoglobin/g faeces was detected. The control group followed the standard screening pathway and was referred for follow-up colonoscopy. The intervention group were free to choose between colonoscopy and colon capsule endoscopy. RESULTS:The overall FIT participation proportion was significantly lower in the intervention group (63.4 %), compared to the control group (64.9 %). All sociodemographic subgroups in the intervention group had lower participation proportions than their control group counterpart, with an average of 1.4 (range 0.3-2.7) percentage points lower participation. The odds of non-participation, divided by sociodemographic characteristics, were not significantly different between interventions and controls for any subgroup, except for those aged 55-59 in which the odds ratios for non-participation was 1.59 (1.54-1.65) in the control group and 1.48 (1.43-1.53) in the intervention group, comparing them to those aged above 70. CONCLUSIONS:Introducing a free choice between colon capsule endoscopy and colonoscopy if FIT positive did not increase FIT participation in CRC screening. Further, it did not affect the pattern of social inequalities in FIT uptake.

BACKGROUND:Disparities in access to specific foods may contribute to inequalities in diet-related diseases seen at a global and National level. METHODS:Based on aggregated population data on income, education, and employment, area-level socioeconomic differences in food outlet availability were analyzed for 53,368 study participants residing across parishes in the Capital Region of Denmark. Validated data on fast-food outlets, convenience stores, supermarkets, and restaurants were used. Information on individual characteristics, home address and corresponding parishes were linked to the participants through the Danish Civil Registration System. Three multilevel hurdle models were applied for each food outlet type to analyze food outlet density (count/km²) within an 800-meter network buffer around participants' homes across four levels of parish socioeconomic status (SES). Model 1 provided a basic examination of the association between density and area SES. Model 2 adjusted for individual characteristics while Model 3 further included urbanity at the area level. The structure of the chosen hurdle models included was Part (1) a logistic multilevel regression modelling the probability of food outlet presence by using the entire dataset and, Part (2) a standard linear multilevel regression modelling the 10 base logarithmic transformation of only positive food outlet densities with a lognormal distribution. RESULTS:No statistically significant spatial patterning of food outlets across area SES was found in Model 1 and 2, however positive and strong significant odds were seen in part 1 of Model 3 for supermarkets, convenience stores and fast-food outlets. Thus, residents in more disadvantaged SES areas had higher odds of having a supermarket, convenience store, or fast-food outlet near their homes compared to those living in the most advantaged areas. No differences were seen in the density across area SES. CONCLUSION:Area SES influenced the presence of supermarkets, convenience stores, and fast-food outlets, but not the density of these establishments.

PURPOSE: The study aims to explore the association between patients diagnosed with inflammatory bowel disease (IBD) in childhood or youth and mental health disorders. METHODS: The study is a register-based cohort study of patients with IBD-onset before 25 years of age and matched references. They were followed until 30 years of age. The incidence rate and incidence rate ratio (IRR) for a wide spectrum of mental health disorders were assessed based on diagnostic codes from the Danish National Patient Registry, reimbursed prescriptions for psychotropic medications, and composite measures combining diagnosis and medication. Furthermore, the relative excess risk due to interaction (RERI) for parental educational level and parental mental health disorders were estimated. RESULTS: A total of 4904 patients with Crohn's disease (CD), 5794 with ulcerative colitis (UC), and 94,802 matched references were identified. Patients with CD-onset before age 18 had a higher risk of anxiety disorders (IRR 1.58 (CI95%: 1.33-1.86)), while patients with CD-onset between age 18 to 24 had a higher risk of both anxiety and mood disorders. Patients with UC-onset before age 18 had a higher risk of anxiety disorders (IRR: 1.39 (CI95%: 1.19-1.64)). In general, patients with IBD had a higher risk of receiving psychotropic medication. Parental education had a subadditive interaction with the risk of emotional disorders for both patients with CD and UC, while maternal mental health disorders had a subadditive interaction for patients with UC. CONCLUSION: Patients with CD and UC have a higher risk of mental health disorders, primarily due to an elevated risk of emotional disorders and a higher use of psychotropic medication. Surprisingly, the study demonstrated subadditive effect of parental education and for patients with UC maternal mental health disorders on the risk of emotional disorders.

[This corrects the article DOI: 10.3389/fpubh.2025.1472706.].