This paper deals with individual air-to-air heat pumps in Danish dwellings and summerhouses and the question of to what extent they actually deliver savings of energy consumption. Results show that 20% of the expected reduction of electricity consumption is converted into increased comfort in the homes, including extended heating areas, keeping a higher temperature and a longer heating season and using the heat pump for air conditioning. Data include electricity consumption in 185 households before and after installation of heat pumps together with survey results of 480 households. Furthermore, 12 households were selected for in-depth analysis including technical inspection and qualitative interviewing. Especially for summerhouses, results indicate that on average there is no reduction in electricity consumption, as energy efficiency is counter balanced by increased comfort and changed heating practices. These results have to be taken into account when making long-term energy planning for a sustainable energy system. (C) 2012 Elsevier B.V. All rights reserved.

Methods A standardized questionnaire was used and the results were evaluated by an expert panel from the departments involved. To evaluate differences, we compared data from an audit held in 2010. The total number of patients was 933 in March 2010 and 937 in April 2011. The number of readmitted patients within 30 days was 14 in March 2010 and 37 medical and 24 surgical patients in April 2011. We evaluated all 14 patients from March 2010 and 20 random patients from April 2011. Medical records for these patients were retrospectively reviewed, and entered in an Audit questionnaire. In the audit team included the G.P. physician, home health care team, the patient and their relatives and the A-24 Acute Ward.

Air-to-air heat pumps are increasingly promoted as a means for energy saving and a future component in a more flexible electricity demand (load management). At the same time, heat pumps potentially contribute to long-term changes in comfort behaviour and practices, which may undermine the energy saving potential. This paper sums up the findings from a Danish research project on air-to-air heat pumps, electricity use and comfort. If used properly, heat pumps can provide high efficient heating of houses. However, a Danish spot test indicates that airto-air heat pumps not always result in energy savings. The use of heat pumps might involve changes in the residents’ thermal comfort practices like higher indoor temperatures in the winter or air-conditioning (cooling) in the summer. The reasons for this might be both technical and behavioural. The paper examines the comfort practices that influence the electricity consumption related to air-to-air heat pumps: How do residents use heat pumps? And what are the consequences for the comfort practices and the electricity use? The analysis is based on results from a survey and qualitative interviews among Danish owners of dwellings and summerhouses with focus on their comfort practices. The study also includes results from metering data on the households’ actual electricity consumption and technical inspections of heat pumps. The paper draws on a practice theoretical approach, which understands energy consumption as an integral part of everyday practices that integrate different elements, including habits and technologies. Introduction In Denmark, air-to-air heat pumps are promoted by energy authorities and in energy saving campaigns as an energy-efficient alternative to direct electric heating (usually convection heaters) in dwellings and summerhouses. Thus, visitors to the website of the Danish Energy Saving Trust (an independent, public sector authority that promotes energy savings) can read that “air-to-air heat pumps are a good and cost-efficient alternative to direct electric heating, especially if you also use your summerhouse outside the summer season” (Danish Energy Saving Trust 2011). There are about 215,000 summerhouses in Denmark (Statistics Denmark 2010), and the majority of these (app. 84 %) have direct electric heating installed while only about one out of ten has an air-to-air heat pump (Kofoed et al. 2010). Furthermore, app. 119,000 dwellings, or 8 % of all single-detached, semi-detached, terraced and farm houses, are heated by direct electric heating, while only 7,700 have a heat pump as their primary heating form (Dansk Energi 2010). Thus, the total potential for substituting electric heating with air-to-air heat pumps is considerable. The Danish Energy Agency estimates that the number of installed air-to-air heat pumps is about 75,000 (Wittrup 2010). Many of these probably supplement other forms of heat supply (e.g. direct electric heating). Typical air-source heat pumps deliver an amount of energy for space heating that is 3 to 4 times the electricity consumed. Thus, replacing direct electric heating with an air-to-air heat pump should ideally reduce the electricity consumption for heating by about two-third. However, as documented by studies of the so-called rebound effect (see review in Sorrell et al. 2009), theoretical energy savings from energy efficiency improvements are in general only partly realized due to increased quantities of consumption or a general increase in consump

This paper deals with individual air-to-air heat pumps in dwellings and summerhouses and the question of to what extent they deliver actual savings in energy consumption . Results show that 40% of the expected reduction in electricity consumption is transferred into increased comfort in the homes, including increased heating areas, keeping a higher temperature and a longer heating season and using the heat pump for air-conditioning. Data include electricity consumption in 185 households before and after installation of heat pumps together with survey results of 480 households. Furthermore 12 households are selected for in-depth analysis including technical inspection and qualitative interviewing. Especially for summerhouses results indicate that there on average is no reduction in electricity consumption, as energy efficiency is outbalanced by increased comfort. These results have to be taken into account when making long term energy planning for a sustainable energy system. INTRODUCTION The sale of air-to air heat pumps has been quite high, notably in Norway where there are sold some hundred thousand [1] but also in Sweden and France expanding sales figures of heat pumps are reported. In Sweden domestic heat pump sale rose from approximately 20000 to 80000 per year between 2006 and 2007 and in France from approximately 50000 to 70000 per year [2]. Studies from several different European countries has pointed out that there is good economical reason for the consumers to install air-to-air heat pumps [3, 4, 5]. The question of what role air-to-air heat pumps play in a future sustainable energy system have to be discussed together with other technical changes of the whole energy system including to what extent electricity is produced by renewable energy [6,7] and the energy renovation of the building stock [6]. Replacing direct electric heating with air-to-air heat pumps are, however, always more energy efficient because heat pumps can provide 2-5 times more heat than the electricity they use as driving force [3]. In a scenario for future 100% renewable energy systems in Denmark * Corresponding author * The project team included besides the authors also Troels Fjorbak Larsen, IT Energy; Erik Gudbjerg and Lisbeth Rasmussen, Lokalenergi and Preben Munter, Seas-nve. † The initial project was financed by Elforsk.dk and further analysis for this article was related to the Research Centre for Zero Energy Buildings (http://www.zeb.aau.dk). individual heat pumps are thus also included for areas not covered by district heating [9]. From a socio-technical point of view it can, however, be expected that the full technical potential for energy efficiency will not be met because of changes in user practices towards still higher expectations and norms of comfort [1] as is also known from studies of other types of households’ technologies [10]. Within a techno-economic perspective a corresponding phenomenon is known as the rebound effect focusing on how the economic gains that households get from implementing more efficient technologies will be used to increase consumption in other areas or within the same area resulting in higher standards and thus increased energy consumption. There has been a debate about the size of the rebound effect within the household sector and a recent review suggest a rebound effect on 20% meaning that 20% of the energy savings gained from efficient technologies within the household sector are transformed into increased energy consumption and thus not realised as energy savings [11, 12]. The purpose of the study presented in this paper was to analyse to what extent the potential reduction from installation of air-to-air heat pumps are realised or transformed into increased consumption. Furthermore, it was to go more into detail in explaining within which areas more precisely the increases in comfort is seen and to understand in more sociological terms why and how these changes occur. Today, 8% of houses in Denmark [13] and 84% of summerhouses are heated by direct electric heating [14]. The majority of these are not placed near city centres and thus reachable by district heating and the most relevant future heating supply for these homes is thus individual heat pumps [9]. As these houses have not installed central heating based on water-borne systems, the economically most attractive choice will most often be to install air-to-air heat pumps. Another argument for looking at air-to-air heat pumps in relation to changes in comfort norms is that these can easily be used for air-conditioning as well. Air-conditioning has until now not been normal in Danish households, however, having available technologies installed in the home might contribute to change this. In the following, we will first describe the methods of the study and then, in the main part of the paper, present findings and analysis for permanently occupied dwellings and summerhouse respectively. In the conclusion, results are discussed in relation to the implications for interaction between heating technologies and renewable energy systems.

OBJECTIVE:To describe the function of oral health services and the delivery of oral health care in PR China.DESIGN:Cross-sectional surveys. Self-administered questionnaires gathered information on professional practices and attitudes of Chinese dentists. Patients were examined clinically for caries and services rendered. Patients were interviewed about oral health status, reason of dental visits and consumption of services, perceived need for care and self-care practices.SETTING:Wuhan City of the Hubei Province of China.SUBJECTS:Random samples of dentists (n = 250) working with child and adult patients in 1998 in Wuhan City. Each dentist had a representative sample of 20 patients attending consecutively for care enrolled in the study.RESULTS:On average, the dentists saw 12 patients per day, with most time devoted to restorative treatment and extraction. The majority of dentists held the opinion that in China little attention is given to preventive care. Forty per cent of the patients were new to the dentists and more than half attended care because of pain or acute symptoms. The reported mean number of decayed, missing, and filled teeth varied from 2.6 for 12-year-old patients to 10.7 for patients aged 65-74. Daily toothbrushing was practised by more than 90% of the patients in all age groups, however, the tradition of regular dental visits was weak. Most patients (51-75 per cent) attended for care due to acute problems or pain.CONCLUSION:The study indicated the need for reorientation of the Chinese oral health services towards prevention.

The purpose of this study was to evaluate the changes of oral health knowledge and behaviour among Wuhan citizens after six years of 'Love Teeth Day' campaigns. Representative samples of citizens aged 10-62 years were identified and interviewed in 1987 (n = 1180) and in 1995 (n = 1014). Data on oral health knowledge and practises were collected by structured questionnaires in both surveys and high response rates were obtained (87-94 per cent). In general, improvements in oral health knowledge and toothbrushing behaviour were observed in 1995 as compared with 1987. The younger age group (10-19-year-olds) showed significantly higher improvements of positive answers to knowledge items and toothbrushing behaviour. The findings also indicated that less than half of the interviewees were aware of the anti-caries effect of fluoride and about 30 per cent of the participants brushed their teeth performing the recommended method (vertical). In China, community based oral health education programmes should be implemented to further improve regular self-care practises, especially in relation to the adult population.

The purpose of this survey was to assess the oral health situation of an industrial population in Romania. A total of 311 male and female employees (18-62 years-of-age) were clinically examined according to the WHO Basic Methods criteria and responded to an oral health questionnaire on dental knowledge and health care habits. In the younger age groups, the amount of untreated dental caries was high (18-24 years: DT = 5.7, DMFT = 8.9) whereas missing teeth were prominent in older employees (45 years or more: MT = 7.6, DMFT = 11.9). At age 25-44, 72 per cent had gingival bleeding and calculus. Dental knowledge was relatively poor, and 28 per cent of the participants indicated actual need for treatment. Dental visits within the previous 12 months were reported by 24 per cent of the employees, and 39 per cent had had a tooth extracted at their most recent visit. The study emphasises the need for reorientation of oral health care in Romania, and the relevance of industrial dental services for the implementation of oral health promotion and prevention is highlighted.

Health services research is mainly applied research which can contribute to the production of knowledge necessary to appropriate decisions in health care. As an example, a study of the occurrence of tooth extractions is presented. Two hypotheses were tested: a negative relationship between provider density and consumer income, and the probability of tooth extractions and the number of teeth extracted, conditional upon extraction. A nationwide sample of 1286 non-institutionalized Norwegians 20 yr and above was interviewed by a public survey institute. The data were analyzed using a two-part model including logistic regression and multiple regression analysis. One third of the sample had had a tooth extraction during the last 5 yr. The majority of the sample had few teeth extracted at the time of extraction. The probability of tooth extraction was related to provider density and not to consumer income. The number of teeth extracted was related neither to provider density nor to income. Tooth extraction was not related to age. Some policy implications are discussed.

In one region in the state of Kuwait children in first grade have been offered a systematic dental health care program. The purpose of this study was to assess (1) dental knowledge, attitudes, and health behavior among the mothers of children in first grade, and (2) dental knowledge and attitudes of schoolteachers, and their involvement in health education. Before the children were enrolled in the program 187 mothers (response 76%) were interviewed. Self-administered questionnaires were used to collect data on schoolteachers (n = 135, response 695). Most of the mothers (74%) answered that dental caries is caused by sweets/candy; the role of bacteria was mentioned by 9%. Half of the mothers were aware of the harmful effect of sugary drinks, and 50% knew about the preventive effect of fluoride. Knowledge about causes and prevention of periodontal disease was diffuse. According to the mothers, 68% of the children were in need for dental treatment; 37% were seen by a dentist once a year for symptomatic reasons, and 49% brushed their teeth at least twice a day. Sixteen-percent of the mothers helped their child in brushing every day. Sugar consumption among mothers and children was high, e.g. 66% of the children had chocolate bars and 44% had soft drinks several times a day. The level of dental knowledge was higher among teachers than mothers; the mothers were mostly informed through television/radio, while teachers had received information from various sources, including the dentists. The teachers responded positively to prevention of dental diseases among children and should be considered key persons in dental health education. For the Kuwaiti children and the mothers the active involvement principle, group presentations, and one-to-one communications are recommended for the school based dental health program.