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Recommended Use of Non-Steroidal Anti-Inflammatory Drugs for Pain Treatment Following Primary Total Hip and Knee Arthroplasties in Denmark. A National Survey
No full textBackground: Non-steroidal Anti-inflammatory drugs (NSAIDs) are effective in reducing acute postoperative pain. However, it is currently unknown what type, dosage, and duration of NSAID are used following primary total hip and knee arthroplasties. We aimed to investigate the use of NSAID following total hip and knee arthroplasties in Denmark, describe general postoperative analgesic regimens, and assess clinicians' attitudes towards NSAID treatment. Method: We conducted a web-based survey distributed to local clinicians responsible for total hip and knee arthroplasties in all public Departments of Orthopedic Surgery in Denmark. The survey focused on standard perioperative treatment practices, and in particular the use of NSAIDs. Results: Of the 40 surgeons invited, 98% responded. The majority (37 of 39, 95%) reported NSAIDs as part of standard analgesic regimes after primary total hip and knee arthroplasties. Ibuprofen was the most commonly used NSAID postoperatively (26 of 37, 70%), typically administered at 1200 mg/day (20 of 26, 77%). The median duration of treatment was 8 days (interquartile range (IQR) 6–12) for total hip arthroplasties and 14 days (IQR 10–14) for total knee arthroplasties. However, there were significant variations between hospitals and regions. Multimodal analgesic treatment using paracetamol, NSAIDs, and opioids was the most common analgesia following total hip and knee arthroplasties. Nine of 38 (24%) were concerned regarding daily clinical treatment with NSAID. Conclusion: NSAIDs, especially ibuprofen, are routinely recommended as part of multimodal therapy for postoperative pain after primary total hip and knee arthroplasties in Denmark. The standard dose is 1200 mg/day, with a median treatment duration of 8 days for total hip arthroplasties and 14 days for total knee arthroplasties, though practices vary across different hospitals and regions.</p
The effect of materials in photoplethysmography-enabled mouthguards
No full textThe monitoring of cardiac signals using photoplethysmography (PPG) provides valuable insights into the health state of a person, both in clinical and non-clinical settings. However, current technologies have yet to be deployed in contact sports settings. This study aims to evaluate the impact of placing dental-grade materials, frequently used in mouthguards, over PPG sensors. The effects of signal-to-noise ratio (SNR) of different light wavelengths in ethylene vinyl acetate (EVA) and polymethyl methacrylate (PMMA) samples of varying thickness were explored. The light signals were assessed using a setup of highly absorbing and highly reflective environments, which allows for the assessment of the effect of specific materials on the photodetector. Using non-parametric statistical tests, this research identified that SNR is significantly affected by light wavelength, material thickness and the material forming process. Infrared light going through 1 mm non-thermoformed PMMA resulted in the highest SNR. This research shows the need for careful consideration of material selection and signal processing for the application of PPG sensors in mouthguards.</p
The adverse effects with ibuprofen after major orthopedic surgeries:A protocol for the PERISAFE randomized clinical trial
No full textIntroduction: Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for pain treatment after elective hip and knee arthroplasties. However, evidence regarding the incidence of adverse effects with short-term NSAID treatment following surgery is limited. We, therefore, aim to assess the adverse effects with an eight-day postoperative treatment with ibuprofen after elective hip and knee arthroplasties. Methods and Analysis: PERISAFE is a randomized, placebo-controlled, blinded multicenter trial with 90-day and one-year follow-up. Eligible patients undergoing elective hip or knee arthroplasty are allocated 1:1 to either ibuprofen 400 mg ×3/day or identical placebo ×3/day for eight days after surgery. The primary outcome is a composite of either death, acute myocardial infarction, stroke, pulmonary embolism, deep venous thrombosis, renal failure, major bleeding, re-operation, gastrointestinal ulcer, or readmission within 90 days postoperatively. Secondary outcomes are hospital-free days within 90 days postoperatively, a composite of ibuprofen and opioid-related adverse reactions based on eight-day postoperative diary, and health related quality of life after 90 days postoperatively. A total of 2904 patients are needed to demonstrate a relative risk reduction of 33% in the placebo group, accepting a risk of type I error of 5% and type II error of 20% and a proportion of serious adverse events in the ibuprofen group of 8%. The primary analysis will be in the modified intention-to-treat population. Ethics and Dissemination: The trial is approved by the Danish Medicine Agency and the Research Ethics Committee (EU CT no. 2022-502, 502-32-00). We plan to submit for publication in a major international peer-reviewed journal and present results at scientific meetings.</p
Biomarkers of connective tissue turnover in inflammatory bowel disease - diagnostic and predictive capacity
No full textKronisk inflammatorisk sygdom (CID), inklusiv inflammatorisk tarmsygdom (IBD), består af idiopatiske, prævalente og potentielt invaliderende sygdomme. Omend heterogene, udtrykker de ligheder i symptomatologi herunder fluktuerende sygdomsmønster og overlappende komorbiditet. I behandlingen af disse sygdomme ordineres der overvejende biologisk medicin rettet mod den pro-inflammatoriske tumornekrosefaktor (TNF). Med den nuværende medicinske tilgang opnår en betydelig del af patienterne (op til 60%) intet eller et utilstrækkeligt klinisk behandlingsrespons, hvilket understreger manglen på adækvat behandling. Med et livslangt perspektiv og en forventet stigende sygdomsbyrde udgør CID uundgåeligt en betydelig socio-økonomisk byrde. Fokuseres der på nuværende presserende kliniske udfordringer i behandlingen af IBD, skiller følgende sig ud: tidlig diagnose og rettidig og adækvat medicinsk behandling. At stille en tidlig diagnose kan være en klinisk udfordring på grund af fraværet af en guldstandard (ideal reference) og grundet en forholdsvis stor afhængighed af endoskopiske procedurer. Forsinket diagnose og suboptimal behandling kan have negativ indvirkning på sygdomsprogression (irreversibel organskade), rettidig terapeutisk behandling og i sidste ende livskvaliteten for patienter og pårørende.Kronisk inflammation er bl.a. kendetegnet ved overdreven ekstracellulær matrix (ECM) remodellering og forstyrret bindevævsomsætning. ECM biomarkører som afspejler inflammation, bindevævsomsætning og fibrose/fibrogenese har tidligere udvist diagnostisk og prædiktiv værdi. Således var det sandsynligt, at disse ECM biomarkører, som afspejler patologiske processer, havde potentiale som kliniske værktøjer i IBD diagnose, prognose og prædiktion af behandlingsrespons. Denne afhandling var baseret på planlægning, koordinering og gennemførelse af det observationelle NORDTREAT kohorte studie (bestående af et tværsnitsstudie og et longitudinelt studie) i et nordisk samarbejde med prospektiv inklusion af patienter i Danmark, Sverige, Norge og Island. En protokolartikel, der præsenterer studiedesign, metodologi, statistik, samt primære- og sekundære udfaldsmål, blev offentliggjort som en del af denne afhandling. Tværsnitsstudiet i NORDTREAT og BELIEVE kohortestudiet udgjorde grundlaget for de serologiske målinger og studier af ECM biomarkører i de præsenterede kliniske udfordringer indenfor IBD behandling. NORDTREAT tværsnitsstudiet omfattede 241 voksne patienter, som blev henvist til en gastroenterologisk afdeling på mistanke om IBD (symptomatiske og behandlingsnaive, dvs. en klinisk relevante situation). Patienterne fik taget blodprøver ved baseline og blev efterfølgende diagnosticeret med Crohns sygdom (CD), colitis ulcerosa (UC), IBD-uklassificeret (IBD-U) eller inkluderet som symptomatiske kontroller. ELISA-målinger blev udført for at vurdere niveauerne af ECM biomarkører for vævsfibrose: henholdsvis CTX-III, PRO-C4, PROC5 og PRO-C16, inflammation (VICM) og slimhindeskader (C3M, C4M, C6M). Det primære formål med NORDTREAT tværsnitsstudiet var at udforske den kliniske værdi af et panel af ECM biomarkører til diagnosticering af IBD (CD, UC, IBD-U) versus symptomatiske kontroller i forbindelse med første kliniske besøg af patienter henvist på mistanke om IBD. Den logistiske prædiktionsmodel, som opnåede den bedste sondring mellem patienter med IBD versus symptomatiske kontroller omfattede CTXIII og C6M (AUC 0,64, 95 % CI 0,56 - 0,70). En efterfølgende post-hoc analyse af modellens anvendelighed i forhold til differentiering af patienter med kolon CD fra patienter diagnosticeret med UC inkluderede biomarkørerne VICM, C4M, PRO-C5 og PRO-C16. Denne prædiktive regressionsmodel gav en AUC på 0,80 (95 % CI 0,69 - 0,98).Det prospektive kohortestudie BELIEVE (afsluttet i 2020) inkluderede 233 patienter diagnosticeret med CID inklusiv CD, UC, reumatoid arthritis (RA), aksial spondyloarthritis (axSpA), psoriasisarthritis (PsA) og psoriasis (PsO). Voksne patienter med CID, som påbegyndte eller skiftede (efter fejlslagen antiTNF behandling) biologisk behandling, var studieberettigede. Der blev indsamlet blodprøver ved baseline samt efter 14-16 ugers biologisk behandling, og niveauerne af atten ECM biomarkører blev målt i ELISA-undersøgelser. Det primære formål med BELIEVE studiet var at udforske den kliniske værdi af ECM biomarkører som prædiktorer for biologisk behandlingsrespons i en population af patienter med CID. Sygdomsspecifik biologisk behandlingsrespons blev opnået hos 54% af studiepopulationen med CID (fra 44% til 65% i subgrupperne af CID). Anvendeligheden af de enkelte ECM biomarkører til prædiktion af sygdomsspecifik behandlingsrespons blev vurderet ved måling af AUC (værdier fra 0,47 til 0,59). En eksplorativ analyse (PCA) afslørede en gruppering af ECM biomarkørerne i fem undergrupper/komponenter. Vi fandt imidlertid ikke signifikant sammenhæng mellem nogen af de fem komponenter og klinisk behandlingsrespons i den efterfølgende logistiske regressionsanalyse. Konklusionen i denne Ph.d.-afhandling er, at NORDTREAT tværsnitsstudiet dokumenterede, at hverken de enkelte kandidatbiomarkører eller en profil af biomarkører havde tilstrækkelig diagnostisk værdi (foruddefineret nedre grænse for AUC på 0,80). Dette på trods af anvendelsen af et panel af tidligere og grundigt undersøgte ECM biomarkører. Imidlertid afslørede en posthoc analyse en prædiktionsmodel, som med succes kunne skelne patienter med kolon CD fra patienter med UC. BELIEVE studiet dokumenterede, at selvom patienter med CID har adskillige fællestræk, og det anvendte ECM biomarkørpanel var grundigt evalueret, lykkedes det ikke, at påvise nogen enkelt ECM biomarkør eller biomarkørprofil, som kunne prædiktere biologisk behandlingsrespons.Med udsigt til kraftigt stigende CID prævalens er efterspørgslen på valide kliniske værktøjer, som muliggør tidlig diagnose, prognose og pålidelig prædiktion af klinisk behandlingsrespons, så relevant som nogensinde. For at afbøde de uundgåelige konsekvenser af kronisk inflammation, øge livskvaliteten for patienter og minimere forbruget af sundhedsressourcer (f.eks. anvendt på hospitalsindlæggelser, endoskopiske procedurer og overdreven medicinering), er omkostningseffektive og minimalt invasive kliniske værktøjer til differentiering af umiddelbart ens, men væsentligt forskellige sygdomme, og iværksættelse af hurtig og effektiv terapeutisk intervention af enorm stor betydning.Chronic inflammatory disease (CID) including inflammatory bowel disease (IBD) constitute idiopathic, prevalent and potentially debilitating diseases. Albeit heterogeneity, they express similarities in symptomatology e.g., fluctuating disease pattern and overlapping co-morbidity. Biological medications targeting the proinflammatory tumor necrosis factor (TNF) are predominantly prescribed. Currently, a significant part of patients (up to 60%) has no or insufficient clinical treatment response, pinpointing the lack of adequate management. With a lifelong perspective and an overall increasing disease burden, CID inevitably constitutes a significant socio-economic burden. If focusing on present clinical challenges in IBD management, early diagnosis and timely and adequate therapeutic treatment stand out. Early diagnosis may pose a clinical challenge, due to the absence of a golden standard, and relative dependency on endoscopic procedures. Delayed diagnosis and suboptimal treatment may negatively affect disease progression (irreversible organ damage), timely therapeutic management and ultimately quality of life for patients and relatives.A hallmark of chronic inflammation is excessive extracellular matrix (ECM) remodeling and disturbed connective tissue turnover. Biomarkers of the ECM mirroring inflammation, connective tissue turnover, and fibrosis/fibrogenesis have previously demonstrated diagnostic and predictive utility. Therefore, it was plausible that these biomarkers of ECM reflecting pathological processes had potential as clinical tools for aiding IBD diagnosis, prognosis, and prediction of treatment response. This thesis was based upon the planning, coordination and conduction of the observational NORDTREAT cohort study (consisting of a cross-sectional study and a longitudinal study) partnering in a Nordic collaboration with prospective enrolment of patients in Denmark, Sweden, Norway and Iceland. A protocol article highlighting details of study design, methodology, statistics, primary and secondary outcomes was published, as part of this thesis. The NORDTREAT cross-sectional study and the BELIEVE cohort study constituted the foundation of the serological investigations of ECM biomarkers in the two clinical challenges within IBD management presented above. The NORDTREAT cross-sectional study enrolled 241 adult patients referred on suspicion of IBD (symptomatic and treatment naïve i.e., clinical relevant setting). Patients had blood samples taken at baseline, and were subsequently diagnosed with either Crohn’s disease (CD), ulcerative colitis (UC), IBDunclassified (IBD-U) or symptomatic controls. ELISA was conducted to assess levels of biomarkers of tissue fibrosis: CTX-III, PRO-C4, PRO-C5, and PRO-C16, immune cell activity (VICM), and mucosal damage (C3M, C4M, C6M), respectively. The primary aim of the NORDTREAT cross-sectional study was to explore the utility of a panel of ECM biomarkers on diagnosis of IBD (CD, UC, IBD-U) versus symptomatic controls at first clinical visit in patients referred to a gastroenterology department with suspected IBD. The logistic prediction model achieving the best distinction of patients with IBD versus symptomatic controls included CTXIII and C6M (AUC 0.64, 95% CI 0.56 - 0.70). Subsequent post-hoc analysis of the discriminative utility of the model to separate patients with colonic CD from patients diagnosed with UC included the biomarkers VICM, C4M, PRO-C5, and PRO-C16. This predictive model provided an AUC of 0.80 (95% CI 0.69 - 0.98).The BELIEVE cohort study (finalized in 2020) prospectively enrolled 233 patients with CID including CD, UC, rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), and psoriasis (PsO). Adult patients initiating or switching (after anti-TNF failure) biological therapy were eligible for participation. Blood samples were collected at baseline and 14-16 weeks after initiating biological therapy, and levels of eighteen ECM biomarkers were measured by ELISA. The primary aim of the BELIEVE study was to explore the clinical utility of ECM biomarkers as predictors of biological treatment response in a population of patients with CID. Disease-specific biological treatment response was achieved in 54% of the study population with CID (ranging from 44% to 65% in the subgroups of CID). The utility of the single ECM biomarkers for prediction of disease specific treatment response was addressed by measuring the AUC (values ranging from 0.47 to 0.59). An explorative principal component analysis was conducted and revealed a clustering of the ECM biomarkers in five groups/components. However, the logistic regression analysis did not demonstrate any significant association between the five components retrieved and clinical treatment response. In conclusion, the NORDTREAT study documented, that even though exploring previously applied and thoroughly investigated ECM biomarkers, neither of the single candidate biomarkers nor profile of biomarkers had sufficient diagnostic utility (predefined lower limit of AUC of 0.80). However, post hoc analysis revealed a prediction model successfully discriminating patients with colonic CD from patients with UC. The BELIEVE study documented, that despite of multiple common features in patients with CID and application of an intensively assessed ECM biomarker panel, we did not succeed retrieving any single ECM biomarker nor biomarker profile predictive of biological treatment response.With future prospects of sharply increasing prevalence of CIDs the search for valid clinical tools enabling early diagnosis, prognosis of disease course and reliable prediction of treatment response is as relevant as ever. To mitigate the inevitable consequences of chronic inflammation, increase the quality of live for patients, and minimize scarce health care resources (e.g., spent on hospitalizations, endoscopic procedures and excessive medication), cost-efficient and minimally invasive clinical measures to distinguish similar but essentially different diseases, and enabling prompt and efficient therapeutic intervention is of immense importance.<br/
The Influence of Negative Online Social Support on Entrepreneurship
No full textSocial støtte anerkendes bredt som en vigtig ressource i entreprenørskab, som udveksles gennem netværk for at give følelsesmæssig opmuntring, praktisk hjælp og en følelse af tilhørsforhold. Disse ressourcer bidrager til positive resultater, der hjælper entreprenører med at navigere i usikkerhed, opbygge modstandskraft og forfølge muligheder. Traditionelt har sådan støtte været forankret i offline-interaktioner, hvor ansigt-til-ansigt kommunikation og relationel nærhed former, hvordan støtten udvikler sig og fortolkes. Dog har fremkomsten af online-platforme markant ændret landskabet for entreprenørielle netværk. Onlinefunktioner såsom asynkron kommunikation, bredere rækkevidde og reducerede relationelle begrænsninger gør det muligt for entreprenører at engagere sig i forskellige netværk og få adgang til støtte ud over geografiske og sociale grænser. Disse funktioner har udvidet omfanget af social støtte og giver entreprenører mulighed for at signalere behov, modtage uopfordret feedback og opretholde en bred vifte af kontakter, som de kan aktivere i fremtiden. Dette skift har introduceret nye dynamikker i støtteprocessen og ændret, hvordan entreprenører søger, fortolker og reagerer på ressourceinput.Mens meget af litteraturen om entreprenørskab fremhæver fordelene ved social støtte, skifter denne afhandling fokus til dens negative dimensioner, som stadig er underbelyst, især i online sammenhænge. I modsætning til offline kontekster udvisker online platforme ofte sociale grænser og reducerer ansvarlighed, hvilket tillader individer, herunder fremmede eller ikkenære relationer, at deltage i samtaler uden den store investering i relationen og uden omtanke for konsekvenserne. Disse forhold kan give anledning til negative og forstyrrende interaktioner, såsom trolling eller uopfordret kritik, som kan eskalere og påvirke entreprenørers kognitive bearbejdning og adfærdsmæssige reaktioner.Det er vigtigt at understrege, at denne afhandling ikke ser entreprenører som passive modtagere af støtte, men som aktive agenter, der strategisk engagerer sig i deres netværk. Afhandlingen undersøger, hvordan entreprenører aktivt deltager i online miljøer, strategisk tiltrækker social støtte og reagerer på negative sociale interaktioner, og den fremhæver de konsekvenser, som interaktionerne har for entreprenørernes adfærd og trivsel. Dette agentiske perspektiv udfordrer traditionelle antagelser og understreger den dynamiske karakter af entreprenørielle netværk.Ved at betragte entreprenører som netværksagenter frem for passive modtagere, understreger afhandlingen vigtigheden af at forstå både de betingelser, hvorunder støtte mobiliseres, og de resultater, der følger, når støtten opfattes eller udøves som negativ. Dette perspektiv leder til afhandlingens centrale forskningsspørgsmål:“Hvad er de forudgående faktorer for og konsekvenser af online social støtte i entreprenørskab, særligt når støtten er negativ?” Denne afhandling undersøger først forudsætningerne for social støtte i online og offline kontekster og fremhæver entreprenører som aktive agenter, der strategisk engagerer deres netværk. Den viser, hvordan entreprenører tilpasser sig normer og funktioner i hver kontekst for at mobilisere støtte fra ikke-nære relationer.Dernæst undersøger afhandlingen effekterne af negativ social støtte på entreprenørielle handlinger, med fokus på hvordan destruktiv feedback kognitivt bearbejdes og omsættes til handling. Tillid til muligheden identificeres som en central mediator, og effekten af feedback herpå afhænger af, hvordan den leveres. Bemærkelsesværdigt er det, at negativ støtte ikke altid udløser en umiddelbar negativ reaktion online.Afhandlingen undersøger også, hvordan negativ online social støtte påvirker entreprenørers livstilfredshed. Reaktioner fra fremmede kan forstyrre kognitive processer mere end feedback fra nære relationer, og det fremhæver dermed både de følelsesmæssige omkostninger ved online engagement såsom livstilfredshed, samt betydningen af den relationelle kontekst.Forskningsspørgsmålet besvares gennem kvantitative analyser i tre separate studier, hver baseret på et selvstændigt datasæt. Alle tre artikler i afhandlingen er struktureret omkring testbare hypoteser og anvender statistiske metoder til at undersøge relationer mellem centrale variable. Analyserne inkluderer blandt andet multiple regressionsmodeller og OLS-regression, anvendt til at vurdere både forudsætninger for og konsekvenser af online social støtte i entreprenørielle sammenhænge.Ved at integrere tre dimensioner – netværksmæssige forudsætninger, adfærdsmæssige reaktioner og trivselsmæssige konsekvenser – bidrager denne afhandling til en mere nuanceret forståelse af social støtte i entreprenørskab. Den understreger den kontekstafhængige karakter af social støtte og viser, at social støtte ikke kun formes af relationelle dynamikker, men også af de særlige funktioner i de miljøer, hvori den leveres. Resultaterne giver teoretiske og praktiske indsigter i, hvordan entreprenører navigerer i online miljøer, fortolker negativ social støtte, og hvordan disse fortolkninger former deres efterfølgende entreprenørielle adfærd og trivsel.Denne afhandling bidrager med tre centrale indsigter. For det første defineres entreprenøriel social støtte som en kontekstafhængig og agentisk proces. Entreprenører tilpasser aktivt deres strategier til online og offline kontekster ved at anvende sociale færdigheder og mægleradfærd for at mobilisere støtte baseret på hver konteksts funktioner.For det andet udfordrer afhandlingen antagelsen om, at social støtte er overvejende positiv ved at undersøge dens negative dimensioner online. Destruktiv feedback fra fremmede kan føre til, at idéer revideres frem for at blive opgivet, men en sådan feedback kan også reducere livstilfredsheden på grund af opadgående social sammenligning. Feedback fra nære relationer viser sig at være mindre forstyrrende på grund af tillid og fortrolighed.For det tredje tydeliggør afhandlingen, hvordan entreprenører kognitivt bearbejder negativ online støtte. Tillid til muligheden og opadgående social sammenligning identificeres som centrale mekanismer, der former adfærdsmæssige og følelsesmæssige reaktioner. Selvom feedback i første omgang kan reducere tilliden til muligheden, kan refleksiv bearbejdning føre til konstruktiv omfortolkning og øget selvtillid efter idéen er revideret.Social support is widely recognized as a vital resource in entrepreneurship, where it is exchanged through networks to provide emotional encouragement, practical assistance, and a sense of belonging. These resources contribute to positive outcomes that help entrepreneurs navigate uncertainty, build resilience, and pursue opportunities. Traditionally, such support has been rooted in offline interactions, where face-to-face communication and relational closeness shape the nature and interpretation of support. However, the rise of online platforms has significantly transformed the landscape of entrepreneurial networking. Online affordances, such as asynchronous communication, broader reach, and reduced relational constraints, enable entrepreneurs to engage with diverse networks and access support beyond geographic and social boundaries. These affordances have expanded the scope of social support, allowing entrepreneurs to broadcast their needs, receive unsolicited feedback, and maintain a wide range of contacts for future engagement. This shift has introduced new dynamics into the support process, altering how entrepreneurs seek, interpret, and respond to resource inputs.While much of the entrepreneurship literature emphasizes the benefits of social support, this dissertation shifts focus to its negative dimensions, which remain underexplored, particularly in online settings. Unlike offline contexts, online platforms often blur social boundaries and reduce accountability, allowing individuals—including strangers or non-close relations—to participate in conversations with minimal relational investment or consequences. These conditions can give rise to negative, disruptive interactions such as trolling or unsolicited criticism, which may escalate and influence entrepreneurs’ cognitive processing and behavioral responses.Crucially, this study does not view entrepreneurs as passive recipients of support, but rather as active agents who strategically engage with their networks. It explores how entrepreneurs proactively participate in online environments, strategically elicit social support, and respond to negative social interactions, highlighting their consequences on entrepreneurial behavior and well-being. This agentic perspective challenges traditional assumptions and emphasizes the dynamic nature of entrepreneurial networking.By viewing entrepreneurs as network agents rather than passive recipients, the study emphasizes the importance of understanding both the conditions under which support is mobilized and the outcomes that follow when the support is perceived as negative. This perspective leads to the central research question of the dissertation:“What are the antecedents and outcomes of online social support in entrepreneurship, particularly when the support is negative?” This dissertation first examines the antecedents of social support in both online and offline settings, with a focus on entrepreneurs as active agents who strategically engage with their networks. It highlights how entrepreneurs adapt to the norms and affordances—or allowing functions— of each context to mobilize support from non-close relations.Second, the dissertation explores the effects of negative social support on entrepreneurial behavior, focusing on how destructive feedback is cognitively processed and subsequently acted upon. Opportunity confidence is identified as a key mediator, and the impact of feedback depends on how it is delivered. Notably, negative support does not always trigger an immediate adverse response in online settings.Third, the dissertation investigates how negative online social support affects entrepreneurs’ life satisfaction. It shows that reactions from strangers can disrupt cognitive processes more than those from strong ties, highlighting the costs of online engagement and the importance of relational context.The research question is addressed through quantitative analyses across three distinct studies, each based on a separate dataset. All three papers in the dissertation are structured around testable hypotheses and employ statistical techniques to examine relationships between key variables. Specifically, the analyses include multiple regression models such as ordinary least squares (OLS) regressions and hierarchical regression, ANOVA analysis with LSD post hoc and PROCESS Model 4 which are applied to assess both the antecedents and outcomes of online social support in entrepreneurial contexts.By integrating the three dimensions of networking antecedents, behavioral responses, and wellbeing outcomes, this dissertation contributes a more nuanced understanding of social support in entrepreneurship. It emphasizes the context-sensitive nature of support, showing that its effects are shaped not only by relational dynamics but also by the distinct affordances of the settings in which it is delivered. The findings offer theoretical and practical insights into how entrepreneurs navigate online environments, interpret negative social support, and how these interpretations shape their subsequent entrepreneurial behavior and well-being.This dissertation makes three key contributions. First, it conceptualizes entrepreneurial social support as a context-sensitive and agentic process. Entrepreneurs actively adapt their strategies to online and offline settings, using social skills and brokerage behaviors to mobilize support based on each context’s affordances. Second, it challenges the assumption that social support is inherently positive by examining its negative dimensions in online settings. Destructive feedback from strangers can prompt idea revision rather than abandonment, but upward social comparison in response to such feedback reduces life satisfaction. Notably, negative feedback from strong ties is less disruptive due to trust and familiarity. Third, the dissertation clarifies how entrepreneurs cognitively process negative online support. Opportunity confidence and upward social comparison are identified as key mechanisms shaping behavioral and emotional responses. While feedback may initially lower confidence, reflective processing can lead to constructive reframing and an increase in confidence following subsequent revisions
Outdoor Physical Activity: Exploring Evidence and Health Outcomes in People Living with Chronic Musculoskeletal Diseases
No full textBaggrundKroniske muskuloskeletale sygdomme (MSS) er blandt de væsentligste årsager til funktionsnedsættelse. Hyppige tilstande som artrose, leddegigt, lænderygsmerter, osteoporose og fibromyalgi påvirker millioner af mennesker på verdensplan. Da mange oplever smerter og nedsat livskvalitet, anbefales fysisk aktivitet (FA) som en central del af behandlingen. Imidlertid er det ofte en udfordring for mange med MSS, at fastholde anbefalet aktivitetsniveau. Udendørsmiljøer kan fungere som en lovende ramme for FA interventioner, idet de kombinerer de fysiologiske effekter af FA med psykologiske og motiverende fordele forbundet med naturen. På trods af stigende interesse er evidensen for udendørs FA-interventioner blandt personer med MSS fortsat begrænset.FormålFormålet med denne afhandling er at udforske både den eksisterende evidens og virkningen af en FA-intervention udført i udendørsmiljøer blandt personer med MSS. Ved at kombinere en systematisk gennemgang af litteraturen med evalueringen af en stor national kohorte, tilstræbte afhandlingen at opnå en samlet forståelse af udendørs FA-interventioner, samt de potentielle fordele og begrænsninger ved sådanne interventioner for personer med MSS.MetoderArtikel I identificerede randomiserede kontrollerede forsøg (RCT’er) og observationsstudier, der undersøgte strukturerede udendørs FA interventioner udført i miljøer som parker, skove eller grønne byområder. Den systematiske søgning blev gennemført i marts 2023 i databaserne MEDLINE, CENTRAL, EMBASE og CINAHL. Meta analyser blev udført for helbredsrelateret livskvalitet (HRQOL), fysisk funktion, smerte og mentale helbred, og vurderingsredskabet ’Grading of Recommendations, Assessment, Development, and Evaluations (GRADE)’ evaluerede kvaliteten af den inkluderede evidens.Artikel II og Artikel III beskrev OUTPAC-kohorten, 12-ugers gruppebaseret udendørs FA-forløb med frivillige instruktører, implementeret på landsplan i samarbejde med Gigtforeningen. Deltagere med selvrapporterede MSS gennemførte validerede spørgeskemaer og fysiske tests. Artikel II fokuserede på udviklingen af det overordnede OUTPAC design, kohortens baseline-karakteristika og baselines-scores. Artikel III evaluerede ændringer umiddelbart efter interventionen blandt 925 deltagere, der gennemførte både før- og efter-spørgeskemaer. Lineære mixed-effects modeller blev anvendt til at estimere gennemsnitlige ændringer på tværs af domæner (HRQOL, fysisk aktivitet, fysisk funktion, smerte og mental trivsel), og subgruppeanalyser undersøgte forskelle mellem sygdomsgrupper.ResultaterDen systematiske gennemgang (20 studier; n = 1.759 deltagere) viste små men signifikante effekter, der favoriserede udendørs FA for HRQOL (k = 10, Standardiseret gennemsnitsforskel (SMD) = 0,45; 95% konfidensinterval (CI): 0,19 til 0,71) og fysisk funktion (k = 14, SMD = 0,39; 95% CI: 0,13 til 0,64) samt en moderat effekt på mentale udfald (k = 13, SMD = -0,52; 95% CI: -0,82 til -0,23), men den samlede evidensstyrke var meget lav. Der var for få studier til at vurdere effekten på smerte. Enkelte studier (n = 4) rapporterede bivirkninger, herunder ikke-alvorlige (fald, smerte, træthed) og enkelte alvorlige (indlæggelse, lungebetændelse).OUTPAC-kohorten omfattede 1.943 deltagere (gennemsnitsalder 65 år; 92% kvinder), hovedsageligt med artrose, leddegigt eller lænderygsmerter. Ved baseline rapporterede deltagerne moderate smerter og træthed, men relativt høj HRQOL (0,81) og mental trivsel (63 point). Blandt de 925 deltagere, der gennemførte opfølgning, var en lille, men signifikant forbedring i HRQOL (ændring = 0,01; p = 0,003), mens øvrige selvrapporterede outcomes ikke ændrede sig. De fysiske tests viste derimod signifikante forbedringer i både 40-meter gangtest (Gennemsnitsændring = -2,2 sekunder; p: 0,000) og 30 sekunders rejse-sætte-sig test (Gennemsnitsændring = 2,9 gentagelser; p: 0,000), hvilket overgår grænsen for relevant klinisk forbedring. Højere fremmøde var forbundet med bedre HRQOL og mental trivsel umiddelbart efter interventionen.KonklusionDenne afhandling kombinerer eksisterende evidens med en praksisnær, pragmatisk evaluering for at undersøge de potentielle fordele, ulemper og begrænsninger ved udendørs FA for personer med MSS. Resultaterne giver en samlet forståelse af, hvordan udendørs FA kan påvirke helbredsrelaterede faktorer i denne population. Udendørs FA fremstår som en gennemførbar og skalerbar tilgang med potentiale til at forbedre livskvalitet, fysisk funktion og mental trivsel. Personer med rygrelaterede eller degenerative sygdomme havde dog en tendens til at opnå mindre udbytte, hvilket tyder på, at effekten kan variere afhængigt af typen af MSS. Afhandlingen understreger desuden vigtigheden af tværsektorielt samarbejde, fleksibel lokal implementering og det udendørs miljø interventionen gennemføres i. Det anbefales, at fremtidig forskning anvender mere robuste studiedesigns, eksempelvis et RCT-studie, og inkluderer bredere sociale, psykologiske og kontekst relaterede faktorer for bedre at undersøge kompleksiteten af udendørs FA for personer med MSS.BackgroundChronic musculoskeletal diseases (MSDs) are among the leading contributors to disability worldwide, with highly prevalent conditions such as osteoarthritis, rheumatoid arthritis, low back pain, osteoporosis, and fibromyalgia influencing millions of people. As individuals are often experiencing pain and reduced quality of life, physical activity (PA) is recommended as a vital part of management. Yet, adherence to clinical guidelines remains a challenge. Outdoor environments may represent a promising setting for PA interventions, combining the physiological effects of PA with psychological and motivational benefits linked to nature exposure. Despite growing public interest, the evidence for outdoor PA interventions in people with MSDs remains limited. AimThis thesis aims to explore both the existing evidence and impact of performing PA interventions in outdoor settings for people living with MSDs. By addressing both the current evidence and evaluating a large nationwide cohort, this thesis sought to provide a comprehensive understanding of the outdoor PA concept, and the potential benefits and limitations related to outdoor PA interventions for people with MSDs.MethodsPaper I identified and synthesized randomized controlled trials (RCTs) and observational studies examining structured outdoor PA interventions conducted in outdoor environments such as parks, forests, or urban green areas. The inception for the systematic search was Marts 2023 using MEDLINE, CENTRAL, EMBASE, and CINAHL. Meta-analyses were performed on health-related quality of life (HRQOL), physical function, pain, and mental outcomes, with certainty of evidence assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).Paper II and Paper III reported on the OUTdoor Physical ACtivity (OUTPAC) cohort, a volunteer-led, 12-week group-based outdoor PA intervention implemented nationwide in close collaboration with the Danish Rheumatism Association. Participants with self-reported MSDs completed validated questionnaires and performance-based tests. Paper II focused on the OUTPAC setup, the baseline characteristics of the cohort, and the baseline scores. Paper III evaluated immediate post-intervention changes in 925 participants who completed both pre- and post-intervention questionnaires. Linear mixed-effects models estimated mean changes across outcome domains (HRQOL, physical activity, physical function, pain and mental well-being), with subgroup analyses exploring disease group differences.ResultsThe systematic review (20 studies; n = 1,759 participants) indicated small but significant effects favoring outdoor PA for HRQOL (k = 10, Standardized mean difference (SMD) = 0.45, 95% Confidence Interval (CI): 0.19 to 0.71) and physical function (k = 14, SMD = 0.39, 95% CI: 0.13 to 0.64) and a moderate effect on mental outcomes (k = 13, SMD = -0.52, 95% CI: -0.82 to -0.23), although overall certainty was very low. Due to a lack of studies measuring pain, the review could not conclude on the outdoor PA interventions effect on pain. Few studies (n = 4) reported adverse events including non- serious (falls, pain, fatigue) and serious (hospitalization, pneumonia).The OUTPAC cohort enrolled 1,943 participants (mean age 65 years; 92% women), mostly with osteoarthritis, rheumatoid arthritis, or low back pain. Baseline data showed moderate pain and fatigue but relatively high HRQOL (0.81) and mental well-being (63 points). Among 925 participants completing follow-up, HRQOL improved slightly (mean change = 0.01; p = 0.003), while other self-reported outcomes showed no mean change. Performance-based tests improved significantly in both 40-meter walking test (mean change = -2.2 seconds; p = 0.000) and 30-second chair test (mean change = 2.9; p = 0.000), exceeding minimal clinically important differences. Higher attendance also predicted better HRQOL and mental well-being immediately post-intervention.ConclusionThis thesis combines existing evidence with a real-world, pragmatic evaluation to explore the potential benefits, harms, and limitations of outdoor PA interventions for people with MSDs. The findings provide a comprehensive understanding of how outdoor PA may influence health outcomes in this population. Outdoor PA appears feasible and scalable, with potential to improve HRQOL, physical function, and mental well-being. Yet, people with spine-related or degenerative diseases tended to benefit less, suggesting that outcomes vary depending on type of MSDs. This thesis further emphasizes the importance of cross-sectoral collaboration, flexible community delivery, and the environmental context in outdoor PA initiatives. It is recommended that future research use rigorous designs, such as RCTs, to further examine the effect of outdoor PA interventions, and include broader social, psychological, and environmental outcomes to capture the complexity of performing PA in an outdoor setting for people with MSDs
”Jeg løber panden mod en mur – konstant”:Om fængslingens betydning for adgangen til sundhedsbehandling
No full textI denne artikelbaserede afhandling undersøges, hvordan individets adgang til sundhedsbehandling på virkes under fængsling, samt hvilken betydning ligestillingsprincippet har for adgangen til sundhedsbehandling. Problemstillingen er belyst gennem i alt fem artikler, som giver indsigt i, hvordan adgangen til sundhedsbehandling påvirkes af indsættelse i et fængsel ud fra retlige og empiriske indgangsvinkler. Artiklernes tematikker omhandler 1) muligheden for at klage over adgangsmæssige begrænsninger, 2) restriktioner under COVID-19, 3) sundhedsrettigheder hos gruppen af fængslede uden CPR-nummer, 4) skønudøvelse ved ordination af medicin samt 5) sundhedspersonalets dobbelte loyalitetskrav. Det empiriske materiale i afhandlingen er indsamlet gennem et etnografisk feltarbejde, som er gennemført i tre fængsler og tre arrester i Danmark. Der er foretaget interviews med i alt 39 forskellige fængslede personer og 11 sundhedspersonaler samt gennemført observation (N = 156 timer). Dertil redegøres for ligestillingsprincippet ved inddragelse af national ret inden for sundhed og straffuldbyrdelse samt Den Europæiske Menneskerettighedskonvention med henblik på at forstå princippets rolle i sundhedsbehandlingen.Den teoretiske ramme udgøres af Felstiner et al.’s (1999; 1981) teori om den før-retlige sagstransformation med udgangspunkt i faserne naming, blaming og claiming. Gennemgående er også den teoretiske vinkel om fængselsspecifikke smerter (Hayes, 2018; Sykes, 2007 [1958]), som også kommer til udtryk ved fraværet eller begrænsningen af sundhedsrettigheder. Denne teoretiske ramme er med til at frem hæve sammenhænge mellem artiklernes analyser og de før-retlige aspekter, som fremgår heraf. I de fem artikler indgår desuden teoretiske koncepter, som trækker på Thomas Mathiesens (1965) begreb om ’censoriousness’, Lorbers (1975) om ’problem’ patienter sammen med Lipsky’s (2010 [1980]) begrebssætning om frontlinjemedarbejder og afslutningsvist Bloche (1999) om loyalitetskrav i sundhedspersonalets praksis. I den teoretiske rammesætning af artiklerne vises det, at sundhedsbehandlingen i kriminalforsorgen er påvirket af fængselsmæssige og strukturelle omstændigheder, som medfører, at fængslets opbygning omkring sikkerhedsmæssige hensyn skaber barrierer.Det konkluderes, at adgangen til sundhedsbehandling kan begrænses med henvisning til sikkerheds- og ordensmæssige hensyn, men begrænses også på grund af retlige forhold, f.eks. ved manglende bopælsregistrering. Analysen viser, at retten til sundhed er forbundet med (og begrænset af) de sikkerheds- og ordensmæssige hensyn, som bl.a. kommer til udtryk i den transformationsproces, som fængslede personers sociale problemstillinger gennemgår, før de bliver til en egentlig sag. De retlige begrænsninger reflekteres dertil i sundhedspersonalets praksis, hvor mødet med fængslede personer er præget af sikkerheds- og driftsmæssige overvejelser, f.eks. i forbindelse med beslutninger om transport ud af huset eller ordination af medicin. Dertil ses barrierer, som ikke direkte kan tilskrives sikkerhedshensynene, men de afsavn som følger af frihedsberøvelsen, og som påvirker individets opfattelse af sig selv som et rettighedsbærende individ og som bidrager til at forværre afsavn og smerter, hvilket vanskeliggør indi videts aktivering af sundhedsrettigheder.This article-based PhD thesis investigates how the individual’s access to healthcare is affected during imprisonment and the impact of the principle of equivalence on access to healthcare. The problem formulation is explored through five articles that provide insights into how access to healthcare is affected by imprisonment from legal and empirical perspectives. The articles address the following themes: 1) complaint options about healthcare issues, 2) restrictions during COVID-19, 3) health rights of imprisoned individuals without Danish CPR-registration, 4) discretion when prescribing medication, and 5) dual loyalty conflicts of healthcare professionals practicing in prisons. The empirical data in the thesis has been collected through ethnographic fieldwork conducted in three Danish prisons and three remand prisons. Interviews were conducted with a total of 39 imprisoned people and 11 healthcare professionals. Further, observation studies have been carried out (N = 156 hours). The principle of equality is described through the inclusion of national law in health and sentence execution as well as the European Convention on Human Rights in order to understand its role in health care.The theoretical framework consists of Felstiner et al’s (1981) theory regarding the pre-dispute case transformation, taking a starting point the phases of naming, blaming and claiming. Throughout the analysis is also the theoretical angle of prison specific pains (Hayes, 2018; Sykes, 2007 [1958]) that are inherent in the deprivations and limitations related to healthcare rights experienced by the imprisoned people. This theoretical framework will also emphasise relations between the articles’ analyses and the pre-dispute aspects that appears hereof. In the five articles, the theoretical concepts applied are drawn from Mathiesen’s (1965) concept of ’censoriousness, Lorber’s (1975) ’problem’ patients together with Lipsky’s (2010 [1980]) conceptual foundation of street-level bureaucrats and finally, Bloche’s concept of loyalty in healthcare staff’s practices. In the theoretical framework of the articles, it is shown that healthcare provisions in prison are influenced by the prison and structural circumstances, which results in security considerations creating barriers.It is concluded that access to healthcare can be restricted due to the prison’s tasks of security and order, but can also be limited due to legal reasons, such as lack of residence registration. The analysis shows that the right to health is connected to and restricted by the prison’s focus on security and order. This is demonstrated in the pre-dispute transformation process that the imprisoned people’s social cases go through before turning into a legal case. Legal restrictions are reflected in the practices of healthcare staff, where interactions with imprisoned individuals are shaped by the prison’s security and operational priorities. This is evident in decisions concerning transfers to external healthcare facilities and in the prescribing of medication. Finally, barriers, which stem not only from security concerns but from the inherent deprivations of imprisonment, affect the individual's self-perception as a right-bearing subject. These barriers exacerbate prison-specific pains and complicate the exercising of healthcare rights
“So fast on the keys, when do you have time to meet”:Interactionally generated invitations in Danish Tinder chats
No full textThis paper investigates how Tinder users in Denmark interactionally generate invitations to meet through post-match chats. Based on a collection of 194 Tinder chats collected in 2020, from which 19 examples involving invitations were identified and analyzed using methodology inspired by Conversation Analysis focusing on the strategies used to navigate the delicate process of proposing a meeting.The paper analyzed three ways of generating invitations interactionally: 1) interpreting response time as an indicator of interest, where quick replies are taken as signs of engagement and willingness to meet; 2) basing the invitation on contextually favorable conditions, such as weather or proximity, which are framed as low-effort and convenient for the recipient; and 3) utilizing self-disclosure to propose meeting activities that align with the recipient’s preferences or personal information revealed during the chat.These strategies allow users to test the waters before asking for a meeting, thus minimizing the likelihood of rejection. By treating invitations as collaborative actions, where the recipient’s interest is implied rather than directly solicited, users manage the potential social risks involved in proposing face-to-face interactions. The findings highlight the unique affordances of Tinder as a platform, such as timestamps and geolocation features, which shape the way invitations are constructed and understood. This study contributes to existing research on digital communication by showing how invitations in online dating are interactionally achieved through subtle, recipient-designed strategies that exploit the app’s features while preserving face and mitigating social risks
Perioperative High-Dose Steroid in Insulin-Treated Patients With Diabetes Undergoing Fast-Track Hip and Knee Arthroplasty:Impact on Length of Stay and Discharge Blood Glucose Levels
No full textBackground: Perioperative high-dose steroids are widely used to reduce postoperative inflammation, pain, and complications but remain controversial in patients with insulin-treated diabetes due to concerns about hyperglycemia and infections. This study aimed to examine the use of perioperative high-dose steroids and its effect on discharge glucose concentration, length of stay (LOS), and 30-day readmissions in insulin-treated patients with diabetes undergoing fast-track hip or knee arthroplasty. Methods: We conducted a prospective observational study in patients with insulin-treated diabetes undergoing fast-track hip or knee arthroplasty across eight Danish centers. Patient demographics, including diabetes treatments, perioperative steroid, discharge blood glucose concentration, LOS, and 30-day readmissions were prospectively extracted from the electronic health records through chart review. Our primary outcome was differences in mean discharge blood glucose concentration between patients with insulin-treated diabetes receiving perioperative high-dose steroid and no/antiemetic steroid. Secondary outcomes included the fraction with a LOS > 2 and 30-day readmissions between the groups. As a sensitivity analysis, discharge blood glucose concentration was compared between the insulin-treated patients and a propensity-score matched cohort of non-insulin-treated patients with diabetes all receiving high-dose steroids. Results: Of 292 registered patients with insulin-treated diabetes, 64% received high-dose steroids. Median discharge blood glucose was 11.0 mmol/L [IQR 8.9–13.5] in the high-dose steroid group versus 9.7 mmol/L [IQR 7.4–12] in the no/antiemetic steroid group (p = 0.011). LOS > 2 days occurred in 10.1% (95% CI: 6.6–15.3) of the high-dose group and 15.2% (95% CI: 9.6%–23.3%) of the no/antiemetic steroid group (p = 0.200). The 30-day readmission rates were 8% (95% CI: 4.8–13) and 8.3% (95% CI: 4.3–15.6), respectively (p = 0.923). Compared to propensity-matched patients with non-insulin-treated diabetes receiving high-dose steroids, patients with insulin-treated diabetes had a 2.1 mmol/L (95% CI: 1.3–2.8) higher mean discharge blood glucose concentration (p = < 0.001). Conclusions: Glucose levels at discharge were slightly, but significantly higher in insulin-treated patients with diabetes receiving high-dose steroids compared to those receiving no/antiemetic doses and to non-insulin treated diabetes patients receiving high-dose steroids. However, there was no increase in fraction with LOS > 2 days or 30-day readmissions in the patients having high-dose steroids. Despite increased discharge glucose concentration, this suggests no evident safety concerns using high-dose steroids in insulin-treated diabetes patients having fast-track arthroplasty. Editorial Comment: This multicenter study addresses the debated use of a high-dose perioperative glucocorticoid in insulin-treated patients with diabetes undergoing fast-track arthroplasty. Despite modestly increased discharge glucose levels, no safety signals were observed regarding length of stay or readmissions. These findings support cautious use of a single high-dose perioperative glucocorticoid in this population. However, larger randomized studies are needed to confirm these findings.</p
Professionalisation and performance of Airbnb hosts in rural regions
No full textThis paper explores the professionalisation and performance aspects of Airbnb hosts in rural regions in Denmark, Iceland, and Norway. More specifically, based upon the professionalisation of hosts, which represents a proxy for the scale of their entrepreneurial engagement, the host landscape in the rural regions is investigated, resulting in different host profiles, including individual single- and multiple-listing hosts, and small and large tourism companies. The paper subsequently estimates the service quality performance of Airbnb hosts in relation to their professionalisation in rural regions through a u-shaped relationship, with the professionalisation influencing the performance evaluation of the hosts by the users. This twofold empirical analysis amends the extant literature, as it provides both a more nuanced and more comprehensive description of the nature and scale of Airbnb host engagement in rural regions, and points to the vast entrepreneurial opportunities for private households and companies on the platform