218 research outputs found
Receptionen af Søren Ulrik Thomsens forfatterskab 1981-2000
No full textInternational audienceA presentation of the reception and interpretations of the Danish author Søren Ulrik Thomsen's work from his first collection of poems and app 20 years o
Receptionen af Søren Ulrik Thomsens forfatterskab 1981-2000
No full textInternational audienceA presentation of the reception and interpretations of the Danish author Søren Ulrik Thomsen's work from his first collection of poems and app 20 years o
Social inequalities in colorectal cancer screening uptake: comparing colon capsule endoscopy and colonoscopy
No full textDen samlede internationale byrde forbundet med tarmkræft har været stigende iflere årtier. Ved at screene individer, er det muligt at finde og behandle tidligekræfttilfælde, mens man kan fjerne de langsomt udviklende forstadier, før deudvikler sig til kræft. Den empiriske evidens har vist os, at screening fortarmkræft kan nedbringe forekomsten af sygdommen, mens chancen foroverlevelse forbedres også hos dem der får sygdommen. Dette har retfærdiggjort indførslen af tarmkræftscreeningsprogrammer verden over. De fleste afdisse programmer, herunder det danske, er udfordret af uligheder i deltagelsenmellem demografiske og socioøkonomiske undergrupper af befolkningen. Detvækker bekymring fordi disse uligheder muligvis påvirker udfaldene aftarmkræftscreening, såsom uligheder i nye kræfttilfælde og i dødelighed. De internationale og national kriterier for at igangsætte screening konstaterer atsådanne programmer bør sikre lige adgang for hele befolkningen. De danskekriterier beskriver derudover at programmerne bør give en retfærdig fordeling afanvendte sundhedsressourcer.Det danske tarmkræftscreeningsprogram inviterer alle borgere i alderen 50-74til at indsende en afføringsprøve hvert andet år. Denne prøve bliver så testet forkoncentrationen af blod i afføringen, og hvis den overstiger en forudbestemtgrænseværdi, så indkaldes individet til en opfølgende koloskopi (kikkertundersøgelse via endetarmen).Borgere fra Europæiske lande, som er blevet inviteret til tarmkræftscreening,har rapporteret barrierer til deltagelse såsom manglende opmærksomhed, frygtfor kræft, udskydelse/forglemmelse, processen med at tage afføringsprøven,samt angst og frygt for koloskopien, herunder også ubehaget og risikoen forkomplikationer. Det er uvist om de barrierer der har med koloskopien at gøre, erlige mellem undergrupper af forskellig socioøkonomisk status, men hvis de ermere almindelige i nogle grupper, så bidrager det muligvis til den overordnedeulighed i deltagelse.Kolonkapselendoskopi er en mindre invasiv undersøgelse, som kan undersøgetyk- og endetarmen. Den udføres ved at sluge en kapsel med to kameraer i,som sender billeder fra fordøjelseskanalen til en modtager der bæres rundt omlivet. Kolonkapselendoskopier er forbundet med mindre ubehag, færre komplikationer og er mindre invasive end koloskopier. Kolonkapselendoskopier kræver dog en mere omfattende udtømning af tarmen, og inkomplette undersøgelser, eller undersøgelser med positive fund, fører til en opfølgende koloskopi. Vi foreslog at ulighederne i deltagelse til tarmkræftscreening mellem socioøkonomiske undergrupper, måske delvist skyldes socioøkonomiske forskelle imodviljen mod koloskopi. Derudover foreslog vi at man ved at indføre et tilbudom kolonkapselendoskopi, som et alternativ til koloskopi, muligvis kunne nedbringe ulighederne i deltagelse og øge den samlede deltagelse.Formål:Det overordnede formål for denne afhandling var derfor at se om vi kunne nedbringe sociale uligheder i screeningsdeltagelse, samt øge den samlede screeningsdeltagelse. De underliggende formål var:1. At undersøge det forventede ubehag fra kolonkapselendoskopi og koloskopi på baggrund af socioøkonomisk status.2. At undersøge forskellen mellem forventet og oplevet ubehag fra kolonkapselendoskopi og koloskopi på baggrund af socioøkonomisk status. 3. At teste hvorvidt det at tilbyde screeningsinviterede valget mellem kolonkapselendoskopi og koloskopi, kunne øge den samlede screeningsdeltagelse og nedbringe sociale uligheder i deltagelse.Vi forsøgte at opnå disse mål med tre studier, som er inkluderet i denne afhandling. Alle tre studier inkluderede borgere som var inviteret til tarmkræftscreening i Region Syddanmark mellem den 3. august, 2020, og den 12. december, 2022. Individerne som blev inviteret i den periode, blev tilfældigt fordelt i to grupper. Interventionsgruppen blev tilbudt et frit valg mellem kolonkapselendoskopi og koloskopi, hvis deres afføringsprøve var positiv, hvorimod kontrolgruppen modtog almindelig invitation til tarmkræftscreening. Forsøget hed CareForColon2015 og kørte indtil 2,031 individer havde fået foretaget en kolonkapselendoskopi. Deltagere modtog spørgeskemaer i løbet af deres udredningsforløb, hvori de rapporterede deres forventede og oplevede ubehag for hver fase af deres kolonkapselendoskopier og eventuelle efterfølgende koloskopier.Studie 1: Socioøkonomiske forskelle i forventet ubehag ved koloskopi og kolonkapselendoskopiI det første studie brugte vi data fra spørgeskemaerne i CareForColon2015. Vi sammenlignede det forventede ubehag fra selve procedurerne og det overordnede ubehag ved henholdsvis kolonkapselendoskopi og koloskopi, mellem grupper med forskellig socioøkonomisk status.Vi fandt forskellige niveauer af forventet ubehag for de forskellige socioøkonomiske grupper. Sammenhængen var dog omvendt end det vi havde forventet. Det forventede ubehag ved kolonkapselendoskopi og koloskopi steg med stigende uddannelsesniveau, og i nogen grad også med stigende indtægt. Dette bakker ikke op om at forventet ubehag ved kolonkapselendoskopi og koloskopi er en større barriere for deltagelse i grupper med lav socioøkonomisk status 1.Studie 2: Socioøkonomiske forskelle i diskrepansen mellem forventet og oplevet ubehag ved koloskopi og kolonkapselendoskopi.I det andet studie brugte vi også data fra spørgeskemaerne i CareForColon2015. Vi sammenlignede det overordnede ubehag oplevet ved henholdsvis kolonkapselendoskopi og koloskopi, mellem grupper med forskellig socioøkonomisk status. Derudover sammenlignede vi forskellene mellem forventet og oplevet ubehag mellem grupperne.Som vi også så for forventet ubehag, så steg det oplevede ubehag med stigende uddannelsesniveau. Derudover fandt vi at udtømningen af tarmen havde den højeste medianværdi for oplevet ubehag af alle faserne, på tværs af begge undersøgelsestyper og socioøkonomiske grupper. Medianværdien for forskellen mellem forventet og oplevet ubehag var negativ for alle socioøkonomiske grupper. Det betyder, at i alle socioøkonomiske grupper, forventede flertallet i gruppen, mere ubehag end de faktisk oplevede2.Studie 3: Effekten af at indføre kolonkapselendoskopi i tarmkræftscreening på deltagelse og sociodemografiske uligheder: et randomiseret kontrolleret forsøg.I det tredje studie identificerede vi alle individer som var blevet inviteret til screening i Region Syddanmark i løbet af vores forsøg. Vi koblede dem med nationale registre, som indeholder individuelle sociodemografiske informationer, samt med lister over individer der har indsendt en afføringsprøve for at deltage i screening. Ved at sammenligne dem der blev tilbudt almindelig screening (kontrolgruppen), med dem der fik valget mellem kolonkapselendoskopi og koloskopi (interventionsgruppen), kunne vi undersøge effekterne på overordnet deltagelse og uligheder imellem de to strategier.Vi fandt ikke noget bevis for at interventionsstrategien kunne øge deltagelsen eller nedbringe uligheden. Faktisk var deltagelsen lavere i interventionsgruppen (63.4 %), sammenlignet med kontrolgruppen (64.9 %). Vi kan ikke konkludere hvorfor, men foreslår at det kan skyldes en overbelastning af informationer eller den ekstra beslutning der skulle træffes. Deltagelsen var lavere i alle sociodemografiske undergrupper i interventionsgruppen, sammenlignet med deres modstykker i kontrolgruppen.Konklusion og perspektivering: Forventet og oplevet ubehag ved koloskopi og kolonkapselendoskopi var ikke større i grupper med lavere socioøkonomisk status. Mønstrene vi så i vores stikprøve viste enten det modsatte eller ingen forskelle. Forskellen mellem forventet og oplevet ubehag var også større i de grupper med højere socioøkonomisk status, sammenlignet med dem med lavere. Alle deltagere der har rapporteret deres forventede og oplevede ubehag, har deltaget i screening og har indikeret at de foretrak kolonkapselendoskopi. Mønstrene for ubehag kan derfor ikke nødvendigvis generaliseres til den brede screeningsbefolkning. At tilbyde screeningsinviterede valget mellem kolonkapselendoskopi og koloskopi kunne ikke øge den overordnede screeningsdeltagelse eller nedbringe ulighederne i deltagelse i vores forsøg.Valgfri kolonkapselendoskopi synes derfor ikke at være en gangbar intervention at målrette mod ulighederne i deltagelse ved indsendelse af afføringsprøve, baseret på vores fund. Vi ved dog ikke hvad effekterne på deltagelse havde været, hvis vi havde indført kolonkapselendoskopi som standard fremfor som et tilvalg. Sådan en tilgang kunne muligvis have begrænset risikoen for overbelastning af information og/eller effekten af at skulle træffe en ekstra beslutning. Nogle individer som først deltager ved at indsende en afføringsprøve, vælger ikke at deltage ved den efterfølgende koloskopi. Kolonkapselendoskopi kan muligvis være et attraktivt tilbud til den bestemte gruppe, men det blev ikke testet i vores forsøg. Sådan en intervention, som målrettes mod specifikke undergrupper, i stedet for hele screeningbefolkningen, kan muligvis være mere effektive. Et ekstra fund fra denne afhandling var at udtømningen af tarmen bidrog med mest ubehag ved koloskopi og kolonkapselendoskopi. For individer, hvor udtømningen af tarmen er den afgørende faktor for ikke at deltage i screening, der er kolonkapselendoskopi, med dens udvidede tarmudtømning, sandsynligvis ikke den rigtige løsning.The colorectal cancer disease burden has been increasing globally for decades.By screening individuals it is possible to detect and treat early cancers, while removing the slowly progressing early precursor lesions before they become cancerous. The empirical evidence has shown that colorectal cancer screening candecrease the incidence while improving the survival of those who are diagnosedwith the disease. This has justified the introduction of colorectal cancer screening programmes throughout the world. Most of these programmes, including theone in Denmark, are challenged by inequalities in the participation between demographic and socioeconomic subgroups of the population. This raises concernas these inequalities may influence the outcomes of colorectal cancer screeningin terms of disparities in incidence and mortality. The international and nationalcriteria for implementation of screening states that such programmes should ensure equal access to the entire population. The Danish national criteria furtherstates that such programmes should provide a just distribution of utilised healthresources.The Danish colorectal cancer screening programme invites all citizens aged 50-74 biennially to submit a faecal sample. This sample undergoes a test determining the blood concentration of the stool, and if this exceeds a predeterminedthreshold, the individual is invited for a follow-up colonoscopy (investigation ofthe large bowel, through the rectum).Citizens from European countries invited for colorectal cancer screening havereported common barriers to participation such as lack of awareness, fear ofcancer, procrastination, the faecal sampling, and anxiety or fear of colonoscopyincluding the discomfort and risk of complications. It is unknown whether thebarriers related to the colonoscopy is equal among subgroups of socioeconomicstatus, but if it is more common in specific groups, it may contribute to the overall inequalities in participation.Colon capsule endoscopy is a less invasive procedure, which allows an investigation of the colon and rectum. This is done by swallowing a capsule with twocamera heads that submits pictures from the gastrointestinal tract to a receiverbelt worn around the waist. Colon capsule endoscopies are associated with lessdiscomfort, invasiveness and complications, compared to colonoscopies. However, colon capsule endoscopy requires a more extensive bowel preparation regimen and incomplete investigations, or investigations with positive findings,leads to follow-up colonoscopy.We suggested, that the inequalities in participation in colorectal cancer screening between socioeconomic subgroups might partially be caused by socioeconomic differences in an aversion to colonoscopy. Further, we suggested that introducing an offer of colon capsule endoscopy as an alternative to colonoscopy,could possibly reduce the inequalities in uptake and increase the overall participation. Aim:The overall aim of this thesis was therefore to see if we could reduce social inequalities in screening participation and increase the overall screening uptake.The underlying aims were:1. To investigate the expected discomfort from colon capsule endoscopyand colonoscopy based on socioeconomic status.2. To investigate the discrepancy between expected and experienceddiscomfort, from colon capsule endoscopy and colonoscopy based onsocioeconomic status.3. To test if offering screening invitees the choice between colon capsuleendoscopy and colonoscopy, could increase overall screening participation and decrease social inequalities in uptake.We tried to meet these underlying aims with three studies included in this thesis. All three studies included citizens invited for colorectal cancer screening inthe Region of Southern Denmark between August 3rd, 2020, and December12th, 2022. Individuals invited in that period were randomised between twogroups. The intervention group were offered a free choice between colonoscopyor colon capsule endoscopy if their faecal sample was positive, whereas thecontrol group received regular invitation to screening. The trial was namedCareForColon2015 and ran until 2,031 individuals had undergone colon capsuleendoscopy. Participants received questionnaires throughout their diagnosticcourse, in which they reported their expected and experienced discomfort specific to different stages of the colon capsule endoscopies and possible subsequent colonoscopies.Study 1: Socioeconomic differences in expected discomfort from colonoscopyand colon capsule endoscopy.In the first study, we used questionnaire data from CareForColon2015. Wecompared the expected procedural and overall discomfort from colon capsule endoscopy and colonoscopy, respectively, between groups of differing socioeconomic status.We did find different levels of expected discomfort between socioeconomic subgroups. However, the association was opposite to our hypothesis. The expecteddiscomfort from colon capsule endoscopy and colonoscopy increased with increasing educational levels and, to some extent, also with increasing income.This did not suggest expected discomfort from colonoscopy or colon capsuleendoscopy to be a greater barrier to participation in subgroups of lower socioeconomic status1. Study 2: Socioeconomic differences in discrepancies between expected and experienced discomfort from colonoscopy and colon capsule endoscopy.In the second study, we also used questionnaire data from CareForColon2015.We compared the experienced overall discomfort from colon capsule endoscopy and colonoscopy, respectively, between groups of differing socioeconomicstatus. Further, the differences between expected and experienced discomfortwas compared between the groups.As we saw for expected discomfort in the first study, the experienced discomfortin study two also increased with educational level. We further found that thebowel preparation had the highest median experienced discomfort of any stageacross both investigation types and socioeconomic subgroups. The median difference between expected and experienced discomfort was negative in all socioeconomic subgroups. This means that in all socioeconomic subgroups, themajority of individuals expected more discomfort than they actually experienced2.Study 3: The effect of implementing colon capsule endoscopy in colorectal cancer screening on participation and sociodemographic inequalities: A randomisedcontrolled trial.In the third study, we identified all individuals invited for screening in the Regionof Southern Denmark, during the course of our trial. We linked them with national registers containing individual sociodemographic information, and withlists of individuals who submitted a faecal sample to participate in screening. Bycomparing those who were offered regular screening (control group), with thoseoffered the choice between colon capsule endoscopy and colonoscopy (intervention group), we were able to investigate the effects on overall participationand inequalities between the two strategies.We found no evidence of the intervention strategy being able to increase participation or reduce inequalities. Actually, the participation was lower in the intervention group (63.4 %), compared to the control group (64.9 %). We cannotconclude why, but suggest information overload and added decision-making tohave had an impact. The participation was lower in all sociodemographic subgroups in the intervention group, compared to their counterparts in the controlgroup3.Conclusions and perspectives:Expected and experienced discomfort from colonoscopy and colon capsule endoscopy was not higher in the lower socioeconomic subgroups. The patternsseen in our sample, showed either the opposite or no differences. The difference between expected and experienced discomfort was also higher in the subgroups of higher socioeconomic status, compared to lower. All participants reporting their expected and experienced discomfort have participated in screening and indicated a preference for colon capsule endoscopy. The patterns ofdiscomfort reported, can therefore not necessarily be generalised to the generalscreening population. Offering screening invitees the choice between colon capsule endoscopy and colonoscopy, was not able to increase overall screeningparticipation or decrease social inequalities in uptake in our trial.Optional colon capsule endoscopy therefore does not seem like a viable intervention to target inequalities in participation by submitting a stool sample, basedon our findings. However, we do not know what the effects on participationwould have been, if we had implemented colon capsule endoscopy by defaultinstead of as a choice. Such a design could possibly have limited the risk of information overload and/or the effects of the additional decision-making. Someindividuals initially participating in screening by submitting a faecal sample,choose not to undergo follow-up colonoscopy. Colon capsule endoscopy mayprovide an attractive alternative offer to that select subgroup, but this was nottested in our work. Such interventions, aiming to decrease inequalities by targeting specific subgroups, rather than the entire screening population, may bemore efficient. An additional finding of this thesis was that the bowel preparationwas the key contributor of discomfort in colonoscopy and colon capsule endoscopy. In individuals, where the bowel preparation regimen is the deciding factornot to participate in screening, the colon capsule endoscopy, with its enhancedbowel preparation, does not seem like a viable solution.<br/
: Eller hvordan man skriver sig igennem et forbillede
No full textWritten in collaboration with Svend Skriver.An interpretation of a poem by the Danish author Søren Ulrik Thomsen which sees the poem in the light of its relationship to a poem by the Swedish author Gunnar Ekelöf
: Eller hvordan man skriver sig igennem et forbillede
No full textWritten in collaboration with Svend Skriver.An interpretation of a poem by the Danish author Søren Ulrik Thomsen which sees the poem in the light of its relationship to a poem by the Swedish author Gunnar Ekelöf
Intermediate outcomes for clinical trials of multiple sclerosis rehabilitation interventions: Conceptual and practical considerations
No full textBackground:Rehabilitation is an essential health care service and a critical component of comprehensive multiple sclerosis (MS) care. Objective:As part of a 2-day meeting hosted by the International Advisory Committee on Clinical Trials in MS in December 2022, a panel initiated a discussion on the conceptual and practical issues related to selecting intermediate outcomes for clinical trials of MS rehabilitation interventions. Results:The overarching goal of rehabilitation - optimal functioning - was acknowledged as a complex biopsychosocial phenomenon that varies with patient priorities and environmental context. This complexity means that multiple causal pathways and potential intermediate outcomes must be carefully considered during the design of clinical trials in MS rehabilitation that aim to improve functioning. In addition, practical issues must be considered such as psychometric properties of outcome measures, measure type, and characteristics of the target population, including severity of dysfunction. Conclusion:This article uses the International Classification of Functioning, Disability and Health as a foundation for determining relevant intermediate outcomes for clinical trials of MS rehabilitation interventions.The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: The International Advisory Committee on Clinical Trials in Multiple Sclerosis and the International Conference on Innovations in Clinical Trial Design & Enhancing Inclusivity of Clinical Trial Populations were supported by the National Multiple Sclerosis Society and the European Committee for Treatment and Research in Multiple Sclerosis. There was no involvement of the sponsors in the design, collection, analysis or interpretation of data discussed at the Conference. The opinions expressed are those of the authors. Open access was made possible by the participation of Queen’s University in the Canadian Research Knowledge Network
Inequality in participipation for colorectal cancer screening in the Region of Northern Jutland, Denmark
No full textBaggrund: Screeningsprogrammet blev indført i Danmark i 2014, og består af en indledende screening ved indsendelse af afføringsprøve, samt en opfølgende koloskopi hvis der findes blod. Dette speciale omhandler ulighed i deltagelse i indledende del af screeningen. Ulighed i deltagelse kan betyde ulighed i screeningsprogrammets effekt for nogle befolkningsgrupper. Problemformuleringen søger derfor svar på, hvordan udformning af udviklingstiltag kan mindske ulighed i deltagelse og øge den overordnede deltagelse i indledende screening, samt hvorledes disse kan implementeres og evalueres.Metode: Den metodiske ramme for dette speciale var mixed methods. I mixed methods-undersøgelsen indgik tre delundersøgelser; statistisk analyse, dokumentanalyse og semistrukturerede interviews. Udviklingstiltagene blev fremanalyseret med udgangspunkt i én samlet analyse af de tre delundersøgelser. Ved logistiske regressionsanalyser estimeredes risikoen for ikke at deltage i screening på baggrund af sociodemografiske variable. På baggrund af dette udpegedes målgruppen for tiltagene. Syv semistrukturerede interviews af deltagere i screeningsprogrammet og en dokumentanalyse bidrog til udvikling af indholdet i tiltagene. Dette ved fortolkning med Health Belief Model som teoretisk referenceramme for interviews og med inddragelse af health literacy ved dokumentanalyse. Leavitts systemmodel blev anvendt til forandringsanalyse af udviklingstiltagene, med henblik på at afdække organisatoriske påvirkninger og mulige konsekvenser ved implementering.Resultater: Ud af 93.500 inviterede borgere i 2014 og 2015 deltog 62.995 (67,37%) i den kolorektale cancerscreening. Laveste deltagelse forekom for enlige (54.2%). Multivariat logistisk regressionsanalyse viste, at enlige var i øget risiko for ikke at deltage (OR 1,63 KI95% 1,56;1,70), sammenlignet med samlevende efter justering for køn, alder, uddannelsesniveau, indkomstkvartiler og immigrationsstatus. Semistrukturerede interviews frembragte 6 kategorier: beslutning truffet på forhånd, forholdet til afsender, praktiske forhold, anvendelse af invitationsmaterialet, risikotanker og omgangskreds. Efter analyse viste fortolkning ved Health Belief Model, at grunden til ikke-deltagelse kan være manglende signaler til handling og en lav grad af refleksion. I dokumentanalysen vurderedes det, at dokumenterne ikke supplerer hinanden godt som samlet beslutningsværktøj, og at der skal foretages ændringer for at tilpasse dette.Den samlede mixed methods-analyse udmundede i fire udviklingstiltag: 1) udsendelse af forhåndsmeddelelse, 2) geografisk inddelte invitationsområder, 3) samtale med egen læge og 4) revideret invitationsbrev. Forandringsanalyse viste ændringer indenfor teknologi, struktur, aktører, opgaver og omgivelser. Evaluering kunne foretages ved procesevaluering, hvor de identificerede elementer i Leavitts systemmodel kan fungere som udgangspunkt for både proces- og evalueringsmål.Konklusion: I Region Nordjylland ses en ulighed i deltagelse mellem enlige og samlevende, idet enlige har 1,63 gange risikoen for ikke-deltagelse, sammenlignet med samlevende. Dermed opnår enlige ikke screeningsprogrammets gavnlige effekt i samme grad. Ved at give enlige flere signaler til handling og skabe øget refleksion kan deltagelsen muligvis øges og uligheden mindskes. Fire udviklingstiltag foreslås for at opnå dette; udsendelse af en forhåndsmeddelelse, revideret invitationsbrev, invitation efter geografiske områder og samtale med egen læge. Det vurderes at udviklingstiltagene vil medføre forandringer i organisationen for tarmkræftscreeningen. Effekten af tiltagene skal løbende evalueres samtidig med implementering.Background: Colorectal cancer screening was introduced in Denmark in 2014 and included an initial screening, testing for blood in a stool sample, and a following colonoscopy if blood were found. This master thesis revolved around the initial screening. Inequality in participation by sociodemographic predictors, may lead to inequalities in the benefits of participation for some subgroups. The problem statement therefore asked, how the development of interventions can reduce inequalities in participation and increase overall uptake of initial screening procedure, as well as how these interventions can be implemented and evaluated.Methods: The methodological framework for this thesis is mixed methods. In the mixed methods study, three substudies are included; statistical analysis, document analysis and semi-structured interviews. Interventions were developed, using a combined analysis of the results from the substudies. Using logistic regression analyses, the risk of non-participation, were estimated for each sociodemographic variable. From this a target population was found. Seven semi-structured interviews with participants and a document analysis contributed to the substance of the interventions. This was done by interpreting the results, using the Health Belief Model as theoretical framework. Leavitt’s diamond was applied, in an analysis of change, to uncover organisational changes and consequences of intervention implementation.Results: From 93,500 invited citizens, 62,995 (67.37%) participated in colorectal cancer screening. Single individuals had the lowest participation proportion (54.2%). Logistic regression analyses showed that singles had an increased risk of non-participation (OR 1.63 CI95% 1.56;1.70), compared to individuals with a registered partner, after adjustment for gender, age, educational level, income and immigration status. Semi-structured interviews resulted in six categories: Decision made previous to invitation, relation to sender, practical circumstances, use of the invitation material, thoughts of risk, and social circle. Interpretation of interviews, using the Health Belief Model, showed that non-participation could be due to a lack of cues to action and limited reflections. The document analysis assessed that the documents did not supplement each other well as a combined decision aid and alterations are therefore needed.The overall mixed methods analysis resulted in four intervention strategies: 1) distribution of an advance notification letter, 2) inviting geographical areas simultaneously, 3) general practitioner involvement and 4) revised invitation letter. The analysis of change resulted in changes in technology, structure, people, tasks and surroundings. Evaluation could be conducted using process evaluation, in which the identified elements from Leavitt’s diamond could be incorporated as evaluator measures, for both process- and implementation goals.Conclusion: Inequality in participation was evident in the region of Northern Jutland, Denmark, as singles had a 1.63-fold risk of non-participation, compared to individuals with a registered partner. Thereby singles do not obtain the benefits of screening, to the same extend. By giving singles additional cues to action and enhancing reflections, the overall uptake may be increased and inequality decreased. Four interventions were suggested to accomplish this. These interventions will cause organisational changes. The effects of the interventions must be evaluated continuously while implementation is occurring
Generation hvad og hvorfor?
No full textAbstract This report is a literary project which deals with five collections of poems written by writers, who are all considered as being part of the designation “Generation Ethic” (Generation Etik). The collections of poems are: det nemme og det ensomme of Asta Olivia Nordenhof, Jeg æder mig selv som lyng of Olga Ravn, Mörkhall of Rasmus Halling Nielsen, I civil of Amalie Smith and Atlanterhavet vokser of Julie Sten-Knudsen. The designation Generation Ethics has emerged in connection with an article in the newspaper Information, where among others lecturer in Literature at Lund University state that, the above-mentioned authors express a so-called ethical obligation to the world and a political consciousness, through their collections of poems. The article has contributed to a debate on, for example the literary blog Promenaden and furthermore caused a string of other articles regarding the subject to be written, whereas some of them are written by the authors themselves. It is discussed whether the so-called Generation Ethics-authors write innovatory literature, and whether or not they can be categorized as a generation. Additionally it is discussed if it is the ethical and political aspect they have in common, or if it is in fact something else, that connects the authors. The report will through a thorough analysis of each of the collections of poems explore, what connects the authors – focus will be on the body and family as general themes and authenticity as a general stylistic device. The report is based on Hans-Georg Gadamers philosophical hermeneutics and David Perkins’ book Is literary history possible?, where Perkins ideas regarding literary history is portrayed, and where he also outlines how literature can be classified. The report will in addition, with inspiration from the Danish author Søren Ulrik Thomsen and his essay Farvel til det blå rum from 1990 explore, to what extent the collections of poems can portray the society, in which they are written in. Through Wittgensteins family resemblance theory the report will explore if the body, family and authenticity can be looked at as family resemblances throughout the collections of poems, and if there are enough family resemblances in order to characterize the Generation Ethics-authors as generation. Last but not least the report contains a discussion on whether or not Generation Ethics is the right name for the authors, or if it should in fact be, based on the focus in the analysis – the body, family and authenticity – called something else.Abstract This report is a literary project which deals with five collections of poems written by writers, who are all considered as being part of the designation “Generation Ethic” (Generation Etik). The collections of poems are: det nemme og det ensomme of Asta Olivia Nordenhof, Jeg æder mig selv som lyng of Olga Ravn, Mörkhall of Rasmus Halling Nielsen, I civil of Amalie Smith and Atlanterhavet vokser of Julie Sten-Knudsen. The designation Generation Ethics has emerged in connection with an article in the newspaper Information, where among others lecturer in Literature at Lund University state that, the above-mentioned authors express a so-called ethical obligation to the world and a political consciousness, through their collections of poems. The article has contributed to a debate on, for example the literary blog Promenaden and furthermore caused a string of other articles regarding the subject to be written, whereas some of them are written by the authors themselves. It is discussed whether the so-called Generation Ethics-authors write innovatory literature, and whether or not they can be categorized as a generation. Additionally it is discussed if it is the ethical and political aspect they have in common, or if it is in fact something else, that connects the authors. The report will through a thorough analysis of each of the collections of poems explore, what connects the authors – focus will be on the body and family as general themes and authenticity as a general stylistic device. The report is based on Hans-Georg Gadamers philosophical hermeneutics and David Perkins’ book Is literary history possible?, where Perkins ideas regarding literary history is portrayed, and where he also outlines how literature can be classified. The report will in addition, with inspiration from the Danish author Søren Ulrik Thomsen and his essay Farvel til det blå rum from 1990 explore, to what extent the collections of poems can portray the society, in which they are written in. Through Wittgensteins family resemblance theory the report will explore if the body, family and authenticity can be looked at as family resemblances throughout the collections of poems, and if there are enough family resemblances in order to characterize the Generation Ethics-authors as generation. Last but not least the report contains a discussion on whether or not Generation Ethics is the right name for the authors, or if it should in fact be, based on the focus in the analysis – the body, family and authenticity – called something else
Day-to-day reliability, agreement and discriminative validity of measuring walking-related performance fatigability in persons with Multiple Sclerosis
No full textBackground: Day-to-day reliability and cut-off values to detect abnormal walking fatigability (WF)
remain to be investigated in persons with multiple sclerosis (pwMS).
Methods: In all, 49 pwMS (mean Expanded Disability Status Scale (EDSS) ± standard deviation (SD):
3.3 ± 1.9) and 28 matched healthy controls (HC) performed the six-minute walking test (6MWT) on two
different days to determine day-to-day reliability (intraclass correlation coefficient (ICC)) and limits of
agreement (LOA) for five different equations of WF.
Objective: To examine day-to-day reliability, agreement and discriminative validity for measuring WF.
Results and conclusion: WF expressed as the ratio between the first and sixth minute had the best day-to-day
reliability (ICC’s range of 0.76–0.95 and 0.60–0.86, respectively) in both pwMS and HC, while LOA were
15% and 7%, respectively. Ecological validity and clinical importance should be further investigated.The author(s) received no financial support for the research, authorship, and/or publication of this article
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