Central Denmark Region

Loneliness is associated with adverse physical and mental health outcomes. It affects individuals across all age groups and geographical regions. To characterise the extent that WHO Member States address loneliness, social isolation and social connection through national policies. We searched government websites using key terms. A matrix was used to extract data, followed by in-depth document analysis. By February 2025, only eight WHO Member States (Denmark, UK (England, Scotland, Wales), Finland, Germany, Netherlands, Sweden, Japan, USA) had policies directly addressing loneliness, social isolation or social connection. Policymakers validated the findings. Common policy aims included building a more connected society, addressing loneliness as a wider societal challenge rather than just an individual issue, and supporting both individuals and organisations to manage loneliness. Key recommendations in these policies often highlighted the need to increase knowledge through research, raise public awareness to reduce stigma, promote cross-sectoral collaboration, integrate loneliness into government policy and implement community-based approaches. National policies emerged following societal activism, initiatives from government departments or a large-scale research project. Various policies are in place to help address loneliness at the national level. To maximise impact, policies require adequate funding. To date, none of the national policies had undergone rigorous evaluation concerning their effectiveness. This review highlights the growing political focus on loneliness and provides a starting point for those seeking to understand, develop or strengthen national strategies to address loneliness, social isolation or social connection.

Background: Remote ischemic conditioning (RIC) initiated in the prehospital setting did not improve functional outcome at 90 days in patients with acute stroke in the RESIST trial. Trials of other neuroprotective therapies have identified the duration of treatment received prior to reperfusion (“dwell time”) as a treatment effect modifier. We examined whether the effects of RIC might be modified by the duration of prehospital treatment that patients received. Methods: In this post-hoc analysis of the RESIST randomized-controlled trial (Clinicaltrials.gov: NCT03481777), we compared outcomes in patients with prehospital stroke symptoms for less than 4 hours, assigned to RIC versus sham, and diagnosed with acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) – the modified intention-to-treat (mITT) population – stratified by time from randomization to hospital admission (i.e. prehospital treatment duration). The primary outcome was improvement in the ordinal 90-day modified Rankin Scale (mRS) score. Secondary outcomes included 90-day mRS 0-2 and neurological improvement according to the National Institutes of Health Stroke Scale (NIHSS) at 24-hours. Results: Among 902 patients in the mITT population with AIS (n=737) and ICH (n=165), the median randomization-to-admission time was 29.4 minutes (IQR 19.6-39.4 minutes). Upon examining the effect of RIC treatment by pre-hospital treatment duration, there were no significant treatment effects in either the combined mITT, ICH, or AIS groups in any of the transport time groups. Further stratifying patients with AIS based on receipt of reperfusion therapies also revealed no significant differences in RIC efficacy across time. There was no interaction between RIC and pre-hospital treatment duration in relation to 90-day mRS or early NIHSS improvement in the AIS or ICH populations. Conclusion: Longer prehospital treatment duration was not associated with efficacy of RIC in patients with AIS or ICH in the RESIST trial including among AIS patients who received reperfusion therapies, although durations were generally under an hour.

Powered 2-wheeler (PTW) riders are a highly vulnerable road-user group who frequently require helicopter emergency medical services (HEMS) for critical care and transport. This study aimed to describe the population of injured PTW riders attended by the Danish Air Ambulance and compare them with the wider Danish HEMS trauma population. This was a retrospective population-based study of Danish HEMS missions from January 1, 2018, to December 31, 2023, including all primary missions involving a PTW patient. Data were collected from the Danish HEMS database on patient demographics, vehicle type, interventions performed, and destination. We also registered International Classification of Diseases, 10th edition, diagnoses and National Advisory Committee for Aeronautics (NACA) scores. A total of 228 patients (90% male) were included. The most common diagnosis was unspecified multiple injuries (49%), indicating polytrauma. Significant differences were noted between vehicle types: 58% of injured motorcyclists were involved in accidents with another vehicle, whereas 59% of scooter rider incidents were single vehicle. Notably, 67% of PTW patients were assigned a NACA score of ≥4, and 71% required at least 1 prehospital intervention. Most were transported to a major trauma center (MTC) (85% of motorcyclists vs. 76% of scooter riders). Compared with the general Danish HEMS trauma population, PTW patients had higher NACA scores, were more likely to be conveyed to MTCs, and more frequently required prehospital interventions. PTW riders attended to by the Danish Air Ambulance represent a severely injured patient cohort who more frequently require advanced prehospital treatment and transport than the wider trauma population.

Background Out-of-hours primary care (OOH-PC) plays a key role in initial stroke triage, yet the accuracy of telephone assessments by general practitioners (GPs) and their impact on prehospital stroke care remain insufficiently studied. Aims To evaluate the sensitivity of stroke and transient ischemic attack (TIA) identification by GPs during OOH-PC telephone triage and examine associations with time from first call to admission, treatment rates, and admission pathways. Patients and methods We conducted a retrospective cohort study including patients admitted to stroke centers in the Central Denmark Region (2020–2022) following OOH-PC contact within 48 h. Triage classification was based on GP documentation and compared with final hospital diagnoses. Outcomes included triage sensitivity, intravenous thrombolysis (IVT) rates, and time to admission. Results Among 4414 patients, 2738 had a final diagnosis of stroke or TIA, of whom 1728 were triage positive, corresponding to a sensitivity of 63.1% (95% CI, 61.2–64.9). Among patients with acute ischemic stroke (AIS) and symptom onset ≤3 h before OOH-PC contact, 387 of 544 were identified (71.1%, 95% CI, 67.2–74.8). Triage-positive AIS patients had higher IVT rates (adjusted difference: 8.9%, 95% CI, 5.4–12.5) and shorter call-to-admission time. In early-presenting AIS, the adjusted IVT difference was 10.9% (95% CI, 1.4–20.5), and triage-negative patients more often presented with impaired consciousness and visual symptoms. Conclusions GPs demonstrated moderate sensitivity in telephone triage of stroke in OOH-PC. Symptom presentation differed between triage groups, suggesting recognition may be influenced by symptom type as well as time from onset.

BackgroundLong COVID affects patients’ daily functioning and activity participation. However, gender-specific differences remain insufficiently explored despite well-documented effects of gender on health outcomes. This study examines gender differences in sociodemographic characteristics, employment status, sick leave, and mental fatigue among individuals with long COVID. Furthermore, this study explores self-reported and prioritised problems with activities of daily living (ADL) across genders and compares patterns between women and men. We hypothesised that traditional gender roles would manifest in distinct challenges for women and men.MethodsWe included 780 individuals (567 women and 213 men) diagnosed with long COVID who were referred to occupational therapy at a Danish outpatient clinic for long COVID. Sociodemographic characteristics, employment status, and sick leave were self-reported. Mental fatigue was assessed using the Mental Fatigue Scale, and ADL problems using the Canadian Occupational Performance Measure. A qualitative deductive content analysis was conducted to further categorise prioritised ADL problems.ResultsA higher proportion of women than men had higher education (55% vs. 37%). No statistically significant gender difference was seen in the prevalence of sick leave (57% vs. 50%). Moderate to severe mental fatigue was reported by 78% of women and 68% of men, with women reporting significantly higher fatigue (p < 0.001). Minor gender differences in ADL problems were observed, with more women reporting difficulties in household management, quiet recreation, and social interaction. Both women and men prioritised similar ADL problems, such as paid work, physical activity, social interaction, and fulfilling caregiving roles.ConclusionADL challenges reported by women and men were largely similar and had a significant impact on their daily lives. Identifying key activity limitations is essential to inform effective rehabilitation strategies.

Automated external defibrillators (AEDs) have the potential to save lives when used during cardiac arrest. While most cardiac arrests occur at home, there is limited evidence for AED use in private homes. To determine whether AEDs in private homes are effective and cost-effective. This cohort study used observational data from the Cardiac Arrest Registry to Enhance Survival in the US from January 2017 to December 2024 to determine the effectiveness of AEDs when used for cardiac arrests in private homes. A difference-in-difference approach was used to determine the causal relationship between AED application and survival to hospital discharge. A decision-analytic model was then created to evaluate the cost-effectiveness of purchasing an AED in a private home in the US. Application of an AED. Survival to hospital discharge and cost-effectiveness. Of 582 536 included patients, 359 809 (61.8%) were male, and the median (IQR) age was 65 (52-76) years. Survival was better with AED application compared with no AED application in patients with a shockable rhythm (risk ratio, 1.26; 95% CI, 1.01-1.57) but not in those with a nonshockable rhythm (risk ratio, 1.00; 95% CI, 0.68-1.46). Results were consistent in the difference-in-difference analysis. The incremental cost-effectiveness ratio for an AED in a private home was $4 481 659 per quality-adjusted life-year. At a cost-effectiveness threshold of $200 000 per quality-adjusted life-year, AEDs in private homes would be considered cost-effective at a yearly cardiac arrest incidence per person above 1.3% or at an AED cost less than $65 (not including bystander training cost). In this study, AEDs in private homes were effective at improving outcomes for patients with cardiac arrest and a shockable rhythm. Given the relative rarity of cardiac arrest at a given home, general purchase of AEDs for individual private homes cannot be considered cost-effective at the current pricing of AEDs.

Background: Secretin, traditionally considered a gastrointestinal hormone, has recently been shown to elicit a substantial modulatory effect on renal glomerular filtration mediated through dilation of the efferent arteriole. Congruently, loss of the receptor leads to glomerular hyperfiltration, a condition that entails irreversible kidney damage over time. This study aims to investigate whether secretin and its receptor play a role in the development of renal disease. Methods: The effects of an abolished secretin response on kidney and cardiovascular function were investigated using the secretin receptor (SCTR) KO mice. SCTR KO and WT mice were examined during normal ageing and after subjection to a hypertensive and a western diet challenge. Changes in renal and cardiovascular function were assessed via transcutaneous GFR, blood pressure, echocardiography, urine and blood analysis, western blotting and tissue staining. Results: Under baseline conditions, SCTR KO and WT mice had similar blood pressure and cardiac function. KO mice had elevated GFR when young but showed a marked age-dependent GFR decline compared to WTs. In kidney tissue from 1-year-old KO and WT mice, KOs had elevated mRNA levels of collagen 1a1 and collagen 3, indicative of ongoing renal fibrosis and damage. Concordantly, KOs had significantly elevated protein levels of aSMA and fibronectin on western blot. When challenged with a Western diet, both KOs and WTs developed proteinuria, and the KOs became hypertensive while the WTs remained normotensive. Data from the hypertensive challenge is pending. Conclusion: Based on the results, SCTR KO mice exhibit a phenotype indicative of progressive renal disease. The phenotype progresses with normal ageing and is slightly exacerbated by a dietary challenge. Further in vivo and ex vivo experiments have commenced, expanding on the current findings.