Peer-to-peer sharing in public health interventions: strategies when people share health-related personal information on social media.

PURPOSE: As sharing on social media has become an integrated part of everyday life, health and public health actors have started to show interest in the potential of people's peer-to-peer sharing of health-related personal information (HRI) for health interventions. In this article we focus on how people make sense of sharing HRI on social media. METHODS: Twenty-two people between the ages 40 and 60 who had taken part in a regional health intervention were interviewed. Using theories about social media sharing, we explore their understandings and negotiations about whether, how much, and how to share HRI and discuss the results in relation to peer-to-peer sharing as a strategy in interventions. RESULTS: We identified three aspects that were perceived as particularly risky: loss of control, effects on identity, and affecting others negatively, along with strategies that were used to manage risks in practice: avoiding sharing, allocating, and embedding HRI. CONCLUSIONS: By allocating and embedding HRI, people can unlock motivating affordances for health work. However, strategies to manage risks can also be counterproductive. For actors to provide equality in health promotion, initiatives that include social media sharing need to be mindful of the sometimes counterproductive effects this may have on people's engagement.

Sustainable Behavior Change for Health Supported by Person-Tailored, Adaptive, Risk-Aware Digital Coaching in a Social Context: Study Protocol for the STAR-C Research Programme.

Introduction: The Västerbotten Intervention Programme (VIP) in the Region Västerbotten Sweden is one of the very few cardiovascular disease (CVD) prevention programmes globally that is integrated into routine primary health care. The VIP has been shown as a cost-effective intervention to significantly reduce CVD mortality. However, little is known about the effectiveness of a digital solution to tailor risk communication strategies for supporting behavioral change. STAR-C aims to develop and evaluate a technical platform for personalized digital coaching that will support behavioral change aimed at preventing CVD. Methods: STAR-C employs a mixed-methods design in seven multidisciplinary projects, which runs in two phases during 2019-2024: (i) a formative intervention design and development phase, and (ii) an intervention implementation and evaluation phase. In the 1st phase, STAR-C will model the trajectories of health behaviors and their impact on CVDs (Project 1), evaluate the role of the social environment and social networks on behavioral change (Project 2) and assess whether and how social media facilitates the spread of health information beyond targeted individuals and stimulates public engagement in health promotion (Project 3). The findings will be utilized in carrying out the iterative, user-centered design, and development of a person-tailored digital coaching platform (Project 4). In the 2nd phase, STAR-C will evaluate the implementation of the coaching programme and its effectiveness for promoting behavioral change and the spreading of health information across social networks and via social media (Project 5). The cost-effectiveness (Project 6) and ethical issues (Project 7) related to the coaching programme intervention will be evaluated. Discussion: The STAR-C research programme will address the knowledge and practice research gaps in the use of information technologies in health promotion and non-communicable disease (NCD) prevention programmes in order to narrow the health inequality gaps. Ethics: STAR-C has received approval from the Swedish Ethical Review Authority (Dnr. 2019-02924;2020-02985). Dissemination: The collaboration between Umeå University and Region Västerbotten will ensure the feasibility of STAR-C in the service delivery context. Results will be communicated with decision-makers at different levels of society, stakeholders from other regions and healthcare professional organizations, and through NGOs, local and social media platforms.

Reopening elite sport during the COVID-19 pandemic: Experiences from a controlled return to elite football in Denmark.

As the SARS-CoV-2 infection rate decreased in spring 2020, phased reopening of Danish society began, including a reopening of elite football (soccer), adhering to a strict protocol. In this study, we report the consequences of resumption of competitive play in the two best football (soccer) leagues for men in Denmark measured by number of SARS-CoV-2 positive players. The players were tested weekly for SARS-CoV-2 for 11 consecutive weeks. The test protocol comprised 26 teams with 748 players. In total, 6511 tests were done with a positivity rate of 0.06%. The incidence rate of players testing positive for SARS-CoV-2 was 0.53% (4/748). There were no signs of a chain of infection. We found a low incidence rate of SARS-CoV-2, and based on this, a controlled reopening of professional football strictly following a detailed protocol appears safe for the players.

Older people and rural eHealth: perceptions of caring relations and their effects on engagement in digital primary health care.

BACKGROUND: The aim of this article is to describe older people's perceptions of caring relations in the context of rural eHealth, as well as to explore how such relations can facilitate engagement in digital primary health care. There is an ongoing implementation of eHealth in Western health care, and rural areas and older people are specifically targeted. eHealth is said to be a solution to emergent problems and a technology that will facilitate people's opportunities to achieve good and equal health. From this perspective, it is crucial that older people engage in eHealth services, but there are barriers for use, and care providers need to adapt to the preferences of older people. METHODS: Semi-structured interviews with 19 individuals aged 61-85 were conducted. The participants were using digital services at two primary healthcare centres located in northern Sweden. Qualitative content analysis was used. An important theoretical tenet was that older people's perceptions of and engagements in eHealth are affected by the specific rural conditions. Ethical approval for the study has been obtained. RESULTS: The analysis rendered a total of three themes: in-person interaction was central to people's perceptions of good caring relations; patient-nurse relations were particularly emphasised; and caring relations in rural eHealth appeared to be multi-directional and fuelled by a shared sense of rural community. Altogether, this facilitated participants' engagement in local eHealth initiatives. CONCLUSIONS: eHealth is an opportunity for primary health care and for rural communities. However, the results provide insight into matters that can affect the quality, access, and equality of rural primary health care. Participants' engagement in eHealth was almost always facilitated by close caring relations with local Registered Nurses. Digital care needs to be approached as a combination of digital and in-person presence. Separating digital and physical task assignments among different personnel could make older people refrain from seeking health care.

Rotavirus is frequent among adults hospitalised for acute gastroenteritis.

INTRODUCTION: Rotavirus infection is the most common aetiology of acute gastroenteritis (AGE) among young children. In adults, diagnostics focus mainly on bacterial causes, though recent studies suggest that rotavirus is a frequent agent. The aim of this study was to examine the proportion of rotavirus in adults hospitalised with AGE and to identify possible predictors. METHODS: During a 24-month period from 1 May 2010 adults (> 15 years) with AGE admitted to one of four hospitals in the Central Denmark Region were examined for rotavirus with VIKIA Rota-Adeno rapid test in addition to routine culture for bacterial pathogens. RESULTS: A total of 265 adult patients were included. 9.4% tested positive for rotavirus. Enteropathogenic bacteria were found in 24.5% of the cases. In the majority of cases (62.3%), no pathogen was found. Overall, rotavirus was the second-most frequent pathogen, exceeded only by Campylobacter spp. Immunosuppression and a C-reactive protein (CRP) below 50 mg/l (0-8 mg/l) were associated with rotavirus. The seasonality of rotavirus differed markedly from that of bacterial gastroenteritis. CONCLUSION: Rotavirus is the second-most frequently identified pathogen in adults hospitalised with AGE. Close contact to children or travel activity does not predict rotavirus gastroenteritis, but immunosuppression and a CRP below 50 mg/l do. The seasonality of rotavirus differs from that of bacterial gastroenteritis, making rotavirus the most frequently identified cause of AGE in adults admitted to hospital in the colder months. FUNDING: The trial was funded by an unrestricted grant from Sanofi Pasteur MSD. TRIAL REGISTRATION: not relevant.

The Danish PEP Registry: Experience with the use of post-exposure prophylaxis following blood exposure to HIV from 1999-2012.

BACKGROUND: The risk of occupational exposures to blood cannot be eliminated completely and access to post-exposure prophylaxis (PEP) to prevent HIV transmission is important. However, PEP administration has been associated with frequent adverse effects, low compliance and difficulties to ensure a proper risk assessment. This nationwide study describes 14 years of experience with the use of PEP following blood exposure in Denmark. METHODS: A descriptive study of all PEP cases following non-sexual exposure to HIV in Denmark from 1999-2012. RESULTS: A total of 411 cases of PEP were described. There was a mean of 29.4 cases/year, increasing from 23 cases in 1999 to 49 cases in 2005 and then decreasing to 16 cases in 2012. Overall 67.2% of source patients were known to be HIV-positive at the time of PEP initiation, with no significant change over time. The median time to initiation of PEP was 2.5 h (0.15-28.5) following occupational exposure. Adverse effects were reported by 50.9% with no significant difference according to PEP regimen. In 85.1% of cases with available data, either a full course of PEP was completed or PEP was stopped because the source was tested HIV-negative. Only 6.6% stopped PEP early due to adverse effects. CONCLUSIONS: PEP in Denmark is generally prescribed according to the guidelines and the annual number of cases has declined since 2005. Adverse effects were common regardless of PEP regimens used and new drug regimens should be considered.

Clinical findings in a multi-ethnic adult hepatitis B virus patient population in Denmark with emphasis on genotypic characteristics.

OBJECTIVE: Most knowledge about chronic hepatitis B virus (HBV) infection is based upon studies in high-endemic areas with one or two predominant genotype(s). The aim of the study was to describe clinical characteristics of a heterogeneous genotypic HBV patient population in a low-endemic European country. METHODS: Data from HBV patients currently followed in a Danish university hospital and affiliated regional clinics were reviewed in accordance to genotype status. RESULTS: Of 540 HBV patients, 462 (86%) were of non-Danish ethnicity originating from 43 different countries. HBV genotype was known in 37% of the patients: A (11%), B (25%), C (25%), D (37%) and E (2%). Logistic regression analysis of pre-treatment data among genotype A-D patients receiving nucleos(t)ide analogue (NA) therapy revealed a decreased HBeAg rate by age (OR = 0.93; CI: 0.89-0.97; p < 0.01) and an increased rate in genotype C patients (OR = 20.5; CI: 3.3-129; p < 0.01). Among untreated patients HBeAg rate was also significantly decreased by age (OR = 0.90 (0.85:0.95; p < 0.0001), whereas the rate was increased in both genotype B and C patients (OR = 7.5; CI: 1.8-30.5; p < 0.01 and OR = 12.2; CI: 3.2-46.6; p < 0.001, respectively). No significant variation was found in HBV DNA level in any of the two groups when adjusting for age, gender, genotype and HBeAg. Increased liver pathology prevalence was, irrespectively of treatment status, associated to age and male gender, but not to any genotype. CONCLUSION: In this study population, genotype B and C was found associated with higher HBeAg rate but not with increased liver pathology.

[Life-threatening appendicitis caused by Fusobacterium necrophorum].

Fusobacterium necrophorum is a well-known cause of Lemierre's syndrome. Recent studies suggest a causative association between F. necrophorum and acute appendicitis. We present a case of a 15-year-old previously healthy girl who presented with acute non-perforated appendicitis, intra-abdominal abscesses and thrombosis that led to omental necrosis. This resulted in a life-threatening septic shock with the need for prolonged intensive care. We suggest that F. necrophorum identified in pus from the abdomen caused this fulminant variation of appendicitis with findings similar to those seen with Lemierre's syndrome.

[Septic arthritis caused by Streptococcus suis]. / Septisk artritis forårsaget af svinestreptokokker.

Streptococcus suis is a global endemic swine pathogen. S. suis can cause meningitis, endocarditis and severe sepsis in humans, who are exposed to swine. Human infection with S. suis was first reported in 1968, since then, human infections have been sporadic although an outbreak in China counted 215 cases. In a rare case of disseminated arthritis we found that correct clinical diagnosis was difficult due to unspecific symptomatology and slow growing bacterial culture. However, conducting thorough examinations is crucial, and if treated correctly the outcome is favourable.

[Rickettsiosis should be considered as a differential diagnosis in patients having fever related to travelling]. / Rickettsiose som differentialdiagnostisk overvejelse ved rejserelateret feber.

Rickettsial diseases are increasingly reported in international travellers. Prospective studies have shown that 2-4 % of travellers returning with fever have a rickettsiosis. We discuss epidemiology, clinical findings, diagnostics, treatment and prevention of rickettsiosis. In conclusion, rickettsiosis should be considered in the returned traveller with fever, especially when malaria, dengue fever and typhoid fever have been excluded. There is a possibility that doxycycline may have a prophylactic effect on rickettsiosis, but this thesis is only imaginary and needs further investigation.

[Rickettsiosis is a neglected cause of fever in returned travellers]. / Rickettsiose er en overset årsag til feber hos hjemvendte rejsende.

We present two cases of rickettsial infections in travellers caused by Rickettsia typhi and R. africae respectively. The two cases illustrate the widely varying symptomatology and aetiology. Incidence and treatment of the disease are discussed. The diagnosis is complex, and we believe that rickettsiosis is an underestimated cause of fever in returned travellers from the tropics. In the past two years only 26 cases have been diagnosed in Denmark. Whenever rickettsiosis is clinically suspected, empiric treatment with doxycycline should be initiated.

Toxic shock syndrome: A rare complication to enhanced external counterpulsation.

Enhanced external counterpulsation (EECP) is known to reduce angina pectoris in patients in whom revascularization is not possible. The therapy is associated with few adverse effects. A case with a previously unknown complication - toxic shock syndrome - that occurred twice in an EECP-treated patient is described. Toxic shock syndrome initially resembles the state of septic shock. Early recognition of the syndrome and initiation of therapy is of vital importance to prevent rapid progression and a possibly fatal outcome. Awareness of this condition among cardiologists offering EECP is essential.

The Danish PEP registry: experience with the use of postexposure prophylaxis (PEP) following sexual exposure to HIV from 1998 to 2006.

BACKGROUND: Studies indicate that antiretroviral postexposure prophylaxis (PEP) after sexual exposure to HIV reduce the risk of infection considerably. Since 1998 PEP after sexual HIV exposure within the preceding 24 hours, has been available in Denmark. PEP can only be prescribed at clinical centers with specialists experienced in HIV treatment. The objective of this study is to describe the use of PEP after sexual exposure from 1998 to 2006. METHODS: The Danish PEP registry collects data from all cases of PEP use in Denmark after exposure to HIV through a structured questionnaire. RESULTS: There were 374 cases of PEP use after sexual exposure. The incidence increased from 5 cases in 1997 to 87 in 2006. PEP was used by heterosexuals (40%) as well as men who have sex with men (57%). The HIV-status of the source was unknown in 41% of the cases of which 90% involved a source belonging to a high risk group, and 63% involved exposure by receptive anal intercourse. PEP was administered within 24 hours in 95% of the cases and the median time to initiation (N = 225) was 11.0 hours (range 0.5-60.0). PEP was completed by 65%. CONCLUSIONS: This nationwide study showed a steady but moderate increase in the use of PEP after sexual HIV-exposure from 1998 to 2006. Time to initiation of PEP was low and the PEP prescription practice was targeted toward high risk exposures.

[Hepatitis E transmission in Denmark]. / Transmission af hepatitis E i Danmark.

A case of acute hepatitis due to hepatitis E virus genotype 3 was diagnosed by serology and genomic sequencing. Phylogenetic analysis demonstrated a strain identical to one isolated from a Swedish pig, which supports the hypothesis that swine serves as reservoirs for HEV infection. The patient did not have any recent travel history, had experienced no contact with animals and the origin of the infection remained unknown. We emphasize that health personnel should be aware of acute hepatitis E even among patients without a travel history.

[Leptomeningeal carcinomatosis--an infrequent cause of hearing loss]. / Leptomeningeal karcinomatose--en usaedvanlig årsag til høretab.

The causes of acquired hearing loss may be many. We present a case of sudden onset of bilateral sensorineural hearing loss due to leptomeningeal carcinomatosis. The most common clinical features and typical CSF changes are reviewed, and the potential difficulties in reaching the diagnosis are discussed. Modes of therapy and prognosis are briefly mentioned.

Liver biopsy performance and histological findings among patients with chronic viral hepatitis: a Danish database study.

We investigated the variance of liver biopsy frequency and histological findings among patients with chronic viral hepatitis attending 10 medical centres in Denmark. Patients who tested positive for HBsAg or HCV- RNA were retrieved from a national clinical database (DANHEP) and demographic data, laboratory analyses and liver biopsy results were collected. A total of 1586 patients were identified of whom 69.7% had hepatitis C, 28.9% hepatitis B, and 1.5% were coinfected. In total, 771 (48.6%) had a biopsy performed (range 33.3-78.7%). According to the Metavir classification, 29.3% had septal fibrosis (> or =F2) and 13.9% had cirrhosis (F4). The frequency of cirrhosis varied from 8.3 to 18.6% among centres, and was independently associated with age, male gender, elevated alanine-aminotransferase (ALT) and non-Danish origin. Among 141 patients with hepatitis C and known duration of infection, cirrhosis had developed in 23% after 20 y of infection. Age above 40 y was a better predictor of cirrhosis than elevated ALT. National database comparison may identify factors of importance for improved management of patients with chronic viral hepatitis.

Incidence of pneumococcal endocarditis: a regional health register-based study in Denmark 1981-1996.

The aim of this study was to determine the incidence of pneumococcal endocarditis in 3 Danish counties. By linking the National Hospital Discharge Registry to regional blood culture registries maintained by the Department of Clinical Microbiology and autopsy registries from the Department of Pathology, a total of 31 cases of pneumococcal endocarditis was identified in the 3 counties during a period of 16 y (1981-1996). One patient experienced 2 independent episodes as determined by serotyping. The annual incidence increased approximately 4-fold during the study period, giving an overall incidence rate of 0.15 per 100,000 inhabitants. Pneumococcal endocarditis was diagnosed in 1.2% of cases of pneumococcal bacteraemia. Some cases may have remained undetected, and this underlines the need for clinical attention to this diagnosis. The study confirms that linkage of health registries is a valid method of conducting surveys of uncommon diseases.

Incidence and short-term prognosis of infective endocarditis in Denmark, 1980-1997.

Infective endocarditis is a serious bacterial infection, but there are relatively few data about its occurrence and prognosis. The incidence rate, 30-d case fatality and mortality rate of infective endocarditis were estimated in this registry-based cohort study. The Danish National Registry of Patients was used to estimate national incidence rates, and information on the date of death was obtained through linkage to the Civil Registration System. The study included 3351 patients with infective endocarditis from 1980 to 1997. The incidence rate for men increased from 4 to 6 per 100,000 person-years, and for women from 3 to 4 per 100,000 person-years. The mean incidence rate varied from 1.5 per 100,000 person-years in women younger than 50 y to 15.5 in men older than 70 y. The incidence increased in most age groups but was most pronounced in younger men. The overall 30-d case fatality rate of 23% increased with age and decreased with calendar time. The mean mortality rate was 0.94 per 100,000 y and decreased in the study period in most age groups. There was an increasing incidence of infective endocarditis and an improvement in the prognosis.