A three-year national follow-up study on the development of community-level cancer rehabilitation in Denmark.

Aims: Scandinavian cancer care policies emphasise community-level rehabilitation services, but little is known about changes in service provision over time. This follow-up study explores development in these services in Danish municipalities, focusing on availability, utilisation and organisation of services, including existing opportunities and challenges. Methods: A national survey among all 98 Danish municipalities was conducted in 2013 (baseline) and repeated in 2016 (follow-up). The electronic questionnaire comprised closed- and open-ended questions. Data were analysed using descriptive statistics and content analysis. Results: A total of 93 municipalities responded (95% response rate) and the services offered primarily comprised group physical activity, dietary advice, smoking cessation and individual counselling on physical activity. The number of patients enrolled was below the estimated number needing rehabilitation in Denmark. Inequality in utilisation by ethnicity, age and gender was reported. Key challenges for the delivery of services were: inadequate referral and recruitment procedures; lack of needs assessment tools; obstacles to ensuring collaboration and referral of patients between hospitals and municipalities; and inadequate evidence on the rehabilitation's effect. Key recommendations include ensuring collaboration between municipalities; provision of diagnosis-specific group-based activities; services focusing on physical activity; and gender-specific activities directed particularly at men. Conclusions: This study, which highlights improvements in the provision of community-level cancer rehabilitation, recommends that more effort be made to ensure equality in utilisation across patient groups, improved integration of municipal-level services into cancer care trajectories, more uniform documentation of service delivery and the enforcement of patient outcomes to gradually build a more robust evidence base for community-level cancer rehabilitation.

Results from the family and coping oriented palliative homecare intervention study (FamCope)-A randomized controlled trial.

We tested if a family-and-coping-oriented basic palliative homecare intervention (six visits within 15 weeks) could improve quality-of-life and reduce anxiety and depression of advanced cancer patients and their closest relative, and reduce acute hospital admissions of patients. Fifty-seven families were randomized, but patient enrollment was terminated before reaching target sample due to a low recruitment rate. We found no evidence of effect of the FamCope-intervention, but further investigation of effective methods to support how families cope with advanced cancer at home is needed as levels of distress is as high in relatives as it is in patients. However, duration of interventions to support family-coping may need a considerable time-span to show effect on quality-of-life. We recommend that recruitment is undertaken in close collaboration with the hospital clinics, and that complexity of problems is used as inclusion criterion to decide when a family-coping intervention is needed based on the level of problems and distress in the family.

Changes in Health-Related Quality of Life During Rehabilitation in Patients With Operable Lung Cancer: A Feasibility Study (PROLUCA).

INTRODUCTION: Surgical resection in patients with non-small cell lung cancer (NSCLC) may be associated with significant morbidity, functional limitations, and decreased quality of life. OBJECTIVES: The objective is to present health-related quality of life (HRQoL) changes over time before and 1 year after surgery in patients with NSCLC participating in a rehabilitation program. METHODS: Forty patients with NSCLC in disease stage I to IIIa, referred for surgical resection at the Department of Cardiothoracic Surgery RT, Rigshospitalet, were included in the study. The rehabilitation program comprised supervised group exercise program, 2 hours weekly for 12 weeks, combined with individual counseling. The study endpoints were self-reported HRQoL (Functional Assessment of Cancer Therapy-Lung, European Organization for Research and Treatment in Cancer-Quality of Life Questionnaire-QLQ-C30, Short-Form-36) and self-reported distress, anxiety, depression, and social support (National Comprehensive Cancer Network Distress Thermometer, Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support), measured presurgery, postintervention, 6 months, and 1 year after surgery. RESULTS: Forty patients were included, 73% of whom completed rehabilitation. Results on emotional well-being ( P < .0001), global quality of life ( P = .0032), and mental health component score ( P = .0004) showed an overall statistically significant improvement during the study. CONCLUSION: This feasibility study demonstrated that global quality of life, mental health, and emotional well-being improved significantly during the study, from time of diagnosis until 1 year after resection, in patients with NSCLC participating in rehabilitation.

[In Denmark, there is a lack of consensus in the definition of frailty].

Emerging evidence demonstrates the value of frailty as a predictor of adverse outcomes in older persons. Identification of early stages of frailty offers the opportunity to reverse the development of frailty through targeted interventions. Awareness of the vulnerability in frailty can guide appropriate counselling of patients and their families when considering medical interventions. Recognition of frailty may also help identify and optimize the management of coexisting conditions. There is a lack of consensus in Denmark to use frailty and how to best identify, assess and diagnose frailty.

The Importance of Risk and Subgroup Analysis of Nonparticipants in a Geriatric Intervention Study.

Background. A major concern in intervention studies is the generalizability of the findings due to refusal of intended participants to actually take part. In studies including ill older people the number of those declining to participate may be large and the concern is therefore relevant. Objectives. To compare patients characteristics, rates of acute readmission, and mortality after one and six months among older persons who agreed and those who declined to participate in a randomized controlled trial and to describe subgroups of nonparticipants. Design. Comparative study based on a randomized controlled trial. Setting. University hospital in the Capital Region of Denmark. Participants. Patients ≥70 years discharged home after a short Emergency Department stay. 399 were requested to participate; 271 consented, whereas 128 refused. Results. Refusers were more likely to be readmitted (p < 0.001) or die (p = 0.006). The largest subgroup of refusers described as "too ill" had the highest risk of readmission (OR = 3.00, 95% CI = 1.61-5.47, p = 0.001) and of mortality within six months (OR = 3.50, 95% CI = 1.64-7.49, p = 0.002). However, this seems not to have affected the results of our randomized study. Conclusion. We recommend that intervention studies among older people or other fragile patient groups include analysis of relevant risk and subgroup analyses of refusers.

Alcoholic liver disease patients' perspective of a coping and physical activity-oriented rehabilitation intervention after hepatic encephalopathy.

AIM AND OBJECTIVE: To identify and describe the impact of a coping and physical activity-oriented rehabilitation intervention on alcoholic liver disease patients after hepatic encephalopathy in terms of their interaction with professionals and relatives. BACKGROUND: Patients who have experienced alcohol-induced hepatic encephalopathy have reduced quality of life, multiple complications, and social problems, and rehabilitation opportunities for these patients are limited. DESIGN: A grounded theory study and an evaluation study of a controlled intervention study. METHODS: Semi-structured interviews were conducted with 10 alcoholic liver disease patients who were diagnosed with hepatic encephalopathy and participated in a coping and physical activity-oriented rehabilitation intervention. Richard S. Lazarus's theory of stress and coping inspired the interview guide. RESULTS: The significance of a coping and physical activity-oriented rehabilitation intervention on alcoholic liver disease patients' ability to cope with problems after surviving alcohol-induced hepatic encephalopathy in terms of their interaction with professionals and relatives was characterised by the core category 'regain control over the diseased body'. This is subdivided into three separate categories: 'the experience of being physically strong', 'togetherness' and 'self-control', and they impact each other and are mutually interdependent. CONCLUSION: Alcoholic liver disease patients described the strength of the rehabilitation as regaining control over the diseased body. Professionals and relatives of patients with alcoholic liver disease may need to focus on strengthening and preserving patients' control of their diseased body by facilitating the experience of togetherness, self-control and physical strength when interacting with and supporting patients with alcoholic liver disease. RELEVANCE TO CLINICAL PRACTICE: A coping and physical activity-oriented rehabilitation intervention may help alcoholic liver disease patients to regain control over their diseased body and give patients the experience of togetherness, self-control and physical strength. Professionals should be aware of giving the patients the experience of togetherness in their interactions, help them perceive self-control and gain physical strength during their rehabilitation.

Perioperative Rehabilitation in Operable Lung Cancer Patients (PROLUCA): A Feasibility Study.

Introduction Surgical resection in patients with non-small cell lung cancer (NSCLC) may be associated with significant morbidity, functional limitations, and decreased quality of life. Objectives The safety and feasibility of a preoperative and early postoperative rehabilitation program in patients operated for NSCLC was determined in a nonhospital setting, with focus on high-intensity interval exercise. Methods Forty patients with biopsy-proven NSCLC stages I to IIIa referred for surgical resection at the Department of Cardiothoracic Surgery RT, Rigshospitalet, University of Copenhagen, were randomly assigned to 1 of 4 groups (3 intervention groups and 1 control group). The preoperative intervention consisted of a home-based exercise program, while the postoperative exercise program comprised a supervised group exercise program involving resistance and high-intensity interval cardiorespiratory exercise 2 hours weekly for 12 weeks combined with individual counseling. The study endpoints were inclusion rate, adherence, and number of adverse events. Results Forty patients (of 124 screened; 32%) were included and randomized into the 4 groups. The postoperative exercise was completed by 73% of the patients randomized to this intervention. No adverse events were observed, indicating that the early postoperative exercise program is safe. The preoperative home-based exercise program was not feasible due to interfering diagnostic procedures and fast-track surgery that left only 1 to 2 weeks between diagnosis and surgery. Conclusion The early postoperative exercise program for patients with NSCLC was safe and feasible, but in a fast-track set up, a preoperative home-based exercise program was not feasible for this population.

Assessment of rehabilitation needs in colorectal cancer treatment: Results from a mixed audit and qualitative study in Denmark.

Background Systematic assessments of cancer patients' rehabilitation needs are a prerequisite for devising appropriate survivorship programs. Little is known about the fit between needs assessment outlined in national rehabilitation policies and clinical practice. This study aimed to explore clinical practices related to identification and documentation of rehabilitation needs among patients with colorectal cancer at Danish hospitals. Material and methods A retrospective clinical audit was conducted utilizing data from patient files randomly selected at surgical and oncology hospital departments treating colorectal cancer patients. Forty patients were included, 10 from each department. Semi-structured interviews were carried out among clinical nurse specialists. Audit data was analyzed using descriptive statistics, qualitative data using thematic analysis. Results Documentation of physical, psychological and social rehabilitation needs initially and at end of treatment was evident in 10% (n = 2) of surgical patient trajectories and 35% (n = 7) of oncology trajectories. Physical rehabilitation needs were documented among 90% (n = 36) of all patients. Referral to municipal rehabilitation services was documented among 5% (n = 2) of all patients. Assessments at surgical departments were shaped by the inherent continuous assessment of rehabilitation needs within standardized fast-track colorectal cancer surgery. In contrast, the implementation of locally developed assessment tools inspired by the distress thermometer (DT) in oncology departments was challenged by a lack of competencies and funding, impeding integration of data into patient files. Conclusion Consensus must be reached on how to ensure more systematic, comprehensive assessments of rehabilitation needs throughout clinical cancer care. Fast-track surgery ensures systematic documentation of physical needs, but the lack of inclusion of data collected by the DT in oncological departments questions the efficacy of assessment tools and points to a need for distinguishing between surgical and oncological settings in national rehabilitation policies.

Coping and rehabilitation in alcoholic liver disease patients after hepatic encephalopathy--in interaction with professionals and relatives.

AIMS AND OBJECTIVES: To identify and describe conditions that limit or support patients, with alcoholic liver disease after surviving alcohol-induced hepatic encephalopathy, ability to cope with current and potential physical and psychosocial problems--in interaction with professionals and relatives--and to recommend appropriate interventions. BACKGROUND: Alcoholic liver disease patients surviving alcohol-induced hepatic encephalopathy have significantly impaired quality of life. Internationally, there is a lack of knowledge about the conditions that affect alcoholic liver disease patients' coping and rehabilitation. DESIGN: A grounded theory study. METHODS: Semi-structured interviews, conducted with 11 alcoholic liver disease patients who were diagnosed with hepatic encephalopathy. The interview guide was inspired by Richard S. Lazarus's theory of stress and coping. RESULTS: The elements that support or limit alcoholic liver disease patients' ability to cope with physical and psychosocial problems in interaction with professionals and relatives were represented by the core category 'Struggle for preservation of identity as a significant individual'. It was characterised by three categories, which are interrelated and impact upon each other: 'Acknowledgement', 'Struggle to maintain control' and 'Achieving a sense of security'. CONCLUSION: Alcoholic liver disease patients experience a struggle to preserve their identity as a significant individual. It can be assumed that professionals and relatives in their interaction with, and support of, patients should focus on strengthening and preserving patients' identity in the form of acknowledgement, helping alcoholic liver disease patients maintain self-control and providing a safety net so patients feel a sense of security. RELEVANCE TO CLINICAL PRACTICE: It can be assumed that professionals should support alcoholic liver disease patients' appraisal of, and coping with, physical and psychosocial problems based on acknowledgment, understanding and a sympathetic attitude. Professionals should proactively approach patients when they withdraw. It may be useful for professionals to be aware of alcoholic liver disease patients' individual coping strategies and thereby their individual requirements for professional supportive intervention.

Recruitment and Reasons for Non-Participation in a Family-Coping-Orientated Palliative Home Care Trial (FamCope).

Cancer patients and their family caregivers need support to cope with physical, psychosocial, and existential problems early in the palliative care trajectory. Many interventions target patient symptomatology, with health care professionals acting as problem-solvers. Family coping, however, is a new research area within palliative care. The FamCope intervention was developed to test if a nurse-led family-coping-orientated palliative home care intervention would help families cope with physical and psychosocial problems at home--together as a family and in interaction with health care professionals. However, an unexpectedly high number of families declined participation in the trial. We describe and discuss the recruitment strategy and patient reported reasons for non-participation to add to the knowledge about what impedes recruitment and to identify the factors that influence willingness to participate in research aimed at family coping early in the palliative care trajectory. Patients with advanced cancer and their closest relative were recruited from medical, surgical, and oncological departments. Reasons for non-participation were registered and characteristics of participants and non-participants were compared to evaluate differences between subgroups of non-participants based on reasons not to participate and reasons to participate in the trial. A total of 65.9% of the families declined participation. Two main categories for declining participation emerged: first, that the "burden of illness is too great" and, second, that it was "too soon" to receive this kind of support. Men were more likely to participate than women. Patients in the "too soon" group had similar characteristics to participants in the trial. Timing of interventions and readiness of patients and their relatives seems to affect willingness to receive a family-coping-orientated care approach and impeded recruitment to this trial. Our findings can be used in further research and in clinical practice in order to construct interventions and target relevant populations for early family-coping-orientated palliative care.

Need for strengthened focus on cancer rehabilitation in Danish municipalities.

INTRODUCTION: Danish municipalities have recently been given a mandate to organise cancer rehabilitation services. Knowledge is therefore needed about the services provided and their utilisation. The aim of this national Danish baseline survey was to explore the availability, utilisation, content and organisation of municipal cancer rehabilitation services. METHODS: Electronic questionnaires were sent to all 98 Danish municipalities in January 2013. The questionnaire consisted of closed-ended and open-ended questions. Descriptive statistics and contents analysis were used. RESULTS: A total of 91 municipalities responded (93% response rate). Of these, 75% reported that they provided cancer rehabilitation services. The number of patients enrolled was below the estimated proportion of patients needing rehabilitation services. Services consisted predominantly of physical training in groups, followed by "stop smoking" courses, dietary advice, physical training guidance, patient education and individual physical training. Inequality in referral by ethnicity, age and gender was reported. Challenges encountered included low patient numbers, inadequate collaboration within and across sectors and lack of evidence-based models for cancer rehabilitation. CONCLUSION: There is a need for increased capacity and improved alignment between patients' rehabilitation needs and the available services. FUNDING: This study was funded by grants from The Centre for Integrated Rehabilitation of Cancer Patients (CIRE), and received support from The Danish Cancer Society and The Novo Nordisk Foundation. TRIAL REGISTRATION: not relevant.

[Medical focus on nursing homes]. / Lagefaglig indsats i plejeboliger

Older people living in nursing homes in Denmark are among the most frail. The mean age at moving in is 84 years. Mean time living in nursing homes is 25 months for men and 32 for women. The dwellers can choose their usual general practitioner but change in organisation is now being evaluated. Medical focus is dementia, prevention of delirium, falls and especially the medical treatment. Polypharmacy is a huge challenge. Collaboration and communication with nursing staff is essential in order to do prevention, rehabilitation and palliation among the frail dwellers.

Hypnotics and mortality--partial confounding by disease, substance abuse and socioeconomic factors?

PURPOSE: The aim of this Cohort study of 10 527 Danish men was to investigate the extent to which the association between hypnotics and mortality is confounded by several markers of disease and living conditions. METHODS: Exposure was purchases of hypnotics 1995-1999 ("low users" (150 or less defined daily dose (DDD)) or "high users" (151 or more DDD)). Follow-up for all-cause mortality was from 1 Jan 2000 to 19 June 2010. Cox proportional hazard models were used to study the association. Covariates were entered one at a time and simultaneously. Results were reported using hazard ratio (HR) and 95% confidence intervals (CI). RESULTS: When covariates were entered one at a time, the changes in HR estimates showed that psychiatric disease, socioeconomic position and substance abuse reduced the excess risk by 17-36% in the low user group and by 45-52% in the high user group. Somatic disease, intelligence score and cohabitation reduced the excess risk by 2-11% in the low user group and 8-24% in the high user group. When adjusting for all covariates, the HR was reduced to 1.22 95% CI (0.97-1.54) in the low user group and 1.43 95% CI (1.11-1.85) in the high user group. CONCLUSIONS: The results of this study point at psychiatric disease, substance abuse and socioeconomic position as potential confounding factors partly explaining the association between use of hypnotics and all-cause mortality.

Exercise intervention for patients diagnosed with operable non-small cell lung cancer: a qualitative longitudinal feasibility study.

PURPOSE: The purpose was to explore operable lung cancer patient experiences with an exercise intervention from a longitudinal perspective according to patient motivation and patient perceived benefits and barriers of exercise. METHODS: Nineteen patients enrolled in an exercise intervention 2 weeks post-surgery participated in qualitative interviews at three time points. A criteria sampling strategy was applied. Ricoeur's phenomenological hermeneutical philosophy inspired the analysis. RESULTS: Patients initiated exercising median 15 days postoperative. Eight patients included in the interview study dropped out of the intervention due to side effects of chemotherapy (n = 3) and external circumstances (n = 5). The mean attendance rate for the eleven participants who completed the intervention was 82 %. No patients experienced severe adverse events. Motivation for participation included patients' expectations of physical benefits and the security of having professionals present. Patients experienced physical and emotional benefits and affirmed their social identity. Barriers were primarily related to side effects of chemotherapy. CONCLUSION: The exercise intervention was undertaken safely by operable lung cancer patients initiated 2 weeks after surgery. The intervention put the patients on track to a healthier lifestyle regarding physical activity and smoking. The study indicates that exercise initiated early in the treatment trajectory is beneficial for operable lung cancer patients and especially for those who were physically active and motivated pre-illness and who did not experience side effect of treatment.

Diagnosis as the First Critical Point in the Treatment Trajectory: An Exploration of Operable Lung Cancer Patients' Lived Experiences.

BACKGROUND: Significant advances have been made in the surgical treatment of lung cancer while patient experiences with diagnosis, treatment, and rehabilitation remain only sparsely researched. OBJECTIVE: The objective of this study was to investigate how the diagnosis affects the daily lives of patients with operable lung cancer in order to identify their needs for care interventions from the point of diagnosis to hospitalization. METHODS: We investigated patients' lived experiences from a longitudinal perspective at 4 critical time points during the treatment trajectory; we present here the findings from the first time point, diagnosis. Data were collected through interviews conducted 7 to 10 days following diagnosis of lung cancer. Data from 19 patients are included, and the analysis is based on Ricoeur's interpretation theory. The study framework is inspired by Schutz's phenomenological sociology. RESULTS: The findings are presented as themes that summarize and express the ways in which a diagnosis affects patients' daily lives: the cancer diagnosis comes as a shock, it changes everyday awareness; it presents the patient with an unfamiliar body, disturbs social relationships, forces the patient to face a new life situation, and demands one-on-one supportive care. CONCLUSIONS: Diagnosis is the first critical point for patients with operable lung cancer and disrupts their daily life. Patients need psychosocial support during the period from diagnosis to surgical intervention and patient-tailored one-on-one information. IMPLICATIONS FOR PRACTICE: This article contributes to the knowledge base of support needs of lung cancer patients. Interventions aimed at supportive care during the period between diagnosis and surgical intervention should be researched.

[Uncertain efficiency of follow-up home visits among older patients after hospital discharge]. / Usikker effekt af opfølgende hjemmebesøg til ældre medicinske patienter efter hospitalsindlæggelse.

Improving the vulnerable hospital discharge process among older people has been in focus for decades. The economic impact and ease of measurement of all-cause hospital readmission rates have questioned whether they are reducible. This review aimed to identify the efficiency of follow-up home visits after hospital discharge by district nurses in coordination with general practice. Six settings in Denmark have been evaluated in different controlled designs. Results are inconsistent and inconclusive due to selection bias and methods chosen. Targeting and management organisation need further research.

A longitudinal exploration of 'Four Critical Moments' during treatment trajectory in patients with operable lung cancer and the feasibility of an exercise intervention: a research protocol.

AIM: This article described a research protocol for a study exploring the lived experiences of patients with operable lung cancer in daily life at 'Four Critical Moments' during the disease and treatment trajectory. BACKGROUND: Patients with lung cancer may experience complex problems during the disease and treatment trajectory, and studies conclude this population to be at higher risk in developing emotional distress than other cancer populations. It is required to explore the supportive needs of patients with lung cancer through the treatment trajectory. DESIGN: A longitudinal design with a method of multiple data collection. The study is performed at four time points 'Four Critical Moments'. METHODS: The study contained three samples. Sample I and sample II explored the expected four critical moments for patients with operable lung cancer within the first 4 months following diagnosis and surgery. Sample III explored the patients' participation and the feasibility of an exercise intervention targeting patients with operable lung cancer. For all three samples, interviews will be performed: (1) 5 days following diagnosis; (2) the day after surgery; (3) 7 weeks; and (4) 4 months following surgery. Data from questionnaires for all three samples will be collected at baseline and 4 months following surgery. DISCUSSION: The study will add new perspectives on the lived experiences of patients with lung cancer along the treatment trajectory based on empirical and theoretical findings for both the general lung cancer population and patients participating in an exercise intervention. This will provide a basis for optimizing and developing interventions for patients with lung cancer starting in the surgical context.

[Rehabilitation for older adults].

The positive effect of rehabilitation is well documented among older adults where functional disability affects daily activities and participation. Existing knowledge, however, needs to be implemented in daily routines. Everyday rehabilitation in the municipalities is improving. Fast-track methods are tested in hospitals. More studies are needed for follow-up evaluation and regarding how, for whom and for how long rehabilitation should take place. All doctors should be aware of and able to handle the patient's need of rehabilitation in an integrated health-care perspective.

Perioperative rehabilitation in operation for lung cancer (PROLUCA) - rationale and design.

BACKGROUND: The purpose of the PROLUCA study is to investigate the efficacy of preoperative and early postoperative rehabilitation in a non-hospital setting in patients with operable lung cancer with special focus on exercise. METHODS: Using a 2 x 2 factorial design with continuous effect endpoint (Maximal Oxygen Uptake (VO2peak)), 380 patients with non-small cell lung cancer (NSCLC) stage I-IIIa referred for surgical resection will be randomly assigned to one of four groups: (1) preoperative and early postoperative rehabilitation (starting two weeks after surgery); (2) preoperative and late postoperative rehabilitation (starting six weeks after surgery); (3) early postoperative rehabilitation alone; (4) today's standard care which is postoperative rehabilitation initiated six weeks after surgery. The preoperative rehabilitation program consists of an individually designed, 30-minute home-based exercise program performed daily. The postoperative rehabilitation program consists of a supervised group exercise program comprising cardiovascular and resistance training two-hour weekly for 12 weeks combined with individual counseling. The primary study endpoint is VO2peak and secondary endpoints include: Six-minute walk distance (6MWD), one-repetition-maximum (1RM), pulmonary function, patient-reported outcomes (PROs) on health-related quality of life (HRQoL), symptoms and side effects of the cancer disease and the treatment of the disease, anxiety, depression, wellbeing, lifestyle, hospitalization time, sick leave, work status, postoperative complications (up to 30 days after surgery) and survival. Endpoints will be assessed at baseline, the day before surgery, pre-intervention, post-intervention, six months after surgery and one year after surgery. DISCUSSION: The results of the PROLUCA study may potentially contribute to the identification of the optimal perioperative rehabilitation for operable lung cancer patients focusing on exercise initiated immediately after diagnosis and rehabilitation shortly after surgery. TRIAL REGISTRATION: NCT01893580.

Childhood socioeconomic position, young adult intelligence and fillings of prescribed medicine for prevention of cardiovascular disease in middle-aged men.

OBJECTIVES: To explore the relationship between childhood socioeconomic position (SEP) and filling of medicine prescriptions for prevention of cardiovascular diseases (CVDs), with young adult intelligence (IQ) as a potential mediator. DESIGN: Birth cohort study with logistic and Cox-proportional hazard regression analyses of associations between childhood SEP, retrieved from birth certificates, and prevalence, initiation of and refill persistency for CVD preventive medicine. SETTING: Denmark. PARTICIPANTS: 8736 Danish men born in 1953, who had no CVD at the start of follow-up in 1995, were followed in the Danish National Prescription Register for initiation of and refill persistency for antihypertensives and statins, until the end of 2007 (age 54 years). RESULTS: Low childhood SEP at age 18 was not associated with prescription fillings of antihypertensives, but was weakly associated with initiation of statins (HR = 1.19 (95% CI 1.00 to1.42)). This estimate was attenuated when IQ was entered into the model (HR=1.10 (95% CI 0.91 to 1.23)). Low childhood SEP was also associated with decreased refill persistency for statins (HR=2.23 (95% CI 1.13 to 4.40)). Thus, the HR for SEP only changed slightly (HR=2.24 (95% CI 1.11 to 4.52)) when IQ was entered into the model, but entering other covariates (education and body mass index in young adulthood and income in midlife) into the model attenuated the HR to 2.04 (95% CI 1.00 to 4.16). CONCLUSIONS: Low childhood SEP was related to more frequent initiation of and poorer refill persistency for statins. IQ in young adulthood explained most of the association between childhood SEP and initiation of statins, but had no impact on refill persistency.