The LEAD trial - the effectiveness of a decision aid on decision making among citizens with lower educational attainment who have not participated in FIT-based colorectal cancer screening in Denmark: study protocol for a randomized controlled trial

Background: Colorectal cancer screening participation is a preference-sensitive choice, in which trade-offs between benefits and harms must be made by individual citizens. Often the decision is made without any contact with healthcare professionals. Citizens with lower educational attainment tend to participate less in colorectal cancer screening than citizens with average educational attainment. Further, they tend to have lower levels of knowledge about colorectal cancer screening. Providing lower educational attainment citizens with a targeted decision aid embracing their diverse information needs might increase these citizens’ ability to make informed decisions. The aim of this trial is to test the effectiveness of such a newly developed self-administered decision aid. Methods: The LEAD (Lower Educational Attainment Decision aid) trial will be conducted as a two-arm randomized controlled trial among 10,000 50–74-year-old citizens, resident in the Central Denmark Region not yet invited to take up colorectal cancer screening. Citizens will receive a baseline questionnaire. Respondents will be allocated into the intervention or the control groups. Citizens in the intervention group will receive the decision aid whereas the control group will not. Those who return a stool sample within 45 days after receiving the screening invitation and those with medium or higher educational attainment are excluded. Both groups will receive a follow-up questionnaire 90 days after being invited to colorectal cancer screening. A historic cohort consisting of 5000 50–74-year-old citizens resident in the Central Denmark Region, having received their screening invitation in the beginning of 2017 will be included. This cohort will receive a follow-up questionnaire 6–9 months after they received the screening invitation. Informed choice will be evaluated by assessing levels of knowledge, attitudes, and screening uptake. Analyses will be conducted as intention-to-treat analyses. Additionally, differences between levels of worry and decisional conflict between groups will be assessed as secondary outcomes

Genome analysis of Clostridium perfringens isolates from healthy and necrotic enteritis infected chickens and turkeys

Objective: Clostridium perfringens causes gastrointestinal diseases in both humans and domestic animals. Type A strains expressing the NetB toxin are the main cause of necrotic enteritis (NE) in chickens, which has remarkable impact on animal welfare and production economy in the international poultry industry. Three pathogenicity loci NELoc-1, -2 and -3 and a collagen adhesion gene cnaA have been found to be associated with NE in chickens, whereas the presence of these has not been investigated in diseased turkeys. The purpose was to investigate the virulence associated genome content and the genetic relationship among 30 C. perfringens isolates from both healthy and NE infected chickens and turkeys, applying whole-genome sequencing. Results: NELoc-1, -3, netB and cnaA were significantly associated with NE isolates from chickens, whereas only NELoc-2 was commonly observed in both diseased turkeys and chickens. A putative collagen adhesion gene that encodes a von Willebrand Factor (vWF) domain was identified in all diseased turkeys and designated as cnaD. The phylogenetic analysis based on single nucleotide polymorphisms showed that the isolates generally were not closely related. These results indicate that virulence factors and pathogenicity loci associated with NE in chickens are not important to the same extent in diseased turkeys except for NELoc-2. A putative collagen adhesion gene which potentially could be of importance in regard to the NE pathogenesis in turkeys was identified and need to be further investigated. Thus, the pathogenesis of NE in turkeys appears to be different from that of broiler chickens

Spread of avian pathogenic Escherichia coli ST117 O78:H4 in Nordic broiler production

BACKGROUND: Escherichia coli infections known as colibacillosis constitute a considerable challenge to poultry farmers worldwide, in terms of decreased animal welfare and production economy. Colibacillosis is caused by avian pathogenic E. coli (APEC). APEC strains are extraintestinal pathogenic E. coli and have in general been characterized as being a genetically diverse population. In the Nordic countries, poultry farmers depend on import of Swedish broiler breeders which are part of a breeding pyramid. During 2014 to 2016, an increased occurrence of colibacillosis on Nordic broiler chicken farms was reported. The aim of this study was to investigate the genetic diversity among E. coli isolates collected on poultry farms with colibacillosis issues, using whole genome sequencing. METHODS: Hundred and fourteen bacterial isolates from both broilers and broiler breeders were whole genome sequenced. The majority of isolates were collected from poultry with colibacillosis on Nordic farms. Subsequently, comparative genomic analyses were carried out. This included in silico typing (sero- and multi-locus sequence typing), identification of virulence and resistance genes and phylogenetic analyses based on single nucleotide polymorphisms. RESULTS: In general, the characterized poultry isolates constituted a genetically diverse population. However, the phylogenetic analyses revealed a major clade of 47 closely related ST117 O78:H4 isolates. The isolates in this clade were collected from broiler chickens and breeders with colibacillosis in multiple Nordic countries. They clustered together with a human ST117 isolate and all carried virulence genes that previously have been associated with human uropathogenic E. coli. CONCLUSIONS: The investigation revealed a lineage of ST117 O78:H4 isolates collected in different Nordic countries from diseased broilers and breeders. The data indicate that the closely related ST117 O78:H4 strains have been transferred vertically through the broiler breeding pyramid into distantly located farms across the Nordic countries. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12864-016-3415-6) contains supplementary material, which is available to authorized users

A stitch in time saves nine: perceptions about colorectal cancer screening after a non-cancer colonoscopy result. Qualitative study

Objectives To explore perceptions of colorectal cancer (CRC) screening among participants who have experienced a 'false alarm' for CRC, and to explore perceptions about the relevance of screening for themselves or others. Methods Semi-structured interviews with screening participants who had participated in the Danish CRC screening program and experienced a 'false alarm' for colorectal cancer. A thematic analysis was performed, based on an interpretive tradition of ethnography. Results Perceptions about CRC screening after a non-cancer colonoscopy result were characterized by trust in the colonoscopy result showing no CRC, and satisfaction with the screening offer despite the risk for 'false alarm'. The patient-involving behavior of the healthcare professionals during the examination was for most participants a cornerstone for trusting the validity of the colonoscopy result showing no CRC. Strong notions about perceived obligation to participate in screening were common. Conclusions Prominent themes were trust in the result, satisfaction with the procedure, and moral obligations to participate both for themselves and for others. Practice implications Information to future invitees after a 'false alarm' experience could build on peoples' trust in the validity of a previous non-cancer result and should underscore the importance of subsequent screening even after a 'false alarm' for cancer

Intervention effects on dietary intake among children by maternal education level: results of the Copenhagen School Child Intervention Study (CoSCIS)

Dietary intake among Danish children, in general, does not comply with the official recommendations. The objectives of the present study were to evaluate the 3-year effect of a multi-component school-based intervention on nutrient intake in children, and to examine whether an intervention effect depended on maternal education level. A total of 307 children (intervention group: n 184; comparison group: n 123) were included in the present study. All had information on dietary intake pre- and post-intervention (mean age 6·8 and 9·5 years for intervention and comparison groups, respectively) assessed by a 7-d food record. Analyses were conducted based on the daily intake of macronutrients (energy percentage (E%)), fatty acids (E%), added sugar (E%) and dietary fibre (g/d and g/MJ). Analyses were stratified by maternal education level into three categories. Changes in nutrient intake were observed in the intervention group, mainly among children of mothers with a short education ( < 10 years). Here, intake of dietary fibre increased (β = 2·1 g/d, 95 % CI 0·5, 3·6, P= 0·01). Intake of protein tended to increase (β = 0·6 E%, 95 % CI − 0·01, 1·2, P= 0·05), while intake of fat (β = − 1·7 E%, 95 % CI − 3·8, 0·3, P= 0·09) and SFA (β = − 0·9, 95 % CI − 2·0, 0·2, P= 0·10) tended to decrease. Also, a significant intervention effect was observed on the intake of SFA among children of mothers with a long education (β = − 0·8, 95 % CI − 1·5, − 0·03, P= 0·04). This multi-component school-based intervention resulted in changes in the dietary intake, particularly among children of mothers with a short education. As the dietary intake of this subgroup generally differs most from the recommendations, the results of the present study are particularly encouraging

Mindfulness – det oppmerksomme nærvær

Bakgrunn: Evnen til å være til stede er et kjerneelement i sykepleiefaget. Trening på oppmerksomt nærvær (ON) kan være en metode til å utvikle denne evnen. Hensikt: Studiens mål var å utforske hvordan sykepleiere opplever fenomenet nærvær i sin sykepleieutøvelse og hvordan trening på oppmerksomt nærvær i form av Mindfulness-Based Stress-Reduction (MBSR), kan påvirke deres opplevelse. Metode: Et MBSR-program ble gjennomført for seks sykepleiere fra et universitetssykehus og etterfulgt av dybdeintervjuer som ble analysert ved fenomenologisk- hermeneutisk metode. Resultater: Sykepleiernes opplevelse av nærvær kan beskrives ved to hovedtemaer. «Å være nær»; en gjenkjennelse av fellesmenneskelige vilkår i relasjonene. «Å balansere i nærvær»; nærhet avhenger av balanse mellom pasienten og andre oppgaver, og mellom nærhet og profesjonell distanse. Etter treningen på ON kan deres opplevelse av nærvær beskrives ved tre hovedtemaer. «Å stå i det åpne»; nærværets åpenhet skaper tillit som påvirker kvaliteten i relasjonene. «Å se»; et nytt blikk som er både mer våkent og mer vennlig. «Å være»; en endring fra å gjøre til å være som gir selvinnsikt og større ro. Konklusjon: Fra å være et relasjonelt fenomen uttrykt ved det å være nær noen, fører ON til en opplevelse av nærvær som indikerer en kompetanseutvikling i retning av Rosemarie Rizzo Parse’s teoretiske beskrivelse av sykepleierens «true presence» og Kari Martinsens begrep «Mesterskapet i å se med hjertets øye», og kan innebære en forbedring av sykepleiernes faglige kompetanse