Background: Psoriasis (PsO) and psoriatic arthritis (PsA) are chronic diseases that affect patients' quality of life. The purpose of the present study was to develop a pilot outcome-based, patient-centric management model for PsO and PsA.

Methods: The non-interventional IMPROVE (Incentives for healthcare management based on patient-related outcomes and value) study being conducted in Denmark consists of 5 phases: 1) collecting real-world evidence to estimate treatment patterns and disease burden to the healthcare sector and patients; 2) identifying disease aspects which matter most to patients by use of concept mapping; 3) conducting interviews with healthcare professionals and patient organization involved in a typical PsO or PsA patient journey in order to determine relevant measures to quantify patient-identified outcomes; 4) developing a value-based remuneration model based on outcomes from phases 1-3; and 5) testing the outcome-based model in pre-selected hospitals in Denmark.

Results: Both PsO and PsA are associated with multiple co-morbidities, increased healthcare costs, and loss of earnings. Seven important 'clusters' of disease aspects were identified for both PsO and PsA, including uncertainty about disease progression and treatments, as well as inter-personal relations with healthcare providers. Hospital-based treatment was associated with high treatment costs. Although the outcome-based model could result in strategic behavior by doctors, those involved in defining the best outcome goals consider it unlikely.

Conclusion: The new patient-centric outcome-based management model is expected to support optimal treatment and secure best possible outcomes for patients suffering from PsO or PsA. The practical implication of the present study are that the models developed are expected to increase focus on patient-centered healthcare, and help eliminate some of the inappropriate incentives that exist in activity-based remuneration systems.

Trial registration: Not applicable; data collected from patient registries in Denmark.

Interhospital transport of sick newborn infants is dangerous, but the risk of adverse events can be reduced, when transport is being performed by trained neonatal retrieval teams. In this review, we describe the current organisation of neonatal retrieval service in Denmark. The services are based at the neonatal intensive care units of the four university hospitals. Improved cooperation and harmonisation of operations between the teams is needed, as this is a prerequisite for the development of a national clinical consensus guideline and national quality metrics enabling benchmarking both within Denmark and abroad.

Introduction: Occupational therapy (OT) is based on the core assumption that humans are active beings through engagement in occupations. Within OT, occupation is typically used as primary means and/or ends i.e. occupation-focused and/or occupation-based interventions are employed. Studies evaluating such interventions are limited.Objectives: To synthesize experiences about occupation-focused and/or occupation-based interventions. Hence, to identify, organize and prioritize experiences with employing occupation as a core element in OT intervention studies.Methods: Participants were OT PhD students and researchers involved in studies concerning occupation-focused and/or occupation-based interventions. Group Concept Mapping was applied.Results: Based on 133 ideas, a conceptual model emerged encompassing two overall dimensions concerning 'developing interventions' and 'planning intervention studies', respectively. Moreover, ten themes related to one or both dimensions were defined and 94 ideas across clusters had high importance ratings.Conclusion: Synthesis of participants' experiences indicates that 'doing' as agent of change is a core element of OT interventions. Moreover, a multi-level perspective is needed to reach sustainable changes in doing. Group- and peer-support can work as amplifier for change, and flexibility is important during intervention. Such complex interventions need special design and mixed methods in the development, and evaluation of outcome needs to address occupation.

BACKGROUND: Air pollution exposure has been linked to coronary heart disease, although evidence on

PM

2.5

and myocardial infarction (MI) incidence is mixed.

OBJECTIVES: This prospective cohort study aimed to investigate associations between long-term exposure to air pollution and MI incidence, adjusting for road traffic noise.

METHODS: We used data from the nationwide Danish Nurse Cohort on 22,882 female nurses (

>
44
 years

of age) who, at recruitment in 1993 or 1999, reported information on cardiovascular disease risk factors. Data on MI incidence was collected from the Danish National Patient Register until the end of 2014. Annual mean concentrations of particulate matter (PM) with a diameter

<
2.5
 
μg
/

m

3

(

PM

2.5

),

PM

10

, nitrogen dioxide (

NO

2

), and nitrogen oxides (

NO

x

) at the nurses' residences since 1990 (

PM

10

and

PM

2.5

) or 1970 (

NO

2

and

NO

x

) were estimated using the Danish Eulerian Hemispheric Model/Urban Background Model/AirGIS (DEHM/UBM/AirGIS) dispersion model. We used time-varying Cox regression models to examine the association between 1- and 3-y running means of these pollutants, as well as 23-y running means of

NO

2

and

NO

x

, with both overall and fatal incident MI. Associations were explored in three progressively adjusted models: Model 1, adjusted for age and baseline year; Model 2, with further adjustment for potential confounding by lifestyle and cardiovascular disease risk factors; and Model 3, with further adjustment for road traffic noise, modeled as the annual mean of a weighted 24-h average (

L

den

).

RESULTS: Of the 22,882 women, 641 developed MI during a mean follow-up of 18.6 y, 121 (18.9%) of which were fatal. Reported hazard ratios (HRs) were based on interquartile range increases of 5.3, 5.5, 8.1, and

11.5
 
μ
g
/

m

3

for

PM

2.5

,

PM

10

,

NO

2

, and

NO

x

, respectively. In Model 1, we observed a positive association between a 3-y running mean of

PM

2.5

and an overall incident MI with an

HR
=

 1.20 (95% CI: 1.07, 1.35), which attenuated to

HR
=

 1.06 (95% CI: 0.92, 1.23) in Model 2. In Model 1 for incident fatal MI, we observed a strong association with a 3-y running mean of

PM

2.5

, with an

HR
=

 1.69 (95% CI: 1.33, 2.13), which attenuated to

HR
=

 1.35 (95% CI: 1.01, 1.81) in Model 2. Similar associations were seen for

PM

10

, with 3-y, Model 2 estimates for overall and fatal incident MI of

HR
=

 1.06 (95% CI: 0.91, 1.23) and

HR
=

 1.35 (95% CI: 1.01, 1.81), respectively. No evidence of an association was observed for

NO

2

or

NO

x

. For all pollutants, associations in Model 2 were robust to further adjustment for road traffic noise in Model 3 and were similar for a 1-y running mean exposure.

CONCLUSIONS: We found no association between long-term exposure to

PM

2.5

,

PM

10

,

NO

2

, or

NO

x

and overall MI incidence, but we observed positive associations for

PM

2.5

and

PM

10

with fatal MI. We present novel findings that the association between PM and MI incidence is robust to adjustment for road traffic noise. https://doi.org/10.1289/EHP5818.

BACKGROUND/OBJECTIVES: To investigate the associations between indicators of obesity and fat distribution, such as body mass index (BMI), fat mass, and skinfold measures during preschool age, and attained height at school entry.

SUBJECTS/METHODS: The Healthy Start primary intervention study comprised 1100 obesity-prone preschool children from the greater Copenhagen area, with a mean [standard deviation (SD)] age of 4.0 (1.1) years at baseline. Anthropometry was measured by trained health professionals at baseline (preschool age) and follow-up height at school entry was gathered by school nurses. Prospective associations between body fat measures and later attained height were examined using generalized linear models with adjustments for potential confounders.

RESULTS: Greater adiposity at preschool age was directly associated with a higher attained height at follow-up at school-age, when adjusting for confounders. A baseline difference of one BMI unit was associated with a greater attained height of 0.8 cm [(95% confidence interval (CI) 0.5; 1.2]. Furthermore, a difference of 1 mm in the sum of four skinfolds measured at baseline was associated with a greater attained height of 0.1 cm (95% CI 0.03; 0.2) at follow-up. Children with overweight or obesity at baseline attained a significantly higher height of 2.9 (95% CI 1.6; 4.1) cm at follow-up after full adjustment than normal weight children.

CONCLUSIONS: Our results supports that greater adiposity at preschool age is associated with greater tallness. Although a greater height is assumed to be desirable, accelerated growth in childhood may in itself be a risk factor for obesity later in life.