Characterizing healthcare utilization patterns in a Danish population with headache: results from the nationwide headache in Denmark (HINDER) panel

INTRODUCTION: Worldwide, far from all of those who would benefit make use of headache services, largely because of clinical, social, and political barriers to access. Identifying the factors contributing to low healthcare utilization can generate evidence to guide health policy. Our purpose here is better to characterize healthcare utilization patterns in Denmark. METHODS: The Headache in Denmark (HINDER) study is a nationwide cross-sectional survey of people with headache, conducted using SurveyXact (Rambøll Group A/S, Copenhagen). Healthcare utilization was assessed in a study sample generated by population screening and recruitment. Data collection occurred over two weeks, from September 23rd until October 4th, 2021. The questions enquired into disease characteristics, management, burden, medication intake and healthcare utilization. RESULTS: The number of participants included in the HINDER panel was 4,431, with 2,990 (67.5%: 2,522 [84.3%] female, 468 [15.7%] male; mean age 40.9 ± 11.6 years) completing the survey. One quarter of participants (27.7%) disagreed or strongly disagreed that they were able to manage their headache attacks. Most participants (81.7%) agreed or strongly agreed that their headache was a burden in their everyday lives. The most reported acute medications, by 87.2% of participants, were simple analgesics; of note, 8.6% reported using opioids for their headache. One quarter of participants (24.4%) had never consulted a medical doctor for their headache; one in six (16.5%: more than two thirds of the 24.4%) had never done so despite agreeing or strongly agreeing that their headache was a burden in their everyday lives. Two thirds (65.3%) of participants overall, and almost three quarters (72.4%) of those with weekly headache, had tried one or more complementary or alternative therapies outside conventional medical care. CONCLUSIONS: Our findings are indicative of inadequate delivery of headache care in a country that provides free and universal coverage for all its residents. The implications are twofold. First, it is not sufficient merely to make services available: public education and increased awareness are necessary to encourage uptake by those who would benefit. Second, educational interventions in both pre- and postgraduate settings are necessary, but a prerequisite for these is a resetting of policy priorities, properly to reflect the very high population ill-health burden of headache

Recent changes in drainage route and outburst magnitude of the Russell Glacier ice-dammed lake, West Greenland

Glacial lake outburst floods (GLOFs) or jökulhlaups from ice-dammed lakes are frequent in Greenland and can influence local ice dynamics and bedrock motion, cause geomorphological changes, and pose flooding hazards. Multidecadal time series of lake drainage dates, volumes, and flood outlets are extremely rare. However, they are essential for determining the scale and frequency of future GLOFs, for identifying drainage mechanisms, and for mitigating downstream flood effects. In this study, we use high-resolution digital elevation models (DEMs) and orthophotos (0.1 × 0.1 m) generated from uncrewed-aerial-vehicle (UAV) field surveys, in combination with optical satellite imagery. This allows us to reconstruct robust lake volume changes associated with 14 GLOFs between 2007 and 2021 at Russell Glacier, West Greenland. As a result, this is one of the most comprehensive and longest records of ice-dammed lake drainages in Greenland to date. Importantly, we find a mean difference of ∼ 10 % between our lake drainage volumes when compared with estimates derived from a gauged hydrograph 27 km downstream. Due to thinning of the local ice dam, the potential maximum drainage volume in 2021 is ∼ 60 % smaller than that estimated to have drained in 2007. Our time series also reveals variations in the drainage dates ranging from late May to mid-September and drainage volumes ranging between 0.9 and 37.7 Mm3. We attribute these fluctuations between short periods of relatively high and low drainage volumes to a weakening of the ice dam and an incomplete sealing of the englacial tunnel following the large GLOFs. This syphoning drainage mechanism is triggered by a reduction in englacial meltwater, likely driven by late-season drainage and sudden air temperature reductions, as well as annual variations in the glacial drainage system. Furthermore, we provide geomorphological evidence of an additional drainage route first observed following the 2021 GLOF, with a subglacial or englacial flow pathway, as well as supraglacial water flow across the ice margin. It seems probable that the new drainage route will become dominant in the future. This will drive changes in the downstream geomorphology and raise the risk of flooding-related hazards as the existing buffering outlet lakes will be bypassed.</p

One-quarter of individuals with weekly headache have never consulted a medical doctor: a Danish nationwide cross-sectional survey

INTRODUCTION: Large numbers of people with headache who would benefit are not reached by headache services. Among the causes are poor or disorganized provision of headache services, but reluctance to seek healthcare has frequently been identified as a significant barrier. We conducted a national survey of people with headache to assess the extent of this problem in Denmark, a country with well organized, highly resourced, and readily accessible services. METHODS: We conducted a nationwide cross-sectional survey of adults ≥ 18 years old in Denmark reporting at least one headache day in the last year. We used social media (Facebook) to publicize and drive a recruitment campaign. The survey investigated five items: (1) disease burden, (2) social life, (3) presenteeism, (4) social support, and (5) healthcare utilization. RESULTS: We included 6,567 respondents from May 2021 to June 2021; 70.2% were female, 39.8% male, and mean age was 43.2 ± 13.4 years. Of the respondents, 54.2% reported headache at least once a week, 33.4% reported headache a couple of times a month, and 12.4% reported headache a couple of times a year. Two-thirds of respondents (66.6%) reported that headache limited their social lives occasionally or frequently. Most respondents (86.8%) reported going to work or attending educational activities occasionally or more frequently even though they had headache. Half of the respondents (49.5%) experienced lack of understanding of their headaches from people occasionally or more frequently. Almost half of respondents (43.7%) had never consulted a medical doctor for their headache; even of those with weekly headache, more than a quarter (28.3%) had never done so in their lifetimes. CONCLUSIONS: Headache disorders continue to be a problem, even in a high-income country with free and easily accessible headache services. Further studies are needed to investigate and clarify why even people with the highest burden are hesitant to seek and make use of widely available headache services