Equity in digital healthcare – the case of Denmark

As digital healthcare services are expanding in use and purpose in a Danish context so are the functionalities embedded in these, constituting citizens’ access to healthcare services and personal health data. In Denmark, the impact of inequalities in digital healthcare remains largely unexplored, making it crucial to pay close attention to this aspect as the digital transformation of the sector progresses. According to the Danish Health Act (2019), the Danish healthcare system is required to ensure easy and equal access to healthcare, high-quality treatment, coherent patient pathways, freedom of choice, easy access to information, transparency, and short waiting times for every citizen. These are focal law-based requirements influenced by the digitalisation of healthcare. Hence, based on insights from a highly digitalised country, in this case, Denmark, this paper aims to initiate a discussion on inequities in digital healthcare, address current challenges, and consider future directions by elaborating on conceptual, ethical, evidence-informed, and methodological issues linked to inequities in digital healthcare. Specifically, this paper discusses why inequities in digital healthcare in a Danish context need increased attention, how health equity is embedded in Danish legislation and how it can be approached from an ethical perspective. The central focus revolves around the essential principles of empowerment, emancipation, and equity, which are being highlighted to emphasise that the digitalisation of healthcare should actively work towards preventing and avoiding the perpetuation of healthcare inequalities. The paper concludes by discussing future directions for ensuring a more sustainable, robust, and equitable digital healthcare system

Treatment planning comparison in the PROTECT-trial randomising proton versus photon beam therapy in oesophageal cancer:Results from eight European centres

PURPOSE To compare dose distributions and robustness in treatment plans from eight European centres in preparation for the European randomized phase-III PROTECT-trial investigating the effect of proton therapy (PT) versus photon therapy (XT) for oesophageal cancer. MATERIALS AND METHODS All centres optimized one PT and one XT nominal plan using delineated 4DCT scans for four patients receiving 50.4 Gy (RBE) in 28 fractions. Target volume receiving 95% of prescribed dose (V95%iCTVtotal) should be >99%. Robustness towards setup, range, and respiration was evaluated. The plans were recalculated on a surveillance 4DCT (sCT) acquired at fraction ten and robustness evaluation was performed to evaluate the effect of respiration and inter-fractional anatomical changes. RESULTS All PT and XT plans complied with V95%iCTVtotal >99% for the nominal plan and V95%iCTVtotal >97% for all respiratory and robustness scenarios. Lung and heart dose varied considerably between centres for both modalities. The difference in mean lung dose and mean heart dose between each pair of XT and PT plans was in median [range] 4.8 Gy [1.1;7.6] and 8.4 Gy [1.9;24.5], respectively. Patients B and C showed large inter-fractional anatomical changes on sCT. For patient B, the minimum V95%iCTVtotal in the worst-case robustness scenario was 45% and 94% for XT and PT, respectively. For patient C, the minimum V95%iCTVtotal was 57% and 72% for XT and PT, respectively. Patient A and D showed minor inter-fractional changes and the minimum V95%iCTVtotal was >85%. CONCLUSION Large variability in dose to the lungs and heart was observed for both modalities. Inter-fractional anatomical changes led to larger target dose deterioration for XT than PT plans

Shared genetic background between children and adults with attention deficit/hyperactivity disorder

Attention deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by age-inappropriate symptoms of inattention, impulsivity, and hyperactivity that persist into adulthood in the majority of the diagnosed children. Despite several risk factors during childhood predicting the persistence of ADHD symptoms into adulthood, the genetic architecture underlying the trajectory of ADHD over time is still unclear. We set out to study the contribution of common genetic variants to the risk for ADHD across the lifespan by conducting meta-analyses of genome-wide association studies on persistent ADHD in adults and ADHD in childhood separately and jointly, and by comparing the genetic background between them in a total sample of 17,149 cases and 32,411 controls. Our results show nine new independent loci and support a shared contribution of common genetic variants to ADHD in children and adults. No subgroup heterogeneity was observed among children, while this group consists of future remitting and persistent individuals. We report similar patterns of genetic correlation of ADHD with other ADHD-related datasets and different traits and disorders among adults, children, and when combining both groups. These findings confirm that persistent ADHD in adults is a neurodevelopmental disorder and extend the existing hypothesis of a shared genetic architecture underlying ADHD and different traits to a lifespan perspective

Genetic correlation between amyotrophic lateral sclerosis and schizophrenia

A. Palotie on työryhmän Schizophrenia Working Grp Psychiat jäsen.We have previously shown higher-than-expected rates of schizophrenia in relatives of patients with amyotrophic lateral sclerosis (ALS), suggesting an aetiological relationship between the diseases. Here, we investigate the genetic relationship between ALS and schizophrenia using genome-wide association study data from over 100,000 unique individuals. Using linkage disequilibrium score regression, we estimate the genetic correlation between ALS and schizophrenia to be 14.3% (7.05-21.6; P = 1 x 10(-4)) with schizophrenia polygenic risk scores explaining up to 0.12% of the variance in ALS (P = 8.4 x 10(-7)). A modest increase in comorbidity of ALS and schizophrenia is expected given these findings (odds ratio 1.08-1.26) but this would require very large studies to observe epidemiologically. We identify five potential novel ALS-associated loci using conditional false discovery rate analysis. It is likely that shared neurobiological mechanisms between these two disorders will engender novel hypotheses in future preclinical and clinical studies.Peer reviewe

Developing visual tangible artefacts as an inclusive method for exploring digital activities with young people with learning disabilities

Background: Young people with learning disabilities use many digital technologies to undertake meaningful and social activities in their everyday lives. Understanding these digital activities is essential for supporting their digital participation. Including them in exploring their digital activities can be challenging with conventional qualitative research methods, because digital activities are a complex and abstract topic to discuss, particularly for people with learning disabilities. In this paper, we present the rationale for developing and using visual tangible artefacts (VTAs) to include young people with learning disabilities in exploring their digital activities. Methods: We devised a suite of VTAs to engage young people (aged 14–27 years) with learning disabilities in exploring their digital activities via interviews, diaries, and workshops. The VTAs comprised Talking Mats (TMs), probing with technology, digital snapshots and inspiration cards. Findings: Our significant methodological findings were that VTAs are useful for exploring digital activities with young people with learning disabilities. TMs and probing with technology can engage participants to map, recall and explain their digital activities. Digital snapshots are valuable for validating findings with participants, and inspiration cards aid perspectives about digital aims. Although communication and abstract representations can be challenging for people with learning disabilities, VTAs that combine familiar, simple, intuitive, individualised, rewarding elements and collaboration with participants proved valuable for exploring their digital activities. Conclusion: We concluded that VTAs are inclusive tools for exploring the digital activities of and with young people with learning disabilities. The VTAs allowed access to conversations, information and insights that are not obtainable otherwise. As such, the VTAs may be regarded as a new model for inclusive research in the field of disability and technology studies.</p

Developing visual tangible artefacts as an inclusive method for exploring digital activities with young people with learning disabilities

Background: Young people with learning disabilities use many digital technologies to undertake meaningful and social activities in their everyday lives. Understanding these digital activities is essential for supporting their digital participation. Including them in exploring their digital activities can be challenging with conventional qualitative research methods, because digital activities are a complex and abstract topic to discuss, particularly for people with learning disabilities. In this paper, we present the rationale for developing and using visual tangible artefacts (VTAs) to include young people with learning disabilities in exploring their digital activities. Methods: We devised a suite of VTAs to engage young people (aged 14–27 years) with learning disabilities in exploring their digital activities via interviews, diaries, and workshops. The VTAs comprised Talking Mats (TMs), probing with technology, digital snapshots and inspiration cards. Findings: Our significant methodological findings were that VTAs are useful for exploring digital activities with young people with learning disabilities. TMs and probing with technology can engage participants to map, recall and explain their digital activities. Digital snapshots are valuable for validating findings with participants, and inspiration cards aid perspectives about digital aims. Although communication and abstract representations can be challenging for people with learning disabilities, VTAs that combine familiar, simple, intuitive, individualised, rewarding elements and collaboration with participants proved valuable for exploring their digital activities. Conclusion: We concluded that VTAs are inclusive tools for exploring the digital activities of and with young people with learning disabilities. The VTAs allowed access to conversations, information and insights that are not obtainable otherwise. As such, the VTAs may be regarded as a new model for inclusive research in the field of disability and technology studies.</p