Awakening of the Sleeping Lion. EUMA Papers, Vol.4 No.2 January 2007

[From the introduction]. The constitution of the European Union, a common security policy and further enlargement: Three big challenges - if not the largest - to the modern European Union. Challenges that need to be solved and understood, this paper will argue, if the EU is to grow into its full potential as a global political and economical power

INDSATS FOR BØRN I KRISE- OG KATASTROFESITUATIONER

Børn i krise- og katastrofesituationer er særligt sårbare. Børns kognitive beredskab er ikke færdigudviklet, de har begrænsede copingstrategier og resilience, og deres grundlæggende antagelser om livet er umodne og lette at ryste. En stabil og forudsigelig dagligdag, psykosocial stimulering samt beskyttende omsorgspersoner er afgørende for børns trivsel; og det er disse ting, der bryder sammen i kata strofe situationer. Børn udsat for traumatiske hændelser samt depriveret opvækst vil fejludvikles og mærkes for resten af livet. Nødhjælpsprogrammer bør være direkte rettet mod børnene, såvel som deres primære og sekundære netværk. Generelt er det lettest at styrke resilience og reetablere en hverdag ved akutte katastrofer. Det er sværere at hjælpe under kroniske kriser, når de fundamentale trusler og problemer ikke står til at ændre. Her kan programmerne alene give lettelse og bedring af vilkår i hverdagen. Interventionen kan være overvejende klinisk eller psykosocial, ligesom den kan være rettet mod enkelt per soner eller grupper. Vægtningen i det enkelte program afhænger af behov, kontekst og politiske prioriteter. Et program bør bestå i en kortlægning af problemer og behov, opbygningen af et samarbejde med lokale partnere og medarbejdere og et tæt samarbejde om udviklingen af intervention. Psykologien kan dels støtte forskellige clusterprogrammer i at inkorporere psykosociale aspekter, dels er den fundamentet for udformningen af mental health og psykosociale programmer

Simulation-based training for colonoscopy:establishing criteria for competency

The aim of this study was to create simulation-based tests with credible pass/fail standards for 2 different fidelities of colonoscopy models. Only competent practitioners should perform colonoscopy. Reliable and valid simulation-based tests could be used to establish basic competency in colonoscopy before practicing on patients. Twenty-five physicians (10 consultants with endoscopic experience and 15 fellows with very little endoscopic experience) were tested on 2 different simulator models: a virtual-reality simulator and a physical model. Tests were repeated twice on each simulator model. Metrics with discriminatory ability were identified for both modalities and reliability was determined. The contrasting-groups method was used to create pass/fail standards and the consequences of these were explored. The consultants significantly performed faster and scored higher than the fellows on both the models (P < 0.001). Reliability analysis showed Cronbach α = 0.80 and 0.87 for the virtual-reality and the physical model, respectively. The established pass/fail standards failed one of the consultants (virtual-reality simulator) and allowed one fellow to pass (physical model). The 2 tested simulations-based modalities provided reliable and valid assessments of competence in colonoscopy and credible pass/fail standards were established for both the tests. We propose to use these standards in simulation-based training programs before proceeding to supervised training on patients

A review of smartphone applications designed to improve occupational health, safety, and well-being at workplaces

BACKGROUND: As smartphones become more widespread, software applications for occupational health, safety and well-being (OHS&W) at work are increasing. There is sparse knowledge about the available apps and the research evidence of their effects. This study aims to identify available smartphone applications designed to improve OHS&W at workplaces, and examine to what extent the apps are scientifically validated. METHODS: We searched the Danish App Store and Google Play for free OHS&W apps. Apps were included if they targeted OHS&W and were designed for workplace use. After categorizing the apps, we searched bibliographic databases to identify scientific studies on the ‘intervention apps’. RESULTS: Altogether, 57 apps were included in the study; 19 apps were categorized as digital sources of information, 37 apps contained an intervention designed for workplace changes, and one app had too sparse information to be classified. Based on the publicly available information about the 37 intervention apps, only 13 had references to research. The bibliographic database search returned 531 publications, resulting in four relevant studies referring to four apps aimed at ergonomic measures, noise exposure, and well-being, which showed either limited effect or methodological limitations. CONCLUSION: There is no conceptual clarity about what can be categorized as an OHS&W app. Although some of the apps were developed based on scientific research, there is a need to evaluate the apps’ effects in promoting OHS&W. The sparse documentation of evidence should be kept in mind when applying apps to improve OHS&W. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-022-13821-6

Automatic and unbiased assessment of competence in colonoscopy:exploring validity of the Colonoscopy Progression Score (CoPS)

Background and aims: Colonoscopy is a difficult procedure to master. Increasing demands for colonoscopy, due to screening and surveillance programs, have highlighted the need for competent performers. Valid methods for assessing technical skills are pivotal for training and assessment. This study is the first clinical descriptive report of a novel colonoscopy assessment tool based on Magnetic Endoscopic Imaging (MEI) data and the aim was to gather validity evidence based on the data collected using the “Colonoscopy Progression Score” (CoPS). Methods: We recorded 137 colonoscopy procedures performed by 31 endoscopists at three university hospitals. The participants performed more than two procedures each (range 2 – 12) and had an experience of 0 – 10 000 colonoscopies. The CoPS was calculated for each recording and validity was explored using a widely accepted contemporary framework. The following sources of validity evidence were explored: response process (data collection), internal structure (reliability), relationship to other variables (i. e. operator experience), and consequences of testing (pass/fail). Results: Identical set-ups at all three locations ensured uniform data collection. The Generalizability coefficient (G-coefficient) was 0.80, and a Decision-study (D-study) revealed that four recordings were sufficient to ensure a G-coefficient above 0.80. We showed a positive correlation between CoPS and experience with Pearson’s r of 0.61 (P < 0.001). A pass/fail standard of 107 points was established using the contrasting group method to explore the consequences of testing. Conclusion: This study provides evidence supporting the validity of the CoPS for use in assessing technical colonoscopy performance in the clinical setting. Study registration: NCT01997177

Lower risk of hypoglycaemia and greater odds for weight loss with initiation of insulin detemir compared with insulin glargine in Turkish patients with type 2 diabetes mellitus: local results of a multinational observational study

BACKGROUND: The purpose of this analysis is to evaluate the safety and effectiveness of insulin initiation with once-daily insulin detemir (IDet) or insulin glargine (IGlar) in real-life clinical practice in Turkish patients with type 2 diabetes mellitus (T2DM). METHODS: This was a 24-week multinational observational study of insulin initiation in patients with T2DM. RESULTS: The Turkish cohort (n = 2886) included 2395 patients treated with IDet and 491 with IGlar. The change in glycosylated haemoglobin (HbA(1c)) from the pre-insulin levels was -2.21% [95% confidence interval (CI) -2.32, -2.09] in the IDet group and -1.88% [95% CI -2.17, -1.59] in the IGlar group at the final visit. The incidence rate of minor hypoglycaemia increased in both groups from the pre-insulin to the final visit (+0.66 and +2.23 events per patient year in the IDet and IGlar groups, respectively). Weight change in the IDet group was -0.23 kg [95% CI -0.49, 0.02 kg], and +1.55 kg [95% CI 1.11, 2.00 kg] in the IGlar group. Regression analysis with adjustment for previously identified confounders (age, gender, duration of diabetes, body mass index, previous history of hypoglycaemia, microvascular disease, number and change in oral anti-diabetic drug therapy, HbA(1c) at baseline and insulin dose) identified an independent effect of insulin type (IDet versus IGlar) with a risk of at least one episode of hypoglycaemia (odds ratio (OR): 0.33 [95% CI 0.21, 0.52], p <0.0001), and weight loss ≥1 kg (OR: 1.75 [95% CI 1.18, 2.59], p = 0.005), but not on HbA(1c) (+0.05% [95% CI -0.15, 0.25%], p = 0.6). CONCLUSIONS: Initiation of basal insulin analogues, IDet and IGlar, were associated with clinically significant glycaemic improvements. A lower risk of minor hypoglycaemia and greater odds of weight loss ≥1 kg was observed with IDet compared with IGlar. TRIAL REGISTRATION: NCT00825643 and NCT0074051

Sproglæring på arbejdspladser:En videnspakke om sproglæring på arbejdspladser i de nordiske lande og erfaringer med sprogunderstøttende indsatser på danske arbejdspladser

Videnspakke om sproglæring på arbejdspladser i de nordiske lande og erfaringer med sprogunderstøttende indsatser på danske arbejdspladse