Publications by authors named "Katrine Madsen"

32 Publications

Coordinated maintenance of H3K36/K27 methylation by histone demethylases preserves germ cell identity and immortality.

Cell Rep 2021 Nov;37(8):110050

Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Ole Maaløes vej 5, Copenhagen DK-2200, Denmark. Electronic address:

Germ cells have evolved unique mechanisms to ensure the transmission of genetically and nongenetically encoded information, whose alteration compromises germ cell immortality. Chromatin factors play fundamental roles in these mechanisms. H3K36 and H3K27 methyltransferases shape and propagate a pattern of histone methylation essential for C. elegans germ cell maintenance, but the role of respective histone demethylases remains unexplored. Here, we show that jmjd-5 regulates H3K36me2 and H3K27me3 levels, preserves germline immortality, and protects germ cell identity by controlling gene expression. The transcriptional and biological effects of jmjd-5 loss can be hindered by the removal of H3K27demethylases, indicating that H3K36/K27 demethylases act in a transcriptional framework and promote the balance between H3K36 and H3K27 methylation required for germ cell immortality. Furthermore, we find that in wild-type, but not in jmjd-5 mutants, alterations of H3K36 methylation and transcription occur at high temperature, suggesting a role for jmjd-5 in adaptation to environmental changes.
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http://dx.doi.org/10.1016/j.celrep.2021.110050DOI Listing
November 2021

Underweight among adolescents in Denmark: prevalence, trends (1998-2018), and association of underweight with socioeconomic status.

Fam Pract 2021 Oct 29. Epub 2021 Oct 29.

National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.

Background: Underweight among adolescents is an important clinical and public health issue. It is associated with adverse health outcomes throughout the life-span and may reflect food poverty, unhealthy eating habits, or some underlying health conditions.

Objective: To study prevalence and trends in underweight among adolescents 1998-2018, to examine social inequality in underweight, and whether social inequality changed over time.

Methods: Data were derived from 6 cross-sectional school surveys from The Health Behaviour in School-aged Children study in Denmark. The study included 11-, 13-, and 15-year-old schoolchildren in random samples of schools in 1998, 2002, 2006, 2010, 2014, and 2018 (n = 22,177). Underweight was determined by body mass index-for-age thinness grade 2-3 (the Cole and Lobstein method). Socioeconomic status was determined using occupational social class (the Danish OSC Measurement).

Results: The overall prevalence of underweight was 3.1% among boys and 5.3% among girls (P < 0.0001) and decreased by age (P < 0.0001) among both boys and girls. The prevalence of underweight was almost stable from 1998 to 2018. There was no observed absolute or relative social inequality in the prevalence of underweight among boys or girls.

Conclusion: The prevalence of underweight in 11- to 15-year-olds was significantly higher among girls than boys. The prevalence remained stable from 1998 to 2018. There was no significant association between SES and prevalence of underweight. It is important to elucidate the underlying causes of underweight such as malnutrition, eating disorders, eating problems, loss of appetite, chronic diseases, insufficient knowledge of nutrients effects on bodily functions, and persistent pain.
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http://dx.doi.org/10.1093/fampra/cmab134DOI Listing
October 2021

Chronic backpain among adolescents in Denmark: trends 1991-2018 and association with socioeconomic status.

Eur J Pediatr 2021 Sep 16. Epub 2021 Sep 16.

University of Southern Denmark, National Institute of Public Health, Studiestræde 6, 1455, Copenhagen, Denmark.

Chronic backpain among adolescents is important because the prevalence is high, above 10%, and more than 10% of all adolescents experience impacts on important day-to-day activities. Chronic backpain tracks into adulthood and is associated with several health problems. The objective was to study trends in the prevalence of chronic backpain among adolescents 1991-2018, to examine the association with socioeconomic status (SES), and whether this association changed over time. The study used data from eight comparable cross-sectional school surveys of nationally representative samples of 11-15-year-olds in 1991, 1994, 1998, 2002, 2006, 2010, 2014, and 2018, which constitute the Danish arm of the international Health Behaviour in School-aged Children (HBSC) study. The participation rate was 74.6% of the eligible study population, n = 29,952. Chronic backpain was defined as self-reported backpain daily or several days a week during the last 6 months. The prevalence of chronic backpain was 11.1%, significantly increasing from 8.9% in 1991 to 11.7% in 2018. The OR for chronic backpain was 1.20 (95% CI: 1.10-1.31) in middle, and 1.56 (95% CI: 1.41-1.73) in low compared to high SES. Sensitivity analyses with two other cut-points for backpain frequency showed similar associations.Conclusion: Chronic backpain is common among adolescents and the prevalence increased from 1991 to 2018. The prevalence was highest in lower SES families. We recommend increased efforts to prevent chronic backpain. What is Known: • Chronic backpain among adolescents is common, has a high burden of disability, is associated with several health problems, and tracks into adulthood. What is New: • The prevalence of chronic backpain among adolescents in Denmark increased from 8.9% in 1991 to 11.7% in 2018. • The prevalence was highest among adolescents from lower SES families.
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http://dx.doi.org/10.1007/s00431-021-04255-0DOI Listing
September 2021

Peer mentors' role in school-based health promotion: qualitative findings from the Young & Active study.

Health Promot Int 2021 Aug 2. Epub 2021 Aug 2.

Department of Health and social context, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark.

Peer-led interventions are highlighted as promising strategies to promote health among adolescents, but little is known about the mechanisms underlying this approach. To better understand the role of peer mentors (PMs) as implementers in school-based health promotion, we combined participant observations, focus group interviews and video recordings to explore high school students' reception of a peer-led intervention component (Young & Active). Young & Active aimed to increase well-being among first-year high school students (∼16 years of age) through the promotion of movement and sense of community and was implemented during the school year 2016-2017 in a larger school-based intervention study, the Healthy High School study in Denmark. The Healthy High School study was designed as a cluster-randomized controlled trial with 15 intervention schools and 15 control schools. At each intervention school, university students in Sports Science and Health (members of the research group) facilitated an innovation workshop aiming at inspiring all first-year students to initiate movement activities at schools. The findings illustrate potentials and challenges implied in the PM role. The peer mentors' profound commitment, as well as their response and sensibility to situational contingencies, were found to be significant for the students' reception and experience of the intervention. In conclusion, the specific job of PMs as implementers seems to consist of simultaneously following a manual and situationally adjusting in an emerging context balancing commitment and identification to the target group and the intervention project.
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http://dx.doi.org/10.1093/heapro/daab089DOI Listing
August 2021

The Association between Loneliness, Mental Well-Being, and Self-Esteem among Adolescents in Four Nordic Countries.

Int J Environ Res Public Health 2021 07 11;18(14). Epub 2021 Jul 11.

Faculty of Sport and Health Sciences, University of Jyväskylä, FI-40014 Jyväskylä, Finland.

Positive mental health is central to adolescent well-being. The present study examines the prevalence of loneliness and positive mental health indicators (mental well-being and self-esteem) in four Nordic countries and associations between loneliness, mental well-being, and high self-esteem. This study is based on data from the Health Behaviour in School-aged Children (HBSC) study which was conducted in 2018 in Denmark, Finland, Iceland, and Sweden. Participants were 5883 15-year-old boys and girls. To examine the associations between loneliness, mental well-being, and self-esteem, structural equation modeling (SEM) was applied. In the comparison of Nordic countries, the prevalence of loneliness was highest among Finnish and Icelandic adolescents. High mental well-being and high self-esteem were most prevalent in Denmark and Sweden. In general, boys scored higher on positive mental health indicators and girls on loneliness. Loneliness was also a strong indicator of low mental well-being and low self-esteem in all Nordic countries. Loneliness is not only associated with mental health problems such as anxiety and depression, but it is also a risk factor for adolescents' positive mental health. Positive mental health is important for healthy maturation and there is a need to develop initiatives to reduce adolescent loneliness and so support positive development.
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http://dx.doi.org/10.3390/ijerph18147405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308002PMC
July 2021

Social Disconnectedness, Loneliness, and Mental Health Among Adolescents in Danish High Schools: A Nationwide Cross-Sectional Study.

Front Behav Neurosci 2021 12;15:632906. Epub 2021 Apr 12.

Department of Psychology, University of Copenhagen, Copenhagen, Denmark.

Previous research has suggested that social disconnectedness experienced at school is linked to mental health problems, however, more research is needed to investigate (1) whether the accumulation of various types of social disconnectedness is associated with risk for mental health problems, and (2) whether loneliness is a mechanism that explains these associations. Using data from the Danish National Youth Study 2019 (UNG19), nation-wide cross-sectional data from 29,086 high school students in Denmark were analyzed to assess associations between social disconnectedness experienced at school (lack of classmate support, lack of teacher support, lack of class social cohesion, and not being part of the school community) and various mental health outcomes, as well as the mediating role of loneliness for each type of disconnectedness. Multilevel regression analyses were conducted to assess the associations. Descriptive analyses suggest that 27.5% of Danish high school students experience at least one type of social disconnectedness at school. Each type of social disconnectedness was positively associated with mental health problems (depression symptoms, anxiety symptoms, stress, sleep problems, suicidal ideation, non-suicidal self-injury, eating disorder, body dissatisfaction, and low self-esteem) and negatively associated with mental well-being. In all cases, loneliness significantly mediated the associations. We found a clear dose-response pattern, where each addition in types of social disconnectedness was associated with (1) stronger negative coefficients with mental well-being and (2) stronger positive coefficients with mental health problems. Our results add to a large evidence-base suggesting that mental health problems among adolescents may be prevented by promoting social connectedness at school. More specifically, fostering social connectedness at school may prevent loneliness, which in turn may promote mental well-being and prevent mental health problems during the developmental stages of adolescence. It is important to note that focusing on single indicators of school social connectedness/disconnectedness would appear to be insufficient. Implications for practices within school settings to enhance social connectedness are discussed.
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http://dx.doi.org/10.3389/fnbeh.2021.632906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078177PMC
April 2021

Parental education, parent-child relations and diagnosed mental disorders in childhood: prospective child cohort study.

Eur J Public Health 2021 07;31(3):514-520

National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.

Background: Mental disorder in childhood is an important public health issue. We aimed to examine the prospective association between parental education at childbirth and diagnosed mental disorders in young children and explore whether this association was mediated or modified by parent-child relations in infancy.

Methods: Prospective cohort study of all newborn was from 2002 to 2010 from 16 municipalities in the capital region of Copenhagen, Denmark, with follow-up until their 8th birthday, N = 40 762. Baseline data included information from national population registers and from health visitors' records at child aged 0 to 10 months. Outcome variable: any mental disorder diagnosed at hospital from age 11 months to 8 years.

Results: Low parental education was predictive of diagnosed child mental disorder, adjusted odds ratio (AOR) = 1.83 (95% CI 1.49-2.23). Problematic parent-child relation at age 8-10 months was also predictive of mental disorder, AOR = 2.06 (1.57-2.70) but did not mediate the association between parental education and mental disorder. AOR for mental disorders was 3.24 (2.03-5.16 for the combination vocational training and problematic parent-child relation and 2.49 (1.42-4.38) for the combination primary school and problematic parent-child relation.

Conclusions: Low parental education and problematic parent-child relation were independent risk factors for diagnosed mental disorders in the age span of 11 months to 8 years.
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http://dx.doi.org/10.1093/eurpub/ckab053DOI Listing
July 2021

Economics of mental well-being: a prospective study estimating associated health care costs and sickness benefit transfers in Denmark.

Eur J Health Econ 2021 Sep 16;22(7):1053-1065. Epub 2021 Apr 16.

Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark.

Background: Previous literature has examined the societal costs of mental illness, but few studies have estimated the costs associated with mental well-being. In this study, a prospective analysis was conducted on Danish data to determine 1) the association between mental well-being (measured in 2016) and government expenditure in 2017, specifially healthcare costs and sickness benefit transfers.

Methods: Data stem from a Danish population-based survey of 3,508 adults (aged 16 + years) in 2016, which was linked to Danish registry data. A validated scale (WEMWBS) was used for the assessment of mental well-being. Costs are expressed in USD PPP. A two-part model was applied to predict costs in 2017, adjusting for sociodemographics, health status (including psychiatric morbidity and health behaviour), as well as costs in the previous year (2016).

Results: Each point increase in mental well-being (measured in 2016) was associated with lower healthcare costs ($- 42.5, 95% CI = $- 78.7, $- 6.3) and lower costs in terms of sickness benefit transfers ($- 23.1, 95% CI = $- 41.9, $- 4.3) per person in 2017.

Conclusions: Estimated reductions in costs related to mental well-being add to what is already known about potential savings related to the prevention of mental illness. It does so by illustrating the savings that could be made by moving from lower to higher levels of mental well-being both within and beyond the clinical range. Our estimates pertain to costs associated with those health-related outcomes that were included in the study, but excluding other social and economic outcomes and benefits. They cover immediate cost estimates (costs generated the year following mental well-being measurement) and not those that could follow improved mental well-being over the longer term. They may therefore be considered conservative from a societal perspective. Population approaches to mental health promotion are necessary, not only to potentiate disease prevention strategies, but also to reduce costs related to lower levels of mental well-being in the non-mental illness population. Our results suggest that useful reductions in both health care resource use and costs, as well as in costs due to sick leave from the workplace, could be achieved from investment in mental well-being promotion within a year.
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http://dx.doi.org/10.1007/s10198-021-01305-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318969PMC
September 2021

Associations Between Multiple Leisure Activities, Mental Health and Substance Use Among Adolescents in Denmark: A Nationwide Cross-Sectional Study.

Front Behav Neurosci 2020 21;14:593340. Epub 2020 Dec 21.

The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.

Previous research has suggested that leisure activity may benefit mental health and protect against substance use among adolescents, but more research is needed to asses associations with a wide range of outcomes. The aim of this study was to assess associations between multiple leisure activities and (1) mental health outcomes and (2) substance use outcomes in a sample of Danish adolescents. Using data from the Danish part of the European School Survey Project on Alcohol and Other Drugs (ESPAD) collected in 2019, nation-wide cross-sectional data from 2,488 participants aged 15 or 16 in Denmark were analyzed to assess associations between number of leisure activity types and outcomes pertaining to mental health and substance use. Our results show that engaging in multiple activity types at least once a week-as compared to one single type of activity-is associated with increased odds for high mental well-being, and reduced odds for mental health problems. Engaging in multiple activity types is also associated with reduced odds for overall substance use and for using substances as a coping method. Among those using substances, engaging in multiple activity types is associated with reduced odds of above average substance use. Increasing opportunities for adolescents to engage in leisure activities is suggested to be useful in enhancing mental health and preventing substance use and promoting mental health. Promoting and increasing access to leisure activities among adolescents could be a promising avenue for policy and practice.
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http://dx.doi.org/10.3389/fnbeh.2020.593340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779398PMC
December 2020

The moderating role of social network size in the temporal association between formal social participation and mental health: a longitudinal analysis using two consecutive waves of the Survey of Health, Ageing and Retirement in Europe (SHARE).

Soc Psychiatry Psychiatr Epidemiol 2021 Mar 9;56(3):417-428. Epub 2020 Oct 9.

Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark.

Introduction: Previous studies have shown that engaging in formal social participation may protect against declining mental health, but social network size (the number of close social ties a person has) may moderate the relationship. We assessed the potential moderating role of social network size using longitudinal data.

Methods: Nationally representative data from two consecutive waves (2011, 2013) of the SHARE survey were analyzed. The data consisted of 38,300 adults from 13 European countries aged 50 years and older in 2011. Measures pertaining to formal social participation, social network size, quality of life, and depression symptoms were used. Multivariable linear regression models were conducted.

Results: The majority of participants (over 70% of the sample) had a social network size of four or less close social ties. We identified significant moderations in both models. Individuals with relatively few close social ties may have benefitted from formal social participation both in terms of reductions in depression symptoms and increases in quality of life, while formal social participation among those with many social ties did not appear to be beneficial, and may even to some extent have been detrimental.

Conclusions: Declines in mental health specifically among those with relatively few close social ties could potentially be prevented through the promotion of formal social participation. It is possible that such strategies could have a greater impact by specifically targeting individuals that are otherwise socially isolated. High levels of formal participation among those with relatively many close social ties may not be pragmatically beneficial.
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http://dx.doi.org/10.1007/s00127-020-01961-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904560PMC
March 2021

Recurrent abdominal pain among adolescents: trends and social inequality 1991-2018.

Scand J Pain 2021 01 7;21(1):95-102. Epub 2020 Sep 7.

University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark.

Objectives: The association between socioeconomic status and recurrent abdominal pain (RAP) among adolescents is an understudied issue. No study has examined whether such an association changes over time. The aim was to examine trends in RAP among adolescents in Denmark from 1991 to 2018, to examine whether there was social inequality in RAP and whether this inequality varied over time.

Methods: The study used data from the Danish part of the international Health Behaviour in School-aged Children (HBSC) study of nationally representative samples of 11-, 13- and 15-year-olds. This study pooled data from eight comparable surveys from 1991 to 2018, overall participation rate 88.0%, n=30,048. The definition of RAP was self-reported stomach-ache daily or several days per week during the past six months. We reported absolute inequality as prevalence difference in RAP between low and high socioeconomic status and relative inequality as odds ratio for RAP by socioeconomic status.

Results: In the entire study population, 5.6% reported RAP, 3.1% among boys and 7.8% among girls. There was a significant increase in RAP from 1991 to 2018 among boys and girls, test for trend, p<0.0001. The prevalence of RAP was significantly higher in low than high socioeconomic status, OR=1.63 (95% CI: 1.42-1.87). The absolute social inequality in RAP fluctuated with no consistent increasing or decreasing pattern.

Conclusions: The prevalence of RAP increased from 1991 to 2018. The prevalence was significantly higher among girls than among boys, and significantly higher in low socioeconomic status families. Professionals should be aware of RAP as common and potentially serious health problems among children and adolescents. In addition to clinical examination it is important to focus on improving the child's quality of life, reduce parents' and children's concerns about the seriousness of the condition, and consider supplements to medicine use.
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http://dx.doi.org/10.1515/sjpain-2020-0062DOI Listing
January 2021

Measuring positive mental health and flourishing in Denmark: validation of the mental health continuum-short form (MHC-SF) and cross-cultural comparison across three countries.

Health Qual Life Outcomes 2020 Sep 4;18(1):297. Epub 2020 Sep 4.

Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark.

Background: The Mental Health Continuum-Short Form (MHC-SF) is a measure of positive mental health and flourishing, which is widely used in several countries but has not yet been validated in Denmark. This study aimed to examine its qualitative and quantitative properties in a Danish population sample and compare scores with Canada and the Netherlands.

Methods: Three thousand five hundred eight participants aged 16-95 filled out an electronic survey. Both the unidimensional and multidimensional aspects of the Danish MHC-SF were studied through bifactor modelling. Cognitive interviews examined face validity and usability.

Results: The general score of the Danish MHC-SF was reliable for computing unit-weighted composite scores, as well as using a bifactor model to compute general factor scores or measurement models in an SEM context. Nonetheless, subscale scores were unreliable, explaining very low variance beyond that explained by the general factor. The participants of the qualitative interviews observed problems with wording and content of the items, especially from the social subscale. The general score correlated with other scales as expected. We found substantial variation in flourishing prevalence rates between the three cultural settings.

Conclusions: The Danish MHC-SF produced reliable general scores of well-being. Most of the issues observed regarding the subscale scores have been shown in previous research in other contexts. The further analysis of indices of the bifactor model and the inclusion of qualitative interviews allowed for a better understanding of the possible sources of problems with the questionnaire's subscales. The use of subscales, the substantive understanding of the general score, as well as the operationalization of the state of flourishing, require further study.
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http://dx.doi.org/10.1186/s12955-020-01546-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7650216PMC
September 2020

Implementing Mental Health Promotion Initiatives-Process Evaluation of the ABCs of Mental Health in Denmark.

Int J Environ Res Public Health 2020 08 11;17(16). Epub 2020 Aug 11.

The Danish National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark.

Treatment and prevention alone are unlikely to make a significant difference in reducing the burden of poor mental health and mental illness. Therefore, mental health promotion (MHP) initiatives are advocated. In 2014, the ABCs of mental health (ABCs) partnership was established in Denmark; in the partnership, partner organisations, e.g., municipalities and NGOs, use a research-based framework for MHP, the ABC-framework, to develop and implement MHP initiatives. This paper has two aims: (1) to outline the overall characteristics of these MHP initiatives; and (2) to explore local coordinator and stakeholder perceptions of the implementation processes and the impact of the MHP initiatives. Questionnaire surveys, individual interviews and group interviews were conducted during 2017-2020. The MHP initiatives were grouped according to three strategies: building MHP capacity, campaign activities to promote mental health awareness and knowledge and establishing and promoting opportunities to engage in mentally healthy activities. The ABC-framework was positively received and viewed as providing relevant knowledge for working with MHP as well as fostering intersectoral and interprofessional collaborations. However, using a bottom-up approach to develop and implement MHP initiatives can be time-consuming and resource demanding, and it requires a deliberate balancing of local adaptability and concrete guidance when engaging stakeholders and implementers. Overall, using the ABC-framework to develop and implement MHP initiatives holds great promise for advancing and promoting MHP practice.
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http://dx.doi.org/10.3390/ijerph17165819DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460269PMC
August 2020

Implementation of initiatives to prevent student stress: process evaluation findings from the Healthy High School study.

Health Educ Res 2020 06;35(3):195-215

Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark.

Process evaluation of public health interventions is important for understanding intervention results and can help explain why interventions succeed or fail. This study evaluated implementation of a school-based intervention combining educational and environmental strategies to prevent stress among Danish high school students. We investigated dose delivered, dose received, fidelity, appreciation, barriers and facilitators at the 15 intervention schools using mixed methods and multiple data sources: questionnaires among students, teachers and school coordinators; semi-structured interviews with school coordinators; telephone interviews with student counsellors; and focus group interviews with students and teachers. Implementation varied by schools and classes. Half of the intervention schools delivered the environmental strategies. For the educational strategies, dose delivered differed according to intervention provider. Students reported a lower dose received compared with dose delivered reported by school staff. Overall, student counsellors, school coordinators and students-especially those with low perceived stress-were satisfied with the stress preventive initiatives while teacher satisfaction varied. Five main barriers and three facilitators for implementation were identified. The use of multiple data sources and data methods created new knowledge of the implementation process which is important for the interpretation of effect evaluation and development of future interventions.
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http://dx.doi.org/10.1093/her/cyaa003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243719PMC
June 2020

Formal social participation protects physical health through enhanced mental health: A longitudinal mediation analysis using three consecutive waves of the Survey of Health, Ageing and Retirement in Europe (SHARE).

Soc Sci Med 2020 04 3;251:112906. Epub 2020 Mar 3.

The Danish National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, Denmark.

Introduction: Previous studies have shown that formal social participation may reduce the risk of developing chronic conditions. Yet, the underlying mechanisms are largely unknown. In this study, we assessed the potential mediating roles of quality of life and depressive symptoms using longitudinal data.

Method: We analyzed nationally representative data from three consecutive waves (2011, 2013, 2015) of the SHARE survey, including 28,982 adults from 12 European countries aged 50 years and above at baseline. Measures were self-reported and included formal social participation (i.e. active participation within volunteer organizations, educational institutions, clubs, religious organizations, or political/civic groups), quality of life (CASP-12), depressive symptoms (EURO-D), and chronic conditions. Structural equation modeling was used to construct a focused longitudinal path model.

Results: Formal social participation at baseline was inversely associated with the number of chronic conditions at 4-year follow-up. We identified two significant longitudinal mediation patterns: 1) formal social participation predicted higher levels of quality of life, which in turn, predicted lower levels of chronic conditions; and 2) formal social participation predicted lower levels of depressive symptoms, which, in turn, also predicted lower levels of chronic conditions.

Conclusions: Formal social participation functions as a protective factor against the onset or development of chronic conditions. This association is partially explained by enhanced quality of life and diminished depressive symptoms.
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http://dx.doi.org/10.1016/j.socscimed.2020.112906DOI Listing
April 2020

Predictors of high and low mental well-being and common mental disorders: findings from a Danish population-based study.

Eur J Public Health 2020 06;30(3):532-538

The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.

Background: Mental well-being is fundamental for a good life. Previous literature has examined the predictors of mental disorders and continuous measures of positive mental health. Very few studies have specifically focused on the predictors of different levels of mental well-being, but those that have suggest a different picture. This study aimed to compare socioeconomic and relational/recreational behaviour predictors of different levels of mental well-being as well as common mental disorders (CMDs).

Methods: Data from 3508 adults aged 16+ years old from the Danish Mental Health and Well-Being Survey 2016 were linked to Danish national register-based data. Mental well-being was assessed using the Warwick-Edinburgh Mental Well-being Scale, and information on CMDs was assessed using the Patient Health Questionnaire (PHQ-4). Regression analyses were conducted to estimate the predictors of low and high mental well-being compared to moderate mental well-being and also of CMDs.

Results: Lower socioeconomic position (education, income and employment status) was associated with increased odds of low mental well-being and the presence of CMDs, but did not significantly predict high mental well-being. Relational/recreational behaviours (informal and formal social participation, social support and recreational activity) were associated with reduced odds of low mental well-being and CMDs, and also with increased odds of high mental well-being.

Conclusions: Socioeconomic predictors of high mental well-being do not mirror those of low mental well-being and CMDs, whereas relational/recreational predictors of high mental well-being do mirror those of low mental well-being and CMDs. These findings have important implications for public mental health strategies.
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http://dx.doi.org/10.1093/eurpub/ckaa021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292340PMC
June 2020

Study protocol of the Healthy High School study: a school-based intervention to improve well-being among high school students in Denmark.

BMC Public Health 2020 Jan 22;20(1):95. Epub 2020 Jan 22.

Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.

Background: The prevalence of low well-being, perceived stress and unhealthy behaviours is high among high school students, but few interventions have addressed these problems. The aim of this paper is to present a study protocol of a cluster randomised controlled trial evaluating the Healthy High School (HHS) intervention programme. The intervention programme is designed to improve well-being (primary outcome) by preventing 1) stress and promoting 2) sleep, 3) sense of community, 4) physical activity (PA) and 5) regular and healthy meals among high school students in Denmark.

Methods: The development of the HHS study was guided by the Intervention Mapping protocol. The intervention comprises four components: 1) a teaching material, 2) a smartphone app, 3) a catalogue focusing on environmental changes, and 4) a peer-led innovation workshop aiming at inspiring students to initiate and participate in various movement activities. The HHS study employs a cluster-randomised controlled trial design. Thirty-one high schools across Denmark were randomly allocated to intervention (16 schools) or control (15 schools) groups. The study included all first-year students (~ 16 years of age) (n = 5976 students). Timeline: Intervention: August 2016 - June 2017. Collection of questionnaire data: Baseline (August 2016), 1st follow-up (May 2017) and 2nd follow-up (April 2018). All students were invited to participate in a monthly sub-study about perceived stress using text messages for data collection (September 2016 - June 2017). PA was objectively assessed among a sub-sample of students using accelerometers (Axivity, AX3) in August 2016 and May 2017.

Primary Outcome Measures: Student well-being measured by the Cantril Ladder and the five item World Health Organisation Well-being Index (individual level outcomes).

Secondary Outcome Measures: Stress (10-item Perceived Stress Scale), sleep (quantity and quality), PA (hours of moderate-to-vigorous PA per week, hours of daily sedentary time and average daily PA), meal habits (daily intake of breakfast, lunch, snacks and water), and strong sense of community in class and at school, respectively (individual level outcomes). The study encompasses process and effect evaluation as well as health economic analyses.

Trial Registration: ISRCTN ISRCTN43284296, 28 April 2017, retrospectively registered.
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http://dx.doi.org/10.1186/s12889-020-8194-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6977303PMC
January 2020

Loneliness in the lives of Danish adolescents: Associations with health and sleep.

Scand J Public Health 2020 Dec 23;48(8):877-887. Epub 2020 Jan 23.

National Institute of Public Health, University of Southern Denmark, Denmark.

We examined the relationship between loneliness and health among young adolescents. We also investigated the validity of a single-item measure of loneliness by comparing this to a composite score. The current data come from a nationally representative sample of 11- to 15-year-old adolescents (=3305; =52%) from Denmark collected in 2014 as part of the Health Behaviour in School-aged Children (HBSC) collaborative cross-national survey. A series of binary logistic regressions showed that higher loneliness among adolescents, whether measured using the single- or multi-item measurement, was associated with poorer self-rated health, higher frequency of headache, stomach ache, backache, difficulties sleeping, greater sleep disturbance and more instances of feeling tired in the morning. Those associations were relatively consistent across sex and age groups.
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http://dx.doi.org/10.1177/1403494819865429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678339PMC
December 2020

Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis.

Lancet Public Health 2020 01;5(1):e62-e70

The Danish National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.

Background: Research indicates that social isolation and loneliness increase the risk of mental disorders, but less is known about the distinct contributions of different aspects of isolation. We aimed to distinguish the pathways through which social disconnectedness (eg, small social network, infrequent social interaction) and perceptions of social isolation (eg, loneliness, perceived lack of support) contribute to anxiety and depression symptom severity in community-residing older adults aged 57-85 years at baseline.

Methods: We did a longitudinal mediation analysis with data from the National Social Life, Health, and Aging Project (NSHAP). The study included individuals from the USA born between 1920 and 1947. Validated measures on social disconnectedness, perceived isolation, and depression and anxiety symptoms were used. Structural equation modelling was used to construct complete longitudinal path models.

Findings: Using data from 3005 adults aged 57-85 years, we identified two significant longitudinal mediation patterns with symptoms of depression, and two with anxiety symptoms. Overall, social disconnectedness predicted higher subsequent perceived isolation (β=0·09; p<0·0001), which in turn predicted higher depression symptoms (β=0·12; p<0·0001) and anxiety symptoms (β=0·12; p<0·0001). The reverse pathways were statistically supported as well, suggesting bi-directional influences.

Interpretation: Social network structure and function are strongly intertwined with anxiety and depression symptoms in the general population of older adults. Public health initiatives could reduce perceived isolation by facilitating social network integration and participation in community activities, thereby protecting against the development of affective disorders.

Funding: Nordea-fonden.
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http://dx.doi.org/10.1016/S2468-2667(19)30230-0DOI Listing
January 2020

Increasing prevalence of emotional symptoms in higher socioeconomic strata: Trend study among Danish schoolchildren 1991-2014.

Scand J Public Health 2019 Nov 15;47(7):690-694. Epub 2018 Jan 15.

National Institute of Public Health, University of Southern Denmark, Denmark.

The aims of this study were: (a) to examine trends in daily emotional symptoms among 11- to 15-year-olds from 1991 to 2014 in Denmark, and (b) to examine trends in social inequality in daily emotional symptoms, that is, whether the differences in prevalence between adolescents with parents of varying occupational social class changed over time. We combined seven comparable cross-sectional Health Behaviour in School-aged Children surveys (=31,169). Daily emotional symptoms were measured by the HBSC Symptom Check List and occupational social class (OSC) by students' reports about parents' occupation. We calculated absolute (per cent) differences in emotional symptoms between high and low OSC and relative differences by odds ratio for emotional symptoms by parents' OSC. Eight per cent reported at least one daily emotional symptoms, with an increasing trend from 1991 to 2014 (<0.001). The prevalence in high, middle and low OSC was 6.2%, 7.4% and 10.6% (<0.0001). From 1991 to 2014, there was an increase in the prevalence of daily emotional symptoms in high (<0.0001) and middle (<0.0001) but not low OSC (=0.4404). This resulted in a diminishing absolute social inequality in emotional symptoms. The statistical interaction between OSC and survey year was significant (=0.0023) and suggests a diminishing relative social inequality in emotional symptoms from 1991 to 2014.
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http://dx.doi.org/10.1177/1403494817752520DOI Listing
November 2019

Loneliness and Ethnic Composition of the School Class: A Nationally Random Sample of Adolescents.

J Youth Adolesc 2016 Jul 10;45(7):1350-65. Epub 2016 Feb 10.

National Institute of Public Health, University of Southern Denmark, Oester Farimagsgade 5A, 2nd Floor, DK-1353, Copenhagen, Denmark.

Loneliness is a public health concern that increases the risk for several health, behavioral and academic problems among adolescents. Some studies have suggested that adolescents with an ethnic minority background have a higher risk for loneliness than adolescents from the majority population. The increasing numbers of migrant youth around the world mean growing numbers of heterogeneous school environments in many countries. Even though adolescents spend a substantial amount of time at school, there is currently very little non-U.S. research that has examined the importance of the ethnic composition of school classes for loneliness in adolescence. The present research aimed to address this gap by exploring the association between loneliness and three dimensions of the ethnic composition in the school class: (1) membership of ethnic majority in the school class, (2) the size of own ethnic group in the school class, and (3) the ethnic diversity of the school class. We used data from the Danish 2014 Health Behaviour in School-aged Children survey: a nationally representative sample of 4383 (51.2 % girls) 11-15-year-olds. Multilevel logistic regression analyses revealed that adolescents who did not belong to the ethnic majority in the school class had increased odds for loneliness compared to adolescents that belonged to the ethnic majority. Furthermore, having more same-ethnic classmates lowered the odds for loneliness. We did not find any statistically significant association between the ethnic diversity of the school classes and loneliness. The study adds novel and important findings to how ethnicity in a school class context, as opposed to ethnicity per se, influences adolescents' loneliness.
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http://dx.doi.org/10.1007/s10964-016-0432-3DOI Listing
July 2016

The Relationship Between Immigrant School Composition, Classmate Support and Involvement in Physical Fighting and Bullying among Adolescent Immigrants and Non-immigrants in 11 Countries.

J Youth Adolesc 2016 Jan;45(1):1-16

Increasing numbers of migrant youth around the world mean growing numbers of heterogeneous school environments in many countries. Contradictory findings regarding the relationship between immigrant school composition (the percentage of immigrant versus non-immigrant students in a school) and adolescent peer violence necessitate further consideration. The current study examined the relationship between immigrant school composition and peer violence, considering classmate support as a potential moderator among 51,636 adolescents (50.1% female) from 11 countries. The findings showed that a higher percentage of immigrant adolescents in a school was related to higher levels of physical fighting and bullying perpetration for both immigrant and non-immigrant adolescents and lower levels of victimization for immigrants. In environments of low classmate support, the positive relationship between immigrant school composition and fighting was stronger for non-immigrants than in environments with high classmate support. In environments of low classmate support, the negative relationship between immigrant school composition and fighting and bullying victimization was stronger for immigrant adolescents than in environments with high classmate support. In general, the contribution of immigrant school composition was modest in comparison to the contribution of classmate support. The findings emphasize that it is not just the number of immigrants in a class per se, but rather the environment in the classroom which influences levels of peer violence. The results highlight a need for school intervention programs encouraging positive relations in schools with immigrant populations.
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http://dx.doi.org/10.1007/s10964-015-0367-0DOI Listing
January 2016

An Internationally Comparative Study of Immigration and Adolescent Emotional and Behavioral Problems: Effects of Generation and Gender.

J Adolesc Health 2015 Dec 21;57(6):587-94. Epub 2015 Aug 21.

Health Promotion Research Centre, National University of Ireland, Galway, Ireland.

Purpose: Although the potential consequences of immigration for adolescent problem behaviors have been addressed in many former studies, internationally comparative research is scarce. This study investigated the impact of immigration on four indicators of adolescents' emotional and behavioral problems in 10 countries, taking into account gender and immigrant generation as moderating factors.

Methods: Analyses were based on data from 11-, 13-, and 15-year-old adolescents participating in the Health Behavior in School-aged Children study in Denmark, Germany, Greece, Iceland, Ireland, Italy, the Netherlands, Spain, the United States, and Wales (total N = 53,218).

Results: Both first- and second-generation immigrant adolescents reported higher levels of physical fighting and bullying and a lower life satisfaction than native adolescents, whereas second-generation immigrant adolescents reported more psychosomatic symptoms than native adolescents. Effect sizes varied considerable for the different outcomes, and similar effects were found for first- and second-generation immigrant adolescents. Differences in these indicators of emotional and behavioral problems between immigrant and native adolescents did not vary significantly with the receiving country. With two exceptions, effects of immigrant status were similar for boys and girls. Although no differences in psychosomatic symptoms were found between first-generation immigrant and native girls, first-generation immigrant boys reported less psychosomatic symptoms than native boys. Furthermore, both second-generation immigrant boys and girls reported higher levels of physical fighting than their native peers, but differences were more pronounced for boys than for girls.

Conclusions: Overall, the results of this study support a risk perspective on the impact of immigration on adolescent problem behaviors.
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http://dx.doi.org/10.1016/j.jadohealth.2015.07.001DOI Listing
December 2015

Health promotion in Danish schools: local priorities, policies and practices.

Health Promot Int 2016 Jun 8;31(2):480-9. Epub 2015 Mar 8.

Department of Education, Aarhus University, Research Programme on Care, Sustainability and Health, Tuborgvej 164, Copenhagen NV, 2400, Denmark.

This article discusses the findings from a study mapping out the priorities, policies and practices of local authorities concerning health promotion (HP) and health education (HE) in primary and lower secondary schools in Denmark. The aim of the study was to identify the gaps, tensions and possibilities associated with the demand to increase the quality and effectiveness of HP in schools. The recent national school reform, which emphasizes the importance of health and well-being while simultaneously increasing the focus on performance and accountability in terms of subject proficiency and narrowly defined academic attainment, provides the broader political context for the study. Data were generated through a structured online survey administered to all 98 Danish municipalities. Respondents were educational consultants or others representing the administrative units responsible for the municipality's schools. The findings were discussed within the conceptual framework of Health Promoting Schools. The study points to a potential tension between the health and education sectors, despite evidence of intersectoral collaboration. While there is a strong policy focus on health and well-being in schools, it is disconnected from the utilization of the HE curriculum by the municipal consultants. The study also points to a lack of professional development opportunities for teachers in the field of HP in schools. On the basis of these findings and theoretical perspectives used, we argue that HP in schools needs to (re)connect with the core task of the school, education, and to integrate both health and education goals in local priorities, policies and practices.
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http://dx.doi.org/10.1093/heapro/dav009DOI Listing
June 2016

Perceived problems with computer gaming and Internet use are associated with poorer social relations in adolescence.

Int J Public Health 2015 Feb 23;60(2):179-88. Epub 2014 Dec 23.

National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5, 1353, Copenhagen K, Denmark,

Objectives: Young people's engagement in electronic gaming and Internet communication have caused concerns about potential harmful effects on their social relations, but the literature is inconclusive. The aim of this paper was to examine whether perceived problems with computer gaming and Internet communication are associated with young people's social relations.

Methods: Cross-sectional questionnaire survey in 13 schools in the city of Aarhus, Denmark, in 2009. Response rate 89%, n = 2,100 students in grades 5, 7, and 9. Independent variables were perceived problems related to computer gaming and Internet use, respectively. Outcomes were measures of structural (number of days/week with friends, number of friends) and functional (confidence in others, being bullied, bullying others) dimensions of student's social relations.

Results: Perception of problems related to computer gaming were associated with almost all aspects of poor social relations among boys. Among girls, an association was only seen for bullying. For both boys and girls, perceived problems related to Internet use were associated with bullying only.

Conclusions: Although the study is cross-sectional, the findings suggest that computer gaming and Internet use may be harmful to young people's social relations.
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http://dx.doi.org/10.1007/s00038-014-0633-zDOI Listing
February 2015

Socioeconomic differences in emotional symptoms among adolescents in the Nordic countries: recommendations on how to present inequality.

Scand J Public Health 2015 Feb 6;43(1):83-90. Epub 2014 Nov 6.

National Institute of Public Health, University of Southern Denmark.

Aims: This comparative study examines absolute and relative socioeconomic differences in emotional symptoms among adolescents using standardised data from five Nordic countries and gives recommendations on how to present socioeconomic inequality.

Methods: The Health Behaviour in School-aged Children (HBSC) international cross-sectional study from 2005/2006 provided data on 29,642 11-15-year-old adolescents from nationally random samples in Denmark, Finland, Iceland, Norway and Sweden. The outcome was daily emotional symptoms. Family Affluence Scale (FAS) was used as indicator of socioeconomic position. We applied four summary measures of inequality: Prevalence Difference, Odds Ratio, Slope Index of Inequality and Relative Index of Inequality, and presented the socioeconomic inequality by a graphical illustration of the prevalence of emotional symptoms, the size of the FAS groups and the summary indices of inequality in each country.

Results: The prevalence of emotional symptoms ranged from 8.1% in Denmark to 13.2% in Iceland. There were large country variations in the size of the low FAS-group ranging from 2% in Iceland to 12% in Finland. The largest absolute and relative socioeconomic inequalities were found in Iceland and the smallest in Finland for girls and in Denmark for boys.

Conclusions: Emotional symptoms were more common among nordic adolescents from low affluence families this association appeared in the study of both absolute and relative inequality. A comprehensive presentation of socioeconomic inequality should include the prevalence of the health outcome, the size of the socioeconomic groups, and the regression line representing the summary indices of inequality.
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http://dx.doi.org/10.1177/1403494814557885DOI Listing
February 2015

Close relations to parents and emotional symptoms among adolescents: beyond socio-economic impact?

Int J Public Health 2014 Oct 2;59(5):721-6. Epub 2014 Sep 2.

National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark,

Objectives: This study examined the relationship between trustful communication with parents and frequency of emotional symptoms in schoolchildren and whether this relationship was modified by the family's socio-economic position.

Methods: Pooled data (n = 15,646) from the Danish Health Behaviour in School-aged Children surveys 2002, 2006 and 2010 were analysed by multilevel multivariable logistic regression.

Results: 8 % of all schoolchildren reported emotional symptoms almost daily. Odds ratio for daily symptoms was 2.1 (1.8-2.4) for children without trustful communication with parents compared to children with trustful communication. This association appears unaffected by family occupational class. A substantial socio-economic gradient in emotional symptoms persisted, independent of parent-child communication.

Conclusions: Trustful communication with parents might have a fundamental importance, regardless of socio-economic position.
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http://dx.doi.org/10.1007/s00038-014-0600-8DOI Listing
October 2014

Perceived problems with computer gaming and internet use among adolescents: measurement tool for non-clinical survey studies.

BMC Public Health 2014 Apr 15;14:361. Epub 2014 Apr 15.

National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK 1353 Copenhagen K, Denmark.

Background: Existing instruments for measuring problematic computer and console gaming and internet use are often lengthy and often based on a pathological perspective. The objective was to develop and present a new and short non-clinical measurement tool for perceived problems related to computer use and gaming among adolescents and to study the association between screen time and perceived problems.

Methods: Cross-sectional school-survey of 11-, 13-, and 15-year old students in thirteen schools in the City of Aarhus, Denmark, participation rate 89%, n=2100. The main exposure was time spend on weekdays on computer- and console-gaming and internet use for communication and surfing. The outcome measures were three indexes on perceived problems related to computer and console gaming and internet use.

Results: The three new indexes showed high face validity and acceptable internal consistency. Most schoolchildren with high screen time did not experience problems related to computer use. Still, there was a strong and graded association between time use and perceived problems related to computer gaming, console gaming (only boys) and internet use, odds ratios ranging from 6.90 to 10.23.

Conclusion: The three new measures of perceived problems related to computer and console gaming and internet use among adolescents are appropriate, reliable and valid for use in non-clinical surveys about young people's everyday life and behaviour. These new measures do not assess Internet Gaming Disorder as it is listed in the DSM and therefore has no parity with DSM criteria. We found an increasing risk of perceived problems with increasing time spent with gaming and internet use. Nevertheless, most schoolchildren who spent much time with gaming and internet use did not experience problems.
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http://dx.doi.org/10.1186/1471-2458-14-361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990242PMC
April 2014

Characterization of spray dried bioadhesive metformin microparticles for oromucosal administration.

Eur J Pharm Biopharm 2013 Nov 15;85(3 Pt A):682-8. Epub 2013 Jun 15.

Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark.

Delivery of drugs into or via the oral cavity offers some distinct advantages due to the easy access to the oral mucosa, fast onset of action, and avoidance of hepatic and intestinal degradation mechanisms. To overcome the effective removal mechanisms existing in this area, bioadhesive drug delivery systems are considered a promising approach as they facilitate a close contact between the drug and the oral mucosa. In this study, bioadhesive chitosan-based microparticles of metformin hydrochloride were prepared by spray drying aqueous dispersions with different chitosan:metformin ratios and chitosan grades with increasing molecular weights. A recently developed ex vivo flow retention model with porcine buccal mucosa was used to evaluate the bioadhesive properties of spray dried microparticles. An important outcome of this study was that microparticles with the desired metformin content could be prepared and analyzed using the ex vivo retention model. We observed an increase in metformin retention on porcine mucosa with increasing chitosan:metformin ratios, while no effect of increasing the chitosan molecular weight was found. Rheological characterization of feeds for spray drying was performed and used for designing the microparticles. This way, novel microparticles with similar particle size distribution, high encapsulation efficiencies, and low moisture content were obtained independent of the chitosan:metformin ratio and the chitosan molecular weight. In conclusion, chitosan:metformin microparticles with significant bioadhesive properties on porcine buccal mucosa were developed.
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http://dx.doi.org/10.1016/j.ejpb.2013.05.017DOI Listing
November 2013
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