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What role should students take in shaping their education, their university, and the wider society? These questions have assumed new importance in recent years as universities are reformed to become more competitive in the “global knowledge economy.” With Denmark as the prism, this book shows how negotiations over student participation — influenced by demands for efficiency, flexibility, and student-centered education — reflect broader concerns about democracy and citizen participation in increasingly neoliberalised states. Combining anthropological and historical research, Gritt B. Nielsen develops a novel approach to the study of policy processes and opens a timely discussion about the kinds of future citizens who will emerge from current reforms.

Introduction: The Danish National Patient Register (NPR) was established in 1977, and it is considered to be the finest of its kind internationally. Content: At the onset the register included information on inpatient in somatic wards. The content of the register has gradually been expanded, and since 2007 the register has included information on all patients in Danish hospitals. Validity and coverage: Although the NPR is overall a sound data source, both the content and the definitions of single variables have changed over time. Changes in the organisation and provision of health services may affect both the type and the completeness of registrations. Conclusion: The NPR is a unique data source. Researchers using the data should carefully consider potential fallacies in the data before drawing conclusions.

•High-dose influenza vaccine reduces laboratory-confirmed influenza, but its effectiveness against severe cardio-respiratory outcomes in the older general population has not been assessed in a fully powered, individually randomized trial.•DANFLU-2 is a pragmatic, individually randomized trial to assess the relative effectiveness of high-dose vs standard-dose influenza vaccine against cardio-respiratory hospitalizations in older adults ≥65 years.•Utilizing innovative recruitment and online informed consent methods, the trial has randomized 332,438 participants over 3 influenza seasons.•DANFLU-2 is the largest individually randomized influenza vaccine trial ever conducted.•The trial will provide high-quality data on the effectiveness of high-dose influenza vaccine in preventing hospitalizations to inform vaccination policies on a global level. The high-dose inactivated influenza vaccine (HD-IIV) has been shown to reduce the incidence of influenza infection compared with standard-dose inactivated influenza vaccine (SD-IIV); however, its effectiveness in preventing severe respiratory and cardiovascular outcomes in the older general population has not yet been assessed in a fully powered individually randomized trial. DANFLU-2 is an ongoing pragmatic, registry-based, open-label, active-controlled, individually randomized trial conducted in Denmark during the 2022/2023, 2023/2024, and 2024/2025 influenza seasons. Utilizing innovative electronic recruitment strategies and an online informed consent process, the trial has enrolled 332,438 older adults ≥65 years; enrollment was completed in October 2024. Participants were randomly allocated in a 1:1 ratio to either HD-IIV or SD-IIV. Baseline, endpoint, and safety data are primarily obtained from the nationwide Danish administrative health registries. The primary endpoint is hospitalization for influenza or pneumonia with the trial also powered to assess the first secondary endpoint of hospitalization for any cardio-respiratory disease. The additional secondary endpoints of all-cause hospitalization and mortality will be tested hierarchically. Key ancillary analyses include cost-effectiveness and health care resource consumption assessments as well as a home self-swab sub-cohort. DANFLU-2 is the largest individually randomized influenza vaccine trial ever conducted and will provide critical, high-quality evidence on the effectiveness of HD-IIV against cardio-respiratory hospitalizations and mortality in the older general population. Clinicaltrials.gov: NCT05517174, registered August 24, 2022, https://clinicaltrials.gov/study/NCT05517174.

Media, politicians, and reform proponents frequently assert that public sector organizations are inefficient and burdened by administrative procedures. But are negative stereotypes of the public sector reflected in people's perceptions of public service provision? Given the methodological challenges of isolating the perception of publicness from other factors related to public organizations, little is known about whether public organizations have a negative image. The authors use a survey experimental design to isolate the effect of publicness on perceptions of the performance of hospitals. The results suggest that public sector organizations have a negative image on productivity-related aspects of performance but not on normative aspects of performance. As this article is a randomized experiment, it provides strong evidence regarding the causal nature of the relationship between publicness and perceptions of performance. Implications for researchers aiming to understand these mechanisms and for public managers concerned about the image of their organization are discussed.

Respiratory syncytial virus (RSV) can cause serious illness in older adults and those with chronic conditions. While the bivalent RSVpreF vaccine has been shown to protect against RSV-related respiratory tract disease, its impact on severe RSV-related and broader cardiorespiratory hospitalizations remains untested in a fully powered randomized trial. This pragmatic, individually randomized, open-label, parallel-group trial aims to evaluate RSVpreF vaccine effectiveness (VE) in reducing the risk of RSV-related and all-cause cardiorespiratory hospitalizations in adults aged 60 and older. DAN-RSV is randomizing Danish adults 1:1 to receive either RSVpreF or no RSV vaccine. The trial uses nationwide registries for recruitment, where eligible citizens are identified and invited via the national electronic messaging system and can provide electronic informed consent remotely. Baseline, safety, and outcome data are collected through the national health registries using the civil registration number provided at consent. Up to 130,000 participants will be enrolled during the 2024/2025 winter season. The primary objective is to assess vaccine effectiveness (VE) against RSV-related respiratory tract disease hospitalization. Secondary endpoints include RSV-related and all-cause lower respiratory tract disease hospitalizations, RSV-related and all-cause cardiorespiratory hospitalizations, and all-cause death. DAN-RSV is an innovative trial combining the gold standard of individual randomization with pragmatic data collection via centralized health records and national health registries. This design offers a feasible approach to assess the impact of RSVpreF on clinically meaningful cardio-respiratory outcomes in adults ≥60 years in a real-world setting – while minimizing bias through use of randomization. The results will support cost-effectiveness analyses and inform future vaccination policies. NCT06684743, registered November 9, 2024 (https://clinicaltrials.gov/study/NCT06684743)

Questions of how and when managers can motivate the workforce of public organizations are fundamental for scholars and practitioners alike. A dominant assertion is that goal-oriented leadership strategies, such as transformational leadership, foster public service motivation (PSM). However, existing studies rely on designs that are vulnerable to endogeneity and rarely investigate the scope conditions of the leadership-PSM relationship. Combining a field experiment with 364 managers and surveys of their 3,470 employees, the authors show that transformational leadership and transactional leadership, when induced experimentally, do not have the claimed positive effect on PSM. In fact, the results indicate that goal-oriented leadership can have demotivating effects when employee and organizational values are incongruent. Public managers should therefore carefully assess existing levels of value (in) congruence before implementing goal-oriented leadership strategies, and—in case of value conflicts—seek to align perceptions of the desirable among members of the organization.

SummaryThe Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study investigated the effectiveness of a two-step screening program for osteoporosis in women. We found no overall reduction in fractures from systematic screening compared to the current case-finding strategy. The group of moderate- to high-risk women, who accepted the invitation to DXA, seemed to benefit from the program.IntroductionThe purpose of the ROSE study was to investigate the effectiveness of a two-step population-based osteoporosis screening program using the Fracture Risk Assessment Tool (FRAX) derived from a self-administered questionnaire to select women for DXA scan. After the scanning, standard osteoporosis management according to Danish national guidelines was followed.MethodsParticipants were randomized to either screening or control group, and randomization was stratified according to age and area of residence. Inclusion took place from February 2010 to November 2011. Participants received a self-administered questionnaire, and women in the screening group with a FRAX score ≥ 15% (major osteoporotic fractures) were invited to a DXA scan. Primary outcome was incident clinical fractures. Intention-to-treat analysis and two per-protocol analyses were performed.ResultsA total of 3416 fractures were observed during a median follow-up of 5 years. No significant differences were found in the intention-to-treat analyses with 34,229 women included aged 65–80 years. The per-protocol analyses showed a risk reduction in the group that underwent DXA scanning compared to women in the control group with a FRAX ≥ 15%, in regard to major osteoporotic fractures, hip fractures, and all fractures. The risk reduction was most pronounced for hip fractures (adjusted SHR 0.741, p = 0.007).ConclusionsCompared to an office-based case-finding strategy, the two-step systematic screening strategy had no overall effect on fracture incidence. The two-step strategy seemed, however, to be beneficial in the group of women who were identified by FRAX as moderate- or high-risk patients and complied with DXA.

A main rationale of performance information is to empower citizens to make informed decisions by presenting them with unambiguous information about the performance of institutions. However, even objective, clear, and unambiguous performance information is subject to biased interpretation depending on whether the information is consistent with the prior beliefs held by those who receive the information. Integrating the theory of motivated reasoning with the literature on performance information, the authors hypothesize that performance information that is inconsistent with prior beliefs is less likely to be interpreted correctly than belief-consistent information. Using randomized survey experiments in which respondents were presented with quantitative performance data, the authors show that subjects systematically interpret performance information in ways that conform with their prior beliefs. The findings question the assumption that providing performance information automatically increases knowledge about government performance, let alone improves political decisions.