ObjectivesTo investigate the relationship between different indicators of socioeconomic position and the risk of spontaneous abortion.DesignCohort study.Setting1996–2002, Denmark.ParticipantsAll first time participants, a total of 89 829 pregnant women, enrolled in the Danish National Birth Cohort were included in the present study. Overall, 4062 pregnancies ended in spontaneous abortion. Information on education, income and labour market attachment in the year before pregnancy was drawn from national registers.Main outcome measureSpontaneous abortion, that is, fetal death within the first 22 weeks of pregnancy, was the outcome of interest. The authors estimated HRs of spontaneous abortion using Cox regression analysis with gestational age as the underlying time scale.ResultsWomen with <10 years of education had an elevated risk of spontaneous abortion when compared with women with >12 years of education (HR 1.19 (95% CI 1.05 to 1.34)). The HR estimates for the four lowest income quintiles were all increased (HRs between 1.09 and 1.15) as compared with the upper quintile but did not differ considerably from each other. In general, no statistically significant association was found between labour market attachment and the risk of spontaneous abortion; however, the group of women on disability pension had an increased HR of spontaneous abortion when compared with women who were employed (HR 1.32 (95% CI 0.82 to 2.13)).ConclusionsEducational level and income were inversely associated with the risk of spontaneous abortion. As these factors most likely are non-causally related to spontaneous abortion, the findings indicate that factors related to social position, probably of the environmental and behavioural type, may affect spontaneous abortion risk. The study highlights the need for studies addressing such exposures in order to prevent spontaneous abortions.

Our study emphasizes the complex relationships between patient activation, distress and behaviour, specific treatment modalities and glycaemic control. Knowledge of treatment goals, achieving patient activation in coping with diabetes, and lowering disease-related emotional stress are important patient education goals. However, the large unexplained component of HbA(1c) variance highlights the need for more research to understand the mechanisms of glycaemic control.

Rationale, aims and objective: Most patient education is based on a professional understanding of patients’ needs for learning, rather than a patient perspective. This generates a risk of neglecting issues that are important to patients, but unrecognised by educators. The aim of this study was to develop a health educational model for group-based patient education in chronic illness based on patient-perceived challenges.Methods: Design Thinking was used as a method of inquiry. Four interactive workshops with 25 Danish patients with Type 2 diabetes, heart disease and chronic obstructive pulmonary disease provided data on patient-perceived challenges. Workshops with 28 educators informed the development of the model. A constant comparative method was used for analyses.Results: Patients with chronic illness experience a constant need to balance their lives, which imposes new challenges in their everyday life. We identified 4 main challenges: Bodily Infirmities, Lowered Expectations, Challenging Relations and Changeable Moods. In response to these challenges, researchers and educators developed The Balancing Person, a health educational model with 4 interconnected meta-needs for the education process: Wholeness, Clarity, Timeliness and Connectedness.

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