IntroductionPolice officers are frequently exposed to potentially traumatic events at work that increases risk of developing mental health problems, in particular post-traumatic stress disorder (PTSD). Individual and organisational factors may influence the detrimental effects of cumulative exposure to traumatic events. Occupational stress and lack of organisational support are associated with increased risk of PTSD among police officers. The Are You All right? (AYA) project is a prospective cohort study investigating the cumulative effect of traumatic events at work on mental health problems and absenteeism among police officers. The study also investigates whether potential risk and protective factors modify the association of traumatic events at work with mental health problems and absenteeism.Method and analysisThe AYA-study includes the entire Danish police force. Prospective survey data are collected over a 3-year period beginning in the spring of 2021. Electronic surveys are sent out at baseline with 1-year, 2-year and 3-year follow-up. Further, short surveys are sent out every third month, covering exposure to traumatic events and current mental health status. The survey data are paired with workplace register data on sickness absence. Register data on sickness absence cover the period from 2020 to 2025.Ethics and disseminationThis study was presented for evaluation at the National Ethics Committee in Denmark (reference number: 20202000-216), but according to Danish legislation, survey studies do not require approval by official Danish scientific or ethical committees. Participation in the project is based on informed consent, and data are handled in accordance with the Danish data legislation (journal number: 20/41457). Results are published in scientific journals and disseminated at international conferences.

BACKGROUND AND AIMS Mineralocorticoid receptor antagonist treatment is kidney protective but not recommended in patients with advanced renal failure due to perceived risk of hyperkalaemia and death. The aim of the present study was to examine the impact of mineralocorticoid receptor antagonist treatment in progressive chronic kidney disease on risk of hyperkalaemia and to evaluate subsequent attributable mortality. METHOD Based on data from multiple nationwide health care registers, all Danish residents >18 years with more than or equal to one recorded plasma creatinine measurement were identified in Denmark between 2008 and 2021, and followed until either incident hyperkalaemia >6 mmol/L,  death or end-of follow-up (5 October 2021). Cases were identified based on incident hyperkalaemia and subsequently matched with four controls without hyperkalaemia. eGFR was computed based on the latest creatinine measurement until 30 days prior to index using the CKD-EPI equation. Patients with no recorded creatinine measurement within 2 years until 30 days prior of index were excluded. Mineralocorticoid receptor antagonist associated susceptibility for hyperkalaemia was computed across strata of estimated glomerular filtration rate (eGFR) (>60, 30–60 and <30 mL/min/1.73 m2) in a conditional logistic regression model comparing rate of hyperkalaemia with stratification of baseline hazard rate by age, gender, diabetes and hypertension. Model fitting was accomplished using a nested case–control design with 1:4 risk-set matching of cases with age-, gender-, diabetes- and hypertension-matched controls. Subsequent risk of 30-day mortality was assessed in a retrospective cohort study including patients with hyperkalemia only. Patients were followed from the date of hyperkalemia until death, 30 days or end of follow-up (5 October 2021) with comparison of MRA-attributable mortality across strata of eGFR based on the Kaplan–Meier estimator and multiple Cox regression models adjusted for age and gender. RESULTS From a population of 4 255 962 Danish citizens with recorded plasma creatinine, a total of 51 775 patients with incident hyperkalaemia were identified between 2008 and 2021. Pre-existing plasma creatinine permitting estimation of renal function was available in 34 442 (66.5%) patients. The 34 442 cases with incident hyperkalaemia were matched 1:4 with 131 410 controls. Gender distribution was 57% male, median age was 73.5 (IQR 64.0–82.0) years and median eGFR was 74 (IQR 55–89) mL/min/1.73 m2. Mineralocorticoid receptor antagonist treatment was associated with increased rates of hyperkalaemia with HRs of 8.32 (95% CI: 7.82–8.85), 4.55 (95% CI: 4.26–4.86) and 2.00 (95% CI: 1.71–2.32) in patients with eGFR > 60 mL/min/1.73 m2 eGFR 30–60 mL/min/1.73 m2 and eGFR < 30 mL/min/1.73 m2 respectively (reference = No mineralocorticoid receptor antagonist treatment). 30-day mortality in patients with hyperkalaemia stratified on mineralocorticoid receptor antagonist treatment is shown in Figures 1 and 2. Overall, mineralocorticoid receptor antagonist treatment was associated with lower subsequent mortality: HR 0.84 (95% CI: 0.78–0.90); P < 0.001, 0.67 (95% CI: 0.62–0.73); P < 0.001 and 0.98 (95% CI: 0.86–1.1); P = 0.77 for eGFR > 60 mL/min/1.73 m2 30–60 mL/min/1.73 m2 and <30 mL/min/1.73 m2 respectively (reference = mineralocorticoid receptor antagonist). CONCLUSION Although mineralocorticoid receptor antagonist treatment was associated with increased risk of hyperkalaemia for all strata of kidney impairment, subsequent 30-day mortality was lower compared with patients with corresponding kidney function without mineralocorticoid receptor antagonist treatment.

Introduction: Critical incidents in ambulance work are not easily compared to other risk occupations. Understanding types of incidents that can be considered critical in operational ambulance work is important to prevent work-related post-traumatic stress (PTS).Aim: This study aimed to develop a scale of critical incidents in ambulance work and assess its predictive validity in relation to the severity of PTS symptoms.Methods: A total of 1092 open-ended descriptions from Danish ambulance personnel were content analysed to develop a categorical scale that identifies types of events perceived as critical to operative ambulance personnel. Multiple regression was used to assess whether the scale predicted PTS symptoms and to assess the cumulative effect of exposure to these events.Results: The study found that the 1092 descriptions of critical events could be condensed into 28 categories of critical events. These ranged from life-threatening situations and deaths, to more daily events such as handling strong emotional reactions from patients’ relatives and working with terminally ill children. The frequency of events significantly predicted the severity of PTS symptoms with low to moderate effect (std beta = 0.2, t(375) = 3.7, p < .001), even when adjusting for known risk factors for post-traumatic stress disorder.Conclusion: This study showed that critical events in ambulance work included events that are not normally considered traumatic, and indicated that understanding the cumulative effect of these events is important when trying to prevent traumatic sequalae in ambulance personnel. The study highlighted the importance of increased focus on non-traumatic incidents that have an ongoing impact on paramedics’ mental health and well-being. The Critical Incidents Scale for Ambulance Work ‐ Denmark (CISAW-D) is a promising tool for systematic screening for exposure to critical events in ambulance work.

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