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Srivarathan A, Kristiansen M, Jensen AN. Opportunities and challenges in public-private partnerships to reduce social inequality in health in upper-middle-income and high-income countries: a systematic review and meta-synthesis. BMJ Open 2024; 14:e076209. [PMID: 38184305 PMCID: PMC10773340 DOI: 10.1136/bmjopen-2023-076209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVES There is a need for novel approaches to address the complexity of social inequality in health. Public-private partnerships (PPPs) have been proposed as a promising approach; however, knowledge on lessons learnt from such partnerships remain unclear. This study synthesises evidence on opportunities and challenges of PPPs focusing on social inequality in health in upper-middle-income and high-income countries. DESIGN A systematic literature review and meta-synthesis was conducted using the Mixed Methods Appraisal Tool for quality appraisal. DATA SOURCES PubMed, PsychInfo, Embase, Sociological Abstracts and SocIndex were searched for studies published between January 2013 and January 2023. ELIGIBILITY CRITERIA Studies were eligible if they applied a quantitative, qualitative, or mixed methods design and reported on lessons learnt from PPPs focusing on social inequality in health in upper-middle-income and high-income countries. Studies had to be published in either English, Danish, German, Norwegian or Swedish. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and appraised the quality of the included studies. A meta-synthesis with a descriptive intent was conducted and data were grouped into opportunities and challenges. RESULTS A total of 16 studies of varying methodological quality were included. Opportunities covered three themes: (1) creating synergies, (2) clear communication and coordination, and (3) trust to sustain partnerships. Challenges were identified as reflected in the following three themes: (1) scarce resources, (2) inadequate communication and coordination, and (3) concerns on distrust and conflicting interest. CONCLUSIONS Partnerships across public, private and academic institutions hold the potential to address social inequality in health. Nevertheless, a variety of important lessons learnt are identified in the scientific literature. For future PPPs to be successful, partners should be aware of the availability of resources, provide clear communication and coordination, and address concerns on distrust and conflicting interests among partners. PROSPERO REGISTRATION NUMBER CRD42023384608.
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Affiliation(s)
- Abirami Srivarathan
- Houston Center for Innovations in Quality, Effectiveness and Safety, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Nedergaard Jensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
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Bergien SO, Skovgaard L, Kristiansen M. Unfolding biographies-a participatory narrative study on how older adults with multiple sclerosis make sense of and manage their everyday lives. BMC Geriatr 2023; 23:794. [PMID: 38041101 PMCID: PMC10693063 DOI: 10.1186/s12877-023-04504-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Today, public health research on later life, including the literature on aging with multiple sclerosis, is often centered on aging as a biological phenomenon. By applying a participatory narrative approach, this study conveys how studying biographical aging provides important insights into the elements of aging that people find relevant and meaningful. Based on narratives told by older adults living with multiple sclerosis, we explore how sensemaking unfolds and shapes the management of later life with a chronic and progressive disease. METHODS Twenty-four older adults (aged 65 years or older) living with multiple sclerosis in Denmark were engaged in taking photographs of their everyday lives and unfold the stories framed in their photographs in subsequent narrative interviews. Interview data were analyzed using a thematic narrative analysis. Aligned with the narrative approach, the findings of the analysis are presented using five cases chosen because they provide insight into the general patterns and themes identified across the narratives of the 24 participants. RESULTS Based on their photographs, the participants narrated stories centered around what they perceived as meaningful activities and social identity when aging with a progressive disease. Three themes emerged from the analysis in relation to how participants made sense of and managed aging with multiple sclerosis: 1) a life woven by non-detachable life experiences, 2) envisioning the future and 3) challenging life circumstances. CONCLUSION The findings of the study highlight that aging with multiple sclerosis is not only a biological phenomenon but also something nested in people's biographies. How people make sense of and manage their everyday lives is shaped by strategies from all parts of their lives-past, present and future. This understanding of later life with multiple sclerosis may enhance the care offered to older adults living with multiple sclerosis if greater emphasis is placed on the exploration of their narratives and the things they find meaningful.
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Affiliation(s)
- Sofie Olsgaard Bergien
- The Danish Multiple Sclerosis Society, Poul Bundgaards Vej 1, Valby, 2500, Denmark.
- Department of Public Health, University of Copenhagen, Oester Farimagsgade 5A, Copenhagen K, Copenhagen, 1014, Denmark.
| | - Lasse Skovgaard
- The Danish Multiple Sclerosis Society, Poul Bundgaards Vej 1, Valby, 2500, Denmark
| | - Maria Kristiansen
- Department of Public Health, University of Copenhagen, Oester Farimagsgade 5A, Copenhagen K, Copenhagen, 1014, Denmark
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Bernt Jørgensen SM, Johnsen NF, Maribo T, Brøndum S, Gislason G, Kristiansen M. Factors shaping return to work: a qualitative study among heart failure patients in Denmark. Disabil Rehabil 2023:1-11. [PMID: 37818938 DOI: 10.1080/09638288.2023.2266998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE For people of working-age diagnosed with heart failure, return to work (RTW) is often a significant rehabilitation goal. To inform vocational rehabilitation strategies, we conducted a qualitative study aiming at exploring patient experienced support needs, and barriers and facilitators to RTW. MATERIALS AND METHODS Ten men and eight women with heart failure (48-60 years) were interviewed in Denmark during 2022. A thematic analysis was conducted using the Sherbrooke model as framework. RESULTS Multiple factors operating at different levels shaped participants' RTW processes. Personal factors included motivation, mental and physical health, social relations, and financial concerns. Factors in the health care system shaping RTW included access to medical treatment, mental health care, and cardiac rehabilitation. Factors in workplace system shaping RTW included job type, employer support, and social relations. Factors in the legislative and insurance system shaping RTW included authorities' administration of sickness benefits, professional assistance, vocational counselling, and interdisciplinary cooperation. CONCLUSION Findings illustrate a need to include vocational rehabilitation within comprehensive cardiac rehabilitation programmes, to identify people in need of support, to improve the coordination of care across the health and social care sectors, and to involve employers, health care professionals, and social workers in individualised RTW strategies.IMPLICATIONS FOR REHABILITATIONVocational re-integration is shaped by multiple factors operating at different levels (including personal factors, work-related factors, factors in the health care system, and factors in the legislative and insurance system).To improve return to work following heart failure, there is a need for multi-level initiatives, including policy measures and efforts to enhance continuity and coordination of care.People with heart failure in need of vocational support should be identified early within comprehensive cardiac rehabilitation programmes.Health care professionals should address work-related issues and provide individualised information and clear advice regarding timely and safe return to work.Individualised return-to-work plans should be developed within interdisciplinary teams across health and social care sectors and involve employers to ensure that they are aware of relevant work accommodations.
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Affiliation(s)
- Sidsel Marie Bernt Jørgensen
- The Danish Heart Foundation, Section of Cardiovascular Research, Copenhagen, Denmark
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Nina Føns Johnsen
- The Danish Heart Foundation, Section of Cardiovascular Research, Copenhagen, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Central Denmark Region, DEFACTUM, Aarhus, Denmark
| | - Stig Brøndum
- The Danish Heart Foundation, Section of Cardiovascular Research, Copenhagen, Denmark
| | - Gunnar Gislason
- The Danish Heart Foundation, Section of Cardiovascular Research, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Rasmussen SKB, Lidegaard LP, Pisinger C, Johnsen NF, Kristiansen M. Corrigendum: Implementation fidelity of a smoke-free workplace intervention in a private medical company: A mixed-methods process evaluation. Tob Prev Cessat 2023; 9:31. [PMID: 37794857 PMCID: PMC10546946 DOI: 10.18332/tpc/173032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 10/06/2023]
Abstract
[This corrects the article DOI: 10.18332/tpc/162878.].
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Affiliation(s)
- Sofie K. B. Rasmussen
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg University Hospital, Capital Region of Denmark, Frederiksberg, Denmark
| | | | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg University Hospital, Capital Region of Denmark, Frederiksberg, Denmark
- Department of Research, Danish Heart Foundation, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nina F. Johnsen
- Department of Research, Danish Heart Foundation, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Bergien SO, Siersma VD, Kristiansen M, Skovgaard L. Social relations and leisure activities as predictors of wellbeing among older adults with multiple sclerosis: A cross-sectional survey study in Denmark. Mult Scler Relat Disord 2023; 77:104878. [PMID: 37429098 DOI: 10.1016/j.msard.2023.104878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Due to the growing number of people aging with multiple sclerosis (MS), there has been a call for rehabilitation specially targeted older adults with MS in order to support them in better wellbeing, despite physical and cognitive impairment. However, the existing research within the area of rehabilitation has primarily focused on the physical and psychological aspects of aging with MS, omitting the social element. OBJECTIVE This study aims to examine how social relations and engagement in leisure activities predict wellbeing among older adults with MS living in Denmark. Furthermore, the study aims to identify which sociodemographic and health-related factors are the most important in predicting whether older adults with MS face challenges in participating in leisure activities and experiencing different kinds of social relations. METHOD A cross-sectional survey was designed to measure social relations, wellbeing, and engagement in leisure activities among older adults with MS. Of the 4,329 people over 65 years diagnosed with MS in Denmark in 2022, 2,574 (59.46%) were invited to participated in the study, and 1,107 (43.03%) ended up answering the survey. Linear and logistic regression analyses and dominance analyses were conducted to examine the associations between wellbeing, leisure activities, social relations, sociodemographic and health-related factors. RESULTS The results of the study show that perceived emotional social support (mean difference 8.69, 95% CI 5.23; 12.14) and perceived instrumental social support (mean difference 4.15, 95% CI 0.95; 7.35), were associated with better wellbeing among older adults with MS. Perceived strained social relations (mean difference -7.95, 95% CI -10.66; -5.26) were on the contrary associated with lower levels of wellbeing. Strained social relations were the most important predictors of wellbeing accounting for 59% of the predicted variance. Experiencing social emotional support from friends, coworkers, or neighbors (39% of the predicted variance), experiencing instrumental social support from children or children in law (43% of the predicted variance), and experiencing strained social relations with partner (48% of the predicted variance) constituted he most important predictor of wellbeing. Engagement in five out of fourteen leisure activities were associated with better wellbeing among the participants. The leisure activities there was found to be the most important predictor of wellbeing represented both social (37% of the predicted variance), physical (18% of the predicted variance), and creative elements (13% of the predicted variance). Finally, cohabitation was found to be the most important predictor of having perceived emotional social support (59% of the predicted variance), instrumental social support (78.9% of the predicted variance) and strained social relations (18.8% of the predicted variance) and mobility was found to be the most important predictor of challenges in participating in leisure activities (81.8% of the predicted variance). CONCLUSION The findings of the study highlight that rehabilitation targeting older adults with MS should focus on both physical, psychological, and social elements of peoples' everyday life. Further, the results indicate that future rehabilitation focusing on social elements of aging with MS should take into account health and sociodemographic characteristics such as cohabitation, mobility, age, and sex, as these potentially relate to participation in leisure activities as well as social relations among older adults.
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Affiliation(s)
- Sofie Olsgaard Bergien
- The Danish Multiple Sclerosis Society, Valby, Denmark; Center for Healthy Aging, Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Volkert Dirk Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Center for Healthy Aging, Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Cotta A, Kristiansen M. Enacting person-centred care: a multi-perspective study of practices in clinical encounters for people living with chronic kidney disease. BMC Nephrol 2023; 24:185. [PMID: 37349691 PMCID: PMC10288716 DOI: 10.1186/s12882-023-03245-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/16/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND There is growing emphasis on the need for ensuring person-centred care for patients living with chronic kidney disease as this will benefit patients, providers, and healthcare systems alike. Nevertheless, less emphasis is given to how this complex concept is practiced in clinical encounters and how it is experienced by patients. This qualitative multi-perspective study investigates how person-centred care for people living with chronic kidney disease is practiced and experienced by patients in clinical encounters at a nephrological ward at a hospital in the capital region of Denmark. METHODS The study builds upon qualitative methodologies, including field notes from observations of clinical encounters between clinicians and patients in an out-patient clinic (n = ~ 80) and in-person interviews with patients in peritoneal dialysis (n = 4). Key themes from field notes and interview transcripts were identified through thematic analysis. Analyses were informed by practice theory. RESULTS Findings illustrate that person-centred care is practiced in a relational and situational encounter between patients and clinicians as dialogues about choice of treatment modality, which is shaped by the individual's life circumstances, preferences, and values. The practice of person-centred care appeared to be complex and interlinked with a range of factors, individual to each patient. We identified three themes of relevance for practices and experiences related to person-centred care: (1) Patients' perceptions of living with chronic kidney disease. Perceptions differed according to medical history, life situation and prior experiences with treatment in the healthcare system. These patient-related factors were perceived to be important for person-centred care to unfold; (2) Relations between patients and healthcare professionals were important for patients' experiences of trust and appeared fundamental for the practice and experiences of person-centred care; and (3) Decision-making on treatment modality that is the best fit for each patient's everyday life, appear to be shaped by the patient's need for knowledge about treatment modalities and level of self-determination in the decision-making. CONCLUSIONS The context of clinical encounters influences the practices and experiences of person-centred care, where health policies and lack of embodiment are identified as barriers for providing and experiencing person-centred care.
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Affiliation(s)
- Amie Cotta
- Center for IT and Medical technology, Capital Region, Borgervaenget 5, 2100 Copenhagen Ø, Denmark
| | - Maria Kristiansen
- Department of Public Health, Center for Healthy Aging, University of Copenhagen, Øster Farimagsgade 5, DK 1353 Copenhagen K, Denmark
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Rasmussen SKB, Lidegaard LP, Pisinger C, Johnsen NF, Kristiansen M. Implementation fidelity of a smoke-free workplace intervention in a private medical company: A mixed-methods process evaluation. Tob Prev Cessat 2023; 9:17. [PMID: 37251694 PMCID: PMC10214475 DOI: 10.18332/tpc/162878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/30/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Smoke-free workplaces are considered an important part of tobacco control strategies. The purpose of this study was to evaluate implementation fidelity and explore the significance of social and contextual factors for the implementation of a strict smoke-free workplace intervention in a large Danish medical company. METHODS The UK Medical Research Council's guidance for process evaluation was used as a framework. Data were collected from approximately six months before the implementation until ten months after (2019-2020). A mixed method study design was used (a survey of 398 employees, a focus group of four employees and field visits on two days). Data were analyzed separately and later integrated through triangulation. We used the Fisher's exact test in the analysis of the questionnaire. RESULTS We assessed the implementation fidelity through four key factors: reach, dose and delivery, mechanisms of change, and context for the intervention components. Despite compliance issues, the policy component had high implementation fidelity. However, the implementation fidelity of the smoking cessation support component was low. We identified three social mechanisms influencing the employees' responsiveness towards the policy: expectation, the social aspect of the smoking facilities, and management leadership. COVID-19 was identified as the main contextual factor affecting the implementation. CONCLUSIONS Although not all elements of the intervention components were implemented as planned, the strict smoke-free workplace intervention is considered implemented. Further strategies can be initiated to raise implementation fidelity through better communication concerning the cessation support component, compliance, and enforcement of the policy.
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Affiliation(s)
- Sofie K. B. Rasmussen
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg University Hospital, Capital Region of Denmark, Frederiksberg, Denmark
| | | | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg University Hospital, Capital Region of Denmark, Frederiksberg, Denmark
- Department of Research, Danish Heart Foundation, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nina F. Johnsen
- Department of Research, Danish Heart Foundation, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Sørensen CW, Sonne C, Sacha M, Kristiansen M, Hannemose SZ, Stein DJ, Carlsson J. Potential advantages of combining randomized controlled trials with qualitative research in mood and anxiety disorders - A systematic review. J Affect Disord 2023; 325:701-712. [PMID: 36642313 DOI: 10.1016/j.jad.2023.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Most randomized controlled trials (RCTs) of mood and anxiety disorders employ solely quantitative methods. Supplementing quantitative data with qualitative methods, a so-called mixed-method approach, would seem useful, however this area has not been rigorously reviewed. We undertook a systematic review of RCTs of mood and anxiety disorders that employed concurrent quantitative data collection and qualitative methods exploring the participants' perspective, with the aim of 1. determining the number of such studies, 2. describing study characteristics, and 3. identifying potential advantages of a mixed-method approach. METHODS Following PRISMA guidelines, a systematic literature search for RCTs of mood and anxiety disorders, concurrently applying quantitative and qualitative methods, was conducted using EMBASE, PsycINFO and Pubmed, from their inception to February 2021. Categories of potential advantages of this mixed method approach were developed. RESULTS A total of 45 RCTs were included. The qualitative components typically included 10-40 participants, mostly consisting of interviews after the intervention. The majority of papers did not state a specific rationale for using a mixed method approach. Four categories of advantages emerged: 1. determine acceptability/feasibility, 2. investigate efficacy, 3. inform implementation in clinical practice and 4. generate new hypotheses based on the combination of quantitative and qualitative data. LIMITATIONS Lack of cross-referencing and consistent terminology challenged identification of relevant publications. CONCLUSION There are a number of potential advantages of applying mixed method approaches in RCTs within psychiatric research. Intentional consideration of such advantages early in trial design may increase the likelihood of gaining added value.
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Affiliation(s)
- Carina Winkler Sørensen
- The Mental Health Services of the Capital Region of Denmark, Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark; Mental Health Centre Copenhagen, Denmark.
| | - Charlotte Sonne
- The Mental Health Services of the Capital Region of Denmark, Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark
| | - Maria Sacha
- The Mental Health Services of the Capital Region of Denmark, Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sigrid Zeuthen Hannemose
- The Mental Health Services of the Capital Region of Denmark, Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry, South Africa; Neuroscience Institute, University of Cape Town, South Africa
| | - Jessica Carlsson
- The Mental Health Services of the Capital Region of Denmark, Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Rasmussen GHF, Madeleine P, Arroyo-Morales M, Voigt M, Kristiansen M. Resistance Training-Induced Acute Hypoalgesia in Women With Persistent Pain After Breast Cancer Treatment. J Strength Cond Res 2023; 37:e16-e24. [PMID: 36173261 DOI: 10.1519/jsc.0000000000004320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Fogh Rasmussen, GH, Madeleine, P, Arroyo-Morales, M, Voigt, M, and Kristiansen, M. Resistance training-induced acute hypoalgesia in women with persistent pain after breast cancer treatment. J Strength Cond Res 37(3): e16-e24, 2023-The aim of this study was to determine whether a single bout of resistance training (RT) produces acute exercise-induced hypoalgesia (EIH) in breast cancer survivors (BCS) suffering from persistent pain ≥1.5 years after treatment. Twenty individuals with self-reported pain ≥3 on a 0-10 Numerical Rating Scale after treatment for breast cancer completed 3 experimental sessions, (a) familiarization; (b) 1 repetition maximum (1RM) normalization, and (c) training, consisting of 3 sets of 10 repetitions at 60% of 1 repetition maximum. Pressure pain thresholds (PPTs) were measured before and after training for the dorsal and ventral shoulder regions of the affected side. Movement-evoked pain (MEP) and rating of perceived exertion (RPE) were collected immediately after each set. A p -value less than 0.05 was considered statistically significant. The results demonstrated a significant increase in PPTs of the ventral shoulder region after a single bout of RT ( p ≤ 0.05), indicating a localized analgesic response for this area. By contrast, no change was detected in PPTs on the dorsal shoulder region. No significant differences were found in MEP between sessions despite a significant increase in load and RPE during 1RM assessment ( p ≤ 0.05), indicating that MEP was not affected by increase in absolute and relative intensity. In conclusion, a single bout of submaximal RT reduced PPTs for the ventral shoulder region of BCS with persistent pain after treatment and was well tolerated. Hence, RT may be a useful therapeutic tool for managing persistent pain after breast cancer treatment in clinical practice.
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Affiliation(s)
- G H F Rasmussen
- Sport Sciences-Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; and
| | - P Madeleine
- Sport Sciences-Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; and
| | - M Arroyo-Morales
- Department of Physical Therapy, Faculty of Health Sciences, Sport and Health Institute Research (IMUDS), Biohealth Institute Research Granada (IBS.Granada), Granada, Spain
| | - M Voigt
- Sport Sciences-Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; and
| | - M Kristiansen
- Sport Sciences-Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; and
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Affiliation(s)
- Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Ingeborg P M Griffioen
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Zuid-Holland, The Netherlands
| | - Nanon H M Labrie
- Department of Language, Literature & Communication, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Kobenhavn, Denmark
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Rasmussen GHF, Madeleine P, Arroyo-Morales M, Voigt M, Kristiansen M. Pain sensitivity and shoulder function among breast cancer survivors compared to matched controls: a case-control study. J Cancer Surviv 2023; 17:150-159. [PMID: 33495914 PMCID: PMC9970942 DOI: 10.1007/s11764-021-00995-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Persistent pain and loss of shoulder function are common adverse effects to breast cancer treatment, but the extent of these issues in comparison with healthy controls is unclear for survivors beyond 1.5 years after treatment. The purpose of this study was to benchmark differences in pressure pain thresholds (PPT), maximal isokinetic muscle strength (MIMS), and active range of motion (ROM) of females with persistent pain ≥1.5 years after breast cancer treatment (BCS) compared with pain-free matched controls (CON), and examine the presence of movement-evoked pain (MEP) during assessment of MIMS. METHODS The PPTs of 18 locations were assessed using a pressure algometer and a numeric rating scale was used to assess intensity of MEP. Active ROM and MIMS were measured using a universal goniometer and an isokinetic dynamometer, respectively. RESULTS A two-way analysis of variance revealed that PPTs across all locations, MIMS for horizontal shoulder extension/flexion and shoulder adduction, active ROM for shoulder flexion, horizontal shoulder extension, shoulder abduction, and external shoulder rotation were significantly lower for BCS compared with CON (P < 0.05). MEP was significantly higher for BCS and MEP intensity had a significant, negative correlation with PPTs (P < 0.01). DISCUSSION/CONCLUSION BCS with persistent pain ≥1.5 years after treatment demonstrates widespread reductions in PPTs and movement-specific reductions in MIMS and active ROM of the affected shoulder, along with MEP during physical performance assessment. IMPLICATIONS FOR CANCER SURVIVORS BCS with persistent pain ≥1.5 years after treatment shows signs of central sensitization and may benefit from individualized rehabilitation.
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Affiliation(s)
- G H F Rasmussen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | - P Madeleine
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - M Arroyo-Morales
- Department of Physical Therapy, Faculty of Health Sciences, Sport and Health Research Institute, Biohealth Research Institute Granada, University of Granada, Granada, Spain
| | - M Voigt
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - M Kristiansen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Andersen EB, Kristiansen M, Bernt Jørgensen SM. Barriers and facilitators to return to work following cardiovascular disease: a systematic review and meta-synthesis of qualitative research. BMJ Open 2023; 13:e069091. [PMID: 36707117 PMCID: PMC9884880 DOI: 10.1136/bmjopen-2022-069091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Return to work is a key rehabilitation goal, however, people recovering from cardiovascular disease (CVD) often struggle with returning to work. The aim of this study was to conduct a systematic review and meta-synthesis of the existing qualitative evidence on barriers and facilitators to return to work experienced by people with CVD. METHODS A systematic literature search was conducted in PubMed, Embase, Web of Science, PsycINFO, Scopus and CINAHL in August 2022. The reference lists of the included articles were searched. The Critical Appraisal Skills Programme was used for quality appraisal and a meta-synthesis was employed. FINDINGS This review includes 15 studies of overall high methodological quality. Barriers covered four themes: physical limitations, psychological and relational factors, the working context and support within health and social care systems. Facilitators were related to five themes: return to normality, enhancing well-being, financial concerns, the working context and support within health and social care systems. CONCLUSION Our findings highlight that return to work following CVD is a complex process influenced by individual factors, as well as work-related factors, factors in the health and social care systems and social security policies and regulations. To improve return to work, this review illustrates a need for individualised, multidisciplinary and coordinated vocational rehabilitation programmes that accommodate potential barriers to re-employment. Similarly, this review highlights how vocational rehabilitation programmes should ensure individualised information and support early in the rehabilitation process, as well as the importance of engaging relevant stakeholders, such as employers, in making individualised return-to-work plans.
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Affiliation(s)
- Emma Borre Andersen
- Section of Cardiovascular Research, The Danish Heart Foundation, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Sidsel Marie Bernt Jørgensen
- Section of Cardiovascular Research, The Danish Heart Foundation, Copenhagen, Denmark
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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13
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Bernt Jørgensen SM, Gerds TA, Johnsen NF, Gislason G, El-Chouli M, Brøndum S, Maribo T, Kristiansen M. Diagnostic group differences in return to work and subsequent detachment from employment following cardiovascular disease: a nationwide cohort study. Eur J Prev Cardiol 2023; 30:182-190. [PMID: 36316291 DOI: 10.1093/eurjpc/zwac249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 01/27/2023]
Abstract
AIMS Return to work and employment maintenance following cardiovascular disease (CVD) are important rehabilitation goals for people of working age. To identify people in particular need of vocational rehabilitation, we examined differences in return to work and subsequent detachment from employment among people with atrial fibrillation (AF), heart failure (HF), heart valve disease, and ischaemic heart disease. METHODS AND RESULTS We conducted a nationwide cohort study and included all individuals of working age (35-65 years) who were employed when diagnosed with incident CVD in 2018. We estimated sex- and age-standardized probabilities of remaining employed at 3, 6, and 12 months after diagnosis, and of detachment from employment within 6 months after having returned to work. Of 46 912 individuals diagnosed in 2018, 8187 were of working age and employed at diagnosis. The mean age was 54.7 years (SD = 6.7), and 74.0% were men. Within 1 year, 89.8% had returned to work, but within the subsequent 6 months, 23.5% of these experienced detachment from employment. At 3, 6, and 12 months after diagnosis the highest standardized probability of being employed was found among people with AF, whereas the lowest probability was found among people with HF {78.9% [95% confidence interval (CI): 77.3-80.4] vs. 62.2% [95% CI: 59.0-65.4] at 12 months}. Similarly, the highest probability of detachment was found for people with HF [30.3% (95% CI: 26.9-33.7)]. CONCLUSION People with HF present the highest probability of not returning to work. There is a need for developing and documenting effects of vocational rehabilitation strategies within comprehensive cardiac rehabilitation programmes.
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Affiliation(s)
- Sidsel Marie Bernt Jørgensen
- The Danish Heart Foundation, Section of Cardiovascular Research, Vognmagergade 7, 3rd Floor, 1120 Copenhagen K, Denmark
- Department of Public Health & Center for Healthy Aging, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark
| | - Thomas Alexander Gerds
- The Danish Heart Foundation, Section of Cardiovascular Research, Vognmagergade 7, 3rd Floor, 1120 Copenhagen K, Denmark
- Department of Public Health, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark
| | - Nina Føns Johnsen
- The Danish Heart Foundation, Section of Cardiovascular Research, Vognmagergade 7, 3rd Floor, 1120 Copenhagen K, Denmark
| | - Gunnar Gislason
- The Danish Heart Foundation, Section of Cardiovascular Research, Vognmagergade 7, 3rd Floor, 1120 Copenhagen K, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Mohamad El-Chouli
- The Danish Heart Foundation, Section of Cardiovascular Research, Vognmagergade 7, 3rd Floor, 1120 Copenhagen K, Denmark
| | - Stig Brøndum
- The Danish Heart Foundation, Section of Cardiovascular Research, Vognmagergade 7, 3rd Floor, 1120 Copenhagen K, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
- DEFACTUM, Central Denmark Region, P. P. Ørums Gade 11, 8000 Aarhus C, Denmark
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark
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Srivarathan A, Jørgensen TSH, Lund R, Nygaard SS, Kristiansen M. 'They are breaking us into pieces': A longitudinal multi-method study on urban regeneration and place-based social relations among social housing residents in Denmark. Health Place 2023; 79:102965. [PMID: 36608586 DOI: 10.1016/j.healthplace.2023.102965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/20/2022] [Accepted: 12/31/2022] [Indexed: 01/05/2023]
Abstract
Urban regeneration often intends to improve the physical, economic, and social environment of disadvantaged neighborhoods. However, evidence on the consequences of such interventions on place-based social relations is limited in Scandinavia. This study investigates the relationship between urban regeneration and diverse forms of place-based social relations among middle-aged and older social housing residents in Denmark. A longitudinal multi-method design was applied using data from administrative registers and semi-structured individual interviews. The quantitative results showed small changes in household-restricted place-based social relations, whereas participants in the qualitative sample described the disruption of place-based social relations to negatively affect their well-being.
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Affiliation(s)
- Abirami Srivarathan
- Section for Health Services Research, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, DK-1014, Copenhagen K, Denmark; Center for Healthy Aging, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark.
| | - Terese Sara Høj Jørgensen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, DK-1014, Copenhagen K, Denmark
| | - Rikke Lund
- Center for Healthy Aging, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark; Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, DK-1014, Copenhagen K, Denmark
| | - Siv Steffen Nygaard
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, DK-1014, Copenhagen K, Denmark
| | - Maria Kristiansen
- Section for Health Services Research, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, DK-1014, Copenhagen K, Denmark; Center for Healthy Aging, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark
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15
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Lindberg LG, Carlsson J, Kristiansen M, Skammeritz S, Johansen KS. The Cultural Formulation Interview-Generating distance or alliance? A qualitative study of practice changes in Danish mental healthcare. Transcult Psychiatry 2022; 59:740-755. [PMID: 35331059 DOI: 10.1177/13634615211065617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article presents provider experiences with the Cultural Formulation Interview (CFI) in Danish mental healthcare for migrant patients. Semi-structured interviews with 17 providers and 20 recorded CFI sessions were analyzed with a constructivist grounded theory approach. Based on our empirical material, we endorse the CFI's ability to facilitate working alliance and a profound and contextually situated understanding of the patient. Further, the CFI supported less-experienced providers in investigating cultural issues. Conversely, we found that CFI questions about cultural identity and background evoked notions of distance and 'othering' in the encounter. Nine providers had felt discomfort and professional insecurity when the CFI compelled them to introduce explanatory frameworks of culture in the mental health assessment. Eleven providers had experienced that the abstract nature of the questions inhibited patient responses or led to short and stereotypical descriptions, which had limited analytical value. We describe the contradictory CFI experiences of alliance versus distance at three levels: 1) at the CFI instrument level; 2) at the organizational level; and 3) at the contextual and structural level. We demonstrate benefits and pitfalls of using the CFI with migrants in Denmark, which is an example of a European healthcare context where cultural consultation is not an integrated concept in health education programs and where the notion of culture is contentious due to negative political rhetoric on multiculturalism.We suggest that the CFI should be introduced with thorough training; focus on fidelity; and supervision in the clinical application and understanding of the concept of culture.
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Affiliation(s)
- Laura Glahder Lindberg
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Aging, University of Copenhagen, Denmark
| | - Signe Skammeritz
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Katrine Schepelern Johansen
- Competence Centre for Dual Diagnosis, Mental Health Center Sct Hans, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
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Bhargava S, Czapka E, Hofvind S, Kristiansen M, Diaz E, Berstad P. Polish immigrants’ access to colorectal cancer screening in Norway – a qualitative study. BMC Health Serv Res 2022; 22:1332. [DOI: 10.1186/s12913-022-08719-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
The Norwegian colorectal cancer (CRC) screening programme started in May 2022. Inequities in uptake of CRC screening is a concern, and we expect that immigrants are at risk of non-uptake. Immigrants from Poland are the most populous immigrant group in Norway. The purpose of this study was to identify and explore factors that may facilitate Polish immigrants’ access to the Norwegian CRC screening programme.
Material and methods
This study was based on qualitative interviews with ten Polish immigrants in Norway. The participants represented a convenience sample that varied in terms of gender, education, employment, time in Norway, place of residence, Norwegian language skills and ties to the Norwegian-Polish community. We performed thematic content analysis to understand CRC screening from the perspective of Polish immigrants, using transnationalism and Levesque’s conceptualization of accessibility as theoretical frameworks.
Results
We grouped our findings into three themes; “understanding of CRC development and the need to access health care”, “binationalism” and “improving accessibility through information”. Within these themes, various factors influenced the participants’ accessibility to CRC screening, namely knowledge about the screening and about causes, development and prevention of the disease, language, choice of screening country, trust in health personnel’s competence, information needs, methods and sources, as well as participants’ perception of the faecal immunochemical test screening user manual. These factors were further influenced by communication between the Polish community in Norway and Poland, as well as travel between the countries.
Conclusion
We identified several factors that can be targeted with an aim to increase Polish immigrants’ access to the Norwegian CRC screening programme. Effective measures could include increasing cultural competence among health care providers and providing information in Polish through Polish-speaking health care professionals, general practitioners and internet portals used by the Polish-speaking community. Focusing on accessibility in a transnational setting, our findings may be of interest for policy makers and service providers planning preventive health measures for immigrants.
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17
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Nygaard SS, Høj Jørgensen TS, Srivarathan A, Brønnum-Hansen H, Kivikoski C, Kristiansen M, Lund R. Association Between Urban Regeneration and Healthcare-Seeking Behavior of Affected Residents: A Natural Experiment in two Multi-Ethnic Deprived Housing Areas in Denmark. Int J Health Serv 2022:207314221126283. [PMID: 36121903 DOI: 10.1177/00207314221126283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Area regeneration of deprived neighborhoods is being used to reduce health inequality, socioeconomic deprivation and ethnic segregation. This quasi-experimental study examines if long-term graded exposure to urban regeneration is associated with primary healthcare-seeking behavior among residents. We compared general practitioner (GP) contacts from 2015-2020 in two adjacent, deprived social housing areas, one exposed to area regeneration. Populations were into Western and non-Western males and females aged 15 years and older (N = 3,960). Mean annual GP contact frequency for each group were estimated and a difference-in-difference (DiD) analysis was conducted with adjustments for propensity scores based on baseline characteristics. GP contact frequency increased for all groups across time with a systematically higher level and faster increase in the control groups. In particular, the mean difference between the exposed and control area for non-Western women more than doubled from -0.61 to -1.47 annual contacts across the period. The mean differences in contact frequency increased for all groups but results of the DiD analyses were insignificant. In conclusion, an emerging gap in GP contact frequency, with the highest levels in the control area, was observed for all comparisons across time. More long-term research is needed to understand how the emerging gaps evolve.
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Affiliation(s)
- Siv Steffen Nygaard
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Terese Sara Høj Jørgensen
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Abirami Srivarathan
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Brønnum-Hansen
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie Kivikoski
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Department of Public Health, Section for Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Lund
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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18
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Srivarathan A, Kristiansen M, Jørgensen TSH, Lund R. The association between social integration and neighborhood dissatisfaction and unsafety: a cross-sectional survey study among social housing residents in Denmark. Arch Public Health 2022; 80:190. [PMID: 35962422 PMCID: PMC9373542 DOI: 10.1186/s13690-022-00945-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/27/2022] [Indexed: 12/05/2022] Open
Abstract
Background Social integration and perceived neighborhood environment are recognized as important social determinants of health. However, little is known about the association between social integration and perceived neighborhood environment among underrepresented population groups, such as residents in disadvantaged neighborhoods, in public health research. The aim of this study is to: 1) Describe the levels of social integration and 2) Investigate the association between social integration and neighborhood dissatisfaction and unsafety among middle-aged and older social housing residents. Methods A multilingual face-to-face interviewer-administrated survey questionnaire was conducted among 206 residents aged 45 years and above (response rate: 34.1%) of various nationalities in disadvantaged socioeconomic positions in a social housing area in Denmark. The assessment of social integration was based on cohabitation status, frequency of face-to-face and non-face-to-face interaction with social relations and participation in local association activities. Neighborhood dissatisfaction measured the level of dissatisfaction with the neighborhood, and neighborhood unsafety assessed the level of unsafety being outdoors in the neighborhood. Descriptive statistics were conducted to illustrate respondent characteristics and the distribution of social integration among the study population. Logistic regression models were applied to analyze associations between social integration and neighborhood dissatisfaction and unsafety, adjusted for age, sex, country of origin, educational attainment and employment status. Results In total, 23.8% of the respondents reported low levels of social integration. A medium level of social integration was associated with higher odds of neighborhood dissatisfaction (OR: 2.36; 95% CI: 1.04–5.38) compared to the highest level of integration. A low frequency of face-to-face interaction was associated with higher odds of neighborhood dissatisfaction (OR: 2.65; 95% CI: 1.16–6.06) and neighborhood unsafety (OR: 2.41; 95% CI: 1.04–5.57) compared to the highest frequency of face-to-face interaction. Conclusions Almost one-fourth of respondents reported low levels of social integration. A medium level of social integration was associated with neighborhood dissatisfaction. A low frequency of face-to-face interaction was associated with neighborhood dissatisfaction and unsafety. The results suggest that targeted health promotion interventions designed to foster face-to-face interaction, hold potential to reduce neighborhood dissatisfaction and unsafety among residents in disadvantaged neighborhoods. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00945-9.
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Reitzel SB, Magyari M, Skovgaard L, Kristiansen M. Patient involvement in the development of PROMs within the MS Field: A systematic review. Patient Experience Journal 2022. [DOI: 10.35680/2372-0247.1662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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20
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Mikkelsen ASB, Lund R, Siersma V, Jørgensen TSH, Christensen U, Kristiansen M. Social relations and contact with general practitioner in a middle-aged Danish population: a prospective register- and survey-based cohort study. BMC Health Serv Res 2022; 22:481. [PMID: 35410245 PMCID: PMC9004143 DOI: 10.1186/s12913-022-07658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/14/2022] [Indexed: 11/28/2022] Open
Abstract
Background Findings about the relationship between individuals’ social relations and general practitioner (GP) contact are ambiguous as to whether weak social relations are associated with an increased or decreased consultation pattern. Furthermore, social relations may affect GP contact differently for men compared to women, between socioeconomic groups and according to perceived need. The overall aim of the study is to examine the association between functional aspects of social relations, perceived emotional and instrumental social support, the tendency to consult a GP and the frequency of GP contact. Methods The study comprised 6911 individuals aged 49–61 at baseline from the Copenhagen Aging and Midlife Biobank (CAMB). We conducted a two-part regression to explore the association between perceived emotional and instrumental social support and GP contact (tendency and frequency), controlling for age, sex, occupational social class, cohabitation status and number of morbidities. Results Results show no overall effect of the perceived social support aspects of social relations on GP contact independent of health-related needs. Conclusions Our results do not support that perceived social support, reflecting functional aspects of social relations, are associated with general practitioner contact among middle-aged people. Trial registration The study has been registered and approved by the Danish Data Protection Agency and the local ethical committee (approval No.H-A-2008-126 and No. 2013-41-1814).Keywords: social relations, perceived social support, healthcare utilisation, general practitioner, middle-aged
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Affiliation(s)
- Anne Sophie Bech Mikkelsen
- Department of Public Health & Center for Healthy Aging, Section of Health Services Research, University of Copenhagen, Copenhagen, Denmark.
| | - Rikke Lund
- Department of Public Health & Center for Healthy Aging, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Terese Sara Høj Jørgensen
- Department of Public Health, University of Copenhagen, Section of Social Medicine, Copenhagen, Denmark
| | - Ulla Christensen
- Department of Public Health, University of Copenhagen, Section of Social Medicine, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, Section of Health Services Research, University of Copenhagen, Copenhagen, Denmark
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Jørring Pallesen AV, Kristiansen M, Westendorp RGJ, Mortensen LH. Polypharmacy occurrence and the related risk of premature death among older adults in Denmark: A nationwide register-based cohort study. PLoS One 2022; 17:e0264332. [PMID: 35196345 PMCID: PMC8865634 DOI: 10.1371/journal.pone.0264332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background Polypharmacy, defined as the concurrent use of ≥5 medications, increases the risk of drug-drug and drug-disease interactions as well as non-adherence to drug therapy. This may have negative health consequences particularly among older adults due to age-related pharmacokinetic and pharmacodynamic changes. This study aims to uncover the occurrence of polypharmacy among older adults in Denmark and investigate how polypharmacy relates to mortality. Method This nationwide register-based study included 1,338,058 adults aged 65+ years between January 2013 and December 2017 in Denmark. Polypharmacy prevalence was measured at time of inclusion while incidence and the association between polypharmacy and mortality were measured over the five-year follow-up using Cox regression. In an attempt to adjust for confounding by indication, propensity scores with overlap weighting were introduced to the regression model. Results At time of inclusion, polypharmacy prevalence was 29% and over the five years follow-up, 47% of the remaining adults transitioned into polypharmacy. Identified risk factors included multimorbidity (2+ morbidities: HR = 3.51; 95% CI = 3.48–3.53), age (95+ years: HR = 2.85; 95% CI = 2.74–2.96), socioeconomic factors (Highest income quartile: HR = 0.81; 95% CI = 0.80–0.81), region of birth region (Non-western migrants: HR = 0.77; 95% CI = 0.75–0.79), marital status (Divorced: HR = 1.10; 95% CI = 1.10–1.12) and year of inclusion (2017: HR = 1.19; 95% CI = 1.19–1.22). Further analyses showed that polypharmacy involves many different drug cocktails with medication for the cardiovascular system (95%), blood and blood-forming organs (69%), alimentary tract and metabolism (61%) and nervous system (54%) contributing the most. After adjustment for propensity scores with OW, both polypharmacy (HR = 3.48, CI95% = 3.41–3.54) and excessive polypharmacy (HR = 3.48, CI95% = 3.43–3.53) increased the risk of death substantially. Conclusion A considerable proportion of older adults in Denmark were exposed to polypharmacy dependent on health status, socio-economic status, and societal factors. The associated three- to four-fold mortality risk indicate a need for further exploration of the appropriateness of polypharmacy among older adults.
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Affiliation(s)
- Anna Vera Jørring Pallesen
- Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Maria Kristiansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Health Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rudi G. J. Westendorp
- Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Health Aging, University of Copenhagen, Copenhagen, Denmark
| | - Laust Hvas Mortensen
- Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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22
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Sandholdt CT, Srivarathan A, Kristiansen M, Malling GMH, Olesen KVM, Jeppesen M, Lund R. OUP accepted manuscript. Health Promot Int 2022; 37:ii48-ii47. [PMID: 35748284 PMCID: PMC9384324 DOI: 10.1093/heapro/daac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study reports on a health promotion intervention (HPI), where graphic facilitation (GF) was used as an innovative method to enable participation in a co-design process in a multi-ethnic and disadvantaged neighbourhood in Denmark. The aim was to enable middle-aged and older residents to participate in the research process of planning and evaluating the HPI, as well as in the activities it constituted. GF was used to document statements and inputs from residents through visual meeting minutes and resident experiences with coronavirus disease 2019 (COVID-19) lockdown were drawn by a graphic facilitator. We use the ladder of participation as a framework to unfold the participation enabled by GF. During the HPI, data were produced through ethnographic field studies in and outside the neighbourhood and in design workshops with residents. The study finds that GF helped in reaching a target group difficult to engage in research and that the engagement of a graphic facilitator shifted the power-balance between the researchers and the residents, redistributing expertise. Carrying out GF in a HPI is a collaborative endeavour and in addition to research competences, it requires the artistic and relational skills of a graphic facilitator. The co-created process of the visual minutes and COVID-19 experiences created a sense of ownership and encouraged the residents to reflect on their interaction with the researchers. The redistribution of expertise was conditioned by the power dynamics present and GF helped unfold these dynamics. This is especially important in an HPI engaging socio-economically vulnerable populations.
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Affiliation(s)
| | - Abirami Srivarathan
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, Section of Health Services, University of Copenhagen, Copenhagen, Denmark
| | - Gritt Marie Hviid Malling
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Mette Jeppesen
- CEO of Tanke-streger, Graphic facilitation and visual story-telling, Birkedommervej 31, 2.floor, 2400 Copenhagen NV, Denmark
| | - Rikke Lund
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
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Westergaard K, Skovgaard L, Magyari M, Kristiansen M. Patient perspectives on patient-reported outcomes in multiple sclerosis treatment trajectories: A qualitative study of why, what, and how? Mult Scler Relat Disord 2021; 58:103475. [PMID: 34995975 DOI: 10.1016/j.msard.2021.103475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Interest in patient-reported outcomes has been growing in multiple sclerosis research and clinical care in recent years. This situation reflects the need for developing, testing, and integrating measures that adequately capture patients' perspectives on symptoms, functional capacity, health status, and health-related quality of life. However, the patient perspective on the relevance, content, and use of patient-reported outcomes is yet to be investigated. Hence, this study aims to investigate the perspectives of people with multiple sclerosis on the value of patient-reported outcomes in clinical encounters, the most important aspects of living with multiple sclerosis that should be reflected in these reports, and possible opportunities and barriers for integrating this data into clinical care. METHODS A qualitative study was conducted to capture patient perspectives in a Danish population of people with multiple sclerosis. Initially, two focus group interviews were conducted with a total of 11 participants to explore their perspectives on patient-reported outcomes and related prospects and barriers. Subsequently, nine individual interviews were conducted to further investigate the identified aspects, opportunities, and barriers to use patient-reported outcomes in clinical care and treatment. RESULTS In general, the informants were motivated to report patient-reported outcomes, and they believed these reports to be relevant in clinical encounters as well as to have potential to promote patient involvement by focusing on current challenges for others with this disease. However, differences in the perceived need for reporting patient-reported outcomes were detected regarding the stage in the multiple sclerosis care trajectory and in relation to the disease phenotypes. In terms of domains to be incorporated into patient-reported outcomes, a total of 28 were identified by the informants, including neurological symptoms, cognitive impairments, mental health and well-being, self-care activities, and social challenges. Several factors for integrating patient-reported outcomes into clinical care emerged as important, in particular related to timing and frequency of reporting patient reported outcomes, considerations of cognitive impairments, the need for individualized approaches to patient-reported outcomes, and the need for active use of these reports for adjustment of treatment approaches in clinical encounters. CONCLUSION From the perspective of people with multiple sclerosis, patient-reported outcomes hold important potential for enhanced patient involvement leading to a more multifaceted agenda in clinical consultations. However, patient-reported outcomes need to be comprehensive and encompass a broad range of measures regarding neurological symptoms, cognitive impairments, mental health and well-being, self-care activities, and social challenges to adequately capture and support the needs of people with multiple sclerosis in clinical encounters. It is important to address barriers for integration of patient-reported outcomes into clinical care, with the aim of preventing misuse. Future studies should focus on the synergy between perspectives from both patients and clinicians to understand how integration of patient-reported outcomes in clinical care can succeed.
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Affiliation(s)
- Katrine Westergaard
- The Danish Multiple Sclerosis Society, Valby, Denmark; The Danish Multiple Sclerosis Registry, Copenhagen University Hospital Rigshospitalet, Denmark.
| | | | - Melinda Magyari
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Denmark; The Danish Multiple Sclerosis Registry, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Abstract
INTRODUCTION Person-centred care based on systematic and comprehensive patient-engagement is gaining momentum across healthcare systems. Providing care that is responsive to the needs, values and priorities of each patient is important for patients, relatives and providers alike, not least for the growing population of older patients living with multi-morbidity and associated complex care trajectories. OBJECTIVES The aim of this systematic review is to investigate the effects of patient engagement interventions for older patients with multimorbidity. METHODS Systematic review conducted in August 2021. Two reviewers independently screened the international databases Embase and PubMed. Reviewers carried out duplicate and independent data extraction and assessment of study quality. Grading of Recommendations Assessment, Development and Evaluation was used to assess the quality of the evidence for each study. RESULTS We included twelve studies from primary care setting and hospitals. The included studies were heterogeneous in terms of characteristics of populations, types of interventions to enhance patient-engagement, outcome measures and length of follow-up. Nine of the 12 included studies found significant improvements in health and patient-reported outcomes such as higher quality-adjusted life-years, fewer hospital visits and disease specific symptoms. Quality of the included studies was of low to moderate. CONCLUSION This review identifies potential beneficial effects of interventions to enhance patient-engagement in older adults with multimorbidity. Nevertheless, the limited and very diverse evidence-based calls for more robust studies into efficient approaches to engaging older adults with multimorbidity in care trajectories.
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Affiliation(s)
- Mathilde Bendix Søgaard
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Andresen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Lindberg LG, Johansen KS, Kristiansen M, Skammeritz S, Carlsson J. Negotiating Engagement, Worthiness of Care and Cultural Identities Through Intersubjective Recognition: Migrant Patient Perspectives on the Cultural Formulation Interview in Danish Mental Healthcare. Cult Med Psychiatry 2021; 45:629-654. [PMID: 33170411 DOI: 10.1007/s11013-020-09694-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2020] [Indexed: 11/28/2022]
Abstract
This qualitative study presents migrant patient perspectives on using the Cultural Formulation Interview (CFI) in mental health assessments in Denmark. Empirical data consisted of 20 recorded CFI sessions and 16 patient interviews, coded with a constructivist grounded theory approach. Empirical findings prompted us to draw on the theoretical framework of intersubjective recognition in the analytical process. Our analysis showed how patients had multiple previous experiences of misrecognition in life and healthcare. This seemed to restrain their self-esteem and available positions for expressing preferences and reservations during the CFI and led to negotiations of worthiness of care. Despite occasional lack of flow and information in the recorded CFI sessions, patients subsequently recounted how they felt the CFI recognised the complexity and context of their cultural identities and illness narratives. Patients described how the CFI-guided provider approach of curiosity and empowerment carried significant meaning and left them feeling dignified, hopeful and engaged in future care. Intersubjective recognition is fundamental in all human interaction, but we argue that the recognising CFI approach is particularly important in vulnerable and asymmetrical mental health assessment encounters where access to care is determined and when working with migrants or other marginalised groups.
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Affiliation(s)
- Laura Glahder Lindberg
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Maglevænget 21, 2750, Ballerup, Denmark. .,Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Katrine Schepelern Johansen
- Competence Centre for Dual Diagnosis, Mental Health Centre Sct. Hans, Mental Health Services of the Capital Region of Denmark, Roskilde, Denmark
| | - Maria Kristiansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Signe Skammeritz
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Maglevænget 21, 2750, Ballerup, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Maglevænget 21, 2750, Ballerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Nygaard SS, Srivarathan A, Mathisen J, Kristiansen M, Christensen U, Kvorning MF, Lund R. Challenges and lessons learnt from conducting a health survey in an ethnically diverse population. Scand J Public Health 2021; 50:995-1006. [PMID: 34711102 DOI: 10.1177/14034948211054663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim: To document the challenges of developing and executing an interviewer-driven survey questionnaire in an ethnically diverse and deprived social housing area undergoing reconstruction in Denmark. Methods: The survey was initially planned to be conducted in three waves (before, during and after reconstruction of the housing area), based on a questionnaire covering health, wellbeing and social relations. The first two waves took place in 2018 and 2019 (invited n=~600 per wave) and the third wave will be conducted once the reconstruction is finalised. The approach to the third wave is under revision by the research team. The questionnaire was translated from Danish into the seven most common languages in the housing area. A bilingual interview team went door to door interviewing residents. Field notes were collected systematically during each wave to document the process. Results: The response rates were 35% (n=209) and 22% (n=132) for waves 1 and 2, respectively. There was an overall decrease in response rates between waves 1 and 2 for all language groups, but particularly for Arabic and Turkish-speaking men. The most frequently stated reasons for non-participation included illness and language barriers. The key lessons learnt were that overcoming linguistic and cultural barriers to conducting research among residents in this social housing area requires time and resources. Conclusions: Several challenges are associated with conducting a survey in ethnically diverse and deprived social housing areas. Documenting the challenges and learning from experience are both important, in order to include this hard-to-reach population in health research.
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Affiliation(s)
- Siv Steffen Nygaard
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Denmark
| | - Abirami Srivarathan
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Denmark
| | - Jimmi Mathisen
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Denmark
| | - Maria Kristiansen
- Center for Healthy Aging, University of Copenhagen, Denmark.,Department of Public Health, Section for Health Services Research, University of Copenhagen, Denmark
| | - Ulla Christensen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Denmark
| | | | - Rikke Lund
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Denmark
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Buch Mejsner S, Kristiansen M, Eklund Karlsson L. Civil Servants and Non-Western Migrants' Perceptions on Pathways to Health Care in Serbia-A Grounded Theory, Multi-Perspective Study. Int J Environ Res Public Health 2021; 18:10247. [PMID: 34639551 PMCID: PMC8547138 DOI: 10.3390/ijerph181910247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/15/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Informal patient payments continue to persist in the Serbian health care system, exposing vulnerable groups to private spending on health care. Migrants may in particular be subject to such payments, as they often experience barriers in access to health care. Little is known about migrants paying informally to access health care in Serbia. The study aims to explore pathways of accessing health care, including the role of informal patient payments, from the perspectives of civil servants and non-western migrants in Serbia. (2) Methods: Respondents (n = 8 civil servants and n = 6 migrants) were recruited in Belgrade in 2018, where semi-structured interviews were conducted. The interviews were analysed applying the grounded theory methodological steps. (3) Results: Data reveal different pathways to navigate the Serbian health care system, and ultimately whether paying informally occurs. Migrants appear less prone to paying informally and receive the same or better-quality health care. Locals experience the need to pay informal patient payments, quasi-formal payments and to bring medicine, materials or equipment when in health facilities. (4) Conclusions: Paying informally or using private care in Serbia appear to have become common. Despite a comprehensive health insurance coverage, high levels of out-of-pocket payments show barriers in accessing health care. It is highly important to not confuse the cultural beliefs with forced spending on health care and such private spending should be reduced to not push people into poverty.
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Affiliation(s)
- Sofie Buch Mejsner
- Unit for Health Promotion Research, University of Southern Denmark, Degnevej 14, 6705 Esbjerg, Denmark;
| | - Maria Kristiansen
- Department of Public Health, Center for Healthy Aging, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark;
| | - Leena Eklund Karlsson
- Unit for Health Promotion Research, University of Southern Denmark, Degnevej 14, 6705 Esbjerg, Denmark;
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Bergien S, Petersen CM, Lynning M, Kristiansen M, Skovgaard L. "I need personal experiences or some sort of documentation": a qualitative study on where people with multiple sclerosis seek information on dietary and herbal supplements. BMC Complement Med Ther 2021; 21:213. [PMID: 34419015 PMCID: PMC8379853 DOI: 10.1186/s12906-021-03377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background The use of dietary and herbal supplements (DIHES) is widespread among people with multiple sclerosis (PwMS). PwMS are a highly informed patient group, and they use several types of sources to seek information on subjects related to their disease. However, it is still unknown where PwMS seek information about DIHES. It is important that PwMS make decisions about DIHES based on accurate, useful and accessible information. Therefore, the aim of this study was to explore where PwMS seek information on DIHES and how they experience and engage with this information. Methods Semi-structured interviews were conducted with eighteen PwMS using DIHES. Participants were selected from a cross-sectional survey. Diversity sampling was used, based on relevant characteristics such as gender and number of DIHES used during the past 12 months. The interviews were conducted face-to-face or over the telephone and lasted between 30 min and 1 hour. The interviews were recorded, transcribed verbatim, and analyzed using thematic network analysis in NVivo 12 Pro software. Results Three main themes emerged in the analysis: i) engaging with healthcare professionals (HCPs) regarding DIHES, ii) social networks as a source of information regarding DIHES, and iii) reliance on bodily sensations. Most participants navigated all three types of sources. All participants had at some point discussed DIHES with an HCP. Information from HCPs was considered reliable and valuable, but HCPs were viewed as uncommitted to the dialogue about DIHES. Recommendations from others were often the driver of decisions regarding use of DIHES. However, the information from PwMS’ networks could be overwhelming and difficult to navigate. Finally, PwMS relied on their own experiences regarding DIHES and let their bodily sensations guide their use of DIHES. Conclusions Participants often rely on all three types of information sources to create a nuanced and comprehensive information base. However, PwMS may feel overwhelmed or confused with all the information they have gathered. These findings indicate the need for better guidance for PwMS concerning DIHES and an openness among HCPs to engage in dialogue. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-021-03377-0.
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Affiliation(s)
- Sofie Bergien
- The Danish Multiple Sclerosis Society, Poul Bundgaards Vej 1, Valby, Denmark.
| | - Clara M Petersen
- The Danish Multiple Sclerosis Society, Poul Bundgaards Vej 1, Valby, Denmark
| | - Marie Lynning
- The Danish Multiple Sclerosis Society, Poul Bundgaards Vej 1, Valby, Denmark
| | - Maria Kristiansen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen K, Denmark
| | - Lasse Skovgaard
- The Danish Multiple Sclerosis Society, Poul Bundgaards Vej 1, Valby, Denmark
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Kristiansen M, Nedergaard Jensen A, Norredam M, Srivarathan A. Targeting preventive home visits to older adults in disadvantaged communities: Perspectives of professionals. Health Soc Care Community 2021; 29:1051-1060. [PMID: 32794327 DOI: 10.1111/hsc.13139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/10/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
This study explored the implementation of multidimensional preventive home visits targeted to older adults living in a disadvantaged community in Denmark. The intervention was adapted to include the following key components: involvement of community members in recruitment processes; a combination of individual and group-based dissemination; adaptation of materials to overcome language barriers; and diversity-sensitivity training for professionals. The study took place over 12 months between August 2016 and August 2017 and used various data sources: registry-based data, participant observations, combined with individual and focus group interviews with the target population (n = 22) and relevant health care professionals (n = 8). Here, we report on findings pertaining to implementation barriers and facilitators as seen from the perspective of professionals. Socioeconomic vulnerability was prominent, and uptake of health care services was low, indicating under-utilisation. Implementation facilitators and barriers were identified including potentials in nurturing local partnerships and proximity during recruitment; overcoming language barriers; offering diversity-sensitivity training for professionals; and a need for a more multidisciplinary, comprehensive scope of preventive visits for diverse older adults in disadvantaged communities. Thus, more focus on participatory, comprehensive and community-based health promotion are needed to ensure healthy ageing in the context of social inequality and ethnic diversity.
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Affiliation(s)
- Maria Kristiansen
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
| | - Andrea Nedergaard Jensen
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
| | - Abirami Srivarathan
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
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30
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Jensen AN, Kristiansen M, Tolstrup JS, Gamst-Jensen H. Associations between degree-of-worry, self-rated health and acute hospitalisation after contacting a medical helpline: a Danish prospective cohort study. BMJ Open 2021; 11:e042287. [PMID: 34045212 PMCID: PMC8162089 DOI: 10.1136/bmjopen-2020-042287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Self-rated health (SRH) is a strong predictor for healthcare utilisation among chronically ill patients. However, its association with acute hospitalisation is unclear. Individuals' perception of urgency in acute illness expressed as degree-of-worry (DOW) is however associated with acute hospitalisation. This study examines DOW and SRH, respectively, and their association with acute hospitalisation within 48 hours after calling a medical helpline. DESIGN A prospective cohort study. SETTING The Medical Helpline 1813 (MH1813) in the Capital Region of Denmark, Copenhagen. PARTICIPANTS Adult (≥18 years of age) patients and relatives/close friends calling the MH1813 between 24 January and 9 February 2017. A total of 6812 callers were included. OUTCOME MEASURES The primary outcome measure was acute hospitalisation. Callers rated their DOW (1=minimum worry, 5=maximum worry) and SRH (1=excellent, 5=poor). Covariates included age, sex, Charlson Comorbidity Score and reason for calling. Logistic regression was conducted to measure the associations in three models: (1) crude; (2) age-and-sex-adjusted; (3) full fitted model (age, sex, comorbidity, reason for calling, DOW/SRH). RESULTS Of 6812 callers, 492 (7.2%) were acutely hospitalised. Most callers rated their health as being excellent to good (65.3%) and 61% rated their worry to be low (DOW 1-3). Both the association between DOW and acute hospitalisation and SRH and acute hospitalisation indicated a dose-response relationship: DOW 1=ref, 3=1.8 (1.1;3.1), 5=3.5 (2.0;5.9) and SRH 1=ref, 3=0.8 (0.6;1.4), 5=1.6 (1.1;2.4). The association between DOW and acute hospitalisation decreased slightly, when further adjusting for SRH, whereas the estimates for SRH weakened markedly when including DOW. CONCLUSIONS DOW and poor SRH were associated with acute hospitalisation. However, DOW had a stronger association with hospitalisation than SRH. This suggests that DOW may capture acutely ill patients' perception of urgency better than SRH in relation to acute hospitalisation after calling a medical helpline. TRIAL REGISTRATION NUMBER NCT02979457.
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Affiliation(s)
| | - Maria Kristiansen
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Zealand, Denmark
| | - Janne Schurmann Tolstrup
- Department of Population Health and Morbidity, National Institute of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Hejdi Gamst-Jensen
- Department of Clinical Research and the Emergency Department, Hvidovre Hospital, Hvidovre, Zealand, Denmark
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31
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Lidegaard LP, Kristiansen M, Pisinger C. Readiness for implementation of smoke-free work hours in private companies: A qualitative study of perceptions among middle managers. Tob Prev Cessat 2021; 7:38. [PMID: 34056145 PMCID: PMC8145195 DOI: 10.18332/tpc/134800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Workplaces are important settings for implementation of smoke-free environments. In this study, we follow a medical production company with 677 employees that implemented one of the most stringent tobacco policies legally possible in Denmark – smoke-free work hours – which means that employees are not allowed to smoke during work time. This study explores tobacco use restrictions during work hours regarding readiness of implementation, focusing specifically on middle managers’ perceptions and considerations, as well as their perceived responsibility in enforcing these. METHODS A case study is presented. Two focus groups of 10 middle managers were conducted, seven months before smoke-free work hours were implemented. The facilitators used open-ended questions, which consisted of a structured section with specific themes related to the implementation of smoke-free work hours. Focus groups were recorded, transcribed, and analyzed thematically. RESULTS We identified five main themes: 1) Benefits of the new policy due to better health, lower sickness-related absences, increased productivity, and improved branding value; 2) Social interactions across smoking status; 3) Smoking is a private matter with ethical dimensions; 4) The role of middle managers and concerns about enforcement; and 5) Limited experience with resistance from the smoking employees. CONCLUSIONS The findings suggest that workplaces in the preparation phase should ensure that: 1) The middle managers gain training on how to talk with employees about smoking cessation; 2) The middle managers are equipped to handle the new policy and have a joint vision and understanding of why and how they should enforce it; and 3) Room is made for discussions on resistance and enforcement-related challenges as well as ethical issues.
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Affiliation(s)
- Lærke P Lidegaard
- Department of Research, Danish Heart Foundation, Copenhagen, Denmark
| | - Maria Kristiansen
- Center for Healthy Aging, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charlotta Pisinger
- Department of Research, Danish Heart Foundation, Copenhagen, Denmark.,Center for Healthy Aging, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg University Hospital, University of Copenhagen, Copenhagen, Denmark
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32
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Wahl AM, Musaeus KD, Sørensen TL, Kristiansen M. Reasons for late diagnosis of neovascular age-related macular degeneration: a mixed-methods study. Acta Ophthalmol 2021; 99:e443-e445. [PMID: 33073483 DOI: 10.1111/aos.14568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/03/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Anna M. Wahl
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- Faculty of Health and Medical Sciences Department of Public Health Center for Healthy Aging University of Copenhagen Copenhagen Denmark
| | - Katrine D. Musaeus
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- Faculty of Health and Medical Sciences Department of Public Health Center for Healthy Aging University of Copenhagen Copenhagen Denmark
| | - Torben L. Sørensen
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
| | - Maria Kristiansen
- Faculty of Health and Medical Sciences Department of Public Health Center for Healthy Aging University of Copenhagen Copenhagen Denmark
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Pallesen AVJ, Herrstedt J, Westendorp RGJ, Mortensen LH, Kristiansen M. Differential effects of colorectal cancer screening across sociodemographic groups in Denmark: a register-based study. Acta Oncol 2021; 60:323-332. [PMID: 33427545 DOI: 10.1080/0284186x.2020.1869829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) does not affect different sociodemographic groups uniformly. CRC screening programmes could seek to reduce this inequality; however, the screening programmes themselves might be subject to differential participation across sociodemographic groups. This study investigates the sociodemographic inequality at all steps in Denmark's nationwide CRC screening programme: screening participation, faecal immunochemical test (FIT) results, colonoscopy compliance, CRC diagnosis, and cancer stage. MATERIAL AND METHODS This cohort study includes all first-time invitees from the beginning of the Danish population-based CRC screening programme from 1 March 2014 to 31 December 2017. RESULTS Sixty-four percent of the invitees participated in the screening programme, and of those 7% were FIT-positive. After being invited to further diagnostic procedures, 90% responded to the invitation, and among those 5% were CRC-positive. Among those diagnosed with CRC, 9% were stage IV. Through multivariable analyses, we identified sociodemographic inequalities in all steps of the screening programme from returning a stool sample to being diagnosed with CRC. Specifically, we identified inequalities across sex, age, migration status, relationship status, the screening status of one's partner, education, income, and use of health services. Women were more likely to participate compared to men (RR = 1.13; 95% CI: 1.12-1.13), but had a lower risk of a positive FIT result (RR = 0.67; 95% CI: 0.66-0.68) and of a CRC diagnosis (RR = 0.88; 95% CI: 0.82-0.93) compared to men. The likelihood of participating as well as the risk of positive FIT results and CRC diagnosis increased with age. CONCLUSION All steps of the screening programme were subject to sociodemographic inequalities. Interventions are needed to target groups identified as having lower uptake as well as high-risk of being FIT- and/or CRC-positive. These groups include males, individuals aged 60+ years and individuals who do not visit their GP regularly.
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Affiliation(s)
- Anna Vera Jørring Pallesen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - Jørn Herrstedt
- Department of Clinical Oncology and Palliative Care Units, Zealand University Hospital, Roskilde and Naestved, Denmark
| | - Rudi G. J. Westendorp
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Laust Hvas Mortensen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Cherbuin N, Iijima K, Kalula S, Malhotra R, Rasmussen LJ, Chan A, Lafortune L, Harper S, Zheng X, Lindeman D, Walsh E, Hussain R, Burns R, Kristiansen M, Sugawara I, Son B, Tanaka T, Buckner S, Hoffman J, Combrinck M. Societal Need for Interdisciplinary Ageing Research: An International Alliance of Research Universities "Ageing, Longevity and Health" Stream (IARU-ALH) Position Statement. Biomed Hub 2021; 6:42-47. [PMID: 33791316 DOI: 10.1159/000513513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 11/19/2022] Open
Abstract
Ageing is a global concern with major social, health, and economic implications. While individual countries seek to develop responses to immediate, pressing needs, international attention and collaboration is required to most effectively address the multifaceted challenges and opportunities an ageing global population presents in the longer term. The Ageing, Longevity and Health stream of the International Alliance of Research Universities (IARU-ALH) was built on a solid foundation of first-class interdisciplinary research and on innovative outreach and communication centres. This interdisciplinary network conducts projects that span biology, medicine, social sciences, epidemiology, public health, policy, and demography, and actively engages with the public and other societal stakeholders. Here we posit that such international interdisciplinary networks are needed and uniquely placed to address major challenges related to health and ageing and ultimately will produce new understanding and knowledge to promote the awareness of healthy ageing and encourage societal change via novel, science-informed interventions. Global interdisciplinary research presents great potential and opportunities to accelerate our understanding of human ageing and to produce new, more effective solutions to a pressing, complex problem. However, more focused, strategic efforts and investments are required in order to deliver on these potentials and reap maximum benefits for individuals and societies. IARU-ALH members are determined to contribute, in collaboration with others, to delivering on this vision.
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Affiliation(s)
- Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Katsuya Iijima
- Institute of Gerontology, Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
| | - Sebastiana Kalula
- Albertina and Walter Sisulu Institute of Ageing in Africa, University of Cape Town, Cape Town, South Africa
| | - Rahul Malhotra
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | | | - Angelique Chan
- Duke-National University of Singapore Medical School, Singapore, Singapore.,Department of Sociology, National University of Singapore, Singapore, Singapore
| | - Louise Lafortune
- Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Sarah Harper
- Oxford Institute of Population Health, University of Oxford, Oxford, United Kingdom
| | - Xiaoying Zheng
- Institute of Population Research, Beijing University, Beijing, China
| | - David Lindeman
- Center for Information Technology Research in the Interest of Society, UC Berkeley, Berkeley, California, USA
| | - Erin Walsh
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rafat Hussain
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Richard Burns
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Maria Kristiansen
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Ikuko Sugawara
- Institute of Gerontology, Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
| | - Bokyung Son
- Institute of Gerontology, Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
| | - Tomoki Tanaka
- Institute of Gerontology, Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
| | - Stefanie Buckner
- Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Jaco Hoffman
- Albertina and Walter Sisulu Institute of Ageing in Africa, University of Cape Town, Cape Town, South Africa.,Oxford Institute of Population Health, University of Oxford, Oxford, United Kingdom
| | - Marc Combrinck
- Albertina and Walter Sisulu Institute of Ageing in Africa, University of Cape Town, Cape Town, South Africa
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Mikkelsen AS, Kristiansen M. Qualitative Study of the Implementation and Potential of a Social Intervention at Nursing Homes in Denmark. Int J Environ Res Public Health 2021; 18:1808. [PMID: 33673281 PMCID: PMC7918481 DOI: 10.3390/ijerph18041808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: The effect of social relations on health and wellbeing is well documented. However, knowledge about social interventions specifically in nursing homes and their potential for health and wellbeing is inadequate. In this qualitative study, we explore the implementation of a social intervention entitled Tell Stories for Life implemented in Danish nursing homes. (2) Methods: Through a qualitative multi-perspective longitudinal approach, nursing home residents and employees were interviewed from May-December 2016 (N = 14). The authors made participatory observations and took field notes. (3) Results: The intervention did not appear to establish or strengthen social relations between nursing home residents. However, nursing home residents enjoyed participating, narrating and having someone listen to their stories. The identity of nursing home residents and their relationships to nursing home employees facilitating the intervention appeared to be strengthened. Barriers were related to lack of support from management, nursing home employees' educational backgrounds and experiences, and nursing home residents' cognitive ability. (4) Conclusions: This study found that the Tell Stories for Life intervention did not appear to strengthen and establish social relations among nursing home residents. However, we found that there might be potential for strengthening residents' sense of identity and the relation between residents and nursing home employees.
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Affiliation(s)
- Anne Sophie Mikkelsen
- Center for Healthy Aging, Section for Health Services Research, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark;
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Pallesen AVJ, Herrstedt J, Westendorp RGJ, Mortensen LH, Kristiansen M. Do we know the effects of colorectal cancer screening? A short communication on selective uptake and differential effects of colorectal cancer screening in Scandinavia. Scand J Public Health 2020; 49:841-844. [PMID: 33016227 DOI: 10.1177/1403494820960641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Colorectal cancer (CRC) contributes extensively to the overall cancer burden, with substantial and increasing social inequality in both incidence and survival. In several countries, this social inequality in incidence and survival has been increasing over time, and the increase is expected to continue. To overcome this, it is advised to implement nationwide CRC screening programmes, as these are effective in detecting possible signs of CRC, hence identifying earlier-stage cancer and reducing mortality. However, little is known about the distribution of these effects across population groups. It is possible that the outcomes of CRC screening are not equally distributed among participants, but rather that the screening programme serves some population groups better than others. The aim of this short communication based on published data is to describe the status of selective uptake according to sociodemographic and economic factors in CRC screening in Scandinavia. Furthermore, we raise questions that need to be addressed in future research in order to grasp the full effects of the screening programme and ultimately to ensure high uptake as well as participation in subsequent diagnostic procedures across population groups.
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Affiliation(s)
- Anna Vera Jørring Pallesen
- Department of Public Health and Centre for Healthy Aging, University of Copenhagen, Denmark.,Methods and Analysis, Statistics Denmark, Denmark
| | - Jørn Herrstedt
- Department of Clinical Oncology and Palliative Care Units, Zealand University Hospital, Denmark
| | - Rudi G J Westendorp
- Department of Public Health and Centre for Healthy Aging, University of Copenhagen, Denmark
| | - Laust Hvas Mortensen
- Department of Public Health and Centre for Healthy Aging, University of Copenhagen, Denmark.,Methods and Analysis, Statistics Denmark, Denmark
| | - Maria Kristiansen
- Department of Public Health and Centre for Healthy Aging, University of Copenhagen, Denmark
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Lindberg LG, Mundy SS, Kristiansen M, Johansen KS, Carlsson J. Satisfaction with mental health treatment among patients with a non-Western migrant background: a survey in a Danish specialized outpatient mental health clinic. Eur J Public Health 2020; 29:700-705. [PMID: 31155672 DOI: 10.1093/eurpub/ckz090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Global migration increases ethnic and cultural diversity and demands mental health services to adapt to provide all patients with equal access to good quality care. Patient satisfaction surveys can inform this service delivery, thus we explored patient satisfaction among non-Western migrants receiving treatment in a Danish specialized outpatient mental health clinic [Competence Centre for Transcultural Psychiatry (CTP)]. METHODS We used multivariate logistic regression models to estimate associations between 'Overall treatment satisfaction' and treatment-related items plus potential confounders from a cross-sectional patient satisfaction survey (n = 686). The satisfaction questionnaire was a self-report measurement tool developed locally at CTP. Participants were non-Western migrants above 18 years with Post-Traumatic Stress Disorder (PTSD) or depression diagnoses according to ICD-10. RESULTS Most participants (n = 497; 82.6%) reported overall satisfaction with their mental health treatment, but less than half (n = 311; 48.8%) reported an improvement in health and situation after end of treatment. Participants who experienced a subjective improvement in their health and situation had significantly higher odds of being satisfied with their mental health treatment [odds ratio (OR) = 8.5, 95% confidence interval (CI): 4.0-18.1]. Perceptions of influence on the treatment course (OR = 4.7, 95% CI: 2.4-9.2), and of understanding and respect for one's cultural background (OR = 3.4, 95% CI: 1.5-7.6) were significantly associated with treatment satisfaction. Age and sex were insignificant in the final regression model. CONCLUSIONS Implications for practice based on our findings are to enhance person-centred care and shared decision-making with all patients regardless of cultural background and to prioritize pre- and postgraduate training in cultural competences and cultural humility for healthcare providers.
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Affiliation(s)
- Laura Glahder Lindberg
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sara Skriver Mundy
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
| | - Maria Kristiansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
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Jensen AN, Bonnén KB, Kristiansen M. "We don't talk about his heart": Narrative sense-making and long-term readjustment among older out-of-hospital cardiac arrest survivors and their spouses. Resusc Plus 2020; 3:100024. [PMID: 34223307 PMCID: PMC8244505 DOI: 10.1016/j.resplu.2020.100024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/16/2020] [Accepted: 08/11/2020] [Indexed: 01/10/2023] Open
Abstract
Aim of the study Globally, there has been an increase in the survival rate and the average age of survivors from out-of-hospital cardiac arrest (OHCA). However, little is known about the joint OHCA-associated experiences among older survivors and their spouses in a long-term perspective. The aim of this study was to explore how narrative sense-making processes following OHCA shapes everyday life in a long-term perspective among older survivors and their spouses. Methods Five older male survivors and their female spouses were interviewed individually using narrative methods. Arthur Frank’s theory on illness narratives informed the analysis. Participant observation at two meetings for survivors and relatives regarding cardiac arrest was used for qualification of the interview guide. Results Five married couples participated. The mean age of the survivors and spouses was 70,4 and 71,4 years respectively, and time since OHCA varied from 12 to 66 months. Two themes of the dyadic experience emerged: 1) experiences during OHCA, and 2) experiences in life following OHCA. Subthemes differed with survivors emphasising a desire to return to the same life as before the OHCA, and the spouses narrating feelings of anxiety. Potential complications of the OHCA were often explained with reference to ageing processes, and the OHCA was contextualised in relation to previous life-changing events. Conclusion In a long-term perspective, OHCA shapes the life trajectory of both the survivor and the spouse, and the relationship between them, underscoring a need for patient-centred care with a greater focus on the relationship of the dyads. Unmet needs among survivors and spouses should be addressed by follow-up dialogue. Life after OHCA is embedded in the context of age and biography. A narrative approach in encounters could strengthen the support for couples. Survivors and spouses’ experiences contrasted pointing towards individual needs.
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Affiliation(s)
- Andrea Nedergaard Jensen
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Katrine Bruun Bonnén
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Maria Kristiansen
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark
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Rosenkrands HS, Kristiansen M, Hansen AL, Norredam M. Providing targeted healthcare services for immigrants with complex health needs. Dan Med J 2020; 67:A03190160. [PMID: 33046201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Providing targeted healthcare for immigrants with complex needs is an innovative approach to reducing health inequities. This study explores sociodemographic characteristics, symptoms and morbidity patterns of patients attending one such pioneering clinic. METHODS This was a cross-sectional survey based on 408 patients seen from 1 January 2014 to 20 November 2017. Data on socio-demographics, referral patterns, migration background, symptoms and multimorbidity were collected using a standardised screening questionnaire. Baseline blood test results were included for a subpopulation (n = 178). Data were analysed using descriptive statistics and logistic regression analysis. RESULTS The patients, among whom 83% (n = 334) were women, represented 43 nationalities and had a mean age of 49 years. A total of 19% (n = 78) had no formal schooling. More than 70% (n = 287) reported an (oral and written) interpreter need despite most (63%) having resided in Denmark for > 20 years. Reported symptoms were often pain-related, and 87% (n = 355) reported ≥ 5 symptoms. Multi-morbidity (≥ 2 reported diagnoses) was seen in 73% (n = 298) of the patients. Women had a significantly lower odds ratio (OR) of having > 5 symptoms (OR = 0.44; 95% confidence interval (CI): 0.21-0.92) and an insignificantly lower risk of multi-morbidity (OR = 0.76; 95% CI: 0.40-1.43) than men; no significant differences were seen according to migrant status. CONCLUSIONS The patients presented with a complex disease burden, language and a disadvantaged socioeconomic status highlighting the need for targeted health services for vulnerable immigrant groups in order to reduce inequities in health. FUNDING Department of Infectious Diseases, Hvidovre Hospital. TRIAL REGISTRATION none.
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Srivarathan A, Lund R, Christensen U, Kristiansen M. A qualitative study on resident engagement in a community-based health promotion intervention. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Emerging evidence points towards lower quality of life, more fragile social relations and suboptimal health behaviour and health status of residents living in social housing areas characterized by ethnic diversity and socioeconomic disadvantage. Residents from social housing areas are less likely to engage in health promotion interventions compared to the rest of society. Community-based health promotion interventions developed in collaboration with the target group and adjusted to local context can affect the acceptance of and engagement in such interventions. However, few studies have investigated the potential of community-based interventions in social housing areas. This study explores resident perspectives on engagement in a community-based health promotion intervention focusing on enhancing social relations. Engagement was the key foundation for the designing and implementation of the intervention by the use of graphic facilitation. The intervention consisted of social outings to different sights and historical landmarks in Denmark. The study builds on qualitative methods including participant observations combined with pre- and post-intervention interviews with a selected group of residents (n = 9). Data were thematically analysed with a focus on participation in an everyday life context and by concepts of othering and territorial stigmatization. Engagement in the intervention was motivated by a need for establishing and enhancing social relations, and exploring the world outside the housing area. However, barriers including cultural and language differences among residents and competing contextual factors challenged engagement. We conclude that participatory community-based interventions have a potential to enhance social relations in social housing areas. Nevertheless, it is necessary to understand the motives and barriers to ensure feasible and relevant health promotion interventions and future engagement among residents living in social housing areas.
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Affiliation(s)
- A Srivarathan
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - R Lund
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - U Christensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M Kristiansen
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Nygaard S, Srivarathan A, Mathisen J, Kristiansen M, Lund R. Experiences and challenges in collecting survey data in an ethnically diverse social housing area. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Socio-economically disadvantaged groups are characterised by a higher burden of disease than the background population. Paradoxically, they are often underrepresented in health research. Failing to include socio-economically disadvantaged groups in research impairs the ability to address the social mechanisms creating health disparities. The study describes how we have tried to accommodate identified challenges from the literature in conducting a questionnaire survey in a socio-economically deprived and ethnically diverse social housing area, and which new challenges we identified. The survey is planned before, during and after the structural changes take place. Through innovative approaches, we sought to accommodate identified barriers to reaching participants. The questionnaire was translated from Danish to the seven most prevalent languages in the area, based on data from the national register. A survey corps of native speaking interviewers went door-to-door to perform face-to-face interviews. To encourage participation, we used a recruitment strategy inspired by ethnographic data collection traditions, such as local presence, participation in local activities, and graphic facilitation on invitation letters. Wave 1 and 2 had a response rate of 35% (N = 209) and 22% (N = 132), respectively. 79 respondents participated in both waves. Despite our efforts to accommodate identified challenges such as language, illiteracy, and mistrust, the response rates are low. We identified new challenges in recruiting participants including participation fatigue, frustration with the restructure process, and a feeling of limited individual gain from participation. Many challenges are associated with conducting research among socio-economically disadvantaged groups. Documenting processes and learning from experiences are important steps in including groups with lower socio-economic status in health research in order to address the underlying social mechanisms creating health disparities.
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Affiliation(s)
- S Nygaard
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Srivarathan
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - J Mathisen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M Kristiansen
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - R Lund
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Sandholdt CT, Cunningham J, Westendorp RG, Kristiansen M. Towards Inclusive Healthcare Delivery: Potentials and Challenges of Human-Centred Design in Health Innovation Processes to Increase Healthy Aging. Int J Environ Res Public Health 2020; 17:ijerph17124551. [PMID: 32599806 PMCID: PMC7344669 DOI: 10.3390/ijerph17124551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 11/16/2022]
Abstract
National healthcare systems need to adjust services and operations to accommodate the needs of complex, aging populations living with multimorbidity and polypharmacy. This paper suggests the use of a human-centred design as a method to engage older adults and key professionals in innovation processes aiming to design person-centred healthcare services and improve quality of life in older adults. We outline three innovation phases and highlight how such processes can create engagement and new insights on how life experiences of older adult's shape preferences, beliefs, and habits. It is important to incorporate these insights into the design of successful strategies for ensuring age-friendly healthcare services. Our viewpoint is contextualised through a small-scale case study focusing on polypharmacy in older adults. From this case study, we extracted three challenges to producing co-designed health research: recruitment, time and resources, and funding. We discuss how to address these challenges. We argue for the involvement of older adults and professional stakeholders at an early stage in the design process to align expectations and to increase the likelihood of successful implementation of healthcare innovations that improve the quality of life for older adults.
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Affiliation(s)
- Catharina Thiel Sandholdt
- Department of Public Health and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, DK-1014 Copenhagen, Denmark; (R.G.J.W.); (M.K.)
- Correspondence: ; Tel.: +45-3532-6359
| | - Jason Cunningham
- Family Physician, Chief Executive Officer, West County Health Centers, 14045 Mill Street, P.O. Box 1449, Guerneville, CA 95446, USA;
| | - Rudi G.J. Westendorp
- Department of Public Health and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, DK-1014 Copenhagen, Denmark; (R.G.J.W.); (M.K.)
| | - Maria Kristiansen
- Department of Public Health and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, DK-1014 Copenhagen, Denmark; (R.G.J.W.); (M.K.)
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Bergien SO, Petersen CM, Lynning M, Kristiansen M, Skovgaard L. Use of natural medicine and dietary supplements concomitant with conventional medicine among people with Multiple Sclerosis. Mult Scler Relat Disord 2020; 44:102197. [PMID: 32531752 DOI: 10.1016/j.msard.2020.102197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of complementary and alternative medicine (CAM) are widespread among people with Multiple Sclerosis (PwMS) and are often used concomitant with conventional treatment. Natural medicine and dietary supplements (NADS) are the most frequently used CAM modality and among other patient groups use of NADS concomitant with conventional medicine has been reported as a potential risk to patients' safety due to risk of drug interactions. The use of NADS concomitant with conventional medicine has, however, not been investigated among PwMS. This study's aim was to investigate the prevalence of NADS and conventional MS-related medicine use among PwMS, specific types of NADS and conventional MS-related medicine used, the prevalence of NADS used concomitant with conventional MS-related medicine, and to characterize PwMS who use NADS and PwMS who use NADS concomitant with conventional MS-related medicine in a Danish context. METHODS The study was a cross-sectional study conducted as an interviewer-administered survey via phone in April 2019. The questionnaire includes questions about the use of NADS and conventional MS medicine as well as sociodemographic and health-related factors. In total 384 PwMS answered the questionnaire. Both descriptive and logistic analyses were used to analyze the data. RESULTS The results show that the majority of PwMS use conventional MS-related medicine. In total, 85 % (n=322) had used at least one NADS within the last 12 months including vitamin D. When excluding vitamin D, the use of NADS within the last 12 months was 78.4% (n=298). Beside vitamin D the most reported types of NADS used were fatty acids (37%), Multivitamins (37%), and Calcium (35%). A total of 75.8% (n=288) reported using NADS concomitant with conventional MS medicine, and the products most often combined with conventional MS medicine were Vitamin D, Multivitamin, Calcium, Magnesium, and fatty acids. The results suggest that PwMS using NADS concomitant with conventional MS-related medicine are characterized by a high prevalence of young and newly diagnosed patients with a high education level. CONCLUSION The study contributes to a better understanding of NADS used among PwMS. The study shows that the majority of PwMS use NADS and that they use it concomitant with conventional MS-medicine. Furthermore, the detailed mapping of the specific types of NADS used gives a nuanced insight into the specific products of NADS used among PwMS, including different kinds of vitamins, minerals, and herbal remedies.
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Affiliation(s)
- S O Bergien
- The Danish Multiple Sclerosis Society, Valby, Denmark.
| | - C M Petersen
- The Danish Multiple Sclerosis Society, Valby, Denmark
| | - M Lynning
- The Danish Multiple Sclerosis Society, Valby, Denmark
| | - M Kristiansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - L Skovgaard
- The Danish Multiple Sclerosis Society, Valby, Denmark
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Rasmussen GHF, Kristiansen M, Arroyo-Morales M, Voigt M, Madeleine P. Absolute and relative reliability of pain sensitivity and functional outcomes of the affected shoulder among women with pain after breast cancer treatment. PLoS One 2020; 15:e0234118. [PMID: 32492064 PMCID: PMC7269234 DOI: 10.1371/journal.pone.0234118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/19/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Breast cancer survivors (BCS) are often characterized by decreased pressure pain thresholds (PPT), range of motion (ROM) and strength in and around the shoulder affected by the treatment. This intra-rater reliability study was to establish the relative and absolute reliability of PPT's, active ROM and maximal isokinetic muscle strength (MIMS) of the affected shoulder in BCS with persistent pain after treatment. METHODS Twenty-one BCS participated in the study. The PPTs of 17 locations and pain intensity were assessed using a pressure algometer and a numeric rating scale. The ROM was measured using a universal goniometer and MIMS was measured using an isokinetic dynamometer. Relative reliability was estimated using intra class correlation coefficient (ICC), and absolute reliability using standard error of measurement (SEM). Minimum detectable change (MDC) was calculated from SEM. RESULTS The ICCs for PPTs ranged from 0.88-0.97, with SEM values ranging from 12.0 to 28.2 kPa and MDC ranging from 33.2 to 78.2 kPa. The ICCs for ROM ranged from 0.66-0.97, with SEM values ranging from 3.0 to 7.5° and MDC ranging from 8.4 to 20.8°. Finally, ICCs for MIMS ranged from 0.62-0.92, with SEM values ranging from 0.03 to 0.07 Nm/Kg FFM and MDC ranging from 0.09 to 0.19 Nm/kg FFM. CONCLUSION The results of this study indicate that PPTs, ROM and MIMS can be measured reliably on the affected shoulder in BCS with pain after treatment. This offer the possibility of using these measures to assess the effectiveness of interventions in this population.
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Affiliation(s)
- G. H. F. Rasmussen
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Denmark
| | - M. Kristiansen
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Denmark
| | - M. Arroyo-Morales
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - M. Voigt
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Denmark
| | - P. Madeleine
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Denmark
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Mikkelsen ASB, Petersen S, Dragsted AC, Kristiansen M. Social Interventions Targeting Social Relations Among Older People at Nursing Homes: A Qualitative Synthesized Systematic Review. Inquiry 2019; 56:46958018823929. [PMID: 30791836 PMCID: PMC6376508 DOI: 10.1177/0046958018823929] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Social relations are part of the complex set of factors affecting health and well-being in old age. This systematic review seeks to uncover whether social interventions have an effect on social and health-related measures among nursing home residents. The authors screened PubMed, Scopus, and PsycINFO for relevant peer-reviewed literature. Interventions were included if (1) they focused primarily on social relations or related terms such as loneliness, social support, social isolation, social network, or being involuntarily alone either as the base theory of the intervention or as an outcome measure of the intervention; (2) they were implemented at nursing homes (or similar setting); (3) they had a narrative activity as its core (as opposed to dancing, gardening or other physical activity); (4) their participants met either physically or nonphysically, ie, via video-conference or the like; and if (5) they targeted residents at a nursing home. The authors systematically appraised the quality of the final selection of studies using the Mixed Methods Assessments Tool (MMAT) version 2011 and did a qualitative synthesis of the final study selection. A total of 10 studies were included. Reminiscence therapy was the most common intervention. Studies also included video-conference, cognitive, and support group interventions. All studies found the social interventions brought about positive trends on either/or the social and health-related measures included. Despite limited and very diverse evidence, our systematic review indicated a positive social and health-related potential of social interventions for older people living in nursing homes or similar institutions.
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Affiliation(s)
- Anne Sophie Bech Mikkelsen
- 1 Section for Health Services Research, Department of Public Health & Center for Healthy Aging, University of Copenhagen, Denmark
| | - Signe Petersen
- 1 Section for Health Services Research, Department of Public Health & Center for Healthy Aging, University of Copenhagen, Denmark
| | - Anne Cathrine Dragsted
- 1 Section for Health Services Research, Department of Public Health & Center for Healthy Aging, University of Copenhagen, Denmark
| | - Maria Kristiansen
- 1 Section for Health Services Research, Department of Public Health & Center for Healthy Aging, University of Copenhagen, Denmark
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Lund R, Christensen U, Mathisen J, Sørensen KS, Srivarathan A, Molbo D, Halby K, Kristiansen M. Health, well-being and social relations in a changing neighbourhood: protocol for a prospective, multimethods study of the consequences of large structural changes in an ethnic diverse social housing area in Denmark. BMJ Open 2019; 9:e030936. [PMID: 31221894 PMCID: PMC6588977 DOI: 10.1136/bmjopen-2019-030936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Residential areas constitute an important arena for health, well-being and social relations. Structural interventions such as demolition and area renewal have been used to reduce inequality in health and well-being in disadvantaged areas. However, the effects of larger structural interventions are inconclusive. In a longitudinal perspective, this study aims to analyse how large-scale structural changes in an ethnic diverse social housing area are associated with the residents' health, well-being and social relations. METHODS AND ANALYSIS In this multimethods study, we examine this aim among middle-aged and older residents in a multiethnic social housing area in a Danish municipality by the inclusion of comprehensive survey (in 2018, 2019 and 2020), register (yearly 2015-2025) and qualitative (2018-2020) data. Municipal Health Profile survey data from 2017 and 2021 will be used for comparison. The area will undergo large structural changes in the built environment during 2018-2021. A 'natural experiment' (n=6000) compares differences in health and social outcomes across the study period between the study area and a similar neighbouring area not undergoing structural changes. Through user engagement in the design of the study, throughout the different phases of the study and in the two co-created interventions embedded in the study design, a focus on empowerment and recognition of the resources and perspectives of residents are encouraged. ETHICS AND DISSEMINATION The study is registered in the University of Copenhagen's record of biobanks and research projects containing personal data and will be conducted in accordance with the principles of the Helsinki Declaration. Residential and municipal representatives and local non-governmental organisations are engaged in the design and execution of the study to ensure the usefulness, reflexive interpretation of data, and relevance of interventions. Results will be published in international peer-reviewed scientific journals, presented at conferences and as short reports through the use of both written and visual outputs.
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Affiliation(s)
- Rikke Lund
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Christensen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jimmi Mathisen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Abirami Srivarathan
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Drude Molbo
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Halby
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, Section of Health Services Research, University of Copenhagen, Copenhagen, Denmark
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Pallesen AVJ, Byberg S, Kristiansen M. Improving Dietary Behavior Among Ethnic Minority Women in Denmark: A Feasibility Study Based on a Participatory and Culturally Adapted Intervention. Int J Environ Res Public Health 2019; 16:ijerph16050795. [PMID: 30841498 PMCID: PMC6427310 DOI: 10.3390/ijerph16050795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/14/2019] [Accepted: 02/28/2019] [Indexed: 11/16/2022]
Abstract
The Danish Heart Foundation and the non-governmental organization Neighborhood Mothers have co-developed a culturally adapted intervention seeking to promote healthy dietary behaviour among ethnic minority women. This feasibility study explores the potential of the intervention to reach ethnic minority women using health promotion initiatives. Participants attended instructor courses or cooking events, where culturally adapted, healthy recipes were introduced and meals prepared. Feasibility was explored using a mixed-method approach. Surveys were completed by 59 volunteers and 150 participants at five instructor courses and 21 cooking events. Individual interviews and focus group discussions were conducted with volunteers and participants after completion of the intervention. After the intervention, 61% of the 150 participants had high levels of knowledge about dietary recommendations, 96% intended to cook healthy dishes in the future and 84% intended to incorporate measuring equipment into their daily cooking routine. Participants with a high level of knowledge reported intention to change dietary behaviour more often than participants with lower levels of knowledge. Interviews confirmed that the participants cooked healthy dishes after participating, and incorporated knowledge about healthy food practices into their daily cooking. Few participants used measuring equipment. The intervention proved to be feasible as a health promotion initiative targeting a hard-to-reach population.
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Affiliation(s)
- Anna Vera Jørring Pallesen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, 1014 Copenhagen, Denmark.
| | - Stine Byberg
- Steno Diabetes Center Copenhagen, 2820 Copenhagen, Denmark.
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, 1014 Copenhagen, Denmark.
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Srivarathan A, Jensen AN, Kristiansen M. Community-based interventions to enhance healthy aging in disadvantaged areas: perceptions of older adults and health care professionals. BMC Health Serv Res 2019; 19:7. [PMID: 30611262 PMCID: PMC6321658 DOI: 10.1186/s12913-018-3855-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 12/26/2018] [Indexed: 01/17/2023] Open
Abstract
Background The number of older adults with different ethnic and socioeconomic background is steadily increasing. There is a need for community-based health promotion interventions for older adults that are responsive to ethnic and socioeconomic diversity among target populations. The aim of this study is to explore encounters between older adults living in disadvantaged areas and health care professionals in the context of community-based health promotion. Methods Qualitative methods were used involving interviews and focus groups with older adults (n = 22) and municipal health care professionals (n = 8), and multiple observations were conducted. Data were analyzed thematically. Results Findings show a gap between health promotion services and older adults due to a perception of services as being neither accessible nor acceptable in the context of complex health and psychosocial needs. Health care professionals reported trust, proximity and presence as fundamental factors for improving acceptability and accessibility of health promotion services. Conclusions There is a need to develop participatory approaches to engage older adults who live in disadvantaged areas in municipal health promotion services and to ensure that these services are relevant to these groups.
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Affiliation(s)
- Abirami Srivarathan
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
| | - Andrea Nedergaard Jensen
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Maria Kristiansen
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
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Buch Mejsner S, Kristiansen M, Eklund Karlsson L. Migrants’ perceptions of equity in Serbian health care. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky218.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Buch Mejsner
- Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
| | - M Kristiansen
- Center for healthy aging and Department of public health, University of Copenhagen, Copenhagen, Denmark
| | - L Eklund Karlsson
- Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
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Jessen MAB, Pallesen AVJ, Kriegbaum M, Kristiansen M. The association between loneliness and health - a survey-based study among middle-aged and older adults in Denmark. Aging Ment Health 2018; 22:1338-1343. [PMID: 28685595 DOI: 10.1080/13607863.2017.1348480] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND While the association between overall poor health and loneliness among older adults continues to be examined closely, less attention has been given to middle-aged adults. This paper examines the relationship between loneliness and health as measured by self-rated health, physical ability and multi-morbidity in a large sample of Danish adults between the ages of 52-92 years. Furthermore, it identifies vulnerable groups with regard to the year of birth and gender. METHOD We apply the survey-study method, using data collected by The Danish National Centre for Social Research in 2012. We analysed the association between loneliness and health in 9154 Danish adults through multi-variate regression analyses adjusting for the year of birth, gender, marital status, cohabitation status, employment status and home ownership. RESULTS We found that loneliness was associated with increased risks of poor self-rated health (OR, 2.58; 95% Cl, 1.20-3.35), limited physical abilities (OR, 1.91; 95% Cl, 1.58-2.32) and multiple diagnoses (OR, 1.77; 95% Cl, 1.48-2.12). Lonely middle-aged adults (52-62 years of age) had an increased risk of having limited physical abilities. CONCLUSION Among middle-aged and older Danish adults, loneliness was strongly associated with poor self-rated health, limited physical ability and multi-morbidity.
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Affiliation(s)
- Mathilde Amalie Buchwald Jessen
- a Unit for Health Services Research, Department of Public Health, Center for Healthy Aging , University of Copenhagen , Copenhagen , Denmark
| | - Anna Vera Jørring Pallesen
- a Unit for Health Services Research, Department of Public Health, Center for Healthy Aging , University of Copenhagen , Copenhagen , Denmark
| | - Margit Kriegbaum
- a Unit for Health Services Research, Department of Public Health, Center for Healthy Aging , University of Copenhagen , Copenhagen , Denmark
| | - Maria Kristiansen
- a Unit for Health Services Research, Department of Public Health, Center for Healthy Aging , University of Copenhagen , Copenhagen , Denmark
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