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Access to outreach specialist palliative care teams among cancer patients in Denmark.

https://arctichealth.org/en/permalink/ahliterature114285
Source
J Palliat Med. 2013 Aug;16(8):951-7
Publication Type
Article
Date
Aug-2013
Author
Mette Asbjoern Neergaard
Anders Bonde Jensen
Frede Olesen
Peter Vedsted
Author Affiliation
The Palliative Team, Aarhus University Hospital, Aarhus, Denmark. mettneer@rm.dk
Source
J Palliat Med. 2013 Aug;16(8):951-7
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Community-Institutional Relations
Cross-Sectional Studies
Denmark
Female
Health Services Accessibility - statistics & numerical data
Humans
Male
Middle Aged
Multivariate Analysis
Neoplasms - physiopathology - therapy
Palliative Care - manpower - organization & administration
Patient Care Team - organization & administration - standards
Registries
Sex Distribution
Socioeconomic Factors
Specialization
Terminal Care - manpower - organization & administration
Young Adult
Abstract
Equal access to end-of-life care is important. However, social inequality has been found in relation to place-of-death. The question is whether social and economic factors play a role in access to specialist palliative care services.
The study analyzed the association between access to outreach specialist palliative care teams (SPCTs) and socioeconomic characteristics of Danish cancer patients who died of their cancer.
The study was a population-based, cross-sectional register study. We identified 599 adults who had died of cancer from March 1 to November 30, 2006, in Aarhus County, Denmark. Data from health registers were retrieved and linked based on the unique personal identifier number.
Multivariate analysis with adjustment for age, gender, and general practitioner (GP) involvement showed a higher probability of contact with an SPCT among immigrants and descendants of immigrants than among people of Danish origin (prevalence ratio [PR]: 1.55; 95% confidence interval (CI): 1.04;2.31) and among married compared to unmarried patients (PR: 1.25; 95% CI: 1.01;1.54). The trends were most marked among women.
We found an association between females, married patients, and female immigrants and their descendants and access to an SPCT in Denmark. However, no association with the examined economic factor was found. Need for specialized health care, which is supposed to be the main reason for access to an SPCT, may be related to economic imbalance; and despite the relative equality found, SPCT access may not be equal for all Danish residents. Further research into social and economic consequences in palliative care services is warranted.
PubMed ID
23631614 View in PubMed
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[A new, empirically established hypochondriasis diagnosis--secondary publication].

https://arctichealth.org/en/permalink/ahliterature173279
Source
Ugeskr Laeger. 2005 Aug 8;167(32):2896-9
Publication Type
Article
Date
Aug-8-2005
Author
Per K Fink
Eva Ørnbøl
Tomas Toft
Kaj Sparle Christensen
Lisbeth Frostholm
Frede Olesen
Author Affiliation
Arhus Universitetshospital, Arhus Sygehus, Forskningsklinikken for Funktionelle Lidelser og Psykosomatik, ogAarhus Universitet, Forskningsenheden for Almen Praksis. flip@as.aaa.dk
Source
Ugeskr Laeger. 2005 Aug 8;167(32):2896-9
Date
Aug-8-2005
Language
Danish
Publication Type
Article
Keywords
Adult
Aged
Denmark - epidemiology
Family Practice
Female
Humans
Hypochondriasis - classification - diagnosis - psychology
Interview, Psychological
Male
Mass Screening
Middle Aged
Psychiatric Status Rating Scales
Questionnaires
Somatoform Disorders - classification - diagnosis - epidemiology
Abstract
The narrow ICD-10 and DSM-IV definition of hypochondriasis makes it a rarely used diagnosis. Based on a latent class analysis of the symptoms exhibited by 701 patients (ages 18-65) in general practice, a new and more valid hypochondriasis diagnosis was defined in this study. The main symptom is "obsessive rumination about illnesses", and the patient must also have at least one of five other symptoms. The prevalence was 9.5 for both genders. There was a good agreement between the diagnoses made during the psychiatric interview and the physicians' assessments.
PubMed ID
16109196 View in PubMed
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Associations between successful palliative trajectories, place of death and GP involvement.

https://arctichealth.org/en/permalink/ahliterature99272
Source
Scand J Prim Health Care. 2010 Sep;28(3):138-45
Publication Type
Article
Date
Sep-2010
Author
Mette Asbjoern Neergaard
Peter Vedsted
Frede Olesen
Ineta Sokolowski
Anders Bonde Jensen
Jens Sondergaard
Author Affiliation
The Palliative Team, Department of Oncology, Aarhus University Hospital, Denmark. man@alm.au.dk
Source
Scand J Prim Health Care. 2010 Sep;28(3):138-45
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Death
Cross-Sectional Studies
Denmark
Family Practice
Female
Home Care Services
House Calls
Humans
Male
Middle Aged
Neoplasms - nursing - psychology - therapy
Palliative Care - manpower - methods
Physician's Role
Physicians, Family - psychology
Professional-Family Relations
Questionnaires
Registries
Retrospective Studies
Terminal Care - manpower - methods
Abstract
OBJECTIVE: General practitioner (GP) involvement may be instrumental in obtaining successful palliative cancer trajectories. The aim of the study was to examine associations between bereaved relatives' evaluation of palliative cancer trajectories, place of death, and GP involvement. DESIGN: Population-based, cross-sectional combined register and questionnaire study. SETTING: The former Aarhus County, Denmark. SUBJECTS: Questionnaire data on GPs' palliative efforts and relatives' evaluations of the palliative trajectories were obtained for 153 cases of deceased cancer patients. MAIN OUTCOME MEASURES: A successful palliative trajectory as evaluated retrospectively by the relatives. RESULTS: Successful palliative trajectories were statistically significantly associated with home death (PR 1.48 (95% CI 1.04; 2.12)). No significant associations were identified between the evaluations of the palliative trajectory at home and GP involvement. "Relative living with patient" (PR 1.75 (95% CI: 0.87; 3.53)) and "GP having contact with relatives" (PR 1.69 (95% CI 0.55; 5.19)) were not significantly associated, but this may be due to the poor number of cases included in the final analysis. CONCLUSION: This study indicates that home death is positively associated with a higher likelihood that bereaved relatives will evaluate the palliative trajectory at home as successful. No specific GP services that were statistically significantly associated with higher satisfaction among relatives could be identified, but contact between GPs and relatives seems important and the impact needs further investigation.
PubMed ID
20698730 View in PubMed
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Bereavement care in general practice: a cluster-randomized clinical trial.

https://arctichealth.org/en/permalink/ahliterature120841
Source
Fam Pract. 2013 Apr;30(2):134-41
Publication Type
Article
Date
Apr-2013
Author
Mai-Britt Guldin
Peter Vedsted
Anders Bonde Jensen
Frede Olesen
Robert Zachariae
Author Affiliation
Research Unit for General Practice, University of Aarhus, Aarhus C, Denmark. m.guldin@alm.au.dk
Source
Fam Pract. 2013 Apr;30(2):134-41
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Clinical Competence
Denmark
Depression - diagnosis - etiology - therapy
Education, Medical, Continuing - methods - organization & administration
Female
Follow-Up Studies
General Practice - education - methods
Grief
Hospice Care - methods
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Psychological Tests
Questionnaires
Young Adult
Abstract
The loss of a loved person may lead to complicated grief (CG). General practitioners (GPs) consider bereavement care to be important but find training for this task to be insufficient. We hypothesized that improvement in skills that facilitate early identification of CG and enhance GPs' clinical care may reduce adverse health outcomes. Aim. To test whether implementation of a bereavement management program in general practice could improve the GPs' ability to identify CG and provide clinical care.
A cluster-randomized controlled trial allocating GPs and their listed patients suffering from bereavement to either a intervention or a control group.
Close relatives of patients who had died from cancer in Denmark were recruited (N = 402).
The primary outcomes were defined as the bereaved relatives' score on the Beck's Depression Inventory II and the Inventory of Complicated Grief-Revised (ICG-R), the GP's clinical assessment of the relative's grief reaction and the relative's number of contacts with general practice.
Larger improvements in ICG-R scores were found in the intervention group than in the control group. In the intervention group, patients exhibiting CG symptoms were more likely to receive supportive care and to be referred to mental health practitioners, whereas GP's in the control group more often prescribed psychotropic drugs for patients with symptoms of CG. The GP's ability to identify CG at 13 months did not seem to be better in the intervention group than in the control group.
While only statistically near significant, we found some indications of an effect of the intervention compared with usual care. Our results underscore the need for improving GPs' clinical skills in identifying patients with CG.
PubMed ID
22964078 View in PubMed
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A brief case-finding questionnaire for common mental disorders: the CMDQ.

https://arctichealth.org/en/permalink/ahliterature9248
Source
Fam Pract. 2005 Aug;22(4):448-57
Publication Type
Article
Date
Aug-2005
Author
Kaj Sparle Christensen
Per Fink
Tomas Toft
Lisbeth Frostholm
Eva Ornbøl
Frede Olesen
Author Affiliation
The Research Unit for General Practice, University of Aarhus, Denmark. kasc@alm.au.dk
Source
Fam Pract. 2005 Aug;22(4):448-57
Date
Aug-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Cross-Sectional Studies
Denmark
Family Practice
Female
Humans
Male
Mental Disorders - classification - diagnosis
Middle Aged
Questionnaires
Research Support, Non-U.S. Gov't
Abstract
OBJECTIVES: The aim of the study was to validate a new case-finding instrument for common mental disorders (CMDQ). METHODS: A cross-sectional, stratified, two-phase study was carried out in 28 general practices in Aarhus County, Denmark. 1785 consecutive patients, 18-65 years old, consulting 38 GPs with a new health problem participated. Patients were screened before consultation using a one-page screening questionnaire including subscales for somatisation (SCL-SOM and Whiteley-7), anxiety (SCL-ANX4), depression (SCL-DEP6) and alcohol abuse (CAGE). A stratified subsample of 701 patients was interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview. We tested the external validity of the scales using the SCAN interview as gold standard. All data were analysed using appropriate weighted procedures to control for the two-phase sampling design and non-response bias. RESULTS: Estimates of sensitivity and specificity for relevant ICD-10 diagnoses at theoretical optimal cut-off points on subscales: Depressive disorder: 78/86 (SCL-DEP6); Alcohol abuse or dependence: 78/97 (CAGE); Severe anxiety disorder: 77/85 (SCL-ANX4); Somatisation disorder: 83/56 (SCL-SOM); and 75/52 (Whiteley-7); any mental disorder: 72/72 (SCL-8). At the theoretical optimal cut-off points the CMDQ demonstrated higher diagnostic accuracy than GPs on any diagnosis evaluated. CONCLUSION: The study results suggest that the CMDQ has excellent external validity for use as a diagnostic aid in primary care settings.
PubMed ID
15814580 View in PubMed
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Cancer survivors' rehabilitation needs in a primary health care context.

https://arctichealth.org/en/permalink/ahliterature152224
Source
Fam Pract. 2009 Jun;26(3):221-30
Publication Type
Article
Date
Jun-2009
Author
Thorbjørn Mikkelsen
Jens Sondergaard
Ineta Sokolowski
Anders Jensen
Frede Olesen
Author Affiliation
The Research Unit for General Practice, University of Aarhus, Vennelyst Boulevard 6, Aarhus C 8000, Denmark. thm@alm.au.dk
Source
Fam Pract. 2009 Jun;26(3):221-30
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cohort Studies
Continuity of Patient Care
Denmark
Family Practice
Female
Health Care Surveys
Health services needs and demand
Humans
Male
Middle Aged
Neoplasms - rehabilitation
Quality of Life
Survivors - psychology
Abstract
Studies of cancer survivors' rehabilitation needs have mostly addressed specific areas of needs, e.g. physical aspects and/or rehabilitation needs in relation to specific cancer types.
To assess cancer survivors' perceived need for physical and psychosocial rehabilitation, whether these needs have been presented to and discussed with their GP.
A survey among a cohort of cancer survivors approximately 15 months after diagnosis. The questionnaire consisted of an ad hoc questionnaire on rehabilitation needs and the two validated questionnaires, the SF-12 and the Research and Treatment of Cancer quality of life questionnaire, the QLQ C-30 version 3.
Among 534 eligible patients, we received 353 (66.1%) answers. Two-thirds of the cancer survivors had discussed physical rehabilitation needs with their GPs. Many (51%) feared cancer relapse, but they rarely presented this fear to the GP or the hospital staff. The same applied to social problems and problems within the family. Good physical and mental condition and low confidence in the GP were associated with no contact to the GP after hospital discharge.
Cancer survivors have many psychosocial rehabilitation needs and intervention should effectively target these needs. If this task is assigned to the GPs, they need to be proactive when assessing psychosocial aspects.
PubMed ID
19264838 View in PubMed
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Cancer suspicion in general practice, urgent referral and time to diagnosis: a population-based GP survey and registry study.

https://arctichealth.org/en/permalink/ahliterature263418
Source
BMC Cancer. 2014;14:636
Publication Type
Article
Date
2014
Author
Henry Jensen
Marie Louise Tørring
Frede Olesen
Jens Overgaard
Peter Vedsted
Source
BMC Cancer. 2014;14:636
Date
2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cross-Sectional Studies
Denmark - epidemiology
Early Detection of Cancer - standards - statistics & numerical data
Female
General practice
General practitioners
Humans
Male
Middle Aged
Neoplasms - diagnosis - epidemiology
Physician's Practice Patterns - standards - statistics & numerical data
Quality of Health Care - standards
Questionnaires
Referral and Consultation - standards - statistics & numerical data
Registries - statistics & numerical data
Young Adult
Abstract
Many countries have implemented standardised cancer patient pathways (CPPs) to ensure fast diagnosis of patients suspected of having cancer. Yet, studies are sparse on the impact of such CPPs, and few have distinguished between referral routes. For incident cancer patients, we aimed to determine how often GPs suspected cancer at the time of first presentation of symptoms in general practice and to describe the routes of referral for further investigation. In addition, we aimed to analyse if the GP's suspicion of cancer could predict the choice of referral to a CPP. Finally, we aimed to analyse associations between not only cancer suspicion and time to cancer diagnosis, but also between choice of referral route and time to cancer diagnosis.
We conducted a population-based, cross-sectional study of incident cancer patients in Denmark who had attended general practice prior to their diagnosis of cancer. Data were collected from GP questionnaires and national registers. We estimated the patients' chance of being referred to a CPP (prevalence ratio (PR)) using Poisson regression. Associations between the GP's symptom interpretation, use of CPP and time to diagnosis were estimated using quantile regression.
5,581 questionnaires were returned (response rate: 73.8%). A GP was involved in diagnosing the cancer in 4,101 (73.5%) cases (3,823 cases analysed). In 48.2% of these cases, the GP interpreted the patient's symptoms as 'alarm' symptoms suggestive of cancer. The GP used CPPs in 1,426 (37.3%) cases. Patients, who had symptoms interpreted as 'vague' had a lower chance of being referred to a CPP than when interpreted as 'alarm' symptoms (PR = 0.53 (95%CI: 0.48;0.60)). Patients with 'vague' symptoms had a 34 (95% CI: 28;41) days longer median time to diagnosis than patients with 'alarm' symptoms.
GPs suspect cancer more often than they initiate a CPP, and patients were less likely to be referred to a CPP when their symptoms were not interpreted as alarm symptoms of cancer. The GP's choice of referral route was a strong predictor of the duration of the diagnostic interval, but the GP's symptom interpretation was approximately twice as strong an indicator of a longer diagnostic interval.
Notes
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PubMed ID
25175155 View in PubMed
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[Care coordination for patients suffering from a chronic disease or cancer]

https://arctichealth.org/en/permalink/ahliterature97789
Source
Ugeskr Laeger. 2010 Mar 8;172(10):801-4
Publication Type
Article
Date
Mar-8-2010
Author
Christian Wulff
Jens Søndergaard
Frede Olesen
Peter Vedsted
Author Affiliation
Forskningsenheden for Almen Praksis, Institut for Folkesundhed, Aarhus Universitet, DK-8000 Aarhus C, Denmark. christian.wulff@alm.au.dk
Source
Ugeskr Laeger. 2010 Mar 8;172(10):801-4
Date
Mar-8-2010
Language
Danish
Publication Type
Article
Keywords
Case Management - organization & administration
Chronic Disease - therapy
Continuity of Patient Care - organization & administration
Denmark
Disease Management
Humans
Neoplasms - diagnosis - therapy
Outcome Assessment (Health Care)
Patient Care Planning - organization & administration
Abstract
Care coordination is a superordinate term for terms related to the optimization of care for people suffering from chronic diseases and cancer. In this article, we present Danish terms for "disease management programme" and "case management" among others, and effects are summarized. The central Danish terms explored are "forløbskoordinering", "forløbsprogram", "forløbskoordinator", and "tovholder".
PubMed ID
20211089 View in PubMed
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Case-finding and risk-group screening for depression in primary care.

https://arctichealth.org/en/permalink/ahliterature101715
Source
Scand J Prim Health Care. 2011 Jun;29(2):80-4
Publication Type
Article
Date
Jun-2011
Author
Kaj Sparle Christensen
Ineta Sokolowski
Frede Olesen
Author Affiliation
Research Unit for General Practice, Aarhus University, Denmark. kasc@mail.dk
Source
Scand J Prim Health Care. 2011 Jun;29(2):80-4
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cross-Sectional Studies
Denmark - epidemiology
Depression - diagnosis - epidemiology
Depressive Disorder - diagnosis - epidemiology
Female
General practice
Humans
Male
Mass Screening
Middle Aged
Outcome Assessment (Health Care)
Prevalence
Primary Health Care
Psychiatric Status Rating Scales
Risk factors
Young Adult
Abstract
OBJECTIVE. Central health organizations suggest routine screening for depression in high-risk categories of primary care patients. This study compares the effectiveness of high-risk screening versus case-finding in identifying depression in primary care. DESIGN. Using an observational design, participating GPs included patients from 13 predefined risk groups and/or suspected of being depressed. Patients were assessed by the Major Depression Inventory (MDI) and ICD-10 criteria. Setting. Thirty-seven primary care practices in Mainland Denmark. Main outcome measures. Prevalence of depression, diagnostic agreement, effectiveness of screening methods, risk groups requiring special attention. RESULTS. A total of 37 (8.4%) of 440 invited GP practices participated. We found high-risk prevalence of depression in 672 patients for the following traits: (1) previous history of depression, (2) familial predisposition to depression, (3) chronic pain, (4) other mental disorders, and (5) refugee or immigrant. In the total sample, GPs demonstrated a depression diagnostic sensitivity of 87% and a specificity of 67% using a case-finding strategy. GP diagnoses of depression agreed well with the MDI (AUC values of 0.91-0.99). The potential added value of high-risk screening was 4.6% (31/672). Patients with other mental disorders were at increased risk of having an unrecognized depression (PR 3.15, 95% CI 1.91-5.20). If patients with other mental disorders were routinely tested, then 42% more depressed patients (14/31) would be recognized. CONCLUSIONS. A broad case-finding approach including a short validation test can help GPs identify depressed patients, particularly by including patients with other mental disorders in this strategy. This exploratory study cannot support the screening strategy proposed by central health organizations.
PubMed ID
21542671 View in PubMed
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Chlamydia trachomatis infection in young adults - association with concurrent partnerships and short gap length between partners.

https://arctichealth.org/en/permalink/ahliterature274288
Source
Infect Dis (Lond). 2015;47(12):838-45
Publication Type
Article
Date
2015
Author
Marianne Johansson Jørgensen
Helle Terkildsen Maindal
Mette Bach Larsen
Kaj Sparle Christensen
Frede Olesen
Berit Andersen
Source
Infect Dis (Lond). 2015;47(12):838-45
Date
2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Chlamydia Infections - epidemiology - microbiology - prevention & control - transmission
Chlamydia trachomatis
Cross-Sectional Studies
Denmark - epidemiology
Female
Humans
Male
Prevalence
Risk factors
Risk-Taking
Sexual Behavior
Sexual Partners
Surveys and Questionnaires
Time Factors
Young Adult
Abstract
Sexually transmitted infections (STIs) continue to be highly prevalent in young people. New understanding of sexual risk behaviour is essential for future preventive initiatives. Studies based on self-reported STI history indicate that gap length between sexual partnerships is an important determinant in STI transmission, but little is known about the impact of concurrent partnerships and short gap length. This study aimed to examine the significance of concurrent partnerships and short gap length between serially monogamous partnerships in Chlamydia trachomatis-infected individuals compared to the general population.
A Danish cross-sectional study was conducted among individuals aged 15-29 years with a verified C. trachomatis infection and a sample of the background population. Participants answered a web-based questionnaire on sexual behaviour. Associations were identified in multivariate analyses.
In total, 36% of the included young adults reported that they had two or more partners within the last year. Concurrent partnerships were frequent (46%), and the gap length between serially monogamous partnerships tended to be short (median gap length, 64 days, interquartile interval (IQI) = 31, 122). A strong association was found between concurrent partnerships (odds ratio (OR) = 12.5, 95% confidence interval (CI) = 7.7-20.4), short gap length between serially monogamous partnerships (OR = 10.0, 95% CI = 5.7-17.4) and having a verified C. trachomatis infection.
C. trachomatis infection was strongly associated with concurrent partnerships or short gap length between serially monogamous partnerships. These findings have considerable implications for public health policy. Both types of risk factors should be considered in future preventive interventions aiming to reduce the spread of C. trachomatis infections.
Notes
Comment In: Infect Dis (Lond). 2015;47(12):835-726260728
PubMed ID
26211606 View in PubMed
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77 records – page 1 of 8.