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An evaluation of a model for the systematic documentation of hospital based health promotion activities: results from a multicentre study.

https://arctichealth.org/en/permalink/ahliterature161244
Source
BMC Health Serv Res. 2007;7:145
Publication Type
Article
Date
2007
Author
Hanne Tønnesen
Mette E Christensen
Oliver Groene
Ann O'Riordan
Fabrizio Simonelli
Lagle Suurorg
Denise Morris
Peder Vibe
Susan Himel
Poul Erik Hansen
Author Affiliation
Clinical Unit of Health Promotion/WHO Collaborating Centre for Evidence Based Health Promotion in Hospitals, Bispebjerg Hospital, DK 2400 Copenhagen, Denmark. Hanne.Tonnesen@bbh.regionH.dk
Source
BMC Health Serv Res. 2007;7:145
Date
2007
Language
English
Publication Type
Article
Keywords
Aftercare - classification - organization & administration - utilization
Counseling - classification - organization & administration - utilization
Critical Pathways
Current Procedural Terminology
Denmark
Diagnosis-Related Groups - classification
Documentation - statistics & numerical data
Europe
Health Promotion - methods - organization & administration - utilization
Hospital Departments - organization & administration - statistics & numerical data
Hospital Information Systems
Humans
Medical Records - classification
Models, organizational
Registries
Rehabilitation - classification - organization & administration - statistics & numerical data
United States
Abstract
The first step of handling health promotion (HP) in Diagnosis Related Groups (DRGs) is a systematic documentation and registration of the activities in the medical records. So far the possibility and tradition for systematic registration of clinical HP activities in the medical records and in patient administrative systems have been sparse. Therefore, the activities are mostly invisible in the registers of hospital services as well as in budgets and balances.A simple model has been described to structure the registration of the HP procedures performed by the clinical staff. The model consists of two parts; first part includes motivational counselling (7 codes) and the second part comprehends intervention, rehabilitation and after treatment (8 codes).The objective was to evaluate in an international study the usefulness, applicability and sufficiency of a simple model for the systematic registration of clinical HP procedures in day life.
The multi centre project was carried out in 19 departments/hospitals in 6 countries in a clinical setup. The study consisted of three parts in accordance with the objectives.A: Individual test. 20 consecutive medical records from each participating department/hospital were coded by the (coding) specialists at local department/hospital, exclusively (n = 5,529 of 5,700 possible tests in total).B: Common test. 14 standardized medical records were coded by all the specialists from 17 departments/hospitals, who returned 3,046 of 3,570 tests.C: Specialist evaluation. The specialists from the 19 departments/hospitals evaluated if the codes were useful, applicable and sufficient for the registration in their own department/hospital (239 of 285).
A: In 97 to 100% of the local patient pathways the specialists were able to evaluate if there was documentation of HP activities in the medical record to be coded.B: Inter rater reliability on the use of the codes were 93% (57 to 100%) and 71% (31 to 100%), respectively.C: The majority of the study participants found the codes to be useful (71%), applicable (92%) and sufficient (92%).
Systematic registration of HP activities is relevant in clinical day life and the suggested codes proved to be applicable for international use. HP is an essential part of the clinical pathway or the value chain. This model promises to improve the documentation and thereby facilitate analysis of records for evidence based medicine as well as cost and policy analyses.
Notes
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PubMed ID
17877788 View in PubMed
Less detail

Brief preoperative smoking cessation counselling in relation to breast cancer surgery: a qualitative study.

https://arctichealth.org/en/permalink/ahliterature98989
Source
Eur J Oncol Nurs. 2009 Dec;13(5):344-9
Publication Type
Article
Date
Dec-2009
Author
Thordis Thomsen
Bente Appel Esbensen
Susanne Samuelsen
Hanne Tønnesen
Ann M Møller
Author Affiliation
Research and Development Unit, Department of Anaesthesiology, Herlev University Hospital, Herlev Ringvej 75, Herlev, Denmark. thotho02@heh.regionh.dk
Source
Eur J Oncol Nurs. 2009 Dec;13(5):344-9
Date
Dec-2009
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Aged
Attitude to Health
Breast Neoplasms - psychology - surgery
Denmark
Female
Humans
Middle Aged
Psychotherapy, Brief
Qualitative Research
Risk Reduction Behavior
Smoking Cessation - psychology
Abstract
AIM: To describe how women smokers with newly diagnosed breast cancer experienced brief preoperative smoking cessation intervention in relation to breast cancer surgery. BACKGROUND: Preoperative smoking cessation intervention is relevant for short- and long-term risk reduction in newly diagnosed cancer patients. Our knowledge of how patients with malignant diagnoses experience preoperative smoking intervention is however scarce. METHODS: A qualitative descriptive study that collected data through one-time individual, semi-structured interviews with 11 Danish women. Ricoeur's theory of interpretation was used for the analysis. RESULTS: The women experienced that brief preoperative smoking intervention triggered reflection upon smoking and health. They furthermore experienced the smoking intervention as an opportune aid to escaping the social stigma of being a smoker. Quitting in the context of cancer diagnosis was difficult for some women. They relapsed to smoking as an ingrown response to emotional distress. The smoking intervention heightened the women's awareness of their addiction to smoking; however, they expressed a need for prolonged smoking cessation support. For others, the smoking intervention was supportive of cessation, and these women experienced smoking cessation as an enactment of a duty of responsibility to themselves and those nearest to them. They furthermore experienced a sense of personal achievement, improved well-being and endorsement from family and friends. CONCLUSION: In newly diagnosed breast cancer patients, brief preoperative smoking intervention motivated smoking cessation. However, prolonged intervention, pre- and postoperatively, may more effectively support cessation in breast cancer patients and should therefore be evaluated in this patient population.
PubMed ID
19535292 View in PubMed
Less detail

Brief smoking cessation intervention in relation to breast cancer surgery: a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature140646
Source
Nicotine Tob Res. 2010 Nov;12(11):1118-24
Publication Type
Article
Date
Nov-2010
Author
Thordis Thomsen
Hanne Tønnesen
Mette Okholm
Niels Kroman
Annerikke Maibom
Marie-Louise Sauerberg
Ann M Møller
Author Affiliation
Department of Anaesthesiology, Herlev University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark. thotho02@heh.regionh.dk
Source
Nicotine Tob Res. 2010 Nov;12(11):1118-24
Date
Nov-2010
Language
English
Publication Type
Article
Keywords
Adult
Breast Neoplasms - surgery
Denmark
Female
Humans
Intervention Studies
Middle Aged
Patient Compliance - statistics & numerical data
Patient Education as Topic - methods
Postoperative Complications - prevention & control
Preoperative Care - methods
Professional-Patient Relations
Smoking Cessation - methods - psychology
Treatment Outcome
Women's health
Abstract
Smokers are more prone to develop postoperative complications. Smoking cessation intervention beginning 4-8 weeks prior to surgery improves the postoperative outcome. Cancer patients, however, often undergo surgery less than 4 weeks after diagnosis. The primary objective of this study was therefore to examine if a brief smoking cessation intervention shortly before breast cancer surgery would influence postoperative complications and smoking cessation.
A randomized controlled multicentre trial with blinded outcome assessment conducted at 3 hospitals in Denmark. One hundred and thirty patients were randomly assigned to brief smoking intervention (n = 65) or standard care (n = 65). The intervention followed the principles of motivational interviewing and included personalized nicotine replacement therapy aimed at supporting smoking cessation from 2 days before to 10 days after surgery.
The overall postoperative complication rate (including seroma requiring aspiration) was 61% in both groups risk ratio (RR) 1.00 (95% CI 0.75-1.33). The wound complication rate was 44% versus 45%. The effect on perioperative smoking cessation was modest, 28% intervention versus 11% control group patients, RR 2.49 (95% CI 1.10-5.60). There was no effect on smoking cessation at 12 months, 13% versus 9%.
Brief smoking intervention administered shortly before breast cancer surgery modestly increased self-reported perioperative smoking cessation without having any clinical impact on postoperative complications. The study adds to the body of evidence indicating that brief intervention has no clinical importance for surgical patients in regard to postoperative morbidity. Future studies should be designed to determine the optimal time of smoking cessation before surgery.
PubMed ID
20855414 View in PubMed
Less detail

Cancer incidence among patients with alcohol use disorders--long-term follow-up.

https://arctichealth.org/en/permalink/ahliterature150599
Source
Alcohol Alcohol. 2009 Jul-Aug;44(4):387-91
Publication Type
Article
Author
Lau Caspar Thygesen
Pernille Mikkelsen
Tina Veje Andersen
Hanne Tønnesen
Knud Juel
Ulrik Becker
Morten Grønbaek
Author Affiliation
National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5, DK-1399 Copenhagen. lct@niph.dk
Source
Alcohol Alcohol. 2009 Jul-Aug;44(4):387-91
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alcoholism - epidemiology
Cohort Studies
Denmark - epidemiology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neoplasms - epidemiology
Registries
Abstract
The aim of this study was to compare the cancer morbidity in a large cohort of patients with alcohol use disorders in the general Danish population.
We included 15,258 men and 3552 women free of cancer when attending the Copenhagen Outpatient Clinic for Alcoholics in the period from 1954 to 1992. The cancer incidence until 1999 of the patients and the general Danish population was obtained through linkage with the Danish Cancer Registry. The incidence rates were standardized (SIR) according to sex, age and calendar time.
A total of 2145 men developed cancer compared to 1140.8 expected cases (SIR = 1.9; 95% confidence interval (CI) 1.8-2.0), while 601 women developed cancer compared to 239.1 expected cases (SIR = 2.5; 95% CI 2.3-2.7). Highly significant and strongly elevated incidence rates were found for cancer of the tongue, mouth, pharynx, oesophagus, liver, larynx and lung. A higher incidence rate was seen for renal cancer for both men (1.4; 1.1-1.8) and women (2.1; 1.0-3.8). The incidence of breast cancer in women was non-significantly elevated, but significantly elevated incidence rate was found for cervical cancer (1.8; 1.2-2.6). We did not observe increased incidence of colon, rectal or urinary bladder cancer.
In conclusion, this study confirms the well-established association between high alcohol intake and cancer of the upper digestive tract and liver. In addition, the results indicate a significantly elevated occurrence of renal cancer, but not of breast cancer and colorectal cancer, in patients with alcohol use disorders.
PubMed ID
19491282 View in PubMed
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Case management in aftercare of involuntarily committed patients with substance abuse. A randomized trial.

https://arctichealth.org/en/permalink/ahliterature122051
Source
Nord J Psychiatry. 2013 Jun;67(3):197-203
Publication Type
Article
Date
Jun-2013
Author
Marianne Larsson Lindahl
Mats Berglund
Hanne Tönnesen
Author Affiliation
Department of Health Sciences, Lund University, Lund, Sweden. marianne.larsson_lindahl@med.lu.se
Source
Nord J Psychiatry. 2013 Jun;67(3):197-203
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Adult
Aftercare - methods
Case Management
Female
Humans
Male
Middle Aged
Patient Discharge
Substance-Related Disorders - psychology - therapy
Sweden
Treatment Outcome
Young Adult
Abstract
Case management has since the 1970s been widely used to co-ordinate services for mental health patients. The methodology has expanded to support patients in many different types of conditions. This study is one of very few randomized trials on case management in a European setting. It examined the impact of case management on substance abuse and use of service after discharge from court-ordered institutional care.
Court-ordered patients with substance abuse ( n = 36) were randomly assigned to either strengths based case management or treatment-as-usual during 6 months in aftercare. Data was collected at intake, at conclusion of intervention and at 6 month's follow-up with a follow-up rate of 94%.
Case management interventions were well received by the patients with no drop-out during intervention. Patients with the support of a case manager seemed to sustain abstinence in a higher degree compared with treatment-as-usual but no differences were detected in regard to use of care. A subgroup analysis showed that patients with a continuous drug abuse did have access to care from both social welfare and hospital care systems.
Case management may be useful in order to retain abstinence in aftercare following court-ordered treatment. The social welfare and hospital care systems seem to provide care irrespective of case manager intervention. The study design, interventions and assessments instruments were well received by patients but needs to be replicated with a larger population.
The 100% retention in the case management support group indicates that patients were satisfied with this type of intervention and the methodology seems to be useful in order to retain abstinence.
PubMed ID
22853707 View in PubMed
Less detail

Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial.

https://arctichealth.org/en/permalink/ahliterature67397
Source
Lancet. 2002 Jan 12;359(9301):114-7
Publication Type
Article
Date
Jan-12-2002
Author
Ann M Møller
Nete Villebro
Tom Pedersen
Hanne Tønnesen
Author Affiliation
Department of Anaesthesiology, Bispebjerg University Hospital, 2400 NV, Copenhagen, Denmark. docamm@yahoo.com
Source
Lancet. 2002 Jan 12;359(9301):114-7
Date
Jan-12-2002
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - adverse effects
Arthroplasty, Replacement, Knee - adverse effects
Counseling - methods - standards
Denmark - epidemiology
Female
Ganglionic Stimulants - therapeutic use
Humans
Length of Stay - statistics & numerical data
Male
Middle Aged
Morbidity
Nicotine - therapeutic use
Patient Education - methods - standards
Postoperative Complications - epidemiology - etiology - prevention & control
Preoperative Care - methods - standards
Research Support, Non-U.S. Gov't
Risk factors
Smoking - adverse effects - prevention & control
Smoking Cessation - methods
Time Factors
Treatment Outcome
Abstract
BACKGROUND: Smokers are at higher risk of cardiopulmonary and wound-related postoperative complications than non-smokers. Our aim was to investigate the effect of preoperative smoking intervention on the frequency of postoperative complications in patients undergoing hip and knee replacement. METHODS: We did a randomised trial in three hospitals in Denmark. 120 patients were randomly assigned 6-8 weeks before scheduled surgery to either the control (n=60) or smoking intervention (60) group. Smoking intervention was counselling and nicotine replacement therapy, and either smoking cessation or at least 50% smoking reduction. An assessor, who was masked to the intervention, registered the occurrence of cardiopulmonary, renal, neurological, or surgical complications and duration of hospital admittance. The main analysis was by intention to treat. FINDINGS: Eight controls and four patients from the intervention group were excluded from the final analysis because their operations were either postponed or cancelled. Thus, 52 and 56 patients, respectively, were analysed for outcome. The overall complication rate was 18% in the smoking intervention group and 52% in controls (p=0.0003). The most significant effects of intervention were seen for wound-related complications (5% vs 31%, p=0.001), cardiovascular complications (0% vs 10%, p=0.08), and secondary surgery (4% vs 15%, p=0.07). The median length of stay was 11 days (range 7-55) in the intervention group and 13 days (8-65) in the control group. INTERPRETATION: An effective smoking intervention programme 6-8 weeks before surgery reduces postoperative morbidity, and we recommend, on the basis of our results, this programme be adopted.
Notes
Comment In: ACP J Club. 2002 Jul-Aug;137(1):712093206
Comment In: CMAJ. 2002 Jun 11;166(12):156912074128
Comment In: Evid Based Nurs. 2002 Jul;5(3):8412123268
Comment In: Med J Aust. 2004 Feb 2;180(3):126-714748676
PubMed ID
11809253 View in PubMed
Less detail

Gold standard program for heavy smokers in a real-life setting.

https://arctichealth.org/en/permalink/ahliterature107349
Source
Int J Environ Res Public Health. 2013 Sep;10(9):4186-99
Publication Type
Article
Date
Sep-2013
Author
Tim Neumann
Mette Rasmussen
Berit L Heitmann
Hanne Tønnesen
Author Affiliation
Clinical Health Promotion Centre, Department of Health Sciences, Lund University, Skåne University Hospital, Entrance. 108, Malmö SE 205 02, Sweden. tim.neumann@charite.de
Source
Int J Environ Res Public Health. 2013 Sep;10(9):4186-99
Date
Sep-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Denmark - epidemiology
Female
Humans
Male
Middle Aged
Patient Compliance - statistics & numerical data
Program Evaluation
Smoking - epidemiology - therapy
Smoking Cessation - methods - statistics & numerical data
Young Adult
Abstract
High-intensity smoking cessation programs generally lead to more continuous abstinence, however, lower rates of success have been reported among heavy smokers. The aim was to evaluate continuous abstinence among heavy smokers during the intensive 6-week Gold Standard Program (GSP) and to identify modifiable factors associated with continuous abstinence.
In this nationwide clinical study based on 36,550 smokers attending an intensive cessation program in Denmark. Heavy smoking was defined as =7 points in the Fagerström Nicotine Dependency Test, smoking =20 cigarettes daily or =20 pack-years.
Overall, 28% had a Fagerström score =7 points, 58% smoked =20 cigarettes daily and 68% smoked =20 pack-years. Continuous abstinence was 33% in responders (6-months response rate: 78%); however, abstinence was approximately 1-6% lower in the heavy smokers than the overall population. Attending GSP with an individual format (vs. group/other, OR 1.23-1.44); in a hospital setting (vs. pharmacy/municipality services, OR 1.05-1.11); and being compliant (attending the planned meetings OR 4.36-4.89) were associated with abstinence. Abstinence decreased in a dose-dependent manner with increasing smoking severity.
Abstinence after GSP was 1-6% lower in the heavy smokers than in the overall study population. Modifiable factors may be used for small improvements in continued abstinence. However attempts to improve compliance seemed especially promising.
Notes
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PubMed ID
24022655 View in PubMed
Less detail

The Gold Standard Program for smoking cessation is effective for participants over 60 years of age.

https://arctichealth.org/en/permalink/ahliterature272778
Source
Int J Environ Res Public Health. 2015 Mar;12(3):2574-87
Publication Type
Article
Date
Mar-2015
Author
Mette Kehlet
Torben V Schroeder
Hanne Tønnesen
Source
Int J Environ Res Public Health. 2015 Mar;12(3):2574-87
Date
Mar-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Cohort Studies
Denmark
Female
Humans
Male
Middle Aged
Patient compliance
Retrospective Studies
Smoking - prevention & control
Smoking Cessation - methods - statistics & numerical data
Young Adult
Abstract
Tobacco smoking is more prevalent among the elderly than among the young, and the elderly also have the most frequent contact with the health care system. The aim of this study was to evaluate the effectiveness of the Gold Standard Program, which is an intensive six-week smoking cessation program, on continuous self-reported abstinence rates after six months, on participants over the age of 60 years in a real life setting.
This was a retrospective cohort study from the national Danish smoking cessation database.
The database registered 7369 participants over the age of 60 years (range 60-82) and 24,294 below 60 years (range 15-59). Continuous abstinence rate after six months was 37% for the elderly compared to 35% for the younger (p
Notes
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PubMed ID
25734789 View in PubMed
Less detail

The Gold Standard Programme: smoking cessation interventions for disadvantaged smokers are effective in a real-life setting.

https://arctichealth.org/en/permalink/ahliterature123377
Source
Tob Control. 2013 Nov;22(6):e9
Publication Type
Article
Date
Nov-2013
Author
Tim Neumann
Mette Rasmussen
Nermin Ghith
Berit L Heitmann
Hanne Tønnesen
Author Affiliation
WHO CC, Clinical Health Promotion Centre, Bispebjerg University Hospital, Copenhagen, Denmark.
Source
Tob Control. 2013 Nov;22(6):e9
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Denmark
Educational Status
Female
Health Behavior
Humans
Male
Middle Aged
Program Evaluation
Prospective Studies
Smoking
Smoking Cessation - methods
Tobacco Use Disorder - therapy
Treatment Outcome
Unemployment
Vulnerable Populations
Young Adult
Abstract
To evaluate the real-life effect of an evidence-based Gold Standard Programme (GSP) for smoking cessation interventions in disadvantaged patients and to identify modifiable factors that consistently produce the highest abstinence rates.
Observational prospective cohort study.
GSPs in pharmacies, hospitals and communities in Denmark, reporting to the national Smoking Cessation Database.
Disadvantaged patients, defined as patients with a lower level of education and those receiving unemployment benefits.
6-week manualised GSP smoking cessation interventions performed by certified staff.
6 months of continuous abstinence, response rate: 80%.
Continuous abstinence of the 16?377 responders was 34% (of all 20?588 smokers: 27%). Continuous abstinence was lower in 5738 smokers with a lower educational level (30% of responders and 23% of all) and in 840 unemployed (27% of responders and 19% of all). In respect to modifiable factors, continuous abstinence was found more often after programmes in one-on-one formats (vs group formats) among patients with a lower educational level, 34% (vs 25%, p=0.037), or among unemployed, 35% (vs 24%, p=0.099). The variable 'format' stayed in the final model of multivariable analyses in patients with a lower educational level, OR=1.31 (95% CI 1.05 to 1.63).
Although continuous abstinence was lower among disadvantaged smokers, the absolute difference was small. If the programme had been as effective in disadvantaged as in non-disadvantaged groups, there would have been an extra 46 or 8 quitters annually, respectively. Promoting individual interventions among those with a low education may increase the effectiveness of GSP.
Notes
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PubMed ID
22705716 View in PubMed
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Health and the need for health promotion in hospital patients.

https://arctichealth.org/en/permalink/ahliterature140091
Source
Eur J Public Health. 2011 Dec;21(6):744-9
Publication Type
Article
Date
Dec-2011
Author
Kristian Oppedal
Sverre Nesvåg
Bolette Pedersen
Svein Skjøtskift
Anne Kari Hersvik Aarstad
Solveig Ullaland
Karen Louise Pedersen
Kari Vevatne
Hanne Tønnesen
Author Affiliation
Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway. kiop@sus.no
Source
Eur J Public Health. 2011 Dec;21(6):744-9
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Health promotion
Humans
Inpatients
Logistic Models
Male
Middle Aged
Needs Assessment
Norway
Nutrition Assessment
Questionnaires
Risk Reduction Behavior
Abstract
Integrated health promotion improves clinical outcomes after hospital treatment. The first step towards implementing evidence-based health promotion in hospitals is to estimate the need for health promoting activities directed at hospital patients. The aim of this study was to identify the distribution and association of individual health risk factors in a Norwegian hospital population and to estimate the need for health promotion in this population.
We used a validated documentation model (HPH-DATA Model) to identify the prevalence of patients with nutritional risk (measurements of waist and weight), self-reported physical inactivity, daily smoking and hazardous drinking. We used logistic regression to describe the associations between health risk factors and demographic characteristics.
Out of 10 included patients, 9 (N = 1522) had one or more health risk factors. In total 68% (N = 1026) were overweight, 44% (N = 660) at risk of under-nutrition, 38% (N = 574) physically inactive, 19% (N = 293) were daily smokers and 4% (N = 54) hazardous drinkers. We identified a new clinical relevant association between under-nutrition and smoking. The association between hazardous drinking and smoking was sustained.
Nearly all patients included in this study had one or more health risk factors that could aggravate clinical outcomes. There is a significant need, and potential, for health-promoting interventions. Multi-factorial interventions may be frequently indicated and should be the subject of interventional studies.
PubMed ID
20943993 View in PubMed
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