Steno Health Promotion Center


Steno Health Promotion Center

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Rogvi S.,Steno Health Promotion Center | Almdal T.P.,Steno Diabetes Center | Schiotz M.L.,Steno Health Promotion Center | Willaing I.,Steno Health Promotion Center
Diabetic Medicine | Year: 2012

Aims To investigate the association between glycaemic control and patient socio-demographics, activation level, diabetes-related distress, assessment of care, knowledge of target HbA1c, and self-management behaviours, and to determine to what extent these factors explain the variance in HbA1c in a large Danish population of patients with Type 2 diabetes. Methods Cross-sectional survey and record review of 2045 patients from a specialist diabetes clinic. Validated scales measured patient activation, self-management behaviours, diabetes-related emotional distress, and perceived care. The electronic patient record provided information about HbA1c, medication, body mass index, and duration of diabetes. Data were analysed using multiple linear regression models with stepwise addition of covariates. Results The response rate was 54% (n=1081). Good glycaemic control was significantly associated with older age, higher education, higher patient activation, lower diabetes-related emotional distress, better diet and exercise behaviours, lower body mass index, shorter duration of disease and knowledge of HbA1c targets (P<0.05 for all). Patient socio-demographics, behaviour; perceptions of care and diabetes distress accounted for 14% of the total variance in HbA1c levels (P=0.0134), but the variance explained was higher for respondents treated with medications other than insulin. Conclusions Our study emphasizes the complex relationships between patient activation, distress and behaviour, specific treatment modalities and glycaemic control. Knowledge of treatment goals, achieving patient activation in coping with diabetes, and lowering disease-related emotional stress are important patient education goals. However, the large unexplained component of HbA1c variance highlights the need for more research to understand the mechanisms of glycaemic control. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

Aagaard-Hansen J.,Steno Health Promotion Center | Nombela N.,World Health Organization | Alvar J.,World Health Organization
Tropical Medicine and International Health | Year: 2010

This review provides an overview of the complex ways in which population movements are linked to spread and control of neglected tropical diseases - often exacerbated by insufficient medical services and sanitary infrastructure. A new typology of population movements is suggested which builds on previous work but offers a more comprehensive typology based on the variables of 'onset', 'cause', 'direction' and 'motivation'. Schistosomiasis and leishmaniasis provide examples of the intricate ways in which population movements may play a role. A thorough and context-specific understanding of these patterns combined with the ability and will to launch targeted public health interventions is needed to achieve adequate control of neglected tropical diseases as well as other infectious diseases. © 2010 Blackwell Publishing Ltd.

Schwennesen N.,Steno Health Promotion Center | Koch L.,Steno Health Promotion Center
Sociology of Health and Illness | Year: 2012

This article investigates processes of knowledge production and decision-making in the practice of the first trimester prenatal risk assessment (FTPRA) at an ultrasound clinic in Denmark. On the basis of ethnographic material and interviews with professionals facilitating FTPRAs in Denmark, we draw attention to the active engagement of health professionals in this process. Current professional and policy debate over the use of prenatal testing emphasises the need for informed choice making and for services that provide prospective parents with what is referred to as 'non-directive counselling'. Studies focusing on professional practice of prenatal counselling tend to deal mainly with how professionals fail to live up to such ideals in practice. In this article we extend such studies by drawing attention to practices of care in prenatal testing and counselling. In doing so, we identify three modes of 'doing' good care: attuning expectations and knowledge, allowing resistance and providing situated influence in the relationship between the pregnant woman and the professional. Such practices may not be seen as immediately compatible with the non-directive ethos, but they express ways of reducing emotional suffering and supporting a pregnant woman's ability to make meaningful choices on the basis of uncertain knowledge. As such, these practices can be seen as representing another (caring) solution to the problem of paternalism and authoritarian power. In opposition to an ethics aiming at non-interference (non-directiveness) such modes of doing good care express an ethics of being locally accountable for the ways in which programmes of prenatal testing intervene in pregnant women's lives and of taking responsibility for the entities and phenomena that emerge through such knowledge production. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Hempler N.F.,Steno Health Promotion Center | Ekholm O.,University of Southern Denmark | Willaing I.,Steno Health Promotion Center
Scandinavian Journal of Public Health | Year: 2013

Aims: Poor social support and lack of social network are well-established risk factors for morbidity and mortality in general populations. Good social relations, such as social support and network contacts, are associated with better self-management and fewer psychosocial problems in persons with type 2 diabetes. The aim of this study was to investigate whether persons with type 2 diabetes have poorer social relations than the general population. Methods: We conducted a cross-sectional survey in three settings: a specialist diabetes clinic (SDC) (n = 1084), a web panel (WP) consisting of persons with type 2 diabetes (n = 1491) and a sample from the 2010 Danish Health and Morbidity Survey, representative of the general population (n = 15,165). We compared social relations using multivariate logistic regression. Results: Compared to the general population, persons with type 2 diabetes more often lived without a partner (SDC, OR 1.75, 95% CI 1.49-2.06; WP, OR 1.64, 95% CI 1.43-1.87), met with family less than once a month (SDC, OR 1.78, 95% CI 1.40-2.27; WP, OR 2.35, 95% CI 1.94-2.84) and were less certain they could count on help from others in case of illness (WP, OR 1.23, 95% CI 1.08-1.41). Conclusions: Our findings suggest that persons with type 2 diabetes have poorer social relations than the general population. From a public health point of view, special attention is needed with regards to strengthening existing networks and establishing alternative networks among persons with type 2 diabetes. © 2013 the Nordic Societies of Public Health.

Grabowski D.,Steno Health Promotion Center
Health Education | Year: 2013

Purpose: The main aim of the paper is to explore whether health theatre as a school-based health promotion initiative communicates relevant health knowledge to children and the interrelated processes of identity development, knowledge acquisition and participation. Development of the definition of "health identity" was a subsidiary objective of the study. Design/methodology/approach: This was a qualitative study based on observation of five health theatre performances, with 20 focus group interviews with a total of 98 children and 22 individual interviews with teachers and parents. Findings: Three themes emerged from the qualitative analysis: children's varying capacities for participation affect knowledge acquisition and identity development; health knowledge acquisition is enhanced when information is made relevant by linking health to everyday life; and acquisition of health information and children's health identities are closely related. Coherent information and environments are conducive to knowledge acquisition, and health promotion efforts must be careful to avoid reinforcing negative health identities and furthering perceived divisions between "healthy" and "unhealthy" children. Originality/value: The paper provides important foundational information for school-based health theatre initiatives. It presents knowledge for practitioners working with knowledge-based health promotion for children and explores the connection between identities, health knowledge acquisition and participation within an alternative theoretical framework. © Emerald Group Publishing Limited.

Objective: To analyse the interrelated processes of identity, participation and knowledge in the context of the health educational Lifecalculator computer game. The analysis focuses on if and how this school-based health promotion initiative communicated relevant health knowledge to adolescents. Further development of the concept of health identity was a secondary objective of the study. Setting: Danish public schools. Methods: A qualitative study based on 21 focus group interviews with a total of 103 adolescents and 10 individual interviews with their teachers. Results: The simplified description of health and health choices in Lifecalculator makes it hard for the adolescents to relate the game to their everyday lives. They know that everyday health choices are more complex and they consequently dismiss the information altogether and do not gain much knowledge. The adolescents' identities and the way they interpret themselves and their health in relation to others decide if and how they acquire knowledge. Healthy adolescents, who consider themselves as healthy, find it easier to relate to the health knowledge than the unhealthy adolescents who are aware of their unhealthiness. Lifecalculator seems to confirm that healthy adolescents (who view themselves as healthy) are healthy and unhealthy adolescents (who view themselves as unhealthy) are unhealthy and, as such, this approach does very little in terms of motivating participation and presenting the adolescents with new health knowledge. Conclusions: The study of Lifecalculator and the theoretical advances disclose the multi-layered interrelatedness of health identity, knowledge and participation. This interrelatedness creates multiple perspectives for both practice and research. © 2012 The Author(s).

Joensen L.E.,Steno Health Promotion Center | Tapager I.,Incentive | Willaing I.,Steno Health Promotion Center
Diabetic Medicine | Year: 2013

Aims: To examine and assess (1) the internal consistency and validity of a Danish translation of the Diabetes Distress Scale (DDS17) among adults with Type 1 diabetes mellitus, (2) the properties of the brief version of DDS17 and (3) cut points for the DDS17. Methods: Cross-sectional survey of 2419 adults with Type 1 diabetes mellitus. Validated scales and questions measured diabetes distress (DDS17), diabetes empowerment (DES-SF), healthy diet, physical activity, self-rated health (SF-12) and quality of life (WHOQoL-BREF). An electronic patient record provided information about glycaemic control (HbA1c). We examined internal consistency, construct validity, subscale construction and cut points for determining clinically relevant diabetes distress, as well as two- and four-item brief versions of the DDS17. Results: The DDS17 had a Cronbach's alpha of 0.92; subscale alphas were 0.83-0.89. A four-factor division into subscales was appropriate and the division corresponded closely to the four domains described in the development of the DDS17. The DDS17 correlated well with relevant measures; higher distress was correlated with low diabetes empowerment, low quality of life, unhealthy diet, not being physically active, poor glycaemic control and low scores on the mental component score of the SF-12. A two-item brief scale performed as well as a four-item version. The relationship between DDS17 and outcomes did not suggest distinct cut points for DDS17. Conclusions: Our results provide support for the use of this Danish adaptation of the DDS17 for assessing psychosocial distress among adults with Type 1 diabetes mellitus. © 2013 Diabetes UK.

Hindhede A.L.,Steno Health Promotion Center
Health Care Analysis | Year: 2015

Focusing on the largest and, arguably, the least visible disability group, the hearing impaired, this paper explores present-day views and understandings of hearing impairment and rehabilitation in a Danish context, with particular focus on working-age adults with late onset of hearing impairment. The paper shows how recent changes in perception of the hearing impaired patient relate to the introduction of a new health care reform that turns audiological rehabilitation into a consumer issue. Ethnographic and interview data from hearing clinics provides evidence that the hearing technologies that are on offer stabilise in specific forms through processes of negotiation among a variety of social actors representing the interests of science, industry, government, and hearing-impaired people. The discussion critically considers the emergence of an “informed consumer” in audiological practices. © 2013, Springer Science+Business Media New York.

Torenholt R.,Steno Health Promotion Center | Schwennesen N.,Steno Health Promotion Center | Willaing I.,Steno Health Promotion Center
Diabetic Medicine | Year: 2014

Aims: Family interventions are increasingly recognized as important in the care of people with diabetes. The aim of this study was to synthesize the existing literature on family interventions among adults with Type 1 and Type 2 diabetes and to determine the degree to which they were family centred. Methods: The literature search was carried out in four databases (Scopus, CINAHL, PsycINFO and ERIC). Two reviewers independently screened the search results. Only English-language articles about interventions on education, care and/or support of adult individuals with diabetes involving the participation of both the individual with diabetes and at least one family member were included. Results: From an initial 1480 citations, 10 reports were included. The intervention studies varied considerably in terms of design and population. The family dimension generally represented a modest part of the interventions: Two interventions applied a family-relevant theoretical framework. Disease knowledge and lifestyle changes were more prevalent intervention themes than family issues. Biological and behavioural outcomes were most prevalent, whereas psychosocial and family outcomes were used in six of the studies. Conclusions: The number of trials and statistically significant results in family interventions targeting adults with diabetes is limited. Because of inhomogeneity, it is difficult to come to a conclusion on effective approaches in family interventions. The interventions are inconsistent with regard to theoretical framework, intervention themes and measured outcomes. However, psychosocial and familial dimensions seem sensitive to family-based interventions. From development to evaluation, the family dimension needs to be included to prove the specific effect of family interventions. © 2013 Diabetes UK.

Willaing I.,Steno Health Promotion Center
Diabetic medicine : a journal of the British Diabetic Association | Year: 2013

The aim of this study was to investigate associations between HbA1c recall by patients with Type 2 diabetes and self-management behaviours, patient activation, perception of care and diabetes distress. In a cross-sectional survey, 993 patients with Type 2 diabetes reported their latest HbA(1c). Validated scales measured self-management behaviours, patient activation, perception of care and diabetes distress. Self-reported HbA(1c) was compared with latest measured HbA(1c). Using logistic regressions, associations between HbA(1c) recall and the variables of interest were investigated. Sixty-four per cent of patients recalled their latest HbA(1c). Poor HbA(1c) recall was significantly associated with unhealthy eating behaviour, low level of exercise, low level of patient activation, poor glycaemic control, not knowing target HbA(1c) level, low educational level and being female. There were no associations between recall of HbA(1c) and diabetes distress or perceived care. Recall of HbA(1c) level may increase patient activation and health-promoting behaviours. However, low educational level may be a barrier for using HbA(1c) as a motivator for health-promoting behaviours. This study indicates a need for studies of causal relationships, as well as mechanisms and challenges in using patient awareness of HbA(1c) as a driver for health-promoting behaviours. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.

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