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  1. Article ; Online: [No title information]

    Jønsson, Alexandra Brandt Ryborg / Brodersen, John

    Ugeskrift for laeger

    2023  Volume 185, Issue 46

    Abstract: Overdiagnosis is the process of making people into patients unnecessarily. Besides undermining the quality of care and patient outcomes, overdiagnosis (and overuse) prompts the urge to look at how to reduce low-value care to face the climate crisis. It ... ...

    Title translation The carbon footprint of overdiagnosis.
    Abstract Overdiagnosis is the process of making people into patients unnecessarily. Besides undermining the quality of care and patient outcomes, overdiagnosis (and overuse) prompts the urge to look at how to reduce low-value care to face the climate crisis. It is estimated that 80% of the total CO2 emission from the healthcare sector stems from clinical activity and that 40% of this is low-value care. This review finds that we need research on the benefits and harms of clinical activity in Denmark to provide evidence-based reforms minimizing low-value care, thus cutting the CO2 emissions substantively in healthcare.
    MeSH term(s) Humans ; Overdiagnosis ; Carbon Dioxide ; Carbon Footprint ; Delivery of Health Care
    Chemical Substances Carbon Dioxide (142M471B3J)
    Language Danish
    Publishing date 2023-10-31
    Publishing country Denmark
    Document type Review ; English Abstract ; Journal Article
    ZDB-ID 124102-3
    ISSN 1603-6824 ; 0041-5782
    ISSN (online) 1603-6824
    ISSN 0041-5782
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  2. Article ; Online: Rethinking the logic of early diagnosis in cancer.

    Damhus, Christina Sadolin / Risør, Mette Bech / Brodersen, John Brandt / Jønsson, Alexandra Brandt Ryborg

    Health (London, England : 1997)

    2024  , Page(s) 13634593241234481

    Abstract: To reduce morbidity and mortality of cancer, more countries have implemented strategies to detect cancer, based on the logic of 'the sooner the better'. ...

    Abstract To reduce morbidity and mortality of cancer, more countries have implemented strategies to detect cancer, based on the logic of 'the sooner the better'.
    Language English
    Publishing date 2024-02-26
    Publishing country England
    Document type Journal Article
    ZDB-ID 1338717-0
    ISSN 1461-7196 ; 1363-4593
    ISSN (online) 1461-7196
    ISSN 1363-4593
    DOI 10.1177/13634593241234481
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  3. Article ; Online: General practitioners' experiences of providing somatic care for patients with severe mental illness: a qualitative study.

    Jønsson, Alexandra Brandt Ryborg / Brodersen, John Brandt / Reventlow, Susanne / Svanholm, Christina / Møller, Anne / Kousgaard, Marius Brostrøm

    BMC primary care

    2024  Volume 25, Issue 1, Page(s) 96

    Abstract: Background: Patients dealing with severe mental illnesses (SMI) often face suboptimal clinical outcomes and higher mortality rates due to a range of factors, including undetected physical health conditions. The provision of care for individuals with SMI ...

    Abstract Background: Patients dealing with severe mental illnesses (SMI) often face suboptimal clinical outcomes and higher mortality rates due to a range of factors, including undetected physical health conditions. The provision of care for individuals with SMI is frequently disjointed, as they engage with diverse healthcare providers. Despite this fragmentation, primary care, particularly general practitioners (GPs), assumes a pivotal role in the care of SMI patients. Our study aimed to delve into the first-hand experiences of GPs in delivering somatic care to SMI patients, concentrating on the challenges they encounter and the strategies they employ to navigate these difficulties.
    Methods: We conducted in-depth interviews with fifteen GPs, utilizing a semi-structured interview guide, supplemented by ethnographic observations during clinical consultations in general practice. Through inductive coding, interview transcripts and observational field notes were systematically analysed using interpretative phenomenological analysis (IPA). The findings were then deliberated upon within the author group.
    Results: GPs revealed that managing the chronic somatic care of SMI patients posed significant challenges. These challenges encompassed the multifaceted needs of patients, their behavior tied to symptoms, a lack of care continuity, and overarching time constraints. To tackle these challenges, the GPs had devised various strategies. However, all participants underscored the critical importance of having adequate time to properly prepare for, conduct, and follow up on consultations.
    Conclusion: The GPs' interactions with SMI patients brought numerous challenges, although treating these patients were concurrently acknowledged as vital and fulfilling. The findings suggest that increased allocated time in general practice consultations for patients with SMI is important to support the somatic treatment requirements of this patient group.
    MeSH term(s) Humans ; General Practitioners ; Mental Disorders/therapy ; General Practice ; Qualitative Research ; Mentally Ill Persons
    Language English
    Publishing date 2024-03-22
    Publishing country England
    Document type Journal Article
    ISSN 2731-4553
    ISSN (online) 2731-4553
    DOI 10.1186/s12875-024-02338-z
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  4. Article: Generating Items for Measuring Needs-Based Quality of Life and Self-Perceived Health Inequity in Patients with Multimorbidity: Development of the MultiMorbidity Questionnaire (MMQ).

    Bissenbakker, Kristine Henderson / Møller, Anne / Jønsson, Alexandra Brandt Ryborg / Brodersen, John Brandt

    Patient related outcome measures

    2023  Volume 14, Page(s) 269–282

    Abstract: Purpose: To describe the processes of developing domains and items for the MultiMorbidity Questionnaire (MMQ), a multimorbidity-specific PROM for the assessment of Needs-based QoL.: Patients and methods: We developed items and domains for the MMQ ... ...

    Abstract Purpose: To describe the processes of developing domains and items for the MultiMorbidity Questionnaire (MMQ), a multimorbidity-specific PROM for the assessment of Needs-based QoL.
    Patients and methods: We developed items and domains for the MMQ through 17 qualitative content validity questionnaire interviews with adults with multimorbidity by testing items from an item bank (covering items with content inspired by existing Needs-based QoL measures for single diseases). The interviews alternated between an explorative part and more focused cognitive interview techniques.
    Results: Testing the 47 items from the first draft of the MMQ items showed that the Needs-based approach as a framework did not cover all the QoL aspects our informants stated as being important. Therefore, the conceptual framework was supplemented by Self-perceived health inequity, and new items were generated. MMQ, measuring Needs-based QoL (MMQ1) and Self-perceived health inequity (MMQ2), was assembled. MMQ1 covers the domains: "Physical ability" (10 items), "Limitations in everyday life" (15 items), "Worries" (11 items), "My social life" (11 items), "Self-image" (12 items), and "Personal finances" (2 items). Self-perceived health inequity proved to be a relevant framework for other aspects of QoL not covered by the Needs-based approach to QoL. MMQ2 covers the domains: "Experiences of being stigmatized" (five items), "Experiences of not being seen and heard" (four items), "Insufficient understanding of the burden of disease" (three items) and "Experiences of feeling powerless" (five items).
    Conclusion: We have developed the final MMQ draft, a multimorbidity-specific PROM for the assessment of Needs-based QoL (MMQ1) and Self-perceived health inequity (MMQ2) with high content validity (regarding content relevance and comprehensiveness). The final MMQ draft will be assessed for its psychometric properties using Modern Test Theory.
    Language English
    Publishing date 2023-10-10
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2586660-6
    ISSN 1179-271X
    ISSN 1179-271X
    DOI 10.2147/PROM.S427183
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  5. Article ; Online: Spaces out of reach? Service user involvement in residents' meetings at recovery-oriented social housing facilities for young people with mental health disorders.

    Steno, Anne Mia / Jønsson, Alexandra Brandt Ryborg

    Health (London, England : 1997)

    2022  Volume 27, Issue 6, Page(s) 941–957

    Abstract: Through anthropological fieldwork among people with severe mental health disorders, this article focuses on these service users' interactions and relations with the professionals and with other service users at recovery-oriented housing facilities in ... ...

    Abstract Through anthropological fieldwork among people with severe mental health disorders, this article focuses on these service users' interactions and relations with the professionals and with other service users at recovery-oriented housing facilities in Denmark. We discuss how recovery-oriented spaces designed for the service users may feel out of reach to them, hence making the service users feel awkward and reluctant to participate. The study shows how service users, initially recognized as "unengaged," rather are to be understood as active actors involved in their recovery and forming social bonds. The research seeks to put forward new perspectives on recovery as a concept in psychosocial rehabilitation, arguing that recovery and healing may take up different forms in different spaces and that recognizing services users' enactment of reluctancy and disengagements could serve as an important part of recovery work in rehabilitation.
    MeSH term(s) Humans ; Adolescent ; Mental Health Services ; Housing ; Mental Health ; Mental Disorders/rehabilitation ; Emotions
    Language English
    Publishing date 2022-02-03
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1338717-0
    ISSN 1461-7196 ; 1363-4593
    ISSN (online) 1461-7196
    ISSN 1363-4593
    DOI 10.1177/13634593221075950
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  6. Article ; Online: Fictitious cases as a methodology to discuss sensitive health topics in focus groups.

    Gram, Emma Grundtvig / Brodersen, John Brandt / Hansen, Cæcilie / Pickles, Kristen / Smith, Jenna / Jønsson, Alexandra Ryborg Brandt

    International journal of qualitative studies on health and well-being

    2023  Volume 18, Issue 1, Page(s) 2233253

    Abstract: Purpose: It can be challenging to research aspects of people's health behaviour, attitudes, and emotions due to the sensitive nature of these topics. We aimed to develop a novel methodology for discussing sensitive health topics, and explore the ... ...

    Abstract Purpose: It can be challenging to research aspects of people's health behaviour, attitudes, and emotions due to the sensitive nature of these topics. We aimed to develop a novel methodology for discussing sensitive health topics, and explore the effectiveness in focus groups using prostate cancer and screening as an example.
    Method: We developed a fictitious case and employed it as a projective technique in focus groups on prostate cancer and screening. The participants were men and their partners who lived in Denmark.
    Results: The technique encouraged emotional and cognitive openness in focus group discussions about the risk of prostate cancer, the benefits and harms of screening, and decision-making about screening. It appeared that using the fictitious case allowed the participants to personally distance themselves from the topic, project emotions onto the case, and thereby openly talk about their emotions.
    Conclusion: This article presents a methodological contribution to communication about sensitive topics in focus groups, using prostate cancer screening as an example. Further refinement of the methodology is needed to enable participants to transfer improvements in knowledge to their own decision about screening.
    MeSH term(s) Male ; Humans ; Prostatic Neoplasms/diagnosis ; Prostate-Specific Antigen ; Focus Groups ; Decision Making ; Early Detection of Cancer/methods ; Mass Screening/methods
    Chemical Substances Prostate-Specific Antigen (EC 3.4.21.77)
    Language English
    Publishing date 2023-07-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2232726-5
    ISSN 1748-2631 ; 1748-2623
    ISSN (online) 1748-2631
    ISSN 1748-2623
    DOI 10.1080/17482631.2023.2233253
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  7. Article ; Online: Measuring needs-based quality of life and self-perceived health inequity in patients with multimorbidity: investigating psychometric measurement properties of the MultiMorbidity Questionnaire (MMQ) using primarily Rasch models.

    Bissenbakker, Kristine / Siersma, Volkert / Jønsson, Alexandra Brandt Ryborg / Møller, Anne / Christensen, Karl Bang / Brodersen, John Brandt

    Journal of patient-reported outcomes

    2023  Volume 7, Issue 1, Page(s) 94

    Abstract: Background: Multimorbidity is a burden for the individual and to the healthcare sector worldwide, leading to a rising number of intervention studies towards this patient group. To measure a possible effect of such interventions, an adequate patient- ... ...

    Abstract Background: Multimorbidity is a burden for the individual and to the healthcare sector worldwide, leading to a rising number of intervention studies towards this patient group. To measure a possible effect of such interventions, an adequate patient-reported outcome measure (PROM) is essential. The aim of this study was to assess the draft MultiMorbidity Questionnaire (MMQ), a PROM measuring needs-based quality of life and self-perceived inequity in patients with multimorbidity, for its psychometric properties and to adjust it accordingly to create a content- and construct valid measure.
    Methods: The draft MMQ was sent to 1198 eligible respondents with multimorbidity. Modern test theory and classical test theory were used to analyse data. Dimensionality of the suggested domains and invariance of the items were assessed through item analysis, examining the fit to a psychometric model.
    Results: The psychometric analyses were based on responses from 390 patients with multimorbidity. In the MMQ1, measuring needs-based QoL, evidence of six unidimensional scales was confirmed: physical ability (6 items), worries (6 items), limitations in everyday life (10 items), my social life (6 items), self-image (6 items), and personal finances (3 items). The psychometric analyses of the MMQ2 outlined four unidimensional scales measuring the feeling of Self-perceived inequity in patients with multimorbidity: experiences of being stigmatised (4-5 items), Experiences of insufficient understanding of the burden of disease (3 items), Experiences of not being seen and heard (4 items), Experience of powerlessness (5 items). These scales are relevant for patients' with multimorbidity encounters with (1) their general pratitioner, (2) staff at their general practitioner's surgery, (3) healthcare professionals, (4) staff at the local authorities and (5) friends, family, and others.
    Conclusion: The MMQ, a QoL measure for patients living with multimorbidity has been validated: the MMQ1 is a condition-specific PROM with adequate psychometric properties designed to measure needs-based QoL. The MMQ2 measuring Self-perceived inequity, has also been found to possess adequate measurement properties; however due to the risk of type 2 error a revalidation of MMQ2 is suggested.
    MeSH term(s) Humans ; Psychometrics ; Quality of Life ; Multimorbidity ; Health Inequities ; Physical Examination
    Language English
    Publishing date 2023-09-18
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2509-8020
    ISSN (online) 2509-8020
    DOI 10.1186/s41687-023-00633-4
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  8. Article: Questioning 'Informed Choice' in Medical Screening: The Role of Neoliberal Rhetoric, Culture, and Social Context.

    Gram, Emma Grundtvig / Jønsson, Alexandra Brandt Ryborg / Brodersen, John Brandt / Damhus, Christina Sadolin

    Healthcare (Basel, Switzerland)

    2023  Volume 11, Issue 9

    Abstract: Participation in medical screening programs is presented as a voluntary decision that should be based on an informed choice. An informed choice is often emphasized to rely on three assumptions: (1) the decision-maker has available information about the ... ...

    Abstract Participation in medical screening programs is presented as a voluntary decision that should be based on an informed choice. An informed choice is often emphasized to rely on three assumptions: (1) the decision-maker has available information about the benefits and harms, (2) the decision-maker can understand and interpret this information, and (3) the decision-maker can relate this information to personal values and preferences. In this article, we empirically challenge the concept of informed choice in the context of medical screening. We use document analysis to analyze and build upon findings and interpretations from previously published articles on participation in screening. We find that citizens do not receive neutral or balanced information about benefits and harms, yet are exposed to manipulative framing effects. The citizens have high expectations about the benefits of screening, and therefore experience cognitive strains when informed about the harm. We demonstrate that decisions about screening participation are informed by neoliberal arguments of personal responsibility and cultural healthism, and thus cannot be regarded as decisions based on individual values and preferences independently of context. We argue that the concept of informed choice serves as a power technology for people to govern themselves and can be considered an implicit verification of biopower.
    Language English
    Publishing date 2023-04-26
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2721009-1
    ISSN 2227-9032
    ISSN 2227-9032
    DOI 10.3390/healthcare11091230
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  9. Article ; Online: Conceptualisation of a measurement framework for Needs-based Quality of Life among patients with multimorbidity.

    Bissenbakker, Kristine / Møller, Anne / Brodersen, John Brandt / Jønsson, Alexandra Brandt Ryborg

    Journal of patient-reported outcomes

    2022  Volume 6, Issue 1, Page(s) 83

    Abstract: Background: Multimorbidity is both an individual and societal problem. For society, patients with multimorbidity increase healthcare costs. For the individual, living with multimorbidity is complex, and there is an inverse relationship between a patient' ...

    Abstract Background: Multimorbidity is both an individual and societal problem. For society, patients with multimorbidity increase healthcare costs. For the individual, living with multimorbidity is complex, and there is an inverse relationship between a patient's Quality of Life (QoL) and their number of chronic conditions. Numerous intervention studies target these problems, yet there is no multimorbidity-specific patient-reported outcome measure (PROM) developed specifically for this group with adequate measurement properties to assess QoL. This study explores what overall needs regarding QoL are affected by living with multimorbidity through qualitative interviews. With this, we conceptualise Needs-based QoL specifically for this group, ensuring high content validity (regarding relevance and comprehensiveness) of using the Needs-based approach to measure their QoL. This is essential as this preliminary study leads to the development of the MultiMorbidity Questionnaire (MMQ), a PROM measuring QoL among patients with multimorbidity.
    Methods: This study draws upon qualitative interviews with fifteen patients with multimorbidity based on a semi-structured interview guide following the Needs-based approach. This approach allowed the patients to cover needs relevant for their QoL in relation to the complexities of living with multimorbidity. The transcribed interviews were thematically analysed, inspired by Braun and Clarke's reflexive approach.
    Results: Analysis of the interviews resulted in the construction of six intertwined domains relevant to patients with multimorbidity, covering their Needs-based QoL; "Physical ability", "Self-determination", "Security", "Partner and social life", "Self-image", and "Personal finances". "Physical limitations" and "Personal finances" were stated as core needs implicating the other domains.
    Conclusion: This study shows six intertwined overall domains relevant for patients with multimorbidity regarding their Needs-based QoL; "Physical ability", "Self-determination", "Security", "Partner and social life", "Self-image", and "Personal finances". These needs are relevant in a Danish context, with a generally high standard of living. Based on this conceptual framework of Need-based QoL for patients with multimorbidity, we will develop items for a new patient-reported outcome measure called the MMQ.
    Language English
    Publishing date 2022-07-27
    Publishing country Germany
    Document type Journal Article
    ISSN 2509-8020
    ISSN (online) 2509-8020
    DOI 10.1186/s41687-022-00489-0
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  10. Article ; Online: Responsibilities of Risk: Living with Mental Illness During COVID-19.

    Ryborg Jønsson, Alexandra Brandt / Christensen, Iben Emilie / Reventlow, Susanne / Risør, Mette Bech

    Medical anthropology

    2022  Volume 41, Issue 3, Page(s) 302–314

    Abstract: Following the COVID-19 pandemic, Denmark introduced repeated lock-downs of society, including outreach services and visits from social workers for people living with mental illnesses. Based on ethnographic fieldwork, in this article we explore how people ...

    Abstract Following the COVID-19 pandemic, Denmark introduced repeated lock-downs of society, including outreach services and visits from social workers for people living with mental illnesses. Based on ethnographic fieldwork, in this article we explore how people with mental illness react to and manage their lives amid COVID-19 mitigations, focusing on how they experience and negotiate vulnerability at personal and community level. We argue, that the subjective management of restrictions implicated in their personal lives notions of risk, vulnerability and agency, and shows a diversity and heterogeneity of responses to the pandemic that allowed the mentally ill to perform good citizenship.
    MeSH term(s) Anthropology, Medical ; COVID-19 ; Communicable Disease Control ; Humans ; Mental Disorders ; Pandemics
    Language English
    Publishing date 2022-03-10
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 603228-x
    ISSN 1545-5882 ; 0145-9740
    ISSN (online) 1545-5882
    ISSN 0145-9740
    DOI 10.1080/01459740.2022.2045288
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