Hvad blev der af ’normalen’? Hvordan overdiagnostik af psykiske sygdomme hos børn bringer pædagogikkens vilkår i forandring

Resume Antallet af børn og unge som diagnosticeres med en psykisk sygdom er stigende. Det betyder dog ikke, at alle de diagnosticerede børn har en sygdom, fordi denne stigning også delvist kan være et udtryk for overdiagnostik. I denne oversigtsartikel redegør vi for, med baggrund i nyeste viden og publicerede artikler, hvad psykiske diagnoser hos børn er, og hvorfor der kan forekomme overdiagnostik. Vi viser desuden, at opfattelser af det ’normale’ ændres, både fordi symptomer kan blive så udbredte, at det ikke længere giver mening at tale om symptomer, men om normal-tilstande, og fordi der er en øget tendens til at medikalisere og diagnosticere adfærd, der er en reaktion på specifikke begivenheder. Vi argumenterer for, at det er en væsentlig baggrundsviden at have for dem, som er beskæftiget inden for det pædagogiske område, særligt i folkeskolen, hvor børnene har den alder, de oftest diagnosticeres i. Vi slutter derfor med en diskussion af overdiagnostik i et pædagogisk perspektiv. Den pædagogiske faglighed kan være nøglen til at være mere præcis over for, hvordan en given adfærd skal tolkes – og kan derved medvirke til, at færre børn bliver overdiagnosticerede med en diagnose, de aldrig får gavn af. Abstract Leaving Normal? How overdiagnosis enter and form the field of pedagogic practiceThe number of children and adolescents diagnosed with mental diseases is rising. It does, however, not mean that all these children necessarily have a mental disease; overdiagnosis is a well-known problem among medical researchers, but the pedagogical researchers and staff also need this insight. In this paper, we provide an overview of mental diagnoses among children and adolescents, the diagnostic procedures that may lead to overdiagnosis and how the concept of normal are constantly changing. This is relevant for the pedagogical staff that will evidently meet children with severe and invalidating mental illnesses, but also children, whose illness and symptoms are potentially overdiagnosed. The professional insights from pedagogy and pedagogical research are much needed if we are to improve the diagnostic process by input to better distinguish between the children who will need medical attention – and thus a diagnosis – and children who may have challenges, but not related to any medical conditions

Hvad blev der af ’normalen’?

Resume Antallet af børn og unge som diagnosticeres med en psykisk sygdom er stigende. Det betyder dog ikke, at alle de diagnosticerede børn har en sygdom, fordi denne stigning også delvist kan være et udtryk for overdiagnostik. I denne oversigtsartikel redegør vi for, med baggrund i nyeste viden og publicerede artikler, hvad psykiske diagnoser hos børn er, og hvorfor der kan forekomme overdiagnostik. Vi viser desuden, at opfattelser af det ’normale’ ændres, både fordi symptomer kan blive så udbredte, at det ikke længere giver mening at tale om symptomer, men om normal-tilstande, og fordi der er en øget tendens til at medikalisere og diagnosticere adfærd, der er en reaktion på specifikke begivenheder. Vi argumenterer for, at det er en væsentlig baggrundsviden at have for dem, som er beskæftiget inden for det pædagogiske område, særligt i folkeskolen, hvor børnene har den alder, de oftest diagnosticeres i. Vi slutter derfor med en diskussion af overdiagnostik i et pædagogisk perspektiv. Den pædagogiske faglighed kan være nøglen til at være mere præcis over for, hvordan en given adfærd skal tolkes – og kan derved medvirke til, at færre børn bliver overdiagnosticerede med en diagnose, de aldrig får gavn af. Abstract Leaving Normal? How overdiagnosis enter and form the field of pedagogic practice The number of children and adolescents diagnosed with mental diseases is rising. It does, however, not mean that all these children necessarily have a mental disease; overdiagnosis is a well-known problem among medical researchers, but the pedagogical researchers and staff also need this insight. In this paper, we provide an overview of mental diagnoses among children and adolescents, the diagnostic procedures that may lead to overdiagnosis and how the concept of normal are constantly changing. This is relevant for the pedagogical staff that will evidently meet children with severe and invalidating mental illnesses, but also children, whose illness and symptoms are potentially overdiagnosed. The professional insights from pedagogy and pedagogical research are much needed if we are to improve the diagnostic process by input to better distinguish between the children who will need medical attention – and thus a diagnosis – and children who may have challenges, but not related to any medical conditions

Fictitious cases as a methodology to discuss sensitive health topics in focus groups

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

Informationens ironi: Patienters frie adgang til sundhedsdata

Med indførslen af sundhed.dk har borgere i Danmark fået digital adgang til deres egne helbredsoplysninger såsom test- og screeningsvar, journalnotater osv. Den stigende trans- parens i sundhedsvæsenet påstås at fremme medinddragelse og mulighed for at engagere sig i eget helbred. I denne artikel fokuserer vi derfor på, hvad der sker i praksis, når forskellige mennesker tilgår deres helbredsoplysninger på sundhed.dk. Sammensat af to etnografiske studier og et interviewstudie viser vi, hvordan testsvar for deltagerne er svære at forstå, og hvordan abnorme testsvar, selv uden klinisk betydning, skaber bekymring og angst – også længe efter at svaret er givet og en eventuel behandling ovre. Med udgangspunkt i en teoretisk diskussion af hvordan det postmoderne informationssamfund beror på troen på oplysning, argumenterer vi for, at målet om at skabe mere tryghed gennem adgang til egen helbredsjournal, faktisk for nogle i stedet kan skabe utryghed, og ligefrem skade den enkelte, det vi kalder informationens ironi. Ved at bruge dette begreb diskuterer vi, hvordan di- gitale helbredsjournaler som sundhed.dk ikke i sig selv fremmer demokratiske rettigheder som inddragelse og adgang til egne data, men ligefrem kan skade. Vi argumenterer derfor for, at digitale helbredsinitiativer også underlægges en etisk afvejning af gavn og skade

an overview and re-analysis of systematic reviews

OKThe degree of overdiagnosis in common cancer screening trials is uncertain due to inadequate design of trials, varying definition and methods used to estimate overdiagnosis. Therefore, we aimed to quantify the risk of overdiagnosis for the most widely implemented cancer screening programmes and assess the implications of design limitations and biases in cancer screening trials on the estimates of overdiagnosis by conducting an overview and re-analysis of systematic reviews of cancer screening. We searched PubMed and the Cochrane Library from their inception dates to November 29, 2021. Eligible studies included systematic reviews of randomised trials comparing cancer screening interventions to no screening, which reported cancer incidence for both trial arms. We extracted data on study characteristics, cancer incidence and assessed the risk of bias using the Cochrane Collaboration's risk of bias tool. We included 19 trials described in 30 articles for review, reporting results for the following types of screening: mammography for breast cancer, chest X-ray or low-dose CT for lung cancer, alpha-foetoprotein and ultrasound for liver cancer, digital rectal examination, prostate-specific antigen, and transrectal ultrasound for prostate cancer, and CA-125 test and/or ultrasound for ovarian cancer. No trials on screening for melanoma were eligible. Only one trial (5%) had low risk in all bias domains, leading to a post-hoc meta-analysis, excluding trials with high risk of bias in critical domains, finding the extent of overdiagnosis ranged from 17% to 38% across cancer screening programmes. We conclude that there is a significant risk of overdiagnosis in the included randomised trials on cancer screening. We found that trials were generally not designed to estimate overdiagnosis and many trials had high risk of biases that may draw the estimates of overdiagnosis towards the null. In effect, the true extent of overdiagnosis due to cancer screening is likely underestimated.publishersversionpublishe

The long-term psychosocial consequences of screen-detected ductal carcinoma in situ and invasive breast cancer

Publisher Copyright: © 2023 The AuthorsObjective: Ductal carcinoma in situ (DCIS) is a risk factor for invasive breast cancer (IBC). The prognosis of DCIS is considerably better than for IBC, yet women do not distinguish between the threat. We aimed to compare the psychosocial consequences of screen-detected DCIS and IBC, and to examine this comparison over time. Methods: We surveyed a Danish mammography-screening cohort from 2004 to 2018. We assessed outcomes at six-time points: baseline, 1, 6, 18, 36 months, and 14 years after the screening. We measured psychosocial consequences with the Consequences Of Screening – Breast Cancer (COS-BC): a condition-specific questionnaire that is psychometrically validated and encompasses 14 psychosocial dimensions. We used weighted linear models with generalized estimating equations to compare responses between groups. We used a 1% level of significance. Results: 170 out of 1309 women were diagnosed with breast cancer (13.0%). 23 were diagnosed with DCIS (13.5%) and 147 with IBC (86.5%). From baseline to six months after diagnosis, there were no significant differences between women with DCIS and IBC. However, mean scores indicated that IBC generally was more affected than DCIS. After six months, we observed that women with DCIS and IBC might be affected differently in the long term; mean scores and mean differences showed that IBC were more affected on some scales, while DCIS were on others. Conclusion: Overall, the DCIS and IBC experienced similar levels of psychosocial consequences. Women might benefit from renaming DCIS to exclude cancer nomenclature.publishersversionpublishe

The SOFIA pilot study:assessing feasibility and fidelity of coordinated care to reduce excess mortality and increase quality of life in patients with severe mental illness in a general practice setting; a cluster-randomised pilot trial

Abstract Objective To evaluate the feasibility and fidelity of implementing and assessing the SOFIA coordinated care program aimed at lowering mortality and increasing quality of life in patients with severe mental illness by improving somatic health care in general practice. Design A cluster-randomised, non-blinded controlled pilot trial. Setting General Practice in Denmark. Intervention The SOFIA coordinated care program comprised extended structured consultations carried out by the GP, group-based training of GPs and staff, and a handbook with information on signposting patients to relevant municipal, health, and social initiatives. Patients Persons aged 18 years or older with a diagnosis of psychotic, bipolar, or severe depressive disorder. Main outcome measures We collected quantitative data on the delivery, recruitment and retention rates of practices and patients, and response rates of questionnaires MMQ and EQ-5D-5 L. Results From November 2020 to March 2021, nine practices were enrolled and assigned in a 2:1 ratio to the intervention group (n = 6) or control group (n = 3). Intervention group practices included 64 patients and Control practices included 23. The extended consultations were delivered with a high level of fidelity in the general practices; however, thresholds for collecting outcome measures, and recruitment of practices and patients were not reached. Conclusion Our findings suggest that delivering the coordinated care program in a fully powered trial in primary care is likely feasible. However, the recruitment methodology requires improvement to ensure sufficient recruitment and minimize selective inclusion. Trial registration The date of pilot trial protocol registration was 05/11/2020, and the registration number is NCT04618250

Ja tak til Robustheds-kommissionens anbefalinger:Mindre overdiagnostik i sundhedsvæsenet

Det er til gavn for både den enkelte og for fællesskabet, hvis sundhedsvæsenet i fremtiden tilbyder færre sundhedsydelser. Især de mest syge vil få en bedre behandling