Exercise on Prescription: trial protocol and evaluation of outcomes

BACKGROUND: In many countries exercise prescriptions are used in an attempt to initiate a physically active lifestyle in sedentary populations. Previous studies have primarily evaluated low intensive exercise prescription interventions and found moderately positive effects on physical activity and aerobic fitness. In a highly intensive Danish exercise prescription scheme called 'Exercise on Prescription' (EoP) the general practitioners can prescribe EoP to sedentary patients with lifestyle diseases. The aim of this randomized trial is to assess the short- and long-term effects of the EoP scheme. Thus, the aim of this paper is to describe the randomized controlled trial designed for evaluating effectiveness of EoP, and to present results from validations of outcome measures. METHODS/DESIGN: EoP involves a 16-week supervised training intervention and five counselling sessions (health profiles). All patients referred to EoP were eligible for the trial and were offered participation during the baseline health profile. Comparisons between the EoP group and the control group were made at baseline, and after four and ten months. Physiological measures used were maximal oxygen uptake (VO(2)max), glycosylated haemoglobin (HbA1c), bodyweight, and BMI. Patient-reported measures used were physical activity, health-related quality of life, amount and intensity of exercise, compliance with national guidelines for physical activity, and physical fitness. The validation of the cycle ergometer test found a strong correlation between maximal work capacity and VO(2)max, and acceptable test-retest reliability at group level. Calibration of the HbA1c apparatus was stable over ten weeks with minimal use, and test-retest reliability was good. High agreement percents were found for test-retest reliability for the self-administered questionnaire. DISCUSSION: The trial is designed to provide information about the effectiveness of the EoP scheme. The trial is part of a health technology assessment of EoP, which besides the effectiveness covers the patient perspective, the organization, and the health economy. All three methods validated were found useful for the EoP trial

Utilizing a New Graphical Elicitation Technique to Collect Emotional Narratives Describing Disease Trajectories

Elicitation techniques in connection with semi-structured interviews are scantily used, but reported to be beneficial to research. We developed and tested a new visual technique to be utilized in the latter part of semi-structured interviews. It has proved to be feasible and beneficial to use, and it could possibly be used by others. This way of extending the interviews generates more data in a visual form, as well as in a verbal form, by supporting the participants in remembering nearly forgotten parts of their experiences and in expressing emotions associated with those significant experiences. As a contribution to qualitative research, our study showed that the visual data, created by the participants, also contributed to getting the elaborated narratives

How does HPV vaccination status relate to risk perceptions and intention to participate in cervical screening?:a survey study

Abstract Background Women in several countries will soon be covered by two preventive programmes targeting cervical cancer: HPV vaccination and cervical screening. The HPV vaccines are expected to prevent approximately 70 % of cervical cancers. It has been speculated, that HPV vaccinated women will not attend screening because they falsely think that the vaccine has eliminated their cervical cancer risk. The aim of this study was to investigate the association between HPV vaccination status and perceptions of cervical cancer risk; perceptions of vaccine effect; and intention to participate in cervical screening. Furthermore, to investigate associations between perceptions of cervical cancer risk and intention to participate in cervical screening. Methods A random sample of Danish women from the birth cohorts 1993–1995 was invited to complete a web-based questionnaire concerning risk perceptions and intentions to participate in cervical screening. Main outcomes were: perceived lifetime-risk of cervical cancer; perceived HPV vaccine effect; and intention to participate in cervical screening. Results HPV vaccinated women more often than unvaccinated women intended to participate in screening: adjusted odds ratio (OR) for being HPV vaccinated when intending to participate in screening of 3.89 (95 % CI: 2.50–6.06). HPV vaccinated women perceived cervical cancer risk to be higher than unvaccinated women did: adjusted OR of 0.11 (95 % CI: 0.03–0.39) and 0.51 (95 % CI: 0.33–0.78) for being HPV vaccinated while having the lowest perception of risk (in two different pre-specified dichotomisations). HPV vaccinated women perceived the vaccine effect to be larger than unvaccinated women did: adjusted OR of 0.31 (95 % CI: 0.18–0.51) and 0.37 (95 % CI: 0.25–0.53) for being HPV vaccinated while having the lowest perception of vaccine effect (in two different pre-specified dichotomisations). There were no associations between perceived cervical cancer risk and intention to participate in screening. Conclusions HPV vaccinated women more often than unvaccinated women intended to participate in screening and they perceived cervical cancer risk to be higher and the vaccine effect to be larger than unvaccinated women did. However, in our analyses, risk perceptions could not explain screening intentions neither among vaccinated nor among unvaccinated women

Benefits and challenges perceived by patients with cancer when offered a nurse navigator

<p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Introduction: </span></strong><span style="font-family: " lang="EN-US">Lack of communication, care and respect from healthcare professionals can be challenges for patients in trajectories of cancer, possibly accompanied by experienced fragmentation of the care, anxiety and worries. One way to try to improve delivery of care is additional help from Nurse Navigators (NN) offered in a predefined shorter or longer period, but patients´ experiences with this have seldom been investigated.</span></span></p><p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Aims: </span></strong><span style="font-family: " lang="EN-US">To explore patients´ experiences of an NN offered in a short period of a longer trajectory of cancer. </span></span></p><p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Methods: </span></strong><span style="font-family: " lang="EN-US">NN worked from the hospital side in the transition between primary care and a university hospital before admission. A phenomenological-hermeneutical longitudinal study was performed from referral and until two months after discharge from the hospital. Semi-structured interviews provided data for the analysis, which started open-minded.</span></span></p><p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Results: </span></strong><span style="font-family: " lang="EN-US"><span style="mso-spacerun: yes;"> </span>Affectional bonds were made to NN and patients felt that they benefited from her presence and her help,<strong style="mso-bidi-font-weight: normal;"> </strong>which they requested until one month after discharge. They were deeply disappointed and felt rejected when the contact to the NN stopped. </span></span></p><p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Conclusion:</span></strong><span style="font-family: " lang="EN-US"> In efforts to increase quality of care for patients with cancer we recommend paying special attention to critical periods in their trajectories, as well as to the theory of attachment to supplement thoughts of continuity of care and coordination in the care for women. In short, it is fine to offer additional help to those who can use it, but in practice as well as in research we call attention to awareness on how and when to stop the help, to prevent patients from feeling hurt.</span></span></p

Mental Well-being during Stages of COVID-19 Lockdown among pregnant women and new mothers

Acknowledgments The authors would like to thank the funders for their financial support and research assistant Sinead Shahrzad for data management. Funding This work was supported by TRYGfonden [grant number 125227] and the quality and continuing education committee for general practice in the Capital Region [grant number 19035774].Peer reviewedPublisher PD

Participation in cancer rehabilitation and unmet needs: a population-based cohort study

PURPOSE: To investigate associations between cancer survivors’ sex, age, and diagnosis in relation to their (1) need for rehabilitation, (2) participation in rehabilitation activities, and (3) unmet needs for rehabilitation in a 14-month period following date of diagnosis. METHODS: A population-based cohort study was performed on incident cancer patients diagnosed from 1 October 2007 to 30 September 2008. Fourteen months after diagnosis, participants completed a questionnaire developed to measure the aspects of rehabilitation. Logistic regression analyses were used to explore the association between sex, age, and diagnosis, and the outcome variables for rehabilitation. RESULTS: A total of 3,439 patients participated, yielding an overall response rate of 70%. One third of the cancer patients reported a need for physical rehabilitation and one third for psychological rehabilitation. Half of the patients participated in at least one activity. Unmet needs were most often reported in psychological, sexual, and financial areas. Women expressed more needs, participated more often in rehabilitation activities, and had, to a higher extent, their emotional needs fulfilled. Breast cancer patients participated more often in physical rehabilitation. Elderly who expressed rehabilitation needs more often had them unresolved. CONCLUSIONS: A substantial variation in rehabilitation needs, participation in activities, and unmet needs in relation to sex, age, and cancer type was observed. Cancer care ought to systematically address the wide range of needs in all groups through integration of systematic needs assessment and targeted supply of offers