Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis:results from the Danish nationwide DANBIO registry

BACKGROUND/PURPOSE: Early diagnosis of inflammatory rheumatic diseases is important in order to improve long-term outcome. We studied whether delay in diagnosis (time between onset of symptoms and establishment of diagnosis) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PSA) and ankylosing spondylitis (AS) changed from year 2000 to 2011. METHODS: Month and year of initial symptoms and diagnosis, gender, hospital, year of birth and date of first data entry were obtained for 13 721 patients with RA, PSA or AS who had been registered in the DANBIO registry. Time between symptom onset and diagnosis was modelled using generalised linear regression to predict the average duration for each calendar year of initial symptoms with adjustments for gender, year of birth and date of DANBIO entry. RESULTS: Patients with valid data (RA: 10 416 (73%); PSA: 1970 (68%); AS: 1335 (65%)) did not differ significantly from the whole DANBIO population, except more missing data in early years. The regression model showed that the mean duration from initial symptoms to diagnosis for RA, PSA and AS declined steadily from 30, 53 and 66 months (year 2000), respectively, to 3–4 months (year 2011). Sensitivity analyses including patients who were included after 2005, patients who had received biological treatment or had symptom onset less than 2 and 5 years prior to first entry into DANBIO showed similar results. CONCLUSION: Since the year 2000, a significant reduction in diagnostic delay was observed in this large cohort of patients with RA, PSA or AS, probably reflecting a stronger awareness of the importance of early diagnosis

Freedom, joy and wonder as existential categories of childhood – reflections on experiences and memories of outdoor play

This study conveys how young adults reflect upon their childhood experiences and memories of outdoor play, friluftsliv and outdoor places. Inspired by a phenomenological approach, we conducted walking interviews in nature areas where they used to play as children, revisiting the same informants and places as in a research project 14 years earlier. Today the respondents emphasise the experience of freedom encompassing joy, wonder and communication with surrounding nature and people, associating it with autonomy and self-determination. Joy, wonder and communication in someone’s experience are subjective existential categories often used to characterise friluftsliv in outdoor education. Personally meaningful to the young adults, these experiences have become important parts of who they are today. These results differ from previous research on outdoor play as it highlights freedom, joy and wonder. Based on this, we argue for facilitating self-directed outdoor play, and emphasize conscious choice of location for outdoor pedagogical work.publishedVersionPaid Open Acces

Helhetlig smertelindring

Vi ønsker å fordype oss i tema smertelindring til kreftpasienter, da smertelindring er en viktig del i utøvelsen av sykepleie. Ut ifra erfaring fra praksisfeltet opplever vi at mange kreftpasienter uttrykker utilstrekkelig smertebehandling. Det kan være mange årsaker til det. Blant annet for lite kunnskap hos helsepersonell, redsel for respirasjonsdepresjon og påføre avhengighet over tid. Smertelindring omfatter ikke bare den fysiske smerten, men også den sosiale, psykiske, åndelige og eksistensielle. Som sykepleiere har vi ansvar for å ivareta pasienten, og kan dermed ha innvirkning på en kreftpasients opplevelse av sykdommen og hans livskvalitet. Å sørge for at mennesker i et vanskelig stadium i livet har det best mulig, er krevende, og vi vil gjennom oppgaven øke vår kunnskap om emne. I tillegg finner vi det valgte temaet i fagplanens mål. I følge fagplanens mål 3.3.2 skal sykepleieren ha kunnskap om smerter og smertebehandling, vise forståelse og respekt for pasientens subjektive oppfatning av smerte (Rammeplan og forskrift for sykepleierutdanningen, 2004

Labour market attachment among parents and self-rated health of their offspring:an intergenerational study

Background Unemployment influences the individual’s health, whether this effect passes through generations is less studied. The aim of this intergenerational study was to investigate whether parents’ labour market attachment (LMA) were associated with self-rated health (SRH) among adolescents using preceding labour market events. Methods The study was performed using questionnaire data from the Danish Future Occupation of Children and Adolescents cohort (the FOCA cohort) of 13 100 adolescents (mean age 15.8 years) and their accompanying parents identified through registers. Adolescents’ SRH was measured using one item from SF-36. Information on parents’ LMA was obtained from a national register, analyzed on a weekly basis in a 5-year period before the adolescents completed the questionnaire. An integration indicator was calculated from an initial sequence analysis to determine how well the parents were integrated in the labour market. The association between the adolescents’ SRH and parents’ LMA was examined by logistic regression and an extended sequence analysis stratified on adolescents’ SRH. Results Totally, 29.1% of the adolescents reported moderate SRH. The adjusted odds ratios (OR) of moderate SRH was higher among adolescents of parents with low labour market integration (OR: 1.5 95% CI: 1.3–1.6 for fathers and OR: 1.4 95% CI: 1.2–1.5 for mothers). Also, adolescents with moderate SRH had parents who were less integrated in the labour market and had more weeks on non-employment benefits compared with the adolescents, who reported high SRH. Conclusions Unstable LMA among parents affected SRH among their adolescent children, indicating a negative effect of labour market marginalization across generations.publishedVersio