International Journal of Diabetes and Clinical Research, 2015
Objectives: To investigate the relationship between diabetes, mortality and exit from work using ... more Objectives: To investigate the relationship between diabetes, mortality and exit from work using various Danish Pension schemes. Methods: We linked the Danish National Diabetes register with socioeconomic and population-based registers and followed prevalent and incident cases of diabetes for ten years, adjusting for gender, age and socio-occupational group. We analysed the proportion of individuals with diagnosed diabetes before and after entering a normal retirement pension , voluntary early retirement pension or disability pension. Risk ratios for entering pensions, emigration and mortality were calculated using Poisson regression. Results: Among 1,628,087 adults between the ages of 30 and 59, the relative risk for mortality was increased for those with incident and prevalent diabetes by 11-145%, compared to individuals without diabetes. Voluntary early retirement pension was the most common path out of the workforce, especially for individuals with diabetes. Compared to those without diabetes, the relative risk of disability retirement for individuals with prevalent and incident diabetes was 2.98 (95% CI, 2.89-3.07) and 2.40 (95% CI, 2.34-2.45), respectively. More than one fifth of participants were diagnosed with diabetes after retirement. There was a marked negative socio-occupational gradient for mortality, voluntary early retirement and disability pension. Conclusions: Increasing the retirement age will increase the proportion of workers who develop diabetes while still in the workforce. Since the number and severity of complications are related to longer disease duration, it is likely that, under proposed retirement reforms, more employees will experience health problems managing their jobs, especially among the most vulnerable socioeconomic groups. The aim of this study is to investigate how diabetes is related to exit from work, particularly through three Danish pension schemes, and to examine the proportion of diabetes that is diagnosed before and after entering each pension scheme. Methods Diabetes incidence is derived from the DNDR, which provides
Background: Interventions in occupational health often target worksites rather than individuals. ... more Background: Interventions in occupational health often target worksites rather than individuals. The objective of this paper is to describe the (lack of) stability in units of analysis in occupational health and safety intervention projects directed toward worksites. Methods: A case study approach is used to describe naturally occurring organizational changes in four, large, Nordic intervention projects that ran 3-5 years, covered 3-52 worksites, cost 0.25 mill-2.2 mill €, and involved 3-7 researchers. Results: In all four cases, high rates of closing, merging, moving, downsizing or restructuring was observed, and in all four cases at least one company/worksite experienced two or more reorganizations during the project period. If individual worksites remained, ownership or (for publicly owned) administrative or legal base often shifted. Forthcoming closure led employees and managers to seek employment at other worksites participating in the studies. Key employees involved in the intervention process often changed. Conclusion: Major changes were the rule rather than the exception. Frequent fundamental changes at worksites need to be taken into account when planning intervention studies and raises serious questions concerning design, analyses and interpretation of results. The frequent changes may also have deleterious implications for the potential effectiveness of many real life interventions directed toward worksites. We urge researchers and editors to prioritize this subject in order to improve the quality of future intervention research and preventive action.
During the past five decades occupational researchers have documented that bus drivers' health is... more During the past five decades occupational researchers have documented that bus drivers' health is worse than in almost any other profession. The authors suggest that the reason there has not been any successful attempt to change this situation is because the focus until now on removing statistically associated external risk factors has been too narrow. The article describes a project whose purpose was to improve the health and well-being of 3500 Copenhagen bus drivers. At the end, more than 200 interventions were implemented. The authors adopted a new approach of combining epidemiological results and qualitative methodologies, creating a broader explanatory foundation for action, linked by repetitive processes of critical reflection, which was central to defining problems, explaining causes, developing sufficiently effective interventions and measuring effects. The project revealed the importance of several new and potentially preventable factors involving such issues as lifestyle, private stressors and inappropriate management. During the project period an evaluative framework was developed to explore and measure the complex effects of multiple interventions. Three years after the interventions were launched, follow-ups revealed remarkable improvements such as reductions in stress and body pains, an increase in satisfaction, and improvements in management and the drivers' cabin. This article is the story of a methodological journey, from classical epidemiology to an approach combining the strengths of survey (broad coverage), qualitative methods (in-depth focus) followed by critical reflections and ending with action research.
This post-discharge survey showed that 15.7% had been treated with antibiotics, because of pus in... more This post-discharge survey showed that 15.7% had been treated with antibiotics, because of pus in the wound, 12.4% had to have the wound reopened and 6.6% experienced both these treatments.
Absiract. The compliance of practice to national guidelines on urethral catheter care has been ex... more Absiract. The compliance of practice to national guidelines on urethral catheter care has been examined. Questionnaires on the practices used with patients under their care were sent to 1350 nursing staff. Replies were received from 1153 individuals, 692 from hospitals, 345 from nursing homes and 116 from home care. While national guidelines stress the importance of maintaining a closed urine drainage system, the results revealed that 25.4% of respondents opened the drainage system to collect samples of urine for analysis, 57.9% to perform bladder washouts and 76% to change urine bags. 26% of respondents reported that they collected urine samples for routine bacteriological surveillance, a procedure considered unnecessary in the guidelines. 83% of staff reported that they washed their hands after emptying urine bags. Staff awareness of written guidelines for various aspects of catheter care ranged from 2 5 4 8 % in hospitals, 27-45% in nursing homes and 7-17% in home care. A marginal costs analysis was performed to estimate the economic consequences of non-compliance to the national guidelines.
Scandinavian journal of public health, Jan 9, 2016
This study aimed to combine three consecutive cohorts representative of the general working popul... more This study aimed to combine three consecutive cohorts representative of the general working population to estimate the lifestyle, work and health of the entire Danish working population and to explore the influence of these factors on socio-occupational inequality in relation to incident diabetes over ten years. This study linked the National Danish Diabetes Register with (a) three questionnaire rounds (1995, 2000, 2005) on work, health and lifestyle from the Danish Work Environment Cohort Study (DWECS) among 6823 representative Danish workers aged 30-59 years and (b) the different socio-occupational groups of the entire Danish population aged 30-59 years (n=1,833,756). The relative risk (RR) was calculated using a Poisson regression. In DWECS, none of the investigated job factors was associated with incident diabetes. Lifestyle factors in terms of smoking (RR = 1.35; 95% confidence interval (CI) 1.07-1.70), high body mass index (overweight RR = 2.81; 95% CI 2.11-3.74 and obesity RR...
There is still a solid foundation for a further reduction of surgical wound infections. Every twe... more There is still a solid foundation for a further reduction of surgical wound infections. Every twentieth surgical bed is occupied by a patient with this complication. Though three out of four wards register the infections, serious problems with the methods have been established. Thus, it would not be justifiable to use the current registrations for monitoring for clinical and administrative purposes. Death or serious health consequences are to many patients the reality after a wound infection; the social and economical costs are also important. Better systems for surveillance of infections or complications must be developed specifically for the Danish hospitals. The hygienic expertise must be strengthened. Increased resources based on long-term planning are required to prevent more wound infections. Hospital hygiene will be a suitable subject for quality improvement. The surgical specialties should be encouraged to settle standards for specific procedures as to acceptable levels of i...
This review describes health problems in persons primarily exposed to grain dust. The main epidem... more This review describes health problems in persons primarily exposed to grain dust. The main epidemiological investigations from the nineteen seventies and eighties are reviewed. The commonest complaints were mucus membrane irritation. In the majority of investigations, an excess incidence of chronic bronchitis was encountered and it cannot be disproved that asthma developed in a number of the employees. Influenza-like symptoms compatible with the organic dust syndrome have been described in several investigations from silos but allergic alveolitis has not been described in this branch. The latter condition has been encountered in farm workers working with mouldy grain. With dust concentrations of about the Danish threshold limit value, many health problems still occur. The following prophylactic measures are recommended: Effective drying of corn before storage, effective ventilation and cleaning and covering of dusty working procedures. Epidemiological investigations are proposed in ...
The aim of this study was to examine the extent and distribution of disability retirement among p... more The aim of this study was to examine the extent and distribution of disability retirement among people with diabetes in the workforce. Using four population registries, the study examined the relative rates of disability retirement among employees in Denmark over a 10-year period. The findings highlight that the risk of disability retirement increases as occupational status decreases. With an ageing workforce and increasing prevalence of diabetes, it is important to target primary, secondary and tertiary prevention to the groups that need it most in attempts to prolong the working lives of individuals.
Diabetic medicine : a journal of the British Diabetic Association, 2014
To contribute to the research on diabetes and social inequality by presenting national data on in... more To contribute to the research on diabetes and social inequality by presenting national data on incident diabetes mellitus, stratified according to socio-economic status. National registers were combined, linking socio-economic status with incident diabetes over a 10-year period (2001-2010). The study population comprised employees in Denmark aged 20-59 years at baseline. Poisson regression analysis was used to estimate socio-economic rate ratios. Excess fraction analysis was used to determine the proportion of cases that would not have occurred if morbidity rates in each socio-economic group had been as low as those in the reference group. Monte Carlo simulation was used to calculate 95% CIs for excess fraction estimates A total of 1 005 572 men and 951 039 women were included in the analysis. The follow-up yielded 43 439 cases in 9 533 199 person-years at risk among men and 29 266 cases in 9 163 405 person-years at risk among women. Using 'professionals' as a reference grou...
The amount of quality data continues to increase. To help prioritise resources for quality improv... more The amount of quality data continues to increase. To help prioritise resources for quality improvement, managers need thorough reviews to help them decide which indicators are most important to improve. The reality is that data is presented in piles of reports and hundreds of tables and graphs that are very time-consuming to go through and that rarely result in a simple comprehensive overview. This paper presents an empirically tested tool to create a simple overview of complex quality data. Data comes from a questionnaire-based patient satisfaction survey of 13,129 patients and 1,589 staff members at Ribe County Hospital. A method is described: how to use colour coding in order to present the results for 16 indicators, measured both by patients and three staff member groups, for 28 departments and 46 ambulatories, in one page. Data for mean satisfaction scores on all questions are shown for each department in a core map. Aggregated departmental mean satisfaction scores are then cal...
Two consecutive bedside prevalence studies of 455 surgical patients were made by the same infecti... more Two consecutive bedside prevalence studies of 455 surgical patients were made by the same infection control nurse in 15 surgical and gynaecological departments in eight Danish hospitals. Four point six percent had a deep and another 4.6% a superficial surgical wound infection (SWI). Two months after the second survey only one third of the infections were correctly recorded by the hospital routine surveillance of surgical wound infections (SWI). Registration systems that are simpler and more valid than the existing ones need to be developed. A follow-up was carried out with self-administered questionnaires in 2976 patients, of whom 1447 (48.6%) responded. A patient-diagnosed SWI was defined as an antibiotic treatment of a wound and/or a wound reopening by a health care professional. A total of 311 patients were treated for a SWI, 42% with antibiotics, 27% with wound reopening and 31% received both these treatments. Post-discharge surveillance cannot be recommended as a routine.
This study examined if surgical wound infections (SWI) result in a severe prognosis regarding gen... more This study examined if surgical wound infections (SWI) result in a severe prognosis regarding general health and increase the consumption of social resources. A group of 1301 patients were interviewed by self-administered questionnaires during 1993-1994, while operated during hospitalization in seven Danish hospitals. These patients were followed up at least once by similar questionnaires at a median time of 5.5 and 10.0 months postoperatively. The consequences of surgically diagnosed SWI were analyzed in a hospital cohort of 58 infected patients and 648 controls. Postdischarge infections were analyzed in a patient cohort of 263 cases and 767 controls. Changes in health was measured by the General Health Questionnaire, Activities of Daily Living index, and self-assessed health. Consumption of resources were estimated by reliance on assistance from family and friends, use of home services, and contacts to doctors. It was found that the long-term prognosis of general health was unaffe...
The aim of this study was to see if introduction of continuous monitoring of the incidence of sur... more The aim of this study was to see if introduction of continuous monitoring of the incidence of surgical wound infections would result in a reduction in the cumulated infection rates. Data from a Danish sentinel system, including more than 65,000 operations, are shown to be sufficiently representative to be used as the basis of a national surveillance system for surgical wound infections. The overall infection rates increased with age and with contamination of the wound. Antibiotic prophylaxis was used in 36% of the operations, with a higher fraction among elderly patients, and in contaminated or major operations. The length of stay was significantly and equally extended for patients with superficial or deep infections, compared to patients without wound infections. The results from 13 departments could be followed at least two years from the beginning of the registration. No general preventive effects of the continuous monitoring were found in these surgical units.
To evaluate the state of the surveillance of surgical infections in Denmark. To investigate wheth... more To evaluate the state of the surveillance of surgical infections in Denmark. To investigate whether a negative attitude to infection registration on the part of the chief surgeon is correlated to departments with no plans of recording their infections. Questionnaire sent to all surgical and gynaecological departments in Denmark. The National Centre for Hospital Hygiene, Statens Seruminstitut, Copenhagen, Spring 1991. 73 general, 34 orthopaedic, eight thoracic and vascular surgical departments, seven reconstructive, five neurosurgical, and 31 gynaecological departments. Kind of specialty, attitudes to infection registration, do register, plan to register, no plans to register, type of program, year of start of registration, satisfaction, problems and suggestive improvements. Out of 170 possible units, 65 were already recording their infection rates, 59 had plans to start registration, 34 had no plans to start, five did not state whether they had any plans to start, and seven units di...
International Journal of Behavioral Nutrition and Physical Activity, 2014
Background The concept of health promotion rests on aspirations aiming at enabling people to incr... more Background The concept of health promotion rests on aspirations aiming at enabling people to increase control over and improve their health. Health promotion action is facilitated in settings such as schools, homes and work places. As a contribution to the promotion of healthy lifestyles, we have further developed the setting approach in an effort to harmonise it with contemporary realities (and complexities) of health promotion and public health action. The paper introduces a modified concept, the supersetting approach, which builds on the optimised use of diverse and valuable resources embedded in local community settings and on the strengths of social interaction and local ownership as drivers of change processes. Interventions based on a supersetting approach are first and foremost characterised by being integrated, but also participatory, empowering, context-sensitive and knowledge-based. Based on a presentation of "Health and Local Community", a supersetting initiative addressing the prevention of lifestyle diseases in a Danish municipality, the paper discusses the potentials and challenges of supporting local community interventions using the supersetting approach. Discussion The supersetting approach is a further development of the setting approach in which the significance of integrated and coordinated actions together with a participatory approach are emphasised and important principles are specified, all of which contribute to the attainment of synergistic effects and sustainable impact of supersetting initiatives. The supersetting approach is an ecological approach, which places the individual in a social, environmental and cultural context, and calls for a holistic perspective to change potentials and developmental processes with a starting point in the circumstances of people's everyday life. The supersetting approach argues for optimised effectiveness of health promotion action through integrated efforts and long-lasting partnerships involving a diverse range of actors in public institutions, private enterprises, non-governmental organisations and civil society.
International Journal of Diabetes and Clinical Research, 2015
Objectives: To investigate the relationship between diabetes, mortality and exit from work using ... more Objectives: To investigate the relationship between diabetes, mortality and exit from work using various Danish Pension schemes. Methods: We linked the Danish National Diabetes register with socioeconomic and population-based registers and followed prevalent and incident cases of diabetes for ten years, adjusting for gender, age and socio-occupational group. We analysed the proportion of individuals with diagnosed diabetes before and after entering a normal retirement pension , voluntary early retirement pension or disability pension. Risk ratios for entering pensions, emigration and mortality were calculated using Poisson regression. Results: Among 1,628,087 adults between the ages of 30 and 59, the relative risk for mortality was increased for those with incident and prevalent diabetes by 11-145%, compared to individuals without diabetes. Voluntary early retirement pension was the most common path out of the workforce, especially for individuals with diabetes. Compared to those without diabetes, the relative risk of disability retirement for individuals with prevalent and incident diabetes was 2.98 (95% CI, 2.89-3.07) and 2.40 (95% CI, 2.34-2.45), respectively. More than one fifth of participants were diagnosed with diabetes after retirement. There was a marked negative socio-occupational gradient for mortality, voluntary early retirement and disability pension. Conclusions: Increasing the retirement age will increase the proportion of workers who develop diabetes while still in the workforce. Since the number and severity of complications are related to longer disease duration, it is likely that, under proposed retirement reforms, more employees will experience health problems managing their jobs, especially among the most vulnerable socioeconomic groups. The aim of this study is to investigate how diabetes is related to exit from work, particularly through three Danish pension schemes, and to examine the proportion of diabetes that is diagnosed before and after entering each pension scheme. Methods Diabetes incidence is derived from the DNDR, which provides
Background: Interventions in occupational health often target worksites rather than individuals. ... more Background: Interventions in occupational health often target worksites rather than individuals. The objective of this paper is to describe the (lack of) stability in units of analysis in occupational health and safety intervention projects directed toward worksites. Methods: A case study approach is used to describe naturally occurring organizational changes in four, large, Nordic intervention projects that ran 3-5 years, covered 3-52 worksites, cost 0.25 mill-2.2 mill €, and involved 3-7 researchers. Results: In all four cases, high rates of closing, merging, moving, downsizing or restructuring was observed, and in all four cases at least one company/worksite experienced two or more reorganizations during the project period. If individual worksites remained, ownership or (for publicly owned) administrative or legal base often shifted. Forthcoming closure led employees and managers to seek employment at other worksites participating in the studies. Key employees involved in the intervention process often changed. Conclusion: Major changes were the rule rather than the exception. Frequent fundamental changes at worksites need to be taken into account when planning intervention studies and raises serious questions concerning design, analyses and interpretation of results. The frequent changes may also have deleterious implications for the potential effectiveness of many real life interventions directed toward worksites. We urge researchers and editors to prioritize this subject in order to improve the quality of future intervention research and preventive action.
During the past five decades occupational researchers have documented that bus drivers' health is... more During the past five decades occupational researchers have documented that bus drivers' health is worse than in almost any other profession. The authors suggest that the reason there has not been any successful attempt to change this situation is because the focus until now on removing statistically associated external risk factors has been too narrow. The article describes a project whose purpose was to improve the health and well-being of 3500 Copenhagen bus drivers. At the end, more than 200 interventions were implemented. The authors adopted a new approach of combining epidemiological results and qualitative methodologies, creating a broader explanatory foundation for action, linked by repetitive processes of critical reflection, which was central to defining problems, explaining causes, developing sufficiently effective interventions and measuring effects. The project revealed the importance of several new and potentially preventable factors involving such issues as lifestyle, private stressors and inappropriate management. During the project period an evaluative framework was developed to explore and measure the complex effects of multiple interventions. Three years after the interventions were launched, follow-ups revealed remarkable improvements such as reductions in stress and body pains, an increase in satisfaction, and improvements in management and the drivers' cabin. This article is the story of a methodological journey, from classical epidemiology to an approach combining the strengths of survey (broad coverage), qualitative methods (in-depth focus) followed by critical reflections and ending with action research.
This post-discharge survey showed that 15.7% had been treated with antibiotics, because of pus in... more This post-discharge survey showed that 15.7% had been treated with antibiotics, because of pus in the wound, 12.4% had to have the wound reopened and 6.6% experienced both these treatments.
Absiract. The compliance of practice to national guidelines on urethral catheter care has been ex... more Absiract. The compliance of practice to national guidelines on urethral catheter care has been examined. Questionnaires on the practices used with patients under their care were sent to 1350 nursing staff. Replies were received from 1153 individuals, 692 from hospitals, 345 from nursing homes and 116 from home care. While national guidelines stress the importance of maintaining a closed urine drainage system, the results revealed that 25.4% of respondents opened the drainage system to collect samples of urine for analysis, 57.9% to perform bladder washouts and 76% to change urine bags. 26% of respondents reported that they collected urine samples for routine bacteriological surveillance, a procedure considered unnecessary in the guidelines. 83% of staff reported that they washed their hands after emptying urine bags. Staff awareness of written guidelines for various aspects of catheter care ranged from 2 5 4 8 % in hospitals, 27-45% in nursing homes and 7-17% in home care. A marginal costs analysis was performed to estimate the economic consequences of non-compliance to the national guidelines.
Scandinavian journal of public health, Jan 9, 2016
This study aimed to combine three consecutive cohorts representative of the general working popul... more This study aimed to combine three consecutive cohorts representative of the general working population to estimate the lifestyle, work and health of the entire Danish working population and to explore the influence of these factors on socio-occupational inequality in relation to incident diabetes over ten years. This study linked the National Danish Diabetes Register with (a) three questionnaire rounds (1995, 2000, 2005) on work, health and lifestyle from the Danish Work Environment Cohort Study (DWECS) among 6823 representative Danish workers aged 30-59 years and (b) the different socio-occupational groups of the entire Danish population aged 30-59 years (n=1,833,756). The relative risk (RR) was calculated using a Poisson regression. In DWECS, none of the investigated job factors was associated with incident diabetes. Lifestyle factors in terms of smoking (RR = 1.35; 95% confidence interval (CI) 1.07-1.70), high body mass index (overweight RR = 2.81; 95% CI 2.11-3.74 and obesity RR...
There is still a solid foundation for a further reduction of surgical wound infections. Every twe... more There is still a solid foundation for a further reduction of surgical wound infections. Every twentieth surgical bed is occupied by a patient with this complication. Though three out of four wards register the infections, serious problems with the methods have been established. Thus, it would not be justifiable to use the current registrations for monitoring for clinical and administrative purposes. Death or serious health consequences are to many patients the reality after a wound infection; the social and economical costs are also important. Better systems for surveillance of infections or complications must be developed specifically for the Danish hospitals. The hygienic expertise must be strengthened. Increased resources based on long-term planning are required to prevent more wound infections. Hospital hygiene will be a suitable subject for quality improvement. The surgical specialties should be encouraged to settle standards for specific procedures as to acceptable levels of i...
This review describes health problems in persons primarily exposed to grain dust. The main epidem... more This review describes health problems in persons primarily exposed to grain dust. The main epidemiological investigations from the nineteen seventies and eighties are reviewed. The commonest complaints were mucus membrane irritation. In the majority of investigations, an excess incidence of chronic bronchitis was encountered and it cannot be disproved that asthma developed in a number of the employees. Influenza-like symptoms compatible with the organic dust syndrome have been described in several investigations from silos but allergic alveolitis has not been described in this branch. The latter condition has been encountered in farm workers working with mouldy grain. With dust concentrations of about the Danish threshold limit value, many health problems still occur. The following prophylactic measures are recommended: Effective drying of corn before storage, effective ventilation and cleaning and covering of dusty working procedures. Epidemiological investigations are proposed in ...
The aim of this study was to examine the extent and distribution of disability retirement among p... more The aim of this study was to examine the extent and distribution of disability retirement among people with diabetes in the workforce. Using four population registries, the study examined the relative rates of disability retirement among employees in Denmark over a 10-year period. The findings highlight that the risk of disability retirement increases as occupational status decreases. With an ageing workforce and increasing prevalence of diabetes, it is important to target primary, secondary and tertiary prevention to the groups that need it most in attempts to prolong the working lives of individuals.
Diabetic medicine : a journal of the British Diabetic Association, 2014
To contribute to the research on diabetes and social inequality by presenting national data on in... more To contribute to the research on diabetes and social inequality by presenting national data on incident diabetes mellitus, stratified according to socio-economic status. National registers were combined, linking socio-economic status with incident diabetes over a 10-year period (2001-2010). The study population comprised employees in Denmark aged 20-59 years at baseline. Poisson regression analysis was used to estimate socio-economic rate ratios. Excess fraction analysis was used to determine the proportion of cases that would not have occurred if morbidity rates in each socio-economic group had been as low as those in the reference group. Monte Carlo simulation was used to calculate 95% CIs for excess fraction estimates A total of 1 005 572 men and 951 039 women were included in the analysis. The follow-up yielded 43 439 cases in 9 533 199 person-years at risk among men and 29 266 cases in 9 163 405 person-years at risk among women. Using 'professionals' as a reference grou...
The amount of quality data continues to increase. To help prioritise resources for quality improv... more The amount of quality data continues to increase. To help prioritise resources for quality improvement, managers need thorough reviews to help them decide which indicators are most important to improve. The reality is that data is presented in piles of reports and hundreds of tables and graphs that are very time-consuming to go through and that rarely result in a simple comprehensive overview. This paper presents an empirically tested tool to create a simple overview of complex quality data. Data comes from a questionnaire-based patient satisfaction survey of 13,129 patients and 1,589 staff members at Ribe County Hospital. A method is described: how to use colour coding in order to present the results for 16 indicators, measured both by patients and three staff member groups, for 28 departments and 46 ambulatories, in one page. Data for mean satisfaction scores on all questions are shown for each department in a core map. Aggregated departmental mean satisfaction scores are then cal...
Two consecutive bedside prevalence studies of 455 surgical patients were made by the same infecti... more Two consecutive bedside prevalence studies of 455 surgical patients were made by the same infection control nurse in 15 surgical and gynaecological departments in eight Danish hospitals. Four point six percent had a deep and another 4.6% a superficial surgical wound infection (SWI). Two months after the second survey only one third of the infections were correctly recorded by the hospital routine surveillance of surgical wound infections (SWI). Registration systems that are simpler and more valid than the existing ones need to be developed. A follow-up was carried out with self-administered questionnaires in 2976 patients, of whom 1447 (48.6%) responded. A patient-diagnosed SWI was defined as an antibiotic treatment of a wound and/or a wound reopening by a health care professional. A total of 311 patients were treated for a SWI, 42% with antibiotics, 27% with wound reopening and 31% received both these treatments. Post-discharge surveillance cannot be recommended as a routine.
This study examined if surgical wound infections (SWI) result in a severe prognosis regarding gen... more This study examined if surgical wound infections (SWI) result in a severe prognosis regarding general health and increase the consumption of social resources. A group of 1301 patients were interviewed by self-administered questionnaires during 1993-1994, while operated during hospitalization in seven Danish hospitals. These patients were followed up at least once by similar questionnaires at a median time of 5.5 and 10.0 months postoperatively. The consequences of surgically diagnosed SWI were analyzed in a hospital cohort of 58 infected patients and 648 controls. Postdischarge infections were analyzed in a patient cohort of 263 cases and 767 controls. Changes in health was measured by the General Health Questionnaire, Activities of Daily Living index, and self-assessed health. Consumption of resources were estimated by reliance on assistance from family and friends, use of home services, and contacts to doctors. It was found that the long-term prognosis of general health was unaffe...
The aim of this study was to see if introduction of continuous monitoring of the incidence of sur... more The aim of this study was to see if introduction of continuous monitoring of the incidence of surgical wound infections would result in a reduction in the cumulated infection rates. Data from a Danish sentinel system, including more than 65,000 operations, are shown to be sufficiently representative to be used as the basis of a national surveillance system for surgical wound infections. The overall infection rates increased with age and with contamination of the wound. Antibiotic prophylaxis was used in 36% of the operations, with a higher fraction among elderly patients, and in contaminated or major operations. The length of stay was significantly and equally extended for patients with superficial or deep infections, compared to patients without wound infections. The results from 13 departments could be followed at least two years from the beginning of the registration. No general preventive effects of the continuous monitoring were found in these surgical units.
To evaluate the state of the surveillance of surgical infections in Denmark. To investigate wheth... more To evaluate the state of the surveillance of surgical infections in Denmark. To investigate whether a negative attitude to infection registration on the part of the chief surgeon is correlated to departments with no plans of recording their infections. Questionnaire sent to all surgical and gynaecological departments in Denmark. The National Centre for Hospital Hygiene, Statens Seruminstitut, Copenhagen, Spring 1991. 73 general, 34 orthopaedic, eight thoracic and vascular surgical departments, seven reconstructive, five neurosurgical, and 31 gynaecological departments. Kind of specialty, attitudes to infection registration, do register, plan to register, no plans to register, type of program, year of start of registration, satisfaction, problems and suggestive improvements. Out of 170 possible units, 65 were already recording their infection rates, 59 had plans to start registration, 34 had no plans to start, five did not state whether they had any plans to start, and seven units di...
International Journal of Behavioral Nutrition and Physical Activity, 2014
Background The concept of health promotion rests on aspirations aiming at enabling people to incr... more Background The concept of health promotion rests on aspirations aiming at enabling people to increase control over and improve their health. Health promotion action is facilitated in settings such as schools, homes and work places. As a contribution to the promotion of healthy lifestyles, we have further developed the setting approach in an effort to harmonise it with contemporary realities (and complexities) of health promotion and public health action. The paper introduces a modified concept, the supersetting approach, which builds on the optimised use of diverse and valuable resources embedded in local community settings and on the strengths of social interaction and local ownership as drivers of change processes. Interventions based on a supersetting approach are first and foremost characterised by being integrated, but also participatory, empowering, context-sensitive and knowledge-based. Based on a presentation of "Health and Local Community", a supersetting initiative addressing the prevention of lifestyle diseases in a Danish municipality, the paper discusses the potentials and challenges of supporting local community interventions using the supersetting approach. Discussion The supersetting approach is a further development of the setting approach in which the significance of integrated and coordinated actions together with a participatory approach are emphasised and important principles are specified, all of which contribute to the attainment of synergistic effects and sustainable impact of supersetting initiatives. The supersetting approach is an ecological approach, which places the individual in a social, environmental and cultural context, and calls for a holistic perspective to change potentials and developmental processes with a starting point in the circumstances of people's everyday life. The supersetting approach argues for optimised effectiveness of health promotion action through integrated efforts and long-lasting partnerships involving a diverse range of actors in public institutions, private enterprises, non-governmental organisations and civil society.
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Papers by Kjeld Poulsen