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Biomedical subjects

Frede Olesen

Publications and source records attributed to Frede Olesen.

At least 37 records · Page 2Linked to original sources
PubMed2005

Mental disorders in primary care: prevalence and co-morbidity among disorders. results from the functional illness in primary care (FIP) study.

BACKGROUND: Prevalence and co-occurrence of mental disorders is high among patients consulting their family general practitioner (GP) for a new health problem, but data on diagnostics and socio-demographics are sketchy. METHOD: A cross-sectional two-phase epidemiological study. A total of 1785 consecutive patients with new complaints, aged 18-65 years, consulting 28 family practices during March-April 2000 in Aarhus County, Denmark were screened, in the waiting room, for mental and somatic symptoms with SCL-8 and SCL-Somatization questionnaires, for illness worry with Whitely-7 and for alcohol dependency with CAGE. In a stratified random sample of 701 patients, physician interviewers established ICD-10 diagnoses using the SCAN interview. Prevalence was calculated using weighted logistic regression, thus correcting for sample skewness. RESULTS: Half of the patients fulfilled criteria for an ICD-10 mental disorders and a third of these for more than one group of disorders. Women had higher prevalence of somatization disorder and overall mental disorders than men. Men had higher prevalence of alcohol abuse and hypochondriasis than women. Psychiatric morbidity tended to increase with age. Prevalence of somatoform disorders was 35.9% (95% CI 30.4-41.9), anxiety disorders 164% (95% CI 12.7-20.9), mood disorders 13.5% (95% CI 11.1-16.3), organic mental disorders 3.1% (95% CI 1.6-5.7) and alcohol abuse 2.2% (95% CI 1.5-3.1). Co-morbidities between these groups were highest for anxiety disorders, where 89% also had another mental diagnosis, and lowest for somatoform disorders with 39%. CONCLUSIONS: ICD-10 mental disorders are very prevalent in primary care and there is a high co-occurrence between most disorders. Somatoform disorders, however, more often than not exist without other mental disorders.

Adult↗
PubMed2005

Somatization, heartsink patients, or functional somatic symptoms? Towards a clinical useful classification in primary health care.

Several definitions of somatization exist and try to deal with the fundamental problem that a large group of patients present with physical symptoms for which a conventional pathology cannot be identified. However, the concept remains somewhat confusing. The prevalence of somatization is high in general practice. Nevertheless, patients do not receive proper treatment and risk iatrogenic somatic fixation and harm, the doctor-patient relationship is often negatively affected and the overall healthcare system suffers from high expenditure on unnecessary physical investigations and treatments. During the last decade research has shown that somatization may be treated effectively in specialist care. Little is known about effective treatment in primary care but the Reattribution Model and the Extended Reattribution and Management Model have shown promising results. The development and evaluation of new treatment strategies is, however, hampered by the confusion of definitions and concepts. In this article an overview is presented of the various concepts relevant to the clinical work and research in primary health care. It is important to realize that somatizing patients in primary health care present a broader spectrum of severity than patients seen in a specialist setting. Hence, primary care cannot apply definitions from specialist care directly but needs a definition that also includes the mild cases. We need classifications and agreed definitions applicable in primary health care in order to develop appropriate management strategies, to predict prognosis, and to enable rigorous research concerning the large group of somatizing patients in primary health care.

Concept Formation↗
PubMed2005

Classification of somatization and functional somatic symptoms in primary care.

OBJECTIVE: A substantial proportion of patients found in primary care complain of physical symptoms not attributable to any known conventionally defined disorder, that is, medically unexplained or functional somatic symptoms. The objective of this paper is to outline the problems with the current classification and propose a classification more suitable for primary health care. METHOD: We refer to and discuss relevant literature including papers on our own research on the topic in the light of our experiences from major projects on somatizing patients in primary health care. RESULTS: Functional somatic symptoms may impose severe suffering on the patient and are costly for society because of high health-care utilization, lost working years and social expenses. At present, studies on functional somatic symptoms and disorders and their treatment are hampered by lack of a valid and reliable diagnostic classification. The diagnostic categories of somatoform disorders are overlapping. Thus, the present situation is that patients with identical symptoms and clinical pictures may receive different diagnostic labels depending on the focus of interests of the assessing physician. A particular problem in primary care is that the somatoform diagnostic categories only include persistent cases and do not offer the opportunity for classification of the patients with short-symptom duration found in this setting. We present a framework for a new descriptive classification of functional somatic symptoms and unfounded illness worrying, and outline a new classification that covers the whole spectrum of severity seen in clinical practice. CONCLUSION: A precondition for an appropriate management of patients with functional somatic symptoms is a valid taxonomy common for all medical specialties facilitating cooperative care. Classification systems as outlined in this paper may be a candidate for such a system, but it should be subject to further evaluation in research.

Humans↗
PubMed2005

Social environment and frequent attendance in Danish general practice.

BACKGROUND: A lack of social support is associated with increased morbidity and mortality and a decreased effect of prevention. Frequent attenders to primary care are characterised by poorer social conditions than other patients in general practice, but we do not know whether this is due to social inequalities in health or whether social factors in themselves determine the use of general practice. AIM: To examine if social factors are associated with frequent attendance in general practice after adjusting for physical and psychological health variables. DESIGN OF STUDY: Population-based cross-sectional survey. SETTING: Two hundred and twenty GPs in 132 practices in the county of Aarhus, Denmark, and the listed adult population (aged 20-64 years). METHOD: A sample of frequent attenders and infrequent attenders was drawn. The study included only those resident in the county and who had consulted a GP during the period November 1997-October 1998. A questionnaire about physical, psychological and social factors was sent to the patients. The associations between social factors and frequent attendance were adjusted for physical and psychological health and tendency towards somatisation. RESULTS: A total of 1423 (73.7%) frequent attenders and 1103 (74.9%) infrequent attenders responded. Male frequent attendance was associated, with statistical significance, with living alone and being without work or on a disability pension. Among women, lack of professional education or being without work tended to increase the likelihood of frequent attendance. CONCLUSION: This study shows that for men, social factors may in themselves determine the use of general practice. None of the investigated social factors seemed to restrict the use of general practice.

Adult↗
PubMed2004

Physical, mental and social factors associated with frequent attendance in Danish general practice. A population-based cross-sectional study.

Knowledge of which factors are prompting patients to seek primary care is important to the ongoing effort to improve management in general, and management of frequent attenders (FAs) in particular. We conducted a cross-sectional population-based study with the aim at examining associations between physical, mental and social factors and frequent attendance in general practice. We collected questionnaire and registry data in the County of Aarhus (630,000 inhabitants), Denmark. Half of the county general practices (132 practices, 220 GPs) were selected randomly. FAs were defined as the top 10% attenders over the past 12 months. A questionnaire including SF-36 and questions about physical and mental health and social conditions was sent to age and gender stratified samples of FAs and non-FAs from these practices. Impairments (SF-36) associated with frequent attendance were physical in 54-71% (prevalence difference (PD): 16-33%, adjusted prevalence ratio (adj. PR): 1.1-1.7), mental in 58-70% (PD: 17-25%, adj. PR:1.1-1.4) and social in 40-59% (PD: 13-28%, adj. PR:0.9-1.5). Among FAs, 46-88% had used three or more different drugs (PD: 26-39%, adj. PR:1.5-2.3) and 27-41% had been referred one or more times to outpatient specialists (PD: 4-19%, adj. PR:1.2-2.5). Although our data cannot determine the direction of causality, they clearly demonstrate that FAs carry a large burden of physical, mental and social impairments which underpins the complexity and heterogeneity of the problems which they present. The results make clear that biopsychosocial management is a core issue in FA management in general practice.

Adult↗
PubMed2004

Is there an association between rumination and self-reported physical health? A one-year follow-up in a young and an elderly sample.

Cross-sectional studies have suggested an association between rumination and subjective health. The aim of the present study was to investigate in a longitudinal design whether rumination was related to self-reported physical health. A total of 96 young (age range 20-35) and 110 elderly (age range 70-85) participants completed questionnaires measuring rumination, negative affect, life events, and self-reported physical health at baseline and at 1-year follow-up. Multiple linear regressions showed a significant association between self-reported physical health at time I only for the elderly and negative affect mediated the association. At follow-up, rumination was significantly associated with self-reported physical health only for the young and the association was only partly mediated by negative affect. In conclusion, rumination is associated with poorer self-reported physical health, but the association depends on the age of the individual as well as time span studied.

Adaptation, Psychological↗
PubMed2004

Intervention among frequent attenders of the out-of-hours service: a stratified cluster randomized controlled trial.

OBJECTIVE: To investigate whether the number of frequent attenders (FA) contacts with the out-of-hours service can be reduced by deploying a combination of intervention strategies. DESIGN: A stratified cluster randomized controlled trial, each cluster containing a general practice and all its listed patients. SETTING: The out-of-hours service in the county of Northern Jutland (490,000 inhabitants), Denmark. INTERVENTIONS: The following intervention strategies were deployed: predisposition, individual instruction, economic incitement, continuing medical education meetings, feedback/reminder, and patient-mediated intervention. SUBJECTS: An intervention group of 3500 patients and a control group of 4635 patients. MAIN OUTCOME MEASURES: Absolute and relative fall in the number of contacts with the out-of-hours service per patient after 6 and 12 months. RESULTS: Analysed by group, intervention patients saw a more pronounced decline in the number of contacts than controls, except for two outcomes. However, this difference was only significant after 12 months. For women aged 17-66 years with 5-9 contacts during the previous 12 months, the decrease was significantly more pronounced in the intervention group for all outcomes (p=0.004-0.042). However, for the rest of the subgroups the effect varied more, and in several cases it was more distinct in the control group. CONCLUSION: The data collected point towards an effect of intervention on the use of out-of-hours services even if the responses obtained were not uniform and unequivocal. However, one has to consider the problems of multiple comparisons and in conclusion no convincing effect of the intervention was found.

Adolescent↗
PubMed2004

Variation in proportion of frequent attenders between Danish general practices.

AIM: The authors examined the inter-practice variation in the proportion of adult frequent attenders and whether practice factors may explain some of this variation. METHODS: A population-based cross-sectional study was performed on the basis of registers including 262 active general practices and their 419,072 registered adults aged 20 and over in the County of Aarhus, Denmark (630,000 inhabitants) from November 1997 to October 1998. The number of face-to-face daytime contacts with general practitioners was counted for each individual on the basis of data drawn from the files of the National Health Service. Frequent attenders were defined as the 10% most frequent attenders in the county over 12 months for each sex, and four age groups. Both the crude and standardized proportions of frequent attenders in each practice were calculated. Associations between practice factors and the frequent attender proportions were assessed from the squared partial correlation coefficients. RESULTS: The proportion of frequent attenders ranged from 1.9 to 26.2% (factor 13.8) (standardized: 1.6 to 27.8% (factor 17.4)) with 10th to 90th percentiles of 4.4 to 12.9% (factor 2.9) (standardized: 4.3 to 13.2% (factor 3.1)). A low standardized proportion of frequent attenders was statistically significantly associated with a high degree of urbanization, a large number of registered individuals per GP and female GP (multiple R(2) > 0.16 for all practices and 0.22 for solo practices). CONCLUSIONS: Variation in the proportion of frequent attenders was considerable between practices and about one-fifth of this variation could be explained by practice factors.

Adult↗