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Biomedical subjects

Kirsti Malterud

Publications and source records attributed to Kirsti Malterud.

At least 19 recordsLinked to original sources
PubMed2007

[Has the obesity epidemic reached Norway?].

BACKGROUND: The prevalence of obesity has increased worldwide during the last decades. The goal of this article is to explore whether the obesity epidemic has reached Norway. MATERIAL AND METHODS: We have conducted a literature review where we identified and summarized recent population studies of prevalence, distribution and development trends of obesity among adults in Norway. We searched for articles from the last 5 years in PubMed, Google, Kvasir and Yahoo, with the search words "obes*", "prevalence" and "BMI". We included seven Norwegian population studies. RESULTS: In the studies from 2000-2003, the prevalence of obesity (BMI > or = 30) was 11-29% (median 19.5%) for men and 9-38% (median 20%) for women. The prevalence of obese men aged 40-45 years has increased steadily from 1965-69 until today. The prevalence of obese women decreased from 1965-69 to 1984 before it started to increase steadily up till 2000-2003. INTERPRETATION: Our review shows that the obesity epidemic has reached Norway, but the prevalence among all age groups should be established before we can determine the epidemic's extent.

Adult↗
PubMed2006

Coping with headache.

OBJECTIVE: To describe self-initiated actions and cognitive strategies used for coping by women who suffer from episodic tension-type headache. DESIGN: Qualitative data from focus-group interviews were analysed according to Giorgi's phenomenological approach, inspired by Lazarus's theory of coping. SUBJECTS: A total of 15 women with tension-type headache, 20-60 years old, were recruited to three different focus groups through newspaper advertising. RESULTS: To cope with episodic tension-type headache, rhythm and balance in actions like eating, drinking, and sleeping were essential. Several women used thermal modulation. Exercise was important. Taking charge of their own time, pace, and level of commitment and accepting the fact that they had to live with their headache were cognitive strategies used. IMPLICATIONS: The general practitioner should identify the woman's choice of actions and cognitive strategies to manage her headache, and support her coping skills.

Adaptation, Psychological↗
PubMed2006

Women at risk of coronary heart disease experience barriers to diagnosis and treatment: a qualitative interview study.

OBJECTIVE: To explore barriers in the health service to diagnosis and treatment experienced by women at increased risk of coronary heart disease (CHD). DESIGN: Qualitative study using semi-structured interviews. SETTING: Norway. SUBJECTS: Twenty women diagnosed with heterozygous familial hypercholesterolemia (FH) recruited through a lipid clinic. RESULTS: Women reported three specific barriers related to diagnosis and treatment of CHD. They had to struggle to take a cholesterol test; they experienced that their risk was being downplayed by doctors; and that their symptoms of CHD were misinterpreted when they consulted doctors for evaluation and treatment. CONCLUSION: Stereotyping CHD as a man's disease may result in barriers to diagnosis and treatment for women. Doctors should ask the patient about the family history of CHD if a concern about heart disease is on the patient's agenda.

Adolescent↗
PubMed2005

Making the invisible body visible. Bone scans, osteoporosis and women's bodily experiences.

The imaging technology of bone scans allows visualization of the bone structure, and determination of a numerical value. Both these are subjected to professional interpretation according to medical (epidemiological) evidence to estimate the individual's risk of fractures. But when bodily experience is challenged by a visual diagnosis, what effect does this have on an individual? The aim of this study was to explore women's bodily experiences after a bone scan and to analyse how the scan affects women's self-awareness, sense of bodily identity and integrity. We interviewed 16 Danish women (aged 61-63) who had had a bone scan for osteoporosis. The analysis was based on Merleau-Ponty's perspective of perception as an embodied experience in which bodily experience is understood to be the existential ground of culture and self. Women appeared to take the scan literally and planned their lives accordingly. They appeared to believe that the 'pictures' revealed some truth in themselves. The information supplied by the scan fostered a new body image. The women interpreted the scan result (a mark on a curve) to mean bodily fragility which they incorporated into their bodily perception. The embodiment of this new body image produced new symptom interpretations and preventive actions, including caution. The result of the bone scan and its cultural interpretation triggered a reconstruction of the body self as weak with reduced capacity. Women's interpretation of the bone scan reorganized their lived space and time, and their relations with others and themselves. Technological information about osteoporosis appeared to leave most affected women more uncertain and restricted rather than empowered. The findings raise some fundamental questions concerning the use of medical technology for the prevention of asymptomatic disorders.

Body Image↗
PubMed2005

[Is Norwegian public health policy going to be more individual-oriented?].

BACKGROUND: According to a recent Danish study, public health policies in Sweden and Denmark have become more oriented towards the individual over the last few years. We wanted to explore the development in Norway over the last decade. MATERIAL AND METHODS: Changes in policy have been identified by comparing arguments about motives, definitions and strategies in two government white papers on public health from 1993 and 2003. RESULTS AND INTERPRETATION: Both white papers discuss public health policy in a broad sense, not only the state of the health and social services. We find that the 2003 paper focused on the individual's responsibility for his or her own health; the 1993 paper was more about institutions and structures. We conclude that Norwegian policy in this field has an increasing focus on the individual. At the same time we observe a greater concern over social inequality in relation to health.

Health Policy↗
PubMed2005

Why did I get chronic fatigue syndrome? A qualitative interview study of causal attributions in women patients.

OBJECTIVES: To explore causal attributions among women with chronic fatigue syndrome (CFS). DESIGN: Qualitative study where data from individual semi-structured interviews were analysed according to Malterud's systematic text condensation. SETTING: Bergen, Norway. SUBJECTS: A purposeful sample of eight women aged 25-55, recruited among members of a self-help organization. MAIN OUTCOME MEASURES: Accounts of causal attribution for CFS among the informants, focusing on gender. RESULTS: The participants agreed that their way of living could have increased the vulnerability of their resistance resources. Pressure they put upon themselves, workload burdens without subsequent relaxation, emotional conflicts, or preparing for assumed problem-solving were mentioned as gendered dimensions. They presented different explanations regarding potential triggers encountering their fragile immune systems, most often a virus infection. The participants thought women might have a weaker immune system than men, or that CFS was caused by a virus that women are more likely to catch. In their experience, their symptoms were activated when people put pressure on them, such that they might be nervous as to whether they could live up to the demands of their surroundings, and in the case of emotional strain related to family and work. CONCLUSION: More studies are needed exploring hypotheses concerning the complex interplay between molecular predispositions and more or less gendered lifestyle issues in CFS. Doctors need to challenge their strong beliefs regarding medically unexplained conditions, where facts still remain unresolved. Recognizing this, the doctor may provide realistic support and advice, and contribute to the establishment of common ground for understanding and managing the condition.

Adult↗
PubMed2005

Long-term impact of elevated cardiovascular risk detected by screening. A qualitative interview study.

OBJECTIVE: To explore how persons with an elevated cardiovascular risk score (CRS) balanced health-related advice against the life they wanted to live or were able to live. SETTING: 2000 Danes aged 30-50 were invited to participate in a health-screening project in general practice. Screenings were conducted at baseline and after one and five years, and included among other screening procedures a calculation of CRS (see Figure 1). DESIGN: Participants with an elevated CRS were asked to participate in a qualitative semi-structured interview. They were selected by stratified purposeful sampling reflecting variations in age, sex. and perceived health. SUBJECTS: Nine men and five women aged 33-50 years. THEORETICAL FRAMES OF REFERENCE: Bandura's theory of self-efficacy and the Health Belief Model's consideration of individuals' cues to act against a health threat supported analysis. RESULTS: Being informed about an elevated CRS had a considerable impact on the informants. They initiated significant lifestyle changes, though only to a limited degree when such changes would affect their quality of life adversely. In cases where other results of the multiphasic screening were normal, interpreted as such, or if there were stressful circumstances in the informant's life, the elevated CRS receded into the background. INTERPRETATION: Doctors, who inform individuals about the impact of risk factors, need to know that the consequences and health advice are not always interpreted by laypeople as supposed by the medical culture.

Adult↗
PubMed2005

Awareness of risk of osteoporosis may cause uncertainty and worry in menopausal women.

AIMS: A study was undertaken to explore how menopausal women are affected by awareness of potential risk of osteoporosis. METHODS: A qualitative interview study, including analysis of in-depth interviews with 17 women who independently gave views on risk, out of 24 women interviewed about their menopausal symptoms. The women were selected on the basis of a survey including 1261 women chosen at random, to cover a broad spectrum of Danish women, their menopausal experiences, and contact with the healthcare system. The study was part of a larger project targeting menopause. RESULTS: Awareness of osteoporosis risk caused a feeling of uncertainty and worry in some women. Only women reacting in this way seemed to act in order to prevent future fractures. The affected women were puzzled to realize that risk-reducing medication could introduce new hazards. Most of the women had heard about osteoporosis related to menopause as culturally embedded knowledge. CONCLUSIONS: Making individual women uncertain and worried must be considered a potentially serious side effect of health promotion. The findings raise the question of whether introducing healthy people to the threat of future diseases is ethically justifiable. As hormonal treatment is no longer recommended for long-term use, it is suggested that the strong link between osteoporosis and menopause should be toned down when counselling menopausal women.

Aged↗
PubMed2005

"The pain isn't as disabling as it used to be": how can the patient experience empowerment instead of vulnerability in the consultation?

AIM: This study explores how doctors can help patients transform vulnerability into strength, instead of increasing a feeling of disempowerment. METHODS: The authors analysed their findings from four previously written articles based on qualitative interviews with 10 women with chronic pain, comparing the reported negative consultation experiences with the beneficial effects of good treatment experiences, in order to identify potentials for change. RESULTS: Altering the way in which the women are encountered may empower and help them deal with a painful life. Doctors can challenge stereotyped macro-structures of women's "unexplained" pain as hysteria by admitting the shortcomings of medical knowledge. The blame is then put on the medical discipline instead of the individual patient who presents bodily symptoms or reveals help-seeking behaviour that does not fit with biomedical expectations of what illness is and how it should be performed. Thus, the vulnerable position described by the patients can be converted or transformed into strength or resources in spaces that promote empowerment through recognition. CONCLUSION: Although doctors may feel helpless or puzzled in the consultation, they must take the responsibility for turning the consultation into a space for empowerment of the patient.

Adaptation, Psychological↗
PubMed2004

[Cardiopulmonary resuscitation in municipal health services--a simple program for training and maintenance].

BACKGROUND: Cardiopulmonary resuscitation (CPR) with defibrillation may be a life-saving procedure. We present a course for CPR training and skills preservation developed by local paramedics and GPs and aimed at primary care professionals. MATERIAL AND METHODS: In a three-hour course programme for 10-16 participants we simulate emergency scenarios with an advanced computerised phantom as patient. Participants work in teams with physicians, ambulance personnel and nurses responsible for defibrillation and medication, with the other participants providing basic cardiopulmonary resuscitation. Constructive feedback based on the national guidelines follows every training session. Instructors are the ambulance leader and a GP. RESULTS AND INTERPRETATION: The training is well received and courses fully booked. The optimal number of physicians is two to four. The success of the course suggests that there is a motivation for quality improvement in CPR in Norwegian local communities.

Cardiopulmonary Resuscitation↗