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Biomedical subjects

H Hollnagel

Publications and source records attributed to H Hollnagel.

At least 19 recordsLinked to original sources
PubMed2001

The purpose of the general practice consultation from the patient's perspective--theoretical aspects.

BACKGROUND: Medical practice and research are paying increasing attention to what patients want, as reflected by the growth of routine surveys of patients' satisfaction and more formal studies of patients' views of medical care. However, the field lacks conceptual clarity. OBJECTIVES: The aim of this study was to propose a theoretical clarification of the concept of the patients' purpose of a consultation by presenting a patient-centred definition, applicable for clinical work and research in general practice. METHODS: An extensive literature review was conducted to explore presumptions and definitions reported by previous studies. Most authors failed to define or distinguish the concept under investigation. We took these shortcomings as our starting point, added some significant dimensions drawn from a few selected authors who had discussed relevant perspectives in their work and arrived at a proposed working definition of the 'purpose' concept. RESULTS: The proposed definition allows for multiple purposes for the consultation. We incorporate what the patient hopes to gain from the consultation, as opposed to their 'expectations of the most likely outcome'. Our working definition aims to identify patients' a priori wishes and hopes for a specific process and outcome, while acknowledging that these may not be voiced and may be modified by the patient during the consultation. General characteristics of the doctor, such as being considerate or professionally skillful, are not included.

Communication↗
PubMed2001

Gendered health resources and coping--a study from general practice.

AIM: The aim of this study was to explore gender and coping in primary health care patients, by comparing self-assessed health resources in men and women. METHODS: Female and male patients' self-assessed health resources were identified by mean of key questions, developed separately for men and women. Patients' answers were audiotaped and analyzed qualitatively. An explorative gender comparative analysis was done. The setting comprised two women GPs and their consultations. The subjects were 37 consecutive female patients and 39 consecutive male patients aged 19-85 years. RESULTS: The analysis indicated notable differences in spite of apparent similarities in self-assessed personal health resources in men and women. In men, personal strength was part of a proud identity, while women reported that they were able to manage because they just had to. Work was often mentioned as a health resource, but while men emphasized their well-being at work and a capacity to relax at home, women handled stressful tensions by diving into household activities. While men spoke of gaining health from being with others, women talked about social relations as contexts for gaining as well as giving health. CONCLUSION: None of the phenomena described by the respondents can be reasonably categorized as respectively problem-focused, emotion-focused or avoidance coping strategies. Asking people about their own ideas regarding health resources may provide more complex understandings of coping and gender. In a clinical setting skilful listening can prevent gender essentialism, where all men are regarded as different from all women.

Adaptation, Psychological↗
PubMed2000

From risk factors to health resources in medical practice.

The healing and preventive powers of people's health resources and self-assessed knowledge have so far been grossly underestimated in medicine. In this article, we call attention to ethical and epistemological dilemmas related to knowledge, values, communication, and autonomy embedded in the prevailing risk-oriented epidemiology, and suggest a patient-centred salutogenetic approach to promote a better balance between resources and risks in medicine. Identification and intervention upon risk factors can provide hypotheses about origins of disease and predict and sometimes prevent disease at a group level. However, there are several pitfalls related to this perspective concerning causal factors, group level based possibilities, adequate end points for intervention, informed consent, and medicalization, especially in the individualized context of the clinical encounter. By introducing a salutogenic perspective, we urge to shift the attention toward resources, agency and strength, which may counteract risk of disease and empower the patient. Talk can mediate oppression as well as empowerment. A communicative key question approach, and self-assessed health resources identified through this strategy, are briefly presented as examples of empowerment through dialogue.

Communication↗
PubMed2000

Men's self-assessed personal health resources: approaching patients' strong points in general practice.

OBJECTIVE: To explore resource-oriented, gender-sensitive approaches in general practice by identifying what men perceive to be their personal health resources. METHODS: A key question was developed to invite men to tell their GPs about personal health resources during ordinary visits. The answers of 39 consecutive male patients (aged 19-84 years) visiting two female GPs were audio taped and analysed, qualitatively inspired by Giorgi's phenomenological approach, supported by theories on salutogenesis, patient-centredness and gender perspectives. The main outcome measures were personal qualities and strategies considered by men to be their health resources. RESULTS: Men considered that the following were personal health resources: optimism, good self-esteem, job satisfaction, ability to cope with stress at work, leisure activities and relaxation with friends producing energy, and fitness and lifestyle activities. CONCLUSION: A key question can give a doctor access to men's thoughts about their strong points. Self-assessed personal health resources can be identified and mobilized by the GP and support a salutogenic approach, which contrasts with the tendency of contemporary medical practice to focus on risk. Asking people about their own ideas may reveal that coping patterns are more complex than reflected in prevailing research.

Adaptation, Psychological↗
PubMed1999

[Individual registration of children in the national health service. New possibilities for epidemiological research in primary health care].

Since January 1st 1996 all Danish citizens, children included, have been recorded individually in The National Health Service Register (SSR). Services rendered to children are no longer registered with an adult person. This article describes the implementation of this new arrangement. The part of health services to children recorded under an adult personal identification number is getting asymptotically closer to a minimum of about four percent, which is determined by the average time of naming of children. After the introduction of individual registration of children the SSR has improved considerably as a basis for epidemiological studies in Danish primary care.

Adult↗
PubMed1999

Encouraging the strengths of women patients. A case study from general practice on empowering dialogues.

This case study illustrates how the use of empowering dialogues in general practice can contribute to alternative images of women, by identifying and emphasizing their strong points. It is a single case study, sampled theoretically from a series of 37 consultations during which key questions about self-assessed health resources were put to women patients. Two women GPs and their consultations were studied. An 18-min dialogue between a 52-year-old woman GP and a 69-year-old woman patient with asthma and back pain was audiotaped and transcribed according to Nessa's principles, supported by pragmatic linguistic theory. The woman's answers changed the doctor's perception of the patient, from that of a passive and resigned sufferer, to that of a strong woman who was active in spite of her pain. Acknowledging this, alternative paths of management could be chosen. In conclusion, disempowering medicalization of women patients can be opposed by resource oriented dialogues in clinical work. However, to change cultural images requires more than individual action.

Adult↗
PubMed1998

[Self-rated health as a predictor of ischemic heart disease development].

The study objective was to analyse the association between self-rated health and the incidence of fatal and non-fatal coronary heart disease in a Danish cohort followed up over 16 years. The study included 1052 men and women born in 1936. During the 16 years' follow-up 50 cases of coronary heart disease were registered either with the Danish register of deaths or the register of hospital admissions. Univariate analysis showed the following relative risks of coronary heart disease in the four self-rated health groups: "extremely good": 1.0, "good": 4.0, "poor": 5.8, "miserable": 12.1 (p = 0.02). After control for the conventional coronary risk factors and a substantial number of other potential confounders the relative risks were: 1.0, 4.2, 6.5, and 18.6 (p = 0.02) respectively. Self-rated health was an independent predictor of coronary heart disease in this recent cohort. If confirmed, the association between self-rated health and coronary heart disease may lead to new insights into psychosocial processes leading to this disease.

Aged↗
PubMed1998

Talking with women about personal health resources in general practice. Key questions about salutogenesis.

We want to share experiences from an approach for clinical communication and research, intended to identify and mobilize personal health resources in female patients, and promote strategies for resource oriented talk in general practice. We used an action research design with qualitative evaluation to summarize the process where we developed a key question about self-assessed health resources in women, based on The Health Resource/Risk Balance Model, including salutogenesis, patient-centredness and gender perspectives. From consultations with 49 female patients in our own practices, we have drawn a narrative description of the development process, a summary of issues that facilitated resource talk, and our final version of the key question. We suggest that resource talk is based on 1) an explicit shift of language from disease to health, but nevertheless recognizing the fact that illness occurs, 2) options for answers given by the female patient and not by the doctor, 3) signification of the woman's assessment of her own situation (in contrast to the doctor's assessment), and 4) taking for granted that women's personal health resources exist as numerous strategies which are utilized, and may be identified. We have learnt that communicative action can provide tools for shifting the attention of doctor and patients from risks and diseases to resources and strengths. This is an example of one way to change your practice through systematic reflection in dialogue with a colleague.

Attitude to Health↗
PubMed1997

Social and biological predictors of early menopause: a model for premature aging.

OBJECTIVES: To investigate possible social, lifestyle-related and biological predictors of early menopause in middle-aged women, followed prospectively for 11 years. DESIGN: A prospective, population-based, cohort follow-up, observational study. SETTING: Glostrup Hospital, Copenhagen, Denmark. SUBJECTS: A total of 493 female subjects, all aged 40 years at baseline, and divided into three groups according to self-reported menopausal age (40-45, 46-51, 51+ years), after 12 months of amenorrhoea. Women having had medical or surgical interventions to influence menopausal state were excluded. MAIN OUTCOME MEASURES: Body mass index, glucose, insulin, lipids, creatinine, uric acid, thyroid-stimulating hormone (TSH), lung function tests (forced VC, FEV1, peak flow), blood pressure; a self-administered questionnaire with questions on psychosocial variables, lifestyle, and self-rated health. RESULTS: An early menopausal age correlated in an univariate way with impaired lung function, increased smoking habits and low social class (in childhood or present), as well as with a feeling of tiredness, all measured at the baseline investigation. On the contrary, a later menopausal age correlated with higher serum insulin and uric acid levels. In multiple regression analysis, with menopausal age as the dependent variable, it was found that smoking habits (number of years smoking) was inversely (P < 0.001), and insulin as well as uric acid were positively (P < 0.05) correlated with menopausal age. CONCLUSIONS: Females who smoke run an increased risk of early menopause, whereas relative hyperinsulinaemia is independently associated with later menopause. At the age of 40 years, high insulin levels in females might be just a marker for normal female sex hormone physiology, not for insulin resistance, as seen in postmenopausal female subjects. Early menopause might be useful as a potential model of premature ageing.

Adult↗
PubMed1997

Women's self-assessed personal health resources.

OBJECTIVE: To contribute to the development of a resource-oriented medical language by identifying self-assessed personal health resources in women. DESIGN: Key questions were developed to invite the patient to tell the general practitioner about such resources. Patients' answers were audiotaped and analysed qualitatively according to Giorgi's phenomenological approach. The theoretical frame of reference included salutogenesis, patient-centredness, and gender perspectives. SETTING: Two female general practitioners and their consultations. SUBJECTS: 37 consecutive female patients aged 24-85 years. MAIN OUTCOME MEASURES: Common aspects of personal qualities and strategies considered by women as their health resources. RESULTS: The material unveiled health resources related to 1) internal strength mobilized by external strain, 2) interactive networks within and outside the family, 3) lifestyle practices, 4) physical and social activity, 5) acceptance and facilitation of the natural course of Disease, and 6) constitution. CONCLUSION: Female patients have explicit and intelligible ideas about their self-assessed personal health resources, which can be identified and mobilized by the general practitioner and form part of potentially empowering strategies in medical practice.

Adaptation, Psychological↗
PubMed1997

The Danish National Health Service Register. A tool for primary health care research.

The purpose of the article is to describe the Danish National Health Service Register and its value in primary health care research, using mainly general practice as an example. The Danish National Health Service Register is a data system available for counties and municipalities to manage the National Health Insurance covering primary health care providers. The counties use the register for administrative purposes, especially for the settling of accounts with providers. The register contains data on all citizens, providers, and health care services reimbursed by the health authorities, but holds no data regarding health status. The accuracy and degree of completeness of persons and variables in the National Health Service Register rests on the fact that most primary health care services in Denmark are reimbursed and, therefore, included in the data base. This tie to the economy of both health care authorities and providers is supposed to confer the final register with a high degree of completeness. It is a clear advantage that almost all citizens in Denmark are assigned to only one general practice, and that the attitude towards research is positive among Danish patients and doctors. The register has so far only been used occasionally for research purposes. To take advantage of the register for research purposes within clinical and health services research, however, one must possess not only a detailed knowledge of the Danish society, including the structure of the Danish health care system, but also an intimate acquaintance with rather complex agreement system and the actual interpretation of this.

Denmark↗
PubMed1997

[From risk factors to health resources. From theory to medical practice].

In this article, we emphasize some of the problems related to the choice of risk factor identification and intervention as the dominant medical strategy for diagnosis, treatment and prevention of disease. Knowledge about risk factors can provide hypotheses about origins of disease and predict disease at a group level. However, there are several pitfalls related to this perspective concerning causal factors, end points, informed consent, group level based possibilities and medicalization. A salutogenic perspective shifts the attention toward resources which might counteract risk of disease. Increased attention to people's personal health resources--assessed by the doctor as well as by the person herself--can contribute to a better balance in medical theory and practice by stimulating the strength of people rather than looking only for weaknesses.

Health Resources↗
PubMed1996

Self rated health as a predictor of coronary heart disease in Copenhagen, Denmark.

STUDY OBJECTIVE: To analyse the association between self rated health and the incidence of fatal and non-fatal coronary heart disease (CHD) in a Danish cohort followed up over 16 years. DESIGN: This was a prospective epidemiological follow up study. SETTING: A cohort from the County of Copenhagen, Denmark. PARTICIPANTS: The study included 1052 men and women born in 1936. During the 16 years' follow up 50 cases of CHD were registered in either the Danish register of deaths or the register of hospital admissions. MAIN RESULTS: Univariate analysis showed the following relative risks of CHD in the four self rated health groups: 'extremely good': 1.0, 'good': 4.0, 'poor': 5.8, 'miserable': 12.1 (p = 0.02). After control for the conventional CHD risk factors and a substantial number of other potential confounders the relative risks were: 1.0, 4.2, 6.5, and 18.6 (p = 0.02) respectively. CONCLUSIONS: Self rated health was an independent predictor of CHD in the present cohort. If confirmed, the association between self rated health and CHD may lead to new insight into psychosocial processes leading to this disease.

Adult↗
PubMed1995

Shifting attention from objective risk factors to patients' self-assessed health resources: a clinical model for general practice.

The study was designed to present and apply theoretical and empirical knowledge for the construction of a clinical model intended to shift the attention of the general practitioner from objective risk factors to self-assessed health resources in male and female patients. Review, discussion and analysis of selected theoretical models about personal health resources involving assessing existing theories according to their emphasis concerning self-assessed vs. doctor-assessed health resources, specific health resources vs. life and coping in general, abstract vs. clinically applicable theory, gender perspective explicitly included or not. Relevant theoretical models on health and coping (salutogenesis, coping and social support, control/demand, locus of control, health belief model, quality of life), and the perspective of the underprivileged Other (critical theory, feminist standpoint theory, the patient-centred clinical method) were presented and assessed. Components from Antonovsky's salutogenetic perspective and McWhinney's patient-centred clinical method, supported by gender perspectives, were integrated to a clinical model which is presented. General practitioners are recommended to shift their attention from objective risk factors to self-assessed health resources by means of the clinical model. The relevance and feasibility of the model should be explored in empirical research.

Adaptation, Psychological↗
PubMed1991

[Social status and cardiovascular risk factors in Danish males].

In a prospective investigation of a cohort of 504 men from the population studies in Glostrup, the participants were examined at the ages of 40 and 51 years. On both of these occasions, the social status was investigated together with a series of cardiovascular risk factors. The main hypothesis of the investigation was that the risk of cardiovascular disease was greater the lower the social status. This hypothesis was confirmed as regards the following risk factors at the examination at the age of 51 years: Plasma-fibrinogen (p less than 0.001), low stature (p less than 0.001), smoking (p less than 0.05), physical inactivity during leisure time (p less than 0.01), shift work (p less than 0.05), job strain (p less than 0.05), living alone (p less than 0.01) and a poor social network (p less than 0.05). Two factors showed a significantly opposite association with social status: Type A behaviour (p less than 0.001) and physical inactivity during work (p less than 0.001). In many countries, during the past 10-15 years, a tendency towards an even more marked association between social status and the risk factors for cardiovascular disease has been observed. This tendency was not observed in the present investigation.

Adult↗