Background: In Denmark, few people with Chronic Obstructive Pulmonary Disease (COPD) engage in physical activity although it is evident that pulmonary rehabilitation has positive effects on physical activity, dyspnoea, anxiety, fatigue and quality of life. Objective: The purpose of this pilot study was to explore why people with COPD do not engage in physical activity and to explore motivational factors and barriers towards physical activity. Furthermore, to explore the role general practitioners have in this matter. Design: We conducted fieldwork among five people with COPD and three general practitioners using qualitative semi-structured interviews. We made a thematic analysis and our analytical perspective was based on The Health Belief Model and Self Determination Theory. Results: Findings revealed that people with COPD was not active because they did not receive the necessary information from the general practitioners about the benefits of physical activity neither about the negative consequences of an inactive lifestyle. Motivational factors were knowledge about COPD and benefits of physical activity. Experiencing the benefits on their own bodies, feeling that it was not dangerous to feel breathless and being successful coping with breathlessness were motivational. Functional tests like walking tests were very important and motivational for the participants because they outlined the progress achieved during activity and provided evidence of progress that was easy to comprehend compared with spirometry tests. General practitioners did not inform about the benefits of physical activity because they felt that medication was more important than physical activity and that people with COPD would not be motivated to be active. Conclusions: The main reason for people with COPD not being physically active in our study was lack of sufficient information from their general practitioners. This study described some barriers, enablers and motivational factors for a physically active lifestyle and the general practitioners’ role in this. Thus, it is important that people with COPD receive early information about physical activity - and it should start with the general practitioners, who are the gate keepers in the health care system. We recommend that lung function test results are never used as a single indicator of disease progression and that more focus should be paid to functional tests like The Shuttle Walking Test or The Six Minute Walking Test.Further studies to identify barriers to, and facilitators for referral people with COPD to physical activity in daily life from the perspective of Danish general practitioners are required.
In a prospective, double-blind, placebo-controlled study, twenty-eight healthy, male patients, aged 20-69 years, scheduled for unilateral elective inguinal herniorrhaphy ad modum Bassini were randomized to receive postoperative infiltration of the surgical wound with either bupivacaine 0.25%, or isotonic saline. General anaesthesia was induced with thiopentone 3-5 mg.kg-1 and alfentanyl 10 micrograms.kg-1, and maintained with alfentanyl 5 micrograms.kg-1 15 min and N2O/O2. After herniorrhaphy, the internal fascia was infiltrated with bupivacaine 0.25% or saline, 10 ml. After closure of the external fascia, the subcutaneous tissue was infiltrated with bupivacaine 0.25% or saline, 15 ml on both sides of the surgical wound. Pain at rest, during mobilisation and during cough was significantly decreased in patients receiving bupivacaine compared to placebo. Median time to first request for morphine was increased from 25 min to 135 min, and the consumption of supplementary morphine during the 24 h study period reduced from four to two doses of 0.1 mg.kg-1 iv or 0.125 mg.kg-1 im, in patients who received bupivacaine compared to placebo.
In Denmark mental disorders are the most prevalent disease, accounting for 25 % of the total burden of disease. This underlines the need of initiatives for prevention and treatment in which the role of physical activity and bodily experiences contains unexploited opportunities and obvious catches people’s attention. The aim of this study was to explore the experiences from people with mental disorders doing Stand-Up Paddle (SUP) and to explore if and how the experiences influenced their mental health. Anthropological fieldwork including participant observation and qualitative interviews for three months in Denmark among eight people living with mental disorders, participating in a project called ‘Freedom on water’ including SUP. Empirical material was thematically analysed at first and secondly theoretically analysed with perspectives of Merleau-Ponty, Deci & Ryan and Csikszentmihalyi. Themes identified concerned social interaction, nature, mind-body connection, and experiences of success. The participants’ mental health was affected positively by doing SUP. When fully concentrated, managing the (bodily) challenges on the SUP-board their rumination disappeared and they felt present in the moment. Forgetting oneself, flow, skills, coping mechanisms, self-confidence and positively social integration were strengthened. This study proves the value of including the physical body in initiatives for mental health.
I denne artikel udforskes og diskuteres screeningers mulige implikationer for individer og samfund – her med udgangspunkt i screening for brystkræft, livmoderhalskræft, forhøjet kolesterol og knogleskørhed. Der fokuseres på screeningers mulige betydninger for følelsen af krop og selv med henblik på at diskutere, hvilken rolle screening kan have set i et forebyggelses- og sundhedsfremmeperspektiv. Formålet med artiklen er at skabe diskussion om screeningers positive og negative betydninger. I artiklen argumenteres for at screening udover at redde liv og give tryghed også medvirker til usikkerhed og ængstelse. Derudover kan screening muligvis medvirke til risikotænkning, afhængighed af eksperter og til at kropslige signaler overhøres. Screening er en forbyggende foranstaltning der ikke nødvendigvis giver mulighed for et sundt liv. Artiklen foreslår at fokus på kropsbevidsthed styrkes i takt med, at antallet af screeninger stiger – samt bidrager til diskussionen om det etisk forsvarlige i, at raske mennesker i stigende grad screenes for mulige fremtidige sygdomme.
Assessing changes in functional exercise capacity is highly relevant in the treatment of people with Chronic Obstructive Pulmonary Disease (COPD), as lung function is often static. In Denmark, most people with COPD are followed in general practice where traditional functional tests, like six-minute walk test, require too much time and space. Therefore, there is an urgent need for a quick functional exercise capacity test that can be performed in a limited setting, such as general practice. This study aimed to identify a quick test to measure functional exercise capacity in people with COPD and identify which factors could affect the implementation of such a test in general practice. A mixed method feasibility study composed of a literature review and qualitative interviews was used. Quick functional tests for people with COPD were identified and evaluated through the COSMIN methodology. For the interviews, 64 general practices were included, and 50 staff members and 14 general practitioners (GPs) participated in the interviews. Responses were categorized and thematically analyzed. The 1 min sit-to-stand-test (1 M STST) was found suitable for a general practice setting. The COSMIN methodology rated it “sufficient” in reliability (ICC 0.90–0.99), measurement error (MID 2.5–3), construct validity and responsiveness (AUC 0.72), and found a moderate to strong correlation in criterion validity (r = 0.4–0.75). Several GPs wished for a quick functional test and emphasized evidence, information, and limitations as essential when deciding on implementation. Other factors identified included time, other tests, and economy. 1 M STST is a valid test to assess functional exercise capacity in people with COPD. The test is quick and can easily be performed in a standard consultation, and several GPs wished for such a test.
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