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Nielsen MH, Jensen AL, Pedersen ML, Seibæk L. Living with chronic obstructive pulmonary disease or type 2 diabetes in Greenland - a qualitative interpretive description study. Int J Circumpolar Health 2024; 83:2296706. [PMID: 38127836 PMCID: PMC10763871 DOI: 10.1080/22423982.2023.2296706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Non-communicable diseases such as chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2D) represent major challenges for health systems all over the world. In an interview study, we explored patient experiences and perspectives of being diagnosed and living with COPD or T2D in Greenland. Participants (n = 24) were selected by purposeful sampling and recruited by phone. We conducted individual semi-structured interviews at the National Hospital in Nuuk and the four regional hospitals. Interviews were audio-recorded, transcribed verbatim, and analysed using interpretive description. Three themes emerged: shock and shame on receiving the diagnosis, coping with a changed life, and varying needs for care and communication. We found that being diagnosed with COPD or T2D required a rapid change in the participants' everyday lives and lifestyle behaviours. Some self-managed their disease well and were able to transfer their knowledge and integrate it into their daily lives, while others struggled to make lifestyle changes. Additionally, living with COPD or T2D could be related to silence and shame. The findings contribute to a better understanding of living with COPD or T2D in the Arctic region and the development of future, culturally-adapted patient education initiatives.
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Affiliation(s)
- Maja Hykkelbjerg Nielsen
- Queen Ingrid’s Hospital, Steno Diabetes Center Greenland, Nuuk, Greenland
- Greenland Center for Health Research, Department of Health and Nature, Ilisimatusarfik/University of Greenland, Nuuk, Greenland
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Annesofie Lunde Jensen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Lynge Pedersen
- Queen Ingrid’s Hospital, Steno Diabetes Center Greenland, Nuuk, Greenland
- Greenland Center for Health Research, Department of Health and Nature, Ilisimatusarfik/University of Greenland, Nuuk, Greenland
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lene Seibæk
- Greenland Center for Health Research, Department of Health and Nature, Ilisimatusarfik/University of Greenland, Nuuk, Greenland
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
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Flyger J, Mejldal A, Nielsen B, Niclasen B, Nielsen AS. A quality assurance study of the development of quality of care in outpatient clinics for treatment of addiction in Greenland. Nord J Psychiatry 2024; 78:363-369. [PMID: 38557415 DOI: 10.1080/08039488.2024.2329583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION In 2016, a new addiction treatment service, Allorfik, was introduced in Greenland. Allorfik has, throughout the implementation and after, used auditing of patient records with feedback to develop the quality of care in treatment. Audits and feedback are routinely done in each treatment center. This study wishes to investigate the development of the quality of treatment through the case notes from the journal audits. METHODOLOGY This study is based on case notes audits from 2019, 2020 and 2021. In the audits, the focus has been on the quality of documentation and content for ten specific areas in each patient record. Each area was scored on a Likert scale of 0-4 for both outcomes. Statistical analyses were done using Stata 17, and P-values < 0.05 were considered statistically significant. We present baseline characteristics for patients and illustrate the development of quality for both outcomes as time trends with scatter plots. RESULTS The analysis was based on data from 454 patients and audits of their case notes. The mean number of weeks in treatment is 12.72, and the mean age for the people in the audited case notes is 39. Time had a positive effect on both outcomes, and so each month, documentation increased by 0.21 points (p-value = <0.001), and content increased by 0.27 points (p-value = <0.001). CONCLUSION For documentation and content, the quality level has increased significantly with time, and the quality of case notes is at an excellent level at the final audits of all treatment centers.
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Affiliation(s)
- Julie Flyger
- Unit of Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Institute of Nursing and Health Science, Ilisimatusarfik - University of Greenland, Greenland, Denmark
| | - Anna Mejldal
- Unit of Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network, The Region of Southern Denmark, Odense, Denmark
| | - Bent Nielsen
- Unit of Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Birgit Niclasen
- Institute of Nursing and Health Science, Ilisimatusarfik - University of Greenland, Greenland, Denmark
- Allorfik - the National Addiction Treatment Services, Greenland, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network, The Region of Southern Denmark, Odense, Denmark
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Backe MB, Kallestrup P, Rasmussen K, Jørgensen ME, Pedersen ML. Burden of selected chronic non-communicable diseases in a primary healthcare setting in Nuuk, Greenland, compared to a Danish suburb. Scand J Prim Health Care 2024:1-7. [PMID: 38578458 DOI: 10.1080/02813432.2024.2334746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Noncommunicable diseases (NCDs) constitute a massive global burden and are the leading cause of death and disability worldwide. In Greenland, the prevalence of NCDs has historically been low. However, during the past approximately 70 years, life circumstances have changed dramatically resulting in increased life expectancy. Today, the proportion of inhabitants in Greenland ≥65 years has nearly tripled since the 1980s, and the prevalence of obesity and diabetes has increased rapidly within the past decades. The aim of this study was to describe the burden of selected NCDs in a primary care setting in Nuuk and compare it to a modern westernized suburban general practice in Denmark. METHODS The study was performed as a cross sectional register-based study using data extracted from the electronic medical records (EMR) based on diagnosis codes from inhabitants living in Nuuk, Greenland, and a suburb in Denmark. Estimates of prevalence were age-standardized to the WHO world standard population. RESULTS In both Nuuk and the Danish suburb, the highest prevalence was observed for hypertension (13.2% for both populations), followed by asthma (4.4 and 9.5%, respectively) and diabetes (4.3 and 2.9%, respectively). The age-standardized prevalences of diabetes, COPD, atrial fibrillation, and heart failure, were significantly higher in Nuuk, while seven NCDs including asthma, ischemic heart disease, arthritis urica, psoriasis, hyperthyreosis, hypothyreosis and osteoporosis were significantly higher in the Danish suburb. CONCLUSION In contrast to the disease pattern observed in Greenland in the last century, the prevalence of diagnosed NCDs in Nuuk is no longer rare. Thus, the overall prevalence of NCDs in the population of Nuuk is now comparable to or even higher than in the suburb in Denmark. This calls for increased focus on all NCDs in the primary healthcare system in Greenland and adaption of the primary healthcare services to a changed disease spectrum.
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Affiliation(s)
- Marie Balslev Backe
- Steno Diabetes Center Greenland, Nuuk, Greenland
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Per Kallestrup
- Skødstrup Lægepraksis, General Practice Clinic, Skødstrup, Denmark
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Center for Global Health, Aarhus University, Aarhus, Denmark
| | - Kurt Rasmussen
- Skødstrup Lægepraksis, General Practice Clinic, Skødstrup, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Greenland, Nuuk, Greenland
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Center for Public Health in Greenland, University of Southern Denmark, Copenhagen, Denmark
| | - Michael Lynge Pedersen
- Steno Diabetes Center Greenland, Nuuk, Greenland
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
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Botvid SHC, Storgaard Hove L, Sauer Mikkelsen C, Skovgaard N, Lynge Pedersen M, Balslev Backe M. Patterns in contacts with primary health care centres in Greenland. Int J Circumpolar Health 2023; 82:2217007. [PMID: 37219998 DOI: 10.1080/22423982.2023.2217007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/25/2023] Open
Abstract
The aim of this study was to evaluate the activity within the primary health care (PHC) in Greenland by identifying the patterns of all registered contacts made by patients in 2021, and to compare the most frequently used types of contacts and diagnostic codes in Nuuk to the rest of Greenland. The study was designed as a cross-sectional register study using data from the national electronic medical records (EMR) and diagnostic codes from the ICPC-2-system. In 2021, 83.7% (46,522) of the Greenlandic population were in contact with the PHC, resulting in 335,494 registered contacts. The majority of the contacts with PHC was made by females (61.3%). On average, females were in contact with PHC 8.4 times per patient per year, while males were in contact with PHC 5.9 times per patient per year. The most frequently used diagnostic group was "General and unspecified", followed by "Musculoskeletal" and "Skin". The results are in line with studies from other northern countries and indicate an easily accessible PHC system, with a predominance of female contacts.
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Affiliation(s)
- Sofia Hedvig Christina Botvid
- Queen Ingrid's Health Care Center, Queen Ingrid's Hospital, Nuuk, Greenland
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Carsten Sauer Mikkelsen
- Hudklinikken i Brønderslev, Research Center, Department of Dermato-venereology, Aalborg University Hospital, Aalborg, Denmark
| | - Nils Skovgaard
- Steno Diabetes Center Greenland, Inuunerissaavik Steno Kalaallit Nunaat, Nuuk, Greenland
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Michael Lynge Pedersen
- Steno Diabetes Center Greenland, Inuunerissaavik Steno Kalaallit Nunaat, Nuuk, Greenland
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Marie Balslev Backe
- Steno Diabetes Center Greenland, Inuunerissaavik Steno Kalaallit Nunaat, Nuuk, Greenland
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
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Nielsen MH, Lynge AR, Pedersen ML. High burden of symptoms reported among patients diagnosed with chronic obstructive pulmonary disease (COPD) in Greenland after introducing the COPD Assessment Test in clinical practice. Int J Circumpolar Health 2023; 82:2220476. [PMID: 37267504 DOI: 10.1080/22423982.2023.2220476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/04/2023] Open
Abstract
The aim was to test the internal consistency of the Greenlandic version of the COPD Assessment Test (CAT) questionnaire and to estimate the symptom burden in patients with chronic obstructive pulmonary disease (COPD) in Greenland using the CAT questionnaire. A Greenlandic version of the CAT questionnaire was developed including forward translation, reconciliation, backwards translation, and pilot test. Afterwards, a cross-sectional study of patients with COPD was conducted. The internal consistency assessed by the Cronbach α coefficient was 0.823 for the Greenlandic version of the questionnaire (n = 103). The CAT was negatively correlated to spirometry values and current smoking. In the cross-sectional study (n = 250), 81.1% of the patients experienced a high symptom burden (≥10). The main CAT score was 17 (range 0-38). The CAT was used in 9 out of 17 towns in Greenland. The Greenlandic version of the CAT questionnaire demonstrated a good internal consistency. We observed a high burden of symptoms associated with reduced lung function and active smoking status among patient diagnosed with COPD in Greenland. The questionnaire can be used in clinical practice for assessment of symptom burden in patients with COPD in Greenland and may help to increase focus on symptom control and quality of care.
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Affiliation(s)
- Maja Hykkelbjerg Nielsen
- Steno Diabetes Center Greenland, Queen Ingrid's Hospital, Nuuk, Greenland
- Greenlandic Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anna Rask Lynge
- Steno Diabetes Center Greenland, Queen Ingrid's Hospital, Nuuk, Greenland
| | - Michael Lynge Pedersen
- Steno Diabetes Center Greenland, Queen Ingrid's Hospital, Nuuk, Greenland
- Greenlandic Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
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Brix A, Flagstad K, Backe MB, Pedersen ML, Nielsen MH. Low Prevalence of Chronic Obstructive Pulmonary Disease in Greenland-A Call for Increased Focus on the Importance of Diagnosis Coding. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095624. [PMID: 37174144 PMCID: PMC10177777 DOI: 10.3390/ijerph20095624] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 05/15/2023]
Abstract
The aim of this study was to estimate the prevalence of patients diagnosed with chronic obstructive pulmonary disease (COPD) according to age, gender, and residence in Greenland and to investigate the associated quality of care. The study was performed as an observational cross-sectional study using data on patients diagnosed with COPD, extracted from the electronical medical record (EMR) in Greenland. The total prevalence of patients aged 20-79 years diagnosed with COPD in Greenland in 2022 was 2.2%. The prevalence was significantly higher in the capital Nuuk compared to the remaining parts of Greenland (2.4% vs. 2.0%, respectively). Significantly more women than men were diagnosed with COPD, but the lung function of men was found to be significantly reduced/impaired compared to women. The prevalence of patients aged 40 years or above was 3.8%. The quality of care was significantly higher among patients living in Nuuk compared to the remaining parts of Greenland for eight out of ten quality indicators. The prevalence of COPD in Greenland is lower than in other comparable populations and might be underestimated. Continued focus on early detection of new cases and initiatives to improve and expand monitoring of quality-of-care measurements, including both additional clinical and patient reported outcomes, are recommended.
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Affiliation(s)
- Andreas Brix
- Queen Ingrid's Primary Health Care Center, 3900 Nuuk, Greenland
| | | | - Marie Balslev Backe
- Steno Diabetes Center Greenland, 3900 Nuuk, Greenland
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, 3905 Nuuk, Greenland
- Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
| | - Michael Lynge Pedersen
- Steno Diabetes Center Greenland, 3900 Nuuk, Greenland
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, 3905 Nuuk, Greenland
| | - Maja Hykkelbjerg Nielsen
- Steno Diabetes Center Greenland, 3900 Nuuk, Greenland
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, 3905 Nuuk, Greenland
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
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Frederiksen AL, Laustsen BH, Bælum J, Pedersen ML, Bønløkke JH. Prevalence of Chronic Obstructive Pulmonary Disease and Chronic Bronchitis Among Predominantly Smoking Workers in the Seafood Industry in Greenland. Int J Chron Obstruct Pulmon Dis 2022; 17:1167-1177. [PMID: 35620348 PMCID: PMC9128641 DOI: 10.2147/copd.s349106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction For decades, the prevalence of smoking has been high in Greenland. Even so, the prevalence of chronic obstructive pulmonary disease (COPD), a smoking-related disease, remains largely unexplored. This cross-sectional study aimed to estimate the prevalence of COPD and chronic bronchitis (CB) among Inuit workers in the seafood industry in Greenland. Methods A total of 355 participants, 254 males and 101 females, met the inclusion criteria. Participants had a mean age of 38 years (standard deviation 13.5; range 17–68 years). COPD was diagnosed based on post-bronchodilator ratio between forced expiratory volume within one second and forced vital capacity (FEV1/FVC) below the lower limit of normal (LLN) according to the Global Lung Function Initiative. Participants completed a questionnaire aiming to diagnose CB. Results The overall prevalence was 9.9% for COPD; 7.4% for CB. Participants were predominantly smokers; 73.2% active smokers, 91.8% active or former smokers. The prevalence of COPD was high, especially among those under 40 years of age. Both COPD and CB were associated with smoking status. Discussion This study among Greenlandic seafood workers found that smoking was a risk factor for COPD and CB among Greenlanders of Inuit origin. The high prevalence of COPD and the high prevalence of smoking underlines the importance of further initiatives to reduce smoking in Greenland.
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Affiliation(s)
| | - Birgitte Hamann Laustsen
- Department of Clinical Medicine, Faculty of Medicine, Danish Ramazzini Centre, Aalborg University, Aalborg, Denmark
- Greenland Center for Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland
| | - Jesper Bælum
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Michael Lynge Pedersen
- Steno Diabetes Center Greenland, Nuuk, Greenland
- Greenland Center for Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland
| | - Jakob Hjort Bønløkke
- Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aalborg University Hospital, Aalborg, Denmark
- Correspondence: Jakob Hjort Bønløkke, Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aalborg University Hospital, Havrevangen 1, Aalborg, 9000, Denmark, Tel + 45 97664109, Email
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