Maria Kristiansen

Allergen immunotherapy for the prevention of allergy: A systematic review and meta‐analysis

There is a need to establish the effectiveness, cost‐effectiveness, and safety of allergen immunotherapy (AIT) for the prevention of allergic disease.

Participation in mammography screening among migrants and non-migrants in Denmark

Background. Inequality in use of mammography screening across population groups is a concern since migrants are more likely to become non-users compared to the general population. The aim of this study was to a) identify determinants of participation among migrant groups and Danish-born women with emphasis on the effect of household size, socioeconomic position and use of healthcare services, and b) test whether effects of determinants were consistent across migrant and non-migrant groups. Material and methods. We used data from the first eight invitation rounds of the mammography screening programme in Copenhagen, Denmark (1991–2008) in combination with register-based data. Results. The crude odds ratio (OR) for not participating in mammography screening was 1.38 (95% CI, 1.30–1.46) for women born in other-Western and 1.80 (95% CI, 1.71–1.90) for women born in non-Western countries compared to Danish-born women. The adjusted OR was 1.14 (95% CI, 1.06–1.21) for other-Western and 1.19 (95% CI, 1.11–1.27) for women born in non-Western countries. Lack of contact with a general practitioner or dental services, and not being employed had a significant negative effect on use of mammography screening. Higher-educated women were significantly less likely to use mammo-graphy screening in all groups whilst hospitalisation had a significant effect among Danish-born women. Living alone was consistently associated with non-use of mammography screening. The probability of becoming a non-user was significantly less among women living within households of two to four persons compared to women living alone. Except in the case of age and hospitalisation, trends were similar across country of birth, but the relative importance of specific determinants in explaining use of mammography screening differed. Conclusion. Household size, socioeconomic position and use of healthcare services were determinants of participation in mammography screening. This study emphasises the need for conducting refined analyses distinguishing among subgroups within diverse populations when explaining differences in screening behaviour.

The practice of hope: a longitudinal, multi-perspective qualitative study among South Asian Sikhs and Muslims with life-limiting illness in Scotland

Objectives We explored the role of faith and religious identities in shaping end of life experiences in South Asian Muslims and Sikhs with life-limiting illnesses. Design Secondary analysis of data from a longitudinal, multi-perspective qualitative study of the experience of life-limiting illness and access to palliative care services among South Asian Sikhs and Muslims in Scotland. Up to three semi-structured interviews were conducted with 25 participants, 15 family members and 20 health care professionals over a period of 18 months. Analysis was informed by Mattinglys theory on hope. Results Hope emerged as a central construct in the accounts of illness constructed by the participants as they struggled to make sense of and uphold a meaningful life. Clinical encounters and, for some, religious beliefs served as sources of hope for participants. Hope unfolded as an active process that enabled them to live with the personal and in particular the social ramifications of their illness. Changing images of hope were formulated and reflected as illness progressed or treatments failed. These ranged from hoping for cure, prolonged life, the regaining of lost capabilities needed to fulfil social roles, or at times death when suffering and the consequences for the family became too hard to bear. Conclusions For those suffering from a life-limiting illness, sustaining hope is a complex challenge. The social character of hope is evident as it focuses on envisioning a life that is worth living, not only for oneself, but most importantly for social relations. Continuity in care at the end of life and a holistic approach is important in order to enable patients to articulate complex and changing notions of hope that at times are silenced within families, and for patients to feel confident in discussing the possible role of religious beliefs in shaping personal notions of hope.

Patient perspectives on type 2 diabetes and medicine use during Ramadan among Pakistanis in Denmark

Background Type 2 diabetes is highly prevalent among people of Pakistani background. Studies show that adherence to medicines is complicated for people with type 2 diabetes in general. Also, studies indicate that many people with type 2 diabetes and Muslim background fast during the month of Ramadan without adequate counselling on how to adjust their medicines. Objective To explore patient perspectives on medicine use during Ramadan, reasons for fasting and experiences with counselling on medicine use during Ramadan among people of Pakistani background with type 2 diabetes and at least one other chronic condition. Setting Greater Copenhagen, Denmark. Method The analysis is based on a study exploring lived experiences with counselling on medicines using semi-structured interviews and medication reviews. The analysis presented here builds on the subset of patients with Pakistani background (six interviewers). Results All interviewees pointed out that Islam allows ill people to refrain from fasting during Ramadan. However, all had fasted during Ramadan despite being diagnosed with type 2 diabetes. While fasting, they adapted their use of medicines in different ways, e.g. by changing the time of intake or by skipping morning medicines. Fasting during Ramadan meant a feeling of improvement in well-being for all interviewees. Reasons for this improvement included physiological, social and religious aspects. Healthcare professionals were rarely included in the decision-making process on whether or not to fast. Instead, friends and relatives, especially those with type 2 diabetes, were considered important to the decision-making process. Conclusion For people with Muslim background and a chronic condition, fasting during Ramadan may mean changes in medicine use that are not always discussed with healthcare professionals. Healthcare professionals should acknowledge that Muslim patients may find fasting during Ramadan beneficial to their well-being and therefore choose to fast despite the Islamic rule of exemption. This patient-centred approach to counselling on medicines may facilitate better medicine use and thus better clinical health outcomes among patients that choose to fast.

EAACI guidelines on allergen immunotherapy: Prevention of allergy

Allergic diseases are common and frequently coexist. Allergen immunotherapy (AIT) is a disease‐modifying treatment for IgE‐mediated allergic disease with effects beyond cessation of AIT that may include important preventive effects. The European Academy of Allergy and Clinical Immunology (EAACI) has developed a clinical practice guideline to provide evidence‐based recommendations for AIT for the prevention of (i) development of allergic comorbidities in those with established allergic diseases, (ii) development of first allergic condition, and (iii) allergic sensitization. This guideline has been developed using the Appraisal of Guidelines for Research & Evaluation (AGREE II) framework, which involved a multidisciplinary expert working group, a systematic review of the underpinning evidence, and external peer‐review of draft recommendations. Our key recommendation is that a 3‐year course of subcutaneous or sublingual AIT can be recommended for children and adolescents with moderate‐to‐severe allergic rhinitis (AR) triggered by grass/birch pollen allergy to prevent asthma for up to 2 years post‐AIT in addition to its sustained effect on AR symptoms and medication. Some trial data even suggest a preventive effect on asthma symptoms and medication more than 2 years post‐AIT. We need more evidence concerning AIT for prevention in individuals with AR triggered by house dust mites or other allergens and for the prevention of allergic sensitization, the first allergic disease, or for the prevention of allergic comorbidities in those with other allergic conditions. Evidence for the preventive potential of AIT as disease‐modifying treatment exists but there is an urgent need for more high‐quality clinical trials.

Contextualising migrants’ health behaviour - a qualitative study of transnational ties and their implications for participation in mammography screening

BackgroundLower participation rates in mammography screening are common among migrant women compared to native-born women. Explanations of these lower rates have mainly been based on behavioural theories investigating how lack of knowledge, access to services and culture influence the screening behaviour. The aim of the present study was to contextualise screening behaviour by exploring migrants’ transnational ties and their influence on participation in mammography screening in Denmark.MethodsThe study is based on the analysis of qualitative interviews with 29 women residing in greater Copenhagen, Denmark and born in Somalia, Turkey, India, Iran, Pakistan and Arab-speaking countries.ResultsWe found that while women had knowledge about breast cancer and mammography screening, it was not prioritised. All women were embedded in transnational ties, which they struggled to retain through emotional and financial obligations, and these current struggles in their everyday life seemed to leave little room for concerns about breast cancer and therefore seemed to contribute to their lower participation in screening.ConclusionsThe study emphasises the need to take into account the multi-layered and multi-sided factors in migrants’ everyday life in order to further understand their health behaviour.

Quality of life and coping strategies among immigrant women living with pain in Denmark: a qualitative study

Objective To examine quality of life and coping strategies among immigrant women living with chronic pain. Design Qualitative content analysis based on in-depth semistructured interviews. Setting A clinic specifically targeting immigrants at a larger university hospital in Copenhagen, Denmark. Participants Non-western female immigrant patients suffering from chronic pain (n=13). Main outcome measures Experiences of the impact of chronic pain on quality of life. Results Chronic pain was perceived to have an extensive, adverse effect on all aspects of quality of life, including physical health, mental well-being and social relations. This included the ability to maintain activities of daily living and the ability to work. Chronic pain was further experienced as a cause of emotional distress, depression and altered personalities, which all had great consequences on womens social interactions, causing change and loss of social relations. A variety of coping strategies were used to cope with the pain, manage its consequences, and restore a level of health that would enable women to function and fulfil social roles. Many participants coped with the pain by altering everyday life, keeping daily activities to a minimum and taking pain-killing drugs, offering temporary relief. Seeking healthcare was another coping strategy used as an active means to assert agency and as a temporary distraction from pain. However, accessing healthcare also involved a risk of disagreement and disappointments. Conclusions Chronic pain had a severe negative impact on quality of life and necessitated alterations in everyday life and active health-seeking strategies. Implications for practice imply a need for a more holistic approach to immigrant women with chronic pain, including a family-centred approach. Further research is needed to explore similarities or differences in and between populations with diverse ethnic, socioeconomic and psychosocial backgrounds, and to assess how ethnicity and culture might influence the experiences of chronic pain.

Challenges in the implementation of the EAACI AIT guidelines: A situational analysis of current provision of allergen immunotherapy

The European Academy of Allergy and Clinical Immunology (EAACI) has produced Guidelines on Allergen Immunotherapy (AIT). We sought to gauge the preparedness of primary care to participate in the delivery of AIT in Europe.

Aging and health among migrants in a European perspective

Population aging and the associated changes in demographic structures and healthcare needs is a key challenge across Europe. Healthy aging strategies focus on ensuring the ability to maintain health, quality of life and independent living at old age. Concurrent to the process of population aging, the demographics of Europe are affected by increased migration resulting in substantial ethnic diversity. In this paper, we narratively review the health profile of the growing proportion of aging migrants in Europe, outline key factors shaping health among this diverse group and consider ways of addressing their healthcare needs.Although factors shaping aging processes are largely similar across populations, migrant-specific risk factors exist. These include exposure to health risks before and during migration; a more disadvantaged socioeconomic position; language barriers and low health literacy; cultural factors influencing health-seeking behaviours; and psychosocial vulnerability and discrimination affecting health and quality of life. Overall, migrants experience the same morbidity and mortality causes as the native populations, but with different relative importance, severity and age of onset and with substantial differences within and between migrant groups. Little is known regarding health behaviours among aging migrants, although differences in cancer screening behaviours have been identified. Indications of widening health differentials between migrants and native populations with age and informal barriers to quality healthcare for aging migrants are causes of concern.In conclusion, there is a need for attention to migration alongside other determinants of healthy aging. The diversity in individual characteristics, life course processes and contextual factors shaping aging processes among migrants point to the need for a sensitive and comprehensive approach to policies, practices and research within the field of healthy aging. This is important to accommodate for the needs of the growing number of aging migrants in Europe and counter inequities in health and well-being at old age.

Experiencing Loss: A Muslim Widow’s Bereavement Narrative

In this article, we explore how Islam, minority status and refugee experiences intersect in shaping meaning-making processes following bereavement. We do this through a phenomenological analysis of a biographical account of personal loss told by Aisha, a Muslim Palestinian refugee living in Denmark, who narrates her experience of losing her husband to lung cancer. By drawing on a religious framework, Aisha creates meaning from her loss, which enables her to incorporate this loss into her life history and sustain agency. Her narrative invites wider audiences to witness her tale of overcoming loss, thus highlighting the complex way in which religious beliefs, minority status and migration history come together in shaping meaning-making processes, and the importance of reciprocity in narrative studies.