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Embodied meaning-making in the experiences and behaviours of persons with dementia
Get PDFBackground: The aim of the study was to explore and articulate how meaning-making appears and how meaningfulness is experienced in persons with severe dementia. Although there is little knowledge about meaning-making and experience of meaningfulness for this group, this article assumes that persons with dementia are as much in need of meaningfulness in life as any others, and hence, that they are involved in the process of meaning-making.
Methods: The study was conducted using a qualitative method with exploratory design. Ten patients with severe dementia at a specialized dementia ward at an old age psychiatric department in hospital were observed through participant observation performed over four months. The field-notes from the observation contained narratives carrying with them a dimension of meaning played out in an everyday setting and thus named Meaning-making dramas. The narratives were analyzed looking for expressions where experiences of meaning-making and meaningfulness could be identified.
Results: The narratives demonstrate that persons with severe dementia are involved in processes of meaning-making. The narratives include expressions of meaning-making, and of interactions that include apparent crises of meaning, but also transitions into what may be interpreted as meaningfulness based on experiences of significance, orientation and belonging. The role of the body and the senses has proved significant in these processes. The findings also suggest that experiences of meaning contribute to experience of personhood.
Conclusions: The relevance to clinical practice indicates that working from a person-centred approach in dementia care also includes paying attention to the dimension of meaning. This dimension is important both for the person living with dementia and for the people caring for them. Acknowledging meaning as a central human concern, it is crucial to seek understanding and knowledge about the significance of meaning in vulnerable groups such as persons with dementia.Sykehuset Innlandet HF 150332publishedVersio
Kan kompleksitetsteori bidra til bedre forståelse og tiltak ved aggresjon, overgrep og forsømmelser i sykehjem?
Get PDFSammendrag: Utfra vår erfaring og forskning vet vi at hendelser med aggresjon, overgrep og forsømmelse i sykehjem har en sterk sammenheng, opptrer ofte samtidig, og har flere sammenfallende determinanter. De er vanligvis komplekse fenomener som har en tendens til å gjenta seg, og som praksisfeltet opplever som krevende. Tradisjonelt er vi opplært til å tenke lineært om slike hendelser, dvs. at det finnes en eller flere årsaker vi kan gjøre noe med ved å sette inn noen generelle tiltak som f.eks. tradisjonell opplæring, kurs og forelesninger. Vi stiller spørsmål med om denne lineære måten å forstå aggresjon, overgrep og forsømmelser på, er tilstrekkelig for å tilnærme seg og forebygge disse hendelsene. I denne artikkelen vil vi diskutere hvordan vi ved bruk av kompleksitetsteori kan endre vår forståelse av disse fenomenene og sammenhengen mellom beboeren, ansatte, relasjonene de alle inngår i og konteksten sykehjemmet og samfunnet. En slik forståelse kan også være viktig i utviklingen av effektive modeller for forebygging og tilnærming i praksis. For å underbygge hvordan konsepter fra kompleksitetsteori kan bidra til endringer i vår forståelse av og vår tilnærming til disse fenomenene, har vi anvendt empiri fra våre to dr. gradsprosjekter: Utvikling og evaluering av TID, Tverrfaglig Intervensjonsmodell ved utfordrende atferd ved Demens (TID-studien) og Lederskapets rolle for å fremme pasientsikkerhet og forebygge vold, overgrep og forsømmelser i sykehjem (Ledelse- og pasientsikkerhetsstudien). Nøkkelord: kompleksitet, kompleksitetsteori, aggresjon, overgrep, forsømmelse, wicked problems, TID, ledelse, sykehjem. Can complexity theory contribute to a better understanding and more appropriate measures for aggression, abuse, and neglect in nursing homes?submittedVersio
Covid-19: Kontakt med helsesykepleier i skolehelsetjenesten under første nedstengning – en tverrsnittsstudie
Get PDFSammendrag Bakgrunn: Covid-19-pandemien, som også rammet Norge, påvirket ungdom i stor grad. Skolene stengte, og strenge restriksjoner ble innført. Ungdommene rapporterte om lavere livstilfredsstillelse, de følte seg ensomme og mindre glade. Samtidig med at skolene stengte, skjedde det endringer i skolehelsetjenestene. Flere av helsesykepleierne ble omdisponert til andre oppgaver, noe som førte til et redusert tilbud til ungdommen. Hensikt: Vi ønsket i denne undersøkelsen å se på hvordan ungdommenes bekymringer og utfordringer under første nedstengning påvirket bruken av helsesykepleier i skolehelsetjenesten. Vi så også på i hvilken grad gutter og jenter tok kontakt med en helsesykepleier, og hvorvidt de hadde fått informasjon om hvordan de kunne komme i kontakt med en helsesykepleier da skolen var stengt. Metode: Tverrsnittsstudien ble gjennomført i Innlandet og Viken i mai 2020. Vi samlet inn data med elektroniske spørreskjemaer. Totalt 3347 ungdommer fra 8.–10. klasse deltok. Vi utførte deskriptive analyser og logistisk regresjonsanalyse. Resultat: Pandemien har påvirket flere av ungdommene i en positiv retning (74,9 prosent) enn i en negativ retning(68 prosent). Av jentene var 49,5 prosent bekymret for å bli smittet av covid-19, mens bare 30 prosent av guttene var det. Under halvparten av ungdommene tok kontakt med hjelpetelefon eller chat, og flere jenter enn gutter vurderte det. Det var 41 prosent som hadde fått informasjon om hvordan de kunne komme i kontakt med en helsesykepleier mens skolene var stengt, mens 36 prosent svarte at de ikke hadde fått det. Den logistiske regresjonsanalysen viste at det var mer sannsynlig at jenter tok kontakt med helsesykepleier under første nedstenging enn gutter. Konklusjon: Undersøkelsen viser at første nedstengning påvirket ungdommene både positivt og negativt. Et fåtall hadde fått informasjon om at de kan ta kontakt med en helsesykepleier i skolehelsetjenesten i denne perioden. I slikke situasjoner er det viktig med god informasjon om hvordan helsesykepleieren kan nås, og at helsesykepleieren er tilgjengelig for ungdommen.publishedVersio
HINT1 neuropathy in Norway: clinical, genetic and functional profiling
Get PDFBackground: Autosomal recessive axonal neuropathy with neuromyotonia has been linked to loss of functional HINT1. The disease is particularly prevalent in Central and South-East Europe, Turkey and Russia due to the high carrier frequency of the c.110G > C (p.Arg37Pro) founder variant. Results: In a cohort of 748 Norwegian patients with suspected peripheral neuropathy, we identified two seemingly unrelated individuals, compound heterozygous for a new variant (c.284G > A, p.Arg95Gln) and the most common pathogenic founder variant (c.110G > C, p.Arg37Pro) in the HINT1 gene. Probands presented with motor greater than sensory neuropathy of various onset, accompanied by muscle stiffness and cramps in the limbs. Furthermore, they displayed non-classical symptoms, including pain in the extremities and signs of central nervous system involvement. Haplotype analysis in both patients revealed a common chromosomal background for p.Arg95Gln; moreover, the variant was identified in Swedish carriers. Functional characterization in HINT1-knockout and patient-derived cellular models, and in HNT1-knockout yeast, suggested that the new variant is deleterious for the function of HINT1 and provided mechanistic insights allowing patient stratification for future treatment strategies. Conclusion: Our findings broaden the genetic epidemiology of HINT1-neuropathy and have implications for molecular diagnostics of inherited peripheral neuropathies in Scandinavia.This study was funded by the following funding agencies: Research Foundation-Flanders (FWO): Research Grant #G049217N (to A.J.); postdoctoral fellowship to K.P.; pre-doctoral fellowship to S.A.B. South Eastern Norway Regional Health Authority (HSØ): Research Grant #2016133; postdoctoral fellowship to H.H. None of the funding agencies were directly involved in this study.publishedVersio
Epidemiology of overweight and obesity in children and adolescents in Oppland county
Get PDFBackground:
The burden of disease in children and adolescents has moved from infections to noncommunicable diseases, including overweight and obesity (OWOB). Long-term successful treatment has been limited, and prevention strategies seem to be a more appropriate method. Health-related habits, especially during adolescence, have been found to strongly correspond to habits and health in adulthood. To enable the development of high-quality prevention strategies, a proper start is to become familiar with the prevalence and risk factors for OWOB in a targeted population. The aim of this thesis was to study the prevalence of OWOB in 15–16-year-old adolescents and to examine risk factors for OWOB in children and adolescents in Oppland County.
Material and methods:
The data were collected in Oppland County and consisted of two datasets. One dataset was collected during visits to the local health nurse as routine check-ups. The parental questionnaire was collected at the child`s routine-control performed at six years of age. In the following routine control at eight years of age, the nurse measured height and weight. Thus, we included data from 951 (47%) children born in 2001. The other dataset contained data from a repeated cross-sectional study of all 10th grade students (15–16 years of age) in Oppland County in 2002 and 2017. Questionnaire-data were available from 1675 (80%) adolescents in 2002 and from 1580 (71%) in 2017. It contained questions regarding weight, height, health-related habits, subjective social status (SSS), and mental health problems through the Strength and Difficulties Questionnaire (SDQ). The dataset from 2002 was collected by the Norwegian Institute of Public Health, and the dataset from 2017 was collected by our research team. In Paper I, we explored the prevalence of OWOB and the association between breastfeeding history in infancy and body mass index (BMI) in eight-year-old children through linear and logistic regression. In Paper II we compared BMI, BMI z-scores, BMI distributions, and prevalence of OWOB in the adolescents in 2002 and 2017 stratified by gender. In Paper III we investigated the association between SDQ scores and both BMI and OWOB through linear and logistic regression analyses. We also analyzed whether the associations between mental health problems and BMI were different for boys and girls. In Paper IV, we built a structural equation model to explore whether the association between Subjective sociodemographic status (SSS) and BMI was mediated by unhealthy behaviors.
Results:
In Paper I, we did not reveal any associations between breastfeeding history in infancy and BMI or OWOB in eight-year-old children when adjusted for relevant confounders. In Paper II, we found that for adolescent girls, the mean BMI and the prevalence of OWOB significantly increased in the dataset from 2017 compared to the dataset from 2002. The mean differences in BMI z-scores were also positive across the 5th to the 95th percentile, indicating that the BMI values increased across the entire distribution. No such changes were found for boys. In Paper III, we found an association between reporting more peer problems and increased BMI and also increased risk of OWOB when analyzing data from boys and girls together. Additionally, we also found gender-related differences in the association between increased SDQ sub-scores and both increased BMI, and risk of OWOB. In Paper IV, we did not find an association between SSS and BMI in the 2002 dataset. In the 2017 dataset, we found that the significant association between increased SSS and lower BMI was mediated by hours of leisure-time exercise and through a latent variable consisting of habits related to cigarette smoking, snuff use and alcohol drinking.
Conclusion and clinical implications:
We did not reveal that breastfeeding history in infancy was associated with OWOB in eight-year old children. We found gender-related differences regarding prevalence and risk factors for OWOB when assessing the 15–16-year-old adolescent population of Oppland County at two separate time points 15 years apart. We related and interpreted the finding of no association in 2002, but an association between higher SSS and lower BMI in 2017, to societal changes through the epidemiological transition in the years between the surveys. The health-related behaviors that mediated this association in our study were multifaceted and included several risk factors, such as cigarette smoking, snuff use and alcohol drinking, in addition to exercise. No single risk factor can be identified and eliminated to reduce the prevalence of OWOB. The risk factors of adolescent OWOB should therefore be interpreted within the behavioral and sociodemographic context of adolescents.acceptedVersio
Iron Deficiency in Obesity and After Bariatric Surgery
Get PDFIron deficiency (ID) is particularly frequent in obese patients due to increased circulating levels of acute-phase reactant hepcidin and adiposity-associated inflammation. Inflammation in obese subjects is closely related to ID. It induces reduced iron absorption correlated to the inhibition of duodenal ferroportin expression, parallel to the increased concentrations of hepcidin. Obese subjects often get decreased inflammatory response after bariatric surgery, accompanied by decreased serum hepcidin and therefore improved iron absorption. Bariatric surgery can induce the mitigation or resolution of obesity-associated complications, such as hypertension, insulin resistance, diabetes mellitus, and hyperlipidemia, adjusting many parameters in the metabolism. However, gastric bypass surgery and sleeve gastrectomy can induce malabsorption and may accentuate ID. The present review explores the burden and characteristics of ID and anemia in obese patients after bariatric surgery, accounting for gastric bypass technique (Roux-en-Y gastric bypass—RYGB) and sleeve gastrectomy (SG). After bariatric surgery, obese subjects’ iron status should be monitored, and they should be motivated to use adequate and recommended iron supplementation. Keywords: obesity; iron deficiency; iron metabolism; bariatric surgery; iron supplementpublishedVersio
Iodine nutrition and iodine supplement initiation in association with thyroid function in mildly-to-moderately iodine-deficient pregnant and postpartum women
Get PDFBackground: Whereas the adverse effects of severe iodine deficiency during pregnancy are well documented, the effects of mild-to-moderate deficiency are not well established. Objectives: We aimed to explore whether iodine nutrition and timing of iodine supplement initiation are associated with thyroid function in pregnant and postpartum women. Methods: In this cohort study, 137 pregnant women were enrolled and followed up at gestational weeks (GWs) 18 and 36, and 3 and 6 mo postpartum. Thyroid function tests [thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4)], urinary iodine and creatinine concentration (UIC:Cr), and iodine intake (including iodine supplement use) were measured at each time point. The associations between thyroid hormone concentrations and UIC:Cr, iodine intakes, and iodine supplement use were estimated using multiple generalized estimating equation models. Results: The median UIC at GW18 was 94 μg/L, indicating mild-to-moderate iodine deficiency. UIC:Cr (β; 95% CI) per 100 μg/g was negatively associated with fT3 (-0.191; -0.331, -0.051) and fT4 (-0.756; -1.372, -0.141) concentrations. Iodine intake (β; 95% CI) per 100 μg/d was positively associated with TSH (0.099; 0.022, 0.177), and negatively associated with fT3 (-0.084; -0.0141, -0.027) and fT4 (-0.390; -0.599, -0.182) concentrations. Compared with no use of supplement, those initiating an iodine-containing supplement prepregnancy and continuing through pregnancy had lower TSH (estimated means) (1.35 compared with 1.68 mIU/L, P = 0.021), and higher fT3 (4.48 compared with 4.28 pmol/L, P = 0.035) and fT4 (15.2 compared with 14.4 pmol/L, P = 0.024) concentrations. Conclusions: Lower iodine availability during pregnancy and postpartum was associated with lower TSH, and higher fT3 and fT4 concentrations. The use of an iodine-containing supplement that was initiated prepregnancy and continuing through pregnancy was associated with lower TSH, and higher fT3 and fT4 concentrations, which may suggest improved thyroid function. These findings support the notion that optimization of iodine intake should start before pregnancy.This trial was registered at clinicaltrials.gov as NCT02610959. Keywords: iodine; iodine deficiency; iodine supplementation; pregnancy; thyroid hormones. © The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.publishedVersio
Service User Experiences of How Flexible Assertive Community Treatment May Support or Inhibit Citizenship: A Qualitative Study
Get PDFThe aim of this study was to explore and describe service user experiences of how receiving services from a Flexible Assertive Community Treatment (FACT) team may support or inhibit citizenship. Within a participatory design, individual interviews with 32 service users from five Norwegian FACT teams were analyzed using thematic, cross-sectional analysis. The findings showed that FACT may support citizenship by relating to service users as whole people, facilitating empowerment and involvement, and providing practical and accessible help. Experiences of coercion, limited involvement and authoritarian aspects of the system surrounding FACT had inhibited citizenship for participants in this study.This study was funded by the Research Council of Norway, grant
number 288722.publishedVersio
Endoscopic preperitoneal parastomal hernia repair (ePauli repair) : an observational study
Get PDFAbstract
Background: Aspiring endoscopic surgery with extraperitoneal mesh application to avoid adhesion and pain from mesh fixation, we adopted the principles of the open Pauli repair of parastomal hernia (PSH). We have termed the procedure ePauli repair. The aim of this account is to inform about feasibility and adverse reactions.
Methods: Patients with PSH selected for ePauli repair with transversus abdominis release (TAR) were enrolled in a prospective observational study. Patients were operated with laparoscopic or robotic assistance and endoscopic Rives-Stoppa repair in cases with concomitant midline hernia. Coated meshes or a buffer mesh was used in the retromuscular pocket for this modification of the Sugarbaker principle.
Results: Fifteen patients were included: six patients were operated laparoscopically and nine patients with robotic assistance. The median age of the stomas was 33 months (7-313). Five PSHs were recurrent after previous repairs. Median operating time without midline hernia repair was 156 min (107-233) and with midline hernia repair 241 min (176-286). One serosa lesion arose during operation, prompting intraoperative revision of the ostomy without postoperative morbidity. Two patients had postoperative obstruction and were readmitted to operation: one with multiple adhesions and one had kinking of the stoma bowel caused by insufficient incision of the transversalis fascia. No infections or seromas have been observed. One patient had discoloring of the flank with spontaneous remission, and one patient had recurrence. Median postoperative admission time was 3 days (1-19). Median follow-up is 10 months (0-27).
Conclusions: ePauli repair is technically challenging but feasible. With our limited experience, we are encouraged with the pain, complication, and functional summary after ePauli repair and hopeful for the recurrence profile. ePauli/TAR is not for every patient or every surgeon and whether it should be restrained to recurrent PSH or be offered as first-line treatment for PSH is disputable.No funding.publishedVersio
