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Relasjoner og språk. Psykodynamisk fortolkning av språkets rolle i relasjonsdannelse som bidrag til å forstå grunnlaget for Adult Attachment Interview (AAI)
Get PDFThis paper discusses the role of language in the processes that initiate and develop mental representations of relationships. The study starts with a critical comparison of two
existing theories selected from the field of relational psychoanalysis, aiming to discuss
and assess the interaction between developing language and relational experience. The
findings from this hermeneutic analysis are then applied in an attempt to explain why
verbal behavior can be used to assess the mental representations of relationships as
they are expressed in the Adult Attachment Interview. The two theories chosen from the
field of relational psychoanalysis are the works of Stephen Mitchell and Daniel Stern,
respectively. The contributions from each of them turned out to be compatible with attachment theory and thereby summed up to some tentative voicing of the silent domain
of language development in attachment theorySpråk utvikles i relasjon og påvirker samtidig relasjonens utvikling.
Gjennom denne doble forbindelsen til relasjonen får språket et dynamisk grensesnitt mot psykologiske teorier som har relasjonen som
grunnleggende utgangspunkt. Tilknytningsteorien er en slik teori,
men den er likevel taus om språkets rolle i relasjonsdannelsen. Dette
til tross for at studier av verbal adferd er bærende i forskning på voksnes tilknytningsmønstre. I denne artikkelen henvender vi oss til teorier
av S.A. Mitchell og D.N. Stern, som begge tydelig forholder seg til
interaksjonen mellom språk og relasjon. Hensikten er å se om vi kan
finne forklaringer på hvorfor kunnskap om mentale representasjoner
av relasjoner kan undersøkes og forstås ved å analysere verbalt språk.publishedVersio
Surgical Treatment of Degenerative Disk Disease in Three Scandinavian Countries: An International Register Study Based on Three Merged National Spine Registers
Get PDFAbstract
Study Design: Observational study of prospectively collected data.
Objectives: Patients with chronic low back pain resistant to nonoperative treatment often face a poor prognosis for recovery.
The aim of the current study was to compare the variation and outcome of surgical treatment of degenerative disc disease in the
Scandinavian countries based on The International Consortium for Health Outcomes Measurement core spine data sets.
Methods: Anonymized individual level data from 3 national registers were pooled into 1 database. At the time of surgery, the
patient reports data on demographics, lifestyle topics, comorbidity, and data on health-related quality of life such as Oswestry
Disability Index, Euro-Qol-5D, and back and leg pain scores. The surgeon records diagnosis, type of surgery performed, and
complications. One-year follow-ups are obtained with questionnaires. Baseline and 1-year follow-up data were analyzed to
expose any differences between the countries.
Results: A total of 1893 patients were included. At 1-year follow-up, 1315 (72%) patients responded. There were statistically
significant baseline differences in age, smoking, comorbidity, frequency of previous surgery and intensity of back and leg pain.
Isolated fusion was the primary procedure in all the countries ranging from 84% in Denmark to 76% in Sweden. There was
clinically relevant improvement in all outcome measures except leg pain.
Conclusions: In homogenous populations with similar health care systems the treatment traditions can vary considerably. Despite
variations in preoperative variables, patient reported outcomes improve significantly and clinically relevant with surgical treatment.The author(s) received no financial support for the research, authorship, and/or publication of this article.publishedVersio
Emergency cesarean section among women in Robson groups one and three: A comparison study of immigrant and Norwegian women giving birth in a low-risk maternity hospital in Norway
Get PDFResearchers have shown that some immigrant groups have an increased risk of emergency cesarean section. The authors' aim was to examine the differences in emergency cesarean section rates among immigrant women in Norway with low obstetric risks by using the Robson classification system. We performed secondary analysis on a Norwegian cohort study, where 10,125 women were classified in Robson groups one and three. Women from East, Southeast, and Central Asia, and from Africa had a higher risk of emergency cesarean section. The Robson classification system was a useful tool in comparing cesarean section rates between immigrant groups and host country populations.This work was supported by Vestre Viken Hospital Trusts research fund under Grant number 2303003, and Innlandet Hospital Trusts research fund under Grant number 150388.publishedVersio
Pain Severity and Vitamin D Deficiency in IBD Patients
Get PDFPain and vitamin D deficiency are common in inflammatory bowel disease (IBD). Disease activity, fatigue, frequent relapses, prior surgery and psychological factors all seem to influence the experience of pain in IBD. Vitamin D deficiency has been associated with muscle and skeletal pain. This study aimed to determine whether there is an association between vitamin D deficiency and severity of pain in patients with IBD, and to investigate the influence of other socio-demographic and psychological variables on the experience of pain. Methods: Patients with IBD were recruited from nine hospitals in Norway in a multicenter cross-sectional study. The Brief Pain Inventory (BPI) questionnaire was used to measure pain. Disease activity was assessed using clinical disease activity indices, C-reactive protein (CRP) and fecal calprotectin. Regression models were fitted to explore a possible association between 25-hydroxyvitamin D and pain severity. Results: Of 407 patients included in the analyses, 229 (56%) had Crohn's disease (CD) and 178 (44%) had ulcerative colitis (UC). Vitamin D deficiency was present in half (203/407) of patients. Presence of pain was reported by 76% (309/407). More severe pain was associated with female gender and increased disease activity scores, but not with increased CRP or fecal calprotectin. In CD, patients without prior intra-abdominal surgery reported more severe pain. In multivariate analyses, there was no association between 25-hydroxyvitamin D and pain severity. Conclusions: In this study, no significant association between pain severity and vitamin D deficiency was revealed in patients with IBD.This work was supported by a research grant from Tillotts Pharma and Østfold Hospital Trust, Norway.
Editorial support was provided by Cambridge Medical Ltd., UK in agreement with Pharmacosmos AS, Denmark.
The sponsors had no role in the design, execution, interpretation, or writing of the study.publishedVersio
Decompression alone versus decompression with instrumental fusion the NORDSTEN degenerative spondylolisthesis trial (NORDSTEN-DS); study protocol for a randomized controlled trial
Get PDFBACKGROUND:
Fusion in addition to decompression has become the standard treatment for lumbar spinal stenosis with degenerative spondylolisthesis (DS). The evidence for performing fusion among these patients is conflicting and there is a need for further investigation through studies of high quality. The present protocol describes an ongoing study with the primary aim of comparing the outcome between decompression alone and decompression with instrumented fusion. The secondary aim is to investigate whether predictors can be used to choose the best treatment for an individual. The trial, named the NORDSTEN-DS trial, is one of three studies in the Norwegian Degenerative Spinal Stenosis (NORDSTEN) study.
METHODS:
The NORDSTEN-DS trial is a block-randomized, controlled, multicenter, non-inferiority study with two parallel groups. The surgeons at the 15 participating hospitals decide whether a patient is eligible or not according to the inclusion and exclusion criteria. Participating patients are randomized to either a midline preserving decompression or a decompression followed by an instrumental fusion. Primary endpoint is the percentage of patients with an improvement in Oswestry Disability Index version 2.0 of more than 30% from baseline to 2-year follow-up. Secondary outcome measurements are the Zürich Claudication Questionnaire, Numeric Rating Scale for back and leg pain, Euroqol 5 dimensions questionnaire, Global perceived effect scale, complications and several radiological parameters. Analysis and interpretation of results will also be conducted after 5 and 10 years.
CONCLUSION:
The NORDSTEN/DS trial has the potential to provide Level 1 evidence of whether decompression alone should be advocated as the preferred method or not. Further on the study will investigate whether predictors exist and if they can be used to make the appropriate choice for surgical treatment for this patient group.Helse Vest RHF (the Western Regional Health Authority) has provided funds for the present study. The funder has no influence on study design, management and interpretation of data or the decision to submit data.publishedVersio
How Social Relationships Influence Substance Use Disorder Recovery: A Collaborative Narrative Study
No full textIndividuals with a substance use disorder (SUD) often have fewer social support network resources than those without SUDs. This qualitative study examined the role of social relationships in achieving and maintaining stable recovery after many years of SUD. Semi-structured interviews were conducted with 18 participants, each of whom had been diagnosed with a SUD and each of whom had been abstinent for at least 5 years. A resource group of peer consultants in long-term recovery from SUDs contributed to the study planning, preparation, and initial analyses. The relationship that most participants described as helpful for initiating abstinence was recognition by a peer or a caring relationship with a service provider or sibling. These findings suggest that, to reach and maintain abstinence, it is important to maintain positive relationships and to engage self-agency to protect oneself from the influences of negative relationships. Substance use disorder service providers should increase the extent to which they involve the social networks of clients when designing new treatment approaches. Service providers should also focus more on individualizing services to meet their clients on a personal level, without neglecting professionalism or treatment strategies.The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This study was funded by the Innlandet Hospital Trust, Norway.publishedVersio
Diagnosis and Treatment of Genetic HFE-Hemochromatosis: The Danish Aspect
Get PDFThis paper outlines the Danish aspects of HFE-hemochromatosis, which is the most frequent genetic predisposition to iron overload in the five million ethnic Danes; more than 20,000 people are homozygous for the C282Y mutation and more than 500,000 people are compound heterozygous or heterozygous for the HFE-mutations. The disorder has a long preclinical stage with gradually increasing body iron overload and eventually 30% of men will develop clinically overt disease, presenting with symptoms of fatigue, arthralgias, reduced libido, erectile dysfunction, cardiac disease and diabetes. Subsequently the disease may progress into irreversible arthritis, liver cirrhosis, cardiomyopathy, pancreatic fibrosis and osteoporosis. The effective standard treatment is repeated phlebotomies, which in the preclinical and early clinical stages ensures a normal survival rate. Early detection of the genetic predisposition to the disorder is therefore important to reduce the overall burden of clinical disease. Population screening seems to be cost-effective and should be considered.This study was supported by unrestricted grants from The Danish Haemochromatosis Association (Dansk Haemokromatose Forening) www.haemokromatose.dk and Pharmovital ApS, Rosenkaeret 11B, DK-2860 Soeborg, Denmark.publishedVersio
Cytokine concentrations are related to level of mental distress in inpatients not using anti-inflammatory drugs
Get PDFAbstract
OBJECTIVE:
Cross-sectional data show elevated levels of circulating cytokines in psychiatric patients. The literature is divided concerning anti-inflammatory drugs' ability to relieve symptoms, questioning a causal link between inflammatory pathways and psychiatric conditions. We hypothesised that the development of circulating cytokine levels is related to mental distress, and that this relationship is affected by the use of anti-inflammatory drugs.
METHODS:
The study was a longitudinal assessment of 12-week inpatient treatment at Modum Bad Psychiatric Center, Norway. Sera and self-reported Global Severity Index (GSI) scores, which measure psychological distress, were collected at admission (T0), halfway (T1) and before discharge (T2). Other variables known to distort the neuroimmune interplay were included. These were age, gender, diagnosis of PTSD, antidepressants and anti-inflammatory drugs. A total of 128 patients (92 women and 36 men) were included, and 28 were using anti-inflammatory medication. Multilevel modelling was used for data analysis.
RESULTS:
Patients with higher levels of IL-1RA and MCP-1 had higher GSI scores (p = 0.005 and p = 0.020). PTSD patients scored higher on GSI than non-PTSD patients (p = 0.002). These relationships were mostly present among those not using anti-inflammatory drugs (n = 99), with higher levels of IL-1RA and MCP-1 being related to higher GSI score (p = 0.023 and 0.018, respectively). Again, PTSD patients showed higher GSI levels than non-PTSD patients (p = 0.014).
CONCLUSIONS:
Cytokine levels were associated with level of mental distress as measured by the GSI scores, but this relationship was not present among those using anti-inflammatory drugs. We found no association between cytokine levels and development of GSI score over time.publishedVersio
Sex-related change in BMI of 15- to 16-year-old Norwegian girls in cross-sectional studies in 2002 and 2017
Get PDFBackground: The prevalence of overweight and obesity (OWOB) has stabilized in some countries, but a portion of children with high body mass index (BMI) may have become heavier. This study aimed to describe the distributions of BMI and the point prevalence of OWOB in Norwegian adolescents in 2002 and 2017. Methods: A cross-sectional study involving 15- to 16-year-old adolescents in Oppland, Norway, was undertaken in 2002 and 2017. We calculated their BMI, BMI z-scores (BMIz), and the prevalence of OWOB. Results: The mean BMI increased from 20.7 to 21.4 (p < 0.001) for girls but remained unchanged at 21.5 vs 21.4 (p = 0.80) for boys. The prevalence of OWOB increased from 9 to 14% among girls (difference 5, 95% CI: 2, 8) and from 17 to 20% among boys (difference 3, 95% CI: − 1, 6%). The BMI density plots revealed similar shapes at both time points for both sexes, but the distribution for girls shifted to the right from 2002 to 2017. Conclusion: Contrary to previous knowledge, we found that the increase in OWOB presented a uniform shift in the entire BMI distribution for 15–16-year-old Norwegian girls and was not due to a larger shift in a specific subpopulation in the upper percentiles. Keywords: Adolescent, Body mass index, Body mass index distribution, Obesity, Overweight, Sex differencesThis study was supported by unrestricted grants from the Innlandet Hospital Trust. The funding source did not play any role in the design and implementation of the study; collection, management, analysis or interpretation of the data; and preparation, review or approval of the manuscript.publishedVersio
Effect of Hypnotherapy in Alcohol Use Disorder Compared with Motivational Interviewing: A Randomized Controlled Trial
Get PDFBackground:
Hypnotherapy has proved to be effective for the treatment of several medical and psychiatric conditions. It has been used in the treatment of alcohol use disorder (AUD), but only 2 randomized controlled trials have been conducted for this disorder.
Methods:
This study was carried out at an inpatient clinic in Norway. A 6-week long treatment program included intensive group therapy, but also 5 hours of individual therapy, given as motivational interviewing (MI). Thirty-one patients were randomized either to receive 5 individual sessions of hypnotherapy instead of MI (N=16) or to be in the control group (N=15). The treatment method for the hypnotherapy group was Erickson (permissive) hypnosis. At baseline all the participants were diagnosed using a psychiatric interview and filled in the Alcohol Use Identification Test (AUDIT), Timeline FollowBack (TLFB) for alcohol use, Hopkins Symptoms Check List (HSCL-25) for monitoring mental distress and Traumatic Life Events Questionnaire. AUDIT, TLFB, and HSCL-25 were readministered at follow-up after 1 year.
Results:
There were no differences between groups at baseline. One year later more women were lost to follow-up in the MI group. Both the intervention and control groups had reduced their alcohol consumption significantly. The change in AUDIT score was, however, largest for the hypnotherapy group, albeit only on a trend level (P=0.088).
Conclusions:
Those receiving hypnotherapy did marginally better concerning alcohol use at 1-year follow-up. This small advantage for hypnotherapy could indicate an effect, rendered nonsignificant by an underpowered study. It could also be that neither MI nor hypnotherapy gave an additional effect on top of the substantial group therapy. Lastly the findings could indicate that hypnotherapy is at least as effective as MI.acceptedVersio