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Severity of Neuropsychiatric Symptoms in Nursing Home Residents
Get PDFWe aimed at assessing time shift in the severity of neuropsychiatric symptoms (NPS) in nursing home residents between 2004/2005 and 2010/2011 and associations between NPS and socio-demographic variables, physical health status, dementia severity, and the use of psychotropic drugs. The Neuropsychiatric Inventory Nursing Home Version was used in 2004/2005 (n = 1,163) and 2010/2011 (n = 1,858). Linear mixed model analysis was applied. There was no time shift in the severity of apathy, psychosis, and affective symptoms, but agitation did exhibit a time shift. Agitation was less severe in 2010/2011 than in 2004/2005 in residents with a Clinical Dementia Rating (CDR) sum of boxes score ≤4, and more severe in residents with a CDR sum of boxes score >16. Higher CDR sum of boxes scores and use of psychotropic medication were associated with more severe apathy, agitation, psychosis, and affective symptoms. Poor physical health was associated with more severe apathy, psychosis, and affective symptoms. Women had more severe agitation and less severe affective symptoms than men. A longer stay in a nursing home was associated with more severe agitation and less severe affective symptoms. In conclusion, agitation was less severe in 2010/2011 than in 2004/2005 among nursing home residents with a milder degree of dementia, and more severe in residents with severe dementia.publishedVersio
Process evaluation of five tailored programs to improve the implementation of evidence-based recommendations for chronic conditions in primary care
Get PDFBackground
Although there is evidence that tailored implementation strategies can be effective, there is little evidence on which methods of tailoring improve the effect. We designed and evaluated five tailored programs (TPs) each consisting of various strategies. The aim of this study was to examine (a) how determinants of practice prioritized in the design phase of the TPs were perceived by health care professionals who had been exposed to the TPs and whether they suggested other important determinants of practice and (b) how professionals used the offered strategies and whether they suggested other strategies that might have been more effective.
Methods
We conducted a mixed-method process evaluation linked to five cluster-randomized trials carried out in five European countries to implement recommendations for five chronic conditions in primary care settings. The five TPs used a total of 28 strategies which aimed to address 38 determinants of practice. Interviews of professionals in the intervention groups and a survey of professionals in the intervention and control groups were performed. Data collection was conducted by each research team in the respective national language. The interview data were first analyzed inductively by each research team, and subsequently, a meta-synthesis was conducted. The survey was analyzed descriptively.
Results
We conducted 71 interviews; 125 professionals completed the survey. The survey showed that 76 % (n = 29) of targeted determinants of practice were perceived as relevant and 95 % (n = 36) as being modified by the implementation interventions by 66 to 100 % of professionals. On average, 47 % of professionals reported using the strategies and 51 % considered them helpful, albeit with substantial variance between countries and strategies. In the interviews, 89 determinants of practice were identified, of which 70 % (n = 62) had been identified and 45 % (n = 40) had been prioritized in the design phase. The interviewees suggested 65 additional strategies, of which 54 % (n = 35) had been identified and 20 % (n = 13) had been prioritized, but not selected in the final programs.
Conclusions
This study largely confirmed the perceived relevance of the targeted determinants of practice. This contrasts with the fact that no impact of the trials on the implementation of the recommendations could be observed. The findings suggest that better methods for prioritization of determinants and strategies are needed
Risk assessment of "other substances" – L-proline. Opinion of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy of the Norwegian Scientific Committee for Food Safety. VKM report 2016:61
Get PDFAt the request of the Norwegian Food Safety Authority, the Norwegian Scientific Committee for Food Safety (VKM) has characterised the risk of specified doses of L-proline in food supplements. VKM concludes that:
• In adults (≥18 years), the specified doses 50, 500, 1000, 1500 and 1800 mg/day Lproline in food supplements are unlikely to cause adverse health effects.
• In adolescents (14 to < 18 years), the specified doses 50, 500, 1000, 1500 and 1800 mg/day L-proline in food supplements are unlikely to cause adverse health effects.
• In children (10 to < 14 years), the specified doses 50, 500, 1000, 1500 and 1800 mg/day L-proline in food supplements are unlikely to cause adverse health effects.publishedVersio
Risk assessment of "other substances" – L-phenylalanine and DL-phenylalanine. Opinion of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy of the Norwegian Scientific Committee for Food Safety
Get PDFAt the request from the Norwegian Food Safety Authority (NFSA), the Norwegian Scientific Committee on Food Safety (VKM) has characterised the risk of specified doses of Lphenylalanine and DL-phenylalanine in food supplements. VKM concludes that:
• In adults (≥ 18 years), the specified doses 100, 250, 500, 750 and 1000 mg/day Lphenylalanine in food supplements are considered unlikely to cause adverse health effects.
• In adolescents (14 to < 18 years), the specified doses 100, 250, 500, 750 and 1000 mg/day L-phenylalanine in food supplements are considered unlikely to cause adverse health effects.
• In children (10 to < 14 years), the specified doses 100, 250, 500, 750 and 1000 mg/day L-phenylalanine in food supplements are considered unlikely to cause adverse health effects. Although the highest dose provides 23 mg/kg bw per day which slightly exceeds 22.4 mg/kg bw per day, it is considered unlikely to cause adverse health effects in healthy children 10 to < 14 years.
• None of the above conclusions are applicable for patients with phenylketonuria (PKU).
• No conclusion can be made regarding DL-phenylalaninepublishedVersio
Temporal trends in incidence and case fatality of intracerebral hemorrhage. The Tromsø Study 1995-2012
Get PDFBackground: The aim of this study was to explore temporal trends in incidence and case fa- tality rates of intracerebral hemorrhage (ICH) over the last two decades in a Norwegian mu- nicipality.
Methods: Incident cases of primary ICH were registered in the period from 1995 through 2012 in 32,530 par ticipants of the longitudinal population-based Tromsø Study. Pois- son regression models were used to obtain inci dence rates over time in age- and sex-adjust- ed and age- and sex-specific models. Case fatality rates were calculated and age- and sex- adjusted trends over time were estimated using logistic regression.
Results: A total of 226 ICHs were registered. The age- and sex-adjusted incidence rate [95% confidence interval (CI)] in the overall population was 0.42 (0.37–0.48) per 1,000 person-years. Age-adjusted incidence rates were 0.53 (0.43–0.62) in men and 0.33 (0.26–0.39) in women. In individuals aged <75 years, the age- and sex-adjusted incidence rate was 0.27 (0.22–0.32) and in individuals aged ≥ 75 years, it was 2.42 (1.95–2.89) per 1,000 person-years. There was no significant change in incidence rates over time. The incidence rate ratio (95% CI) in the overall population was 0.73 (0.47–1.12) in 2012 compared with 1995. The overall 30-day case fatality (95% CI) was 23.9% (18.3–29.5) and did not change substantially over time [odds ratio in 2012 vs. 1995 = 0.83 (95% CI 0.27–2.52)].
Conclusion: No significant changes in incidence and case fatality rates of ICH were observed during the last two decades.publishedVersio
Thyroid function among breastfed children with chronically excessive iodine intakes
Get PDFIodine excess may impair thyroid function and trigger adverse health consequences for children. This study aims to describe iodine status among breastfed infants with high iodine exposure in the Saharawi refugee camps Algeria, and further assess thyroid function and iodine status among the children three years later. In 2010, a cross-sectional study among 111 breastfed children aged 0–6 months was performed (baseline study). In 2013, a second cross-sectional study (follow-up study) was conducted among 289 children; 213 newly selected and 76 children retrieved from baseline. Urinary iodine concentration (UIC) and breast milk iodine concentration (BMIC) were measured at baseline. UIC, thyroid hormones and serum thyroglobulin (Tg) were measured at follow-up. At baseline and follow-up, 88% and 72% had excessive iodine intakes (UIC ≥ 300 µg/L), respectively. At follow-up, 24% had a thyroid hormone disturbance and/or elevated serum Tg, including 9% with subclinical hypothyroidism (SCH), 4% with elevated fT3 and 14% with elevated Tg. Children with SCH had poorer linear growth and were more likely to be underweight than the children without SCH. Excessive iodine intakes and thyroid disturbances were common among children below four years of age in our study. Further, SCH seemed to be associated with poor growth and weight.publishedVersio
Risk assessment of magnesium in food supplements. Opinion of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy of the Norwegian Scientific Committee for Food Safety
Get PDFThe Norwegian Scientific Committee for Food Safety (Vitenskapskomiteen for mattrygghet, VKM) has, at the request of the Norwegian Food Safety Authority (Mattilsynet; NFSA), assessed the risk associated with magnesium in food supplements. VKM is requested to evaluate upper tolerable intake levels for magnesium and high and low intakes in the Norwegian population. Pending establishment of common maximum limits in the EU, the NFSA is evaluating the national maximum limits for vitamins and minerals in food supplements. This risk assessment is the scientific basis for NFSA's evaluation of national limits for magnesium.publishedVersio
“Care or control?”: a qualitative study of staff experiences with outpatient commitment orders
Get PDFPurpose Outpatient commitment orders are being increasingly used in many countries to ensure follow-up care of people with psychotic disorders after discharge from hospital. Several studies have examined outpatient commitment in relation to use of health care services, but there have been fewer studies of health professionals’ experiences with the scheme. The purpose of this study was to examine health professionals’ experiences with patients subject to outpatient commitment. Methods This was a focus group study using a descriptive and exploratory approach. The study was based on three focus group interviews with a total of 22 participants. Data were analysed using qualitative content analysis. Results The study showed that health professionals had a positive attitude towards outpatient commitment and considered it necessary for patients with psychosis who lacked insight and did not collaborate on treatment. At the same time their attention to patients’ lack of insight could lead to a paternalistic approach more than measures to enhance patient autonomy. This challenged their therapeutic relationship with the patient. Conclusion Health professionals found it difficult to combine control with therapeutic care, but gave greater emphasis to patients’ need for treatment and continuity of care than to their autonomy. This dilemma indicates a need to discuss whether increased attention to patients’ autonomy rather than insight into their illness would improve treatment cooperation and reduce the use of coercion.“Care or control?”: a qualitative study of staff experiences with outpatient commitment ordersThe study was funded by The Norwegian ExtraFoundation
for Health and Rehabilitation through EXTRA funds, Innlandet
Hospital Trust and the Norwegian National Advisory Unit on Concurrent
Substance Abuse and Mental Health Disorders.publishedVersio
Return to work in patients with chronic musculoskeletal pain: multidisciplinary intervention versus brief intervention: a randomized clinical trial
Get PDFObjective: This randomized clinical trial was performed to compare the effect of a new multidisciplinary intervention (MI) programme to a brief intervention (BI) programme on return to work (RTW), fully and partly, at a 12-month and 24-month follow-up in patients on long-term sick leave due to musculoskeletal pain. Methods: Patients (n = 284, mean age 41.3 years, 53.9 % women) who were sick-listed with musculoskeletal pain and referred to a specialist clinic in physical rehabilitation were randomized to MI (n = 141) or BI (n = 143). The MI included the use of a visual educational tool, which facilitated patienttherapist communication and self-management. The MI also applied one more profession, more therapist time and a comprehensive focus on the psychosocial factors, particularly the working conditions, compared to a BI. The main features of the latter are a thorough medical, educational examination, a brief cognitive assessment based on the non-injury model, and a recommendation to return to normal activity as soon as possible. Results: The number of patients with full-time RTW developed similarly in the two groups. The patients receiving MI had a higher probability to partly RTW during the first 7 months of the follow-up compared to the BI-group. Conclusions: There were no differences between the groups on full-time RTW during the 24 months. However, the results indicate that MI hastens the return to work process in long-term sick leave through the increased use of partial sick leave. Trial Registration: http://www.clinicaltrials.gov with the registration number NCT01346423.Return to work in patients with chronic musculoskeletal pain: multidisciplinary intervention versus brief intervention: a randomized clinical trialInnlandet Hospital Trust, Norway funded the study.publishedVersio
Jakten på helsefremmende faktorer i epidemiologisk forskning: Eksempler fra Helseundersøkelsen i Nord-Trøndelag (HUNT)
Get PDFEpidemiologisk forskning har tradisjonelt hatt fokus på å studere utbredelsen av sykdommer, risikofaktorer og
årsaksfaktorer, og med forebygging som et hovedmål. Forskning på helsefremming har som hensikt å undersøke
hvilke faktorer som er vesentlige for å styrke helsa til enkeltmennesker og befolkninger, og undersøke
hvilke ressurser som kjennetegner mennesker og samfunn som utmerker seg med god helse. Kunnskapen fra
forsking om helsefremmende faktorer skal brukes til å styrke folks helse og mestringsfølelse, enten de i
utgangspunktet er friske eller syke. Det er derfor vesentlige forskjeller på både tenkning og empiri knyttet til
helsefremming sammenlignet med forebygging. Helsefremming er i dag blitt en viktig innfallsvinkel til
helseutfordringer verden over, og i helsefremmende arbeid er politiske beslutninger og policyarbeid en viktig
del av prosessene. Men helsefremmende tenkning har enda ikke fått ordentlig fotfeste innen epidemiologien.
Målet med denne artikkelen er å beskrive mulighetene for å finne ny kunnskap om helsefremmende faktorer
i norske befolkningsdatabaser, med Helseundersøkelsen i Nord-Trøndelag (HUNT) som et eksempel.
I HUNT er det allerede samlet ei rekke helsefremmende faktorer, som fysisk aktivitet, kosthold, sans for
humor, sosial kapital, livssyn og deltakelse i kulturaktiviteter, og flere studier er publisert. Opplevelse av
sammenheng (sense of coherence) og engasjement er andre viktige helsefremmende faktorer. Sammenhengen
mellom musikk og helse har vært kjent lenge, og ei rekke studier har vist både nevrologiske, hormonelle,
immunologiske, psykiske og sosiale effekter av musikk. Også for flere av de andre helsefremmende faktorene
er det beskrevet biologiske effekter, og to oppfølgingsstudier av sans for humor har vist tydelig effekt på
dødelighet.
Konklusjonen er at epidemiologiske studier kan være viktige kilder til kunnskap om helsefremmende faktorer,
og slike studier kan dermed gi vesentlige bidrag til folkehelsearbeidet. Det aller beste vil være å satse på
triangulering av kvalitative (intervju), deskriptive (kvantitativ kartlegging/tverrsnittsstudier) og eksperimentelle
(kausale) metoder, alle med fokus på utvikling av kunnskap om en bestemt faktor basert på data fra en og
samme populasjon.publishedVersio