Helsebibliotekets Research Archive
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Baseline profiles of adolescent vs. adult-onset first-episode psychosis in an early detection program.
No full textOBJECTIVE: Psychotic disorders often start in adolescence. We aim to investigate premorbid and baseline differences characterizing patients with an onset of psychosis in adolescence versus adulthood. METHOD: We compare first-episode, DSM-IV non-affective psychosis with onset before (n = 43) and after (n = 189) 18 years on duration of untreated psychosis (DUP), level of symptoms, suicidal behaviour, and other baseline clinical and demographic characteristics. RESULTS: Adolescent onset patients had poorer premorbid functioning, a longer DUP, higher suicidality, and more depressive symptoms. They also had better cognition, fewer psychotic symptoms, and were more likely to be treated on an out-patient basis. CONCLUSION: Adolescents with first-episode psychosis may have a slower and more silent, i.e. insidious onset, and are at risk of experiencing longer treatment delays than adults. They fit the description of what used to be labeled process (versus reactive) schizophrenia
Miljørettet helsevern. Kjemiske, fysiske og biologiske miljøforholds betydning for helse i vårt land og fordeling av disse
No full textPsykiske problemer og behandling. Levekårsundersøkelsen 2005.
No full textDel 1: Hos hvem har pasientene søkt hjelp,\ud
og hva slags behandling har de fått?\ud
Utarbeidet av: Odd Steffen Dalgard\ud
Del 2: Hvordan vurderer pasientene effekten av behandling?\ud
Utarbeidet av Ingeborg Strømseng Sjetne,\ud
Øyvind Andresen Bjertnæs og Jon Helgeland,\ud
Nasjonalt kunnskapssenter for helsetjeneste
SUPPORT Tools for Evidence-informed policymaking in health 18: Planning monitoring and evaluation of policies.
No full textABSTRACT : This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers.The term monitoring is commonly used to describe the process of systematically collecting data to inform policymakers, managers and other stakeholders whether a new policy or programme is being implemented in accordance with their expectations. Indicators are used for monitoring purposes to judge, for example, if objectives are being achieved, or if allocated funds are being spent appropriately. Sometimes the term evaluation is used interchangeably with the term monitoring, but the former usually suggests a stronger focus on the achievement of results. When the term impact evaluation is used, this usually implies that there is a specific attempt to try to determine whether the observed changes in outcomes can be attributed to a particular policy or programme. In this article, we suggest four questions that can be used to guide the monitoring and evaluation of policy or programme options. These are: 1. Is monitoring necessary? 2. What should be measured? 3. Should an impact evaluation be conducted? 4. How should the impact evaluation be done
Chain of care for patients with intentional self-harm: an effective strategy to reduce suicide rates?
No full textChain of care for patients with intentional self-harm was important in the Norwegian national action plan to prevent suicide. In this study there were two aims: (1) to calculate the potential effects of chain of care on reducing suicide rates, and (2) to assess whether suicide rates decreased more in areas where chain of care had been implemented than in other areas. We observed no differences in changes in suicide rates between areas with and without the intervention. The calculated potential effects of chain of care on national suicide rates were very small, even under unrealistically favorable conditions.NORSK SAMMENDRAG: Er behandlingskjede for pasienter med villet egenskade en effektiv strategi for å redusere selvmordsratene?\ud
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Det å etablere en behandlingskjede for pasienter innlagt i sykehus etter selvmordsforsøk eller annen villet egenskade har vært en viktig strategi i den norske handlingsplanen for forebygging av selvmord. En behandlingskjede innebærer at pasienten følges opp av en eller flere behandlingsinstanser i inntil ett år etter sykehusoppholdet.\ud
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Individrettet strategi\ud
Studien gir ingen belegg for at en slik individrettet risikostrategi er effektiv for å redusere selvmordsratene i befolkningen. SIRUS-forsker Ingeborg Rossow står sammen med Lars Mehlum, Finn Gjertsen og Bjørn Møller bak studien, som er publisert i tidsskriftet Suicide and Life-Threatening Behavior.\ud
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Om studien\ud
Forskerne har beregnet hvor stor den potensielle effekten av behandlingskjeder vil kunne være under ulike betingelser, og sammenliknet endringer i selvmordsrater i befolkningen i områder som har og ikke har innført behandlingskjede.\ud
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Liten effekt\ud
Beregningene av potensielle effekter viste at selv under urealistisk gunstige betingelser ville den forventete effekten på selvmordsrater være veldig liten. I tråd med dette viste også sammenlikningene av observerte selvmordsrater over tid at det ikke var noen forskjeller i endringene i selvmordsrater i områder som har og ikke har innført behandlingskjede
SUPPORT Tools for evidence-informed health Policymaking (STP) 4: Using research evidence to clarify a problem
No full textAbstract This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. Policymakers and those supporting them often find themselves in situations that spur them on to work out how best to define a problem. These situations may range from being asked an awkward or challenging question in the legislature, through to finding a problem highlighted on the front page of a newspaper. The motivations for policymakers wanting to clarify a problem are diverse. These may range from deciding whether to pay serious attention to a particular problem that others claim is important, through to wondering how to convince others to agree that a problem is important. Debates and struggles over how to define a problem are a critically important part of the policymaking process. The outcome of these debates and struggles will influence whether and, in part, how policymakers take action to address a problem. Efforts at problem clarification that are informed by an appreciation of concurrent developments are more likely to generate actions. These concurrent developments can relate to policy and programme options (e.g. the publication of a report demonstrating the effectiveness of a particular option) or to political events (e.g. the appointment of a new Minister of Health with a personal interest in a particular issue). In this article, we suggest questions that can be used to guide those involved in identifying a problem and characterising its features. These are: 1. What is the problem? 2. How did the problem come to attention and has this process influenced the prospect of it being addressed? 3. What indicators can be used, or collected, to establish the magnitude of the problem and to measure progress in addressing it? 4. What comparisons can be made to establish the magnitude of the problem and to measure progress in addressing it? 5. How can the problem be framed (or described) in a way that will motivate different groups
Hva er effekten av langtidsbehandling i institusjon for rusavhengige sammenlignet med poliklinisk kortidsbehandling?
No full textNORSK: Bakgrunn\ud
Nasjonalt kunnskapssenter for helsetjenesten fikk i oppdrag fra Helse Sør-Øst å utføre en systematisk kunnskapsoppsummering om effekten av langtidsbehandling for rusavhengige mennesker.\ud
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Problemstilling\ud
I denne rapporten besvarer vi to overordnede spørsmål: 1) Hva viser forskning om effekt av langtidsbehandling i institusjon sammenlignet med poliklinisk kortidsbehandling for rusavhengige? 2) Hva er helseøkonomiske kostnader ved langtidsbehandling sammenlignet med kortidsbehandling av rusavhengighet?\ud
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Metode\ud
Vi søkte systematisk etter systematiske oversikter, randomiserte kontrollerte studier og observasjonsstudier i relevante internasjonale forskningsdatabaser. Vi valgte studier som oppfylte våre inklusjonskriterier. De inkluderte studiene ble vurdert i forhold til metodisk kvalitet. Deretter oppsummerte og presenterte vi resultatene fra studiene.\ud
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Resultater\ud
Vi inkluderte resultatene fra en systematisk oversikt og fem enkeltstudier. Vår systematiske gjennomgang av forskningslitteraturen viste inkonsistente resultater for sammenligningen av korttid versus langtidsbehandling. Det synes ikke å være datagrunnlag til å hevde at langtidsbehandling var bedre enn kortidsbehandling, men resultatene må tolkes med forsiktighet. Ingen av studiene som omhandlet kostnadseffektivitet kunne med sikkerhet konkludere med at noen behandlingstiltak var mer kostnadseffektive enn andre.\ud
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Konklusjon\ud
Vår systematiske gjennomgang av forskningslitteraturen viste inkonsistente resultater for sammenligning av korttid versus langtidsbehandling for rusavhengige. Dette gjelder også for de helseøkonomiske evalueringene. Det er behov for forskning som sammenligner effekten av langtid versus korttids rusbehandling og spesielt med sammenligninger av korttids poliklinikk med langtids døgninstitusjoner.ENGLISH: 1-page key messages\ud
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Background\ud
The Norwegian Knowledge Centre for the Health Services was asked by Helse Sør-Øst RHF (South-Eastern Norway Regional Health Authority) to review research about the effects of long-term institutional treatment of patients with substance abuse compared with short-term outpatient treatment. \ud
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Objective\ud
The objectives were to assess the effectiveness of; 1) long-term treatment of patients with substance abuse compared to short-term treatment and 2) to estimate the cost-effectiveness of long-term treatment compared to short-term treatment.\ud
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Methods\ud
We searched systematically for systematic reviews, randomised controlled trials and cohort studies in international databases. We appraised and synthesized studies that met our inclusion criteria.\ud
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Results\ud
We included one systematic review and five studies, three cohort studies and two health economy evaluations in our review. Although residential treatment may offer some specific advantages, the conclusion here is that improvement among day treatment clients was not significantly different from that of residential treatment clients. Few baseline predictors were prospectively related to relapse at 12 and 18 months. Results from health economic evaluations suggest that outpatient and short-term residential treatments might be cost effective compared to long-term residential treatment.\ud
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Conclusion\ud
Our systematic review gave no compelling evidence to support long term treatment over short term interventions for drug addiction. However, it was emphasized that the results must be interpreted carefully, because of low quality of economic studies. Results from new research may alter our conclusions
Det vitenskapelige kunnskapsgrunnlaget for behandlingstilbudet for pasienter med leppe-, kjeve- og ganespalte
No full textNORSK: I denne kunnskapsoppsummeringen presenterer vi dokumentasjonsgrunnlaget for effekt av tiltak for behandling og oppfølging av pasienter med leppe-kjeve-ganespalte. Vi søkte etter systematiske oversikter og prospektive primærstudier med samtidig kontrollgruppe.\ud
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Vi fant ingen vitenskapelige studier som tilfredstilte inklusjonskriteriene for temaene utredning eller sammensetning, varighet og intensitet av behandlingstilbudet for pasienter med leppe-, kjeve- og/eller ganespalte. Vi identifiserte heller ingen studier av tiltak som tilfredsstilte våre krav til design for pasienter med velocardiofacialt syndrom. Vi inkluderte 1 systematisk oversikt og 46 primærstudier innafor kategoriene behandling og oppfølging. Av disse ble 39 studier klassifisert som behandling (stort sett kirurgi og kirurgirelaterte tiltak) og 1 systematisk oversikt og 7 primærstudier som oppfølging (mating, tale og sekretorisk otitis media).\ud
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Kvaliteten av dokumentasjonsgrunnlaget for effekten av forskjellige former for preoperativ forming, for resultater fra sammenligninger vedrørende lukning av leppespalte, av ganespalte, av spalte i kjevekammen eller av tiltak for å korrigere neseskjevhet er for lav til å trekke noen konklusjoner. Når det gjelder sekundæroperasjoner, er det mulig at det ikke har noen betydning for velofaryngeal lukning om man opererer med faryngeallapp eller sfinkterplastikk. Kvaliteten av dokumentasjonsgrunnlaget for resultatene fra de fem andre sammenligningene av tiltak innafor sekundæroperasjoner er for lav til å trekke noen konklusjoner. Resultatene fra sammenligninger av tiltak innafor kjeveortopedi, taletrening, sekretorisk otitis media og mating er også for usikre til å trekke noen konklusjoner.\ud
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Kvaliteten av dokumentasjonen som ligger til grunn for dagens praksis i behandling og oppfølging av barn og voksne med leppe-, kjeve- og/eller ganespalte er lav eller svært lav. Dette betyr ikke det samme som at dagens behandling er dårlig. Det betyr at den forskningen som foreligger totalt sett er for usikker til å gi noen sikre holdepunkter for konklusjoner om den relative effekten av forskjellige inngrep, sekvensering og optimale tidspunkter for leppe- og ganespalteoperasjoner, effekt av inngrep for forflytning/forlengelse av kjeve, sekundæroperasjoner og av de forskjellige oppfølgings- og habiliteringstiltak.ENGLISH: 1-page key messages\ud
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In this review we present the evidence base for the effectiveness of interventions in treatment and follow-up of patients with cleft lip, alveolus and/or palate. We searched for systematic reviews and prospective primary studies with a simultaneous control group.\ud
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We found no scientific studies that met the inclusion criteria for the themes examination of or composition, duration and intensity of treatment for patients with cleft lip, alveolus and/or cleft palate. We did not identifiy any studies of measures that satisfied our design requirements for patients with velocardiofacial syndrome. We included 1 systematic review and 46 primary studies within the categories treatment and follow-up. Of these 39 studies were classifieds as treatment (mostly surgery and surgery-related measures) and 1 systematic review and 7 primary studies as follow-up (feeding, speech and otitis media).\ud
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The quality of the evidence of the results of different forms of presurgical orthopaedics, lip-alveolus-palate closure and of correction of nasal septal deformity is too low to draw any conclusions. For secondary surgical procedures pharyngeal flap may be similar to sphincterplasty for velopharyngeal insufficiency, but the evidence for this is of low quality. For the other five comparisons of measures within secondary surgery, the quality of the evidence is too low to draw any conclusions. The results from the comparisons of interventions within orthodontics, speech training, otitis media and feeding methods are also too uncertain to draw any conclusions.\ud
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The evidence base for current practice in treatment and follow-up of children and adults with cleft lip, alveolus and/or palate is low or very low. This does not mean that current practice is poor. It means that existing research is too uncertain to provide good evidence for conclusions about the relative effectiveness of different interventions, sequencing and optimal times for cleft lip and palate surgery, of effectiveness of interventions for maxillary protraction and of the different follow-up and habilitation interventions
Helseøkonomisk analyse av bevacizumab+paclitaxel sammenlignet med paclitaxel alene som førstelinjebehandling ved metastatisk brystkreft
No full textBACKGROUND The Norwegian Knowledge Centre for the Health Services has been commissioned by Norwegian Directorate of Health’s Cancer Programme to make an assessment of the cost per progression-free year gained associated with the use of bevacizumab in combination with paclitaxel versus paclitaxel alone, as first line treatment for metastatic breast cancer. The result is likely to have bearings on a possible revision of the treatment guidelines for breast cancer in Norway.\ud
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METHODS\ud
We developed a health economic model of the Markov type in which we compared data from a clinical study, Miller et al. 2007, with Norwegian cost data associated with the treatment alternatives.\ud
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RESULTS\ud
Mean progression-free time in the group treated with bevacizumab+paclitaxel was 1 1.2 years whereas it was 0.73 years in the comparator group. This resulted in an incremental effect of 0,47 progression-free years. With regard to quality of life, the incremental effect was 0.2 QALYs. We estimated the incremental costs associated with use of bevacizumab+paclitaxel from a health service perspective to be NOK 765 000, which translates into a cost per progression-free life year gained of NOK 1.6 million and a cost per QALY gained of NOK 3.8 million. The estimate from the societal perspective, where tax, value-added tax and social security payments were deducted, was approx. NOK 1.3 million per progression-free life-year and NOK 3 million per QALY gained.\ud
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CONCLUSION\ud
The cost per progression-free year gained is relatively high, and the cost per QALY gained is higher than cost-effective thresholds which have been proposed in Norway
Effekten av psykoterapi for mennesker med depressive lidelser
No full textIn October 2008, the Norwegian Directorate of Health commissioned the Norwegian Knowledge Centre for the Health Services (NOKC) to complete a review about the effects of psychotherapy for adults with depression. The review would help answer the question of how adults with depression should be best managed. We addressed one main question: What are the effects of psychotherapy on depression symptomatology and quality of life indicators for adults with depression?\ud
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We searched systematically for relevant literature in international scientific databases. We evaluated newly published systematic reviews and randomized controlled trials (RCTs) for inclusion using a pre-designed inclusion form. We then appraised the methodological quality of the included studies with appropriate check lists, and summarised the results in tables and text. In accordance with the commissioner's requests, we gave emphasis to findings from the systematic reviews and results related to psychodynamic psychotherapy.\ud
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We included and summarised results from a total of nine studies; six systematic reviews and three RCTs. The great majority of the studies were of high methodological quality. Study results show that patients significantly improved post-treatment. Findings suggest that psychotherapy is effective in reducing patients' depression symptomatology compared to treatment as usual. Improvements in depression symtomatology and social functioning appear to be modest, improvements are similar to those observed for psychopharmacological treatments, and no psychotherapy technique appears to be superior. Psychodynamic psychotherapy does not seem to cause greater improvements in depression symptomatology compared to other types of psychotherapy. \ud
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Based on the best available evidence, it appears that psychotherapy improves depression symptomatology in adults with depressive illnesses. However, the literature search was restricted and the evidence base for the current review was heterogeneous, thus the results must be viewed as tentative