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Spesialisering og profesjonalisering. En beretning om den sivile norske helseforvaltnings utvikling fra 1809 – 2009. Del 1 1809-1983 – Den gamle helseforvaltning
No full textNORSK SAMMENDRAG: Under Napoleonskrigene med engelsk blokade ble det Kongelige norske Sundheds-Collegium i Christiania etablert i 1809. Dette skriftet handler om utviklingen av den sentrale helseforvaltningen fra da og fram til 1983.\ud
Utviklingen etter Den andre verdenskrig blir tillagt stor vekt. Dette var tiden for profesjonalisering og spesialisering både av forvaltningen og helsetjenesten. Oppbyggingen av sentralforvaltningen lå på mange måter foran den organisatoriske utviklingen av selve tjenesteytelsen.\ud
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Sentrale aktører var helsedirektørene Karl Evang og Torbjørn Mork. Skriftet gir et nærbilde av disse to markante personene og de menneskene som omgav dem. Helsedirektoratets ulike roller blir behandlet, og dets virksomhet blir satt inn i et tidsbilde i forhold til samfunnet for øvrig. Legenes styrkede posisjon under Evangs styre blir behandlet, og de ofte konfliktfylte spenningene mellom jurister og leger i helseforvaltningen blir belyst. Historien fortsetter med Morks forsøk på å forsvare skansene etter Evangs styrkeoppbygging, og avsluttes med de omfattende endringene som skjedde tidlig på 1980-tallet.\ud
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Det statlige tilsynets utvikling og styrking de senere år vil bli behandlet i del 2 (1983-2009).\ud
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Ole Berg (f. 1944) er professor i helseadministrasjon og statsvitenskap ved Universitetet i Oslo. Gjennom undervisning på masterstudiet i helseadministrasjon har han hatt stor innflytelse på en generasjon ledere i helsetjenesten. Han ledet studiet fra starten i 1986 og i flere år, og er tildelt St. Olavs orden for dette arbeidet.SUMMARY IN ENGLISH: Under the Napoleonic Wars with the English blockade, the Royal Norwegian Health Collegium (det Kongelige norske Sundheds-Collegium) was established in Christiania in 1809. The theme of this book is the development of the central health administration from that time until 1983.\ud
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The development after the Second World War is focussed on. This was the time of professionalization and specialization, both within administration and the health service. In many ways, the structure of the central administration was ahead of the organizational development of health service provision.\ud
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Karl Evang and Torbjørn Mork were two people who played prominent roles. This book gives a description of these eminent people and their associates. The various roles of the Directorate of Health are described, and the work of this body is placed in the context of society as a whole. The strengthening position of doctors during the time of Evang’s leadership, and the often dramatic conflicts between lawyers and doctors in health administration, are described. The story continues with Mork’s attempts to defend the entrenched parties after Evang had strengthened their positions, and ends with the comprehensive changes that took place at the beginning of the 1980s.\ud
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The development of public supervision during the last few years will be dealt with in Part 2 (1983-2009).\ud
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Ole Berg (born in 1944) is Professor of Health Administration and Political Science at Oslo University. Through his teaching in the master course Master of Health Administration, he has had a large influence on a generation of leaders within the health services. He has been leader of the master course from when it began in 1986 and for several years. He was awarded the Order of St. Olav for his work in this area
TMT handbook : Triage, monitoring and treatment of people exposed to ionising radiation following a malevolent act
No full textTMT handbookThis handbook has been produced to address the need for practical tools to assist those responding to malevolent use of ionising radiation. The handbook is intended for the purpose of planning and training by emergency response organisation and subsequent use in the fiel
SUPPORT Tools for evidence-informed health Policymaking (STP) 10: Taking equity into consideration when assessing the findings of a systematic review
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. In this article we address considerations of equity. Inequities can be defined as "differences in health which are not only unnecessary and avoidable but, in addition, are considered unfair and unjust". These have been well documented in relation to social and economic factors. Policies or programmes that are effective can improve the overall health of a population. However, the impact of such policies and programmes on inequities may vary: they may have no impact on inequities, they may reduce inequities, or they may exacerbate them, regardless of their overall effects on population health. We suggest four questions that can be considered when using research evidence to inform considerations of the potential impact a policy or programme option is likely to have on disadvantaged groups, and on equity in a specific setting. These are: 1. Which groups or settings are likely to be disadvantaged in relation to the option being considered? 2. Are there plausible reasons for anticipating differences in the relative effectiveness of the option for disadvantaged groups or settings? 3. Are there likely to be different baseline conditions across groups or settings such that that the absolute effectiveness of the option would be different, and the problem more or less important, for disadvantaged groups or settings? 4. Are there important considerations that should be made when implementing the option in order to ensure that inequities are reduced, if possible, and that they are not increased
SUPPORT Tools for evidence-informed health Policymaking (STP) 14: Organising and using policy dialogues to support evidence-informed policymaking
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. Policy dialogues allow research evidence to be considered together with the views, experiences and tacit knowledge of those who will be involved in, or affected by, future decisions about a high-priority issue. Increasing interest in the use of policy dialogues has been fuelled by a number of factors: 1. The recognition of the need for locally contextualised 'decision support' for policymakers and other stakeholders 2. The recognition that research evidence is only one input into the decision-making processes of policymakers and other stakeholders 3. The recognition that many stakeholders can add significant value to these processes, and 4. The recognition that many stakeholders can take action to address high-priority issues, and not just policymakers. In this article, we suggest questions to guide those organising and using policy dialogues to support evidence-informed policymaking. These are: 1. Does the dialogue address a high-priority issue? 2. Does the dialogue provide opportunities to discuss the problem, options to address the problem, and key implementation considerations? 3. Is the dialogue informed by a pre-circulated policy brief and by a discussion about the full range of factors that can influence the policymaking process? 4. Does the dialogue ensure fair representation among those who will be involved in, or affected by, future decisions related to the issue? 5. Does the dialogue engage a facilitator, follow a rule about not attributing comments to individuals, and not aim for consensus? 6. Are outputs produced and follow-up activities undertaken to support action
10 råd til pasienter på 10 språk: prosjektdokumentasjon
No full textNasjonal enhet for pasientsikkerhet laget våren 2008 en liten brosjyre til pasienter som skal på sykehus. Brosjyren inneholder enkle råd om hva pasienter kan bidra med for å bedre egen sikkerhet i møte med helsetjenesten. Pasienter som ikke har norsk som morsmål møter særskilte utfordringer i møtet med norsk helsevesen.\ud
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Brosjyren finnes nå på ti språk: arabisk, engelsk, fransk, norsk, polsk, samisk, somalisk, spansk, tyrkisk og urdu, samt som lydfil for blinde og svaksynte.\ud
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De ti rådene er:\ud
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1. Informer om deg selv: Har du behov for tolk? Tar du medisiner? Hva slags behandling får du? Hva annet gjør du for å bedre din egen helse?\ud
2. Spør til du forstår. Ikke vær redd for å spørre flere ganger Noter informasjon du får og spørsmål du vil stille\ud
3. Sjekk at navnet er ditt. Pass på at brev og armbånd bærer ditt navn. Pass på at identiteten din blir sjekket ved prøver og undersøkelser\ud
4. Still spørsmål om kvalitet. Hvem er ansvarlig for deg? Hvilken erfaring har de ansvarlige med din sykdom? Spør hvem som skal operere deg og skriv det ned\ud
5. Kontroller medisinen. Er den din? Hvorfor skal du ta den? Hvordan virker den? Er det rett dose?\ud
6. Pårørende kan hjelpe deg. Familien kan tale din sak når du ikke har krefter selv. Familien kan få informasjon og være med deg om du ønsker det\ud
7. Få kunnskap om hva som feiler deg. Lær om diagnosen. Spør om undersøkelser og behandlinger. Be legen tegne med penn på deg hvis du skal opereres.\ud
8. Si fra om du har smerter eller plager. Gjenta det om nødvendig. Be eventuelt om å få det nedtegnet i rapport/journal.\ud
9. Hva skjer etter sykehusoppholdet? Hvilke smerter og plager kan oppstå? Skal du gjøre noe med kostholdet? Hvor aktiv kan du være?\ud
10. Ved akutt behov for helsehjelp: Hvem skal du kontakte? Lege, legevakt eller sykehus? Hva trenger de av informasjon når du tar kontakt?ENGLISH: 1-page key messages\ud
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In the spring of 2008 the Norwegian Unit for Patient Safety produced a leaflet for patients going to hospital. The leaflet contains simple advices on what patients themselves can contribute with in order to enhance their own safety during hospitalization. The brochure is now available in Norwegian and Sami (the language of the indeginous people of northern Norway), in addition to eight of the major minority languages in Norway: Arabic, Urdu, Turkish, Somali, Polish, English, French and Spanish.\ud
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1. Tell us about yourself : Do you need an interpreter? Do you take any medication? What kind of treatment are you having? Is there anything else you do to improve your health?\ud
2. Ask us until you are sure that you understand. Don’t be afraid to ask more than once. Write down the information you get, and any questions you want to ask us.\ud
3. Check the name. Make sure that letters and wristbands carry your own name. Make sure that your identity is checked every time a test is taken or you are examined.\ud
4. Ask questions about quality. Who is responsible for you? What experience do they have with your type of illness? Ask who is going to perform surgery on you and write down the name.\ud
5. Check the medication. Is this your medication? Why do you have to take it? How does it work? Have you been given the right dose?\ud
6. Family and friend can help you. They can speak up for you when you feel too weak to do so yourself. Your family and friends can be given information and accompany you if you want them to.\ud
7. Learn about your illness. Learn about your diagnosis. Ask about examinations, tests and treatments. If you are to have surgery, ask the doctor to sketch out incision lines on you with a marker pen.\ud
8. Let us know if you are in pain or uncomfortable. If necessary, remind us. You can have the nurse or doctor record your symptoms in your medical records.\ud
9. What happens after you are discharged from the hospital? What aches and pains should you expect? Should you do anything about your diet? How much can you exert yourself?\ud
10. In the event of a medical emergency: Who should you contact: your GP, the casualty clinic or the hospital? What do they need to know when you contact them
Pasienterfaringer i spesialisthelsetjenesten. Et generisk, kort spørreskjema
No full textNORSK:Det er i bruk mange forskjellige spørreskjemaer ment for ulike pasientgrupper lokalt i helsetjenesten. Spørreskjemaene har varierende kvalitet og er lite egnet for sammenlikning av resultater på tvers av tjenester og pasientgrupper. Kunnskapssenteret ble derfor forespurt av Helse Vest RHF om å identifisere 8–10 kjernespørsmål til bruk i lokale pasienterfaringsundersøkelser i regionen, samt vurdere behovet for tilleggsspørsmål for ulike pasientgrupper. For å kunne besvare problemstillingene gjennomførte vi en pilotundersøkelse ved Helse Bergen HF med hovedfokus på pasientenes vurdering av viktigheten av en rekke pasienterfaringsområder. Undersøkelsen omfattet svarergrupper med erfaring fra ni ulike fagområder og omsorgsnivå:\ud
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* Rehabilitering, poliklinikk\ud
* Somatisk avdeling, voksne, døgnopphold\ud
* Somatisk avdeling, voksne, poliklinikk/dagavdeling\ud
* Psykisk helsevern, voksne, døgnopphold\ud
* Psykisk helsevern, voksne, poliklinikk\ud
* Somatisk avdeling, barn, døgnopphold\ud
* Psykisk helsevern, barn, poliklinikk\ud
* Avhengighetsbehandling, døgnopphold\ud
* Avhengighetsbehandling, poliklinikk\ud
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Aktualitet og viktighet var de viktigste kriteriene for å avklare valg av kjernespørsmål. Spørsmål der færre enn 20 prosent svarte at det ikke var aktuelt, ble vurdert som aktuelle og dermed som relevante i et generisk spørreskjema. I piloten ble hvert erfaringsspørsmål etterfulgt av et spørsmål om hvor viktig dette spørsmålet var for svareren. Gjennomsnittsskårer på spørsmålene om viktighet ble brukt for å skille ut de viktigste erfaringsspørsmålene for hver av svarergruppene. Kjernespørsmålene ble valgt ut fra betraktninger om viktighet og aktualitet på tvers av gruppene. Informasjonen ble også brukt til å begrunne særskilte tilleggsspørsmål for hver av gruppene. Basert på undersøkelsen foreslår Kunnskapssenteret 10 generiske kjernespørsmål, og 1–3 tilleggsspørsmål for de enkelte gruppene. \ud
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Fra et psykometrisk synspunkt vil en kortversjon av et spørreskjema ikke ha den samme validiteten og reliabiliteten som et mer omfattende skjema med tilpasning til spesifikke svarergrupper. Det foreliggende forslaget til kjernespørsmål hviler i stor grad på Kunnskapssenterets materiale fra tidligere nasjonale undersøkelser blant svarergruppene (unntatt rehabilitering). Gitt rammene i det foreliggende prosjektet, anser vi forslaget som godt underbygd.ENGLISH: 1-page key messages\ud
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The objective of this study was to identify a set of eight to ten core questions about patient experiences with specialised health care.\ud
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Based on previous research, we selected 24 questions about patient experiences with potential relevance for nine different patient groups.\ud
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Patients, or their guardians in case of minors, were asked to rate their experiences as well as the importance of each question.\ud
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Seven groups of patients were contacted by mail; two groups were contacted in person.\ud
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Criteria for selection of core questions were:\ud
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* Low prevalence ( < 20 %) of “Not applicable”-responses\ud
* High mean importance score across the nine respondent groups\ud
* Not more than two questions about the same patient experiences domain (to secure comprehensiveness)\ud
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Following the criteria we identified ten core questions applicable for all patient groups. In addition, we identified one to three important supplemental questions for each of the nine groups
”Sikker som banken…” - sikrer helseforetakene trygge blodoverføringer? Oppsummering av 14 tilsyn i 2008 i henhold til blodforskriften
No full textNORSK SAMMENDRAG: Helseforetakenes internkontrollsystemer/kvalitetsstyringssystemer er ikke i tråd med blodforskriftens krav. Dette reduserer pasientsikkerheten. \ud
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Statens helsetilsyn gjennomførte i 2008 tilsyn med blodbankvirksomhet i 14 helseforetak. Denne delen av helsetjenesten er utførlig regulert i blodforskriften fordi det er et sårbart område der konsekvensene av svikt kan få alvorlige følger for pasientene. Derfor skal det etter forskriften gjennomføres tilsyn med blodbanker minst annet hvert år. \ud
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Det må være nulltoleranse for at pasientene får blod med feil blodtype, og for at pasientene utsettes for overførbare infeksjonssykdommer ved blodoverføringer. Følgelig må hvert enkelt ledd styres og overvåkes nøye. De ulike elementene i kvalitetsstyringssystemet skal fungere som sikkerhetsbarrierer for å unngå svikt ved blodoverføringer til pasienter. \ud
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Tilsynsrapportene gir et samlet bilde som gir grunnlag for å konkludere med at helseforetakenes blodbankvirksomhet ikke er styrt og ledet slik som forutsatt i blodforskriften. De påviste manglene i helseforetakenes internkontrollsystemer dvs. i deres kvalitetsstyring, reduserer sikkerheten for pasientene. Dette medfører at sannsynligheten for svikt ved blodoverføringer er for høy. Tilsynet har avdekket mangelfull styring og oppfølging både av aktiviteten internt i blodbankene og av samarbeidet mellom blodbankene og andre avdelinger. \ud
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Statens helsetilsyn understreker at kritiske områder i helseforetakenes blodbankvirksomhet må underlegges tilstrekkelig styring og oppfølging fra ledelsens side. De påpekte avvikene vurderes derfor som en alvorlig svikt i helseforetakenes kvalitetsstyringssystemer. Disse forholdene må bringes i orden for at pasientsikkerheten skal bli tilstrekkelig ivaretatt.SUMMARY IN ENGLISH: The internal control systems/quality management systems of the health trusts do not meet the requirements of the regulations relating to blood and blood components. This reduces patient safety.\ud
In 2008, the Norwegian Board of Health Supervisions carried out supervision of blood banks in 14 health trusts. This section of the health service is regulated in detail by the regulations relating to blood and blood components , because it is a vulnerable area in which errors can have serious consequences for patients. Thus, according to the regulations, supervision of blood banks shall be carried out at least once every two years.\ud
Errors in which patients are given the wrong type of blood, or in which patients get a disease which is transmitted through blood, must never occur. Thus, every stage must be carefully supervised and controlled. Each component of the quality management system should function as a safety barrier to prevent errors occurring when patients are given a blood transfusion. \ud
The supervision reports show that there is reason to conclude that the blood banks are not organized and managed in line with the regulations. The deficiencies that were identified in the health trusts’ internal control systems, that is to say, in their quality managements systems, result in reduced safety for patients. This means that the probability for errors occurring when blood transfusion are given is too high. We identified inadequate management and follow up both of activities in the blood banks and of cooperation between the blood banks and other departments.\ud
The Norwegian Board of Health Supervision points out that critical areas in the activity of blood banks must be organized adequately and followed up by the leadership of the health trusts. The nonconformities (departures from the regulations) that were identified must therefore be regarded as serious deficiencies in the quality management systems of the health trusts. These conditions must be dealt with in order to ensure that patient safety is adequate
Molecular Requirements for Sorting of the Chemokine Interleukin-8/CXCL8 to Endothelial Weibel-Palade Bodies.
No full textSorting of proteins to Weibel-Palade bodies (WPB) of endothelial cells allows rapid regulated secretion of leukocyte-recruiting P-selectin and chemokines as well as procoagulant von Willebrand factor (VWF). Here we show by domain swap studies that the exposed aspartic acid in loop 2 (Ser(44)-Asp(45)-Gly(46)) of the CXC chemokine interleukin (IL)-8 is crucial for targeting to WPB. Loop 2 also governs sorting of chemokines to alpha-granules of platelets, but the fingerprint of the loop 2 of these chemokines differs from that of IL-8. On the other hand, loop 2 of IL-8 closely resembles a surface-exposed sequence of the VWF propeptide, the region of VWF that directs sorting of the protein to WPB. We conclude that loop 2 of IL-8 constitutes a critical signal for sorting to WPB and propose a general role for this loop in the sorting of chemokines to compartments of regulated secretion
Heroinforbruk og heroinbeslag i Norge
No full textNORSK SAMMENDRAG: I perioden 2000-2008 ble det i gjennomsnitt beslaglagt 61 kilo heroin i Norge pr. år. Mengden som beslaglegges varierer mye fra år til år, fra 8 kilo heroin i 2007 til 129 kilo i 2004. Politiet stod for 98 prosent av alle beslag, mens Tollvesenet beslagla ca. 55 prosent av total mengde. Tollvesenets andel av total beslagsmengde har økt de siste tre årene.\ud
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Forbruk av heroin\ud
SIRUS har beregnet hvor stort forbruket av heroin er i Norge i løpet av et år på oppdrag av Toll- og avgiftsdirektoratet. Det er første gang en slik beregning er gjort i Norge.\ud
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For å kunne beregne det samlete forbruket av heroin må man beregne antall brukere og mengde heroin de bruker i løpet av et år. Heroinbrukerne er delt inn i tre grupper: problembrukere, sporadiske brukere og eksperimentbrukere. Problembrukerne står for det meste av heroinforbruket i Norge.\ud
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Forskerne anslår at forbruket i perioden 2006-2008 var i underkant av 1500 kilo. Forbruket har gått ned fra 2000-2002 da det estimerte anslaget var i overkant av 2000 kilo. Nedgangen skyldes i all hovedsak en reduksjon i antall problembrukere i Norge i dette tidsrommet.\ud
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Beslag i forhold til beregnet heroinforbruk\ud
Beslaglagt mengde utgjorde i gjennomsnitt fire prosent av beregnet heroinforbruk i perioden 2000-2008. Politi og Tollvesenets beslag sto hver for ca to prosent.\ud
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I forhold til beregnet forbruk og antall problembrukere skiller ikke norske beslag seg fra andre land der det finnes tilsvarende beregninger. I Norge beslaglegges 4,8 kg heroin pr tusen problembrukere mens tilsvarende tall for Storbritannia er 4,5 kg, Australia 4,9 kg, Italia 6,2 kg og Spania 3,9 kg.ENGLISH SUMMARY: • Each year between 2000 and 2008, 61 kilos of heroin were seized in Norway on average. In terms of the number of seizures, the customs authorities took a mere 2 per cent, but in terms of quantities seized, they took about 55 per cent. To estimate how much heroin is consumed in Norway, we estimated the number of persons using heroin in the course of a year and multiplied that number by an estimate of the amount consumed. We adopted as a working assumption a threefold division of heroin users: experimental users; occasional users; and problem users. We subdivided the latter group by route of administration: administration route is considered to impact the amount of heroin taken. We estimated the annual quantities taken by users who only inject, users who only smoke the drug and users who do both. Because of insufficient data subdivision of occasional and experimental users by route of administration proved unfeasible.\ud
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• We used a multiplier method to estimate the number of problem users injecting heroin. The method uses the annual number of drug-related deaths, an estimate of mortality in the group, and the percentage of all causes of death comprised by overdose deaths. We were then able to calculate how many heroin injecting users there would have to be for that number of recorded drug-related deaths to be valid. The numbers of heroin users who ingest only by smoking or by smoking and injecting were estimated as a percentage of this figure. Estimates of the numbers of experimental and occasional users respectively were made on the basis of survey data.\ud
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• Dosage was mainly estimated from information on heroin users obtained by special surveys, including frequency of use and dosage on each occasion. There is wide variation in the quantities taken, both within the group of problem users and, not least, between problem, occasional and experimental users. Our estimates suggest that injecting problem users consume annually about 160 grams, heroin smokers about 118 grams, while combined smokers and injectors consume an annual average of 140 grams. We assume that the occasional users take heroin twice per month, giving an annual consumption rate of 6.6 grams. The smallest share of overall consumption is, naturally enough, down to the experimental users, whom we assume try heroin on average twice, resulting in 0.3 grams for each of them.\ud
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• In 2006, the amount of heroin consumed in Norway was estimated to be around 1,445 kg. 2006 is the last year for which we have reliable data for calculating the number of problem users. It shows a drop from the years 2000?2002, when the estimated figure exceeded 2,000 kg. The main cause of the reduction was a fall in the number of problem users.\ud
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• According to our calculations, problem users are the principal consumers of heroin in Norway. If we change the number of occasional users, for instance, or estimated dosage by 20 per cent, the total quantity changes only by plus/minus 5 kg (1,440?1,450 kg). If we change the number of experimental users or the amount used by them, the effect is minimal. But a 20 per cent change in the number of problem users changes the estimated consumption figures by 15?17 per cent (1,205?1,730 kg), and changing annual consumption figures changes the estimated figure by 16?20 per cent (1,160?1,730 kg).\ud
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• For the years 2000?2008, seizures made by the police and customs authorities amounted, we found, on average to 4 per cent of the total amount of heroin consumed in Norway. Overall average seized by the customs was 2 percent. In per cent of estimated overall consumption, seizures by the customs authorities in 2006 came out on top at 6 per cent, with the lowest rate in the following year, 2007, when less than 1 per cent of the total amount consumed was taken
