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Ambulante psykiatriske helsetjenester til barn og ungdom som alternativ til institusjonsbehandling
No full textEffects of polymorphisms in ERCC1, ASE-1 and RAI on the risk of colorectal carcinomas and adenomas: a case control study.
No full textBACKGROUND: The risk of sporadic colorectal cancer is mainly associated with lifestyle factors and may be modulated by several genetic factors of low penetrance. Genetic variants represented by single nucleotide polymorphisms in genes encoding key players in the adenoma carcinoma sequence may contribute to variation in susceptibility to colorectal cancer. In this study, we aimed to evaluate whether the recently identified haplotype encompassing genes of DNA repair and apoptosis, is associated with increased risk of colorectal adenomas and carcinomas. METHODS: We used a case-control study design (156 carcinomas, 981 adenomas and 399 controls) to test the association between polymorphisms in the chromosomal region 19q13.2-3, encompassing the genes ERCC1, ASE-1 and RAI, and risk of colorectal adenomas and carcinomas in a Norwegian cohort. Odds ratio (OR) and 95% confidence interval (CI) were estimated by binary logistic regression model adjusting for age and gender. RESULTS: The ASE-1 polymorphism was associated with an increased risk of adenomas, OR of 1.39 (95% CI 1.06-1.81), which upon stratification was apparent among women only, OR of 1.66 (95% CI 1.15-2.39). The RAI polymorphism showed a trend towards risk reduction for both adenomas (OR of 0.70, 95% CI 0.49-1.01) and carcinomas (OR of 0.49, 95% CI 0.21-1.13) among women, although not significant. Women who were homozygous carriers of the high risk haplotype had an increased risk of colorectal cancer, OR of 2.19 (95% CI 0.95-5.04) compared to all non-carriers although the estimate was not statistically significant. CONCLUSION: We found no evidence that the studied polymorphisms were associated with risk of adenomas or colorectal cancer among men, but we found weak indications that the chromosomal region may influence risk of colorectal cancer and adenoma development in women
Ingen enkle løsninger. Evaluering av Tiltaksplan for alternativer til rusmiljøene i Oslo sentrum
No full textNORSK SAMMENDRAG: Den tiltagende elendigheten blant rusmiddelmisbrukere og den åpenlyse bruken og omsetningen av narkotika på "Plata" ved Oslo sentralstasjon var gjenstand for stigende bekymring hos sentrale myndigheter. I januar 2003 ble det framlagt en "Tiltaksplan for alternativer til rusmiljøene i Oslo sentrum".\ud
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Det overordnede målet med Tiltaksplanen var å: \ud
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* Løse opp miljøet av rusmiddelmisbrukere i sentrum\ud
* Hindre den omfattende stoffomsetningen samme sted\ud
* Redusere rekrutteringen til miljøet\ud
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Planen inneholdt en rekke tiltak/elementer som tok sikte på å yte hjelp til rusmiddelmisbrukere og holde dem vekke fra sentrumsmiljøet. Det ble lagt opp til at politiet skulle bistå rusmiddelmisbrukere i å få nødvendig hjelp fra sosialtjenesten. Videre ble tett samarbeid mellom ulike kommunale etater, mellom Oslo kommune og andre kommuner, mellom Oslo kommune og Oslo politidistrikt, tillagt stor vekt.\ud
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Evalueringen er en gjennomgang av de ulike tiltakene/elementene og drøfter om og hvilken grad målet med Tiltaksplanen kan sies å være oppnådd.ENGLISH SUMMARY: In light of escalating problems among drug users and the illegal drug dealing on the doorstep of Oslo central station, an area known colloquially as “Plata – the plateau”, there was mounting concern among city and national authorities and the Oslo police. An ad hoc panel was set up to investigate the problem and recommend possible ways forward. Panel members represented Oslo city, Oslo police district and five government ministries. In January 2003, they tendered their report entitled Alternatives to the Drug Scene in the Centre of Oslo – A Plan of Action.22\ud
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By creating alternatives to the city centre drug scene (which itself is divided into several clusters), the action plan aimed to\ud
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• Dissuade drug users from congregating in the city centre\ud
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• Check the comprehensive drug trade in the same place\ud
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• Prevent more people joining the group\ud
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The plan suggested several measures. Taken together they sought to improve help for drug users, and discourage them from congregating in the city centre. The police would be playing a pro-active role here, helping drug users to get the help they needed from the social services. There was an emphasis on collaboration between services in Oslo and other municipalities, and between the city and the Oslo Police District.\ud
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The government provided funding through what was known as the Poverty Plan, subsidizing low-threshold health services and allocating a lump sum to the Oslo police force. Apart from this, the action plan was funded under the ordinary budget.\ud
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SIRUS was asked by the then Department of Social Affairs to evaluate the plan. We used quantitative data, obtained mainly from Oslo city authorities, and qualitative data, collected by us through observation and interviewing etc.\ud
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Findings – individual initiatives\ud
The many individual initiatives contained in the action plan were put in motion largely as envisaged. Although the plan’s completion date has come and gone, many of the initiatives continue in the shape of projects or as part of normal operations.\ud
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• 24 hour institutions offer meals, though to varying degrees. Naturally enough, residents have welcomed the improvement, though the proportion taking advantage of it has varied. Similarly, 24 hour institutions initiated a number of activities for residents. Here, however, participation by residents has been more muted.\ud
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• Several “day shelters” (“væresteder”) have been set up, the largest being Café Trappa at Ila Hybelhus (a residential shelter), where 200 meals are served every day. Other day shelters set up as part of the action plan are Møtestedet F7, Villa Mar Sagene, Villa Mar Øst and Villa Mar Vest.\ud
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• The decentralized needle exchange service is better structured and managed than it was.\ud
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• Low threshold health services have been extended.\ud
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• It is easier to send drug users not officially domiciled in Oslo back to their own communities.\ud
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• Drug users have helped in actions to clean up the city streets and parks, collecting used syringes. Few such exercises have taken place, however.\ud
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• Oslo city has succeeded in “cleaning up” part of the private accommodation market targeted at drug users where landlords frequently charge exorbitant rates. The duties on landlords set out in quality agreements between the city and landlords are easily circumvented by landlords redefining 24 hour accommodation to long-term tenancy agreements.\ud
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• Particular priority has been given to stepping up referral procedures for drug users admitted to emergency places at Ila Hybelhus, Dalsbergstien Hus and Marcus Thranes Hus.\ud
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• A separate project was organized to follow up drug users living in training and/or council flats.\ud
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• A separate project was started to prepare a plan for 25 selected drug users.\ud
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There is no denying the strong commitment of Oslo city through its Alcohol and Drug Addiction Service to organize the measures set out by the action plan. These measures have worked well in most cases for the people they were meant to help. It would be going too far, however, to suggest that the plan succeeded in significantly lowering the number of drug users congregating in various places in the centre of the city. The action plan should therefore be considered more of an “extra”, a supplement rather than an alternative to the places that attract drug users to the town centre.\ud
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The “Plata” action\ud
In spring 2004, the steering committee saw the situation at “Plata” going from bad to worse. The police were no longer in control of the situation. The police, decided the steering committee, should therefore stop turning a blind eye to drug use and drug dealing in the vicinity of Oslo’s central train station. Steps were taken to strengthen police presence and coordinate this with higher preparedness on the part of municipal health and social services. The date agreed by the different parties to launch these measures – April 2004 – had to be postponed for various reasons to June 7 2004. The delay meant that the plans agreed on by the police and Oslo city, however, on coordination procedures, were not practised entirely as envisaged.\ud
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Drug users disappeared from the “Plata” area, but quickly regrouped in Skippergata, a nearby street. The group here counted fewer members, however, and drugs are not injected in full view of the public. This redistribution of the drug scene in Oslo city centre is more the result of what is called the “Plata campaign” than the action plan. The "Plata action" came into being because the action plan had failed to clear drug users away from the station forecourt.\ud
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It was this stronger police presence that was publicly referred to as the “Plata action”. According to some, drug users were being ejected from the station precincts without cause, and it was questioned whether the action was actually legal. There was a certain amount of apprehension at the prospect of higher overdose frequencies as a result of the move. Such fears have proved unfounded, however. Doubts were also raised about claims put out by the police that a large number of drug users at "Plata" were under eighteen.\ud
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Cooperation\ud
Cooperation and coordination were central elements of the action plan. Senior levels at Oslo city and Oslo Police District worked well together from the start. Brought together by regular meetings to implement the action plan made cooperation even better. Both the city and police authorities agree on this assessment. But the situation on the ground is not as clear cut, although operations have gone relatively smoothly there as well. Some had expected the police to do more to help drug users into treatment and other types of assistance than actually transpired.\ud
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Collaboration between the city and the police on the one hand and various voluntary organizations on the other also proved a positive experience in the main. Oslo City Mission and the Salvation Army were slightly unhappy, however, with not being drawn into discussions on the design and implementation of the action plan.\ud
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Oslo’s Alcohol and Drug Addiction Service also seem to have had limited success mobilizing city district authorities to tackle the drug scene in the city centre. In their defence, however, the action plan neither gave priority to this type of collaboration nor suggested how it was supposed to be organized.\ud
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Achievements\ud
The primary objective was to disband the drug scene in the centre of the city. This was not accomplished. Oslo city has nevertheless put a great deal of effort into extending existing services and setting up new options for the group of drug users in question. It is a pertinent question whether the action plan was completely realistic in the first place. Given the aim to dissolve the drug scene in the city centre, setting up a café, needle exchange, outreach health amenity and supervised drug injection facility in Tollbugate 3 – not far from the central station – seems slightly paradoxical.\ud
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While Oslo city deserves praise for its efforts to improve low threshold services for drug users, drug users still face inadequate social and health services. More needs to be done to upgrade individually targeted help by preparing individual plans. This is a challenge for the future, and should be pursued in league with the city district authorities and Alcohol and Drug Addiction Service.\ud
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The nature of the incentives and amount of resources to be spent on the group of drug users in question belong to the realm of political decision making. How the many problems will be tackled depends largely on drug policy ceilings for the health and social services, and indeed the police
Tilbud til barn av foreldre med rusmiddelproblemer
No full textNORSK SAMMENDRAG: Dette er den andre delrapporten om tilbud til barn av foreldre med rusmiddelproblemer som SIRUS har skrevet på oppdrag av Barne- og familiedepartementet. Første delrapport omhandler barn innlagt sammen med foreldre i behandling (SIRUS rapport 5/2005). Bakgrunnen for delrapport 2 er behovet for økt kunnskap om hele spekteret av støtte- og behandlingstilbud i Norge for barn av rusmiddelbrukende foreldre.\ud
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Rapporten konkluderer med at det er det planlagte samspillet mellom de spesifikke rusmiddeltiltakene og de generelle støtte- og behandlingstilbudene for barn, ungdom og familier som synes å fungere. Det anbefales derfor at det utarbeides en overordnet strategi for kompetanseutvikling på rusmiddelrelaterte temaer innen familier for førstelinjens sosial- og helsetjenester, barnehager, skoler og spesialisthelsetjenester.\ud
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Rapporten gir bl.a. følgende faglige anbefalinger:\ud
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* Intensivert innsats overfor gravide misbrukere for å forebygge rusmiddelrelaterte skader i svangerskap og forankret ansvar for tett oppfølging av barna frem til skolealder.\ud
* De gruppebaserte tilbudene utviklet for barn i skolealder samles i et nettverk for erfaringsutveksling og fagutvikling.\ud
* Ivaretakelse av barna må innarbeides i behandlingstiltakene for rusmiddelmisbrukere. Tiltakene må få ansvar for at barnas situasjon blir utredet og ivaretatt.\ud
* Samle erfaringskompetanse og teoretisk kompetanse i tidsavgrensete nettverk.\ud
* Utvikle et forskernettverk for å koordinere ny evaluering og forskning med allerede pågående studier i feltet.ENGLISH SUMMARY: The objective of the second report is to increase knowledge about the entire array of initiatives developed in Norway for support and/or treatment of children of substance abusers. Comprehensive questionnaires were sent to all of the country’s maternal and child health centres, municipal child care and social welfare offices, the special pedagogic and psychological health service linked to the school system, child/adolescent and adult mental health units, treatment facilities for substance abusers and to relevant voluntary organisations. The recipients were asked to report specific initiatives to children of substance abusers. We have material from 821 responses, amounting to about a 50 % return. In addition to the questionnaires, we have conducted research in the field to track down initiatives for children and the description appears to include the most implemented initiatives.\ud
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This report divides the target group into four sub-groups on the basis of whether the substance abuse of the parents is known, and whether the child shows signs of maladjustment or dysfunction. Various measures for helping the children will be mobilised in connection with children in these four groups.\ud
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Among primary care responses, the maternal and child health centres stand out with extra emphasis on helping pregnant substance abusers and parents and their children aged two or under. These centres also offer help, often on a group basis, to school-age children. Counselling groups are usually developed for children aged 7 to 16. The groups are rooted to primary health care and to child and adolescent mental health units. Among treatment facilities for substance abuse patients, 22 % inform of having specific initiatives for children.\ud
There are two major types of initiatives in inpatient treatment units:\ud
(1) Children are admitted together with their parents (Report I);\ud
(2) Children are included in treatment of the family and/or offered help as involved members of the family. Volunteer organisations offer certain specific measures for assisting this target group, primarily in the category of counselling.\ud
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The report covers themes such as recruitment of children to initiatives and follow-ups of children and families through a process of support and treatment. Serious domestic substance abuse is often the result of a complexity of problems, in which psycho-social strains and economic difficulties play a heavy part. Thus there is a need for broad interdisciplinary efforts to approach the children’s and families’ difficulties and in many cases this must be a long-term effort. Our studies coincide with Danish experiences in recent years.\ud
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Main recommendations:\ud
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- An intensive effort should be aimed toward pregnant substance abusers to prevent substance-related prenatal damage. A clearly defined responsibility is needed for close follow-ups of children and to assess their care in preschool years. Various models are suggested.\ud
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- School is a challenging and important arena for children growing up with special burdens. We recommend that group-based initiatives developed for school-age children be organised in a single network to promote exchange of experience and increase professionalism. We also propose that family therapeutic intervention initiatives are included to evaluate group-based initiatives as interventions in families and network structures.\ud
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- To a greater extent, awareness about children and providing for their needs must comprise treatment initiatives for substance abusers. All patients starting treatment should routinely be asked questions about children (number, age, living situation and their care).\ud
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- We need a comprehensive strategy for developing knowledge and recommend the establishment of a research network attending to cumulative and comparative research efforts
Pårørendes erfaringer med somatiske barneavdelinger - Metodedokumentasjon
No full textNORSK SAMMENDRAG: Nasjonalt kunnskapssenter for helsetjenesten gjennomførte i 2005 en undersøkelse blant pårørende til barn innlagt på somatiske barneavdelinger i Norge. Undersøkelsen ble gjennomført på oppdrag fra Sosial- og helsedirektoratet.\ud
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Resultatene fra undersøkelsen presenteres i egne resultatrapporter. I denne rapporten beskrives metoden som er benyttet i undersøkelsen.\ud
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Målgruppene for PasOpp spenner fra befolkning og pasienter til politisk ledelse, helseforvaltningen (inkludert eiere) samt ledere og ansatte i virksomhetene. Det er ofte behov for generaliserbare data, for eksempel i forhold til styrings- og ledelsesformål for kvalitetsforbedring. Det er nødvendig å vite om svarene fra et utvalg pårørende til barn innlagt på sykehus er statistisk representativt slik at de også gjelder for denne gruppen generelt. Spørsmål om representativitet og generaliserbarhet står sentralt i kvantitative metoder, som utgjør hovedtyngden av metodegrunnlaget for undersøkelsen som beskrives her. I arbeidet med utvikling og testing av spørreskjema har også kvalitative metoder blitt benyttet.\ud
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Formålet med denne rapporten er å gjøre rede for: 1. innsamlingsmetode, innsamlingsprosess og utvalg 2. utvikling og validering av spørreskjemaet som er benyttet i undersøkelsen 3. sentrale statistiske begreper
Improving the use of research evidence in guideline development: 16. Evaluation.
No full text: BACKGROUND: The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the last of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. OBJECTIVES: We reviewed the literature on evaluating guidelines and recommendations, including their quality, whether they are likely to be up-to-date, and their implementation. We also considered the role of guideline developers in undertaking evaluations that are needed to inform recommendations. METHODS: We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. KEY QUESTIONS AND ANSWERS: Our answers to these questions were informed by a review of instruments for evaluating guidelines, several studies of the need for updating guidelines, discussions of the pros and cons of different research designs for evaluating the implementation of guidelines, and consideration of the use of uncertainties identified in systematic reviews to set research priorities.How should the quality of guidelines or recommendations be appraised?* WHO should put into place processes to ensure that both internal and external review of guidelines is undertaken routinely.* A checklist, such as the AGREE instrument, should be used.* The checklist should be adapted and tested to ensure that it is suitable to the broad range of recommendations that WHO produces, including public health and health policy recommendations, and that it includes questions about equity and other items that are particularly important for WHO guidelines.When should guidelines or recommendations be updated?* Processes should be put into place to ensure that guidelines are monitored routinely to determine if they are in need of updating.* People who are familiar with the topic, such as Cochrane review groups, should do focused, routine searches for new research that would require revision of the guideline.* Periodic review of guidelines by experts not involved in developing the guidelines should also be considered.* Consideration should be given to establishing guideline panels that are ongoing, to facilitate routine updating, with members serving fixed periods with a rotating membership.How should the impact of guidelines or recommendations be evaluated?* WHO headquarters and regional offices should support member states and those responsible for policy decisions and implementation to evaluate the impact of their decisions and actions by providing advice regarding impact assessment, practical support and coordination of efforts.* Before-after evaluations should be used cautiously and when there are important uncertainties regarding the effects of a policy or its implementation, randomised evaluations should be used when possible.What responsibility should WHO take for ensuring that important uncertainties are addressed by future research when the evidence needed to inform recommendations is lacking?* Guideline panels should routinely identify important uncertainties and research priorities. This source of potential priorities for research should be used systematically to inform priority-setting processes for global research
Kartlegging av bruk av lindrende sedering til døende
No full textNORSK SAMMENDRAG: Statens helsetilsyn gjennomførte høsten 2004 en skriftlig spørreskjemaundersøkelse om lindrende sedering. De viktigste funnene ved undersøkelsen var: Helseforetakene skiller ikke klart mellom lindrende sedering ved livets slutt og den sedering som finner sted som følge av smertebehandling i livets sluttfase. \ud
Lindrende sedering i terminal fase brukes sjelden i norske sykehus. \ud
Sykehusavdelingene er opptatt av de medisinske forutsetningene som må være til stede før slik behandling kan gis. Få avdelinger er imidlertid klar over at pasienten som hovedregel skal samtykke til behandlingen. \ud
Mange avdelinger angir ikke klart hvem som er ansvarlig for behandlingen \ud
Det er uklart hvem som skal dokumentere behandlingen i pasientjournalen og hvor ofte journalnotater skal føres.SUMMARY IN ENGLISH: In the autumn of 2004, the Norwegian Board of Health carried out a questionnaire survey of sedation and pain relief for terminally ill patients in hospitals. The most important findings were:\ud
The health trusts do not distinguish clearly between sedation and pain relief for terminally ill patients, and pain relief in the fi nal stages of life that can have a sedative effect. \ud
Sedation and pain relief for terminally ill patients are seldom used in Norwegian hospitals. \ud
Hospital departments pay much attention to the medical indications for providing sedation and pain relief. However, few departments are aware of the fact that the patient shall normally give consent for treatment. \ud
Many hospital departments do not clearly state who is responsible for the treatment. \ud
There is confusion about who shall record the treatment in the patient record, and how often this shall be done
Bruk av tvang i psykisk helsevern
No full textNORSK SAMMENDRAG: SINTEF Helse har på oppdrag fra Statens helsetilsyn i samarbeid med Sosial- og helsedirektoratet analysert data om tvang fra pasienttellingene i 2003 og 2004 i psykisk helsevern. Vi ønsket bedre kunnskap om de pasientene det anvendes tvang overfor, og det er derfor lagt særlig vekt på kjennetegn ved pasientene.\ud
I rapportens første del presenteres utvalgte resultater, med Helsetilsynets tilsynsmessige vurdering. Andre del er SINTEF Helses rapport ”Analyser av tvang i psykisk helsevern”, med et vedlegg der data om de ulike tvangsformene er sammenstilt.\ud
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SINTEF-rapporten tyder på at bruk av tvang er nært knyttet til fattigdomsproblematikk og bostedsløshet. Mer enn 40 prosent av pasientene under tvungent psykisk helsevern med døgnopphold har ikke egen bolig. I tillegg er det en betydelig andel pasienter med egen bolig, som ikke har egnet bolig eller tilfredsstillende boligsituasjon. De pasientene det blir brukt tvang overfor har jevnt over dårligere økonomi, lavere utdanning og svakere sosial tilknytning enn de pasientene som behandles frivillig. \ud
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Undersøkelsen avdekker også store geografiske og institusjonsvise forskjeller i bruken av tvang. Forskjellene er betydelige når det gjelder alle former for tvang. \ud
Resultatene vil bli gitt nødvendig tilsynsmessig oppfølging av Helsetilsynet i fylkene, men det forutsettes også at tjenestene selv tar tak i situasjonen, og at aktører på ulike nivåer følger opp resultatene innen eget ansvarsområde.SUMMARY IN ENGLISH: SINTEF Health Research has analysed data on compulsory admission and treatment for the Norwegian Board of Health, in cooperation with the National Directorate for Health and Social Affairs. The data describe patients treated in mental health services in 2003 and 2004.\ud
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In the first part of the report, some of the main results are presented, together with our assessment of the findings, in relation to the relevant legal framework. The second part of the report is SINTEF’s report “Analysis of Compulsory Treatment in Mental Health Services”, including an appendix where data on different types of compulsory admission and treatment are analyzed.\ud
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In SINTEF’s report it is suggested that use of compulsory admission and treatment is closely related to problems of poverty and homelessness. More than 40 per cent of the patients who had been admitted involuntarily or who had received compulsory treatment in mental health services, did not have a permanent residence. In addition, a large proportion of patients who did have their own homes, did not have suitable accommodation, or a satisfactory living situation. Patients who had been admitted involuntarily or who had received compulsory treatment generally had lower income, lower education and weaker social networks than patients receiving voluntary treatment.\ud
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There were large differences between regions and institutions in use of compulsory admission and treatment. The differences were large for all types of compulsory admission and treatment.\ud
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The results will be followed up by the Norwegian Board of Health in the Counties. However, we expect that the health and social services deal with the situation, and that managers on different levels follow up the results within their own area of responsibility
Rettssikkerhet for utviklingshemmede. Oppsummering av landsomfattende tilsyn i 2005 med bruk av tvang og makt overfor personer med psykisk utviklingshemning
No full textNORSK SAMMENDRAG: Fylkesmennene gjennomførte i 2005 tilsyn med 53 kommuner som ledd i landsomfattende tilsyn med rettsikkerhet knyttet til bruk av tvang og makt overfor personer med psykisk utviklingshemning. Undersøkelsen gjaldt om kommunene sikrer at brukernes behov for tjenester etter lov om sosiale tjenester etter §4-2, a-d endres i samsvar med endring i behov og at forholdene legges til rette for tjenesteyting med minst mulig bruk av tvang og makt. \ud
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Gjennom tilsynet er det avdekket lovbrudd i 21 av de 53 undersøkte kommunene når det gjelder kommunens sikring av at tjenestetilbudet til utviklingshemmede endres i samsvar med endring i grunnleggende behov. Det er særlig i saksbehandling og rapporterings - og kommunikasjonsrutiner det avdekkes svikt. Mangler når det gjelder saksbehandling og ansvar, rapportering og kommunikasjon mellom ulike ledd i tjenestekjeden fører til sårbarhet og risiko for svikt. \ud
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Lov om sosiale tjenester kapittel 4A åpner for at tvang og makt kan brukes i særlige situasjoner. Helsetilsynet konstaterer at når det er fattet vedtak om bruk av tvang og makt i tråd med lovbestemmelsene gjennomføres disse ofte i samsvar med vedtakene. \ud
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I 41 av de 53 undersøkte kommunene avdekket tilsynet bruk av tvang og makt i strid med lovbestemmelsene. Disse kommunene sikrer ikke i tilstrekkelig grad systematisk arbeid med andre løsninger enn bruk av tvang og makt.\ud
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Mange av de undersøkte kommunene mangler nødvendig styring og ledelse av tjenestene.SUMMARY IN ENGLISH: In 2005, the County Governors carried out supervision of 53 municipalities, as part of countrywide supervision of legal safeguards associated with use of coercion and restraint for people with mental disabilities. It was investigated whether municipalities ensure that the services that clients receive according the Social Services Act § 4-2 a-d are changed in line with changing needs, and that conditions are adapted to ensure the least possible use of coercion and restraint.\ud
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Breaches of the law were detected in 21 of the 53 municipalities that were included in the supervision. These breaches related to the duty of municipalities to ensure that services offered to people with mental disabilities are changed in line with changing basic needs. In particular, deficiencies were found in administrative procedures, reporting routines and communication routines. Deficiencies in administrative procedures, responsibility, reporting and communication between different sectors lead to vulnerability and the risk of deficiencies in the services. \ud
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The Social Services Act Chapter 4A allows for the use of coercion and restraint in special situations. The Norwegian Board of Health established that when a decision about use of coercion and restraint had been made in accordance with statutory requirements, that coercion and restraint were usually carried out in line with the decision.\ud
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In 41 of the 52 municipalities that were included in the supervision, use of coercion and restraint was detected that was contrary to statutory requirements. These municipalities do not adequately ensure that solutions other than use of coercion and restraint are adequately assessed in a systematic way.\ud
Many of the municipalities lacked adequate management and leadership of the services
The human ortholog of the rodent testis-specific ABC transporter Abca17 is a ubiquitously expressed pseudogene (ABCA17P) and shares a common 5' end with ABCA3.
No full textBACKGROUND: During the past years, we and others discovered a series of human ATP-binding cassette (ABC) transporters, now referred to as ABC A-subfamily transporters. Recently, a novel testis-specific ABC A transporter, Abca17, has been cloned in rodent. In this study, we report the identification and characterization of the human ortholog of rodent Abca17. RESULTS: The novel human ABC A-transporter gene on chromosome 16p13.3 is ubiquitously expressed with highest expression in glandular tissues and the heart. The new ABC transporter gene exhibits striking nucleotide sequence homology with the recently cloned mouse (58%) and rat Abca17 (51%), respectively, and is located in the syntenic region of mouse Abca17 indicating that it represents the human ortholog of rodent Abca17. However, unlike in the mouse, the full-length ABCA17 transcript (4.3 kb) contains numerous mutations that preclude its translation into a bona fide ABC transporter protein strongly suggesting that the human ABCA17 gene is a transcribed pseudogene (ABCA17P). We identified numerous alternative ABCA17P splice variants which are transcribed from two distinct transcription initiation sites. Genomic analysis revealed that ABCA17P borders on another ABC A-subfamily transporter - the lung surfactant deficiency gene ABCA3. Surprisingly, we found that both genes overlap at their first exons and are transcribed from opposite strands. This genomic colocalization and the observation that the ABCA17P and ABCA3 genes share significant homologies in several exons (up to 98%) suggest that both genes have evolved by gene duplication. CONCLUSION: Our results demonstrate that ABCA17P and ABCA3 form a complex of overlapping genes in the human genome from which both non-coding and protein-coding ABC A-transporter RNAs are expressed. The fact that both genes overlap at their 5' ends suggests interdependencies in their regulation and may have important implications for the functional analysis of the disease gene ABCA3. Moreover, this is the first demonstration of the expression of a pseudogene and its parent gene from a common overlapping DNA region in the human genome