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Barn som pårørende. Kvalitetssikring av rutiner for oppfølging av barn som pårørende i en psykiatrisk klinikk - en journalgjennomgang ved Helse Fonna HF
Get PDFBakgrunn: En av de hyppigste årsakene til at barn er i kontakt med barnevernet er foreldrenes psykiske sykdom. Forskning viser en sterk sammenheng mellom alvorlighetsgraden av foreldrenes psykiske sykdom og barnets egen helse og utvikling. Stortinget vedtok i 2009 endringer i Lov om helsepersonell og lov om spesialisthelsetjenesten for å sikre identifisering og ivaretakelse av mindreårige barn av pasienter med psykisk sykdom, rusavhengighet og alvorlig somatisk sykdom eller skader. Implementering av lovkravene er imidlertid vist å være utfordrende.
Formål: Formålet med masteroppgaven er å undersøke hvordan lovendringen fra 2009 kommer til uttrykk i en psykiatrisk behandlingsinstitusjon. Målet å bidra med grunnlagsdata for kvalitetsarbeidet i det aktuelle helseforetaket. Følgende problemstillinger er utarbeidet: Er barnet identifisert og kartleggingssamtalen dokumentet i henhold til vedtatte rutiner? Hvilket helsepersonell utfører kartleggingen? Fremkommer helsepersonellets vurdering av barnets situasjon og er pasientens samtykke til videre oppfølging av barnet dokumentert?
Metode: Prosjektet er en retrospektiv journalgjennomgang. Datagrunnlaget består av relevante journaldata fra 750 pasienter i alderen 20-60 år, innlagt for spesialisert behandling ved Klinikk for psykisk helsevern i Helse Fonna HF årene 2010, 2012 og 2014.
Resultater: I utvalget er foreldrestatus dokumentert i 47 % av pasientenes journaler. Av disse er 24 % registrert med barn og 23 % uten. I 2012 var det gjennomført kartleggingssamtaler med 19 % av pasienter identifisert med barn, mens dette var økt til 38 % i 2014. Et gjennomgående funn er mangler ved utfylling av kartleggingsskjemaet. Blant de 159 kartleggingsskjemaene som inngår i utvalget er det registrert behov for melding til barnevernet i kun 4 %. Barnevernet var imidlertid dokumentert å være involvert i 38 %.
Oppsummering: Den lave dokumentasjonsgraden gjenspeiler de utfordringer helsepersonell og pasient opplever når barnets situasjon blir samtaletema. Fremtidig kvalitetssikringsarbeid bør derfor legge til rette for økt faglig støtte ved gjennomføring av kartleggingssamtalen og forenkle dokumentasjonsrutinene.Masteroppgave i barnevernMABARN35
Politics for Exclusion and Strategies for Inclusion: A Scoping Review of Nordic Family Reunification Policies, Practices, and Impact on Refugees
Get PDFIn recent decades, Nordic countries have seen a general move towards stricter migration policy, including in the area of refugee family reunification. While the body of literature on family reunification in these countries is growing, we lack a broad overview of research on policy and practice, as well as the impact of policy on refugee wellbeing. We conducted a scoping review of the academic literature on family reunification policy, practice and impact on refugees in the Nordic countries. The objective of this study was twofold: to collect and review academic literature on family reunification policy in the Nordic countries and on the experiences of and strategies used by refugees to navigate this process. We used a key concept in the theory of salutogenesis, a sense of coherence, to frame the analysis of refugee experiences. The findings of the review indicated that there is an uneven coverage of the Nordic countries in the literature, both in terms of geography and thematic focus. Much research reports on the negative impact on refugee wellbeing, but qualitative approaches allow for more nuanced insights into refugee experiences and responses. The use of a sense of coherence helped identify refugee use of resources and strategies in the literature.publishedVersio
Impact of linear growth-improving interventions on childhood overnutrition at 24 months: a randomized controlled trial
Get PDFBackground: Childhood malnutrition, both undernutrition and overnutrition, is a major health concern in many low- and middle-income countries (LMICs). Efforts to reduce early undernutrition could also lead to obesity. In an earlier study, we reported the successful impact of a package of preconception, pregnancy, postnatal, and/or early childhood interventions (health, nutrition, psychosocial support, and water, sanitation, and hygiene) delivered in the first 1000 d, on reducing stunting in low-to-middle-income populations, in comparison with routine care. However, the impact of these interventions on early body composition and subsequent overweight is not known.
Objectives: The objective of this study was to estimate the effect of a package of interventions directed at preventing stunting in the first 1000 d on body composition at 1 mo and childhood overweight and/or obesity at 24 mo of age.
Methods: Infant body composition was measured by deuterium dilution at 1 mo of age, along with the prevalence of childhood overweight and/or obesity at 24 mo, defined by a body mass index-for-Age Z (BMIz) score >+2 standard deviation.
Results: Children in the preconception, pregnancy, and early childhood intervention group and those in the pregnancy and early childhood intervention group had higher body mass index z scores than those in routine care. However, the prevalence of overweight and/or obesity was low (ranging from 0.0 to 1.3%). Pregnancy interventions significantly increased neonatal fat-free mass (mean difference 0.1 kg, 95% confidence interval [CI]: 0.01, 0.2). However, there was no significant change in fat mass.
Conclusions: Comprehensive interventions from preconception to early childhood improve linear growth but do not result in overweight and/or obesity at 24 mo. With better resultant linear and ponderal growth, they converge with the World Health Organization's “double-duty actions for nutrition” for LMIC settings, where childhood overweight and/or obesity is a growing concern.acceptedVersio
The association between asthma and dental caries in asthmatic children and preventive measures to protect the dental health of asthmatic children
Get PDFThis master's thesis explores the connection between asthma and dental caries in children, highlighting how asthma medications and physiological factors like reduced saliva flow contribute to oral health issues. It emphasizes the role of environmental and geographical factors in shaping these risks. The study suggests preventive strategies like fluoride treatments and regular dental visits, advocating for a multidisciplinary approach to integrate dental care into asthma management. It also identifies the potensial of salivary biomarkers for early diagnosis. The thesis calls for further longitudinal research to better understand the relationship and improve care for asthmatic children.MasteroppgaveOD5MASTMAOD-ODON
Long-term outcome of children with prenatal exposure to opioid maintenance therapy : Visual function, motor skills, visual-motor integration and brain morphology
Get PDFBakgrunn: Opiatavhengighets-syndrom er et verdensomspennende helseproblem og rammer også barn som utsettes for opiat-eksponering i fosterlivet. Legemiddelassistert rehabilitering (LAR) er standard behandling til pasienter med opiat-avhengighet, det gjelder også gravide. I Norge er prevalensen for barn født av mødre i LAR 0,6-0,8/1000, mens forekomsten i USA er det tidobbelte. Barn født av mødre i LAR har færre neonatale komplikasjoner og høyere fødselsvekt enn barn født av mødre med ubehandlet heroinavhengighet, men dyreforsøk og studier på menneskefostre, spebarn og førskolebarn har vist at prenatal LAR- eksponering gir økt risiko for synsvansker, utviklingsforstyrrelser og morfologiske forandringer i hjernen. Kunnskapen om barnas utvikling på lang sikt er imidlertid mangelfull.
Hovedmålet med denne studien var å undersøke mulige langtidsvirkninger etter prenatal eksponering for LAR-medikamenter: kartlegge (1) synsfunksjon, (2) motoriske ferdigheter og (3) visuo-motorisk utvikling samt (4) morfologiske forhold i hjernen og om det var en sammenheng mellom eventuelle morfologiske funn og motoriske / visuo-motoriske vansker. I tillegg ønsket vi å sammenligne prestasjonene til barn som hadde vært eksponert for hhv. metadon og buprenorfin.
Materiale og metode: 63 barn med prenatal LAR-eksponering i alderen 5-13 år ble rekruttert gjennom journalsystemene på Haukeland universitetssjukehus og Sørlandet sykehus, og likeledes 63 kontroll-barn uten eksponering, matchet for kjønn og alder. Data om foreskrevne / ikke-foreskrevne medikamenter og rusmidler, sigarett- og alkoholbruk i svangerskapet ble innhentet fra mødre- journalen. Vi undersøkte (1) synsskarphet, (2) øyemotorisk status, (3) refraksjon, (4) fargesyn og (5) synsfelt. Motoriske ferdigheter ble testet med Movement-ABC test, visuo-motorisk integrasjon med Beery-VMI test og nevromotoriske «soft signs» med Motorisk funksjonsnevrologisk undersøkelse (MFNU) test. 55 LAR-eksponerte barn og 59 kontroll-barn gjennomførte MR undersøkelse av hjernen, og vi estimerte totalt intrakranielt volum (ICV) og volum av basalganglier, amygdala m.m. samt mål på kortikal overflate og tykkelse med dataprogrammet FreeSurfer®.
Resultater: Det var høy-signifikante forskjeller på LAR-eksponerte barn og kontroll-barn på flere områder. LAR-eksponerte barn hadde lavere gjennomsnittsverdi for synsskarphet og høyere andel manifest skjeling (30%, vs. 4.8%) enn kontrollbarna. 16% av LAR-eksponerte barn hadde nystagmus men kun ett av kontroll-barna. Metadon-eksponerte barn hadde dårligere synsfunksjon enn buprenorfin-eksponerte. Videre var forekomsten av motoriske vansker høyere hos de LAR-eksponerte, høyre andel hadde visuo-motoriske problemer og nevromotoriske «soft signs». ICV og relative volumer av basalganglier og amygdala var signifikant lavere hos LAR-eksponerte barn, og de hadde mindre kortikal overflate i venstre midtre frontale gyrus og høyre nedre parietale lobulus. Det var en lett korrelasjon mellom visuo-motorisk integrasjon og ICV. Prenatal eksponering for nikotin var en viktig konfunderende faktor, særlig for ICV og skjeling.
Konklusjon / klinisk relevans: Denne studien støtter antagelsen om at prenatal opiat-eksponering hos barn av mødre i LAR kan ha en negativ innvirkning på fosterhjernen og gi økt risiko for synsproblemer og motoriske / visuo-motoriske vansker på lang sikt. Vi håper at studien vil bidra til en bedre forståelse for utviklingsvanskene mange barn av mødre i LAR kan oppleve. Basert på våre funn, støtter vi særlig behandlingsalternativet i LAR-retningslinjene for gravide om nedtrapping av LAR-medikamenter, for å sikre best mulig fosterhelse og utvikling for barnet på lang sikt.Background: Opioid use disorder (OUD) is a worldwide health problem also affecting infants born after prenatal opioid exposure. Opioid maintenance therapy (OMT) with long-acting opioids is the recommended treatment to people suffering from opioid addiction, including pregnant women. In Norway, the prevalence of childbirth to women in OMT is 0.6-0.8/1000 while the United States has a tenfold higher number. OMT-pregnancy is favorable to untreated OUD-pregnancy as regards neonatal outcome. However, preclinical research and studies on human fetuses, infants and small children have demonstrated that prenatal OMT-exposure increases the risk for visual impairments, developmental problems and altered brain morphology. Less is known about the outcome in older children.
Aims: This study seeks to give knowledge about long-term effects of prenatal OMT-exposure. We aimed to explore (1) visual function, (2) motor skills and (3) visual-motor integration, and possible differences between buprenorphine- and methadone-exposed children. We also aimed to (4) examine brain morphology and possible associations between brain morphology and motor / visual-motor function.
Materials and methods: 63 prenatally OMT-exposed children aged 5-13 years and 63 age and sex matched comparison children were recruited from medical registers in two Norwegian hospitals. To assess visual function we examined visual acuity, orthoptic status, refractive state, color vision and visual field. Motor skills were assessed by the Movement-ABC test and visual-motor integration by the Beery-VMI test. We used the Neuromotor assessment test (MFNU) to examine neuromotor “soft signs”. 55 of the OMT-exposed and 59 of the comparison children carried out MRI brain scans, and by means of the automated software FreeSurfer® we obtained total intracranial volume (ICV), volume of subcortical structures and estimates of cortical surface area and thickness.
Results: The OMT-exposed children had poorer mean visual acuity (p<0.001), and manifest strabismus was more frequent in the OMT-group, 30%, vs. 4.8% in the control group. Nystagmus was present in 16% of the exposed children compared to one child among the un-exposed. Methadone-exposed children had poorer visual functional outcome than the buprenorphine-exposed. Also, exposed children had higher prevalence of motor impairments (p=0.001), visual-motor integration problems (p<0.001) and neuromotor “soft signs” (p<0.001). ICV and relative volumes of basal ganglia, amygdala and parts of corpus callosum were significantly smaller, and the left middle frontal gyrus and right inferior parietal lobule had smaller surface area. There was a weak correlation between visual-motor function and ICV. Prenatal nicotine exposure is an important confounder, particularly for strabismus and ICV.
Conclusions: This thesis supports the assumption that prenatal OMT-exposure have long-term effects on brain morphology. Exposed children had increased risk of visual problems, motor impairments and deviant visual-motor integration.
Our study may hopefully contribute to a better understanding of the lasting problems many children may experience after prenatal OMT-exposure. We propose a stronger emphasis in the Norwegian OMT guidelines that tapering OMT in residential care is the safest way to ensure normal fetal development. Residential management of OMT pregnancies may also be well suited for further research.Doktorgradsavhandlin
Attitudes to gender quotas: Why and where to adjust gender imbalance in leadership
Get PDFWhen individuals are confronted with information about why and where gender quotas should apply, does it affect their attitudes? A growing literature argues that information affects opinions on gender equality, but so far there is more consensus on who supports such policies than on what type of information convinces those on the fence. Using a survey experiment fielded among Norwegian citizens and elected representatives, we examine the potential of new rationales and different areas of application to find out what makes (some) people more supportive of gender quotas. Overall, we find that citizens are more affected by moral arguments than elected representatives. Among citizens, we find that emphasizing women's distinct insights boosts support among those with less fixed opinions, and that a talent framing hinting at women as an untapped resource might cause the opposite reaction. Representatives are affected by information about where gender quotas apply, as they are particularly sensitive to information on gender quotas in politics. Quite unexpectedly, we find that those on the right are more supportive of gender quotas in the leadership of religious institutions than elsewhere, and that this seems to be driven at least partly by scepticism against migrants.publishedVersio
A Critical Reconstruction of Evidence-based Practice in Psychology. Evidence and Ethics
No full textEvidence-based practice in psychology is the dominant regulatory principle in clinical psychology, defining psychological knowledge and its application. This book provides a critical analysis and a reconstruction of the policy statement focusing on epistemology and ethics.
The book shows the ideological and historical background for the development of evidence-based practice in psychology. It covers the main conceptual and empirical arguments leading to this transition including philosophy and evidence-based medicine. The book goes on to show some of the defects of evidence-based practice in psychology: it misconstrues psychological knowledge; reduces the number of ethical resources available to regulate psychological practices; does not fulfil its ambitions of being a tripartite concept; and undertheorises the issue of integration. The closing chapters provide a constructive critique, preserving the valuable aspects of evidence-based practice in psychology while developing it to make it function adequately. In that sense, the book aims to change the way psychological knowledge is understood and used in practice.
This text will be engaging and thought-provoking for anyone using psychological knowledge with patients or clients. It will provide analytic resources to understand psychology better and facilitate the application of psychological knowledge in various settings.publishedVersio
Converging perspectives on the processes exacerbating adolescent obesity: an integrative systems approach
Get PDFAdolescent obesity is a complex public health challenge with steadily increasing and variable prevalence among countries. This paper synthesises the driving feedback mechanisms of adolescent obesity studied in the CO-CREATE project, furthering our understanding of the complexity of this issue. Using systems thinking principles and causal loop diagramming, we integrated the following knowledge and perspectives derived from diverse sources into a causal loop diagram (CLD): a systems map generated by adolescents through participatory modelling workshops, a comprehensive literature review, and input from subject-matter experts during validation workshops. We used a structured and iterative approach to include drivers and to identify feedback loops exacerbating adolescent obesity. The CLD identified 27 key feedback loops across four themes: twelve related to the commercial food environment, six to the physical activity environment, four to mental wellbeing and five to social norms. These loops indicate not only diet and physical activity as drivers of obesity but also stress and other emotional and social pressures. Recognising the imperative need to integrate the perspectives and experiences of adolescents into our analysis, this work advocates for the synthesis of experiential insights with empirical research. The integrated CLD can be used as a visual tool that fosters collaboration among stakeholders and engenders a more comprehensive and inclusive system understanding that can provide holistic intervention considerations to tackle adolescent obesity. Additionally, the CLD lays a foundation for subsequent quantitative modelling works to further address this issue and develop context-based approaches to prevention and evaluation of adolescent obesity.publishedVersio
Etablering av Slepeassistanseteam - Hvordan kan slepeassistanseteam etableres og organiseres?
No full textMasteroppgave i operativ ledelse og myndighetsut�velseEXECUTIVE690EXEC69
Temperature as a Key Modulator: Investigating Phosphorylation Patterns of p.Asn666 PDGFRB Variants and Their Role in Downstream Signaling
No full textFour different amino acid substitutions have been reported at the p.Asn666 position in platelet-derived growth factor receptor β (PDGFRβ): p.Asn666Lys, p.Asn666Tyr, p.Asn666Ser, and p.Asn666His. All four substitutions result in strikingly different phenotypes, ranging from somatic infantile myofibromatosis in p.Asn666Lys and ocular pterygium–digital keloid dysplasia in p.Asn666Tyr to a severe form of Penttinen syndrome in p.Asn666Ser, while p.Asn666His is associated with a complex phenotype characterized by debilitating hand and foot contractures and facial coarseness. Here, we show that the p.Asn666Lys, p.Asn666Tyr, and p.Asn666His substitutions result in increased total PDGFRβ phosphorylation at 32°C compared to 37°C. All four substitutions exhibit distinct activation patterns of specific PDGFRβ tyrosine residues at both temperatures, indicating a unique activation of each variant. The temperature effect on downstream signaling is present across all substitutions, resulting in substitution-specific downstream signaling at both 37°C and 32°C. This complex interplay of downstream signaling proteins could be important for the clinical manifestations of p.Asn666 PDGFRB variants. Furthermore, variant-specific overactivation of tyrosine residues and downstream signaling at 32°C emphasize the importance of temperature as an environmental factor in the pathogenesis of this diverse group of disorders.publishedVersio