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Next Page| Abstract: | Objectives. To examine whether enculturation factors, like cultural activities, ethnic pride and native language competence, are related to decreased internalizing and externalizing symptoms in Indigenous Sami youth from Arctic Norway. The impact of self-efficacy on the relationship between enculturation factors and mental health problems was also examined. Study design. Population-based, cross-sectional questionnaire study. Methods. The Norwegian Arctic Adolescent Health Study was conducted among 10th graders in junior high schools in north Norway during 2003–2005. The study sample consisted of 450 Indigenous Sami youth, aged 15–16 years. Internalizing symptoms were measured with the Hopkins Symptom Check List- 10 (HSCL-10), while externalizing symptoms were measured by two subscales of the Strengths and Difficulties Questionnaire (SDQ). Results. For boys, self-efficacy and participation in cultural activities were associated with decreased internalizing symptoms. Additionally, self-efficacy interacted with Sami language competence and cultural activities: when self-efficacy increased, these enculturation factors were related to symptom reduction. For girls, self-efficacy had an independent effect on internalizing symptoms and also strengthened the relationship between participation in cultural activities and reduced externalizing symptoms. Sami language competence was related to the reduction of both internalizing and externalizing symptoms in girls. Conclusions. In the present study, several enculturation factors as well as self-efficacy were identified as potential protective factors against mental health problems. In order to develop theoretical models that explain the mechanisms between cultural resilience and mental health, there is a need for both qualitative studies and longitudinal studies. |
| Description: | The accepted manuscript version of this article is part of Margrethe Bals' doctoral thesis, which is available in Munin at http://hdl.handle.net/10037/2934 |
| URI: | http://hdl.handle.net/10037/3997 |
| Abstract: | Objectives. To examine whether enculturation factors, like cultural activities, ethnic pride, and native language competence, are related to decreasing internalizing and externalizing symptoms in indigenous Sami youth from Arctic Norway. The impact of self-efficacy on the relationship between enculturation factors and mental health problems was also examined.
Study design. Population-based, cross-sectional questionnaire study.
Methods. The Norwegian Arctic Adolescent Health Study was conducted among 10th graders in junior high schools in North Norway during 2003-2005. The study sample consisted of 450 indigenous Sami youth, aged 15-16 years. Internalizing symptoms were measured with the Hopkins Symptom Check List-10 (HSCL-10), while externalizing symptoms were measured by two subscales of the Strengths and Difficulties Questionnaire (SDQ). Results. For boys, participating in cultural activities and self-efficacy were associated with decreasing internalizing symptoms. Additionally, self-efficacy interacted with Sami language competence and cultural activities: when self-efficacy increased, these enculturation factors were related to symptom reduction. For girls, self-efficacy had an independent effect on internalizing symptoms and self-efficacy also strengthened the relationship between participation in cultural activities and reduced externalizing symptoms. Sami language competence was related to reduction of both internalizing and externalizing symptoms in girls. Conclusions. In the present study, several enculturation factors and self-efficacy were identified as potential protective factors against mental health problems. In order to develop theoretical models that explain the mechanisms between cultural resilience and mental health, there is a need for both qualitative studies and longitudinal studies. |
| Description: | This is the accepted manuscript version of the article. Published version in International Journal of Circumpolar Health is available in Munin at http://hdl.handle.net/10037/3997
This article is part of Margrethe Bals' doctoral thesis, which is available in Munin at http://hdl.handle.net/10037/2934 |
| URI: | http://hdl.handle.net/10037/2935 |
| Abstract: | Chronic pain is believed to be related to a dysfunction of descending pain modulatory mechanisms. Functioning of descending pain modulation can be assessed by various methods, including conditioned pain modulation (CPM). CPM refers to the inhibition of one source of pain by a second noxious stimulus, termed the conditioning stimulus. This procedure can activate an endogenous pain inhibitory mechanism that inhibits early nociceptive processing. Chronic pain and anxiety disorders are more prevalent among females and it has been hypothesized that females react with more negative emotions towards unpleasant stimuli and this might be part of the explanation of greater pain sensitivity in females. The present study investigated whether expectations modulate the effect of conditioning stimulation on pain, subjective stress, and heart rate. In addition, we investigated whether the modulation of CPM by expectations differed between males and females. Seventy-two subjects (including 36 women) received six noxious heat stimuli to the forearm. During three of these stimuli, a conditioning stimulus (cold-water bath) was applied to the contralateral arm in order to activate CPM. One third of the subjects were told that this would reduce pain (analgesia group), one-third that it would increase pain (hyperalgesia group), and one third received no information about its effect (no info group). Information that conditioning stimulation decreased or enhanced pain had the corresponding effect in females, but not in males. Conditioning stimulation increased stress, but not heart rate in females in the hyperalgesia group. A higher expectation of analgesia and lower stress during conditioning stimulation was associated with larger inhibitory CPM. These results suggest that reduced inhibitory CPM can be due to contextually induced cognitive and emotional factors and not necessarily a dysfunction of descending inhibitory pathways. |
| URI: | http://hdl.handle.net/10037/4877 |
| Abstract: | In a randomised placebo-controlled clinical trial it is assumed that psychosocial effects of the treatment, regression to the mean and spontaneous remission are identical in the drug and placebo group. Consequently, any difference between the groups can be ascribed to the pharmacological effects. Previous studies suggest that side effects of drugs can enhance expectancies of treatment effects in the drug group compared to the placebo group, and thereby increase placebo responses in the drug group compared to the placebo group. The hypothesis that side effects of drugs can enhance expectancies and placebo responses was tested. Painful laser stimuli were delivered to 20 healthy subjects before and after administration of a drink with 0 or 4 mg/kg caffeine. The drink was administered either with information that it contained a painkiller or that it was a placebo. Laser-evoked potentials and reports of pain, expectancy, arousal and stress were measured. Results Four milligrammes per kilogramme of caffeine reduced pain. Information that a painkiller was administered increased the analgesic effect of caffeine compared to caffeine administered with no drug information. This effect was mediated by expectancies. Information and expectancies had no effect on pain intensity when 0 mg/kg was administered. The analgesic effect of caffeine was increased by information that a painkiller was administered. This was due to an interaction of the pharmacological action of the drug and expectancies. Hence, psychosocial effects accompanying a treatment can differ when an active drug is administered compared to a placebo. |
| URI: | http://hdl.handle.net/10037/3899 |
| Abstract: | Background: In patients with very severe dementia self-rating of quality of life usually is not possible and appropriate instruments for proxy-ratings are not available. The aim of this project is to develop an instrument of clinical proxy-ratings for this population. Methods: Using electronic instruments, physicians and nurses recorded patient behaviour and changes of behaviour over a period of one year. Based on these data a list of 65 items was generated and subsequently allocated to 14 categories. This list was tested in 217 patients (61–105 yrs) with dementia diagnosed according to ICD-10 by both physicians and nurses. The severity of dementia was assessed by means of the Global Deterioration Scale (GDS) and the Brief Cognitive Rating Scale (BCRS). The Spitzer-Index (proxy-rating) was used as a global quality of life measure. Activity of daily living was rated using the Barthel Index. Results: A factor analysis of the original 65 items revealed 5 factors (communication, negative affect, bodily contact, aggression, and mobility). By stepwise removing items we obtained satisfactory internal consistencies of the factors both for nurses' and physicians' ratings. The factors were generally unrelated. The validity of the instrument was proven by correlations of the factors communication and mobility with the Brief Cognitive Rating Scale (BCRS) and the Barthel-Index. Conclusion: The results demonstrate the reliability and validity of the Vienna List as a proxy rating measurement of quality of life in patients with severe dementia. The psychometric properties of the scale have to be proved in further studies. |
| URI: | http://hdl.handle.net/10037/1135 |
| Abstract: | Survey of workplace bullying in a Norwegian hospital found that 10% of nurses, therapists, and physicians (N=440) had witnessed bullying. Negative Acts Questionnaire (NAQ) scores were low, Minnesota Satisfaction Questionnaire (MSQ) scores were positive, and Organizational Commitment Questionnaire (OCQ) scores were neutral. NAQ scores and having witnessed bullying both predicted low MSQ scores, low over-all job satisfaction, and low OCQ scores. By psychometric triage, some of the NAQ’s 22 negative acts can be identified for priority administrative intervention based on a) the degree to which NAQ items predict decreased satisfaction and decreased commitment, b) the prevalence rates of particular negative acts, and c) efficiency of intervention. Psychometric triage recommended intervention first on the problem of “necessary information withheld”, which had an 18% prevalence rate and predicted lower MSQ and OCQ scores. The second priority should be on “pressure to give up entitlements”, which had prevalence of 2% but also predicted lower MSQ and OCQ scores. The third and fourth priorities should focus on “tasks below level of competence” (reported by 51%) and on “unmanageable workload” (reported by 28%), neither of which predicted MSQ or OCQ scores. |
| URI: | http://hdl.handle.net/10037/3804 |
| Abstract: | Background. A comprehensive meta-analysis to identify the proportions of comorbid personality disorders (PD) across the major subtypes of anxiety disorders (AD) has not previously been published. Methods. A literature search identified 125 empirical papers from the period 1980-2010 on patients with panic disorders, social phobia, generalised anxiety, obsessive-compulsive (OCD) and post-traumatic stress disorder (PTSD). Several moderators were coded. Results. The rate of any comorbid PD was high across all ADs, ranging from .35 for PTSD to .52 for OCD. Cluster C PDs occurred more than twice as often as cluster A or B PDs. Within cluster C the avoidant PD occurred most frequently, followed by the obsessive-compulsive and the dependent PD. PTSD showed the most heterogeneous clinical picture and social phobia was highly comorbid with avoidant PD. A range of moderators were examined, but most were non-significant or of small effects, except an early age of onset, which in social phobia increased the risk of an avoidant PD considerably. Gender or duration of an AD was not related to variation in PD comorbidity. Limitations. Blind rating of diagnoses was recorded from the papers as an indication of diagnostic validity. However, as too few studies reported it the validity of the comorbid estimates of PD was less strong. Conclusions. The findings provided support to several of the proposed changes in the forthcoming DSM-5. Further comorbidity studies are needed in view of the substantial changes in how PDs will be diagnosed in the DSM-5. |
| URI: | http://hdl.handle.net/10037/4559 |
| Abstract: | The Scandinavian guidelines for management of minimal, mild and moderate head injuries were developed to provide safe and cost effective assessment of head injured patients. In a previous study conducted one year after publication and implementation of the guidelines (2003), we showed low compliance, involving over-triage with computed tomography (CT) and hospital admissions. The aim of the present study was to investigate guideline compliance after an educational intervention. We evaluated guideline compliance in the management of head injured patients referred to the University Hospital of Stavanger, Norway. The findings from the previous study in 2003 were communicated to the hospitals physicians, and a feed-back loop training program for guideline implementation was conducted. All patients managed during the months January through June in the years 2005, 2007 and 2009 were then identified with an electronic search in the hospitals patient administrative database, and the patient files were reviewed. Patients were classified according to the Head Injury Severity Scale, and the management was classified as compliant or not with the guideline. The 1 180 patients were 759 (64%) males and 421 (36%) females with a mean age of 31.5 (range 0-97) years. Over all, 738 (63%) patients were managed in accordance with the guidelines and 442 (37%) were not. Compliance was not significantly different between minimal (56%) and mild (59%) injuries, while most moderate (93%) injuries were managed in accordance with the guidelines (p < 0.05). Noncompliance was caused by overtriage in 362 cases (30%) and undertriage in 80 (7%). Guideline compliance was 54% in 2005, 71% in 2007, and 64% in 2009. This study shows higher guideline compliance after an educational intervention involving feed-back on performance. A substantial number of patients are exposed to over-triage, involving unnecessary radiation from CT examinations, and unnecessary costs from hospital admissions. |
| URI: | http://hdl.handle.net/10037/4441 |
| Abstract: | We recorded the pupil diameters of participants performing the words’ color-naming Stroop task (i.e., naming the color of a word that names a color). Non-color words were used as baseline to firmly establish the effects of semantic relatedness induced by color word distractors. We replicated the classic Stroop effects of color congruency and color incongruency with pupillary diameter recordings: relative to non-color words, pupil diameters increased for color distractors that differed from color responses, while they reduced for color distractors that were identical to color responses. Analyses of the time courses of pupil responses revealed further differences between colorcongruent and color-incongruent distractors, with the latter inducing a steep increase of pupil size and the former a relatively lower increase. Consistent with previous findings that have demonstrated that pupil size increases as task demands rise, the present results indicate that pupillometry is a robust measure of Stroop interference, and it represents a valuable addition to the cognitive scientist’s toolbox. |
| URI: | http://hdl.handle.net/10037/3906 |
| Abstract: | We describe a psychoeducational program integrated in a basic computer skills course for participants suffering from social anxiety. The two main aims of the course were: that the participants learn basic computer skills, and that the participants learn to cope better with social anxiety. Computer skills were taught by a qualified teacher. Psychoeducation and cognitive therapy skills, including topics such as anxiety coping, self-accept, and self-regulation, were taught by a clinical psychologist. Thirteen of 16 participants completed the course, which lasted 11 weeks. A qualitative analysis was performed, drawing on observations during the course and on interviews with the participants. The participants were positive about the integration of psychoeducation sessions in the computer course, and described positive outcomes for both elements, including improved computer skills, improved self-esteem, and reduced social anxiety. Most participants were motivated to undertake further occupational rehabilitation after the course. |
| URI: | http://hdl.handle.net/10037/3593 |
| Abstract: | Psychotherapy is an effective treatment for mental health disorders, but even with the most efficacious treatment, many patients do not experience improvement. Moderator analysis can identify the conditions under which treatment is effective or whether there are factors that can attenuate the effects of treatment. In this study, linear mixed model analysis was used to examine whether the Full Scale IQ (FSIQ), Performance IQ (PIQ) and Verbal IQ (VIQ) on the Wechsler Intelligence Scale for Children – Third Edition, moderated outcomes in general functioning and symptom load. A total of 132 patients treated at three outpatient child and adolescent mental health services (CAMHS) were assessed at three different time points. The Children’s Global Assessment Scale (CGAS) and the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) were used to measure the severity of impairments in general functioning and symptom load. IQ was assessed at the start of treatment. Moderator analysis revealed that the FSIQ × time interaction predicted changes in CGAS scores (p < .01), and that the PIQ × time interaction predicted changes in HoNOSCA scores (p < .05). The slopes and intercepts in HoNOSCA scores covaried negatively and significantly (p < .05). The same pattern was not detected for the CGAS scores (p = .08). FISQ and PIQ moderated change in general functioning and symptom load, respectively. This implies that patients with higher IQ scores had a steeper improvement slope than those with lower scores. The patients with the highest initial symptom loads showed the greatest improvement, this pattern was not found in the improvement of general functioning. |
| URI: | http://hdl.handle.net/10037/4959 |
| Abstract: | The issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention. To study whether inpatients’ utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model. The study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization. Most inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients’ utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care. Inpatients’ utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore represent a favourable alternative to traditional central psychiatric hospitals. |
| URI: | http://hdl.handle.net/10037/3916 |
| Abstract: | Rising concern for demonstrated real world comparative effectiveness has heightened interest in “pragmatic trials” design. Pragmatic trials investigate whether the efficacy, presumed or found in explanatory trials under ideal conditions, can also be detected under real world conditions, i.e. effectiveness. It is also recognized that ‘real world’ effects which are usually addressed in public health research gain growing interest in confirming the ‘road capability’ of results obtained under ideal study conditions. This paper demonstrates that studies under ideal or real world conditions use different methods, generate different information and cannot replace each other. The PCT design meets four requirements of public health and of effectiveness research. It includes all individuals who presented with the selected condition. It classifies the included individuals according to baseline risks. It enables plausibility controls. Finally, it compares the outcomes resulting from specified and not-specified interventions or treatments. We propose a pragmatic controlled trial (PCT) design in which patient preference and other co-factors crucial in determining the actual effectiveness of interventional options will not be neutralized by concealed randomization and blinding. This design is applicable to record the selected interventions and generated outcomes in day-to-day health care and is capable of incorporating preference and other participative factors into assessment of effectiveness. The PCT design is useful for public health research, e.g. the effectiveness of interventions to change smoking habits or to prevent death from breast cancer, as well as for comparative effectiveness research where it will supplement the traditional randomized controlled trial (RCT). |
| URI: | http://hdl.handle.net/10037/4960 |
| Abstract: | Most people must remember various numeric passwords, security codes and PIN numbers for banking, credit cards, debit cards, online accounts, mobile phones, door locks, luggage locks, etc. One pilot study (N=13) developed a list of eleven strategies for remembering numeric codes, and another (N=15) optimized the research questionnaire which asked respondents about a) the number of security codes they had, b) the number of self-created codes, c) mnemonic strategies used, d) problems and effort remembering codes, and e) gender, age, and education. Respondents (N=388) had a median of 4 security codes and typically used 2 different memory strategies, the most common of which were based on repetition and on keypad pattern. Difficulties remembering codes were unrelated to gender or education but were positively correlated with age and with number of strategies used. Self-creation of codes slightly reduced difficulties remembering numeric codes. |
| URI: | http://hdl.handle.net/10037/3031 |
| Abstract: | The Eating Disorder Inventory (EDI) is used worldwide in research and clinical work. The 3rd version (EDI-3) has been used in recent research, yet without any independent testing of its psychometric properties. The aim of the present study was twofold: 1) to establish national norms and to compare them with the US and international norms, and 2) to examine the factor structure, the internal consistency, the sensitivity and the specificity of subscale scores. Participants were Danish adult female patients (N = 561) from a specialist treatment centre and a control group (N = 878) of women selected from the Danish Civil Registration system. Small but significant differences were found between Danish and international, as well as US norms. Overall, the internal consistency of the subscales was satisfactory, the factor structure was confirmed, the discriminative validity was good, and sensitivity and specificity were excellent. The implications from these results are discussed. |
| URI: | http://hdl.handle.net/10037/3203 |
| Abstract: | Objective: The purpose of the paper is to study the ranking of disorders according to their perceived importance. Previous studies suggest that rankings according to the perceived or attributed “value” or importance create informal hierarchies of disorders on normative attitudes about symptoms, treatment and outcome. In this work we studied disorder ranking in the general population and among health professionals, and some possible explaining factors. Data source: 1,127 adults representative of the Norwegian National Population Register participated, of whom 220 representatives were of the broad range of health professionals. Study design: Respondents completed a survey questionnaire within a cross-sectional design. Principal findings: Somatic disorders were given the highest rank, but mental disorders were ranked higher than in previous studies. Modest effects were found for explaining variables. Conclusion: The general population rankings of disorders do not differ greatly from rankings made by health professionals. The impact of personalized variables was modest, indicating the need for future studies to explore the impact of more social and culture variables. |
| URI: | http://hdl.handle.net/10037/3201 |
| Abstract: | Few consistent predictive factors for eating disorder have been identified across studies. In the current five year prospective study, the objective was to examine whether (1) personality disorder and child sexual abuse predict the course of severity of eating disorder symptoms after inpatient treatment and (2) how the predictors interact. A total of 74 patients with long standing eating disorder and mean age of 30 years were assessed at the beginning and end of inpatient therapy and at one-, two- and five-year follow-up. Mixed model was used to examine the predictors. Avoidant personality disorder and child sexual abuse interacted in predicting high levels of eating disorder over a long-term course. These results suggest that eating disorder, avoidant personality disorder and sequelae after child sexual abuse are potential targets for treatment that need further investigation. |
| Description: | This is the accepted manuscript version. Reprinted with permission. Published version is available at http://dx.doi.org/10.1037/a0019857
The paper is part of KariAnne Vrabel's doktoral thesis, which is available at http://hdl.handle.net/10037/2699 |
| URI: | http://hdl.handle.net/10037/2723 |
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