Now showing items 1-20 of 35
Next Page| 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: | 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: | A refined computer paradigm for assessing sexual harassment is presented, validated, and used for testing substantive hypotheses. Male participants were given an opportunity to send sexist jokes to a computer-simulated female chat partner. In Study 1 (N = 44), the harassment measure (number of sexist jokes sent) correlated positively with self-reported harassment proclivity. Study 2 (N = 77) included a more elaborate cover story, variations of the female target’s attitude (feminist vs. traditional) and physical attractiveness (low vs. high), and additional measures for construct validation. Results showed that harassment correlated positively with self-reported harassment proclivity, hostile sexism, and male identity. Feminist targets were harassed more than traditional targets, whereas target attractiveness had no effect. Theoretical and applied implications are discussed. |
| Description: | This is the final author version, post refereeing, of the article. |
| URI: | http://hdl.handle.net/10037/2022 |
| 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: | 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 |
| Abstract: | The acculturation paradigm of measuring assimilation, separation, integration and marginalization confuses dimensional and categorical conceptions of its constructs, fails to produce ipsative data from mutually exclusive scales, misoperationalizes marginalization as distress, mismeasures biculturalism using double-barreled questions instead of computing it from unicultural measures, and then tends to misinterpret and miscite this faulty science. Extensive published but widely uncited data cast doubt on claims that integration is preferred by minority groups or is beneficial for them. Such salient but unseen problems suggest that the community of acculturation researchers is biased and blinded by an ideology, probably the commendable ideology of liberalism, which advocates freedom of choice, tolerance, plurality, and redress of harm. Phenomenological observations that challenge the paradigm include the absence of studies of majority group acculturation, the well-replicated fact that minorities never prefer pure uniculturalism, the indistinctiveness of cultures, and the predominance of researchers, theory and data from similar Anglo-Saxon settler societies (USA, Australia, Canada). |
| URI: | http://hdl.handle.net/10037/1996 |
| Abstract: | Focus upon depression and prevention of its occurrence among adolescents is increasing. Novel ways of dealing with this serious problem have become available especially by means of internet-based prevention and treatment programs of depression and anxiety. The use of Internet-based intervention programs among adolescents has revealed some difficulties in implementation that need to be further elucidated. The aim of this study is to investigate the association between personality and adolescent depression and the characteristics of users of an Internet-based intervention program. Method. The Junior Temperament and Character Inventory (JTCI), the General Self-Efficacy scale (GSE) and the Centre for Epidemiological Studies-Depression scale (CES-D) have been administered to a sample (n= 1234) of Norwegian senior high-school students. Results. Multiple regression analysis revealed associations between depression and gender, and several JTCI domains and facets. In line with previous findings in adults, high Harm Avoidance and low Self-Directedness emerged as the strongest predictors of adolescent depressive symptoms. Further, in logistic regression analysis with the covariates JTCI, GSE and CES-D, the only significant variables predicting use/non-use were the CES-D and the temperament domain Reward Dependence. Conclusion. The results in this study revealed level of depressive symptoms as the strongest predictor of the use of the Internet based intervention and that personality might provide useful information about the users. |
| URI: | http://hdl.handle.net/10037/4612 |
| Abstract: | In person perception, emergent attributes are attributes that people ascribe to members of a rare or novel category combination, although they would not ascribe the same attributes to members of either of the constituent categories. The present paper first describes the processing mechanisms suggested by three theoretical models of attribute emergence. Then, competing response time predictions are derived from the models’ respective mechanisms. An empirical test of these predictions in a laboratory experiment with university students (N = 45) is reported. Results support Hastie, Schroeder, and Weber’s (1990) two-stage model, but not Kunda, Miller, and Claire’s (1990) impression-formation model or Smith and DeCoster’s (1998) connectionist account. |
| URI: | http://hdl.handle.net/10037/1882 |
| 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: | Quest begin in the vauge way, as an interest or an orientation, and maybe as a collection of skills. I was probably bent towards this quest at Queen's University, where I was mentored in cross-cultural psychology by John Berry, where I served as a TA in Milt Suboski's statistics and research methods courses, and where I learned the lore of history of psychology with David Murray. Quests often begin unplanned, by happenstance, one thing leading to another. In this case, it was my taking a position at the University of Tromsø, in Norway, arriving just when the first graduating class was seeking supervisors for their thesis research. |
| URI: | http://hdl.handle.net/10037/1997 |
| 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: | 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: | 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: | 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: | The latency of startle reflex potentiation may shed light on the aware and unaware processes underlying associative learning, especially associative fear learning. We review research suggesting that single-cue delay classical conditioning is independent of awareness of the contingency between the conditioned stimulus (CS) and the unconditioned stimulus (US). Moreover, we discuss research that argues that conditioning independent of awareness has not been proven. Subsequently, three studies from our lab are presented that have investigated the role of awareness in classical conditioning, by measuring the minimum latency from CS onset to observed changes in reflexive behavior. In sum, research using this method shows that startle is potentiated 30 to 100 ms after CS onset following delay conditioning. Following trace fear conditioning, startle is potentiated 1500 ms after CS presentation. These results indicate that the process underlying delay conditioned responding is independent of awareness, and that trace fear conditioned responding is dependent on awareness. Finally, this method of investigating the role of awareness is discussed and future research possibilities are proposed. |
| URI: | http://hdl.handle.net/10037/4958 |
Now showing items 1-20 of 35
Next Page
Munin is powered by DSpace 1.8.2
The University Library of Tromsø, N-9037 Tromsø
Tel: +47 77 64 40 00, E-mail: munin@ub.uit.no