Now showing items 1-20 of 44
Next Page| Abstract: | Purpose. Activity related pain may be a barrier to rehabilitation in patients with chronic musculoskeletal disorders. This study investigated patients’ reports of increased pain during activity, and the association between such pain and psychological factors and pain variables. Method. Questionnaires from 232 adults with chronic musculoskeletal pain measured pain intensity, spread of pain and pain duration. Pain during activity was assessed both on a 11 point Numeric Rating Scale (NRS), and operationalized as a dichotomous measure, where responders defined if they experienced pain during general activity and exercise. Psychological factors were measured by the Hopkins Symptom Check List 25, the Tampa Scale for Kinesiophobia and a subscale of the Arthritis Self – Efficacy Scale. Multiple and logistic regression was used to analyse associations between increased pain during activity and associated variables. Results. Increased pain during activity was reported by 69 % of participants. Fear of movement was a significant factor for reporting increased pain during activity, both general activity and exercise, also in a subsample with low psychological distress. Other significant factors were spread of pain and a low sense of self efficacy. Conclusion. Patients with high fear of movement, large spread of pain and low self efficacy were more likely to report increased pain during activity even in the absence of psychological distress. |
| Description: | Accepted manuscript version, reprinted with permission (Informa Helthcare). Published version available at http://dx.doi.org/10.3109/09638280903567877 This article is part of Elin Damsgård's doctoral thesis which is available in Munin at http://hdl.handle.net/10037/2500 |
| URI: | http://hdl.handle.net/10037/3549 |
| Abstract: | OBJECTIVE: To assess the effect of arm motor impairment on actual arm use in the early post-stroke period and explore its association with self-care dependency. SUBJECTS: Thirty-one patients recruited within the 30 first days after stroke. METHODS: Motor impairment of the upper extremity was measured with Fugl-Meyer Motor Assessment (FMA) and arm use was measured with accelerometry. Arm movement ratio (AMR), the ratio of arm use duration between the more and less affected arm, was calculated. Self-care dependency was defined as needing personal assistance in primary self-care activities. RESULTS: FMA of the more affected arm was strongly associated with AMR (Spearman's correlation coefficient -0.851, p > 0.001), although some patients deviated considerably from the regression line. Covariates did not have any influence on this relation. Both arm motor function and actual arm use related to self-care dependency, but were no longer significant when we controlled for lower extremity motor function. CONCLUSION: FMA and AMR correlated highly in the early post-stroke period. These measures relate to different dimensions of the International Classification of Functioning and Health, and could be supplementary measures to reveal non-use of the affected arm. Arm use and arm impairment were not significantly associated with self-care dependency in our sample. |
| URI: | http://hdl.handle.net/10037/4061 |
| Abstract: | De fleste barn og unge i Norge har det godt. De har nok mat, et sted å bo, skole og fritid som fungerer, venner og foreldre som viser at de bryr seg. Dette gjelder dessverre ikke alle, og det er da hjelpeapparatet kan bli koblet inn. Bokens fokus er den subjektive opplevelsen og meningsdimensjonen hos ungdom som mottar hjelp fra helse- og sosialvesen, skole- og utdanningsvesen, NAV, politiet, jurister og Utekontakten. Vi møter fire ungdommer som raust forteller fra egen oppvekst, hvor de enten har fått eller har manglet hjelp i kritiske perioder i livet. Gjennom fortellingene får vi del i hva ungdommene mener er de profesjonelle hjelperes viktigste utfordringer: – Hjelpere må bli flinkere til å gi tid. – Hjelpere må bli dyktigere til å anerkjenne, lytte, se og verdsette, og de må forsøke å få tak i ungdommens perspektiv på hvordan deres liv oppleves. – Hjelpere skal være en god blanding av kompis, ”mor” og hjelper. Dette krever både følelsesmessig og intellektuell innsats. |
| URI: | http://hdl.handle.net/10037/3270 |
| Abstract: | Dette prosjektet vil bestå av 6 casestudier på pasienter med uspesifikke nakkesmerter. Prosjektet har som mål å integrere teori om funksjonell motorisk kontroll i vår behandling av disse pasientene. Gjennom aksjonsforskning vil prøver vi å utvikle vår personlige praksis med bakgrunn i teorien, og vurdere om teorien må endres på bakgrunn av denne erfaringen med reelle praksissituasjoner. |
| URI: | http://hdl.handle.net/10037/2322 |
| Abstract: | This article is based upon a study of 15 students’ learning, educated within a part-time, decentralised and net-supported bachelor program in physiotherapy. The program was found to educate students with skills and attributes which are most needed for health care workers of tomorrow. The research questions were: What are the key factors of the program that contribute to the learning outcomes? How can such a program challenge a more traditional campus-delivered program? The most important factors were 1) the variation between learning arenas; on-campus activities, periods of clinical placement and self-study periods and 2) the stronger emphasize on clinical experiences throughout; regular, weekly skills training in clinics and tasks that stimulated ref lection and social and collaborative learning. Transferring such elements to full-time programs is suggested. This implies more responsibility to the professional field, and affects the role of the teachers, supervisors and the power of the institution. |
| URI: | http://hdl.handle.net/10037/2930 |
| Abstract: | There are an increasing number of educational programs to improve clinical competence and skills to treat mental disorders. For complex disorders there is also a focus on improving the quality of interprofessional work. This paper reports on interprofessional outputs of an educational program on eating disorders. A total of 207 professionals who completed the program were requested to describe up to 12 possible scenarios depicted as realistic prospects for their future work within this field. Analyzing the scenarios resulted in three categories of describing the participants' preferences: (1) interprofessional interventions and treatment; (2) the further development of competence; and (3) organization of the health care system. The findings showed that the participants were considering working across new lines in their current workplaces or crossing borders to new frontiers in the execution of competence. Our findings may be summarized into the concept of "clinical confidence." This concept has so far been understood as some kind of personal trait, disposition, or attitude. The present findings add nuances to this concept in terms of state-dependent encouragement, engagement, and a potential to act and to cross professional borders in order to better treat complex mental disorders. |
| URI: | http://hdl.handle.net/10037/4896 |
| Abstract: | This article aims at giving an example of how practical, clinical knowledge can be explored by the use of a tailor-made Information and Communication Technology (ICT)-tool: Physio-Net. In constructing content to this particular internet- based resource used for bachelor students at Tromsø University College, a clinician expert physiotherapist contributed with a detailed analysis of her own practice and its underpinning rationale, displayed by film and text simultaneously. The clinician was interviewed about how the work had affected later practice and why, and her experiences are discussed in terms of reflective practice. Internalised ways of thinking and acting were changed; she became more aware of the importance of taking the patient’s perspective, of the interaction in the situation, and made more careful conclusions in the clinical reasoning process. Time, observation, writing and guidance were important clues to this learning process and outcome. It is concluded that looking into one’s own practice amongst “critical friends”, mediated in a transparent mode as the Internet tool provides, constitutes a valuable learning potential for the individual and might contribute towards making professional practice more open and easier to discuss and develop. |
| URI: | http://hdl.handle.net/10037/2416 |
| Abstract: | An online learning module for health sciences students with various educational backgrounds was implemented at the University of Tromsø (UiT). The purpose of this article is to examine how participation in a joint, web-based course can be a didactic tool that promotes motivation and contributes to interactions among health sciences students. The study is based upon findings from focus group interviews with students who participated in a joint online course, as well as on recordings of activity in online discussions. |
| URI: | http://hdl.handle.net/10037/5024 |
| Abstract: | Undervisningssykehjemsprosjektet (USP) Tromsø/Nord var et av fire prosjekt som ble etablert i universitetsbyene med utgangspunkt i Nasjonal plan for Undervisningssykehjem. Prosjektet startet opp i 1999, og ble avsluttet ved utgangen av 2003. Prosjektet skulle bidra til å heve kvaliteten i omsorg, pleie, behandling og rehabilitering for syke gamle ved å øke ansattes forutsetninger, og samtidig skape et godt sted å bo over kortere eller lengre tid. Erfaringene i USP Tromsø viser at målrettet arbeid med kompetanseutvikling, fagutvikling, læringsmiljø og forskning gjennom et forpliktende samarbeid mellom parter på tvers av kommune- høgskole- og universitetssektor har vært mulig og gitt resultater. Det har skjedd en positiv utvikling i USP-sykehjemmet og blant de samarbeidende parter som har vært Tromsø kommune, Universitetet i Tromsø, Høgskolen i Tromsø, Universitetssykehuset Nord-Norge HF, UNN og Kvaløya videregående skole. Alle ønsker å fortsette samarbeidet ved varig etablering. |
| URI: | http://hdl.handle.net/10037/2302 |
| Abstract: | I løpet av de siste 10 årene har ”evidensbasert praksis” vokst fram som et begrep innen de fleste helsefagene. Argumentet for etableringen av dette begrepet, fulgt av et omfattende evidensbasert kunnskapssystem - The Cochrane Collaboration and Library - er at medisinsk og helsefaglig praksis i størst mulig grad må bygge på ”sikker” kunnskap. Det vil si kunnskap utviklet gjennom faktaorientert forskning. Pasientene/brukerne er ofte et sentralt element i argumentasjonen. ”Sikre bevis” skal erstatte erfaring som grunnlag for pasientrettete tiltak. Intensjonen er å etablere evidensbasert praksis som et styrende prinsipp for helsefaglig praksis og forskning. I Norge blir evidensbasert ofte oversatt med ”kunnskapsbasert”, uten noen nærmere klargjøring av hvilken kunnskapsforståelse systemet bygger på og er bærer av. Denne boken presenterer en studie av det kunnskapsidealet som ligger til grunn for evidensbasert praksis. Med utgangspunkt i litteratur om evidensbasert medisin, som var startstedet for den evidensbaserte ”bevegelsen”, gjør jeg en kunnskapsteoretisk analyse av de premissene som systemet, mer implisitt enn eksplisitt bygger på og genererer. Funnene fra denne studien vurderes i forhold til argumentasjonen for innføringen av det evidensbaserte kunnskapssystemet i medisinsk og helsefaglig praksis. Jeg ender opp med å sette kritisk søkelys på den kunnskapsforståelsen som det evidensbaserte systemet bygger på, og på sammenhengen mellom den kunnskapen det formidler og den innsikt og kompetanse som trengs for å løse helseproblemer som mennesker i dag sliter med. Dette eksemplifiseres med en sammenlignende analyse av et av kriteriene for den forskningen som aksepteres i Cochrane-systemet, og allmennlegers forståelse og diagnostisering av pasienter med kroniske muskelsmerter. Den evidensbaserte litteraturen har i stor grad preg av å være veiledning i bruk av det evidensbaserte kunnskapssystemet i praksis. Det ser ut til at fagmiljøene i helsetjenesten har vært mer opptatt av å lære seg å bruke systemet enn å reflektere over hva det vil innebære å drive evidensbasert praksis etter disse retningslinjene. Kort sagt har det, så vidt jeg kjenner til, hevet seg få kritiske røster mot evidensbasert praksis her i landet. Derfor var det viktig for meg å få formidlet resultatene av studien min av det evidensbaserte systemet så raskt som mulig. Dette ble gjort i en artikkelserie i fagbladet Fysioterapeuten i 2000. Reaksjonene uteble ikke. Synspunktene mine ble imøtegått av representanter fra det evidensbaserte miljøet. For å understreke at intensjonene med denne boken er å stimulere til videre refleksjon og debatt om fenomenet ”evidensbasert praksis” presenterer jeg motinnlegget og mitt svar på det i slutten av boken. |
| URI: | http://hdl.handle.net/10037/3366 |
| Abstract: | Practical knowledge is essential knowledge in occupational therapy. It is a situated and experienced knowledge, a knowing how and from within the situation. This knowledge has been difficult to facilitate in the learning process of a group of Occupational Therapist students in Gaza. Travel restrictions and the unstable political situation separated teachers and students. Lack of clinical occupational therapists inside Gaza also had a major impact. Educational technology such as videoconferences, internet and films became new and necessary tools. This article is based on results from an action research project following the process of using flexible forms of learning and developing an internet based learning programme named Ergonet and the learning process of the students using it, aiming at answering the following research questions: 1. How do the teachers experience the teaching process of facilitating practical knowledge? 2. How can an internet support program be developed to facilitate practical knowledge in OT education? 3. How do the teachers evaluate the outcome of implementing flexible forms of learning, regarding to the students practical skills? Pedagogical challenges in facilitating practical knowledge to occupational therapy students in a Palestinian culture had an impact on the way flexible forms of learning were developed and used. Experiences from using tools such as videoconferences, the internet, educational films and evaluation films impacted on the way the internet learning programme was developed. Ergonet contains an occupational therapy knowledgebase and clinical films presenting experienced masters doing assessments and therapy with clients. The films are presented and analysed in small sequences followed by written text, photo, articles and web-sites. Our pedagogical intention has been to develop a creative learning platform enhancing more active and deeper learning strategies among the students. The results indicate how rote-learning and lack of reflective and critical thinking have been challenged and changed by the didactic way Ergonet was used. |
| Description: | An action research approach performed in cooperation with teachers in the Occupational Therapist program at Bethlehem University. |
| URI: | http://hdl.handle.net/10037/2294 |
| Abstract: | Artikkelen bygger på intervju av nære pårørende om livsløpet til pasienter med demenssykdom som bor i sykehjem i Nord-Norge. De pårørende ble spesielt spurt om pasientenes vaner, interesser og aktiviteter gjennom livsløpet. Det ble utført narrativ analyse av intervjuene med vekt på fortolkning av livsløp og livshendelser hos pasientene. Artikkelen viser hvordan pårørende konkret bidrar til å videreføre kontinuiteten i livsløpet til pasienten, samtidig som det kommer fram hvordan denne kontinuiteten også har stor betydning for pårørende i deres eget liv. Artikkelen viser og at for at pasienten skal oppleve kontinuitet i eget liv etter flytting til sykehjem, er det viktig med en form for kontakt med hjemplass og landskap, og at det gis rom for tradisjoner og livshistorie. |
| URI: | http://hdl.handle.net/10037/4678 |
| Abstract: | The aim of this study is to examine family members’ experiences of end-of-life decision-making processes in Norwegian intensive care units (ICUs) to ascertain the degree to which they felt included in the decision-making process and whether they received necessary information. Were they asked about the patient’s preferences, and how did they view their role as family members in the decision-making process? A constructivist interpretive approach to the grounded theory method of qualitative research was employed with interviews of 27 bereaved family members of former ICU patients 3–12 months after the patient’s death. The core finding is that relatives want a more active role in end-of-life decision-making in order to communicate the patient’s wishes. However, many consider their role to be unclear, and few study participants experienced shared decision-making. The clinician’s expression “wait and see” hides and delays the communication of honest and clear information. When physicians finally address their decision, there is no time for family participation. Our results also indicate that nurses should be more involved in family–physician communication. Families are uncertain whether or how they can participate in the decision-making process. They need unambiguous communication and honest information to be able to take part in the decision-making process. We suggest that clinicians in Norwegian ICUs need more training in the knowledge and skills of effective communication with families of dying patients. |
| URI: | http://hdl.handle.net/10037/4060 |
| Abstract: | I et paper som dette, ser jeg en anledning til å utforske og rydde i et uoversiktelig landskap for å se hvordan dette nybrottsarbeidet kan bidra til fagutvikling og mer forskningsrettet virksomhet i lærerstaben, primært knyttet til utvikling av nettstøtten. Jeg har noen pragmatiske siktemål med paperet: 1. Å kartlegge, beskrive og drøfte vilkår for å få i gang mer systematisk FoU-arbeid knyttet til prosjektet: Fysio-nett, 2. Å finne fram til en hensiktsmessig strategi for igangsetting av slikt arbeid innenfor nærmeste realistiske ”mulighetssoner”og 3. Å utforske hvilke problemstillinger som kan være aktuelle i et aksjonsforskningsprosjekt. |
| URI: | http://hdl.handle.net/10037/2269 |
| Abstract: | This study aims to understand how the risks of snowmobiling are communicated among northern Norwegian youths. A qualitative design with focus group interviews was chosen. Interviews centred on safety precautions and estimation of risks related to snowmobiling and driving patterns. Eighty-one students (31 girls and 50 boys) aged between 16 and 23 years from 8 high schools were interviewed in 17 focus groups that were segregated by gender. Interview data were analysed using qualitative content analysis. Boys and girls communicated differently about risks. Peer-group conformity appeared stronger among boys than girls. Boys did not spontaneously relate risks to their snowmobile activities, while girls did. Boys focused upon training, coping and balance between control and lack of control while driving. Girls talked about risks, were aware of risks and sought to avoid risky situations, in contrast to boys. Boys’ risk communication in groups was about how to manage challenging situations. Their focus overall was on trying to maintain control while simultaneously testing their limits. Three risk categories emerged: those who drive as they ought to (mostly girls), those who occasionally take some risks (boys and girls) and those who are extreme risk-takers (a smaller number of boys). Perceptions of and communication about risk are related to gender, peer group and familiarity with risk-taking when snowmobiling. Northern Norwegian boys’ driving behaviour highlights a specific need for risk reduction, but this must also draw upon factors such as acceptance of social and cultural codes and common sense related to snowmobiling. |
| URI: | http://hdl.handle.net/10037/4125 |
| Abstract: | The plasma supply of energy substrates plays a key role in determining the cardiac metabolic phenotype. In diabetes, a high plasma supply of fatty acids (FA) leads to a predominant oxidation of FA for energy production, while glucose oxidation is markedly suppressed. The db/db mouse is a well accepted model of type 2 diabetes, showing hyperglycemia, hyperlipidemia, and hyperinsulinemia. Hearts from these mice exhibit altered substrate metabolism, characterized by an over-reliance on FA for energy production and low contribution of glucose. In the present study we tested whether the capacity for glucose utilization could be recovered in isolated working hearts from db/db mice following long-term (4 weeks) treatment with fenofibrate, using two different doses of the compound (0.1% and 0.2%, given as admixture to the diet). Mice treated with K-111 (a PPARα agonist, previously known as BM 17.0744) served as positive controls. In line with previous results, treatment with K-111 resulted in a significant reduction of the plasma concentrations of FA, triacylglycerol (TG) and glucose. Low-dose (0.1 %) fenofibrate treatment resulted in reduced plasma concentration of FA and TG, whereas the concentration of glucose was unaffected. With high-dose (0.2 %) fenofibrate, however, significant reductions of both lipids and glucose were obtained. Hearts from K-111-treated db/db mice showed a 74% decrease in FA oxidation and a near 2-fold increase in glucose oxidation. Treatment with low-dose fenofibrate failed to improve cardiac metabolism, whereas high-dose fenofibrate caused a similar shift in cardiac metabolism as seen with K-111. The alterations in cardiac metabolism were associated with changes in the myocardial and hepatic expression of PPARα-regulated target genes. These results indicate that reduction of plasma lipids alone is not sufficient for improving cardiac metabolism in diabetes, and that reduction of plasma glucose is also required. |
| Description: | This article is part of Ahmed M. Khalid's PhD thesis, which is available in Munin: http://hdl.handle.net/10037/1802 |
| URI: | http://hdl.handle.net/10037/2997 |
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