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A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: patient, staff and ward characteristics
Tonje Husum, Johan Bj?rngaard, Arnstein Finset, Torleif Ruud
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-89
Abstract: Multilevel logistic regression using Stata was applied with data from 1016 involuntary admitted patients that were linked to data about wards. The sample comprised two hierarchical levels (patients and wards) and the dependent variables had two values (0 = no use and 1 = use). Coercive measures were defined as use of seclusion, restraint and involuntary depot medication during hospitalization.The total number of involuntary admitted patients was 1214 (35% of total sample). The percentage of patients who were exposed to coercive measures ranged from 0-88% across wards. Of the involuntary admitted patients, 424 (35%) had been secluded, 117 (10%) had been restrained and 113 (9%) had received involuntary depot medication at discharge. Data from 1016 patients could be linked in the multilevel analysis. There was a substantial between-ward variance in the use of coercive measures; however, this was influenced to some extent by compositional differences across wards, especially for the use of restraint.The substantial between-ward variance, even when adjusting for patients' individual psychopathology, indicates that ward factors influence the use of seclusion, restraint and involuntary medication and that some wards have the potential for quality improvement. Hence, interventions to reduce the use of seclusion, restraint and involuntary medication should take into account organizational and environmental factors.Use of coercion in treatment is controversial [1-5], and reducing use of coercion in psychiatric services is a priority health political issue in Western countries [6-8]. Too much use of coercion in mental health care may be a threat to the quality of care, as well as to patients' human rights. It is of crucial importance to develop a better understanding of the processes and factors involved to reduce the use of coercion. There is evidence of considerable variation in the extent to which coercive measures are used. This is shown in international comparative studie
Work and activity in rehabilitation of persons with co-occurring severe mental health difficulties and substance use problems  [PDF]
Sissel Steihaug, Anne Werner, Tonje Lossius
Health (Health) , 2013, DOI: 10.4236/health.2013.56A2012

Background: Participating in working life is important for most peoples’ economy, self-confidence, independence, social life, and feeling of belonging. Persons with co-occurring severe mental health difficulties and substance use problems have challenges in entering working life. Objective: The aim of the study was to explore the importance of work and activity for the recovery of persons with co-occurring severe mental health difficulties and substance use problems and to determine the significant elements that aid them in getting into work and/or meaningful activities. Methods: A professional development program was conducted to explore how following-up on these persons could lead to participation in working life. The data were collected through qualitative interviews with 24 participants, and with 25 of those carrying out the follow-up. Results: The participants described the benefit from the follow-up as well. They expressed enthusiasm for work and vocational training, although they all did not obtain work. Many had a better life, with more daily structure and less substance abuse. The personal encounter between the helper and the participant was ascribed crucial importance being respected and valued, being relied on, and being able to be honest were considered significant. Conclusions: The participants valued work and regular activities, a more structured life, decreased drug abuse, and altogether a better life. The helpers’ respect, recognition and their ability to see dignity through wretchedness and broken agreements were important. The participants emphasized the importance of getting help for different problems from different helpers at the same time, and the providers’ interdisciplinary collaboration in teams was essential. It seems that the supported employment philosophy on speedy job seeking ought to be adapted to this target group and that prior social training may be necessary.

Prehospital trauma care reduces mortality. Ten-year results from a time-cohort and trauma audit study in Iraq
Mudhafar K Murad, Stig Larsen, Hans Husum
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2012, DOI: 10.1186/1757-7241-20-13
Abstract: In the study period from 1997 to 2006, 2,788 patients injured by land mines, war, and traffic accidents were managed by a chain-of-survival trauma system where non-graduate paramedics were the key care providers. The study was conducted with a time-period cohort design.37% of the study patients had serious injuries with Injury Severity Score ≥ 9. The mean prehospital transport time was 2.5 hours (95% CI 1.9 - 3.2). During the ten-year study period trauma mortality was reduced from 17% (95% CI 15 -19) to 4% (95% CI 3.5 - 5), survival especially improving in major trauma victims. In most patients with airway problems, in chest injured, and in patients with external hemorrhage, simple life support measures were sufficient to improve physiological severity indicators.In case of long prehospital transit times simple life support measures by paramedics and lay first responders reduce trauma mortality in major injuries. Delegating life-saving skills to paramedics and lay people is a key factor for efficient prehospital trauma systems in low-resource communities.The epidemic of trauma is accelerating. Injury is now the fourth leading cause of global deaths, and up to 2030 WHO estimates a further 40% increase in trauma fatalities. Almost 90% of injury deaths occur in low- and middle-income countries [1]. Who is to manage this heavy load of trauma - in disastrous events as well as chronic emergencies like the land mine epidemic? Studies of Western trauma scenarios consistently report that reduced prehospital transport times and level I trauma centers and are the essential components of a good trauma system [2]. However, helicopter evacuations and high-cost surgical centers are not feasible in low-income societies and in countries where the social fabric is broken by war. In our time, local wars and natural disasters especially hit low-resource communities and here the "scoop-and run-for-the hospital" strategy hardly fits. There is thus an urgent need to develop trauma system
Maximizing Product Innovation through Adaptive Application of User-Centered Methods for Defining Customer Value
Overvik Olsen,Tonje; Welo,Torgeir;
Journal of technology management & innovation , 2011, DOI: 10.4067/S0718-27242011000400013
Abstract: establishing deep understanding of customers is a prerequisite to improve success rates of innovations under today’s transient business conditions. this paper summarizes methods and tools to increase customer understanding in new product development. a case study of developing an office chair was conducted, utilizing four such methods (web based survey, interview, observation and workshops) to provide directions for later application. results indicate that methods revealing emotionally-related customer information (workshops and observation) are resource-intensive and provide less amount of information directly applicable to the product development team. the opposite is the case for methods providing more functionally-related information (web based survey and interview). the overall conclusion is that the latter methods are more suitable for product improvements, while the former may provide valuable information for creating more differentiated products.
Northward advection of Atlantic water in the eastern Nordic Seas over the last 3000 yr: a coccolith investigation of volume transport and surface water changes
C. V. Dylmer,J. Giraudeau,F. Eynaud,K. Husum
Climate of the Past Discussions , 2013, DOI: 10.5194/cpd-9-1259-2013
Abstract: Three marine sediment cores distributed along the Norwegian (MD95-2011), Barents Sea (JM09-KA11-GC), and Svalbard (HH11-134-BC) continental margins have been investigated in order to reconstruct changes in the poleward flow of Atlantic Waters (AW) and in the nature of upper surface water masses within the eastern Nordic Seas over the last 3000 yr. These reconstructions are based on a limited set of coccolith proxies: the abundance ratio between Emiliania huxleyi and Coccolithus pelagicus, an index of Atlantic vs. Polar-Arctic surface water masses; and Gephyrocapsa muellerae, a drifted coccolith species from the temperate North Atlantic, whose abundance changes are related to variations in the volume transport of the North Atlantic Current and its northernmost extension (the West Spitsbergen Current – WSC) off western Svalbard. The entire investigated area, from 66 to 77° N, was affected by an overall increase in volume flow of AW from 3000 cal yr BP to Present. The long-term modulation of westerlies strength and location which are essentially driven by the dominant mode of the North Atlantic Oscillation (NAO), is thought to explain the observed dynamics of poleward AW flow. The same mechanism also reconciles the recorded opposite zonal shifts in the location of the Arctic Front between the area off western Norway and the Barents Sea-eastern Fram Strait region. The Little Ice Age was governed by deteriorating conditions, with Arctic/Polar waters dominating in the surface off western Svalbard and western Barents Sea, possibly associated with both severe sea-ice conditions and a strongly reduced AW volume flow. A sudden short pulse of resumed high WSC flow interrupted this cold spell in eastern Fram Strait from 330 to 410 cal yr BP, with a a magnitude only surpassed by the one which characterizes the Modern Period. Our dataset not only confirms the high amplitude warming of surface waters at the turn of the 19th century off western Svalbard, it also shows that such a warming was primarily induced by an excess volume flow of AW which stands as unprecedented over the last 3000 yr.
Socioeconomic differences in cancer survival: The Norwegian Women and Cancer Study
Tonje Braaten, Elisabete Weiderpass, Eiliv Lund
BMC Public Health , 2009, DOI: 10.1186/1471-2458-9-178
Abstract: We used data from The Norwegian Women and Cancer Study, a prospective cohort study including 91 814 women who responded to an extensive questionnaire between 1996 and 1998. A total of 3 899 incident cancer cases were diagnosed during follow-up, of whom 1 089 women died, 919 of them from cancer. Cox Proportional Hazards Model was used to calculate relative risks (RR) of mortality and 95% confidence intervals.We observed an overall negative socioeconomic gradient in cancer survival, which was most evident in the site specific analyses for survival of ovarian cancer by years of education. For colorectal cancer, mortality increased with years of education, but not with income. After adjustment for household size, marital status, disease stage, and smoking status the SES variation in cancer survival became non-significant. We found that the unequal socioeconomic distribution of smoking status prior to diagnosis contributed considerably to the poorer survival in low SES groups.We found an overall negative socioeconomic gradient in cancer survival when SES is measured as years of education or gross household income. Smoking status prior to diagnosis was an important predictive factor for socioeconomic variation in survival.The association between socioeconomic status (SES) and cancer survival has been examined by several epidemiologic studies within a variety of study designs. A number of these are ecologic studies using geographical area based measures as SES indicators (comparing richer with poorer areas). Others are hospital-based or record linkage cohort studies with individual information on socioeconomic status measured by socioeconomic group, income or level of education [1-4]. Occasionally, health insurance status has been applied as a proxy of SES [5,6]. One cohort study among men has been able to consider lifestyle factors such as smoking and alcohol consumption according to SES and cancer survival. Regardless of study design, a number of studies have found an im
Body weight, weight perceptions and food intake patterns. A cross-sectional study among male recruits in the Norwegian National Guard
Solveig Uglem, Tonje H Stea, Wenche Fr?lich, Margareta Wandel
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-343
Abstract: Data were collected with a 4-day food diary among 578 male recruits (age 18-26, mean 19.7) in the Norwegian National Guard (response rate 78%), in addition to a questionnaire, including questions about health and weight perceptions, and food frequency when still living at home. Weight and height were objectively measured. Food patterns were explored with principal component analysis, based on the diary data. A multivariate linear regression analysis determined the association between BMI and food patterns, and attitudes to health and slenderness, adjusting for smoking, physical activity and phase of data collection.Twenty eight percent of the recruits were overweight/obese (BMI > 25 kg/m2). Two-thirds meant that it is important for them to be slender, and these recruits reported more of both light (p = 0.025) and hard (p = 0.016) physical activity than the others. It was a positive association between the recruits' food frequency at home, and the amount of intake in the military camp for several food items. A principal component analysis identified three distinct food patterns, loading on 1) plant foods, 2) fast food/soft drinks, 3) milk/cereals. Those who stated that it is important for them to be slender, or to have good health, did not have significantly different food intake patterns than the others. BMI was inversely related to scores on the plant food pattern, and positive attitudes to slenderness.The majority of the recruits find it important to be slender. This orientation had a bearing on their physical activity pattern, but less on the food intake pattern. The data also indicate that subjects with high intakes of plant foods were less likely to have a high BMI than others. It is important to raise awareness of healthy eating in young men.Young men are among the population groups that are most difficult to reach with health and nutrition information. They are also among the groups with the lowest intake of fruits and vegetables [1,2]. This is alarming since
Upper limb position control in fibromyalgia
Bardal Ellen,Roeleveld Karin,Johansen Tonje,Mork Paul
BMC Musculoskeletal Disorders , 2012, DOI: 10.1186/1471-2474-13-186
Abstract: Background Motor problems are reported by patients with fibromyalgia (FM). However, the mechanisms leading to alterations in motor performance are not well understood. In this study, upper limb position control during sustained isometric contractions was investigated in patients with FM and in healthy controls (HCs). Methods Fifteen female FM patients and 13 HCs were asked to keep a constant upper limb position during sustained elbow flexion and shoulder abduction, respectively. Subjects received real-time visual feedback on limb position and both tasks were performed unloaded and while supporting loads (1, 2, and 3 kg). Accelerations of the dominant upper limb were recorded, with variance (SD of mean position) and power spectrum analysis used to characterize limb position control. Normalized power of the acceleration signal was extracted for three frequency bands: 1–3 Hz, 4–7 Hz, and 8–12 Hz. Results Variance increased with load in both tasks (P < 0.001) but did not differ significantly between patients and HCs (P > 0.17). Power spectrum analysis showed that the FM patients had a higher proportion of normalized power in the 1–3 Hz band, and a lower proportion of normalized power in the 8–12 Hz band compared to HCs (P < 0.05). The results were consistent for all load conditions and for both elbow flexion and shoulder abduction. Conclusion FM patients exhibit an altered neuromuscular strategy for upper limb position control compared to HCs. The predominance of low-frequency limb oscillations among FM patients may indicate a sensory deficit.
Accuracy of Helicobacter pylori serology in two peptic ulcer populations and in healthy controls
Rolv-Ole Lindsetmo, Roar Johnsen, Tor Jac Eide, Tore Gutteberg, Hanne Haukland Husum, Arthur Revhaug
World Journal of Gastroenterology , 2008,
Abstract: AIM: To estimate the test characteristics of Helicobacter pylori (H pylori) serology and of C14-urea breath test (C14-UBT) in two different peptic ulcer populations and in community controls. Second, the aim was to explore the association between the level of H pylori IgG antibodies and severity of inflammation as to active peptic ulceration in the same populations.METHODS: Vagotomized (n = 83), medically treated peptic ulcer patients (n = 73) and one reference group of community controls (n = 88) were gastroscoped. H pylori status was determined by histology, bacterial growth, C14-UBT and serology. Based on the updated Sydney System, cumulative scores from biopsies from the prepyloruos, incisura angularis, corpus and fundus were calculated.RESULTS: The prevalence of H pylori infection varied from 70% to 79%. The C14-UBT had high accuracy compared to the serology test. The sensitivity of the serology test was good, but the specificity was low (41%-71%). The association between H pylori IgG antibodies and scores of gastric mucosal inflammation and current or previous peptic ulcer were weak.CONCLUSION: The accuracy of C14-UBT to diagnose H pylori infection was good, and the clinical utility of a negative H pylori serology test was substantial, while the gain in clinical information of a positive test was meagre. Positive H pylori titres could not distinguish between subjects with or those without active peptic ulceration.
3T3 Cell Lines Stably Expressing Pax6 or Pax6(5a) – A New Tool Used for Identification of Common and Isoform Specific Target Genes
Yury Kiselev, Tonje Engevik Eriksen, Siri Forsdahl, Lan Huong Thi Nguyen, Ingvild Mikkola
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0031915
Abstract: Pax6 and Pax6(5a) are two isoforms of the evolutionary conserved Pax6 gene often co-expressed in specific stochiometric relationship in the brain and the eye during development. The Pax6(5a) protein differs from Pax6 by having a 14 amino acid insert in the paired domain, causing the two proteins to have different DNA binding specificities. Difference in functions during development is proven by the fact that mutations in the 14 amino acid insertion for Pax6(5a) give a slightly different eye phenotype than the one described for Pax6. Whereas quite many Pax6 target genes have been published during the last years, few Pax6(5a) specific target genes have been reported on. However, target genes identified by Pax6 knockout studies can probably be Pax6(5a) targets as well, since this isoform also will be affected by the knockout. In order to identify new Pax6 target genes, and to try to distinguish between genes regulated by Pax6 and Pax6(5a), we generated FlpIn-3T3 cell lines stably expressing Pax6 or Pax6(5a). RNA was harvested from these cell lines and used in gene expression microarrays where we identified a number of genes differentially regulated by Pax6 and Pax6(5a). A majority of these were associated with the extracellular region. By qPCR we verified that Ncam1, Ngef, Sphk1, Dkk3 and Crtap are Pax6(5a) specific target genes, while Tgfbi, Vegfa, EphB2, Klk8 and Edn1 were confirmed as Pax6 specific target genes. Nbl1, Ngfb and seven genes encoding different glycosyl transferases appeared to be regulated by both. Direct binding to the promoters of Crtap, Ctgf, Edn1, Dkk3, Pdgfb and Ngef was verified by ChIP. Furthermore, a change in morphology of the stably transfected Pax6 and Pax6(5a) cells was observed, and the Pax6 expressing cells were shown to have increased proliferation and migration capacities.
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