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Clinical guidance of community physiotherapists regarding people with MS: professional development and continuity of care.

https://arctichealth.org/en/permalink/ahliterature258047
Source
Physiother Res Int. 2014 Mar;19(1):25-33
Publication Type
Article
Date
Mar-2014
Author
Britt Normann
Knut W Sørgaard
Rolf Salvesen
Siri Moe
Author Affiliation
Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, 9037, Tromsø, Norway; Department of Physiotherapy, Nordland Hospital Trust, 8092, Bodø, Norway.
Source
Physiother Res Int. 2014 Mar;19(1):25-33
Date
Mar-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Clinical Competence
Continuity of Patient Care - trends
Education, Professional - trends
Female
Health Knowledge, Attitudes, Practice
Humans
Interviews as Topic
Male
Middle Aged
Multiple Sclerosis - therapy
Norway
Patient care team
Physical Therapists - education
Practice Guidelines as Topic
Abstract
Clinical guidance to community physiotherapists (cPTs) is an integral part of physiotherapy service offered in hospital outpatient (OP) clinics for people with multiple sclerosis (PwMS). There is currently a lack of knowledge on the significance of such guidance. The aims of this study were 1) to identify the features that cPTs perceive to be significant in clinical guidance and 2) how this guidance may affect the cPTs' subsequent treatment of PwMS.
A phenomenological-hermeneutical framework was selected, and qualitative research interviews were performed and complemented with non-participating observations of a strategic sample of nine cPTs who received clinical guidance for their patients. The interviews were recorded and transcribed, and content analysis was conducted by using systematic text condensation, using theories of practice knowledge as analytic perspectives.
The results indicate that cPTs identify participation in authentic movement analysis of a familiar patient as significant for professional development. Vital features are evaluation of the interplay between body parts, exploration of improvement of movement embedded in the OP clinic physiotherapist's explanations, followed by discussion. These elements provide access to dynamic elements in practice knowledge that are available only through first-hand experience and promote clinical reasoning through enhanced reflection during action as well as following action. Such guidance suggests direction for subsequent treatment and may enhance the continuity of care, particularly if the cPTs are experienced. Mutual information flow implementing the cPTs' perspective is requested, as are the use of plain language and supervision of the cPTs handling skills. Professional guidance for cPTs in OP clinics for PwMS should be considered when programmes aiming to develop competency in neurological physiotherapy are designed and when continuity of care for PwMS is discussed. More research regarding potential long-term impact of professional guidance in these clinics is requested.
PubMed ID
23813907 View in PubMed
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Compulsory and voluntary admission in psychiatric hospitals in northern Norway 2009-2010. A national registry-based analysis.

https://arctichealth.org/en/permalink/ahliterature124054
Source
Nord J Psychiatry. 2013 Feb;67(1):47-52
Publication Type
Article
Date
Feb-2013
Author
Jan Norum
Aina Olsen
Inger Nybrodahl
Knut W Sørgaard
Author Affiliation
Northern Norway Regional Health Authority, Bodø, Norway. jan.norum@helse-nord.no
Source
Nord J Psychiatry. 2013 Feb;67(1):47-52
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Coercion
Commitment of Mentally Ill - statistics & numerical data
Female
Hospitalization - statistics & numerical data
Hospitals, Psychiatric - utilization
Humans
Length of Stay
Male
Middle Aged
Norway
Patient Admission - statistics & numerical data
Registries - statistics & numerical data
Retrospective Studies
Young Adult
Abstract
During the last decade, Norwegian healthcare authorities have been concerned about the frequent use of coercive measures in psychiatric care. On this background, we aimed to explore the voluntary and compulsory admissions in psychiatric hospitals in northern Norway, the University Hospital of North Norway in Troms? (UNN-T) and the Nordland Hospital in Bod? (NH-B).
All voluntary and compulsory admissions (2009-2010) among patients aged =18 years registered by the Norwegian Patient Registry (NPR) were analyzed retrospectively. Compulsory admission was registered according to the general practitioner's (GP's) decision and the patients were hospitalized in Bod? or Troms?. A total of 12,237 admissions and 242,148 days in hospital were identified. The female/male ratio of admission and stay was 1.17 and 1.15, respectively.
The admission rate (northern Norway =1.0) varied significantly from south to north (0.60-1.52). Whereas patients living close to the hospitals had the same admission rate as others, the mean hospital stay was significantly longer (ratio =1.32). Furthermore, the UNN-T had a higher re-admission rate (2% vs. 5%). Municipalities with District Psychiatric Centers (DPC) did not differ from others. A significant difference in the use of coercive measures was revealed between hospitals. Forced medication was the most frequent measure employed.
The study documented a south-north gradient in admission rate and indicated differences in the use of coercion. Variation may partly be due to different reporting procedures. This finding and why patients living in the neighborhood of hospitals stay longer should be explored in future studies.
PubMed ID
22631219 View in PubMed
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Diagnosing comorbidity in psychiatric hospital: challenging the validity of administrative registers.

https://arctichealth.org/en/permalink/ahliterature117431
Source
BMC Psychiatry. 2013;13:13
Publication Type
Article
Date
2013
Author
Terje Oiesvold
Mary Nivison
Vidje Hansen
Ingunn Skre
Line Ostensen
Knut W Sørgaard
Author Affiliation
Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, and Division of general psychiatry, Nordland hospital, Bodø, Norway. terje.oiesvold@nlsh.no
Source
BMC Psychiatry. 2013;13:13
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Anxiety Disorders - diagnosis - epidemiology
Comorbidity
Female
Hospitals, Psychiatric - statistics & numerical data
Humans
Interview, Psychological
Male
Mental Disorders - diagnosis - epidemiology
Middle Aged
Norway - epidemiology
Registries - standards - statistics & numerical data
Reproducibility of Results
Schizophrenia - diagnosis - epidemiology
Substance-Related Disorders - diagnosis - epidemiology
Abstract
This study will explore the validity of psychiatric diagnoses in administrative registers with special emphasis on comorbid anxiety and substance use disorders.
All new patients admitted to psychiatric hospital in northern Norway during one year were asked to participate. Of 477 patients found eligible, 272 gave their informed consent. 250 patients (52%) with hospital diagnoses comprised the study sample. Expert diagnoses were given on the basis of a structured diagnostic interview (M.I.N.I.PLUS) together with retrospective checking of the records. The hospital diagnoses were blind to the expert. The agreement between the expert's and the clinicians' diagnoses was estimated using Cohen's kappa statistics.
The expert gave a mean of 3.4 diagnoses per patient, the clinicians gave 1.4. The agreement ranged from poor to good (schizophrenia). For anxiety disorders (F40-41) the agreement is poor (kappa = 0.12). While the expert gave an anxiety disorder diagnosis to 122 patients, the clinicians only gave it to 17. The agreement is fair concerning substance use disorders (F10-19) (kappa = 0.27). Only two out of 76 patients with concurrent anxiety and substance use disorders were identified by the clinicians.
The validity of administrative registers in psychiatry seems dubious for research purposes and even for administrative and clinical purposes. The diagnostic process in the clinic should be more structured and treatment guidelines should include comorbidity.
Notes
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PubMed ID
23297686 View in PubMed
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The epidemiology of post-traumatic stress disorder in Norway: trauma characteristics and pre-existing psychiatric disorders.

https://arctichealth.org/en/permalink/ahliterature283613
Source
Soc Psychiatry Psychiatr Epidemiol. 2017 Jan;52(1):11-19
Publication Type
Article
Date
Jan-2017
Author
Eva Lassemo
Inger Sandanger
Jan F Nygård
Knut W Sørgaard
Source
Soc Psychiatry Psychiatr Epidemiol. 2017 Jan;52(1):11-19
Date
Jan-2017
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Female
Humans
Incidence
Life Change Events
Male
Norway - epidemiology
Prevalence
Retrospective Studies
Risk factors
Sex Factors
Stress Disorders, Post-Traumatic - epidemiology
Young Adult
Abstract
The prevalence of PTSD differs by gender. Pre-existing psychiatric disorders and different traumas experienced by men and women may explain this. The aims of this study were to assess (1) incidence and prevalence of exposure to traumatic events and PTSD, (2) the effect of pre-existing psychiatric disorders prior to trauma on the risk for PTSD, and (3) the effect the characteristics of trauma have on the risk for PTSD. All stratified by gender.
CIDI was used to obtain diagnoses at the interview stage and retrospectively for the general population N = 1634.
The incidence for trauma was 466 and 641 per 100,000 PYs for women and men, respectively. The incidence of PTSD was 88 and 31 per 100,000 PYs. Twelve month and lifetime prevalence of PTSD was 1.7 and 4.3 %, respectively, for women, and 1.0 and 1.4 %, respectively, for men. Pre-existing psychiatric disorders were risk factors for PTSD, but only in women. Premeditated traumas were more harmful.
Gender differences were observed regarding traumatic exposure and in the nature of traumas experienced and incidences of PTSD. Men experienced more traumas and less PTSD. Pre-existing psychiatric disorders were found to be risk factors for subsequent PTSD in women. However, while trauma happens to most, it only rarely leads to PTSD, and the most harmful traumas were premeditated ones. Primary prevention of PTSD is thus feasible, although secondary preventive efforts should be gender-specific.
Notes
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PubMed ID
27757493 View in PubMed
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Patient satisfaction and perception of change following single physiotherapy consultations in a hospital's outpatient clinic for people with multiple sclerosis.

https://arctichealth.org/en/permalink/ahliterature132613
Source
Physiother Theory Pract. 2012 Feb;28(2):108-18
Publication Type
Article
Date
Feb-2012
Author
Britt Normann
Siri Moe
Rolf Salvesen
Knut W Sørgaard
Author Affiliation
Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, Norway. britt.normann@uit.no
Source
Physiother Theory Pract. 2012 Feb;28(2):108-18
Date
Feb-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Health Care Surveys
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Multiple Sclerosis - diagnosis - physiopathology - psychology - therapy
Norway
Outcome and Process Assessment (Health Care)
Outpatient Clinics, Hospital
Patient Education as Topic
Patient satisfaction
Perception
Physical Therapy Modalities
Professional-Patient Relations
Questionnaires
Referral and Consultation
Treatment Outcome
Abstract
The aim of this study was to investigate satisfaction with physiotherapy and perception of change following single physiotherapy consultations in a hospital's outpatient service for people with multiple sclerosis (MS) (PwMS). The consultation included assessment, exploration of treatment, information, and instruction in self-assisted exercises based on the British guidelines for PwMS. Seventy-two PwMS were consecutively included, 54 women and 18 men with a mean age 45 (range 26-80). The Outpatient Experience Questionnaire (OPEQ) was used to record satisfaction; the Patient Global Impression of Change (PGIC) and the Borg's Rating Scale of Perceived Exertion (BRSPE) were used to investigate perceived changes in standing up, sitting down, and walking following the consultation. Sixty-four patients (89%) returned the OPEQ. The results showed strong satisfaction with physiotherapy regarding both interpersonal and clinical skills (mean 9.4, SD 1.0, best score 10) and no significant differences regarding the level of ambulatory independence, gender, or age. The PGIC indicated perceived short-term improvement for 35 (57%) patients, with no patients reporting deterioration. The BRSPE showed a significantly lower perception of exertion during walking after the consultation (Wilcoxon signed-rank test, Z-2.58, p?=?0.010). The study indicates a high level of satisfaction regarding interpersonal and clinical skills, information, and instruction in self-assisted exercises and indicates that perceptions of short-term improvement may occur after single consultations. The study suggests an important role for physiotherapy in hospital outpatient services for PwMS, but further studies are necessary to deepen our understanding.
PubMed ID
21801100 View in PubMed
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Predicting disability pension - depression as hazard: a 10 year population-based cohort study in Norway.

https://arctichealth.org/en/permalink/ahliterature279674
Source
Int J Methods Psychiatr Res. 2016 Mar;25(1):12-21
Publication Type
Article
Date
Mar-2016
Author
Eva Lassemo
Inger Sandanger
Jan F Nygård
Knut W Sørgaard
Source
Int J Methods Psychiatr Res. 2016 Mar;25(1):12-21
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cohort Studies
Community Health Planning
Depression - epidemiology - psychology
Disability Evaluation
Disabled Persons - psychology
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Norway - epidemiology
Pensions - statistics & numerical data
Proportional Hazards Models
Risk factors
Sex Factors
Young Adult
Abstract
Disability pension (DP) is an escalating challenge to individuals and the welfare state, with mental health problems as imminent hazard. The objective of the present paper was to determine if a diagnosis of depression increased the risk of subsequent DP, and whether the risk differed by gender. A population cohort of 1230 persons were diagnostically interviewed (Composite International Diagnostic Interview, CIDI) in a population study examining mental health, linked to the DP registry and followed for 10 years. The risk for DP following depression was estimated using Cox regression. Life-time depression, as well as current depression, increased the risk of subsequent DP for both genders. The fully adjusted [baseline health, health behavior and socio-economic status (SES)] hazard ratios (HRs) for life-time depressed men and women were 2.9 [95% confidence interval (CI) 1.5-5.8] and 1.6 (95% CI 1.0-2.5) respectively. Men were significantly older at time of DP. There are reasons to believe that depression went under-recognized and under-treated. To augment knowledge in the field, without underestimating depression as risk for DP, a deeper understanding of the nature and effects of other distress is needed.
PubMed ID
26098101 View in PubMed
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Prevalence and characteristics of suicide attempters and ideators among acutely admitted psychiatric hospital patients in northwest Russia and northern Norway.

https://arctichealth.org/en/permalink/ahliterature269528
Source
BMC Psychiatry. 2015;15:187
Publication Type
Article
Date
2015
Author
Tore Sørlie
Knut W Sørgaard
Anatoly Bogdanov
Trond Bratlid
Grigory Rezvy
Source
BMC Psychiatry. 2015;15:187
Date
2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cohort Studies
Cross-Cultural Comparison
Cross-Sectional Studies
Depression - ethnology - psychology
Female
Hospitals, Psychiatric - trends
Humans
Male
Middle Aged
Norway - ethnology
Patient Admission - trends
Prevalence
Psychotic Disorders - ethnology - psychology
Russia - ethnology
Substance-Related Disorders - ethnology - psychology
Suicidal ideation
Suicide, Attempted - ethnology - psychology - trends
Abstract
More knowledge about suicidality and suicide risk profiles in acute psychiatric hospital patients (both first-time and chronic patients) is needed. While numerous factors are associated with suicidality in such populations, these may differ across cultures. Better understanding of factors underlying suicide risk can be informed by cross-cultural studies, and can aid development of therapeutic and preventive measures.
An explorative, cross-sectional cohort study was carried out. Acutely admitted patients at one psychiatric hospital in northwest Russia and two in northern Norway were included. At admission, demographic, clinical, and service use data were collected, in addition to an assessment of suicidal ideation and attempts, comprising five dichotomic questions. Data from 358 Norwegian and 465 Russian patients were analyzed with univariate and multivariate statistics. Within each cohort, attempters and ideators were compared with patients not reporting any suicidality.
The observed prevalence of suicidal ideation and attempts was significantly higher in the Norwegian cohort than in the Russian cohort (?(2)?= 168.1, p
Notes
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PubMed ID
26239359 View in PubMed
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Schizophrenia and contact with health and social services: a Nordic multi-centre study.

https://arctichealth.org/en/permalink/ahliterature71280
Source
Nord J Psychiatry. 2003;57(4):253-61
Publication Type
Article
Date
2003
Author
Knut W Sørgaard
Mikael Sandlund
Jyrki Heikkilä
Lars Hansson
Hanne R Vinding
Olafur Bjarnason
Anita Bengtsson-Tops
Lars Merinder
Lise-Lotte Nilsson
Thomas Middelboe
Author Affiliation
Nordlandssykehuset, Bodø, Norway. knut.soergaard@nlsh.no
Source
Nord J Psychiatry. 2003;57(4):253-61
Date
2003
Language
English
Publication Type
Article
Keywords
Adult
Cross-Sectional Studies
Demography
Female
Humans
Male
Mental Health Services - utilization
Middle Aged
Research Support, Non-U.S. Gov't
Rural Population
Scandinavia
Schizophrenia - rehabilitation
Schizophrenic Psychology
Social Work, Psychiatric - statistics & numerical data
Urban Population
Abstract
BACKGROUND: In a Nordic multi-centre study investigating the life and care situation of persons with schizophrenia living in the community, factors explaining use of health and social services were examined. METHOD: Four hundred and eighteen individuals with schizophrenia from 10 sites were interviewed about their contact with different services (support functions within and outside the mental health services, general practitioners (GPs), physicians in the mental health, psychotherapy, day-care and inpatient treatment), psychopathology, social network and needs for care. RESULTS: Physicians and support contacts within the mental health system were most used and GPs and psychotherapy least. Three groups of variables were stabile predictors of contact: rural-urban differences, diagnoses (hebephrenic schizophrenia associated with less contact with physicians in the mental services and more with GPs) and health needs as experienced by the patients. No differences between the centres with regard to total service use were found, but the patterns of contact reflected urban-rural variance. A low number of health needs predicted contact with physicians within the mental health services, whereas a high number of such needs was related to contact with GPs and support functions within the mental health services. Social relations exhibited the highest number of unmet needs. CONCLUSIONS: Contact with physicians working in the mental health services was much more common than contact with GPs. Based on a broad spectre of demographic, clinical and network variables, it was not possible to find models that explained substantial parts of the variance of service use. Patterns of contact were different in rural, town and city-surroundings, and with the exception of psychotherapy, the rural pattern was characterized by use of less specialized services. The importance of health needs and diagnosis as predictors of contact illustrate the profound and lasting effects on health of having a diagnosis of schizophrenia.
PubMed ID
12888399 View in PubMed
Less detail

Structure of needs among persons with schizophrenia.

https://arctichealth.org/en/permalink/ahliterature9273
Source
Soc Psychiatry Psychiatr Epidemiol. 2005 Mar;40(3):233-9
Publication Type
Article
Date
Mar-2005
Author
Jyrki Korkeila
Jyrki Heikkilä
Lars Hansson
Knut W Sørgaard
Tero Vahlberg
Hasse Karlsson
Author Affiliation
Dept. of Psychiatry, Turku University Central Hospital and University of Turku, Turku, Finland. jyrki.korkeila@turku.fi
Source
Soc Psychiatry Psychiatr Epidemiol. 2005 Mar;40(3):233-9
Date
Mar-2005
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Ambulatory Care
Cross-Sectional Studies
Female
Health services needs and demand
Humans
Male
Mental Health Services - organization & administration
Quality of Life - psychology
Questionnaires
Scandinavia
Schizophrenia - therapy
Schizophrenic Psychology
Abstract
BACKGROUND: The importance of needs assessment for service development has been widely recognised. Several studies have focused on the associations between ratings of needs by patients and staff and have found clear differences, especially concerning the unmet needs. METHODS: The present study is part of a Nordic Multicentre study that investigates the life and care of outpatients with a schizophrenia group illness in all the Nordic countries. The aim of this paper is to study the patterns of needs as identified by patients and staff according to the Camberwell Assessment of Needs (CAN). Quality of life, level of functioning, and psychiatric symptoms were assessed. RESULTS: The sample includes 300 patients, 194 (65%) men and 106 (35%) women. The factor analysis identified five factors for patients and four factors for staff in the questionnaire on ratings of needs. In four of the five patient-related factors a meaningful interpretation was possible, and the factors were named skills, illness, coping, and substance abuse. The staff-related factors were named skills, impairment, symptom, and substance abuse. There were significant associations between the sum scores constructed from the factors and measures of functioning level and symptoms. CONCLUSIONS: It seems that the sum factor reflecting secondary needs was the most important of the identified factors among both patient and staff ratings. The item-by-item comparisons in previous studies have emphasised differences between patient and staff ratings, but our analysis of the structure of needs also found similarities in the structures and in the associations between the identified sum scores and measures of symptoms, functioning level, and quality of life.
PubMed ID
15742229 View in PubMed
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Suicidality related to first-time admissions to psychiatric hospital.

https://arctichealth.org/en/permalink/ahliterature137396
Source
Soc Psychiatry Psychiatr Epidemiol. 2012 Mar;47(3):419-25
Publication Type
Article
Date
Mar-2012
Author
Terje Øiesvold
Tony Bakkejord
Vidje Hansen
Mary Nivison
Knut W Sørgaard
Author Affiliation
Nordland Hospital, 8092, Bodø, Norway. terje.oiesvold@nlsh.no
Source
Soc Psychiatry Psychiatr Epidemiol. 2012 Mar;47(3):419-25
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adult
Cohort Studies
Female
Hospitals, Psychiatric
Humans
Male
Norway
Patient Admission
Prospective Studies
Suicidal ideation
Abstract
The epidemiology of suicidality shows considerable variation across sites. However, one of the strongest predictors of suicide is a suicidal attempt. Knowledge of the epidemiology of suicidal ideas and attempts in the general population as well as in the health care system is of importance for designing preventive strategies. In this study, we will explore the role of the psychiatric hospital in suicide prevention by investigating treated incidence of suicidal ideation and attempt, and further, discern whether sociodemographic, clinical and service utilization factors differ between these two groups at admission.
The study was a prospective cohort study on treated incidence in a 1-year period and 12-month follow-up. The two psychiatric hospitals in northern Norway, serving a population of about 500,000 people, participated in the study. A total of 676 first-time admissions were retrospectively checked for suicidality at the time of admission. A study sample of 168 patients was found eligible for logistic regression analysis to elucidate the risk profiles of suicidal ideators versus suicidal attempters. GAF, HoNOS and SCL-90-R were used to assess symptomatology at baseline.
52.2% of all patients admitted had suicidal ideas at admission and 19.7% had attempted suicide. In the study sample, there were no differences in risk profile between the two groups with regard to sociodemographic and clinical factors. Males who had made a suicide attempt were less likely to have been in contact with an out-patient clinic before the attempt. The rating scales not measuring suicidality directly showed no differences in symptomatology.
The findings provide evidence for the importance of the psychiatric hospital in suicide prevention. About half of the admissions were related to suicidality and the similar risk profiles found in suicidal ideators and suicidal attempters indicate that it is the ideators who mostly need treatment that get admitted to the hospital, and should be evaluated and treated with equal concern as those who have attempted suicide.
Notes
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PubMed ID
21287142 View in PubMed
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