Sexual quality of life in patients with axial spondyloarthritis

Paper I, paper II and paper III are excluded from the dissertation due to copyright.Accepted versions of paper II and paper III follow as separate files.Background: Research on the impact of health status on sexual activity and sexual quality of life (QOL) in patients with axial spondyloarthritis (axSpA) is scarce. Aim: The overall aim of the studies was to examine the impact of health status on sexual activity and sexual QOL in male and female patients with axSpA. Methods: Three hundred and seventy-nine consecutive patients with axSpA, aged 18–81 years, who visited the outpatient rheumatology clinics at two Norwegian hospitals were included. Data on demographic factors, disease, treatment, and lifestyle variables were collected by doctors and nurses from questionnaires, laboratory test results, direct interviews, and physical examinations, at the baseline and after 5 years. At the followup, 245 patients participated. A broad-spectrum data collection method was used to obtain data for demographics, patient-reported outcome measures (PROMS), and disease activity/damage. PROMS measures included the Health Assessment Questionnaire (HAQ), Bath Ankylosing Spondylitis Patients Global Score (BAS-G), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Activity Index (BASDAI), 15D Measure of Health-Related Quality of Life (15D), Health Survey Short-Form-36 items (SF-36), and Sexual Quality of Life–Female (SQOL-F). Data on disease activity and damage were obtained from the Bath Ankylosing Spondylitis Metrology Index (BASMI) and the Maastricht Ankylosing Spondylitis Enthesis Score (MASES). Conclusions: This cohort of outpatient patients with axSpA reported a low impact of health status on sexual activity and sexual QOL. Sexual QOL did not seem to worsen over time and remained stable through the 5-year follow-up despite an increase in the number of comorbidities. Effective disease control and changes in healthy lifestyle habits may help to improve the outcomes for these patients.publishedVersio

The Relevance of Shame Across Time and Location

Twitter is used among various entities professionals, politicians, and the general public as an online social network. Many tweets are informational, but others are reactive based on judgment that leads to public shaming. In response to the book “The Shame Machine” (by Cathy O’Neil), we look at Tweets to determine a linguistical and content analysis of shame. The research focuses on content analysis to define if a tweet contains language that is deduced as public shaming. Other factors relating to the tweet are the time, date, location of the author, and if it’s the initial post or a response to the post, are included. The practical implications of the results indicate how social media, particularly Twitter, opens the door for shaming discourse

Barnehusevalueringen 2012 : delrapport 1 : barnehusmodellens implikasjoner for politiets arbeid med fokus på dommeravhør og rettsmedisinsk undersøkelse

«Barnehusene» er et tverrfaglig, samlokalisert tiltak rettet mot barn og unge utsatt for seksuelle overgrep eller vold, eller som har vært vitne til vold. Det første barnehuset i Norge ble opprettet i 2007, og det er nå barnehus i Oslo, Bergen, Trondheim, Kristiansand, Hamar, Tromsø og Stavanger - det åttende åpner i Ålesund i løpet av 2012. På barnehusene gjennomføres dommeravhør, rettsmedisinsk undersøkelse, rådgivning og behandling. Ordningen går ut på at fagfolkene kommer til den som har vært utsatt for overgrep, slik at han eller hun slipper å forholde seg til mange ulike instanser. Det er lagt vekt på at lokalene skal være innbydende og funksjonelle, og være tilpasset barn og ungdom i ulike aldersgrupper. I rapporten presenteres barnehusenes historikk, erfaringer med barnehus fra andre land, og ikke minst hvilke erfaringer man så langt har med de norske barnehusene. Grunnlagsmaterialet bygger på intervjuer, spørreundersøkelser og dokumenter. Våre funn viser at måten dommeravhørene gjennomføres på ikke endres i barehusene, men at rammevilkårene for dommeravhørene har blitt vesentlig bedre. Det tverrfaglige samarbeidet vurderes som positivt, og til tross for en del utfordringer, er impliserte aktører i hovedsak tilfreds med arbeidet ved barnehusenes. På noen områder er det samtidig behov for avklaringer. Dette gjelder både rammebetingelser og målgrupper, og spørsmål knyttet til gjennomføringen av rettsmedisinsk undersøkelse

Instruments to Identify Symptoms of Paternal Depression During Pregnancy and the First Postpartum Year: A Systematic Scoping Review

Men often experience depressive symptoms during the transition to parenthood, but there is a lack of synthesized knowledge of instruments used to identify such symptoms. The aim of this scoping review was to identify instruments used to measure symptoms of depressive symptoms among fathers in pregnancy and the postpartum period, and to describe the instruments’ characteristics and measurement properties. We identified studies published since 1990 through searches in databases such as MEDLINE, EMBASE, and PsycINFO and in gray literature. Pairs of reviewers selected relevant studies based on predetermined inclusion criteria. For each included study, we collected information relevant to the review question, guided by the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN). We included 13 instruments, described in 59 studies with about 29,000 participants across 25 countries. There were 12 validation studies. None of the instruments were uniquely developed for assessing paternal depressive symptoms related to fatherhood. The three most extensively examined instruments were the Edinburgh Postnatal Depression Scale (EPDS), Center for Epidemiologic Studies Depression Scale, and Beck Depression Inventory. For seven of the 13 instruments, there was no information reported about the instruments’ properties beyond internal consistency, but for the other six instruments the 12 validation studies reported on both reliability and validity. No studies reported on measurement error or responsiveness. EPDS was both the most extensively assessed instrument and reported to be the most reliable and valid. Further research on instruments for identifying men with depression in pregnancy and the postpartum period is warranted

“Opening up a well of emotions”: A qualitative study of men's emotional experiences in the transition to fatherhood

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Aim: To explore the emotional changes and reactions men experience in their transition to fatherhood. Design: This study used a qualitative design. Methods: Data were collected through in-depth interviews with 13 Norwegian fathers. Results: Through thematic analysis, three main themes were developed: (1) from selffocus to family perspective; (2) emotional vulnerability; and (3) from insecurity to selfassurance. The themes describe fathers' emotional process during the child's first year of life, ranging from positive feelings like affection and mastery, to challenging feelings like exclusion, jealousy and exhaustion. Many fathers describe taboos and shame over their own emotional reactions, although these can be considered a natural part of the postnatal period.publishedVersio

“Opening up a well of emotions”: A qualitative study of men's emotional experiences in the transition to fatherhood

Aim To explore the emotional changes and reactions men experience in their transition to fatherhood. Design This study used a qualitative design. Methods Data were collected through in-depth interviews with 13 Norwegian fathers. Results Through thematic analysis, three main themes were developed: (1) from self-focus to family perspective; (2) emotional vulnerability; and (3) from insecurity to self-assurance. The themes describe fathers' emotional process during the child's first year of life, ranging from positive feelings like affection and mastery, to challenging feelings like exclusion, jealousy and exhaustion. Many fathers describe taboos and shame over their own emotional reactions, although these can be considered a natural part of the postnatal period

Norwegian fathers’ experiences with a home visiting program

Objective - To explore fathers’ experiences with a Norwegian home visiting program during the prenatal period and the first-year postpartum. Design - Qualitative design with interpretive description (ID) as the methodological approach. Sample - Individual interviews with fathers (n = 13) who received home visits by a public health nurse (PHN) within the New Families home visiting program. Measures - Interviews were guided by a semi-structured interview-guide, which contained open-ended questions encouraging informants to reflect on their experiences with home visits. The analysis of the data was informed by content analysis. Results - Two main themes that reflect the fathers’ experiences emerged: (1) The importance of being on their home ground captures the fathers’ experience of receiving home visits and building a trusting relationship with the PHN. (2) Including fathers in the home visit represents their thoughts about the content and focus of the home visits. Conclusions - Fathers experienced the universal New Families home visiting program as an important contribution towards a more available and tailored service, with the home environment as a suitable arena for developing a trusting relationship with the PHN. However, the fathers often felt insufficiently included in the home visits, with only scant attention towards them as independent caregivers, their emotional reactions, roles, and family relationships. Pre-birth home visits might contribute to strengthening preparations for fatherhood and increase fathers’ engagement in the Child Health Service

The uniqueness question in the multidimensional moment problem with applications to phase space observables

The theory of holomorphic functions of several complex variables is applied in proving a multidimensional variant of a theorem involving an exponential boundedness criterion for the classical moment problem. A theorem of Petersen concerning the relation between the multidimensional and one-dimensional moment problems is extended for half-lines and compact subsets of the real line. These results are used to solve the moment problem for the quantum phase space observables generated by the number states.Comment: 13 pages, submitted to Reports on Mathematical Physic

Palliativ enhet eller palliative plasser ved sykehjem i Stange kommune

Oppdragsgiver: Stange kommuneHøgskolen i Hedmark, avdeling for helse‐ og idrettsfag, institutt for sykepleiefag har på oppdrag fra Stange kommune utarbeidet foreliggende utredning om organisering av palliasjon i kommunen. Utredningen tar for seg hva palliasjon er, fordeler og ulemper ved henholdsvis palliative senger i ordinær sykehjemsavdeling og egen palliativ enhet og økonomi knyttet til de ulike alternativene. Palliasjon er aktiv behandling, pleie og omsorg for pasienter med uhelbredelig sykdom. Lindring av pasientens fysiske smerte og andre plagsomme symptomer, uavhengig av diagnose/sykdom, står sentralt. Målet er best mulig livskvalitet for pasienten og de pårørende. Dette innebærer at pasient og pårørende blir møtt og forstått i forhold til sin situasjon med uhelbredelig sykdom i familien. For å lykkes med palliasjon i kommunen kreves kompetanse hos personalet og tverrfaglig samarbeid – og samarbeid med spesialisthelsetjenesten i Sykehuset Innlandet HF. Det foreligger erfaring fra andre kommuner i Norge med både palliative enheter i sykehjem og palliative senger i eksisterende sykehjemsavdelinger. Noen har gått enda ”lenger” og etablert intermediær (1 ½‐linje) avdeling i sykehjem, og noen har etablert hospice‐enhet. Disse erfaringene, forutsatt at folketallet i kommunen er større enn 10 – 15 000 innbyggere, tilsier at palliativ enhet har flere fordeler enn palliative senger i eksisterende sykehjemsavdeling. Behandlingstilbudet i palliative enheter er kostbart i forhold til driften ved ordinære sykehjemsavdelinger, men billig i forhold til behandling i sykehus (Garåsen m.fl., 2003). I tråd med utspillene fra nåværende helseminister Bjarne Håkon Hansen den siste tiden, er det rimelig å anta at kommunen dermed vil få et utvidet ansvar i forhold til pasientgruppene med behov for palliasjon framover. Utfordringen er å ta stilling til på hvilken måte Stange kommune skal løse dette: Palliaitv enhet eller palliative senger i sykehjem? Hvilken kompetanse er nødvendig for å håndtere utfordringene? Hvilke økonomiske konsekvenser gir realisering og drifting av tiltaket som velges?Abstract: Hedmark University, Department of Health and Sports Sciences, Department of Nursing, has, on behalf of Stange Municipality, prepared the present report on the organization of palliative care in the municipality. The report addresses what palliative care is, the advantages and disadvantages of palliative beds in the ordinary nursing home ward and its own palliative care unit and finances related to the various alternatives. Palliative care is active treatment, nursing and care for patients with incurable disease. Relief of the patient's physical pain and other troublesome symptoms, regardless of diagnosis / illness, is the key. The goal isthe best possible quality of life forthe patient and the relatives. This meansthat the patient and relatives are met and understood in relation to theirsituation with incurable disease in the family. In order to succeed with palliative care in the municipality, the competence of the staff and interdisciplinary collaboration is required ‐ and collaboration with the specialist health service at Sykehuset Innlandet HF. There is experience from other municipalities in Norway with both palliative units in nursing homes and palliative beds in existing nursing home wards. Some have gone even “further” and established an intermediate (1 ½‐line) ward in a nursing home, and some have established a hospice unit. These experiences, provided that the population in the municipality is greater than 10 ‐ 15 000 inhabitants, indicate that the palliative care unit has more advantages than palliative care beds in the existing nursing home ward. The treatment offered in palliative care units is expensive in relation to the operation of ordinary nursing home wards, but cheap in relation to treatment in hospitals (Garåsen et al., 2003). In line with the proposalsfrom the reasent Minister of Health Bjarne Håkon Hansen recently, it isreasonable to assume that the municipality will thus have an expanded responsibility in relation to the patient groups with a need for palliation in the future. The challenge is to decide in which way Stange municipality will solve this: Palliaitv unit or palliative beds in nursing homes? What skills are needed to handle the challenges? What financial consequences does the realization and operation of the measure chosen have?publishedVersio