Self-reported cognitive and psychiatric symptoms at 3 months predict single-item measures of fatigue and daytime sleep 12 months after ischemic stroke

Introduction: Post-stroke fatigue and increased need for daytime sleep are multidimensional and insufficiently understood sequelae. Our aim was to study the relationships of self-reported cognitive and psychiatric symptoms at 3 months with fatigue and daytime sleep at 12 months post-stroke. Methods: Ischemic stroke patients without reported history of dementia or depression completed postal surveys 3- and 12-months post-stroke. At 3 months, psychiatric symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS), and self-reported changes in cognitive symptoms (concentration and memory) compared to pre-stroke were assessed using single-item measures. At 12 months, single-item questions about changes in self-reported difficulties sleeping at night, fatigue and daytime sleep were included. First, we studied whether self-reported cognitive and/or psychiatric symptoms at 3 months were associated with daytime sleep and fatigue at 12 months using multiple logistic regression. Second, we fitted 2 structural equation models (SEMs) predicting fatigue and 2 models predicting daytime sleep. We compared a model where only age, sex, stroke severity (National Institutes of Health Stroke Scale; NIHSS), and difficulties sleeping at night predicted fatigue and daytime sleep at 12 months to a model where mental distress (i.e., a latent variable built of cognitive and psychiatric symptoms) was included as an additional predictor of fatigue and daytime sleep at 12 months. Results: Of 156 patients (NIHSS within 24 hours after admission (mean ± SD) = 3.6 ± 4.3, age = 73.0 ± 10.8, 41% female) 37.9% reported increased daytime sleep and 50.0% fatigue at 12 months. Increased psychiatric symptoms and worsened cognitive symptoms were associated with fatigue and daytime sleep at 12 months, after controlling for NIHSS, age, sex, and difficulties sleeping at night. SEM models including mental distress as predictor showed adequate model fit across 3 fit measures (highest RMSEA = 0.063, lowest CFI and TLI, both 0.975). Models without mental distress were not supported. Conclusion: Self-reported cognitive and psychiatric symptoms at 3 months predict increased daytime sleep and fatigue at 12 months. This highlights the relevance of monitoring cognitive and psychiatric symptoms in the subacute phase post-stroke. However, future research using validated measures of self-reported symptoms are needed to further explore these relationships.publishedVersio

Digital mobbing blant barn og unge: En litteraturgjennomgang av eksisterende forskning på årsaker til digital mobbing blant barn og unge

Med framveksten av digitale kommunikasjonsmidler har mobbingen inntatt den digital arena. I Elevundersøkelsen, gjennomført i 2016, rapporterte hele 69,3 prosent barn at de blir kalt stygge ting og ertet på nett. Denne oppgaven har som mål å undersøke hva forskningslitteraturen beskriver som mulige teknologiske-, individuelle- og demografiske årsaker til at digital mobbing oppstår blant barn og unge. Metode: Jeg har identifisert relevant litteratur fra 2002 til 2016 og gitt en samlet fremstilling og gjennomgang av eksisterende forskning på årsaker til digital mobbing. Resultater: Forskningen viser at årsakene til at digital mobbing oppstår er knyttet til teknologiske funksjoner, karakteristikker hos mobber og offer, og gjennom demografiske variabler. Teknologiske funksjoner: Barn og unges motivasjon til digital mobbingen kan stimuleres gjennom teknologiske funksjoner. Opplevd anonymitet og avstand fremmer en fristelseseffekt og medfører en lavere terskel til å utøve negative handlinger på nett. «Likes-knappen» bidrar også til sosiale ekskluderingsmekanismer og mobbehandlinger. Individuelle årsaker: Digitale mobbeofre kan kjennetegnes med karakteristikker som usikker fremtreden, passivitet, depresjon og angst. Karakteristikker som kjennetegner digitale mobbeutøvere er blant annet lav skoleforpliktelse, manipulativ adferd, dårlige hjemmeforhold, aggressivitet og lav empatisk respons. Foreldrenes innsikt, kunnskap, overvåkning og engasjement i barns aktiviteter på nett kan også ha innflytelse på om barna mobber eller blir mobbet på digitale medier. Demografiske variabler: Studiene som har sett på årsakssammenhenger knyttet til kjønn, alder, rase og digital mobbing viser varierende resultater og kun noen få studier gir en indikasjon på at demografiske variabler kan forutsi digitale mobbeofre og / eller digitale mobbeutøvere. Studier som har undersøkt kjønnsforskjeller viser varierende resultater. Forskningstendensen viser imidlertid at det er gutter som hyppigest mobber andre digitalt, jenter er hyppigest ofre for digital mobbing, flere barn og unge med høyere sosioøkonomisk status mobber andre digitalt. Jenter og barn med lavere sosioøkonomisk status er oftere ofre. Veien videre: Framtidig forskning bør skille mellom ulike handlinger og typer aggressiv adferd. Dette kan avgrense digital mobbing og gi en mer spesifikk kunnskap om årsaker til fenomenet. Det er behov for mer helhetlige, sosialpsykologiske og interaksjonistiske tilnærminger som ser på gruppeprosesser og gjensidig påvirkning i interaksjonen. Videre forskning bør inkludere mer kvalitative design i sine studier

The Relationship Between Executive Impairment and Emotional Distrubances in Stroke Patients

Executive impairment and emotional symptoms are commonly seen post-stroke. These symptoms may impact several aspects of daily life, such as employability and ability to maintain reasonable self-care. In this study, we examine the association between executive impairment and emotional symptoms in post-stroke patients. Increased knowledge about these relationships can help provide better care for stroke patients. The aim of this study was to examine the associations between executive impairment and emotional symptoms in stroke patients. The study is based on a group of 86 patients (MMSE>23) with ischemic infarctions (37 with cortical infarctions and 49 with lacunar supratentorial infarctions), recruited from a stroke unit at Akershus University Hospital. The average age at recruitment was 64.4 years, and 68% were male. Neuropsychological examination was performed one week and three months post-stroke. The patients were divided into two groups based on their performance on executive tests. When comparing the patients with executive impairment (defined as 1.5 SD below the mean for the normative sample on at least one executive test) to the remaining patients, the impairment group had significantly higher levels of depressive symptoms on the depression subscale of HADS (p<.05) at both one week and three months post-stroke. Multiple regression models showed that the depression subscale of HADS significantly influenced the outcome on 7 executive measures, while the anxiety subscale significantly influenced 2. The results of this study indicate that some stroke patients might have an increased need for follow-up, due to the relationship between depressive symptoms and executive impairment, and the consequences this may have for treatment

A study of IPOs in the Nordic markets between 2007 and 2017 – Are underwriting analysts’ recommendations outperforming or suffering from overoptimism?

Masteroppgave(MSc) in Master of Science in Business, Finance - Handelshøyskolen BI, 2018This thesis presents a study of the credibility on underwriting analysts’ recommendations issued on 100 initial public offerings (IPOs) in the Nordic markets between 2007 and 2017. By following the methodology presented in a study by Michaely and Womack (1999), we investigate four main hypotheses. The first hypothesis investigates whether underwriting analysts issue biased recommendations, this is referred to as the conflict of interest hypothesis. The second hypothesis investigates whether underwriting analysts issue more accurate recommendations as they benefit from superior information obtained in the marketing and due diligence processes of the IPO, this is referred to as the superior information hypothesis. The third hypothesis investigates whether underwriting analysts attempt to boost stock prices of poor preforming IPOs. The fourth hypothesis investigates whether the market discounts recommendations issued by underwriting analysts immediately after the announcement. By investigating 274 buy recommendations in an event study, we find no evidence that underwriting analysts issue biased recommendations. This indicate no appearance of the potential conflict of interest in between investment banking and the research department. Although we find that firms recommended by underwriting analysts overall perform better, we cannot conclude that underwriting analysts have superior information to others as the difference is not significant. These findings conflict with the findings of Michaely and Womack (1999). We present the implementation of new regulations and legislations in the financial markets as one possible explanation to this. The analysis is extended to test if there are characteristics that are more important for the performance of a recommended IPO. We find some evidence for the conflict of interest hypothesis on small sized IPOs. These results suggest that smaller IPOs, which is likely to receive less analyst coverage, allow underwriter analysts to issue biased recommendations. We find some evidence for the superior information hypothesis for IPOs receiving six or more recommendations

What are the consequences of externalities and ignorance in online platforms? An economic investigation of current practices and potential remedies.

The pace at which online platforms have become an integral part of our everyday life is nothing short of impressive. Many of such platforms have experienced high growth in recent years which highlights the economic value of data. Using a simple economic model, we investigate the consequences of negative externalities in the market for online services and their welfare implications. We find that the consumers do not internalise the social cost of consumption, and hence the social planner suggests a lower level of consumption than in the decentralised market. Consequently, we investigate whether Pigouvian taxation can replicate the planner solution. Despite this, there seems to be a dichotomy between people’s privacy attitudes and their behaviour, which raises questions regarding the efficiency in the market for such online services. Therefore, we investigate whether ignorance among consumers’ privacy preferences can explain why they fail to adequately address their privacy concerns, leading to a higher level of consumption. Lastly, knowing the complexities of fixing this market, we investigate an alternative solution that could possibly replicate the planner solution without the need for intrusive government intervention

Du får hjelp, men det er ikke sikkert det er akkurat den hjelpen du hadde ønsket

Bakgrunn: Fragmenterte tjenester er ofte et problem for brukere med rus- og psykiatrilidelser. Sykepleier har en sentral rolle i arbeidet med å tilrettelegge for helhetlige og koordinerte tjenester. Hensikt: Undersøke hvordan sykepleier i kommunehelsetjenesten kan legge til rette for helhetlige og koordinerte tjenester for personer med samtidig rus- og psykiatrilidelse. Resultat: På bakgrunn av resultatene i de inkluderte vitenskapelige artiklene, er det særlig fire faktorer som kom frem som viktige for å fremme helhetlige og koordinerte tjenester: - Oppsøkende team - Brukermedvirkning - Samhandling mellom kommune- og spesialisthelsetjenesten - Relasjoner Konklusjon: For helhetlig og koordinerte tjenester til brukere med samtidig rus- og psykiatrilidelse er brukermedvirkning nødvendig. Samtidig kommer det frem at en trygg og likeverdig relasjon mellom bruker og sykepleier er sentralt for at brukermedvirkning skal kunne skje. Kontinuitet trengs for å danne en trygg relasjon

The Relationship of Psychiatric Symptoms with Performance-Based and Self-Reported Cognitive Function After Ischemic Stroke

Objective: Findings on the relationship of psychiatric symptoms with performance-based and self-reported cognitive function post-stroke are inconclusive. We aimed to (1) study the relation of depression and anxiety to performance-based cognitive function and (2) explore a broader spectrum of psychiatric symptoms and their association with performance-based versus self-reported cognitive function. Method: Individuals with supratentorial ischemic stroke performed neuropsychological examination 3 months after stroke. For primary analyses, composite scores for memory and attention/executive function were calculated based on selected neuropsychological tests, and the Hospital Anxiety and Depression Scale (HADS) was used. Psychiatric symptoms and self-reported cognitive function for secondary aims were assessed using the Symptom-Checklist-90 – Revised (SCL-90-R). Results: In a sample of 86 patients [mean (M) age: 64.6 ± 9.2; Mini-Mental State Examination (MMSE), 3–7 days post-stroke: M = 28.4 ± 1.7; National Institutes of Health Stroke Scale (NIHSS) after 3 months: M = 0.7 ± 1.6] depressive symptoms (HADS) were associated with poorer memory performance after controlling for age, sex, and education (p ≤ .01). In a subsample (n = 41; Age: M = 65.7 ± 8.1; MMSE: M = 28.4 ± 1.8; NIHSS: M = 1.0 ± 1.9), symptoms of phobic anxiety (SCL-90-R) were associated with poorer performance-based memory and attention/executive function, and symptoms of anxiety (SCL-90-R) with lower attention/executive function. Higher levels of self-reported cognitive difficulties were associated with higher scores in all psychiatric domains (p ≤ .05). Conclusion: Even in relatively well-functioning stroke patients, depressive symptoms are associated with poorer memory. The results also suggest that various psychiatric symptoms are more related to self-reported rather than to performance-based cognitive function. Screening for self-reported cognitive difficulties may not only help to identify patients with cognitive impairment, but also those who need psychological treatment

Self-reported cognitive and psychiatric symptoms at 3 months predict single-item measures of fatigue and daytime sleep 12 months after ischemic stroke

Introduction: Post-stroke fatigue and increased need for daytime sleep are multidimensional and insufficiently understood sequelae. Our aim was to study the relationships of self-reported cognitive and psychiatric symptoms at 3 months with fatigue and daytime sleep at 12 months post-stroke. Methods: Ischemic stroke patients without reported history of dementia or depression completed postal surveys 3- and 12-months post-stroke. At 3 months, psychiatric symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS), and self-reported changes in cognitive symptoms (concentration and memory) compared to pre-stroke were assessed using single-item measures. At 12 months, single-item questions about changes in self-reported difficulties sleeping at night, fatigue and daytime sleep were included. First, we studied whether self-reported cognitive and/or psychiatric symptoms at 3 months were associated with daytime sleep and fatigue at 12 months using multiple logistic regression. Second, we fitted 2 structural equation models (SEMs) predicting fatigue and 2 models predicting daytime sleep. We compared a model where only age, sex, stroke severity (National Institutes of Health Stroke Scale; NIHSS), and difficulties sleeping at night predicted fatigue and daytime sleep at 12 months to a model where mental distress (i.e., a latent variable built of cognitive and psychiatric symptoms) was included as an additional predictor of fatigue and daytime sleep at 12 months. Results: Of 156 patients (NIHSS within 24 hours after admission (mean ± SD) = 3.6 ± 4.3, age = 73.0 ± 10.8, 41% female) 37.9% reported increased daytime sleep and 50.0% fatigue at 12 months. Increased psychiatric symptoms and worsened cognitive symptoms were associated with fatigue and daytime sleep at 12 months, after controlling for NIHSS, age, sex, and difficulties sleeping at night. SEM models including mental distress as predictor showed adequate model fit across 3 fit measures (highest RMSEA = 0.063, lowest CFI and TLI, both 0.975). Models without mental distress were not supported. Conclusion: Self-reported cognitive and psychiatric symptoms at 3 months predict increased daytime sleep and fatigue at 12 months. This highlights the relevance of monitoring cognitive and psychiatric symptoms in the subacute phase post-stroke. However, future research using validated measures of self-reported symptoms are needed to further explore these relationships

The Relationship of Psychiatric Symptoms with Performance-Based and Self-Reported Cognitive Function After Ischemic Stroke

Objective: Findings on the relationship of psychiatric symptoms with performance-based and self-reported cognitive function post-stroke are inconclusive. We aimed to (1) study the relation of depression and anxiety to performance-based cognitive function and (2) explore a broader spectrum of psychiatric symptoms and their association with performance-based versus self-reported cognitive function. Method: Individuals with supratentorial ischemic stroke performed neuropsychological examination 3 months after stroke. For primary analyses, composite scores for memory and attention/executive function were calculated based on selected neuropsychological tests, and the Hospital Anxiety and Depression Scale (HADS) was used. Psychiatric symptoms and self-reported cognitive function for secondary aims were assessed using the Symptom-Checklist-90 – Revised (SCL-90-R). Results: In a sample of 86 patients [mean (M) age: 64.6 ± 9.2; Mini-Mental State Examination (MMSE), 3–7 days post-stroke: M = 28.4 ± 1.7; National Institutes of Health Stroke Scale (NIHSS) after 3 months: M = 0.7 ± 1.6] depressive symptoms (HADS) were associated with poorer memory performance after controlling for age, sex, and education (p ≤ .01). In a subsample (n = 41; Age: M = 65.7 ± 8.1; MMSE: M = 28.4 ± 1.8; NIHSS: M = 1.0 ± 1.9), symptoms of phobic anxiety (SCL-90-R) were associated with poorer performance-based memory and attention/executive function, and symptoms of anxiety (SCL-90-R) with lower attention/executive function. Higher levels of self-reported cognitive difficulties were associated with higher scores in all psychiatric domains (p ≤ .05). Conclusion: Even in relatively well-functioning stroke patients, depressive symptoms are associated with poorer memory. The results also suggest that various psychiatric symptoms are more related to self-reported rather than to performance-based cognitive function. Screening for self-reported cognitive difficulties may not only help to identify patients with cognitive impairment, but also those who need psychological treatment