Intraoral Vertical Ramus Osteotomy - Objective and Subjective Treatment Outcomes

Combined orthodontic and orthognathic surgical treatment is conducted when a jaw discrepancy exceeds what can be treated with orthodontic treatment alone with an acceptable esthetical and functional result. The intraoral vertical ramus osteotomy (IVRO) is one of mainly three different surgical techniques used to move the mandible posteriorly in patients with a skeletal Class III jaw relationship due to excess growth of the mandible. The purpose of this thesis is to evaluate the IVRO procedure with special focus on stability, satisfaction with treatment, oral health-related quality of life (OHRQoL), and impact on respiratory function during sleep. Thirty-six previous skeletal Class III patients operated with an isolated IVRO procedure and subsequent six weeks of intermaxillary fixation were examined 10-15 years after surgery and completed a 37- item structured questionnaire. Pre- and post-surgical orthodontic treatment had been performed in all patients. Skeletal and dental changes were evaluated with lateral cephalograms and dental casts obtained before treatment started, eight weeks, one year and 10-15 years after surgery. OHRQoL was measured with the OIDP index. A prospective cohort study was performed to evaluate the effect of mandibular setback surgery on the respiratory function during sleep. Eight otherwise healthy skeletal Class III patients between 18 and 33 years of age conducted in-home respiratory sleep recordings within two weeks before and at least three months after surgery. Primary outcome variable was apnoea hypopnea index (AHI). In the long-term follow-up study mean mandibular surgical setback was 8.3 mm (range 4.5 - 13.5 mm). The mean skeletal change between eight weeks and 10-15 years after surgery was 1.6 mm in anterior direction. Ninety-two percent had positive horizontal overjet 10-15 years after surgery. Sixty-one percent were very satisfied and the remainder were reasonably satisfied with the treatment. The mean OIDP frequency score was 8.49, indicating that OHRQoL was good. In the group of patients conducting pre- and post-operative sleep recordings, the AHI was below three events per hour before surgery and below four events per hour after surgery in all patients. The mean surgical setback was 4.3 mm (range: 2.5-7.4 mm) in this patient group. In conclusion, 10-15 years after mandibular setback surgery with the IVRO procedure the clinical result was good in most of the patients. All were either reasonably or very satisfied with the treatment, and OHRQoL was reported to be good. In the group of eight young, adult skeletal Class III patients in the prospective study, surgery did not increase AHI above five events per hour, i.e. all were below the threshold for mild obstructive sleep apnoea

Hverdagen som langtids sosialklient: - mestring i et (bruker)medvirkningsperspektiv

Avhandling (ph.d.) - NTNU Fakultet for samfunnsvitenskap og teknologiledelse, Institutt for sosialt arbeid og helsevitenskap, Trondheim, 2007Avhandlingen er en fenomenologisk studie av langtids sosialklienters opplevelser av hverdagsmestring i et (bruker)medvirkningsperspektiv. Teorigrunnlaget tar utgangspunkt i kognitiv psykologi (Lazarus & Folkman 1984, Lazarus 1991,1999), opplevelse av sammenheng (Antonovsky 1979, 1987, 2000) og sosial støtte fra uformelle og formelle nettverk (Dalgard & Sørensen 1988, Thoits 1995, Fyrand 2005). Empirien er basert på kvalitative samtaleintervjuer med 21 brukere av sosialtjenestene fra to kommuner på Østlandet. Alle informantene hadde vært avhengige av økonomisk sosialhjelp minimum seks måneder i løpet av det siste kalenderåret. Resultatene indikerer at informantene er en svært heterogen gruppe som mestrer utfordringene i sine livsverdener på en rekke kreative måter. Som et ledd i analysearbeidet ble mestringsmodellen og samspillsmodellen konstruerte. Informantenes generelle mestringsmønstre i deres livssituasjoner ble fortolket å være selvrealisering, overflødiggjøring, svingning, ambivalens, avmakt og resignering. Halvparten av informantenes livssituasjoner fordelte seg på de to mestringsposisjonene svingning eller ambivalens. Deres livssituasjoner opplevdes ustabile og uavklarte. Problemforståelser med flere perspektiver (individ, omgivelser og interaksjon mellom individ(er) og omgivelser) synes å øke informantenes opplevelser av mestringsressurser. Økonomisk sosialhjelp sikret et visst økonomisk grunnlag, men det økonomiske mestringsrommet opplevdes stramt og sosialt begrensende. Å ha penger til å være i (sosial) aktivitet var viktig for å øke trivsel og ivareta sine arbeidsevner. Brukere opplevde seg som dumme når de ikke hadde penger til dette. De erfarte sin mestring som god når det gjaldt å finne systemer for å drøye sosialhjelpen lengst mulig. Informantene opplevde det som viktig å få gjøre tingene på sine egne måter. Opplevd innflytelse til å skaffe seg arbeid var relativt liten, men flere influerte på sin hverdag ved å sysselsette seg med meningsfulle aktiviteter. Ikke alle hadde helse til å arbeide lenger. Aktører som planla med lengre tidshorisonter opplevde å mestre livet bedre enn dem som levde ”her og nå”. Informanter som hadde problemer med rusmidler, opplevde at hverdagen ble styrt av stadige kamper for å skaffe penger til rusmidler. De ønsket behandling (legemiddelassistert rehabilitering), men kommunen hadde ikke flere penger igjen på budsjettet. Brukernes opplevelser av uformell, sosial støtte var at den hadde stor betydning for deres mestring av hverdagen. Støtten måtte foregå til ”riktig” tid (i kraftvendepunkter) og oppleves på en kvalitativ god måte. Formelle hjelpere trakk ikke uformelle nettverk inn i samarbeidet med brukerne. Slik brukerne husket det, var ingen av dem blitt spurt om de ønsket dette. Støtten fra formelle nettverk opplevdes svært varierende. Hvis hjelp som gis kan spille mer på lag med brukernes opplevde mestringsressurser og til ”riktig” tid, vil hjelpen oppleves mer effektiv

Service Users Facing Household Challenges

This article is based on a study of an educational and developmental programme, in which the task-centred coping approach (TCCA) was a central part. Twenty social worker practitioners from Norwegian municipal social services (MSS) participated in the programme, and practiced TCCA with 74 of their service users. The aim of the study was to develop knowledge about how service users evolve their housing competence by utilizing TCCA.The study was based on a way of participatory action research, in which the researcher was positioned as a partly participating researcher. The researcher tried to attain knowledge from the individualized activities of the service users and the practitioners, and use this knowledge as a contribution to developing their practice and the programme. User participation was one of the cornerstones of the study, and individualization meant matching the approaches of the practitioners to the experienced needs of the individual service user

Brukermedvirkning i bo-oppfølging. Et spenningsfelt mellom å yte omsorg og å bidra til systematiske endringsprosesser

Household support takes place in users’ homes and neighbourhoods. User participation is basic in developing support services, which meet the needs of users with mental health and/or addiction challenges. Decisions made in collaboration with social work practitioners from the Norwegian municipal social services, have to target the users’ life-situations. The aim of this article is to explore how practitioners experience user participation. The article is based on a part of a big research project, practicing user participation and the Task-Centred Coping Approach. Twenty-five practitioners from the MSS in Norway participated in focus-group interviews. The results were summarized into four themes: practitioners’ understanding of user participation, users’ personal and environmental resources, users’ motivation for household support and users’ goals.publishedVersio

I need to be who I am : a qualitative interview study exploring the needs of people with dementia in Norway

Objective Many people with dementia receive community services. These services are often based on the needs of informal caregivers and professional caregivers’ assessment. User involvement and participation are main objectives in the Norwegian National Dementia Plan 2020. To enhance user involvement and individual tailoring of healthcare services, more information is required about the needs of people with dementia. The aim of this study was to explore the experienced needs of people with dementia in order to facilitate user involvement in provided services. Methods An explorative cross-sectional study design was used. We performed semistructured interviews with people with dementia who were recruited from all regions of Norway. The sample comprised 35 participants diagnosed with dementia. The interviews were audio-recorded and transcribed, and the data material was analysed using a qualitative content analysis. Results Three main categories emerged from the interviews: (1) to stay connected; (2) to be active and participate; and (3) to live for the moment. The overarching theme was: the need to be who I am. Conclusions People with dementia participating in the study were heterogeneous regarding wants and requirements. Most of them expressed the need and wish to hold on to who they are. Close and robust relations with family and friends can give significant support to people with dementia. However, living with dementia might put considerable strain on relations. Services should provide support to enhance relationships, encourage existing networks to remain stable and facilitate participation in meaningful activities for people living with dementia.publishedVersio

Hvilke erfaringer har helsepersonell i fire hjemmetjenestedistrikter i Nord-Norge med innføring av elektronisk medisineringsstøtte, og hvilke faktorer har vært fremmende, og hvilke faktorer har vært hemmende i innføring av slik støtte i en eksisterende helsetjeneste?

Temaet for masteroppgaven er innføring av velferdsteknologi i kommunale helsetjenester. I denne studien har jeg ønsket å få vite mer om hvilke erfaringer helsepersonell i Nord-Norge har hatt med innføring av elektronisk medisineringsstøtte. Da særlig på hvilke faktorer som har vært fremmende, og hvilke faktorer har vært hemmende i innføringen av slik støtte i eksisterende helsetjeneste. Informantene beskrev først og fremst at valg av organisering påvirket ansattes engasjement, eierskapsfølelse og drivkraft under deltagelse i innovasjonsprosjektet. Ved en samarbeidsdreven innovasjonsprosess, ses de ulike aktørene som likeverdige parter, og de har samme forståelse og mål for prosjektet tross ulik fagbakgrunn. En toppstyrt innovasjonsprosess bidro til det motsatte ifølge informantene, og skapte usikkerhet, skepsis og motstand hos ansatte som skulle ta i bruk innovasjonen. Superbruker ble opplevd som en nøkkelfunksjon for opplæring og igangsetting av drift. Det som ifølge informantene bidro mye til suksess var kompetanseheving gjennom praksisnær opplæring. En forutsetning for å lykkes med teknologi var ifølge deres erfaringer at det tekniske fungerte, og at man hadde systemer som fanget opp uforutsette hendelser. Informantene mente også at for pasienter kunne innføringen av teknologi bidra til økt egenmestring og selvstendighet, mens for ansatte ble antall hjemmebesøk redusert. Informantene gav uttrykk for at når det gjaldt økonomiske gevinster var disse avhengige av antall dispensere i drift. Demografiske forhold spilte også en rolle mente de, i den forstand at innovasjonsprosessen hadde gitt mer økonomisk gevinst i tettbefolkede områder med større pasienttilgang. Ensomhet ble også trukket frem som en risikofaktor når antallet besøk ble redusert, en risiko som nødvendiggjorde en pågående etisk vurdering av konsekvensene av slikt innovasjonsarbeid

Building Resilience in Social-Ecological Food Systems in Vermont

There is an expanding interest in Local Food Systems (LFSs) in Vermont, along with a growing effort to create adaptive governance to facilitate action. In this case study, we investigate how adaptive governance of LFS can provide ideas and act as a catalyst for creating resilience in other social-ecological systems (SESs). By participating in meetings and interviewing stakeholders inside and outside the Vermont LFS network, we found that consumers were highly motivated to participate by supporting environmental issues, the local economy, and interactive communities, as well as building social relationships. Farmers experienced better income and increased respect in the local community. All participants found adequate “safe space” to share new ideas and explore partnerships. Their identities and values were also place-specific, reflecting the working landscape of Vermont. Adaptive governance was built on equal partnerships, where problems were discussed and responsibilities were shared among many stakeholders across geographic areas and multiple sectors. Some skepticism was expressed towards mainstreaming local food production and sales. Challenges remain to more fully include farmers, for-profit players, and low-income consumers in the network. This might limit the resilience and sustainability of the LFS. Because SESs are held together by common culture and identities, the risk of non-adaptive social patterns exemplifies one key challenge for future adaptive management towards resilient and sustainable outcomes. There is a critical need for developing relevant theory and conducting further research on LFSs and their potential roles in local SESs