Collaboration between general hospitals and community health services in the care of suicide attempters in Norway: a longitudinal study

<p>Abstract</p> <p>Background</p> <p>The aim of this paper was to study the collaboration between emergency departments (EDs) in general hospitals and community health services (CHS) in Norway when providing psychosocial care and aftercare to patients treated in EDs following a suicide attempt. We wanted to explore the extent to which quality indicators at the hospital level measured in 1999 and 2006 could predict the presence or absence of a chain of care structure in the CHS in 2006.</p> <p>Methods</p> <p>Data were collected through structured interviews with informants from 95% of all general hospitals in Norway in 1999 and 2006, and informants from CHS, in a stratified sample of Norwegian municipalities in 2006 (n = 47).</p> <p>Results</p> <p>In 15 of the 47 municipalities (32%), the CHS reported having a chain of care structure in 2006. A discriminant function analysis revealed that the hospitals that in 1999 had: (a) a collaboration agreement with aftercare providers, and (b) written guidelines, including a quality assurance system, were significantly more likely to have municipalities with a chain of care structure in their catchment area in 2006.</p> <p>Conclusions</p> <p>Hospitals' and municipalities' self-reported provision of aftercare services for patients treated after a suicide attempt was markedly below the recommendations given in national standards. Systems at the hospital level for the management and care of patients admitted after a suicide attempt and systematic collaboration between hospitals and aftercare providers seem to be important elements in the long-term maintenance of continuity of care for suicide attempters.</p

Social and life skills in adolescents who have self-harmed: analysis of survey responses from a national sample of adolescents in Norway

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Growth in children conceived by ART

STUDY QUESTION Is the growth pattern of children conceived by ART different compared to naturally conceived children. SUMMARY ANSWER Both ART and underlying parental subfertility may contribute to differences in early childhood growth between children conceived with and without the use of ART. WHAT IS KNOWN ALREADY Children conceived by ART weigh less and are shorter at the time of delivery. The extent to which differences in growth according to mode of conception persist during childhood, and the role of underlying parental subfertility, remains unclear. STUDY DESIGN, SIZE, DURATION We conducted a prospective study population-based study. We studied 81 461 children participating in the Norwegian Mother, Father and Child Cohort Study (MoBa) and 544 113 adolescents screened for military conscription. PARTICIPANTS/MATERIALS, SETTING, METHODS Conception by ART as registered in the Medical Birth Registry. We compared maternally reported length/height and weight among children in MoBa from mid-pregnancy to age 7 according to mode of conception using mixed-effects linear regression. Differences in self-reported height and weight at 17 years of age at screening for military conscription were assessed with linear regression. MAIN RESULTS AND THE ROLE OF CHANCE At birth, children conceived by ART were shorter (boys −0.3 cm; 95% CI, −0.5 to −0.1), girls −0.4 cm; 95% CI, −0.5 to −0.3) and lighter (boys −113 grams; 95% CI, −201 to −25, girls −107 grams; 95% CI, −197 to −17). After birth, children conceived by ART grew more rapidly, achieving both greater height and weight at age 3. Children conceived by ART had a greater height up to age 7, but did not have a greater height or weight by age 17. Naturally conceived children of parents taking longer time to conceive had growth patterns similar to ART children. Children born after frozen embryo transfer had larger ultrasound measures and were longer and heavier the first 2 years than those born after fresh embryo transfer. LIMITATIONS, REASONS FOR CAUTIONS Selection bias could have been introduced due to the modest participation rate in the MoBa cohort. Our reliance on self-reported measures of length/height and weight could have introduced measurement error. WIDER IMPLICATIONS OF THE FINDINGS Our findings provide reassurance that offspring conceived by ART are not different in height, weight or BMI from naturally conceived once they reach adolescence.publishedVersio

Ingen er alene om å være ensom - Kan Kirkens SOS forebygge selvmord ved å lindre ensomhet?

Som telefonvakt ved Kirkens SOS ble jeg oppmerksom på at ensomhet er en viktig del av mange suicidale kriser. Kirkens SOS lærer sine frivillige at de kan hindre selvmord ved å lindre menneskelig nød som ensomhet og fortvilelse. Dette ble utgangspunkt for min problemstilling: Kan Kirkens SOS virke selvmordsforebyggende ved å lindre ensomhet? En litteraturgjennomgang viste at fenomenet ensomhet ikke er behandlet i lys av en enkelt teori. Ensomhet blir ofte sett på som en årsak til eller naturlig konsekvens av manglende sosiale ferdigheter alderdom eller sykdom. Søkeprosessen og gjennomlesning av litteraturen utvidet min forståelse av ensomhet som et nyansert begrep med både positiv og negativ betydning, og lærte meg at ensomhet kan lindres. Selv om forskning ikke har etablert ensomhet som en kausal årsaksfaktor for selvmordsadferd, viser en rekke studier at ensomhet er en risikofaktor for selvmordshandlinger, enten alene eller i samspill med andre etablerte risikofaktorer. I 2004 var ensomhet tema i 22,3 % av alle samtalene ved Kirkens SOS i Norge. Kirkens SOS viktigste redskap for å lindre følelsesmessig ensomhet er ved å gi innringeren en opplevelse av at han/hun ikke er alene og ved å akseptere den andre slik hun/han er. Anonymiteten og avstanden i det fysiske rom mellom samtalepartnerne gir en uforpliktende frihet som muliggjør en nærhet det kunne vært vanskelig å skape dersom partene hadde møtt hverandre ansikt til ansikt. Enhver genuin erfaring av nærhet med en annen beveger en bort i fra ensomheten. Kirkens SOS kan også lindre følelsesmessig ensomhet ved å tilby støtte, omsorg og forståelse til mennesker som føler seg ensomme og et tros- og bønnefellesskap til de som ønsker det. Kirkens SOS kan lindre sosial ensomhet ved å gi innringeren erfaring i menneskelig samhandling som han/hun kan bruke for å etablere andre relasjoner. En lindring av ensomhetens intensitet kan muligens redusere suicidalimpulser

Adolescents and self-harm. A study of factors associated with suicide and use of health care services following self-harm in national representative populations of Norwegian adolescents

This thesis uses data recorded in Norwegian governmental health registers, as well as data collected in a nationwide school survey carried out in Norway, to study risk factors for suicide and factors associated with the use of health services following self-harm in adolescents. Paper I examined suicide in a population of half a million men with physician-diagnosed minor or major mental health impairment in adolescence. The main finding was that risk of suicide was elevated both in apparently well-functioning young men with minor mental health impairment and in young men with major mental health impairment. Paper II examined the characteristics of adolescents who were admitted to hospital for self-poisoning with medications and identified factors associated with hospital readmission for subsequent self-poisoning with medications. This study demonstrated significant differences between the sexes in hospital admissions and in treatment for this condition. Moreover, the study showed that nearly 20% of the adolescents who were hospitalized for self-poisoning with medications were subsequently readmitted for the same reason. Female gender and secondary psychiatric diagnosis had a strong predictive effect on hospital readmission. Paper III examined self-reported use of health care services in adolescents who reported self-harm with or without suicide intent and lived in areas with different geographic proximity to the hospital. The study found that adolescents who self-harmed with suicide intent reported more help and treatment compared to those who self-harmed without suicide intent. Adolescents who attended school in municipalities in which a hospital was located were more likely than those who lived outside these areas to report using health services following self-harm, but this association was only present among adolescents who self-harmed without suicide intent

Use of health services following self-harm in urban versus suburban and rural areas: a national cross-sectional study

OBJECTIVES: This study examines whether there is a difference between urban versus suburban and rural adolescents in their use of health services following two types of self-harm distinguished as self-harm with or without suicide intent. SETTING: A nationwide cross-sectional school survey of 11 406 Norwegian adolescents aged 13-19 years in 73 Norwegian junior and senior high schools. PARTICIPANTS: Adolescents who reported self-harm and provided valid responses to a follow-up question about having received subsequent help or treatment (n=959) were included in the study. Adolescents were divided into urban versus suburban and rural depending on: (1) the location of municipalities where they attended school and (2) the place of residence. Associations between urban versus suburban and rural areas and the use of health services following self-harm were assessed in those who self-harmed with and without suicide intent. PRIMARY OUTCOME MEASURE: Use of health services following self-harm. RESULTS: 1 in 4 adolescents reported using health services following self-harm. Adolescents reporting self-harm with suicide intent were more likely to use health services than those who self-harmed without suicide intent. Following self-harm without suicide intent, adolescents in urban areas were four times more likely to use health services than adolescents in suburban and rural areas. There was no statistically significant area difference in the use of health services following self-harm with suicide intent. CONCLUSIONS: This study found a geographical variation in the use of health services following self-harm without suicide intent, but not following self-harm with suicide intent. Differences in perception of self-harm and help-seeking behaviour between areas and different accessibility to services are suggested as possible explanations. There is a need to better understand how the interplay between individual characteristics and accessibility to services influences adolescents' use of health services following self-harm. We suggest that multilevel models are a valuable approach to achieve this goal

Health at age 17 in Norwegian adolescents: Mental and physical status in the national cohort born in 2001

Aims: We present self-reported data on physical and mental health at age 17 years from 82% of Norwegians born in 2001. Methods: In Norway, the Armed Forces require that each resident who reaches the age of 17 years completes a self-administered declaration of health that is used for military selection. The declaration collects information on height and weight, various clinically diagnosed diseases, mental and behavioural disorders, and other health conditions where clinical diagnosis is not required. In 2018, there were 65,913 adolescents born in 2001 living in Norway, of whom 10,223 were exempt from completing the declaration; declarations were therefore sent to 55,690 participants. We included 54,132 participants who completed the declaration (response rate 97.2%): 27,220 male and 26,912 female respondents. Results: We found that 18% of male and 28% of female respondents reported at least one clinically diagnosed disease, mental disorder or behavioural disorder. Among health condition where clinical diagnosis was not required, 19% of male and 37% of female respondents reported anxiety/depression affecting daily life and 10 versus 18% reported migraines/recurring headaches. The respondents probably represent the healthiest part of the total cohort of 17-year-old Norwegians because those who are exempt from completing the declaration are already considered unfit for military service. Conclusions: These data represent a rich resource for further research. Similar data exist for the birth cohorts in 1993–2003. We encourage further research that can help decision-makers identify areas of concern that should be targeted for interventions