Samspill mellom barn og voksne under polyadiske forhold : en videoundersøkelse i en småbarnsgruppe

Denne undersøkelsens fokus er på samspill mellom barn og voksne under polyadiske forhold, med en spesiell interesse for hvordan voksne imøtekommer barns initiativ. Inspirasjonskilder til å skrive denne undersøkelsen var min egen interesse for temaet samt en artikkel av Ese (2008). Jeg hadde et ønske om å se hvordan samspillet i småbarnsgruppen foregår, der barn og voksne lever sammen i en gruppe. Undersøkelsens teoretiske perspektiver omfatter relasjoner, gruppe og felleskap med fokus på det individuelle barnet og gruppen. Videre er atmosfære og improvisasjonsteorier sentrale i undersøkelsen. Atmosfære viser i undersøkelsen hva som må ligge til grunn for at de voksne skal kunne imøtekomme barns initiativ. Med improvisasjonsteorier som analytisk verktøy gis det mulighet til å nyansere det som skjer mellom barn og voksne med henblikk på flere deltagere. Ved å trekke inn flere perspektiver, har jeg hatt mulighet til å ta tak i det komplekse i samspillet. Med fokus på samspill i gruppen, har jeg reflektert over om enkeltindividets initiativ blir ivaretatt, og om gruppen som helhet spiller en rolle i samspillet. For å kunne se nærmere på samspillet mellom barn og voksne, har jeg foretatt videoobservasjon i en småbarnsgruppe med tolv barn fra ett til tre år og fire voksne. Ved å benytte video har jeg hatt mulighet til å trekke fram detaljene i samspillet og synliggjøre det som ikke er så synlig med det hverdagslige blikket. Det har vært viktig med etiske refleksjoner under hele undersøkelsen. I undersøkelsen brukes observasjonsmaterialet til å reflektere over og drøfte samspillet, med fokus på det individuelle barnet og gruppen. Observasjonsmaterialet viser at samspillet er komplekst og at det er mye som foregår. Det viser at barn ofte kommer med innspill til en dyade eller en gruppe som allerede er etablert. De går ut og inn av samspill og lar seg tydelig inspirere av det som foregår i nærheten. Materialet viser også at mange barn står og følger med på samspill mellom to eller flere. Funnene tyder på at voksnes lydhørhet overfor det individuelle barnet har betydning for barns mulighet til å bidra til samspillet, og for barnets følelse av å bli sett og bidra i den store gruppesammenhengen.The focus of this study is on children - teacher interaction under polyadic conditions, with a special interest in how teachers meet children's initiative. Sources of inspiration to this study were my own interest in the topic as well as an article by Ese (2008). I wanted to see how the interactions take place in daycare for the youngest children, where children and teachers live a life as a group. The theoretical perspectives include relations, group and togetherness, with a focus on the individual child and group. Furthermore, atmosphere and improvisation are central theories in the study. Atmosphere in this study, shows what must be the basis of teacher responsiveness to children. Improvisation theories, as an analytical tool gives opportunity to shade and vary what is happening between children and teacher with a view on several participants. By bringing in multiple perspectives, I have been able to grasp the complexity of the interaction. With a focus on interaction in the group, I have reflected on whether the individual initiatives are taken care of, and whether the group as a whole plays a role in the interaction. To be able to study the child – teacher interaction, I have been using digital video in a toddler group of twelve children from one to three years and four teachers. Using video gave me the opportunity to highlight the details of the interaction and make visible what is not so visible in the everyday gaze. Ethical reflections have been important during the whole investigation. The study included use of video to reflect on and discuss the child – teacher interaction with focus on the individual child and the group. Video records show that the interaction is complex and that there is much going on. Further on they show that children often add input to a dyad or to a group that has already been established. Children go in and out of interactions and can be clearly inspired by what is happening around them. The material is also showing children standing and watching the interactions between two or several other participants. The findings suggest that the teachers’ responsiveness to the individual child is important for the children's opportunity to contribute to the interactions and also to the child's sense of being seen and its ability to contribute to the context of a larger group.Master i barnehagepedagogik

"..Litt mer frem med brystkassa for helsesøstre og den jobben de gjør" : psykisk helsearbeid i skolen: læreres beskrivelser og erfaringer omkring helsesøsters rolle og funksjon

Masteroppgave i psykisk helsearbeid- Universitetet i Agder 2010The background for this project is adolescent mental health and collaboration between school nurses and teachers. Surveys show challenges connected to this kind of work. The intention is to reveal knowledge aiming school nurses and leaders of public health service, for improving the quality of collaboration. The topic is: “How do school teachers describe and experience the school nurse’s acting and role, concerning student mental health service?” Data material is collected by semi-structured interviews of six teachers practicing in secondary classes. The conversations are digitally taped and systematic text condensation is used for data analysis. The findings can be categorized in different types of roles. “Included expert” means that the school nurse is included as an expert on physical and mental health issues. The respondents have little experience with school nurse’s competence on health promoting and preventive work, and she is not included in psychosocial promoting studentmass actions. As “Peer” she is included on the same level as the teachers, where the roles concerning psychosocial work don’t differ. “Paying visits” is explained by the school nurse working single concerning the students, and the fact that she is not automatically included in the school. None of them taking initiative, might cause little collaboration. “To be available” is pointed out because the school nurse’s time allocated in school health service, matters a lot to the collaboration. It seems that time available, the teacher’s knowledge of the school nurse’s competence on mental health issues, as well as mental health promoting and preventive work, matters to the quality of the collaboration. Keywords: Mental health promoting and preventive work, teachers, school nurses, collaboration, including, role definition, availabilit

Forsikring i Norge

Økonomiske analyser er tilgjengelige via www.ssb.noForsikringssektorens betydning i Norge har økt betraktelig i løpet av de siste årene, og total forvaltningskapital for forsikring nærmer seg 400 milliarder kroner. Veksten har vært sterkere enn for bankene og andre finansinstitusjoner, og husholdningene har en stadig voksende andel av sin formue plassert i ulike pensjons- og forsikringsordninger. Statistisk sentralbyrås tall for finansielle sektorbalanser viser at forsikringskravenes andel av husholdningenes totale fordringer har økt fra 29 prosent til rundt 38 prosent i perioden 1988-1995. Norske husholdninger plasserer en større andel av sine sparemidler i form av livs- og pensjonsforsikringer enn husholdningene i de fleste andre land

Effects of a brief pre‑admission telephone reminder on no‑show and dropout rates in substance use disorder treatment: a quasi‑experimental study

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The EU project “United4Health”: Results and experiences from automatic health status assessment in a Norwegian telemedicine trial system

Introduction Patients with chronic obstructive pulmonary disease require help in daily life situations to increase their individual perception of security, especially under worsened medical conditions. Unnecessary hospital (re-)admissions and home visits by doctors or nurses shall be avoided. This study evaluates the results from a two-year telemedicine field trial for automatic health status assessment based on remote monitoring and analysis of a long time series of vital signs data from patients at home over periods of weeks or months. Methods After discharge from hospital treatment for acute exacerbations, 94 patients were recruited for follow-up by the trial system. The system supported daily measurements of pulse and transdermal peripheral capillary oxygen saturation at patients' homes, a symptom-specific questionnaire, and provided nurses trained to use telemedicine ("telenurses") with an automatically generated health status overview of all monitored patients. A colour code (green/yellow/red) indicated whether the patient was stable or had a notable deterioration, while red alerts highlighted those in most urgent need of follow-up. The telenurses could manually overwrite the status level based on the patients' conditions observed through video consultation. Results Health status evaluation in 4970 telemonitor datasets were assessed retrospectively. The automatic health status determination (subgroup of 33 patients) showed green status at 46% of the days during a one-month monitoring period, 28% yellow status, and 19% red status (no data reported at 7% of the days). The telenurses manually downrated approximately 10% of the red or yellow alerts. Discussion The evaluation of the defined real-time health status assessment algorithms, which involve static rules with personally adapted elements, shows limitations to adapt long-term home monitoring with adequate interpretation of day-to-day changes in the patient's condition. Thus, due to the given sensitivity and specificity of such algorithms, it seems challenging to avoid false high alerts.acceptedVersionnivå

Effectiveness of Internet-Based Cognitive Behavioral Therapy with Telephone Support for Noncardiac Chest Pain: Randomized Controlled Trial

Background: Noncardiac chest pain has a high prevalence and is associated with reduced quality of life, anxiety, avoidance of physical activity, and high societal costs. There is a lack of an effective, low-cost, easy to distribute intervention to assist patients with noncardiac chest pain. Objective:In this study, we aimed to investigate the effectiveness of internet-based cognitive behavioral therapy with telephone support for noncardiac chest pain. Methods: We conducted a randomized controlled trial, with a 12-month follow-up period, to compare internet-based cognitive behavioral therapy to a control condition (treatment as usual). A total of 162 participants aged 18 to 70 years with a diagnosis of noncardiac chest pain were randomized to either internet-based cognitive behavioral therapy (n=81) or treatment as usual (n=81). The participants in the experimental condition received 6 weekly sessions of internet-based cognitive behavioral therapy. The sessions covered different topics related to coping with noncardiac chest pain (education about the heart, physical activity, interpretations/attention, physical reactions to stress, optional panic treatment, and maintaining change). Between sessions, the participants also engaged in individually tailored physical exercises with increasing intensity. In addition to internet-based cognitive behavioral therapy sessions, participants received a brief weekly call from a clinician to provide support, encourage adherence, and provide access to the next session. Participants in the treatment-as-usual group received standard care for their noncardiac chest pain without any restrictions. Primary outcomes were cardiac anxiety, measured with the Cardiac Anxiety Questionnaire, and fear of bodily sensations, measured with the Body Sensations Questionnaire. Secondary outcomes were depression, measured using the Patient Health Questionnaire; health-related quality of life, measured using the EuroQol visual analog scale; and level of physical activity, assessed with self-report question. Additionally, a subgroup analysis of participants with depressive symptoms at baseline (PHQ-9 score ≥5) was conducted. Assessments were conducted at baseline, posttreatment, and at 3- and 12-month follow-ups. Linear mixed models were used to evaluate treatment effects. Cohen d was used to calculate effect sizes. Results: In the main intention-to-treat analysis at the 12-month follow-up time point, participants in the internet-based cognitive behavioral therapy group had significant improvements in cardiac anxiety (–3.4 points, 95% CI –5.7 to –1.1; P=.004, d=0.38) and a nonsignificant improvement in fear of bodily sensations (–2.7 points, 95% CI –5.6 to 0.3; P=.07) compared with the treatment-as-usual group. Health-related quality of life at the 12-month follow-up improved with statistical and clinical significance in the internet-based cognitive behavioral therapy group (8.8 points, 95% CI 2.8 to 14.8; P=.004, d=0.48) compared with the treatment-as-usual group. Physical activity had significantly (P<.001) increased during the 6-week intervention period for the internet-based cognitive behavioral therapy group. Depression significantly improved posttreatment (P=.003) and at the 3-month follow-up (P=.03), but not at the 12-month follow-up (P=.35). Participants with depressive symptoms at baseline seemed to have increased effect of the intervention on cardiac anxiety (d=0.55) and health-related quality of life (d=0.71) at the 12-month follow-up. In the internet-based cognitive behavioral therapy group, 84% of the participants (68/81) completed at least 5 of the 6 sessions. Conclusions: This study provides evidence that internet-based cognitive behavioral therapy with minimal therapist contact and a focus on physical activity is effective in reducing cardiac anxiety and increasing health related quality of life in patients with noncardiac chest pain.publishedVersio

Hjemmebehandling med intravenøs antibiotika : Gjennomførbarhet og pasienters erfaringer

Home treatment of infections with intravenous antibiotics is common internationally but is uncommon in Norway. The purpose of this study was to survey a patient population and to describe patients' experiences with intravenous home treatment with antibiotics and to assess the feasibility of the course of treatment. All patients treated at home with intravenous antibiotics from November 2016 to June 2021 were asked to participate in the study. Journal review and questionnaires were used to collect data. Quantitative data were processed with descriptive statistics and qualitative data were analyzed with manifest content analysis. The study includes 175 patients with an average age of 65 years. The most frequent infections were endocarditis, prosthesis infection and septic arthritis. The study showed that the patients were very satisfied with home treatment and that also elderly patients could be treated at home (45% were ≥70 years old). 90% of the patients answered that they would choose home treatment again if they needed it and that home treatment increased well-being and subjective quality of life, but that training of and follow-up from clinical staff were important.Hjemmebehandling av infeksjoner med intravenøs antibiotika er vanlig internasjonalt, men er lite brukt i Norge. I denne studien er hensikten å kartlegge en pasientpopulasjon og beskrive pasienters erfaringer med intravenøs hjemmebehandling med antibiotika og gjennomførbarheten av behandlingsforløpet. Alle pasienter som ble behandlet hjemme med intravenøs antibiotika fra november 2016 til juni 2021 ble spurt om å delta i studien. Journalgranskning og spørreskjema ble brukt for å innhente data. Kvantitative data ble bearbeidet med deskriptiv statistikk og kvalitative data ble analysert med manifest innholdsanalyse. Studien inkluderer 175 pasienter, gjennomsnittsalder 65 år. Hyppigste infeksjoner var endokarditt, proteseinfeksjon og septisk artritt. Studien viste at pasientene var svært tilfredse med hjemmebehandling og at eldre pasienter kunne behandles hjemme (45 % var ≥70 år). 90 % av pasientene svarte at de ville valgt hjemmebehandling igjen dersom de trengte det og at hjemmebehandling ga økt trivsel og subjektiv livskvalitet, men at opplæring og oppfølgning var viktig

Telemedicine follow up of Chronic Obstructive Pulmonary Disease Integrated into a Patient-centered Health Care Team Setting- Impacts on Patient Empowerment and Safety

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Interventions to improve adherence to inhaled steroids for asthma.

BACKGROUND: Despite its proven efficacy in improving symptoms and reducing exacerbations, many patients with asthma are not fully adherent to their steroid inhaler. Suboptimal adherence leads to poorer clinical outcomes and increased health service utilisation, and has been identified as a contributing factor to a third of asthma deaths in the UK. Reasons for non-adherence vary, and a variety of interventions have been proposed to help people improve treatment adherence. OBJECTIVES: To assess the efficacy and safety of interventions intended to improve adherence to inhaled corticosteroids among people with asthma. SEARCH METHODS: We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted the most recent searches on 18 November 2016. SELECTION CRITERIA: We included parallel and cluster randomised controlled trials of any duration conducted in any setting. We included studies reported as full-text articles, those published as abstracts only and unpublished data. We included trials of adults and children with asthma and a current prescription for an inhaled corticosteroid (ICS) (as monotherapy or in combination with a long-acting beta2-agonist (LABA)). Eligible trials compared an intervention primarily aimed at improving adherence to ICS versus usual care or an alternative intervention. DATA COLLECTION AND ANALYSIS: Two review authors screened the searches, extracted study characteristics and outcome data from included studies and assessed risk of bias. Primary outcomes were adherence to ICS, exacerbations requiring at least oral corticosteroids and asthma control. We graded results and presented evidence in 'Summary of findings' tables for each comparison.We analysed dichotomous data as odds ratios, and continuous data as mean differences or standardised mean differences, all using a random-effects model. We described skewed data narratively. We made no a priori assumptions about how trials would be categorised but conducted meta-analyses only if treatments, participants and the underlying clinical question were similar enough for pooling to make sense. MAIN RESULTS: We included 39 parallel randomised controlled trials (RCTs) involving adults and children with asthma, 28 of which (n = 16,303) contributed data to at least one meta-analysis. Follow-up ranged from two months to two years (median six months), and trials were conducted mainly in high-income countries. Most studies reported some measure of adherence to ICS and a variety of other outcomes such as quality of life and asthma control. Studies generally were at low or unclear risk of selection bias and at high risk of biases associated with blinding. We considered around half the studies to be at high risk for attrition bias and selective outcome reporting.We classified studies into four comparisons: adherence education versus control (20 studies); electronic trackers or reminders versus control (11 studies); simplified drug regimens versus usual drug regimens (four studies); and school-based directly observed therapy (three studies). Two studies are described separately.All pooled results for adherence education, electronic trackers or reminders and simplified regimens showed better adherence than controls. Analyses limited to studies using objective measures revealed that adherence education showed a benefit of 20 percentage points over control (95% confidence interval (CI) 7.52 to 32.74; five studies; low-quality evidence); electronic trackers or reminders led to better adherence of 19 percentage points (95% CI 14.47 to 25.26; six studies; moderate-quality evidence); and simplified regimens led to better adherence of 4 percentage points (95% CI 1.88 to 6.16; three studies; moderate-quality evidence). Our confidence in the evidence was reduced by risk of bias and inconsistency.Improvements in adherence were not consistently translated into observable benefit for clinical outcomes in our pooled analyses. None of the intervention types showed clear benefit for our primary clinical outcomes - exacerbations requiring an oral corticosteroid (OCS) (evidence of very low to low quality) and asthma control (evidence of low to moderate quality); nor for our secondary outcomes - unscheduled visits (evidence of very low to moderate quality) and quality of life (evidence of low to moderate quality). However, some individual studies reported observed benefits for OCS and use of healthcare services. Most school or work absence data were skewed and were difficult to interpret (evidence of low quality, when graded), and most studies did not specifically measure or report adverse events.Studies investigating the possible benefit of administering ICS at school did not measure adherence, exacerbations requiring OCS, asthma control or adverse events. One study showed fewer unscheduled visits, and another found no differences; data could not be combined. AUTHORS' CONCLUSIONS: Pooled results suggest that a variety of interventions can improve adherence. The clinical relevance of this improvement, highlighted by uncertain and inconsistent impact on clinical outcomes such as quality of life and asthma control, is less clear. We have low to moderate confidence in these findings owing to concerns about risk of bias and inconsistency. Future studies would benefit from predefining an evidence-based 'cut-off' for acceptable adherence and using objective adherence measures and validated tools and questionnaires. When possible, covert monitoring and some form of blinding or active control may help disentangle effects of the intervention from effects of inclusion in an adherence trial

Chronic disease management programmes for adults with asthma (intervention Review)

BACKGROUND: The burden of asthma on patients and healthcare systems is substantial. Interventions have been developed to overcome difficulties in asthma management. These include chronic disease management programmes, which are more than simple patient education, encompassing a set of coherent interventions that centre on the patients' needs, encouraging the co-ordination and integration of health services provided by a variety of healthcare professionals, and emphasising patient self-management as well as patient education. OBJECTIVES: To evaluate the effectiveness of chronic disease management programmes for adults with asthma. SEARCH METHODS: Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register, MEDLINE (MEDLINE In-Process and Other Non-Indexed Citations), EMBASE, CINAHL, and PsycINFO were searched up to June 2014. We also handsearched selected journals from 2000 to 2012 and scanned reference lists of relevant reviews. SELECTION CRITERIA: We included individual or cluster-randomised controlled trials, non-randomised controlled trials, and controlled before-after studies comparing chronic disease management programmes with usual care in adults over 16 years of age with a diagnosis of asthma. The chronic disease management programmes had to satisfy at least the following five criteria: an organisational component targeting patients; an organisational component targeting healthcare professionals or the healthcare system, or both; patient education or self-management support, or both; active involvement of two or more healthcare professionals in patient care; a minimum duration of three months. DATA COLLECTION AND ANALYSIS: After an initial screen of the titles, two review authors working independently assessed the studies for eligibility and study quality; they also extracted the data. We contacted authors to obtain missing information and additional data, where necessary. We pooled results using the random-effects model and reported the pooled mean or standardised mean differences (SMDs). MAIN RESULTS: A total of 20 studies including 81,746 patients (median 129.5) were included in this review, with a follow-up ranging from 3 to more than 12 months. Patients' mean age was 42.5 years, 60% were female, and their asthma was mostly rated as moderate to severe. Overall the studies were of moderate to low methodological quality, because of limitations in their design and the wide confidence intervals for certain results.Compared with usual care, chronic disease management programmes resulted in improvements in asthma-specific quality of life (SMD 0.22, 95% confidence interval (CI) 0.08 to 0.37), asthma severity scores (SMD 0.18, 95% CI 0.05 to 0.30), and lung function tests (SMD 0.19, 95% CI 0.09 to 0.30). The data for improvement in self-efficacy scores were inconclusive (SMD 0.51, 95% CI -0.08 to 1.11). Results on hospitalisations and emergency department or unscheduled visits could not be combined in a meta-analysis because the data were too heterogeneous; results from the individual studies were inconclusive overall. Only a few studies reported results on asthma exacerbations, days off work or school, use of an action plan, and patient satisfaction. Meta-analyses could not be performed for these outcomes. AUTHORS' CONCLUSIONS: There is moderate to low quality evidence that chronic disease management programmes for adults with asthma can improve asthma-specific quality of life, asthma severity, and lung function tests. Overall, these results provide encouraging evidence of the potential effectiveness of these programmes in adults with asthma when compared with usual care. However, the optimal composition of asthma chronic disease management programmes and their added value, compared with education or self-management alone that is usually offered to patients with asthma, need further investigation