Måleegenskaper ved den norske versjonen av Symptom Checklist-90-Revidert (SCL-90-R)

Symptom Checklist-90 Revised (SCL-90-R) er et bredspektret screeningverktøy for psykiske plager hos personer over 13 år. SCL-90 ble utviklet av Derogatis og kolleger i 1973 og revidert i 1976 til SCL-90-R. Instrumentet ble oversatt til norsk på 1980-tallet, og i 2010 utga Pearson Inc. en norsk autorisert utgave med instrukser for skåring og administrering. Autoriserte psykologer og leger kan administrere, skåre og tolke testen. Testen er et selvutfyllingsskjema og består av 90 spørsmål som kartlegger symptombelastning innenfor ni forskjellige symptomskalaer. I denne kunnskapsoppsummeringen ønsket vi å undersøke hvilke måleegenskaper som er rapportert for SCL-90-R i skandinaviske studier med ungdom og unge voksne i alderen 13–26 år. Av 1359 referanser inkluderte vi 13 studier i oppsummeringen. Ti studier var basert på kliniske utvalg (f.eks. pasienter med atferdsforstyrrelser, depresjon og spiseforstyrrelser). Ikke-kliniske utvalg inkluderte bl.a. studenter, adopterte barn og barn av skilte foreldre. Ingen av de inkluderte studiene var valideringsstudier. De fleste målte effekt av behandling eller andre tiltak. Det er rapportert gjennomsnitt, standardavvik og indre konsistens. Ingen av de inkluderte studiene inneholdt utfyllende informasjon om for SCL-90-Rs måleegenskaper for ungdom og unge voksne i alderen 13–26 år. Kunnskapsgrunnlaget for SCL-90-R er ikke tilstrekkelig for å kunne si noe om bruken av instrumentet hos denne gruppen.publishedVersio

Kan tjenestedesign bidra til økt medvirkning og involvering for pasienter og brukere på individnivå i helse- og omsorgstjenestene?

Pasient – og brukermedvirkning er en lovfestet rettighet som skal sikre pasienter og brukere økt innflytelse i helse og omsorgstjenesten. Forskning viser imidlertid at helsepersonell anvender en paternalistisk tilnærming i sin yrkesutøvelse, noe som truer pasienters rettigheter. Helsepersonell anbefales derfor å ta i bruk tjenestedesign som metodikk for å øke den reelle medvirkningen og involveringen av pasienter og brukere. Formålet med økt bruker- og pasientmedvirkning og involvering er å utvikle tjenester av høy kvalitet med utgangspunkt i brukernes behov. Behovsdrevne tjenester vil oppleves som nyttige og meningsfulle for brukerne. Det er derfor viktig at helsepersonell forstår verdien av brukermedvirkning i kvalitetsarbeid og tilegner seg kunnskap om tjenestedesign. Can service design promote expanding user participation and user involvement in health care services? Patient- and user participation is a legislative right intending to ensure service users involvement in health care services. However, research shows that healthcare professionals employ a paternalistic approach in their professional practice, which may threaten patients' rights. Healthcare professionals are recommended to use service design as a methodology to increase the genuine user participation and user involvement, aiming to develop high-quality services based on users' needs. Demand-driven services may be perceived as beneficial and meaningful for the patients. Therefore, the health professionals’ knowledge and comprehension of the value of user participation and service design are of importance

Limited benefit of marine protein hydrolysate on physical function and strength in older adults : a randomized controlled trial

Age-related muscle wasting can compromise functional abilities of the elderly. Protein intake stimulates muscle protein synthesis; however, ageing muscle is more resistant to stimuli. This double-blinded, randomized, controlled trial is one of the first registered studies to evaluate the effects of a supplement of marine protein hydrolysate (MPH) on measures of physical function and strength. Eighty-six older adults received nutritional supplements containing 3 g of MPH or a placebo for up to 12 months. Short Physical Performance Battery (SPPB), grip strength and gait speed were measured, and dietary intake was registered at baseline, 6 months, and 12 months. No difference was found between the intervention and control groups in mean change in SPPB (independent sample t-test, p = 0.41) or regarding time trend in SPPB, grip strength, or gait speed (linear mixed model). The participants in our study were well functioning, causing a ceiling effect in SPPB. Further, they had sufficient protein intake and were physically active. Differences in physical function between those completing the intervention and the dropouts might also have created bias in the results. We recommend that future studies of MPH be carried out on a more frail or malnourished population. Keywords: hydrolysate, fish protein, ageing, physical function, dietary assessment, seafood intake, healthy ageingpublishedVersio

Prioriteringspraksis og ventetid. En undersøkelse av helseforetak i Helse Midt-Norge

Background: The Act on Patients Rights should ensure that people should have equal access to health services of good quality, regardless of age, gender, economy and place of residence. Several studies show that there are variations in the allocation of health care, both among the regional health authorities and among health enterprises within the regional health authorities. To ensure a consistent practice and harmonization of prioritizing, priority guidelines are developed. They include a description of medical conditions, with a recommendation of an allocation of patients with or without a legal right to treatment and also a medically maximum waiting time. Priority regulation allows the use of medical duration of discretion, but we have little knowledge of what are the reasons for prioritization decisions. Purpose: The purpose of this study is to examine how the health authorities by specialists make their decisions on the allocation of the health care and whether patients have access to treatment according to priority regulation criteria. Material: The study is based on data from the fields of general medicine, substance abuse and mental health care in a health authority. Information of prioritization practice was obtained from six specialists from various disciplines and four department heads as well as data of waiting time and proportion of patients with prioritized health care from the Norwegian Patient Register. Methods: The collection of data is done through qualitative, structured interviews and retrospective quantitative analysis of data from the Norwegian Patient Register. Results: The interviews indicated that there was no systematic practice of prioritization in the selected areas of healthcare. Priority Regulation criteria of cost effectiveness is not used in the assessment of referrals. Both the regional health authorities and health enterprises have a high proportion of patients with prioritized health care, and the fields of mental health and substance abuse have a right share of close to 100% also in 1’st tertial of 2010. Conclusion: The findings indicate that the priority regulations and priority guidelines are implemented to a limited extent in the local health authority, and priority decisions are mainly based on clinical discretion

Måleegenskaper ved den norske versjonen av Symptom Checklist-90-Revidert (SCL-90-R)

Symptom Checklist-90 Revised (SCL-90-R) er et bredspektret screeningverktøy for psykiske plager hos personer over 13 år. SCL-90 ble utviklet av Derogatis og kolleger i 1973 og revidert i 1976 til SCL-90-R. Instrumentet ble oversatt til norsk på 1980-tallet, og i 2010 utga Pearson Inc. en norsk autorisert utgave med instrukser for skåring og administrering. Autoriserte psykologer og leger kan administrere, skåre og tolke testen. Testen er et selvutfyllingsskjema og består av 90 spørsmål som kartlegger symptombelastning innenfor ni forskjellige symptomskalaer. I denne kunnskapsoppsummeringen ønsket vi å undersøke hvilke måleegenskaper som er rapportert for SCL-90-R i skandinaviske studier med ungdom og unge voksne i alderen 13–26 år. Av 1359 referanser inkluderte vi 13 studier i oppsummeringen. Ti studier var basert på kliniske utvalg (f.eks. pasienter med atferdsforstyrrelser, depresjon og spiseforstyrrelser). Ikke-kliniske utvalg inkluderte bl.a. studenter, adopterte barn og barn av skilte foreldre. Ingen av de inkluderte studiene var valideringsstudier. De fleste målte effekt av behandling eller andre tiltak. Det er rapportert gjennomsnitt, standardavvik og indre konsistens. Ingen av de inkluderte studiene inneholdt utfyllende informasjon om for SCL-90-Rs måleegenskaper for ungdom og unge voksne i alderen 13–26 år. Kunnskapsgrunnlaget for SCL-90-R er ikke tilstrekkelig for å kunne si noe om bruken av instrumentet hos denne gruppen.publishedVersio

Systems modelling to support the complex nature of healthcare services

Healthcare is a service commonly associated with lacking performance in relation to output and the economy of production. Contingency theory and complex systems thinking are approaches here combined to study the logistics of healthcare service fows. Contingency theory directs attention to networked interdependencies while complex systems thinking concerns process emergence and fexible resource use in supporting logistics. This hybrid form of analysis gives conceptual direction to information technology development and use to support the logistics of healthcare services. Three small examples of healthcare service as logistics processes in their as-is state are provided and analysed based on the developed analytical framework. These illustrate in detail what exemplifes complexity in this industry. Given the inherently complex nature of many types of healthcare services, this discussion concerns how to conceptually model information systems in healthcare services as a complex system. This chosen complexity-sensitive approach of service logistics constitutes a basis for information technology enabled healthcare service development sensitive to this type of service provision directing focus to the emergent features of healthcare service needs. It is also a basis for further investigation into this topic of information technology use to support the inherent logistical complexity of healthcare services

Assessment of the quality of life in parents of children with ADHD : validation of the Multicultural Quality of Life in Norwegian pediatric mental health settings

Background: The brief generic Multicultural Quality of Life Index (MQLI) is a culturally informed self-report 10-item questionnaire used to measure health-related quality of life (QoL). QoL is an important outcome measure in guiding healthcare and is held as a substantial parameter to evaluate the effectiveness of healthcare. Attention Deficit Hyperactivity Disorder (ADHD) in children might negatively influence the parents’ QoL. Having a validated questionnaire to measure QoL for this population will therefore be a vital first step in guiding healthcare for parents of children with ADHD. We aimed to examine the reliability and validity of the Norwegian version of the MQLI in a sample of parents of children with ADHD. Methods: In a cross-sectional study, 128 parents of children with ADHD were recruited from four outpatient clinics within the Child and Adolescents Mental Health Services (CAMHS) in Norway. They completed the MQLI along with an alternative well-being scale, the Five-item World Health Organization Well-being Index (WHO-5), and a form including demographic variables. Reliability and validity of the MQLI were examined. We conducted a factor analysis and calculated internal consistency and the correlation between the MQLI and the WHO-5. Results: Factor analysis of the parents reported MQLI yielded a one-factor solution. For the MQLI, Cronbach’s alpha was 0.73. The correlation between the two measures of MQLI and WHO-5 was high (r = 0.84), reflecting convergent validity since the association between the two measures was strong. Conclusion: Results from this study support the reliability and validity of the Norwegian version of the MQLI for assessment of quality of life in parents of children with ADHD with good psychometric properties. Study findings support the use of the questionnaire in CAMHS

Assessment of shared decision-making in community mental health care : validation of the CollaboRATE

Background/Objective: CollaboRATE is a 3-item self-report measure of the patient experience of shared decision-making (SDM) process. The objective of this study is to assess the psychometric properties of CollaboRATE in community mental health care. Method: A cross-sectional study was conducted at a Community Mental Health Center of the Canary Islands Health Service. Two hundred and fifty consecutive psychiatric outpatients were invited to participate. Of those, 191 accepted (76.40% of response rate) and completed the CollaboRATE, the Control Preferences Scale (CPS), and a form with sociodemographic and clinical variables. Results: Exploratory factor analysis ratified the unidimensionality of the measure. High internal consistency was found (α Cronbach = .95, Guttman's λ = .93, and ω = .95). Strong positive correlations (p < .0001) were found between the CollaboRATE and the CPS. Only 39.80% of respondents gave the best possible score on CollaboRATE. Conclusions: This study provides evidence for the reliability and validity of the Spanish version of the CollaboRATE as a measure of SDM. The measure is quick to complete and feasible for use in outpatient mental health care. At present, a significative number of psychiatric outpatients are not involved in SDM. The use of this measure in psychiatric routine care can be a key tool in assessing and implementing SDM. Keywords: CollaboRATE measure, mental disorders, shared decision-making, instrumental stud

Exploring patterns in psychiatric outpatients’ preferences for involvement in decision-making : a latent class analysis approach

Background: Shared decision-making (SDM), a collaborative approach that includes and respects patients’ preferences for involvement in decision-making about their treatment, is increasingly advocated. However, in the practice of clinical psychiatry, implementing SDM seems difficult to accomplish. Although the number of studies related to psychiatric patients’ preferences for involvement is increasing, studies have largely focused on understanding patients in public mental healthcare settings. Thus, investigating patient preferences for involvement in both public and private settings is of particular importance in psychiatric research. The objectives of this study were to identify different latent class typologies of patient preferences for involvement in the decision-making process, and to investigate how patient characteristics predict these typologies in mental healthcare settings. Methods: We conducted latent class analysis (LCA) to identify groups of psychiatric outpatients with similar preferences for involvement in decision-making to estimate the probability that each patient belonged to a certain class based on sociodemographic, clinical and health belief variables. Results: The LCA included 224 consecutive psychiatric outpatients’ preferences for involvement in treatment decisions in public and private psychiatric settings. The LCA identified three distinct preference typologies, two collaborative and one passive, accounting for 78% of the variance. Class 1 (26%) included collaborative men aged 34–44 years with an average level of education who were treated by public services for a depressive disorder, had high psychological reactance, believed they controlled their disease and had a pharmacophobic attitude. Class 2 (29%) included collaborative women younger than 33 years with an average level of education, who were treated by public services for an anxiety disorder, had low psychological reactance or health control belief and had an unconcerned attitude toward medication. Class 3 (45%) included passive women older than 55 years with lower education levels who had a depressive disorder, had low psychological reactance, attributed the control of their disease to their psychiatrists and had a pharmacophilic attitude. Conclusions: Our findings highlight how psychiatric patients vary in pattern of preferences for treatment involvement regarding demographic variables and health status, providing insight into understanding the pattern of preferences and comprising a significant advance in mental healthcare research. Keywords: community mental health services, latent class analysis, mental disorders, preferences, private mental health service, psychiatry, shared decision-makin

Prevalence and long-term predictors of persistent chronic widespread pain in the general population in an 11-year prospective study: the HUNT study

Background: Chronic widespread pain (CWP) is common and associated with prominent negative consequences. The aim of this study was to assess the prevalence of persistent CWP in an 11-year prospective cohort study in the general population, and to examine anxiety, depression, alcohol use, poor sleep, body mass index (BMI) and chronic disease, along with demographic, lifestyle and other health-related variables as possible predictors for the assumed CWP persistence. Methods: CWP was defined as having pain at three or more predefined sites (involving the trunk and upper and lower limbs) for at least three months in the last year. We used a Norwegian general population cohort of 28,367 individuals who responded to both the second (1995–1997) and the third (2006–2008) waves of the Nord-Trøndelag Health Study (HUNT2 and HUNT3, respectively). Data were analysed with logistic regression models. Results: CWP prevalence in HUNT2 was 17%. Of those reporting CWP in HUNT2, 53% still reported CWP at follow-up in HUNT3. Adjusted analyses revealed that depression and alcohol consumption were not substantially associated with the 11-year prospective CWP outcome. Poor sleep, obesity and chronic disease predicted persistent CWP, and being male and/or 60 years or older was protective. Conclusions: This cohort study revealed that nearly half of the participants with baseline CWP resolved from CWP 11 years later. Among those whose CWP did not resolve, obesity, sleeping problems and chronic disease predicted CWP persistence, while aging and male sex was protective. Anxiety, mixed anxiety and depression, former smoking, and overweight were weakly associated, while depression, moderate exercise, and alcohol use were not associated with persistent CWP