Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway

<p><strong>Background: </strong>The issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention.</p><p><strong>Aims: </strong>To study whether inpatients' utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model. <strong> </strong></p><p><strong>Method: </strong>The study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization.<strong> </strong></p><p><strong>Results</strong>: Most inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients' utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care. </p><p><strong>Conclusion</strong>: Inpatients' utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore represent a favourable alternative to traditional central psychiatric hospitals.</p

Time-trends in the utilization of decentralized mental health services in Norway - A natural experiment: The VELO-project

<p>Abstract</p> <p>Background</p> <p>There are few reports on the effects of extensive decentralization of mental health services. We investigated the total patterns of utilization in a local-bed model and a central-bed model.</p> <p>Methods</p> <p>In a time-trend case-registry design, 7635 single treatment episodes, from the specialist and municipality services in 2003-2006, were linked to 2975 individual patients over all administrative levels. Patterns of utilization were analyzed by univariate comparisons and multivariate regressions.</p> <p>Results</p> <p>Total treated prevalence was consistently higher for the central-bed system. Outpatient utilization increased markedly, in the central-bed system. Utilization of psychiatric beds decreased, only in the central-bed system. Utilization of highly supported municipality units increased in both systems. Total utilization of all types of services, showed an additive pattern in the local-bed system and a substitutional pattern in the central-bed system. Only severe diagnoses predicted inpatient admission in the central-bed system, whereas also anxiety-disorders and outpatient consultations predicted inpatient admission in the local-bed system. Characteristics of the inpatient populations changed markedly over time, in the local-bed system.</p> <p>Conclusions</p> <p>Geographical availability is not important as a filter in patients' pathway to inpatient care, and the association between distance to hospital and utilization of psychiatric beds may be an historical artefact. Under a public health-insurance system, local psychiatric personnel as gatekeepers for inpatient care may be of greater importance than the availability of local psychiatric beds. Specialist psychiatric beds and highly supported municipality units for people with mental health problems do not work together in terms of utilization. Outpatient and day-hospital services may be filters in the pathway to inpatient care, however this depends on the structure of the whole service-system. Local integration of psychiatric services may bring about additive, rather than substitutional patterns of total utilization. A large proportion of decentralized psychiatric beds may hinder the development of various local psychiatric services, with negative consequences for overall treated prevalence.</p

Decentralization matters – Differently organized mental health services relationship to staff competence and treatment practice: the VELO study

<p>Abstract</p> <p>Background</p> <p>The VELO study is a comparative study of two Community Mental Health Centres (CMHC) in Northern Norway. The CMHCs are organized differently: one has no local inpatient unit, the other has three. Both CMHCs use the Central Mental Hospital situated rather far away for compulsory and other admissions, but one uses mainly local beds while the other uses only central hospital beds. In this part of the study the ward staffs level of competence and treatment philosophy in the CMHCs bed units are compared to Central Mental Hospital units. Differences may influence health service given, resulting in different treatment for similar patients from the two CMHCs.</p> <p>Methods</p> <p>167 ward staff at Vesterålen CMHCs bed units and the Nordland Central Mental Hospital bed units answered two questionnaires on clinical practice: one with questions about education, work experience and clinical orientation; the other with questions about the philosophy and practice at the unit. An extended version of Community Program Philosophy Scale (CPPS) was used. Data were analyzed with descriptive statistics, non-parametric test and logistic regression.</p> <p>Results</p> <p>We found significant differences in several aspects of competence and treatment philosophy between local bed units and central bed units. CMHC staff are younger, have shorter work experience and a more generalised postgraduate education. CMHC emphasises family therapy and cooperation with GP, while Hospital staff emphasise diagnostic assessment, medication, long term treatment and handling aggression.</p> <p>Conclusion</p> <p>The implications of the differences found, and the possibility that these differences influence the treatment mode for patients with similar psychiatric problems from the two catchment areas, are discussed.</p

Decentralization matters - Differently organized mental health services relationship to staff competence and treatment practice : the VELO study

Background: The VELO study is a comparative study of two Community Mental Health Centres (CMHC) in Northern Norway. The CMHCs are organized differently: one has no local inpatient unit, the other has three. Both CMHCs use the Central Mental Hospital situated rather far away for compulsory and other admissions, but one uses mainly local beds while the other uses only central hospital beds. In this part of the study the ward staffs level of competence and treatment philosophy in the CMHCs bed units are compared to Central Mental Hospital units. Differences may influence health service given, resulting in different treatment for similar patients from the two CMHCs. Methods: 167 ward staff at Vesterålen CMHCs bed units and the Nordland Central Mental Hospital bed units answered two questionnaires on clinical practice: one with questions about education, work experience and clinical orientation; the other with questions about the philosophy and practice at the unit. An extended version of Community Program Philosophy Scale (CPPS) was used. Data were analyzed with descriptive statistics, non-parametric test and logistic regression. Results: We found significant differences in several aspects of competence and treatment philosophy between local bed units and central bed units. CMHC staff are younger, have shorter work experience and a more generalised postgraduate education. CMHC emphasises family therapy and cooperation with GP, while Hospital staff emphasise diagnostic assessment, medication, long term treatment and handling aggression. Conclusion: The implications of the differences found, and the possibility that these differences influence the treatment mode for patients with similar psychiatric problems from the two catchment areas, are discussed

Inside the volcano : Three-dimensional magmatic architecture of a buried shield volcano

Acknowledgements: Funding from NERC (Oil and Gas CDT) and BGS is gratefully acknowledged. DAJ and SP are part-funded by the Research Council of Norway Centre of Excellence funding scheme (project No. 223272). TGS is thanked for providing seismic data to the University of Aberdeen. Seismic interpretation was undertaken using Schlumberger Petrel software and gravity modelling using ARK CLS XField software. Thanks go to Steffi Burchardt, Eric Horsman and Christian Eide for constructive reviews which greatly improved the manuscript.Peer reviewedPublisher PD

Quaternary and Neogene Reservoirs of the Norwegian Continental Shelf and the Faroe-Shetland Basin

Glaciogenic reservoirs host important hydrocarbon resources across the globe. Examples such as the Peon and Aviat discoveries in the North Sea show that Quaternary and Neogene reservoirs can be prospective in the region. In this study, we interpret 2D and 3D reflection seismic data combined with borehole information to document unconventional play models from the shallow subsurface of the Norwegian Continental Shelf and the Faroe-Shetland Basin. These plays include (i) glacial sands in ice-marginal outwash fans, sealed by stiff subglacial tills (the Peon discovery), (ii) meltwater turbidites, (iii) contouritic fine-grained glacimarine sands sealed by gas hydrates, (iv) remobilized oozes above large evacuation craters which are sealed by megaslides and glacial muds, and (v) Neogene sand injectites. The hydrocarbon reservoirs are characterized by negative-polarity reflections with anomalously high amplitudes in the reflection seismic data as well as density and velocity decreases in the borehole data. Extensive new 3D reflection seismic data are crucial to correctly interpret glacial processes and distinguish shallow reservoirs from shallow seals. These data document a variety of play models with the potential for gas in large quantities and enable the identification of optimal drilling targets at stratigraphic levels which have so far been overlooked

The pre-breakup stratigraphy and petroleum system of the Southern Jan Mayen Ridge revealed by seafloor sampling

The authors would like to acknowledge the contribution from the vessel’s crew (captain I. Rasmussen) and operator (Thor Ltd), the two surveyors (K. Høysæth and H.B. Bortne), and two sampling assistants (F. Gausepohl and A.-M. Voelsch). Sverre Planke and Dougal Jerram are partly funded through a Norwegian Research Council Centers of Excellence project (project number 223272, CEED). Adriano Mazzini is funded by the European Research Council under the European Union's Seventh Framework Programme Grant agreement n° 308126 (LUSI LAB project, PI A. Mazzini). TGS and VBPR funded the cruise and allowed the publication of the data and interpretation. Steve Killops from APT refined our interpretation of the biomarker data. The reviewers and the editor are also thanked for their constructive comments. Finally, this article is dedicated to the biostratigrapher Haavard Selnes who sadly passed away in 2015.Peer reviewedPostprin

Igneous seismic geomorphology of buried lava fields and coastal escarpments on the Vøring volcanic rifted margin

Voluminous igneous complexes are commonly present in sedimentary basins on volcanic rifted margins, and they represent a challenge for petroleum explorationists. A 2500 km2 industry-standard 3D seismic cube has recently been acquired on the Vøring Marginal High offshore mid-Norway to image subbasalt sedimentary rocks. This cube also provides a unique opportunity for imaging top- and intrabasalt structures. Detailed seismic geomorphological interpretation of the top-basalt horizon, locally calibrated with high-resolution P-Cable wide-azimuth data, reveals new insight into the late-stage development of the volcanic flow fields and the kilometer-high coastal Vøring Escarpment. Subaerial lava flows with compressional ridges and inflated lava lobes cover the marginal high, with a comparable structure and size to modern subaerial lava fields. Pitted surfaces, likely formed by lava emplaced in a wet environment, are present in the western part of the study area near the continent-ocean boundary. The prominent Vøring Escarpment formed when eastward-flowing lava reached the coastline. The escarpment morphology is influenced by preexisting structural highs, and these highs are locally bypassed by the lava. Volcanogenic debris flows are well-imaged on the escarpment horizon, along with large-scale large slump blocks. Similar features exist in active volcanic environments, e.g., on the south coast of Hawaii. Numerous postvolcanic extensional faults and incised channels cut into the marginal high and the escarpment, and we found that the area was geologically active after the volcanism ceased. In summary, igneous seismic geomorphology and seismic volcanostratigraphy are two very powerful methods to understand the volcanic deposits and development of rifted margins. Our study demonstrates great promise for further understanding the igneous development of offshore basins as more high-quality 3D seismic data become available

Structural and fluid-migration control on hill-hole pair formation: Evidence from high-resolution 3D seismic data from the SW Barents Sea

Hill-hole pairs are subglacial landforms consisting of thrust-block hills and associated source depressions. Formed by evacuation of material where ice sheets have been locally frozen to the substrate, they give insights into paleo-ice-sheet dynamics. The aim of this study was to document the relationships between ancient hill-hole pairs identified on a buried glacial unconformity with the structure of the underlying sedimentary deposits, and then to determine if the basin geology and glacial fluid migration pathways promoted local subglacial freeze-on during the hill-hole pair formation. The study is based on seismic geomorphological interpretation of four high-resolution 3D seismic cubes covering an area of 800 km2 in the SW Barents Sea, and fluid seepage data from 37 gravity cores. The seismic datasets allowed the identification of 55 hill-hole pairs along the buried unconformity. The hills are characterized by chaotic to homogenous seismic facies forming up to 19 m high mounds, each covering areas of 2000–644,000 m2. The holes form depressions between 1 and 44 m deep and 2000–704,000 m2 in areal extent, which cut into preglacial Mesozoic bedrock and later infilled by glacial till. The holes are often found above fault terminations. High-amplitude reflections identified along the faults and in the strata below the holes are interpreted as shallow gas migrating upward towards the glacial unconformity. Geochemical data of the seabed sediment cores further indicates an association between hill-hole pair occurrence and present-day thermogenic hydrocarbon seepage. The hill-hole pairs geometries were also used to identify five paleo-ice-flow directions along the glacial unconformity. These ice flows exhibit polythermal regimes, and four of them are parallel to ice-stream flow sets interpreted from glacial lineations. The integrated interpretation supports localized fault-related basal freezing of the Barents Sea Ice Sheet which resulted in the formation of hill-hole pairs when the ice sheet moved. In this context, the faults functioned as migration pathways for deep thermogenic fluids, possibly sourced from leaking Jurassic reservoirs.>p> This study highlights the importance of the underlying geology for ice-sheet dynamics: While hill-hole pairs above glacial till appear to be commonly associated with dispersed gas hydrates, hill-hole pairs above bedrock additionally indicate a link to underlying fault systems and hydrocarbon reservoirs. Freeze-on of underlying bedrock to the basal ice along the strike of faults in sedimentary bedrock explains deeper hill-hole pairs with smaller extents along the glacial unconformity compared to areally larger but shallow hill-hole pairs detected above glacial till on modern seabeds. Such close association between paleo-thermogenic gas seepage and the location of hill-hole pairs strongly support that hill-hole pairs are excellent markers revealing exit points of fluid migration pathways in petroleum system models

Diachronous evolution of Late Jurassic-Cretaceous continental rifting in the northeast Atlantic (west Iberian margin)

Regional (2-D) seismic reflection profiles, outcrop, and borehole data are used to characterize the evolution of deep offshore sedimentary basins in southwest Iberia (Alentejo Basin). The interpreted data indicate the bulk of Late Jurassic–earliest Cretaceous subsidence occurred in the present-day continental slope area, as shown by (1) significant thickening of synrift strata basinward from a slope-bounding fault system (SFS), west of which the total thickness of sediment can reach more than 9.0 km, and (2) relatively thin Mesozoic strata east of the SFS, where thickening of synrift units against principal faults is limited. Five principal regressive events and their basal unconformities reflect tectonic uplift and relative emersion in proximal basins, which were located on the rift shoulder to subsiding tilt blocks west of the SFS. These regressive events are correlated with major rift-related events occurring on the deeper margin. Direct comparisons with the Peniche Basin of northwest Iberia reveal that significant portions of the Iberian lower plate margin were uplifted and eroded during the last stages of continental rifting. This process was repeated at different times (and in different areas) as the locus of rifting and continental breakup migrated northward. As a result, two distinct rift axes are recognized in west Iberia, a first axis extending from the Porto Basin to the Alentejo Basin and a second axis located on the outer proximal margin north of 38°30N. In addition, the SFS delimited (1) prograding deposits of Cretaceous-Paleogene age and (2) late Cenozoic deposits draping the modern continental slope. These latter facts demonstrate that on lower plate passive margins, the relative position of the continental slope is established during the final rifting episode(s) preceding continental breakup