Brukerkunnskap : - i nettverk, forskning og utviklingsarbeid

-Brukere med psykiske helseproblemer, fagfolk og forskere i Agder har sammen utviklet ny kunnskap gjennom arbeid og dialog i nettverk, der likeverd har vært et overordnet mål. Når fagfolk, brukere og forskere møtes, skjer det noe spennende og interessant. Taus kunnskap trer frem og blir satt ord på, svake stemmer blir sterkere og betydningsfulle. Gjennom dialog får vi en dypere innsikt og lærer av hverandre

Sublim nytelse. : om overskridelse i underholdning, vold og dannelse

Problemområde Den påfølgende oppgaven tar for seg en idéhistorisk tilnærming til begrepet om det sublime i forskjellige historiske kontekster. Den europeiske antikken, og tiden rundt Kant og hans nære ettertid blir særlig vektlagt. Problemet som stilles er hvordan en følelse av overveldelse, avmakt og ubehag kan overskrides og bli opphav til en følelse av sublimt velbehag. Er en slik overskridelse mulig? I dette ligger også spørsmålet om overskridelsens ”fryktinngytende” objekt kan og bør relateres til pedagogiske spørsmål som for eksempel moralsk dannelse, men også hvordan det sublime inngår som ren underholdning – som nytelse i seg selv. Det idéhistoriske perspektivet er valgt for å se de historiske forskyvningene i relasjon til det sublime, mellom dannelse og underholdning. Scenekunsten i antikken står sentralt. Det samme gjør modernismens estetiske teori, og da særlig Immanuell Kant. Spørsmålet er om det fins noen klare fellestrekk i disse forskyvningene? Metode Oppgaven fremstår som en kvalitativ tekstanalyse der utvalget er bestemt av de nevnte problemstillingene. Ettersom tekstutvalget er hentet fra to millennier er metoden basert på et svært selektivt utvalg av anerkjente tekster. Tidsspennet og problematikkens dybde har ført meg til Max Webers idealtypiske fremstillinger. Jeg belyser enkelte særtrekk (det typiske) ved den aktuelle tidsepoke og tilpasser metoden til bestemte og uttalte problemområder. Da er det også mulig å gi den historiske fortolkning en plass i vår egen samtid, og vurdere i hvilken grad historiske analyser fortsatt kan kaste lys over pedagogiske problemstillinger . Data/kilder Tekstene som hentes frem er valgt ut fra deres historiske betydning reelt sett, eller fordi de har stor forklaringsverdi. De idealtypiske trekkene vises ved å presentere de aktuelle tidsepoker gjennom autoriteter som Platon, Aristoteles og de greske dramatikere, deretter Kant, Weber, Rousseau og Nietzsche. Disse blir presentert gjennom originaltekster/henvisninger eller sekundærlitteratur fra nyere anerkjent ekspertise. Denne kombinasjonen gir muligheten til å hente inn egen forståelse i en hermeneutisk prosess hvor min primærlesning finner kvalifiserte korrektiver for ny forståelse. Resultat/hovedkonklusjon Det sublime viser seg som et dannelseselement i den greske tragedien gjennom det dionysiske i deres litterære kultur. Det overveldende i ”kulturens ubehag”, iscenesettes i tragedien og komedien som et forsøk på å gjenskape lidelsen. Det pedagogiske elementet finner vi i refleksjonen som denne iscenesettelsen vekker i oss. Den greske bystaten var for frie borgere et rimelig sikkert ståsted, i en verden der det tragiske i sin voldsomhet likevel var overkommelig. Imperiet fjernet bystatens forholdsvis ”enhetlige” preg, og individets personlige forhold til staten og omgivelsene settes på ny prøve. Teateret som dannelsesinstitusjon blir derfor irrelevant, som en følge av at det mister sin rolle i bindeleddet mellom individ og stat – subjekt og objekt. Den sceniske vold blir reality og komedien trivialisert til ren nytelse - uten et pedagogisk anliggende. Subjektet ble ”mindre” og objektet ”større”. Oppgaven viser hvordan dette kan forstås innenfor Kants behandling av det sublime, hvor dette ”overveldende” blir en autonom estetisk kategori, men hvor forholdet mellom subjektet og de objektive omgivelse er ute av proporsjoner. Kant frisetter estetikken prinsipielt, og kaster problemet tilbake på subjektet, som må overskride objektet (naturen i videste forstand) i kraft av sin rasjonalitet. Weber griper tilbake til den meningsbærende kulturen for å finne balansen mellom subjektet og det stadig voksende objektet. Han frykter at heller ikke verdiene vil overleve objektets voldsomhet i sin institusjonaliserte form. Løsningen finner han i en farlig utopi som forener det karismatiske hos enkeltindividet og byråkratiets iboende logikk. Rousseau så det samme problemet, men ender opp i en ren utopi. Nietzsche for sin del så det eneste håpet i individets biologiske opprør mot kulturen og historien. Han vender hele den rasjonelle kulturen ryggen og søker tilbake til menneskets ”urgrunn”, som er ”vilje til makt”. Overskridelsens objekt blir derfor, for Nietzsche, våre egne grenser som kulturmennesket har satt opp for seg selv, men som kommer i konflikt med vår sanne biologiske natur

Professional work in the squeeze

This article examines the effects on the professional system of creating a new system for the quality assurance of residential care in the Norwegian child welfare service. Since 2004, all institutions, private as well as governmental, have undergone a quality evaluation process. A set of indicators was given by the Ministry, with the regional authorities expected to assess the institutions according to these indicators.The main purpose of the article is to discuss to what extent, and in which way, the new control system may exert an impact on the jurisdiction of social work and professional practice in the everyday life of the institutions. The discussion is based on empirical data from a project entitled, “A control regime in transition”, which is supported by the previous Ministry for Children and Family Affairs. The project work started at the end of 2004, and followed the new control regime for three and a half years

Group‑delivered cognitive behavioural therapy versus waiting list in the treatment of insomnia in primary care: study protocol for a pragmatic, multicentre randomized controlled trial

Background Insomnia is common in the general population and is a risk factor for ill-health, which highlights the importance of treating insomnia effectively and cost-efficiently. Cognitive-behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment due to its long-term effectiveness and few side-effects, but its availability is limited. The aim of this pragmatic, multicentre randomized controlled trial is to investigate the effectiveness of group-delivered CBT-I in primary care compared to a waiting-list control group. Methods A pragmatic multicentre randomized controlled trial will be conducted with about 300 participants recruited across 26 Healthy Life Centres in Norway. Participants will complete online screening and provide consent before enrolment. Those who meet the eligibility criteria will be randomized to a group-delivered CBT-I or to a waiting list according to a 2:1 ratio. The intervention consists of four two-hour sessions. Assessments will be performed at baseline, 4 weeks, 3- and 6 months post-intervention, respectively. The primary outcome is self-reported insomnia severity at 3 months post-intervention. Secondary outcomes include health-related quality of life, fatigue, mental distress, dysfunctional beliefs and attitudes about sleep, sleep reactivity, 7-day sleep diaries, and data obtained from national health registries (sick leave, use of relevant prescribed medications, healthcare utilization). Exploratory analyses will identify factors influencing treatment effectiveness, and we will conduct a mixed-method process evaluation to identify facilitators and barriers of participants’ treatment adherence. The study protocol was approved by the Regional Committee for Medical and Health Research ethics in Mid-Norway (ID 465241). Discussion This large-scale pragmatic trial will investigate the effectiveness of group-delivered cognitive behavioural therapy versus waiting list in the treatment of insomnia, generating findings that are generalizable to day-to-day treatment of insomnia in interdisciplinary primary care services. The trial will identify those who would benefit from the group-delivered therapy, and will investigate the rates of sick leave, medication use, and healthcare utilization among adults who undergo the group-delivered therapy.publishedVersio

Usability and acceptability of an app (SELFBACK) to support self-management of low back pain: mixed methods study.

Self-management is the key recommendation for managing non-specific low back pain (LBP). However, there are well-documented barriers to self-management, therefore methods of facilitating adherence are required. Smartphone apps are increasingly being used to provide feedback and reinforcement to support self-management of long-term conditions such as LBP. The aim of this study was to assess the usability and acceptability of the selfBACK smartphone app, designed to support and facilitate self-management of non-specific LBP. The app provides weekly self-management plans, comprising physical activity, strength/flexibility exercises, and patient education. The plans are tailored to the patient's characteristics and symptom progress by using case-based reasoning methodology. The study was carried out in two stages, using a mixed-methods approach. All participants undertook surveys and semi-structured telephone interviews were conducted with a subgroup of participants. Stage 1 assessed an app version with only the physical activity component and a web-questionnaire that collects information necessary for tailoring the self-management plans. The physical activity component included monitoring of steps recorded by a wristband, goal-setting, and a scheme for sending personalised, timely and motivational notifications to the user's smartphone. Findings from stage 1 were used to refine the app and inform further development. Stage 2 investigated an app version that incorporated three self-management components (physical activity, exercises and education). A total of sixteen participants (age range 23-71 years) with ongoing or chronic non-specific LBP were included in stage 1, and eleven participants (age range 32-56) were included in stage 2. In stage 1, 94% of participants reported that the baseline questionnaire was easy to answer and 84% found completion time to be acceptable. Overall, participants were positive about the usability of the physical activity component but only 31% found the app functions to be well integrated. 90% of the participants were satisfied with the notifications and 80% perceived the notifications to be personalised. In stage 2, all participants reported that the web-questionnaire was easy to answer and the completion time acceptable. The physical activity and exercise components were rated useful by 80%, while 60% rated the educational component useful. Overall, participants were satisfied with the usability of the app; however, only 50% found the functions to be well integrated and 20% found them to be inconsistent. Overall, 80% of participants reported it to be useful for self-management. The interviews largely reinforced the survey findings in both stages. This study has demonstrated that participants considered the selfBACK app to be acceptable and usable, and that they thought it would be useful for supporting self-management of LBP. However, we identified some limitations and suggestions, which will be useful in guiding further development of the selfBACK app and other mHealth interventions

Spread of avian pathogenic Escherichia coli ST117 O78:H4 in Nordic broiler production

BACKGROUND: Escherichia coli infections known as colibacillosis constitute a considerable challenge to poultry farmers worldwide, in terms of decreased animal welfare and production economy. Colibacillosis is caused by avian pathogenic E. coli (APEC). APEC strains are extraintestinal pathogenic E. coli and have in general been characterized as being a genetically diverse population. In the Nordic countries, poultry farmers depend on import of Swedish broiler breeders which are part of a breeding pyramid. During 2014 to 2016, an increased occurrence of colibacillosis on Nordic broiler chicken farms was reported. The aim of this study was to investigate the genetic diversity among E. coli isolates collected on poultry farms with colibacillosis issues, using whole genome sequencing. METHODS: Hundred and fourteen bacterial isolates from both broilers and broiler breeders were whole genome sequenced. The majority of isolates were collected from poultry with colibacillosis on Nordic farms. Subsequently, comparative genomic analyses were carried out. This included in silico typing (sero- and multi-locus sequence typing), identification of virulence and resistance genes and phylogenetic analyses based on single nucleotide polymorphisms. RESULTS: In general, the characterized poultry isolates constituted a genetically diverse population. However, the phylogenetic analyses revealed a major clade of 47 closely related ST117 O78:H4 isolates. The isolates in this clade were collected from broiler chickens and breeders with colibacillosis in multiple Nordic countries. They clustered together with a human ST117 isolate and all carried virulence genes that previously have been associated with human uropathogenic E. coli. CONCLUSIONS: The investigation revealed a lineage of ST117 O78:H4 isolates collected in different Nordic countries from diseased broilers and breeders. The data indicate that the closely related ST117 O78:H4 strains have been transferred vertically through the broiler breeding pyramid into distantly located farms across the Nordic countries. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12864-016-3415-6) contains supplementary material, which is available to authorized users

An app-delivered self-management program for people with low back pain: protocol for the selfBACK randomized controlled trial.

Background: Low back pain (LBP) is prevalent across all social classes, in all age groups, and across industrialized and developing countries. From a global perspective, LBP is considered the leading cause of disability and negatively impacts everyday life and well-being. Self-management is a recommended first-line treatment, and mobile apps are a promising platform to support self-management of conditions like LBP. In the selfBACK project, we have developed a digital decision support system made available for the user via an app intended to support tailored self-management of nonspecific LBP. Objective: The trial aims to evaluate the effectiveness of using the selfBACK app to support self-management in addition to usual care (intervention group) versus usual care only (control group) in people with nonspecific LBP. Methods: This is a single-blinded, randomized controlled trial (RCT) with two parallel arms. The selfBACK app provides tailored self-management plans consisting of advice on physical activity, physical exercises, and educational content. Tailoring of plans is achieved by using case-based reasoning (CBR) methodology, which is a branch of artificial intelligence. The core of the CBR methodology is to use data about the current case (participant) along with knowledge about previous and similar cases to tailor the self-management plan to the current case. This enables a person-centered intervention based on what has and has not been successful in previous cases. Participants in the RCT are people with LBP who consulted a health care professional in primary care within the preceding 8 weeks. Participants are randomized to using the selfBACK app in addition to usual care versus usual care only. We aim to include a total of 350 participants (175 participants in each arm). Outcomes are collected at baseline, 6 weeks, and 3, 6, and 9 months. The primary end point is difference in pain-related disability between the intervention group and the control group assessed by the Roland-Morris Disability Questionnaire at 3 months. Results: The trial opened for recruitment in February 2019. Data collection is expected to be complete by fall 2020, and the results for the primary outcome are expected to be published in fall 2020. Conclusions: This RCT will provide insights regarding the benefits of supporting tailored self-management of LBP through an app available at times convenient for the user. If successful, the intervention has the potential to become a model for the provision of tailored self-management support to people with nonspecific LBP and inform future interventions for other painful musculoskeletal conditions

Investigation of the presence of human or bovine respiratory syncytial virus in the lungs of mink (Neovison vison) with hemorrhagic pneumonia due to Pseudomonas aeruginosa

<p>Abstract</p> <p>Background</p> <p>Hemorrhagic pneumonia is a disease of farmed mink (<it>Neovison vison</it>) caused by <it>Pseudomonas aeruginosa</it>. The disease is highly seasonal in Danish mink with outbreaks occurring almost exclusively in the autumn. Human respiratory syncytial virus (RSV) has been shown to augment infection with <it>P. aeruginosa</it> in mice and to promote adhesion of <it>P. aeruginosa</it> to human respiratory cells.</p> <p>Findings</p> <p>We tested 50 lung specimens from mink with hemorrhagic pneumonia for bovine RSV by reverse transcriptase polymerase chain reaction (PCR) and for human RSV by a commercial real-time PCR. RSV was not found.</p> <p>Conclusions</p> <p>This study indicates that human and bovine RSV is not a major co-factor for development of hemorrhagic pneumonia in Danish mink.</p

Is Preoperative Quantitative Sensory Testing Related to Persistent Postsurgical Pain?:A Systematic Literature Review

Contains fulltext : 225328.pdf (Publisher’s version ) (Closed access)Persistent postsurgical pain (PPSP) is a common complication of surgery that significantly affects quality of life. A better understanding of which patients are likely to develop PPSP would help to identify when perioperative and postoperative pain management may require specific attention. Quantitative sensory testing (QST) of a patient's preoperative pain perception is associated with acute postoperative pain, and acute postoperative pain is a risk factor for PPSP. The direct association between preoperative QST and PPSP has not been reviewed to date. In this systematic review, we assessed the relationship of preoperative QST to PPSP. We searched databases with components related to (1) preoperative QST; (2) association testing; and (3) PPSP. Two authors reviewed all titles and abstracts for inclusion. Inclusion criteria were as follows: (1) QST performed before surgery; (2) PPSP assessed ≥3 months postoperatively; and (3) the association between QST measures and PPSP is investigated. The search retrieved 905 articles; 24 studies with 2732 subjects met inclusion criteria. Most studies (22/24) had moderate to high risk of bias in multiple quality domains. Fourteen (58%) studies reported a significant association between preoperative QST and PPSP. Preoperative temporal summation of pain (4 studies), conditioned pain modulation (3 studies), and pressure pain threshold (3 studies) showed the most frequent association with PPSP. The strength of the association between preoperative QST and PPSP varied from weak to strong. Preoperative QST is variably associated with PPSP. Measurements related to central processing of pain may be most consistently associated with PPSP