Gender and military issues : a categorized research bibliography

The purpose of this report is to give an overview of research related to gender issues in the military

Deconstructing (e)health literacy: aspects that promote and inhibit understanding of health information in breast cancer patient pathways

Purpose: Deconstructing current definitions of “health literacy (HL)” and “eHealth literacy (eHL)”, into the core notion of “understanding health information (HI)”, this study provides insights into what promotes and inhibits the understanding of HI for breast cancer patients during cancer patient pathways (CCP) in Norway. Methods: Seven well-educated women were interviewed. Through a stepwise deductive-inductive analysis of the transcribed interviews, the following topics were identified: 1) explanations accompanied by drawings, 2) individualized knowledge-based information, 3) information processing capacity, and 4) ambiguity in medical information. Results: The women's understanding of HI increased when spoken communication was accompanied by visual illustrations, which served as roadmaps throughout the CPP. Even if HI should be targeted to the patients’ individual needs, some HI can be generalized if it refers to established knowledge about the health phenomena. The women described their changing mental and physical status during the CPP and how these changes influenced their understanding of HI. Conclusion: The results challenge the idea that HL and eHL are fixed, stable, personal characteristics. On the contrary, HL/eHL, in this case particularly the understanding of HI, depends on the individual (temporary) physical and cognitive capacity of the patient and adaptation in the institutional and private contexts.publishedVersio

A qualitative study of bereaved family caregivers: feeling of security, facilitators and barriers for rural home care and death for persons with advanced cancer

Background For cancer patients and their family, an important factor that determines the choice to die at home is the caregivers’ feeling of security when caring for the patient at home. Support to caregivers from healthcare professionals is important for the feeling of security. In rural areas, long distances and variable infrastructure may influence on access to healthcare services. This study explored factors that determined the security of caregivers of patients with advanced cancer who cared for the patients at home at the end of life in the rural region of Sogn og Fjordane in Norway, and what factors that facilitated home death. Methods A qualitative study using semi-structured in-depth interviews with bereaved with experience from caring for cancer patients at home at the end of life was performed. Meaning units were extracted from the transcribed interviews and divided into categories and subcategories using Kvale and Brinkmann’s qualitative method for analysis. Results Ten bereaved caregivers from nine families where recruited. Five had lived together with the deceased. Three main categories of factors contributing to security emerged from the analysis: “Personal factors”, “Healthcare professionals” and “Organization” of healthcare. Healthcare professionals and the organization of healthcare services contributed most to the feeling of security. Conclusion Good competence in palliative care among healthcare professionals caring for patients with advanced cancer at home and well- organized palliative care services with defined responsibilities provided security to caregivers caring for advanced cancer patients at home in Sogn og Fjordane.publishedVersio

A Web-Based Communication Tool for Postoperative Follow-up and Pain Assessment at Home After Primary Knee Arthroplasty: Feasibility and Usability Study

Background: We report the use of an electronic tool, Eir (Eir Solutions AS, Norway), for symptom registration at home after knee arthroplasty. This electronic tool was used in a randomized controlled trial (RCT) comparing 3 different analgesic regimens with respect to postoperative pain and side effects. Objective: The aim of this substudy was to investigate this electronic tool for symptom registrations at home with respect to usability (ie, how easy it was to use) and feasibility (ie, how well the tool served its purpose). Methods: To assess the tool's usability, all participants were invited to fill out the 10-item System Usability Scale (SUS) after using the tool for 8 days. To assess feasibility, data regarding the participants' ability to use the tool with or without assistance or reminders were collected qualitatively on a daily basis during the study period. Results: A total of 134 patients completed the RCT. Data concerning feasibility of the web-based tool were collected from all 134 patients. The SUS was completed by 119 of the 134 patients; 70.2% (94/134) of the patients managed to use the tool at home without any technical support. All technical challenges were related to the login procedure or internet access. The mean SUS score was 89.6 (median 92.5; range 22.5-100). Conclusions: This study showed high feasibility and high usability of the Eir web tool. The received reports gave the necessary information needed for both research data and clinical follow-up.publishedVersio

The impact of extended electrodiagnostic studies in Ulnar Neuropathy at the elbow

Background: This study aimed to explore the value of extended motor nerve conduction studies in patients with ulnar nerve entrapment at the elbow (UNE) in order to find the most sensitive and least time-consuming method. We wanted to evaluate the utility of examining both the sensory branch from the fifth finger and the dorsal branch of the ulnar nerve. Further we intended to study the clinical symptoms and findings, and a possible correlation between the neurophysiological findings and pain. Methods: The study was prospective, and 127 UNE patients who were selected consecutively from the list of patients, had a clinical and electrodiagnostic examination. Data from the most symptomatic arm were analysed and compared to the department's reference limits. Student's t - test, chi-square tests and multiple regression models were used. Two-side p-values < 0.05 were considered as significant. Results: Ulnar paresthesias (96%) were more common than pain (60%). Reduced ulnar sensitivity (86%) and muscle strength (48%) were the most common clinical findings. Adding a third stimulation site in the elbow mid-sulcus for motor conduction velocity (MCV) to abductor digiti minimi (ADM) increased the electrodiagnostic sensitivity from 80% to 96%. Additional recording of ulnar MCV to the first dorsal interosseus muscle (FDI) increased the sensitivity from 96% to 98%. The ulnar fifth finger and dorsal branch sensory studies were abnormal in 39% and 30% of patients, respectively. Abnormal electromyography in FDI was found in 49% of the patients. Patients with and without pain had generally similar conduction velocity parameter means. Conclusion: We recommend three stimulation sites at the elbow for MCV to ADM. Recording from FDI is not routinely indicated. Sensory studies and electromyography do not contribute much to the sensitivity of the electrodiagnostic evaluation, but they are useful to document axonal degeneration. Most conduction parameters are unrelated to the presence of pain

Pupil assessment and adapted education: What can pupil assessment mean for adapted education? What does school–home co-operation mean for adapted education?

Norsk: Denne rapporten omhandler tilpasset opplæring med fokus på elevvurdering og samarbeid hjem–skole. Vi har stilt følgende 3 forskningsspørsmål: 1. Hvordan forstås og praktiseres elevvurdering sett i relasjon til tilpasset opplæring? 2. Hvilken sammenheng kan det være mellom skolens samarbeid med elevenes foresatte og tilpasset opplæring? 3. Hvordan kan skolen utvikle gode vurderingskulturer? Vi har gjennomført to delprosjekter og involvert 4 skoler i undersøkelsen som hovedsakelig er kvalitativ. Feltarbeidet har omfattet en rekke ulike metoder som observasjon, intervju, lærerlogg og dokumentstudier. Den ene skolen, «Lund skole», er fulgt spesielt i en form for forskende partnerskap hvor ett av målene var å utvikle vurderingskulturen. Resultatene viser at de feste lærerne har et bevisst forhold til elevvurderingens sentrale betydning for tilpassing av opplæringen. Vi registrerte samtidig at det er stor spredning i forståelsen av begrepet elevvurdering. Elevenes egen medvirkning i vurderingen ble spesielt høyt verdsatt av lærerne i intervjuene, men i observasjonene var elevenes medvirkning i egenvurderingen ofte ikke så framtredende. Et slående inntrykk var også den store variasjonen vi observerte i vurderingshandlinger (et sentralt uttrykk i rapporten), men på alle skolene ble elevsamtalen sett som sentral. De intensjonene som ble presentert i skolens dokumenter, når det gjelder for eksempel hyppighet av elevsamtalen, ble ikke alltid overholdt. I de aller feste observerte samtalene virket det imidlertid som om situasjonen ble opplevd som god for elevene, og at de følte seg sett og ivaretatt. Når det gjelder skole–hjem-samarbeid, viste undersøkelsen at vurderinger av elevenes prestasjoner ofte ble brukt av lærerne som informasjon og tilbakemelding til de foresatte. Hvis vi ser våre funn i lys av begrepene verdi- og interessefellesskap/-konfikt, kan det synes som om mangel på gjensidig informasjon, kunnskap og tillit kan føre til konfikter snarere enn fellesskap. Lærerne ga uttrykk for noe usikkerhet i samarbeidet med foresatte fra språklige minoriteter, og de foresatte sa klart at de ønsket mer kunnskap om eget barn i skolen og hvilken vurderings- og undervisningspraksis skolen benyttet. Mangel på denne kunnskapen om skolen kan trolig være en årsak til at lærerne kan oppfatte dem som lite interesserte. På bakgrunn av dette kan det synes som om skolen i større grad bør arbeide med å gjøre undervisningens mål, innhold og vurderingspraksis mer eksplisitt for de foresatte, uavhengig av språklig og kulturell bakgrunn. I arbeidet med å utvikle vurderingskulturen ved ’Lund skole’ framkom det tidlig i prosessen at synet på vurderingskulturen var sprikende i personalet. For å forankre arbeidet videre så vi det som avgjørende å etablere et forpliktende samarbeid med både ledelsen og de ansatte. Milepelplaner og tiltak ble derfor avklart i samarbeidsmøter mellom de involverte og høgskolen. Underveis ønsket lærerne selv påfyll av mer kompetanse når det gjelder gjennomføring av elevsamtalen samt hvordan de kunne styrke samarbeidet med minoritetsspråklige foresatte spesielt. Elevsamtalen ble viet spesiell fokus på en planleggingsdag, og både elevsamtalen og samarbeid med minoritetsspråklige ble defnert som skolens satsningsområder videre. Vi hadde før dette arbeidet som utgangspunkt at vurderingen kom først og tilpassingen etterpå. Dette er selvfølgelig fremdeles tilfelle i et «vurdering for læring»-perspektiv. I tillegg er utrykket «vurdering som læring» på sin plass når eleven aktivt medvirker i vurderingsprosessen. Alle aktørenes stemmer fremheves gjennom dialogen i vurderingshandlingen; vurderingen blir en form for tilpassing av opplæringen i seg selv. Vi er derfor så frimodige at vi introduserer et nytt begrep: Vurdering SOM tilpasset opplæring. Denne undersøkelsen er en del av et større prosjekt som heter tilpasset opplæring og pedagogisk praksis. Hensikten med paraplyprosjektet har vært å utvikle forskningsbasert kunnskap om forholdet mellom pedagogisk innsats og elevenes faglige og sosiale utvikling (se Nordahl & Dobson, 2009).English: The topic of this research report is adapted education with a focus upon pupil assessment and school–home co-operation. Three research questions have been posed: 1. How is pupil assessment understood and practiced in relation to adapted education? 2. What is the connection between school co-operation with parents and adapted education? 3. How can the school develop a good assessment culture? We have carried two sub-projects and involved 4 schools in our research, which has mainly been of a qualitative character. Fieldwork has utilised a num- ber of methods, such as observation, interview, teacher log and document studies. One of the schools has followed by adopting a form of research partnership with the goal of developing an assessment culture. We found a wide and varied understanding of the concept pupil assessment. Teachers valued in particular pupil self-assessment, but in observations of classroom activity it was not so prevalent. A striking impression was the great variation in observed assessment actions (a central concept in the report). The pupil conversation was regarded as central in all the schools. The intentions presented in school policy documents, for example with reference to the frequency of the pupil conversation, were not realised. Nevertheless, in most of the observed conversations the activity was experienced as good for the pupils, and that they felt they were well looked after. With respect to the question of school-home co-operation we noted that teachers as information and feedback to parents often used the assessment of pupil performance. But at the same time, it appears that a lack of mutual information, knowledge and trust acts as a foundation for conficts, rather than a sharing of values and interests. Teachers expressed in particular uncertainty with respect to co-operation with minority language parents, and parents for their part clearly stated a desire for more knowledge about their own children in school and what kind assessment practice the school followed. A lack of this knowledge about the school and a feeling of impotence might well be a reason for a sense of passifcation and teachers regarding this as a lack of interest. Such fndings suggest that the school to a greater degree should work to make teaching goals, content and assessment practice more explicit for parents, irrespective of their linguistic and cultural background. In the development of the assessment culture at our selected school it quickly became apparent that staff had very different conceptions of assessment culture. To ensure that the process was anchored in the school organization co-operation with mutual obligation was agreed between teachers and the school’s management team. Pupils conversations were given a dedicated place in one of the school’s planning days, along with co-operation with minority language pupils they became policy focus areas for the school. When we embarked upon this research project we assumed as a point of departure that assessment came frst and adapted education afterwards. This of course the case in an assessment for learning perspective. In addition the expression assessment as learning is relevant when pupils actively participate in the assessment process. The voices of participant are prominent in the assessment action’s dialogue; assessment becomes a form of adaption of education in itself. We therefore take the step of proposing a new concept: assessment AS adapted education. This research belongs to part of a larger project called adapted Education and Educational Practice. The intention of the over-arching project has been to develop research-based knowledge about the relationship between educational resources and their role in the development of pupils subject knowledge and their social competence (see Nordahl & Dobson, 2009).Norges forskningsrå

Parenteral Nutrition in Advanced Cancer: The Healthcare Providers’ Perspective

Introduction: The evidence base for parenteral nutrition (PN) in advanced cancer patients is limited. We studied healthcare providers’ (HCPs’) experiences with PN in cancer patients, focusing on perceived treatment benefits and challenges. Methods: An 18-item online survey was emailed to HCPs attending one of three regional palliative care seminars held within a 6-month period. The survey included single-response items, multiple-response items, and free text boxes concerning PN. Descriptive statistics and qualitative thematic content analysis were applied. Results: One hundred and two seminar participants completed the survey. Ninety-three percent were female, 86% were nurses/oncological nurses, and 80% worked in primary care. Respondents reported a well-functioning collaboration across levels of care. They perceived that PN may increase the patients’ level of energy, improve the general condition, and reduce eating-related distress. On the downside, HCPs observed burdensome side effects, that the treatment was resource-demanding, and that decisions on PN withdrawal were difficult. Conclusion: The study results are based on the perspectives of more than 100 HCPs with comprehensive clinical experience with PN. Their knowledge represents an important experience base for improvement of healthcare services and advanced care planning.publishedVersio

Når barnevernet overtar omsorgen – en forenklet kunnskapsoppsummering

Formålet med dette prosjektet har vært å utforme en forenklet systematisk kunnskapsoppsummering om tiltak i barnevern etter vedtak om omsorgsovertakelse. Systematiske søk ble gjennomført i utvalgte databaser for å identifisere publikasjoner som omhandler barnevern og tiltak i Norge. Det ble foretatt manuell filtrering, og det gjenværende utvalget (n=95) ble kodet. Tilsvarende ble gjort for grålitteratur (n=35). Den klart største andelen av forskningen omhandler fosterhjem, inkludert ulike sider ved det å være / ha vært i fosterhjem; noe forskning ble identifisert om ulike sider ved barnevernsinstitusjoner, mens svært få identifiserte studier omhandlet adopsjon. Noe forskning på biologiske foreldre fratatt omsorg, samt på barnevernstjenesten / systemet ble også identifisert. Effektforskning var nærmest fraværende blant de identifiserte studiene. ISBN: 978-82-14-07917-3publishedVersio

Pancreatic Secretory Trypsin Inhibitor (SPINK1) Gene Mutation in Patients with Acute Alcohol Pancreatitis (AAP) Compared to Healthy Controls and Heavy Alcohol Users without Pancreatitis

Only 3–5% of heavy alcohol users develop acute alcohol pancreatitis (AAP). This suggests that additional triggers are required to initiate the inflammatory process. Genetic susceptibility contributes to the development of AAP, and SPINK1 mutation is a documented risk factor. We investigated the prevalence of the SPINK1(N34S) mutation in patients with AAP compared to heavy alcohol users who had never suffered an episode of pancreatitis. Blood samples for the mutational analysis from patients with first episode (n = 60) and recurrent AAP (n = 43) and from heavy alcohol users without a history of AAP (n = 98) as well as from a control population (n = 1914) were obtained. SPINK1 mutation was found in 8.7% of the patients with AAP. The prevalence was significantly lower in healthy controls (3.4%, OR 2.72; 1.32–5.64) and very low in alcoholics without pancreatitis (1.0%, OR 9.29; 1.15–74.74). In a comparison adjusted for potential cofounders between AAP patients and alcoholics, SPINK1 was found to be an independent marker for AAP. The prevalence of the SPINK1 mutation is overrepresented in AAP patients and very low in alcoholics without pancreatitis. This finding may play a role in understanding the variable susceptibility to AAP found in heavy alcohol users.publishedVersionPeer reviewe