”Jokainen meistä on ansainnu sitä empatiaa ja sellasta pysähtymistä ja kohtaamista” : narratiivinen tutkimus empaattisuudesta hoitotyössä

Tässä tutkielmassa tarkastelen hoitajien empatiaa narratiivisen tutkimusotteen avulla. Tutkielmani käsitteellisenä lähtökohtana on emotionaalinen työ (engl. emotional labor) ja siihen liittyvä empatia. Empatia, kyky ymmärtää ja myötäelää toisen ihmisen tunteita, on keskeinen osa hoitotyötä. Tutkimuksessa pyrin selvittämään, miten hoitajat kokevat ja kertovat empatiasta suhteessa potilaisiinsa. Tutkimukseni lähestymistavaksi olen valinnut narratiivisen tutkimuksen. Aineisto koostui neljän potilastyötä tekevän hoitajan haastattelusta, joissa he kuvasivat omaa työskentelyään, potilassuhteitaan ja ammatillista kasvuaan. Narratiivisessa analyysissä nousi esiin useita empatiaan liittyviä teemoja, joiden pohjalta muodostin kolme narratiivia. Nämä narratiivit ovat työympäristönarratiivi, joka korostaa ympäristötekijöiden vaikutusta hoitajien empatiaan, potilaan ymmärtämisen narratiivi, joka keskittyy potilaan kokemuksen ymmärtämiseen ja siihen, miten hoitaja voi empatian avulla tukea potilasta sekä ammatillisen kehittymisen narratiivi, joka kuvastaa hoitajien henkilökohtaista ja ammatillista kasvua empatian kautta. Tutkimuksen tulokset osoittavat empatian moninaisuuden ja monimutkaisuuden hoitotyössä. Empatia ei ole vain yksilöllinen kyky, vaan se on jatkuvassa vuorovaikutuksessa ympäristön, potilaan ja hoitajan ammatillisen identiteetin kanssa. Tutkimus korostaa empatian keskeistä merkitystä laadukkaassa hoitotyössä ja tarvetta tukea hoitajien empatiakykyä työyhteisössä

Norwegian Consumers’ Skepticism towards Smoke-Flavoring of Salmon—Is It for Real?

The aim of the present study was to explore Norwegian consumers’ attitudes toward smoke-flavoring of cold smoked salmon (CSS), by conducting a digital survey and focus group discussions. Some of the smoke-flavoring techniques, like atomized purified condensed smoke, is considered healthier than conventional smoking. Manufacturers of CSS are, however, hesitant to use all kinds of smoke-flavoring due to expected consumer skepticism. In the digital survey, the expected skepticism was confirmed (n = 487). Only 15% of the respondents were positively oriented toward smoke-flavoring of CSS. The selection criterion for the focus group discussion was based on the results from the survey and resulted in three attitude-oriented focus groups (negative, neutral, and positive). The negative focus group considered smoke-flavored CSS to be unnatural and out of the question to buy or eat. Unlike the negative focus group, the neutral group was curious to learn more and open to potential smoke-flavor benefits. However, credible information or science was crucial to influence CSS choice. Future studies may investigate whether the existent of this large group of curious neutral consumers (47% of the respondents) influence manufacturers (of CSS) skepticism or how various types of product information could steer consumer acceptance of smoke-flavoring of CSS.publishedVersio

Vitamin B12, folate, and cognition in 6-to 9-year-olds: a randomized controlled trial

BACKGROUND AND OBJECTIVES: Vitamin B12 and folate are important for normal brain development. Our objective for this study was to measure the effects of 6-month supplementation of vitamin B12 and/or folic acid in early childhood on cognition when the children were 6 to 9 years old. METHODS: The study is a follow-up of a factorial randomized, double-blind, placebo-controlled trial in 1000 North Indian children. Children 6 to 30 months of age were randomly assigned to receive a placebo or 1.8 µg of vitamin B12, 150 mg of folic acid, or both daily for 6 months. After 6 years, we re-enrolled 791 of these children for cognitive assessments. We compared the scores of the main outcomes (the Wechsler Intelligence Scale for Children, Fourth Edition [India], the Crichton Verbal Scale, and subtests of the NEPSY-II) between the study groups. We also measured the associations between markers of the B vitamins (plasma cobalamin, folate, and total homocysteine concentrations) in early childhood and the cognitive outcomes. RESULTS: There were no differences between the intervention groups and the placebo group on the cognitive outcomes. Plasma cobalamin, folate, and total homocysteine concentrations in early childhood were associated with the cognitive outcomes at follow-up in the unadjusted models. These associations disappeared in models adjusted for relevant confounders. CONCLUSIONS: Our findings, from both an observational and a randomized design suggest that vitamin B12 and folate in children 6 to 36 months have limited public health relevance for long-term cognition.Thrasher Research Fund (grant 02827) and the Research Council of Norway (grants 172226 and 234495) provided financial support for the original and the follow-up study.AcceptedVersio

Prevalence of Underweight, Overweight, and Obesity in Adults in Bhaktapur, Nepal in 2015–2017

Introduction: There is an increase in the double burden of malnutrition globally, with a particular rise documented in Asia. In Nepal, undernutrition has been prevalent for decades. Today, however, the incidence of overweight and obesity (OWOB) in the country has increased substantially. There is a need to conduct local studies reporting on the concurrent burden of both underweight and OWOB across adult populations. This study addresses this need by describing the distribution of body mass index (BMI) in a defined population of adults living in the peri-urban community of Bhaktapur, Nepal. Material and methods: For this cross-sectional analysis, we used data that were available from 600 women and 445 men whose children were enrolled in an individually randomized, double-blind, placebo-controlled trial assessing the effect of daily vitamin B12 supplementation. Upon enrolment of their 6–11-month old children, mothers and fathers were interviewed about their socio-demographic details. In addition, their weight and height were measured by trained field workers. Each parent's BMI was calculated as the ratio of body weight (in kg) and height squared (in m), expressed as kg/m2, and categorized according to the WHO recommendation. We used linear and multinomial logistic regression models to assess associations between the BMI of the mothers and fathers, and their baseline characteristics. Results: The mean BMI was 23.7 kg/m2 for both the mothers and fathers with a standard deviation (SD) of 3.6 and 3.7, respectively. The proportion categorized as underweight, overweight, and obese was also similar in the two groups with around 5% being underweight, 30% being overweight and 5% being obese. Age was positively associated with BMI in both groups. Those categorized as daily wage earner had a lower mean BMI than those in other occupational groups. Conclusion: Our results contribute to documenting the burden of both under- and overnutrition in a selected group of young adults living in a peri-urban community in Nepal. As Nepal is undergoing an improvement in its economic situation, as well as a nutrition transition, it is important to provide sufficient information to enable timely action, and evidence-based decision-making to prevent a further increase in Nepal's growing double burden of malnutrition.publishedVersio

Milk-cereal mix supplementation during infancy and impact on neurodevelopmental outcomes at 12 and 24 months of age: A randomized controlled trial in India

Inadequate protein intake and lack of micronutrients may affect neurodevelopment in infants. This randomised controlled trial was conducted to measure the effect of two milk–cereal mixes with modest and high amounts of protein and enriched with multiple micronutrients, given between 6 and 12 months, on cognitive, language, motor and behavioural scores at 12 and 24 months of age, compared with no-supplementation. The two supplements were also compared with each other. The study was conducted in urban Delhi, India, and the infants were randomised in a 1:1:1 ratio to the three study groups. At 12 and 24 months of age, 1134 and 1214 children were available, respectively. At 12 months of age, compared with no-supplement group, an increase in the motor scores (mean difference, MD 1·52, 95 % CI: 0·28, 2·75) and a decrease in the infant temperament scores (MD − 2·76, 95 % CI: −4·23, −1·29) in the modest-protein group was observed. Those in the high-protein group had lower socio-emotional scores (MD − 1·40, 95 % CI: −2·43, −0·37) and higher scores on Infant Temperament Scale (MD 2·05, 95 % CI: 0·62, 3·48) when compared with modest-protein group. At 24 months, no significant differences in any of the neurodevelopment scores between the three study groups was found. In conclusion, supplementation with modest amount of protein and multiple micronutrients may lead to short-term small improvements in motor function and infant temperament. There appears no advantage of supplementing with high protein, rather negative effects on infant behaviour were observedpublishedVersio

Kultursensitivitet : Flyktningkontorets blikk på praksis

Studentarbeid i sosialt arbeid (bachelorgrad) - Universitetet i Nordland, 201

Earthquake Exposure and Post-traumatic Stress Among Nepalese Mothers After the 2015 Earthquakes

Introduction: Nepal suffered from major earthquakes in April 2015 resulting in great damage to the society. The objective of the current study is to describe the earthquake exposure, the impact on family’s daily life and the symptoms of post-traumatic stress disorder (PTSD) and their association in Nepalese mothers 20 months following the earthquakes.Methods: In a clinical trial in Bhaktapur, Nepal, 558 mothers responded to an inventory on earthquake exposure and the Impact of Event Scale – Revised (IES-R) 20 months after the earthquakes. In multiple linear regression models, we estimated the associations between the earthquake exposure and the impact on the families’ life and the IES-R score.Results: Over 60% reported that the earthquakes had a great deal of negative impact on their family’s life. In 4.7%, close family members died, and in 10.5%, family members were injured. 24% had IES-R scores indicating PTSD symptoms within clinical concern or a possible diagnosis. Lower levels of education were associated with higher scores on the total IES-R. Mothers who report that the earthquakes had a great deal of negative impact had higher total IES-R scores [9.8, 95% CI (5.9, 13.6)] compared to mothers that reported no such negative impact. Mothers with family members who were killed had higher IES-R scores [3.6, 95% CI (1.6, 5.5)] than those with no family members who died. Mothers assisting in rescue efforts had lower IES-R scores [2.8, 95% CI (0.8, 4.8)] than those not assisting.Conclusion: Our study demonstrates high levels of exposure to traumatic events, large negative impact on the everyday life of the families, and a high level of PTSD symptoms. There was a consistent and graded association between the exposure variables and PTSD symptoms. The large impact of the earthquakes on these Nepalese mothers underscore the importance of awareness of mental disorders following major natural catastrophes for marginalized families

The effect of vitamin B12-supplementation on actigraphy measured sleep pattern; a randomized control trial

Background Vitamin B12 deficiency is common worldwide and has been associated with poor sleep. The effect of vitamin B12 supplementation on sleep in infants is not known. Aims To measure the effect of daily supplementation of vitamin B12 for one year on sleep in infants at risk of deficiency. Methods This was an individually randomized double-blind placebo-controlled trial in 600 infants in low-to middle-income neighborhoods in Bhaktapur, Nepal of daily supplementation of vitamin B12 for one year. Infants were included if they were 6–11 month year-old and with a length-for-age less than one z-score. Sleep was a predefined, secondary outcome, and was measured by actigraphy including sleep duration at night and total sleep duration (day and night), sleep onset latency (SOL), and wake after sleep onset (WASO). The effect of vitamin B12 on sleep was additionally assessed in predefined subgroups defined by stunting, underweight, vitamin B12 status, low birthweight, anemia and exclusive breastfeeding for 3 months. Results There was no effect of vitamin B12 supplementation on sleep duration at night, total sleep duration, or WASO. There was a small significant negative effect for SOL. None of the included subgroup analyses revealed effect modification on any of the sleep outcomes. Conclusion Overall, vitamin B12 supplementation did not have an effect on sleep in infants or for high-risk subgroups, with the exception of a small negative effect for SOL. The present study does not support vitamin B12 supplementation to improve sleep in infants.publishedVersio

The feasibility of the Ages and Stages Questionnaire for the assessment of child development in a community setting in Nepal

Background: The Ages and Stages Questionnaire Third Edition (ASQ‐3) may be a feasible and cost‐effective tool to screen children's development in resource poor settings. We have assessed the feasibility of the ASQ‐3 “home procedure” when conducted by fieldworkers in a community‐based nutritional interventional trial on early child development in Nepal. Method: Six hundred children aged 6–11 months at risk of stunting were assessed by trained fieldworkers in their homes by the ASQ‐3. Three fieldworkers performed standardization exercises and were double scored with a gold standard during the study period. Intraclass correlations (ICCs) were calculated to measure the interrater agreement. The internal consistency was expressed by standardized Cronbach's alphas. The association between total ASQ score and gestation, low birth weight, and stunted children is presented to give an estimate of the construct validity of the tool. Result: Mean scores of the 600 Nepalese children were consistently lower than in the American norm sample. The ICCs from the standardization exercises were initially good to excellent but declined throughout the study period. The standardized alphas for the total score in the different age groups indicate good internal consistency but varied in the subscales. Children who were preterm, children with low birth weight, and children who were stunted scored substantially lower on the total ASQ score than those who were not. Conclusion: Although the ASQ‐3 “home procedure” is low at cost and easily accessible in a Nepalese context, the tool requires rigorous and stringent training to achieve acceptable interrater agreement. Further adjustment is required to achieve satisfactory internal consistency.acceptedVersio