Identification of Children of Mentally Ill Patients and Provision of Support According to the Norwegian Health Legislation: A 11-Year Review

Background: According to amended legislation implemented in Norway in 2010, personnel in healthcare services for adults are obligated to identify patients’ minor children and to assess the family situation. Health personnel is also obligated to contribute to adequate support to families affected by parental mental illness or substance use disorders. The intention behind the amendment was to support and protect children of mentally ill parents, as they are at risk of developing problems of their own. The aim of the present study was to evaluate health personnel’s practice during the years 2010-2020, more specifically; (a) to what extent children of patients with mental illness and substance use disorders are registered in patient records, and (b) to what extent activities relating to the assessment and support of patients’ minor children are documented in patient records. Method: The participants in the study are patients admitted to Division for Mental Health and Substance Use at the University Hospital of North Norway in the years 2010–2020. The data was drawn from patient records during October 2021. Results: The registration of patients’ minor children is considerably strengthened since the introduction of the new Norwegian Health Personnel Act in 2010, and estimates show that 56% of patients’ minor children are identified. However, only 31% of cases where patients have identified minor children this result in health personnel performing activities to support the children. Discussion: Based on the rising proportion of identified minor children throughout the 10-year period, it seems evident that the dissemination efforts have contributed to the development of some new skills among health personnel. However, compared with the national estimation that 35% of mentally ill and substance abusing patients have minor children, a large proportion of children remains unidentified. After identification, there seem to still be a long way to go before minor children are systematically offered support. Different solutions to strengthen the implementation of new skills in clinical practice, to ensure the identification of minor children and provision of necessary support for them is discussed

Target Values and Daytime Variation of Bone Turnover Markers in Monitoring Osteoporosis Treatment After Fractures

The serum bone turnover markers (BTM) procollagen type 1 N-terminal propeptide (P1NP) and C-terminal cross-linking telopeptide of type 1 collagen (CTX) are recommended for monitoring adherence and response of antiresorptive drugs (ARD). BTM are elevated about 1 year after fracture and therefore BTM target values are most convenient in ARD treatment follow-up of fracture patients. In this prospective cohort study, we explored the cut-off values of P1NP and CTX showing the best discriminating ability with respect to adherence and treatment effects, reflected in bone mineral density (BMD) changes. Furthermore, we explored the ability of BTM to predict subsequent fractures and BTM variation during daytime in patients using ARD or not. After a fragility fracture, 228 consenting patients (82.2% women) were evaluated for ARD indication and followed for a mean of 4.6 years (SD 0.5 years). BMD was measured at baseline and after 2 years. Serum BTM were measured after 1 or 2 years. The largest area under the curve (AUC) for discrimination of patients taking ARD or not was shown for P1NP 2% gain in BMD (lumbar spine and total hip) was largest at cut-off values for P1NP <30 μg/L and CTX <0.25 μg/L. Higher P1NP was associated with increased fracture risk in patients using ARD (hazard ratio [HR]logP1NP = 15.0; 95% confidence interval [CI] 2.7–83.3), p = 0.002. P1NP and CTX were stable during daytime, except in those patients not taking ARD, where CTX decreased by 21% per hour during daytime. In conclusion, P1NP <30 μg/L and CTX <0.25 μg/L yield the best discrimination between patients taking and not taking ARD and the best prediction of BMD gains after 2 years. Furthermore, higher P1NP is associated with increased fracture risk in patients on ARD. BTM can be measured at any time during the day in patients on ARD.publishedVersio

A comprehensive profile of circulating RNAs in human serum

Non-coding RNA (ncRNA) molecules have fundamental roles in cells and many are also stable in body fluids as extracellular RNAs. In this study, we used RNA sequencing (RNA-seq) to investigate the profile of small non-coding RNA (sncRNA) in human serum. We analyzed 10 billion Illumina reads from 477 serum samples, included in the Norwegian population-based Janus Serum Bank (JSB). We found that the core serum RNA repertoire includes 258 micro RNAs (miRNA), 441 piwi-interacting RNAs (piRNA), 411 transfer RNAs (tRNA), 24 small nucleolar RNAs (snoRNA), 125 small nuclear RNAs (snRNA) and 123 miscellaneous RNAs (misc-RNA). We also investigated biological and technical variation in expression, and the results suggest that many RNA molecules identified in serum contain signs of biological variation. They are therefore unlikely to be random degradation by-products. In addition, the presence of specific fragments of tRNA, snoRNA, Vault RNA and Y_RNA indicates protection from degradation. Our results suggest that many circulating RNAs in serum can be potential biomarkers

The effect of feedback to general practitioners on quality of care for people with type 2 diabetes. A systematic review of the literature

<p>Abstract</p> <p>Background</p> <p>There have been numerous efforts to improve and assure the quality of treatment and follow-up of people with Type 2 diabetes (PT2D) in general practice. Facilitated by the increasing usability and validity of guidelines, indicators and databases, feedback on diabetes care is a promising tool in this aspect. Our goal was to assess the effect of feedback to general practitioners (GPs) on the quality of care for PT2D based on the available literature.</p> <p>Methods</p> <p>Systematic review searches were conducted using October 2008 updates of Medline (Pubmed), Cochrane library and Embase databases. Additional searches in reference lists and related articles were conducted. Papers were included if published in English, performed as randomized controlled trials, studying diabetes, having general practice as setting and using feedback to GPs on diabetes care. The papers were assessed according to predefined criteria.</p> <p>Results</p> <p>Ten studies complied with the inclusion criteria. Feedback improved the care for PT2D, particularly process outcomes such as foot exams, eye exams and Hba1c measurements. Clinical outcomes like lowering of blood pressure, Hba1c and cholesterol levels were seen in few studies. Many process and outcome measures did not improve, while none deteriorated. Meta analysis was unfeasible due to heterogeneity of the studies included. Two studies used electronic feedback.</p> <p>Conclusion</p> <p>Based on this review, feedback seems a promising tool for quality improvement in diabetes care, but more research is needed, especially of electronic feedback.</p

A low-gluten diet induces changes in the intestinal microbiome of healthy Danish adults

\ua9 2018, The Author(s). Adherence to a low-gluten diet has become increasingly common in parts of the general population. However, the effects of reducing gluten-rich food items including wheat, barley and rye cereals in healthy adults are unclear. Here, we undertook a randomised, controlled, cross-over trial involving 60 middle-aged Danish adults without known disorders with two 8-week interventions comparing a low-gluten diet (2 g gluten per day) and a high-gluten diet (18 g gluten per day), separated by a washout period of at least six weeks with habitual diet (12 g gluten per day). We find that, in comparison with a high-gluten diet, a low-gluten diet induces moderate changes in the intestinal microbiome, reduces fasting and postprandial hydrogen exhalation, and leads to improvements in self-reported bloating. These observations suggest that most of the effects of a low-gluten diet in non-coeliac adults may be driven by qualitative changes in dietary fibres

Physical activity and diabetes in the South-Asian population in Oslo

Physical activity and diabetes in the South-Asian population in Oslo Trine Lauritzen , Gerd Holmboe-Ottesen (tutor). Marz 2005 Background: Oslo is the city in Norway with the largest population of immigrants from from the South-Asian countries. The prevalence of selfreported diabetes in this group is high (11%) compared to norwegians (2,6%) and immigrants from western countries, and the actual prevalence is even higher. My project comprises investigation of the patterns of physical activity in the South-Asians in relation to better understanding of the high diabetes prevalence, because it is a well-known fact that inactivity and obesity is related to diabetes. Materials and methods: In 2000-2001, a total of 18770 individuals, 45,9% of those invited, participated in the Oslo Health Study. 508 originated from South Asia (Pakistan, India, Bangladesh and Sri Lanka), in this cross-sectional survey, with 5 age cohorts (30-76 years). Particpants received a postal invitation with a questionnaire and thereafter attended a physical examination with several measurements and blood sample. Additional questionnaires were handed out, but my analysis are based on the first one (Main qustoinnaire). The statistical program SPSS was used for the analysis. Results: I have found that the South Asians are less physically active than the norwegians. 55% of the men and 50% of the women were doing light exercise less than one hour per week or not at all (norwegians 17% men and 15% women). I also found that the women were less active than the men. I made an index for physical activity from 1-10. 1-2 means inactive, 3-4 some active and so on. Men scored mean 3,8 and women 3,6 (norwegians total mean was 5,8). I have found that low physical activity are related to high hip-waist-ratio in women, and high bloodlglucoses among those without known diabetes. There is no significant differece in physical activity beteween those with selfreported diabetes and those without. Conclusion: Physically inactivity may very well be one of the reasons why the South Asians in Oslo have a high prevalence of diabetes, and interventions done in the right manner can benefit this group

Økonomisk sosialhjelp er mer enn stønadsutbetaling: Følgeevaluering av Prosjekt forsvarlige tjenester Hedmarken (PROFH)

Høgskolen i Innlandet har gjennomført en følgeevaluering av «Prosjekt forsvarlige tjenester Hedmarken» (PROFH) gjennom hele 2019. I denne rapporten dokumenterer vi prosessen og erfaringer i prosjektet. PROFH er fase tre av samarbeidsprosjektet «Økte sosialhjelpsutgifter» som Nav Ringsaker, Nav Hamar, Nav Stange og Nav Løten har hatt siden 2014. Prosjektet er initiert av Ringsaker kommune og finansiert av Fylkesmannen i Hedmark. Hovedfunnene fra følgeevalueringen er at det var en entydig positiv innstilling til prosjektet fra både kommuneledelse, Nav-ledere og veiledere i de fire deltakende kommunene. Fra alle var det en forventning om at prosjektet kunne bidra til likere praksis og mer likeverdige tjenester både internt ved kontorene og i regionen, samt en effektivisering i form av tidsbruk totalt og iverksetting av egnende og målrettede aktiviteter og tiltak for brukere. Med andre ord var det en forventing om at prosjektet kan føre med seg positive effekter for både den ansatte, kontoret, regionen og brukerne. Forventningene til prosjektet erfares å være imøtekommet. Alle planlagte aktiviteter har vært gjennomført, og dette har bidratt til en praksisendring ved alle kontorene. Disse endringene har vist seg størst i siste halvdel av prosjektperioden