Exploration of shame and disclosure in chronic drug dependence

This thesis explores levels of shame in 31 chronic poly-drug users, in an out-patient methadone prescription program, compared to 31 non-drug users closely matched on gender, ethnicity, and socio-economic and employment status. In addition to this, this thesis looks at the relationship between shame and disclosure. All participants completed the Experience of Shame Scale (ESS; Andrews et al., 2002) as well as standard measures of depression, aggression and dissociation. Chronic drug users scored significantly higher on levels of characterological and behavioural shame, but not on bodily shame. However, when controlling for levels of depression, only the group difference on characterological shame remained. Within the chronic drug user group, the level of shame about drug use was significantly higher than characterological, behavioural and bodily shame. Thirty-two percent of the chronic drug users were identified as non-disclosers. Non-disclosure was associated with increased levels of depression and shame on all three standard shame sub-scales on the ESS, but not with shame about drug use. This study replicates previous findings, based on shame measures more susceptible to mood-state effects, that drug dependence is associated with increased shame. It extends the existing literature in terms of suggesting possible sources of shame particular to drug dependence and their relationship to non-disclosure. Implications for treatment and future research are discussed

Dual sensory loss and social participation in older Europeans

The purpose of the study was to describe the prevalence of hearing difficulties, vision difficulties and dual sensory difficulties in 11 European countries, and to study whether sensory difficulties are associated with social inactivity in older Europeans. This cross-sectional study is based on the 2004 data collection of the Survey of Health, Ageing and Retirement in Europe comprising 27,536 men and women aged 50 years and older. Hearing and vision difficulties, as well as participation in seven different social activities were assessed using a structured computer-assisted personal interview. Logistic regression models were used for analyses. Altogether, 5.9 % of the participants reported both hearing and vision difficulties (dual sensory loss), 10.2 % vision difficulties only, and 13.5 % hearing difficulties only. More than two-thirds (68.6 %) of the participants with dual sensory loss were socially inactive compared to half of those who reported no sensory difficulties. The participants who reported dual sensory loss had 2.18 (95 % CI 1.83–2.59) times higher odds for social inactivity compared to persons without hearing or vision difficulties. In a model adjusted for age, gender, mobility, depressive symptoms, cognition, education and wealth the corresponding odds ratio was 1.21 (95 % CI 1.00–1.47). According to our results, sensory difficulties were associated with social inactivity, but the higher likelihood for social inactivity among persons with sensory difficulties was attenuated by other health and socio-economic indicators. Our results suggest that various preventive and rehabilitative actions targeting older persons’ sensory functions may enhance their social activity.peerReviewe

Prevalence of missed nursing care and its association with work experience: A cross-sectional survey

Background: Nurses faced with multiple demands in hospitals are often compelled to prioritize nursing care. Knowledge of missed nursing care provides insight into whether necessary nursing care is delivered, what is missed, and the reasons for missed nursing care. This insight is essential to support evidence-based policy and practice to improve patient care, enhance nursing practice, and optimize the work environment. Research on factors influencing missed nursing care is imperative to implement targeted strategies. However, studies investigating work experience as a predictor are inconclusive, and no identified studies have examined how nurses’ work experience is associated with different elements of missed nursing care. Objectives: To investigate the prevalence and reasons for missed nursing care and whether nurses' work experience was associated with missed nursing care. Design: The design was cross‐sectional, using the Danish version of the MISSCARE survey. Setting: The study was conducted at a public Danish university hospital with 1,150 beds and approximately 10,350 employees. Participants: Across 34 surgical, medical, and mixed bed wards for adults, 1,241 nurses were invited by email to respond anonymously to the Danish MISSCARE survey. Of these nurses, 50.3% responded, and 42.6% fully completed the questionnaire. Methods: A total score mean and a mean score were calculated and then compared between experience (≤5 years/>5 years) in a linear regression model adjusting for unequally distributed variables. Results: More than two thirds of the nurses reported that emotional support, patient bathing, ambulation, mouth care, interdisciplinary conferences, documentation, and assessing effectiveness of medication were frequently missed elements of nursing care. The most significant reasons for missed nursing care were an inadequate number of nurses, an unexpected rise in patient volume, urgent patient situations, heavy admission, and discharge activity. Nurses with work experience of less than 5 years reported more missed nursing care, especially within fundamental care. Conclusions: Nursing elements to avoid potentially critical situations and nursing related to treatment observations were rarely missed, while nursing care elements visible only to the patient and the nurse were most often missed. By increasing transparency and explicitness within nursing care, the results enable critical evaluation of prioritization of nursing care elements. The number of staff not balancing the number and acuity of patients was the main reason for missed nursing care. The perception of missed nursing care was most pronounced in less experienced nurses. The study contributes to the global research community to achieve a broader understanding of missed nursing care. Tweetable abstract: Nursing to avoid potentially critical situations and treatment observations are prioritized over fundamental care, perceived mainly by less experienced nurses

Health and function assessments in two adjacent Danish birth cohorts of centenarians: Impact of design and methodology

International audienceUsing the results from measures of functional ability, cognitive and physical performance from two adjacent birth cohorts of 100-year-old adults, we aimed to elucidate the possible impact of difference in participation rates, design, and interviewer mode. Participants were birth cohort members born in 1910 (DK-1910) and 1911-12 (DK-1911). Both surveys used the same assessment instruments, but the design was different, and data collection was carried out by trained survey agency interviewers in DK-1910 and trained nurses in DK-1911. Participation rate in DK-1911 (49.8 % (251/504)) was lower than in DK-1910 (66.9 % (273/408)) (p < 0.001). The proportion of interviews with the participant answering alone or mainly alone was significantly higher in DK-1911 (77 %) than in DK-1910 (56 %), and the proportion living in nursing home was significantly lower (44 vs. 54 %, respectively). Higher proportions of DK-1911 independently performed all activities of daily living (ADL) compared to DK-1910, but only significantly for toileting, bathing, and feeding (all p < 0.01). Mini-mental state examination (MMSE) score was higher in DK-1911 than in DK-1910 (23.5 vs. 21.0; p < 0.001). Handgrip strength, gait speed, and chair stand were almost similar. DK-1911 participants had significantly better one-year survival than DK-1911 non-participants and DK-1910 participants and non-participants (p = 0.001). These results suggest that lower participation rate entails selection towards healthier participants in terms of ADL and cognitive functioning. Caution is warranted when comparing studies of centenarians with different participation rates, design, and interviewer mode, and further studies of these methodological issues are required

Post-Stroke Mortality, Stroke Severity, and Preadmission Antipsychotic Medicine Use – A Population-Based Cohort Study

<div><p>Background and Purpose</p><p>It has been suggested that antipsychotic medication may be neuroprotective and may reduce post-stroke mortality, but studies are few and ambiguous. We aimed to investigate the post-stroke effects of preadmission antipsychotic use.</p><p>Methods</p><p>We conducted a nationwide, population-based cohort study of 81,143 persons admitted with stroke in Denmark from 2003–2010. Using Danish health care databases, we extracted data on preadmission use of antipsychotics and confounding factors. We examined the association between current, former, and never use of antipsychotics and stroke severity, length of hospital stay, and 30-day post-stroke mortality using logistic regression analysis, survival analysis, and propensity score matching.</p><p>Results</p><p>Current users of antipsychotics had a higher risk of severe or very severe stroke on The Scandinavian Stroke Scale than never users of antipsychotics (adjusted odds ratios, 1.43; 95% CI, 1.29–1.58). Current users were less likely to be discharged from hospital within 30 days of admission than never users (probability of non-discharge, 27.0% vs. 21.9%). Antipsychotics was associated with an increased 30-day post-stroke mortality among current users (adjusted mortality rate ratios, 1.42; 95% CI, 1.29–1.55), but not among former users (adjusted mortality rate ratios, 1.05; 95% CI, 0.98–1.14).</p><p>Conclusions</p><p>Preadmission use of antipsychotics was associated with a higher risk of severe stroke, a longer duration of hospital stay, and a higher post-stroke mortality, even after adjustment for known confounders. Antipsychotics play an important role in the treatment of many psychiatric conditions, but our findings do not support the hypothesis that they reduce stroke severity or post-stroke mortality.</p></div