Asymmetry in inter-municipal cooperation in health services – how does it affect service quality and autonomy?

Throughout Europe, local health services are increasingly being provided through various forms of inter-municipal cooperation (IMC). One of the most common forms of IMC is when small municipalities delegate the operational responsibility for providing health services to a larger host municipality. However, despite the size asymmetry usually inherent in this type of IMC, this aspect has largely been neglected in the existing literature, which mainly focuses on the size of individual municipalities. Based on data from 97 partner municipalities and 25 host municipalities in Norway, this study examines how varying degrees of size asymmetry between them affect the perceived service quality and loss of autonomy resulting from IMC in health services. From the perspective of the relatively smaller partner municipalities, the results suggest that these are likely to benefit greatly from size asymmetry in terms of improved service quality, although this would appear to be at the expense of losing decision-making autonomy to their host. However, from the perspective of the relatively larger hosts municipalities, this type of asymmetry is likely to affect service quality negatively while having no effect on decision-making autonomy.publishedVersio

‘Health in All Policies’ and the Urge for Coordination: The Work of Public Health Coordinators and Their Impact and Influence in Local Public Health Policies: A Cross-Sectional Study

Building heavily on the Health in All Policies (HiAP) approach, Norway implemented the Public Health Act in 2012 to reduce social inequalities in health. Local public health coordinators (PHCs) at municipal levels were seen as tools to provide local intersectoral public health work. In this study, we examine factors related to intersectoral agency and if intersectoral work is understood as relevant to securing social justice in local policy outcomes. A national web-based survey in 2019 of all Norwegian PHCs (n = 428) was conducted with a response rate of 60%. Data were analysed through multiple linear regression, hierarchical regression modelling and structural equation modelling. Neither factors relating to community contexts nor individual characteristics were associated with intersectoral agency. Organisational factors, especially position size, being organised at the top level and having a job description, were significantly associated with perceptions of intersectoral agency. PHCs seeing themselves as intersectoral agents also found themselves able to affect annual budgets and policy outcomes. We conclude that municipal PHC positions can be important HiAP tools in local public health policies. However, organisational factors affect how PHCs perceive their influence and role in the municipal organisation and thereby their possibilities to influence local policymaking through intersectoral agencypublishedVersio

Predictors of weight loss after an intensive lifestyle intervention program in obese patients: a 1-year prospective cohort study

Published Version of an article in the journal: Health and Quality of Life Outcomes. Also available from the publisher at: http://dx.doi.org/10.1186/1477-7525-11-165 Open accessBackground Studies of lifestyle intervention programs in morbid obesity report large variations in weight loss outcomes. This is reported not only between but also within standardized programs. Such reports point to participants’ characteristics as possible predictors of this outcome. The aim of this prospective cohort study was to identify predictors of weight loss after a 1-year partly residential intensive lifestyle intervention program (ILI). Methods Morbidly obese patients (n=199), all Caucasian, 71% women, mean (SD) age 45.2 (11.1) years, body mass index (BMI) 42.0 (6.2) kg/m2, and excess body weight (>BMI=25 kg/m2) 49.4 (19.6) kg, were referred from public hospitals to a rehabilitation center and enrolled consecutively. The 1-year ILI comprised of four (n=104) or five (n=95) stays at the rehabilitation center. In both cases there was one main stay for 4 weeks and the remaining stays lasted 1 week each. In the home periods the patients were followed up by telephone and by their general practitioners (GP). The patients were also encouraged to use a predefined paper based diary. Health related quality of life (HRQL), diagnostic, anthropometric, socio-demographic, psychosocial and intervention characteristics were measured at baseline, 12 weeks and 1 year. Multiple linear regression analyses were performed to extract possible predictors of weight loss at 1-year. Direct and indirect effects of these predictors were tested through structural equation modeling. Results The mean (SD) 1-year weight loss was 10 (11) kg, corresponding to an 8 (8) % reduction of body weight from baseline. Mean excess weight loss (EWL) was 20 (22) % ranging from 104% to -77%. The adherence to a diary (r=.16), type 2 diabetes (r=-.14) and frequency of GP-visits (r=.23) were significantly associated with EWL at 12 weeks. Predictors of 1-year EWL were 12 week EWL (r=.66), occupational status (r=.11), age (r=.19), and mental HRQL (r=-.16), all p<.05. The path model explained 50% of the variation (r2=.50) of 1-year EWL. Conclusion Larger 12 week weight loss, being employed, lower mental HRQL and being older predicts larger weight loss after 1 year in morbidly obese patients following ILI. Not having type 2 diabetes, using a diary combined with regular GP follow-up influence the 12-week weight loss

Associations between nurse managers’ leadership styles, team culture and competence planning in Norwegian municipal in-patient acute care services: A cross-sectional study

Background Increased complexity in the primary healthcare services has followed in the wake of health reforms and reveals the need for competence enhancement in the nursing services. Effective and visionary leadership, sufficiently qualified staff and cooperation among professionals are considered as key measures to safeguard quality in the services. Aims To identify which leadership styles characterise first-line nurse managers in Norwegian municipal in-patient acute care (MipAC) units and to investigate how first-line nurse managers’ leadership styles are associated with team culture and documented nursing competence planning. Methods A cross-sectional survey was distributed to all the first-line nurse managers in Norwegian MipAC units (n = 229). Data were collected between March and June 2019. The response rate was 80.5% (n = 182). First-line managers’ background information and data about their focus on team culture and competence planning were recorded. Furthermore, we noted organisational structural characteristics, and managers’ transformational (relational) leadership and transactional (task-oriented) leadership styles. Results The managers exhibited a high degree of transformational leadership behaviour, which was significantly associated with team culture. No significant associations between leadership behaviours and documented competence planning were found. Notably, we found a significant correlation between transformational and transactional leadership styles, indicating that the managers adapt their leadership behaviours to actual requirements and situations. Organisational structural factors: the share of registered nurses (RNs) on the staff and having a position for a professional development nurse were positively associated with competence planning. Conclusion A relational leadership style promotes team culture and both factors may empower the professional nursing environment. However, first-line nurse managers need to acknowledge nursing competence planning as a central part of effective leadership. Having a professional development nurse position seems to complement leadership and ease the manager's responsibilities regarding team culture and competence planning.publishedVersio

Materiell og profesjonell stigmatisering av mennesker med sykelig overvekt

The aim of this study is to show how people suffering from severe obesity mightexperience stigmatization. We interviewed 6 persons recruited from aNorwegian rehabilitation center, specialized in lifestyle intervention in severeobesity. We found that the participants suffering from severe obese experiencedstigmatization and thus felt that they a) did not fit into the materiel world and b)experienced a lack of respect from health care professionals. The results arediscussed according to how contemporary symbols are embedded in oursurroundings and in our bodies. The conclusion underlines severe obesity as acomplex problem which is strengthened by rooms and interior designed for idealsizes. The prejudices that health care professionals express worsen thesepatients feeling of stigma. We refer to this as material and professionalstigmatization

Single-centre, triple-blinded, randomised, 1-year, parallel-group, superiority study to compare the effects of Roux-en-Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes and β-cell function in subjects with morbid obesity: a protocol for the Obesity surgery in Tønsberg (Oseberg) study

publishedVersio

Employment Is Associated with the Health-Related Quality of Life of Morbidly Obese Persons

Published version of an article in the journal: Obesity Surgery. The original publication is available at Springerlink. http://dx.doi.org/10.1007/s11695-010-0289-6. Open AccessBackground&nbsp;&nbsp;We aimed to investigate whether employment status was associated with health-related quality of life (HRQoL) in a population of morbidly obese subjects. Methods&nbsp;&nbsp;A total of 143 treatment-seeking morbidly obese patients completed the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36) and the Obesity and Weight-Loss Quality of Life (OWLQOL) questionnaires. The former (SF-36) is a generic measure of physical and mental health status and the latter (OWLQOL) an obesity-specific measure of emotional status. Multiple linear regression analyses included various measures of the HRQoL as dependent variables and employment status, education, marital status, gender, age, body mass index (BMI), type 2 diabetes, hypertension, obstructive sleep apnea, and treatment choice as independent variables. Results&nbsp;&nbsp;The patients (74% women, 56% employed) had a mean (SD, range) age of 44 (11, 19–66) years and a mean BMI of 44.3 (5.4) kg/m2. The employed patients reported significantly higher HRQoL scores within all eight subscales of SF-36, while the OWLQOL scores were comparable between the two groups. Multiple linear regression confirmed that employment was a strong independent predictor of HRQoL according to the SF-36. Based on part correlation coefficients, employment explained 16% of the variation in the physical and 9% in the mental component summaries of SF-36, while gender explained 22% of the variation in the OWLQOL scores. Conclusion&nbsp;&nbsp;Employment is associated with the physical and mental HRQoL of morbidly obese subjects, but is not associated with the emotional aspects of quality of life

&lsquo;Health in All Policies&rsquo; and the Urge for Coordination: The Work of Public Health Coordinators and Their Impact and Influence in Local Public Health Policies: A Cross-Sectional Study

Building heavily on the Health in All Policies (HiAP) approach, Norway implemented the Public Health Act in 2012 to reduce social inequalities in health. Local public health coordinators (PHCs) at municipal levels were seen as tools to provide local intersectoral public health work. In this study, we examine factors related to intersectoral agency and if intersectoral work is understood as relevant to securing social justice in local policy outcomes. A national web-based survey in 2019 of all Norwegian PHCs (n = 428) was conducted with a response rate of 60%. Data were analysed through multiple linear regression, hierarchical regression modelling and structural equation modelling. Neither factors relating to community contexts nor individual characteristics were associated with intersectoral agency. Organisational factors, especially position size, being organised at the top level and having a job description, were significantly associated with perceptions of intersectoral agency. PHCs seeing themselves as intersectoral agents also found themselves able to affect annual budgets and policy outcomes. We conclude that municipal PHC positions can be important HiAP tools in local public health policies. However, organisational factors affect how PHCs perceive their influence and role in the municipal organisation and thereby their possibilities to influence local policymaking through intersectoral agency

Standaryzacja tekstów w perspektywie historycznej. Analiza zbitek leksykalnych = Text-type standardisation in a historical perspective. Analysing lexical bundles

No abstract available

Generic Health-Related Quality of Life May Not Be Associated with Weight Loss 4 Years After Bariatric Surgery: a Cross-Sectional Study

Background: There seem to exist a belief that weight-loss is proportionally associated with improvement of health-related quality of life (HRQoL) after bariatric surgery. HRQoL is a complex multidimensional construct of one’s perception of health and well-being and is measured through generic and disease specific questionnaires. Objectives: This study aimed to test the associations between weight-loss after bariatric surgery, and both generic and obesity-specific HRQoL, and mental distress, controlling for other patient characteristics. Methods: The study was conducted at the Department of Surgery at Haugesund Hospital (Norway) based on a cohort of bariatric surgery patients operated between 2010 and 2013. Primary outcome measures included the SF-36 (generic HRQoL), IWQoL-Lite (obesity-specific HRQoL), and HADS (mental distress). Blocks of variables (time since surgery, personal characteristics, socioeconomics, comorbidities, surgical complications, experienced life crisis, and weight-loss) were entered into hierarchical linear regression models with the four outcome measures as dependent variables. Cumulative explained variance (r2) and increase in r2 after entry of each block of variables is reported. Results: A total of 206 completed the outcome measures a mean (SD) of 4.4 (1.1) years after surgery. The generic SF-36 physical and mental composite scores were significantly associated (p<.05) with socioeconomics, baseline comorbidities and surgical complications. Obesity-specific IWQoL-Lite scores were significantly (p<.05) associated with weight-loss. Conclusions: The study indicates that post-operative weight loss is associated with obesity-specific HRQoL but demonstrates no associations between weight-loss and generic HRQoL, when controlling for other patient characteristics