Health Services In Norway Research Articles

The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care

Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics (i.e., ethical theory, moral deliberation and clinical ethics support) in such initiatives. This study adds to this subject by exploring health professionals' descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were carried out in 2012 with key informants in charge of central development projects and quality-assurance work in mental health services in Norway. No facilities used formal clinical ethics support. However, the informants described five areas in which ethics was of importance: moral concerns as implicit parts of local quality improvement initiatives; moral uneasiness and idealism as a motivational source of change; creating a normative basis for development work; value-based leadership; and increased staff reflexivity on coercive practices. The study shows that coercion entails both individual and institutional ethical aspects. Thus, various kinds of moral deliberation and ethics support could contribute to addressing coercion challenges by offering more systematic ways of dealing with moral concerns. However, more strategic use of implicit and institutional ethics is also needed.

Comorbidity and Childhood Epilepsy: A Nationwide Registry Study.

Children with epilepsy are at increased risk of other disorders and difficulties, preceding, cooccurring with, or after the diagnosis of epilepsy. Risk estimates vary, few studies are population-based, and few provide comprehensive assessments of comorbidities. We used nationwide registry data to describe frequencies of medical, neurologic, developmental, and psychiatric conditions occurring before and after children are diagnosed with childhood epilepsy. Data were obtained from the Norwegian Patient Registry, which is an administrative database recording International Classification of Diseases, 10th Revision diagnoses from all government-funded specialist health services in Norway (outpatient consultations and hospitalizations). We included data from the years 2008 through 2013 for all children born in Norway between 1996 and 2013 (0-17 years of age at the end of follow-up). Children with epilepsy were compared with the general child population, adjusting for sex and age. We also compared children with complicated epilepsies (ie, epilepsies with additional neurologic and/or developmental disorders) to children with uncomplicated epilepsies. The study population included 1 125 161 children. There were 6635 (0.6%) children with epilepsy. Nearly 80% of children with epilepsy had ≥1 comorbid disorder. All types of disorders were more frequent in children with epilepsy, with additional medical disorders recorded in 55%, neurologic disorders in 41%, and developmental/psychiatric disorders in 43%. Children with complicated epilepsies had the highest overall levels of comorbidity, but the risk of medical and psychiatric comorbidities was also substantial among children with uncomplicated epilepsies. The overall frequency of comorbid disease is high in children with epilepsy, including children with presumably uncomplicated epilepsies.

"Where to find those doctors?" A qualitative study on barriers and facilitators in access to and utilization of health care services by Polish migrants in Norway.

BackgroundPoles constitute the largest group of migrants in Norway. Research confirms a steady inflow and a minimal outflow of Polish migrants. One of the key aspects of migrants’ structural integration is access to health care services. This study explored barriers to and facilitators of Polish migrants’ access to Norwegian health care services.MethodsA qualitative interview-based study was carried out between November 2013 and July 2014. The study is part of a larger, ongoing mixed-method study of Polish migrants’ access to health care services in Norway. Semi-structured interviews were conducted with 19 Polish migrants in Oslo. The interviews were transcribed, coded, and analyzed. Thematic analysis was performed to identify barriers and facilitators related to the use of Norwegian health care services.ResultsMigrants experienced several barriers to and facilitators of access to health care services in Norway. The barriers most often mentioned were problems resulting from insufficient command of the language, related communication problems, and lack of knowledge about navigating the Norwegian health care system. Other barriers related to the organization of the health care system, perceptions of doctors’ skills and practices, and attitudes among health personnel. Factors such as having a Polish social network, meeting friendly health personnel, and perceptions of equal treatment of all patients, facilitated access to and use of health care services.ConclusionsThe study shows that there are both system- and patient-related barriers to and facilitators of migrants’ access to health services in Norway. These findings suggest that successful inclusion of migrants into the Norwegian health system requires regular evaluation of access and utilization of health care services.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1715-9) contains supplementary material, which is available to authorized users.

Posterior composites and new caries on adjacent surfaces - any association? Longitudinal study with a split-mouth design.

BackgroundThe aim of this longitudinal study was to compare caries incidence in sound approximal surfaces adjacent to newly placed composite restorations with the caries incidence in corresponding surfaces in contralateral teeth without any restorations in contact; and to assess risk factors for dentine caries development on adjacent and control surfaces.MethodsData from a practice-based study, where 4030 posterior approximal restorations placed in permanent teeth by clinicians working in a Public Dental Health Service in Norway, were used. The study was approved by the Regional Committee for Medical Research Ethics. The present study is based on a subsample of patients with a sound surface adjacent to a newly placed composite posterior approximal restoration. All individuals who had intact corresponding contralateral pairs of teeth in the same jaw, were included.At the end of the follow-up period, the study restorations and their adjacent surfaces were evaluated clinically and radiographically. Status of the contralateral tooth pair at baseline and end point was based on recordings from routine dental examinations, retrospectively extracted from the electronic dental records.ResultsOne hundred and ninety three patients (mean age 15.0 years, SD = 3.4) met the inclusion criteria. The surfaces were followed on average for 4.8 years. Follow-up observations revealed that 41 % of adjacent surfaces remained sound, compared with 67 % of the control surfaces (p < 0.001). Restorations were placed in 17 % of adjacent surfaces, compared with 3 % of the control surfaces (p < 0.001). In multivariate logistic regression analysis adjacent surfaces in maxillary teeth had increased risk for dentine caries development (OR 3.1, CI 1.3–7.3).ConclusionsCaries incidence in intact approximal surfaces adjacent to newly placed composite posterior approximal restorations was significantly higher compared with the contralateral control surface without a restoration in contact. Adjacent surfaces in maxillary teeth had increased risk for dentine caries development.

Caring through discipline? Analyzing house rules in community mental health services in Norway

In Scandinavian countries, public housing and recreation programs for people suffering from mental health or substance abuse problems emphasize normalization of life and participation in a normal social life. The theoretical approach taken by community health care services has been de-institutionalization. To study if and how this movement from patient to fully participating citizen was reflected in these new institutions, written house rules in sheltered housing and day centers for adults were collected and analyzed by content analysis. The findings show that the formal language represents the voice of professionals, while the content pertained to regulation of the service user’s daily life. House rules mostly mediate an image of the service user as a person in need of being controlled, and the ideological practices of hospital-managed care seem to be maintained.

Accreditation of occupational health services in Norway.

BackgroundIn 2010, an accreditation system for occupational health services (OHS) in Norway was implemented.AimsTo examine OHS experiences of the accreditation system in Norway 4 years after its implementation.MethodsA web-based questionnaire was sent to all accredited OHS asking about their experiences with the accreditation system. Responses were compared with a similar survey conducted in 2011.ResultsThe response rate was 76% (173/228). OHS reported that the most common changes they had had to make to achieve accreditation were: improvement of their quality assurance system (53%), a plan for competence development (44%) and increased staffing in occupational hygiene (36%) and occupational medicine (28%). The OHS attributed improved quality in their own OHS (56%) and in OHS in Norway (47%), to the accreditation process.ConclusionsThe accreditation system was well accepted by OHS, who reported that it had improved the quality of their OHS and of OHS in Norway. The results are similar to the findings of a 2011 survey.

Interprofessional collaboration in the mental health services in norway.

The aim of this study was to describe and interpret interprofessional collaboration between healthcare professionals (HCPs) working at the district psychiatric centre (DPC) and employed in community mental health care (CMHC) using a dialogue-oriented co-operative approach. Data were collected by means of multistage focus groups and qualitative content analysis was performed. The main theme “development of interprofessional collaboration by means of organisational strategies and interactional styles” encompassed the following categories: “improved communication skills,” “developing structures for coordination and responsibility” and “ increased professional insight into the values and conditions necessary for decision-making.” In conclusion, more attention should be paid to leadership in terms of coordination and feedback. The HCPs must be acknowledged, understood and strengthened in their work to improve the quality of CMHC. Finally, we recommend that a range of organisational and administrative models of care be used in order to support improvement work.

Norwegian industry and health promotion 1910-1967.

The development of occupational health services in Norway is explored by making a case study of both a chocolate factory and a cement factory. The study shows how different motives and ideological positions promoted the industrial health service. Prominent among them were a social and political philosophy, those of welfare capitalism, as an alternative to socialism and state policy in building the affluent society and the move toward improvements of production. All leading to a growing interest in the human factor in industry, where the medical officer should help to shape a satisfied, rational and productive worker in a healthy work environment.

Reaching out to people struggling with their lives: a discourse analysis of answers from Internet-based services in Norway and Sweden.

The Internet has enlarged the scope of human communication, opening new avenues for connecting with people who are struggling with their lives. This article presents a discourse analysis of 101 responses to 98 questions that were posted on 14 different Internet-based mental health services in Norway and Sweden. We aimed to examine and describe the dominant understandings and favored recommendations in the services’ answers, and we reflected upon the social consequences of those answers. The services generally understood life struggles as an abnormal state of mind, life rhythms, or self-reinforcing loops. Internet-based mental health services primarily counsel service users to seek help, talk to health care professionals face-to-face, and discuss their life struggles openly and honestly. They also urge service users to take better care of themselves and socialize with other people. However, such answers might enhance the individualization of life problems, masking social origin and construction. Consequently, the services are challenged to include social explanations in their answers and strengthen their responsibility to amplify peoples’ messages at a societal level. Potentially, such answers could strengthen democratic structures and put pressure on social equity.

Happiness, inspiration and the fully functioning person: Separating hedonic and eudaimonic well-being in the workplace

The study investigates the idea that feeling good and functioning well-being are regulated by two different mechanisms: hedonic and eudaimonic. At the state level it is assumed that happiness is a hedonic feeling typically experienced when life is easy or a goal is reached. Inspiration is a eudaimonic feeling typically experienced when facing challenges in the process of goal attainment. At the trait level, we assume that personal growth is connected with eudaimonic rather than hedonic mechanisms. These assumptions were confirmed with data from 465 employees of the Occupational Health Services in Norway using day reconstruction method. Multilevel analyses showed that complex work situations increased inspiration and decreased happiness. Personal growth had a stronger effect on inspiration than on happiness. Our results support the idea that pleasant feelings (hedonia) and optimal functioning (eudaimonia) have different roles to play in the regulation of behavior, and therefore need to be distinguished from one another.

Internet-based Mental Health Services in Norway and Sweden: Characteristics and Consequences

Internet-based mental health services increase rapidly. However, national surveys are incomplete and the consequences for such services are poorly discussed. This study describes characteristics of 60 Internet-based mental health services in Norway and Sweden and discusses their social consequences. More than half of the services were offered by voluntary organisations and targeted towards young people. Professionals answered service users' questions in 60% of the services. Eight major themes were identified. These characteristics may indicate a shift in the delivery of mental health services in both countries, and imply changes in the understanding of mental health.

The effects of performance appraisal in the Norwegian municipal health services: a case study

IntroductionPrevious research in performance appraisal (PA) indicates that variation exists in learning and job motivation from performance appraisal between occupational groups. This research evaluates the potential effect of job motivation, learning and self-assessment through performance appraisals for health personnel.Case descriptionThis article focuses on goal-setting, feedback, participation and training in performance appraisals in municipal health services in Norway; and job motivation, learning and self-assessment of performance are the dependent factors. Questionnaires were distributed to a representative sample of 600 health personnel from the Norwegian municipal health service, with a response rate of 62%. Factor analysis and regression analysis were run in SPSS 12.Discussion and evaluationThe study suggests that respondents learn from performance appraisal. Nurses experienced some higher job motivation from performance appraisal than auxiliary nurses. All subordinates perceived higher job motivation after performance appraisal than managers.ConclusionUseful feedback, active participation and higher education are fundamental elements of discussion in performance appraisal, as well as the role of increasing employees' job motivation. In this study, nurses' job motivation seems to be more effected by PA, than for auxiliary nurses. Both nurses and auxiliary nurses indicate that there is a learning effect from PA. This study may be of interest to health researchers and managers in municipal health services.

Inpatient service providers’ perspectives on service user involvement in Norwegian community mental health centres

For two decades, mental health services in Norway have focused on service user involvement. Despite this, there is little knowledge about how inpatient mental health services have promoted user involvement. To examine service providers' reports of service user involvement at the individual and departmental levels in Norwegian community mental health centres (CMHCs). One hundred and eighty six (186) inpatient service providers in five CMHCs filled out a questionnaire. Confirmatory factor analysis showed that service provider perceptions and awareness of service user involvement can be measured by three subscales: organizational user involvement; patient collaboration; and assisted patient involvement. Little user involvement was reported at the departmental level. Providers more often reported user involvement at the individual level. Providers in two of the CMHCs reported a somewhat higher degree of departmental-level user involvement. There were no significant differences across gender, age, leader position, profession and job tenure, though evening/night shift workers reported a lesser degree of user involvement. The results suggest that user involvement at the departmental level needs to be addressed in future efforts to promote user involvement in CMHCs.

Time-trends in the utilization of decentralized mental health services in Norway - A natural experiment: The VELO-project.

BackgroundThere are few reports on the effects of extensive decentralization of mental health services. We investigated the total patterns of utilization in a local-bed model and a central-bed model.MethodsIn a time-trend case-registry design, 7635 single treatment episodes, from the specialist and municipality services in 2003-2006, were linked to 2975 individual patients over all administrative levels. Patterns of utilization were analyzed by univariate comparisons and multivariate regressions.ResultsTotal treated prevalence was consistently higher for the central-bed system. Outpatient utilization increased markedly, in the central-bed system. Utilization of psychiatric beds decreased, only in the central-bed system. Utilization of highly supported municipality units increased in both systems. Total utilization of all types of services, showed an additive pattern in the local-bed system and a substitutional pattern in the central-bed system. Only severe diagnoses predicted inpatient admission in the central-bed system, whereas also anxiety-disorders and outpatient consultations predicted inpatient admission in the local-bed system. Characteristics of the inpatient populations changed markedly over time, in the local-bed system.ConclusionsGeographical availability is not important as a filter in patients' pathway to inpatient care, and the association between distance to hospital and utilization of psychiatric beds may be an historical artefact. Under a public health-insurance system, local psychiatric personnel as gatekeepers for inpatient care may be of greater importance than the availability of local psychiatric beds. Specialist psychiatric beds and highly supported municipality units for people with mental health problems do not work together in terms of utilization. Outpatient and day-hospital services may be filters in the pathway to inpatient care, however this depends on the structure of the whole service-system. Local integration of psychiatric services may bring about additive, rather than substitutional patterns of total utilization. A large proportion of decentralized psychiatric beds may hinder the development of various local psychiatric services, with negative consequences for overall treated prevalence.

Amtsfysikus Christian Lintrups virke i Hedemarkens amt i årene 1800-31

The first decades after 1800 were dominated by war, bad crops and epidemics and the few existing public physicians worked under difficult conditions. A review of medical reports from the period 1804-31 and county physician Christian Lintrup's (1768-1844) correspondence with other public physicians in the county of Hedmark (Hedemarken at the time) and the county official (their administrative leader). Lintrup was born in Denmark, took his medical university degree in 1798 in Copenhagen and was appointed county physician in Hedemarken in 1799. The doctors had a basic salary and their possibility for an income from private practice was uncertain, especially in the rural districts. Many sick calls required long and time-consuming journeys. Use of quacks was common, not only among the poor. Lintrup's work was affected by the Age of Reason's rationalism and belief in knowledge, which was apparent in his handling of psychotic patients. He took the initiative to employ public midwives and spent much time travelling in the county to inform people about health-related issues in general and vaccination against copper especially. Despite of few resources, Christian Lintrup and his colleagues succeeded in developing and consolidating a local health service. They formed the basis for later county physicians work and for development of a modern public health service in Norway.

Mental health quality and outcome measurement and improvement in Norway

To describe and discuss results from scientific articles in 2008-2009 on outcome and quality and improvement of these in the mental health services in Norway. Good outcome is documented for several types of interventions and patient groups such as information campaigns to reduce duration of untreated psychosis, dynamic psychotherapy with transference interpretations for patients with less mature object relations, group and individual therapy for patients with personality disorders, parent training to reduce conduct problems in small children and opioid maintenance treatment to reduce deaths from overdose. At the same time, there is a lack of adherence in clinicians' prescriptions of antipsychotic medication, in patients' use of medication and of integrated treatment for psychiatric disorders and substance abuse. General practitioners' rating of mental health services may be a more valid quality indicator than patients' satisfaction. There is a lack of studies on quality, treatment fidelity, service improvements and implementation of best practice. In spite of some documented treatments with good outcome, we know too little about the quality and outcome of the mental health services. Strategies for implementation of evidence-based treatment accompanied by research studies need to be the norm, not the exception.

Should traditional healing be integrated within the mental health services in Sámi areas of northern Norway? Patient views and related factors

Objectives. The purpose of this study was to evaluate whether including traditional healing methods within mental health services is desirable among users of these services in Sámi areas of northern Norway.Study design. A cross-sectional questionnaire based survey among users of the mental health services in Finnmark and Nord-Troms Norway.Methods. The percentages of participants desiring traditonal healing modalities within the health services were calculated, and univariate and multivariate anslysis were performed with respect to factors associated with a desire for integration.Results. A total of 186 users responded to the survey, of which 72 reported some degree of Sámi cultural affiliation. Forty-eight had Sámi-speaking grandparents on both sides of the family. The desire for the integration of traditional healing was high among all with a Sámi cultural background. Eighty-one percent of those with Sámi speaking grandparents on both sides of the family desired such an integration. In a regression analysis, both Sámi affiliation and having used traditional healing forms were significantly associated with a desire for the integration of traditional healing within mental health services.Conclusions. The integration of traditional healing methods within health services has been suggested both by the World Health Organization and is used in some of the services to Indigenous populations in Western countries. This study shows that such integration is desirable among Sámi users of mental health services in Norway.

The prisoner as patient - a health services satisfaction survey

BackgroundThere is evidence for higher morbidity among prison inmates than in the general population. Despite this, patient satisfaction with the prison health services is scarcely investigated. The aim of the present study was to investigate patient satisfaction with prison health services in Norway and to analyze possible patient and service effects.MethodsThe survey took part in 29 prisons in the southern and central part of Norway, representing 62% of the total prison capacity in Norway. A total of 1,150 prison inmates with prison health services experiences completed a satisfaction questionnaire (90% response rate). The patients' satisfaction was measured on a 12-item index. Multilevel analyses were used to analyze both patient and service characteristics as predictors of satisfaction.ResultsThe study revealed high levels of dissatisfaction with prison health services. There were substantial differences between services, with between-service-variance accounting for 9% of the total variance. Satisfaction was significantly associated with a senior staff member's evaluation of the health services possessing adequate resources and the quality of drug abuse treatment. At the patient level, satisfaction was significantly associated with older age, frequent consultations and better self-perceived health.ConclusionPrison inmates' satisfaction with the health services provided are low compared with patient satisfaction measured in other health areas. The substantial differences observed between services - even when adjusting for several known factors associated with patient satisfaction - indicate a potential for quality improvement.

Befolkningens tilfredshet med helsetjenesten og legers tilfredshet med arbeidssituasjonen

To assess whether development of health services in Norway has been well balanced in terms of satisfaction; time series variation has been compared for population satisfaction with health services and physician job satisfaction. Data were retrieved from the following sources and years: the reference panel of The Research Institute of the Norwegian Medical Association on physician job satisfaction in the years 1994, 2000, 2002 and 2006; the municipal surveys of TNS Gallup on population satisfaction with health care (primary) in the years 1995 - 2000, 2003 and 2005 and in 1999, 2000 and 2003 for satisfaction with hospitals, and from the Norwegian part of the International Social Survey Program (ISSP) on population willingness to allocate resources to public health care (in 1990 and 2006). Time series of physician satisfaction were computed from changes in satisfaction between consecutive surveys. Time series of population satisfaction were computed from annual regression-adjusted means that control for the association between satisfaction and observable personal characteristics. On a scale from 10 to 70, hospital doctors' job satisfaction increased from 50.2 in 1994 to 52.3 in 2006. General practitioners' job satisfaction increased from 52.3 to 55.5 in the same period. From 1995 to 2005, consumer satisfaction with primary care increased from 4.43 to 4.54 and with hospital services from 4.23 to 4.47 (on a scale from 1 to 6). The proportion of the population who believes more public resources should be spent on health care increased from 82.7 % in 1990 to 85.2 % in 2006. The development in the health care sector seems to be balanced in the sense that views of the population and health personnel have followed parallel trajectories. A large and increasing share of the population is willing to allocate more resources to health care.

Factors influencing dentists’ choice of amalgam and tooth-colored restorative materials for Class II preparations in younger patients

Objective. To identify factors associated with dentists’ decisions on choice of restorative material in children and adolescents. Material and methods. In the period 2001–2004, 27 dentists in the Public Dental Health Service in Norway placed 4030 Class II restorations in 1912 patients. The reason for placement, previous caries experience (DMFT), oral hygiene, and characteristics of the cavity were recorded. Results. The most frequently used material was resin composite (81.5%), followed by compomer (12.7%), amalgam (4.6%), and glass ionomer cement (1.2%). Tooth-colored restorations were more frequently placed than amalgam in younger patients (p=0.017). Female patients received fewer amalgam restorations than male patients (p=0.006). Amalgam was more often used in patients with high DMFT (p<0.001) and more commonly in treatment of deeper dentine caries than caries near the dentino-enamel border (p=0.021). Amalgam was more frequently placed in molars than in premolars (p<0.001). In a logistic regression model, gender, DMFT, caries severity, and tooth type were significantly related to choice of material. Conclusion. Dentists’ choices of restorative material indicate that the majority prefer amalgam in more challenging restorations with respect to caries activity, lesion depth, and tooth type. The findings indicate that in a period when the use of amalgam was phasing out, resin composite was the predominant material of choice for Class II restorations in children and adolescents.