Wards In Norway Research Articles

Seroprevalence of SARS-CoV-2 antibodies in a prospective cohort of patients admitted to an acute psychiatric ward in Norway during the initial months of the COVID-19 pandemic

Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) spread around the world during the first part of 2020. The purpose of the study was to assess the prevalence of SARS-CoV-2 infection among patients acutely admitted to the Psychiatric Clinic, Haukeland University Hospital. Methods Serum tests to assess for antibodies to SARS-CoV-2 were administered at admission to the clinic together with a questionnaire on symptoms and demographical information. Further information was obtained from the medical records. Results The cumulative seroprevalence in the 266 participants was 0.75%, the cumulative reported cases in the Norwegian general population was 0.61% at the end of the inclusion period of the study. Twenty-five percent of participants had risk factors for a serious course of COVID-19. There was a low prevalence of cohabitation and only 20% had their main income derived from ordinary salaries (not welfare). Conclusion The prevalence of SARS-CoV-2 infection in a sample of patients acutely admitted to the Psychiatric Clinic, Haukeland University Hospital, was comparable to reported cases in the general population. A possible link to governmental and municipal restrictions, general low workplace participation and cohabitation is discussed.

Midwives' experiences of encountering immigrant women during labour and birth who do not master the host country's language. A lifeworld hermeneutic study.

Immigrant women are in a vulnerable position during labour and birth due to language barriers. Communication with women who do not master the host country's language is difficult for midwives, but there are few studies about midwives' experiences. To explore Norwegian midwives' experiences of encountering immigrant women during labour and birth who do not master the native language. A hermeneutic lifeworld approach. Interviews with eight midwives working at specialist clinics and hospital maternity wards in Norway. The findings were interpreted based on four concepts in the theory "Birth territory: A theory for midwifery practice" by Fahy and Parrat presented in five themes: language barriers can cause disharmony and prevent participation, language barriers can lead to midwifery domination and poorer care, midwives strive for harmony and to be a guardian, medicalisd birth due to language barriers, and disharmony can lead to crossing boundaries. The main interpretation shows that it is midwifery domination and disintegrative power that are prominent. However, the midwives strived to use their integrative power and be guardians, but in doing so they encountered challenges. Midwives need strategies for better communication with immigrant women involving the women and for avoiding a medicalised birth. To be able to meet immigrant women's needs and to establish a good relationship with them, challenges in maternity care need to be addressed. There are needs of care that focus on cultural aspects, leadership teams that support midwives, and both theoretical and organisational care models that support immigrant women.

Exploring trends of severe postpartum haemorrhage: a hospital-based study

BackgroundOver the past two decades several high-income countries have reported increased rates of postpartum haemorrhage (PPH). Many of the studies are registry studies with limited access to detailed information. We aimed to explore trends of severe PPH in the largest labour ward in Norway during a 10-year period with a hospital based study. Our population constituted all women who gave birth after week 22 at Oslo University Hospital between 2008 and 2017. The main outcome measure was severe PPH, defined as registered blood loss greater than 1500 ml, or transfusion of blood products due to PPH.MethodsWe estimated the incidence of severe PPH and blood transfusions, and performed temporal trend analysis. We performed Poisson regression analysis to investigate associations between pregnancy characteristics and severe PPH, presented using crude incidence rate ratios (IRR) with 95% confidence intervals (CI)s. We also estimated annual percentage change of the linear trends.ResultsAmong 96 313 deliveries during the 10-year study period, 2621 (2.7%) were diagnosed with severe PPH. The incidence rate doubled from 17.1/1000 to 2008 to 34.2/1000 in 2017. We also observed an increased rate of women receiving blood transfusion due to PPH, from 12.2/1000 to 2008 to 27.5/1000 in 2017. The rates of invasive procedures to manage severe PPH did not increase, and we did not observe a significant increase in the number of women defined with maternal near miss or massive transfusions. No women died due to PPH during the study period.ConclusionWe found a significant increasing trend of severe PPH and related blood transfusions during the 10-year study period. We did not find an increase in massive PPH, or in invasive management, and we suspect that the rise can be at least partly explained by increased awareness and early intervention contributing to improved registration of severe PPH.

Facilitating a safe and caring atmosphere in everyday life in forensic mental health wards - a qualitative study

ABSTRACT Purpose To explore healthcare professionals’ experiences with facilitating a safe and caring atmosphere in patients’ everyday lives in forensic mental health wards. Methods This qualitative study employed interviews with 16 healthcare professionals working shifts in two forensic mental healthcare wards in Norway. Data were analysed using phenomenological hermeneutic analysis. Results The findings are presented in terms of two themes. The first theme is “Creating a calming atmosphere” and includes the subthemes “Creating caring surroundings with safety, comfort and trust” and “Balancing everyday life activities”. The second theme is “Facilitating risk assessments and care” and includes the subthemes “Acting as a team”, “Becoming aware of the meaning in signs” and “Becoming aware of vulnerability and the window of tolerance”. Conclusions Involvement in patients’ history and lived lives is important both for understanding general social behaviour as well as for assessing signs, symptoms, and changes in patients’ conditions; furthermore, it provides valuable information that allows healthcare professionals to become aware of the underlying meanings in signs, which can facilitate examinations and treatment. Acting as a team is essential to solve issues in a calm and safe way when signs of violence occur. In addition, our participants highlighted the need to be aware of individual patients’ vulnerability and windows of tolerance to obtain a deeper understanding of patients’ lived lives as a whole in the context of providing therapy and care to patients.

Interprofessional collaboration in a community virtual ward: A focus group study.

The problem of a lack of nurses is expected to worsen in the future. With an ever-increasing number of elderly patients with multimorbidity and a shortage of healthcare professionals, primary care must innovatively organise their services to offer more sustainable healthcare services. Organising healthcare services in a community virtual ward has been found to improve the quality of life for vulnerable elderly populations. The aim of the study was to explore healthcare professionals' experiences of interprofessional collaboration in care for patients with multimorbidity in a community virtual ward in the Norwegian context. Focus group interviews were conducted in this qualitative exploratory study. A purposive sample of 17 healthcare professionals working in a community virtual ward in Norway was interviewed. Data were analysed using thematic analysis. The study results show that healthcare professionals recognise a need for patient involvement in the community virtual ward to offer more sustainable healthcare services at home. Furthermore, the results show how healthcare professionals experience the use of assessment tools and whiteboard meetings as useful tools for facilitating interprofessional collaboration. The study results also describe how interprofessional and holistic follow-up with patients with multimorbidity contributes to increased focus on health promotion in the community virtual ward. We found that interprofessional collaboration in community virtual wards may be a sustainable way of organising healthcare services for patients with multimorbidity living at home. Interprofessional collaboration with a patient-centred and health promotion approach, seems to increase the quality of the follow-up for patients with multimorbidity living at home. Additionally, mutual interprofessional trust and respect seems to be essential for making use of the unique expertise of different professions in the follow-up for patients with multimorbidity. In the future, both the patient's voice and opinion of their next of kin should be considered in the development of more sustainable homecare services.

Finding good alternatives to hospitalisation: a data register study in five municipal acute wards in Norway

BackgroundIn Norway, municipal acute wards (MAWs) have been implemented in primary healthcare since 2012. The MAWs were intended to offer decentralised acute medical care 24/7 for patients who otherwise would be admitted to hospital. The aim of this study was to assess whether the MAW represents the alternative to hospitalisation as intended, through 1) describing the characteristics of patients intended as candidates for MAWs by primary care physicians, 2) exploring the need for extended diagnostics prior to admission in MAWs, and 3) exploring factors associated with patients being transferred from the MAWs to hospital.MethodsThe study was based on register data from five MAWs in Norway in the period 2014–2020.ResultsIn total, 16 786 admissions were included. The median age of the patients was 78 years, 60% were women, and the median length of stay was three days. Receiving oral medication (OR 1.23, 95% CI 1.09–1.40), and the MAW being located nearby the hospital (OR 2.29, 95% CI 1.92–2.72) were factors associated with patients admitted to MAW after extended diagnostics. Patients needing advanced treatment, such as oxygen therapy (OR 2.13, 95% CI 1.81–2.51), intravenous medication (OR 1.60, 95% CI 1.45–1.81), intravenous fluid therapy (OR 1.32, 95% CI 1.19–1.47) and MAWs with long travel distance from the MAW to the hospital (OR 1.46, 95% CI 1.22–1.74) had an increased odds for being transferred to hospital.ConclusionsOur findings indicate that MAWs do not represent the alternative to hospitalisation as intended. The results show that patients receiving extended diagnostics before admission to MAW got basic treatment, while patients in need of advanced medical treatment were transferred to hospital from a MAW. This indicates that there is still a potential to develop MAWs in order to fulfil the intended health service level.

A human factors intervention in a hospital - evaluating the outcome of a TeamSTEPPS program in a surgical ward

BackgroundPatient safety in hospitals is being jeopardized, since too many patients experience adverse events. Most of these adverse events arise from human factors, such as inefficient teamwork and communication failures, and the incidence of adverse events is greatest in the surgical area. Previous research has shown the effect of team training on patient safety culture and on different areas of teamwork. Limited research has investigated teamwork in surgical wards. The aim of this study was to evaluate the professional and organizational outcomes of a team training intervention among healthcare professionals in a surgical ward after 6 and 12 months. Systems Engineering Initiative for Patient Safety 2.0 was used as a conceptual framework for the study.MethodsThis study had a pre-post design with measurements at baseline and after 6 and 12 months of intervention. The intervention was conducted in a urology and gastrointestinal surgery ward in Norway, and the study site was selected based on convenience and the leaders’ willingness to participate in the project. Survey data from healthcare professionals were used to evaluate the intervention. The organizational outcomes were measured by the unit-based sections of the Hospital Survey of Patient Safety Culture Questionnaire, and professional outcomes were measured by the TeamSTEPPS Teamwork Perceptions Questionnaire and the Collaboration and Satisfaction about Care Decisions in Teams Questionnaire. A paired t-test, a Wilcoxon signed-rank test, a generalized linear mixed model and linear regression analysis were used to analyze the data.ResultsAfter 6 months, improvements were found in organizational outcomes in two patient safety dimensions. After 12 months, improvements were found in both organizational and professional outcomes, and these improvements occurred in three patient safety culture dimensions and in three teamwork dimensions. Furthermore, the results showed that one of the significant improved teamwork dimensions “Mutual Support” was associated with the Patient Safety Grade, after 12 months of intervention.ConclusionThese results demonstrate that the team training program had effect after 12 months of intervention. Future studies with larger sample sizes and stronger study designs are necessary to examine the causal effect of a team training intervention in this context.Trial registration numberISRCTN13997367 (retrospectively registered).

Elevated alcohol consumption among geriatric psychiatric in-patients.

Introduction:Although a clear relationship has been established between elevated alcohol consumption and psychiatric problems in old age, there are few descriptions of the prevalence of elevated alcohol consumption in older adults who have been referred to geriatric psychiatric treatment.Aim:To describe the prevalence of self-reported elevated alcohol consumption in men and women referred to geriatric psychiatry wards in Norway, and to explore factors associated with elevated alcohol consumption.Method:This cross-sectional study includes data from a registry of geriatric psychiatry patients aged ≥ 65 years from December 2016 until December 2018. The outcome measure was reported elevated alcohol consumption assessed with the short version of the Alcohol Use Disorders Identification Test (AUDIT-C). The analyses used demographic data as well as a measure of cognitive function, psychiatric diagnosis and use of psychotropic drugs.Results:In total, 367 patients (131, 35.7% men) with a mean (SD) age of 74.7 (7.6) years were included. Of these patients, 27% scored above the pre-set cut-off for elevated alcohol consumption according to AUDIT-C (≥ 3 and 4 for women and men, respectively). The prevalence of elevated alcohol did not differ by gender. In adjusted logistic regression analysis, older age, living with someone and use of antidepressants were associated with reduced odds for reporting elevated alcohol consumption (OR 0.93, 95% CI 0.89–0.96; OR 0.54, 95% CI 0.31–0.97; and 0.54, 95% CI 0.32–0.92, respectively).Conclusion:A relatively high proportion of psychiatric patients aged 65 years or older reported elevated alcohol consumption, regardless of diagnosis. Older age, living with someone and use of antidepressants were associated with lower odds for elevated alcohol consumption.

The impact of hospitalisation to geriatric wards on the use of medications and potentially inappropriate medications - a health register study

BackgroundThe use of potentially inappropriate medications (PIMs) are associated with negative health effects for older adults. The purpose of this study was to apply national register data to investigate the impact of hospitalisation to geriatric wards in Norway on the use of medications and PIMs, and to compare two explicit PIM identification tools.MethodsWe included 715 patients ≥65 years (mean 82.5, SD = 7.8) admitted to Norwegian geriatric wards in 2013 identified from The Norwegian Patient Registry, and collected their medication use from the Norwegian Prescription Database. Medication use before and after hospitalisation was compared and screened for PIMs applying a subset of the European Union (EU)(7)-PIM list and the Norwegian General Practice – Nursing Home (NORGEP-NH) list part A and B.ResultsThe mean number of medications increased from 6.5 (SD = 3.5) before to 7.5 (SD = 3.5) (CI:1.2–0.8, p < 0.001) after hospitalisation. The proportion of patients with PIMs increased from before to after hospitalisation according to the EU(7)-PIM list (from 62.4 to 69.2%, p < 0.001), but not according to The NORGEP-NH list (from 49.9 to 50.6%, p = 0.73). The EU(7)-PIM list and the NORGEP-NH list had more than 70% agreement on the classification of patients as PIM users.ConclusionsMedication use increased after hospitalisation to geriatric wards. We did not find that geriatric hospital care leads to a general improvement in PIM use after hospitalisation. According to a subset of the EU(7)-PIM list, PIM use increased after hospitalisation. This increase was not identified by the NORGEP-NH list part A and B. It is feasible to use health register data to investigate the impact of hospitalisation to geriatric wards on medication use and PIMs.

Feasibility and acceptability of introducing advance care planning on a thoracic medicine inpatient ward: an exploratory mixed method study

Background and aimsAdvance care planning (ACP) is communication about wishes and preferences for end-of-life care. ACP is not routinely used in any Norwegian hospitals. We performed a pilot study (2014–2017)...

"Like Walking in a Fog"-Parents' perceptions of sleep and consequences of sleep loss when staying overnight with their child in hospital.

Disruption of parental sleep in hospital, with frequent awakenings and poor sleep quality, limits the parents' resources to meet the child's needs and maintain parental wellbeing. The aim of the study was to explore and describe how parents perceive their sleep when staying overnight with their sick child in hospital. A further aim was to explore and describe parents' perception of what circumstances influence their sleep in the hospital. Twenty-two parents who were accommodated with their sick child (0-17years) in paediatric wards in Norway and Sweden participated. Interviews were conducted during the hospital stay to elicit their perspectives. Phenomenography was used to analyse data.Two descriptive categories were found: (a) "Perceptions of sleep", with two sub-categories: "Sleep in the paediatric ward" and "Consequences of sleep loss"; and (b) "Circumstances influencing sleep in the paediatric ward" with three sub-categories: "The importance of the family", "Information and routines at the paediatric ward", and "Accommodation facilities". Parents' sleep and needs must be acknowledged in paediatric wards. An individual plan of care for the upcoming night could be a valuable tool for both the parents and nurses. The child's medical needs must be met with respect to the parents' willingness to take part in the child's care during the night, and the need for rest and sleep for both parent and child.

Walking on a tightrope-Caring for ambivalent women considering abortions in the first trimester.

To improve the understanding and competence of health personnel when caring for ambivalent pregnant women, the aim of this study was to explore the experiences of encountering women who are unsure whether to complete or terminate pregnancy. Feelings of ambivalence are present in a significant number of women preparing for abortions and may challenge the provision of health care. Health personnel have reported an ideal to be nonjudgemental and supportive. Insufficient attention has been directed to the experiences of health personnel who prepare women for abortions in gynaecological units. Qualitative design with a hermeneutic-phenomenological approach. Focus group interviews were conducted with health personnel from four gynaecological outpatient clinics and wards in Norway (n=20). The health personnel felt responsible for contributing to patient well-being. This demanded focused attention towards all women being prepared for abortions and meant a consciousness and balancing act towards revealing, handling and being involved in the woman's potential unsureness without influencing her decision. When involved, the health personnel risked being confronted with their own vulnerabilities and values. The health personnel tried to balance their care and support without influencing the woman's decision. Although they viewed the women as fully autonomous and responsible, they became personally involved, to varying degrees, in the uncertainty and were faced with their own vulnerabilities and values. They lacked a possibility for immediate debriefing and regular counselling after complicated consultations. Knowledge of the experiences of health personnel can provide input for professional development at gynaecological departments. These findings contribute to discussions about what information should be given and whether the woman's feelings should be discussed in preparation for an abortion. The ability of health personnel to discuss subjects related to ethically challenging encounters with women who are considering abortions should be established, namely, professional education and workshops at the national level and small groups with counselling and case study discussions at hospitals.

Midwifery care based on a precautionary approach: Promoting normal births in maternity wards: The thoughts and experiences of midwives

ObjectiveThe aim of this study was to gain a deeper understanding of the thoughts and experiences of midwives in the attempt to promote normal births in Norwegian maternity wards. MethodsA qualitative approach was selected for data collection, and the data presented are derived from in-depth interviews. Nine midwives at three different maternity wards in Norway participated in the study. The qualitative data were analysed with the help of systematic text condensation. ResultsThe findings included two main themes: (1) “Individualized maternity care” (2) “A woman-centred and a biomedical perspective - a dilemma. Working in a small maternity ward increased the possibility for continuous support during labour and continuity of care throughout pregnancy, birth and the postnatal period. The midwives had a great desire to promote normal births with a minimum of interventions. Still, they adhered to an ideology based on both a woman-centred and a biomedical view of birth. Their work was often based on a precautionary approach in which problem-solving strategies were related to potential risks. ConclusionThe midwives experienced challenges, as they worked in an environment where different ideologies prevailed. They utilized the positive aspects of small maternity wards, like the opportunity for continuous support during labour and continuity of care during the childbearing process. Midwives should encourage discussions about their precautionary approach and the use of technology for low-risk women, while reflecting on their own views on normal births.

Former suicidal inpatients’ experiences of treatment and care in psychiatric wards in Norway

ABSTRACTPurpose: The purpose of this study is to explore how former suicidal inpatients experienced treatment and care in psychiatric wards in Norway following the implementation of the National guidelines for prevention of suicide in mental health care. The focus of the analysis was on aspects of treatment and care with potential for improvement. Method: We interviewed five former inpatients and analysed the data by means of Interpretative Phenomenological Analysis. Results: Experiencing a sense of companionship with the staff and receiving individualized treatment and care was important for the participants. This involved establishing trusting connections with mental health workers who treated them with respect, made them feel valued, and who recognized their suffering and needs. The formerly suicidal patients experienced being in a recovery process, which was promoted by the support of mental health workers. Although the participants reported mostly positive experiences, there were examples of insufficient care. Sometimes, they felt that their suffering and suicidality were not sufficiently recognized. Conclusion: Our study indicates that although there has been increased focus on suicidality in the mental health services, among other through clinical guidelines, some mental health workers still lack competence and should focus more fully on how to provide individualized care for suicidal inpatients.

Unplanned admissions to inpatient psychiatric treatment and services received prior to admission

BackgroundInpatient bed numbers are continually being reduced but are not being replaced with adequate alternatives in primary health care. There is a considerable risk that eventually all inpatient treatment will be unplanned, because planned or elective treatments are superseded by urgent needs when capacity is reduced. Aims of the studyTo estimate the rate of unplanned admissions to inpatient psychiatric treatment facilities in Norway and analyse the difference between patients with unplanned and planned admissions regarding services received during the three months prior to admission as well as clinical, demographical and socioeconomic characteristics of patients. MethodUnplanned admissions were defined as all urgent and involuntary admissions including unplanned readmissions. National mapping of inpatients was conducted in all inpatient treatment psychiatric wards in Norway on a specific date in 2012. Binary logit regressions were performed to compare patients who had unplanned admissions with patients who had planned admissions (i.e., the analyses were conditioned on admission to inpatient psychiatric treatment). ResultsPatients with high risk of unplanned admission are suffering from severe mental illness, have low functional level indicated by the need for housing services, high risk for suicide attempt and of being violent, low education and born outside Norway. ConclusionSpecialist mental health services should support the local services in their efforts to prevent unplanned admissions by providing counselling, short inpatient stays, outpatient treatment and ambulatory outpatient psychiatry services. Implications for health policiesThis paper suggests the rate of unplanned admissions as a quality indicator and considers the introduction of economic incentives in the income models at both service levels.

User participation in a Municipal Acute Ward in Norway: dilemmas in the interface between policy ideals and work conditions.

User participation has become an increasingly important principle in health care over the last few decades. Healthcare professionals are expected to involve patients in treatment decisions. Clear guidance as to what this should entail for professionals in clinical work is not accounted for in legislation. In this study, we explore how healthcare professionals in a Municipal Acute Ward perceived, experienced and performed user participation. The ward represents a new short-time service model for emergency assistance in Norway. We focused on the challenges the professionals faced in clinical work and how they dealt with these. Data were drawn from qualitative interviews with 11 healthcare professionals and from 10 observations in relation to previsits and physician's rounds in the ward. Transcripts of interviews and observations were analysed using a method for systematic text condensation. In the analysis, we applied Lipsky's perspective on dilemmas of street-level bureaucrats. The results show that that the professionals perceived user participation as an important and natural part of their work. They experienced difficulties related to collaboration with patients, caregivers, and professionals in other services, and with framework conditions that caused conflicting expectations, responsibility, and priorities. The professionals seemed to take a pragmatic approach to user participation, managing it within narrow perspectives. Our study indicates that the participants dealt with the dilemmas at the cost of user participation. The results demonstrate that there is a gap between the outlined health policy and the professionals' opportunities to fulfil this policy in clinical work regarding user participation. The policy decision-makers should recognise the balancing work required of healthcare professionals to deal with difficulties in clinical work. The knowledge that professionals possess as performers of services and the need for valuing in policy processes should be acknowledged.

Kartlegging av astmaundervisning til barn og foreldre i barneavdelinger mellom 2004, 2006 og 2014

The aim of the study was to investigate the organization of asthma education for children and parents in children’s wards in Norway over a ten-year period and how Ane and Bronky teaching material has been implemented. A prospective cross-sectional study using a questionnaire was conducted in 28, 22 and 29 children’s wards in 2004, 2006 and 2014. The response rate varied between 86 percent and 97 percent. Statistical analysis by means of Fisher’s exact test was used. The findings revealed that organized asthma education for children increased between 2004 and 2006, while it decreased in 2014. Dialogue and demonstration were common teaching methods. User participation in teaching sessions increased between 2004 and 2006. Only half of the wards reported that asthma education was the responsibility of management to a large/very large extent. This presents future challenges in establishing, prioritizing and ensuring stability in health education for children and their families.

Predictors of suicide in the patient population admitted to a locked-door psychiatric acute ward

ObjectiveNo prior study appears to have focused on predictors of suicide in the general patient population admitted to psychiatric acute wards. We used a case-control design to investigate the association between suicide risk factors assessed systematically at admission to a locked-door psychiatric acute ward in Norway and subsequent death by suicide.MethodFrom 2008 to 2013, patients were routinely assessed for suicide risk upon admission to the acute ward with a 17-item check list based on recommendations from the Norwegian Directorate of Health and Social Affairs. Among 1976 patients admitted to the ward, 40 patients, 22 men and 18 women, completed suicide within December 2014.ResultsCompared to a matched control group (n = 120), after correction for multiple tests, suicide completers scored significantly higher on two items on the check list: presence of suicidal thoughts and wishing to be dead. An additional four items were significant in non-corrected tests: previous suicide attempts, continuity of suicidal thoughts, having a suicide plan, and feelings of hopelessness, indifference, and/or aggression. A brief scale based on these six items was the only variable associated with suicide in multivariate regression analysis, but its predictive value was poor.ConclusionSuicide specific ideations may be the most central risk markers for suicide in the general patient population admitted to psychiatric acute wards. However, a low predictive value may question the utility of assessing suicide risk.

Obstetric Outcomes of First- and Second-Generation Pakistani Immigrants: A Comparison Study at a Low-Risk Maternity Ward in Norway.

This population-based study compares obstetric outcomes of first- and second-generation Pakistani immigrants and ethnic Norwegians who gave birth at the low-risk maternity ward in Baerum Hospital in Norway from 2006 to 2013. We hypothesized that second-generation Pakistani immigrants are more similar to the ethnic Norwegians because of increased acculturation. Outcome measures were labor onset, epidural analgesia, labor dystocia, episiotomy, vaginal/operative delivery, postpartum hemorrhage, preterm birth, birth weight, transfer to a neonatal intensive care unit, and neonatal jaundice. Compared to first-generation Pakistani immigrants, the second-generation reported more health issues before pregnancy, and they had a higher proportion of preterm births compared to Norwegians. Newborns of first-generation immigrants were more often transferred to a neonatal intensive care compared to Norwegian newborns. Few intergenerational differences in the obstetric outcomes were found between the two generations. A high prevalence of consanguinity in second-generation immigrants suggests the maintenance of a traditional Pakistani marriage pattern.

Predicting patient post-detoxification engagement in 12-step groups with an extended version of the theory of planned behavior.

IntroductionIndividuals with substance use disorders can receive important abstinence-specific support in 12-step groups (TSGs). However, our understanding of key factors that influence TSG participation remains limited. This study used an extended version of the theory of planned behavior (TPB) to enhance the understanding of TSG affiliation.MethodsData were retrieved from a controlled trial of a 12-step facilitation intervention conducted on an inpatient detoxification ward in Norway (N = 140). Surveys at baseline included a TPB questionnaire. The behavioral target was to attend at least two TSG meetings per month in the 6-month follow-up period. Structural equation modeling was used to analyze the predictors of behavior at follow-up.ResultsWe found that attitudes, the moral norm, and perceived behavior control accounted for 81 % of the variance in the intention to participate regularly in TSGs after treatment. Subjective norms did not significantly influence the intention to participate. Moreover, the intention to participate significantly predicted behavior (β = 0.42, p < 0.001). In contrast to theory, there was a substantial, model-independent pathway from past to later behavior (β = 0.22, p = 0.047). The model explained 46 % (p < 0.001) of the variance in behavior. Attending ≥ 12 TSG meetings in the follow-up period was associated with a high percentage of abstinent days at follow-up (β = 0.38, p = 0.023).ConclusionsThe present TPB questionnaire worked well for assessing patient intentions to attend a TSG. Treatment providers should encourage patient intentions to participate in TSGs post-detoxification.Electronic supplementary materialThe online version of this article (doi:10.1186/s13722-015-0036-3) contains supplementary material, which is available to authorized users.