Helsebiblioteket's Research Archive (HeRA)

The impact of optimality on maternal sensitivity in mothers with substance abuse and psychiatric problems and their infants at 3 months.

Wed, 01 Feb 2012 00:00:00 GMT

Title: The impact of optimality on maternal sensitivity in mothers with substance abuse and psychiatric problems and their infants at 3 months. Authors: Siqveland, Torill; Smith, Lars; Moe, Vibeke Abstract: The main aim of this study was to investigate the predictive validity of four different optimality indexes, as well as infant perinatal status, in relation to maternal sensitivity in interaction at 3 months. The four optimality indexes comprised items related to substance abuse, psychiatric condition, relational experience and socioeconomic status (SES). Maternal sensitivity in mother-infant interaction was assessed in two different groups of mothers. One group consisted of mothers with substance abuse and psychiatric problems who underwent treatment during pregnancy. The other group of mothers had neither substance abuse nor psychiatric problems. The expectant mothers were interviewed in the third trimester of pregnancy. Medical records and meconium were obtained from the infants at birth. Three months after birth, maternal sensitivity in mother-infant interaction was assessed. Altogether 79 mother-infant dyads participated in the study. The mothers' optimality associated with relational experiences, as well as the infants' perinatal status were found to predict maternal sensitivity in mother-infant interaction at 3 months. The SES index was also significantly related to maternal sensitivity. The relation between group and maternal sensitivity was mediated by the mothers' optimality associated with relational experiences. This study points to the importance of addressing the mothers' own relational experiences and their current representations of motherhood during treatment, in order to support and enhance maternal sensitivity.

”Vi får satt fokus, blir bevisstgjort og må skjerpe faget vårt ekstra…” En deskriptiv undersøkelse av tilsyn med kommunale helse- og omsorgstjenester til eldre

Sat, 01 Jun 2013 00:00:00 GMT

Title: ”Vi får satt fokus, blir bevisstgjort og må skjerpe faget vårt ekstra…” En deskriptiv undersøkelse av tilsyn med kommunale helse- og omsorgstjenester til eldre Abstract: NORSK SAMMENDRAG: Størsteparten av kommunene oppfatter Fylkesmannens tilsyn med helse- og omsorgstjenester til eldre i 2010 og 2011 som et godt grunnlag for forbedringsarbeid. Det viser en deskriptiv undersøkelse som Agenda Kaupang gjennomførte for Statens helsetilsyn høsten 2012. I alt 325 kommuner fikk tilsendt et elektronisk spørreskjema om hvilken innvirkning tilsynet hadde hatt. 220 kommuner (68 prosent) svarte. I tillegg ble det gjennomført telefonintervjuer med virksomhetsledere, rådmenn og medarbeidere i 10 kommuner. Snaut 90 prosent av virksomhetene svarer at dialogen med fylkesmennene og rapporten fra tilsynet samlet sett har gitt et godt grunnlag for kommunens arbeid med å forbedre tjenestetilbudet til skrøpelige eldre. Ifølge virksomhetene virket tilsynet bevisstgjørende og gav impulser til forbedrings- og endringsarbeid. Gledelig nok mener virksomhetene det samme enten tilsynet har påvist lovbrudd eller ikke. I perioden 2009-2012 gjennomførte Statens helsetilsyn og fylkesmennene en 4-årig satsing på tilsyn med tjenester til eldre. Ved avslutningen av satsingen ønsket vi å få undersøkt hvilke prosesser og tiltak kommunene satte i gang og om det var noe som gjorde det vanskelig å bruke resultatene fra tilsynet i forbedring av tjenestene. Kommunene ble også bedt om å komme med synspunkter på hvordan tilsyn kan være et konstruktivt bidrag til forbedring i kommunale helse- og omsorgstjenester. Tilbakemeldingene fra kommunene tilsier at det er særlig to forhold som må være førende for Statens helsetilsyn og fylkesmennenes arbeid med utvikling av tilsyn framover: •Systematisk arbeid med risikovurderinger ved valg av tilsynstemaer bidro til at kommunene oppfattet tilsynstemaene som relevante og vesentlige for deres virksomhet. •Dialogen med og kompetansen hos medarbeiderne hos fylkesmennene stimulerte endringsarbeidet.; ENGLISH SUMMARY: Most municipalities regard the supervision of health and welfare services for elderly people, carried out in 2010 and 2011 by the Offices of the County Governors, as a good basis for improving the services. This was shown by a descriptive study carried out in 2012 by Agenda Kaupang for the Norwegian Board of Health Supervision. Altogether, 325 municipalities received an electronic questionnaire about the effects of supervision. 220 municipalities (68 per cent) answered. In addition, telephone interviews were carried out with leaders, deputy mayors and employees in ten municipalities. Almost 90 per cent of the respondents reported that the supervision reports and dialogue with the Offices of the County Governors provided a sound basis for working with quality improvement of services for frail elderly people. Supervision raised the level of consciousness about quality improvement, and gave the municipalities new impulses. It is positive that this was the case both in municipalities in which breaches of the regulations were detected and in those where no breaches were detected. During the period 2009-2012, the Norwegian Board of Health Supervision and the Offices of the County Governors focussed on supervision of services for elderly people. At the end of this period, we wished to examine which processes and measures had been initiated by the municipalities, and whether the results of supervision were difficult to use for improving services. The municipalities were also asked to give their views about how supervision can make a constructive contribution to improving municipal health and welfare services. Feedback from the municipalities identified two conditions in particular that should be taken into account by the Norwegian Board of Health Supervision and the Offices of the County Governors when developing supervision in the future: •Systematic work with risk assessment when choosing the topics for supervision was important so that the municipalities regarded the topics as relevant and important for their services. •Dialogue with the Offices of the County Governors and the competence of the staff stimulated change.

Fremmede i Norge, fremmede på Plata? - en kvalitativ studie av innvandrere i Oslos synlige rusmiljø

Wed, 01 May 2013 00:00:00 GMT

Title: Fremmede i Norge, fremmede på Plata? - en kvalitativ studie av innvandrere i Oslos synlige rusmiljø Authors: Sandøy, Thomas Anton Abstract: NORSK SAMMENDRAG: Såkalte innvandrergjenger har blitt koblet til narkotikaomsetningen i Norge siden 70-tallet. Brukermiljøene har på sin side hovedsakelig bestått av etnisk norske.Innvandrere spiller fortsatt en rolle på tilbydersiden, men befinner seg i dag i økende grad på mottakersiden av narkotikatransaksjoner. Siden slutten av 90-tallet har andelen innvandrere i Oslos synlige rusmiljø økt. Få studier er blitt gjort av det som må sies å være en av de mest marginale gruppene i det norske samfunn. Dette til tross for at det «nye» segmentet av rusmiddelmisbrukere vekker både oppsikt og bekymring. Denne rapporten handler om livshistoriene til 13 innvandrermenn med lang fartstid i Norge, rusmiddelmisbruk og Oslos synlige rusmiljø. På intervjutidspunktet oppholdt de seg på de åpne omsetningsstedene ved Oslo Sentralbanestasjon, diverse lavterskeltilbud og hospitser. Felles for de intervjuede er at de ankom Norge utenfra, bruker/brukte tunge rusmidler og er/var en del av det synlige rusmiljøet i Oslo. Utover dette er det stor variasjon i migrasjonshistorier, rusmiddelkarrierer og grad av tilknytning til rusmiljøet. For å fange spennvidden i historiene ligger det en åpen tilnærming til grunn for rapporten. Den studerer hvordan en gruppe innvandrere i Oslos synlige rusmiljø selv forstår situasjonen de befinner seg i. Problemstillingene dreier seg om tilhørighet til Norge, forklaringer på rusmiddelmisbruk og relasjon til rusmiljøet. Samtlige av de intervjuede fremstiller opphavet, i form av røtter, tradisjoner og kultur, som grunnleggende for eget liv. De er dypest sett utlendinger. Dette gjør identifiseringen med det norske samfunn og «norskhet» ambivalent. De fleste er glade over å befinne seg i Norge, men forteller samtidig om manglende eiendomsforhold til landet. Til tross for at informantene behersker språket, antatt norske væremåter og sosial omgang med nordmenn, opplever de at de aldri kan bli fullt ut norske. På den annen side er språk, væremåter og kontakt med majoritetsbefolkningen avgjørende for tilhørigheten til Norge. Informantene har oppholdt seg lenge i landet og behersker «norskhet» i praksis. Av denne grunn fremstår tilhørigheten til Norge som sterkere enn det egenidentifikasjonen tilsier. Rusmiddelmisbruk er ikke noe det primært fortelles om – det forklares. Informantenes forklaringer er i stor utstrekning migrasjonsspesifikke, i den forstand at de bygger på erfaringer forut for, under eller etter utreise fra opphavslandet. Noen forklaringer er av allmenn karakter. Disse forklaringene bygger ikke på migrasjonserfaringer, men faktorer som gjør seg gjeldende på tvers av etniske skillelinjer. Det viktigste skillet går imidlertid ikke mellom migrasjonsspesifikke og allmenne forklaringer, men mellom individuelle og strukturelle forklaringer. Ifølge informantene skyldes rusmiddelmisbruket eksterne forhold. Disse forholdene tar bolig i enkeltindivider på måter som psykologiserer og individualiserer narkotikaproblemet. Med noen unntak uteblir kritikken av norske samfunnsforhold. I tråd med studier av rusmiddelmisbrukere med majoritetsbakgrunn forteller innvandrerne om et usolidarisk, fragmentert rusmiljø. Rusmidlene organiserer, hierarkiserer og korrumperer samhandlingen. På den annen side bidrar rusmidlene til nedtoning av symbolske grenser. I kraft av delte skjebner – avhengighet og sosial nød – fremstår rusmiljøet som inkluderende. Miljøet er med andre ord både asosialt og sosialt. Det sosiale potensialet veier tungt for innvandrere som opplever seg som fremmede i samfunnet for øvrig.; ENGLISH SUMMARY: So-called immigrant gangs have been linked to the drug trade in Norway since the 1970s. The user environments, on the other hand, have primarily consisted of ethnic Norwegians. While immigrants still play a role on the supply side, they are currently to be found in increasing numbers on the demand side of drug transactions. Since the late 1990s, the proportion of immigrants in Oslo’s open drug scene has grown. Few studies have been conducted on what must be characterized as one of the most marginal social groups in Norway. The lack of studies is somewhat surprising, considering the general attention and concern this «new» segment of the substance abuse population attracts. This report is about the life stories of 13 immigrant men, all with a long history of drug use and participation in the drug milieu in Oslo. The interviewees were recruited at the open drug scene by the Oslo Central Station, various low-threshold facilities and shelters. What the interviewees have in common is that they immigrated to Norway, use/used heavy drugs, and are/were involved in the open drug scene on the streets of Oslo. Beyond this, their migration histories, drug careers and association with the drug milieu vary widely. So as to capture the breadth of their stories, an open approach forms the basis of this report. The report examines how a group of immigrants in the drug environment understand the situation in which they find themselves. The research issues touch on their sense of belonging in Norway, their reasons for using drugs, and their relations with the drug scene. Origins in the form of roots, traditions and culture are fundamental in all of the life stories. The interviewees remain foreigners in essence. This makes their identification with Norwegian society and «norwegianness» ambivalent. Most are happy to live in Norway, but lack any real sense of ownership to the country. And although they speak the language, act like and mix with Norwegians socially, they can never be fully Norwegian. On the other hand, knowledge of the language, of social conventions, and contact with the majority population are essential to a sense of belonging in Norway. The interviewees have lived in the country for many years and masters «norwegianness» in practice. For this reason their attachment to Norway would appear to be stronger than their own sense of identification would suggest. Substance abuse is not something that is merely described – it is, rather, explained. The majority of reasons offered by the interviewees pivot on migration, i.e. to experiences prior to, during or after leaving their country of origin. Some reasons are general in nature. They are not based on migration-related experiences, but factors that apply across ethnic divisions. The most important distinction is, however, not between migration-related and general explanations, but between individual and structural ones. According to the immigrant men, drug abuse is caused by external factors. These factors take root in the individual drug user, and in ways that psychologize and individualize the drug problem. With few exceptions, Norwegian society is not singled out for criticism. In line with the findings of studies of ethnic majority drug users, the immigrants describe a fragmented drug scene lacking in solidarity. Drugs organize, hierarchize and corrupt interaction. On the other hand, drugs help reduce symbolic boundaries. By virtue of a common destiny – addiction and social distress – the drug scene gives an appearance of inclusivity. The drug scene, in other words, is asocial and social at the same time. The social potential weighs heavily on immigrants who otherwise see themselves as aliens in society.

Evaluation of a web portal for improving public access to evidence-based health information and health literacy skills: a pragmatic trial.

Sun, 01 Jan 2012 00:00:00 GMT

Title: Evaluation of a web portal for improving public access to evidence-based health information and health literacy skills: a pragmatic trial. Authors: Austvoll-Dahlgren, Astrid; Bjørndal, Arild; Odgaard-Jensen, Jan; Helseth, Sølvi Abstract: Using the conceptual framework of shared decision-making and evidence-based practice, a web portal was developed to serve as a generic (non disease-specific) tailored intervention to improve the lay public's health literacy skills.; To evaluate the effects of the web portal compared to no intervention in a real-life setting.; A pragmatic randomised controlled parallel trial using simple randomisation of 96 parents who had children aged <4 years. Parents were allocated to receive either access to the portal or no intervention, and assigned three tasks to perform over a three-week period. These included a searching task, a critical appraisal task, and reporting on perceptions about participation. Data were collected from March through June 2011.; Use of the web portal was found to improve attitudes towards searching for health information. This variable was identified as the most important predictor of intention to search in both samples. Participants considered the web portal to have good usability, usefulness, and credibility. The intervention group showed slight increases in the use of evidence-based information, critical appraisal skills, and participation compared to the group receiving no intervention, but these differences were not statistically significant.; Despite the fact that the study was underpowered, we found that the web portal may have a positive effect on attitudes towards searching for health information. Furthermore, participants considered the web portal to be a relevant tool. It is important to continue experimenting with web-based resources in order to increase user participation in health care decision-making.; ClinicalTrials.gov NCT01266798.