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1.  A cross-sectional study of self-reported general health, lifestyle factors, and disease: the Hordaland Health Study 
PeerJ  2014;2:e609.
Background. Information on self-reported health is important for health professionals, and the aim of this study was to examine associations between lifestyle factors and self-reported health and the mediating effect of disease in a Norwegian population.
Methods and Materials. The data collection was conducted as part of the Hordaland Health Study (HUSK) 1997–99, which was a cross-sectional epidemiological study. All individuals in Hordaland county born in 1953–1957 were invited to participate (aged 40–44 years). Complete information for the present study was obtained from 12,883 individuals (44% response rate). Height and weight were measured at a physical examination. Information on lifestyle factors, self-reported health, disease (heart attack, apoplexy, angina pectoris, and diabetes), and socio-demographic variables was obtained from a self-administered questionnaire. Self-reported health was measured with a one-item question. Odds ratios for fair or poor self-reported health were calculated using multiple logistic regression analyses adjusted for disease and socio-demographic variables.
Results. Respondents reporting adverse lifestyle behaviours (obesity (odds ratio (OR) 1.7, p < 0.001), smoking (OR 1.2, p < 0.001), or excessive intake of alcohol (OR 3.3, p < 0.001)) showed an increased risk of poor self-reported health. Furthermore, a moderate intake of wine (OR 0.6, p < 0.001) or strenuous physical activity (OR 0.5, p < 0.001) decreased the risk of poor health. Disease did not mediate the effect.
Conclusion. A one-item question measuring self-reported health may be a suitable measure for health professionals to identify levels of subjective health and reveal a need to target lifestyle factors in relatively young individuals with or without disease.
PMCID: PMC4185289  PMID: 25289193
Life style; Epidemiology; Self report; Health; Obesity; Physical activity; Smoking; Alcohol
2.  Therapeutic elements in a self-management approach: experiences from group participation among people suffering from chronic pain 
Chronic pain is a complex, multifaceted subjective experience that involves the whole person. Self-management is the dynamic and continuous process of adapting one’s situation to the cognitive, behavioral, and emotional responses necessary to maintain a satisfactory quality of life. Approaches based on cognitive behavioral therapy (CBT) are described as appropriate in assisting people suffering from chronic pain because they challenge maladaptive beliefs and behaviors in relation to pain. This study aimed to explore patients’ experiences of therapeutic elements from group participation in a chronic pain management program.
A qualitative research design with a phenomenological hermeneutic approach was used. Six months after participation in the 8-week course, 34 participants formulated and submitted written reports based on open-ended questions related to their group participation and self-help achievement. These reports were analyzed by elements of qualitative content analysis.
The analysis resulted in two subthemes: “The significance of active involvement in gaining new insight” and “The significance of community and group support.” These were abstracted in the main theme: “Successful self-management is related to several significant contributions in the group.”
An active role with writing, self-revelation, and exchanges of thoughts and feelings in the group seemed to be the key tools for success. In addition, group support and access to other group members’ experiences were significant therapeutic elements. We suggest that successful self-management requires knowledge of essential therapeutic elements. In a CBT-based group approach, such elements may offer an important health care contribution.
PMCID: PMC4144840  PMID: 25170253
pain management; cognitive behavioral therapy; group therapy; self-directed therapy
3.  Exploring the information needs of patients with unexplained chest pain 
Unexplained chest pain is a common condition. Despite negative findings, a large number of these patients will continue to suffer from chest pain after being investigated at cardiac outpatient clinics. Unexplained chest pain covers many possible complaints, and diagnosing a single cause for a patient’s pain is often described as difficult, as there are a number of possible factors that can contribute to the condition. For health professionals to meet patients’ expectations, they must know more about the information needs of patients with unexplained chest pain. The aim of this study was to describe information needs among patients with unexplained chest pain and how those needs were met by health professionals during medical consultations.
A qualitative design was used. Data were collected by means of seven individual interviews with four women and three men, aged 21–62 years. The interviews were analyzed by qualitative content analysis.
The results are described in two subthemes, ie, “experiencing lack of focus on individual problems” and “experiencing unanswered questions”. These were further abstracted under the main theme “experiencing unmet information needs”.
Existing models of consultations should be complemented to include a person-centered approach to meeting patients’ beliefs, perceptions, and expressions of feelings related to experiencing unexplained chest pain. This is in line with a biopsychosocial model with active patient participation, shared decision-making, and a multidisciplinary approach. Such an approach is directly within the domain of nursing, and aims to take into account patient experience.
PMCID: PMC3772772  PMID: 24043934
information needs; qualitative research; unexplained chest pain
4.  A narrative approach to explore grief experiences and treatment adherence in people with chronic pain after participation in a pain-management program: a 6-year follow-up study 
The aim of this study was to explore grief caused by chronic pain and treatment adherence, and how these experiences are integrated into ongoing life stories.
A 6-year follow-up using a qualitative mixed-methods design based on written narratives and image narratives was performed. Five women suffering from chronic pain comprised the purposive sample. They had completed an 8-week group pain-management program with two follow-ups, and thereafter continued as a self-help group. A narrative approach was used to analyze the written and image narratives guided by three analytic steps.
Findings showed that experiences of grief over time were commonly associated with chronic pain. The participants’ past experiences reflected their grief at having to abandon jobs and social networks, and revealed loneliness and despair. The present life situation seemed to reflect adaptation, and hope for the future had been established. Overall, forward progression means an ongoing struggle towards a reintegrated body and a meaningful life.
Through such narratives, health-care workers can identify treatment adherence related to grief and pain, and learn how people might regain their lives beyond using traditional interviews.
PMCID: PMC3749063  PMID: 23990710
chronic pain; follow-up; grief; image; narrative; nursing
5.  Results from a systematic writing program in grief process: part 2 
This paper, the second of two, reports the results of a systematic writing program used as a tool in the grief process. The study was based on a specifically developed program, which has been described and discussed previously in Part 1.
The study had a qualitative research design, with a hermeneutic phenomenological approach. The research tool of the study, a writing program, was developed and implemented. A purposive sample was used, consisting of 13 bereaved adults.
From an analysis of all of the texts written during the program, we drew four conclusions. Writing yields new thoughts and increases knowledge. Writing is stressful as well as a relief. Writing awakens and preserves memories. The value of writing is related to the forms, ways, and situations of writing.
We have discussed handling grief with a unique process. Our findings reveal a great breadth and variation in the experiences associated with different writing forms, ways of writing, and writing situations. This implies that flexibility and individualization are important when implementing grief management programs like this. We believe that a structured writing program can be helpful in promoting thought activity and as a tool to gain increased coherence and understanding of the grief process. This writing program may be a valuable guide for program development and future research.
PMCID: PMC3034296  PMID: 21311698
bereavement; grief; writing
6.  A systematic writing program as a tool in the grief process: part 1 
The basic aim of this paper is to suggest a flexible and individualized writing program as a tool for use during the grief process of bereaved adults.
An open, qualitative approach following distinct steps was taken to gain a broad perspective on the grief and writing processes, as a platform for the writing program.
Following several systematic methodological steps, we arrived at suggestions for the initiation of a writing program and its structure and substance, with appropriate guidelines.
We believe that open and expressive writing, including free writing and focused writing, may have beneficial effects on a person experiencing grief. These writing forms may be undertaken and systematized through a writing program, with participation in a grief writing group and with diary writing, to achieve optimal results.
A structured writing program might be helpful in promoting thought activities and as a tool to increase the coherence and understanding of individuals in the grief process. Our suggested program may also be a valuable guide to future program development and research.
PMCID: PMC3003609  PMID: 21206518
bereavement; grief process; writing process
7.  Dealing with grief related to loss by death and chronic pain: suggestions for practice. Part 2 
This paper, the second of two, represents a theoretical framework for interventions related to loss by death of someone close, or chronic pain. This work is based on our previous understanding where grief is considered an integrated experience which involves movements on several continua.
We have performed a comparison between two interventions dealing with grief and chronic pain using different designs. Interrelated experiences and processes were identified.
Life phenomena like grief and loss caused by death and chronic pain, seem to have many qualities in common and may overlap each other. A common core containing emptiness, vulnerability and exhaustion is identified.
Despite advances in research and thinking in recent years, several issues related to grief caused by death or chronic pain remain a challenge in clinical settings and research. When preparing interventions, we must pay attention to the relearning process, the common core and the interplay between these bodily expressions.
We believe there is a value in future research and practice to consider losses caused by death and chronic pain, together as well as separately. Our comprehensive approach indicates that understanding the processes involved in one sort of grief may help understand the processes involved in the other.
PMCID: PMC2915551  PMID: 20694178
nursing; program development; grief
8.  Dealing with grief related to loss by death and chronic pain: An integrated theoretical framework. Part 1 
Based on the present authors’ research and several approaches to grief related to loss by death and nonmalignant chronic pain, the paper suggests a new integrated theoretical framework for intervention in clinical settings.
An open qualitative review of the literature on grief theories was performed searching for a new integrated approach in the phenomenological tradition. We then investigated the relationship between grief, loss and chronic nonmalignant pain, looking for main themes and connections and how these could be best understood in a more holistic manner.
Two main themes were formulated, “relearning the world” and “adaptation”. Between these themes a continuous movement emerged involving experience such as: “despair and hope”, “lack of understanding and insight”, “meaning disruption and increased meaning”, and “bodily discomfort and reintegrated body”. These were identified as paired subthemes.
Grief as a distinctive experience means that health care must be aimed at each individual experience and situation. Grief experience and working with grief are considered in terms of relearning the world while walking backwards and living forwards, as described in our integrated model. We consider that this theoretical framework regarding grief should offer an integrated foundation for health care workers who are working with people experiencing grief caused by death or chronic pain.
PMCID: PMC2898114  PMID: 20622913
health care; loss; grief
9.  A man could never do what women can do: Mental health care and the significance of gender 
The basic aim of this paper is to examine how women and men in mental health care understand their own strengths and weaknesses and those of the other gender.
This is a qualitative study based on individual and focus group interviews with 49 participants. Content analysis was performed.
Our findings indicate a gender imbalance in strengths and weaknesses on several levels. The female workers describe mothering as a female identity, and think women have a greater natural quality for caring than men. They orientate towards relationships and are inclined to take on too much responsibility. Men, on the other hand, use their gender power as a mobilizing attitude. However, they have a tendency to consider themselves too objective and too emotionally reserved. Female workers consider men’s professional distance in caring as a strength. Although the latter’s lack of handling emotions is considered a weakness. Male workers emphasize the women’s willingness to offer care as a strength, although women taking on too much responsibility is described as a weakness.
The imbalance between genders in mental health care may have some consequences for decision-making in relation to patients and care planning. Thus there is a need for work organizations to focus on the influence of gender not only for the working milieu, but also to better use the competence that exists to the benefit of the patients.
PMCID: PMC2875717  PMID: 20517468
gender; mental health care; mental health
10.  Health professionals’ experiences of person-centered collaboration in mental health care 
The basic aim in this paper is to discuss health care professionals’ experiences of person-centered collaboration and involvement in mental health rehabilitation and suggest ways of improving this perspective. Furthermore, the paper explains the supportive systems that are at work throughout the process of rehabilitation.
The study design is a qualitative approach using three focus group interviews with a total of 17 informants with different professional backgrounds such as nurses, social workers, and social pedagogies. In addition, one nurse and one social worker participated in a semi-structured in-depth interview to judge validity.
Our results may demonstrate deficits concerning mental health care on several levels. This understanding suggests firstly, that a person-centered perspective and involvement still are uncommon. Secondly, multidisciplinary work seems uncommon and only sporadically follows recommendations. Thirdly, family support is seldom involved. Lastly, firm leadership and knowledge about laws and regulations seems not to be systematically integrated in daily care.
Taking these matters together, the improvement of a person-centered perspective implies cooperation between different services and levels in mental health care. In order to bring about improvement the health care workers must critically consider their own culture, coordination of competence must be increased, and leadership at an institutional and organizational level must be improved so that scarce rehabilitation resources are used to the optimal benefit of people with a mental illness.
PMCID: PMC2770397  PMID: 19920972
multidisciplinary teams; person-centered collaboration; supportive systems; rehabilitation

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