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1.  Increase in psychotropic drug use between 2006 and 2010 among adolescents in Norway: a nationwide prescription database study 
Clinical Epidemiology  2012;4:225-231.
Background
The purposes of this study were to investigate the prevalence of psychotropic (hypnotic, antidepressant, and anxiolytic) drug use among adolescents aged 15–16 years during the period 2006–2010 according to gender and subcategories of psychotropics, and to study psychotropic drug use over the period 2007–2010 among incident users in 2007.
Methods
This was a one-year prevalence and follow-up study based on information retrieved from the nationwide Norwegian prescription database for the period 2006–2010. The study population consisted of adolescents aged 15–16 years who had filled at least one prescription for a psychotropic drug in the study period. The main outcome measures were filling of hypnotic, antidepressant, and/or anxiolytic drug prescriptions.
Results
Overall use of psychotropic drugs increased from 13.9 to 21.5 per 1000 among boys and from 19.7 to 24.7 per 1000 among girls during the 2006– 2010 period. Hypnotic drugs, and melatonin in particular, accounted for most of the increase. For melatonin, the annual median amount dispensed was 180 defined daily doses through the period until 2010, at which time it decreased to 90 defined daily doses. In total, 16.4% of all incident psychotropic drug users in 2007 were still having prescriptions dispensed in 2010.
Conclusion
This study shows an increase in hypnotic drugs dispensed for adolescents in Norway, mainly attributable to the increasing use of melatonin. The amount of melatonin dispensed indicates more than sporadic use over longer periods, despite melatonin only being licensed in Norway for use in insomnia for individuals aged 55 years or older.
doi:10.2147/CLEP.S31624
PMCID: PMC3429152  PMID: 22936858
psychotropic drugs; hypnotics; sedatives; antidepressive agents; antianxiety agents; adolescents; prescription database; defined daily dose; long-term use
2.  Barriers to research utilization and research use among registered nurses working in the care of older people: Does the BARRIERS Scale discriminate between research users and non-research users on perceptions of barriers? 
Background
One strategy to enhance research use and change current practice is to identify barriers and then implement tailored interventions to reduce these barriers. In nursing, the BARRIERS scale has been frequently used to identify nurses' perceptions of barriers to research utilization. However, this scale has not been applied to care of older people, and only one study has investigated how identified barriers link to research utilization. Therefore, the purpose of this study was twofold: to describe RNs' perceptions of barriers to and facilitators of research utilization and to examine the validity of the BARRIERS scale in relation to research use.
Methods
A cross-sectional survey design was used and registered nurses (RNs) working in the care of older people participated (response rate 67%, n = 140/210). Two questionnaires, the BARRIERS scale and the Research Utilization Questionnaire (RUQ), were used. Data were analyzed using descriptive and bivariate inferential statistics.
Results
Characteristics of the organization and the presentation of research findings were rated as the most prominent barriers. The three items most frequently reported as barriers were: the nurse is isolated from knowledgeable colleagues with whom to discuss the research (89%); the facilities are inadequate for implementation (88%); and, the relevant literature is not compiled in one place (81%). Surveyed RNs suggested more support from unit managers and better availability of user-friendly reports in Swedish to enhance research use.
The RNs reported a modest use of research. A weak but significant correlation was found between the Research Use index in RUQ and the Presentation subscale in the BARRIERS scale (r = -0.289, p < 0.01), suggesting that the RNs reporting more research use were less likely to perceive presentation of research as a barrier. Dividing the sample into research users (n = 29) and non-research users (n = 105), the research users rated significantly lower on the subscales Presentation, Nurse and Research in the BARRIERS scale.
Conclusion
The BARRIERS scale revealed differences in the perception of barriers between research users and non-research users. Thus, methodologically the scale appears useful in identifying some types of barriers to research utilization but not organizational barriers. The identified barriers, however, are general and wide-ranging, making it difficult to design useful specific interventions.
doi:10.1186/1748-5908-3-24
PMCID: PMC2405784  PMID: 18452603
3.  Adolescents' experiences of being food-hypersensitive: a qualitative study 
BMC Nursing  2007;6:8.
Background
Experiencing or being at risk of adverse reactions to certain food items is a common health issue, especially among children and adolescents. Research has shown that living with the risk of food reactions and always having to take measures to avoid certain food in one's diet has a negative impact on quality of life. The aim of this study was to illuminate adolescents' experiences of being food hypersensitive.
Methods
Three focus group interviews and six individual interviews were carried out with all together 17 adolescents, 14–18 years of age, who had exclusion diets at school due to food hypersensitivity. The interviews were taped and transcribed verbatim and a qualitative content analysis was carried out.
Results
Five categories with subcategories, and one pervading theme, emerged. The categories were: Perceiving oneself as being particular, Feeling constrained, Experiencing others' ignorance, Keeping control, and Feeling it's okay. A pervading theme was conceptualised as Striving to normalise the experience of being food-hypersensitive. The adolescents regarded themselves as competent and courageous, but also described how they avoided the extra attention it implied to ask for special food considerations taken into account. Their self-conceptions were probably essential for their management of and attitude toward the hypersensitivity condition. They felt deprived, and those at risk of severe food reactions experienced insecurity and fear. Feelings of being disregarded were expressed, as well as facing unreliability and a lack of understanding from others. The continual work of constant vigilance and decision-making was described as time-consuming and frustrating. However, the adolescents also experienced considerate and supportive surroundings and were at pains to tone down the negative experiences and consequences of being food-hypersensitive.
Conclusion
Food avoidance by itself, and not only the somatic food reactions, brings about consequences with significant impacts on adolescents' lives. The findings from this study have implications for all of those who deal with adolescents who are food-hypersensitive, and not only health professionals. A deeper insight into adolescents' experiences gives an understanding which can improve the care-givers' efforts.
doi:10.1186/1472-6955-6-8
PMCID: PMC2104527  PMID: 17922926
4.  Health-related quality of life in food hypersensitive schoolchildren and their families: parents' perceptions 
Background
About 20% of schoolchildren and adolescents in Sweden suffer from perceived food hypersensitivity (e.g. allergy or intolerance). Our knowledge of how child food hypersensitivity affects parents HRQL and what aspects of the hypersensitivity condition relate to HRQL deterioration in the family is limited. Thus the aim of this study was to investigate the parent-reported HRQL in families with a schoolchild considered to be food hypersensitive. The allergy-associated parameters we operated with were number of offending food items, adverse food reactions, additional hypersensitivity, allergic diseases and additional family members with food hypersensitivity. These parameters, along with age and gender were assessed in relation to child, parent and family HRQL.
Methods
In May 2004, a postal questionnaire was distributed to parents of 220 schoolchildren with parent-reported food hypersensitivity (response rate 74%). Two questionnaires were used: CHQ-PF28 and a study-specific questionnaire including questions on allergy-associated parameters. In order to find factors that predict impact on HRQL, stepwise multiple linear regression analyses were carried out.
Results
An important predictor of low HRQL was allergic disease (i.e. asthma, eczema, rhino conjunctivitis) in addition to food hypersensitivity. The higher the number of allergic diseases, the lower the physical HRQL for the child, the lower the parental HRQL and the more disruption in family activities. Male gender predicted lower physical HRQL than female gender. If the child had sibling(s) with food hypersensitivity this predicted lower psychosocial HRQL for the child and lower parental HRQL. Food-induced gastro-intestinal symptoms predicted lower parental HRQL while food-induced breathing difficulties predicted higher psychosocial HRQL for the child and enhanced HRQL with regards to the family's ability to get along.
Conclusion
The variance in the child's physical HRQL was to a considerable extent explained by the presence of allergic disease. However, food hypersensitivity by itself was associated with deterioration of child's psychosocial HRQL, regardless of additional allergic disease. The results suggest that it is rather the risk of food reactions and measures to avoid them that are associated with lower HRQL than the clinical reactivity induced by food intake. Therefore, food hypersensitivity must be considered to have a strong psychosocial impact.
doi:10.1186/1477-7525-4-48
PMCID: PMC1564003  PMID: 16901348
5.  The two-year impact of first generation protease inhibitor based antiretroviral therapy (PI-ART) on health-related quality of life 
Background
Protease inhibitor based antiretroviral therapy (PI-ART) was introduced in 1996 and has greatly reduced the incidence of HIV-related morbidity and mortality in the industrialised world. PI-ART would thus be expected to have a positive effect on health-related quality of life (HRQL). On the other hand, HRQL might be negatively affected by strict adherence requirements as well as by short and long-term adverse effects. The aim of this study was to assess the influence of two years of first generation PI-ART on HRQL in patients with a relatively advanced state of HIV-infection. Furthermore, we wanted to investigate the relation between developments in HRQL and viral response, self-reported adherence and subjective experience of adverse effects in patients with PI-ART.
Methods
HRQL was measured by the Swedish Health-Related Quality of Life Questionnaire (SWED-QUAL). Sixty-three items from the SWED-QUAL forms two single-item and 11 multi-item dimension scales. For this study, two summary SWED-QUAL scores (physical HRQL composite score and emotional HRQL composite score) were created through a data reduction procedure. At the 2-year follow-up measurement (see below), items were added to measure adherence and subjective experience of adverse effects. Demographic and medical data were obtained from specific items in the questionnaires and from the medical files. Seventy-two patients who were among the first to receive PI-ART (indinavir or ritonavir based) responded to the questionnaire before the start of PI-ART. Of these, 54 responded to the same instrument after two years of treatment (13 had died, four had changed clinic and one did not receive the questionnaire).
Results
The main findings were that the emotional HRQL deteriorated during two years of PI-ART, while the physical HRQL remained stable. Multiple linear regression analyses showed that experience of adverse effects contributed most to the deterioration of emotional HRQL.
Conclusion
In this sample of patients with relatively advanced state of HIV-infection, our data suggested that a negative development of physical HRQL had been interrupted by the treatment and that the emotional dimension of HRQL deteriorated during two years after start of PI-ART. Subjective experience of adverse effects made a major contribution to the decrease in emotional HRQL. The results underline the importance of including HRQL measures in the evaluation of new life prolonging therapies.
doi:10.1186/1477-7525-3-32
PMCID: PMC1173133  PMID: 15871738
6.  Health-related quality of life among adolescents with allergy-like conditions – with emphasis on food hypersensitivity 
Background
It is known that there is an increase in the prevalence of allergy and that allergic diseases have a negative impact on individuals' health-related quality of life (HRQL). However, research in this field is mainly focused on individuals with verified allergy, i.e. leaving out those with self-reported allergy-like conditions but with no doctor-diagnosis. Furthermore, studies on food hypersensitivity and quality of life are scarce. In order to receive information about the extent to which adolescent females and males experience allergy-like conditions and the impact of these conditions on their everyday life, the present study aimed to investigate the magnitude of self-reported allergy-like conditions in adolescence and to evaluate their HRQL. Special focus was put on food hypersensitivity as a specific allergy-like condition and on gender differences.
Methods
In connection with lessons completed at the children's school, a study-specific questionnaire and the generic instrument SF-36 were distributed to 1488 adolescents, 13–21 years old (response rate 97%).
Results
Sixty-four per cent of the respondents reported some kind of allergy-like condition: 46% reported hypersensitivity to defined substances and 51% reported allergic diseases (i.e. asthma/wheezing, eczema/rash, rhino-conjunctivitis). A total of 19% reported food hypersensitivity. Females more often reported allergy-like conditions compared with males (p < 0.001). The adolescents with allergy-like conditions reported significantly lower HRQL (p < 0.001) in seven of the eight SF-36 health scales compared with adolescents without such conditions, regardless of whether the condition had been doctor-diagnosed or not. Most adolescents suffered from complex allergy-like conditions.
Conclusions
The results indicate a need to consider the psychosocial impact of allergy-like conditions during school age. Further research is needed to elucidate the gender differences in this area. A team approach addressing better understanding of how allergy-like conditions impair the HRQL may improve the management of the adolescent's health problems, both in health-care services and in schools.
doi:10.1186/1477-7525-2-65
PMCID: PMC534793  PMID: 15555064
Health-related quality of life; hypersensitivity; allergic disease; food hypersensitivity; adolescence; gender
7.  Critical thinking dispositions among newly graduated nurses 
Journal of Advanced Nursing  2010;66(10):2170-2181.
wangensteen s., johansson i.s., björkström m.e. & nordström g. (2010) Critical thinking dispositions among newly graduated nurses. Journal of Advanced Nursing66(10), 2170–2181.
Aim
The aim of the study was to describe critical thinking dispositions among newly graduated nurses in Norway, and to study whether background data had any impact on critical thinking dispositions.
Background
Competence in critical thinking is one of the expectations of nursing education. Critical thinkers are described as well-informed, inquisitive, open-minded and orderly in complex matters. Critical thinking competence has thus been designated as an outcome for judging the quality of nursing education programmes and for the development of clinical judgement. The ability to think critically is also described as reducing the research–practice gap and fostering evidence-based nursing.
Methods
A cross-sectional descriptive study was performed. The data were collected between October 2006 and April 2007 using the California Critical Thinking Disposition Inventory. The response rate was 33% (n= 618). Pearson’s chi-square tests were used to analyse the data.
Results
Nearly 80% of the respondents reported a positive disposition towards critical thinking. The highest mean score was on the Inquisitiveness subscale and the lowest on the Truth-seeking subscale. A statistically significant higher proportion of nurses with high critical thinking scores were found among those older than 30 years, those with university education prior to nursing education, and those working in community health care.
Conclusion
Nurse leaders and nurse teachers should encourage and nurture critical thinking among newly graduated nurses and nursing students. The low Truth-seeking scores found may be a result of traditional teaching strategies in nursing education and might indicate a need for more student-active learning models.
doi:10.1111/j.1365-2648.2010.05282.x
PMCID: PMC2984541  PMID: 20384637
California Critical Thinking Disposition Inventory; critical thinking; newly graduated nurses; Norway; nurse education

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