Family members' involvement in psychiatric care: experiences of the healthcare professionals' approach and feeling of alienation

The involvement of family members in psychiatric care is important for the recovery of persons with psychotic disorders and subsequently reduces the burden on the family. Earlier qualitative studies suggest that the participation of family members can be limited by how they experience the professionals' approach, which suggests a connection to the concept of alienation. Thus, the aim of this study was in a national sample investigate family members' experiences of the psychiatric health care professionals' approach. Data were collected by the Family Involvement and Alienation Questionnaire. The median level and quartiles were used to describe the distributions and data were analysed with non-parametric statistical methods. Seventy family members of persons receiving psychiatric care participated in the study. The results indicate that a majority of the participants respond that they have experiencing a negative approach from the professionals, indicating lack of confirmation and cooperation. The results also indicate that a majority of the participants felt powerlessness and social isolation in the care being provided, indicating feelings of alienation. A significant but weak association was found between the family members' experiences of the professionals' approach and their feelings of alienation.

A method to analyse observer disagreement in visual grading studies: example of assessed image quality in paediatric cerebral multidetector CT images

The purpose was to demonstrate a non-parametric statistical method that can identify and explain the components of observer disagreement in terms of systematic disagreement as well as additional individual variability, in visual grading studies. As an example, the method was applied to a study where the effect of reduced tube current on diagnostic image quality in paediatric cerebral multidetector CT (MDCT) images was investigated. Quantum noise, representing dose reductions equivalent to steps of 20 mA, was artificially added to the raw data of 25 retrospectively selected paediatric cerebral MDCT examinations. Three radiologists, blindly and randomly, assessed the resulting images from two different levels of the brain with regard to the reproduction of high- and low-contrast structures and overall image quality. Images from three patients were assessed twice for the analysis of intra-observer disagreement. The intra-observer disagreement in test-retest assessments could mainly be explained by a systematic change towards lower image quality the second time the image was reviewed. The inter-observer comparisons showed that the paediatric radiologist was more critical of the overall image quality, while the neuroradiologists were more critical of the reproduction of the basal ganglia. Differences between the radiologists regarding the extent to which they used the whole classification scale were also found. The statistical method used was able to identify and separately measure a presence of bias apart from additional individual variability within and between the radiologists which is, at the time of writing, not attainable by any other statistical approach suitable for paired, ordinal data.

Wilms' tumor gene 1 protein represses the expression of the tumor suppressor interferon regulatory factor 8 in human hematopoietic progenitors and in leukemic cells

Wilms' tumor gene 1 (WT1) is a transcription factor involved in developmental processes. In adult hematopoiesis, only a small portion of early progenitor cells express WT1, whereas most leukemias show persistently high levels, suggesting an oncogenic role. We have previously characterized oncogenic BCR/ABL1 tyrosine kinase signaling pathways for increased WT1 expression. In this study, we show that overexpression of BCR/ABL1 in CD34+ progenitor cells leads to reduced expression of interferon regulatory factor 8 (IRF8), in addition to increased WT1 expression. Interestingly, IRF8 is known as a tumor suppressor in some leukemias and we investigated whether WT1 might repress IRF8 expression. When analyzed in four leukemia mRNA expression data sets, WT1 and IRF8 were anticorrelated. Upon overexpression in CD34+ progenitors, as well as in U937 cells, WT1 strongly downregulated IRF8 expression. All four major WT1 splice variants induced repression, but not the zinc-finger-deleted WT1 mutant, indicating dependence on DNA binding. A reporter construct with the IRF8 promoter was repressed by WT1, dependent on a putative WT1-response element. Binding of WT1 to the IRF8 promoter was demonstrated by chromatin immunoprecipitation. Our results identify IRF8 as a direct target gene for WT1 and provide a possible mechanism for oncogenic effects of WT1 in leukemia.

Trender i insidens og mortalitet av kreft i Norge

 ENGLISH SUMMARYTretli S, Robsahm TE, Svensson E. Time trends in cancer incidence and mortality in Norway.Nor J Epidemiol  2001; 11 (2): 177-185.The aim of this study is to decribe the trends in incidence and mortality of cancer by calendar time.Most types of cancer, except those with high case fatality short time after the diagnosis, demonstrate alarger increase in incidence than in mortality over time. For persons below 70 years of age during theperiod 1931-95 the mortality rate has been close to constant. Obviously, the mortality of lung andstomach cancer has changed over time, however, these have changed in different direction and almostlevelled out. In this paper, it is discussed how registration routines, classification rules, treatment resultsand the basis of the diagnosis can influence the incidence and mortality trends.

Rectumcancerregisteret gir kvalitetsforbedring i kreftbehandlingen

 SAMMENDRAGResultatene etter operasjon for kreft i endetarmen har vært preget av høy frekvens av lokalt residiv og deravlav overlevelse. Resultater blant kurativt opererte i Norge i perioden 1986-88 viste at 28% utviklet lokaltresidiv og bare 55% overlevde fem år. For å bedre prognosen ved endetarmskreft (rectumcancer) ble det i1993 startet et nasjonalt prosjekt, og hensikten med denne studien er å evaluere effekten av de tiltak som bleiverksatt for å heve kvaliteten av behandlingen. Prosjektet har fokusert på å optimalisere kirurgisk behandlingved å innføre operasjonsmetoden ”Total Mesorectal Excision” (TME). I tillegg har en lagt vekt på åstandardisere de patologisk anatomiske undersøkelsene. En rekke kurs er blitt arrangert for å lære kirurgeneden nye operasjonsteknikken, mens patologer har gjennomgått kurs for å sikre kvaliteten i vurderingen avoperasjonspreparatene. Et nasjonalt register for endetarmskreft, etablert og drevet av fagmiljøene, ble opprettetved Kreftregisteret. Fra dette sentrale Rectumcancerregisteret får alle kirurgiske avdelinger regelmessigetilbakemeldinger om sine egne resultater. Fra november 1993 til desember 1999 ble det diagnostisert5382 nye tilfeller av endetarmskreft i Norge. Blant de 3432 (64%) som ble kurativt operert var det 8% somutviklet lokalt residiv etter en median observasjonstid på 31 måneder, og av de under 75 år var den estimerte5-års overlevelsen 71%. I 1999 ble mer enn 95% av pasientene operert med TME teknikken. Det nasjonalesamarbeidsprosjektet for kreft i endetarmen har hittil redusert frekvensen av lokale residiver fra 28% til 8%og øket 5-års overlevelsen fra 55% til 71%. Spesialutdanning av kirurger og patologer, og etablering avRectumcancerregisteret har vært viktige kvalitetsforbedrende tiltak i norsk kreftbehandling.Wibe A, Svensson E, Bjerkeset T, Carlsen E, Langmark F, Norstein J, Wiig JN, Søreide O,on behalf of Norsk Rectum Cancer Gruppe. The Norwegian Rectal Cancer Registry entailsquality improvement in cancer treatment. Nor J Epidemiol 2001; 11 (2): 159-163.  ENGLISH SUMMARYThe outcome following rectal cancer surgery has been characterised by high local recurrence rates and lowsurvival. In a Norwegian national audit, 28% of the patients developed local recurrence, and the 5-yearsurvival was 55% (patients

Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability

AIMS AND OBJECTIVES

In this study we describe the development of a short, easy-to-use questionnaire to measure postoperative recovery and evaluate its content validity and intra-patient reliability. The questionnaire is designed to evaluate the progress of postoperative recovery and the long-term follow-up of possible effects of interventions during recovery.

METHODS

The study involved four steps. (1) A conceptualization and item definitions were based on a theoretical framework and a description of patients' postoperative recovery from the perspective of patients, registered nurses and surgeons; (2) Content validity of items was tested through expert judgements; (3) A test run of the questionnaire was performed to confirm its feasibility and workload requirement; and (4) The stability of the questionnaire was evaluated through intra-patient reliability assessment.

RESULTS

As a result of the operationalization process of the concept postoperative recovery, five dimensions (physical symptoms, physical functions, psychological, social, activity) and 19 items were identified. Each item was formulated as a statement in the questionnaire. Content validity was judged to be high. After the pre-test of the questionnaire a revision with refinements in the layout was made. The vast majority of items showed a high level of intra-patient reliability.

CONCLUSION

Based on a theoretical framework and empirical data, we developed a short and easy-to-use tentative questionnaire to measure patient-reported postoperative recovery. Initial support for content validity was established. The vast majority of items showed a high level of test-retest reliability.

Changes in formal help seeking for psychological distress: the OsLof study

BACKGROUND

Data from the Norwegian HUNT suggests that only 10-13% of individuals suffering from depression and anxiety have sought professional help, fuelling concerns that only a fraction of individuals with clinically significant mental health problems receive adequate treatment in Norway.

AIM

The aim of this study was to examine formal help seeking for psychological distress in two communities in Norway (one urban and one rural) over time, in relation to the prevalence of distress. In addition, the proportion with potential unmet need for professional help was examined.

METHODS

A randomly drawn selection of individuals from Oslo (urban) and Lofoten (rural), the OsLof study, were interviewed about help seeking and administered the Hopkins Symptom Checklist (HSCL-25) in 1990 and 2001.

RESULTS

Results showed a significant shift in help seeking over time, whereas the prevalence of distress (HSCL-25 >or= 1.75) remained stable in both communities, ranging between 13% and 16%. A significant increase occurred in the proportion seeking help from psychiatrists/psychologists, together with a significant decrease in help seeking from GPs and non-medical services.

CONCLUSION

Multiple explanatory factors might account for the decline in overall formal help seeking, such as the improvement in the economical situation observed across the decade. No urban-rural difference in help seeking was observed, despite Oslo having a higher calculated man-labour year in psychiatric services. Even though potential unmet need has been decreasing among the psychologically distressed, only 40% had sought help from mental health professionals in 2001, indicating the need of the speciality health services to address this issue further.

Developing the concept of family involvement and the alienation questionnaire in the context of psychiatric care

Research shows that family members of people with a mental illness often experience a lack of involvement in the psychiatric care of their relative. An interpretation of the findings of these studies raises the question of whether the family members' experience of not being involved can be conceptualized in terms of alienation towards mental health services from their encounter with psychiatric care. In order to explore this possibility, the Family Involvement and Alienation Questionnaire (FIAQ) was constructed, guided by relevant theoretical frameworks and empirical research. The content validity of the questionnaire was evaluated by two groups of experienced researchers who had sound knowledge of the theoretical frameworks used. Validity based on the response process was evaluated by the parents of people with mental illness. The reliability of the questionnaire was evaluated by a test-retest design with a group of 15 family members. The data were analyzed by a non-parametric statistical method. The results of the validity and reliability evaluations showed that of the 46 original items in the questionnaire, 28 would be useful in exploring the concept of family involvement and alienation in the context of psychiatric care. Further, minor modifications could make the FIAQ useful in exploring these concepts in other settings.

Grip strength in children: test-retest reliability using Grippit

AIM

To examine the reliability of peak and sustained grip strength in children using the Grippit. We compared the reliability of one trial, the best and mean of three trials and the reliability within 6-, 10- and 14-year-old groups.

DESIGN

Test-retest study.

METHODS

Grip strength with the Grippit instrument was evaluated at two test occasions in 58 children. Intraclass correlation coefficient 2.1 (ICC), standard error of measurement (SEM) also expressed as a percentage value (SEM%), coefficient of repeatability and coefficient of variation were calculated.

RESULTS

The test-retest reliability was good for both peak and sustained grip strength. The mean and best of three trials were equally reliable. Peak grip strength best of three trials, for example, was more reliable for the 6-year-olds (ICC 0.96, SEM% 6.3) and 14-year-olds (ICC 0.96, SEM% 5.2) compared to the 10-year-olds (ICC 0.78, SEM% 12.5). For peak grip strength in the whole sample, there was a systematic bias with better performance at the second measurement.

CONCLUSION

Grip strength assessment in children with Grippit results in good relative and absolute reliability for peak and sustained grip strength. We recommend that three test trials are used. The mean of and the best of three trials are comparable.

Self-reported activity level and knee function in amateur football players: the influence of age, gender, history of knee injury and level of competition

The aim of this study is to investigate if self-reported activity level or knee functions are influenced by subject characteristics, level of competition and history of knee injury. Cross-Sectional study using questionnaires distributed at a personal visit. One hundred and eighty-eight (65 women) amateur football players in 10 football clubs from each division below national level participated in the study. Self-reported Tegner Activity Scale, and the Knee injury and Osteoarthritis Outcome Score (KOOS) are the main outcome measures. Older age, female gender and lower level of competition (football division) were independently associated with lower self-reported Tegner Activity Scale (P < 0.001). Subjects reporting history of knee injury had significantly worse KOOS scores (P < 0.001 for all subscales). In future studies, a clear description of how the Tegner Activity Scale was administered is recommended. We suggest that self-reported Tegner Activity Scale scores should be adjusted for age, gender and level of competition. In amateur football players, KOOS scores do not need adjustment for age and gender.

Depression and anxiety amongst multiple sclerosis patients

The aim of this study was to investigate the prevalence of symptoms of depression and anxiety amongst multiple sclerosis (MS) patients, and the associations with demographic and clinical characteristics. The current treatment for depression and anxiety was also evaluated amongst the MS patients. A total of 140 MS patients from Eastern Norway underwent neuropsychiatric and clinical examinations, with registration of symptoms of depression and anxiety (Hopkins Symptom Checklist-25), as well as information about any help seeking for depression were obtained. A total of 31.4% patients reported symptoms of depression, whilst 19.3% reported anxiety; both symptoms were significantly higher than that amongst the general population (P < 0.001). Fatigue and younger age at onset were significantly associated with symptoms of depression, whilst fatigue and pain, lower Expanded Disability Status Scale score and younger age at onset were associated with symptoms of anxiety. The proportion of reported treatment of depression was 15.9% and for anxiety 11.1%. Of untreated patients with symptoms, 18.2% expressed the need for treatment. A greater focus on depression and anxiety amongst MS patients is needed to establish the appropriate treatment for patients suffering from MS.

Urban-rural differences in BMI, overweight and obesity in Norway (1990 and 2001)

AIM

The aim of this study was to examine body mass index and the prevalence of overweight and obesity in 1990 and 2001 in Oslo and Lofoten, Norway.

METHODS

A randomly selected study population of 1,924 individuals (OsLof) underwent a structured personal interview in 1990. In 2001, 1629 individuals underwent the same interview. These samples were analysed as two cross-sectional datasets.

RESULTS

Overall mean BMI in 1990 was 24.7 for men and 22.9 for women, increasing significantly in 2001 to 26.1 and 24.6, respectively. In 1990, 37% of men and 20% of women were overweight, while 5% of men and 4% of women were obese. The corresponding figures for 2001 were 48% and 27% for overweight, and 12% and 11% for obesity, respectively.

DISCUSSION

The greatest increases in average BMI occurred for the youngest (18-34 years) for both genders and geographic regions. In 1990, urban-rural differences existed for mean BMI and proportion overweight for both genders, although geographic differences persisted only for women 10 years later.

Changes in body mass index by age, gender, and socio-economic status among a cohort of Norwegian men and women (1990-2001)

Background

Consistent with global trends, the prevalence of obesity is increasing among Norwegian adults. This study aimed to investigate individual trends in BMI (kg/m²) by age, gender, and socio-economic status over an 11-year period.

Methods

A cohort of 1169 adults (n = 581 men; n = 588 women) self-reported BMI during a general health interview twice administered in two regions in Norway.

Results

Average BMI increased significantly from 23.7 (SD = 3.4) to 25.4 (SD = 3.8), with equivalent increases for both genders. Proportion of obesity (BMI ≥ 30) increased from 4% to 11% for women and 5% to 13% for men. Of those already classified as overweight or obese in 1990, 68% had gained additional weight 10 years later, by an average increase of 2.6 BMI units. The greatest amount of weight gain occurred for the youngest adults (aged 20–29 years). Age-adjusted general linear models revealed that in 1990, women with a lower level of education had a significantly greater BMI than more educated women. In both 1990 and 2001, rural men with the highest level of household income had a greater BMI than rural men earning less income. Weight gain occurred across all education and income brackets, with no differential associations between SES strata and changes in BMI for either gender or region.

Conclusion

Results demonstrated significant yet gender-equivalent increases in BMI over an 11-year period within this cohort of Norwegian adults. Whereas socio-economic status exerted minimal influence on changes in BMI over time, young adulthood appeared to be a critical time period at which accelerated weight gain occurred.

Deregulation of the Wilms' tumour gene 1 protein (WT1) by BCR/ABL1 mediates resistance to imatinib in human leukaemia cells

The Wilms' tumour gene 1 (WT1) protein is highly expressed in most leukaemias. Co-expression of WT1 and the fusion protein AML1-ETO in mice rapidly induces acute myeloid leukaemia (AML). Mechanisms behind expression of WT1, as well as consequences thereof, are still unclear. Here, we report that the fusion protein BCR/ABL1 increases expression of WT1 mRNA and protein via the phosphatidylinositol-3 kinase (PI3K)-Akt pathway. Inhibition of BCR/ABL1 or PI3K activity strongly suppressed transcription from WT1 promoter/enhancer reporters. Forced expression of BCR/ABL1 in normal human progenitor CD34+ cells increased WT1 mRNA and protein, further supporting the notion of BCR/ABL1-driven expression of WT1 in human haematopoietic cells. Forced expression of WT1 in K562 cells provided protection against cytotoxic effects of the ABL1 tyrosine kinase inhibitor imatinib, as judged by effects on viability measured by trypan blue exclusion, metabolic activity, annexin V and DAPI (4', 6-diamidino-2-phenylindole) staining. None of the isoforms provided any detectable protection against apoptosis induced by arsenic trioxide and only very weak protection against etoposide, indicating that WT1 interferes with specific apoptotic signalling pathways. Our data demonstrate that WT1 expression is induced by oncogenic signalling from BCR/ABL1 and that WT1 contributes to resistance against apoptosis induced by imatinib.

Diagnostic performance of computed tomography colonography in symptomatic patients and in patients with increased risk for colorectal disease

PURPOSE

To evaluate the diagnostic performance (colorectal lesions) of computed tomography (CT) colonography in 111 patients, a majority of whom were at high risk for colorectal neoplasia.

MATERIAL AND METHODS

After bowel preparation, CT colonography was performed, immediately followed by conventional colonoscopy. The diagnostic performance of CT colonography was analyzed relative to lesion size, histological diagnosis, and diagnostic certainty.

RESULTS

The sensitivity of CT colonography increased with lesion size (P<0.001), and was 91% (21/23) for lesions > or = 10 mm. All 10 carcinomas and 86% (19/22) of adenomas > or = 5 mm were detected. Unconfirmed or false-positive CT findings were generally small and/or reported with low diagnostic certainty. The specificity of CT colonography would be 45% (30/66; 95% CI 34% to 57%) if patients with findings of any size and any diagnostic certainty were selected for follow-up, and 92% (85/92; 95% CI 85% to 96%) if only patients with CT findings > or = 10 mm classified as certain were selected.

CONCLUSION

CT colonography had a high sensitivity for lesions > or = 5 mm. The diagnostic performance increased with lesion size and degree of diagnostic certainty, and was higher for adenomas.

Frailty modelling of colorectal cancer incidence in Norway: indications that individual heterogeneity in risk is related to birth cohort

Some cancer types level off or decrease in incidence at older age groups, not following the Weibull hazard rate. This stagnation can be explained by the frailty model, which describes the population effect of mixing individuals who are susceptible, with high risk of cancer, with those that are "non-susceptible", with a low risk of cancer even in the oldest age groups. The aim of the study was to apply a frailty model on colorectal cancer incidence data for the Norwegian population aged 40-99 years, diagnosed 1956-2000. The model provided an acceptable fit to the data. The estimated proportion of susceptibles increased from about 5% to about 24% from the first cohort (1851-1855) to the last cohort (1946-1950), in line with the rise in incidence of the disease during this period. According to the frailty modelling, the estimated number of genetic events necessary for a malignant lesion to develop in the colorectum is seven to eight, which accords with the present knowledge regarding colorectal carcinogenesis. The frailty phenomenon may thus be present in this cancer form. The findings indicate that it is possible to model the development of colorectal cancer in the population based on large heterogeneity in risk between individuals, in such a manner that a small group of individuals are susceptible to develop the disease, whereas the remaining majority have a low susceptibility.

Corticotropin releasing factor in urine—A possible biochemical marker of fibromyalgia

The purpose of this preliminary study was to evaluate the relationship between a possible biochemical marker of stress, 24-h urinary concentrations of Corticotropin Releasing Factor-Like Immunoreactivity (CRF-LI), and ratings of stress-related symptoms like depression and anxiety, as well as to evaluate pain and emotional reactions in patients with fibromyalgia (FM). Another purpose was to study the effects of massage and guided relaxation, with respect to change in the same variables. Urine sampling and ratings were performed before treatments, after and 1 month after completed treatments. Concentrations of CRF-LI was analysed with radioimmnoassay technique. For the assessment of depression, anxiety and pain the CPRS-A questionnaire was used and for rated pain and emotional reactions the NHP questionnaire was used. The 24-h urinary concentration of the CRF-LI was found to be related to depression, mood and inability to take initiative. After treatment the urinary CRF-LI concentrations and the rated levels of pain and emotional reactions were found to have decreased. In conclusion, the 24-h urinary CRF-LI concentration may be used as a biochemical marker of stress-related symptoms such as depression in patients with FM and possibly also other conditions characterized by chronic pain. Therapies such as massage and guided relaxation may be tried for the amelioration of pain and stress but further studies are required.

Post-thrombotic syndrome, recurrence, and death 10 years after the first episode of venous thromboembolism treated with warfarin for 6 weeks or 6 months

BACKGROUND

The influence of the duration of anticoagulant therapy after venous thromboembolism (VTE) on the long-term morbidity and mortality is unclear.

AIM

To investigate the long-term sequelae of VTE in patients randomized to different duration of secondary prophylaxis.

METHODS

In a multicenter trial comparing secondary prophylaxis with vitamin K antagonists for 6 weeks or 6 months, we extended the originally planned 2 years follow-up to 10 years. The patients had annual visits and at the last visit clinical assessment of the post-thrombotic syndrome (PTS) was performed. Recurrent thromboembolism was adjudicated by a radiologist, blinded to treatment allocation. Causes of death were obtained from the Swedish Death Registry.

RESULTS

Of the 897 patients randomized, 545 could be evaluated at the 10 years follow-up. The probability of developing severe PTS was 6% and any sign of PTS was seen in 56.3% of the evaluated patients. In multivariate analysis, old age and signs of impaired circulation at discharge from the hospital were independent risk factors at baseline for development of PTS after 10 years. Recurrent thromboembolism occurred in 29.1% of the patients with a higher rate among males, older patients, those with permanent triggering risk factor - especially with venous insufficiency at baseline - signs of impaired venous circulation at discharge, proximal deep vein thrombosis, or pulmonary embolism. Death occurred in 28.5%, which was a higher mortality than expected with a standardized incidence ratio (SIR) of 1.43 (95% CI 1.28-1.58), mainly because of a higher mortality than expected from cancer (SIR 1.83; 95% CI 1.44-2.23) or from myocardial infarction or stroke (SIR 1.28; 95% CI 1.00-1.56). The duration of anticoagulation did not have a statistically significant effect on any of the long-term outcomes.

CONCLUSION

The morbidity and mortality during 10 years after the first episode of VTE is high and not reduced by extension of secondary prophylaxis from 6 weeks to 6 months. A strategy to reduce recurrence of VTE as well as mortality from arterial disease is needed.