Associations between structures, processes and outcomes in inter-municipal cooperation in out-of-hours services in Norway: A survey study

Abstract Inter-municipal cooperation (IMC) has gained widespread recognition as a beneficial strategy for improving efficiency and quality in the provision of out-of-hours emergency care services (OOH services). Little attention, however, has been given to the additional costs of cooperation and the relational processes through which benefits and costs are likely to result. Based on survey data from 266 (77%) Norwegian municipalities involved in IMC in OOH services in 2015, this study aimed to investigate how the structure (governance form, complexity and stability) and quality (trust and consensus) of cooperation processes interact to influence the perceived outcomes (benefits and costs) o…

Standard vs Distal Roux-en-Y Gastric Bypass in Patients With Body Mass Index 50 to 60: A Double-blind, Randomized Clinical Trial.

Up to one-third of patients undergoing bariatric surgery have a body mass index (BMI) of more than 50. Following standard gastric bypass, many of these patients still have a BMI greater than 40 after peak weight loss.To assess the efficacy and safety of standard gastric bypass vs distal gastric bypass in patients with a BMI of 50 to 60.Double-blind, randomized clinical parallel-group trial at 2 tertiary care centers in Norway (Oslo University Hospital and Vestfold Hospital Trust) between May 2011 and April 2013. The study included 113 patients with a BMI of 50 to 60 aged 20 to 60 years. The 2-year follow-up was completed in May 2015.Standard gastric bypass (alimentary limb, 150 cm) and dist…

Generic Health-Related Quality of Life May Not Be Associated with Weight Loss 4 Years After Bariatric Surgery: a Cross-Sectional Study

Background: There seem to exist a belief that weight-loss is proportionally associated with improvement of health-related quality of life (HRQoL) after bariatric surgery. HRQoL is a complex multidimensional construct of one’s perception of health and well-being and is measured through generic and disease specific questionnaires. Objectives: This study aimed to test the associations between weight-loss after bariatric surgery, and both generic and obesity-specific HRQoL, and mental distress, controlling for other patient characteristics. Methods: The study was conducted at the Department of Surgery at Haugesund Hospital (Norway) based on a cohort of bariatric surgery patients operated betwee…

The effectiveness of secondary and tertiary care lifestyle intervention in morbidly obese patients: a 1-year non-randomized controlled pragmatic clinical trial

Summary In this non-randomized clinical pragmatic trial, we aimed to compare the effectiveness of an outpatient intensive lifestyle intervention (ILI) programme conducted in a tertiary care obesity rehabilitation centre with an outpatient moderate lifestyle intervention (MLI) programme at a secondary care obesity centre. Effectiveness was measured in terms of the 1-year effect each programme had on body weight, physical activity and health-related quality of life (HRQL). A total of 232 morbidly obese subjects were recruited to the ILI group and 140 to the MLI group, with retention rates of 78% and 44%, respectively. The ILI group had a significantly larger mean (95% confidence interval [CI]…

La sexologie en Norvège entre 2001 et 2011 : une étude comparative

Resume Les praticiens en sexologie norvegiens ont fait l’objet d’une etude transversale et comparative sur la base de deux enquetes menees en 2001 et en 2011 portant sur leur experience professionnelle, leur formation en sexologie, les approches therapeutiques et les problemes de sexologie clinique rencontres. Les professionnels exercant la sexologie en Norvege sont un petit groupe. L’Association norvegienne de sexologie clinique (NACS) comptait environ 150 membres en 2011. En 2001, un programme de formation continue en sexologie (de deux ans et demi sur un mi-temps) a debute a l’universite d’Agder. Cent soixante-quatre conseillers en sexologie ont ete formes dans le cadre de ce programme d…

‘Health in All Policies’ and the Urge for Coordination: The Work of Public Health Coordinators and Their Impact and Influence in Local Public Health Policies: A Cross-Sectional Study

Building heavily on the Health in All Policies (HiAP) approach, Norway implemented the Public Health Act in 2012 to reduce social inequalities in health. Local public health coordinators (PHCs) at municipal levels were seen as tools to provide local intersectoral public health work. In this study, we examine factors related to intersectoral agency and if intersectoral work is understood as relevant to securing social justice in local policy outcomes. A national web-based survey in 2019 of all Norwegian PHCs (n = 428) was conducted with a response rate of 60%. Data were analysed through multiple linear regression, hierarchical regression modelling and structural equation modelling. Neither f…

Obesity and other medical comorbidities among NT1 patients after the Norwegian H1N1 influenza epidemic and vaccination campaign.

Abstract Study Objectives Narcolepsy type 1 (NT1) may be complicated by comorbidities. We aimed to study the extent of obesity and other medical comorbidities in a Norwegian population of NT1 patients with debut of symptoms after the 2009 H1N1 influenza epidemic and vaccination campaign. We also aimed to explore factors associated with obesity. Methods Ninety-one patients (48 children and 43 adults) were included in this cross-sectional study, 80 of whom were H1N1-vaccinated. All participants were hospitalized and underwent sleep investigation and physical examination, and completed a semi-structured clinical interview. Results In children, 16 females (70%) and 10 males (40%) were classifie…

Health-related quality of life after bariatric surgery: a systematic review of prospective long-term studies

Author´s accepted manuscript Impaired health-related quality of life (HRQoL) is common in bariatric surgery candidates and is often one of the motivating factors for seeking bariatric surgery. Although many studies have reported changes in HRQoL after bariatric surgery, few are long-term prospective studies and no systematic review has been conducted. A systematic database search identified studies reporting HRQoL preoperatively and ≥ 5 years after bariatric surgery. Change in HRQoL over time was the outcome variable, divided into primary and secondary outcomes. Seven prospective cohort studies met the inclusion criteria. Eight HRQoL measures and six surgical methods were identified. Longte…

Impact of body weight, low energy diet and gastric bypass on drug bioavailability, cardiovascular risk factors and metabolic biomarkers: protocol for an open, non-randomised, three-armed single centre study (COCKTAIL)

IntroductionRoux-en-Y gastric bypass (GBP) is associated with changes in cardiometabolic risk factors and bioavailability of drugs, but whether these changes are induced by calorie restriction, the weight loss or surgery per se, remains uncertain. The COCKTAIL study was designed to disentangle the short-term (6 weeks) metabolic and pharmacokinetic effects of GBP and a very low energy diet (VLED) by inducing a similar weight loss in the two groups.Methods and analysisThis open, non-randomised, three-armed, single-centre study is performed at a tertiary care centre in Norway. It aims to compare the short-term (6 weeks) and long-term (2 years) effects of GBP and VLED on, first, bioavailability…

Asymmetry in inter-municipal cooperation in health services - How does it affect service quality and autonomy?

Throughout Europe, local health services are increasingly being provided through various forms of inter-municipal cooperation (IMC). One of the most common forms of IMC is when small municipalities delegate the operational responsibility for providing health services to a larger host municipality. However, despite the size asymmetry usually inherent in this type of IMC, this aspect has largely been neglected in the existing literature, which mainly focuses on the size of individual municipalities. Based on data from 97 partner municipalities and 25 host municipalities in Norway, this study examines how varying degrees of size asymmetry between them affect the perceived service quality and l…

Single-centre, triple-blinded, randomised, 1-year, parallel-group, superiority study to compare the effects of Roux-en-Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes and β-cell function in subjects with morbid obesity: a protocol for the Obesity surgery in Tønsberg (Oseberg) study

IntroductionBariatric surgery is increasingly recognised as an effective treatment option for subjects with type 2 diabetes and obesity; however, there is no conclusive evidence on the superiority of Roux-en-Y gastric bypass or sleeve gastrectomy. The Oseberg study was designed to compare the effects of gastric bypass and sleeve gastrectomy on remission of type 2 diabetes and β-cell function.Methods and analysisSingle-centre, randomised, triple-blinded, two-armed superiority trial carried out at the Morbid Obesity Centre at Vestfold Hospital Trust in Norway. Eligible patients with type 2 diabetes and obesity were randomly allocated in a 1:1 ratio to either gastric bypass or sleeve gastrecto…

Health related quality of life after gastric bypass or intensive lifestyle intervention: a controlled clinical study

Background There is little robust evidence relating to changes in health related quality of life (HRQL) in morbidly obese patients following a multidisciplinary non-surgical weight loss program or laparoscopic Roux-en-Y Gastric Bypass (RYGB). The aim of the present study was to describe and compare changes in five dimensions of HRQL in morbidly obese subjects. In addition, we wanted to assess the clinical relevance of the changes in HRQL between and within these two groups after one year. We hypothesized that RYGB would be associated with larger improvements in HRQL than a part residential intensive lifestyle-intervention program (ILI) with morbidly obese subjects. Methods A total of 139 mo…

Exploring nursing competence to care for older patients in municipal in‐patient acute care: A qualitative study

Aim To identify critical aspects of nursing competence to care for older patients in the context of municipal in-patient acute care. Background An increasingly complex and advanced primary healthcare system requires attention to the extent of nursing competence in municipal services. However, competence in complex and advanced care settings must be explored using perspectives which acknowledge the complexity of nurses' performance. Design A phenomenological hermeneutic, qualitative approach with individual in-depth interviews was used. COREQ reporting guidelines have been applied. Methods A sample of eight nurses and two physicians employed in municipal in-patient acute care units (MAUs) we…

Drivers and barriers of inter-municipal cooperation in health services – the Norwegian case

Inter-municipal cooperation in service delivery is widespread, as is the notion that this type of cooperation is primarily driven by economies of scale. However, the empirical results appear to be ...

Obesity and Its Impact Upon Quality of Life

Obesity may have a negative effect on quality of life (QOL) and is an important outcome in the treatment of obesity. In this chapter we discuss the concept of QOL; the measurement of QOL; the mechanisms by which obesity may influence the physical, social, mental, and sexual aspects of QOL; and the effects of weight loss interventions on QOL. Finally, we discuss how health professionals may use QOL measures to improve the quality of clinical practice.

Nursing competence in municipal in-patient acute care in Norway: a cross-sectional study

Abstract Background The primary health care services are becoming increasingly complex, which presents challenges for the municipal nursing services. In Norway, municipal in-patient acute care (MipAC) has been introduced in all municipalities, and the competence at the services has been questioned. Few studies have examined the nursing services in the units. This study aims to get an overview of the nursing competence in those units across geographical regions, and different groups of organisation and localisation. Methods A cross-sectional study was conducted, and an ad hoc questionnaire was distributed to first-line leaders in all the MipAC units in Norway. Data were collected in the peri…

Materiell og profesjonell stigmatisering av mennesker med sykelig overvekt

The aim of this study is to show how people suffering from severe obesity mightexperience stigmatization. We interviewed 6 persons recruited from aNorwegian rehabilitation center, specialized in lifestyle intervention in severeobesity. We found that the participants suffering from severe obese experiencedstigmatization and thus felt that they a) did not fit into the materiel world and b)experienced a lack of respect from health care professionals. The results arediscussed according to how contemporary symbols are embedded in oursurroundings and in our bodies. The conclusion underlines severe obesity as acomplex problem which is strengthened by rooms and interior designed for idealsizes. The…

Sexology in Norway in 2001 and 2011: A comparative and cross-sectional study

Summary In a comparative cross-sectional study Norwegian sexology practitioners have been studied in 2001 and in 2011 concerning professional background, sexology training, therapeutic approaches and clinical sexology problems. The Norwegian sexology professional group is small and the Norwegian Association of Clinical Sexology counted around 150 members in 2011. In 2001, a two-year half time further education program in sexology counselling started at the university of Agder. Since 2001, 164 sexology counsellors have been educated from this program. The objective of the study was to understand how these changes might have influenced the field of sexology in Norway. The participants in the …

A106 Gastroesophageal reflux disease in patients with severe obesity and type 2 diabetes one year after sleeve gastrectomy or Roux-en-Y gastric bypass. A randomized controlled trial.

Health-related quality of life after camp-based family obesity treatment: an RCT.

ObjectiveTo compare the effects of a 2-year camp-based immersion family treatment for obesity with an outpatient family-based treatment for obesity on health-related quality of life (HRQoL) in two generations.DesignRandomised controlled trial.SettingRehabilitation clinic, tertiary care hospital and primary care.PatientsFamilies with at least one child (7–12 years) and one parent, both with obesity.InterventionsSummer camp for 2 weeks, with four repetition weekends, or lifestyle school, including four outpatient days over 4 weeks. Behavioural techniques to promote a healthier lifestyle.Main outcome measuresChildren’s and parents’ HRQoL were assessed using generic and obesity-specific measure…

Changes in quality of life in individuals with narcolepsy type 1 after the H1N1-influenza epidemic and vaccination campaign in Norway: a two-year prospective cohort study

Abstract Objective Cross-sectional studies show a lower health-related quality of life (HRQoL) in individuals with narcolepsy. We aimed to describe changes in HRQoL after two years of multidisciplinary follow-up in a cohort of mainly post-H1N1 vaccination narcolepsy type-1 (NT1) patients in Norway. Methods Prospective-cohort study. Narcolepsy diagnosis was based on the International Classification of Sleep Disorders (third edition). Psychiatric comorbidity was assessed using the Achenbach System of Empirically Based Assessment (ASEBA). HRQoL was evaluated with the Pediatric Quality of Life Inventory (PedsQL™ Generic Core Scales 4.0) at baseline and follow-up. Mean follow-up time was 20.7 (2…

Employment Is Associated with the Health-Related Quality of Life of Morbidly Obese Persons

Published version of an article in the journal: Obesity Surgery. The original publication is available at Springerlink. http://dx.doi.org/10.1007/s11695-010-0289-6. Open Access Background We aimed to investigate whether employment status was associated with health-related quality of life (HRQoL) in a population of morbidly obese subjects. Methods A total of 143 treatment-seeking morbidly obese patients completed the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36) and the Obesity and Weight-Loss Quality of Life (OWLQOL) questionnaires. The former (SF-36) is a generic measure of physical and mental health status and the latter (OWLQOL) an obesity-specific measure of emotional…

Predictors of weight loss after an intensive lifestyle intervention program in obese patients: a 1-year prospective cohort study.

Published Version of an article in the journal: Health and Quality of Life Outcomes. Also available from the publisher at: http://dx.doi.org/10.1186/1477-7525-11-165 Open access Background Studies of lifestyle intervention programs in morbid obesity report large variations in weight loss outcomes. This is reported not only between but also within standardized programs. Such reports point to participants’ characteristics as possible predictors of this outcome. The aim of this prospective cohort study was to identify predictors of weight loss after a 1-year partly residential intensive lifestyle intervention program (ILI). Methods Morbidly obese patients (n=199), all Caucasian, 71% women, mea…

Psychiatric symptoms in patients with post-H1N1 narcolepsy type 1 in Norway.

Study objectives Several studies have reported psychiatric comorbidity in patients with narcolepsy type 1 (NC1). The primary aim of this study was to explore the extent of psychiatric symptoms in a cohort of Norwegian NC1 patients, most of whom were H1N1-vaccinated. We also wanted to explore possible causes of the psychiatric symptoms seen in NC1. Methods Cross-sectional study. Psychiatric symptoms were assessed by the Achenbach System of Empirically Based Assessment (ASEBA) Child Behavior Check List (CBCL) in children and by Adult Self Report (ASR) in adults. Results The mean (SD) total T-scores were 58.6 (9.2) for children and 57.0 (9.8) for adults, these being mainly driven by internaliz…