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Elia Gabarron,1 Enrique Dorronzoro,2 Meghan Bradway,1,3 Octavio Rivera-Romero,2 Rolf Wynn,3,4 Eirik Årsand1,3 1Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway; 2Department of Electronic Technology, Universidad de Sevilla, Seville, Spain; 3Department of Clinical Medicine, Faculty of Health Sciences, UiT – Arctic University of Norway, Tromsø, Norway; 4Division of Mental Health and Addictions, University Hospital of North Norway, Tromsø, Norway Background: Nowadays, rapid and accessible participatory research on diabetes can be carried out using social media platforms. The objective of this study was to identify preferences and interests of diabetic social media users regarding a health-promotion intervention targeting them. Methods: Social media followers of the Norwegian Diabetes Association were invited to participate in the creation of a health-promotion intervention on diabetes by expressing their opinions through an online questionnaire posted on Facebook, Twitter, and Instagram. The questionnaire asked participants about their demographics and preferences regarding type of health content: format, frequency, and channels to deliver content. Questions regarding the perceived quality of diabetes-related information and satisfaction with content on social media were also included. Results: The questionnaire was answered by 346 participants: 332 (96%) of those were reached via Facebook, 66.5% of respondents (n=230) identified themselves as women, 54% (n=187) as individuals diagnosed with type 1 diabetes, and 71% (n=235) were aged 30–64 years. The preferred type of content was “research and innovation on diabetes”, selected by 78.0% of the respondents. “Text format” was the choice for 93.4%, and 97.3% would prefer to find health-promotion content on Facebook. There was heterogeneity in the desired frequency of this content. In a scale ranging from 0 to 100, the perceived quality of diabetes-related information on social media was 62.0±1.2 and satisfaction with such content 61.9±1.3. Conclusion: The approach used in this study was successful in reaching and involving participants quickly, and could also potentially increase diabetes patients’ engagement and satisfaction with health-promotion interventions, enhance their sense of community, and thus help people attain healthier lifestyles. It is a limitation that our sample might not have been fully representative, as the most interested social media users might have chosen to participate. Keywords: community-based participatory research, diabetes, health promotion, health education, social media

In Norway, GPs may decide to refer patients to involuntary psychiatric treatment. Internationally, there has been a discussion regarding criteria for involuntary admission. In Norway and in other countries where the treatment criterion is still used, some have suggested its removal.To examine which legal criteria GPs used to refer patients to involuntary admission, whether they had thought about using a different criterion, and on which information they based their decision.A total of 74 doctors who had referred patients to involuntary admission at one major Norwegian psychiatric hospital participated in semi-structured interviews.In total, 38% (28) had applied the danger criterion only and 23% (17) had applied the treatment criterion only; 32% (24) had applied both criteria, while 7% (5) did not answer this question; 74% (55) said that they could not have chosen a different criterion; 45% (33) had based their decision on events/behaviour prior to and during the consultation, 43% (32) on events prior to the consultation only, and 8% (6) on information obtained during the consultation only; 4% (3) did not answer this question. None had used tools to aid in the assessment of danger.The danger criterion was frequently used by the referring GPs. It is unclear how a removal of the treatment criterion from Norwegian legislation might impact clinical practice.While the danger criterion was applied by a majority, the treatment criterion was also chosen by many and was of importance to the doctors' reasoning regarding referrals to involuntary admission. Most thought they could not have chosen a different criterion.

The use of the internet for health purposes is increasing, as is the number of sites and online communities aimed at helping people to stop smoking. Some of the effects of online communities may be mediated through a sense of community. By using the computer-program Linguistic Inquiry and Word Count with a Norwegian dictionary, we investigated whether there was a development of sense of community in a forum related to a Norwegian smoking cessation intervention, by examining the use of self-referencing vs. collective referencing words. Data from a 4-year period, including in total 5242 web pages, were included. There was a significant increase in the use of collective words over time and a significant decrease in the use of self-referencing words. The increase in the use of collective words suggests that there appears to be a development of a sense of community in the forum over time. More research is needed to study the importance of an online sense of community.

Aims. Participation in everyday activities positively influences well-being, but few have studied how participation in activities influences well-being among patients with substance use disorders. The authors examined the number of past, recent, and desired future activities of patients being admitted to five units for inpatient substance abuse treatment at a Norwegian university hospital. Major findings. The total number of activities had dropped significantly compared with before the respondents started abusing substances, and the respondents desired an increase in activities in the future. A lower level of well-being as measured by the WHO-5 was predicted by a more pronounced drop in number of activities from past to recent and by more severe use of alcohol and other substances. Principal conclusion. Substance abuse is associated with a change in number of activities. Losing activities may contribute to a decrease in well-being. Helping substance abuse patients regain positive activities could...

Many countries allow for the use of restraint and seclusion in emergencies with psychiatric inpatients. Authors have suggested that the attitudes of staff are of importance to the use of restraint and seclusion.To examine the attitudes to coercion at two Norwegian psychiatric units. In contrast to the idea that attitudes to coercion vary much within and between institutions, we hypothesized that staff's attitudes would be quite similar.We distributed a questionnaire to staff at two psychiatric units in two Norwegian counties. Eight wards were included. The questionnaire contained fictitious case histories with one patient that was violent and one patient that was self-harming, and staff were asked to describe how they would intervene in each emergency. Emergency strategies were sorted according to degree of restrictiveness, from the highly restrictive (restraint, seclusion) to the unrestrictive (talking, offering medication). Data were analysed with regression analyses.There was only a limited degree of variance in how staff at the different units and various groups of staff responded. Staff were more likely to favour a highly restrictive intervention when the patients were physically violent. Male staff and unskilled staff were significantly more prone to choosing a highly restrictive intervention.Our hypothesis was confirmed, as there was a limited degree of variance in staff's responses with respect to degree of restrictiveness. The study supported the idea that a range of different interventions are used in emergency situations.

We examined changes in serum levels of a selection of neurotrophic factors, TSH, HGH and cortisol in conjunction with ECT treatment. Fifteen patients suffering from affective disorders were included, all were treated with antidepressants and psychotherapy and 10 also with ECT. The patients were examined clinically and with blood samples during treatment. Serum levels of cortisol, thyroid stimulating hormone (TSH), nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT3), neuropetide Y (NPY) and human growth hormone (HGH) were studied. No significant changes were found in levels of NGF, BDNF, NT3, HGH and TSH. A change in NPY levels was statistically significant, but of uncertain clinical value as it affected only two patients. Levels of cortisol rose significantly during treatment. We did find significant correlations between the base values of NGF and HAM-D scores at inclusion and between the end-values of NT3 and NPY and the HAM-D scores prior to discharge. We were unable to reproduce findings from animal studies suggesting that a range of neurotrophic factors rise during ECT treatment. This may be because of physiological differences between animals and humans or, possibly, a result of the small number of patients included in this pilot study.

Aims: To examine the occurrence of comorbid non‐substance abuse axis‐1 disorders among patients being treated for substance abuse.Design, setting and participants: Prospective study of patients admitted to a Norwegian clinic for substance abuse treatment. All patients in treatment during a 3‐month period were invited to participate.Measurements: Patients were clinically interviewed and MINI and GAF were scored. Data were analysed with Chi‐square tests and multiple regression analyses.Findings: Twenty‐four patients (77.4%) participated, of whom 91.7% had at least one comorbid non‐substance abuse axis‐1 disorder. Of the patients, 70.8% had suffered a psychotic episode and prior episodes of psychosis occurred significantly more often among those who had a main abuse of amphetamines. Many patients also abused benzodiazepines and/or cannabis as secondary substances.Conclusions: A high level of prior psychotic episodes could be related to a high use of amphetamine and cannabis, and possibly to a shortage of low...

While the use of coercion, such as involuntary medication and physical restraints, is widespread in psychiatric treatment, little is known about the outcomes of the use of these interventions. Nineteen patients who had been involuntarily medicated, physically restrained, or secluded from other patients, were matched to 19 controls. Outcome variables were overall satisfaction with treatment, self-rated improvement, recommendation of treatment to others, satisfaction with information about treatment, and degree of influence over own treatment. Data were analysed with paired t tests. There were no statistically significant differences between the patients who had been subjected to the coercive interventions and their controls. Overall satisfaction with treatment was poor for both groups, while self-rated improvement was rated as neither poor nor good. It is possible that other factors, such as the nature of the disorder and the duration of treatment, are of greater importance than the use of coercive interve...

When facing aggressive, violent, and self-harming patients, staff in psychiatric hospitals have to balance the need for patient and staff safety against the need to provide humane care and efficient treatment. In the present study, simulated case histories were used to examine which types of formal and informal interventions staff at a Norwegian psychiatric hospital prefer when caring for patients that are violent or self-harming. Continuous attention and evaluation of the use of the interventions subjected to formal control procedures (i.e. restraint and seclusion), as well as of a range of other interventions in use, represents an important means for securing improved care for violent and self-harming patients. The interventions available in such emergencies range from talking to patients to giving patients “time out” and using restraint and seclusion. Results demonstrated that staff chose the least restrictive interventions, and that restraint and seclusion were reserved for those situations where pati...

To examine how general practitioners (GPs) respond to patients who are non-compliant with medical advice and who doctors believe act irresponsibly towards their health.Quantitative analysis of responses to questionnaire with case histories.93 questionnaires completed by a random stratified sample of Norwegian GPs.Scores relating to GPs' feelings and choice of main and sub-strategies for further treatment of patients.The respondents typically felt discouraged or unaffected by non-compliant patients, younger doctors more often felt helpless while older ones were more content, and female doctors more often than male doctors felt irritated or angry. The main strategy preferred was to give the patient a new appointment. The young, the inexperienced, and females tended more often to ask a colleague for advice or refer to a specialist. Patient-centred sub-strategies were generally preferred, especially by younger doctors.GPs' feelings towards and strategies for dealing with non-compliant patients vary, and the doctor's age, sex and clinical experience are central variables.

To investigate the relationship of the amount of words spoken by general practitioners and patients to the main topics of the consultations and the sex of the patients.Sample of 60 face-to-face doctor-patient consultations, with five different doctors and 60 different patients, randomly chosen from a database of British general practitioner-patient consultations. All the doctors were male; 33 patients were female, 27 male.Number of words spoken by doctors and patients, related to sex of patients and the consultations' main topics.There was no significant difference in the overall amount of words spoken by doctors and patients. However, doctors uttered significantly more words than their patients in those consultations in which the main topic was somatic, while patients spoke significantly more words than their doctors in those consultations in which the main topic was psychosocial.The main topics of the consultations were more important than the sex of the patients with regard to the proportion of words uttered by doctors and by patients.

Objectives. There has recently been an increased focus on the use of coercion in psychiatric care and on the need to consider the patients’ autonomy. Staff that are faced with aggressive, violent, or self-harming inpatients, must consider patient and staff safety, as well as the need to provide humane and efficient treatment. Although physical and pharmacological restraint and seclusion are used regularly in psychiatric institutions in many countries, little has been published about staff’s motivation for using the interventions, and the effects they have. In the present work, the objectives were to identify the number of incidents and the characteristics of the patients involved, the staff’s reasons for the use and choice of a particular type of intervention, the effects of the interventions, and possible alternatives to the use of restraint and seclusion. (Int J Circumpolar Health 2004; 63(4):445-447) Keywords: psychiatry, coercion, violence, physical restraint, pharmacological restraint, seclusion, staff’s attitudes, patients’ experiences, Norway