Fatigue, Cortisol and ACT: A pre-post study on the effects of workrelated rehabilitation

Objective: There is evidence that chronic stess leads to sustained levels of arousal, causing a dysregulation of the stress response. Patients with chronic fatigue often suffer from hypocortisolim. This study aimed to find to whether a 3.5 week long work-focused acceptance and commitment therapy (ACT) could change acute salivary cortisol response in patients with subjective chronic fatigue. Methods: Participants (n=42) were consecutively recruited from the Hysnes outpatient clinic at St. Olavs Hospital, Trondheim. We used the Trier Social Stress Test for Groups to measure the effect of acute psychosocial stress in a laboratory setting before and after treatment of ACT. Saliva samples were used to measure neuroendocrine respnses to stress. 31 patients with fatigue (fatigue group) and 11 patients without fatigue  (non-fatigue group) were included in the study. Results: The results showed no significant differences in cortisol output post treatment in the fatigue group or the non-fatigue group. A significant reduction of symptoms of anxiety, depression and fatigue was found in the fatigue group but not in the non-fatigue group. Conclusion: ACT did not have a direct effect on cortisol output in this study. However the results imply that it lead to reduction of symptoms of patients with subjectively reported chronic fatigue

Boligmerket – Et steg på veien til sosial bærekraft i leiemarkedet?

Denne masteroppgaven undersøker hvilken rolle en merkeordning for utleieboliger, kalt Boligmerket, kan være med på å bidra til å sikre sosial bærekraft i leiemarkedet i Norge. Det boligpolitiske fokuset om at flest mulig skal eie egen bolig har skapt et fragmentert utleietilbud, hvor markedet på egen hånd ikke klarer å dekke befolkningens boligbehov på en god måte. Nøkkelutfordringer i dagens leiemarked inkludere generelt dårlige bovilkår blant leietakere, større uforutsigbarhet ovenfor fremtiden og diskriminering. Denne masteroppgaven benytter pilotprosjektet boligmerket som en case-studie som metode for å løse problemstillingen. Masteroppgaven utforsker begrepene sosial bærekraft gjennom dokumentanalyse av konseptbeskrivelsen til boligmerket, rapport fra pilotering av merkeordningen, i tillegg til kvalitative intervjuer av sentrale aktører i prosjektet boligmerker. Ved å anvende teoretiske perspektiver om bærekraft, samstyring og planleggingens styringsverktøy er hensikten med oppgaven å finne ut på hvilken måte boligmerket kan sørge for sosial bærekraft, og hvordan planleggingens styringsverktøy kan være med på å bygge opp rundt sosial bærekraft. Forskningen konkluderer med at boligmerket kan være med på å løse utfordringer knyttet til dagens leiemarked som går på bokvalitet, trygghet og inkludering. Planlegging kan bygge opp om dette ved hjelp av koordinerte strategier og mål for helhetlig og god samfunnsplanlegging. Videre forskning på hvordan en eventuell revidering av plan- og bygningslovens arealplanverktøy kan være med på å påvirke mulighetene planlegging har til å påvirke sosial bærekraft i leiemarkedet.This master thesis examines what role a labeling scheme for rental housing, called Boligmerket, can play in helping to ensure social sustainability in the rental market in Norway. The housing policy focus on as many people as possible owning their own home has created a fragmented rental offer, where the market on its own is unable to meet the population's housing needs in a good way. Key challenges in today's rental market include generally poor living conditions among tenants, greater unpredictability of the future and discrimination. This master's thesis uses the housing brand pilot project as a case study as a method to solve the problem. The master thesis explores the concepts of social sustainability through document analysis of the concept description of the housing brand, report from the piloting of the branding scheme, in addition to qualitative interviews of key actors in the housing brands project. By applying theoretical perspectives on sustainability, co-management and planning's management tools, the purpose of the assignment is to find out in what way the housing brand can ensure social sustainability, and how planning's management tools can help to build around social sustainability. The research concludes that the housing brand can help solve challenges linked to today's rental market, which focus on housing quality, safety and inclusion. Planning can build on this with the help of coordinated strategies and goals for comprehensive and good social planning. Further research into how a possible revision of the Planning and Building Act's area plan tool can help to influence the opportunities planning has to influence social sustainability in the rental market

«Kognitiv atferdsterapi ved psykoser og behandling i allmenpsykiatrisk døgnpost»

Masteroppgave psykisk helsearbeid- Universitetet i Agder, 2015In 2013, Directorate of Health published guidelines for assessment, treatment and monitoring of patients with psychotic disorders, with recommendations that cognitive behavioral therapy should be offered to all patients with psychosis symptoms as well as to be used in all treatment phases. The purpose of our study is to gain knowledge about how cognitive behavioral therapy can be used in public psychiatric inpatient wards. The issue of our study is: How to use the principles and potential of cognitive behavioral therapy in the establishment of treatment programs for people with psychotic disorders in general psychiatric inpatient wards? This is a qualitative hermeneutical study based on data from five semi-structured interviews with experts in cognitive behavioral therapy. Applied method of analysis is Malteruds systematic text condensation, inspired by Giorgis phenomenological analysis. Findings: "Inpatient wards work according to a pragmatic style; cognitive behavioral therapy in psychosis provides meaningful structure in common understanding" and "Structure of the treatment is gradual, through bonding of knowledge." Conclusion: Cognitive behavioral therapy's theoretical framework has the potential to be a bridge between the scientific-based practices that are still prevalent within specialist health care and the contextual practice of user involvement in focus, which is prevalent in mental health work. As a common theoretical superstructure in the ward it will be able to strengthen the interdisciplinary cooperation, with the goal of more comprehensive services for patients. The structure of cognitive behavioral therapy of psychosis by normalization and psychoeducation, may contribute to the experience of milieu therapy as meaningful and targeted. The service provided through the inpatient wards may be developed gradually through experience, as long as "a cognitive way of thinking" remains in focus. Keywords: Cognitive behavioral therapy, psychosis, psychotic symptoms, cognitive milieu therapy, inpatient ward

Rettferdig markedspris og gode prosesser

Executive Master of Management i Strategisk forretningsutvikling og innovasjon fra Handelshøyskolen BI, 2023Formålet med denne prosjektoppgaven har vært å få innsikt i hva næringsfestekunder av Opplysningsvesenets Fond (OVF) mener er problematisk med reguleringsprosessen av festetomter. Det pågår et arbeid med digitalisering i organisasjonen i dag, uten betydelig innsikt i kundenes synspunkter og meninger. Gjennom å utforske deres opplevelse, vil vi bedre forstå rotårsakene til problemer som oppstår i reguleringsprosessen. I følge OVF er hovedproblemet å bli enige med kundene om markedspris ved regulering av leien, også kalt festeavgift. Dersom kundenes problemer samsvarer med OVFs problemer, kan utvikling av en troverdig prismodell løse både kundens og OVFs problemer. Vi har foretatt kvalitative intervjuer av næringsfestekunder, som har gitt oss god innsikt i rotårsaker til deres frustrasjon og misnøye som kan oppstå ved regulering av festekontrakten til næringsfestekunder. I tillegg har vi intervjuet to ansatte, for å se om de samme problemene dukker opp hos både ansatte og kunder. Basert på våre funn har vi foreslått løsningsforslag, som favner om tre dimensjoner av funn; - Forbedret datagrunnlag/digitalisering - Rettferdig prissetting - Kommunikasjon mellom kunde og OVF Målet med løsningsforslaget er å skape en bedre kundeopplevelse, gjennom å utvikle en prismodell som bygger på et troverdig prisgrunnlag. Prismodellen skal visualiseres i form av en verdirapport, som gir kundene en oversiktlig, transparent og forståelig fremstilling av markedsprisen som settes. Dette vil også bidra til å effektivisere reguleringsprosessen for de ansatte. Altså vil løsningsforslaget ha verdi for både kunder og ansatte, og kunne innby til dialog fremfor steile fronter mellom kunder og OVF. Vi har tatt utgangspunkt i innovasjonsmodellen som er presentert i boken til Furr et al. (2014) «The Innovator’s Method”, hvor vi har fulgt fasene; 1 innsikt, 2 problem og 3 løsning. Vårt arbeid har avdekket at OVF har behov for å heve kvaliteten til interne datakilder som skal benyttes i prismodellen og å forbedre kommunikasjonen mellom kunde og OVF. Vår oppgave går derfor fra fase 3 og over til en konklusjon og anbefaling om hvordan OVF kan arbeide videre mot et løsningsforslag som kan påvirke forretningsmodellen. Utvikling av en virksomhetsarkitektur for datafangst og tilgjengeliggjøring av masterdata er noe OVF bør prioritere høyt fremover. Innsikten vi har fått viser at det er et klart behov for et mer troverdig datagrunnlag, rettferdig prissetting og en bedre kommunikasjon mellom kunde og OVF, som gir mulighet for en god dialog. Denne kunnskapen har blitt brukt inn i et pågående prismodell-prosjekt i OVF for å finne riktig og rettferdig markedspris når næringsfestetomter skal reguleres. Vi har testet ut en virtuell prototype mot et utvalg av næringsfestekunder i to iterasjoner, hvor den siste iterasjonen var et forbedret utkast. Kundene opplever at denne verdirapporten er oversiktlig, med relevante kilder, som gir et godt utgangspunkt for en dialog med OVF om prisforslaget. Vi anbefaler at OVF prioriterer å bruke innsikten vi har fått i videre arbeid med kommunikasjon og virksomhetsarkitektur, og at de er villige til å teste ut løsningsforslag med kunder, slik at de kan øke kundetilfredsheten. Tett kontakt med kunde vil gi verdi for kunde og OVF

Forslag til fagprosedyre for anestesisykepleierens ansvar og funksjon for å diagnostisere anafylaksi hos pasienter som får generell anestesi

Master i anestesisykepleieProsjektets bakgrunn: Ved generell anestesi eksponeres pasienten for en rekke agens som potensielt sett gir en risiko for perioperativ anafylaksi. Anestesisykepleierens selvstendige rolle bygger på funksjonsbeskrivelsen til anestesisykepleiere som blant annet setter fokus på både å arbeide med fagutvikling men også ansvaret for å forebygge, observere og bedømme komplikasjoner, samt prioritere og iverksette sykepleietiltak. I forlengelsen av dette ser arbeidsgruppen et behov for en fagprosedyre for å kunne diagnostisere perioperativ anafylaksi. Hensikt og problemstilling: Hensikten med denne oppgaven er å gi anestesisykepleieren et enkelt og oversiktlig verktøy ved perioperativ anafylaksi, hvor pasientsikkerhet er sentral. Oppgavens problemstilling er; Forslag til fagprosedyre for anestesisykepleierens ansvar og funksjon for å diagnostisere anafylaksi hos pasienter som får generell anestesi Metode: Fagprosedyren ble utarbeidet etter Kunnskapssenterets modell for kvalitetsforbedring (2015) og Helsedirektoratets veileder for utvikling av kunnskapsbaserte retningslinjer (2012). Resultater: Systematisk litteratursøk har resultert i et forslag til en kunnskapsbasert fagprosedyre for anestesisykepleiers ansvar og funksjon for å diagnostisere perioperativ anafylaksi. Det er valgt fire intervensjoner som i litteraturen fremstår som vesentlige i denne sammenheng. Konklusjon: Diagnostisering av perioperativ anafylaksi er et ansvar anestesisykepleieren har, og kandidatene anser prosedyren som praksisnær og relevant i klinisk arbeid som anestesisykepleier på en operasjonsavdeling.Background: In general anesthesia, the patient is exposed to several agents that may give perioperative anaphylaxis. The anesthetic nurse's independent role is based on the function description of anesthetic nurses, as the focus on both working with professional development, but also the responsibility for preventing, observing and assessing complications, as well as prioritizing and implementing nursing measures. In the extension of this, the working group sees a need for a disciplinary procedure to diagnose perioperative anaphylaxis. Study objective: The purpose of this thesis is to provide anesthetic nurse a simple and visual tool for perioperative anaphylaxis where patient safety is central. The master thesis is; Proposed clinical procedure for the anesthetic nurse's responsibility and function for diagnosing anaphylaxis in patients receiving general anesthesia. Method: The disciplinary procedure is based on associated guidelines on recommended terms from Helsedirektoratet (2012), the model from Kunnskapssenteret (2015). Results: The systematic review on guidelines and articles in the thesis results in an evidencebased guideline in the nurse anesthetists' role and responsibility to detect and diagnose perioperative anaphylaxis. Four interventions are selected which was found significant in the chosen literature. Conclusion: Diagnosing perioperative anaphylaxis is a responsibility of the nurse anesthetist. The candidates finds this disciplinary procedure clinical relevant in the OR Keywords: General anesthesia, anesthesiology, perioperative anaphylaxis, anaphylaxis.publishedVersio

Is set-shifting and central coherence in anorexia nervosa influenced by body mass index, anxiety or depression? A systematic review

Abstract Background Anorexia nervosa (AN) is a severe eating disorder, recognized by a relentless pursuit for thinness and extreme low body weight. The disorder is often accompanied by comorbid disorders such as anxiety and depression, and altered neuropsychological function in terms of poor set-shifting and reduced central coherence. The aim of this review was to evaluate whether neuropsychological impairments in AN are influenced by body mass index, anxiety or depression. Method A systematic review approach was used, following the PRISMA guidelines for systematic reviews. Literature was identified via searches in PubMed, PsychInfo and Embase database, by using the search words [anorexia nervosa] AND [central coherence], and [anorexia nervosa] AND [set-shifting]. Studies were included if they were written in English, peer-reviewed, included individuals with AN, included tests measuring set-shifting and/or central coherence, investigated associations between set-shifting/central coherence with anxiety and/or depression and/or BMI. Risk of bias was assessed by using a critical appraisal checklist from the Joanna Briggs Institute. Results were summarized in a narrative synthesis. Results Although results are heterogeneous, the majority of studies report that neither body mass index (BMI), anxiety or depression is associated with altered central coherence and set-shifting in individuals with AN. Conclusions Findings indicate that BMI, depression and anxiety does not influence neuropsychological function in AN, suggesting that it could be a characteristic of the disorder. A complete understanding of predisposing, precipitating and maintaining factors in AN needs to be addressed in future research. This could contribute to the development of better and more targeted treatment strategies. </jats:sec

Malnutrition among children in Madagascar : a study on knowledge and child rearing practices

Background. Malnutrition is a global health problem. Madagascar has had an increase in the percentage of malnourished children since the beginning of 1980. Forty-nine percent of children less than 5 years of age are stunted. Research have shown that stunting is a result of chronic malnutrition due to inadequate diet and recurrent illness. The political situation in Madagascar has changed towards a more democratic and transparent system. This may lead to more external donors and humanitarian aid. Both politicians and organisations will need updated research in order to design interventions in projects aimed at improving children’s health. The findings of this study will provide useful insight and local knowledge in infant feeding practices and management of diarrhoeal episodes. Objectives. The broad objective was to identify factors associated with malnutrition in young children, with an emphasis on knowledge and child rearing practices related to feeding and management of acute, watery diarrhoea. Design and subjects. Cross-sectional survey was conducted on 143 households with children between 6 and 36 months. This is also the total number of subjects. In four villages all children in the age group were included (n=38). Another 105 children were included from two villages, interviewed consecutively. All the caretakers were interviewed based on a pre-tested, structured questionnaire with closed and open ended questions. Body weight, height and MUAC were measured for all children by trained personnel. Results. At the time of the survey 61.5% of the children were below -2SD WA, 50% were stunted and 9.9% were wasted. Lastly 12.6% were malnourished following MUAC. Mean duration of exclusively breastfeeding was 5.0 months (±2.1), mean duration of breastfeeding was 20.2 months (±2.1). Fifty-six percent of the caretakers had an adequate knowledge in exclusively breastfeeding. Ninety-five percent were agreed that a child should start with weaning food at 6 months of age. However, 74% claimed that certain food should not be given during introduction of complementary food. Mean age of introduction of weaning food was 5.6 months and the mean number of meals per day was 3.1. Thirty percent of the children had experienced diarrhoea within two weeks prior to the interview. Sixty-nine percent of the caretakers knew the symptoms of acute diarrhoea and 99% knew more than four causes of diarrhoea. In 29 of the 43 cases with diarrhoea improper measures were taken. Eighty-four percent reported to have used ORS. Caretakers tended to mix symptoms and consequences of dehydration or include wrong symptoms 50% and45%, respectively. Fifty-eight percent agreed that a child need extra food after an episode with diarrhoea. Sixty-four percent of the caretakers reported that they boiled the child’s drinking water and 39% claimed that they always washed the child hands before meals. No significant association were observed between children’s nutritional status and the reported knowledge and practices. However, association were found between nutritional status and socio-economic and demographic factors as well as between the knowledge and rearing practices and socio-economic and demographic factors. Conclusion. Childhood malnutrition is a severe problem in this are. The infant feeding practices and management of diarrhoea were not optimal according to WHO’s recommendations. However, our results show a positive shift towards better feeding practices and rearing practices, especially among younger mothers. Even though this study reveal few specific risk factors for developing malnutrition, improvements in socio-economic strata is decisive as this is associated with some of the potential indicators of malnutrition. Further studies should focus on barriers in preventing caretakers from practicing their knowledge. Both governmental and non-governmental organisations should continue to promote and encourage caretakers in recommended practices

Fatigue, Cortisol and ACT: A pre-post study on the effects of workrelated rehabilitation

Objective: There is evidence that chronic stess leads to sustained levels of arousal, causing a dysregulation of the stress response. Patients with chronic fatigue often suffer from hypocortisolim. This study aimed to find to whether a 3.5 week long work-focused acceptance and commitment therapy (ACT) could change acute salivary cortisol response in patients with subjective chronic fatigue. Methods: Participants (n=42) were consecutively recruited from the Hysnes outpatient clinic at St. Olavs Hospital, Trondheim. We used the Trier Social Stress Test for Groups to measure the effect of acute psychosocial stress in a laboratory setting before and after treatment of ACT. Saliva samples were used to measure neuroendocrine respnses to stress. 31 patients with fatigue (fatigue group) and 11 patients without fatigue&nbsp; (non-fatigue group) were included in the study. Results:&nbsp;The results showed no significant differences in cortisol output post treatment in the fatigue group or the non-fatigue group. A significant reduction of symptoms of anxiety, depression and fatigue was found in the fatigue group but not in the non-fatigue group. Conclusion: ACT did not have a direct effect on cortisol output in this study. However the results imply that it lead to reduction of symptoms of patients with subjectively reported chronic fatigue