Biomedical subjects

Arnstein Finset

Publications and source records attributed to Arnstein Finset.

At least 19 recordsLinked to original sources

PubMed2006

Intracranial pressure parameters in idiopathic normal pressure hydrocephalus patients with or without improvement of cognitive function after shunt treatment.

BACKGROUND/AIMS: Previous research has shown improvements in the clinical triad (gait, incontinence and cognitive dysfunction) after shunt surgery in idiopathic normal pressure hydrocephalus (iNPH) patients with intracranial pulse pressure amplitudes >4-5 mm Hg, the pulse amplitudes being <4 mm Hg in the nonresponders. However, it is unknown whether similar differences exist regarding change in cognitive functioning after shunt surgery. The aim of this study was to compare preoperative intracranial pressure (ICP) parameters between iNPH that either improved or not improved in cognitive function after shunt treatment. METHODS: Neuropsychological testing was performed before and after surgery in 27 consecutive iNPH patients treated with ventriculoperitoneal shunts. The ICP recordings were performed as part of routine preoperative assessment, stored as raw data files, and analyzed retrospectively. The mean ICP as well as single ICP wave amplitudes were computed and analyzed in consecutive 6-second time windows. RESULTS: Significant improvement in neuropsychological tests, defined as a 4-point improvement in Folstein Mini-Mental State Examination or improvement by one standard deviation in 50% of subtests of Dementia Rating Scale, was found in 12 patients (44%; shunt responders). In these patients, mean ICP was similar though the mean ICP wave amplitude was significantly higher than in the shunt nonresponders. CONCLUSIONS: While preoperative mean ICP was similar, the mean ICP wave amplitudes were considerably higher in iNPH patients with significant change in cognitive function following shunt surgery.

Aged↗

PubMed2006

Higher levels of pain readiness to change and more positive affect reduce pain reports--a weekly assessment study on arthritis patients.

The objective of the study was to analyze the relationships between Pain Readiness to Change, weekly measures of positive and negative affect and pain over eight subsequent weeks in patients with rheumatoid arthritis (RA). Factor analysis based on data from three different samples of patients with rheumatic diseases and other chronic pain conditions suggested a three factor solution for the Norwegian version of the Pain Stages of Change questionnaire (PSOCQ) representing Precontemplation, Contemplation, and Action/Maintenance (ACT) stages from the original Transtheoretical Model. Multilevel analyses on the weekly assessed data from a sub sample of 40 patients with RA revealed that higher levels of Pain Readiness to Change represented by high ACT scores were associated with more positive affect from week to week while no association was found between Readiness to Change and weekly pain. However, there was an interaction effect between Pain Readiness to Change and weekly positive affect on weekly pain, indicating that those persons having a higher level of Readiness to Change reported less pain in weeks when they also experienced increased positive affect. This may imply that a combination of cognitive factors and positive affect is most effective in relation to pain reduction. Results encourage continued investigation of apparent interactions between chronic pain, affect, and pain self-management.

Adaptation, Psychological↗

PubMed2006

Life satisfaction and resilience in medical school--a six-year longitudinal, nationwide and comparative study.

BACKGROUND: This study examined the relationship between life satisfaction among medical students and a basic model of personality, stress and coping. Previous studies have shown relatively high levels of distress, such as symptoms of depression and suicidal thoughts in medical undergraduates. However despite the increased focus on positive psychological health and well-being during the past decades, only a few studies have focused on life satisfaction and coping in medical students. This is the first longitudinal study which has identified predictors of sustained high levels of life satisfaction among medical students. METHODS: This longitudinal, nationwide questionnaire study examined the course of life satisfaction during medical school, compared the level of satisfaction of medical students with that of other university students, and identified resilience factors. T-tests were used to compare means of life satisfaction between and within the population groups. K-means cluster analyses were applied to identify subgroups among the medical students. Analysis of Variance (ANOVA) and logistic regression analyses were used to compare the subgroups. RESULTS: Life satisfaction decreased during medical school. Medical students were as satisfied as other students in the first year of study, but reported less satisfaction in their graduation year. Medical students who sustained high levels of life satisfaction perceived medical school as interfering less with their social and personal life, and were less likely to use emotion focused coping, such as wishful thinking, than their peers. CONCLUSION: Medical schools should encourage students to spend adequate time on their social and personal lives and emphasise the importance of health-promoting coping strategies.

Adaptation, Psychological↗

PubMed2006

Five years of EACH (European Association for Communication in Healthcare).

Five years after launching EACH (European Association for Communication in Healthcare) we look back at what EACH achieved so far and announce new ideas and activities EACH plans to carry out in the near future. During the past five years several scientific, educational as well as societal changes have taken place in the area of communication in healthcare that all underline the need for continued international collaboration in line with the activities employed by EACH so far. Within communication research the focus has shifted from counting communication utterances to unraveling sequences of patient cues and provider responses. In the field of teaching it is becoming more and more common to attend to the training of trainers as well. Within these developments, new areas of interest arise and need attention. To comply with these increasing demands, EACH invites new persons to become a member of one of the recently launched committees in the area of research, teaching and publishing.

Communication↗

PubMed2006

Rheumatology care: Involvement in medical decisions, received information, satisfaction with care, and unmet health care needs in patients with rheumatoid arthritis and ankylosing spondylitis.

OBJECTIVE: To examine levels of received information, involvement in medical decisions, and satisfaction with care, to explore factors related to current involvement in medical decisions, and to assess patients' unmet health care needs related to their disease. METHODS: A total of 1,193 patients with rheumatoid arthritis and ankylosing spondylitis completed self-reported health status questionnaires, including registration of sociodemographic data and questions about rheumatology care. Separate questions addressed information received, involvement in decisions, and satisfaction with care. Aspects of unmet health were assessed by an open-ended question. RESULTS: The majority of patients reported medium to high levels of received information, involvement in medical decisions, and satisfaction with care. High involvement in medical decisions was univariately associated with high levels of perceived information and satisfaction, as well as with lower age and a good health status. In the multivariate analyses, patient satisfaction (odds ratio [OR] 4.21) and a high level of received information (OR 7.85), age (OR 0.99), and >12 years of formal education (OR 1.46) remained as significant predictors to current involvement. Nearly one-third reported a variety of unmet health care needs, and this report was associated with poor health. CONCLUSION: The results indicate a need for a more flexible and patient centered care model, in which patients to a larger degree can decide which services they need and how these services should be delivered.

Arthritis, Rheumatoid↗

PubMed2006

Positive affect as a factor of resilience in the pain-negative affect relationship in patients with rheumatoid arthritis.

OBJECTIVE: The purpose of this study is to examine positive affect (PA) as a factor of resilience in the relationships between pain and negative affect (NA) in a sample of patients with rheumatoid arthritis. METHODS: Forty-three patients (30 women; mean age, 57 years) were interviewed weekly by telephone for 8 weeks. Multilevel modeling was applied to study the within-week relationships among the variables. RESULTS: There was a Pain x PA interaction effect on NA (beta=-0.05, P<.01) indicating a weaker relationship between pain and NA in weeks with more PA. Pain (beta=0.37, P<.002), interpersonal stress (beta=2.42, P<.001), depression (beta=0.26, P<.01), average perceived stress (beta=10.80, P<.001), and also weekly PA (beta=-0.1, P<.01) had a main effect upon NA. CONCLUSION: Positive affect is most influential in reducing NA during weeks of higher pain and may be a factor of resilience, helping patients experiencing pain fluctuations as less distressful than at lower levels of PA.

Adult↗

PubMed2006

Cognitive and emotional factors in placebo analgesia.

OBJECTIVE: Information that a painkiller has been administrated induces an expectancy of reduced pain, and the expectancy has been shown to reduce pain. This is termed placebo analgesia. We hypothesized that an expectancy of reduced pain reduces stress. METHODS: The present study (N=84) investigated this hypothesis. To further study the effects of stress and emotions on pain, we provided information about the pain stimulus to half the subjects. Pain was induced by the submaximum tourniquet technique. RESULTS: Expectations and pain information both decreased pain to the same degree, but independently, and only in males. Lower pain was not related to subjective stress, cortisol, or circulating beta-endorphin. All experimenters were women, and the finding of placebo analgesia only in males fits well with findings that males report less pain to female experimenters. CONCLUSION: Placebo analgesia is not related to stress and is influenced by the social context in which pain is recorded.

Acetaminophen↗

PubMed2006

Methodological issues concerning lifetime medically unexplained and medically explained symptoms of the Composite International Diagnostic Interview: a prospective 11-year follow-up study.

OBJECTIVE: The objectives of this study were (a) to elucidate the methodological problems arising when examining lifetime symptom data by exploring the accuracy of recall of medically unexplained symptoms (MUS) and medically explained symptoms (MES) in the general population, based on interviews using the Composite International Diagnostic Interview (CIDI) Somatoform Section C, in 1990 and 2001, and (b) to find predictors for failure at follow-up to recall symptoms reported previously at baseline (i.e., symptoms "lost"). METHODS: Four hundred twenty-one persons (response rate, 69.6%; 242 women and 179 men) were reinterviewed in 2001 from a baseline population of 605. Thirty-eight clinically significant MUS and MES were assessed. Linear multiple regression analyses with the numbers of MUS-lost (medically unexplained symptoms lost to recall) and MES-lost (medically explained symptoms lost to recall) as dependent variables were undertaken to find factors affecting symptom loss. RESULTS: A wide range of individual symptoms (22-100%) were lost to recall at follow-up, indicating a large degree of measurement error, mainly due to faulty recall. The number of symptoms recalled when they were grouped was better (approximately 50% for "1-3" symptoms). Recall variability and MUS/MES transition over time undermined the credibility of this distinction. Gender and age emerged as significant (P<.01) predictors for MUS-lost, and a decrease in physical morbidity for MES-lost. Men tended to forget more symptoms than women, and younger respondents with high levels of baseline MUS remembered slightly better at follow-up. CONCLUSION: Lifetime symptom data elicited in community surveys by such instruments as the CIDI should be viewed with caution. Methodological errors weakening data credibility could lead to false impressions of true change over time. A MUS/MES distinction is difficult to maintain.

Adult↗

PubMed2005

Salivary cortisol response after a medical interview: the impact of physician communication behaviour, depressed affect and alexithymia.

OBJECTIVE: To explore if - and possibly how - a medical interview may affect adrenocortical activity in musculo-skeletal pain patients with and without alexithymia. METHODS: Female patients (N = 54) recruited from a patient organization for fibromyalgia completed the Toronto Alexithymia Scale (TAS-20) and subgroups with, respectively, low and high scores were selected for participation. Seven physicians conducted consultations attempting to vary their communication in accordance with given guidelines. All consultations were videotaped and analysed by The Roter Interaction Analysis System (RIAS) to evaluate the actual content of the consultations. RESULTS: An increase in depressed affect from pre- to post-interview was associated with relatively high cortisol levels 24 h after the consultation, but only in patients with alexithymia. Psychosocial questions from the physician were associated with increased depressed affect immediately following the interview, but not with cortisol responses at any time. CONCLUSION: In patients with deficient affect regulation, increase in depressed affect after a medical interview may be associated with delayed effects in adrenocortical activity, possibly mediated by rumination. PRACTICE IMPLICATIONS: Providers should be sensitive to potential deficits of affect regulation in their patients.

Affective Symptoms↗

PubMed2005

Cross-sex hormone treatment does not change sex-sensitive cognitive performance in gender identity disorder patients.

Cognitive performance in untreated early onset gender identity disorder (GID) patients might correspond to their born sex and not to their perceived gender. As a current mode of intervention, cross-sex hormone treatment causes considerable physical changes in GID patients. We asked, as has been suggested, whether this treatment skews cognitive performance towards that of the acquired sex. Somatically healthy male and female early onset GID patients were neuropsychologically tested before, 3 and 12 months after initiating cross-sex hormone treatment, whereas untreated healthy subjects without GID served as controls (C). Performance was assessed by testing six cognitive abilities (perception, arithmetic, rotation, visualization, logic, and verbalization), and controlled for age, education, born sex, endocrine differences and treatment by means of repeated measures analysis of variance. GID patients and controls showed an identical time-dependent improvement in cognitive performance. The slopes were essentially parallel for males and females. There was no significant three-way interaction of born sex by group by time for the six investigated cognitive abilities. Only education and age significantly influenced this improvement. Despite the substantial somatic cross-sex changes in GID patients, no differential effect on cognition over time was found between C and GID participants. The cognitive performance of cross-sex hormone-treated GID patients was virtually identical to that of the control group. The documented test-retest effect should be taken into consideration when evaluating treatment effects generally in psychiatry.

Adult↗

PubMed2005

Changes in physician-patient communication from initial to return visits: a prospective study in a haematology outpatient clinic.

Limited research has investigated how physician-patient interaction changes over time. We have therefore examined physician-patient communication during the two initial, as well as the seventh (on average) patient visit to a haematology outpatient clinic. Consultations were audio taped and analyzed using the Roter interaction analysis system (RIAS). Patients completed the Impact of Events Scale (IES) before and a satisfaction questionnaire after each consultation. Consultations were generally physician dominated and task-focused. While the amount of task-focused communication was significantly reduced between the initial and the return visits, the amount of socio-emotional communication remained quite stable. In return visits (but not in the two initial visits), patients with more severe diagnoses were given longer consultations and they provided more task-focused information to a less verbally dominant physician. Patients were more satisfied in the second and return visits (but not in the first), if consultations contained greater levels of socio-emotional communication.

Adult↗

PubMed2005

Comparing self-reported communication skills of medical students in traditional and integrated curricula: a nationwide study.

OBJECTIVES: To investigate medical students' self-assessments of their communication skills through medical school related to background factors, curriculum design and perceived medical school stress. METHODS: Medical students at all year levels attending Norwegian universities in the spring of 2003 were mailed the Oslo Inventory of Self-reported Communication Skills (OSISCS) developed by the authors. Of the total number of students (N=3055), 60% responded. One school had a traditional curriculum, the other three ran integrated models. RESULTS: Students assessed their instrumental communication skills to increase linearly year by year, while the relational skills showed a curve-linear trajectory reaching the optimum level half-way into the curriculum. Students attending the traditional school reported lower levels of instrumental skills compared to the students from the integrated schools. In relational skills, a similar difference was maintained half-way into the curriculum, but disappeared towards the end. Perceived medical school stress correlated to the self-reported end point levels of the two types of communication skills. DISCUSSION: The trajectories of self-reported instrumental and relational skills indicate significant variations in facilitating mechanisms between curricula, cognitive processing and perceived medical school stress. CONCLUSIONS: Self-reported instrumental and relational communication skills develop differently in medical students over the years according to the type of curriculum. PRACTICE IMPLICATIONS: Curricula should be evaluated for improvement implementations.

Adolescent↗

PubMed2005

Reliability of the Canadian Occupational Performance Measure in patients with ankylosing spondylitis.

OBJECTIVE: The Canadian Occupational Performance Measure (COPM) is a client-centered measure, designed to detect changes in occupational performance over time. The main aim of our study was to examine the test-retest reliability of the Norwegian version of the COPM in patients with ankylosing spondylitis (AS) in 3 different retest modes of data collection. METHODS: A total of 119 patients with AS completed the baseline COPM interview before randomization into one of 3 modes of retest data collection performed 2 weeks later: by personal interview, telephone interview, or mailed questionnaire. Scores were computed for Performance and Satisfaction, and the 2 sets of scores were examined for reliability by intraclass correlations (ICC), and by the Bland-Altman procedure for calculation of smallest detectable difference (SDD). RESULTS: The ICC coefficients for Performance and Satisfaction were as follows: 0.92 and 0.93 (rescoring by personal interview), 0.73 and 0.73 (rescoring by telephone interview), and 0.90 and 0.90 (rescoring by mail). SDD for the Performance and Satisfaction scores were 1.47 and 1.80, respectively, for rescoring by personal interview; 3.14 and 4.00 for rescoring by telephone interview; and 2.20 and 2.41 for rescoring by mailed survey. CONCLUSION: The results confirm that the COPM is a reliable instrument for use in clinical practice in patients with AS, and may serve as an instrument to promote a patient-centered approach in the planning and evaluation of rehabilitation programs. Mailed questionnaires may replace personal interview in followup examinations, while rescoring by telephone interview is less reliable.

Adult↗

PubMed2004

Listening for feelings: identifying and coding empathic and potential empathic opportunities in medical dialogues.

The objective of the study was to validate the model of empathic opportunity (EO) and potential empathic opportunity (PEO) using the Roter Interaction Analysis System (RIAS) in a sample of cancer patients. Thirty-nine audio taped consultations at an outpatient oncology clinic performed by four oncologists were previously coded with the Roter Interaction Analysis System for another purpose. These consultations were also coded by two raters with the empathic and potential empathic opportunity method (E-PE-O method). The reliability of EO and PEO coding was satisfactory. Most of the EOs were found within the RIAS category "showing concern". The PEOs were found in both the socio-emotional and the instrumental categories of the RIAS. We conclude that the E-PE-O method is a good starting point for studying the empathy process in oncology consultations.

Empathy↗

PubMed2004

Physician-patient dialogue surrounding patients' expression of concern: applying sequence analysis to RIAS.

The aim of this study was to analyse with sequence analysis physician-patient dialogue surrounding patients' expression of emotional cues. Two samples, sample 1 consisting of 36 cancer patient consultations conducted by four oncologists, and sample 2 consisting 79 consultations of haematology patients conducted by nine specialists, were audiotaped and coded with the Roter Interaction Analysis System (RIAS). Sequence analysis by means of a generalized sequential querier (GSEQ) was applied to the coded data. Lag sequential analysis (analysed using RIAS categories) showed that certain behaviours of physicians corresponded with patients' expressions of concern. Physicians in both samples used silence and minimal encouragers before patient concern. The oncologists also used optimistic and affirming responses. The most common physician responses to patients' concern were minimal encouragers or affirming and optimistic responses. Sequence analysis based on RIAS coding appears to be a promising method for the study of doctor-patient dialogue and should be utilized more in studies of the communication process in medical consultations.

Adult↗

PubMed2004

Musculo-skeletal pain, psychological distress, and hormones during the menopausal transition.

OBJECTIVE: To investigate the relationship between sex hormones (estradiol, testosterone, androstendione, DHEA-S) and prolactin on one hand and musculo-skeletal pain and psychological distress on the other during the menopausal transition. METHOD: Fifty-seven regularly menstruating women, who were studied over five consecutive years, who reached menopause before the fifth assessment, and did not use hormone replacement therapy were included in the study. Hormones were sampled and a questionnaire including questions on psychological distress and musculo-skeletal pain were administered at the five points of assessment. Data on last year before menopause (T1), first (T2) and second (T3) year after menopause are reported. RESULTS: DHEA-S, but neither testosterone nor androstendione, was inversely related to distress and pain. Pain contributed to the variance of DHEA-S over the menopausal transition, whereas DHEA-S levels did not predict pain or distress when baseline levels were controlled for. Prolactin was at T1 and T2 positively associated with distress and at T2 positively associated with musculo-skeletal pain. Musculo-skeletal pain pre-menopause was significantly related to estradiol. CONCLUSION: DHEA-S was negatively associated, and prolactin positively associated with musculo-skeletal pain and psychological distress. Whereas post-menopause DHEA-S levels were influenced by pain scores, no significant effect of pre-menopause hormones on post-menopause pain and distress was found.

Androstenedione↗

PubMed2004

How do patients with rheumatic disease experience their relationship with their doctors? A qualitative study of experiences of stress and support in the doctor-patient relationship.

This study is evaluated what patients with rheumatic disease perceive as important in their medical encounters. We interviewed two groups of patients: one with a well-defined inflammatory condition (rheumatoid arthritis (RA) or ankylosing spondylitis) (n = 12) and one with non-inflammatory widespread chronic pain such as fibromyalgia (n = 14). Both groups focused on their relationship to their doctor. Two central themes emerged as of importance: 'to be seen' and 'to be believed'. However, these themes had different connotations for the two groups. For the patients with inflammatory conditions, 'to be seen' implied being seen as an individual and not as a mere diagnosis, and 'to be believed' as far as pain and suffering were concerned. For patients with non-inflammatory chronic pain 'to be seen' and 'to be believed' primarily implied being able to obtain a useful somatic diagnosis. Practical implications of these findings are discussed.

Adult↗

PubMed2004

Depressed mood impedes pain treatment response in patients with fibromyalgia.

OBJECTIVE: To investigate prognostic factors in the course of the fibromyalgia syndrome (FM) from baseline to post-treatment. METHODS: Fifty-seven patients with FM were examined in a randomized intervention study. Pre-treatment variables were entered into linear regression analyses: gender, age, duration of disease, allocation to treatment, pain distribution (based on a patient-made drawing), fatigue, sleep disturbance, and depressed mood (based on visual analog scores), with pain distribution at treatment completion as the dependent variable. RESULTS: Depressed mood at baseline was a significant predictor of sustained widespread pain at treatment completion. CONCLUSION: The findings indicate a role for depressed mood as a predictive factor for treatment response.

Adult↗