Biomedical subjects

P Vaglum

Publications and source records attributed to P Vaglum.

At least 19 recordsLinked to original sources

PubMed2000

The impact of job stress and working conditions on mental health problems among junior house officers. A nationwide Norwegian prospective cohort study.

CONTEXT: Previous studies have shown that physicians have an increased risk of mental health problems such as depression, suicide and substance abuse. OBJECTIVES: To study the prevalence of mental health problems during the first postgraduate year, and to investigate whether work-related factors in hospital are linked to these, when we control for gender, previous mental health problems, personality traits, stress in medical school and other possible predictors. DESIGN: Nationwide and prospective postal questionnaire survey. SETTING: University of Oslo. SUBJECTS: Medical students who answered questionnaires in their graduating semester, and 1 year later when they were junior house officers (n=371). RESULTS: Mental health problems (needing treatment) during internship were reported by 11%, with no gender difference. Adjusted predictors of mental health problems were: previous mental health problems, (odds ratio (OR)=5.1, 95% confidence interval (CI) 1.7 to 15.8); being married/cohabitant (OR=0.2, CI 0.1 to 0.7); the personality trait 'vulnerability' (OR=1.5, CI 1.1 to 2.0); negative life events during internship (OR=2.1, CI 1.2 to 3.5), and job stress as house officer (OR=1.05, CI 1.01 to 1.10). The job stress factor of emotional pressure/demands from patients was most important. Perceived study stress and lack of skills at the end of medical school were univariately related to mental health problems in internship, but not when other variables were adjusted. Gender, weekly working hours and lack of sleep were not linked to having problems. CONCLUSION: Job stress is related to mental health problems among young doctors, even when the variables of previous mental health problems and personality traits are controlled for. More support during internship is needed.

Adult↗

PubMed2000

The course of rheumatoid arthritis and predictors of psychological, physical and radiographic outcome after 5 years of follow-up.

OBJECTIVE: : To examine the course of RA over 5 yr and identify predictors of psychological, physical and radiographic outcome. PATIENTS AND METHODS: Out of 238 patients with rheumatoid arthritis of no more than 4 (mean 2.2) yr duration, 182 (76%) completed a clinical examination with follow-up at 1, 2, and 5 yr. The course of the disease was assessed by measures of psychological and physical health status, disease process and radiographic damage. RESULTS: : Over 5 yr we observed at a group level a stable disease course for measures of disease process, psychological and physical health status. Radiographic damage progressed. Health status and radiographic damage after 5 yr were predicted by the baseline measures for the respective outcome. Physical function was also predicted by age and by psychological status when the physical dimension of the Arthritis Impact Measurement Scales was chosen as outcome variable. Erythrocyte sedimentation rate and presence of rheumatoid factor predicted radiographic progression. CONCLUSIONS: : The 5 yr course of RA was characterized by preserved health status measures and clinically preserved disease process measures, whereas joint damage progressed steadily. Outcomes after 5 yr can be predicted partly by certain measures at baseline.

Analysis of Variance↗

PubMed2000

Social functioning of patients with schizophrenia in high-income welfare societies.

OBJECTIVE: The study assessed the level of reintegration into the community of patients with schizophrenia in Oslo, Norway, a country with a well-developed social welfare system and low unemployment rates. METHODS: Eighty-one patients with a DSM-III-R diagnosis of schizophrenia treated in 1980 and in 1983 in a short-term ward of a psychiatric hospital were followed up after seven years. Seventy-four of 76 patients alive at follow-up agreed to participate. Social functioning was measured by the Strauss-Carpenter Level of Functioning Scale and the Social Adjustment Scale. RESULTS: At follow-up 78 percent of patients lived independently, 47 percent were socially isolated, and 94 percent were unemployed. Thirty-four percent had lost employment in the follow-up period. A poor outcome in terms of social functioning and community reintegration was associated with loss of employment. A good outcome was predicted by short periods of inpatient hospitalization, high levels of education, being married, male gender, and not having a late onset of psychosis. CONCLUSIONS: The level of homelessness among these patients with schizophrenia was encouragingly low, which may have been expected in a high-income welfare society. However, insufficient efforts were aimed at social and instrumental rehabilitation, and the level of unemployment was alarmingly high.

Activities of Daily Living↗

PubMed1999

Motivation for medical school: the relationship to gender and specialty preferences in a nationwide sample.

OBJECTIVES: Motivation for going to medical school and career plans of a 1 year cohort of students entering medical school in Norway (n = 420 response rate: 90%, 54% women, mean age: 22 years) were surveyed by a postal questionnaire the first month after they had started. DESIGN: Motives for choosing medicine were categorized into three indexes: 'people orientated', 'status/security orientated' and 'natural science orientated' motives. SETTING: University of Oslo. SUBJECTS: Medical students. RESULTS: Students picked out which they preferred among 53 specialties. The highest motivational scores were on the 'person orientated' index, female students scoring higher than men. Female students were, however, nearly as highly motivated by status/security and interests in natural science as were men. 'Person orientated' and 'natural science orientated' motives exerted the strongest influence on specialty preferences. Those who preferred family medicine were more person orientated and less natural science orientated, while those who preferred internal medicine were more natural science orientated. Father being a physician did not influence the motivational pattern, but increased the preference for laboratory and internal medicine. Frequently repeated upper secondary school exams for acceptance into medical school were negatively related to natural science motivation, and to increased preference for becoming a surgeon. CONCLUSIONS: In this first month of the curriculum students regarded person oriented motives as the most important for becoming a doctor.

Adult↗

PubMed1999

Overdoses and suicide attempts: different relations to psychopathology and substance abuse? A 5-year prospective study of drug abusers.

Two hundred Norwegian drug abusers who consecutively applied for treatment in a therapeutic community were interviewed at intake and personally followed up on average 5 years after. Millon Clinical Multiaxial Inventory and Symptom Checklist-90 were used to assess the clients. Frequent use of opiates and number of months in inpatient treatment were associated with overdoses, while being a case on the Borderline scale or depression was related to suicide attempts. The study shows that overdoses and suicide attempts can be distinguished on the basis of their different psychopathological risk variables and their different relationship to substances. To understand the background of these phenomena is of importance in planning preventive action to hinder fatal overdose and suicide.

Adolescent↗

PubMed1998

[Soccer--more than a game! About development of social aspects of soccer among children and adolescents in Norway].

The three most important social aspects of children's sports are: the social aspect, the preventive aspect, and the social network aspect. In 1981, The Norwegian football Association decided to make general improvements to the sport of football for children and youths. The idea was that all children who wanted to, could join in a game of football in a friendly sporting environment where everybody enjoyed participating. To find out the best way of doing this, we conducted three research projects: an epidemiological study, an outcome study, and a study on new ways of recruiting players and leaders in the local community. The following type of questions were explored: What are the social characteristics of 12 to 16-year old children who play football? Does football recruit children with behavioural or emotional problems? Who are the drop-outs, and why? This paper summarises some of the research findings and describes some of the main changes that were made in rules, organisation of the game, training of leaders, and attitudes and values.

Adolescent↗

PubMed1998

Psychiatric co-morbidity and aftercare among alcoholics: a prospective study of a nationwide representative sample.

AIMS: To study prospectively the type and extent of aftercare sought by patients following their admission for alcohol and other substance abuse treatment as a function of psychiatric co-morbidity. DESIGN: Prospective cohort study with follow-up after 16 months. SETTING AND PARTICIPANTS: A nationwide sample of alcoholics discharged from inpatient treatment (N = 351) in Iceland. MEASUREMENTS: The Diagnostic Interview Schedule was used to assign psychiatric diagnoses at the time of index admission. A questionnaire on the type and number of aftercare attendances was mailed to all participants to obtain information about aftercare. FINDINGS: A combination of attendance at Alcoholics Anonymous (AA) and professional care was the most common aftercare (49%); while only 8% received no aftercare whatsoever. The mean number of AA attendances was over 24 while it was less than 3 for the various professional appointments. Patients with a diagnosis of schizophrenia had a lower rate of attendance at AA. Other types of co-morbidity did not affect AA attendance but did increase rates of professional help-seeking. CONCLUSIONS: Better professional treatment attendance might be gained by integrating AA concepts while AA might benefit from professional input to address the prevalent co-morbid psychiatric disorders.

Adult↗

PubMed1998

Use of alcohol to cope with tension, and its relation to gender, years in medical school and hazardous drinking: a study of two nation-wide Norwegian samples of medical students.

AIMS: To study the association between the use of alcohol to cope with tension and hazardous drinking, and the prevalence and the predictors of such drinking behaviours. DESIGN: Cross-sectional surveys of two nation-wide samples of medical students, one at the beginning and one at the end of medical training. PARTICIPANTS: Medical students entering Norwegian medical schools in 1993 (N = 379) or graduating in 1993 and 1994 (N = 522); 55.6% of the total sample were women. MEASUREMENTS: Postal questionnaires including SCL-5, Perceived Medical School Stress. FINDINGS: Use of alcohol to cope was reported by 10.5% of the students with no significant gender difference. Hazardous drinking ('binge drinking' at least 2-3 times per month) was reported by 14% of all the students, 24% among the men and 6% among the women. There was a strong association between use of alcohol to cope with tension and hazardous drinking, OR = 5.11, 95% CI (2.88-9.07) when controlling for other possible predictors. Use of alcohol to cope was also associated with increasing age, mental distress and lack of religious activity. The senior students used alcohol as a way of coping less often, but not hazardous drinking. Male gender, religious inactivity, high self-esteem and having no children were predictors of hazardous drinking. CONCLUSION: This study suggests that the use of alcohol to cope with tension is an independent risk factor connected with hazardous drinking among medical students, with no difference in prevalence between the genders.

Adaptation, Psychological↗

PubMed1998

Social consequences of substance abuse: the impact of comorbid psychiatric disorders. A prospective study of a nation-wide sample of treatment-seeking patients.

This is both a retrospective and a 16 and 28 months prospective study of the association between psychiatric comorbidity and social consequences (accidents, fights, broken relationships, drunken driving arrest, and reduced employment) related to alcohol in a nation-wide sample (n = 351) of substance abusers seeking inpatient treatment. Psychiatric comorbidity was evaluated with the Diagnostic Interview Schedule, while drinking history and social consequences were assessed with a structured questionnaire. The social consequences had a high rate of re-occurrence. Controlled for alcohol consumption, polysubstance abuse predicted accidents (OR = 2.9) and fights (OR = 3.9) among men, while among pure alcoholics of both sexes phobia (OR = 4.3) and antisocial personality disorder (OR = 3.0) predicted fights. Only level of abuse predicted broken relationships. Antisocials had most drunken driving arrests. Attempts to reduce these social consequences should aim at treating polysubstance abuse, phobia, and antisocial personality disorder. However, the overriding aim should be the promotion of abstinence.

Adult↗

PubMed1997

[Career plans of future physicians. Level of ambition and plans for specialization among medical students].

This nation-wide study inquiry concerned the intended future careers of medical students at the end of their studies and those of a cohort of first-year students. More first-year than final-year students hoped to obtain a position as a hospital physical or surgeon with management responsibility and twice as many men as women wanted such a position in both cohorts. High self esteem, having a doctor as father and successful examinations at medical school were associated with a high level of ambition. Compared with first-year students, more final-year students preferred family medicine and internal medicine, and less preferred surgery, psychiatry and social medicine. Plans for specialisation were influenced by the father's education level, successful examinations at medical school, whether they had children or not, and the university of graduation. More women preferred gynaecology, more men preferred surgery. The interest for surgery among female students is high compared with the low share of female surgeons. Assuming that these trends persist, psychiatry, laboratory medicine and social medicine risk insufficient recruitment. The share of women holding clinical professorships will probably remain low, even in a generation with more female than male medical students.

Adult↗

PubMed1997

Establishing social contact in exile: a prospective community cohort study of Vietnamese refugees in Norway.

The social networks of Vietnamese refugees and predictors of their intra- and inter-ethnic social contact after 3 years in Norway were studied. An unselected community cohort of Vietnamese boat refugees was personally interviewed, first on arrival in Norway (n = 145) and again after 3 years (n = 130). By the time of the second interview, the refugees had to a large degree reconstructed social networks and 54% had good contact with other Vietnamese. Only 17% had equally good contact with Norwegians. Female gender, further education after resettlement and having a close confidant on arrival were related to good inter-ethnic social contact. The latter was the only predictor of good intra-ethnic social contact. Competency in the Norwegian language, surprisingly, did not predict good social contact with Norwegians. The refugees were largely successful in re-establishing a social platform in relation to their own ethnic group in their new environment. It was much more difficult to establish good social contact with Norwegians. Educational institutions appear to be important social arenas in this respect. The personal capacity for close attachments during a period of psychosocial transition is also important.

Acculturation↗

PubMed1997

The 2-year course following detoxification treatment of substance abuse: the possible influence of psychiatric comorbidity.

The influence of psychiatric comorbidity on the course and outcome in a nationwide representative sample (n = 351) of treatment-seeking substance users over a 28-month period was studied prospectively. The patients were administered the Diagnostic Interview Schedule and a questionnaire on drinking history. At 16 and 28 months after admission the patients returned a questionnaire on drinking history and mental health. In cases of those lacking information on either follow-up (45%), details on drinking status was obtained from informants. Completely abstinent were 16%. Generalized anxiety disorder and/or social phobia at the index admission predicted abstinence during the follow-up [odds ratio (OR) = 0.25], whereas onset of alcoholism among these patients after age 25 years predicted a worse prognosis (OR = 13.5). Also increasing number of social consequences related to abuse (OR = 1.3) and drinking more than the median (OR = 2.1) predicted a poor outcome. The abstinent group had significantly better mental health at follow-up. The patients with comorbid psychiatric disorders at admission were worse at follow-up. Although substance use disorders and comorbid psychiatric disorders have to a certain degree separate courses, there is nevertheless significant interaction between them. Early treatment and recognition of comorbid psychiatric disorders among substance abusers is necessary.

Adult↗

PubMed1997

The relationship between psychological distress and traditional clinical variables: a 2 year prospective study of 216 patients with early rheumatoid arthritis.

In this longitudinal study (12 and 24 months follow-up) of 216 patients with early rheumatoid arthritis (RA) (< or = 4 yr duration), we assessed the strength and stability of the relationship between psychological distress and traditional clinical variables examined the ability of these clinical variables to predict changes in mental distress, and explored the directionality between mental distress and the other clinical variables. Study variables were symptoms of anxiety and depression measured by the Arthritis Impact Measurement Scales, tender joint counts, erythrocyte sedimentation rate (ESR), and self-reported pain and disability. Psychological distress showed high levels of stability over time. Pain and disability were the two variables most strongly and consistently related to mental distress. High levels of disability predicted an increase in depression during the next year; otherwise, changes in psychological distress were not predicted by disease-related variables. Attempts at causal modelling of the temporal relationship between mental distress, pain and disability failed to yield consistent results.

Adult↗

PubMed1997

Competence, perceived importance of competence and drop-out from soccer: a study of young players.

The purpose of this study was to examine the psychological centrality hypothesis and the selectivity/discounting hypothesis advanced by Rosenberg and Harter and the motivational consequences thereof within the context of soccer. A representative sample of 223 young soccer players aged 12-16 who were interviewed twice within a period of 16 months served as subjects. Within the younger as well as the older group of players, the psychological centrality hypothesis received support in that the influence of perceived soccer competence upon soccer-related self-esteem was shown to be dependent upon the personal importance of one's own soccer competence. The psychological selectivity/discounting hypothesis, stating that players actively value or devalue how personally important they consider soccer competence to be as a result of changes in the perception of such competence, was also supported. Additional results showed that perceived importance of soccer competence did neither mediate nor moderate soccer drop-out among players with low perceived soccer competence. Low perceived soccer competence, on the other hand, clearly mediated the relationship between low actual soccer competence and increased drop-out within the group of older players.

Adolescent↗

PubMed1997

Correlates of patients' global assessment of arthritis impact. A 2-year study of 216 patients with RA.

Considering the key position of patients' global assessment in clinical practice and research, we wanted to examine the relationships between patients' global assessment and biological, functional, and mental variables, and to explore the relative contribution of these variables on patients' assessment of arthritis impact. Patients with RA of < or = 4 yrs duration were examined at baseline (n = 238) and after 12 and 24 months (n = 216). Study variables were tender joints, ESR, CRP, hand X-ray abnormalities and self-reported global arthritis impact, pain, disability, and symptoms of depression. 2-yr mean scores were computed for all variables. Strong correlations were found between patients' global assessment and pain (r = .73), depression (r = .68), disability (r = .64), and tender joints (r = .51), while ESR, CRP, and X-ray abnormalities correlated weakly with the global assessment. Using a multivariate approach, however, the relative effects of disability and tender joints were no longer statistically significant, whereas pain and depression still had significant impact on patients' global assessments.

Adult↗

PubMed1996

Psychopathology and alcohol consumption among treatment-seeking alcoholics: a prospective study.

The association between psychopathology and alcohol consumption was studied in a nation-wide representative sample of inpatient alcoholics (n = 245) who were examined at intake and 15 months later. As regards baseline observations men and women with antisocial personality disorder or cognitive impairment had consumed more alcohol in the month prior to admission than those not so affected. In contrast, men with panic disorder drank less compared with those not so affected. The prognosis for men consuming more than the median amount of alcohol was worse than that of women. However, after controlling for psychiatric distress and alcohol consumption at baseline, the prognosis of women was worse. Women but not men who had stopped drinking had a higher degree of psychiatric distress at follow-up compared with those still drinking at a low level. Regarding the prognostic significance of psychiatric disorders at baseline, among men panic disorder predicted continued drinking. Psychiatric distress and alcohol consumption at baseline interacted in the prediction of alcohol consumption at follow-up. The study highlights the importance of a thorough assessment of psychopathology and course of drinking when evaluating the outcome of alcoholism treatment.

Adult↗

PubMed1996

Earlier detection and intervention in schizophrenia: unsolved questions.

Secondary prevention in schizophrenia is still not good enough, and the authors of the articles in this issue of Schizophrenia Bulletin present important new knowledge that may increase earlier detection and treatment. This final article discusses some of their main findings in relation to clinical consequences and new research. We need more knowledge about the clinical characteristics of the prodromal phase and about the factors that influence the help-seeking behavior of patients and families in the early phases of schizophrenia. The new models presented for early detection and treatment are promising and should be replicated in other countries and on other continents.

Biomarkers↗

PubMed1996

The importance of ward atmosphere in inpatient treatment of schizophrenia on short-term units.

OBJECTIVE: The reorganization in 1981 of a general hospital psychiatric ward in Oslo, Norway, to achieve a more suitable treatment milieu for patients with schizophrenia resulted in a change in patients' perceptions of the ward atmosphere. Reduced group participation and increased individualized support from staff led patients to perceive of the ward as having a low level of anger and aggression and a high level of order and organization. This study examined whether the reorganization was associated with improved treatment outcome. METHODS: Psychiatrists retrospectively examined the charts of all patients with a DSM-III-R diagnosis of schizophrenia or schizophreniform disorder who were admitted to the ward the year before and the second year after the reorganization. Multiple regression analyses were used to examine treatment outcomes for both groups. Outcome was measured indirectly by length of stay, level of functioning at discharge, and whether the patient was rehospitalized during the following seven years. RESULTS: Patients treated after the reorganization had significantly shorter stays with no reductions in either level of functioning at discharge or length of community tenure after discharge. Differences in demographic characteristics, illness history, or psychopharmacological treatment could not account for differences in outcome. CONCLUSIONS: The results supported the hypothesis that the organization and milieu of brief-stay wards influence the short-term outcome of inpatient treatment of patients with schizophrenia.

Activities of Daily Living↗