Experiences from patients in mental healthcare accessing their electronic health records: results from a cross-national survey in Estonia, Finland, Norway, and Sweden.

BACKGROUND: Patients' online record access (ORA) enables patients to read and use their health data through online digital solutions. One such solution, patient-accessible electronic health records (PAEHRs) have been implemented in Estonia, Finland, Norway, and Sweden. While accumulated research has pointed to many potential benefits of ORA, its application in mental healthcare (MHC) continues to be contested. The present study aimed to describe MHC users' overall experiences with national PAEHR services. METHODS: The study analysed the MHC-part of the NORDeHEALTH 2022 Patient Survey, a large-scale multi-country survey. The survey consisted of 45 questions, including demographic variables and questions related to users' experiences with ORA. We focused on the questions concerning positive experiences (benefits), negative experiences (errors, omissions, offence), and breaches of security and privacy. Participants were included in this analysis if they reported receiving mental healthcare within the past two years. Descriptive statistics were used to summarise data, and percentages were calculated on available data. RESULTS: 6,157 respondents were included. In line with previous research, almost half (45%) reported very positive experiences with ORA. A majority in each country also reported improved trust (at least 69%) and communication (at least 71%) with healthcare providers. One-third (29.5%) reported very negative experiences with ORA. In total, half of the respondents (47.9%) found errors and a third (35.5%) found omissions in their medical documentation. One-third (34.8%) of all respondents also reported being offended by the content. When errors or omissions were identified, about half (46.5%) reported that they took no action. There seems to be differences in how patients experience errors, omissions, and missing information between the countries. A small proportion reported instances where family or others demanded access to their records (3.1%), and about one in ten (10.7%) noted that unauthorised individuals had seen their health information. CONCLUSIONS: Overall, MHC patients reported more positive experiences than negative, but a large portion of respondents reported problems with the content of the PAEHR. Further research on best practice in implementation of ORA in MHC is therefore needed, to ensure that all patients may reap the benefits while limiting potential negative consequences.

"The margin for error": Ritual coping with cultural pressures.

Meritocratic sport cultures, media attention, coaches' ambitions, and "enthused" parents create stress and make coping pivotal for athletes' performance. A transdisciplinary dialogue between a sports-sociologist and a sport-psychologist manifests ritual practices in athletes' lived sport experiences as coping strategies. Based on two empirical strands, field observations of boy's handball and interviews with elite male wrestlers', analysis of pregame routines scrutinize psychosocial dimensions of athletes' ritual practice. The implications of ritual meaning making are investigated as a means to cope with sport specific sociocultural anxieties. Rituals are interpreted as psychosocial processes applied to construct perceived order and comfort in stressful sport milieus. We contend that it is reasonable to believe that successful coping is not solely because of athletes' psychological competencies and experiences, but also their ability to ritually use culture in meaningful ways. To manifest important contextual aspects of athletes' lived sport experiences, to nurture task-oriented sport milieus, and to create change in sport and physical cultural contexts, we consequently suggest that the cultural meanings applied in ritual should be an important aspect to address.

Organizational and media stress among professional football players: testing an achievement goal theory model.

The purpose of this study was to investigate media and coach-athlete stress experienced by professional football players and their relationship to motivational variables by testing an achievement goal theory (AGT) stress model. In order to do so, we developed scales specifically designed to assess media and coach-athlete stress. Eighty-two elite football players (M(age) =25.17 years, SD=5.19) completed a series of questionnaires. Correlations and bootstrapping were used as primary statistical analyses, supplemented by LISREL, to test the hypotheses. Results revealed that a mastery climate was directly and negatively associated with coach-athlete stress, while a performance climate was directly and positively associated with coach-athlete stress. In addition, an indirect positive path between the performance climate and media stress was revealed through ego orientation. These findings support some of the key postulates of AGT; a mastery climate reduces the perception of stress among athletes, and the converse is true for a performance climate. Coaches of elite footballers are advised to try to reduce the emphasis on performance criteria because of its stress-reducing effects.

Coaching communication issues with elite female athletes: two Norwegian case studies.

The aim of this study was to examine the careers of two successful female elite athletes who later stagnated, and to identify possible factors that might have led to their demotivation. Individual interviews and a focus group interview were conducted. Using a multidisciplinary approach, the stories of April and Hazel raised several issues related to coaching, coach education, and the development of female athletes. Their individual profiles revealed that their perception of the lack of long-term development was caused by coach miscommunication, having to cope with sudden fame, and injuries provoked by overtraining. The coach-athlete relationship was discussed with a focus on the inexperience of some coaches, the number of coaches the athletes had to deal with, sociolinguistic issues, and the differing criteria of success communicated. Finally, the importance of their national governing bodies to focus on knowledge transfer, the supervision of coaches, and the infrastructure to monitor athletes were discussed.

Young elite athletes and social support: coping with competitive and organizational stress in "Olympic" competition.

Elite adolescent sport is a relatively unexplored research field. The purpose of this investigation was to examine how the Norwegian Olympic Youth Team (N=29) experienced competitive and organizational stress during the European Youth Olympic Festival in July 2007 and how they coped with the stressors. Participants were aged 14-17 and competed in handball, track and field, swimming, and judo. We used a qualitative methodology with interviews and open-ended questionnaires. Qualitative content analyses revealed that the athletes experienced competitive stressors because of the size and importance of the competition, and organizational stressors (e.g., housing, lining up for food, and transportation) exacerbated by the extreme heat during the Festival. The elite competitive experience was novel to all and overwhelming for some of the more "inexperienced" athletes. The athletes used cognitive coping strategies to some extent in addition to relying on different types of social support. The findings revealed the need for social support for adolescent athletes, and underlined the importance of a good coach-athlete relationship in order to perform well and enjoy the competitive experience.

Health evaluation of volatile organic compound (VOC) emission from exotic wood products.

UNLABELLED: The purpose of this study was to measure and evaluate the impact of the emissions of selected products of exotic wood on health. Ten products were screened for chemical compounds, and five of the most used products which emitted more than 800 microg/kg were selected for further quantitative analyses by climate chamber measurement (iroko, ramin, sheesham, merbau, and rubber tree). Samples of exotic wood (rubber tree and belalu) were further analyzed for emission of chemical compounds by migration into artificial saliva and for content of pesticides and allergenic natural rubber latex (NR latex) (rubber tree). The toxicological effects of all substances identified were evaluated and the lowest concentrations of interest (LCI) assessed. An R-value was calculated for each wood product (R-value below 1 is considered to be unproblematic as regards health). Emission from the evaluated exotic wood only took place to a very limited extent. None of the selected products, under the chosen rating system, is likely to cause adverse health effects. Products with surface treatment might pose a problem if used as kitchen utensils, as children's toys, or when they are in close contact with the skin for a long time. PRACTICAL IMPLICATIONS: The authors investigated the chemical emissions from selected products from exotic wood by climate chamber measurement. Quantitative chemical analyses of emissions from the five most used exotic products in Denmark were performed, and all chemical compounds found were evaluated toxicologically. Emission from the evaluated exotic wood was very limited. None of the products is likely, under our exposure conditions, to cause health problems in relation to indoor air.

Achievement involvement and stress coping in elite wrestling.

The present study explored the relationship between task involvement and coping with stress in elite competition. Participants were 82 elite wrestlers, both male (n=60) and female (n=22), from four different European countries, age 16-37. The data for the study were gathered over an 18-month period, and both qualitative in-depth interviews (n=6) and quantitative approaches were used. The quantitative study measured motivation from an achievement goal theory perspective: achievement goal orientation [Perception of Success Questionnaire], perceptions of the motivational climate [Perceived Motivational Climate in Sport Questionnaire] and coping strategies (Brief COPE). The qualitative part explored motivation and coping in depth. As expected, task involved wrestlers coped better in competitive situations due to their use of more adaptive coping strategies. The wrestlers' experiences seemingly make them prefer to stay task involved and use adaptive coping strategies (both problem-focused and emotion-focused strategies) in competition.

Isolation and characterization of hemolymph antifreeze proteins from larvae of the longhorn beetle Rhagium inquisitor (L.).

We describe a simple and effective procedure to isolate antifreeze proteins (AFPs) from the hemolymph of larvae of the longhorn beetle Rhagium inquisitor, and present some characteristics of their structures. Several AFPs were isolated from the hemolymph of this species by heat and acid extraction followed by cation exchange. The hemolymph contains at least six AFPs ranging in size from 12.5 to 12.8 kDa. Of these, three were separated to purity by the ion exchange step, as indicated by mass spectrometry. The remaining three forms were further separated by size exclusion chromatography, but could not be isolated to purity. All AFPs in the hemolymph of this species appears to have isoelectric points above 8.00. The dominant form, RiAFP(H4), was purified by the ion exchange step. Its amino acid composition reveals a lower level of cysteine and a higher level of threonine, arginine, alanine and glycine than seen in other insect AFPs. Its trypsin fingerprint does not match that of any known protein. It interacts with ice both in the anionic and cationic state.

The role of aberrant crypt foci induced by the two heterocyclic amines 2-amino-3-methyl-imidazo[4,5-f]quinoline (IQ) and 2-amino-1-methyl-6-phenyl-imidazo[4,5-b]pyridine (PhIP) in the development of colon cancer in mice.

Aberrant crypt foci (ACF) have recently been identified as early putative preneoplastic lesions which appear in the colons of experimental animals treated with colon carcinogens. In a recent study the two heterocyclic amines, 2-amino-3-methyl-imidazo[4,5-f]quinoline (IQ) and 2-amino-1-methyl-6-phenyl-imidazo[4,5-b]pyridine (PhIP) were shown to be able to induce ACF in the colon of mice after, respectively, 4 and 10 weeks of exposure. In spite of the induction of ACF in colon of mice, IQ and PhIP have not been found to have colon as target organ in carcinogenicity studies. Therefore, one may question that ACF induced by IQ and PhIP in mice represent early stages of colon cancer. In order to investigate the possible role of PhIP- and IQ-induced aberrant crypt foci in the development of colon cancer in mice, colons from mice participating in other IQ- and PhIP-studies of much longer duration were analyzed for ACF. The results of these studies showed that the number of ACF increased statistically significantly over time, and that the small ACF were predominant (95-100%) at all time-points. In conclusion, this finding suggests that the detection of a high number of ACF with low crypt multiplicity (1-3 AC/Focus) in mice colon after IQ- or PhIP-treatment is not indicative for the end-point colon cancer, and thus supports the hypothesis that only the presence of a high number of ACF with high crypt multiplicity is predictive for tumor outcome.

Refined carbohydrate enhancement of aberrant crypt foci (ACF) in rat colon induced by the food-borne carcinogen 2-amino-3-methyl-imidazo[4,5-f]quinoline (IQ).

The aberrant crypt foci (ACF) bioassay has been used extensively to study the early effects of different dietary components on the colonic mucosa of laboratory rodents. ACF are proposed to represent preneoplastic lesions of colon cancer. Compared to the normally used initiators 1,2-dimethylhydrazine dihydrochloride (DMH) and azoxymethane (AOM), the use of a diet-related colon cancer initiator, such as the heterocyclic amine 2-amino-3-methyl-imidazo[4,5-f]quinoline (IQ) formed during meat cooking, would probably give a more relevant insight into diet-related colon carcinogenesis. In the present study it is shown that a feeding regimen with continuous low IQ doses (0.03% in the diet) throughout a study period of 10 weeks has a significant effect on the induction of ACF in the colon of male F344 rats. In addition, the study illustrates that the incidence of the IQ-induced ACF can be modulated by the amount of refined carbohydrates in the diet. Rats given a high sucrose/dextrin diet showed a significantly higher number of ACF compared to rats given a diet high in starches. The effect on tumor outcome will await the termination of a ongoing parallel study.

Effects of long-term feeding with 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) in C57BL/ByA and E mu-pim-1 mice.

The heterocyclic amine PhIP, 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine, has been shown to be carcinogenic in rats producing colon and mammary carcinomas. There is, so far, only a single long-term study report on PhIP carcinogenicity in mice. However, this study focuses on the lymphoma induction only. Whether PhIP induces tumors in other organs in mice after long-term exposure is yet to be established. To contribute to the knowledge about the long-term effects of PhIP feeding the remaining animals from a 7 months feeding study (0.03% PhIP) were put on standard diet and followed up to 18 months. The results confirmed that PhIP is a potent mouse lymphomagen. In addition, treatment with 0.03% PhIP in the diet for the first 7 months of a life-time study (18 months) gave rise to very few and sporadic tumors in other tissues, indicating weak, if any, carcinogenicity of PhIP to organs other than the lymphatic system under the present study design.

Failure of the cultivated mushroom (Agaricus bisporus) to induce tumors in the A/J mouse lung tumor model.

We studied whether the cultivated mushroom (Agaricus bisporus) or 4-(carboxy)phenylhydrazine (CP) induce lung adenomas in the A/J mouse lung tumor model. For 26 weeks female mice were fed a semisynthetic diet where 11 or 22% of the diet was replaced by freeze-dried mushrooms. The intake of the mushroom diets was equivalent to an intake of agaritine, the major phenylhydrazine derivative occurring in the mushroom, of 92 or 166 mg/kg body weight per day. The intake of CP was 106 mg/kg body weight per day. Neither the freeze-dried mushroom nor CP induced statistically significant increased numbers of lung adenomas in female A/J mice in the administered dosages.

The effect of soy isoflavones on the development of intestinal neoplasia in ApcMin mouse.

Data from epidemiological studies suggest that isoflavones in soy may have a protective effect on the development of colon cancer in humans. Therefore, we have investigated whether soy isoflavones will inhibit intestinal tumour development in Apc(Min) mice. The mice were fed a Western-type high risk diet (high fat, low fibre and calcium) containing two different isolates of soy protein as a protein source. For the control and test groups this resulted in the administration of about 16 and 475 mg of total isoflavones per kg diet, respectively. As a positive control. a third group of mice was administered a low isoflavone diet supplemented with 300 ppm sulindac. No significant differences in the incidence, multiplicity, size and distribution of intestinal tumours were observed between Min mice fed low and high isoflavone-containing diets. However, a clear reduction in the number of small intestinal tumours was observed for the sulindac diet. Thus, in contrast to epidemiological studies, our results demonstrate that high amounts of soy isoflavones present in a Western-type high risk diet do not protect against intestinal tumour development in a relevant animal model such as the Min mice.

Human papillomavirus infection in cervical biopsies from Norwegian gynecological in-patients.

Polymerase chain reaction (PCR) and Southern blotting were used to assess the prevalence of HPV in cervical biopsies of 100 women who were treated at the gynecology department of Telemark Central Hospital for non-cancerous conditions. Nine (9%) of the biopsies were HPV positive. Four (4%) were of HPV type 18, one (1%) was HPV11 positive, and four contained different unrecognized HPV types (HPVX). HPV16 was not detected.

Detection of genital papillomavirus types by polymerase chain reaction using common primers.

We describe the detection of eight genital human papillomavirus (HPV) types, including HPV16 and HPV18, by PCR amplification of a 323 base-pair region of the genome within the L1 open reading frame (ORF). The primer sequences are: TGYAAATATCCWGATTWTWT and GTATCWACMACAGTAACAAA. The method will detect purified HPV16 DNA down to a concentration of as little as a single molecule in 100 microliters. The method is also applicable to purified DNA and crude lysates from tumour biopsies. Typing of the PCR product can be achieved with specific oligonucleotide probes.

Human papillomavirus infection in Norwegian women with cervical cancer.

The objective of the present study was to determine the prevalence of human papillomavirus (HPV) infections in Norwegian women with cervical cancer. We used the polymerase chain reaction (PCR) and Southern blot techniques to assess the prevalence of HPV in cervical biopsies of 133 women admitted to the Norwegian Radium Hospital for treatment of cervical cancer. At the time of sampling (from February 1988 to April 1989) about 85% of Norwegian women with cervical cancer were treated at the Norwegian Radium Hospital. HPV was found in biopsies of 91 (68%) of women with cancer; 70 (53%) biopsies contained HPV type 16, 19 (14%) HPV type 18, 4 (3%) HPV type 33, 2 (1.5%) HPV type 11, and 3 (2%) HPV DNA of unknown type (HPVX). Five percent of biopsies were doubly infected, chiefly with HPV 16 + 18. We found a significant association between HPV 18 and low age, poorly differentiated tumors and adenocarcinomas. Our results show that there is an association between HPV types 16 and 18 and cervical cancer also in a Norwegian setting. PCR was more sensitive than Southern blotting for detection of HPV. Thirty-six (27.5%) of cancer biopsies were positive by PCR but negative by Southern blotting, as against 49 (73.5%) positive by both methods; we also encountered 4 samples positive by Southern blotting and negative by PCR. In 23/53 cancer biopsies positive by Southern blotting we found evidence for integrated or rearranged HPV genomes.

Coexistence of episomal and integrated HPV16 DNA in squamous cell carcinoma of the cervix.

AIMS: To investigate the integration of human papillomavirus (HPV)16 in 13 HPV16 positive cervical squamous carcinomas. METHODS: Samples were investigated by Southern blot analysis of the Pst I digestion pattern, two-dimensional gel-electrophoresis, and in situ hybridisation. RESULTS: Integration of HPV16 was found in all cases. In 12 biopsy specimens episomal HPV16 DNA and integrated HPV16 DNA were seen. The episomal DNA occurred as dimers and multimers. In situ hybridisation showed that both integrated and episomal HPV16 DNA were present in the same cell in most tumour cell nuclei. CONCLUSIONS: An intact episomal E2 gene is present in most cases of these cervical cancers, and could therefore replace the regulatory function of an integrated defective E2 gene.

The ability of two cooked food mutagens to induce aberrant crypt foci in mice.

The aberrant crypt foci assay has been used extensively to study different compounds for chemopreventive action, but almost all investigations have used initiators not normally found in the diet. In the present study two food-borne initiators, 2-amino-3-methyl-imidazo[4,5-f]quinoline (IQ) and 2-amino-1-methyl-6-phenyl-imidazo[4,5-b]pyridine (PhIP) were used. To simulate the human exposure further, we chose a feeding regimen with continuous low IQ- and PhIP-doses. Throughout the study female mice were given diets with or without 0.03% IQ or 0.03% PhIP. Two additional groups were given azoxymethane (AOM) (5 mg/kg body weight) and 1,2-dimethylhydrazine dihydrochloride (DMH-2HCl) (20 mg/kg body weight), respectively, one dose a week for two weeks. Animals were killed after four and 10 weeks. After four weeks only the mice dosed with IQ and PhIP had aberrant crypt foci. A much higher number of aberrant crypt foci were found in the IQ mice (31.8 +/- 5.2) than in the PhIP mice (0.5 +/- 0.3). After 10 weeks aberrant crypt foci were found in all dosed groups. The IQ mice had significantly more (P < or = 0.001) small and total aberrant crypt foci than the other groups. AOM and DMH induced a higher percentage of medium or large sized aberrant crypt foci than PhIP or IQ. The interpretation of the aberrant crypt foci as precursor lesions for colon cancer in the PhIP and IQ mice is difficult because PhIP and IQ have not been reported to be colonic carcinogens. If cooked food mutagens such as IQ or PhIP are to be used as initiators in the aberrant crypt foci test, the use of rats may be preferable.

IQ (2-amino-3-methylimidazo[4,5-f]quinoline)-induced aberrant crypt foci and colorectal tumour development in rats fed two different carbohydrate diets.

In most aberrant crypt foci (ACF) and colorectal tumour studies, chemical carcinogens not normally found in food have been used as initiators. In the present study the food-related compound, IQ (2-amino-3-methylimidazo[4,5-f]quinoline), has been used. A diet high in refined carbohydrates has been associated with enhanced development of ACF and colorectal cancer in humans. The present study was designed as an integrated part of our earlier published ACF study and follows the animals until tumour development. The aim of the study was to investigate (1) the effect of a refined carbohydrate-rich diet on the development of IQ-induced ACF over time and (2) possible correlation between early and late ACF and/or colorectal tumour development. The study showed that a feeding regimen with continuous doses of 0.03% IQ in the diet for 14 weeks, followed by 32 weeks without IQ was able to induce tumours in the rat colon, liver, skin and Zymbal gland. The data demonstrate that a sucrose-rich diet enhance ACF development. A correlation between the outcome of early and late ACF was seen. However, as the tumour incidence of this study was very low it was not possible to obtain a meaningful correlation between ACF development and colorectal tumour incidence.

Effect of potato starch, cornstarch and sucrose on aberrant crypt foci in rats exposed to azoxymethane.

Studies have shown that different kinds of carbohydrates are able to modify the development of colo-rectal cancer in animals as well as humans. In the present study with rats sucrose and two types of starches were investigated for their effects on the development of aberrant crypt foci (ACF), which have been proposed to represent preneoplastic lesions of colorectal cancer. Fifty-six three-week-old male Wistar rats were randomly assigned to four groups and dosed subcutaneously with AOM (15 mg/kg body wt) once a week for 2 weeks. At the end of the dosing period the animals were allocated to their respective diets. Group I was fed the basic diet; in Group II the carbohydrate pool in the diet was replaced by sucrose, in Group III by potato starch and in Group IV by cornstarch. Animals receiving the potato starch diet showed a statistically significant reduction in body weight gain. A statistically significantly lower number of ACF in all categories but small were demonstrated in animals given potato starch, and in addition an effect was seen in the relative distribution of ACF with fewer of the larger ACF. No effect of sucrose or cornstarch was seen. Explanations of the inhibitory effect in the potato starch group on the development of ACF could either be the lower daily caloric intake or the substantial amounts of resistant starch in the potato starch used.