The effects of exceeding low-risk drinking thresholds on self-rated health and all-cause mortality in older adults: the Tromsø study 1994-2020.

BACKGROUND: Based on findings of increasing alcohol consumption in older adults, it is important to clarify the health consequences. Using data from the Tromsø study, we aimed to investigate the relationship between different levels of alcohol consumption in old adulthood and self-rated health trajectories and all-cause mortality. METHODS: This is an epidemiological study utilizing repeated measures from the Tromsø study cohort. It allows follow-up of participants from 1994 to 2020. A total of 24,590 observations of alcohol consumption were made in older adults aged 60-99 (53% women). PRIMARY OUTCOME MEASURES: Self-rated health (SRH) and all-cause mortality. SRH was reported when attending the Tromsø study. Time of death was retrieved from the Norwegian Cause of Death Registry. The follow-up time extended from the age of study entry to the age of death or end of follow-up on November 25, 2020. PREDICTOR: Average weekly alcohol consumption (non-drinker, < 100 g/week, ≥100 g/week). We fitted two-level logistic random effects models to examine how alcohol consumption was related to SRH, and Cox proportional hazards models to examine its relation to all-cause mortality. Both models were stratified by sex and adjusted for sociodemographic factors, pathology, biometrics, smoking and physical activity. In addition, all the confounders were examined for whether they moderate the relationship between alcohol and the health-related outcomes through interaction analyses. RESULTS: We found that women who consumed ≥100 g/week had better SRH than those who consumed < 100 g/week; OR 1.85 (1.46-2.34). This pattern was not found in men OR 1.18 (0.99-1.42). We identified an equal mortality risk in both women and men who exceeded 100 g/week compared with those who consumed less than 100 g/week; HR 0.95 (0.73-1.22) and HR 0.89 (0.77-1.03), respectively. CONCLUSIONS: There was no clear evidence of an independent negative effect on either self-rated health trajectories or all-cause mortality for exceeding an average of 100 g/week compared to lower drinking levels in this study with up to 25 years follow-up. However, some sex-specific risk factors in combination with the highest level of alcohol consumption led to adverse effects on self-rated health. In men it was the use of sleeping pills or tranquilisers and ≥ 20 years of smoking, in women it was physical illness and older age.

Impact of Illness on Electronic Health Use (The Seventh Tromsø Study - Part 2): Population-Based Questionnaire Study.

BACKGROUND: Patients who suffer from different diseases may use different electronic health (eHealth) resources. Thus, those who plan eHealth interventions should take into account which eHealth resources are used most frequently by patients that suffer from different diseases. OBJECTIVE: The aim of this study was to understand the associations between different groups of chronic diseases and the use of different eHealth resources. METHODS: Data from the seventh survey of the Tromsø Study (Tromsø 7) were analyzed to determine how different diseases influence the use of different eHealth resources. Specifically, the eHealth resources considered were use of apps, search engines, video services, and social media. The analysis contained data from 21,083 participants in the age group older than 40 years. A total of 15,585 (15,585/21,083; 73.92%) participants reported to have suffered some disease, 10,604 (10,604/21,083; 50.29%) participants reported to have used some kind of eHealth resource in the last year, and 7854 (7854/21,083; 37.25%) participants reported to have used some kind of eHealth resource in the last year and suffered (or had suffered) from some kind of specified disease. Logistic regression was used to determine which diseases significantly predicted the use of each eHealth resource. RESULTS: The use of apps was increased among those individuals that (had) suffered from psychological problems (odds ratio [OR] 1.39, 95% CI 1.23-1.56) and cardiovascular diseases (OR 1.12, 95% CI 1.01-1.24) and those part-time workers that (had) suffered from any of the diseases classified as others (OR 2.08, 95% CI 1.35-3.32). The use of search engines for accessing health information increased among individuals who suffered from psychological problems (OR 1.39, 95% CI 1.25-1.55), cancer (OR 1.26, 95% CI 1.11-1.44), or any of the diseases classified as other diseases (OR 1.27, 95% CI 1.13-1.42). Regarding video services, their use for accessing health information was more likely when the participant was a man (OR 1.31, 95% CI 1.13-1.53), (had) suffered from psychological problems (OR 1.70, 95% CI 1.43-2.01), or (had) suffered from other diseases (OR 1.43, 95% CI 1.20-1.71). The factors associated with an increase in the use of social media for accessing health information were as follows: (had) suffered from psychological problems (OR 1.65, 95% CI 1.42-1.91), working part time (OR 1.35, 95% CI 0.62-2.63), receiving disability benefits (OR 1.42, 95% CI 1.14-1.76), having received an upper secondary school education (OR 1.20, 95% CI 1.03-1.38), being a man with a high household income (OR 1.67, 95% CI 1.07-2.60), suffering from cardiovascular diseases and having a high household income (OR 3.39, 95% CI 1.62-8.16), and suffering from respiratory diseases while being retired (OR 1.95, 95% CI 1.28-2.97). CONCLUSIONS: Our findings show that different diseases are currently associated with the use of different eHealth resources. This knowledge is useful for those who plan eHealth interventions as they can take into account which type of eHealth resource may be used for gaining the attention of the different user groups.

Electronic Health Use in a Representative Sample of 18,497 Respondents in Norway (The Seventh Tromsø Study - Part 1): Population-Based Questionnaire Study.

BACKGROUND: Electronic health (eHealth) services may help people obtain information and manage their health, and they are gaining attention as technology improves, and as traditional health services are placed under increasing strain. We present findings from the first representative, large-scale, population-based study of eHealth use in Norway. OBJECTIVE: The objectives of this study were to examine the use of eHealth in a population above 40 years of age, the predictors of eHealth use, and the predictors of taking action following the use of these eHealth services. METHODS: Data were collected through a questionnaire given to participants in the seventh survey of the Tromsø Study (Tromsø 7). The study involved a representative sample of the Norwegian population aged above 40 years old. A subset of the more extensive questionnaire was explicitly related to eHealth use. Data were analyzed using logistic regression analyses. RESULTS: Approximately half (52.7%; 9752/18,497) of the respondents had used some form of eHealth services during the last year. About 58% (5624/9698) of the participants who had responded to a question about taking some type of action based on information gained from using eHealth services had done so. The variables of being a woman (OR 1.58; 95% CI 1.47-1.68), of younger age (40-49 year age group: OR 4.28, 95% CI 3.63-5.04), with a higher education (tertiary/long: OR 3.77, 95% CI 3.40-4.19), and a higher income (>1 million kr [US $100,000]: OR 2.19, 95% CI 1.77-2.70) all positively predicted the use of eHealth services. Not living with a spouse (OR 1.14, 95% CI 1.04-1.25), having seen a general practitioner (GP) in the last year (OR 1.66, 95% CI 1.53-1.80), and having had some disease (such as heart disease, cancer, asthma, etc; OR 1.29, 95% CI 1.18-1.41) also positively predicted eHealth use. Self-rated health status did not significantly influence eHealth use. Taking some action following eHealth use was predicted with the variables of being a woman (OR 1.16, 95% CI 1.07-1.27), being younger (40-49 year age group: OR 1.72, 95% CI 1.34-2.22), having a higher education (tertiary/long: OR 1.65, 95% CI 1.42-1.92), having seen a GP in the last year (OR 1.58, 95% CI 1.41-1.77), and having ever had a disease (such as heart disease, cancer or asthma; OR 1.26, 95% CI 1.14-1.39). CONCLUSIONS: eHealth appears to be an essential supplement to traditional health services for those aged above 40 years old, and especially so for the more resourceful. Being a woman, being younger, having higher education, having had a disease, and having seen a GP in the last year all positively predicted using the internet to get health information and taking some action based on this information.

Cytokine profiles and diagnoses in elderly, hospitalized psychiatric patients.

BACKGROUND: There is a paucity of studies on inflammatory markers in elderly psychiatric patients. Hence, our study was undertaken to investigate cytokines as biomarkers in diagnostically unselected elderly patients admitted to a psychiatric hospital. METHODS: Demographic data, clinical data and blood samples, including 27 cytokines, were collected from 98 patients above 60 years, consecutively admitted to a psychiatric hospital in Tromsø, Norway (69°N). RESULTS: The most common diagnosis was Recurrent depressive disorder (26.5%), the second most common was dementia in Alzheimer's disease (20.4%). The most frequent somatic disease was cardiovascular disease (28%). No statistical association (p < 0.01) was found between cytokines and gender, age, BMI, anti-inflammatory drugs, psychotropic drugs, reason for admittance, smoking, vitamin supplements, alcohol consumption, length of stay, somatic disease (present/not-present) or psychiatric diagnoses. However, when allocating patients to two groups, depression and no depression, we found higher levels of 10 cytokines in the no depression group (FDR-p < 0.0044). Possibly, this could in part be explained by the higher prevalence of cardiovascular disease (CVD) and dementia in the no depression group, as these factors were significant predictors of patients being categorized as not depressed in a logistic regression. In addition, other unknown factors might have contributed to the association between no depression and elevated cytokines. On the other hand, the high level of psychiatric and somatic comorbidity in the study population may have led to increased levels of cytokines in general, possibly diluting the potential effect of other factors, depression included, on the cytokine levels. The size of the study, and particularly the size of the subgroups, represents a limitation of the study, as do the general heterogeneity and the lack of a control group. CONCLUSIONS: There was no significant difference in cytokine levels between various psychiatric diagnoses in hospitalized elderly psychiatric patients. This indicates that previous findings of correlations between cytokines and various psychiatric disorders in highly selected adult cases might not be applicable to elderly psychiatric inpatients. Further immunological studies are needed on gerontopsychiatric patients in general and gerontopsychiatric patients with specific disorders, preferably with patients that are physically healthy. TRIAL REGISTRATION: Retrospectively registered in the ISRCTN registry study, with study ID ISRCTN71047363 .

Clenched fist syndrome: a case report.

BACKGROUND: The clenched fist syndrome/psycho-flexed hand, first described in the early 1980s, has not yet entered the major psychiatric textbooks. Curiously, the phenomenon has been illuminated mainly in journals and textbooks on hand surgery. There is a need to examine, describe, and understand this syndrome from a psychiatric perspective. CASE PRESENTATION: We present a case we encountered in an intensive care unit. A 60-year-old white man with schizophrenia, cerebrovascular disease, diabetes mellitus type 2, and peripheral neuropathy, developed rather acutely bilateral clenched fists in the aftermath of a traumatic dislocated hip fracture that was operated on. He later died due to complications from the surgical procedure. CONCLUSIONS: While this was a complex case with some clinical uncertainty regarding the cause of our patient's symptoms, we conclude that psychological processes were central to the development of his clenched fists. The phenomenon of clenched fists and our case are discussed with reference to the accumulated literature on psychogenic hand disorders and the International Statistical Classification of Diseases and Related Health Problems, 10th version. The nosological status appears to be obscure. This case presentation is a first step in increasing the understanding of this syndrome from a psychiatric perspective.

Probable clozapine-induced parenchymal lung disease and perimyocarditis: a case report.

BACKGROUND: Clozapine is the archetypical atypical antipsychotic, its primary indication being treatment resistant schizophrenia. Severe side effects caused by clozapine, including leukopenia, agranulocytosis, and myocarditis, are well known. A rarely described side effect is concurrent perimyocarditis and parenchymal lung disease. CASE PRESENTATION: A previously physically healthy 23-year-old male Caucasian that suffered from schizophrenia presented with flu-like symptoms 1 week after starting clozapine treatment. Treatment with clozapine was discontinued. He developed respiratory distress. Investigations showed significant parenchymal infiltration in both of the lungs, pericardial fluid, and heart failure. He initially received treatment for suspected malignant neuroleptic syndrome and later for suspected infection, but these tentative diagnoses were not confirmed. The patient's condition gradually improved. In retrospect, clozapine-induced parenchymal lung disease and perimyocarditis were deemed the most probable causes. CONCLUSIONS: Concurrent perimyocarditis and parenchymal lung disease are rare side effects of clozapine. Clozapine-induced disease in general is considered an exclusion diagnosis. Lacking a verifiable diagnosis when suspecting a side effect of clozapine, clinicians might treat the most likely and serious condition presenting and consider discontinuing clozapine until the diagnostic uncertainty is reasonably resolved.

The use of cell phones and radio communication systems to reduce delays in getting help for pregnant women in low- and middle-income countries: a scoping review.

BACKGROUND: Delays in getting medical help are important factors in the deaths of many pregnant women and unborn children in the low- and middle-income countries (LMIC). Studies have suggested that the use of cell phones and radio communication systems might reduce such delays. OBJECTIVES: We review the literature regarding the impact of cell phones and radio communication systems on delays in getting medical help by pregnant women in the LMIC. DESIGN: Cochrane Library, PubMed, Maternity and Infant care (Ovid), Web of Science (ISI), and Google Scholar were searched for studies relating to the use of cell phones for maternal and child health services, supplemented with hand searches. We included studies in LMIC and in English involving the simple use of cell phones (or radio communication) to either make calls or send text messages. RESULTS: Fifteen studies met the inclusion criteria. All the studies, while of various designs, demonstrated positive contributory effects of cell phones or radio communication systems in reducing delays experienced by pregnant women in getting medical help. CONCLUSIONS: While the results suggested that cell phones could contribute in reducing delays, more studies of a longer duration are needed to strengthen the finding.

Vitamin D deficiency is common in psychogeriatric patients, independent of diagnosis.

BACKGROUND: Previous studies have found an association between psychiatric disorders and vitamin D deficiency, but most studies have focused on depression. This study aimed to establish the prevalence of vitamin D deficiency in elderly patients with a wider range of psychiatric diagnoses. METHOD: The study included elderly patients (>64 years) referred to a psychiatric hospital in Northern Norway and a control group from a population survey in the same area. An assessment of psychiatric and cognitive symptoms and diagnoses was conducted using the Montgomery and Aasberg Depression Rating Scale, the Cornell Scale for Depression in Dementia, the Mini Mental State Examination, the Clockdrawing Test, and the Mini International Neuropsychiatric Interview (MINI+), as well as clinical interviews and a review of medical records. The patients' mean level of 25-hydroxyvitamin D (25(OH)D) and the prevalence of vitamin D deficiency were compared with those of a control group, and a comparison of vitamin D deficiency across different diagnostic groups was also made. Vitamin D deficiency was defined as 25(OH)D <50 nmol/L (<20 ng/ml). RESULTS: The mean levels of 25(OH)D in the patient group (n = 95) and the control group (n = 104) were 40.5 nmol/L and 65.9 nmol/L (p < 0.001), respectively. A high prevalence of vitamin D deficiency was found in the patient group compared with the control group (71.6% and 20.0%, respectively; p < 0.001). After adjusting for age, gender, season, body mass index, and smoking, vitamin D deficiency was still associated with patient status (OR: 12.95, CI (95%): 6.03-27.83, p < 0.001). No significant differences in the prevalence of vitamin D deficiency were found between patients with different categories of psychiatric diagnoses, such as depression, bipolar disorders, psychosis, and dementia. CONCLUSION: Vitamin D deficiency is very common among psychogeriatric patients, independent of diagnostic category. Even though the role of vitamin D in psychiatric disorders is still not clear, we suggest screening for vitamin D deficiency in this patient group due to the importance of vitamin D for overall health.

Language of motivation and emotion in an internet support group for smoking cessation: explorative use of automated content analysis to measure regulatory focus.

The present study describes a novel approach to the identification of the motivational processes in text data extracted from an Internet support group (ISG) for smoking cessation. Based on the previous findings that a "prevention" focus might be more relevant for maintaining behavior change, it was hypothesized that 1) language use (ie, the use of emotional words) signaling a "promotion" focus would be dominant in the initiating stages of the ISG, and 2) that the proportion of words signaling a prevention focus would increase over time. The data were collected from the ISG site, spanning 4 years of forum activity. The data were analyzed using the Linguistic Inquiry and Word Count application. The first hypothesis - of promotion focus dominance in the initiating stages - was not supported during year 1. However, for all the other years measured, the data showed that a prevention failure was more dominant compared with a promotion failure. The results indicate that content analysis could be used to investigate motivational and language-driven processes in ISGs. Understanding the interplay between self-regulation, lifestyle change, and modern communication channels could be of vital importance in providing the public with better health care services and interventions.

Language use in an internet support group for smoking cessation: development of sense of community.

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

Clinical confidence following an interprofessional educational program on eating disorders for health care professionals: a qualitative analysis.

There are an increasing number of educational programs to improve clinical competence and skills to treat mental disorders. For complex disorders there is also a focus on improving the quality of interprofessional work. This paper reports on interprofessional outputs of an educational program on eating disorders. A total of 207 professionals who completed the program were requested to describe up to 12 possible scenarios depicted as realistic prospects for their future work within this field. Analyzing the scenarios resulted in three categories of describing the participants' preferences: (1) interprofessional interventions and treatment; (2) the further development of competence; and (3) organization of the health care system. The findings showed that the participants were considering working across new lines in their current workplaces or crossing borders to new frontiers in the execution of competence. Our findings may be summarized into the concept of "clinical confidence." This concept has so far been understood as some kind of personal trait, disposition, or attitude. The present findings add nuances to this concept in terms of state-dependent encouragement, engagement, and a potential to act and to cross professional borders in order to better treat complex mental disorders.

The use of short message service (SMS) among hospitalized coronary patients.

OBJECTIVE: The use of cell phones and short message service (SMS, also called "texting") has become pervasive in Western society and increasingly throughout the world. Despite the importance of this technology in everyday life, little is known about how patients draw on SMS to keep in contact with family and friends during their hospitalization. METHODS: A questionnaire was distributed to patients with coronary artery disease discharged from a Norwegian university hospital during the period from June 2005 to June 2006. In addition to questions pertaining to demographics, illness and treatment, mental distress, personality traits, perceived control, Internet usage and lifestyle, respondents were asked if they had contact with family and friends by SMS while in the hospital. RESULTS: Four hundred twelve responded (59%), of which 216 had undergone surgery and 196 had undergone percutaneous coronary interventions. Sixty-three percent had used SMS to keep in touch with family and friends during their stay at the hospital. Use of SMS was positively predicted by Internet usage, gender and the personality trait of Openness, and was negatively predicted by the belief that illness and health were caused by luck or destiny. CONCLUSIONS: SMS is an important means of communication during hospitalization for a majority of coronary disease inpatients.

Coronary patients who returned to work had stronger internal locus of control beliefs than those who did not return to work.

OBJECTIVES: Return To Work (RTW) is an important indicator of recovery from coronary artery disease (CAD), associated with social and economical benefits, and improved quality of life. Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are effective procedures relieving symptoms and reducing the risk for new events, but psychosocial problems are frequent among these patients. The aim was to determine psychosocial and treatment-related factors associated with RTW among PCI and CABG patients in Northern Norway. DESIGN: Cross-sectional design based on questionnaire data from CABG and PCI patients 3-15 months following discharge, and from hospital records. METHODS: Of the 348 responding patients, 168 were younger than 67 years and working prior to hospitalization. Factors associated with RTW were examined in a logistic regression analysis. RESULTS: A total of 108 (64%) had RTW within 3-15 months. Four factors made unique significant contributions to the model, including higher education, time since hospital discharge and Internal Locus of Control (LoC) of the Multidimensional Health Locus of Control Scale (MHLC) as positively associated factors, and Powerful Others LoC as a negatively associated factor. Analyses controlled for data on demographics, emergency status, type of treatment, number of days at the hospital, physical exercise, attending a rehabilitation program, mental distress, Type D personality, and for the CABG patients additional data on coronary health. CONCLUSIONS: Patients' control beliefs and educational level are significant psychosocial factors associated with RTW following PCI and CABG treatment. Implications for hospital treatment and rehabilitation programs are discussed.

Approach and avoidance coping and regulatory focus in patients having coronary artery bypass graft surgery.

Coronary artery bypass graft (CABG) surgery is stressful, and the patient's coping affects recovery and outcome. The aim of the study was to identify patients' thoughts and concerns, and explore the relevance of approach/avoidant coping and Regulatory Focus Theory (RFT). Nine patients were interviewed, using an interpretative phenomenological approach. The patients made use of various avoidant (e.g. neglecting symptoms, delaying help-seeking, avoiding thoughts) and approach strategies (e.g. persistent search for the diagnosis, mental preparation for surgery). RFT versus approach/avoidant coping is discussed. RFT may contribute to our understanding of motivational cognitions in patients' coping with illness and treatment.

Nurse training of a patient-centered information procedure for CABG patients.

OBJECTIVE: At the study hospital, all elective coronary artery bypass graft (CABG) surgery patients were given similar, standardized information by the nurses. The nurses reported problems in establishing contact and interacting with patients when using this approach. To help remedy communication problems between nurses and CABG patients, a programme training nurses in a patient-centred information procedure was developed and implemented. This article describes how challenging interactions were recorded and analysed for training nurses in the patient-centred approach. METHOD: In group training for patient-centeredness, nurses presented audio-recordings of nurse-patient interactions they found problematic. These were used as a basis for discussions and training in the patient-centered approach. A set of cases was developed using a qualitative phenomenological approach, illustrating how the patient-centered approach could be applied to the difficult situations. RESULTS: The nurses found the patient-centered approach particularly useful in situations when patients frequently asked questions, seemed to have difficulties expressing their worries, frequently complained, or when spouses expressed worries. CONCLUSION: Nurses found the patient-centered approach and the training procedure used in this study useful in their clinical work with CABG patients. PRACTICE IMPLICATIONS: This training which requires minimal resources and can be easily implemented, may guide the nurses in their interaction with patients. Providing a patient-centered approach to the CABG patients may enhance the nurse-patient contact and improve patients' hospital experience and subjective health.

Coronary bypass surgery patients' experiences with treatment and perioperative care - a qualitative interview-based study.

AIMS: The purpose of this study was to examine how coronary bypass surgery patients experienced their care. BACKGROUND: In many hospitals, including the study hospital, perioperative care is still organized in such a manner that theatre nurses have little contact with patients prior to and after surgery. Little is known about how patients experience this type of perioperative care. METHOD: Nine patients were interviewed approximately a year after their operations. The interviews were qualitative and were analysed by drawing on the phenomenological method. RESULTS: The patients were generally satisfied with the quality of the staff-patient interactions and the information that was given prior to surgery, but some patients expressed a need for a closer postoperative followup by staff directly involved in the surgery. Most patients believed that information and support given by fellow patients was even more important to them than the support and information that was given by staff. CONCLUSIONS: The findings suggest that the quality of care and patients' satisfaction can be further enhanced by implementing principles from the perioperative dialogue model. For instance, by allowing for a postoperative meeting between the patient and a theatre nurse, continuity of care can be further enhanced.