Confidentiality as a barrier to support seeking among physicians: the influence of psychosocial work factors in four European hospitals (the HOUPE study).

BACKGROUND: Concerns about protecting patient's privacy can interfere with proper stress adaptation which is associated with physician's health. It is important to investigate relevant organizational confounders to this phenomenon to enable interventions that can ameliorate the subjective burden of patient confidentiality. OBJECTIVES: This study investigates factors in the psychosocial work environment that can explain patient confidentiality's prominence in social support seeking among physicians, and if these factors covary differently with support seeking according to country. PARTICIPANTS: University hospital physicians in four European cities (N=2095) in Sweden, Norway, Iceland and Italy participated in a cross-sectional survey. METHODS: Questionnaire comprised items on psychosocial work environment, basic socio-demographics, presence of formal and informal meetings at work, and measurement of confidentiality as a barrier for support. RESULTS: High role conflict, availability of formal or informal meetings, lack of control over decisions, and lack of control over work pace were predictors of confidentiality as a barrier to support. There were differences between countries in how these factors covaried with confidentiality as a barrier to support. High role conflict was the strongest predictor of confidentiality as a barrier to support across all samples. CONCLUSIONS: Psychosocial work factors predicted confidentiality as a barrier to support seeking among physicians. It is important to create routines and an organizational framework that ensures both the patient's right to privacy and physician's ability to cope with emotional demanding situations from work.

Treatment of tunnel phobia: an experimental field study.

The opening of the deepest undersea tunnel in the world (264 m below sea level, 5600 m in length) replaced the ferry from the island of Hitra to the mainland in Norway. This event provoked phobic anxiety for traveling through the undersea tunnel in a number of individuals in the area. A treatment program for tunnel phobia was designed to test whether such a phobia could be mitigated by procedures previously proven effective in the treatment of other phobias. The program was presented to 18 persons with a specific phobia for tunnels and included a general discussion on the construction of undersea tunnels, given by an engineer from the tunnel construction company, and on phobic anxiety. It further consisted of gradual exposure to the tunnel in situ. Treatment effects were strong. All patients were able to travel on their own by car through the tunnel after the treatment. Their somatic complaints and phobic thoughts related to the tunnel were substantially reduced, and their mastery of tunnel driving was convincingly increased compared with the wait-list reference group.

Gambling behavior and gambling problems in Norway 2007.

In Norway, legalized gambling is pervasive, easily accessible and socially accepted, particularly the participation in national lotteries. We conducted a stratified probability sample study during January-March 2007 (age group 16-74 years, N = 3,482, response rate 36.1%) to assess gambling behavior and prevalence of problematic gambling by the NORC Diagnostic Screen (NODS). Overall, 67.9% of the study population had been engaged in past-year gambling and 0.7% were past-year problematic gamblers (NODS score 3+). Male gender, low educational level, single marital status, and being born in a non-Western country were variables positively associated with problematic gambling. Past-year problematic gamblers indicated the slot machine (34.6%) and Internet gambling (26.9%) as the most important games, while most non-problematic gamblers pointed out the lotteries (62.3%) as the most important game. The prevalence of self-reported sleeping disorders, depression and other psychological impairments was significantly higher among problematic gamblers. Gambling problems affect people's lives in multiple ways.

Internet addiction among Norwegian adults: a stratified probability sample study.

Most Norwegians are Internet users. We conducted a stratified probability sample study (Norway, 2007, age-group 16-74 years, N= 3,399, response rate 35.3%, 87.1% Internet users) to assess the prevalence of Internet addiction and at-risk Internet use by the Young Diagnostic Questionnaire (YDQ). The prevalence of Internet addiction (YDQ score 5-8) was 1.0% and an additional 5.2% were at-risk Internet users (YDQ score 3-4). Internet addiction and at-risk Internet use was strongly dependent on gender and age with highest prevalences among young males (16-29 years 4.1% and 19.0%, 30-39 years 3.3% and 10.7%). Logistic regression showed that male gender, young age, university level education, and an unsatisfactory financial situation were factors positively associated with "problematic Internet use" (at-risk and addicted use combined). Time spent on the Internet and prevalence of self-reported sleeping disorders, depression, and other psychological impairments increased linearly with YDQ score. Problematic Internet use clearly affects the lives of many people.

Risk factors for problematic gambling: a critical literature review.

This article is a critical review of risk factors for pathological gambling categorized by demographics, physiological and biological factors, cognitive distortions, comorbidity and concurrent symptoms, and personality symptoms and characteristics. There is also a varia section (availability, parents playing, sensory characteristics, schedules of reinforcement, age of onset, and playing duration). The review found very few well established risk factors for pathological gambling (i.e. more than two studies to support the conclusions). Well established risk factors included demographic variables (age, gender), cognitive distortions (erroneous perceptions, illusion of control), sensory characteristics, schedules of reinforcement, comorbid disorders (OCD, drug abuse), and delinquency/illegal acts. An understanding of risk factors for pathological gambling should enhance prevention and treatment approaches.

Time trends in obesity and eating disorders.

OBJECTIVE: Obesity is a well-known risk factor for eating disorders, and has been increasing in the normal population over the last decades. This study examines whether the increase in obesity is followed by an increase in prevalence of eating disorders in the general female population. METHOD: We compared the prevalence of eating disorders and obesity in two nationally representative surveys in Norway in 1991 (n = 1,537) and 2004 (n = 1,467). Eating disorder diagnoses were obtained using the self-report questionnaire survey for eating disorders (SEDs) at both time points. RESULTS: The prevalence of overweight and obesity has doubled from 1991 to 2004, whereas the prevalence of eating disorders has been stable. Obesity was strongly associated with eating disorders both in 1991 and 2004. CONCLUSION: Despite the strong association between obesity and eating disorders, the increase in obesity is not followed by an increase in eating disorders.

Some health effects of implementing school nursing in a Norwegian high school: a controlled study.

The effects of a school nursing service on health complaints and mood were investigated in a Norwegian high school. The school nursing service was delivered to students in 1 high school, and students in a comparable high school served as the comparison group. There were 41 students in the treatment group and 63 in the comparison group. All students completed a survey at the beginning of 2 successive fall terms. The survey had items on common health complaints, perceived stress, efforts to cope, moods, and sense of humor. Results from multivariate analyses of variance found that test-retest variance was stable for all measures. Level of complaints tended to be reduced as an effect of access to the school nursing service. Sense of humor at follow-up tended to buffer health complaints and negative moods.

Influence of co-morbid generalized anxiety disorder, panic disorder and personality disorders on the outcome of cognitive behavioural treatment of obsessive-compulsive disorder.

This study examined co-morbid generalized anxiety disorder and/or panic disorder and personality disorders as predictors of treatment outcomes in adult outpatients with obsessive-compulsive disorder. The patients received exposure with response prevention (ERP) treatment with the addition of either elements of cognitive therapy (ERP+CT) or relaxation training (ERP+REL). It was hypothesized that the addition of cognitive interventions would yield better treatment outcomes for patients with co-morbid generalized anxiety disorder and/or panic disorder. It was also hypothesized that patients with any personality disorder would show less treatment gains in both conditions. Using intention-to-treat criteria, patients with generalized anxiety disorder and/or panic disorder co-morbidity showed less treatment gains at post-treatment across both treatment conditions. This group showed significantly more treatment gains in the ERP+CT condition at the post-treatment and the 12-month follow-up assessments compared with patients in the ERP+REL condition. However, this was not significant when comparing treatment completers. Patients with a co-morbid Cluster A or B personality disorder showed significantly less treatment gains in both treatment conditions at the 12-month follow-up assessment. Among treatment completers, patients with a Cluster C personality disorder showed significantly better outcomes at the post-treatment assessment in the ERP+REL treatment condition. These results, clinical implications, and the importance of further investigations are discussed.

An open clinical trial of cognitive-behaviour therapy in children and adolescents with obsessive-compulsive disorder administered in regular outpatient clinics.

UNLABELLED: The aim of the present study was to examine the effectiveness of manual-guided cognitive-behaviour therapy (CBT) for childhood obsessive-compulsive disorder (OCD) administered within three regular, i.e., non-academic, Norwegian outpatient child psychiatric clinics. METHODS: A total of 28 youngsters, aged 8-17 with primary OCD entered the study. Assessment at intake included Norwegian versions of the K-SADS-PL, Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and a measure of OCD-specific functional impairment (Child OCD Impact Scale (COIS)). Therapy consisted of 12 manual-guided sessions with combined individual and family CBT-based interventions and was conducted by psychologists and physicians under training and supervision. Outcome was assessed after treatment and at 3- and 6-month follow-ups by means of the CY-BOCS, the Clinical Global Impression (CGI) and the CGI-Improvement scales, and the COIS. RESULTS: Twenty-four youngsters (86%) completed treatment and were available for the follow-up assessments. Significant improvements were found on all outcome measures after treatment, including a mean symptom reduction on the CY-BOCS of 60.6%, increasing to 68.8% at the 6-month follow-up. Estimates of within-group effect sizes showed strong effects of treatment. CONCLUSION: The results of the present study suggest that manual-guided CBT for childhood OCD can be successfully implemented in non-academic community child psychiatric settings with outcomes in accordance with previous findings from highly specialised university clinics.

Treatment motivation, treatment expectancy, and helping alliance as predictors of outcome in cognitive behavioral treatment of OCD.

Predictors of improvement in obsessive-compulsive symptoms (Y-BOCS) in a randomized clinical trial with adult obsessive-compulsive disorder outpatients were examined. Results of multiple regression analyses revealed that a positive helping alliance was significantly predictive of posttreatment Y-BOCS. Treatment expectancy and high motivation to change were not significantly related to posttreatment outcome. None of the predictors were significantly related to Y-BOCS levels at 12-month follow-up, but positive alliance showed a trend to significance.

Characteristics of anorexia nervosa-related deaths in Norway (1992-2000): data from the National Patient Register and the Causes of Death Register.

OBJECTIVE: This study investigated demographic and diagnostic characteristics of individuals whose medical record or death certificate indicated the presence of anorexia nervosa at the time of death. METHOD: Two national registers, the National Patient Register (NPR) and the Causes of Death Register (CODR), were examined in Norway for anorexia nervosa-related deaths occurring across a 9-year period (1992-2000). RESULTS: The medical record or death certificate listed anorexia nervosa as a diagnosis or cause of death for 66 individuals. Rates of death were 6.46 and 9.93 per 100,000 deaths for the NPR and the CODR, respectively. A substantial percentage of deaths (43.9%) in both registers occurred at or above the age of 65 years. For the NPR, the mean age at the time of death was 61 years and 31% of deaths occurred among men. For the CODR, the mean age at the time of death was 49 years and 18% of deaths occurred among men. DISCUSSION: Potential merits and shortcomings of assessing mortality rates using register-based data without linkage to a previously identified clinical sample are discussed.

Problems with computer games without monetary reward: similarity to pathological gambling.

An epidemiological study was performed on a representative sample of the Norwegian youth population (12 to 18 years old, N=3,237; response rate 45.2%). The percentage who were frequent players (weekly) of different computer games was 63.3%, and the percentage of infrequent users was 36.7%. A mean of 2.7% (4.2% of the boys, 1.1% of the girls) could be described as exhibiting "pathological playing" according to the criteria in the 1998 Diagnostic Questionnaire for Internet Addiction of Young, and an additional 9.82% (14.5% of the boys, 5.0% of the girls) were considered to be engaging in "at-risk playing." Of the weekly gamblers, 4.2% fulfilled 5 criteria for pathological playing, and an additional 15.5% 3 to 4 criteria, i.e., at-risk playing. This indicated that frequent gaming on computer games without money rewards may be related to problematic playing even though no monetary reward is involved.

[Eating disorders in a historical perspective]. / Spiseforstyrrelser i et historisk perspektiv.

Disordered eating has been known since antiquity and is mentioned in medical journals as well as in popular literature. The holy anorectics in the Middle Ages wanted to achieve spiritual perfection, while the anorectics of today are seeking bodily perfection. Hilde Bruch and Mara Selvini Palazzoli were the first to focus on anorectic symptoms like leanness and body image disturbance. The breakthrough in clinical and scientific work on bulimia nervosa came around 1980, primarily due to Russell's achievements. In 1874, Sir William Gull was the first to use anorexia nervosa as a diagnosis, while bulimia nervosa was first used in 1979. In the history of Norwegian psychiatry, several psychiatric disorders were described at an early stage, yet eating disorders have only been discussed in the scientific literature from the 1980s and onwards. Eating disorders have now become a cause of concern on the part of health authorities; their policy is to improve clinical skills at all levels rather than to build up specialised clinics.

[Pathological overeating--an overview]. / Patologisk overspising--en oversikt.

An eating disorder apart from anorexia nervosa and bulimia nervosa is "binge eating disorder" (BED): eating in a short period of time a large quantity of food and a feeling of lack of control over food intake. There is also an atypical rest category, "eating disorders not otherwise specified" (EDNOS). Diagnostic criteria for BED and EDNOS are incomplete, particularly with respect to the definition of "bingeing" relative to bulimia nervosa. More restrictive criteria for anorexia nervosa and bulimia nervosa skew the diagnostic distribution towards BED and EDNOS, though the total prevalence of eating disorders remains unchanged. For BED and EDNOS taken together the lifetime prevalence in women is about 6%. The relationship between BED, EDNOS and overweight has mainly been overlooked; further investigations are needed. Lasting treatment effects have been found for overweight people with BED. Other eating disorders apart from anorexia nervosa and bulimia are prevalent and clinically important, and research has opened up a potential for effective treatment.

[Eating disorders--an overview]. / Spiseforstyrrelser--en oversikt.

This article gives an updated review of the history, epidemiology, etiology, and evidence-based treatment of eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder), with specific reference to the Norwegian situation. In order to improve clinical skills there is an emphasis on the need for more treatment resources, particularly for the most serious cases, better implementation of evidence-based treatment and on continuous medical education. Given the somatic manifestations of eating disorders, medical doctors are essential in assessment and treatment. Many patients can be successfully treated by general practitioners provided that the general practitioner takes an interest in and is knowledgeable about eating disorders. The need to increase the number of general practitioners participating in ongoing Norwegian educational programmes on eating disorders is stressed.

Changes of glial-neuronal interaction and metabolism after a subconvulsive dose of pentylenetetrazole.

Pentylenetetrazole (PTZ) injection causes seizures in rodents and this is used in several models of epilepsy. In the present study a low dose (20 mg/kg) was injected into rats in order to analyze metabolic disturbances caused by subconvulsive amounts of PTZ. Intraperitoneal injection of PTZ was followed, 30 min later, by injection of [1-(13C)]glucose plus [1,2-(13C)]acetate and 15 min thereafter decapitation. Analyses of extracts from cerebrum, subcortex and cerebellum were performed using 13C NMRS and HPLC. Whereas convulsive doses of PTZ lead to most pronounced changes in cerebellum [J. Neurochem. 85 (2003) 1200], it could be shown that subconvulsive doses affected mainly amino acid metabolism in cerebrum. In glutamatergic neurons in the cerebrum PTZ affected both the metabolic and releasable pools of glutamate, whereas, in the subcortex and cerebellum only the metabolic pool was affected. This could be deducted from the findings that less [4-(13C)]glutamine, [3,4-(13C)]glutamate and [2-(13C)]aspartate, which are labeled from [1-(13C)]glucose, were detected in this area. Glial metabolism was also changed as evidenced by the decreased pyruvate carboxylation versus pyruvate dehydrogenation ratio both in cerebrum and subcortex. Comparison between convulsive and nonconvulsive doses of PTZ lead to the hypothesis that changes observed in the cerebellum are mainly due to seizures, whereas those in cerebrum and subcortex are coupled to the action of the chemical stimulant.

Internet addiction: characteristics of a questionnaire and prevalence in Norwegian youth (12-18 years).

The use of the Internet has increased considerably during the last few years, and there are also some clinical observations that some people 'get hooked', and develop an Internet addiction. An epidemiological study was performed in a representative sample of the Norwegian youth population (N= 3,237; response rate 45.2%). The proportion not using Internet was only 4.9%, while 35.8% were non-frequent users, and 49.6% (1,591) were frequent (weekly) users. They used the Internet on the mean 4.3 hours a week. A mean of 1.98% (boys 2.42%, girls 1.51%) could be described as having an 'Internet addiction' according to the criteria in the Diagnostic Questionnaire of Young (1998), and an additional 8.68% (in sum 10.66) were considered to have an at-risk Internet use (boys 9.21%, girls 8.13%). If these proportions were calculated on individuals who used the Internet frequently, 4.02% fulfilled 5 criteria, and an additional 17.66% 3-4 criteria, giving quite high figures of problematic Internet use (in sum 21.68). The different diagnostic criteria gave a broad range of affirmative answers (from 0.4% to 27.9%). The results have important implications for further studies of prevalence, implementation of preventive measures, and the development of treatment approaches for Internet addiction.

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.

Prevalence of eating disorders in female and male adolescents (14-15 years).

OBJECTIVE: The main aim of the present study is to establish the prevalence of eating disorders (ED) in adolescents of both genders. To our knowledge, such data have not previously been published using both DSM-IV and DSM-III-R criteria. METHOD: The study sample consisted of 1960 adolescents (1026 girls and 934 boys), 14-15 years of age. The participants completed the Survey for Eating Disorders (SEDs), including DSM-III-R and DSM-IV diagnoses for all subcategories of ED. RESULTS: Lifetime prevalence of any ED among girls was 17.9% anorexia nervosa (AN) 0.7%, bulimia nervosa (BN) 1.2%, binge eating disorder (BED) 1.5%, and EDs not otherwise specified (EDNOS) 14.6%. Corresponding numbers for boys for any ED is 6.5%, AN 0.2%, BN 0.4%, BED 0.9%, and EDNOS 5.0%. DISCUSSION: Our prevalence rates on AN, BN, and BED largely support previous school/community-based studies, while our figures on EDNOS were rather high. Generally, we found high numbers for boys with ED.