Background: Continuity of care and post-discharge follow-up visits can improve the quality of care and reduce the likelihood of relapse and re-hospitalization in patients with psychotic disorders. Purpose: This study aimed to analyze post-discharge follow-up interventions in patients with psychotic disorders, and to identify measurement instruments for intervention outcomes. Method: The literature review described here used a specific framework, where the follow-up interventions and the measurement instruments were analyzed systematically, to investigate fifteen studies identified through electronic databases such as Pubmed, Psychinfo, ProQuest, Cinahl, Medline, and Scopus. Results: The studies used interventions including psychoeducation, cognitive-behavioral therapy, cognitive behaviorally oriented service, optimal clinical management, relapse prevention plan, software suggested intervention, ambulatory outpatient care, community re-entry module, integrated treatment, and hospital-based community psychiatric service. Additionally these studies used thirty-eight measurement instruments to assess change in psychiatric patients or their relatives, based on psychological, social, and occupational factors as well as specific symptoms and symptom severity. The instruments also measured quality of life, insight, self-esteem, and cognitive function. Further, the studies examined therapeutic alliances and the experience of family members. The most commonly used instruments were the Global Assessment of Functioning and the Positive and Negative Syndrome Scale. Conclusion: The interventions reviewed here emphasize an individualized approach that targets education, illness management, coping strategies, social skills training and relapse prevention, and seeks to alter any harmful understanding of the illness. Although researchers can choose among numerous interventions, psychoeducation was the most appealing follow-up intervention for patients suffering from psychotic disorders. Importantly, evaluation instruments must be relevant to psychological symptoms, treatment, time and resources available, and what questions were being sought to answer. Approximately eleven of the thirty-eight instruments reviewed here showed weak or unclear reliability and validity. The most practical instrument for evaluating the outcome of an intervention for patients suffering from psychotic disorders wasthe Positive and Negative Syndrome Scale. / <p>ISBN 978-91-86739-70-6</p>

Baggrund:Hygiejne er et nyt indsatsområde, som er skrevet ind i Sundhedsaftalerne 2011-2014. Sundhedsaftalen beskriver, at der i kommunerne er stigende behov for infektionshygiejnisk rådgivning i de kommunale institutioner. Formål:Formålet med dette studie var at undersøge, beskrive og analysere, hvordan kommuner på baggrund af Sundhedsaftalen 2011-2014arbejdermed oginterntsamarbejderom udvikling af en hygiejneorganisation. Desuden var formålet at afdække om Sundhedsstyrelsens forebyggelsespakke om hygiejne og netværksdannelsen omkring hospitalerne, havde betydning for udviklingen afhygiejneorganisation. Metode: Studiet er et kvalitativt studie,hvor det empiriske materialeblev indsamlet vedsemistrukturerede interview med medlemmer af hygiejnenetværket med hospitalet.Som analysemetode blev anvendt kvalitativ indholdsanalyse. Den teoretiske ramme for studiet er fokuseret på forskellige former for samarbejde, og styrker og svagheder ved samarbejde. Resultat:Studiet viste, at kommuner i Region Hovedstaden arbejder på forskellig vis medudvikling af en hygiejneorganisation.En afgørende faktorfor arbejdet var ledelsesforankring. Samarbejdet kompliceredes af, at kommunen blev opfattet som en stor, uoverskuelig organisation. Sundhedsaftalen, forebyggelsespakken om hygiejne og samarbejdet med hospitalet blev opfattet, som motiverende faktorer for udvikling af en hygiejneorganisation. Det blev opfattet, som en nødvendighed, at kommunen havde adgang til en hygiejnesygeplejerske, så arbejdet med hygiejne ikke kun blev baseret på interesse, men på kompetencer inden for området. Konklusion:Der er forskellige forhold, som er af afgørende betydning for samarbejde om udvikling af en kommunal hygiejneorganisation. Hygiejneorganiastionen skal være ledelsesforankret, og der skal være ledelsesgodkendte rammer for og ressourcer til arbejdet. Kommunen skal have direkte adgang til specialistviden på hygiejneområdet. / Background:Infection control isa new focus areain the intersectoral health agreements 2011-2014,which statesthat municipalities need guidance regarding infection control. Aim:The present study aimed to investigate, describe and analyze, how municipalitiesin Denmark ́s Capital Region collaborate internally while building an infection control organization. The study also aimed to determinehow hygiene suggestions from the National Board of Health and networking with hospitals affected the development of the infection control organization. Method:The empirical material of this qualitative studyincludedsemi-structured interviews with network members.Data was analyzed with qualitative content analysis. Theories supporting the study were different perspectives on collaboration. Results:The study found that municipalities in the Capital Region collaborate in different ways while developing an infection control organization. Management participationplayeda crucial role.. The municipality was considered a large confusing organization. Motivation factors included the health agreements, hygiene suggestions from the National Board of Health and networking with hospitals. Access to an infection control nurse was considered a necessary element, basing collaboration on competencies, rather than personal interest. Conclusion:Different circumstances are crucial when developing an infection control organization. Management must participate, and also must approve settings and resources. The municipality must have directaccess to expert knowledge about infection control / <p>ISBN 978-91-86739-81-2</p>

Målet med dette arbeidet er å få kunnskaper om lederes mobbing, relatere det til konseptet destruktiv ledelse, og undersøke hvilken betydning makt og verdier kan ha i denne prosessen. Hensikten er å bruke kunnskapen til å bekjempe mobbing. Metode: Dette er en litteraturstudie med et systemteoretisk perspektiv. Mobbingen blir sett på som en dynamisk prosess med interaksjon mellom lederen som mobber, mobbeofferet, arbeidsgruppen og organisasjonen, hvor de alle inngår i et flerdimensjonalt system. Det er lagt stor vekt på å presisere begrepene. Resultater: Det er funnetgode holdepunkter for å hevde at ledere som mobber utøveren meget skadelig form for ledelse. I denne prosessen som har en tendens til å eskalere over tid, spiller makt og verdier en viktig rolle. Ledere med en psykopatisk personlighet kan praktisere ledelse på en måte som får store negative konsekvenser for organisasjonen og de ansatte, og slike personer har en tendens til å misbruke makt. De kan likevel bli ansatt som ledere fordi de har egenskaper som organisasjonen søker og setter pris på. Det er ikke enighet om at mobbing er en uetisk handling. Litteraturen viser at enkelte ledere bruker mobbing strategisk for å oppnå egne fordeler, eller for kontrollere eller straffe de ansatte. Mobbing kan inngå i en bevisst ”organisasjonspolitikk” som blir aksepterti visse organisasjoner. Bedriftsetikk ser i mange sammenhenger ut til å være et begrep uten forpliktende innhold. Det er undersøkt hvordan begrepene managementideologi, instrumentell rasjonalitet og paradokser kan påvirkelederes mobbing. Managementideologien som gjennomsyrer synet på ledelse i store deler av samfunnet, i offentlige organisasjoner i form av New Public Management, er preget av instrumentelle verdier og en utilitaristisk etikk. Dette kan stå i motsetning til den grunnleggende respekt for mennesket som er et fundament i Emmanuel Kants etikk. Konklusjon:Studiet viser atlederes mobbingav ansatte er et meget utbredt og alvorlig problem som er svært ødeleggende for personer og organisasjoner. Det er dermed et betydelig folkehelseproblem. / Objectives: This study aimed to gain insight into the process of leaders bullying their subordinates, relate it to the concept of destructive leadership, and examinethe role of power and values in this process. The overall aim was to provide knowledge about how toreduce bullying. Method: This literature study looked at workplace bullying from the perspective of systems theory. Bullying is seen as a dynamic process characterized by interactions between the perpetrator, the victim, the workgroup, and the organization. The author has given priority toprecision of concept definitions. Results: The literature suggests that leaders who bully practicea very destructive form of leadership. Powerand values play an important rolein the bullying process, which tends to escalate over time.Leaders with a psychopathic personality practicea leadership style that may have serious negative consequences for the organization and its employees. Although psychopathic leaders often misuse power they may retain their leadership role because they seem to have personality traits the organization seeks and appreciates. Interestingly, the author found no agreement about bullying being an immoral act. The literature shows that some leaders use bullying strategically for personal gain or to control or punish employees. Bullying may be part of the organization politics accepted by some organizations,and business ethics often sees to be a concept without areal obligation. An overview discusse show the concepts of management ideology, instrumental rationality and paradoxes may affect leaders ́bullying and harassment. Instrumental values and utilitarian ethics dominate the management ideology that strongly influences leadership in a large part of society, and in public organizations such as New Public Management.This is often in opposition to the fundamental respect for the person that is central to the ethics of Emmanuel Kant. Conclusions: This study shows thatorganization leaders who bully their subordinates representa large and serious problem, with very destructive consequences for persons and organizations. Bullying is thus an important public health problem / <p>ISBN 978-91-86739-83-6</p>

Bakgrunn: Forekomsten av overvekt og fedme er økende i de nordiske landene og iverden forøvrig. Utviklingen er bekymringsfull fordi den bringer med seg uhelse og alvorlig sykdom. Ulike virkemidler er tatt i bruk for å løse problemene forårsaket av overvekt og inaktivitet. Samtidig prøver man å påvirke til endret helseatferd. Det er behov for å utvide kunnskapen om hva som i denne sammenheng er effektive strategier. Hensikt: Studiens hensikt er med kvalitativ metodikk å studere hvordan personer som har lykkes med å endre livsstilsvaner, opplevde og håndterte endringsprosessen. Metode: 14 personer, derav åtte menn, i alderen 23 til 68 år er intervjuet individuelt. Modifisert versjon av Grounded Therory er brukt som metode i innsamling av data og i analyseprosessen. Resultat: Studien viser at deltakernes vellykkede livsstilsendring har forløpt gjennom en rekke sosiale prosesser som kan beskrives ut fra tre hovedkonsepter som her er samlet i følgende kategorier; Motiverer til endring, danner nye vaner og håndterer seg selv. Det som kjennetegner endringsprosessen i sin helhet er hvordan hovedpersonene har utviklet større grad av kontroll og håndterbarhet i egne liv. Konklusjon: Vellykket livsstilsendring er en psykologisk empowermentprosess med vekt på prosesser omkring selvregulering, motivering, psykisk uhelse og det å danne nye vane / The incidence of overweight and obesity is steadily increasing in the Nordic countries and the entire world. This trend is a cause for concern because obesity links directly to many several illnesses, some life-threatening. Various methods have been developed in an effort to manage problems associated with obesity and inactivity. These methods also try to initiate positive lifestyle changes. However, it is necessary to broaden the knowledge base regarding the effectiveness of these strategies. Aim: This study aimed to use qualitative methodology to assess people who have succeeded in making positive lifestyle changes, documenting their experiences and learning how they adapted during the change process. Methodology: A group of 14 people consisting of eight men and six women, all between the ages of 23 and 68 years, were individually interviewed using a modified version of Grounded Theory to collect and analyze the data. Results: The study shows that the participants' positive lifestyle changes have gone through a variety of social processes. These processes comprised three main categories: motivation to change, development of new habits, and self-management. A defining factor in the change process of each candidate was how well that individual developed a greater degree of self-control and management of their own lives. Conclusion: Successful lifestyle change is a psychological empowerment process that emphasizes self-regulation, motivation, mental disorders, and the development of new habits. / <p>ISBN 978-91-86739-44-7</p>

Aim To describe the epidemiology of tuberculosis in the city of Liepaja during the last 27 years and the management of patients with tuberculosis during the period 1993-2002; to identify problems in tuberculosis management relevant to increasing level of morbidity and the registered high levels of drug-resistance. Material and methods The cases were all persons reported with tuberculosis in 1975-2002. The data sources were the yearly Health Statistics books at the Latvian Office of Medical Statistics. The study used data from the available 655 individual patient records from Liepaja Tuberculosis Dispensery and TB Register of 1993 – 2002. Information was extracted selectively and extraction sheets containing the variables of interest were developed. The incidence differences according to sex and age, possible clustering of patients in high-risk living areas of the city, differences in occupation of the patients were studied. The differences of time from disease symptoms to diagnosis, as well as investigation data, treatment regimens, the proportions of treatment outcomes were analysed. Analysis was done using EPI-INFO programme for statistical analysis. Results In the 1980s tuberculosis was under control in Latvia and the incidence was at the European average level. After Latvia had regained independence in 1991, with economical and political disruption and changes in the health care system, TB incidence and mortality in the country increased rapidly as well as in Liepaja. Although not very high compared to global TB rates, there was great concern about TB control in Latvia. In addition, the emergence of drug resistance and multi-drug resistant bacteria made the TB epidemic more serious. The TB incidence increase in children suggested that there was quite a big number of undetected cases of TB. Tuberculosis control and early detection activities were not integrated into the PHC system. Treatment results of TB were quite poor and showed high proportions of interruptions, defaults, relapses. The tuberculosis control Programme in Latvia and Liepaja put much effort into the improvement of the epidemiological situation with TB, focusing on TB control activities and management during the period 1993-2002. The incidence of tuberculosis in Liepaja was higher than in Latvia, particularly in some living areas in the city, and above endemic level. Mortality rate in average was higher as in the whole country. The proportion of socially sensitive groups (children, unemployed, pensioners, disabled) comprised more than 50 % of the tuberculosis incidence. Incidence among medical staff was higher than in general population in the all professional groups. Medical delay of diagnosis decreased, but early detection of tuberculosis was not fully integrated in PHC system. There were quite big differences in numbers of MDR-TB in years 1993-2002. DOTS was introduced in Liepaja five years later than in Latvia –in year 2000 and strategy was not fully successful. The number of positive treatment outcomes increased, but the registered numbers of treatment relapses and defaults were higher than in Latvia . Conclusions The situation with regard to tuberculosis development and tuberculosis management in Liepaja during the period under study was unfavourable. Particularly : the incidence and mortality rates, much variation in the diagnostic process, results of treatment ,a high proportion of MDR-TB , unsatisfactory links between local government, family doctors and medical professionals and multi-sectoral collaboration in TB control activities , the objectives set up by WHO for DOTS treatment were not reached / <p>ISBN 91-7997-139-3</p>

The aim of this study was to assess the socio-demographic variations in nutritional habits and their trends over the last decade in Lithuanian adult population. Methods: Six health behaviour surveys were carried out within the international FINBALT HEALTH MONITOR project between 1994-2004. For every survey the national random sample of 3000 inhabitants aged 20-64 was taken from the National Population Register. The study material was collected through mailed questionnaires covering sociodemographic characteristics and some nutrition habits. Response rates ranged from 61.7% to 74.4%. Education was measured using five educational levels. The respondents were categorized into three groups: persons with incomplete secondary education (primary or incomplete secondary), secondary (secondary or vocational), and university education. The degree of urbanization was based on the administrative classification of the places of residence. The respondents were grouped as living in cities, towns, or villages. The effect of age, level of education, place of residence, and marital status upon nutritional habits was evaluated using multifactor logistic regression analysis that was carried out separately for men and women. Results: Positive trends in nutritional habits were observed between 1994-2004 in Lithuania. The diet of the Lithuanian population tended to become closer to the WHO recommendations for healthy nutrition. The intake of animal fat decreased. Almost a half of population replaced butter on bread by low fat margarine. The proportion of men using vegetable oil for cooking increased from 31.1% in 1994 to 82.6% in 2004, and the proportion of women – from 47.7% to 89.4, respectively. The consumption of fresh vegetables, fruit, and dark bread has increased. Although all social groups of the Lithuanian population have changed their diet, social differences in nutrition habits still remained significant. Women, highly educated persons and urban population have healthier diet than men, people with lower education and rural population. The odds ratio of using vegetable oil among men with university education was higher by 98% and among women – by 67% than that among persons with incomplete secondary education. The respondent with university education were more than twice as likely as low educated people to consume fresh fruits daily. The proportion of persons drinking whole milk was much higher in villages (OR 4.80 (CI 4.0-5.8) for men and 7.33 (CI 6.1-8.8) for women) compared to cities. Conclusions: Existing social differences in nutritional habits should be considered in the programs for the promotion of healthy nutrition and implementation of Lithuanian Food and Nutrition Action Plan development / <p>ISBN 91-7997-157-1</p>

Background: Närsjukvården Österlen AB (=NÖAB) won a five-year contract, late in 2000, to operate the local health care services in Simrishamn on behalf of the Region Skåne. The economical forecast for 2002 was a loss of 18 million SEK. A turnaround was urgent. Aim: Primarily to evaluate Knowledge Management (=KM) techniques as a tool in the process of turning a health care organization around. Secondarily, to describe the means by which NÖAB became a more efficient health care organization. In order to evaluate the use of KM in the turnaround process it is necessary to answer three fundamental research questions. Did a turnaround take place? Did the individual projects contribute to increased efficiency? And finally can the approach used in the projects be characterized as KM. Method: The study was an ongoing case study using action research combined with evaluation. The Evaluation uses public data (both quantitative and qualitative) and evaluations done by third parties. That allows for a profound validation of the conclusions. Three central processes were singled out for the evaluation. 1) The makeover of the acute patients’ way into the system, 2) the disease management program (=DPM) for patients suffering from COPD and 3) the introduction of an error-management system. Results: The operating results were raised from minus 15 million SEK in 2002 to plus 10 million SEK in 2005. Manhours were reduced with 20.6%. The average cost for a consultations were reduced with 24.6%. The introduction of the COPD DPM resulted in a saving of approximately 1 million SEK a year. A total of 312 adverse event reports were filled during the first 10 month - an average of 31 a month. The introduction of KM turned the organization into a patient centered, lean health care organization. Changed the decisions making, and resulted in a significant shift towards an acceptance culture. Conclusion: From the nature of the described projects, the description of the landmarks used and the discussion on how the projects fit into a Knowledge Management way of thinking it is concluded that a Knowledge Management approach was applied. The success of the turnaround described in the case makes a strong argument for the use of Knowledge Management when faced with the need to optimize health care systems. / <p>ISBN 91-7997-162-8</p>

Objectives. This studyaimed to assess quality of life in first-onset stroke survivors, and to determine how stroke associates with social and demographic factors, peculiarities of lifestyle, and chronic non-infectious diseases.Material and methods.As part of the European Register of Stroke study, we recruited 508 stroke survivors aged 25–84 years (case group) in Kaunas city Lithuania, and randomly selected 508 age-and sex-matched residents from the city’s stroke-free population (controls). All participants completed the Short Form 12 Health Survey questionnaire. We analyzed participants’ physical and mental quality of life regarding social and demographic factors, lifestyle, chronic non-infectious disease morbidity, and the use of medications. Results. Quality of life among stroke survivors was poorer compared to controls in both the physical (Me=32.8/47.0, p&lt;0.001) and mental (Me=55.9/60.5, p&lt;0.001) health domains. Stroke survivors and controls with arterial hypertension reported poorer physical health, compared to subjects without hypertension (p&lt;0.05 vs. p&lt;0.001, respectively). Additionally, physical quality of life among survivors with atrial fibrillation was poorer compared to subjects without this disorder (p&lt;0.001). Employed stroke survivors reported better physical health (Me=38.9, p&lt;0.001) compared to unemployed survivors (Me=31.5), and we observed a similar pattern among controls (Me=50.8/38.9, p=0.005). Survivors and controls who used alcohol reported better physicalhealth (p&lt;0.001). Notably,both controls (p&lt;0.05) and stroke survivors (p&lt;0.01) reported better health if they did not live alone. During the period from the 3rd up to the 12th month after stroke, average physical and mental quality of life increased significantly among survivors (5.1±0.4 points, p=0.001 vs. 1.4±0.3 points, p=0.001, respectively). Conclusions. Previous stroke impaired both physical and mental quality of life in survivors. This study revealed that chronic non-infectious diseases experiencedprior to stroke significantly influence quality of life.Survivors with arterial hypertension, atrial fibrillation, or diabetes mellitus rated their physical quality of life lower than those who did not have these illnesses. Interestingly, only controls with atrial fibrillation reported decreased quality of life. Both physical and mental health improved12 months after stroke compared to quality of life 3 months after stroke / <p>ISBN 978-91-86739-79-9</p>

Purpose. The purpose of the study was to evaluate the level of job satisfaction among the staff of Pärnu County Hospital and to describe variables related to their job satisfaction. Methods. The study was carried out in December 1998. The opinions of staff regarding satisfaction with their jobs were studied using an Estonian translation of the Norwegian Medical Association Job Satisfaction questionnaire, which was distributed to all 673 staff members of the hospital. Three levels of analyses were carried out. Stepwise regression analysis was used to determine which single item factors were most important in job satisfaction for the various groups of hospital staff. Further, global job satisfaction item and a four items construct called nature of job satisfaction (α=60) were selected as dependent variables. The independent variables consisted of constructs measuring: knowledge in planning (3 items α=70), relationship with superior (5 items α=89), strategic knowledge of workplace (5 items α=84), work stress (6 items α=77), unrealistic expectations (5 items α=72), collegial relationships (2 items α=75), discussions with colleagues (3 items α=80), recognition (3 items α=67) and sense of belonging (single item). Pearson correlations were used to determine whether the independent variables were significantly correlated with job satisfaction. Scheffe’s F-test was used to conduct post-hoc analyses of variance for each independent variable between categories of hospital personnel. Results. The response rate was 77%. The key results were that overall job satisfaction was moderately high (3.86 on a scale of 5); however there are differences in satisfaction models between categories of personnel. In addition, there are significant differences in the correlations between job satisfaction and the independent variables among the groups of personnel. Conclusions. The findings of this study suggest that executives of a health care institution that are informed about the expectations and daily work-related problems of their employees are better able to understand the needs of their employees. Executives should: 1) build up effective relationships between managers and staff; 2) identifynegative working conditionswhich affect staff; 3) appropriately delegate authority to personnel, and hold them accountable for the work done in their organizational units; 4) keep staff informed about changes that will affect them; and 5) express appreciation and recognition for the efforts of staff members in accomplishing the work of the health care organization. In doing this, executives will create a favorable working environment for the hospital staff. The value of the study is that the results can be used as a set of reference levels and indicators for the human resources development component of the quality management system of Pärnu County Hospital / <p>ISBN 978-91-58721-04-7</p>

The purpose of the study is to evaluate hospital costs in Kaunas Medical University Hospital (KMUH). KMUH is the largest hospital in Lithuania, having 1995 in-patient beds, 26 specialised in-patient departments, 5130 employees, and providing wide range of in-patient services. Methods. Methods, used in the study include assessment of inputs and outputs, evaluation of average cost per case, estimation of cost structure, estimation of case-mix dimensions in in-patient departments and clinical categories and assessment of impact of case-mix dimensions to cost per case, using multiple regressionanalysis. Cross-sectional study designwas used in the study, evaluating mainly cases and expenses of all 26 specialised in-patient departments of KMUH per year 2002. Five cost groups have been used and defined inmonetary terms in each in-patient department: labour costs; medication costs; laboratory, radiology and anaesthesiology costs; running costs of medical equipment supply andother costs (including in-patients’ mealcosts, transportation, laundry, communication, etc. costs). Case was defined as one treatment episode in particular in-patient department. Cases were analysed using following case-mix dimensions: sex, age, absenceor presence of surgical operation, patient separation status and in-patientservice group. Results. Average costs per case vary widely among in-patient departments, ranging from 126.01 Litas (36.52 Euro) to 3451.68 Litas (999.73 Euro) per case.During the study average cost per case were also estimated in clinical profiles – surgery – 1161.0 Litas (336.24 Euro), therapy – 1312.15 Litas (380.02 Euro),obstetrics and gynaecology –685.82 Litas (198.62 Euro), newborn and child care – 893.54 Litas (258.78 Euro) and intensive care – 1292.92 Litas (374.45 Euro). Using multiple regression analysis method, costper case ineach in-patient department and clinical category according case-mix dimensions were predicted. In all in-patient departments predicted values of average costs per case according case-mix dimensions, comparing with actual values, did not differ so much. Positive contributions to predictedvalue of cost per case, shows only one variable – IA in-patient service group. In any predicted case contributions of independent variables have notbeen observedas significant (p&gt;0.05). Conclusions. Inputs (measured in the number of beds) and outputs (measured in the number of in-patientcases and the number of bed-days) are different across in-patient departments, as well as outputs (measured inthe number of treatment episodes according to case-mix dimensions). The average costs per case vary widely across in-patient departments and clinical categories. The analysis of the structure of average costs per case demonstrated striking differences in in-patient departments. In all in-patient departments the predicted values of the average costs per case according to case-mix dimensions, do not differ so much comparing with theactual observed costs per case. Positive contributions to the predicted value of the cost per case, shows only onevariable – IA in-patient service group. The results of the study have proved the evidence that clinical casestreated within the same in-patient department of the hospital are not similar. The results of studyhave showedthe failure of use of “in-patient service groups” as proxy of International Disease Classification due to numberof reasons / <p>ISBN 91-7997-101-6</p>