<p>Background: Hypochondriasis is associated with marked impairments in physical and psychological functioning, work performance and increased health care utilization. The prevalence among medical outpatients is estimated to be between 4,2 % and 6,3 %. Notwithstanding there is deficient research in this area. Until recently no specific treatment has been clearly demonstrated to be effective. Objective: The aim was to investigate experiences of what it is like to live with hypochondriasis, but also to examine different treatment options. Methods: In order to illustrate the experiences a latent content analyses was made on a documentary named “Hypokondrikerna” and to examine the treatment options a systematic review was made. Result: The content analysis revealed three categories and nine sub-categories concerning the experiences. The three categories were “health anxiety”, “individual coping strategies” and “emotional consequences”. The systematic review revealed medical treatment which consisted of three different antidepressants as well as seven different kinds of psychological treatments and other interventions, which all reduced hypocondriacal symptoms. Discussion: The findings show that hypochondriasis causes a chronic suffering and indicates that potential treatments are available. Hypochondriasis causes an unproductive health care utilization. A more effective management could reduce the costs and ease the suffering. Therefore we suggest that this disease should be observed and treated. The nurse has an important function to maintain a positive relationship with the patient and create a therapeutic dialogue.</p>

This thesis presents the results of three studies examining the management of migraine in children. First we conducted a systematic review of all clinical trials conducted in children and adolescents of the acute migraine therapy. A meta-analysis of the 26 randomized controlled trials is presented. A single trial with a focus on Emergency Department (ED) management was identified. As such, we then examined current ED practice in two retrospective practice variation studies. The first compared four regional hospital EDs where practice patterns were significantly different between mixed population EDs (both adult and pediatric patients) and the tertiary pediatric ED. The second examined practice variation among ten tertiary pediatric EDs in Canada where significant differences were again observed. Factors that influenced the choice of medications included increasing patient age and the physicians diagnosis of migraine. Important areas of future investigation include: (1) the effectiveness of intravenous fluids alone; and (2) the use of combined medications. / Clinical Epidemiology

Background: Hypochondriasis is associated with marked impairments in physical and psychological functioning, work performance and increased health care utilization. The prevalence among medical outpatients is estimated to be between 4,2 % and 6,3 %. Notwithstanding there is deficient research in this area. Until recently no specific treatment has been clearly demonstrated to be effective. Objective: The aim was to investigate experiences of what it is like to live with hypochondriasis, but also to examine different treatment options. Methods: In order to illustrate the experiences a latent content analyses was made on a documentary named “Hypokondrikerna” and to examine the treatment options a systematic review was made. Result: The content analysis revealed three categories and nine sub-categories concerning the experiences. The three categories were “health anxiety”, “individual coping strategies” and “emotional consequences”. The systematic review revealed medical treatment which consisted of three different antidepressants as well as seven different kinds of psychological treatments and other interventions, which all reduced hypocondriacal symptoms. Discussion: The findings show that hypochondriasis causes a chronic suffering and indicates that potential treatments are available. Hypochondriasis causes an unproductive health care utilization. A more effective management could reduce the costs and ease the suffering. Therefore we suggest that this disease should be observed and treated. The nurse has an important function to maintain a positive relationship with the patient and create a therapeutic dialogue.

Aim: The purpose of this study was to highlight in what forms and manifestations spirituality emerges in medical patients whether they consider themselves believers or not. The other aim was to analyse spiritual ideas of nursing scientists – authors of the patients’ oriented studies to come to the better understanding of the situation with spirituality in caring. Method: Descriptive meta-synthesis was chosen, in which 12 nursing studies were analyzed and compiled in a new integrity. Results: The analysis shows that caregivers must be ready to meet and confirm the spiritual dimension consisting of Faith, Meaning, Relationship and Questions without answers in the various forms and expressions they emerge in patient’s experience. Nursing scientists showed ideas broad enough to confirm patients’ experience. Relevance for clinical practice: By include spirituality only to religion and culture the dimension are easily forgotten, it can also in those forms mean that caregivers doesn’t see it as theirs to confirm. Nursing science do not with hold that small view of spirituality, instead the science presents a broad spectra of forms in which patients spirituality can appear. New insights about patients’ spirituality can be used by health care professionals to improve the care of patients as multidimensional human beings.

Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease that has a highly variable disease course. Three biologic agents, adalimumab, etanercept, and infliximab, have been developed for the treatment of AS. We conducted three studies: 1) an exploratory analysis of a year-long longitudinal dataset to gain insight into the variability of disease activity, physical function, and well-being and to explore the relationship between these outcome measures; 2) a systematic review of the available evidence for the efficacy of biologic treatment; 3) a systematic review of potential adverse effects of this treatment. We found that repeated measures of disease activity, function and well-being fluctuate considerably between patients, with complex patterns occurring over time within patients. There was mostly high quality evidence that these biologics are efficacious against placebo. We did not find evidence of an increase in serious adverse events or serious infections from short-term randomized controlled trials.

Background: Teleradiology is currently being explored to enhance services for patients seeking emergency neurosurgical diagnoses in Ontario, Canada. Design: Systematic review of literature and cost-consequence analysis. Data sources: Medline, Embase, Cochrane, and Database of Abstracts of Reviews of Effects. Methods: Studies published between 1950 and 2008 describing remote consultations for neurosurgical assessments were retrieved. Two reviewers selected studies through multi-staged content screening and extracted data. Results 12 of 3765 studies met the inclusion criteria: two were randomized controlled trials and ten were case series. Teleradiology [88% (207/236)] and video-conferencing [89% (213/239] consultations produced higher diagnostic accuracy than telephone consultations [64% (150/235), p<0.001]. Savings varied by location and were based on avoided costs for ground and air transportation and hospitalization. Conclusions: There is limited evidence of clinical benefit of teleradiology. Savings associated with reduction in patient transfer rates depend on transportation mode and may be attenuated by higher operational costs.

Background: Teleradiology is currently being explored to enhance services for patients seeking emergency neurosurgical diagnoses in Ontario, Canada. Design: Systematic review of literature and cost-consequence analysis. Data sources: Medline, Embase, Cochrane, and Database of Abstracts of Reviews of Effects. Methods: Studies published between 1950 and 2008 describing remote consultations for neurosurgical assessments were retrieved. Two reviewers selected studies through multi-staged content screening and extracted data. Results 12 of 3765 studies met the inclusion criteria: two were randomized controlled trials and ten were case series. Teleradiology [88% (207/236)] and video-conferencing [89% (213/239] consultations produced higher diagnostic accuracy than telephone consultations [64% (150/235), p<0.001]. Savings varied by location and were based on avoided costs for ground and air transportation and hospitalization. Conclusions: There is limited evidence of clinical benefit of teleradiology. Savings associated with reduction in patient transfer rates depend on transportation mode and may be attenuated by higher operational costs.

Knowledge access is crucial for firms, especially those with resource constraints facing the rapid change in technology. This systematic review attempts to provide an understanding on how technology-based small and medium-sized enterprises (SMEs) source external knowledge. With the extant literature pointing to the spatial characteristics as the central theme, I identify four generic conditional dimensions that shape the overall geographical pattern of knowledge sourcing. The industrial knowledge base, the market, the local conditions, and the institutional environment influence from whom and where firms source knowledge. The empirical evidence leads to my contention that the conditional dimensions presented are far from being straightforward. Points of caution that should be incorporated when interpreting general patterns are discussed. The main argument is that further understanding of the geography of knowledge sourcing may start from generic external factors but contextual sensitivity and analytical interpretations are invariably essential. Further research opportunities call for more understanding on a) the relationship between private firms and the institutional environment, b) how an individual firm builds and develops own network, and c) how relational asset and different types of knowledge interact.

Aim This study of a systematic review of systematic reviews on school, learning and mental health investigates the relation between school climate, mental health and positive school outcomes. The aim is to analyze the quality and content of previous reviews and to identify aspects in the school climate that positively affect learning and mental health. Research questions are: What is the quality and content of previous systematic reviews on school, learning and mental health? What is the current state of knowledge concerning causal relationships between school climate, learning and mental health according to systematic reviews? What factors in the school climate can be identified as vital for positive outcomes and good mental health? Method Systematic review of longitudinal or cross-sectional studies. 792 references were identified through literature searches in various databases, with search words considering mental health in combination with search words considering school and learning. Data extraction was performed in three steps; abstract, full text and in-depth data extraction. Criteria for inclusion were: systematic review, published 1999-2009, ages 2-19 years, published in English in peer reviewed journals. The number of reviews that met the criteria set for quality was 37, which were quality rated as of high 27% (10/37), medium 46% (17/37) or low quality 27% (10/37). Results Three categories of content emerge, where much research has been executed: the relation between positive aspects of mental health and learning, between mental health problems and learning and indirect relations between school factors and mental health and learning. The quality is relatively low, only 8% (3/37) meet all the quality criteria. At school level, where the teacher plays an important role, there is a positive relation between school climate and outcome and mental health, as well as on an individual level, where self-efficacy, i.e. will and skill to perform, can be identified as a factor of major importance to school outcome. Conclusions Due to the low quality of research on the relation between school, learning and mental health causal relation cannot be established. There are apparent connections between school outcome, self-efficacy and a positive school climate. Teachers are important in and for school climate and are of vital importance for outcome and mental health. Students’ possibility to influence and control their learning promote school outcome and mental health. Policy aimed at improving achievement and school outcome need to consider perceived self-efficacy. / Syfte och frågeställningar Denna studie av en systematisk översikt över systematiska översikter om skola, lärande och psykisk hälsa undersöker relationen mellan skolmiljö, psykisk hälsa och positiva skolresultat. Syftet är att analysera kvalitet och innehåll i tidigare översikter samt att identifiera faktorer i skolmiljön som påverkar lärande och psykisk hälsa positivt. Frågeställningar är: Vad är kvaliteten hos och innehållet i tidigare systematiska översikter om skola, lärande och psykisk hälsa? Hur ser aktuellt forskningsläge ut gällande orsakssamband mellan skolmiljö, lärande och psykisk hälsa enligt systematiska översikter? Vilka faktorer i skolmiljön kan identifieras som avgörande för positiva skolresultat och god psykisk hälsa? Metod Systematisk översikt av longitudinella eller tvärsnittsstudier. 792 referenser identifierades genom litteratursökningar i olika databaser, med sökord avseende psykisk hälsa i kombination med sökord gällande skola och lärande. Dataextraktion genomfördes i tre steg; abstrakt, fulltext och djupare data extraktion. Kriterier för inklusion var: systematisk översikt, publicerad 1999-2009, ålder 2 – 19 år, publicerad på engelska i tidsskrift granskad av sakkunnig. Antalet översikter som uppfyllde uppställda kriterier för kvalitet var 37 som kvalitetsbedömdes som av hög 27% (10/37), medel 46% (17/37) eller låg kvalitet 27% (10/37). Resultat Innehållsmässigt framträder tre kategorier där mycket forskning genomförts: relationen mellan positiva aspekter av psykisk hälsa och lärande, mellan psykisk ohälsa och lärande, samt indirekta samband mellan skolfaktorer och psykisk hälsa och lärande. Kvaliteten är relativt låg, endast 8% (3/37) uppfyller samtliga kvalitetskriterier. På skolnivå, där läraren spelar en viktig roll, finns det en positiv relation mellan skolmiljö och skolprestation och psykisk hälsa, såväl som på individnivå, där self-efficacy, dvs. vilja och kompetens att prestera, kan identifieras som en avgörande faktor för skolprestationer. Sammanfattning På grund av den låga kvaliteten på forskning om relationen mellan skola, lärande och psykisk hälsa, går orsakssamband inte att fastställa. Tydliga kopplingar finns mellan skolresultat, self-efficacy och en positiv skolmiljö. Lärare är viktiga i och för elevernas skolmiljö och spelar en avgörande roll för skolprestation och psykisk hälsa. Elevens möjlighet att påverka och kontrollera sitt lärande bidrar positivt till skolprestation och psykisk hälsa. Policy för att förbättra skolprestation och skolresultat behöver beakta individens upplevda self-efficacy.

Recorded on July 27, 2007 by Eugene Barsky, Physiotherapy Outreach Librarian, UBC / N/A