Forskningsartikler

Beboere med covid-19-sykdom på norske sykehjem hadde høy risiko for alvorlig forløp og død. Hensikten med denne studien var å utforske sykehjemslegers erfaringer med å ivareta behandlingsansvaret for beboere med covid-19 og hvordan de samarbeidet med pårørende og sykepleiere. Denne intervjustudien inkluderte ti sykehjemsleger med erfaring fra covid-19 i sykehjem fra tre av de fire helseregionene i Norge. Vi gjorde en kvalitativ innholdsanalyse av de transkriberte intervjuene. Analysen identifiserte følgende tre hovedfunn: 1) Krevende ansvar for medisinskfaglige vurderinger og avgjørelser, 2) Kommunikasjon og samarbeid med pårørende – viktig og tidkrevende, og 3) Sykepleierne – en viktig samarbeidspartner. Sykehjemslegene opplevde et krevende ansvar og utfordringer med å ivareta multimorbide og skrøpelige beboere under pandemien. Dette illustrerer behovet for gode rutiner samt lokale og nasjonale retningslinjer. Samarbeidet med erfarne og rutinerte sykepleiere ga trygghet. Sykehjemslegenes beskrivelse av følelsesmessige utfordringer under covid-19-pandemien understreker behovet for faste, kollegiale og faglige nettverk.

Signe Gunn Julnes, Bjørn Lichtwarck, Siren Eriksen, Adelheid Hummelvoll Hillestad, Anita Nilsen, Signe Tretteteig og Anne Marie Mork Rokstad

Objective: To study the association between hearing loss severity, hearing aid use, and subjective memory complaints in a large cross-sectional study in Norway.

Methods: Data were drawn from the fourth wave of the Trøndelag Health Study (HUNT4 Hearing, 2017–2019). Hearing threshold was defined as the pure tone average of 0.5, 1, 2 and 4 kHz in the better ear. The participants were divided into five groups: normal hearing or slight/mild/moderate/severe hearing loss. Subjective self-reported short-term and long-term memory complaints was measured by the nine-item Meta-Memory Questionnaire (MMQ). The sample included 20,092 individuals (11,675 women, mean age 58,3 years) who completed both hearing and MMQ tasks. Multivariate analysis of variance (adjusted for covariates of age, sex, education, and health cofounders) was used to evaluate the association between hearing status and hearing aid use (in the hearing-impaired groups) and long-term and short-term subjective memory complaints.

Results: Multivariate analysis of variance, followed by univariate ANOVA and pairwise comparisons showed that hearing loss was associated only with more long-term subjective memory complaints and not with short-term subjective memory complaints. In the hearing-impaired groups, the univariate main effect of hearing aid use was only observed for subjective long-term memory complaints and not for subjective short-term memory complaints. Similarly, the univariate interaction of hearing aid use and hearing status was significant for subjective long-term memory complaints and not for subjective short-term memory complaints. Pairwise comparisons, however, revealed no significant differences between hearing loss groups with respect to subjective long-term complaints.

Conclusion: This cross-sectional study indicates an association between hearing loss and subjective long-term memory complaints, but not with subjective short-term memory complaints. In addition, an interaction between hearing status and hearing aid use for subjective long-term memory complaints was observed in hearing-impaired groups, which calls for future research to examine the effects of hearing aid use on different memory systems.

Shahram Moradi, Bo Lars Engdahl, Aud Johannessen, Geir Selbæk, Lisa Aarhus og Gro Gade Haanes

Vold, overgrep, utelatt helsehjelp, forsømmelser og aggresjon er begreper som beskriver uønskede hendelser i sykehjem. Samtidig er det ingen enhetlig oppfatning av hvordan disse begrepene forstås eller brukes. I denne artikkelen ser vi nærmere på de mest brukte begrepene og hva som kan være en hensiktsmessig begrepsbruk som er gjenkjennbar både i forskning og praksis. Begrepsavklaring er viktig fordi det former synet og holdningene til beboerne, de ansatte og sykehjemmet. Beboere i norske sykehjem har sammensatte behov, og sykehjemmet er en svært kompleks organisasjon. Kompleksitetsteorien og den kontekstuelle teorien om overgrep vektlegger at multifaktorielle og komplekse fenomener må forstås gjennom kontekstuell kunnskap. Hver hendelse av overgrep, utelatt helsehjelp og aggresjon krever en bred tilnærming og utredning utover individuelle egenskaper hos beboeren eller den ansatte. Vi foreslår en begrepsbruk hvor vi skiller mellom begrepene, og beskriver det som faktisk skjer, for å unngå å bruke fellesbetegnelser for mange ulike hendelser. Vi anbefaler også at begreper med stor negativ og normativ valør, som vold og forsømmelser som sekkebetegnelser, bør unngås, spesielt der en antyder en individuell intensjon om å skade.

Astrid Sandmoe, Janne Myhre, Maria Hélen Iversen, Siren Eriksen and Bjørn Lichtwarck

Background: Healthcare workers (HCWs) are central and serve in the frontlines when epidemics threaten public health. Thus, certain communities may be hardest hit by these challenges. Interventions supporting HCWs are important, and to develop these, understanding their experiences is essential.

Aim: To explore how HCWs in Norwegian public in-home services experienced work during the COVID-19 pandemic over time.

Method: A longitudinal qualitative study with two data collections approximately one year apart (2021 and 2022) was performed. Individual interviews were conducted with HCWs.

Results: The analysis resulted in six main themes: Changing everything, Redefining ‘necessary tasks’, Distancing and loneliness, Cooperation and coordination, More infections and fewer worries and Lessons for the future. These indicate capabilities and processes, how they are evolving over time, and outcomes. The first two themes focus on the first period of the pandemic, the next two on the ongoing intermediate period, and the final two cover the last period.
Conclusion: The HCWs’ narratives have demonstrated their collective coping based on adaptive and transformative capacities. Further, they have enlisted experienced social resilience in their strategies for coping with the COVID-19 challenges.

Aud Johannessen, Anne-Sofie Helvik, Kjerstin Elisabeth Tevik and Kirsten Thorsen

Objectives: This meta-aggregation aims to interpret and synthesize present knowledge on the lifeworld perspectives of people with dementia and develop a model for guidance in clinical practice.

Method: The data consist of four meta-syntheses describing different lifeworld perspectives in accordance with van Manen’s existentials: lived relations, lived space, lived time and lived body. The meta-aggregation summarizes a range of views expressed by people with dementia in qualitative, interview-based studies, with the aim of generating a reliable model based on the studies’ findings.

Results: In total, 88 studies among 1,191 persons with dementia were included. Sixteen areas of focus were found, representing four perspectives: (a) lived relations, consisting of connectedness, independence, equality and competence; (b) lived space, consisting of belonging, meaningfulness, safety and security, and autonomy; (c) lived time, consisting of being rooted in the past, being in the present, viewing the future and being in process; and (d) lived body, consisting of being functional, trustworthy, adaptable and presentable. A model shaped as a tree trunk captures the lifeworld perspectives of people with dementia.

Conclusion: Sixteen areas were revealed from this meta-aggregation and form the basis of a model. This model may be used as a guide for health care personnel to ensure the overall lifeworld-perspectives of people with dementia in care for the target group and conduct lifeworld-preserving care with a person-centred approach.

Siren Eriksen, Knut Engedal and Ellen Karine Grov

I denne artikkelen viser vi hvordan en gruppe forskere ved Lovisenberg diakonale høgskole og Karlstads universitet i Sverige tar strukturerte grep for å unngå forskningssløseri.

Gunilla Borglin, Siren Eriksen, Cecilia Olsson og Edith Roth Gjevjon

Background: Genome-wide Association Studies (GWAS) have reshaped our understanding of the genetic bases of complex diseases in general and neurodegenerative diseases in particular. Despite being a common disorder, dementia with Lewy bodies (DLB), which, together with Parkinson’s disease dementia (PDD), comprise the umbrella term Lewy body dementias (LBD), is far from being well-characterized genetically. This is primarily due to a lack of familial cases and difficulty recruiting large, deeply characterized cohorts, given the high rate of misdiagnosis. By performing the largest GWAS in DLB, we aimed to identify novel risk loci to gain a better understanding of this disease’s pathobiology. Methods: Here, we conducted the largest meta-analysis of genome-wide association studies performed in LBD, using a total of 5,119 cases and 20,988 controls, from five independent datasets, aggregating all previously published DLB genome-wide association results to date, as well as two previously undescribed cohorts. Additionally, we performed a sex stratified GWAS using the discovery datasets. We updated the heritability estimates for DLB and, to fine map these estimates, we used local heritability analysis. We calculated genetic correlation estimates between DLB and a range of other diseases and traits to identify potential pleiotropy. We also performed gene-set analysis to identify genes with excess burden of rare variability and pathway analysis. Lastly, we used the UK Biobank data to perform a PheWas using individuals at the extremes of genetic risk for DLB. Findings: Between November 2018 and September 2022 we analyzed 8.6 million single nucleotide polymorphisms in 3293 DLB cases, 1826 LBD cases and 20,988 controls, as well as phenotypes from the UK Biobank dataset. Despite more than doubling the sample size from the previous GWAS in DLB, we did not identify significant loci in addition to those previously reported at GBA, SNCA, STX1B, and APOE. However, the sex-stratified analysis revealed that the GBA and SNCA signals are mainly driven by males, suggesting a sex-specific genetic architecture of disease. Using only clinical and neuropathologically diagnosed cases, we highlight four loci surpassing the significance threshold. Using the largest cohort of DLB we update our heritability estimates to 13% and fine map these results highlighting regions of the genome with high heritability but no genome-wide significant result so far. Interpretation: These data provide the most comprehensive analysis of genetic variability in DLB to date. The fact that no novel risk loci have been identified after doubling the cohort size indicates the potentially significant role of rare variants in the genetic architecture of DLB and stresses the urgent need for larger, well-characterized cohorts of this disease for genetic studies. The sex-stratified analysis shows that males and females have different signatures of genetic risk for DLB. These results have widespread implications for clinical practice and clinical trials’ design in DLB.

Elizabeth Gibbons, Arvid Rongve, Itziar de Rojas, Alexey Shadrin, Kaitlyn Westra, Allison Baumgartner, Levi Rosendall, Zachary Madaj, Dena G. Hernandez, Owen A. Ross, Valentina Escott-Price, Claire Shepherd, Laura Parkkinen, Sonja W. Scholz, Juan C. Troncoso, Olga Pletnikova, Ted Dawson, Liana Rosenthal, Olaf Ansorge,…Geir Selbæk…Jose Bras