Teaching general practitioners to activate older patients: The intervening role of changes in perceived communication skills.

OBJECTIVE: This report examined whether a change in the perceived communication behaviour (PeCoBe) of general practitioners (GPs) influenced the effect of the Promoting Active Aging (PRACTA) intervention on activation of older patients as perceived by GPs. METHODS: Pre- and post-intervention questionnaires were filled out by 225 GPs, who were assigned to three groups, e-learning, pdf-article, and control. GPs self-reported their communication behaviour and their perceptions of the attitudes of older patients toward treatment and health. RESULTS: Participation in the e-learning intervention showed an increase in the PeCoBe of GPs, while reading the pdf-article resulted in a decrease of such behaviours. An increase in the PeCoBe of GPs was positively related to an increase in their perception of an active attitude among older patients. The indirect effects observed for e-learning and pdf-article interventions had opposite directions. CONCLUSION: Both types of PRACTA intervention exerted an impact on GPs' perception of the attitudes of older patients, and change in PeCoBe of GPs could be considered as a mechanism driving this effect. PRACTICAL IMPLICATIONS: The methods based on a combination of knowledge delivery and modelling of communication skills are strongly recommended forms of teaching for GPs on how to communicate with and activate seniors.

The Relationship Between Positive Mental Health Literacy and Mental Well-Being Among Adolescents: Implications for School Health Services.

Mental health education is a central part of school nurses' practice. Mental health literacy is an asset for health that educational initiatives can strengthen, and a significant determinant of mental health. This study was intended to examine the relationship between positive mental health literacy (PMeHL) and mental well-being to discuss its implications for school health services' mental health education. The relationship was assessed using a multiple linear regression model controlling for relevant covariates. Data were derived from a cross-sectional school-based survey including 1,888 adolescents aged 15-21 years (response rate 97.3%). A weak gender difference was found in PMeHL. The regression model accounted for 41% of the variance in adolescents' mental well-being; PMeHL was a significant explanatory variable of mental well-being. Accordingly, the current study found support for including PMeHL, or knowledge of how to obtain and maintain good mental health, as an integral component of school health services' mental health education among adolescents.

Testing a New Tool Assessing Attitude Towards Treatment and Health in Primary Health Care Setting: Senior Patients and Doctors Perspectives.

AIMS: Patients' attitude towards treatment and health (ATH) is crucial for compliance at all stages of treatment. This study examined the psychometric properties of the developed PRACTA Attitude Towards Treatment and Health questionnaire, designed to measure ATH as perceived by seniors (PRACTA-ATH) and doctors (PRACTA-ATH-D) in primary health care. METHODS: The data were collected in two waves of the Polish-Norwegian PRACTA project. Exploratory factor analyses (EFAs) were conducted on wave 1 data from senior patients ( n = 3392) and their general practitioners ( n = 491). Confirmatory factor analyses (CFAs) were conducted on wave 2 data. This was a new sample of senior patients ( n = 2765) and a follow-up sample of doctors ( n = 393). RESULTS: The EFAs showed that the 16-item four-factor solution is the best solution reflecting the structure of both seniors and doctors' ATH questionnaires. The CFAs conducted to establish the best unified model for PRACTA-ATH and PRACTA-ATH-D indicated three comparatively good solutions: the 16-item four-factor solution, the 12-item four-factor solution and the 12-item five-factor solution. CONCLUSIONS: The questionnaire is found appropriate for use among patients and doctors, and can be used as a good tool to monitor older patients' ATH and concordance between doctors and patients' perspectives.

Psychological distress in elderly people is associated with diet, wellbeing, health status, social support and physical functioning- a HUNT3 study.

BACKGROUND: The increasing proportion of people growing old, demands expanded knowledge of how people can experience successful aging. Having a good life while growing old is dependent on several factors such as nutrition, physical health, the ability to perform activities of daily living, lifestyle and psychological health. Furthermore, unhealthy food intake is found to be a modifiable risk factor for depression in elderly people. To promote elderly's health and wellbeing, the influence of nutrition, lifestyle, physical functioning, and social support on psychological distress needs exploring. Therefore, the purpose of this present study is to investigate the associations between psychological distress and diet patterns when adjusting for other life style behaviors, wellbeing, health status, physical functioning and social support in elderly people. METHODS: The present study is cross sectional, using data from wave three of the Nord-Trøndelag Health Study (2006-2008). Data include psychological distress measured by the Hospital Anxiety and Depression Scale (HADS), sociodemographic information, measurements of lifestyle behaviours (including diet patterns), wellbeing, health status, social support and physical functioning. RESULTS: The sample consisted of 11,621 participants, 65 years or older. Cluster analysis categorized the participants in two food clusters based on similarities in food consumption (healthy N = 9128, unhealthy N = 2493). Stepwise multivariable linear regression analyses revealed that lesser psychological distress in the elderly was dependent on gender, diet, smoking, better scores on health and wellbeing, social support and less problems performing instrumental activities of daily living. CONCLUSION: Knowledge about the influence of diet patterns in relation to psychological distress provide valuable insights into how society can promote healthy lifestyles to an ageing population, e.g. by increasing older people's food knowledge.

The role of gender in the active attitude toward treatment and health among older patients in primary health care-self-assessed health status and sociodemographic factors as moderators.

BACKGROUND: Active attitude toward treatment and health (ATH) leads to improved cooperation and better health outcomes in patients. Supporting it in the population of older adults is a growing need in primary care. Recognising the role of gender, health and other sociodemographic factors can help to distinguish patients who need the most assistance in activation from general practitioners (GPs). The objective of the study was to investigate gender differences in ATH as well as the moderating role of self-assessed health (SAH) and selected sociodemographic factors (age, education, financial status, marital status). METHODS: A cross-sectional, multicentre study among 4936 primary care older patients (aged 50+) was conducted. The PRACTA-Attitude toward Treatment and Health questionnaire (PRACTA-ATH) was used to measure the cognitive, emotional (positive and negative affect), and motivational dimensions of ATH. Patients were approached before and after their visits in the primary health-care facilities randomly selected in Central Poland. RESULTS: Generalised linear models (GENLIN) revealed the main effects of gender, SAH, and sociodemographic characteristics, such as financial status, marital status and education. Interaction effects of gender and age (Wald's χ2 = 24.767, p < 0.001 for ATH Global), as well as gender and SAH (Wald's χ2 = 16.712, p < 0.002 for ATH Global) on ATH were found. The most assistance in regard to ATH was required by men aged 50-74 and men declaring good self-assessed health. Generally, women declared a more active attitude than men, showing more knowledge (M = 5.40, SD = 0.07 and M = 5.21, SD = 0.07, for women and men, respectively, p = 0.046), positive emotion (M = 5.55, SD = 0.06 and M = 5.33, SD =0.06, for women and men, respectively, p = 0.015) and motivation to be involved in their health issues (M = 5.71, SD = 0.07 and M = 5.39, SD = 0.07, for women and men, respectively, p = 0.001). The level of negative emotions related to health was not significantly different between genders (p = 0.971). CONCLUSIONS: The need to create health promoting programmes taking account of particular gender differences in older adults emerges. In regard to clinical practice, building a sense of efficacy and individual responsibility for health, providing information about the means of health promotion and prevention, and recognising health-related cognitions, is recommended especially for men who feel well and are less advanced in age (50-74).

Activation of older patients through PRACTA intervention for primary healthcare doctors: does the method matter?

Background: Activating older adults in medical practice can benefit patients' health and quality of life, as well as the economy and burden of the healthcare system. Placing general practice in the public healthcare system gives the elderly population easy access to the promotion of active attitudes toward health, provided that the doctors have and use relevant activating tools. The aim of this study was to verify the possibility of activating senior patients through an educational intervention for doctors. Methods: Two waves of data collection from primary care patients and their doctors were separated by an intervention for doctors. The intervention took the form of an e-learning programme or article and was developed so as to improve general practitioners' (GP) communication and activation skills, especially when working with older adults. The outcome variable was the change between the waves in patients' scores on the PRACTA Attitude Toward Treatment and Health (ATH) Scale and PRACTA Self-efficacy Scale. Data from patients aged 50 + (n = 2175; 55.6% women; age: M = 69.56, SD = 9.10) appointed at the primary care facilities were analysed. Results: The analysis revealed the effect of doctors' e-learning and, to a lesser extent, the effect of article reading on patients' attitudes toward treatment and health as well as on their self-efficacy. In facilities in which the intervention was implemented, patients' attitudes were more active on follow-up than at baseline when compared with facilities without the intervention. Conclusions: Educational intervention among doctors can result in patients' ATH becoming more active. The form of intervention might diversify the impact.

Dietary Patterns Characterized by High Meat Consumption Are Associated with Other Unhealthy Life Styles and Depression Symptoms.

OBJECTIVE: We aimed to identify dietary patterns (DPs) of Portuguese adults, to assess their socioeconomic, demographic, lifestyle determinants, and to identify their impact on health. DESIGN: EpiDoC 2 study included 10,153 Portuguese adults from the EpiDoC Cohort, a population-based study. In this study, trained research assistants using computer-assisted telephone interview collected socioeconomic, demographic, dietary, lifestyles, and health information from March 2013 to July 2015. Cluster analysis was performed, based on questions regarding the number of meals, weekly frequency of soup consumption, vegetables, fruit, meat, fish, dairy products, and daily water intake. Factors associated with DP were identified through logistic regression models. RESULTS: Two DPs were identified: the "meat dietary pattern" and the "fruit & vegetables dietary pattern." After multivariable adjustment, women (OR = 0.52; p < 0.001), older adults (OR = 0.97; p < 0.001), and individuals with more years of education (OR = 0.96; p = 0.025) were less likely to adopt the "meat dietary pattern," while individuals in a situation of job insecurity/unemployment (OR = 1.49; p = 0.013), Azores island residents (OR = 1.40; p = 0.026), current smoking (OR = 1.58; p = 0.001), daily alcohol intake (OR = 1.46; p = 0.023), and physically inactive (OR = 1.86; p < 0.001) were positively and significantly associated with "meat dietary pattern." Moreover, individuals with depression symptoms (OR = 1.50; p = 0.018) and the ones who did lower number of medical appointments in the previous year (OR = 0.98; p = 0.025) were less likely to report this DP. CONCLUSION: Our results suggest that unhealthy DPs (meat DP) are part of a lifestyle behavior that includes physical inactivity, smoking habits, and alcohol consumption. Moreover, depression symptoms are also associated with unhealthy DPs.

Stress, sense of coherence and subjective health in adolescents aged 13-18 years.

BACKGROUND: This study investigated the relationships between sex, age, stress and sense of coherence (SOC) and each of self-rated health (SRH) and subjective health complaints (SHCs) in adolescents. METHODS: The study was based on a cross-sectional sample of 1239 adolescents aged 13-18 years. The participants reported scores on a questionnaire, including 12 items assessing SHC, the 13-item version of the Orientation to Life Questionnaire and the 30-item Adolescent Stress Questionnaire. Data were analysed with descriptive, comparative and hierarchical multiple regression analyses. RESULTS: Boys scored significantly higher on SRH than girls, whereas girls scored higher on SHCs. In the multivariate model, stress was significantly associated with SHCs, but not with SRH. SOC was significantly positively related to SRH and negatively related to SHC; the associations were significantly stronger for girls than for boys. A significant moderation effect (protective role) of SOC was found on the relation between stress and SHC. CONCLUSIONS: No causal conclusion was possible, but the findings may be used as a basis for further investigation of the role of stress and SOC in longitudinal studies and intervention studies.

Is there an association between food patterns and life satisfaction among Norway's inhabitants ages 65 years and older?

The lack of information regarding older adults' health and lifestyles makes it difficult to design suitable interventions for people at risk of developing unhealth lifestyles. Therefore, there is a need to increase knowledge about older adults' food patterns and quality of life. Our aim was to determine associations among food patterns, anxiety, depression, and life satisfaction in Norwegian inhabitants ages 65+. The Nord-Trøndelag Health Study (The HUNT Study) is a large, population-based cohort study that includes data for 125 000 Norwegian participants. The cohort used for this study is wave three of the study, consisting of 11 619 participants age 65 and over. Cluster analysis was used to categorize the participants based on similarities in food consumption; two clusters were identified based on similarities regarding food consumption among participants. Significant differences between the clusters were found, as participants in the healthy food-patterns cluster had higher life satisfaction and lower anxiety and depression than those in the unhealthy food-patterns cluster. The associations among food patterns, anxiety, depression, and life satisfaction among older adults show the need for increased focus on interactions among food patterns, food consumption, and life satisfaction among the elderly in order to explore how society can influence these patterns.

Disability Pensions Among Young Adults in Vocational Rehabilitation.

OBJECTIVES: Lack of work-participation and early disability pensions (DP's) among young adults are increasing public health problems in most western European countries. The present study investigated determinants of early DP in young adults in vocational rehabilitation. METHODS: Data from 928 young adults (aged 18-40 years) attending a vocational rehabilitation program was linked to DP's recorded in the Norwegian Labor and Welfare Organization registries (1992-2010) and later compared to a group of 65 employees (workers). We used logistic regression to estimate the odds ratio for entitlement to DP following rehabilitation, adjusting for socio-demographical, psychosocial and health-behavior factors. RESULTS: Significant differences in socio-demographical, psychosocial and health-behavior factors were found between the rehabilitation group and workers. A total of 60 individuals (6.5%) were granted a DP during follow-up. Increase in age, teenage parenthood, single status, as well as low education level and not being employed were found to be the strongest independent determinants of DP. CONCLUSION: Poor social relations (being lone), early childbearing and weak connection to working life contributed to increase in risk of DP's among young adults in vocational rehabilitation, also after adjusting for education level. These findings are important in the prevention of early disability retirements among young adults and should be considered in the development of targeted interventions aimed at individuals particularly at risk of not being integrated into future work lives.

The relationships between self-transcendence and spiritual well-being in cognitively intact nursing home patients.

BACKGROUND: Self-transcendence is considered a developmental process of personal maturity and a vital resource of well-being in later adulthood. Measurement of the associations between self-transcendence and spiritual well-being in cognitively intact nursing home patients has not been previously published. AIMS: The aim of this study was to identify the relationships between self-transcendence and spiritual well-being in cognitively intact nursing home patients. METHODS: A cross-sectional design using the self-transcendence scale and the FACIT-Sp spiritual well-being questionnaire was adopted. A sample of 202 cognitively intact nursing home patients in mid-Norway was selected to respond to the questionnaires in 2008 and 2009. Statistical analyses were conducted using lisrel 8.8 (Scientific Software International, Chicago, IL, USA) and structural equation modelling. RESULTS: A hypothesised structural equation model comprising a two-factor construct of self-transcendence and a three-factor construct of spiritual well-being demonstrated significant direct relationships between self-transcendence and spiritual well-being and total effects of self-transcendence on spiritual well-being. IMPLICATIONS FOR PRACTICE: Facilitating patients' self-transcendence, both interpersonally and intrapersonally, might increase spiritual well-being among cognitively intact nursing home patients, which is seen to be of great importance to nursing home patients' overall satisfaction and satisfaction with staff. The two-factor construct of self-transcendence and the three-factor construct of FACIT-Sp allow a more complex examination of the associations between the constructs and prove more specific guidelines for nursing interventions promoting well-being in nursing home patients.

Stress, sense of coherence and emotional symptoms in adolescents.

This paper aims to investigate the association between the domains of stress, sense of coherence (SOC) and emotional symptoms (depression and anxiety) in adolescents, as well as the potential moderating role of SOC on the relationship between stress and emotional symptoms. The study is based on a cross-sectional sample of 1183 adolescents aged 13-18 who attend public elementary and secondary schools in Mid-Norway. The results showed that girls scored higher than boys on stress related to peer pressure, home life, school performance, school/leisure conflict and emotional symptoms. Conversely, boys reported higher SOC than girls. Results from multiple hierarchical regression analyses showed that for boys, stress related to school performance was positively associated with symptoms of both depression and anxiety, whereas stress from peer pressure was associated with depressive symptoms. For girls, stress from peer pressure, romantic relationships and school was associated with more depressive symptoms. SOC was strongly and inversely associated with emotional symptoms, especially anxiety in girls. SOC also moderated the association between stress related to peer pressure and depressive symptoms in both genders. The study provides evidence of the association of SOC with stress and emotional symptoms during adolescence.

Self-esteem and life satisfaction in adolescents-gender and age as potential moderators.

PURPOSE: The present paper investigated gender differences on life satisfaction and self-esteem as well as the association between self-esteem and life satisfaction in Norwegian adolescents aged 13-18 years. The potential moderating role of gender and age in the relation between self-esteem and life satisfaction was also investigated. METHODS: A total of 1,239 adolescents from public elementary and secondary schools in mid-Norway participated in the school-based survey study. Mean score differences on the variables used in the study were tested using t tests. Hierarchical multiple regression analysis was used to evaluate the association between self-esteem and life satisfaction, controlled for gender, age, stress, subjective health, and chronic health conditions. RESULTS: The results showed that boys scored higher than girls on both self-esteem and life satisfaction. Self-esteem was positively associated with life satisfaction, explaining 24 % of the variance. However, no interaction effect of gender × self-esteem or age × self-esteem was found in relation to life satisfaction. CONCLUSION: The results give support for that boys report higher self-esteem and life satisfaction than girls. Self-esteem has a positive role in association with adolescents' life satisfaction, and this relationship is equally strong for both genders and across age.

Testing two self-care-related instruments among older home-dwelling people in Norway.

BACKGROUND: Older persons' ability and agency for self-care is an important issue. Therefore, the development of reliable and valid instruments to measure self-care with regard to both clinical nursing practice and personal health is important for nursing research and practice. Aim and objective. To test reliability and validity of the Norwegian versions of the two self-care-related instruments, the Self-care Ability Scale for the Elderly (SASE) and the Nutritional Form For the Elderly (NUFFE) among older home-dwelling individuals. METHODS: A postal questionnaire that contained these instruments, background variables, health-related questions and two other self-care-related instruments was completed by a randomised sample of 158 older persons in southern Norway. Reliability was assessed as internal consistency and validity as concurrent and construct validity. RESULTS: SASE reached a Cronbach's alpha coefficient of 0.85 and significant Spearman's rank correlations for 16 of 17 items. For NUFFE, a Cronbach's alpha coefficient of 0.64 was obtained and significant correlations for 13 of 15 items. Validity was supported for both instruments. An appropriate cut-off was found for SASE. For NUFFE, a low cut-off point was obtained. CONCLUSIONS: SASE was shown to have sufficient psychometric properties and can be used in research and clinical practice among older persons. Implications for practice. The psychometric properties of NUFFE can be assessed as sufficient, but further studies are needed regarding the cut-off point.

The association between sense of coherence and life satisfaction in adolescents.

PURPOSE: The present paper investigated possible gender and age differences on life satisfaction as well as the association between sense of coherence (SOC) and life satisfaction. The interaction effect of gender by SOC and age by SOC in relation to life satisfaction was also investigated. METHODS: A total of 1,239 adolescents (13-18 years) from public elementary and secondary schools in Mid-Norway participated in the school-based survey study. Two-way between-groups ANOVA was employed to investigate gender and age differences on life satisfaction, and hierarchical multiple regression analysis was used to evaluate the association between SOC and life satisfaction, controlled for gender, age, physical activity, and subjective health. RESULTS: The results showed that boys scored higher on life satisfaction than girls across all ages, except in the age group 17-18 years, where girls scored higher than boys. SOC was strongly and positively associated with life satisfaction. However, no interaction effect of gender by SOC or age by SOC on life satisfaction was found, showing that the strength of the association between SOC and life satisfaction does not differ between genders or across age groups. CONCLUSION: The results give support for the positive role of SOC in relation to subjective well-being in adolescents.

Self-esteem and emotional health in adolescents--gender and age as potential moderators.

The present paper investigates possible gender and age differences on emotional states (depression and anxiety) and self-esteem as well as the association between self-esteem and emotional states. The cross-sectional sectional sample consists of 1,209 adolescents 13-18 years from public elementary and secondary schools in mid-Norway. The results showed that girls reported higher scores on state anxiety and state depression, whereas boys consistently scored higher on self-esteem in all age groups. Self-esteem was strongly and inversely associated with both state depression and state anxiety. An interaction effect of gender by self-esteem was found on state depression, where the association was stronger for girls than for boys. The associations found give support for the positive role of self-esteem in relation to adolescents' emotional health and well-being.

Self-transcendence and nurse-patient interaction in cognitively intact nursing home patients.

AIMS AND OBJECTIVES: The aim of this study was to test whether nurse-patient interaction affects cognitively intact nursing home patients' interpersonal and intrapersonal self-transcendence, as well as testing the psychometric properties of the Nurse-Patient Interaction Scale (NPIS). BACKGROUND: Self-transcendence is considered a spiritual developmental process of maturity in adulthood, and a vital resource of well-being at the end of life. The concept of self-transcendence has previously been explored in various populations, yet the nurse-patient interactions' potential influence on self-transcendence in nursing home patients has not been published previously. DESIGN AND METHODS: A cross-sectional design employing the Self-Transcendence Scale and the NPIS was adopted. A sample of 202 cognitively well-functioning nursing home patients in Norway was selected. The statistical analyses were carried out using lisrel 8.8 and structural equation modelling. RESULTS: Structural equation modelling-analysis indicates statistical significant effect of nurse-patient interaction on the patients' self-transcendence. Direct influence on the intrapersonal and indirect influence on the interpersonal self-transcendence aspects was disclosed. CONCLUSION: Nurse-patient interaction significantly affected both interpersonal and intrapersonal self-transcendence among cognitively intact nursing home patients. Hence, facilitating caring interventions can be significantly beneficial to older patients' self-transcendence and thereby well-being, both emotional and physical. RELEVANCE TO CLINICAL PRACTICE: Caring behaviour signifies the vital and ultimate qualitative nursing behaviour, which promotes self-transcendence and thereby well-being. These findings are important for clinical nursing that intends to increase patients' well-being.

Sense of coherence and emotional health in adolescents.

UNLABELLED: The present paper investigates possible gender and age differences on emotional states (state depression and state anxiety) and sense of coherence (SOC) as well as the association between SOC and emotional states. The cross-sectional sectional sample consists of 1209 adolescents 13-18 years from public elementary and secondary schools in Mid-Norway. The results showed that girls reported higher scores on state anxiety and state depression, whereas boys consistently scored higher on SOC in all age groups. SOC was inversely associated with both state depression and state anxiety. An interaction effect of gender by SOC was found on both state depression and state anxiety, where the association was stronger for girls than for boys. CONCLUSIONS: The associations found give support for the implications of salutogenic factors in relation to emotional health in adolescents.

Evaluation of the Norwegian version of the Adolescent Stress Questionnaire (ASQ-N): factorial validity across samples.

In spite of the potential significance of stressors, the past decades have yielded only limited and incremental progress in the field of the development of valid and reliable stress inventories for adolescents. The Adolescent Stress Questionnaire (ASQ-N) was developed to address the domain of stressors specific to adolescent experience. The present study reports an evaluation of factorial validity, as well as the construct validity of the Norwegian version of the Adolescent Stress Questionnaire (ASQ-N) across two samples, with the use of confirmatory factor analysis (CFA). Gender and age differences on the ASQ-N sub-dimensions are also evaluated. The CFA supported a seven-factor structure, where all sub-dimensions showed adequate internal consistency. The sub-dimensions were correlated positively with measures of depression and anxiety, and were correlated negatively with self-esteem, supporting the construct validity of the ASQ-N. Significant gender differences in self-reported adolescent stress were found in five of the seven scales, where girls had higher mean scores than boys. The correlation between each stress scale and age was weak, with significant correlations found in four of the seven scales. It is suggested that the ASQ-N is a measure of adolescent stress that is adequate for the research context, as well as for clinical investigation.