Risk factors for requiring cholecystectomy for gallstone disease in a prospective population-based cohort study.

BACKGROUND: The relationship between different lifestyle factors and the risk of needing cholecystectomy for gallstone disease is not clear. This study aimed to assess the association between anthropometric, lifestyle and sociodemographic risk factors and the subsequent risk of requiring cholecystectomy for gallstone disease during long-term follow-up in a defined population cohort. METHODS: Data from a large population-based cohort study performed from 1995 to 1997 were used (the second Norwegian Nord-Trøndelag health study, HUNT2). Following HUNT2, from 1998 to 2011, all patients operated on for gallstone disease with cholecystectomy at the two hospitals in the county, Levanger Hospital and Namsos Hospital, were identified. A Cox proportional hazards model was used for multivariable risk analysis. RESULTS: The HUNT2 cohort included 65 237 individuals (69·5 per cent response rate), aged 20-99 years. During a median follow-up of 15·3 (range 0·6-16·4) years, 1162 cholecystectomies were performed. In multivariable analysis, overweight individuals (body mass index (BMI) 25·0-29·9 kg/m(2) ) had a 58 per cent increased risk of cholecystectomy compared with individuals with normal weight (BMI less than 25·0 kg/m(2) ). Obese individuals (BMI 30 kg/m(2) or above) had a twofold increased risk. Increasing waist circumference independently increased the risk of cholecystectomy. In women, current hormone replacement therapy (HRT) increased the risk, whereas hard physical activity and higher educational level were associated with reduced risk of cholecystectomy. CONCLUSION: High BMI and waist circumference increased the risk of having cholecystectomy for both sexes. In women, the risk was increased by HRT, and decreased by hard physical activity and higher educational level.

Being in a process of transition to psychosis, as narrated by adults with psychotic illnesses acutely admitted to hospital.

To assist in improving early interventions for psychosis, this study explored how adult people narrated their experience of becoming psychotic, and how contact with mental health personnel was established. Narrative interviews were conducted with 12 participants with psychotic illnesses recruited from acute psychiatric wards. The interviews were content analysed. Participants described being in a process of transition to psychosis as follows: experiencing changes as well-known signs of psychosis, experiencing sudden unexpected changes as signs of psychosis and experiencing unidentified changes as signs of illness. Our results show that participants and their close others who knew the signs of psychosis established a dialogue with mental health personnel and were better equipped to prevent and mitigate the psychosis. Our results demonstrate that participants who did not perceive the signs of psychosis and did not have other people to advocate for them were at risk for delayed treatment, poor communication and coercive interventions. Furthermore, participants who did not know the signs of psychosis perceived these changes as deterioration in their health and awareness of illness. We suggest that participants' experiential knowledge of transitioning to psychosis and an awareness of illness can be used to improve the communication during interventions for psychosis.

Psychiatric nurses' response to suicidal psychiatric inpatients: struggling with self and sufferer.

Research on nurses' responses to suicidal patients is sparse. The purpose of this secondary analysis of qualitative data from interviews with 19 nurses employed in Norway was to describe nurses' responses to suicidal psychiatric inpatients. Thematic analyses revealed four themes: 'struggling with discernment of self and sufferer'; 'reconciling inner dialogue'; 'opening up while envisioning self from sufferer'; and 'revisioning the meaning of life revealed over time'. The main theme was 'struggling with self and sufferer'. While these findings reveal existential issues and self reflections of psychiatric nurses' struggle with the suffering of suicidal patients, they also contribute to a methodological debate. Further research is needed to examine nurses' responses to suicidal patients in various settings and to develop secondary analysis of qualitative data.

Being met--a passageway to hope for relatives of patients at risk of committing suicide: a phenomenological hermeneutic study.

Fifteen Norwegian relatives narrated their experiences of "being met" by mental health care personnel regarding the care of their adult family member who had seriously thought about or attempted suicide. The narrative interviews were audiotaped, transcribed into text, and then interpreted using a phenomenological hermeneutic method. The results of the interpretation revealed that the context of being met was characterized by "being helpless and powerless." The six themes that were constructed describing being met were: Being-seen as a human being; participating in an I-Thou relationship; trusting personnel, treatment, and care; feeling trusted by personnel; being consoled; and entering into hope. The experience of being met in the midst of the care of a relative in crisis created possibilities for hope. Being met, in this context, is a passageway to hope.

The meaning of suicidal psychiatric inpatients' experiences of being treated by physicians.

Twenty-one psychiatric inpatients who had thought about, expressed a wish to, or even attempted to commit suicide narrated their experiences of receiving treatment from physicians. The interview texts were transcribed and interpreted using a phenomenological-hermeneutic method inspired by the philosophy of Ricoeur. Two main themes and eight themes were found. Participating Approach: being with the patients, listening to patients without prejudice, trusting each other, respecting patients' integrity; and Observing Approach: leaving patients to themselves, listening to patients with prejudice, mistrusting each other, not respecting patients' integrity. These findings were interpreted in the light of the writings of Hegel, Buber and Cissna and Sieburg. The suicidal patients expressed their need for confirmation in their interaction with physicians, that is they needed to meet with respect and interest when staying in the hospital with suicidal thoughts or after suicidal attempts.

Physicians' stories about suicidal psychiatric inpatients.

Fourteen Norwegian, three Danish, and two Swedish physicians employed at a Norwegian psychiatric hospital narrated their lived experiences in caring for suicidal psychiatric inpatients. The interview text was transcribed and interpreted using a phenomenological-hermeneutics method, inspired by Ricoeur's philosophy. Two main themes were found: Power Over, i.e. Communicating with the patients; Not accepting one's own mortality; Not accepting one's own vulnerability; Not accepting one's own fallibility; Being rejected by the patients; and Power To, Deep communicating with the patients; Accepting one's own mortality; Accepting one's own vulnerability; Accepting one's own fallibility; Being trusted by the patients. These findings were pondered in the light of Cissna's and Sieburg's writings about confirming. The study emphasizes the importance to physicians of confronting their own strong and frightening feelings about mortality, vulnerability and fallibility in order to confirm suicidal psychiatric patients during interactions with them, when in hospital after suicide thoughts and attempts.

The meaning of suicidal psychiatric in-patients' experiences of being cared for by mental health nurses.

Twenty-one psychiatric in-patients who had thought about, expressed the wish or even attempted to commit suicide narrated their experiences of receiving care from mental health nurses. The interview texts were transcribed and interpreted using a phenomenological-hermeneutic method, inspired by Ricoeur's philosophy. Two main themes with subthemes were found: Confirming: attending to patients' basic needs; seeing patient; having time for patient; being with patient; listening to patient without prejudice; being open to patient; accepting patient's feelings; communicating hope to patient; and Lack of confirming: overlooking patient's basic needs; not seeing patient; not having time for patient; leaving patient to herself or himself; listening to patient with prejudice; not being open to patient; denying patient her or his feelings; communicating hopelessness to patient. These findings were interpreted in the light of Hegel's philosophy of mutual recognition and confirmation. When relating episodes of good or bad nursing care suicidal patients emphasized their need for confirmation during their interaction with nurses when in hospital after suicide attempts.

Male nurses--reasons for entering and experiences of being in the profession.

In order to illuminate male nurse teachers' and nurse students' reasons for choosing to become nurses, and their experiences and positions within the profession, all 13 males among a total of 184 nurse teachers and students at one nursing school in Norway were interviewed twice with a 10-year interval between the interviews. In a personal interview in 1984 all the interviewees emphasized that their desire to become nurses was connected with a wish to act in a woman's role and expressed feminine values. The interviewees' fathers disapproved while their mothers approved with their choices to become nurses. The subjects thought that female nurses did not accept that they were bedside nurses, and exerted pressure on them to adopt roles within nursing that were perceived to be male; i.e. teachers, or administrators. In a telephone interview in 1994 they were asked about their experiences and positions within the profession. Eight interviewees had worked as nurses within psychiatric care and ten had current senior positions. They stated that the most positive thing in the profession was the contact with the patients and meaning so much to someone. All said they would have made the same choice today and become nurses.