Geir Lorem - Academia.edu (original) (raw)

Papers by Geir Lorem

Comparison of change in comorbitiy (HII) according to weight group at beginning and end of follow... more Comparison of change in comorbitiy (HII) according to weight group at beginning and end of follow-up period. (PDF 60 kb)

Additional file 1: Supplementary Table 1. Physical activity level according to age and sex. Suppl... more Additional file 1: Supplementary Table 1. Physical activity level according to age and sex. Supplementary figure 1. Activity level according to age and sex.

Additional file 2: Supplementary Table 2. Results from the random coefficient proportional odds m... more Additional file 2: Supplementary Table 2. Results from the random coefficient proportional odds model with estimates for the sex-specific associations of subject-specific factors with self-reported health.

Additional file 1. Interview schedule.

Health and quality of life outcomes, Jan 2, 2017

Utilizing a cohort study design combining a survey approach with repeated physical examinations, ... more Utilizing a cohort study design combining a survey approach with repeated physical examinations, we examined the independent effects of BMI on mortality and self-reported health (SRH) and whether these independent effects change as people grow older. The Tromsø Study consists of six surveys conducted in the municipality of Tromsø, Norway, with large representative samples of a general population. In total, 31,985 subjects participated in at least one of the four surveys administered between 1986 and 2008. Outcomes of interest were SRH and all-cause mortality. Overweight and underweight subjects reported significantly lower levels of SRH, but age affected the thinnest subjects more than all others. The SRH trajectory of underweight subjects at age 25 was slightly above the other categories (0.08), but it fell to -.30 below the reference category at age 90. For obese subjects, the difference was -0.15 below the reference category at age 25 and -0.18 below at age 90. This implies that ...

Nursing ethics, 2018

Visual technologies are central to youth culture and are often the preferred communication means ... more Visual technologies are central to youth culture and are often the preferred communication means of adolescents. Although these tools can be beneficial in fostering relations, adolescents' use of visual technologies and social media also raises ethical concerns. We explored how school public health nurses identify and resolve the ethical challenges involved in the use of visual technologies in health dialogues with adolescents. This is a qualitative study utilizing data from focus group discussions. Participants and research context: We conducted focus group discussions using two semi-structured discussion guides with seven groups of public health nurses (n = 40) working in Norwegian school health services. The data were collected during January and October 2016. Discussions were audio recorded, transcribed, and coded into themes and subthemes using systematic text condensation. Ethical considerations: The leader of the public health nursing service who agreed to provide access ...

International Journal of Mental Health Nursing, 2014

The use of coercion in mental health care is not self-evident and requires moral justification. A... more The use of coercion in mental health care is not self-evident and requires moral justification. A joint understanding is difficult to achieve, because patients and health professionals often evaluate coercion differently. The present study aims to discuss patients' 'moral' evaluation of coercion. We believe that such a focus can form the basis for a better and more differentiated understanding of how we evaluate coercion. This is a qualitative study based on participant observation and interviews with patients. In order to focus specifically on the moral evaluation of coercion, we looked within patients' narratives to examine whether we could differentiate between how they experienced coercion and how they morally evaluated its use, and how they envision/describe good coercion. We found that patients differentiated implicitly between experiences and moral evaluation. The findings have been ordered into three types of reactions: agreeing and accepting, fighting or resisting, and resignation. Further reflection upon patients' positive and negative moral evaluations of coercion resulted in the formulation of different concrete elements at three levels: threshold elements, process elements, and empathic elements. These elements helped us to understand what these patients considered 'good coercion'. The implications are that good clinical practice cannot be separated from the formal, moral evaluation of coercion. A differentiated moral understanding of coercion can form the basis for better and more sensitive communication about coercion among all those involved. A more respectful dialogue on the moral evaluation of coercion might also raise awareness during both the decision-making process and the actual practising of coercion.

Journal of advanced nursing, Jan 29, 2017

We aimed to explore how using visual methods might improve or complicate the dynamics of the heal... more We aimed to explore how using visual methods might improve or complicate the dynamics of the health dialogue between public health nurses (PHNs) and school pupils. This was done from the perspective of PHNs, specifically examining how they understood their role and practice as a PHN and the application of visual methods in this practice. The health dialogue is a method used by PHNs in school nursing in Norway. In this practice, there can be communicative barriers between pupils and PHNs. Investigating how PHNs understand their professional practice can lead to ways of addressing these communicative barriers, which can affect pupil satisfaction and achievement of health-related behaviours in the school context. Specifically, the use of visual methods by PHNs may address these communicative barriers. The research design was qualitative, using focus groups combined with visual methods. We conducted focus group interviews using a semi-structured discussion guide and visual methods with ...

International Journal of Circumpolar Health, 2021

Given the higher suicide rates among the adult population in the northernmost part of Norway and ... more Given the higher suicide rates among the adult population in the northernmost part of Norway and some unfavourable psychosocial outcomes associated with the Laestadian revival movement in this region, it is reasonable to investigate the relationship between religiosity/spirituality and suicidal behaviour in this context. This study used cross-sectional data from the population-based SAMINOR 2 questionnaire survey (2012; n = 11,222; 66% non-Sámi; 22% Laestadian-affiliated; 27% response rate) in mixed Sámi-Norwegian areas of Mid and North Norway. We analysed the associations between religious/spiritual factors and lifetime suicidal ideation and attempts, age at the first attempt, motives, and number of attempts. Multivariable-adjusted regression models considering sociodemographics, Sámi background and self-ascription, and health-related risk factors were applied. Sámi and Laestadian affiliations were significantly associated with religious self-ascription, regular attendance, and Est...

Mental Health, Religion & Culture

ABSTRACT Research has found psychological dimensions of religiosity/spirituality (R/S) beneficial... more ABSTRACT Research has found psychological dimensions of religiosity/spirituality (R/S) beneficial against non-suicidal self-injury (NSSI), whereas the effect of R/S social aspects is less studied. Using data from the SAMINOR 2 Questionnaire Survey (2012, n = 10,717 ages 18–69; response rate: 27%; non-Sami: 66%; females: 55%), we examined the association of R/S—religious attendance, congregational affiliation, Laestadian family background, religious importance/view of life—with NSSI in the adult Sami and non-Sami population of Arctic Norway. We also applied multivariable-adjusted regression models and mediation analyses to explore how religious participation transmits its effect on NSSI through violence exposure and symptoms of anxiety and depression. Across ethnicities, 3.3 percent (n = 355) reported lifetime NSSI—ranging from 1.2 percent among Laestadians to 7.7 percent in unaffiliated. Regular religious attendance had a significant negative total effect on NSSI (OR = .59). Ninety-five percent of this effect seemed to be due to fewer anxiety and depression symptoms in the attendance group.

Sarcoma

Background. This study explored how patients with metastatic gastrointestinal stromal tumour (GIS... more Background. This study explored how patients with metastatic gastrointestinal stromal tumour (GIST) experience the psychosocial challenges associated with their disease and its treatment, as well as how that experience influenced their practical, relational, vocational, and existential life. Methods. This qualitative study has an explorative design and applied a phenomenological and hermeneutical approach. We conducted in-depth, semistructured interviews with 20 patients with metastatic GIST in long-term clinical remission. The gathered data were interpreted using a thematic analysis. Results. Living with metastatic GIST, as well as the side effects of the required medication, led to changes that limited the participants’ daily life. They expressed how tiredness, impaired memory, and physical challenges were among the detrimental impacts of the disease on their family life, vocational life, social life, and leisure time. Adjustments were necessary to ensure they had sufficient energ...

Scientific Reports

Self-reported health (SRH) is widely used as an epidemiological instrument given the changes in p... more Self-reported health (SRH) is widely used as an epidemiological instrument given the changes in public health since its introduction in the 1980s. We examined the association between SRH and mortality and how this is affected by time and health measurements in a prospective cohort study using repeated measurements and physical examinations of 11652 men and 12684 women in Tromsø, Norway. We used Cox proportional hazard regression to estimate hazard ratios (HRs) of death for SRH, controlling for pathology, biometrics, smoking, sex and age. SRH predicted mortality independently of other, more objective health measures. Higher SRH was strongly associated with lower mortality risk. Poor SRH had HR 2.51 (CI: 2.19, 2.88). SRH is affected by disease, mental health and other risk factors, but these factors had little impact on HRs (Poor SRH: HR 1.99; CI: 1.72, 2.31). SRH predicted mortality, but with a time-dependent effect. Time strongly affected the hazard ratio for mortality, especially a...

Clinical Sarcoma Research

Background: This study aims to explore how patients with metastatic gastrointestinal stromal tumo... more Background: This study aims to explore how patients with metastatic gastrointestinal stromal tumour (GIST) experience the adverse effects of treatment, as expressed by the individuals themselves. Methods: A qualitative, phenomenological and hermeneutic design was applied. Twenty patients with metastatic GIST participated in the study. In-depth and semi-structured interviews were conducted and then analysed by means of an inductive thematic analysis. Results: The majority of participants reported experiencing a changed life after being diagnosed with metastatic GIST and commencing systemic medical treatment. More than half of them described partially debilitating selfreported side effects and complaints that had a detrimental impact on their lives. The life-prolonging tyrosine kinase inhibitor treatment prompted the participants to adapt to 'a new normal'. Several participants also emphasised having an ambivalent relationship with the pill, although most looked upon it as 'a friend' because it kept them alive. Paradoxically, while the participants struggled with the side effects of treatment as well as the consequences of living with a chronic cancer, half of them considered themselves to be healthy and, thus, to not actually be cancer patients. Conclusions: We observed a gap between the biomedical perspective on disease that health professionals typically adopt and the individual experiences of patients living with metastatic GIST. For those patients who are living in limbo between having metastatic cancer and offered an effective treatment, a holistic view of health on the part of their healthcare providers seems crucial. A vital goal should hence be to improve communication between healthcare professionals and GIST patients so as to secure an individualised follow-up with guidance on coping with, and adapting to, their new normal.

Journal of Clinical Nursing

Acknowledgements: The authors would like to thank the study participants for their contributions ... more Acknowledgements: The authors would like to thank the study participants for their contributions and Randi Elisabeth Olsen for assistance in planning and conducting the study.

Narrative Inquiry

This article deals with user involvement in mental health care and emerges from interviews with f... more This article deals with user involvement in mental health care and emerges from interviews with four service users at a community mental health center in northern Norway. The stories told by the participants were related to an impending closure of the center following a new health care reform. The aim of this article is to take a closer look at how user involvement was performed by the participants in the storytelling context. We explore the stories told using narrative contextualization analysis. Through our analysis, we find that narrative environments demands our attention to turn to storytelling as stories play out in the here and now of everyday life in mental health care.

Mental Health Review Journal, 2016

Purpose The concept of user participation is well accepted internationally. Nevertheless, studies... more Purpose The concept of user participation is well accepted internationally. Nevertheless, studies show that both patients and health professionals find it challenging to maintain patient-centred ideals in the context of severe mental illness. The purpose of this paper is to explore how professionals deal with the ideals in light of patients’ right to participate in planning and decision making regarding milieu therapeutic measures and activities. Design/methodology/approach This is a qualitative study with an interactionist approach based on fieldwork at three district psychiatric centres in Norway during 2011-2012. The observations focused on patient-staff interaction in milieu therapeutic activities. Interviews were based on observed situations. Findings Adherence to treatment, rules and routines restricted patient autonomy. The professionals’ practical orientation towards routines overrode the ideals of patients’ rights. The staff regarded user participation primarily as particip...

Journal of Mental Health, 2016

Community treatment orders (CTOs) are being increasingly used in Western countries. The scheme im... more Community treatment orders (CTOs) are being increasingly used in Western countries. The scheme implies that mental health patients can live outside a hospital, but still be subject to coercive care to ensure compliance with their treatment. There is limited knowledge of how the scheme is practised. To gain knowledge of how decision makers weigh and evaluate various considerations when making decisions on CTOs. Qualitative in-depth interviews with decision makers responsible for CTOs in Norway. Decision makers viewed CTOs as a useful scheme to ensure control, continuity and follow-up care in the treatment of outpatients with a history of poor treatment motivation. They had varied interest in and knowledge of the patient's life situation and how the scheme affects the patient's everyday life. Little attention was devoted to patient experiences of formal and informal coercion. When deciding on CTOs, decision makers should pay more attention to the negative consequences that patients may experience. In many cases, decision makers are probably not aware of these coercive factors.

Comparison of change in comorbitiy (HII) according to weight group at beginning and end of follow... more Comparison of change in comorbitiy (HII) according to weight group at beginning and end of follow-up period. (PDF 60 kb)

Additional file 1: Supplementary Table 1. Physical activity level according to age and sex. Suppl... more Additional file 1: Supplementary Table 1. Physical activity level according to age and sex. Supplementary figure 1. Activity level according to age and sex.

Additional file 2: Supplementary Table 2. Results from the random coefficient proportional odds m... more Additional file 2: Supplementary Table 2. Results from the random coefficient proportional odds model with estimates for the sex-specific associations of subject-specific factors with self-reported health.

Additional file 1. Interview schedule.

Health and quality of life outcomes, Jan 2, 2017

Utilizing a cohort study design combining a survey approach with repeated physical examinations, ... more Utilizing a cohort study design combining a survey approach with repeated physical examinations, we examined the independent effects of BMI on mortality and self-reported health (SRH) and whether these independent effects change as people grow older. The Tromsø Study consists of six surveys conducted in the municipality of Tromsø, Norway, with large representative samples of a general population. In total, 31,985 subjects participated in at least one of the four surveys administered between 1986 and 2008. Outcomes of interest were SRH and all-cause mortality. Overweight and underweight subjects reported significantly lower levels of SRH, but age affected the thinnest subjects more than all others. The SRH trajectory of underweight subjects at age 25 was slightly above the other categories (0.08), but it fell to -.30 below the reference category at age 90. For obese subjects, the difference was -0.15 below the reference category at age 25 and -0.18 below at age 90. This implies that ...

Nursing ethics, 2018

Visual technologies are central to youth culture and are often the preferred communication means ... more Visual technologies are central to youth culture and are often the preferred communication means of adolescents. Although these tools can be beneficial in fostering relations, adolescents' use of visual technologies and social media also raises ethical concerns. We explored how school public health nurses identify and resolve the ethical challenges involved in the use of visual technologies in health dialogues with adolescents. This is a qualitative study utilizing data from focus group discussions. Participants and research context: We conducted focus group discussions using two semi-structured discussion guides with seven groups of public health nurses (n = 40) working in Norwegian school health services. The data were collected during January and October 2016. Discussions were audio recorded, transcribed, and coded into themes and subthemes using systematic text condensation. Ethical considerations: The leader of the public health nursing service who agreed to provide access ...

International Journal of Mental Health Nursing, 2014

The use of coercion in mental health care is not self-evident and requires moral justification. A... more The use of coercion in mental health care is not self-evident and requires moral justification. A joint understanding is difficult to achieve, because patients and health professionals often evaluate coercion differently. The present study aims to discuss patients' 'moral' evaluation of coercion. We believe that such a focus can form the basis for a better and more differentiated understanding of how we evaluate coercion. This is a qualitative study based on participant observation and interviews with patients. In order to focus specifically on the moral evaluation of coercion, we looked within patients' narratives to examine whether we could differentiate between how they experienced coercion and how they morally evaluated its use, and how they envision/describe good coercion. We found that patients differentiated implicitly between experiences and moral evaluation. The findings have been ordered into three types of reactions: agreeing and accepting, fighting or resisting, and resignation. Further reflection upon patients' positive and negative moral evaluations of coercion resulted in the formulation of different concrete elements at three levels: threshold elements, process elements, and empathic elements. These elements helped us to understand what these patients considered 'good coercion'. The implications are that good clinical practice cannot be separated from the formal, moral evaluation of coercion. A differentiated moral understanding of coercion can form the basis for better and more sensitive communication about coercion among all those involved. A more respectful dialogue on the moral evaluation of coercion might also raise awareness during both the decision-making process and the actual practising of coercion.

Journal of advanced nursing, Jan 29, 2017

We aimed to explore how using visual methods might improve or complicate the dynamics of the heal... more We aimed to explore how using visual methods might improve or complicate the dynamics of the health dialogue between public health nurses (PHNs) and school pupils. This was done from the perspective of PHNs, specifically examining how they understood their role and practice as a PHN and the application of visual methods in this practice. The health dialogue is a method used by PHNs in school nursing in Norway. In this practice, there can be communicative barriers between pupils and PHNs. Investigating how PHNs understand their professional practice can lead to ways of addressing these communicative barriers, which can affect pupil satisfaction and achievement of health-related behaviours in the school context. Specifically, the use of visual methods by PHNs may address these communicative barriers. The research design was qualitative, using focus groups combined with visual methods. We conducted focus group interviews using a semi-structured discussion guide and visual methods with ...

International Journal of Circumpolar Health, 2021

Given the higher suicide rates among the adult population in the northernmost part of Norway and ... more Given the higher suicide rates among the adult population in the northernmost part of Norway and some unfavourable psychosocial outcomes associated with the Laestadian revival movement in this region, it is reasonable to investigate the relationship between religiosity/spirituality and suicidal behaviour in this context. This study used cross-sectional data from the population-based SAMINOR 2 questionnaire survey (2012; n = 11,222; 66% non-Sámi; 22% Laestadian-affiliated; 27% response rate) in mixed Sámi-Norwegian areas of Mid and North Norway. We analysed the associations between religious/spiritual factors and lifetime suicidal ideation and attempts, age at the first attempt, motives, and number of attempts. Multivariable-adjusted regression models considering sociodemographics, Sámi background and self-ascription, and health-related risk factors were applied. Sámi and Laestadian affiliations were significantly associated with religious self-ascription, regular attendance, and Est...

Mental Health, Religion & Culture

ABSTRACT Research has found psychological dimensions of religiosity/spirituality (R/S) beneficial... more ABSTRACT Research has found psychological dimensions of religiosity/spirituality (R/S) beneficial against non-suicidal self-injury (NSSI), whereas the effect of R/S social aspects is less studied. Using data from the SAMINOR 2 Questionnaire Survey (2012, n = 10,717 ages 18–69; response rate: 27%; non-Sami: 66%; females: 55%), we examined the association of R/S—religious attendance, congregational affiliation, Laestadian family background, religious importance/view of life—with NSSI in the adult Sami and non-Sami population of Arctic Norway. We also applied multivariable-adjusted regression models and mediation analyses to explore how religious participation transmits its effect on NSSI through violence exposure and symptoms of anxiety and depression. Across ethnicities, 3.3 percent (n = 355) reported lifetime NSSI—ranging from 1.2 percent among Laestadians to 7.7 percent in unaffiliated. Regular religious attendance had a significant negative total effect on NSSI (OR = .59). Ninety-five percent of this effect seemed to be due to fewer anxiety and depression symptoms in the attendance group.

Sarcoma

Background. This study explored how patients with metastatic gastrointestinal stromal tumour (GIS... more Background. This study explored how patients with metastatic gastrointestinal stromal tumour (GIST) experience the psychosocial challenges associated with their disease and its treatment, as well as how that experience influenced their practical, relational, vocational, and existential life. Methods. This qualitative study has an explorative design and applied a phenomenological and hermeneutical approach. We conducted in-depth, semistructured interviews with 20 patients with metastatic GIST in long-term clinical remission. The gathered data were interpreted using a thematic analysis. Results. Living with metastatic GIST, as well as the side effects of the required medication, led to changes that limited the participants’ daily life. They expressed how tiredness, impaired memory, and physical challenges were among the detrimental impacts of the disease on their family life, vocational life, social life, and leisure time. Adjustments were necessary to ensure they had sufficient energ...

Scientific Reports

Self-reported health (SRH) is widely used as an epidemiological instrument given the changes in p... more Self-reported health (SRH) is widely used as an epidemiological instrument given the changes in public health since its introduction in the 1980s. We examined the association between SRH and mortality and how this is affected by time and health measurements in a prospective cohort study using repeated measurements and physical examinations of 11652 men and 12684 women in Tromsø, Norway. We used Cox proportional hazard regression to estimate hazard ratios (HRs) of death for SRH, controlling for pathology, biometrics, smoking, sex and age. SRH predicted mortality independently of other, more objective health measures. Higher SRH was strongly associated with lower mortality risk. Poor SRH had HR 2.51 (CI: 2.19, 2.88). SRH is affected by disease, mental health and other risk factors, but these factors had little impact on HRs (Poor SRH: HR 1.99; CI: 1.72, 2.31). SRH predicted mortality, but with a time-dependent effect. Time strongly affected the hazard ratio for mortality, especially a...

Clinical Sarcoma Research

Background: This study aims to explore how patients with metastatic gastrointestinal stromal tumo... more Background: This study aims to explore how patients with metastatic gastrointestinal stromal tumour (GIST) experience the adverse effects of treatment, as expressed by the individuals themselves. Methods: A qualitative, phenomenological and hermeneutic design was applied. Twenty patients with metastatic GIST participated in the study. In-depth and semi-structured interviews were conducted and then analysed by means of an inductive thematic analysis. Results: The majority of participants reported experiencing a changed life after being diagnosed with metastatic GIST and commencing systemic medical treatment. More than half of them described partially debilitating selfreported side effects and complaints that had a detrimental impact on their lives. The life-prolonging tyrosine kinase inhibitor treatment prompted the participants to adapt to 'a new normal'. Several participants also emphasised having an ambivalent relationship with the pill, although most looked upon it as 'a friend' because it kept them alive. Paradoxically, while the participants struggled with the side effects of treatment as well as the consequences of living with a chronic cancer, half of them considered themselves to be healthy and, thus, to not actually be cancer patients. Conclusions: We observed a gap between the biomedical perspective on disease that health professionals typically adopt and the individual experiences of patients living with metastatic GIST. For those patients who are living in limbo between having metastatic cancer and offered an effective treatment, a holistic view of health on the part of their healthcare providers seems crucial. A vital goal should hence be to improve communication between healthcare professionals and GIST patients so as to secure an individualised follow-up with guidance on coping with, and adapting to, their new normal.

Journal of Clinical Nursing

Acknowledgements: The authors would like to thank the study participants for their contributions ... more Acknowledgements: The authors would like to thank the study participants for their contributions and Randi Elisabeth Olsen for assistance in planning and conducting the study.

Narrative Inquiry

This article deals with user involvement in mental health care and emerges from interviews with f... more This article deals with user involvement in mental health care and emerges from interviews with four service users at a community mental health center in northern Norway. The stories told by the participants were related to an impending closure of the center following a new health care reform. The aim of this article is to take a closer look at how user involvement was performed by the participants in the storytelling context. We explore the stories told using narrative contextualization analysis. Through our analysis, we find that narrative environments demands our attention to turn to storytelling as stories play out in the here and now of everyday life in mental health care.

Mental Health Review Journal, 2016

Purpose The concept of user participation is well accepted internationally. Nevertheless, studies... more Purpose The concept of user participation is well accepted internationally. Nevertheless, studies show that both patients and health professionals find it challenging to maintain patient-centred ideals in the context of severe mental illness. The purpose of this paper is to explore how professionals deal with the ideals in light of patients’ right to participate in planning and decision making regarding milieu therapeutic measures and activities. Design/methodology/approach This is a qualitative study with an interactionist approach based on fieldwork at three district psychiatric centres in Norway during 2011-2012. The observations focused on patient-staff interaction in milieu therapeutic activities. Interviews were based on observed situations. Findings Adherence to treatment, rules and routines restricted patient autonomy. The professionals’ practical orientation towards routines overrode the ideals of patients’ rights. The staff regarded user participation primarily as particip...

Journal of Mental Health, 2016

Community treatment orders (CTOs) are being increasingly used in Western countries. The scheme im... more Community treatment orders (CTOs) are being increasingly used in Western countries. The scheme implies that mental health patients can live outside a hospital, but still be subject to coercive care to ensure compliance with their treatment. There is limited knowledge of how the scheme is practised. To gain knowledge of how decision makers weigh and evaluate various considerations when making decisions on CTOs. Qualitative in-depth interviews with decision makers responsible for CTOs in Norway. Decision makers viewed CTOs as a useful scheme to ensure control, continuity and follow-up care in the treatment of outpatients with a history of poor treatment motivation. They had varied interest in and knowledge of the patient's life situation and how the scheme affects the patient's everyday life. Little attention was devoted to patient experiences of formal and informal coercion. When deciding on CTOs, decision makers should pay more attention to the negative consequences that patients may experience. In many cases, decision makers are probably not aware of these coercive factors.