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Introduction: The implementation and evaluation of patient participation to obtain high‐quality transitional care for older people is an international priority. Intermediate care (IC) services are regarded as an important part of the patient's pathway from the specialist to the primary care levels, bridging the gap between the hospital and the home. Patients may experience varying capacities and conditions for patient participation. Yet, few tools for evaluating patients' preferences for patient participation within IC services are at hand. Accordingly, further knowledge is needed to understand and scaffold processes for patient participation in IC. Therefore, the aim of this project was to translate, validate and pilot test the Patient Preferences for Patient Participation (the 4Ps) with patients in IC services in Norway. Methods: This project comprised two phases: (1) a careful translation and cultural adaptation process, followed by a content validity trial among 15 patients and staff in Norwegian IC and (2) a cross‐sectional survey of the instrument with 60 patients admitted to IC. Results: The translation between Swedish and Norwegian required no conceptual or contextual adaptations. The subsequent cross‐sectional study, designed as a dialogue between the patients and staff, revealed that only 50% of the participants received a sufficient level of patient participation based on their preferences, mostly indicating that patients were receiving less‐than‐preferred conditions for engaging in their health and healthcare issues. Conclusion: The 4Ps instrument was deemed suitable for measuring patient participation based on patient preferences in the IC context and was feasible for both healthcare professionals and patients to complete in an interview when arriving at and leaving services. This may support person‐centred communication and collaboration, calling for further research on what facilitates patient participation and the implementation of person‐centred services for patients in IC. Patient or Public Contribution: First, the current paper is part of the IPIC study (i.e., the implementation of patient participation in IC). Influenced by a James Lind Alliance process, the study addresses research uncertainties identified by patients, next of kin, staff and researchers in the cocreation process. Second, cognitive interviewing was conducted with 15 representatives of the target population: seven patients receiving IC services, one home‐dwelling previous IC patient (altogether four women and four men, most of them 80 years or older) and seven healthcare staff working in IC services. The interviews determined the relevance, comprehensiveness and clarity of the 4Ps. Finally, 60 patients admitted to IC took part in the cross‐sectional study. [ABSTRACT FROM AUTHOR]

The present study aims to explore the forms paternalistic communication can take in doctor–patient interactions and how they should be considered from a normative perspective. In contemporary philosophical debate, the problem with paternalism is often perceived as either undermining autonomy (the autonomy problem) or the paternalist viewing their judgment as superior (the superiority problem). In either case, paternalism is problematized mainly in a general, theoretical sense. In contrast, this paper investigates specific doctor–patient encounters, revealing distinct types of paternalistic communication. For this study, I reviewed videorecorded encounters from a Norwegian hospital to detect paternalism—specifically, doctors overriding patients' expressed preferences, presumably to benefit or protect the patients. I identified variations in paternalistic communication styles—termed paternalist modes—which I categorized into four types: the fighter, the advocate, the sympathizer, and the fisher. Drawing on these findings, I aim to nuance the debate on paternalism. Specifically, I argue that each paternalist mode carries its own normative implications and that the autonomy and the superiority problems manifest differently across the modes. Furthermore, by illustrating paternalism in communication through real‐life cases, I aim to reach a more comprehensive understanding of what we mean by paternalistic doctors. [ABSTRACT FROM AUTHOR]

Background: The surge of online platforms has generated interest in how specialized platforms support formal and informal learning in various disciplinary domains. Knowledge is still limited regarding how undergraduate students navigate and use platforms to learn. Objectives: This study explores computer and software engineering students' learning practices, wherein online platforms are used as resources for both curricular learning activities and students' interest‐driven learning. Methods: The learning practices of 73 students were examined using a mixed‐methods design and a conceptualization of practices accounting for the context and purpose of their enactment. The dataset includes students' self‐reports on domain‐specific learning activities, three‐month‐long web‐browsing history of multiple platforms and stimulated‐recall interviews. The data were analysed through latent class and thematic analyses. Results and Conclusion: Five distinct patterns were found in the use of online platforms. These patterns show that different types of platforms were used purposely and in combination during curricular and interest‐driven activities aimed at learning software development. Moreover, students' purposes were driven by both the need to progress in their learning activities and the development of their interest in software development. The findings highlight the complexity of students' learning with online platforms, which develop quite extensively beyond curricular boundaries. Implications: The findings stress the need to recognize that undergraduate students' learning practices involve multiple online platforms and activities beyond the formal curriculum and that these play a key role in developing students' interests in learning software development. Moreover, our findings indicate the importance of taking into account the way students' learning practices unfold within platforms and how these relate to domain‐specific practices. Lay Description: What is already known about this topic?: Online platforms are mostly used by teaching staff in undergraduate education to support student learning during formal curricular tasks.Research knowledge is limited mostly to specific features of social networking platforms, such as Facebook Groups or instant messaging technologies.Students informally use interest‐driven activities and both social and domain‐specific platforms to support their learning.Research on students' interest in using massive open online courses suggested that students' learning is motivated by academic success, prospective economic opportunities, and personal interests. What this paper adds?: Students combine various types of online platforms purposely (e.g., search engines or Q&A sites), many of which are domain‐specific (e.g., Stack Overflow).Students use online platforms informally during work on curricular tasks to, for example, collaborate, solve problems, and understand concepts or methods.Domain‐specific (e.g., software engineering) platforms are used during other study‐related leisure and entrepreneurial activities.Online platforms play a key role in how students develop their interests in learning. Through them, students connect not only with other students but also with professionals, companies, and information about them. Implications of study findings for practitioners: Curriculum developers and faculty should consider preparing students to use disparate types of online platforms beyond what is included in the curriculum.Curriculum developers should also consider other activities beyond the classroom that are study‐related and meaningful for students and their learning. [ABSTRACT FROM AUTHOR]

Background: Globally, digital skills are a crucial aspect of education that schools should develop systematically. Research on digital skills tends to be measured using self‐reports, performance tests or interventions. There is less knowledge about student and teacher uptake of technology in school, making it important to investigate the actual use of technology and digital skills in authentic classroom settings. Objectives: This study contributes unique baseline data concerning students' use of technology and digital skills across mandatory English courses in real classroom settings in secondary schools in Norway over time. Methods: The study adapted a national framework for digital skills into an observation protocol. With it, this study analysed videos from 60 naturally occurring English lessons in 13 English classes at seven lower secondary schools over two school years (grades 9 and 10), following 186 students (aged 13–15) and 10 teachers. Results and Conclusions: Students used digital skills critical for education in half of the video‐recorded English lessons, with more digital skill use at some schools over time. The main finding across classrooms and school years regards students' use of basic, not advanced, digital skills. Takeaways: Although teachers provide opportunities for students to use digital skills in school, more advanced skills are needed. This work calls for continued use of video recordings to provide systematic comparisons of potential shifts in students' digital skills in real English secondary classroom settings over time. Lay Description: What is currently known: Digital skills is a crucial aspect of education globallyStudent and teacher uptake of technology varies extensivelyMost studies on the use of digital technology concern self‐reports and interventionsFew studies exist concerning the actual use of digital skills in the classroom What this paper adds: Video recordings from seven English classrooms across two school years are analysed.A framework for digital skills is adopted and used as observation protocolAttention is given to the difference between basic and advanced digital skillsHow technology is actually used matters more than how much technology is available Implications of study findings for practitioners: Teachers should offer opportunities for students' use of digital skills in the classroomSubject‐specific use of digital skills should be prioritizedThere is a need for more emphasis on reflection and digital judgementWe need to encourage the use of advanced digital skills and not only basic skills [ABSTRACT FROM AUTHOR]

Background: The development and promotion of educational games are still outpacing knowledge of these games' effects, raising calls for evidence of benefits and challenges. Studies suggest that students and teachers like games, but the payoff of the investment in terms of increased motivation and achievement remains unclear. Objectives: This study investigates the pure effect of a marketing simulation game on motivation, perceived learning and achievement, above and beyond regular student‐active instruction. Methods: We applied a randomized, controlled experiment in a marketing course in upper‐secondary schools (Nclasses = 22; Nstudents = 433) comparing a collaborative–competitive marketing simulation game with regular, case‐based, student‐active instruction on three groups of outcome measures: motivation, perceived ability, and achievement. Additionally, students and teachers provided quantitative and qualitative feedback on game experiences. Results and Conclusions: We showcase the importance of a robust study design with valid compound instruments. Moreover, investigations of the game implementation and experiences reveal insights about intervention timing, differential negative consequences by gender and need for reflection opportunities. We find no clear evidence of positive or negative effects of the game, despite students' and teachers' satisfaction. Implications: Beyond the effect evaluation, we offer recommendations to researchers and developers of educational games about scaffolding, timing and teacher competence building. Lay Description: What is already known about this topic: Some curricula contains many terms and complex knowledge links.Simulation games are a popular remedy for these challenges.Prior studies have relied on users' satisfaction with the game and unrealistic comparisons. What this paper adds: This experiment compares game usage and regular student‐active instruction.They use various measures of satisfaction, motivation, perceived learning and achievement.The game has no effect on main outcomes. Implications for practice and/or policy: Game implementation requires digitally acquainted and trained teachers.Uncritical game design and use may motivate competitive boys over collaborative girls. [ABSTRACT FROM AUTHOR]

This paper investigates different uses of the Journal Impact Factor (JIF) in national journal rankings and discusses the merits of supplementing metrics with expert assessment. Our focus is national journal rankings used as evidence to support decisions about the distribution of institutional funding or career advancement. The seven countries under comparison are China, Denmark, Finland, Italy, Norway, Poland, and Turkey—and the region of Flanders in Belgium. With the exception of Italy, top‐tier journals used in national rankings include those classified at the highest level, or according to tier, or points implemented. A total of 3,565 (75.8%) out of 4,701 unique top‐tier journals were identified as having a JIF, with 55.7% belonging to the first Journal Impact Factor quartile. Journal rankings in China, Flanders, Poland, and Turkey classify journals with a JIF as being top‐tier, but only when they are in the first quartile of the Average Journal Impact Factor Percentile. Journal rankings that result from expert assessment in Denmark, Finland, and Norway regularly classify journals as top‐tier outside the first quartile, particularly in the social sciences and humanities. We conclude that experts, when tasked with metric‐informed journal rankings, take into account quality dimensions that are not covered by JIFs. [ABSTRACT FROM AUTHOR]

Background: Problem‐solving is a multidimensional and dynamic process that requires and interlinks cognitive, metacognitive, and affective dimensions of learning. However, current approaches practiced in computing education research (CER) are not sufficient to capture information beyond the basic programming process data (i.e., IDE‐log data). Therefore, how cognition and affect intertwine and unfold over time in programming problem‐solving activities are rarely investigated. Objectives: In this study, we examined how the theory‐informed measures from multimodal data that we have selected as proxies for cognitive and affective dimensions of learning, are associated with student performance, and in comparison, to prior‐knowledge. Methods: A high‐frequency temporal data was collected with a camera, an electroencephalogram, and an eye‐tracker from 40 computer science students (bachelor and master studies) in the context of a code‐debugging activity. To study the cognitive processes associated with learning we focused on cognitive load theory (CLT) and the human information processing model. In addition, we complemented CLT with the model of affective dynamics in learning to avoid the machine reductionism perspective. Results: Our findings demonstrated that attention, convergent thinking, and frustration were positively correlated with students' successful code‐debugging (i.e., performance), and frequently manifested by high performing participants. Cognitive load, memory load, and boredom were negatively correlated with students' performance, and typically manifested by low performing participants. Implications: Extending the context of analysis in reference to student cognitive processes and affective states, affords educators not just to identify lower performers, but also to understand the potential reasons behind their performance, making our method an important contribution in the confluence of CER and the learning technology communities. In addition, the insights extracted from our analyses allow us to discuss potential avenues for improving learning design and the design of interactive learning systems to support the development of students' problem‐solving skills. Lay Description: What is currently known about the subject matter: ● Problem‐solving interlinks cognitive, affective and metacognitive dimensions of learning. ● In digital settings instructors struggle to distinguish cognitive‐affective states of students. ● Learning technologies require interventions based on cognitive‐affective states of students. What the paper adds: ● When and what cognitive‐affective states are triggered during solving a programming problem. ● What and how measures as proxies for cognitive‐affective states are associated with performance. ● Emphasizes the benefits of augmenting IDE‐log data with sensor data in the context of learning design. Implications of study findings for practitioners: ● Methodology guidelines to identify and model variability in humans' natural behaviours. ● Importance of content and instructions personalization for student engagement and learning. ● Identification of multimodal data proxies for flexible and adaptive multimodal interfaces. [ABSTRACT FROM AUTHOR]

Aim: To explore midwives' experiences with providing home‐based postpartum care during the COVID‐19 pandemic in Norway. Design: A descriptive and explorative qualitative study. Methods: The study is based on semi‐structured individual interviews with 11 midwives experienced in offering home‐based postpartum care. We explored their experiences of such care during the first wave of the COVID‐19 pandemic. Data collection occurred from October through November 2020. An inductive thematic analysis was performed using Systematic Text Condensation (STC) by Malterud (2012). Results: The following two main results emerged from the analyses: (1) the midwives adapted quickly to changes in postpartum care during the pandemic and (2) midwives saw the experience as an opportunity to re‐evaluate their practices. Conclusion: This study highlights midwives' resilience and adaptability during the first wave of COVID‐19 pandemic. It emphasises the crucial role of face‐to‐face interactions in postpartum care, while recognising the value of technology when direct access is limited. By shedding light on midwives' experiences, this research contributes to improving postpartum care in unforeseen circumstances. It underscores the significance of interdisciplinary integration in planning postpartum care services and the lasting influence of lessons learned on addressing future challenges. Implications for Practice: The valuable insights gained from lessons learned during the COVID‐19 pandemic may have a lasting influence on the postpartum care system, empowering it to tackle unforeseen challenges both today and in the future. Impact: The current study addressed midwives' experience with providing home‐based postpartum care during the COVID‐19 pandemic in Norway. Midwives received an opportunity to re‐evaluate their own practices and valued being included when changes were implemented. The current findings should alert policy makers, leaders and clinicians in postpartum care services when planning future practice. [ABSTRACT FROM AUTHOR]

Background: During the COVID‐19 pandemic, nursing home leaders implemented infection control to protect residents and staff. Aim: To understand the barriers and facilitators for leading nursing homes through the COVID‐19 pandemic. Methods: We invited 34 nursing homes to participate, and 20 leaders (59%) attended focus group interviews. The COM‐B model and the theoretical domains framework were used in design and analysis of the study. Results: The barriers for infection control were organisational unpreparedness, high volumes of information, lack of clinical skills, protective equipment, and testing capacity, the nursing home's architectural design, health authorities' low priority of nursing homes, staff's fear, and mental pressure on the leaders over time. The facilitators were having a customised corona plan, change of routines, certification of new skills, access to the municipal quality system, the ability for crisis leadership, loyalty to the nursing home, and support from the environment. The number of part‐time positions and the opportunity to outsource parts of the services were also important determinants for infection control. Conclusions: The results identify several barriers and facilitators for nursing home leaders' behaviour for infection control. The results confirm the importance of supporting the leaders' resilience and crisis leadership while working in the pressurised environment of a pandemic. Relevance to Clinical Practice: The study provides important insights into barriers and facilitators for leading nursing homes through the COVID‐19 pandemic, which could help to inform future strategies for infection control. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Introduction: Regular exercise is associated with reduced risk of cardiovascular disease. Paradoxically, an increased risk of sudden cardiac arrest (SCA) is documented during or immediately after exercise and in athletes compared to the nonathletic population. Our objective was to identify, through multiple sources, the total number of exercise‐related versus non‐exercise‐related SCA in the young population in Norway. Methods: We collected primary data from the prospective Norwegian Cardiac Arrest Registry (NorCAR) for all patients aged 12–50 suffering SCA of presumed cardiac cause from 2015 to 2017. We collected secondary data about prior physical activity and the SCA, through questionnaires. We searched media reports for SCA incidents in sports. Exercise‐related SCA is defined as SCA during or <1 h after exercise. Results: Overall, 624 patients, median age 43 years, were included from NorCAR. Two thirds (393) replied to the study invitation, of whom 236 answered the questionnaires: 95 survivors and 141 next of kin. The media search resulted in 18 relevant hits. With a multiple source approach, we identified 63 cases of exercise‐related SCA, equivalent to an incidence of 0.8/100 000 person‐years, versus 7.8/100 000 person‐years of non‐exercise‐related SCA. Among those who answered (n = 236), almost two thirds (59%) exercised regularly, most commonly (45%) 1–4 h/week. Endurance exercise (38%) was the most prevalent type of regular exercise and the most common activity during exercise‐related SCA (53%). Conclusion: The burden of exercise‐related SCA was low (0.8 per 100 000 person‐years) and ten times lower than non‐exercise‐related SCA in the young population in Norway. [ABSTRACT FROM AUTHOR]

Aim: The aim of this retrospective observational study was to describe the scope of physiotherapy, the population and the physiotherapy management of Covid‐19 patients referred to physiotherapy at a university hospital in the period from March 2020 to July 2021. Method: A descriptive observational study with access to data from a quality register, which contains clinical data of all patients admitted with Covid‐19 to a university hospital in Norway. Data was obtained from electronic data sheets, where daily parameters for physiotherapy treatment were registered. Results: In total, 729 Covid‐19 patients were admitted during this period. Of these, 507 (69.6%) received treatment by a physiotherapist (3510 sessions). The physiotherapy treatments were performed on intensive care units (ICU) (50%), intermediate care units (11%) and general medical units (39%), respectively. Patients were mainly treated during the day (98.5%) and 21% of the sessions were given on weekends or holidays. Within the 3510 sessions, 9459 interventions were performed in total (one to seven interventions per session). The most common intervention provided was positioning (35.4%). The most common interventions in medical units and intermediate care units were training with a positive expiratory pressure device (17.3% and 15.9% respectively), and techniques for reducing work of breathing (13% and 15% respectively). The most common intervention in the ICUs was passive mobilization (21.3%), mostly in combination with positioning, manual techniques and/or airway clearance. Conclusion: This study provides characteristics of, and experiences with early physiotherapy, in sequentially hospitalized patients at a university hospital in Norway. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to assess the paediatric and adult diabetes care provided to adolescents and young adults with childhood‐onset type 1 diabetes during the transition. Methods: This nationwide population‐based cohort study included 776 individuals with type 1 diabetes who were last registered in the Norwegian Childhood Diabetes Registry (NCDR) between 2009 and 2012 and had received adult health care for at least 2 years. The patients' experiences were reported in a validated questionnaire. Clinical data from the annual registrations in the NCDR were coupled with data from the medical records in adult diabetes care. The longitudinal measures of glycaemic control were analysed using a growth mixture model. Results: A total of 321 young people answered the questionnaire and provided written informed consent for the collection of their data from their medical records. The mean age at transfer was 18.0 years (range = 15.0–23.5 years), and the mean age at participation was 22.7 years (range = 20.9–26.7 years). Significant differences (p < 0.001) in patient experiences were found between paediatric and adult diabetes care in several areas: contact with health‐care personnel, continuity of care, interval between consultations and overall satisfaction. Registry and medical records data confirmed the patient‐reported experiences. The longitudinal analyses identified two groups with distinctly different trajectories of glycaemic outcome over time. Patient–provider continuity and perceived preparedness for transfer were the most influential predictors. Conclusions: This study highlights several areas to be addressed for improving health care and the transition to adult diabetes care in adolescents and young adults with type 1 diabetes, including provider continuity, individualised care and involvement of multidisciplinary teams. [ABSTRACT FROM AUTHOR]

Adolescents with a visible difference to the face or body (e.g., due to a congenital condition, illness, or injury), may be at risk of elevated psychological distress. Young Person's Face IT (YPF), a web‐based psychosocial intervention, has displayed effectiveness, but no previous study has specifically evaluated its cost‐effectiveness. The aim of our study was to investigate whether YPF could be a cost‐effective alternative for psychosocial support to adolescents distressed by a visible difference, relative to care‐as‐usual (CAU). Within the context of a randomized controlled trial in Norway, 102 participants (43% boys) were allocated to intervention (n = 55) or waiting list control group (n = 47). Mean age was 13.9 years (SD = 1.71; range 11–18), and all self‐identified as experiencing distress related to a visible difference. Participants answered questionnaires including measures of health‐related quality of life and social anxiety at baseline and 3‐month follow‐up. A health economic evaluation using the method of cost‐utility analysis was performed, including quality‐adjusted life‐years (QALYs). Results indicated that the incremental cost‐effectiveness of YPF was 63,641 Norwegian kroner per QALYs gained, which is well within the acceptability threshold in the Norwegian healthcare sector. Hence, YPF could potentially be considered a cost‐effective intervention for adolescents experiencing distress related to a visible difference, but more research is needed that includes comparisons of YPF to other health‐ and societal resources and long‐term follow‐ups. Our study also constitutes an addition to research as, compared to interventions for somatic diseases, there is a lack of studies exploring the cost‐effectiveness of psychological interventions. [ABSTRACT FROM AUTHOR]

Introduction: Scarce health resources and differing views between persons with hand osteoarthritis (OA) and health professionals concerning care preferences contribute to sustaining a gap between actual needs and existing clinical guidelines for hand OA. The aim of this study is to explore the experiences of persons diagnosed with hand OA in their encounters with health services and how those experiences influence negotiations and decision‐making in hand OA care. Methods: Data from 21 qualitative interviews with persons diagnosed with hand OA were collected, transcribed verbatim and analysed using reflexive thematic analysis. Results: Three main themes were developed: symptoms are perceived as ordinary ageing in everyday life, consultations are shaped by trust in healthcare and the responsibilities of prioritisation and self‐care govern interactions. Conclusion: Ideas of ageing, professional knowledge and self‐management dominate hand OA health encounters and contribute to shaping illness perceptions, preferences and opportunities to negotiate decisions in consultations. Patient or Public Contribution: Two patient research partners with hand OA are members of the study project group. One of them is also a co‐author of this manuscript. [ABSTRACT FROM AUTHOR]

If children in child protection cannot be cared for by their natural parents, should they be adopted or live in foster home? Results from a study of representative samples of populations (n = 12 330), in eight European countries—Austria, England, Estonia, Finland, Germany, Ireland, Norway and Spain—and California, USA, reveal that people would recommend adoption over foster care, if a child in public care cannot grow up with their natural parent(s). There are cross‐country differences between populations, and examining if institutional context such as type of child protection system explains differences, we find that child maltreatment‐oriented systems are more supportive of adoption than other types of systems. Citizens having little confidence in the child protection system were only weakly correlated with preference for adoption. In conclusion, people prefer adoption as placement options for children in care are more than foster homes, and possible this finding reflects a sort of refamalialization of children into the private sphere. [ABSTRACT FROM AUTHOR]

In child welfare policies, as in contemporary society in general, great attention has been given to parenting roles and investing in 'positive' parenting practices. Several studies have suggested that socio‐economic factors frame parenting practices. There is broad evidence of a significant correlation between socio‐economic inequalities and child welfare intervention rates. Nevertheless, few studies have investigated parenting practices in a child welfare population. The aim of the present study was to investigate the association between socio‐economic status (SES) and parenting practices in a Norwegian child welfare population. The study was based on a cross‐sectional survey conducted in 2018–2019. The sample consisted of 256 parents (71.5% females). Linear regression analysis, adjusting for potential confounding and intermediate factors, was conducted. Lower SES was associated with higher levels of positive parenting/involvement practices (b = 0.146, CI: 0.026–0.266, P = 0.018), indicating an inverse pattern compared with the general population. When adjusting for symptoms of anxiety and depression, the association was slightly attenuated but remained statistically significant. No significant association was found between SES and inconsistent discipline/other disciplinary practices. The present study offers insights that should be useful in practice and further large‐scale studies. [ABSTRACT FROM AUTHOR]

Background: Women who experience physical or sexual violence report poor self‐perceived health. Knowledge of daily hassles, daily uplifts and coping styles, as well as how these factors can affect health and well‐being among survivors of sexual abuse, is important for healthcare professionals to understand and target their needs. Aim: The aim of the current study was to explore the association of daily hassles, daily uplifts, coping strategies and stress‐related symptoms among female survivors of sexual abuse. Methods: A group of women (n = 57), exposed to sexual abuse, were recruited from nine support centres in Norway. Participants completed a questionnaire that addressed demographics, socioeconomic conditions, trauma history, daily hassles, daily uplifts, coping styles and stress‐related symptoms. Two groups of participants were compared: one group that had above‐median scores on uplifts and adaptive coping styles and one group that had above‐median scores on daily hassles and maladaptive coping styles. Results: Results indicate that women who experienced more daily hassles and used maladaptive coping styles reported significantly more stress‐related symptoms, and particularly emotional symptoms, than women who experienced more daily uplifts and used adaptive coping styles. There were few differences between the two groups related to socioeconomic conditions and trauma history. Conclusion: The results indicate that women in both groups struggle with stress‐related physical, emotional, cognitive and target group‐specific symptoms. However, high incidence of daily hassles and the use of maladaptive coping styles were associated with an increase in stress‐related symptoms. Novell's findings indicate that despite severe traumatic experiences, adaptive coping styles and favourable perceptions of stress in everyday life were associated with a lower frequency of stress‐related symptoms. It may therefore be helpful to focus on altering maladaptive coping styles to reduce stress‐related symptoms among sexual abuse survivors. [ABSTRACT FROM AUTHOR]

Background: Fetal alcohol spectrum disorder (FASD) describes a combination of developmental, cognitive, and behavioral disabilities in children with prenatal exposure to alcohol. The literature suggests that there are higher rates of sleep disturbances in these children. Few studies have investigated sleep disturbances in relation to common comorbidities of FASD. We examined the prevalence of disturbed sleep and the relationship between parent‐reported sleep problems in different FASD subgroups and comorbidities like epilepsy or attention‐deficit hyperactivity disorder (ADHD) and impact on clinical functioning. Methods: In this prospective cross‐sectional survey, caregivers of 53 children with FASD completed the Sleep Disturbance Scale for Children (SDSC). Information about comorbidities was collected, and EEG and assessment of IQ, daily‐life executive and adaptive functioning were performed. Group comparisons and ANCOVA interaction models were used to test the associations between different sleep disturbances and clinical factors that could interfere with sleep. Results: An abnormal sleep score on the SDSC was very common, affecting 79% of children (n = 42) with equal prevalence in all FASD subgroups. Difficulty falling asleep was the most common sleep problem, followed by difficulty staying asleep and waking early. The incidence of epilepsy was 9.4%, with an abnormal EEG seen in 24.5%, and a diagnosis of ADHD in 47.2% of children. The distribution of these conditions was equal in all FASD subgroups. Children with signs of sleep disturbance had poorer working memory, executive function, and adaptive functioning. Children with ADHD had a greater prevalence of sleep disturbance than those without ADHD (OR 1.36; 95% CI 1.03 to 1.79). Conclusion: Problems with sleep are very common in FASD children and seem independent of FASD subgroup and the presence of epilepsy or a pathological EEG finding, while those with ADHD had more sleep problems. The study underscores the importance of screening for sleep disturbances in all children with FASD as these problems may be treatable. [ABSTRACT FROM AUTHOR]

How is expert evidence used in care order proceedings when children are considered for foster care placement because of familial violence? What are important factors and how do the decision‐makers use and evaluate evidence from specialists and experts? In this in‐depth analysis of 104 published care order decisions from the Norwegian County Boards, I investigate how decision‐makers use and evaluate evidence from expert witnesses to determine whether a care order may be granted. The analysis shows that the evidence largely revolves around social functioning, care context and topics about how parents and children relate to each other. Led by the law, the decision‐makers use this evidence to determine whether the child's situation is harmful, whether support services are viable and whether a care order is in the child's best interests. I find that decision‐makers draw unevenly on evidence with regards to these legal requirements, and that the use predominantly defers to expert authority. However, there is also evidence of independent reasoning, where deferral to the epistemic authority of the experts is weakened. This is shown through evaluative and critical assessments and scrutiny of the disciplinary evidence. [ABSTRACT FROM AUTHOR]

This qualitative case study aimed to explore environmental circumstances and interactional processes that appeared to be relevant for the dynamics of resilience in adolescents exposed to child abuse. Fieldwork at a learning and coping centre for children and their families was combined with semi‐structured interviews with adolescent participants aged 12 to 18 years. A critical realist approach was used to unpack what has been called the 'ordinary magic' of resilience. We found that intensively validating qualities of both the environment and relationships seemed to be driving components for resilience. Borrowing ideas from the sociometer theory, we propose that particularly the consistent intensiveness may offer a recalibration of the adolescents' immediate life‐worlds, in terms of how they perceive the people they meet and the environments they step into. In keeping with the transactional‐ecological model of resilience, we suggest that such a recalibration leads to altered social agency that becomes visible through their immediate social participation. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to report the presence of categorical and dimensional personality disorders (PD) in adults with longstanding eating disorders (ED) over a period of 17 years and to investigate whether changes in PD predict changes in ED symptoms or vice versa. Methods: In total, 62 of the 80 living patients (78% response rate) with anorexia nervosa (n = 23), bulimia nervosa (n = 25), or other specified feeding or ED (n = 14) at baseline were evaluated during hospital treatment and at 1‐year, 2‐year, 5‐year, and 17‐year follow‐up. PD were assessed using the Structured Clinical Interview for DSM‐IV Axis II disorders, and the eating disorder examination (EDE) interview was used to assess ED. Data were analyzed using multilevel modeling. Results: From baseline to the 17‐year follow‐up, the number of patients with any PD decreased significantly from 74.2% to 24.2%, and the total number of PD diagnoses declined from 80 to 22. Mean EDE score was significantly reduced from 4.2 (SD: 1.1) to 2.0 (SD: 1.6). There was a positive association between ED and PD where the initial level of either disorder was followed by similar levels of the other disorder throughout the entire follow‐up period. High baseline levels of borderline PD predicted less decrease in ED symptoms. No significant within‐person effects were found. Conclusions: Both ED and PD significantly declined over time. As the severity of either disorder seems to be associated with the other, thorough assessment and treatment that incorporates both the ED psychopathology and the personality disturbances are advisable. Public Significance Statement: While personality disorders were highly prevalent in the sample of patients with longstanding eating disorders, both disorders were significantly reduced at the 17‐year follow‐up. The disorders are related in the sense that an initial high level of either disorder is associated with a high level of the other over time. A thorough assessment and attention to both illnesses are advisable in therapy. Clinical Trial Identifier: NCT03968705. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the recovery of physical function, health related quality of life (HRQoL), and pain for people following hip fracture for the initial 12 months, and to examine whether postoperative outcome measures of physical function, HRQoL, and pain can predict physical function at 3 and 12 months. Design: A prospective single‐center observational study, as part of the HIPFRAC trial. Settings: One hospital with two associated municipalities in Norway. Subjects: 207 participants with hip fracture included in the study (140 participants transferred to a short‐term nursing home placement and 67 transferred directly home at discharge from hospital). Method: Outcome measures were Short Physical Performance Battery (SPPB), Timed Up & Go (TUG), Stair climbing test (SC), Numeric Rating Scale (NRS) for pain at rest and in activity, and EQ‐5D‐5L index and health score. Data were analysed by repeated measures of variance and multivariate regression analyses. Results: There were statistically significant improvements in physical function (SPPB total score and TUG), NRS‐pain in activity, and HRQoL (EQ‐5D‐5L) from hospital discharge to 3‐month follow‐up for the whole cohort and the two groups (p < 0.001). However, the largest improvements occurred within the first 3 months. Further statistically significant improvements occurred between 3 and 12 months (p < 0.05). The strongest predictors of physical function at 3 and 12 months post‐fracture were physical function (SPPB) at hospital discharge and pre‐fracture requirement of a walking aid. Conclusion: The recovery of physical function, HRQoL, and pain in participants after hip fracture indicates gradual improvements during the initial 12‐month follow‐up, with the largest improvements within the first 3 months. [ABSTRACT FROM AUTHOR]

Aim: Given the apparent link between gender and ethnicity, and the diversity and career opportunities in nursing, this study examined gender and ethnicity's influence on first‐year nursing students' educational motivation and career expectations. Design: Cross‐sectional. Methods: Through bootstrapped linear regressions, we analysed data on 504 Norwegian first‐year nursing students' self‐reported educational motivation and career expectations, from the StudData survey at the Centre for the Study of Professions (SPS) at Oslo Metropolitan University (OsloMet). Results: The sample consisted of 67 (13%) male and 437 (87%) female nursing students. Female students were more motivated compared to male students by professional interest and to pursue a specialization, less likely to assume leadership positions in the future, and more likely to prioritize family and pursue positions in the traditional nursing field. In total, 425 (84%) respondents stated a Norwegian background. Respondents who stated that both of their parents were born in a country other than Norway made up the 79 (16%) students of immigrant background. Those with immigrant backgrounds were more motivated than other students by income, status and flexible working hours and less likely to pursue a specialization or future employment in the nursing field. [ABSTRACT FROM AUTHOR]

This study aims to explore what worries youth were having during the seventh to ninth week of the COVID‐19 lockdown. Our findings build on the responses to an open‐ended survey question from 1314 youths. The worries covered three main themes: 'That my mom dies, then I am left all alone': worries related to COVID‐19 virus infection; 'To me, this is lost youth': worries about the consequences of measures for the present life and near future; and 'I will face a very difficult life in the future': worries about the consequences of measures for the outlook on life. Young people worried that the measures would have a huge impact on their present life and outlook on life. The costs of restriction measures were unevenly distributed and indicated that the measures affected their mental health. Listening to youth voices during the pandemic is important for practitioners, educators and policymakers. The results indicate that the threshold for closing schools also including the provision of distance learning should be kept high. Social and health services for youth should offer early intervention and be prepared for an escalation in mental health problems in the imminent future. [ABSTRACT FROM AUTHOR]

This study aims to test the nomological validity of the People Performance Scales (PPS) using the job demands‐resources (JD‐R) model. All employees at two large companies in Norway (a governmental agency and a worker's union) were invited to complete the PPS questionnaire electronically. A total of 2,469 respondents completed the questionnaire, resulting in an 87 percent response rate. Data was analyzed Structural Equation Modelling. First, all 15 scales included in the PPS showed excellent internal and construct validity. PPS was also found to have configural‐, construct‐level metric‐ and scale‐level metric invariance across age groups and genders. Second, findings indicate that the PPS can be used for both research and consultancy based upon the JD‐R model, while simultaneously assessing constructs of particular importance in Norwegian and Scandinavian legislation. The PPS represents a short and efficient questionnaire which measures the most relevant working environment constructs in a reliable and distinct way. The questionnaire has great psychometric characteristics and is well suited for use in organizations to measure employees' experience of working environment factors, allowing organizations to identify areas of improvement and to support organizational development. [ABSTRACT FROM AUTHOR]

Youth within the child welfare system (CWS) have often experienced adverse life events, and many need support from health services. This study aimed to compare mental health problems and health service use among adolescents receiving in‐home services (IHS), living in foster care (FC) and general population youth (GP). Data stem from the youth@hordaland survey, a population‐based study of adolescents (N = 10,257, age 16–19) conducted in 2012 in Hordaland County, Norway. The adolescents provided self‐reported data on CWS contact, health service use, adverse life events and multiple instruments assessing mental health problems. The IHS and FC groups had significantly higher symptom scores across most mental health measures than peers from the GP. Youth receiving IHS had significantly higher scores on measures of general internalizing and externalizing problems, attention deficit hyperactivity disorder (ADHD) and depression compared with peers in FC. Those receiving IHS reported the highest health service use. Adverse life events accounted for a substantial part of the differences between the groups. Mental health problems are frequent among older adolescents within the CWS, especially among youth receiving IHS. Service providers and policymakers should be aware of the present and likely continued challenges faced by many of these youth. [ABSTRACT FROM AUTHOR]

Background: Cancer patient pathways (CPPs) were implemented in Norway in 2015–2017 to advance cancer diagnostics and treatment initiation. The aim of CPPs is to ensure standardized waiting times, but also to strengthen patient participation and shared decision‐making. This study investigates how patients enrolled in a CPP experienced shared decision‐making. Methods: This study comprised of 19 individual semistructured interviews with patients who had been enrolled in a CPP at three hospitals in Norway. Twelve patients had breast cancer, four patients had prostate cancer and three patients had malignant melanoma. We analyzed their experiences using a narrative approach. Findings: This study showed how participating in a standardized CPP provided different possibilities for shared decision‐making. The patients' narratives of shared decision‐making in CPPs included stories from the three cancer diagnoses through the following themes: (1) The predictable safeness of standardizations, (2) the ambivalence of making decisions and (3) opposing standardizations and pushing for action. Conclusion: Standardized CPPs provided patients with predictability and safety. Shared decision‐making was possible when the cancer diagnoses supported preference‐sensitive treatment options. Balancing standardizations with individualized care is necessary to facilitate patient participation in CPPs, and the possibility of shared decision‐making needs to be discussed for each specific CPP. Patient or Public Contribution: A service user representative from the Norwegian Cancer Society participated in designing this study. [ABSTRACT FROM AUTHOR]

Aims: To explore whether the general practitioners' (GPs') performance of recommended processes of care was associated with estimated risk of cardiovascular disease (CVD) and poor glycaemic control in patients with type 2 diabetes. Methods: A cross‐sectional study from Norwegian general practice including 6015 people with type 2 diabetes <75 years old, without CVD and their 275 GPs. The GPs were split into quintiles based on each GP's average performance of six recommended processes of care. The quintiles were the exposure variable in multilevel regression models with 10‐year risk of cardiovascular events estimated by NORRISK 2 (total and modifiable fraction) and poor glycaemic control (HbA1c >69 mmol/mol (>8.5%)) as outcome variables. Results: The mean total and modifiable estimated 10‐year CVD risk was 12.3% and 3.3%, respectively. Compared with patients of GPs in the highest‐performing quintile, patients treated by GPs in the lowest quintile had an adjusted total and modifiable CVD risk that was 1.88 (95% CI 1.17–2.60) and 1.78 (1.14–2.41) percent point higher. This represents a relative mean difference of 16.6% higher total and 74.8% higher modifiable risk among patients of GPs in the lowest compared with the highest quintile. For patients with GPs in the lowest‐performing quintile, the adjusted odds of poor glycaemic control was 1.77 (1.27–2.46) times higher than that for patients with a GP in the highest quintile. Conclusions: We found a pattern of lower CVD risk and better glycaemic control in patients of GPs performing more recommended diabetes processes of care. [ABSTRACT FROM AUTHOR]