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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]

Aim: This paper reports associations among socio‐demographic variables, stressor experience, self‐efficacy and life satisfaction among Norwegian adolescents aged 15–21 years and the potential moderating role of self‐efficacy on the association between stressor experience and life satisfaction. Methods: The cross‐sectional school‐based survey study involved 1816 upper‐secondary school students from Mid‐Norway. Data were analysed with independent samples t test, Pearson's product moment correlation and multiple linear regression analysis. Results: Bivariate results showed that boys scored higher than girls on life satisfaction and self‐efficacy, whereas girls scored higher than boys on all stressor domains. Multiple linear regression analysis showed that life satisfaction declined weakly with age, whereas stronger family economy and having parents who work full‐time associated with higher life satisfaction. Stress with teacher interaction, peer pressure, home life, school attendance, school–leisure conflict and school performance were all negatively associated with life satisfaction, whereas self‐efficacy associated positively and strongly with life satisfaction. Self‐efficacy moderated the association between both interpersonal and school‐related stressors and life satisfaction. Conclusion: The results provide support for the unique role of stressor experience and self‐efficacy in association with adolescents' life satisfaction as well as self‐efficacy as a stress moderator in relation to life satisfaction. [ABSTRACT FROM AUTHOR]

This paper examines the prevalence of multiple symptoms and the relationships between future expectations and multiple symptoms in a cross-sectional study of 100 patients with chronic obstructive pulmonary disease. A questionnaire was used to examine the patients' symptoms of breathlessness, anxiety, depression, sleeplessness, fatigue, and pain, and their outlook for the future. All patients reported breathlessness, 64% anxiety, 69% depression, 28% sleeplessness, 72% fatigue, and 45% pain. Those with anxiety reported significant depression ( P < 0.001), and those with fatigue reported significant depression ( P = 0.004). Patients who reported pain also reported significant sleeplessness ( P = 0.022). A negative outlook for the future was reported by 42% of patients who also reported significantly more anxiety, depression, sleeplessness, fatigue, and pain ( P ≤ 0.049). Multiple symptoms are common in chronic obstructive pulmonary disease, and patients with a pessimistic view of the future reported more symptoms. Those with multiple symptoms and a negative outlook toward the future may benefit from interventions to help them achieve a more positive outlook for the future, which may relieve symptom burden. [ABSTRACT FROM AUTHOR]

The aim of this paper was to investigate whether psychosocial functioning in adulthood (e.g., friends support, cohabitation, community connectedness and work satisfaction) could be predicted by mental health, subjective well-being, social relations and behavior problems in adolescence, and whether gender was a moderator in these associations. Data were obtained from a major population-based Norwegian study, the Nord-Trøndelag Health Study ( HUNT), in which 517 men and 819 women completed an extensive self-report questionnaires at baseline (mean age 14.4 years) and at follow-up (mean age 26.9 years). Community connectedness as well as work satisfaction were predicted by subjective well-being. Cohabitation was predicted by male gender and frequency of meeting friends in adolescence, and friends support was predicted by frequency of meeting friends. Gender had a minor effect as a moderator. Frequency of meeting friends and subjective well-being seemed to be the strongest adolescent predictors of psychosocial functioning in young adulthood. These findings may have implications both for prevention and intervention in adolescence, as well as for future research. [ABSTRACT FROM AUTHOR]

Jøsendal, O. & Aarø, L. E. (2012). Adolescent smoking behavior and outcome expectancies. Scandinavian Journal of Psychology 53, 129-135. Adolescent smoking behavior is assumed to be associated with smoking outcome expectancies. Results in this paper are based on data from the control group of two data collections among Norwegian secondary school students taken approximately 30 months apart (T1 and T2). The dimensionality of smoking outcome expectancies was the same at both time points, revealing three components ('Addicted', 'Not harmful' and 'Social'). After correction for attenuation, the Pearson's correlation between T1 and T2 was 0.41 for the total sumscore, indicating low to moderate relative stability. When examining smoking expectancy sumscore means by smoking habits at T1 and T2, never smokers were different from smokers on both occasions. Never smokers scored low on 'Social' and 'Not harmful', and high on 'Addictive'. All associations were statistically significant ( p < 0.001). The 'Social' dimension was the strongest predictor of smoking behavior at T1 and T2. One of the outcome expectancy sumscores ('Addictive') at T1 predicted smoking habits at T2 after controlling for smoking habits at T1 ( p < 0.01). This predictor was significant also after entering outcome expectancy sumscores at T2 into the model ( p < 0.05). These results indicate that outcome expectations other than the health-related ones should be paid attention to when planning new prevention programs. [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]

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]

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 and purpose: Reduced balance and musculoskeletal pain are frequently reported among patients with long‐lasting dizziness. However, the association between musculoskeletal function and postural sway among these patients has not been examined. The objective of this study was to examine if there is an association between aspects of musculoskeletal function and postural balance in patients with long‐lasting dizziness. Methods: This was a cross‐sectional study, using data of 105 outpatients with long‐lasting dizziness. Aspects of musculoskeletal function was assessed by examining body flexibility, grip strength, preferred and fast walking speed, in addition to musculoskeletal pain. Musculoskeletal pain was evaluated using the Subjective Health Complaints questionnaire. Postural balance was assessed by path length of postural sway by using a balance platform on both firm and soft surfaces, with eyes open and closed. The association between musculoskeletal function and postural sway was assessed using linear regression analyses. Results: When adjusting for age and gender we found that on a firm surface, there was an association between increased musculoskeletal pain and increased postural sway measured with eyes open (p = 0.038). In addition, there was an association between decreased body flexibility and decreased postural sway with eyes open (p = 0.025). On a soft surface, decreased fast walking speed was associated with increased postural sway with eyes open (p = 0.027). In addition, decreased grip strength was associated with increased postural sway on a soft surface with eyes closed (p = 0.015). Discussion: The findings from this study imply that musculoskeletal function may associate with postural sway in patients with long‐lasting dizziness, although the associations were weak. [ABSTRACT FROM AUTHOR]

Background: Patients are expected to participate in the hospital discharge process, assume self‐management after discharge and communicate relevant information to their general practitioner; however, patients report that they are not being sufficiently empowered to take on these responsibilities. The aim of this study was to explore and understand the discharge process with a focus on medicines communication, from the patient perspective. Methods: Patients were included at a hospital ward, observed during health‐care personnel encounters on the day of discharge and interviewed 1‐2 weeks after discharge. A process analysis was performed, and a content analysis combined data from observations and data from patient interviews focusing on medicines communication in the discharge process. Results: A total of 9 patients were observed on the day of discharge, equalling 67.5 hours of observations. The analysis resulted in the following themes: (a) the observed discharge process; (b) patient initiatives; and (c) the patient role. The medicines communication in the discharge process appeared unstructured. Various patient preferences and needs were revealed. The elements of the best practice structured discharge conversation were observed; however, some patients did not have a discharge conversation at all. Conclusions: The study contributes to a broader understanding of the discharge process, how patients experience it, including their role. It is evident that the discharge process is not always tailored to meet the patients' needs. More focus on early patient involvement and communication, in order to better prepare patients for self‐management of their medications, is important for their health outcomes. [ABSTRACT FROM AUTHOR]

Background: There have been inconsistent findings from studies examining factors associated with quality of life (QoL) for children affected by parental illness. Aim: The aim of this study was to explore factors associated with self‐reported QoL in children affected by parental illness or parental substance abuse. Design: A cross‐sectional multicentre study. Methods: The sample included 246 families with children 8–18 years recruited via ill parents who received treatment for severe physical illness, mental illness or substance abuse in specialised health services. We performed multiple linear regression analyses to examine factors associated with the children's self‐reported QoL. Main outcome measure: KIDSCREEN‐27. Results: The children's self‐reported QoL was positively associated with the ill parent's self‐reported physical health, the children's self‐reported social skills, the degree to which other adults took over the ill parent's responsibilities, provision of sibling care, provision of health care for the ill parent and positive outcome of caregiving. The children's QoL was negatively associated with the children's self‐reported responsibilities due to parental illness, provision of emotional care for the ill parent, negative outcomes of caregiving and external locus of control. The model explained 63% of the variance (adjusted R2) in children's total QoL. Study limitations: Sampling bias may have occurred during recruitment. Conclusions: The findings suggest factors of importance for the children's QoL. Clinicians should assess whether an ill parent's physical health may influence negatively on their ability to perform daily responsibilities at home and care for their children, and clinicians can use children's self‐reported QoL to identify children who are most negatively affected. [ABSTRACT FROM AUTHOR]

Iodine deficiency during pregnancy and in the post‐partum period may lead to impaired child development. Our aim is to describe iodine status longitudinally in women from pregnancy until 18 months post‐partum. Furthermore, we explore whether iodine status is associated with dietary intake, iodine‐containing supplement use and breastfeeding status from pregnancy until 18 months post‐partum. We also assess the correlation between maternal iodine status 18 months post‐partum and child iodine status at 18 months of age. Iodine status was measured by urinary iodine concentration (UIC) during pregnancy (n = 1,004), 6 weeks post‐partum (n = 915), 6 months post‐partum (n = 849), 12 months post‐partum (n = 733) and 18 months post‐partum (n = 714). The toddlers' UIC was assessed at 18 months of age (n = 416). Demographic variables and dietary data (food frequency questionnaire) were collected during pregnancy, and dietary data and breastfeeding practices were collected at all time points post‐partum. We found that iodine status was insufficient in both pregnant and post‐partum women. The UIC was at its lowermost 6 weeks post‐partum and gradually improved with increasing time post‐partum. Intake of milk and use of iodine‐containing supplements significantly increased the odds of having a UIC above 100 μg/L. Neither the mothers' UIC, vegetarian practice, nor exclusion of milk and dairy products were associated with the toddlers UIC 18 months post‐partum. Women who exclude milk and dairy products from their diets and/or do not use iodine‐containing supplements may be at risk of iodine deficiency. The women possibly also have an increased risk of thyroid dysfunction and for conceiving children with nonoptimal developmental status. [ABSTRACT FROM AUTHOR]

The measurement of user experience has gained international attention as a tool for improving quality of care. Because foster families have a high need for service support, we examined quality of care from the foster parent's perspective and associated characteristics. We collected information about type and frequency of service use in the last 2 years and standardized measures of user‐reported experiences and outcomes from foster parents of youths aged 11–18 years in Norway (N = 290). We analysed the data using descriptive statistics, independent samples t‐tests and multiple regressions. Overall, foster parents had positive service experiences, and around half reported improvement in youth condition and function compared with before the service contact. The foster parents gave similar evaluations of child welfare services and specialized mental health services but indicated different strengths and weaknesses of the providers. Younger age, more frequent service contact and less waiting time were associated with positive service experiences, while less mental health problems and fewer years in current foster home were related to positive perceptions of outcomes. Our results indicate focus areas for increasing quality of care from the user perspective, for example, sharing information, cooperation between services, having frequent enough service contact and reducing waiting time. [ABSTRACT FROM AUTHOR]

Background: Post‐traumatic stress (PTS) symptoms following intensive care unit (ICU) treatment can lead to post‐traumatic stress disorder and represent a severe health burden. In trauma patients, a strong sense of coherence (SOC) is associated with fewer PTS symptoms. However, this association has not been investigated in a general ICU sample. Aims and objectives: To examine the occurrence of PTS symptoms in general ICU patients early after ICU discharge and to assess possible associations between PTS symptoms and SOC, ICU memory, pain, and demographic and clinical characteristics. Design: This was a cross‐sectional study. Methods: Adult patients aged ≥18 years admitted for ≥24 hours to five ICUs between 2014 and 2016 were recruited. PTS symptoms and SOC were measured at the ward within the first week after discharge from the ICU using the Posttraumatic Stress Scale‐10 and Sense of Coherence Scale‐13. Multiple linear regression analysis was used to identify associations between PTS symptoms and SOC and the selected independent variables. Results: A total of 523 patients were included (17.8% trauma patients; median age 57 years [range 18‐94]; 53.3% male). The prevalence of clinically significant PTS symptoms was 32%. After adjustments for gender and age, lower SOC (P < 0.001), more ICU delusional memories (P < 0.001), greater pain interference (P < 0.001), not being a trauma patient (P = 0.02), and younger age (P = 0.03) were significantly associated with more PTS symptoms. Conclusions: One third of patients experienced clinically relevant PTS symptoms early after discharge from the ICU. In the present study, SOC, delusional memory, pain interference, younger age, and not being a trauma patient were factors associated with more PTS symptoms. Relevance to clinical practice: Early individual follow up after ICU discharge focusing on pain relief and delusional memory may reduce PTS symptoms, with a potential of improving rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Correct electrode placement and proper skin preparation for cardiac telemetry monitoring of patients at risk for arrhythmias increase the quality of the arrhythmic surveillance. Inconsistent arrhythmia surveillance can compromise patient safety and care outcomes. An inspection of international literature demonstrates that nurses generally do not adhere to cardiac monitoring standards. Aim: The aims of this study were to determine cardiovascular nurses' knowledge of and adherence to practice standards for cardiac surveillance and whether their knowledge and practice improves over time. Study design: A comparative study design was applied, and data were obtained by survey methodology. Methods: Nurse delegates at the Annual National Congress on Cardiovascular Nursing in Norway completed surveys in 2011 and 2017 (delegates from 44 and 38 hospitals, respectively). Results: In total, 363 cardiac nurses (70%) responded to the questionnaires. Of these, 95% were female, with a mean age of 41 years. In 2011, 97% of participants were unaware of international practice standards. However, by 2017 unawareness decreased to 78% (P <.001). Despite their lack of knowledge of practice standards, 94% of participants often or always prepared patients' skin for telemetry; this improved from 2011 to 2017 (P =.001). Overall, 73% of nurses never or seldom scrubbed or washed the patients' skin before electrode placement, and 38% of the electrodes were misplaced. In 2011, 49% of nurses used protective telemetry covers; this increased to 80% in 2017 (P <.001). Overall, 64% always informed patients of the purpose of cardiac monitoring. Conclusion: A significant percentage of nurses fail to adhere to recommendations for electrode placement, skin preparation and providing patients with telemetry information. In order to raise the quality of arrhythmic surveillance, investment in educational programmes in cardiac telemetry monitoring is required. Relevance to Clinical Practice: Improved in‐hospital telemetry practice is required to ensure patient safety and better care outcomes. [ABSTRACT FROM AUTHOR]

Background: Multiple factors can influence the working alliance and treatment outcome in speech and language therapy. The 'working alliance' is an important concept in treatment and can be described as the degree to which a treatment dyad is engaged in collaborative, purposive work. To date, relatively little attention has been paid to this concept within speech and language treatment in general, and within stuttering treatment research in particular. Aims: To investigate the role of the working alliance within stuttering treatment, and to evaluate whether the quality of the working alliance correlated with clients' concept of motivation and treatment outcomes 6 months post‐therapy. Methods & Procedures: Eighteen adults (21‐61 years) participated in this multiple single‐case treatment study, with treatment facilitated by an experienced speech and language therapist. The working alliance was investigated using the Working Alliance Inventory—Short Version Revised (WAI‐SR), an Extended version of the Client Preferences for Stuttering Treatment (CPST‐E), the Overall Assessment of Speakers' Experience of Stuttering—Adult version (OASES‐A), the Wright & Ayre Stuttering Self‐Rating Profile (WASSP) and the Hospital Anxiety and Depression Scale (HADS). Outcomes & Results: Analyses demonstrated significant associations between the working alliance and client motivation (r = 0.781) and treatment outcomes (r = 0.644) 6 months post‐treatment. The association between client‐led goals and therapy tasks appeared particularly important. Conclusions & Implications: : The working alliance between speech and language therapists and persons who stutter matters. Within the alliance, the level of client–clinician agreement on treatment goals and therapy tasks may be of greater importance than the bond between client and clinician. Further research with greater numbers of participants is warranted. [ABSTRACT FROM AUTHOR]

Background: In most maternity wards in Norway, early discharge (<48 hour) is the norm. To monitor newborns' and women's health during the first week after delivery, most maternity wards offer early check‐ups, where families return to the hospital (standard care). However, a few municipalities offer home visits by midwives (domiciliary care) to ensure seamless services for the family. Aim: The primary aim of this study was to explore whether different follow‐up strategies were differently associated with maternal depression and breastfeeding habits, 6 weeks and 6 months postpartum. The secondary aim was to investigate whether families at risk of postpartum depression were included in the home visiting programme in the municipality that offered both follow‐up strategies. Method: This study draws on data from the 'Little in Norway' (LIN) study, which followed families from pregnancy until the child was 18 months. This study used data from two different well‐baby clinics in two municipalities, where one offered standard care (n = 95) and the other domiciliary (n = 64) and standard care (n = 17). The Edinburg Postnatal Depression Scale (EPDS) was used to measure maternal depression. Breastfeeding habits were measured using a self‐report questionnaire. The Life Stress subscale of the Parenting Stress Index (PSI) was used to identify women at risk of postpartum depression. Results: There were no differences in maternal depressive symptoms or breastfeeding habits at neither 6 weeks nor 6 months postpartum between women who received standard or domiciliary care in the two municipalities. Within the municipality that offered both follow‐up strategies, a higher number of women scoring high on prenatal life stress were included in domiciliary – compared to standard care. Conclusion: Differential follow‐up strategies in the first week after birth did not impact on maternal depression or breastfeeding habits. However, domiciliary care seems to be regarded as supportive and nonstigmatising for women at risk of postpartum depression. [ABSTRACT FROM AUTHOR]

Rationale: Previous studies have shown that children may take on higher extents of caring activities if their parents are affected by severe illness or disability, especially when their parents lack access to formal and informal care. Aims and objectives: This study examined the extent and nature of caring activities done by patients’ children; differences in caring activities between different types of parental illness; factors associated with caring activities. Design: An explorative cross‐sectional multicentre study. Methods: Parents as patients in specialised healthcare services, and their children, were recruited from five health trusts in Norway. The sample included 246 children aged 8–17 years and their 238 parents with severe physical illness (neurological disease or cancer) (n = 135), mental illness (n = 75) or substance abuse (n = 28). Main outcome measure: Multidimensional Assessment of Caring Activities (MACA‐YC18). Results: A large number of children with ill parents are performing various caring activities. Increased caring activities among children due to their parent's illness were confirmed by their parents, especially with regard to personal care. We found no significant differences in the extent of caring activities between illness types, but there were some differences in the nature of these activities. Factors significantly associated with the extent and nature of caring activities were as follows: better social skills and higher external locus of control among the children; and poorer physical parental health. Parent's access to home‐based services was limited. Study limitations: In recruitment of participants for the study, a sampling bias may have occurred. Conclusion: To promote coping and to prevent inappropriate or extensive caring activities among children with ill parents, there is a need for increased access to flexible home‐based services adapted to the type of parental illness. [ABSTRACT FROM AUTHOR]

Oral health promotion to young children is delivered by primary care nurses as part of general health promotion given to all children in Norway. Objective The objective was to evaluate established routines for referral of children by primary care nurses to the dental services and to study whether referred children younger than 3 years required contact with dental personnel. Methods All children referred by primary care nurses to the dental services in one county during one year were included. Primary care nurses referred children using criteria developed by dental personnel. At the dental clinic, anamnestic information, dental health and oral health behaviour of the referred children were registered. Results Altogether, 181 children were referred; 53% were younger than 3 years. The most frequent reasons for referral of children younger than 3 years were caries or dental plaque, and 34% had visible plaque accumulation and/or visible signs of caries. All referred children had at least one risk factor for caries. The referral reasons given by primary care nurses corresponded partly with findings at dental examination. The results indicated that 2% of the children younger than 3 years were referred to the dental services. Conclusion The results indicated that by using established referral routines, all children referred from well-baby clinics to the dental services were caries risk children who required early contact with dental personnel. However, the low proportion of children in the studied population referred by primary care personnel may indicate under-referral of children to the dental services. [ABSTRACT FROM AUTHOR]

Aims To estimate whether parental socio-economic status (SES) is associated with adolescent drinking, and the degree to which a possible association may be accounted for by various parental factors. Design and setting Cross-sectional Norwegian school survey from 2006 (response rate: 86%). Participants Students aged 13-14 years ( n = 5797), 15-16 years ( n = 6613) and 17-18 years ( n = 5351), of whom 51% were girls. Measurements Parents' education was our main SES indicator, and we distinguished between low (7%) and middle/high (93%) educational level. The outcomes comprised past-year drinking and intoxication. We also applied measures on general parenting, parents' alcohol-related permissiveness and parental intoxication. The main analyses were conducted using Poisson regression. Findings Parents' education had no statistically significant impact on alcohol use among the 17-18-year-olds, while 13-16-year-olds with low educated parents had an elevated relative risk (RR) of both drinking [RR = 1.21, 95% confidence interval (CI) = 1.13-1.29] and intoxication (RR = 1.32, 95% CI = 1.21-1.44). The RRs became statistically insignificant when including all the parental factors as covariates in the regression models. Among adolescents who had consumed alcohol, low parental education was related to more frequent drinking (RR = 1.24, 95% CI = 1.11-1.38) and intoxication episodes (RR = 1.42, 95% CI = 1.22-1.66). Again, the RRs became statistically insignificant when we accounted for all the parental factors. This pattern was replicated when we applied an alternative indicator for low parental SES. Conclusions Adolescent drinking in Norway appears to be related inversely to parents' social standing. The elevated risk of low socio-economic status vanishes when general parenting, alcohol-related parental permissiveness and parents' drinking are accounted for. [ABSTRACT FROM AUTHOR]

Background Spirituality has demonstrated a significant impact on quality of life in nursing-home patients. Likewise, as essential aspects of spirituality, hope, self-transcendence, and meaning are found to be vital resources to nursing-home patients' global well-being. Further, nurse-patient interaction has demonstrated a powerful influence on patient's hope, self-transcendence, and meaning-in-life, as well as on anxiety and depression. Aim The present study investigated the associations of hope, self-transcendence, meaning, and perceived nurse-patient interaction with quality of life. Design and method In a cross-sectional design, a sample of 202 cognitively intact nursing-home patients in Mid-Norway responded to the Herth Hope Index, the Self-Transcendence scale, the Purpose-in-Life test, the Nurse-Patient Interaction scale, and a one-item overall measure on quality of life. Using SPSS ordinal regression, bivariate and multivariate analyses were conducted with quality of life as dependent variable. Results Controlling for gender, age, and residential time, all the scales were significantly related to quality of life in the bivariate analyses. Intrapersonal self-transcendence showed an exceptional position presenting a very high odds ratio in the bivariate analysis, and also the strongest association with quality of life in multivariate analyses. Meaning and nurse-patient interaction also showed independent and significant associations with quality of life. Conclusion The associations found encourage the idea that intrapersonal self-transcendence, meaning-in-life, and nurse-patient interaction are powerful health-promoting factors that significantly influence on nursing-home patients' quality of life. Therefore, pedagogical approaches for advancing caregivers' presence and confidence in health-promoting interaction should be upgraded and matured. Proper educational programs for developing interacting skills including assessing and supporting patients' intrapersonal self-transcendence and meaning-in-life should be utilised and their effectiveness evaluated. [ABSTRACT FROM AUTHOR]

Objectives To examine whether delirium in individuals with hip fracture is associated with high C-reactive protein ( CRP), interleukin-6 ( IL-6), and soluble IL-6 receptor ( sIL-6R) levels in the cerebrospinal fluid ( CSF). Design Prospective cohort study. Setting Two university hospitals in Oslo, Norway, and Edinburgh, United Kingdom. Participants Individuals admitted with acute hip fracture (N = 151). Measurements Participants were assessed for delirium pre- and postoperatively using the Confusion Assessment Method. Prefracture cognitive impairment was detected using the Informant Questionnaire on Cognitive Decline in the Elderly ( IQCODE). Serum was collected preoperatively and CSF just before the onset of spinal anesthesia. Cytokine levels in serum and CSF samples were determined using an enzyme-linked immunosorbent assay. Student t-tests or Mann-Whitney U-tests were used for between-group comparisons. Spearman rho was used for correlations. Results Sixty participants had prior cognitive impairment ( IQCODE score ≥3.44). Delirium was diagnosed in 46 participants (77%) with prior cognitive impairment and 25 (29%) without. In participants without prior cognitive impairment, CSF CRP levels were higher in participants with delirium (median 0.05 μg/mL, interquartile range ( IQR) 0.02-0.12 μg/mL) than in those without delirium (median 0.01 μg/mL, IQR 0.00-0.06 μg/mL) ( P = .01); there were no differences in participants with prior cognitive impairment. In secondary analyses, in participants with prior cognitive impairment, the concentration of CSF sIL-6R was higher in those participants who developed delirium than in the other subgroups, but this difference was not statistically significant. Serum levels of CRP, IL-6, and sIL-6R were not different according to delirium in participants with or without prefracture cognitive impairment. Conclusion High CSF levels of CRP and sIL-6R may be associated with delirium. Different pathophysiological mechanisms may operate in different subgroups, notably in relation to the presence of prior cognitive impairment. [ABSTRACT FROM AUTHOR]

Objectives Longitudinal studies considering social disparities in the utilization of dental services are scarce. Repeated measures should be accounted for by the use of appropriate statistical methods. The purpose of this study was first to describe the patterns of less frequent dental attendance (less than once a year) over time from the age of 65-70 in Norwegian and Swedish 1942 cohorts. Second, this study estimated the influence of predisposing, enabling and need-related social predictors using marginal model with robust variance estimators and random intercept model, RIM, to account for the clustered structure of the repeated observations. Third, the study aimed to compare the estimates of associations between social predictors and less frequent dental attendance derived from marginal and random intercept models. Methods In 2007 and 2012, all residents born in 1942 in selected counties of Norway and Sweden were invited to participate in a questionnaire survey. In Norway, the response rate was 58.0% ( n = 4211) in 2007 and 54.5% ( n = 3733) in 2012 with a follow-up rate of 70%. The corresponding figures in Sweden were 73.1% ( n = 6078) and 72.2% ( n = 5697), with a follow-up rate of 80%. Marginal and random intercept models were fitted for population-averaged and person-specific estimates. Design effects were calculated by comparing the results from ordinary logistic regression analyses and the marginal model with robust variance estimators. The proportion of the total variation due to differences between persons was reported using the intraclass correlation coefficient (ICC). Results Less frequent dental attendance declined from 14.5% to 12.2% in Norway and from 13.6% to 12.9% in Sweden. According to marginal and random intercept models, time-invariant (gender, country of birth, education) and time-variant social predictors (working status, social network, marital status, smoking and perceived health) contributed to less frequent dental attendance. A likelihood ratio test confirmed that adjustment for clustered observations was appropriate. The ICC was 0.90 in Norway and 0.85 in Sweden. Conclusions The prevalence of less frequent dental attendance was low and dropped by increasing age from 65 to 70 years. Both at population and at person-specific levels, being advantaged on social aspects protects against less frequent dental attendance after 65 years of age in the Norwegian and Swedish cohorts investigated. [ABSTRACT FROM AUTHOR]

Objectives To determine how development of delirium after surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) could predict activity of daily living (ADL) and instrumental ADLs (IADL) disability, cognitive function, and self-reported health in individuals aged 80 and older. Design Prospective cohort study. Setting Tertiary university hospital. Participants Individuals aged 80 and older undergoing elective SAVR or TAVI (N = 136). Measurements Delirium was assessed for 5 days using the Confusion Assessment Method. The Barthel Index, Nottingham Extended ADL Scale, and SF-12 were used to determine ADL and IADL ability and self-reported health at baseline and 1- and 6-month follow-up. Cognition was assessed using the Mini-Mental State Examination at baseline and 6-month follow-up. Results Participants had lower IADL scores 1 month after SAVR than at baseline (baseline 58, 1 month: delirium 42, no delirium 50, P ≤ .02), but scores had returned to baseline levels at 6 months. The Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) Physical Component Summary (PCS) score was higher at 6-month follow-up (48) than at baseline (39), especially in participants who did not develop delirium ( P < .001). No differences in other outcomes were found. Regression models suggest that delirium may help predict IADL disability 1 month after baseline ( P ≤ .07) but does not predict large differences in ADL disability, cognitive function, or SF-12-scores. Individuals who underwent TAVI and developed delirium had lower ADL (baseline 19, 1-month 16, P < .001) and IADL (baseline 49, 1-month 40, P = .003) scores at 1-month follow-up. SF-12 PCS score (baseline 30) increased from baseline to 1- (35, P = .04) and 6- (35, P = .02) month follow-up in individuals who underwent TAVI and did not develop delirium. Delirium after TAVI predicted greater ADL and IADL disability at 1-month but not at 6-month follow-up. Conclusion Individuals who develop delirium after SAVR and TAVI have poorer short-term IADL function but do not seem to have long-term reductions in physical, mental, or self-reported health. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that public awareness of aphasia is vital for extending services, research support, social inclusion and targeted raising of awareness. Earlier studies show that knowledge of aphasia varies across a range of variables, but is very low compared with other conditions. Aims: To report a series of surveys of public awareness of aphasia from six countries, the largest study conducted this far. Methods & Procedures: Surveys were conducted in Argentina ( N = 800), Canada ( N = 831), Croatia ( N = 400), Greece ( N = 800), Norway ( N = 251) and Slovenia ( N = 400) using the same methodology requesting information on age, sex and occupation, asking whether respondents had heard of aphasia and where they had heard of it. Respondents were tested on their levels of knowledge of aphasia. Outcomes & Results: Results revealed low levels of awareness of aphasia in countries surveyed with marked variability that appeared to interact with occupation, country, age and sex. We surveyed 3483 respondents (mean age = 43.16; SD = 17.68). Between 60% (Croatia) and 16% (Slovenia) said they had heard of aphasia (37.1% overall), but those with actual knowledge ranged from 13.9% (Norway) to 1.0% (Argentina). The combined mean of those with basic knowledge was 9.2%. Those who had heard of aphasia were younger; and females had higher levels of awareness. We also found associations between socio-economic status and awareness. Those working in health, social and educational spheres had the highest levels. Respondents mainly heard about aphasia through the media and work or personal contact with aphasia. Conclusions & Implications: Levels of awareness are low everywhere in absolute terms, and relative to the awareness of other conditions, with significant variability between countries, sex and socio-economic status. We examine how surveys can be utilized to plan ways to increase understanding and discuss the comparison of awareness of aphasia with other conditions. [ABSTRACT FROM AUTHOR]

Background and Aims Flaws in previous studies mean that findings of J-shaped risk curves for gambling should be disregarded. The current study aims to estimate the shape of risk curves for gambling losses and risk of gambling-related harm (a) for total gambling losses and (b) disaggregated by gambling activity. Design Four cross-sectional surveys. Setting Nationally representative surveys of adults in Australia (1999), Canada (2000), Finland (2011) and Norway (2002). Participants A total of 10 632 Australian adults, 3120 Canadian adults, 4484 people aged 15-74 years in Finland and 5235 people aged 15-74 years in Norway. Measurements Problem gambling risk was measured using the modified South Oaks Gambling Screen, the NORC DSM Screen for Gambling Problems and the Problem Gambling Severity Index. Findings Risk curves for total gambling losses were estimated to be r-shaped in Australia {β losses = 4.7 [95% confidence interval (CI) = 3.8, 6.5], β losses2 = -7.6 (95% CI = -17.5, -4.5)}, Canada [β losses = 2.0 (95% CI = 1.3, 3.9), β losses2 = -3.9 (95% CI = -15.4, -2.2)] and Finland [β losses = 3.6 (95% CI = 2.5, 7.5), β losses2 = -4.4 (95% CI = -34.9, -2.4)] and linear in Norway [β losses = 1.6 (95% CI = 0.6, 3.1), β losses2 = -2.6 (95% CI = -12.6, 1.4)]. Risk curves for different gambling activities showed either linear, r-shaped or non-significant relationships. Conclusions Player loss-risk curves for total gambling losses and for different gambling activities are likely to be linear or r-shaped. For total losses and electronic gaming machines, there is no evidence of a threshold below which increasing losses does not increase the risk of harm. [ABSTRACT FROM AUTHOR]

Relationships among interoceptive sensitivity (IS), body image dissatisfaction, body mass index (BMI), and self-reported body awareness were investigated in a cross-sectional study. Eighty-two Norwegian high school students and 70 Hungarian undergraduate university students participated in the study. Subjects completed two questionnaires (Body Image Ideals Questionnaire - BIQ; Body Awareness Questionnaire - BAQ) followed by the assessment of interoceptive sensitivity using the Mental Tracking Method (MTM). An inverse, medium-level relationship between body image dissatisfaction and IS was found in both the Norwegian and the Hungarian samples. The relationships between IS and self-reported body awareness, and between body image dissatisfaction and BMI were uniformly non-significant in both samples. Predictors of body image dissatisfaction were resting heart rate, gender, and IS in the regression analysis after controlling for BMI, age, and nationality. The negative relationship between IS and body image dissatisfaction described in patients with anorexia nervosa also exists in healthy individuals. There is no direct connection between IS and self-reported body awareness. [ABSTRACT FROM AUTHOR]

Background Although pregnancy can be associated with adaptive changes in weight and eating behaviour for women with eating disorders, less is known about whether these changes are maintained in the postpartum period. We used a longitudinal design to examine gestational and postpartum weight trajectories in mothers with and without eating disorders in the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Methods Fifty-six women reported anorexia nervosa (AN), 636 bulimia nervosa, 3327 binge eating disorder and 69 eating disorder not otherwise specified, purging type. The referent group included 61 233 mothers with no eating disorder. We used a mixed effects model to predict weight change over time by eating disorder subtype. Results Mothers with AN, bulimia nervosa, binge eating disorder and eating disorder not otherwise specified had greater increases in body mass index (BMI) during pregnancy and greater decreases in BMI over the first 6 months postpartum. Women with AN shifted from the underweight BMI range before pregnancy to the normal weight range at 36 months postpartum Conclusions Patterns of maternal weight gain and retention during the perinatal period vary across eating disorder subtype and warrant clinical attention. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Background and Purpose High-intensity aerobic interval training (AIT) has shown to be beneficial in patients with cardiac and pulmonary diseases. Presumably, patients with stroke also benefit from such treatment. However, the feasibility and potential efficacy of high-intensity AIT should be investigated for patients early after stroke. Methods This was a single-group, pre-test-post-test, intervention study. The intervention consisted of a 6-week high-intensity AIT programme, performed twice a week. The AIT comprised 4 × 4-minute intervals, at 85-95% of peak heart rate, interrupted by 3-minute active breaks. Adherence to the protocol, compliance and adverse events were registered to assess feasibility. Cardiorespiratory fitness and functional outcomes were assessed before and after the intervention and at 6 and 12 weeks follow-up. Results Ten men and five women (mean age 70.0 ± 7.7; range 61-85 years) with mild to moderate stroke were included, 3-9 months after onset. One patient was diagnosed with cancer during follow-up. There were three minor events, but no serious adverse events occurred. All patients accomplished all training sessions and reached the 85% intensity level, except one patient who discontinued the last session. The mean peak oxygen uptake showed no significant improvement from pre-treatment, 28.7 ± 3.8 ml kg−1 min−1, to post-treatment, 29.6 ± 3.6 ml kg−1 min−1, p = 0.189, whereas the mean 6-minute walk test improved from 410.7 ± 101.4 m to 461.0 ± 99.6 m, p = 0.001, and the median (interquartile range) Rivermead Motor Assessment Scale improved from 12.0 (11.0-13.0) to 13.0 (11.0-13.0) points, p = 0.100. These improvements continued after the intervention was concluded. Conclusions This study has shown that high-intensity AIT is feasible for a selected group of stroke patients. However, the training should be accomplished in line with the American College of Sports Medicine guidelines for high-risk populations to ensure safety. The participants achieved a clinically highly significant improvement in walking distance. This intervention should be tested out in a randomized controlled trial to assess if it is superior to other interventions. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aims Within-country temporal changes in alcohol consumption in the United States, Finland and Norway were examined to assess (i) whether a change in mean alcohol consumption is accompanied by a change in the prevalence of heavy drinkers, (ii) whether this mean change reflects a collective displacement in the whole distribution of consumption and (iii) whether collective displacement is found for both an upward and a downward shift in mean consumption. Methods We applied repeated cross-sectional survey data on distribution measures for estimated annual alcohol consumption from national population sample surveys covering 30–40-year periods in two countries with increasing trends in mean consumption (Finland and Norway) and one country with decreasing trends (the United States). Results There was a strong positive association (P < 0.001) between changes in mean consumption and changes in the prevalence of heavy drinkers in all three countries. Moreover, a change in mean consumption was accompanied by a consumption change in the same direction in all consumer categories in all three countries, i.e. a collective displacement. The regression coefficients were approximately 1. Conclusions Drinkers at all levels of consumption appear to move in concert, both up and down the consumption scale, in Finland, Norway and the United States, as predicted by Skog’s theory of the collectivity of drinking cultures. [ABSTRACT FROM AUTHOR]

Background Knowledge is scarce on what contributes to whether children with early language delay (LD) show persistent, recovering or sometimes late-onset LD without a prior history of early LD in subsequent preschool years. Aims To explore whether an integrative model of vital risk factors, including poor early communication skills, family history of language-related difficulties and male gender, predicts the development of persistent, recovering or late-onset LD trajectories from 3 to 5 years quantitatively and qualitatively differently. Methods & Procedures LD was assessed by maternal reports on the Ages and Stages Questionnaire at 3 and 5 years for 10 587 children in The Norwegian Mother and Child Cohort Study. Children were classified across time as having no, late onset, transient or persistent LD. Multinomial logistic regression analyses included the integrative model of vital risk factors and covariates. Outcome & Results Across time, 3%, 5% and 6.5% of the children displayed persistent, transient and late-onset LD, respectively. The odds for persistent LD were doubled for boys and children with low language comprehension at 1.5 years; and tripled by late-talking familial risk. These same odds decreased for transient LD, and even further for late-onset LD. Familial risk for writing and reading difficulties especially increased the odds for late-onset and persistent LD, while familial risk of unintelligible speech increased the odds for transient LD. Although girls had on average far better language comprehension than boys, low language comprehension was a stronger risk factor for persistent LD in girls. Conclusions & Implications Preschool LD trajectories were uniquely predicted from the integrative risk model of poor early communicative skills, family history and male gender. This might benefit identification of different LD trajectories by supporting broader severe vulnerability for persistent LD, milder vulnerability for transient LD, and possibly a specific risk for reading and learning difficulties for children with late-onset LD. [ABSTRACT FROM AUTHOR]

Aims To describe and compare the perceived social provision for a group reporting never feeling lonely with that of a group reporting feeling lonely and to explore the meaning of loneliness. Subjects Participants (N = 101) were recruited from geriatric wards. Inclusion criteria were as follows: aged 65 years or more, the absence of dementia, one or more chronic physical disorders and plans to be discharged from the hospital to their home. The mean age was 81.3 years (range: 65-96 years), 68% were women, and 66% lived alone. Measures Assessments of social provisions and loneliness were collected by a subjective report using the Social Provision Scale ( SPS), and the Montgomery-Aasberg Depression Rating Scale ( MADRS) was used to assess depression. The participants were also asked whether they felt lonely and were then asked to describe the meaning of loneliness if they had indicated feeling lonely. Narratives were then condensed by the participants into short sentences. Results Seventy-five per cent of the participants reported feeling lonely, of these 54% were living alone, and 18% identified with depression. Three subscales of SPS scores were significantly lower in the lonely group: attachment (p < 0.001), a sense of reliable alliance (p = 0.001) and the obtaining of guidance (p = 0.01). The overall view of the experience of loneliness was dominated by emptiness and negative emotions. The following themes were identified: Emotions were dominated by sadness, anxiety and restlessness, anger and guilt. Relationships were dominated by being left alone, being confined and feeling useless. Existential dimensions were characterised by emptiness, endless boredom, isolation and the potential for change. Conclusion The study shows that loneliness is prevalent among older people suffering from chronic physical illness and confirms the complexity of the concept. A mixed-methods design contributed to nuanced and detailed information about the meaning of loneliness. [ABSTRACT FROM AUTHOR]

Aims To examine characteristics of 15- to 16-year-old adolescents who used over-the-counter analgesics daily to weekly (high-frequency users) as compared to those who used less or no analgesics (low-frequency users). Further to analyse the differences in pain experience, lifestyle, self-esteem, school attendance and educational ambition. Methods An anonymous cross-sectional questionnaire-based study. The questionnaire covered the use of over-the-counter analgesics, pain experience, sociodemographics, lifestyle factors, self-esteem, school absence and future educational plans. The study took place in the 10th grade in six junior high schools in a medium-sized town in Norway. The local sales data for analgesics and antipyretics were close to the national average. We invited 626 adolescents to participate. Of the 367 adolescents (59%) who responded, 51% were girls. Associations between the frequency of use of over-the-counter analgesic and the mentioned variables were analysed using multiple logistic regression. Results In total, 26% (42 boys and 48 girls) used over-the-counter analgesics daily to weekly. These high-frequency users experienced more widespread pain, slept less, had more paid spare-time work, drank more caffeinated drinks, participated more often in binge drinking, had lower self-esteem, less ambitious educational plans and more frequent school absence than did the low-frequency users. These associations remained significant when controlling for gender, cultural background and self-evaluated economic status. Conclusion Adolescent, who are high-frequency users of over-the-counter analgesics, suffer more pain and have identifiable characteristics indicative of complex problems. Their ability to handle stress appears to be discordant with the kind of situations to which they are exposed. The wear and tear associated with allostatic mechanisms counteracting stress may heighten their pain experience. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim To explore variability in perceptions of nurse managers and physician directors regarding roles, responsibilities and clinical-decision making related to mechanical ventilator weaning in Norwegian intensive care units ( ICUs). Background Effective teamwork is crucial for providing optimal patient care in ICU. More knowledge on nurses' and physicians' perceptions of responsibility in clinical decision-making for mechanical ventilation is needed. Methods Self-administered survey of mechanical ventilation and weaning responsibilities was sent to nurse managers and physician directors of Norwegian adult ICUs. Nurses' decisional influence and autonomy were estimated on a numeric rating scale ( NRS) from 0 to 10 (least to most). Results Response rate was 38/60 (63%) nurses and 38/52 (73%) physicians. On the NRS nurse managers perceived the autonomy and influence of nurses' ventilator decisions higher than physician directors: median of 7 ( IQR 5-8) (nurses) versus 5 (3-6) (physicians), ( p < 0·01), and 8 (7-9) (nurses) versus 7 (5-8) (physicians), ( p < 0·01) respectively. Respondents agreed that nurses collaborated in assessment of patient response to ventilator changes and titrating ventilator settings: 92% of nurses and 87% of physicians, ( p = 0·46), and recognizing weaning failure 84% of nurses and 84% of physicians, ( p = 0·96). Physician directors perceived significantly less collaborative decision-making on weaning method ( p = 0·01), weaning readiness ( p = 0·04) and readiness to extubate ( p < 0·01) than nurse managers. Both groups acknowledged the importance of 'knowing the patient' for weaning success, and agreed that the assessment of work of breathing, well-being, and clinical deterioration were important for determining weaning tolerance. Conclusions Nurse managers perceived nurses to have greater autonomy, influence and collaborative interaction regarding decisions on mechanical ventilation than physician directors. Greater awareness and acknowledgment of nurses' role may promote interprofessional collaboration and improve patient care. [ABSTRACT FROM AUTHOR]

Objectives To examine whether anticholinergic activity ( AA) in cerebrospinal fluid ( CSF) and serum is associated with risk of delirium in individuals with hip fracture. Design Prospective cohort study. Setting Two university hospitals in Oslo, Norway, and Edinburgh, UK. Participants Individuals admitted with acute hip fracture (N = 151). Measurements Participants were assessed daily for delirium using the Confusion Assessment Method (preoperatively and postoperative days 1-5 (all) or until discharge (participants with delirium)). Prefracture cognitive function was assessed using the Informant Questionnaire on Cognitive Decline in the Elderly ( IQCODE). Serum was collected preoperatively and CSF at the onset of spinal anesthesia. AA in serum ( SAA) and CSF samples was determined according to a muscarinic radio receptor bioassay. The association between AA measures and delirium was evaluated using logistic multivariate analyses. Results Fifty-two (54%) of the participants in Oslo and 20 (39%) in Edinburgh developed delirium. There was no statistically significant difference in AA between participants with and without delirium in Oslo (serum: 7.02 vs 6.08 pmol/mL, P = .54; CSF: 0.39 vs 0.48 pmol/mL, P = .26) or in Edinburgh (serum: 1.35 vs 1.62 pmol/mL, P = .76; CSF: 0.36 vs 0.31 pmol/mL, P = .93). Nor was there any difference in SAA ( Oslo, P = .74; Edinburgh, P = .51) or CSF AA ( Oslo, P = .21; Edinburgh, P = .93) when participants were subdivided into prevalent, incident, subsyndromal, and never delirium. Stratifying participants according to prefracture cognitive status ( IQCODE) gave the same results. Conclusion This is the first study of AA in CSF of individuals with and without delirium. The study does not support the hypothesis that central ( CSF) or peripheral (serum) AA is an important mechanism of delirium in individuals with hip fracture. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this study was to investigate the associations between age, gender, self-transcendence, nurse-patient interaction and multidimensional well-being as the outcome among cognitively intact nursing home patients. Background Self-transcendence is considered to be a vital resource of well-being in vulnerable populations and at the end of life. Moreover, the quality of care and the nurse-patient interaction is found to influence self-transcendence and well-being in nursing home patients. Design and method A cross-sectional design employing the Self- Transcendence Scale, the Nurse- Patient Interaction Scale, the FACT- G Quality of Life and the FACIT- Sp Spiritual Well-Being questionnaires was adopted. A sample of 202 cognitively intact nursing home patients from 44 nursing homes in central Norway was selected. A previous documented two-factor construct of self-transcendence was applied. The statistical analyses were carried out by means of independent sample t-test, correlation and regression analyses. Results Multiple linear regression analyses revealed significant relationships between interpersonal self-transcendence and social, functional and spiritual well-being, whereas intrapersonal self-transcendence significantly related to emotional, social, functional and spiritual well-being. Nurse-patient interaction related to physical, emotional and functional well-being. Age and gender were not significant predictors for well-being, except for functional and spiritual well-being where women scored higher than men. Conclusion Nurse-patient interaction and self-transcendence are vital resources for promoting well-being physically, emotionally, functionally, socially and spiritually among cognitively intact nursing home patients. Relevance to clinical practice Nurse-patient interaction signifies vital and ultimate nursing qualities promoting self-transcendence and multidimensional well-being. These findings are important for clinical nursing intending to increase patients' well-being. [ABSTRACT FROM AUTHOR]

Background and aims Although an increasing number of children are born to mothers in opioid maintenance therapy ( OMT), little is known about the long-term effects of these opioids. Previous studies suggest an association between prenatal OMT exposure and difficulties in eye movement control. Also, the effects of tobacco smoking on eye movements have been reported. The present study examined the influence of eye movements, i.e. smooth pursuit, on visuomotor capabilities in children of smoking mothers in OMT. Design The study comprised a 2 ( OMT versus contrast group) × 2 (slow versus fast smooth pursuit) between-subject factorial design. Setting The cognitive developmental research unit at the University of Oslo, Norway. Participants Participants were 26 4-year-old children of tobacco-smoking women in OMT and 23 non-exposed 4-year-old children, with non-smoking mothers, matched by gender and age. Measurement Eye movements and smooth pursuit were recorded using a Tobii 1750 eyetracker. Visuomotor functions were examined by Bender test. Findings The OMT group tracked slowly moving objects with smooth pursuit in a similar manner to their non-exposed peers. When fast smooth pursuit was measured, the OMT group of children tracked the object more slowly than the contrast group, P = 0.02, ηp 2 = 0.11. A regression analysis showed that fast smooth pursuit predicted children's performance on a visuomotor task, R2 = 0.37. Conclusion Impaired eye-tracking skills in 4-year-old children exposed to methadone or buprenorphine and tobacco prenatally could inhibit the development of some cognitive functions in later life. [ABSTRACT FROM AUTHOR]

We investigated whether fatigue can be used to screen nursing populations for risk of sickness absence. Data were available from a prospective cohort study of 2,059 Norwegian nurses working in hospital care, psychiatric care, and nursing home/home care settings. Physical and mental fatigue were measured at baseline with Chalder's Fatigue Questionnaire (FQ). Self-rated sickness absence at 1-year follow-up was considered high if nurses reported >30 sick days in the past year. Physical fatigue accurately predicted high sickness absence and adequately discriminated between high- and low-risk nurses in nursing home/home care settings. Mental fatigue was not predictive in any setting. The FQ is suitable for screening specific nursing populations for the risk of high sickness absence. [ABSTRACT FROM AUTHOR]

Objectives To compare the effect of high-intensity aerobic interval exercise ( HIA) with home-based exercise ( HB) in older adults with chronic disease soon after discharge from the hospital. Design Randomized controlled trial. Setting Hospital. Participants Community-dwelling older adults aged 70 to 92 (N = 115) were recruited while in the hospital. After discharge, they were randomized to HIA group (n = 59) or HB (n = 56). Intervention High-intensity aerobic interval exercise ( HIA) consisted of endurance, strength, and balance exercises. The HB consisted of low-intensity exercises and telephone follow-up from a physical therapist. Measurements Health-related quality of life ( HRQOL) was assessed using the Medical Outcomes Study 36-item Short Form Survey, physical fitness was measured using the Senior Fitness Test, and physical activity was assessed using the Physical Activity Scale for the Elderly. Results Intention-to-treat analysis showed that both groups improved their HRQOL and physical activity after 3 months. Improvements on the Senior Fitness Test (chair stand, arm curl and 6-minute walk (6 MWT)) were significantly greater in the HIA group than the HB group. The mean difference was 25.9 m on the 6 MWT ( P = .001, effect size d = 0.2), 1.3 per 30 seconds on the chair stands mean ( P = .001, effect size d = 0.3), and 1.6 per 30 seconds on the arm curl ( P = .001, effect size d = 0.4). Conclusion High-intensity aerobic interval exercise ( HIA) participants significantly improved their physical fitness. Both groups increased their HRQOL and physical activity. The findings suggest that exercise therapy should be incorporated as a part of the treatment for older people at risk for functional decline. [ABSTRACT FROM AUTHOR]

Objective: Previous research in eating disorders suggests that treatment satisfaction is closely related to the manner in which care is delivered. The present research is a systematic in depth study of health professional characteristics preferred by AN-patients. Method: Thirty-eight women with AN aged 18-51 were interviewed in depth using a phenomenological study design. Interviews were tape-recorded, transcribed, and analyzed using the QSR-NVivo7 software program. Results: Four factors associated with patients' satisfaction with their therapists were identified: 'acceptance,' 'vitality,' 'challenge,' and 'expertise.' Patients' responses suggested that treatment of AN requires therapists who are capable of using a complex set of behaviors when interacting with their patients. Discussion: There is accumulating evidence that across treatment modality, the manner in which treatment is delivered is critical to therapeutic change. Our findings increase the understanding of factors that may be associated with treatment retention, further help seeking, and overall treatment outcome. These exploratory and informant-centered results could guide clinicians in developing a strong therapeutic alliance with AN-patients and promote increased knowledge about the mechanisms that engage this population. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2012) [ABSTRACT FROM AUTHOR]

Tooth-coloured restorative materials are being used increasingly more often in Class II preparations in permanent teeth. Using a practice-based study design, we aimed to assess the survival time of Class II restorations and to identify factors relevant to their longevity. Class II restorations ( n = 4,030), consisting of resin composites (81.5%), compomers (12.7%), amalgams (4.6%), and glass-ionomer cement restorations (1.2%), were placed in 1,873 patients with a median age of 15 yr. In total, 92.7% of restorations were placed due to primary caries and 5.8% were replacements. After an average follow-up period of 4.6 yr, 61.6% of the restorations were successful, 11.2% had failed, and 27.2% were not available for evaluation (owing to patient drop-out). The mean annual failure rate was 2.9% for resin-composite restorations and 1.6% for amalgams. For resin-composite restorations, secondary caries was the most common reason for replacement (73.9%), followed by loss (8.0%), fracture (5.3%), and marginal defects (2.4%). Multilevel Cox-regression analyses identified young age of the patient, high previous caries experience, deep cavities, and saucer-shaped preparation technique as predisposing to shorter longevity of resin-composite restorations. One brand of resin composite had a shorter survival time than the others. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims This study investigates changes in criminal involvement among patients in opioid maintenance treatment (OMT) over a 7-year period prior to, during and after treatment, particularly in relation to differences in treatment engagement. Design, setting and participants Treatment data on all patients who started OMT in Norway between 1997 and 2003 ( n = 3221) were cross-linked with national criminal records. The period of observation was divided into four phases; pre-treatment, in-treatment, between treatments and post-treatment. Findings During OMT, rates of criminal convictions for the cohort were reduced to fewer than half of waiting-list levels [incidence rate (IR) 0.63 versus 1.57]. Patients in continuous treatment had the fewest convictions (IR 0.47) during treatment. The highest rates were found among patients out of treatment after several treatment episodes (IR 1.52). All groups had significantly fewer criminal convictions during treatment compared to before treatment. Staying in OMT for 2 years or more was associated with significantly reduced rates of convictions during treatment. Younger age and pre-treatment criminal convictions were associated with significantly ( P < 0.001) more convictions during treatment. Those who left treatment, permanently or temporarily, relapsed into high levels of convictions outside treatment. Conclusions Criminal activity appears to be reduced in Norway during opiate maintenance treatment. Younger age and prior history of criminal activity are important risk factors for continued criminal activity during treatment. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total cholesterol is a frequently used variable in the risk estimates. Some studies indicate that the predictive properties of cholesterol might not be as straightforward as widely assumed. Our aim was to document the strength and validity of total cholesterol as a risk factor for mortality in a well-defined, general Norwegian population without known CVD at baseline. Methods We assessed the association of total serum cholesterol with total mortality, as well as mortality from CVD and ischaemic heart disease (IHD), using Cox proportional hazard models. The study population comprises 52 087 Norwegians, aged 20-74, who participated in the Nord-Trøndelag Health Study (HUNT 2, 1995-1997) and were followed-up on cause-specific mortality for 10 years (510 297 person-years in total). Results Among women, cholesterol had an inverse association with all-cause mortality [hazard ratio (HR): 0.94; 95% confidence interval (CI): 0.89-0.99 per 1.0 mmol L−1 increase] as well as CVD mortality (HR: 0.97; 95% CI: 0.88-1.07). The association with IHD mortality (HR: 1.07; 95% CI: 0.92-1.24) was not linear but seemed to follow a 'U-shaped' curve, with the highest mortality <5.0 and ≥7.0 mmol L−1. Among men, the association of cholesterol with mortality from CVD (HR: 1.06; 95% CI: 0.98-1.15) and in total (HR: 0.98; 95% CI: 0.93-1.03) followed a 'U-shaped' pattern. Conclusion Our study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the 'dangers' of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial. [ABSTRACT FROM AUTHOR]

Objective Reluctance to recover may explain poor treatment outcome and high dropout and relapse rates in the treatment of anorexia nervosa (AN). This study systematically explored what AN patients describe as interfering with their wish to recover. Method Two independent samples of women with AN (total N = 36) were interviewed in-depth using a phenomenological study design. Interviews were tape recorded, transcribed and analysed using QSR-NVivo7 (QSR International, Melbourne, Australia) software. Results Seven core obstacles were found to interfere with informants' wish to recover as follows: (i) 'perceiving judgements'; (ii) 'feeling stuck'; (iii) 'feeling distressed'; (iv) 'denying AN'; (v) 'eating'; (vi) 'gaining weight'; and (vii) 'appreciating the benefits'. Conclusion The wish to recover is an autonomously based, fundamental motivational requirement for becoming ready to change. Understanding factors that contribute to this wish adds to the clinician's toolbox in motivational work with AN patients. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2011; 25; 725-734 Psychosocial health in children and adolescents surviving cancer Aim: To explore psychosocial health in children and adolescents surviving cancer three years after diagnosis compared with healthy controls, as assessed by adolescents themselves, their parents and teacher. Material and methods: Case-control study included 50 children and adolescents diagnosed with cancer between 1 January 1993 and 1 January 2003 and treated at the Paediatric Department St. Olav's University Hospital, Trondheim, Norway. Data were collected using the Strengths and Difficulties Questionnaire (self-report, parent report and teacher report), as well as the Achenbach System of Empirically Based Assessment questionnaire (teacher report). Results: Children surviving cancer had more emotional symptoms, higher total problem scores and poorer academic performance than their peers. Emotional problems were consistently reported by parents, teachers and adolescents themselves, in particular in children with brain tumours and among survivors with late effects. Conclusion: Our study shows that children surviving cancer are at higher risk for emotional problems when compared with their friends, even after several years following diagnosis and treatment. We conclude that when planning long-term follow-up care, rehabilitation of children and adolescents with cancer, especially for survivors with brain tumours and late effects, should particularly take into account their psychological problems and psychosocial functioning. [ABSTRACT FROM AUTHOR]

Objectives. Even though many studies demonstrate cognitive impairment in the acute phase of depression and several studies indicate that this impairment might be long lasting despite symptom reduction and recovery, there is a lack of longitudinal studies on this field with considerable follow-up length. The aim of this study was to investigate whether the impairment observed in cognitive inhibition in the acute phase of depression is reversible or irreversible in a 10-year follow-up assessment. Design. A longitudinal study of 38 individuals, 19 with recurrent unipolar depression and 19 healthy controls matched for gender, age, and education were included in the study. Method. Cognitive inhibition was investigated using the Stroop test at three different occasions: acute phase, short-term (6 months), and long-term (10 years) follow-up. Results. The results show that recurrent major depressive disorder patients have a long-lasting impairment in inhibition as measured by the Stroop test in 10-year follow-up. Further there is high consistency in inner group performance suggesting that severe impairment in the acute phase of illness is associated with severe impairment 10 years later despite recovery in the patient group. Conclusions. The results show that impairment in cognitive inhibition is long lasting when present in the acute phase of recurrent depression. Impaired cognitive inhibition might be an irreversible vulnerability marker for recurrent depression. [ABSTRACT FROM AUTHOR]

Objectives: Walking impairments are common in individuals with multiple sclerosis. Trunk control is a prerequisite for walking; however, knowledge regarding whether core stability and balance training influence walking is limited. This study aimed to investigate the immediate and long‐term effects of a group‐based, individualized, comprehensive core stability and balance intervention (GroupCoreDIST) compared with those of standard care on walking. Methods: This assessor‐blinded, prospective randomized controlled trial included 80 participants (Expanded Disability Status Scale scores 1–6.5) randomly allocated to GroupCoreDIST, conducted in groups of three for 60 min three times per week for 6 weeks (18 sessions) or standard care (n = 40/40). One participant attended no posttests, leaving 79 subjects for intention‐to‐treat analysis. The assessments were performed at baseline and at Weeks 7, 18, and 30. Outcomes included the 2‐min walk test (2MWT), 10‐m walk test‐preferred/fast/slow speed (10MWT), Multiple Sclerosis Walking Scale‐12 (MSWS‐12), Patient Global Impression of Change‐walking (PGIC‐walking), Rivermead Visual Gait Assessment (RVGA), and ActiGraphsWgt3X‐BT activity monitors (ActiGraph). The statistical analyses included repeated‐measures mixed models performed in IBM SPSS Version 24. Results: There were no significant between‐group differences in the outcome measurements at baseline. The mean differences between groups were significant at all follow‐up time points in favour of GroupCoreDIST for the 2MWT, 16.7 m at 7 weeks (95% CI [8.15, 25.25], 15.08 m at 18 weeks (95% CI [6.39, 23.77]) and 16.38 m at 30 weeks (95% CI [7.65, 25.12]; and the PGIC‐walking, 0.89 points at 7 weeks (95% CI [1.34, 0.45]), 0.97 points at 18 weeks (95% CI [1.42, 0.52]), and 0.93 points at 30 weeks (95% CI [1.39, 0.48]; all p ≤.001). The 10MWT‐fast speed and the MSWS‐12 showed significant between‐group differences at 7 and 18 weeks and the RVGA at 7 weeks. No between‐group differences were found regarding activity level (ActiGraph) or the 10MWT‐preferred or slow speed. Conclusion: Compared with standard care, GroupCoreDIST significantly improved walking immediately after the intervention for up to 24 weeks of follow‐up. [ABSTRACT FROM AUTHOR]

In Norway, there were parallel increases and subsequent decreases in birth weight (BW) and consumption of sugar-sweetened carbonated soft drinks (SSC) during the period 1990-2010, and by an ecological approach, we have suggested that the relationship was causal. The objective of this study was to examine if such a relationship was present in a prospectively followed cohort of pregnant women. The study population included 62,494 term singleton mother-infant dyads in the Norwegian Mother and Child Cohort Study (MoBa), a national prospective cohort study in Norway from 1999 to 2008. The association between SSC consumption and BW was assessed using multiple regression analyses with adjustment for potential confounders. Each 100 ml intake of SSC was associated with a 7.8 g (95% confidence interval [CI]: −10.3 to −5.3) decrease in BW, a decreased risk of BW > 4,500 g (odds ratio [OR]: 0.94, 95% CI: 0.90 to 0.97) and a near significantly increased risk of BW < 2,500 g (OR: 1.05, 95% CI: 0.99 to 1.10). The negative association with SSC consumption was aggravated by smoking, lack of exercise, and obesity. For mothers with gestational diabetes mellitus, we observed an increased risk of BW > 4,500 g (OR: 1.18, 95% CI: 1.00 to 1.39) and a trend towards significant increase in mean BW (25.1 g, 95% CI: −2.0 to 52.2) per 100 ml SSC. Our findings suggest that increasing consumption of rapidly absorbed sugar from SSC had opposite associations with BW in normal pregnancies and pregnancies complicated by gestational diabetes mellitus. [ABSTRACT FROM AUTHOR]