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Background: Schools are important arenas for the promotion of critical health literacy (CHL) among adolescents. Key domains of CHL are information appraisal, understanding social determinants of health, and abilities to act on determinants of health. In this paper, we examine the psychometric properties of the Critical Health Literacy for Adolescents Questionnaire (CHLA-Q). Methods: A cross-sectional survey study was performed at 5 schools in Norway. Respondents included 522 pupils aged 13-15 years old. Confirmatory factor analysis (CFA) was conducted to examine the structural validity. Internal reliability was assessed using ordinal Cronbach's alpha. Results: The estimated model had acceptable closeness of fit. Five of 6 scales displayed adequate internal reliability. Conclusion: The results indicate acceptable fit of the CHLA-Q framework and that 5 of the 6 scales are applicable to inform future research and interventions. More research is needed on measurement of the second domain of CHL.

Background: In many countries, health care professionals are legally obliged to share information from electronic health records with patients. However, concerns have been raised regarding the sharing of notes with adolescents in mental health care, and health care professionals have called for recommendations to guide this practice. Objective: The aim was to reach a consensus among authors of scientific papers on recommendations for health care professionals' digital sharing of notes with adolescents in mental health care and to investigate whether staff at child and adolescent specialist mental health care clinics agreed with the recommendations. Methods: A Delphi study was conducted with authors of scientific papers to reach a consensus on recommendations. The process of making the recommendations involved three steps. First, scientific papers meeting the eligibility criteria were identified through a PubMed search where the references were screened. Second, the results from the included papers were coded and transformed into recommendations in an iterative process. Third, the authors of the included papers were asked to provide feedback and consider their agreement with each of the suggested recommendations in two rounds. After the Delphi process, a cross-sectional study was conducted among staff at specialist child and adolescent mental health care clinics to assess whether they agreed with the recommendations that reached a consensus. Results: Of the 84 invited authors, 27 responded. A consensus was reached on 17 recommendations on areas related to digital sharing of notes with adolescents in mental health care. The recommendations considered how to introduce digital access to notes, write notes, and support health care professionals, and when to withhold notes. Of the 41 staff members at child and adolescent specialist mental health care clinics, 60% or more agreed with the 17 recommendations. No consensus was reached regarding the age at which adolescents should receive digital access to their notes and the timing of digitally sharing notes with parents. Conclusions: A total of 17 recommendations related to key aspects of health care professionals' digital sharing of notes with adolescents in mental health care achieved consensus. Health care professionals can use these recommendations to guide their practice of sharing notes with adolescents in mental health care. However, the effects and experiences of following these recommendations should be tested in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Radiotherapy is the main treatment modality in cancer. There is sparse knowledge on how patients with cancer experience their radiotherapy trajectory, and which factors might be associated with patients' experiences. Objectives: The aim of the present study was to explore how adults with cancer receiving radiotherapy evaluate the quality of their care, utilizing a patient-reported experience measure, and how patient- and service-related characteristics are associated with their evaluation. Methods: An explorative cross-sectional study using a self-completed questionnaire to assess patients' radiotherapy experiences was performed. Participants were recruited consecutively, within their last week of treatment, from two different hospitals in Norway from January 2021 to January 2022. Four hundred and eighty paper questionnaires were distributed to recruited patients, 240 at each hospital. Questionnaires were self-completed at home and returned by mail. The instrument person-centered coordinated care experience questionnaire (P3CEQ) was used. In addition to this, participants completed the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and The Sense of Coherence 13 scale (SOC-13). Data were analyzed using descriptive statistics, parametric tests, and unadjusted/adjusted linear regression models were estimated. Results: The study included 373 patients. Patients evaluated quality of care in terms of P3CEQ scores, with a mean score of 19.5 (standard deviation = 5.4). Lowest scores were identified in areas concerning person-centeredness and service coordination. There were no significant differences in P3CEQ scores between the younger and older groups. Having a partner and better SOC-13 scores were independently associated with the overall patient-reported experience score, whereas age was not. Conclusion: Patient-reported experience scores indicate that improvements are needed in some areas, such as informing and involving patients in the planning and coordination of their care. Findings suggest paying special attention to patients without a partner to offer patients the best possible care. [ABSTRACT FROM AUTHOR]

Making sure that health surveillance data are integrated into public health planning and decision-making is demanding. Politicians and their administration may lack knowledge, interest, or will to take it into account. Politics is at its core solution-driven, and this need for imminent action may outweigh the importance of solid knowledge. This paper focuses on Norwegian municipalities and fleshes out two factors that may provide an enabling environment for educating relevant personnel in health surveillance data; i) the existence of a public health coordinator and ii) the set-up of inter-sectoral working groups. We have anticipated that those organisational resources play an important role in linking the bodies of information provided in the municipalities' health surveillance document ; the municipal health profile ; and the health promotion priorities. The findings confirm the anticipated centrality of organisational resources. Having dedicated and inter-sectoral organizational resources working as boundary spanners – such as public health coordinators – is decisive to meeting the demands of current public health challenges. Moreover, dedication is useless unless there is a critical volume of the coordinator's work. It is only when she/he is in a full position that the profile is fully integrated. The study further identifies other conducive conditions for integration. For example, does knowledge on health determinants resides not only in statistical data, but also in qualitative experiences of people and professional practitioners. Of interest for further research is to explore how to educate such organisations to integrate such experiences into health promotion action. [ABSTRACT FROM AUTHOR]

Background: Cancer survivors are a diverse group with varying needs that are patient-, disease-, and/or treatment-specific. Cancer survivors have reported supplementing conventional anti-cancer treatment with Traditional and Complementary Medicine (T&CM). Although female cancer survivors are reported to have more severe anticancer adverse effects, little is known about the association between anticancer treatment and T&CM use among Norwegian cancer survivors. The aims of this study are therefore to investigate (1) associations between cancer diagnosis characteristics and T&CM utilization and (2) associations between anticancer treatment and T&CM utilization among cancer survivors in the seventh survey of the Tromsø study. Methods: Data was collected from the seventh survey of the Tromsø Study conducted in 2015-16 among all inhabitants of Tromsø municipality aged 40 and above (response rate 65%), where inhabitants received online and paper form questionnaires. Data from the data linkage to the Cancer Registry of Norway for cancer diagnosis characteristics was also used. The final study sample was made up of 1307 participants with a cancer diagnosis. Categorical variables were compared using Pearson's Chi-square test or Fisher's exact test while independent sample t-test was used to compare continuous variables. Results: The use of T&CM the preceding 12 months was reported by 31.2% of the participants with natural remedies as the most reported modality of T&CM (18.2%, n = 238), followed by self-help practices of meditation, yoga, qigong, or tai chi, which was reported by 8.7% (n = 114). Users of T&CM were significantly younger (p =.001) and more likely to be female (p <.001) than the non-users, with higher use of T&CM among female survivors with poor self-reported health and being 1–5 years post-diagnosis. Lower use of T&CM was found among female survivors who received a combination of surgery with hormone therapy and those who received a combination of surgery with hormone therapy and radiotherapy. Similar usage was seen in male survivors, but not at a significant level. For both male and female survivors, T&CM was most frequently used by those with only one cancer diagnosis (p =.046). Conclusion: Our results indicate that the profile of the Norwegian cancer survivor who uses T&M is slightly changing compared to previous findings. Additionally, compared to male survivors, more clinical factors are associated with use of T&CM among female cancer survivors. These results should serve as a reminder to conventional health care providers to discuss the use of T&CM with patients across the entire cancer survivorship continuum to promote safe use, especially among female survivors. [ABSTRACT FROM AUTHOR]

A negative relationship between mathematics anxiety (MA) and mathematics performance is well documented. One suggested explanation for this relationship is that MA interferes with the cognitive processes needed when solving mathematics problems. A demand for using more cognitive effort (e.g., when performing harder mathematics problems), can be traced as an increase in pupil dilation during the performance. However, we lack knowledge of how MA affects this relationship between the problem difficulty and cognitive effort. This study investigated, for the first time, if MA moderates the effect of arithmetic (i.e., multiplication) problem difficulty on cognitive effort. Thirty‐four university students from Norway completed multiplication tasks, including three difficulty levels of problems, while their cognitive effort was also measured by means of pupil dilation using an eye tracker. Further, the participants reported their MA using a questionnaire, and arithmetic competence, general intelligence, and working memory were measured with paper‐pencil tasks. A linear mixed model analysis showed that the difficulty level of the multiplication problems affected the cognitive effort so that the pupil dilated more with harder multiplication problems. However, we did not find a moderating effect of MA on cognitive effort, when controlling for arithmetic competence, general intelligence, and working memory. This suggests that MA does not contribute to cognitive effort when solving multiplication problems. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject: Previous studies of interdisciplinarity and nursing responsibilities have mainly focused on outcomes such as patient safety, job satisfaction and organizational factors.Mental health nurses often describe role confusion in relation to other health professionals.Opportunities for interdisciplinary communication with other professionals may benefit health care. What the paper adds to existing knowledge: The current large‐scale study is the first to investigate whether mental health and SUD nurses' perceptions of their opportunities to accommodate patients' needs are related to interdisciplinarity in the treatment unit and a nursing role with clearly defined responsibilities.Strong interdisciplinarity was associated with greater perceived opportunities to accommodate patients' psychosocial, somatic, and economic and legal needs, while strictly defined nursing roles/responsibilities were related to weaker opportunities to do so. What are the implications of practice: The findings highlight the need to address how mental health and SUD nurses organize practice to meet patients' diverse needsInterdisciplinary teamwork could strengthen nurses' ability to address patient needsFinding the best possible balance of providing service in teams or individually could improve resource utilization at the same time as strengthening patient care, and making sure that the patients' various needs are met. Introduction: Nurses' roles in specialist mental health and substance use disorder (SUD) treatment services are multidimensional and complex. Their responsibility, autonomy and interdisciplinary collaboration may be of importance for their perceived opportunities to accommodate patients' health needs. Previous studies of interdisciplinarity and nursing responsibilities have mainly focused on outcomes such as patient safety, job satisfaction and organizational factors, and included relatively small samples. The studies have also mainly been conducted in other sectors than the mental health and SUD nursing sectors. Aim/Question: The aim of this study is to examine the associations between nurses' roles, interdisciplinarity and their perceived opportunities to accommodate patients' psychosocial, somatic and economic/legal needs. Method: A cross‐sectional web‐based questionnaire survey was conducted in a nationwide sample of Norwegian nurses in the mental health, SUD treatment and combined mental health and SUD treatment sectors. Of 5,501 contactable nurses (74% of the population), 1918 (35%) responded. Results: The results revealed that interdisciplinarity was significantly associated with greater perceived opportunity to accommodate patient needs, whereas strictly defined nursing roles/responsibilities were associated with less opportunity to accommodate these needs. Discussion/Implication for practice: Facilitation of interdisciplinary collaboration may improve quality of care for patients in mental health and SUD treatment services. [ABSTRACT FROM AUTHOR]

The paper sets out to study Norwegians' experiences of non-monogamy. Data were collected by questionnaires in a web sample of 4160 Norwegians (18–89 years). 26.3% of men and 17.8% of women reported that they ever had non-consensual non-monogamy. Consensual non-monogamy was reported by 3%. Compared to participants with no or non-consensual experience, consensual non-monogamy was highly related to relationship intimacy and positive sexual attitudes toward sex and sexuality. At the most recent extradyadic event, 21.5% of heterosexual men and 47.1% of gay/bisexual men reported condom use, which implies a risk for sexually transmitted diseases. [ABSTRACT FROM AUTHOR]

Background: A staff e-learning course was developed to prepare for scaling up a national take-home naloxone (THN) program in Norway. The aims of the study were to (a) describe participant characteristics for those that completed a THN e-learning course, (b) compare opioid overdose knowledge scores before and after e-learning course completion, and (c) to explore subsequent THN distribution by those trained. Methods: This was a quasi-experimental pre-test, post-test longitudinal cohort study of individuals completing a THN e-learning course from April 2021 to May 2022. Frequency analyses were performed for participant characteristics and subsequent naloxone distributions at 1-week and 1-month follow-up. The opioid overdose knowledge scale (OOKS) was used to measure pre-test-posttest knowledge among participants. Wilcoxon signed-rank test was performed for comparison between pre-test and post-test. Effect size was calculated using Cohen criteria. Results: In total, 371 individuals were included in this study. Most were either nurses or social workers (n = 277, 75%). Participant knowledge increased by medium or large effect for all items measured. At 1-month follow-up, 15% reported naloxone distribution. During the study period, 94 naloxone kits were distributed. Major reasons for not distributing were "clients not interested", "workplace not distributing" and "workplace in process of distributing". Conclusions: Our findings suggest that an e-learning course is equally effective in terms of knowledge transfer as an in-person classroom setting, and may provide engagement in terms of naloxone distribution. However, our findings also emphasize the importance of clear implementation routines, including support from central coordinators to optimize the implementation process. [ABSTRACT FROM AUTHOR]

This study explored the experiences of public health nurses (PHN) in preventing obesity in preschool children and following national guidelines. We used a descriptive qualitative design with an online open-ended questionnaire based on vignettes describing fictitious practical situations during the follow-up of children presenting with overweight issues in child health clinics. Following qualitative content analysis, we identified one main theme: Strong but complex feelings of responsibility toward supporting parents in preventing obesity in preschool children and adhering to the guidelines. We also identified four subthemes: (a) Difficulties in deciding if the child's weight is a concern. (b) Challenges with meeting children's healthcare needs when weight is a concern. (c) Approaches for engagement and caring weight talks with parents. (d) The need for resources and interdisciplinary collaboration. PHNs suggested improvements for preventing childhood obesity and called for municipal prioritizing of organizational and personnel-related resources to ensure PHNs can efficiently follow national guidelines. [ABSTRACT FROM AUTHOR]

Background: Pakistani immigrants are the largest non-Western ethnic minority group in Norway. Traditional medicines (TM) are extensively used in Pakistan, and studies show that ethnic minorities also use them to recover from illness after migration to the Western world. This study aims to explore Pakistani immigrants' experiences and perceptions of risk regarding the use of TM to treat illnesses. Methods: A qualitative study was conducted through in-depth interviews (n = 24) with Pakistani immigrants in Norway from February to March 2023. Participants were recruited through purposive and snowball sampling methods. The data was analyzed using Braun & Clarke's reflexive thematic analysis (RTA) using Nvivo. Results: RTA revealed three main themes and six sub-themes. The main themes were: (a) House of knowledge, (b) Choosing the best possible approach for health restoration, and (c) Adverse effects of TM used. A total of 96 different TM were identified, including herbs, food items, animal products, minerals, herbal products, and ritual remedies. All participants used TM to restore health in acute and chronic diseases, and many used TM along with conventional medicines. The participants' mothers were the primary source of knowledge about TM, and they passed it on to the next generation. They also frequently used religious knowledge to recover from illness. Although TM is considered safe because of its natural origin, some participants experienced adverse effects of TM, but none of them reported it to the health authorities. Conclusion: The study helps to understand the experiences and perceptions of risk of Pakistani immigrants in Norway regarding traditional practices for treating health complaints. Public health policies to improve the health of these immigrants should consider the importance of TM in their lives. Further research is necessary to explore the safety and toxicity of those TM that are common in Pakistani households in Norway. [ABSTRACT FROM AUTHOR]

Objective: As prospective outcomes of septoplasty with or without turbinoplasty beyond the first year are few and have diverging results, this study evaluated later septoplasty results three to four years post-operatively. Methods: Patients undergoing septoplasty completed the Nasal Surgical Questionnaire pre-operatively, and at 6–12 months (early post-operative assessment) and 36–48 months (late post-operative assessment) after surgery. Primary outcome was visual analogue scale ratings for nasal obstruction (with a scale ranging from 0 to 100). Results: In 604 patients with high response rates, the largest improvements in nasal obstruction were from pre-operative to early post-operative assessments (daytime score reduction = 33.9, night-time reduction 40.5). Nasal obstruction ratings worsened slightly between early and late post-operative assessments (daytime score increase = 5.3, night-time score increase = 9.7). Improvements were better in patients aged over 35 years and in those with pre-operative nasal obstruction scores of more than 62. There were no differences based on surgery type, septal deviation, allergy or smoking. Conclusion: Septoplasty improves nasal obstruction in both the first and the fourth year after surgery. Post-operative improvements decline slightly over time but remain significant. [ABSTRACT FROM AUTHOR]

Background: Patient experience is an important indicator of the quality of healthcare. Patients with multimorbidity often face adverse health outcomes and increased healthcare utilisation. General practitioners play a crucial role in managing these patients. The main aim of our study was to perform an in-depth assessment of differences in patient-reported experience with general practice between patients living with chronic conditions and multimorbidity, and those with no chronic conditions. Methods: We performed secondary analyses of a national survey of patient experience with general practice in 2021 (response rate 41.9%, n = 7,912). We described the characteristics of all survey respondents with no, one, two, and three or more self-reported chronic conditions. We assessed patient experience using four scales from the Norwegian patient experience with GP questionnaire (PEQ-GP). These scales were used as dependent variables in bivariate and multivariate analyses and for testing the measurement model, including confirmatory factor analysis and a multigroup CFA to assess measurement invariance. Sentiment and content analysis of free-text comments was also performed. Results: Patients with chronic conditions consistently reported lower scores on the GP and GP practice experience scales, compared to those without chronic conditions. This pattern persisted even after adjustment for patient background variables. The strongest associations were found for the scale of "Enablement", followed by the scales of "GP" and "Practice". The subscale "Accessibility" did not correlate statistically significantly with any number of chronic conditions. The analysis of free-text comments echoed the quantitative results. Patients with multimorbidity stressed the importance of time spent on consultations, meeting the same GP, follow-up and relationship more often than patients with no chronic conditions. Our study also confirmed measurement invariance across patients with no chronic conditions and patients with multimorbidity, indicating that the observed differences in patient experience were a result of true differences, rather than artifacts of measurement bias. Conclusions: The findings highlight the need for the healthcare system to provide customised support for patients with chronic conditions and multimorbidity. Addressing the specific needs of patients with multimorbidity is a critical step towards enhancing patient experience and the quality of care in general practice. [ABSTRACT FROM AUTHOR]

Background: Child maltreatment is a global problem that puts children at risk of mental illness, substance abuse, and premature death. Interdisciplinary collaboration is important in preventing and detecting child maltreatment. In Norway, children undergo universal preventive health assessments and receive complimentary follow-up care from specialized public health nurses in child and family health clinics. These nurses conduct regular check-ups and home visits to monitor children for signs of maltreatment. Objective: The objective of this study is to describe how public health nurses at child and family health clinics follow the National Clinical Guidelines to prevent and detect child maltreatment, with a particular focus on clinical procedures and interdisciplinary collaboration. Furthermore, we aim to determine factors that are associated with identification of child maltreatment. Design: A cross-sectional online survey was conducted among public health nurses working in primary care between October 24th and December 31st, 2022. Public health nurses who worked with children aged 0–5 years and had consultations with families were eligible to participate, resulting in 554 responses. The study employed descriptive analysis, including frequency, percentage and mean, as well as a two-step logistic regression analysis. The study was approved by the relevant authority, and informed consent was obtained through questionnaire completion. Results: The public health nurses in this study displayed strong adherence to the guidelines and utilized various comprehensive assessment procedures to monitor child well-being, growth, and development. However, there was limited and infrequent collaboration with other professionals, such as child protection services, general practitioners, and hospitals. Most public health nurses reported occasional suspicion of child maltreatment, with age and years of experience in child and family clinics influencing these suspicions. Older public health nurses were more likely to suspect physical violence, while those with less than two years of experience reported less experience in suspecting maltreatment. Additional education increased the probability of suspecting sexual violence. Conclusions: This study provides insights into the practices of public health nurses in Norway regarding the detection and prevention of child maltreatment in child and family clinics. While adherence to guidelines is strong, suspicion of maltreatment is relatively rare. Collaboration across agencies is crucial in addressing child maltreatment. Age and experience may influence the detection of maltreatment. Improved collaboration, targeted guidelines, and ongoing professional development are needed to enhance child protection. [ABSTRACT FROM AUTHOR]

Introduction: Patients with cancer often want to spend their final days at home. In Norway, most patients with cancer die in institutions. We hypothesized that full integration of oncology and palliative care services would result in more time spent at home during end-of-life. Methods: A prospective non-randomized intervention trial was conducted in two rural regions of Mid-Norway. The hospitals' oncology and palliative care outpatient clinics and surrounding communities participated. An intervention including information, education, and a standardized care pathway was developed and implemented. Adult non-curative patients with cancer were eligible. Proportion of last 90 days of life spent at home was the primary outcome. Results: We included 129 patients in the intervention group (I) and 76 patients in the comparison group (C), of whom 82% of patients in I and 78% of patients in C died during follow-up. The mean proportion of last 90 days of life spent at home was 0.62 in I and 0.72 in C (p = 0.044), with 23% and 36% (p = 0.073), respectively, dying at home. A higher proportion died at home in both groups compared to pre-study level (12%). During the observation period the comparison region developed and implemented an alternative intervention to the study intervention, with the former more focused on end-of-life care. Conclusion: A higher proportion of patients with cancer died at home in both groups compared to pre-study level. Patients with cancer in I did not spend more time at home during end-of-life compared to those in C. The study intervention focused on the whole disease trajectory, while the alternative intervention was more directed towards end-of-life care. "Simpler" and more focused interventions on end-of-life care may be relevant for future studies on integration of palliative care into oncology. Trial Registration: ClinicalTrials.gov Identifier: NCT02170168. Plain Language Summary: Palliative care is an important part of cancer care to improve patients' quality of life. To be cared for and die in the preferred place are quality markers in palliative care. Patients with cancer often want to spend their final days at home. In Norway, most patients with cancer die in institutions. We hypothesized that full integration of cancer and palliative care would result in more time spent at home during end-of-life. An intervention that included information, education, and a standardized care pathway was developed and implemented in a region of Mid-Norway (the intervention region, I). A similar region served as comparison region (C). Adult patients with cancer treated with non-curative intent were eligible. Altogether, 129 patients in I and 76 patients in C were included in the study, of whom 82% in I and 78% in C died during follow-up. The mean proportion of time spent at home last 90 days of life was 0.62 in I and 0.72 in C (p = 0.044), and 22.6% and 35.6% (p = 0.073) died at home, respectively. A higher proportion died at home in both groups compared to pre-study national levels (12%). During the study period, C developed and implemented an alternative intervention to the study intervention, with the former placing more focus on end-of-life care compared to the she study intervention that focused on the whole disease trajectory. This may explain why the intervention did not result in more time spent at home during end-of-life as compared to C. "Simpler" interventions directed towards the study's primary outcome may be relevant for future studies on integration of palliative care into oncology. [ABSTRACT FROM AUTHOR]

Introduction: Often, homecare services are task-focused rather than personbased and fragmented instead of integrated. Consequently, several stakeholders have requested a transformation of the service ecosystem for senior citizens living at home. This transformation may be facilitated by an idealized design approach. However, few studies have applied such an approach. Moreover, previous research did not assess the ways in which the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home. Therefore, the purpose of this study is to gain an understanding of how the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home, according to different stakeholders. Methods: Four stakeholder groups (n = 57) from a Norwegian municipality participated in an interview study (2019--2020): senior citizens, carers, healthcare professionals and managers. A directed qualitative content analysis was applied, guided by a four-category framework for the preferred service ecosystem. Results: All stakeholder groups highlighted several limitations that hindered continuity of the services. There was also agreement on deficiencies in professionals' competence, yet professionals themselves did not focus on this as a significant aspect. Managers emphasised the importance of professionals' reablement competence, which was also considered to be deficient in the current homecare services. Contrary to the other stakeholder groups, most senior citizens seemed satisfied with the practical and social support they received. Together with carers, they also explained why they thought some professionals lack compassion. Their dependency on professionals may limit them in sharing honestly their opinions and preferences during care provision. Involvement of senior citizens in improvement of the current services was limited. Insufficient time and resources, as well as a complex organisation impacted the existing homecare services, and therefore served as barriers to the preferred service ecosystem. Discussion: In this study there were different degrees of correspondence between the existing homecare services and the preferred service ecosystem according to four stakeholder groups. To develop the preferred service ecosystem, aspects such as predictability, adaptivity, and relationships are key, as well as continuous involvement of senior citizens and other stakeholders. The four-category framework applied in this study served as a tool to assess the existing homecare services. [ABSTRACT FROM AUTHOR]

Background: Stress and burnout are widespread problems among radiological personnel Individual and organizational resilience and mindfulness offer protection against burnout. Aim: To investigate the level of resilience and mindfulness among radiological personnel, the associations between organizational resilience, individual resilience, and mindfulness, and how these factors impact the quality of care provided in radiological departments. Methods: An online questionnaire consisting of the Connor-Davidson Resilience Scale, the Mindful Attention Awareness Scale, the Benchmark Resilience Tool, and questions regarding burnout, and quality and safety was used. Data analysis consisted of descriptive statistics, bivariate correlation and standard multiple regression. Results and Conclusion: Few participants considered burnout a significant challenge. Individual and organizational resilience were low (30.40 ± 4.92 and 63.21 ± 13.63 respectively), and mindfulness was high (4.29 ± 0.88). There was a significant correlation between individual and organizational resilience (p = 0.004), between individual resilience and mindfulness (p = 0.03), and between organizational resilience and mindfulness (p = 0.02). Individual and organizational resilience affect each other. However; neither significantly affect quality and safety, nor mindfulness [ABSTRACT FROM AUTHOR]

There is increasing attention toward students' satisfaction and how they perceive the quality of the program they attend. This study examined stability and change across time with regard to the relationships between learning environment factors and occupational therapy students' satisfaction with the program. In the two consecutive cross-sectional analyses performed in this study, 163 second-year students and 193 third-year students from all six occupational therapy education programs in Norway participated. The Course Experience Questionnaire was used to assess learning environment factors and study satisfaction. The data were analyzed with Pearson's correlation coefficient r and with hierarchical linear regression. Bivariate associations between the learning environment scales were positive and most associations were statistically significant in both study years. Relatively stable associations between the learning environment variable "good teaching" and higher study satisfaction were detected, while other associations differed between years of study. Embedding quality into the learning process, in particular by emphasizing good teaching and the clear dissemination of goals and standards, is important for student satisfaction throughout years of study. [ABSTRACT FROM AUTHOR]

Background: Research has indicated that providing women with information about menopause can improve their attitudes towards it and symptom experience. Nevertheless, information shared on the menopause is often arbitrary. Aim: To examine women's information needs about menopause, and understand if, when, and from whom they want information. Design & setting: A cross-sectional study was undertaken. A questionnaire survey was distributed to women in the waiting room of 54 general practice clinics in South-Eastern Norway in autumn 2022. Method: Medical students recruited women in the clinic waiting rooms. A 1-page study-specific questionnaire was used, focusing on need for information about menopause. A multinominal logistic regression model was used to analyse the association between the desire for information and education level, country of birth, and menopausal status. Results: A total of 625 women were included, with a mean age of 44.4 years (standard deviation [SD] 8.7). In all, 59% answered that they wanted information about menopause, and 81% of these wanted their GP to inform them, from a median age of 45 years. According to the women, only 10% of GPs had initiated a discussion on the menopause. Higher education was a predictor for wanting information. A main driver of information needs was to help oneself in the present and in the future. In all, 33% did not want information. The main reasons were that they already possessed sufficient information, would take menopause as it comes, were too young, or were already postmenopausal. The sex of the GP did not influence the results. Conclusion: Most women wanted information about menopause from their GP. The study emphasises the need for GPs to consider prioritising this discussion, and to keep up to date on recommendations and treatment options. [ABSTRACT FROM AUTHOR]

Background: Symptom assessment is key to effective symptom management and palliative care for patients with advanced cancer. Symptom prevalence and severity estimates vary widely, possibly dependent on the assessment tool used. Are symptoms specifically asked about or must the patients add them as additional symptoms? This study compared the prevalence and severity of patient-reported symptoms in two different versions of a multi-symptom assessment tool. In one version, three symptoms dry mouth, constipation, sleep problems were among those systematically assessed, while in the other, these symptoms had to be added as an "Other problem". Methods: This retrospective cross-sectional study included adult patients with advanced cancer at an inpatient palliative care unit. Data were collected from two versions of the Edmonton Symptom Assessment System (ESAS): modified (ESAS-m) listed 11 symptoms and revised (ESAS-r) listed 9 and allowed patients to add one "Other problem". Seven similar symptoms were listed in both versions. Results: In 2013, 184 patients completed ESAS-m, and in 2017, 156 completed ESAS-r. Prevalence and severity of symptoms listed in both versions did not differ. In ESAS-m, 83% reported dry mouth, 73% constipation, and 71% sleep problems, but on ESAS-r, these symptoms were reported by only 3%, 15% and < 1%, respectively. Although ESAS-r severity scores for these three symptoms were higher than on ESAS-m, differences did not reach statistical significance. Conclusion: We identified significant differences in patient symptom reporting based on whether symptoms like dry mouth, obstipation and sleep problems were specifically assessed or had to be added by patients as an "Other problem". [ABSTRACT FROM AUTHOR]

Background: The objective was to investigate self-reported hand eczema, and skin complaints at other skin locations among workers exposed to particulate matter, especially ultrafine particles. Method: We conducted a cross-sectional study on workers from one ferro-silicon smelter plant, eight chimney sweeper stations and one firefighter station across Norway. Participants answered an extended version of the Nordic Occupational Skin Questionnaire (NOSQ-2022), with additional questions about whole-body skin complaints and visible dust deposition. Results are presented as descriptive data using firefighters as reference group. Odds ratio (OR) was calculated using logistic regression on lifetime prevalence of hand eczema adjusted for potential confounders and mediators. P-values were calculated using likelihood ratio test against the crude OR. Results: A total of 186 participants answered the questionnaire: 74 chimney sweepers, 52 firefighters and 60 smelter workers. Participation rate was 95.0, 94.5 and 63.6%, respectively. Lifetime prevalence of hand eczema was 9.5, 9.6, and 28.3%, respectively. The point prevalence of hand eczema was 1.4, 1.9 and 10.0%, respectively. We estimated OR for lifetime hand eczema in smelter workers to 4.36 [95% CI: 1.31–14.43, p = 0.016] and for lifetime skin complaints in other locations to 2.25 [95% CI: 0.98–5.18, p = 0.058]. The lifetime prevalence of skin complaints at other locations was 18.9, 23.1 and 40.0%, respectively. The point prevalence was 14.9, 9.6 and 16.7%, respectively. These estimates were not statistically significant but indicates that smelter workers have more skin complaints also at other locations. Conclusion: This study reports a more than four-fold increased risk of hand eczema in smelter workers, and possibly a higher risk of skin complaints in other body locations, compared to the other occupations. Longitudinal studies with larger population are needed to verify the marked increased risk of eczema among smelters and establish causation. [ABSTRACT FROM AUTHOR]

Background: The understanding and conceptualizing of gender and sexuality are continuously negotiated between individuals and cultures. Recently, new gender identity orientations have emerged, fighting pathologization and establishing new spaces and options for being sexually active gendered beings. Objective: To investigate variations in sexual activities across different gender identity orientations. Method: A questionnaire used in France was adapted to the Norwegian context and implemented in this study. The participants were recruited through therapists, TGD organizations, and social media. Results: A total of 538 individuals responded to the questionnaire, of which 336 provided a written description of their gender identity. Based on an analysis of the degree of male gender identity orientation, the degree of female gender identity orientation, and the degree of nonbinary gender identity orientation, three clusters appeared and were used in the analyses of sexual activities and preferences. Conclusions: Some findings could be attributed to lingering aspects of traditional gender roles, while others may be indicative of sexual expression stemming from societal acceptance of gender diversity and new identity orientations. [ABSTRACT FROM AUTHOR]

Introduction: People should have access to healthcare services that are effective, safe and secure, patient‐centred, and coordinated and continuous. One group that has consistently reported negative experiences and feels dissatisfied with services are patients with Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS). The objective of this study was to develop a deeper understanding of the experiences of dissatisfaction among ME/CFS patients and explore the reasons for such dissatisfaction. Methods: We conducted in‐depth interviews with 48 people from 24 households (comprising patients and family members), providing insight into the experiences of 37 ME/CFS sufferers in Norway. The participants were purposively sampled and included persons of different ages, genders, time since having the condition (3–30 years), and severity. Results: Four main themes were developed: (1) 'Nonexistent services' cover patients' experience that healthcare services had nothing to offer them after receiving their ME/CFS‐diagnosis. (2) 'Nonpersonalised services' documents experiences where patients did receive services, which in theory was appropriate for relieving a specific health problem, but in practice were experienced as inappropriate because they were not adapted to the patient's need. (3) 'Slow services' address patients' experience of getting services too late (or too little) to be useful. (4) 'Wrong services' comprise patients' experiences of being offered and/or 'forced' to accept services that they felt were inappropriate for their health problems. Conclusions: Providers' lacking knowledge of the condition and lack of precise recommendations for follow up may partly explain unsatisfactory experiences. Providers' belief (or disbelief) in the condition could furthermore influence caregiving. Also, systemic issues in the healthcare sector, like high workloads and bureaucracy, can negatively affect care provision. Finally, users' unsatisfactory experiences may also be due to a lack of patient involvement in the design of such services. Further research should investigate how patients can be involved in service design, and also providers' perspectives on caregiving and the barriers they experience for providing high‐quality care. Patient or Public Contribution: The ME‐patient organisation suggested research topics to the call from which this study got funding. Patients and caregivers provided feedback during analysis and interpretation of data. [ABSTRACT FROM AUTHOR]

Background: The mouth is a central organ for communication and fluid intake, also for dying nursing home patients. This study describes the prevalence and severity of oral symptoms from nursing home admission until the day of perceived dying and the day of death. Methods: A prospective, longitudinal cohort study including 696 patients who were admitted to 47 Norwegian nursing homes in 35 municipalities. During the first year of their stay, 189 died (27%), of whom 82 participants were assessed on the day they were perceived as dying and 134 on the day of death. Mouth care, nutrition, and bedsores were assessed with the Residents' Assessment Instrument for nursing homes (RAI-NH) and palliative care (RAI-PC). Pain intensity was assessed with the Mobilization-Observation-Behaviour-Intensity-Dementia-2 Pain Scale (MOBID-2). Results: The proportion of patients with ≥ 6 oral symptoms increased from 16% when perceived as dying to 20% on the day of death (P = 0.001). On the day of death, xerostomia (66%), dysphagia (59%), and mastication problems (50%) were the most frequently observed oral symptoms. Only 16% received mouth care every hour and 12% were in pain during this procedure. Compared to people without dementia, those with a diagnosis of dementia at admission (N = 112, 86%) had xerostomia and mastication problems more frequently (50% vs. 73%; 32% vs. 56% (P = 0.038), respectively) on the day of death. Conclusions: The high extent of oral symptoms such as xerostomia, dysphagia, and mastication problems underline the need for systematic assessment and improved oral palliative care for dying nursing home patients with dementia. Trial registration: Clinicaltrials.gov NCT01920100 08/08/2013. First submission to BMC oral 15/03/2023. [ABSTRACT FROM AUTHOR]

Background: The relationships between periodontitis and non-communicable diseases (NCDs) have been investigated through several different case-definitions. The differences in methodology may have hindered the basis of comparison between these studies. The classification from the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions offers a unison platform that may facilitate future comparison of such research. The present study aimed to reproduce associations between periodontitis and other NCDs using the 2017 Classification, in the Trøndelag Health Study (HUNT). Material and methods: The fourth HUNT-survey was carried out between 2017 and 2019. Clinical variables, blood samples and answers to questionnaires were collected from 4933 participants. Periodontal status was assessed based on the latest staging system, and its associations with NCDs were estimated by logistic regression models adjusted for potential confounders. Results: Compared to no or Stage I periodontitis, participants with Stage III/IV periodontitis (radiographic bone loss exceeding 33%) were associated with cardiovascular disease, hyperglycemia in participants with diabetes and chronic obstructive pulmonary disease (COPD)/emphysema. Associations with hyperglycemia in participants with diabetes and COPD/emphysema were also observed in participants with Stage II periodontitis. The only observed association when considering never-smokers alone, was with COPD/emphysema. Conclusion: Periodontitis Stage II and III/IV were associated with major NCDs. Effect sizes increased with increasing periodontitis stages, which implies greater occurrence of coincident comorbidities in patients with severe periodontitis. [ABSTRACT FROM AUTHOR]

Background: Pregnancy-related lumbopelvic pain is a frequently reported musculoskeletal disorder, but few studies have compared data between countries. Objectives: Examine prevalence, severity, and sick leave and explore potential risk factors associated with pregnancy-related lumbopelvic pain in Italian women and compare the results to a similar study in Norway, utilizing the same questionnaire. Design: Cross-sectional Methods: Italian (n = 481) and Norwegian women (n = 435) were allocated from two public hospitals in Rome (Fatebenefratelli San Giovanni Calibita-Isola Tiberina) and Oslo (Oslo University Hospital), as well as four antenatal clinics in Modena (Italy). The questionnaire was completed between gestation weeks 32 and 36, addressing women's experiences of pregnancy-related lumbopelvic pain and sick leave in current week, and retrospectively for prepregnancy, first and second trimesters. Results: In Italy and Norway, 39% and 57% of pregnant women reported pregnancy-related lumbopelvic pain, respectively, with 11% and 25% experiencing severe pregnancy-related lumbopelvic pain. Pregnancy-related lumbopelvic pain was associated with sick leave in Norway (p < 0.01), but not in Italy (p = 0.66) at late gestation. In both countries, women with pregnancy-related lumbopelvic pain versus those with no pregnancy-related lumbopelvic pain were more likely to be multiparous (Italy: 40% versus 31%, p = 0.06 and Norway: 53% versus 38%, p < 0.01), and have gestational weight gain above guidelines (Italy: 21% versus 13%, p = 0.02% and Norway: 27% versus 14%, p < 0.01) and previous experience of pregnancy-related lumbopelvic pain (Italy: 15% versus 2%, p < 0.01 and Norway: 31% versus 4%, p < 0.01). Maternal exercise (⩾2 times weekly) was associated with less pregnancy-related lumbopelvic pain (Italy: odds ratio = 0.33, 95% confidence interval = 0.11–1.0, p = 0.05 and Norway: odds ratio = 0.55, 95% confidence interval = 0.29–1.0, p = 0.06). Conclusion: We observed high rates of pregnancy-related lumbopelvic pain in Italy and Norway, with Norwegian women reporting the highest prevalence and severity level. While both countries had similar rates of sick leave in late gestation, an association between pregnancy-related lumbopelvic pain and sick leave was observed among Norwegian women only. Health care providers should be proactive in addressing pregnancy-related lumbopelvic pain through open communication and seeking input from pregnant individuals. However, it is essential to acknowledge that the current evidence on effective treatments remains limited and inconclusive, highlighting the need for further research in this field. [ABSTRACT FROM AUTHOR]

Background: Pain in adolescence is considered a worldwide concern. Adolescents' pain affects family functioning. However, bidirectional associations should be considered as parental determinates such as pain, stress, and sociodemographic factors are also shown to influence pain in adolescence. Objectives: This study explored the associations between maternal and paternal sociodemographic factors, pain, and stress and adolescents' pain, and stress on adolescents' pain. Methods: In total, 508 school-based Norwegian adolescents with a corresponding parent were included. All adolescents completed an electronic survey during school hours, and their respective parents responded electronically. The survey included sociodemographic data, the Perceived Stress Questionnaire, and the Brief Pain Inventory. Results: Herein, 385 adolescents reported an average pain of 2.1 (SD, 1.9), and 308 of the participating parents reported an average pain of 1.6 (SD, 1.8). Regressions stratified by parental gender revealed nonsignificant associations in fathers' study variables predicting adolescents' pain. However, having the highest maternal educational level (p ≤ 0.01) and working part-time (p ≤ 0.01) were associated with lower pain in adolescents. Conclusions: The findings of this study demonstrated that sociodemographic factors such as high educational status in mothers and mothers working part-time were associated with lower pain in Norwegian adolescents. These findings highlight the importance of a holistic approach to pain management in adolescence. [ABSTRACT FROM AUTHOR]

Background: Although, studies from Norway indicate a reduction in dental caries experience, in Northern-Norway this non-communicable oral condition is still prevalent. There is conflicting evidence of presence of social inequalities in dental caries in an adult population. Therefore, the aim of this study was to assess an association between educational level and dental caries experience in adults in urban Tromsø municipality, Northern-Norway, using The World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) framework of health determinants. Methods: Data from 3752 participants having recorded dental caries status and educational level in the seventh survey of the Tromsø Study: Tromsø7 were included. Dental status was examined clinically as decayed-, missing-, filled-teeth (DMFT score). For statistical analyses DMFT score was grouped into lower (DMFT < 19) and higher (DMFT ≥ 20). Educational level was obtained from a questionnaire and categorized as primary/partly secondary education, upper secondary education, tertiary education, short and tertiary education, long. Data on social and intermediary determinants was also self-reported. Univariable and multivariable binary logistic regression analyses were applied. Result: This study included 1939 (52%) women and the mean age of the participants was 57.11. The mean DMFT score was 18.03. The odds of having higher DMFT score followed a gradient based on educational level. Participants who reported lower than secondary education had 2.06 -fold increased odds of having higher DMFT score than those with tertiary education, long (OR: 2.06, 95% CI: 1.50–2.83). Those with upper secondary education had 60% higher odds of having higher DMFT score (OR: 1.60, 95% CI: 1.21–2.11), and those with tertiary education, short had 66% higher odds of having higher DMFT score (OR: 1.66, 95% CI: 1.24–2.22). Conclusion: The current cross-sectional study suggested an educational gradient in dental caries experience in an adult population of Northern- Norway. Further studies validating our results and investigating mechanisms of educational inequalities in oral health are warranted. [ABSTRACT FROM AUTHOR]

Background: Adverse childhood experiences (ACEs) are associated with poor oral health. Using a life course theoretical framework, this study explored the associations of specific and cumulative ACEs with caries and toothbrushing frequency in a Norwegian adolescent population. Methods: Participants were adolescents (n = 6351) age 13–17 years from The Young-HUNT4 Survey. Clinical data were retrieved from dental health records. Oral health outcomes were toothbrushing frequency, dentine caries experience (Decayed, Missing, and Filled Teeth – DMFT), and enamel caries. ACE exposure variables were physical abuse, sexual abuse, witness to violence, parental separation/divorce, parental alcohol problems, and bully victimization. Negative binominal regression models (incident rate ratios, IRRs; 95% confidence intervals, CIs) were used to determine the associations of the various ACEs with caries; logistic regression analyses (odds ratios, ORs; 95% CIs) were used to estimate associations with toothbrushing frequency. Potential effect modification by age was assessed using likelihood ratio test. Results: Adolescents exposed to physical abuse by others, sexual abuse by peers, parental separation/divorce, bullying, or who had witnessed violence, were more likely to report non-daily toothbrushing compared with those with no exposure to the given ACEs. Each cumulative increase in ACE exposure was associated with a 30% higher likelihood of non-daily toothbrushing (OR 1.30, 95% CI 1.19–1.42). Similarly, increasing number of adversities were associated with both higher dentine caries experience (IRR 1.06, 95% CI 1.02–1.09) and higher enamel caries (IRR 1.07, 95% CI 1.03–1.11). This effect was modified by age (13–15 vs. 16–17 years) for dentine caries experience. Furthermore, there was evidence of effect modification by age with bully victimization for both toothbrushing frequency (Pinteraction = 0.014) and dentine caries experience (Pinteraction < 0.001). Specifically, bully victimization was associated with a higher likelihood of non-daily toothbrushing (OR 2.59, 95% CI 1.80–3.72) and higher dentine caries experience (IRR 1.30, 95% CI 1.14–1.50) among 16–17-year-olds. Conclusions: Several specific ACEs were associated with non-daily toothbrushing and a higher caries experience among Norwegian adolescents in the Young-HUNT4 Survey. [ABSTRACT FROM AUTHOR]

Background: Meeting the oral health needs of the increasing population of older adults presents a major challenge in dental care. Knowledge about the oral health status in the young-elderly age group is essential for the planning of future oral health education and prevention programs. The aims of the present study were therefore to investigate the caries experience among 65-year-olds in Oslo, Norway, and to explore associations between having decayed teeth and sociodemographic, behavioural, and biological factors. Methods: A random sample of 65‑year‑olds in Oslo answered a questionnaire and underwent clinical and radiographic examinations (n = 457, 52% men and 48% women) at the Research Clinic, Faculty of Dentistry, University of Oslo, between February and December 2019. Primary- and secondary coronal and root caries lesions, root remnants, and missing and restored teeth were recorded. Decayed teeth (DT) were defined as teeth with coronal- and root caries lesions that had progressed into dentine and root remnants, and the DMFT/S scores were calculated. Results: The mean number of teeth was 25 (SD: 4) and the mean DMFT was 19.4 (SD: 4.7). Thirty seven percent of the individuals had at least one decayed tooth (DT > 0), and the mean number of filled teeth (FT) was 16.1 (SD: 5.4). Multivariable logistic regression analysis showed that male gender (OR: 1.8, 95% CI: 1.2–2.8), basic level of education (OR: 1.9, 95% CI: 1.2–2.9), irregular dental attendance (OR: 2.2, 95% CI: 1.0-4.8), and hyposalivation (OR: 2.1, 95% CI: 1.0-4.4) were significant risk indicators for having decayed teeth (DT > 0) (p < 0.05). Conclusions: In conclusion, 65-year-olds in Oslo had a low average number of decayed and missing teeth, and a high number of restored teeth. Irregular dental attendance and hyposalivation were the strongest risk indicators for having decayed teeth. Based on the present results, it will be important to ensure access to regular dental care and to increase the emphasis on caries preventive measures for individuals with hyposalivation in this age group. [ABSTRACT FROM AUTHOR]

Identifying attention-deficit/hyperactivity disorder (ADHD) in pre-schoolers may improve their development if treated, but it is unclear whether ADHD symptoms from this age are stable enough to merit treatment. We aimed to investigate the stability of parent- and teacher-reported ADHD symptoms and ADHD classified above the diagnostic symptom thresholds, including for hyperactivity-impulsivity (HI), inattention and combined presentations from age 3 to 8 years. This study is part of the longitudinal, population-based Norwegian Mother, Father and Child Cohort Study. At child age 3 years, parents were interviewed and teachers rated ADHD symptoms. At age 8 years, parents (n = 783) and teachers (n = 335) reported ADHD symptoms by the Child Symptom Inventory-4. We found a significant reduction in the mean number of parent-reported ADHD and HI symptoms from age 3 to 8 years, but otherwise similar mean numbers. Parent-reported ADHD symptoms were moderately correlated between ages, while correlations were low for teachers. A total of 77/108 (71%) of the children classified with parent-reported HI presentation at age 3 years were no longer classified within any ADHD presentation at age 8 years, the only clear trend across time for either informant. There was a low to moderate parent–teacher-agreement in the number of reported symptoms, and very low informant agreement for the classified ADHD presentations. Overall, clinicians should exercise caution in communicating concern about HI symptoms in preschool children. Age 3 years may be too early to apply the ADHD diagnostic symptom criteria, especially if parents and teachers are required to agree. [ABSTRACT FROM AUTHOR]

Music-Oriented Parent Counseling (MOPC) is a clinical way to work with parents, using musical improvisations and listening. This study examined effects of MOPC on level of stress, quality of life perception and daily use of music by the parents of autistic children. Fourteen parents of young autistic children received either three MOPC sessions (n = 7) or ten MOPC sessions (n = 7), parallel to either music therapy (MT) or standard care for their children. Change in parental stress, parents' perception on children's and families' quality of life and the daily use of music (routine and joint music activities) were measured with standardized assessments and parent interviews. Descriptive and inferential parametric statistics were conducted, as well as thematic analysis. We found little change and no significant effect on parental stress. Children's quality of life showed improvement with but not without MT and a tendency towards a larger improvement with high-intensity than low-intensity MOPC. Family quality of life showed less change but a somewhat larger improvement in high-intensity than low-intensity MOPC. Routine music activities increased in high-intensity MOPC but decreased in low-intensity MOPC; joint music activities showed less change but a similar trend. Qualitative analysis of the interviews suggested that parents participating in high-intensity MOPC felt less stressed, perceived improved quality of life, and increased music use. Findings provide preliminary support for high-intensity MOPC to help parents of autistic children increase children's and families' quality of life and music use. More research is needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Objectives. Workplace inspection supports improving the working environment. Changes in workplaces following inspections are construed as the inspection's outcome. This study aimed to develop a tool for inspection performance assessment (TIPA) based on identified inspection prerequisites and evaluate the tool's appropriateness for performance assessment. Methods. Occupational safety and health experts ranked the prerequisites for effective inspection performance, based on their experiences and perception of importance of the prerequisites. The outcome formed the basis for weighting and assignment of values to the prerequisite subgoals. An assessment tool interface, with which inspectors can assess their workplace inspection performance was designed. Inspectors from different national authorities provided feedback on the tool's appropriateness for measuring inspection performance. Results. Results showed much agreement between the inspectors. A five-level performance consideration based on inspection performance index attained was implemented. High average ratings for the test criteria were obtained, with high inter-rater consistency, and reliability. Conclusion. TIPA provides a systematic inspection performance quantification supporting inspectors' self-actualization, improving performance. Furthermore, the tool's generality allows for use irrespective of the inspection area without affecting inspection areas' specificity adjustments. In addition, the ease of use adds to its utility, with agreement on the tool's appropriateness for inspection performance assessment. [ABSTRACT FROM AUTHOR]

Background: Life expectancy (LE) is increasing worldwide, while there is lack of information on how this affects older individuals' use of formal home care services. Aim: We aimed to decompose LE into years with and without home care services and estimate projected number of users towards 2050 in Norway for people 70 years or older. Methods: This study is based on a sample of 25,536 participants aged 70 years and older in the Trøndelag Health Study (HUNT) survey 2 (1995–1997), 3 (2006–2008), or 4 (2017–2019) linked with national data on mortality. Prevalence of home care services was standardised to the Norwegian population by age and sex. The Sullivan method was used to estimate expected years with and without home help services and nursing services for the years 1995, 2006 and 2016. Data from HUNT4 and Statistics Norway were used to estimate projected use of these services between 2020 and 2050. Results: During 1995–2017, the use of home help services decreased from 22.6% to 6.2% (p < 0.001), and from 6.4% to 5.5% (p = 0.004) for home nursing services. Adjusted for age and sex, the use of home help services decreased significantly over time (p < 0.001), while home nursing services were stable (p = 0.69). LE at age 70 increased from 11.9 to 15.3 years in men (p < 0.05) during 1995–2017, and from 14.7 to 17.1 in women (p < 0.05). In the same period, the expected years receiving home help decreased from 2.6 to 1.1 in men (p < 0.05), and from 4.4 to 2.1 in women (p < 0.05). The expected years receiving home nursing increased from 0.6 to 0.9 in men (p < 0.05), and from 1.3 to 1.7 in women (p < 0.05). Projected numbers of people 70+ in Norway in need of either of these services were estimated to rise from 64,000 in 2020 to 160,000 in 2050. Conclusion: While overall life expectancy increased, the expected years receiving home help have decreased and home nursing slightly increased among the Norwegian population aged 70 years and older during 1995–2017. However, the substantial increase in the projected number of older adults using home care services in the future is an alert for the current health care planners. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of a structured goal-setting and tailored follow-up rehabilitation intervention with existing rehabilitation in patients with rheumatic and musculoskeletal diseases. Design: A pragmatic stepped-wedge cluster randomized trial. Setting: Eight rehabilitation centers in secondary healthcare, Norway. Participants: A total of 374 adults with rheumatic and musculoskeletal diseases were included in either the experimental (168) or the control group (206). Interventions: A new rehabilitation intervention which comprised structured goal setting, action planning, motivational interviewing, digital self-monitoring of goal progress, and individual follow-up support after discharge according to patients' needs and available resources in primary healthcare (the BRIDGE-intervention), was compared to usual care. Main measures: Patient-reported outcomes were collected electronically on admission and discharge from rehabilitation, and after 2, 7, and 12 months. The primary outcome was patients' goal attainment measured by the Patient Specific Functional Scale (0–10, 10 best) at 7 months. Secondary outcome measures included physical function (30-s Sit-To-Stand test), health-related quality of life (EQ-5D-5L-index), and self-assessed health (EQ-VAS). The main statistical analyses were performed on an intention-to-treat basis using linear mixed models. Results: No significant treatment effects of the BRIDGE-intervention were found for either primary (Patient Specific Functional Scale mean difference 0.1 [95% CI: −0.5, 0.8], p = 0.70), or secondary outcomes 7 months after rehabilitation. Conclusion: The BRIDGE-intervention was not shown to be more effective than existing rehabilitation for patients with rheumatic and musculoskeletal diseases. There is still a need for more knowledge about factors that can improve the quality, continuity, and long-term health effects of rehabilitation for this patient group. [ABSTRACT FROM AUTHOR]

Aims: To gain a comprehensive understanding of nurses' infection control practices, antibiotics stewardship attitudes and self‐efficacy when caring for patients with multidrug‐resistant bacterial infections in a hospital setting. Background: Multidrug‐resistant bacteria cause a substantial health burden by complicating infections and prolonging hospital stays. Attitudes and self‐efficacy can inform professional behaviour. Nurses' attitudes and self‐efficacy concerning multidrug‐resistant bacteria, infection prevention and control and antibiotic stewardship are vital in keeping patients safe. Design: A descriptive and convergent mixed‐methods design involving quantitative and qualitative approaches was used. Methods: Two hundred and seventeen nurses working in clinical practice at seven different hospital wards (i.e., general medicine, surgical, haematological and oncology) at a Norwegian university hospital were invited to participate. Data were collected in February and March 2020 via two questionnaires: the Multidrug‐Resistant Bacteria Attitude Questionnaire and the General Perceived Self‐Efficacy Scale (n = 131) and four focus group interviews (n = 22). The data were analysed using descriptive statistics and systematic text condensation. Results: Most nurses showed moderate knowledge, adequate behavioural intentions towards infection prevention and antibiotic stewardship, and high self‐efficacy. However, they reported negative emotions towards their knowledge level and negative emotions towards nursing care. The nurses appeared uncertain about their professional influence and role in antibiotic stewardship practices. Organisational and relational challenges and ambivalent perceptions of nurses' role were potential explanations. Conclusion: Nurses report moderate attitudes and high self‐efficacy when caring for patients with multidrug‐resistant bacterial infections. This study suggests that nurses experience organisational and relational factors in their work environment that challenge their attitudes towards infection prevention and control and antibiotic stewardship practices. Measures that strengthen their knowledge and emotional response underpin correct infection prevention and control behaviour. A role clarification is needed for antibiotic stewardship. No Patient or Public Contribution. Relevance to clinical practice: Measures to increase attitudes towards infection prevention and control, antibiotic stewardship and multidrug resistance is recommended. Measures should be taken to overcome organisational challenges. A clarification of the nurses' role in antibiotic stewardship is needed. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To investigate the association between perceived nurse–patient interaction and quality‐of‐life among nursing home residents, adjusted for loneliness, anxiety and depression. Background: Symptoms of anxiety and depression are known to residents of nursing homes along with cognitive impairment, physical inactivity and low quality‐of‐life. Anxiety, depression and loneliness are found detrimental to NH residents' quality‐of‐life. The nurse–patient relationship is important for patient's well‐being, both in terms of illness and symptom management. Design: Cross‐sectional design. Methods: Data were collected in 2017 and 2018 from 188 residents in 27 nursing homes resided in two large urban municipalities in Middle and Western Norway. The inclusion criteria were: (1) local authority's decision of long‐term NH care; (2) residential stay 3 months or longer; (3) informed consent competency recognised by responsible doctor and nurse; (4) capable of being interviewed, and (5) aged 65 years or older. This article is executed in accordance with STROBE statement. Results: Adjusting for age, sex, anxiety, depression and loneliness, perceived nurse–patient interaction was statistically significant to quality‐of‐life. While anxiety and depression showed insignificant estimates, loneliness demonstrated a significant relation with quality‐of‐life. Nurse–patient interaction and loneliness explained together 25% of the variation in quality‐of‐life. Conclusion: This study suggests that loneliness is frequent as well as more detrimental to quality‐of‐life among nursing home residents compared to anxiety and depression. Furthermore, the present results show that the nurse–patient interaction represents an essential health‐promoting resource for Quality‐of‐life in this population. Relevance to clinical practice: Staff nurses need to exercise their awareness of loneliness to meet residents' needs. Nursing educations should provide knowledge about nurse–patient interaction, and students as well as staff nurses in NHs should be trained, for instance by simulation, to use the nurse–patient interaction as a health‐promoting resource. Finally, loneliness represents a bigger challenge than depression and anxiety; accordingly, building nurses that are capable of meeting patients' needs and facilitate care that counteracts loneliness is highly warranted [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the longitudinal experiences using an application named remote home care for remote palliative care among patients with cancer living at home. Background: Introducing welfare technology in home‐based care for patients with cancer in the palliative phase is internationally suggested as a measure to remotely support palliative care needs. However, little is known about the experiences of patients utilising welfare technology applications to receive home‐based care from healthcare professionals in a community care context. Although living with cancer in the palliative phase often presents rapidly changing ailments, emotions and challenges with patients' needs changing accordingly, no studies exploring the longitudinal experiences of patients were found. Design: A qualitative study with a longitudinal, exploratory design. Methods: Data were collected through individual interviews with 11 patients over 16 weeks. The data were analysed using qualitative content analysis. The COREQ checklist guided the reporting of the study. Results: Three themes were identified: (1) potential to facilitate self‐governance of life‐limiting illness in daily life, (2) need for interpersonal relationships and connections, and (3) experiences of increased responsibility and unclear utility of the Remote Home Care. Conclusion: The results showed that remote home care facilitated patients' daily routines, symptom control and improved illness‐management at home. Interpersonal relationships with healthcare professionals were considered pivotal for satisfactory follow‐up. Infrastructural glitches regarding data access, information sharing and lack of continuous adjustments of the application represented major challenges, with the potential to impose a burden on patients with cancer in the palliative phase. Relevance to Clinical Practice: By exploring the experiences of patients in palliative care over time as the disease progresses, this study provides constructive insights for the design and development of welfare technology applications and optimal care strategies. Patient or Public Contribution: The remote home care was developed by interdisciplinary healthcare professionals. [ABSTRACT FROM AUTHOR]

Given the scarcity of evidence concerning the long-term sexual health of breast cancer (BC) survivors (BC-Pop), we aimed to assess how BC treatments affect short- and long-term sexual functioning, sexual enjoyment, and body image, and compare with aged-matched women in the Norwegian general population (F-GenPop). The 349 patients in BC-Pop treated at Trondheim University Hospital in 2007–2014, were assessed in clinical controls at the hospital; before starting radiotherapy (T1, baseline), immediately after ending radiotherapy (T2), and after 3, 6, and 12 months (T3–T5), and at a long-term follow-up 7–12 years after baseline (T6). Meanwhile, F-GenPop included 2254 age-matched women in the Norwegian general population. The impact of BC treatment on sexual functioning was examined using a Linear Mixed Model. Sexual functioning, sexual enjoyment, and body image were assessed with the EORTC′s QLQ-BR23 scales and compared between the populations in the four age groups (30–49, 50–59, 60–69, and 70+ years) using means with 95% confidence intervals and Student t-test. Linear regression, adjusted for age and comorbidity was applied to estimate individual scores. BC survivors treated with mastectomy had overall lower sexual functioning than patients who had received breast-conserving surgery (p = 0.017). Although BC survivors treated with chemotherapy had lower sexual functioning than those treated without chemotherapy at T1–T5 (p = 0.044), both groups showed the same level of functioning at T6. BC-Pop exhibited significantly poorer sexual functioning (p < 0.001), lower sexual enjoyment (p < 0.05), and better body image (p < 0.001) than F-GenPop in all age groups. The impact of specific BC treatments on sexual functioning was modest; only mastectomy had a persistent negative influence. Nevertheless, all age groups in BC-Pop displayed significantly poorer sexual functioning than F-GenPop at both 12 months and up to 12 years after treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: Persons with severe intellectual disability (ID) may be non-verbal and unable to communicate pain or distress. Consequently, painful conditions may go undetected, and non-verbal persons with ID may not receive adequate care and treatment. OBJECTIVE: This study aims to explore how professional caregivers and parents identify pain and distress in non-verbal persons with ID, and their attitudes towards using wearable sensors to identify pain and distress in daily life situations. METHODS: Exploratory, mixed method study. Caregivers (83) answered an online questionnaire, and professional caregivers (18) and parents (7) were interviewed. RESULTS: Professional caregivers and parents recognise pain and distress from observations and behavioural signs that are often equivocal. They experience that this is inadequate to reliably detect pain and distress in non-verbal persons with ID. Professional caregivers and parents' express frustration and fear that painful conditions may remain untreated. They are positive towards using wearable sensors on condition that sensors do not infringe on user autonomy and privacy. CONCLUSIONS: There is a need for sensors and methods that can objectively identify pain and distress and ensure adequate treatment, that may improve quality of life of non-verbal persons with ID. [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]

The western world is seeking increased implementation of assistive technology (AT) to meet the challenges of an ageing population. The objective of this study is to explore perspectives on AT use among home-dwelling older adults with or without cognitive impairment. This study combines findings from a cross-sectional study with a questionnaire package (n = 83) and from qualitative individual interviews (n = 7) and is part of a larger study, the Assisted Living Project. Combining methods promotes complementary inquiries into a phenomenon. The participants already use ATs: TVs, social alarms, mobile phones, stove timers, electronic medical dispensers, PCs and tablet computers. They were both optimistic and skeptical of AT, and expressed different perspectives and expressed different perspectives on ATs in relation to usability, privacy and fear of losing personal face-to-face care. This study reveals that older adults' perspectives on AT are multifaceted and complex, and can partly be explained by the interacting factors in the HAAT model: person, technology, environment, and context. Further exploration in relation to older adults with health challenges, as well as ethical perspectives on AT implementation, is required for this group. The Norwegian Research Council, Number 47996, funds the Assisted Living Project (ALP). The study was useful in order to inform the health care services about older adults "perspectives on assistive technology". This study reveals the complexity of understanding perspectives towards and the use of assistive technology among older adults with or without cognitive impairment. This study contributes to the understanding of the interactions between the four components: humans, activities, technology and the context. [ABSTRACT FROM AUTHOR]

Plant-based diets may increase the risk of vitamin B12 deficiency due to limited intake of animal-source foods, while dietary folate increases when adhering to plant-based diets. In this cross-sectional study, we evaluated the B12 and folate status of Norwegian vegans and vegetarians using dietary B12 intake, B12 and folic acid supplement use, and biomarkers (serum B12 (B12), plasma total homocysteine (tHcy), plasma methylmalonic acid (MMA) and serum folate). Vegans (n 115) and vegetarians (n 90) completed a 24-h dietary recall and a FFQ and provided a non-fasting blood sample. cB12, a combined indicator for evaluation of B12 status, was calculated. B12 status was adequate in both vegans and vegetarians according to the cB12 indicator; however 4 % had elevated B12. Serum B12, tHcy, MMA concentrations and the cB12 indicator (overall median: 357 pmol/l, 9·0 µmol/l, 0·18 µmol/l, 1·30 (cB12)) did not differ between vegans and vegetarians, unlike for folate (vegans: 25·8 nmol/l, vegetarians: 21·6 nmol/l, P = 0·027). Serum B12 concentration < 221 pmol/l was found in 14 % of all participants. Vegetarians revealed the highest proportion of participants below the recommended daily intake of 2 µg/d including supplements (40 v. 18 %, P < 0·001). Predictors of higher serum B12 concentrations were average daily supplement use and older age. Folate deficiency (< 10 nmol/l) was uncommon overall (< 2·5 %). The combined indicator cB12 suggested that none of the participants was B12-depleted; however, low serum B12 concentration was found in 14 % of the participants. Folate concentrations were adequate, indicating adequate folate intake in Norwegian vegans and vegetarians. [ABSTRACT FROM AUTHOR]

Limited data exist regarding the role of meat consumption in early-stage colorectal carcinogenesis. We examined associations of red and processed meat intake with screen-detected colorectal lesions in immunochemical fecal occult blood test (FIT)-positive participants, enrolled in the Norwegian CRCbiome study during 2017–2021, aged 55–77 years. Absolute and energy-adjusted intakes of red and processed meat (combined and individually) were assessed using a validated, semi-quantitative FFQ. Associations between meat intake and screen-detected colorectal lesions were examined using multinomial logistic regression analyses with adjustment for key covariates. Of 1162 participants, 319 presented with advanced colorectal lesions at colonoscopy. High v. low energy-adjusted intakes of red and processed meat combined, as well as red meat alone, were borderline to significantly positively associated with advanced colorectal lesions (OR of 1·24 (95 % CI 0·98, 1·57) and 1·34 (95 % CI 1·07, 1·69), respectively). A significant dose–response relationship was also observed for absolute intake levels (OR of 1·32 (95 % CI 1·09, 1·60) per 100 g/d increase in red and processed meat). For processed meat, no association was observed between energy-adjusted intakes and advanced colorectal lesions. A significant positive association was, however, observed for participants with absolute intake levels ≥ 100 v. < 50 g/d (OR of 1·19 (95 % CI 1·09, 1·31)). In summary, high intakes of red and processed meat were associated with presence of advanced colorectal lesions at colonoscopy in FIT-positive participants. The study demonstrates a potential role of dietary data to improve the performance of FIT-based screening. [ABSTRACT FROM AUTHOR]

Background: Social alarms are considered an appropriate technology to ensure the safety and independence of older adults, but limited research has been conducted on their actual use. We, therefore, explored the access, experiences, and use of social alarms among home-bound people with dementia and their informal caregivers (dyads). Methods: From May 2019 to October 2021, the LIVE@Home.Path mixed-method intervention trial collected data from semi-quantitative questionnaires and qualitative interviews conducted among home-dwelling people with dementia and their informal caregivers in Norway. The study focused on data from the final assessment at 24 months. Results: A total of 278 dyads were included, and 82 participants reached the final assessment. The mean age of the patients was 83 years; 74.6% were female; 50% lived alone; and 58% had their child as a caregiver. A total of 62.2% of subjects had access to a social alarm. Caregivers were more likely to answer that the device was not in use (23.6%) compared to patients (14%). Qualitative data revealed that approximately 50% of the patients were not aware of having such an alarm. Regression analyses assessed that access to a social alarm was associated with increasing age (86-97 years, p = 0.005) and living alone (p < 0.001). Compared to their caregivers, people with dementia were more likely to answer that the device gave them a false sense of security (28% vs. 9.9%), while caregivers were more likely to answer that the social alarm was of no value (31.4% vs.14.0%). The number of social alarms installed increased from 39.5% at baseline to 68% at 24 months. The frequency of unused social alarms increased from 12 months (17.7%) to 24 months (23.5%), and patients were less likely to feel safe during this period (60.8% vs. 70%). Conclusion: Depending on their living situation, patients and family members experienced the installed social alarm differently. There is a gap between access to and the use of social alarms. The results indicate an urgent need for better routines in municipalities with regard to the provision and follow-up of existing social alarms. To meet the users' changing needs and abilities, passive monitoring may help them adapt to declining cognitive abilities and increase their safety. [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]

In this study, we aimed to examine health-related quality of life during the COVID-19 pandemic among a general sample of young people in Norway aged 11–19 years. More specifically, we examine: (1) Change over 2 time-points in five health-related quality of life dimensions, (2) Whether sociodemographic- and COVID-19-related factors contributed to change in these five dimensions, (3) Whether parental stress and socioeconomic status at T1 interacted with change in health-related quality of life across T1 and T2. Data collection lasted from April 27th to May 11th, 2020 (T1), and from December 16th, 2020, to January 10th, 2021 (T2). Youth aged 11–19 years (N = 2997) completed the KIDSCREEN-27, COVID-19 related and sociodemographic items. Parents (N = 744) of youth aged 15 years and younger completed the parental stress scale and sociodemographic items. Physical and psychological wellbeing declined significantly from March to December 2020. Subscale scores for social support and peers increased. Controlling for a broad number of sociodemographic and COVID-19-related factors did not make an overall impact on the estimates. Those worried about infection, older aged, girls, and youth born outside Norway had a steeper decline in health-related quality of life subdimensions from T1 to T2. In the wake of the COVID-19 pandemic, we warrant special attention to the recovery of youth's physical and psychological wellbeing. [ABSTRACT FROM AUTHOR]

Nonattendance for cervical cancer screening is often understood in terms of a lack of 'appropriate' or 'correct' knowledge about the risks and prevention of the disease. Few studies have explored how lay persons—the users themselves—interpret and contextualise scientific knowledge about cervical cancer. In this study, we address the following research question: How is the epidemiology of cervical cancer and its prevention discussed among women who are late for cervical cancer screening in Norway? We completed nine focus group interviews (FGIs) with 41 women who had postponed cervical screening. The analyses were both inductive and explorative, aiming to unpack the complexity of lay understandings of cervical cancer. Interactive associations expressed in the FGIs reflected multiple understandings of aetiology and risk factors, screening, and interpretations of responsibility for acquiring cervical cancer. The term 'candidacy' was employed to provide an enhanced understanding of lay reasoning about the explanations and predictions of cervical cancer, as reflected in the FGIs. Both interpretations of biomedical concepts and cultural values were used to negotiate acceptable and nuanced interpretations of candidacy for cervical cancer. Uncertainties about risk factors for acquiring cervical cancer was an important aspect of such negotiations. The study's findings provide an in-depth understanding of the contexts in which screening may be rendered less relevant or significant for maintaining health. Lay epidemiology should not be considered inappropriate knowledge but rather as a productive component when understanding health behaviours, such as screening attendance. [ABSTRACT FROM AUTHOR]

Aim: To assess the anti-plaque effect of a high concentration sodium bicarbonate dentifrice on plaque formation, and gingivitis, as compared to a control toothpaste, irrespective of individual brushing technique and plaque quality. Methods: The experimental gingivitis model, with a split-mouth design was used to assess the anti-plaque effect of a high concentration sodium bicarbonate dentifrice on plaque formation. By producing individual fitted trays, the toothpaste was applied in the test quadrant and a control dentifrice in the contralateral. The participants used the individual fitted trays for 1 min every morning and evening, for 21 days. In this period, the participants was only allowed to brush the teeth in the opposite jaw, as usual. Twenty healthy individuals successfully completed the study. Results: At 21 days, there was no statistically significant difference between test quadrant and control quadrant with regard to plaque indices, gingival index and number of bleeding sites. Conclusion: This study demonstrated that the high concentration sodium bicarbonate dentifrice used did not produce statistically significant anti-plaque effect compared to the control dentifrice, in terms of Plaque- and Gingival Indices, number of bleeding sites or by Quigely and Hein, the Turesky modification Plaque Index, irrespective of brushing technique and individual plaque quality. Trial registration: Regional Committee for Medical Research and Ethics, South-East Norway in 2021 (REK.2021/370116). Clinical Trial Registration: NCT05441371 (First registered 09/06/2022, First posted 01/07/2022) (http://www.clinicaltrials.gov). (Retrospectively registered). [ABSTRACT FROM AUTHOR]

Previous research relates violent victimization early in life to a wide range of unfavorable outcomes in adulthood, among them a lack of educational attainment. A tendency to conduct separate investigations into violent victimization in different areas of life has so far hampered our understanding of both overall victimization processes and its outcomes. The present study overcomes this issue by investigating the cumulative burden of violent victimization during childhood and adolescence as well as the associations between victimization and educational attainment in young adulthood. The study uses a nationally representative sample of 18 to 19-year-old Norwegian students (n = 3,160) from the school-based UngVold 2007 survey, merged with information from official registers up to 2016 (age 27–28). Using latent class analysis (LCA), we combine retrospective accounts of experiences with parental, peer, and sexual violence during childhood and adolescence with educational attainment in young adulthood. The analyses reveal five classes of violent victimization: (1) non-victims (55.7%), (2) peer victims (16.6%), (3) victims of parental violence (14.5%), (4) victims witnessing domestic violence (5.6%), and (5) polyvictims (experiencing parental, peer, and/or sexual violence: 7.6%). They also show lower educational attainment in all groups reporting victimization through physical contact compared to non-victims, particularly among peer victims and polyvictims. Violence thus seems to impair educational attainment for a large share of the population. The identification of particularly lower education among the polyvictims also show the importance of considering the cumulative burden of violence when deciding on treatment needs and the design of help services for victims. [ABSTRACT FROM AUTHOR]