Search

Introduction: Physical inactivity is a global health challenge, exacerbated by increased screen time and sedentary behaviors. Enhancing physical activity levels at schools offers a promising approach to promote lifelong healthy habits. Methods: This protocol paper outlines the MOVE12 pilot study, a 12-week intervention study designed to increase physical activity among Norwegian upper secondary school students through 6–7-min daily MOVE-breaks integrated into lessons. Developed using the six-phase Intervention Mapping (IM) protocol, grounded in the social-ecological model and self-determination theory, the intervention focuses on fostering motivation and creating a supportive environment. Key steps include needs assessment, performance objectives, theoretical methods, and program structuring for sustainability. Results: Linear mixed models, t -tests, and regression analyses will evaluate quantitative outcomes, while qualitative focus groups will explore engagement and behavior change. Discussion: MOVE12 provides insights into scalable school-based interventions addressing physical inactivity, highlighting the potential of the IM framework to establish sustainable health promotion strategies. [ABSTRACT FROM AUTHOR]

When choosing estimands and estimators in randomized clinical trials, caution is warranted, as intercurrent events, such as, due to patients who switch treatment after disease progression, are often strongly associated with patients' time-varying prognostic factors. Consequently, for patients who did experience intercurrent events, there are typically no comparable patients who did not. Statistical analyses may then easily lure one into making large implicit extrapolations, which often go unnoticed. We will illustrate this problem of implicit extrapolations using a real oncology case study, with a right-censored time-to-event endpoint, in which patients can cross over from the control to the experimental treatment after disease progression, for ethical reasons. We address this by developing an estimator for the survival risk ratio contrasting the survival probabilities at each time t if all patients would take experimental treatment with the survival probabilities at those times t if all patients would take control treatment up to time t, using randomization as an instrumental variable to avoid reliance on no unmeasured confounders assumptions. This doubly robust estimator can handle time-varying treatment switches and right-censored survival times. Insight into the rationale behind the estimator is provided and the approach is demonstrated by reanalyzing the oncology trial. [ABSTRACT FROM AUTHOR]

Background: Emerging knowledge about supportive neurodevelopmental neonatal care shows the need for an individual approach to establish breastfeeding. However, evidence on how cue-based breastfeeding is supported in neonatal intensive care units (NICUs) is scarce. Therefore, the aim was to describe supporting practices for cue-based breastfeeding. Method: Through Delphi rounds, a questionnaire was developed comprising questions on the usage and occurrence of supportive practices for cue-based breastfeeding. A multinational online survey was distributed September to October in 2023 to NICUs in Europe using snowball sampling. Practices such as the practice of skin-to-skin contact (SSC), restrictions for breastfeeding, providing information to parents, observing and responding to infants’ cues were explored. Results: The survey was completed by 105 neonatal units across 15 European countries. Less than half (46%) of the NICUs had no restrictions upon placing the infant in SSC with the parents. Approximately half (49%) of the NICUs stated that infants had SSC within the first hour after birth. Many units (68%) had some restriction for breastfeeding. One week after birth, 48% of the NICUs encouraged breastfeeding for infants at 33 postmenstrual age whenever the infant showed cues, regardless of scheduled tube feeding time. This percentage increased to 59% at 33–35 gestational age. Less than half of the units (47%) stated that they had the necessary tools/instruments to support the transition from tube feeding to breastfeeding. There were variations in how milk intake was assessed, such as weighing before and after breastfeeding or estimating milk intake by time spent sucking. Infants in 50% of the units had to be fed exclusively orally before discharge. Many units (65%) provided specific support to or enabled discharge before the infant was exclusively orally fed. Conclusion: European NICUs employ supportive practices, SSC, early initiation of breastfeeding, and provide information to parents. Staff plays a significant role in fostering cue-based feeding in preterm infant-mother dyads. There still exist restrictions for SSC and breastfeeding. To understand the impact of different strategies and practices, there is need for evaluations by parents and testing of the implementation of cue-based feeding practices in neonatal care. [ABSTRACT FROM AUTHOR]

Background: Changes in gastrointestinal physiology following bariatric surgery may affect the pharmacokinetics of drugs. Data on the impact of bariatric surgery on drugs used for attention‐deficit/hyperactivity disorder (ADHD) are limited. Methods: In patients treated with ADHD medication and undergoing bariatric surgery, serial drug concentrations were measured for 24 h preoperatively and one, six and 12 months postoperatively. Primary outcome was change in area under the concentration‐time curve from 0 to 24 h (AUC0–24), with other pharmacokinetic variables as secondary outcomes. Results: Eight patients treated with lisdexamphetamine (n = 4), dexamphetamine (n = 1), methylphenidate (n = 1) and atomoxetine (n = 2) were included. In total, 409 samples were analysed. Patients underwent sleeve gastrectomy (n = 5) and Roux‐en‐Y gastric bypass (n = 3). AUC0–24 and Cmax of dexamphetamine increased after surgery in those using the prodrug lisdexamphetamine. There was no clear‐cut reduction in tmax postoperatively. For ritalinic acid and atomoxetine, no changes in AUC0–24 were observed, but for atomoxetine, a higher Cmax and a shorter tmax were observed postoperatively. Conclusion: Bariatric surgery may increase the systemic exposure of dexamphetamine after intake of lisdexamphetamine. Patients using lisdexamphetamine should be followed with regard to adverse drug reactions after bariatric surgery, and, if available, therapeutic drug monitoring should be considered. [ABSTRACT FROM AUTHOR]

Objective: To explore how patients and therapists in an outpatient specialized substance use disorder treatment setting experienced the first treatment session, and to identify relational facilitators and barriers seen from both patient and therapist perspectives. Method: The study is based on a qualitative approach and semi-structured interviews of patients (n = 12) and therapists (n = 12). Interviews were conducted soon after the first treatment session and analyzed in accordance with reflexive thematic analysis. Results: We identified subthemes for patients and therapists, respectively. In addition, we found that patients and therapists described certain comparable experiences and actions which we integrated as core themes: (a) feeling uncertain about what to expect; (b) forming first impressions; (c) balancing multiple concurrent concerns; (d) seeking feedback from the other; and (e) sensing a way forward. The subthemes specify patients' and therapists' unique meanings and approaches to each core theme. Finally, we summarized unique and shared relational facilitators and barriers. Conclusion: Patients and therapists use the first session to form an impression of the other, but they are also concerned with the impression they themselves give. They, therefore, monitor the other's in-session reactions and responses which constitute facilitators or barriers for their own further relational actions. [ABSTRACT FROM AUTHOR]

Introduction: Enhancing the proficiency of healthcare workers (HCWs) in handling birth-related complications is crucial for reducing maternal and newborn morbidity and mortality. To achieve this, the Safer Births Bundle of Care offers a comprehensive set of innovative, simulation-based training interventions designed to strengthen the skills and competencies of HCWs working as skilled birth attendants. Objective: To describe the use of in-situ low-dose, high-frequency simulation-based training, and the experiences of this usage among HCWs and stakeholders at facilities in Tanzania. Methods: This mixed-methods study included quantitative and qualitative data collected between July 2021 and July 2022 across 30 health facilities in five regions of Tanzania. NeoNatalie Live (NNL) simulators were installed for independent skills and scenario training, and in-situ facilitator-led team simulations were introduced. The training frequency was analyzed using descriptive and analytical statistics, and mentorship and supervision reports were analyzed using qualitative content analysis. Results: A large and sustained number of in-situ NNL skill-training sessions (n = 35,101) and facilitator-led team simulations (n = 266) were conducted during the first year. Clinical burden per HCW did not affect the frequency of NNL skills training at the health facility level (r = −0.16, p =.40) nor facilitator-led team simulations. There was a positive but weak correlation between the frequency of facilitator-led team simulations and NNL skills training (r = 0.34, p =.05). Qualitative data showed a high degree of motivation and participation among all stakeholders, and active use of hospital data, both clinical indicators and training data, was perceived as a success factor. Conclusion: Facilitator-led in-situ simulation training was more likely to occur where individual skills-training sessions were recorded. Training sessions took place regardless of the increased workload. [ABSTRACT FROM AUTHOR]

AbstractAdenosine 5’-monophosphate (AMP)-activated protein kinase (AMPK) plays a crucial role in regulation of metabolic homeostasis. To understand the role of the catalytic α2 subunit of AMPK in skeletal muscle energy metabolism, myotube cultures were established from AMPKα2+/+ and AMPKα2-/- mice. Myotubes from AMPKα2-/- mice had lower basal oleic acid and glucose oxidation compared to myotubes from AMPKα2+/+ mice. However, the relative response to mitochondrial uncoupling was increased for oleic acid oxidation. Incorporation of acetate into lipids was also lower in myotubes from AMPKα2-/- mice. Proteomics analysis revealed that AMPKα2-/- myotubes had upregulated pathways related to mitochondrial function and fatty acid oxidation, and decreased pathways related to fatty acid biosynthesis. In conclusion, ablation of AMPKα2 catalytic subunit in skeletal muscle cells resulted in reduced basal oxidation of glucose and fatty acids, however upregulated pathways related to mitochondrial function and fatty acid oxidation and reduced lipid formation. [ABSTRACT FROM AUTHOR]

In this article, we employed a third-space methodology to bring together two researchers and four teachers who have sustained physically active learning in their practice to explore the real-world applicability and processes of enacting physically active learning in teaching. We co-developed the Core Aspects of Physically Active Learning Enactment (CAPAbLE) model through six meetings. The model outlines 12 core aspects that can support pedagogical considerations about the purposes of enacting PAL through the iterations of planning, organising and evaluating. The CAPAbLE model may support the sustainability of PAL in schools and set the stage for future empirical investigations. [ABSTRACT FROM AUTHOR]

Background and objective: Few longitudinal studies have described the prevalence and development of biochemical hypogonadism in aging testicular cancer survivors (TCSs) in comparison to men from the general population (control subjects). Methods: Serum total and free testosterone (Ttotal, Tfree) were measured in 593 TCSs median11 and 27 years after TC diagnosis (Survey-First; Survey-Last). Post-treatment adverse health outcomes (AHOs) were recorded. The results were compared to those in 578 control subjects. Treatment was stratified as surgery alone, radiotherapy alone, or platinum-based chemotherapy. Biochemical hypogonadism was defined as Ttotal

IntroductionIt is unclear how drug-interaction with apixaban influences recurrent venous thromboembolism (VTE) and bleedings in cancer patients.MethodsA post-hoc analysis of a single-arm interventional clinical trial on apixaban treatment of cancer patients with VTE to investigate whether the occurrence of any of the endpoints could be associated with the concurrent use of an interacting drug. Drugs taken by the patients during the trial period were categorized as either increasing bleeding risk, increasing thrombosis risk, both or neither.Results298 patients were divided into groups based on whether they used no interacting drugs (controls, n=74), drugs increasing bleeding risk (n=55), drugs increasing thrombosis risk (n=8), or both (n=161). Odds ratios (OR) were calculated for recurrent VTE, clinically relevant non-major bleeding (CRNMB), and major bleeding during the 36-month follow-up period. Each patient took a median of 13 different drugs over the study period. 67% of the patients used drugs expected to both increase bleeding and thrombosis. The use of fluconazole appeared associated with CRNMB (OR 3.6, 95% confidence interval (CI) 0.99-13), but not with major bleeding (OR 0.56, 95% CI 0.06 - 4.8). Non-steroid anti-inflammatory drugs were not associated with CRNMB (OR 1.0, 95% CI 0.25-4.1) or major bleedings (OR 0.72, 95% CI 0.14 - 3.6). Use of antiplatelet therapy was not associated with CRNMB (OR 0.75, 95% CI, 0.22 - 2.58) or major bleeding (OR 0.2, 95% CI, 0.02-1.6). There were no major bleedings in 23 patients using aprepitant nor in the 10 patients taking macrolides. We found no association between drugs and recurrent VTE, except that there were no recurrent VTE in 19 patients using bevacizumab.ConclusionsDespite the high number of drugs taken that could potentially interact with apixaban, none were found to clearly influence clinical outcomes, except that fluconazole may increase the risk of CRNMB.

Objective To evaluate the feasibility of implementing family-integrated newborn care (FINC) for hospitalised preterm and low birthweight infants in Ethiopia. Despite the WHO’s call for family engagement in newborn care, evidence of the feasibility of implementation remains scarce.Design An observational feasibility study employing a mixed-methods design comprising a quantitative cross-sectional survey among 157 healthcare providers (HCPs) and a qualitative Participatory Rural Appraisal.Setting The study was conducted in 30 neonatal care units (NCUs) of hospitals in Tigray, Northern Ethiopia.Participants HCPs who were on duty in NCUs during the data collection period were included in the study.Analysis Descriptive statistics were obtained for the quantitative data using STATA V.16, while qualitative data were coded and analysed using a framework analysis approach with qualitative data analysis software (Atlas.ti V.9).Results In total, 157 HCPs were enrolled with a mean (SD) age of 32 (±6.8) years. Participants scored a higher weighted mean score for implementability (0.75) and a lower mean score for adaptability (0.50). Out of the 157 HCPs, the majority perceived that FINC was technically implementable (96%), conceptually acceptable (74%) and ethically correct (88%). Furthermore, 49% perceived that integrating FINC into the existing system was technically manageable, while 52% agreed that it was expandable to other healthcare facilities. However, HCPs reported lower confidence regarding its practicality (32%), integration (31%) and adaptability (16%). NCU space (97%), number of NCU rooms (87%) and increased risk of infection (83%) were perceived as potential challenges to the feasibility of FINC. More importantly, only 33% of HCPs felt that there was an organisational demand to consider FINC in NCUs. Furthermore, there was a statistically significant variation in the mean score for acceptability and perception of additional burden between age groups (p=0.04).Conclusions and recommendations The current study shows that FINC is conceptually acceptable, technically implementable and expandable to other settings, with weighted mean scores of 0.75, 0.72 and 0.66, respectively. However, its practicality (0.53), integration (0.52) and adaptability (0.50) could be generally constrained mainly by the poor organisational infrastructure related to NCU space and infection prevention measures. Addressing motivational, attitudinal and competency gaps of NCU HCPs, along with organisational capacity, would be required.

Background and purpose: Recommended treatment of urothelial muscle-invasive bladder cancer (MIBC) is cisplatin-based neoadjuvant chemotherapy (NAC) followed by cystectomy, but there are challenges with low utilization of NAC. We aimed to evaluate the utilization of NAC, perioperative complications and oncological efficacy in a real-world setting. Patients and methods: All patients operated with radical cystectomy at the University Hospital of North Norway during 2011–2021 for MIBC were included. NAC consisted of three cycles of dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (ddMVAC) every second week. Complications after cystectomy (Clavien-Dindo ≥ grade 3 within 30 days), histopathologic NAC response, cancer recurrence, relapse-free survival (RFS), overall survival (OS) and cause of death were reported. Results: We included 124 patients, median observation time of 4 years. Fifty-nine patients (48%) received NAC. Most common causes for not receiving NAC were age ≥ 75 years (n = 38; 31%), cardiovascular disease (n = 7; 5.6%), and reduced kidney function (n = 6; 4.8%). Overall 34 patients (27%) had a ≥ grade 3 complication. The 5-year actuarial OS rate was higher among patients treated with NAC than those without NAC (67% vs. 45%, p = 0.02). Among NAC-treated patients, 29 (49%) were downstaged to non-muscle invasive stage (≤pT1), and the 5-year actuarial RFS and OS were higher among patients with ≤pT1 in the post-cystectomy specimen than those with ≥ pT2 (92% vs. 35%, and 94% vs. 39%, both p < 0.001). Interpretation: The utilization of NAC was high in this real-world setting. Treatment with ddMVAC with achieved downstaging to ≤pT1 was associated with considerably improved RFS and OS.

Introduction Enhancing the proficiency of healthcare workers (HCWs) in handling birth-related complications is crucial for reducing maternal and newborn morbidity and mortality. To achieve this, the Safer Births Bundle of Care offers a comprehensive set of innovative, simulation-based training interventions designed to strengthen the skills and competencies of HCWs working as skilled birth attendants. Objective To describe the use of in-situ low-dose, high-frequency simulation-based training, and the experiences of this usage among HCWs and stakeholders at facilities in Tanzania. Methods This mixed-methods study included quantitative and qualitative data collected between July 2021 and July 2022 across 30 health facilities in five regions of Tanzania. NeoNatalie Live (NNL) simulators were installed for independent skills and scenario training, and in-situ facilitator-led team simulations were introduced. The training frequency was analyzed using descriptive and analytical statistics, and mentorship and supervision reports were analyzed using qualitative content analysis. Results A large and sustained number of in-situ NNL skill-training sessions ( n = 35,101) and facilitator-led team simulations ( n = 266) were conducted during the first year. Clinical burden per HCW did not affect the frequency of NNL skills training at the health facility level ( r = −0.16, p = .40) nor facilitator-led team simulations. There was a positive but weak correlation between the frequency of facilitator-led team simulations and NNL skills training ( r = 0.34, p = .05). Qualitative data showed a high degree of motivation and participation among all stakeholders, and active use of hospital data, both clinical indicators and training data, was perceived as a success factor. Conclusion Facilitator-led in-situ simulation training was more likely to occur where individual skills-training sessions were recorded. Training sessions took place regardless of the increased workload.

ObjectivesMore knowledge about health related quality of life (HRQoL) among mothers with inflammatory joint disease (IJD) is needed to understand the complex challenges for this group of patients. The overall aim of this study was to investigate changes in HRQoL among mothers with IJD from year 2000 to year 2020.MethodsThis study had a comparative cross-sectional design with two study groups 20 years apart, year 2000 (n = 77) and year 2020 (n = 197). Patients were identified from RevNatus, a Norwegian nationwide medical quality register (2020 cohort) and from a national centre for pregnancy and rheumatic disease (2000 cohort). Mothers with the diagnoses of rheumatoid arthritis, juvenile idiopathic arthritis, axial spondyloarthritis and psoriatic arthritis with children aged 0–6 were included. Data on HRQoL were self-reported and assessed by the RAND-36 (SF-36) questionnaire, along with data on educational status, number of children, months since last childbirth and eight questions on experienced motherhood limitations and experienced anxiety and distress for the children. Descriptive statistics were performed using the Mann-Whitney U-test, the Pearson chi-squared test and independent samples t-test. Multivariable linear regression were used to investigate changes and association between the RAND36 (SF-36) scores and the two study groups and possible confouders.ResultsThe 2020 cohort had significantly higher scores on bodily pain (p

IntroductionPhysical inactivity is a global health challenge, exacerbated by increased screen time and sedentary behaviors. Enhancing physical activity levels at schools offers a promising approach to promote lifelong healthy habits.MethodsThis protocol paper outlines the MOVE12 pilot study, a 12-week intervention study designed to increase physical activity among Norwegian upper secondary school students through 6–7-min daily MOVE-breaks integrated into lessons. Developed using the six-phase Intervention Mapping (IM) protocol, grounded in the social-ecological model and self-determination theory, the intervention focuses on fostering motivation and creating a supportive environment. Key steps include needs assessment, performance objectives, theoretical methods, and program structuring for sustainability.ResultsLinear mixed models, t-tests, and regression analyses will evaluate quantitative outcomes, while qualitative focus groups will explore engagement and behavior change.DiscussionMOVE12 provides insights into scalable school-based interventions addressing physical inactivity, highlighting the potential of the IM framework to establish sustainable health promotion strategies.

BackgroundHealth care is shifting toward 5 proactive approaches: personalized, participatory, preventive, predictive, and precision-focused services (P5 medicine). This patient-centered care leverages technologies such as artificial intelligence (AI)–powered robots, which can personalize and enhance services for users with disabilities. These advancements are crucial given the World Health Organization’s projection of a global shortage of up to 10 million health care workers by 2030. ObjectiveThis study aimed to investigate the acceptance of a humanoid assistive robot among users with physical disabilities during (1) AI-powered (using a Wizard of Oz methodology) robotic performance of predefined personalized assistance tasks and (2) operator-controlled robotic performance (simulated distant service). MethodsAn explorative qualitative design was used, involving user testing in a simulated home environment and individual interviews. Directed content analysis was based on the Almere model and the model of domestic social robot acceptance. ResultsNine participants with physical disabilities aged 27 to 78 years engaged in robot interactions. They shared their perceptions across 7 acceptance concepts: hedonic attitudes, utilitarian attitudes, personal norms, social norms, control beliefs, facilitating conditions, and intention to use. Participants valued the robot’s usefulness for practical services but not for personal care. They preferred automation but accepted remote control of the robot for some tasks. Privacy concerns were mixed. ConclusionsThis study highlights the complex interplay of functional expectations, technological readiness, and personal and societal norms affecting the acceptance of physically assistive robots. Participants were generally positive about robotic assistance as it increases independence and lessens the need for human caregivers, although they acknowledged some current shortcomings. They were open to trying more home testing if future robots could perform most tasks autonomously. AI-powered robots offer new possibilities for creating more adaptable and personalized assistive technologies, potentially enhancing their effectiveness and viability for individuals with disabilities.