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This paper poses the following question: To what extent do European Union (EU) policies affect national policies? In essence this paper studies the Europeanisation of policy in the field of research and higher education (R&E). The field of R&E is largely neglected in the literature on European integration and Europeanisation. I argue that processes of Europeanisation of R&E mirror two interrelated processes: both the emergence of supranational policies at the EU level and national convergence towards these policies. The empirical scope of the paper is the relationship between the EU’s R&E policies and the corresponding Norwegian policies. Our empirical observations based on documentary data and existing bodies of literature reveal that the emergence of creeping supranational policies of R&E at the EU level has accompanied moderate convergence of Norwegian R&E policies. This moderate level of convergence, I argue, reflects a mix of moderate institutionalised linkages between Norwegian ministries and agencies and the EU, moderate adaptational pressures towards Norwegian R&E policies from the EU, and institutional path dependencies in Norwegian R&E policies. [ABSTRACT FROM AUTHOR]

Background: Norwegian public health nurses prevent diseases and promote health in children and young people aged 0–20 and their families. Public health nursing programs prepare students for their practical role and provide relevant theoretical knowledge. Objectives: To gain knowledge of the literature in the Norwegian public health nursing curricula, and to examine further the nursing base in these curricula. Design: An explorative and descriptive design was chosen. Sample: Reading lists based on syllabus documents from the 10 higher educational institutions in Norway offering programs in public health nursing. Measurements: A summative content analysis and a categorization of content from reading lists were performed. Results: Numerical information on the content and categorization of reading lists shows that social science and humanities literature dominates, followed by psychology and medicine. Nursing texts, theories and philosophy comprise only a minor part of the curricula. Conclusion: The paper provides valuable data on the theoretical focus in Norwegian public health nursing and raises important questions about the paucity of nursing texts in the curriculum. The imbalance in reading lists in Norway should be studied further and similar studies conducted in other countries to encourage reflection on the theoretical content of public health nursing education globally. [ABSTRACT FROM AUTHOR]

Siblings are key actors in the social network of young people in care. This paper explores young people's perceptions of changes in the quality of sibling relationships and the pathways relationships follow during the transition from the biological family into care. A thematic analysis of interviews with young Norwegian people (n = 25) in care showed that, in the biological family, sibling relationships are characterized by alliances, parentification, conflicts or nonexistence. After admission to child welfare services care, sibling relationships developed along multiple pathways. Their sibling relationships reshaped into either close and supportive, conflictual or completely broken relationships. Sibling relationships were dynamic, complex, with the pathway, and its impact on well‐being, being unique to each young person. Sibling relationship quality in the biological home did not predict relationship quality after admission to child welfare services. The implications for social worker practice are discussed. [ABSTRACT FROM AUTHOR]

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ABSTRACT This paper presents the findings of an exploratory study on parenting in the midst of suspicion of child sexual abuse (CSA). Data were drawn from in-depth interviews with 19 parents. Five of these had been accused of CSA. Study methods followed guidelines of grounded theory approaches. Specific parenting conditions during CSA suspicion were identified. Six analytic categories were developed: uncertainty concerning abuse, dilemmas on protection, changes in parent-child relationships, changes in the natural support network, dependency upon professional competence and severe emotional strain. The results are suggested as a tool for identifying themes in order to support and strengthen parenting in ensuring the safety and well-being of children in these kinds of situations. The current paper contributes to the field by exploring the perspectives of both suspected and non-suspected parents. [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]

BSTRACT [ABSTRACT FROM AUTHOR]

Background: The problem of a lack of nurses is expected to worsen in the future. With an ever‐increasing number of elderly patients with multimorbidity and a shortage of healthcare professionals, primary care must innovatively organise their services to offer more sustainable healthcare services. Organising healthcare services in a community virtual ward has been found to improve the quality of life for vulnerable elderly populations. Aim: The aim of the study was to explore healthcare professionals' experiences of interprofessional collaboration in care for patients with multimorbidity in a community virtual ward in the Norwegian context. Methods: Focus group interviews were conducted in this qualitative exploratory study. A purposive sample of 17 healthcare professionals working in a community virtual ward in Norway was interviewed. Data were analysed using thematic analysis. Results: The study results show that healthcare professionals recognise a need for patient involvement in the community virtual ward to offer more sustainable healthcare services at home. Furthermore, the results show how healthcare professionals experience the use of assessment tools and whiteboard meetings as useful tools for facilitating interprofessional collaboration. The study results also describe how interprofessional and holistic follow‐up with patients with multimorbidity contributes to increased focus on health promotion in the community virtual ward. Conclusion: We found that interprofessional collaboration in community virtual wards may be a sustainable way of organising healthcare services for patients with multimorbidity living at home. Interprofessional collaboration with a patient‐centred and health promotion approach, seems to increase the quality of the follow‐up for patients with multimorbidity living at home. Additionally, mutual interprofessional trust and respect seems to be essential for making use of the unique expertise of different professions in the follow‐up for patients with multimorbidity. In the future, both the patient's voice and opinion of their next of kin should be considered in the development of more sustainable homecare services. [ABSTRACT FROM AUTHOR]

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

Background: Nurses encounter many ethical dilemmas in their practice. The ability to make good ethical decisions is a necessary competence in healthcare professions. International studies call for development and research on various methods to teach healthcare professionals ethics. This article describes an approach for learning how to be aware of and discover ethical dilemmas. By applying experienced narratives from healthcare practice and using question guidelines from a structured ethical model, nursing students learn to discover and find possible solutions for ethical problem in their practice. Aim: The aim of this study was to describe second‐ and third‐year nursing students' experiences by using structured ethical reflection as an approach to increase ethical awareness and deal with ethical decisions. Design: This study has a descriptive exploratory design. A three‐day ethics seminar was carried out to help students learn how to recognize and explore ethical dilemmas in their practice. Materials and Methods: The data are collected from questionnaires used to evaluate the ethics seminar where 52 nursing students participated. The questionnaire contained open‐ended and closed questions and was analysed using Braun and Clarke's reflexive thematic analysis. The empirical data were collected by 52 nursing students answering an evaluation questionnaire after the ethics seminar. Findings Four themes were developed: Becoming aware of ethical dilemmas, Learning ethics by discussing knowledge and experiences with other students, Increased curiosity about ethics as a subject and Understanding the importance of critical ethical reflection work in clinical practice. Discussion The process of learning how to understand the ethical principles in real‐life nursing context continues progressing through the bachelor's program. Using group discussions and discussing examples of ethical dilemmas from practice help the students to a more comprehensive reflection process. Conclusion: The nursing students experienced video lessons, group discussions and the use of a structured reflection model as a valuable approach in learning to recognize ethical dilemmas and how to deal with real‐life ethical dilemmas. [ABSTRACT FROM AUTHOR]

Background: Reflection is essential for students to learn and understand caring, their formation as human and caring beings, and their ability to meet patients in a caring way. Consequently, to facilitate nurse students' development into professionals, learning support is needed where the focus is on understanding caring and becoming caring nurses. Aim and research questions: The exploratory study aim is to gain knowledge of the meaning of reflection in first‐term nursing education, and how reflection grounded in caring theory can deepen the students' understanding of caring and their professional formation of becoming a caring nurse. Method: Data consisted of individual written reflections and were collected from 64 nursing students from Norway, who had completed their instruction in caring theories and participated in four reflection groups where they reflected on caring and becoming a caring nurse. A thematic analysis was used. Findings: The results are based on the three main themes, Reflection provides an understanding of caring by developing a language for caring; Reflection provides an understanding of seeing the person behind the illness; and Reflection contributes to increased self‐understanding and awareness of oneself as a caring nurse. Conclusions: Instruction in caring theories and participation in reflection groups, with reflection grounded in caring theory, has a key function in facilitating students' development of a language for caring in nursing and appropriation of caring theory. The appropriation of caring theory provides a foundation for the nurse students to see themselves within a broader perspective and is important for mutual support in the professional formation of becoming a caring nurse. The expected outcome of such integration is a nursing curriculum that progressively supports the development of nursing students professionally and personally in the formation of becoming a caring nurses. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effects of a person‐centred and thriving‐promoting intervention on nursing home residents´ experiences of thriving and person‐centredness of the environment, and to evaluate if the effects varied between female and male residents. Design: A multi‐centre, non‐equivalent controlled group before‐after intervention design. Methods: Six nursing homes in Australia, Norway and Sweden were allocated to either intervention or control group. The intervention comprised a staff educational programme. A survey using proxy‐ratings by staff was administered before (T0), immediately after (T1) and six months after (T2) the intervention. The sample varied between 205 and 292 residents. Linear regression models were used to explore effects. Results: Statistically significant effects were found on experiences of thriving and person‐centredness of the environment. These effects were significant for male residents but not for female residents. The results emphasize the importance of individually tailored social and recreational activities. [ABSTRACT FROM AUTHOR]

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

Background: Approximately 30% of patients admitted to an intensive care unit experience respiratory distress. The COVID‐19 pandemic has led to an enormous increase in patients with respiratory symptoms. Nurse competence is essential for ensuring quality treatment and care for these patients; however, research on nursing strategies for patients with respiratory insufficiency is limited. Aim: This study explored nurses' perspectives on and nursing strategies in patients with respiratory insufficiency when admitted to three different intensive care units. Design: The study had an exploratory, descriptive, qualitative design. Methods: Four focus group interviews with a total of 20 nurses, critical care nurses, and critical care nursing students were conducted. Data were analysed using content analysis. Results: Participants' perspectives fell into two main themes: "nurse competence" and "the art of balancing." "Nurse competence" incorporated the sub‐themes "observations and assessments," "to make decisions," and "collaboration." The theme 'the art of balancing' incorporated the sub‐themes "nursing interventions," "patients feeling safe," and "patient participation." Conclusion: This study contributes new knowledge about nurses' perspectives on patients with respiratory insufficiency. Nurse competence was assumed essential to observe, assess, and treat patients with respiratory insufficiency. Nursing strategies included balancing nursing interventions, conducting medical treatment, and taking a whole‐person approach to patients' needs. Relevance to clinical practice: The COVID‐19 pandemic has shown the need for nurse competence in caring for patients with respiratory insufficiency. This study adds to existing literature emphasizing the need for competence in health care services. Caring for patients with respiratory insufficiency requires nurses with experience; competence in observation, assessment, and medical treatment; and a whole‐person approach to patients' needs. [ABSTRACT FROM AUTHOR]

Aims and objectives: The study describes experiences of registered nurses and general practitioners when using the Modified Early Warning Score (MEWS) to assess acute functional decline in older home nursing care patients. Background: Acute functional decline is common among older home nursing care patients; typically characterised by nonspecific symptoms and a mix of manifestations. Early warning score systems for detecting clinical deterioration have been thoroughly evaluated in hospital settings, but few studies have evaluated these systems used with older people in a community care setting. Methods: A descriptive exploratory research design and a qualitative approach. 36 nurses and eight general practitioners were purposively sampled. Data were collected in seven mixed focus groups and analysed using an inductive thematic content analysis in an iterative process that moved between text, codes, categories and themes. The COREQ checklist was used. Results: Two main themes were developed in the analysis. The first theme derived, was that the MEWS along with medical‐technical equipment and clinical judgement, was used to support nurses' and general practitioners' clinical decisions in assessing older deteriorating patients. The second theme referred to nurses' and general practitioners' experiences with several adjustments when using the MEWS with the older patient group and in complying with its trigger recommendations. Conclusion: The use of the MEWS when assessing older patients in home nursing care is potentially useful in supporting clinical reasoning. However, the tool's usefulness is limited because it is not experienced as sufficiently adapted to neither the home nursing care services nor to older patients. Implications for practice: This study increases our knowledge of how the MEWS tool is used in a community care setting and highlights the importance of adjustment of assessment procedures for older persons with acute functional decline. [ABSTRACT FROM AUTHOR]

Background and purpose: A new national system for funding research in universities and hospitals in Norway based on publication output is described. Methods: All scientific publications were counted and weighted according to the quality of the publication channel. Author addresses were credited. This led to a number of publication points for each institution/department. Results: The number of publication points for neurology had increased from 75.0 in 2005 to 98.3 in 2007. Publishing and the quality of publications were given more attention than before, and there was a stronger focus on facilitating research at the institutions. Research was regarded as not only an institutional but also as an individual responsibility. Conclusions: The principle of performance-based funding in addition to funding based on project applications has been well received, and it stimulates more and better research. Scientific publications represent a useful marker, whereas the way of counting author addresses and determining quality is still debated. [ABSTRACT FROM AUTHOR]

Background: Civilian and military guidelines recommend early balanced transfusion to patients with life-threatening bleeding. Low titer group O whole blood was introduced as the primary blood product for resuscitation of massive hemorrhage at Haukeland University Hospital, Bergen, Norway, in December 2017. In this report, we describe the whole blood program and present results from the first years of routine use.Study Design and Methods: Patients who received whole blood from December 2017 to April 2020 were included in our quality registry for massive transfusions. Post-transfusion blood samples were collected to analyze isohemagglutinin (anti-A/-B) and hemolysis markers. Administration of other blood products, transfusion reactions, and patient survival (days 1 and 30) were recorded. User experiences were surveyed for both clinical and laboratory staff.Results: Two hundred and five patients (64% male and 36% female) received 836 units in 226 transfusion episodes. Patients received a mean of 3.7 units (range 1-35) in each transfusion episode. The main indications for transfusion were trauma (26%), gastrointestinal (22%), cardiothoracic/vascular (18%), surgical (18%), obstetric (11%), and medical (5%) bleeding. There was no difference in survival between patients with blood type O when compared with non-group O. Haptoglobin level was lower in the transfusion episodes for non-O group patients, however no clinical hemolysis was reported. No patients had conclusive transfusion-associated adverse events. Both clinical and laboratory staff preferred whole blood to component therapy for massive transfusion.Discussion: The experience from Haukeland University Hospital indicates that whole blood is feasible, safe, and effective for in-hospital treatment of bleeding. [ABSTRACT FROM AUTHOR]

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

Objective: To compare levels of grip strength in individuals with hand osteoarthritis (OA) with normative values, and to examine how hand OA severity and other biopsychosocial factors are associated with grip strength.Methods: Levels of grip strength across age groups were compared with normative values from the general population in sex-stratified analyses using 2-sample t-tests. Associations between radiographic hand OA severity (Kellgren/Lawrence sum score) in different joint groups and grip strength of the same hand were examined in 300 individuals from the Nor-Hand study using linear regression. Analyses were repeated using markers of pain, demographic factors, comorbidities, and psychological and social factors as independent variables. We adjusted for age, sex, and body mass index.Results: Individuals with hand OA had lower grip strength than the general population, especially in individuals age <60 years. In thumb base joints, increasing radiographic severity (range 0-8) and the presence of pain were associated with lower grip strength (β = -0.83 [95% confidence interval (95% CI) -1.12, -0.53] and β = -2.15 [95% CI -3.15, -1.16], respectively). Negative associations with grip strength were also found for women, low education, higher comorbidity index, and higher resting heart rate.Conclusion: Individuals with hand OA have lower grip strength than the general population. Our results support the idea that studies on thumb base OA should include grip strength as an outcome measure. However, other biopsychosocial factors should also be considered when the grip strength is being interpreted, because other factors such as sex, socioeconomic factors, physical fitness, and comorbidities are negatively associated with grip strength. [ABSTRACT FROM AUTHOR]

Aim: The aim was to explore how nurse mentors experience the assessment of nursing students in clinical placements at hospitals and in municipal health care. Design: The study is qualitative with an explorative and descriptive design. Methods: Based on an interview guide, we conducted 19 individual qualitative interviews and four focus group interviews with nurse mentors from various levels and fields of nursing education at a Norwegian university. Results: Feedback in and on action was an integrated part of the formative assessment. In the summative assessment, where the university lecturer also participates, the nurse mentors perceived their role as passive. A disturbing finding was that divergent views on the student's competence sometimes occurred in these situations, thus challenging the credibility of the student assessment. Perceptions of nursing values and concerns embedded in nursing practice as collective criteria appear to have an impact on the mentors' assessment of the nursing students. [ABSTRACT FROM AUTHOR]

Against the background of Bowen and Ostroff's () human resource management ( HRM) process theorization, this study explores influences on individual employee perceptions of the visibility, validity, and procedural and distributive justice of performance appraisal in subsidiaries of multinational corporations, and at what levels these influences reside. The study adopts an embedded, multiple-case design with interview data from 33 managers and professionals in six subsidiaries of three corporations. The findings show that perceptions of the performance appraisal process are driven by a number of influences pertaining to the unit, relationship, and individual levels. Further, the study highlights differences and similarities of influences across four performance appraisal process features, and identifies overlaps and inter-linkages between the process features suggested by Bowen and Ostroff (). For practitioners, the value of our study lies in the identification of steps that can be taken to increase the likelihood that HRM practices are perceived positively and as intended by the organization. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Introduction: In Norway, all patient-reported claims for compensation are evaluated by The Norwegian System of Patient Injury Compensation (NPE). The number of claims from women with cervical cancer is rising, and the approval rate is high. Our aim was to study claims for compensation from women with cervical cancer to identify the type of failures, when, during the time-course of treatment, the medical failures occurred, and the consequences of the failures.Material and Methods: A retrospective, descriptive study of claims for compensation to NPE from cervical cancer patients during a 12-year period, from 2007 through 2018. We used anonymized medical expert statements and summaries of NPE cases.Results: In all, 161 women claimed compensation for alleged medical failure related to cervical cancer. Compensation was approved for 100 (62%) women. Mean age at the time of alleged failure was 37.5 years (SD ±9.9). The main reasons why women sought medical attention were routine cervical screening (56%), or vaginal bleeding or discharge (30%). In approved cases, incorrect evaluation of cytology and histology was the cause of most failures (72%). Mean delay of cervical cancer diagnosis for approved cases was 28 months (SD ±22). Treatment not in accordance with guidelines was the cause of failure in 2% of the cases, and failure during follow up was the cause of failure in 12%. Consequences of the failures were as follows: worsening of cancer prognosis (89%), treatment-induced adverse effects, such as loss of fertility (43%) and/or loss of ovarian function in premenopausal women (50%), and permanent injury after chemo-radiation (27%). Seven women (7%) died, most probably as a consequence of the failure.Conclusions: The main cause of medical failure in women with cervical cancer was incorrect pathological diagnosis. The main consequences of failures were worsening of cancer prognosis and treatment-induced adverse effects. Increased focus on the quality of pathological examinations, and better routines in all parts of the cervical examinations might improve patient safety for women in risk of cervical cancer. [ABSTRACT FROM AUTHOR]

Introduction: The present study aimed first to investigate the change in prevalence of major levator ani muscle (LAM) defects, also called avulsions, from 6 weeks to 1 year postpartum, and second to assess maternal and obstetric risk factors for having persistent major LAM defects/avulsions at 1 year postpartum.Material and Methods: This is a secondary analysis of data from a prospective cohort study including 300 nulliparous women at 17-19 weeks of gestation. Major LAM defects were diagnosed at 6 weeks and 1 year postpartum using transperineal ultrasonography. We defined persistent major LAM defects as a defect diagnosed both at 6 weeks and 1 year postpartum. Maternal and obstetric data were obtained from the hospital's electronic birth records. Pelvic floor muscle function was measured vaginally by manometer at 21 weeks of gestation. The main outcome measurement was change in prevalence of major LAM defects. Maternal and obstetric risk factors for having persistent major LAM defect were also assessed.Results: Prevalence of major LAM defects was 19.4% at 6 weeks and 10.4% at 1 year postpartum. No new major LAM defects were diagnosed at 1 year postpartum. Persisting major LAM defects were associated with longer second stage of labor (median 74.5 minutes vs median 48.0 minutes, P = .012) and higher neonatal birthweight (mean difference of 232.3 g, 95% confidence interval [CI] 21.5-443.1). Vacuum delivery was independently associated with persistent major LAM defects, adjusted OR 3.0 (95% CI 1.0-9.0).Conclusions: There was a 50% reduction of sonographically diagnosed major LAM defects from 6 weeks to 1 year postpartum. This finding suggests that assessment of the major LAM 6 weeks postpartum may be too early to diagnose defects/avulsions. Long second stage of labor, high neonatal birthweight and vacuum delivery were associated with persistent major LAM defects/avulsions. [ABSTRACT FROM AUTHOR]

Introduction: Emergency contraceptive pill (ECP) use is reported to have increased in several countries over time. In this multi-country population-based questionnaire study, we aimed to describe the patterns of ECP use and identify factors associated with its use.Material and Methods: In 2011-2012, women aged 18-45 years were randomly selected from national registers in Denmark, Norway and Sweden and invited to respond to questions related to lifestyle and contraceptive use. We used generalized logistic models to estimate odds ratios (ORs) and 95% confidence intervals (CI) comparing women who had used ECP with women who had never used ECP.Results: Of the 45 445 women, 33.9% (Denmark = 32.3%, Norway = 35.1%, Sweden = 34.6%) had used ECP at least once in their lifetime. Among ECP users, 15.8% had used ECP within the last year and 50.0% had used ECP more than once in their life. After adjusting for country, age at response and response type, ECP use was associated with higher education (OR 2.09, 95% CI 1.54-2.84) and being single, divorced or widowed (OR 3.17, 95% CI 2.87-3.49). Binge drinking and smoking increased the odds of ECP use. Furthermore, early age at first intercourse (OR 1.29, 95% CI 1.08-1.55), having a new partner in the last 6 months (≥3 partners: OR 6.44, 95% CI 5.46-7.60) and lack of condom use with a recent new partner (OR 1.42, 95% CI 1.22-1.66) were found to be associated with ECP use.Conclusions: Our study shows that ECP use is common among Scandinavian women. Higher education and being single were associated with increased odds of ECP use. Risk behaviors such as smoking and early age at first sex were also associated with increased odds of ECP use. Since ECP use is not protective against sexually transmitted infections, our findings highlight the need to encourage awareness and regular use of condoms to prevent sexually transmitted diseases in women. [ABSTRACT FROM AUTHOR]

Background: The multidimensional array of clinical features and prognostic factors makes it difficult to optimize management within the heterogeneity of patients with common musculoskeletal pain. This study aimed to identify phenotypes across prognostic factors and musculoskeletal complaints. Concurrent and external validity were assessed against an established instrument and a new sample, respectively, and treatment outcome was described.Methods: We conducted a longitudinal observational study of 435 patients (aged 18-67 years) seeking treatment for nonspecific complaints in the neck, shoulder, low back or multisite/complex pain in primary health care physiotherapy in Norway. Latent class analysis was used to identify phenotypes based on 11 common prognostic factors within four biopsychosocial domains; pain, beliefs and thoughts, psychological and activity and lifestyle.Results: Five distinct phenotypes were identified. Phenotype 1 (n = 77, 17.7%) and 2 (n = 142, 32.6%) were characterized by the lowest scores across all biopsychosocial domains. Phenotype 2 showed somewhat higher levels of symptoms across the biopsychosocial domains. Phenotype 3 (n = 89, 20.5%) and 4 (n = 78, 17.9%) were more affected across all domains, but phenotype 3 and 4 had opposite patterns in the psychological and pain domains. Phenotype 5 (n = 49, 11.3%) were characterized by worse symptoms across all domains, indicating a complex phenotype. The identified phenotypes had good external and concurrent validity, also differentiating for the phenotypes in function and health-related quality of life outcome at 3-month follow-up.Conclusion: The phenotypes may inform the development of targeted interventions aimed at improving the treatment efficiency in patients with common musculoskeletal disorders.Significance: This observational prospective study identified five distinct and clinically meaningful phenotypes based on biopsychosocial prognostic factors across common musculoskeletal pain. These phenotypes were independent of primary pain location, showed good external validity, and clear variation in treatment outcome. The findings are particularly valuable as they describe the heterogeneity of patients with musculoskeletal pain and points to a need for more targeted interventions in common musculoskeletal disorders to improve treatment outcome. [ABSTRACT FROM AUTHOR]

Research activities related to social informatics (SI) are expanding, even as community fragmentation, topical dispersion, and methodological diversity continue to increase. Specifically, the different understandings of SI in regional communities have strong impacts, and each has a different history, methodological grounding, and often a different thematic focus. The aim of this article is to connect three selected perspectives on SI—intellectual (regional schools of thought), methodological, and thematic—and introduce a comparative framework for understanding SI that includes all known approaches. Thus, the article draws from a thematic and methodological grounding of research across schools of thought, along with definitions that rely on the extension and intension of the notion of SI. The article is built on a paralogy of views and pluralism typical of postmodern science. Because SI is forced to continually reform its research focus, due to the rapid development of information and communication technology, social changes and ideologies that surround computerization and informatization, the presented perspective maintains a high degree of flexibility, without the need to constantly redefine the boundaries, as is typical in modern science. This approach may support further developments in promoting and understanding SI worldwide. [ABSTRACT FROM AUTHOR]

Objectives: Single umbilical artery (SUA) is associated with congenital malformations in most organ systems, but reported findings have not been consistent. While it has been suggested that genetic and persisting environmental factors influence the development of SUA, it is not known whether there is an increased risk of recurrence in a subsequent pregnancy of the same woman. The aims of this study were to investigate the occurrence of, and risk factors for, SUA in Norway, to assess its association with congenital malformations and trisomies 13, 18 and 21 and to study the risk of recurrence of SUA in subsequent pregnancies.Methods: This was a population-based study of all (n = 918 933) singleton pregnancies of > 16 weeks' gestation recorded in the Medical Birth Registry of Norway from 1999 to 2014. To identify risk factors and congenital malformations associated with SUA, generalized estimating equations and logistic regression were used to calculate odds ratios (OR) with 95% CIs. ORs were also calculated for the recurrence of SUA in subsequent pregnancy.Results: The occurrence of SUA in our population was 0.46% (4241/918 933). Parity ≥ 4, smoking, maternal pregestational diabetes, epilepsy, chronic hypertension, previous Cesarean delivery and conception by assisted reproductive technology increased the odds of having SUA. There was a particularly strong association between SUA and gastrointestinal atresia or stenosis in the neonate, with ORs of 25.8 (95% CI, 17.0-39.1) and 20.3 (95% CI, 13.4-30.9) for esophageal and anorectal atresia or stenosis, respectively, followed by an OR of 5.9 (95% CI, 1.9-18.5) for renal agenesis. SUA was associated with an up to 7-8 times increased risk of congenital heart defects. There was an association with microcephaly, congenital hydrocephalus and other congenital malformations of the brain and spinal cord. Diaphragmatic hernia, limb reductions and cleft lip or palate had a weaker association with SUA, with ORs ranging from 4.8 to 2.8. The associations with trisomy 18 and 13 were equally strong (OR 14.4 (95% CI, 9.3-22.4) and OR 13.6 (95% CI, 6.7-27.8), respectively), and the risk of trisomy 21 was doubled (OR 2.1 (95% CI, 1.2-3.6)). Pregnancies with SUA, with or without an associated malformation, had a 2-fold increased risk for SUA in a subsequent pregnancy.Conclusions: SUA is associated strongly with gastrointestinal atresia or stenosis, suggesting common developmental mechanisms. The increased risk of recurrence of SUA suggests that genetic and/or persisting environmental factors influence the risk. We found that SUA had equally strong associations with trisomies 13 and 18. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Although it is well known that adolescent delinquent behavior is related to poor outcomes in adulthood, longitudinal research on specific acts of delinquency and their interplay with important individual characteristics in predicting future outcomes is scarce. We aimed to examine how physical fighting-one of the most common acts of violent delinquency among adolescent boys-is related to adult life success in several domains, and how intelligence influences these associations. The study used data from 1,083 boys that participated in the population-based longitudinal Young in Norway Study, following adolescents from 1992 to 2015, by combining self-reports at four time points with comprehensive information from registers. Results showed that adolescent boys' physical fighting was associated with poor adult outcomes in the domains of employment, education, and criminal behavior. Associations remained significant even after controlling for conduct problems in general-which isolated the effects of fighting from other delinquent acts-as well as from a variety of other potential confounders. Detailed analyses on the interplay of physical fighting and intelligence showed that some parts of the associations between adolescent boys' fighting and several adverse adult outcomes could be ascribed to lower intelligence among the fighters. Moreover, intelligence moderated the relationship between physical fighting and adult education. Adolescent fighting was not related to educational attainment among boys with high intelligence, whereas boys with lower intelligence experienced detrimental effects of adolescent fighting. The analyses show the importance of considering adolescent boys' physical fighting as a potential risk factor for future social marginalization. [ABSTRACT FROM AUTHOR]

Introduction: As a growing number of seniors with complex needs are living at home, the implementation of telecare has become a priority. This article aims to identify factors influencing inter‐ and intra‐organisational collaboration in Norwegian primary care. The focus is on collaboration in service provision for senior users with telecare solutions, in this case personal alarms. Methods: Data were collected from two individual interviews with each of seven middle managers from four different units. Additionally, group interviews were conducted during two workshops, both with 16 and 17 front‐line staff members from four local authority units. Results: Challenges and barriers to collaboration and integration were information flow and information sharing, unclear understanding of the division of duties between the units involved and their employees and the lack of meeting points between the emergency medical centre and home nursing. Interagency meetings between the purchasing office and home nursing enhance collaboration. Conclusion: The introduction of telecare does not simplify collaboration or improve services; technology does not solve collaboration challenges. Technology limits information to written form, which may not meet the needs of the service provider and user. Collaboration and integration require common strategies and leadership that implements them, including in telecare. [ABSTRACT FROM AUTHOR]

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

Objective: Neuropsychiatric symptoms (NPS) in dementia are frequent and challenging for patients, carers, and the health care system, but few long-term studies exist. We analyse the longitudinal course of NPS in patients with mild dementia.Methods: A longitudinal cohort study of 223 patients with mild dementia and annual assessments using the Neuropsychiatric Inventory (NPI) for 5 years.Results: A total 1043 NPI assessments, representing 97% of all possible measurements of living cohort members, were analysed. Neuropsychiatric symptoms were common at baseline, and only a moderate increase in total NPS score from 15 to 17 with no increase in the proportion with high NPI total scores. Ninety seven percent scored ≥16, and 49% scored ≥36 on NPI total score at least once during follow-up. Individual NPS fluctuated and often reappeared. The most common symptoms ever reported was apathy (83%), depression (63%), appetite (63%), and aberrant motor behavior (60%). Cognitive decline was associated with higher NPI total score and several NPI items, but only the frequency of apathy increased significantly with time. Lewy body dementia was associated with higher NPI total score and psychotic symptoms. Alzheimer's disease was associated with increase in apathy.Conclusions: Severe NPS are already common at time of dementia diagnosis, and the increase in overall severity over 5 years was moderate. Individual symptoms tend to fluctuate over time within patients and correspond to states rather than traits. These findings highlight the need to focus on, and plan for, NPS as part of dementia pathway, and are relevant for clinical trial design. [ABSTRACT FROM AUTHOR]

Objective: To study the level of carer reported distress in mild dementia, over a 3-year period.Methods: This study is part of the Norwegian DemVest-study and utilises data from carers of people with mild dementia (n = 223). Those diagnosed with dementia with Lewy bodies (DLB, n = 63) and Alzheimer's disease (AD, n = 97) were included together with other dementia types (n = 63). The Relatives' Stress Scale was used to assess the level of reported distress in carers. Descriptive and a linear mixed effects models including diagnosis, time, and the interaction between time and diagnosis were performed.Results: Carer distress in mild dementia increased significantly over time (P = 0.011), particularly from baseline until 2 (P = 0.001) years follow-up. Carer distress in people caring for those with AD increased significantly, from baseline until 2 (P = 0.047) and 3 (P = 0.019) years follow-up. Distress in carers of people with DLB was high at baseline and remained relatively stable across the 3-year period. However, admission to a nursing home during the first year of follow-up was associated with a significantly lower reported carer distress in those caring for a person with DLB (P = 0.002), compared with those caring for a person with DLB living at home.Conclusion: Being a carer to a person with mild dementia is associated with increasing distress. However, the burden of distress changes with the diagnosis, time, and situation, which highlights the dynamic nature of the caring role. Findings have important implications for health services for people diagnosed with mild dementia and their carers. [ABSTRACT FROM AUTHOR]

User participation has become an increasingly important principle in health care over the last few decades. Healthcare professionals are expected to involve patients in treatment decisions. Clear guidance as to what this should entail for professionals in clinical work is not accounted for in legislation. In this study, we explore how healthcare professionals in a Municipal Acute Ward perceived, experienced and performed user participation. The ward represents a new short‐time service model for emergency assistance in Norway. We focused on the challenges the professionals faced in clinical work and how they dealt with these. Data were drawn from qualitative interviews with 11 healthcare professionals and from 10 observations in relation to previsits and physician's rounds in the ward. Transcripts of interviews and observations were analysed using a method for systematic text condensation. In the analysis, we applied Lipsky's perspective on dilemmas of street‐level bureaucrats. The results show that that the professionals perceived user participation as an important and natural part of their work. They experienced difficulties related to collaboration with patients, caregivers, and professionals in other services, and with framework conditions that caused conflicting expectations, responsibility, and priorities. The professionals seemed to take a pragmatic approach to user participation, managing it within narrow perspectives. Our study indicates that the participants dealt with the dilemmas at the cost of user participation. The results demonstrate that there is a gap between the outlined health policy and the professionals' opportunities to fulfil this policy in clinical work regarding user participation. The policy decision‐makers should recognise the balancing work required of healthcare professionals to deal with difficulties in clinical work. The knowledge that professionals possess as performers of services and the need for valuing in policy processes should be acknowledged. [ABSTRACT FROM AUTHOR]

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

Objective: To examine the longitudinal association of dual and single (vision and hearing) sensory loss on symptoms of depression and anxiety in older adults.Methods: Two thousand eight hundred ninety adults aged 60 years or over who participated in the longitudinal population-based Tromsø Study, Norway, were included. The impact of objective vision loss, self-report hearing loss, or dual sensory loss on symptoms of depression and anxiety, as assessed by the Hopkins Symptom Checklist 10, was examined at baseline and 6-year follow-up using linear mixed models.Results: Hearing loss had a cross-sectional relationship with increased depression (b = 0.1750, SE = 0.07, P = .02) and anxiety symptoms (b = 0.1765, SE = 0.08, P = .03); however, these relationships were not significant at the 6-year follow-up. Both vision loss only and dual sensory loss predicted increased depression scores at follow-up (b = 0.0220, SE = 0.01, P = .03; and b = 0.0413, SE = 0.02, P = .01, respectively). Adjustment for social isolation did not attenuate the main depression results.Conclusion: Dual sensory loss resulted in increased depression symptomatology over time and posed an additional long-term risk to depression severity beyond having a single sensory loss only. Only hearing loss is associated with anxiety symptoms. Older adults with vision, hearing, and dual sensory loss have different mental health profiles. Therefore, management and intervention should be tailored to the type of sensory loss. [ABSTRACT FROM AUTHOR]

Background: In the Scandinavian countries and elsewhere, family care is important as a complement for older people in the professional care system. Better understanding of this role could lead to better cooperation between professionals and family carers and better use of family carers as a resource in care for older people. Aim: The aim of this study was to explore experiences of the role of family carers of older people in need of services and therefore to increase our understanding of this role. Method: The study was designed as a qualitative interview study. In 2014 and 2015, we conducted semistructured interviews with a varied sample of 16 family carers of older people in both urban and rural locations in Norway. Interviews were transcribed and analysed thematically. Findings: The way the caregiving role was enacted varied greatly between the family carers in this study, but they all conveyed mixed feelings regarding their role. They saw caring for their relative both as a duty and a strain, as well as a choice and a meaningful task. One reason for their engagement was perceived deficiencies in professional care services. Family carers thus felt they made a difference to the older person's well‐being and health, and more so if this role was acknowledged by professional caregivers. Conclusions: This study suggests that in spite of or perhaps even because of feelings of obligation and strain, family care is experienced as highly meaningful. However, it seems important that family carers receive explicit appreciation from professional health or care staff. [ABSTRACT FROM AUTHOR]

Background: There is growing interest in potential long-term outcomes following intensive care, but few researchers have studied the prevalence of multiple symptoms or the association between pain and other symptoms. Aims: To investigate the prevalence of anxiety, depression, fatigue, sleep disturbance and post-traumatic stress symptoms (PTSS) among intensive care survivors 3 months and 1 year after being discharged from an intensive care unit (ICU) and to determine whether pain is associated with higher prevalence of these symptoms 3 months and 1 year after ICU stay. Study design: Exploratory, longitudinal cohort of intensive care survivors from two mixed ICUs in a tertiary referral hospital in Norway. Methods: Intensive care survivors completed surveys at 3 months (n=118) and 1 year (n=89) after ICU discharge. Clinical Trials: NCT02279212. Results: Prevalence rates of intensive care survivors' symptoms were pain 58 (49·2%), anxiety/depression 24/118 (20·8%), fatigue 18/118(15·3%), PTSS 15 (12·8%) and sleep disturbance 58/118 (49·2%) at 3 months after ICU discharge (n=118). Prevalence rates at 1 year (n=89) changed only slightly to pain 34 (38·2%), anxiety/depression 17 (20·0%), fatigue 12 (13·8%), PTSS 13 (15·1%) and sleep disturbance 40/89 (46·5%). Associations were strong between pain and presence of sleep disturbance, anxiety/depression, PTSS and fatigue. Conclusions: Intensive care survivors have multiple symptoms and the prevalence rates of these symptoms remained almost unchanged from 3 months to 1 year after ICU discharge. The presence of pain was associated with high odds for the presence of sleep disturbance, anxiety/depression, PTSS and fatigue, compared to a no-pain group. ICU survivors may benefit from targeted interventions designed to alleviate the symptom burden. Relevance to clinical practice: Knowledge about ICU survivor's prevalence and risk for having multiple symptoms may help health care professionals to give better care, if needed, to the ICU survivors. [ABSTRACT FROM AUTHOR]

Background Living in a nursing home may be challenging to the residents' experience of dignity. Residents' perception of how their dignity is respected in everyday care is important. Aim To examine how nursing home residents experience dignity through the provision of activities that foster meaning and joy in their daily life. Method A qualitative design was used and 28 individual semistructured interviews conducted with nursing home residents from six nursing homes in Denmark, Norway and Sweden. The data were analysed with qualitative content analysis. Independent ethical committees in all participating countries granted their approval for the study. Findings The participants highlight two dimensions of the activities that foster experiences of dignity in nursing homes in Scandinavia. These two categories were (i) fostering dignity through meaningful participation and (ii) fostering dignity through experiencing enjoyable individualised activities. Conclusion Activities are important for residents to experience dignity in their daily life in nursing homes. However, it is important to tailor the activities to the individual and to enable the residents to take part actively. Nurses should collect information about the resident's preferences for participation in activities at the nursing home. [ABSTRACT FROM AUTHOR]

Introduction: A validation of data regarding the placenta, cord and membranes in Medical Birth Registry of Norway (MBRN) is lacking. Here we investigate the inter- and intra-observer agreement of observations regarding the placenta, cord and membranes to the MBRN in two institutions.Material and Methods: We conducted a dual center validation study of data regarding placenta, cord and membranes. In the inter-observer study, 196 placentas in two institutions were examined by the attending midwife and a blinded colleague, whereas in the intra-observer study registrations by the attending midwife on 195 placentas were compared with her own registrations to the MBRN. In a separate sample consisting of 51 placental pathology reports, midwives' registrations to the MBRN were compared with the pathology report. For categorical and continuous variables, agreement was assessed by kappa value and paired sample t-test, respectively.Results: Inter-observer agreement between two midwives for cord insertion site and bi-placenta, cord knots and vessel anomalies were good (kappa values >0.79 and >0.96, respectively). The inter- and intra-observer study showed no significant differences regarding placental weight and cord length (p = 0.31 and 0.28, p = 0.71 and 0.39, respectively). The inter-observer agreement between the pathology reports and midwives' registrations was good for gross placental and cord variants (kappa 0.73-1.0), but there were significant differences in placental weight and cord length (p < 0.0001).Conclusions: The results suggest that the validity of data regarding placenta and cord in the MBRN is sufficiently high to justify future large-scale epidemiologic research based on this database. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to explore psychiatric nurses' experiences and perspectives regarding patient participation. Patient participation is an ambiguous, complex and poorly defined concept with practical/clinical, organisational, legal and ethical aspects, some of which in psychiatric units may cause ethical predicaments and moral stress in nurses, for instance when moral caring acts are thwarted by constraints. Methods An explorative quantitative pilot study was conducted at a psychiatric subacute unit through three focus group interviews with a total of nine participants. A thematic analytic approach was chosen. Preliminary empirical findings were discussed with participants before the final data analysis. Ethical research guidelines were followed. Results Patient participation is a difficult ideal to realise because of vagueness of aim and content. What was regarded as patient participation differed. Some interviewees held that patients may have a say within the framework of restraints while others saw patient participation as superficial. The interviewees describe themselves as patient's spokespersons and contributing to patients participating in their treatment as a great responsibility. They felt squeezed between their ethical values and the 'system'. They found themselves in a negotiator role trying to collaborate with both the doctors and the patients. Privatisation of a political ideal makes nurses vulnerable to burn out and moral distress. Conclusion Nurses have a particular ethical responsibility towards vulnerable patients, and may themselves be vulnerable when caught in situations where their professional and moral values are threatened. Unclear concepts make for unclear division of responsibility. Patient participation is often a neglected value in current psychiatric treatment philosophy. When healthcare workers' ethical sensibilities are compromised, this may result in moral stress. [ABSTRACT FROM AUTHOR]

Background Recommendations regarding caries-preventive self-care for children are provided by several health authorities. Objective To investigate recommendations given to the public regarding children's caries-preventive self-care by Norwegian dentists, dental hygienists, dental nurses and public health nurses. Methods Questionnaires were sent by e-mail and answered by 808 of 1132 persons who provide oral preventive promotion to children in dental services and health centres. The preventive advice was obtained through questions about the preferred preventive methods, fluoride recommendations and sources of knowledge on which the personnel based the advice about caries prevention in children. The responses were analysed using logistic regression. Results The majority (59-71%) in all professions judged oral hygiene education to be the most important caries-preventive method. Most personnel (84-98%) recommended all children to use fluoride toothpaste, and half of all personnel (53%) recommended fluoride lozenges for 50% or more of children. Multivariate analysis showed that dental nurses recommended lozenges to more children than dentists ( OR 2.5, 95% CI 1.7-3.7), while health nurses recommended lozenges to fewer children than dentists ( OR 0.5, 95% CI 0.3-0.8). The most important source of knowledge reported by dental personnel was professional education, while health nurses relied on information from dental personnel. Conclusions Health professions' recommendations regarding caries-preventive self-care for children were mainly similar, although variation existed both between and within professions. Collaboration between professions and awareness of the evidence base for preventive oral care may improve the consistency of information given by health professionals to the public. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Crime rates are high in substance-using populations; therefore, investigation of factors associated with crime in these populations is highly relevant. We describe crime prevalence and associations between crime, pattern of substance use and psychosocial factors, such as self-control and social network.Design and Methods: This is a cross-sectional study including substance users (n = 549; mean age 34 years; 27% women) entering treatment at 21 treatment centres across Norway (December 2012 to April 2015). Data on demographics, substance use, psychosocial variables and crime in the 6 months prior to treatment were obtained through interviews. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were estimated through logistic regression.Results: Sixty-four percent of participants had committed crime in the 6 months prior to treatment. Of these, 93% committed income-generating crime. Several factors were associated with increased likelihood of having committed crime: use of stimulants (aOR = 1.82, 95% CI 1.04-3.17), use of a higher number of different substances (aOR = 1.16, 95% CI 1.04-1.31) and spending most of their time with family or friends using addictive substances (aOR = 2.38, 95% CI 1.10-5.16 and aOR = 2.22, 95% CI 1.32-3.73). Protective factors associated with decreased likelihood of committing crime were being older (aOR = 0.95, 95% CI 0.92-0.97) and having higher self-control (aOR = 0.94, 95% CI 0.91-0.97).Discussion and Conclusions: Stimulant use, higher number of different substances used, lower self-control, primarily a substance-using social network and being younger were associated with crime in this substance-using population. Treatment clinics should consider these risk factors for crime, and suitable interventions should be implemented and evaluated. [Skjaervø I, Skurtveit S, Clausen T, Bukten A. Substance use pattern, self-control and social network are associated with crime in a substance-using population. Drug Alcohol Rev 2017;36:245-252]. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of a prenatal lifestyle intervention on postpartum weight retention (PPWR).Design: Randomised controlled trial.Setting: Healthcare clinics in southern Norway.Population: Healthy, nulliparous women with body mass index ≥19 kg/m2 , age ≥18 years, and singleton pregnancy of ≤20 gestational weeks.Methods: Women were randomised to intervention (dietary counselling twice by phone and access to twice-weekly exercise groups during pregnancy) or control group (standard prenatal care). Intervention compliance was defined post-factum as attending dietary counselling and ≥14 exercise classes.Main Outcome Measures: PPWR (weight measured postpartum minus self-reported pre-pregnancy weight) and the proportion of women returning to pre-pregnancy weight.Results: Of 606 women randomised, 591 were included in an intention-to-treat analysis of pregnancy outcomes and 391 (64.5%) were analysed 12 months postpartum. Mean PPWR was not significantly different between groups (0.66 kg for intervention versus 1.42 kg for control group, mean difference -0.77 kg, 95% CI -1.81, 0.28; P = 0.149). An increased proportion of intervention participants achieved pre-pregnancy weight (53% versus 43%, OR 1.50, 95% CI 1.003, 1.471; P = 0.045). However, the difference was not statistically significant when we adjusted for missing data (adjusted odds ratio (OR) 2.23, P = 0.067) using logistic mixed-effects models analysis. Women compliant with intervention had significantly lower PPWR than control participants, also after adjusting for potential confounders (adjusted mean diff -1.54 kg, 95% CI -3.02, -0.05; P = 0.039).Conclusions: The Norwegian Fit for Delivery intervention had little effect on PPWR, although women who were compliant with the intervention demonstrated significantly lower PPWR at 12 months.Tweetable Abstract: Norwegian Fit for Delivery RCT: little effect of lifestyle intervention on weight retention 1 year postpartum. [ABSTRACT FROM AUTHOR]

Objectives: The prevalence of neuropsychiatric symptoms in cognitively impaired nursing home residents is known to be very high, with depression and agitation being the most common symptoms. The possible effects of a 12-week intervention with animal-assisted activities (AAA) in nursing homes were studied. The primary outcomes related to depression, agitation and quality of life (QoL).Method: A prospective, cluster randomized multicentre trial with a follow-up measurement 3 months after end of intervention was used. Inclusion criteria were men and women aged 65 years or older, with a diagnosis of dementia or having a cognitive deficit. Ten nursing homes were randomized to either AAA with a dog or a control group with treatment as usual. In total, 58 participants were recruited: 28 in the intervention group and 30 in the control group. The intervention consisted of a 30-min session with AAA twice weekly for 12 weeks in groups of three to six participants, led by a qualified dog handler. Norwegian versions of the Cornell Scale for Depression, the Brief Agitation Rating Scale and the Quality of Life in Late-stage Dementia scale were used.Results: A significant effect on depression and QoL was found for participants with severe dementia at follow-up. For QoL, a significant effect of AAA was also found immediately after the intervention. No effects on agitation were found.Conclusions: Animal-assisted activities may have a positive effect on symptoms of depression and QoL in older people with dementia, especially those in a late stage. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Similarities and differences across borders of Nordic countries constitute a suitable context for investigating and discussing factors related to the development of diabetes nursing research over the last three decades. The present study reviewed the entire body of contemporary diabetes nursing research literature originating in four Nordic countries: Norway, Sweden, Denmark and Iceland. Our aims were (i) to catalogue and characterise trends in research designs and research areas of these studies published over time and (ii) to describe how research involving nurses in Nordic countries has contributed to diabetes research overall. The larger goal of our analyses was to produce a comprehensive picture of this research in order to guide future studies in the field. We conducted a narrative literature review by systematically searching Medline, Medline in process, EMBASE, CINAHL, Psyc INFO and Cochrane databases. These searches were limited to studies published between 1979 and 2009 that had an abstract available in English or a Nordic language. Two researchers independently selected studies for analysis, leading to the inclusion of 164 relevant publications for analysis. In summary, Nordic nurse researchers have contributed to the development of new knowledge in self-management of diabetes in childhood, adolescence and adulthood, and to some extent also in the treatment and care of diabetes foot ulcers. Future research may benefit from (i) larger nurse-led research programmes organised in networks in order to share knowledge and expertise across national groups and borders, (ii) more multidisciplinary collaborations in order to promote patient-centred care and (iii) further research directed towards improving the dissemination and implementation of research findings. Using complex intervention designs and a mix of research methods will enrich the research. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether a customised exercise programme influences pregnant women's psychological wellbeing and general health perception reflecting health-related quality of life (HRQoL) in late pregnancy.Design: A two-armed, two-centred randomised controlled trial.Setting: Trondheim and Stavanger University Hospitals, Norway.Population: A total of 855 healthy Caucasian pregnant women.Methods: The intervention group was offered a 12-week exercise programme between 20 and 36 weeks of pregnancy. One weekly group session was led by physiotherapists, in addition women were encouraged to follow a home exercise programme at least twice a week. The exercise programme followed standard recommendations and included both aerobic and strength training. The control group received regular antenatal care. Pretests and post-tests were performed at 18-22 and 32-36 weeks of pregnancy.Main Outcome Measures: In the original study primary outcome was gestational diabetes mellitus, but in this report the primary outcome is HRQoL. The questionnaire Psychological General Wellbeing Index (PGWBI) was used to assess psychological wellbeing and self-perceived general health before and after the intervention. PGWBI contains six subscales and it is also possible to summarise all items to a global score.Results: No association between antenatal exercise programme allocation and PGWBI (global score and subscales) was found. The study population was homogeneous and had high educational level.Conclusions: The results indicate that offering women an exercise programme during pregnancy does not seem to influence healthy pregnant women's psychological wellbeing and self-perceived general health. Further research is needed to investigate the effects of exercise in pregnancy on psychological wellbeing and self-perceived general health among women from different sociocultural subgroups.Tweetable Abstract: Exercise in pregnancy does not influence healthy pregnant women's health-related quality of life. [ABSTRACT FROM AUTHOR]

Objective: To investigate cardiac function from 14 weeks' gestation in fetuses of obese pregnant women (FOW). Animal studies have shown that maternal obesity induces fibrosis in fetal myocardium. We hypothesized that fetal cardiac function would be impaired among FOW. Methods: A case-control study with longitudinal follow-up was performed at Trondheim University Hospital, Norway. In total, 80 pregnant women were included and the final population comprised 52 obese and 24 of normal weight (mean body mass index before pregnancy, 34.8 ± 4.1 vs 21.0 ± 2.2 kg/m(2) ; P < 0.001). The main outcome measures were global strain rate (GSR) and strain by tissue Doppler imaging, tissue Doppler velocities (TDVs) and interventricular septal thickness assessed by fetal echocardiography at gestational ages of 14, 20 and 32 weeks. Results: In FOW, fetal left ventricle (LV) and right ventricle (RV) GSR and strain were significantly lower than in fetuses of normal-weight pregnant women: LV GSR was 33.3% lower at 14 weeks, 22.4% lower at 20 weeks and 22.8% lower at 32 weeks of gestation (P < 0.001) with no difference in fetal heart rate. Systolic and late diastolic TDVs for LV were significantly lower from 20 weeks' gestation and remained lower throughout pregnancy. Fetal interventricular septum was 26.6% (P < 0.001) thicker in late pregnancy in FOW compared with normal-weight pregnancies. Conclusions: At 14 weeks of gestation, we detected fetal myocardial dysfunction with reduced LV and RV GSR and strain in FOW compared with fetuses of women with normal weight. Our finding is alarming considering the high prevalence of obesity and may partly explain the predisposition of offspring to cardiovascular disease later in life. [ABSTRACT FROM AUTHOR]

Introduction and Aims: This study adds to the meagre body of longitudinal research on the link between emotional distress and alcohol use among young people. We address the following research questions: Are symptoms of anxiety and depressed mood likely to be causally related to heavy episodic drinking (HED)? Does the association change as individuals move from adolescence to early adulthood?Design and Methods: Data stemmed from a national sample of young people in Norway that was assessed in 1992 (T1; mean age = 14.9 years), 1994 (T2), 1999 (T3) and 2005 (T4) (response rate: 60%, n = 2171). We applied fixed-effects modelling, implying that intra-individual changes in the frequency of HED were regressed on intra-individual changes in emotional distress. Hence, confounding due to stable underlying influences was eliminated. Self-perceived loneliness was included as a time-varying covariate.Results: Emotional distress was unrelated to HED in adolescence (T1 to T2). In the transition from adolescence to early adulthood (T2 to T3), changes in depressiveness were positively and independently associated with changes in HED, whereas changes symptoms of anxiety were not. A similar pattern emerged in early adulthood (T3 to T4).Discussion and Conclusions: The potential causal relationship between emotional distress and heavy drinking did not manifest itself in adolescence, but increased symptoms of depressiveness were related to more frequent HED in subsequent periods of life. Hence, this study provides conditional support to the notion that emotional distress and HED may be causally related and indicates that the association among young people may be specific to depressiveness. [ABSTRACT FROM AUTHOR]

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