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Although research has investigated the association between pathological gaming and academic performance in adolescence, the complexity of the relationship has not been thoroughly examined. This short longitudinal study aimed to investigate the interactions between pathological gaming, academic self-efficacy, academic initiative, and academic performance in an adolescent sample, focusing on sex differences. The participants (N = 2853; 50.1% boys) were students in the second and third years of upper secondary school. Their grade point average (GPA) at graduation the same year was obtained. The moderated mediation structural equation model results showed that academic self-efficacy, directly and indirectly through academic initiative, impacted later GPA. There was no direct effect of pathological gaming on academic initiative or GPA. However, academic self-efficacy moderated the impact of pathological gaming on GPA for boys. In other words, boys with increased pathological gaming tended to achieve poorer grades in school if they experienced a strong academic self-efficacy. This study contributes to the understanding of the complex interplay between sex, pathological gaming, academic self-efficacy, academic initiative, and academic performance. We suggest that future research examines confidence or other relevant factors as explanatory mechanisms in the relationships between pathological gaming, academic self-efficacy, and GPA, particularly in male samples.

This article assesses the reliability and validity of the Self-Efficacy in Client-Centredness questionnaire (SECCQ). SECCQ assesses social worker students' subjective belief in their ability to provide client-centered care in their daily interaction with children or families. Self-efficacy is defined as an individual's judgments concerning their capability to perform certain skills necessary to attain a desired outcome of behavior. Client-centeredness, on the other hand, relates to how social workers treat clients, not only from a clinical perspective, but also from an emotional, mental, and social perspective. Overall findings demonstrate that this questionnaire has satisfying psychometric properties and high reliability. Hence, the SECCQ may be a valuable tool for raising students' awareness of their self-efficacy and the evaluation of student learning outcomes.

If students are to acquire deep learning in science, they need to know about the nature of science (NOS), particularly not only the cognitive-epistemic but also the social-institutional aspects of NOS. In this paper, we investigate the content of the Norwegian science curriculum in order to establish how NOS is represented, in particular to the social-institutional aspects of NOS, which have been reported to be underemphasised in science curricula from different parts of the world. We use the Family Resemblance Approach (FRA) to NOS as the theoretical and analytical framework to investigate the science curriculum from Norway where there is a history of emphasising the values human dignity, identity and cultural diversity as well as respect for nature and environmental awareness. The findings show that the dominating aspects of NOS in the science curriculum are scientific practices and social values. The observation about the prominence of social values of science is in sharp contrast to comparable analyses, suggesting a particular orientation to NOS that considers the human element in the Norwegian science curriculum. Implications for science curriculum reform and future studies are discussed.

Background: Toothache is a debilitating condition, often with mild to excruciating pain, swelling, eating difficulties and insomnia. This study aims to delineate the profiles of patients seeking emergency dental care, focusing on the diagnosis, treatment, and outcomes following non-surgical root canal treatment. Methods: This prospective cohort study was conducted from 2012 to 2021 at the Section for Endodontics, Department of Clinical Dentistry, University of Bergen, Norway. A total of 281 emergency patient forms were analyzed. Data registered included patient demographics, dental history, chief complaints, medications used, diagnostic results, treatments provided and outcome. Results: A total of 272 patients (272 teeth) were included in the study. Pain was the predominant complaint (98.5%), where only 57.4% of the patients managed to localize pain to a specific tooth. The mean age of patients was 51.2 years with no significant gender differences. The maxillary right first molar (15.4%) was the most frequent tooth needing treatment. The majority of the patients had experienced pain for three days before they attended the emergency appointment. The most frequently used drug for pain management was paracetamol which was stated to have little effect. Teeth that needed endodontic treatment often had restorations rather than caries. The most frequent diagnoses were pulpitis (26.8%) followed by necrotic pulp (25.4%) and previously root filled teeth (22.8%). Root canal treatment was performed on 60% of the teeth and a success rate of 95% was registered at one-year recall. Conclusions: There was no singular diagnostic cause leading patients to seek an emergency appointment, highlighting the necessity of a thorough diagnostic procedure. Over the counter pain medications have little effect on alleviating dental pain, often resulting in desperate measures of self-medication. 60% of the teeth needing emergency treatment had previous coronal restorations such as fillings or crowns, indicating that conservative treatment does not appear to fully protect against future pulpal disease. The good prognosis of root canal treatment for teeth with acute symptoms supports recommending dentists to attempt root canal treatment rather than opting for tooth extraction. [ABSTRACT FROM AUTHOR]

Part of effective Early Childhood Education and Care is to support children's awareness of hazards and management of possible injuries during risky play. This study evaluated the attitudes of Norwegian kindergarten teachers towards "'Henry' first aid training" and its impact on 3-6-year olds' understanding of first aid. 588 kindergarten employees completed an online survey and 50 children (26 boys and 24 girls) participated in semi-structured interviews gauging their knowledge of first aid before and after using "Henry." These children's knowledge of first aid was compared to 46 children who had used "Henry" over a longer period. Survey results indicated strong enthusiasm among kindergarten teachers for the use of "Henry." Children's understanding of first aid increased from pre- to post- interviews, t (43) = 8.878, p < 0.001, Cohen's d = 1.32. Findings are discussed in relation to the international scalability of Henry and the need for training kindergarten teachers and children in first aid.

Understanding language requires the ability to compose the meanings of words into phrase and sentence meanings. Formal theories in semantics have framed the hypothesis that all instances of meaning composition, irrespective of the syntactic and semantic properties of the expressions involved, boil down to a unique formal operation, that is, the application of a function to an argument, a view known as "Frege's Conjecture." We test the processing consequences of this idea using event-related potentials (ERPs) and a novel experimental paradigm where composition versus noncomposition of words from the same grammatical category (nouns) are compared in two different syntactic environments: predication and modification. We found that noun composition in a modification context, where the noun follows an adjective, elicits a reduced N400 component, whereas noun composition in a predication context, where the noun follows a verb, produces an enhanced LAN component. These data challenge the uniqueness thesis, central to formal semantics, and support instead linguistic theories and processing models that posit different composition operations for predicates and modifiers.

Mel Ainscow has recently written an interesting and important article concerning a challenging aspect of inclusive education, namely how to practically implement the ambitious ideal of inclusion in schools, where inclusion refers to making basic education of a high quality available to all learners by identifying barriers to access to educational opportunities and resources to overcome those barriers. Schools should serve all children, especially those with special educational needs. To work towards inclusive ideals represents a fundamental shift in the traditional approach to teaching, certainly for most schools, in most countries. According to Ainscow, there is confusion about how to move policy and practice forward, a declaration which has found strong support among other researchers. Allan (2008, p. 10), for instance, writes that there is a deep uncertainty about how to create inclusive environments within schools and how to teach inclusively. The article contributes insights into how to reduce this uncertainty. The author presents many principles and practical suggestions for how to promote inclusive education. The intention here is to highlight some of the elements in Ainscow's article that are of most importance. The conclusions drawn here would not be surprising or unfamiliar to Ainscow himself.

Schools in Norway are supposed to meet the ideals connected to inclusive education. The most common definition of inclusive education in Norway is multiple-oriented, meaning that inclusive education is a product of a variety of values, processes and experiences. Learning environment is a particularly central element in inclusive education. The article deals with how varying groups of pupils with special educational needs experience their learning environment in school in Norway, compared with other pupils. The experiences of the learning environment are important for well-being in school and to benefit from teaching. Pupils' experiences have not been widely studied as a basis for educational policy and practise. This goes especially for pupils with difficulties and pupils receiving special education. Data were collected by a net-based survey with about 10,000 pupils answering the questionnaire. The results indicate that pupils with difficulties in school and those in special education experience a learning environment of lower quality than other pupils.

Educational and vocational guidance has received increased attention with regard to policymaking in the Nordic countries over the last 15 years. This has led to a growing interest in research-based knowledge. Updating an earlier article, we undertake a systematic literature review of guidance research in the Nordic countries during this 15-year period. Features and themes, both country-specific and in the region as a whole, are revealed through the analysis of a variety of research documents. Therefore, this article provides insight into research-based knowledge grounded in the Nordic context-relevant for both practitioners and policymakers on a national, Nordic, and international level.

Aims: Life satisfaction is an important aspect of quality of life and plays an essential role in optimal developmental adaption in adolescence. This study investigated whether being active in organised leisure sports is associated with a higher level of life satisfaction among adolescents, both directly and indirectly, through increased body appreciation. Whether gender moderates the mentioned associations will also be examined. Methods: The study was cross-sectional and based on a sample of 541 participants (44% females) between 16 and 19 years of age (M age=16.89 years, SD =0.46). A moderated mediation model was examined using SPSS v27 and the PROCESS macro. Results: Boys had higher life satisfaction and body appreciation levels than girls did. There was no direct effect of organised leisure sports participation on life satisfaction. However, there was a positive association between organised leisure sports participation and life satisfaction through increased body appreciation. No gender differences were observed for the direct association between sports participation and life satisfaction or the indirect associations between sports participation and life satisfaction through body appreciation. Conclusions: Our findings support that body appreciation is a mediator for the association between organised leisure sports participation and life satisfaction for both boys and girls. Longitudinal studies should be conducted to further examine if causal relationships exist. [ABSTRACT FROM AUTHOR]

Background: Generally, there is limited information on longitudinal trends and the interrelations between physical activity (PA), problematic gaming behavior (PGB), described as a dysfunctional pattern of videogame activities, and quality of life (QoL) based on data that include measurements from both pre‐ and postpandemic onset. This is also the case for university students. As society faced unprecedented restrictions during this period, these aspects may have developed unfavorably. Objective: To examine PA, PGB, and QoL among Norwegian University students prior to and during the initial stages of the pandemic and assess their temporal interrelations. Method: The data are derived from the "Students' Psychological Health Over Time" study (SPOT). Linear mixed models were used to examine the development from January 2020 to November 2020 over three time points for the total sample and across gender. A traditional cross‐lagged panel model analysis was used to estimate temporal associations. Age, gender, socioeconomic status, and partner status were included as covariates. Findings: PA and QoL decreased linearly over time (Cohen's d = 0.12 and 0.35, respectively), while only male students reported a small reduction in PGB (Cohen's d = 0.03). PA levels decreased considerably more for male students than female students (Cohen's d = 0.17 and 0.09, respectively). There was a small reciprocal negative temporal association between PA and PGB (standardized β = −0.04 and −0.05, respectively). All other temporal associations were not statistically significant in the adjusted analysis. Conclusion: The findings highlight gender‐variant negative developments in PA and QoL and suggest a negative reciprocal interrelation between PA and PGB. The findings point to potential adverse health effects that should be taken into account when restrictive pandemic measures are considered. [ABSTRACT FROM AUTHOR]

Background: Older men (aged ≥75 years) with high risk, non‐metastatic prostate cancer (PCa) are increasingly treated with curative therapy (surgery or radiotherapy). However, it is unclear if curative therapy prolongs life and improves health‐related quality of life (HRQoL) in this age group compared to conservative therapy, which has evolved considerably during the last decade. Study Design: The Scandinavian Prostate Cancer Group (SPCG) 19/Norwegian Get‐Randomized Research Group‐Prostate (GRand‐P) is a randomised, two‐armed, controlled, multicentre, phase III trial carried out at study centres in Norway, Denmark, Finland, and Sweden. Endpoints: The primary endpoints are overall survival and HRQoL (burden of disease scale, European Organisation for the Research and Treatment of Cancer [EORTC] Elderly Cancer patients). Secondary endpoints are PCa‐specific survival, metastasis‐free survival, role‐functioning scale (EORTC quality of life questionnaire 30‐item core), urinary irritative/obstructive scale (26‐item Expanded Prostate Cancer Index Composite [EPIC‐26]), bowel scale (EPIC‐26), intervention‐free survival, PCa morbidity, use of secondary and tertiary systemic therapies, mean quality‐adjusted life‐years (QALYs), and mean total healthcare costs. Patients and Methods: A total of 980 men (aged ≥75 years) with non‐metastatic, high‐risk PCa will initially be screened with Geriatric 8 (G8) health status screening tool and Mini‐COG© brief cognitive test. Participants identified by G8 as 'fit' or 'frail' will be randomised (ratio 1:1) to either immediate curative therapy (radiotherapy or prostatectomy) or conservative therapy (endocrine therapy or observation). Participants who are unable or unwilling to participate in randomisation will be enrolled in a separate observation group. Randomised patients will be followed for 10 years. Trial Registration: Ethics approval has been granted in Norway (457593), Denmark (H‐22051998), Finland (R23043) and Sweden (Dnr 2023‐05296‐01). The trial is registered on Clinicaltrials.org (NCT05448547). [ABSTRACT FROM AUTHOR]

The centrality of the users as partners in quality development is highlighted in official documents on career guidance, such as the EU Resolutions on Lifelong Guidance from 2004 and 2008. In addition, increased numbers of scholars in the field of organisational development and public service innovation highlight the importance of user participation as key in building stronger and more relevant services. Thus, policy rhetoric and research-based knowledge point in this direction: the main person in guidance interventions is the user, and the user should be involved. With this backdrop, it would seem evident that the voice of users was taken seriously in the planning, in the selection of methods and in the practical ways of offering guidance. Nordic research, however, shows that there is quite a gap between the rhetoric and realities when it comes to the systemic involvement of users in designing and offering guidance, even in the Nordic countries where democracy and active citizenship are so deeply rooted. This situation reveals some aspects of the uneasy relationship between individual and society.

Purpose: The aim of this study was to examine geographic and socioeconomic variation in curative treatment and choice of treatment modality among elderly prostate cancer (PCa) patients. Methods: This register-based cohort study included all Norwegian men ≥ 70 years when diagnosed with non-metastatic, high-risk PCa in 2011–2020 (n = 10 807). Individual data were obtained from the Cancer Registry of Norway, the Norwegian Prostate Cancer Registry, and Statistics Norway. Multilevel logistic regression analysis was used to model variation across hospital referral areas (HRAs), incorporating clinical, demographic and socioeconomic factors. Results: Overall, 5186 (48%) patients received curative treatment (radical prostatectomy (RP) (n = 1560) or radiotherapy (n = 3626)). Geographic variation was found for both curative treatment (odds ratio 0.39–2.19) and choice of treatment modality (odds ratio 0.10–2.45). Odds of curative treatment increased with increasing income and education, and decreased for patients living alone, and with increasing age and frailty. Patients with higher income had higher odds of receiving RP compared to radiotherapy. Conclusions: This study showed geographic and socioeconomic variation in treatment of elderly patients with non-metastatic, high-risk PCa, both in relation to overall curative treatment and choice of treatment modality. Further research is needed to explore clinical practices, the shared decision process and how socioeconomic factors influence the treatment of elderly patients with high-risk PCa. [ABSTRACT FROM AUTHOR]

Background We aimed to evaluate the efficacy of opportunistic treatment of hepatitis C virus (HCV) infection among hospitalized people who inject drugs (PWID). Methods We performed a pragmatic, stepped wedge cluster randomized trial recruiting HCV RNA positive individuals admitted for inpatient care in departments of internal medicine, addiction medicine, and psychiatry at three hospitals in Oslo, Norway. Seven departments were sequentially randomized to change from control conditions (standard of care referral to outpatient care) to intervention conditions (immediate treatment initiation). The primary outcome was treatment completion, defined as dispensing the final package of the prescribed treatment within six months after enrolment. Results A total of 200 HCV RNA positive individuals were enrolled between 1 October 2019 and 31 December 2021 (mean age 47.4 years, 72.5% male, 60.5% injected past 3 months, 20.4% cirrhosis). Treatment completion was accomplished by 67 of 98 (68.4% [95% confidence interval {CI}: 58.2–77.4]) during intervention conditions and by 36 of 102 (35.3% [95% CI: 26.1–45.4]) during control conditions (risk difference 33.1% [95% CI: 20.0–46.2]; risk ratio 1.9 [95% CI: 1.4–2.6]). The intervention was superior in terms of treatment completion (adjusted odds ratio [aOR] 4.8 [95% CI: 1.8–12.8]; P =.002) and time to treatment initiation (adjusted hazard ratio [aHR] 4.0 [95% CI: 2.5–6.3]; P <.001). Sustained virologic response was documented in 60 of 98 (61.2% [95% CI: 50.8–70.9]) during intervention and in 66 of 102 (64.7% [95% CI: 54.6–73.9]) during control conditions. Conclusions An opportunistic test-and-treat approach to HCV infection was superior to standard of care among hospitalized PWID. The model of care should be considered for broader implementation. Clinical Trials Registration. NCT04220645 [ABSTRACT FROM AUTHOR]

Background: The demand for plasma products is growing, necessitating an increase in plasma collection by plasmapheresis. While the 20th edition of the European Guidelines permits plasma donors in Europe to donate with 96-h donation intervals, the potential short- and long-term consequences of high-frequency plasma donations on donor health remain unknown. This study aims to measure the effect of plasma donation frequency on plasma protein composition, including total serum protein (TSP) and immunoglobulin G (IgG), in Norwegian male blood donors. Methods: This randomized controlled trial (RCT) included 120 male blood donors who were randomized into two intervention groups and one control group: high-frequency plasma donors (HFPDs) who donated 650 mL of plasma 3 times every 2 weeks, whereas regular-frequency plasma donors (RFPDs) who donated 650 mL of plasma 1 time every 2 weeks. The control group consisted of whole blood donors. The primary outcomes are the concentrations of TSP and IgG. Discussion: The findings from this study may have implications for recommendations related to donor health and plasma donation frequencies and may contribute to supporting the strategic independence of plasma products in Norway and Europe without compromising donor health. Trial registration: ClinicalTrials.gov: NCT05179200. Registered December 20th, 2021. [ABSTRACT FROM AUTHOR]

The overall objective of business continuity management (BCM) systems is to provide guidance and analytical subcomponents on how to assess and manage risk and sustain operations when facing a disruptive event. Current BCM practices largely follow a standard structure for formal planning processes and riskassessment activities. An underlying assumption in standard practices is that systems can be decomposed in subsystems in a meaningful way, as they are tractable and data are available to predict the system's future functionality. However, the reality is much more complex in our volatile world. Standard BCM approaches do not pay adequate attention to the treatment of uncertainties. Thus, they fall short of addressing the complexity of operations involved with emergencies and crisis. Lack of focus on uncertainty hampers the ability of BCM systems to provide sufficient support for decision making in highly uncertain situations. Dealing with such situations necessitates a shift from a defensive risk-management approach, grounded on an illusion of control and accountability, to a proactive stance based on resilience thinking. Responding to this call, we use concepts from the resilience engineering (RE) field and link them to different components of a BCM system. We develop a novel BCM framework and identify a set of resilience influence factors to enhance resilience in BCM systems. We use a case-example, hosted by a leading organization in a second-line emergency response operation in Norway to reflect on the application of a suggested BCM framework. [ABSTRACT FROM AUTHOR]

Formative assessment, and especially feedback, is considered essential to student learning. To provide effective feedback, however, teachers must act upon the information that students reveal during instruction. In this study, we apply a framework of formative assessment to explore how sensitive teachers are to students' thoughts and ideas when teaching for conceptual understanding. Six elementary school teachers were interviewed and videotaped as they implemented a curriculum that emphasized the teaching of key science concepts through different modes of learning (doing, reading, writing, and talking). We created four main categories for fostering conceptual understanding: identifying learning goals, eliciting student information, interpreting student information, and acting. Findings indicate that elementary school teachers with low levels of pedagogical content knowledge in science do not always know the key concepts of a scientific idea or how to teach them to increase student learning. Therefore, teachers' interpretation of students' responses and their subsequent actions are not likely to be aligned to the scientific idea the key concepts represent. We suggest that teachers need support to identify the key concepts within the discipline of science. Equally important is to realize that to make meaning, these concepts must be taught in a context and in relation to other words within the discipline.

This article seeks to answer three central questions pertaining to public-private partnership in early childhood education and care (ECEC provision) in Norway: How has public-private partnership developed during the last four decades? How is public-private partnership understood in Norwegian ECEC policy? What seem to be the future challenges in public-private partnership in Norway? The approach to these questions is to view ECEC provision in relation to the Norwegian policy areas of welfare, work, family, and education. The developments within public-private partnership in Norwegian ECEC have followed two main principles. The first one is the rational organisational perspective. ECEC is a means to meet major problems in society. This is achieved through rationally constructed policy, and public-private partnership is an integral part of this policy. The second principle is dominated by established organisational traditions. Partnership in itself is in accordance with traditions in the ECEC sector in Norway. This understanding of ECEC quality in partnership is consistent with how this has historically been expressed in the sector.

In the Budding Science and Literacy project, we explored how working with an integrated inquiry-based science and literacy approach may challenge and support the teaching and learning of science at the classroom level. By studying the inter-relationship between multiple learning modalities and phases of inquiry, we wished to illuminate possible dynamics between science inquiry and literacy in an integrated science approach. Six teachers and their students were recruited from a professional development course for the current classroom study. The teachers were to try out the Budding Science teaching model. This paper presents an overall video analysis of our material demonstrating variations and patterns of inquiry-based science and literacy activities. Our analysis revealed that multiple learning modalities (read it, write it, do it, and talk it) are used in the integrated approach; oral activities dominate. The inquiry phases shifted throughout the students' investigations, but the consolidating phases of discussion and communication were given less space. The data phase of inquiry seems essential as a driving force for engaging in science learning in consolidating situations. The multiple learning modalities were integrated in all inquiry phases, but to a greater extent in preparation and data. Our results indicate that literacy activities embedded in science inquiry provide support for teaching and learning science; however, the greatest challenge for teachers is to find the time and courage to exploit the discussion and communication phases to consolidate the students' conceptual learning.

The article has two parts. Part one deals with some historical developments in the field of special education in Norway. There has been a change in formulated policy from a clearly segregated system, then integration and mainstreaming and now intentions about inclusion as an ideal. The second part is about children with behavioural difficulties and especially children diagnosed with ADHD (Attention Deficit and Hyperactivity Disorders) and how they are treated within the education system. Knowledge about these children's situation is not very well developed or widespread in the Norwegian education system. The numbers of children with an ADHD diagnosis vary a lot between schools. Both diagnosis and treatment connected to ADHD have been highly controversial in Norway, as in many other countries. The gap between ideals and realities is a striking element in special education in Norway and also for these children. The inclusion criteria have not been met. The reasons for this are discussed.

Background: There is a need to understand better factors influencing participation in physical education (PE) and the mechanisms involved. The adolescent years are characterised by increasing levels of body-related concerns. In PE, the body is judged for its physical abilities and subject to social comparisons and body judgements. Grounded in the Self-Determination Theory, this study aimed to explore whether body-related factors were associated with adolescents' involvement in PE and whether types of motivation mediated this relationship. Methods: The study involved 2,140 (54.5% girls) secondary students (15-16-yearolds) from Norway participating in the nationally representative "Health Behaviour in School-aged Children (HBSC) study: a WHO collaborative cross-national study." Body-related factors included Body Mass Index (BMI), health complaints, body perception and dietary behaviours. Gender, age, and socioeconomic status (family affluence) were control variables. Motivation for PE was assessed with the Perceived Locus of Causality (PLOCQ) scale measuring three distinct factors: autonomous motivation, controlled motivation and amotivation. PE involvement was self-reported as weekly participation in PE classes and time spent in moderate-to-vigorous physical activity (MVPA) during PE. Results: Gender (girl), family affluence, health complaints, not being on a diet but wanting to lose weight, and body perception (too fat) were negatively associated with weekly PE participation when adjusting for other variables. This association was largely explained by students' autonomous motivation in the case of health complaints and partly in the case of dietary behaviour and body perception. Similar results were observed for MVPA during PE lessons. Additionally, gender was associated with MVPA through amotivation. Conclusion: The study adds new knowledge to the understanding of the relationship between body-related factors and PE, supporting that autonomous motivation is a central mechanism and an avenue for further research. The results should be considered in planning high-quality PE classes and suggest that an autonomous supportive learning climate sensitive to body-related concerns should be a priority to increase adolescent involvement in PE. [ABSTRACT FROM AUTHOR]

Rationale: Increased attention to cancer care has instigated altered systems for screening, diagnosis, and management of various types of cancer, such as in the prostate. While such systems very likely have improved the quality of cancer care, they also result in the altered use of specific services, such as magnetic resonance imaging (MRI). Aims and Objective: To study the change in the use of prostate MRI in the Norwegian health care system from 2013 to 2021 and to investigate some reasons for and potential implications of this change. Method: Data from the Norwegian Health Economics Administration (HELFO), The Cancer Registry of Norway and Cause‐of‐death registry at the Norwegian Institute of public health and the health registry of Vestfold Hospital Trust were used for descriptive statistical analysis. Results: The number of MRIs of the prostate increased threefold from 2013 to 2021, representing an extra cost of 2 million USD in 2020. The incidence of prostate cancer was stable at about 5000 cases per year, corresponding to 178 per 100,000 men, indicating no increased overdiagnosis. However, the clinical staging has changed substantially during this period, indicating stage and grade migration. The number of negative biopsies was reduced, and there are three MRIs per reduced negative biopsy. The number of persons on active surveillance increased during the period. However, these changes are partly independent of the increase in the number of MRIs. Conclusion: There was a substantial increase in the number of prostate MRIs and thus an increase in costs. This appears to have contributed to the reduction of negative biopsies, improved staging and increased active surveillance. However, as these effects are partly independent of the increase in MRIs, we need to document the outcomes for patients from prostate MRIs as their opportunity costs are substantial. [ABSTRACT FROM AUTHOR]

The school is an important setting for physical activity. The purpose of the present study was to examine the association between physical environmental characteristics and participation in daily physical activity during school breaks. Data from 130 schools and 16 471 students (Grades 4-10) in Norway were obtained in 2004 through self-administered questionnaires to principals and students. Multilevel logistic regression models revealed that boys at secondary level with a larger number of outdoor facilities at school had 2.69 times [95% confidence interval (CI) = 1.21-5.98] and girls 2.90 times (95% CI = 1.32-6.37) higher odds of being physically active compared with students in schools with fewer facilities. Boys at secondary level with areas for hopscotch/skipping rope had 2.53 times (95% CI = 1.55-4.13), with a soccer field 1.68 times (95% CI = 1.15-2.45), with playground equipment 1.66 times (95% CI = 1.16-2.37) and with a sledding hill 1.70 times (95% CI = 1.23-2.35) higher odds to be physically active compared with students in schools without these facilities. A sledding hill was also associated with girls' physical activity participation in secondary school (odds ratio = 1.58, 95% CI = 1.11-2.24). Outdoor facilities in secondary schools are associated with students' daily physical activity participation during school breaks. Therefore, improving the outdoor environment should be considered in physical activity promotion school programs in secondary schools.

Using data from in-depth interviews with 20 children, this study finds that children with parents suffering from mental health distress struggle hard to present themselves as "normal" and equal among their peer group. The study shows how they avoid stigma in their presentation of self in everyday life. All the children in this study, regardless of age or parents' suffering, are active participants and impression managers in and of their own lives. The authors question whether their active responsibility for their own and their family's well-being becomes too heavy a burden and should be moved from children's private sphere into public arenas such as schools or social and healthcare services. (Contains 1 table and 1 figure.)

Weather-related risk makes the insurance industry inevitably concerned with climate and climate change. Buildings hit by pluvial flooding is a key manifestation of this risk, giving rise to compensations for the induced physical damages and business interruptions. In this work, we establish a nationwide, building-specific risk score for water damage associated with pluvial flooding in Norway. We fit a generalised additive model that relates the number of water damages to a wide range of explanatory variables that can be categorised into building attributes, climatological variables, and topographical characteristics. The model assigns a risk score to every location in Norway, based on local topography and climate, which is not only useful for insurance companies but also for city planning. Combining our model with an ensemble of climate projections allows us to project the (spatially varying) impacts of climate change on the risk of pluvial flooding towards the middle and end of the 21st century. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic and infection control measures caused changes to daily life for most people. Heavy alcohol consumption and physical inactivity are two important behavioral risk factors for noncommunicable diseases worldwide. The COVID-19 pandemic, with its social distancing measures, home office policies, isolation, and quarantine requirements may have an impact on these factors. This three-wave longitudinal study aims to investigate if psychological distress and worries related to health and economy were associated with levels and changes in alcohol consumption and physical activity during the two first years of the COVID-19 pandemic in Norway. Methods: We used data collected in April 2020, January 2021, and January 2022 from an online longitudinal population-based survey. Alcohol consumption and physical activity status were assessed at all three measuring points via the Alcohol Use Disorder Identification Test (AUDIT-C) and the International Physical Activity Questionnaire (IPAQ-SF). COVID-19-related worries, home office/study, occupational situation, age, gender, children below 18 years living at home, and psychological distress (measured with the Symptom Checklist (SCL-10)) were included as independent variables in the model. A mixed model regression was used and presented with coefficients with 95% confidence intervals (CI). Results: Analysis of data from 25,708 participants demonstrates that participants with substantial symptoms of psychological distress more often reported higher alcohol consumption (1.86 units/week, CI 1.48-2.24) and lower levels of physical activity [-1,043 Metabolic Equivalents of Task (METs) per week, CI -1,257;-828] at baseline. Working/studying from home (0.37 units/week, CI 0.24-0.50) and being male (1.57 units/week, CI 1.45-1.69) were associated with higher alcohol consumption. Working/studying from home (-536 METs/week, CI -609;-463), and being older than 70 years (-503 METs/week, CI -650;-355) were related to lower levels of physical activity. The differences in activity levels between those with the highest and lowest levels of psychological distress reduced over time (239 METs/week, CI 67;412), and similarly the differences in alcohol intake reduced over time among those having and not having children < 18 years (0.10 units/week, CI 0.01-0.19). Conclusion: These findings highlight the substantial increases in risks related to inactivity and alcohol consumption among those with high levels of psychological distress symptoms, and particularly during the COVID-19 pandemic, and increase the understanding of factors associated with worries and health behavior. [ABSTRACT FROM AUTHOR]

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

Root canal treatment (RCT) is often considered a difficult procedure for both the patient and treatment provider. The American Association of Endodontists case difficulty assessment form categorizes cases as minimal, moderate, and high difficulty level. We recently showed that endodontic mishaps occur frequently during treatment of teeth in high difficulty category. The aims were to investigate the clinical and radiographic outcome at least 4 years after RCT and to evaluate patients' perceived oral health-related quality of life (OHRQoL). Two hundred thirty-four patients (257 endodontically treated teeth) who were previously included in a quality assurance study were offered a recall appointment at the Department of Clinical Dentistry, University of Bergen, Norway. Patients were given a thorough clinical, radiographic examination and asked to fill out the Oral Health Impact Profile-14 questionnaire. A total of 149 patients (160 teeth) attended the 4-year (range, 4–6 years) recall appointment. An unchanged or lower Periapical Index (PAI) score at recall visit was registered on 153 teeth (95.6%) (P <.001). Radiographic success rate (PAI score ≤ 2) was 87.5%, and clinical success (absence of clinical signs and symptoms) was 88.8%. Both radiographic and clinical success was observed in 78.8% of teeth. Teeth in high difficulty category, instrumented with engine-driven files, and molars presented with significantly more clinical signs and symptoms but not high PAI score (PAI score ≥ 3) (P <.05). Endodontic mishaps such as overinstrumentation and overfill with gutta-percha resulted in significantly high PAI score (P <.05). Patients with no clinical signs and symptoms after RCT and elderly had a significantly better OHRQoL (P <.05). Presence of clinical signs and symptoms rather than PAI score affected patients' OHRQoL. [ABSTRACT FROM AUTHOR]

Patients in specialist mental healthcare services who are at risk of suicide may experience their struggles as existential in nature. Yet, research on meaning in life has been relatively scarce in suicidology. This qualitative study aimed to explore how patients at risk of suicide perceived their encounters with specialist healthcare professionals after a suicide attempt (SA), with special reference to meaning in life experiences. The study was conducted in specialised mental healthcare services in Norway. Data were collected via individual interviews with eight patients aged 20–75 years. Using a four-step procedure, the interviews were analysed by systematic text condensation. The participants understood their feelings of shame, self-contempt and challenging life experiences as contributing factors to their SA. They perceived that existential themes in relation to financial difficulties, shame and trauma were resolved, while issues associated with the SA, such as death, loss and beliefs, were given less attention. The participants were either ambivalent about continuing to live or wished to rebuild a meaningful life. Overall, their experiences of meaningfulness were hampered. Assisting patients with meaning in life experiences may help them alter their life interpretations and increase their ability to rebuild their lives as meaningful. The present study should be seen as a contribution to meaning-informed approaches in specialist mental healthcare services. More research is needed to equip healthcare personnel in their overall aims of preventing suicide and supporting patients at risk in their efforts to live a meaningful life. [ABSTRACT FROM AUTHOR]

This qualitative study focuses on how hospital chaplains encounter and explore existential themes in their conversations with patients at risk of suicide. Hospital chaplains from three of the four health regions in Norway participated in focus group interviews. The interviews were analysed by systematic text condensation. We found that the participants emphasized support and being a witness to patients' narratives, exploring existential themes regarding life and death, guilt and shame, relatedness and loneliness, faith and hope. The chaplains understood their role as representing life. Their theological perspectives, pastoral clinical education and experiences were seen as being important in these conversations. Further research may investigate how the hospital chaplains' role and existential competence can contribute to interdisciplinary teams working with patients at risk of suicide, examining how conversations about existential themes affect patients' health, and whether these conversations prevent suicide. [ABSTRACT FROM AUTHOR]

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Background: The Corail® cementless stem (DePuy Synthes) has been used in Norway since 1987 and is one of the most frequently used stems in THA worldwide. Although the published survival results of the standard Corail stem have been good, little is known about the long-term (more than 20 years) survival of other stem design variants. Further, some changes were made to the extramedullary part of the stem in 2003, and the effect of these changes on survival is unknown.Questions/purposes: (1) What is the survival up to 30 years of the standard collarless Corail femoral stem, and were extramedullary changes (slimmer, polished and rectangular neck, shorter taper) associated with differences in survivorship? (2) How does the 10-year survival and the risk of revision of other Corail stem variants, including the standard collared stem, coxa vara collared stem, and high offset collarless stem, compare with those of the standard collarless stem? (3) Which factors are associated with an increased risk of revision of the Corail stem, and are there any differences in those factors among the four stem variants?Methods: Data for this study were drawn from the Norwegian Arthroplasty Register. Since 1987, THAs have been registered in the Norwegian Arthroplasty Register with completeness of data greater than 97% for primary THAs and 93% for revisions. To study survivorship with up to 30 years of follow-up (1987 to 2018; median 7.7-year follow-up), and to compare the original stem with stems with extramedullary modifications, we included 28,928 standard collarless Corail stems in 24,893 patients (mean age at time of implantation 62 years; 66% [16,525 of 24,893] were women). To compare the newer stem variants with the standard collarless stem (2008 to 2018), we included 20,871 standard collarless, 10,335 standard collared, 6760 coxa vara collared, and 4801 high offset collarless stems. Survival probabilities were estimated using the Kaplan-Meier method with endpoints of stem revision, revision due to aseptic stem loosening, and periprosthetic fracture. The endpoint of all noninfectious causes of THA revision (including cup revision) was additionally analyzed for the long-term comparison. The proportion of patients who died was limited, and there was no difference in death rate between the groups compared. Therefore, we believe that competing events were not likely to influence survivorship estimates to a large degree. To compare different stem variants and evaluate factors that could be associated with the risk of revision, we calculated hazard ratios using Cox regression analyses with adjustments for gender, age group, surgical approach, diagnosis, and stem size.Results: The 30-year Kaplan-Meier survival of the standard collarless stem was 88.4% (95% confidence interval 85.4% to 91.4%), 93.3% (95% CI 91.1% to 95.5%), and 94.4% (95% CI 92.0% to 96.8%) using stem revision for any noninfectious cause, aseptic loosening, and periprosthetic fracture of the femur as endpoints, respectively. There was no difference in survival between the original stem and the modified stem. The 10-year Kaplan-Meier survivorship free of stem revision (all causes including infection) was 97.6% (95% CI 97.2% to 98.0%) for the standard collarless stem, 99.0% (95% CI 98.8% to 99.2%) for the standard collared stem, 97.3% (95% CI 96.3% to 98.3%) for the coxa vara collared stem, and 95.0% (95% CI 93.6% to 96.4%) for the high offset collarless stem. Compared with the standard collarless stem, the standard collared stem performed better (HR 0.4 [95% CI 0.3 to 0.6]; p < 0.001) and the high offset collarless stem performed more poorly (HR 1.4 [95% CI 1.1 to 1.7]; p = 0.006) with any stem revision as the endpoint, and similar results were found with revision for aseptic stem loosening and periprosthetic fracture as endpoints. Controlling for the noted confounders, the standard collared stem had a lower revision risk. The high offset collarless stem had an increased stem revision risk for any reason (HR 1.4 [95% CI 1.1 to 1.7]; p = 0.006) and aseptic loosening (HR 1.6 [95% CI 1.1 to 2.3]; p = 0.022). Other factors associated with an increased risk of stem revision for all stem variants were being a man (HR 1.7 [95% CI 1.4 to 2.0]; p < 0.001), age 70 to 79 years and 80 years and older compared with the age group of 50 to 59 years (HR 1.6 [95% CI 1.2 to 2.0]; p < 0.001 and HR 1.9 [95% CI 1.4 to 2.6]; p < 0.001, respectively), the anterior approaches (direct anterior Smith-Petersen and anterolateral Watson-Jones combined) compared with the posterior approach (HR 1.4 [95% CI 1.1 to 1.7]; p = 0.005), as well as a preoperative nonosteoarthritis diagnosis (HR 1.3 [95% CI 1.0 to 1.6]; p = 0.02) and small stem sizes (sizes 8-11) compared with the medium sizes (sizes 12-15) (HR 1.4 [95% CI 1.1 to 1.6]; p = 0.001). The very small sizes (8 and 9) were associated with a 2.0 times higher risk of revision (95%. CI 1.4 to 2.6; p < 0.01) compared with all other sizes combined.Conclusion: When using the uncemented Corail stem, surgeons can expect good results with up to 30 years of follow-up. Our results should be generalizable to the typical surgeon at the average hospital in a comparable setting. From our results, using a collared variant would be preferable to a collarless one. Due to an increased risk of periprosthetic fracture, caution with the use of the uncemented Corail stem in patients older than 70 years, especially in women, is warranted. Poorer stem survival should also be expected with the use of small stem sizes. The risk of periprosthetic fractures for the Corail uncemented stem versus cemented stems in different age categories has not been extensively examined, nor has the use of a collar for different age groups and genders, and both should be subjects for further investigation.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Three male sperm whales (Physeter macrocepha-lus) stranded on the island of Andøya in northern Norway in 2020. This created an opportunity to do gross necropsies with a focus on stomach contents as the diet of sperm whales in Norwegian waters is poorly understood and also to study potential presence of marine debris. Four new prey types for sperm whales in Norwegian waters were identified: (1) angler fish, (2) Atlantic cod, (3) cartilaginous fish, and (4) cock-eyed squid. In general, the results support earlier studies of male sperm whale diet in high latitude foraging grounds in the North Atlantic consisting of a mixture of cephalopods and meso and bathypelagic fish. The only type of marine debris found was part of a fishing line. Based on estimates from teeth, the whales were 25, 45, and 49 years old. The size of all individuals was smaller than the median length based on whaling data for these age classes caught in Iceland in the 1970s. [ABSTRACT FROM AUTHOR]

Aims: We investigated the current extent of undiagnosed diabetes and prediabetes and their associated cardiovascular risk profile in a population‐based study. Methods: All residents aged ≥20 years in the Nord‐Trøndelag region, Norway, were invited to the HUNT4 Survey in 2017–2019, and 54% attended. Diagnosed diabetes was self‐reported, and in those reporting no diabetes HbA1c was used to classify undiagnosed diabetes (≥48 mmol/mol [6.5%]) and prediabetes (39–47 mmol/mol [5.7%–6.4%]). We estimated the age‐ and sex‐standardized prevalence of these conditions and their age‐ and sex‐adjusted associations with other cardiovascular risk factors. Results: Among 52,856 participants, the prevalence of diabetes was 6.0% (95% CI 5.8, 6.2), of which 11.1% were previously undiagnosed (95% CI 10.1, 12.2). The prevalence of prediabetes was 6.4% (95% CI 6.2, 6.6). Among participants with undiagnosed diabetes, 58% had HbA1c of 48–53 mmol/mol (6.5%–7.0%), and only 14% (i.e., 0.1% of the total study population) had HbA1c >64 mmol/mol (8.0%). Compared with normoglycaemic participants, those with undiagnosed diabetes or prediabetes had higher body mass index, waist circumference, systolic blood pressure, triglycerides and C‐reactive protein but lower low‐density lipoprotein cholesterol (all p < 0.001). Participants with undiagnosed diabetes had less favourable values for every measured risk factor compared with those with diagnosed diabetes. Conclusions: The low prevalence of undiagnosed diabetes suggests that the current case‐finding‐based diagnostic practice is well‐functioning. Few participants with undiagnosed diabetes had very high HbA1c levels indicating severe hyperglycaemia. Nonetheless, participants with undiagnosed diabetes had a poorer cardiovascular risk profile compared with participants with known or no diabetes. [ABSTRACT FROM AUTHOR]

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

Norway is an example of the Nordic model in which the local level is of fundamental importance. However, the municipalities are relatively small and increasingly subject to decentralisation of their activities. To compensate for scale disadvantages, a mixture of collaborative activities is pursued in order to build system capacity. Paradoxically, little is known about collaboration among key stakeholders. This article makes a contribution to reducing this knowledge gap by focusing on mid-level managers and municipal departments. This research is empirically underpinned by a cross sectional survey of middle managers in 64 municipalities in Norway (N = 1354) and presents, for the first time, comprehensive data on collaboration across the entire municipal sector. It shows that collaboration does exist among municipalities, but that there is significant variation between sectors and types of collaboration. Furthermore, the classic distinction between locals and cosmopolitans is observed, though also an interesting new group of middle managers - "glocals" - who combine local and cosmopolitan orientation. The combination of delegation and entrepreneurial leadership is shown to be particularly important when explaining variation, as delegation creates a greater scope for collaborative management. Interestingly, entrepreneurs in particular appeared to be moving into this area, thus enabling greater innovation and development. [ABSTRACT FROM AUTHOR]

Introduction: To improve quality across levels of care, we developed a standardized care pathway (SCP) integrating palliative and oncology services for hospitalized and home-dwelling palliative cancer patients in a rural region. Methods: A multifaceted implementation strategy was directed towards a combination of target groups. The implementation was conducted on a system level, and implementation-related activities were registered prospectively. Adult patients with advanced cancer treated with non-curative intent were included and interviewed. Healthcare leaders (HCLs) and healthcare professionals (HCPs) involved in the development of the SCP or exposed to the implementation strategy were interviewed. In addition, HCLs and HCPs exposed to the implementation strategy answered standardized questionnaires. Hospital admissions were registered prospectively. Results: To assess the use of the SCP, 129 cancer patients were included. Fifteen patients were interviewed about their experiences with the patient-held record (PHR). Sixty interviews were performed among 1320 HCPs exposed to the implementation strategy. Two hundred and eighty-seven HCPs reported on their training in and use of the SCP. Despite organizational cultural differences, developing an SCP integrating palliative and oncology services across levels of care was feasible. Both HCLs and HCPs reported improved quality of care in the wake of the implementation process. Two and a half years after the implementation was launched, 28% of the HCPs used the SCP and 41% had received training in its use. Patients reported limited use and benefit of the PHR. Conclusion: An SCP may be a usable tool for integrating palliative and oncology services across care levels in a rural region. An extensive implementation process resulted in improvements of process outcomes, yet still limited use of the SCP in clinical practice. HCLs and HCPs reported improved quality of cancer care following the implementation process. Future research should address mandatory elements for usefulness and successful implementation of SCPs for palliative cancer patients. Plain language summary: When a patient has incurable cancer, it is beneficial to introduce palliative care early in the disease trajectory along with anti-cancer treatment. A standardized care pathway is a method to improve quality and reduce variation in healthcare. It can promote integrated healthcare services in palliative care, e.g. by specifying action points when the patient's situation is changing. In this study, a standardized care pathway for cancer patients with palliative care needs was developed in a rural region of Norway. The pathway focused on patients' needs and symptoms and on smooth transition between levels of care. An educational program and an information strategy were developed to ensure implementation. To evaluate the implementation, all activity regarding the implementation process was registered. Cancer patients and healthcare professionals were interviewed and answered questionnaires. One thousand three hundred and twenty healthcare professionals were exposed to the implementation strategy. One hundred and twenty-nine cancer patients were followed up according to the standardized care pathway. Despite different perspectives of care, it was feasible to develop a standardized care pathway for palliative cancer patients across care settings. A paper-based patient-held record was only found to be useful by a limited number of patients. An extensive implementation process was completed and resulted in improvements regarding healthcare professionals' experience with the quality of cancer care in the region, but limited use of the care pathway in clinical practice. Further research should identify the most important elements for usefulness and successful implementation of the care pathway. [ABSTRACT FROM AUTHOR]

Aims: To examine perceived consequences for everyday life, learning outcomes, family relations, sleep problems and worries for infection, for friends and their future, among youth aged 12–19 years during weeks 7 to 9 of the COVID-19 lockdown in Norway. We examine variations by age, gender, socioeconomic status and country of birth. Methods: Youth within the municipality of Bergen were invited via SMS to participate in a 15-minute online survey. A total of 2997 (40%) youths participated. The mean age was 17 years (standard deviation 1.7). Results: Overall, 28% reported feeling somewhat to a lot impacted by schools closing, 63% reported learning less. In total, 62% reported improvement of everyday life. The youth's situation in their family was worse for 13%. Regarding sleep problems, 19% reported difficulties initiating and maintaining sleep, 12% had more nightmares, while 90% reported later bedtime and rise time. Seven per cent worried about getting infected, while 53% worried about infection among family members. A total of 19% worried that the outbreak would lead to a more difficult future, and 32%worried that friends were facing a difficult situation at home. Perceived consequences and worries related to the lockdown varied across sociodemographic groups. Conclusions : The perceived consequences and degree of worries varied by age, gender, socioeconomic status and to a certain degree country of birth. Girls, older youth, youth with lower socioeconomic status and with a migrant background from developing countries seemed to experience the lockdown as more difficult, and thereby possibly accentuating the need for services in these groups. [ABSTRACT FROM AUTHOR]

Background: A severe form of acute hemorrhagic diarrhea syndrome (AHDS) occurred in dogs in the Oslo region of Norway during autumn 2019. Objectives: To characterize the fecal microbiota of dogs with AHDS during the outbreak and compare it to that of healthy dogs from the same period and before the outbreak. Animals: Dogs with AHDS (n = 50), dogs with nonhemorrhagic diarrhea (n = 3), and healthy dogs (n = 11) were sampled during the outbreak. In addition, 78 healthy dogs from the same region were sampled before the outbreak between 2017 and 2018. Methods: Retrospective case‐control study. The fecal microbiotas were characterized using 16S rRNA gene amplicon sequencing. Results: Dogs with AHDS had significantly different microbiota composition (R2 =.07, P <.001) and decreased intestinal diversity relative to healthy dogs from the outbreak period (median, 2.7; range, 0.9‐3.5 vs median, 3.2; range, 2.6‐4.0; P <.001). The microbiota in dogs with AHDS was characterized by a decrease of Firmicutes and an outgrowth of Proteobacteria, with increased numbers of Clostridium perfringens and Providencia spp. Among the Providencia spp., 1 showed 100% sequence identity with a Providencia alcalifaciens strain that was cultivated and isolated from the same outbreak. No Providencia spp. was found in healthy dogs sampled before the outbreak. Conclusions and Clinical Importance: Dogs with AHDS had marked changes in fecal microbiota including increased numbers of Providencia spp. and C. perfringens, which may have contributed to the severity of this illness. [ABSTRACT FROM AUTHOR]

Age at menarche, reproductive lifespan, and age at menopause are associated with several cardiovascular diseases, but their relationship with atrial fibrillation (AF) is uncertain. We linked information on all women who participated in the third survey of the population-based, longitudinal HUNT study in Norway with medical records from all local hospitals. A total of 14,632 women aged 60 or more were followed for validated incident AF. We retrieved age at menarche and age at menopause from the HUNT questionnaires. Reproductive lifespan was defined as the difference between age at menarche and age at menopause. We used Cox proportional hazards regression models to assess associations between AF and age at menarche, reproductive lifespan, and age at menopause. During a median follow-up of 8.17 years (136,494 person-years), 1217 (8.3 %) participants developed AF. In multivariable-adjusted analyses, we observed no associations between early or late age at menarche and AF (hazard ratios (HRs): <12 years: 0.85 [95 % confidence interval (CI), 0.65–1.12]; ≥16 years: 0.99 [95 % CI, 0.80–1.24] compared to those who attained menarche at 13–14 years). The HR for a reproductive lifespan shorter than 30 years was 0.91 [95 % CI, 0.72–1.15] compared to 34–37 years. Likewise, there was no clear association between premature or early age at menopause and AF (HRs: <40 years: 1.21 [95 % CI, 0.83–1.75]; 40–44 years: 0.97 [95 % CI, 0.77–1.22] compared to 50–54 years). In this population of women aged 60 years and over, the risk of AF was not associated with age at menarche, reproductive lifespan, or age at menopause. [Display omitted] [ABSTRACT FROM AUTHOR]

Having interventions that are not only evidence-based and effective but also cost-effective and efficient is important for the prevention and treatment of child and adolescent emotional problems. A randomized clinical trial (RCT) tests the total interventions effect but does not address specific components of the intervention. In this article the hypothesis and a conceptual model of the ECHO study are presented and discussed. The ECHO intervention consists of three different components each containing two levels of intervention. By using a cluster randomized factorial design, children aged 8–12 at 40 schools across Norway will be randomized to eight different experimental conditions investigating the optimal balance between effect, cost-effectiveness, and efficiency. The article presents the design and the different components being tested and discusses how optimalization can be reached through this innovative design. The article also discusses how interventions can be improved by investigating and understanding the mechanisms of change within psychological interventions. For each of the three components in the study we consider the mediators that could be active within the intervention and how the study investigates such mediation. The results will contribute to a better understanding of how psychological interventions work and how we intend to optimize the EMOTION intervention. [ABSTRACT FROM AUTHOR]

Aims: To describe trends in cannabis use from 2010 to 2019 among Norwegian adolescents and relate these to individual- and municipal-level variables. Design: Data from nationwide repeated cross-sectional surveys collected in 2010–2013 (T1), 2014–2016 (T2), and 2017–2019 (T3) were used to describe secular trends in proportions of adolescent cannabis use. Setting: Cross-sectional surveys in 410 of the total 428 municipalities of Norway. Participants: A total of 628,678 survey responses from adolescents aged ~13–19 years of age, in which 566,912 survey responses were eligible for analyses, representing data from 340 municipalities. Measurements: Respondent's past year cannabis use, time, gender, school grade, municipality, geographical location, and municipality population. Findings: Boys reported overall higher cannabis use, with ~2:1 gender ratio for any past year cannabis use and a 3:1 gender ratio for frequent cannabis use. Adolescents in Eastern Norway reported higher cannabis use compared with other areas in the country, and adolescents from municipalities with a higher population size reported higher rates of cannabis use than smaller municipalities. A gradual increase in cannabis use from T1 to T3 was found in Eastern Norway and in the largest municipalities. More generally, proportions of past year cannabis use showed a marked increase from T2 to T3 across genders, grade/age groups, geographical location, and municipality population, with few exceptions. Conclusions: Our findings indicate that proportions of past year cannabis use have increased among Norwegian adolescents in recent years. Preventive interventions to hinder initiation of cannabis use, as well as measures to address frequent cannabis use among Norwegian adolescents, are needed. [ABSTRACT FROM AUTHOR]

Introduction: Preterm delivery (<37 weeks) predicts later cardiovascular disease risk in mothers, even among normotensive deliveries. However, development of subclinical cardiovascular risk before and after preterm delivery is not well understood. We sought to investigate differences in life course cardiovascular risk factor trajectories based on preterm delivery history. Material and methods: The HUNT Study (1984‐2008) linked with the Medical Birth Registry of Norway (1967‐2012) yielded clinical measurements and pregnancy outcomes for 19 806 parous women with normotensive first deliveries. Women had up to three measurements of body mass index, waist‐to‐hip ratio, blood pressure, lipids, non‐fasting glucose, and C‐reactive protein during follow up between 21 years before to 41 years after first delivery. Using mixed effects models, we compared risk factor trajectories for women with preterm vs term/postterm first deliveries. Results: Trajectories overlapped for women with preterm compared with term/postterm first deliveries for all cardiovascular risk factors examined. For instance, the mean difference in systolic blood pressure in women with preterm first deliveries compared with those with term deliveries was 0.2 mm Hg (95% CI −1.8 to 2.3) at age 20 and 1.5 mm Hg (95% CI −0.5 to 3.6) at age 60. Conclusions: A history of preterm delivery was not associated with different life course trajectories of common cardiovascular risk factors in our study population. This suggests that the robust association between preterm delivery and cardiovascular end points in Norway or similar contexts is not explained by one or more commonly measured cardiovascular risk factors. Overall, we did not find evidence for a single cardiovascular disease prevention strategy that would reduce risk among the majority of women who had preterm delivery. [ABSTRACT FROM AUTHOR]

Objective: Recent studies have shown that today's college students more than ever are struggling with mental health and alcohol problems. While poor satisfaction with life and mental health problems have been linked to higher alcohol consumption, there is still a lack of studies examining in detail the shape and nature of the relationship between mental health and alcohol consumption. Aim: To investigate the associations between satisfaction with life, mental health problems and potential alcohol-related problems among Norwegian university students. The shape of the associations was also examined. Methods: Data were drawn from a 2018 national survey of students in higher education in Norway (the SHoT-study). Associations between satisfaction with life, mental health problems and potential alcohol-related problems (AUDIT; risky and harmful alcohol use) were investigated using logistic regression. Both crude models and models adjusted for age, gender and marital status were conducted. To investigate the shape of the associations, logistic regression with quadric and cubic terms was tested. Results: Decreased satisfaction with life and increased mental health problems were associated with potential alcohol-related problems. For satisfaction with life, a curvilinear association with risky alcohol use and a linear association with harmful alcohol use was identified. For mental health problems, curvilinear associations were found for both risky and harmful alcohol use. Conclusion: Many students report potential alcohol-related problems. Students with harmful alcohol use seem to be more at risk of reduced satisfaction with life and increased mental health problems than students with risky alcohol use. Educational institutions may be an ideal setting for raising awareness of mental health issues and responsible alcohol consumption among students. The present study contributes with important information about the shape of the associations between satisfaction with life, mental health problems and potential alcohol-related problems in the student population. [ABSTRACT FROM AUTHOR]

Aims: Knowledge regarding the most effective return to work (RTW) approaches after traumatic brain injury (TBI) is lacking. This trial aimed to compare the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on RTW and work stability after TBI. Methods: We performed a parallel-group randomized controlled trial (RCT) at a TBI outpatient clinic at Oslo University Hospital (OUH), Norway. Patients with a history of mild-to-moderate TBI (n = 116) aged 18–60 were randomized (1:1) by an independent investigator to receive group-based compensatory cognitive training (CCT) and supported employment (SE) (n = 60) or TAU consisting of individualized multidisciplinary treatment (n = 56). Participants were enrolled 2–3 months post-injury. The nature of the intervention prevented blinding of patients and therapists, however, outcome assessors were blinded to group allocation. The primary outcome measure was RTW at 3 and 6 months following study inclusion. Secondary outcomes were work percentage, stability, and productivity. The present study provides results from an interim analysis from the first two planned follow ups, while subsequent publications will present results up to 12 months following study inclusion. Results: Mixed effects models showed no between-group differences in the RTW proportion, work percentage, and hours worked between CCT-SE and TAU from baseline to 6 months. A significantly higher proportion of participants in CCT-SE had returned to work at 3 months when adjusting for baseline differences. The majority of participants who were employed at 3 and 6 months were stably employed. There was a statistically significant within-group improvement on RTW proportion, hours worked and work percentage in both groups. Conclusion: The results revealed no difference between CCT-SE and TAU on work-related outcomes from baseline to 6 months. However, there was a higher RTW proportion in the CCT-SE group compared to TAU at 3 months. Future publications will assess the effectiveness of CCT-SE vs. TAU up to 12 months. Clinical Trial Registration: US National Institutes of Health ClinicalTrials.gov, identifier #NCT03092713. [ABSTRACT FROM AUTHOR]

Evaluation of treatment and survival of pT1 stage (T1) bladder cancer (BC) patients diagnosed with transitional cell carcinoma of the urinary bladder in Norway. According to the Cancer Registry of Norway, 1,108 patients were diagnosed with T1 BC between 2008-2012. Information on surgical and medical procedures was provided by the Norwegian Patients Registry. Regression and survival models were applied to characterize patients receiving bacillus Calmette-Guerin (BCG) and radical cystectomy (RC) as early and delayed treatment and to estimate overall and cause specific survival rates (OS; CSS). Adjustments for sex, age, WHO grade and concomitant cis were made. In total, 449 (41%) patients received BCG treatment, 162 (15%) as early treatment. RC represented the early treatment in 96 (9%) patients and the delayed treatment in 84 (8%). Overall, 850 (77%) patients received neither BCG nor RC as early treatment, of whom 287 (26%) were treated with BCG and 66 (6%) with RC during follow-up. Patients <75 years and patients with high grade tumors or concomitant cis were more likely to receive BCG and RC as early treatment. 5-year survival rates for all T1 BC patients were 84% (CSS) and 65% (OS). Delayed RC was associated with the lowest 5-year CSS (70%). After adjustment, gender did not impact treatment choice and CSS. The use of BCG as early treatment indicates low adherence to existing guidelines. Delayed RC was associated with low survival rates. An increased focus on the management of T1 patients is needed in Norway. [ABSTRACT FROM AUTHOR]