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Cancer survivorship was recently identified as a prostate cancer (PCa) research priority by PIONEER, a European network of excellence for big data in PCa. Despite being a research priority, cancer survivorship lacks a clear and agreed definition, and there is a distinct paucity of patient-reported outcome (PRO) data available on the subject. Data collection on cancer survivorship depends on the availability and implementation of (validated) routinely collected patient-reported outcome measures (PROMs). There have been recent advances in the availability of such PROMs. For instance, the European Organisation for Research and Treatment of Cancer Quality of Life Group (EORTC QLG) is developing survivorship questionnaires. This provides an excellent first step in improving the data available on cancer survivorship. However, we propose that an agreed, standardised definition of (prostate) cancer survivorship must first be established. Only then can real-world data on survivorship be collected to strengthen our knowledge base. With more men than ever surviving PCa, this type of research is imperative to ensure that the quality of life of these men is considered as much as their quantity of life. Patient summary: As there are more prostate cancer survivors than ever before, research into cancer survivorship is crucial. We highlight the importance of such research and provide recommendations on how to carry it out. The first step should be establishing agreement on a standardised definition of survivorship. From this, patient-reported outcome measures can then be used to collect important survivorship data.

Sleeping difficulties are increasingly prevalent among adolescents and have negative consequences for their health, well-being, and education. The aim of this study was to illuminate the meanings of adolescents' lived experiences of sleeping difficulties. The data were obtained from narrative interviews with 16 adolescents aged 14-15 in a Swedish city and were analyzed using the phenomenological hermeneutic method. The findings revealed four themes: feeling dejected when not falling asleep, experiencing the night as a struggle, searching for better sleep, and being affected the next day. The comprehensive understanding illuminates that being an adolescent with sleeping difficulties means it is challenging to go through the night and to cope the next day. It also means a feeling of being trapped by circumstances. As the adolescents' lived experiences become apparent, the possibility for parents, school nurses, and other professional caregivers to support adolescents' sleep increases.

Abstract Background Poor muscle function is associated with a negative prognosis in advanced liver disease but the impact in compensated chronic liver disease is unknown. Similar prognostic uncertainty applies to fatigue. We aimed to assess the prognostic value of muscle performance and fatigue in a cohort of patients with compensated chronic liver disease. Methods We followed 241 patients with compensated chronic liver disease included in a study between 2010 and 2014. Subjects were 52 ± 15 years (mean ± SD; 134 females). All subjects performed four muscle function tests: “Timed Up and Go” test, walking speed, handgrip strength, and standing heel-rises. Fatigue was evaluated by fatigue impact scale. Follow up data was acquired through hospital records and registries. Results During follow up of 6.75 ± 1.4 years, 13 patients died (5.5%) and 11 (4.5%) patients underwent liver transplantation. A timed up and go over 10 s was not significantly associated with a lower survival (Kaplan-Meier, log rank test p = 0.132), or with transplant free survival (p = 0.543), Fig. 3. It was also not specifically associated with liver related causes of death (p = 0.597). The other physical functioning tests and fatigue were not significantly associated with mortality or transplant-free survival (p > 0.05 for all) except for maximal walking speed (2.2 vs. 1.9 m/s, p = 0.007). Conclusions Our study suggests that muscle function and fatigue are not key prognostic factors in compensated chronic liver disease. However, further confirmation in future studies is needed.

Background: Norwegian social educator students' attitudes towards addressing sexual health are unknown, even if their future clients often have needs related to sexual issues. Purpose: To investigate social educator students' readiness to address sexual health in their future profession. Methods: In 2019, 213 social educator students (response rate 34%) responded to the "Students' Attitudes towards addressing Sexual Health Extended" online questionnaire. Results: Most of the social educator students felt comfortable and ready to address sexual health in their future profession, but thought they had insufficient competence and education concerning sexual health. There were gender and age differences when discussing sexual health among persons with intellectual disabilities. Conclusion: Despite most Norwegian social educator students feeling ready to address sexual health, they needed additional competences and education. Further research is needed concerning the effectiveness of educational interventions targeting competence in sexual health, to ensure sufficient support for clients in this field.

Abstract Background The liver is a common site for metastatic disease for a variety of cancers, including colorectal cancer. Both primary and secondary liver tumors are supplied through the hepatic artery while the healthy liver is supplied by the portal vein. Transarterial radioembolization (TARE) using yttrium-90 glass or resin microspheres have shown promising results with reduced side-effects but have similar survival benefits as chemoembolization in patients with hepatocellular carcinoma (HCC). This highlights the need for new novel agents against HCC. Targeted alpha therapy (TAT) is highly potent treatment due to the short range (sparing adjacent normal tissue), and densely ionizing track (high linear energy transfer) of the emitted α-particles. The incorporation of α-particle-emitting radioisotopes into treatment of HCC has been extremely limited, with our recent publication pioneering the field of α-particle-emitting TARE (αTARE). This study focuses on an in-depth evaluation of the αTARE-agent [225Ac]Ac-DOTA-TDA-Lipiodol® as an effective therapeutic agent against HCC regarding pharmacokinetics, dosimetry, stability, and therapeutic efficacy. Results [225Ac]Ac-DOTA-TDA was shown to be a highly stable with bench-top stability at ≥ 95% radiochemical purity (RCP) over a 3-day period and serum stability was ≥ 90% RCP over 5-days. The pharmacokinetic data showed retention in the tumor of [225Ac]Ac-DOTA-TDA-Lipiodol® and clearance through the normal organs. In addition, the tumor and liver acted as suppliers of the free daughters, which accumulated in the kidneys supplied via the blood. The dose limiting organ was the liver, and the estimated maximum tolerable activity based on the rodents whole-body weight: 728–3641 Bq/g (male rat), 396–1982 Bq/g (male mouse), and 453–2263 Bq/g (female mouse), depending on an RBE-value (range 1–5). Furthermore, [225Ac]Ac-DOTA-TDA-Lipiodol® showed significant improvement in survival for both the male and female mice (median survival 47-days) compared with controls (26-days untreated, and 33–35-days Lipiodol® alone). Conclusions This study shows that [225Ac]Ac-DOTA-TDA-Lipiodol® is a stable compound allowing for centralized manufacturing and distribution world-wide. Furthermore, the result of this study support the continue development of evaluation of the αTARE-agent [225Ac]Ac-DOTA-TDA-Lipiodol® as a potential treatment option for treating hepatic tumors.

Studien utforsker uttrykt seksualitet hos personer med utviklingshemming slik ansatte erfarer det fra miljøterapeutisk arbeid. Totalt 20 miljøterapeuter i et kommunalt bofellesskap deltok i refleksjoner individuelt og senere i grupper. Refleksjonene gjennomgikk en totrinnsanalyse basert på kvalitativ innholdsanalyse og resulterte i tre definerte temaer: 1) Når seksuelle uttrykk oppleves krenkende. 2) Det å komme til kort profesjonelt. 3) Arbeid med seksuelle temaer. Studien viser at miljøterapeuter opplevde manglende handlingskompetanse i møte med uttrykt seksualitet. Dette ble ytterligere utfordret av et fraværende system for veiledning, drøfting og kompetanseheving omkring seksuelle temaer. Systematikken som forventes i øvrig miljøterapeutisk arbeid, fantes ikke i arbeidet med seksualitet. Nødvendig tilrettelegging for å hjelpe beboere med å forstå kropp, behov eller utforskning synes å være vanskelig å få på plass. Samarbeid med kollegaer, beboere og deres nettverk utfordres av usikkerhet og manglende tydelighet. Dette handler om fag og etikk, men også om å ivareta beboernes seksuelle rettigheter.

BackgroundA new app, Sukaribit, was designed to enable contact between the caregiver and the patient with the intent to improve self-care and glycemic control (hemoglobin A1c [HbA1c]). ObjectiveThis study investigated the feasibility of the study methodology and the intervention in preparation for a larger effectiveness study. MethodsAdults with type 2 diabetes were recruited in this randomized controlled feasibility study with a mixed methods design. The intervention group (n=28) tried Sukaribit for 2 months. They were encouraged to report blood glucose levels and medications, and they received feedback from a physician. The control group (n=31) received standard care. Both groups were evaluated with pre and postmeasurements of glycemic control (HbA1c), diabetes distress, physical activity, and self-care. Feasibility was evaluated against 5 progression criteria regarding recruitment, study methods, and active participation. ResultsOf the 5 progression criteria, only 2 were met or partially met. The recruitment process exceeded expectations, and data collection worked well for self-reported data but not for HbA1c measured with a home testing kit. The participants were less active than anticipated, and the effect sizes were small. Only the number of blood glucose tests per day was positively affected by the intervention, with 0.6 more tests per day in the intervention group. ConclusionsRecruitment of participants to a future fully powered study may work with minor adjustments. The collection of HbA1c using home testing constituted a major problem, and an alternative strategy is warranted. Finally, the app was not used as intended. In order to proceed with a larger study, the app and study procedures need improvement.

Abstract Background Heart failure is a chronic heart condition. Persons with heart failure often have limited physical capability, cognitive impairments, and low health literacy. These challenges can be barriers to healthcare service co-design with family members and professionals. Experience-Based Co-Design is a participatory healthcare quality improvement approach drawing on patients’, family members’ and professionals’ experiences to improve healthcare. The overall aim of this study was to use Experience-Based Co-Design to identify experiences of heart failure and its care in a Swedish cardiac care setting, and to understand how these experiences can translate into heart failure care improvements for persons with heart failure and their families. Methods A convenience sample of 17 persons with heart failure and four family members participated in this single case study as a part of an improvement initiative within cardiac care. In line with Experienced-Based Co-Design methodology, field notes from observations of healthcare consultations, individual interviews and meeting minutes from stakeholders’ feedback events, were used to gather participants’ experiences of heart failure and its care. Reflexive thematic analysis was used to develop themes from data. Results Twelve service touchpoints, organized within five overarching themes emerged. The themes told a story about persons with heart failure and family members struggling in everyday life due to a poor quality of life, lack of support networks, and difficulties understanding and applying information about heart failure and its care. To be recognized by professionals was reported to be a key to good quality care. Opportunities to be involved in healthcare varied, Further, participants’ experiences translated into proposed changes to heart failure care such as improved information about heart failure, continuity of care, improved relations, and communication, and being invited to be involved in healthcare. Conclusions Our study findings offer knowledge about experiences of life with heart failure and its care, translated into heart failure service touchpoints. Further research is warranted to explore how these touchpoints can be addressed to improve life and care for persons with heart failure and other chronic conditions.

Abstract Background Worldwide people are living longer. The need for healthcare for older adults is increasing. The trend is towards advanced home healthcare, where registered nurses are key figures. This implies challenges for municipal home healthcare, as well as for registered nurses’ leadership. The aim is to explore registered nurses’ perceptions of challenges and suggestions for improvements in their leadership close to older adults in municipal home healthcare. Methods The present study is part of a larger web-based questionnaire survey with a cross-sectional design. The design is inductive, analysing data using qualitative content analysis and descriptive statistics. A questionnaire with open-ended and closed-ended questions was used. A total of n = 70 registered nurses leading close to older adults participated in seven municipalities in two geographic areas in Sweden. Results The results show registered nurses’ perceptions of challenges as leaders close to older adults in terms of 11 categories. The categories are motivating for care, adjusting and coordinating nursing care to the older adult, relating to next of kin, managing communication difficulties, relating to social situations in the home, managing demands, working alone, having lack of time, collaborating with physicians, and care staff having low competence. The registered nurses suggested improvements for their leadership close to older adults in terms of nine categories. The categories are adjusting the work to the older adult, clarifying registered nurses’ responsibility, balancing demands and resources, setting time aside, improving staffs’ competence, ensuring staff’s competence development, improving the work environment, and cooperation between professions in the municipality, as well as between healthcare organizations. Conclusion The results show that registered nurses’ leadership in municipal home healthcare implies a wide range of challenges. There is a need for strategies to improve the organizational preconditions to reduce challenges in registered nurses’ leadership in order to promote positive patient outcomes for safe and quality care.

As concerns about sexual and reproductive health and rights become integrated into public health policies, the demand for higher education in sexology rises. There is a need therefore to evaluate established pedagogical methods to ensure that they are relevant, efficient and lead to valuable competencies. This study explored the current evidence and pedagogical relevance for Sexual Attitude Reassessment and restructuring (SAR) as part of professional higher education in sexology. A systematic review was conducted with eleven included publications. Data were synthesised across studies and presented narratively. The publications were generally old and derive from a small pool of researchers geographically centred to the USA. Several studies were based on small numbers of participants, display a great variety in types of participants, use different evaluation instruments (mostly unvalidated), and a variety of methods to measure the results of SAR. Furthermore, long-term follow-up has been rare. Extensive, high-quality, and up-to-date research for SAR as an effective pedagogical method for use in sexology higher education for professionals today is lacking. Digital solutions focusing on broadening students sexological self-awareness appear more feasible than SAR, and suitable pedagogical and digital solutions need to be developed and evaluated to ensure high-quality teaching of sexology in higher education.

Med bakgrunn i politiske og faglige føringer for styrket tverrfaglig samarbeid i skolen, var studiens hensikt å utforske læreres erfaringer forankret i et konkret endringsprosjekt hvor alle barne- og ungdomsskoler i en mellomstor norsk kommune utforsket samskapende prosesser for tverrfaglig samarbeid. Studiens mixed-methods-design omfattet nettskjema med kvantitative og kvalitative spørsmål knyttet til samarbeid om elevers faglige og sosiale mestring. Studiens resultat gir implikasjoner for videreutvikling av det nasjonale prosjektet Et lag rundt læreren. Resultatene synliggjør bredde i læreres samarbeidsrelasjoner, samt variasjon knyttet til fag- og kontaktlærers rolle og skolers varighet i prosjektet. Studiens resultat viser at økt tilstedeværelse og støtte fra pedagogisk-psykologisk tjeneste (PPT) og helsesykepleier i lærers skolehverdag og etablering av skolevise, tverrfaglige lag bidrar til praksisfellesskap med mer relevant støtte til elevers faglige og sosiale mestring. Studiens resultat drøftes i lys av systemteoretiske perspektiv. Tverrfaglig samarbeid utforskes som sosial støtte i læreres praksisfellesskap og som samskaping på systemnivå. Konklusjonen peker på utfordringer ved ulik tverrfaglig samarbeidspraksis mellom skoler og læreres meningsforhandlinger av prosjektets kunnskapsgrunnlag, noe som utfordrer ledelse av utviklingsarbeidet i prosjektet. English abstract Expanding teachers’ community of practice? Exploring teachers’ experiences of interdisciplinary collaboration in Norway Based on political and professional guidelines to strengthened interdisciplinary collaboration in schools, the purpose of the study was to explore teachers’ experiences with practices of interdisciplinarity in an ongoing project including all primary and secondary schools in a medium-sized Norwegian municipality. Research methods included online forms with quantitative and qualitative questions related to exploring teachers’ experiences. The results of the study give implications to development in the national project A team around the teacher. The results highlight the multitude of teachers’ collaborative relationships, as well as the variation related to teachers’ role and duration in the project. The results of the study show that increased presence and support from the educational psychological service (PPT) and public health nurses in teachers’ everyday work, as well as the establishment of school-wise, interdisciplinary teams (lag), contribute developing communities of practice with more relevant support for academic and social coping for individual pupils. The results of the study are discussed using systems theories. Interdisciplinary collaboration is explored as social support in the teachers’ community of practice and as co-creation at system level. The conclusion points to challenges linked to different interdisciplinary collaborative practices between schools and teachers’ negotiation of the project’s knowledge base, which challenges the management of the development work in the project.

Background Co-production is promoted as an effective way of improving the quality of health and social care but the diversity of measures used in individual studies makes their outcomes difficult to interpret.Objective The objective is to explore how empirical studies in health and social care have described the outcomes of co-production projects and how those outcomes were measured.Design and methods A scoping review forms the basis for this systematic review. Search terms for the concepts (co-produc* OR coproduc* OR co-design* OR codesign*) and contexts (health OR ‘public service* OR “public sector”) were used in: CINAHL with Full Text (EBSCOHost), Cochrane Central Register of Controlled trials (Wiley), MEDLINE (EBSCOHost), PsycINFO (ProQuest), PubMed (legacy) and Scopus (Elsevier). There was no date limit. Papers describing the process, original data and outcomes of co-production were included. Protocols, reviews and theoretical, conceptual and psychometric papers were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. The Mixed Methods Appraisal Tool underpinned the quality of included papers.Results 43 empirical studies were included. They were conducted in 12 countries, with the UK representing >50% of all papers. No paper was excluded due to the Mixed Methods Quality Appraisal screening and 60% of included papers were mixed methods studies. The extensive use of self-developed study-specific measures hampered comparisons and cumulative knowledge-building. Overall, the studies reported positive outcomes. Co-production was reported to be positively experienced and provided important learning.Conclusions The lack of common approaches to measuring co-production is more problematic than the plurality of measurements itself. Co-production should be measured from three perspectives: outputs of co-production processes, the experiences of participating in co-production processes and outcomes of co-production. Both self-developed study-specific measures and established measures should be used. The maturity of this research field would benefit from the development and use of reporting guidelines.

Abstract Background A high intake of phytoestrogens, found in soy, rye, and seeds, is associated with a reduced risk of a prostate cancer diagnosis. Previously, we found that the overall decreased risk of prostate cancer diagnosis in males with a high intake of phytoestrogens was strongly modified by a nucleotide sequence variant in the estrogen receptor-beta (ERβ) gene. However, we do not know if phytoestrogens can inhibit the growth of prostate cancer in males with established diseases. If there is an inhibition or a delay, there is reason to believe that different variants of the ERβ gene will modify the effect. Therefore, we designed an intervention study to investigate the effect of the addition of foods high in phytoestrogens and their interaction with the ERβ genotype on prostate tumor proliferation in patients with prostate cancer. Method The PRODICA trial is a randomized ongoing intervention study in patients with low- and intermediate-risk prostate cancer with a Gleason score