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Aims: To provide an overview of published research on migration and health conducted in Norway and identify gaps in the research field. Methods: Applying a scoping review methodology, we searched Medline for articles on migration health in Norway published between 2008 and 2020, and assessed them according to research topic, methodology, user-involvement and characteristics of the populations studied (country or area of origin, type of migrant/immigrant status). Results: Of the 707 articles retrieved, 303 met the inclusion criteria. Most studies (77%) were within the clinical disciplines reproductive health, mental health, infectious diseases and cardiovascular diseases, or on socio-cultural aspects and the use of healthcare services. One third of the papers (36%) pulled participants from various geographic backgrounds together or did not specify the geographic background. Among those who did so, participants were mostly from The Middle East, South and Southeast Asia and sub-Saharan Africa. Only 14% of the articles specified the type of migrant/immigrant status and those included refugees, asylum seekers and undocumented migrants. A total of 80% of the papers used quantitative methods, of which 15 described an intervention; 15 papers (5%) described different types of user-involvement. Conclusions: Our findings suggest gaps in research related to migrant subgroups, such as those from Eastern-Europe and labour and family reunification migrants. Future studies should further investigate the self-identified health needs of different migrant groups, and might also benefit from a methodological shift towards more intervention studies and participatory approaches.

Dedicated conservation efforts spanning the past two decades have saved the Fennoscandian Arctic fox ( Vulpes lagopus ) population from local extinction, and extensive resources continue to be invested in the species' conservation and management. Although increasing, populations remain isolated, small and are not yet viable in the longer term. An understanding of causes of mortality are consequently important to optimize ongoing conservation actions. Golden eagles ( Aquila chrysaetos ) are a predator of Arctic foxes, yet little information on this interaction is available in the literature. We document and detail six confirmed cases of Golden eagle depredation of Arctic foxes at the Norwegian captive breeding facility (2019-2022), where foxes are housed in large open-air enclosures in the species' natural habitat. Here, timely detection of missing/dead foxes was challenging, and new insights have been gained following recently improved enclosure monitoring. Golden eagle predation peaked during the winter months, with no cases reported from June to November. This finding contrasts with that which is reported from the field, both for Arctic and other fox species, where eagle depredation peaked at dens with young (summer). While the seasonality of depredation may be ecosystem specific, documented cases from the field may be biased by higher survey efforts associated with the monitoring of reproductive success during the summer. Both white and blue color morphs were housed at the breeding station, yet only white foxes were preyed upon, and mortality was male biased. Mitigation measures and their effectiveness implemented at the facility are presented. Findings are discussed in the broader Arctic fox population ecology and conservation context., (© 2023 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Large carnivores influence ecosystem dynamics in multiple ways, for example, by suppressing meso-carnivores and providing carrions for smaller scavengers. Loss of large carnivores is suggested to cause meso-carnivore increase and expansion. Moreover, competition between meso-carnivores may be modified by the presence of larger carnivores. In tundra ecosystems, the smallest meso-carnivore, the Arctic fox, has experienced regional declines, whereas its larger and competitively superior congener, the red fox, has increased, potentially due to changes in the abundance of apex predators. We explored if variation in the occurrence of wolverine and golden eagle impacted the occurrence and co-occurrence of the Arctic fox and red fox in relation to varying abundances of small rodents within the Scandinavian tundra. We applied multi-species occupancy models to an extensive wildlife camera dataset from 2011-2020 covering 98 sites. Daily detection/non-detection of each species per camera trap site and study period (late winter; March-May) was stacked across years, and species occupancy was related to small rodent abundance while accounting for time of the year and status of simulated carcass. The Arctic fox was more likely to co-occur with the red fox when the wolverine was present and less likely to co-occur with the red fox when golden eagles were present and the wolverine was absent. Red foxes increased in occupancy when co-occurring with the larger predators. The Arctic fox responded more strongly to small rodent abundance than the red fox and co-occurred more often with the other species at carcasses when rodent abundance was low. Our findings suggest that the interspecific interactions within this tundra predator guild appear to be surprisingly intricate, driven by facets of fear of predation, interspecific mediation and facilitation, and food resource dynamics. These dynamics of intraguild interactions may dictate where and when conservation actions targeted towards the Arctic fox should be implemented., (© 2022 The Authors. Journal of Animal Ecology published by John Wiley & Sons Ltd on behalf of British Ecological Society.)

Introduction: Recurrent pregnancy loss (RPL), defined as two or more consecutive pregnancy losses in the first trimester, affects around 5% of fertile women. The underlying causes remain unknown in up to 60% of patients; however, most studies point at an immunological pathology in unexplained RPL, and therefore, an effective treatment may be immunomodulatory. This study aims to evaluate the effect of intravenous immunoglobulin (IVIg) and prednisolone on reproductive outcome and the immune system in women with unexplained RPL undergoing assisted reproductive technology treatment., Methods and Analysis: This randomised, placebo-controlled trial with double-blinded randomisation to two parallel arms evaluate if immunomodulatory (active) treatment is superior to placebo in increasing the chance of ongoing pregnancy assessed at nuchal translucency scan in gestational weeks (GW) 11-13 after embryo transfer (ET) in 74 RPL patients with ≥2 pregnancy losses as its primary objective. The active treatment consists of IVIg (one infusion preferably 1-5 days before ET and in GW 5, 6 and 7) and prednisolone (5 mg/day from first day of menstrual bleeding until ET and 10 mg/day from ET to GW 8+0) while the comparator consists of intravenous human albumin (5%) and placebo tablets. Allocation is concealed for participants, caregivers, and investigators until trial termination and is performed in a 1:1 ratio. The secondary objective is to evaluate treatment safety, and the tertiary objective is exploration of the association between treatment, reproductive outcome after ET, and the lymphocyte subset distribution in peripheral blood collected before and after intravenous infusion(s). Excess biological material is stored in a biobank for future research., Ethics and Dissemination: The North Denmark Region Committee on Health Research Ethics (N-20200066) approved this trial. The results will be published in peer-reviewed scientific journals and presented to relevant patient associations, at relevant academic conferences and to key stakeholders., Trial Registration Number: NCT04701034., Competing Interests: Competing interests: USK received consulting fees from Merck for Update of patient information leaflet and from IBSA Nordic for Clinical instruction and support for attending meeting/congress from Merck., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Spatial capture-recapture modelling (SCR) is a powerful tool for estimating density, population size, and space use of elusive animals. Here, we applied SCR modelling to non-invasive genetic sampling (NGS) data to estimate red fox (Vulpes vulpes) densities in two areas of boreal forest in central (2016-2018) and southern Norway (2017-2018). Estimated densities were overall lower in the central study area (mean = 0.04 foxes per km 2 in 2016, 0.10 in 2017, and 0.06 in 2018) compared to the southern study area (0.16 in 2017 and 0.09 in 2018). We found a positive effect of forest cover on density in the central, but not the southern study area. The absence of an effect in the southern area may reflect a paucity of evidence caused by low variation in forest cover. Estimated mean home-range size in the central study area was 45 km 2 [95%CI 34-60] for females and 88 km 2 [69-113] for males. Mean home-range sizes were smaller in the southern study area (26 km 2 [16-42] for females and 56 km 2 [35-91] for males). In both study areas, detection probability was session-dependent and affected by sampling effort. This study highlights how SCR modelling in combination with NGS can be used to efficiently monitor red fox populations, and simultaneously incorporate ecological factors and estimate their effects on population density and space use., (© 2021. The Author(s).)

Background: The purpose of the present multicenter cohort study was to compare the rates of reoperation in elderly patients with pertrochanteric and subtrochanteric fractures that had been treated with a short or long intramedullary nail., Methods: Eleven orthopaedic departments across Denmark delivered data that had been obtained from the Danish Multidisciplinary Hip Fracture Registry (DMHFR) and a review of health-care records. With use of surgical procedure codes for pertrochanteric and subtrochanteric fractures that had been treated with an intramedullary nail, the DMRHF was searched to identify patients who had been ≥65 years of age between 2008 and 2013. The health-care records for patients who had had major reoperations, defined as any reoperation with the exclusion of simple hardware removal, were retrieved from the DMHFR, were reviewed for the type of intramedullary nail and missed reoperations, including peri-implant fractures, within 2 years of follow-up. Crude logistic regression analysis with adjustment for age, sex, and comorbidity was performed, yielding odds ratios (ORs) with 95% confidence intervals (CIs)., Results: Of 2,245 pertrochanteric fractures, 1,867 were treated with a short intramedullary nail and 378 were treated with a long intramedullary nail. The rate of major reoperations was 4.0% in the short intramedullary nail group and 6.3% in the long intramedullary nail group. This yielded a crude OR of 1.61 (1.01 to 2.60) and an adjusted OR of 1.67 (1.04 to 2.70). Of 909 subtrochanteric fractures, 308 were treated with a short intramedullary nail and 601 were treated with a long intramedullary nail. The rate of major reoperations was 8.4% in the short intramedullary nail group and 4.0% in the long intramedullary nail group, yielding a crude OR of 0.45 (0.25 to 0.80) and an adjusted OR of 0.45 (0.25 to 0.81)., Conclusions: This is the first study confirming the theory that, for subtrochanteric fractures, a long intramedullary nail has a lower rate of major reoperations compared with a short intramedullary nail. In contrast, a short intramedullary nail has a lower rate of major reoperations compared with a long intramedullary nail for pertrochanteric fractures but with a lower absolute risk reduction compared with the results for subtrochanteric intramedullary nailing. There is a need for validation of these results in other large studies, especially for pertrochanteric fractures., Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G703)., (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.)

The purpose was to examine the correlation and association between a single-item question of self-rated physical fitness and objective measures of fitness and cardiometabolic risk factors in a large population-based study. Participants were 3441 men and women aged 18-85 years who filled in a questionnaire and participated in a clinical health examination in the Danish Health Examination Survey 2007-2008. Cardiorespiratory fitness was estimated by an indirect maximal exercise test. Muscle strength was measured by (a) sit-to-stand test, (b) handgrip strength, and (c) bent arm strength. Body mass index and fat percentage were used as measures for body composition. Associations were derived from regression analyses, correlations were calculated using Spearman's correlation test, and agreement was tested by kappa statistics. Within categories of self-rated physical fitness moving from lowest to highest, objectively measured cardiorespiratory fitness increased. Self-rated physical fitness was strongly correlated to cardiorespiratory fitness (r men  = 0.69 and r women  = 0.65) and moderately correlated to the sit-to-stand test (r men  = 0.49 and r women  = 0.48), bent arm strength (r = 0.45) and fat percentage (r = 0.46) among men, and handgrip strength among women (r =0.41). Mutually adjusted analysis showed a significant association between self-reported physical fitness and cardiorespiratory fitness for men and women and bent arm strength for women. The single-item question of physical fitness was correlated to cardiorespiratory fitness, muscle strength, and body composition. However, this study suggests that it mainly captures cardiorespiratory fitness. At the population level, the single-item question could be a useful tool to identify and monitor variation in fitness levels., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Selection for crypsis has been recognized as an important ecological driver of animal colouration, whereas the relative importance of thermoregulation is more contentious with mixed empirical support. A potential thermal advantage of darker individuals has been observed in a wide range of animal species. Arctic animals that exhibit colour polymorphisms and undergo seasonal colour moults are interesting study subjects for testing the two alternative hypotheses: demographic performance of different colour morphs might be differentially affected by snow cover with a cryptic advantage for lighter morphs, or conversely by winter temperature with a thermal advantage for darker morphs. In this study, we explored whether camouflage and thermoregulation might explain differences in reproduction and survival between the white and blue colour morphs of the Arctic fox Vulpes lagopus under natural conditions. Juvenile and adult survival, breeding propensity and litter size were measured for 798 captive-bred and released or wild-born Arctic foxes monitored during an 11-year period (2007-2017) in two subpopulations in south-central Norway. We investigated the proportion of the two colour morphs and compared their demographic performance in relation to spatial variation in duration of snow cover, onset of snow season and winter temperatures. After population re-establishment, a higher proportion of blue individuals was observed among wild-born Arctic foxes compared to the proportion of blue foxes released from the captive population. Our field study provides the first evidence for an effect of colour morph on the reproductive performance of Arctic foxes under natural conditions, with a higher breeding propensity of the blue morph compared to the white one. Performance of the two colour morphs was not differentially affected by the climatic variables, except for juvenile survival. Blue morph juveniles showed a tendency for higher survival under colder winter temperatures but lower survival under warmer temperatures compared to white morph juveniles. Overall, our findings do not consistently support predictions of the camouflage or the thermoregulation hypotheses. The higher success of blue foxes suggests an advantage of the dark morph not directly related to disruptive selection by crypsis or thermoregulation. Our results rather point to physiological adaptations and behavioural traits not necessarily connected to thermoregulation, such as stress response, immune function, sexual behaviour and aggressiveness. Our findings highlight the need to explore the potential role of genetic linkage or pleiotropy in influencing the fitness of white and blue Arctic foxes as well as other species with colour polymorphisms., (© 2021 The Authors. Journal of Animal Ecology published by John Wiley & Sons Ltd on behalf of British Ecological Society.)

Scavengers can have strong impacts on food webs, and awareness of their role in ecosystems has increased during the last decades. In our study, we used baited camera traps to quantify the structure of the winter scavenger community in central Scandinavia across a forest-alpine continuum and assess how climatic conditions affected spatial patterns of species occurrences at baits. Canonical correspondence analysis revealed that the main habitat type (forest or alpine tundra) and snow depth was main determinants of the community structure. According to a joint species distribution model within the HMSC framework, species richness tended to be higher in forest than in alpine tundra habitat, but was only weakly associated with temperature and snow depth. However, we observed stronger and more diverse impacts of these covariates on individual species. Occurrence at baits by habitat generalists (red fox, golden eagle, and common raven) typically increased at low temperatures and high snow depth, probably due to increased energetic demands and lower abundance of natural prey in harsh winter conditions. On the contrary, occurrence at baits by forest specialists (e.g., Eurasian jay) tended to decrease in deep snow, which is possibly a consequence of reduced bait detectability and accessibility. In general, the influence of environmental covariates on species richness and occurrence at baits was lower in alpine tundra than in forests, and habitat generalists dominated the scavenger communities in both forest and alpine tundra. Following forecasted climate change, altered environmental conditions are likely to cause range expansion of boreal species and range contraction of typical alpine species such as the arctic fox. Our results suggest that altered snow conditions will possibly be a main driver of changes in species community structure., Competing Interests: The authors declare no conflicts of interest., (© 2020 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Background: Asthma is a common chronic disease worldwide without any known cure. Despite remarkable improvement in asthma treatment, better education and guideline implementation strategies, there is growing interest in using complementary and alternative medicine, like reflexology and homeopathy. However, evidence supporting the effectiveness of homeopathy and reflexology in asthma treatment is not available., Objective: The aim of this study was to evaluate the effect of reflexology and homeopathy as adjunctive therapies in asthma., Methods: In a single centre, randomised, investigator blinded, controlled study 86 asthma patients were enrolled. They were assigned to one of three study groups (conventional treatment alone or conventional treatment with addition of either homeopathy or reflexology). All patients received their asthma treatment during the study and were followed as usual by their general practitioner. The study assignment group of individual patients were blinded to the investigators, who made the clinical evaluation of asthma control. The primary outcome was the change in the asthma quality of life questionnaire (AQLQ) scores after 26 weeks. Secondary outcomes included asthma control questionnaire, EuroQol, forced expiratory volume in 1 sec, morning and evening peak expiratory flow, asthma symptoms, rescue medication use, and total medication score., Results: Minor improvements in the AQLQ score were observed in all three groups. However, no statistically significant changes in AQLQ scores were seen within or between groups. Likewise, secondary outcomes did not differ between groups., Conclusions: In this study, the addition of homeopathy or reflexology to conventional treatment did not result in improved quality of life in asthma., Competing Interests: No potential conflict of interest was reported by the authors., (© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background : Asthma is a common chronic airway disease associated with hyperresponsiveness and airway inflammation. Anti-inflammatory medication especially inhaled corticosteroids are important for control of airway inflammation, decrease of airway hyperresponsiveness and lung function variability, reduce asthma symptoms, and improve lung function as well as quality of life. Most studies investigating the influence of complementary and alternative medicine (CAM) in asthma measure clinical effectiveness, but only few evaluate the impact on markers of airway inflammation. Objective : The aim of this study was to investigate the effect of reflexology and homeopathy added to conventional treatment on different markers of airway inflammation in asthma. Methods : Eighty-four patients with asthma were randomized to receive conventional treatment alone or conventional treatment with addition of homeopathy or reflexology in a single center, investigator blinded, controlled, one-year trial. During the study period, patients regularly consulted their general practitioner for evaluation and asthma treatment. At randomization, and after 6 and 12 months, methacholine challenge test and measurement of exhaled nitric oxide were performed. Blood samples were collected for eosinophil count and measurement of serum eosinophil cationic protein. Results : No significant differences between groups for any of the inflammatory markers were demonstrated. Methacholine responsiveness improved in all three groups but improvements were not statistically significant within and between groups. Conclusions : This randomized controlled study of reflexology and homeopathy failed to show significant improvement on selected markers of inflammation and airway hyperresponsiveness in asthma., (© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

This study investigated associations between levels of oxidatively damaged DNA, measured by the formamidopyrimidine DNA glycosylase (Fpg)-modified comet assay and intake of fish, salad, fruits, vegetables, wholegrain items, and potatoes in a cross-sectional study of 382 men and 591 women between 18 and 93 years. Intake of dietary items was obtained from questionnaires, and stratified into less than once per week, weekly or daily consumption. Intake of fish as main course was inversely associated with levels of Fpg-sensitive sites in peripheral blood mononuclear cells (PBMCs) in especially women (P < 0.001 multivariate linear regression). Intake of fish was also inversely associated with lower levels of Fpg-sensitive sites in men (P < 0.05, univariate analysis), although it was not statistically significant in analysis adjusted for lifestyle and other dietary factors. Intake of salad was inversely associated with levels of Fpg-sensitive sites in men (P < 0.001, multivariate linear regression). Statistically significant associations were also observed for intake of vegetables and potatoes in men, although these were weak and not robust in all statistical models. The sum the six individual dietary items was inversely associated with levels of Fpg-sensitive sites in the strata of men (P < 0.001, multivariate linear regression). Finally, levels of DNA repair incision activity were not associated with individual food categories or the total dietary food score. In summary, consumption of health-promoting foods is associated with lower levels of Fpg-sensitive sites in human PBMCs and strongest effects in the present population were ingestions of fish and salad., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: The objective of this review was to identify, assess and synthesize the best available evidence on the effects of induction prior to post-term on the mother and fetus. Maternal and fetal outcomes after routine labor induction in low-risk pregnancies at 41+0 to 41+6 gestational weeks (prior to post-term) were compared to routine labor induction at 42+0 to 42+6 gestational weeks (post-term)., Introduction: Induction of labor when a pregnancy exceeds 14 days past the estimated due date has long been used as an intervention to prevent adverse fetal and maternal outcomes. Over the last decade, clinical procedures have changed in many countries towards earlier induction. A shift towards earlier inductions may lead to 15-20% more inductions. Given the fact that induction as an intervention can cause harm to both mother and child, it is essential to ensure that the benefits of the change in clinical practice outweigh the harms., Inclusion Criteria: This review included studies with participants with expected low-risk deliveries, where both fetus and mother were considered healthy at inclusion and with no known risks besides the potential risk of the ongoing pregnancy. Included studies evaluated induction at 41+1-6 gestational weeks compared to 42+1-6 gestational weeks. Randomized control trials (n = 2), quasi-experimental trials (n = 2), and cohort studies (n = 3) were included. The primary outcomes of interest were cesarean section, instrumental vaginal delivery, low Apgar score (≤ 7/5 min.), and low pH (< 7.10). Secondary outcomes included additional indicators of fetal or maternal wellbeing related to prolonged pregnancy or induction., Methods: The following information sources were searched for published and unpublished studies: PubMed, CINAHL, Embase, Scopus, Swemed+, POPLINE; Cochrane, TRIP; Current Controlled Trials; Web of Science, and, for gray literature: MedNar; Google Scholar, ProQuest Nursing & Allied Health Source, and guidelines from the Royal College of Obstetricians and Gynaecologists, and American College of Obstetricians and Gynecologists, according to the published protocol. In addition, OpenGrey and guidelines from the National Institute for Health and Care Excellence, World Health Organization, and Society of Obstetricians and Gynaecologists of Canada were sought. Included papers were assessed by all three reviewers independently using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). The standardized data extraction tool from JBI SUMARI was used. Data were pooled in a statistical meta-analysis model using RevMan 5, when the criteria for meta-analysis were met. Non-pooled results were presented separately., Results: Induction at 41+0-6 gestational weeks compared to 42+0-6 gestational weeks was found to be associated with an increased risk of overall cesarean section (relative risk [RR] = 1.11, 95% confidence interval [CI] 1.09-1.14), cesarean section due to failure to progress (RR = 1.43, 95% CI 1.01-2.01), chorioamnionitis (RR = 1.13, 95% CI 1.05-1.21), labor dystocia (RR = 1.29, 95% CI 1.22-1.37), precipitate labor (RR = 2.75, 95% CI 1.45-5.2), uterine rupture (RR = 1.97, 95% CI 1.54-2.52), pH < 7.10 (RR = 1.9, 95% CI 1.48-2.43), and a decreased risk of oligohydramnios (RR = 0.4, 95% CI 0.24-0.67) and meconium stained amniotic fluid (RR = 0.82, 95% CI 0.75-0.91). Data lacked statistical power to draw conclusions on perinatal death. No differences were seen for postpartum hemorrhage, shoulder dystocia, meconium aspiration, 5-minute Apgar score < 7, or admission to neonatal intensive care unit. A policy of awaiting spontaneous onset of labor until 42+0-6 gestational weeks showed, that approximately 70% went into spontaneous labor., Conclusions: Induction prior to post-term was associated with few beneficial outcomes and several adverse outcomes. This draws attention to possible iatrogenic effects affecting large numbers of low-risk women in contemporary maternity care. According to the World Health Organization, expected benefits from a medical intervention must outweigh potential harms. Hence, our results do not support the widespread use of routine induction prior to post-term (41+0-6 gestational weeks).

Objective: Up to 30% of obese individuals are metabolically healthy. Metabolically healthy obese (MHO) individuals are characterized by having low abdominal adiposity, low inflammation level and low risk of developing metabolic comorbidity. In this study, we hypothesize that cardiorespiratory fitness (fitness) is a determinant factor for the MHO individuals and aim to investigate the associations between fitness, abdominal adiposity and low-grade inflammation within different BMI categories., Method: Data from 10,976 individuals from the general population, DANHES 2007-2008, on waist circumference, fitness and C-reactive protein (hsCRP) were analysed using multiple linear and median quantile regressions., Results: In men, an inverse association between fitness (+5 mL min-1 kg-1) and waist circumference (-1.45 cm; 95% CI: -1.55 to -1.35 cm; p<0.001), and an inverse association between fitness (+5 mL min-1 kg-1) and hsCRP (-0.22 mg/L; 95% CI: -0.255 to -0.185 mg/L; p<0.001) was found, all independent of BMI. Similarly in women, an inverse association between fitness (+5 mL min-1 kg-1) and waist circumference (-1.15 cm; 95% CI: -1.25 to -1.0 cm; p<0.001), and an inverse association between fitness (+5 mL min-1 kg-1) and hsCRP (-0.26 mg/L; 95% CI: -0.3 to -0.22 mg/L; p<0.001) was found, all independent of BMI. Additionally, significant positive associations between waist circumference and hsCRP were found for both men and women, independently of BMI., Conclusion: Fitness was found to be inversely associated with both abdominal adiposity and low-grade inflammation independent of BMI. These data suggest that, in spite of BMI, high fitness levels lead to a reduction in abdominal fat mass and low-grade inflammation.

Background: Worldwide implementation of risk-based cardiovascular disease (CVD) prevention requires risk prediction tools that are contemporarily recalibrated for the target country and can be used where laboratory measurements are unavailable. We present two cardiovascular risk scores, with and without laboratory-based measurements, and the corresponding risk charts for 182 countries to predict 10-year risk of fatal and non-fatal CVD in adults aged 40-74 years., Methods: Based on our previous laboratory-based prediction model (Globorisk), we used data from eight prospective studies to estimate coefficients of the risk equations using proportional hazard regressions. The laboratory-based risk score included age, sex, smoking, blood pressure, diabetes, and total cholesterol; in the non-laboratory (office-based) risk score, we replaced diabetes and total cholesterol with BMI. We recalibrated risk scores for each sex and age group in each country using country-specific mean risk factor levels and CVD rates. We used recalibrated risk scores and data from national surveys (using data from adults aged 40-64 years) to estimate the proportion of the population at different levels of CVD risk for ten countries from different world regions as examples of the information the risk scores provide; we applied a risk threshold for high risk of at least 10% for high-income countries (HICs) and at least 20% for low-income and middle-income countries (LMICs) on the basis of national and international guidelines for CVD prevention. We estimated the proportion of men and women who were similarly categorised as high risk or low risk by the two risk scores., Findings: Predicted risks for the same risk factor profile were generally lower in HICs than in LMICs, with the highest risks in countries in central and southeast Asia and eastern Europe, including China and Russia. In HICs, the proportion of people aged 40-64 years at high risk of CVD ranged from 1% for South Korean women to 42% for Czech men (using a ≥10% risk threshold), and in low-income countries ranged from 2% in Uganda (men and women) to 13% in Iranian men (using a ≥20% risk threshold). More than 80% of adults were similarly classified as low or high risk by the laboratory-based and office-based risk scores. However, the office-based model substantially underestimated the risk among patients with diabetes., Interpretation: Our risk charts provide risk assessment tools that are recalibrated for each country and make the estimation of CVD risk possible without using laboratory-based measurements., Funding: National Institutes of Health., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: There has been a call for increased patient autonomy and participation in psychiatry. Some Community Mental Health Centres (CMHC) have implemented services called 'self-referral to inpatient treatment' (SRIT) for patients with severe mental disorders., Aims: To investigate whether SRIT could yield better outcomes after 12 months in use of mental health services for people with severe mental disorders than Treatment As Usual (TAU)., Methods: This was a randomized controlled trial at a CMHC in Norway comparing SRIT and TAU in 12 months. Fifty-four patients with severe mental disorders were included. The patients in the SRIT group could admit themselves as inpatients for up to 5 days for each admission with at least a 2 weeks pause between the admittances., Results: Twenty out of 26 participants (77%) in the SRIT group used the SRIT for a median of 1.5 admissions and 5 inpatient days. With the exception of a somewhat larger number of admissions at the CMHC in the SRIT group, no significant differences were found between the two groups in days as inpatients, admissions, outpatient contacts or coercion. Both groups reduced their inpatients days by 40%., Conclusions: Both the SRIT and the TAU groups reduced their use of services during the 12 months intervention period. Giving patients with severe mental disorders the possibility to self-refer did not change the use of services., Clinical Implications: Self-referral to inpatient treatment for patients with severe mental disorders might increase patient autonomy, but does not seem to save use of inpatient services.

Our aim was to provide up-to-date cardiorespiratory fitness reference data for adults of all ages and to investigate associations between cardiores-piratory fitness and leisure time physical activity as well as sitting time. In the Danish Health Examination Survey 2007-2008, cardiorespiratory fitness was estimated in 16 025 individuals aged 18-91 years from validated cycle ergometer exercise tests. Level of leisure time physical activity (sedentary, light, moderate, and vigorous) and daily sitting time in hours was obtained from a self-administered questionnaire. Men had 20-33% higher cardiorespiratory fitness than women, depending on age, and cardiorespiratory fitness decreased by 0.26 and 0.23 mL/min/kg per year in men and women, respectively. Cardiorespiratory fitness was higher among participants who reported a high level of physical activity in leisure time compared with participants who were sedentary. Among sedentary or lightly physically active participants, inverse associations between total daily sitting time and cardiorespiratory fitness were found, while there was no association between sitting time and cardiorespiratory fitness among moderately or vigorously physically active participants. These data on cardiorespiratory fitness can serve as useful reference material. Although reluctant to conclude on causality, sitting time might impact cardiorespiratory fitness among individuals with low levels of leisure time physical activity., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Service user participation is a central principle in mental healthcare, and the opportunity to self-refer to inpatient treatment is used to increase service user involvement and activation. The aim of this study was to investigate the short-term effect of a self-referral system in an inpatient rehabilitation unit at a community mental health center on patient activation and recovery in individuals with severe mental disorders., Methods: A randomized controlled study including 53 patients (41 % females, mean age 40 years). Twenty-six patients in the intervention group were given a contract for self-referral to inpatient treatment, limited to maximum 5 days and a quarantine time of 14 days between each stay. The control group (27 participants) received treatment as usual, and was offered the intervention after 1 year. The Patient Activation Measure was the primary outcome and secondary outcome was the Recovery Assessment Scale. Mixed models were used to assess group differences., Results: During the 4 months period, 15 (58 %) of 26 participants in the intervention group used the contract of self-referral to inpatient treatment. The intervention group had more admissions than the control group but both groups had a similar total use of inpatient days and out-patient consultations. The self-referral to inpatient treatment counted for 11 % of all inpatient days for the intervention group. There were no significant differences in the outcome between the groups on patient activation (estimated mean difference 2.7, 95 % confidence interval = -5.5 to 10.8, p = 0.52) or recovery (estimated mean difference 0.01, 95 % confidence interval = -0.3 to 0.3, p = 0.92)., Conclusions: Giving persons with severe mental disorders the possibility to self-refer to inpatient treatment did not change their level of patient activation and recovery after 4 months and did not lead to increased use of health services. The cost-effectiveness and long-term effect of self-referral to inpatient treatment should be investigated further., Trial Registration: NCT01133587 , clinicaltrials.gov.

Aims: The treatment of patients with a severe mental disorder is generally not good enough. The aim of this article was to illustrate some alternative approaches for better understanding and treatment for the individual, besides seeing and interpreting the symptoms., Methods: The context of understanding is regulation of emotions whit a person-based approach. The self-referral-to-inpatient-treatment project is presented and discussed as a possible method of intervention to improve patient involvement., Design: Theoretical approach., Results: Involvement in genuine decisions, where the individual is in control and feels emotionally robust, is important. The experience of regaining authority through being self-empowered with sufficient environmental support is essential for re-establishing and preserving hope of recovery.

Background: Several community mental health centres and mental hospitals in Norway now allow users with a diagnosis of severe mental illness to self-refer for admission. This give a group of service users who are well-known to service providers the opportunity to refer themselves for short inpatient stays without contacting their doctor, a duty doctor or emergency department. Evidence on self-referral admissions is lacking., Aim: To explore service users' experiences of having the opportunity to refer themselves for a short inpatient stay., Methods: Forty-two qualitative semi-structured interviews were undertaken between 2010 and 2014 in a group of 28 service users with serious mental illness and with or without substance abuse problems. All respondents had a contract which allowed them to self-refer for inpatient treatment. Systematic text condensation was applied in the analyses., Results: Self-referral inpatient admission is more than just a bed. It was perceived as a new, unconventional health service, which differed substantially from earlier experiences of inpatient care and was characterised by different values and treatment principles. The differences were related to the content, quality and organisation of treatment. Having the option to decide about admission for oneself and having access to services focusing on individual needs seem to enhance service users' confidence, both in the services they use and in their own ability to cope with everyday life., Conclusions: Self-referral inpatient admission is a concrete example of how a user involvement policy can be implemented in mental health services. It is important to emphasise that the self-referral admission process described here is an offer in development and that we are awaiting findings from a larger RCT study. More evidence is needed to determine what aspects of the service are helpful to service users, the long-term effects, appropriateness and cost-effectiveness, and how the service can be integrated into the mental health system.

Objective: To investigate the long-term effect on mental health symptoms and patient activation, from using the Partners for Change Outcome Management System (PCOMS) feedback scales in out-patient mental health consultations, compared to not using feedback scales., Methods: An open parallel-group randomised controlled trial was conducted in a mental health hospital in Norway. Eight therapists treated the intervention group, using two feedback scales, and seventeen therapists treated the treatment as usual group., Results: Seventy-five patients participated. Six and twelve months after starting treatment there were no significant effects on the primary outcomes mental health symptoms or patient activation. Compared to baseline assessment the PCOMS group had significantly improved their patient activation scores after twelve months., Conclusion: We found no long-term effects from using the PCOMS scales on mental health symptoms or patient activation., Practice Implications: This study shows that the use of a feedback system does not increase mental health outcomes or patient activation., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: The Patient Activation Measure-13 (PAM-13) has been found useful for assessing patient knowledge, skills and confidence in management of chronic conditions, but the empirical evidence from mental health is sparse. The psychometric properties of PAM in out-patients waiting for treatment in community mental health centers (CMHC) have therefore been examined., Methods: A total of 290 adults from two CMHC completed PAM. An exploratory factor analysis was conducted with 273 patients. Data at baseline and after 4 weeks were used to analyze test-retest reliability (n=60) and to analyze the sensitivity to change (n=51)., Results: The exploratory factor analysis revealed a fit for a two-factor model (Cronbach's α was 0.86 and 0.67), and was assessed for a one-factor model (α=0.87). The test-retest intraclass correlation coefficient was 0.76. Sensitivity to change was good with a statistically significant activation improvement (p<0.001) on patients receiving a peer co-led-educational intervention (Cohen's d was 0.85)., Conclusion: PAM has appropriate and acceptable psychometric properties in mental health settings., Practice Implications: Assessing activation before treatment might be useful for scheduling the delivery of mental health services as well as evaluating educational interventions aimed at improving patient engagement in mental health., (Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.)

It has been hypothesised that positive associations between age and levels of oxidative stress-generated damage to DNA may be related to an age-dependent decline in DNA repair activity. The objective of this study was to investigate the association between age and repair activity of oxidatively damaged DNA in peripheral blood mononuclear cells (PBMCs). We isolated PBMCs from subjects aged 18-83 years, as part of a health survey of the Danish population that focussed on lifestyle factors. The level of DNA repair activity was measured as incisions on potassium bromate-damaged DNA by the comet assay. There was an inverse association between age and DNA repair activity with a 0.65% decline in activity per year from age 18 to 83 (95% confidence interval: 0.16-1.14% per year). Univariate regression analysis also indicated inverse associations between DNA repair activity and waist-hip ratio (P < 0.05) and plasma concentrations of glycosylated hemoglobin (P = 0.07). However, multivariate regression analysis only showed an inverse association between age and DNA repair activity (P < 0.05), indicating that the decline in repair activity was not mediated by metabolic risk factors. In summary, the results show an inverse association between age and DNA repair activity of oxidatively damaged DNA., (© The Author 2015. Published by Oxford University Press on behalf of the UK Environmental Mutagen Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Treatment of cardiovascular risk factors based on disease risk depends on valid risk prediction equations. We aimed to develop, and apply in example countries, a risk prediction equation for cardiovascular disease (consisting here of coronary heart disease and stroke) that can be recalibrated and updated for application in different countries with routinely available information., Methods: We used data from eight prospective cohort studies to estimate coefficients of the risk equation with proportional hazard regressions. The risk prediction equation included smoking, blood pressure, diabetes, and total cholesterol, and allowed the effects of sex and age on cardiovascular disease to vary between cohorts or countries. We developed risk equations for fatal cardiovascular disease and for fatal plus non-fatal cardiovascular disease. We validated the risk equations internally and also using data from three cohorts that were not used to create the equations. We then used the risk prediction equation and data from recent (2006 or later) national health surveys to estimate the proportion of the population at different levels of cardiovascular disease risk in 11 countries from different world regions (China, Czech Republic, Denmark, England, Iran, Japan, Malawi, Mexico, South Korea, Spain, and USA)., Findings: The risk score discriminated well in internal and external validations, with C statistics generally 70% or more. At any age and risk factor level, the estimated 10 year fatal cardiovascular disease risk varied substantially between countries. The prevalence of people at high risk of fatal cardiovascular disease was lowest in South Korea, Spain, and Denmark, where only 5-10% of men and women had more than a 10% risk, and 62-77% of men and 79-82% of women had less than a 3% risk. Conversely, the proportion of people at high risk of fatal cardiovascular disease was largest in China and Mexico. In China, 33% of men and 28% of women had a 10-year risk of fatal cardiovascular disease of 10% or more, whereas in Mexico, the prevalence of this high risk was 16% for men and 11% for women. The prevalence of less than a 3% risk was 37% for men and 42% for women in China, and 55% for men and 69% for women in Mexico., Interpretation: We developed a cardiovascular disease risk equation that can be recalibrated for application in different countries with routinely available information. The estimated percentage of people at high risk of fatal cardiovascular disease was higher in low-income and middle-income countries than in high-income countries., Funding: US National Institutes of Health, UK Medical Research Council, Wellcome Trust., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Aging is associated with oxidative stress-generated damage to DNA and this could be related to metabolic disturbances. This study investigated the association between levels of oxidatively damaged DNA in peripheral blood mononuclear cells (PBMCs) and metabolic risk factors in 1,019 subjects, aged 18-93 years. DNA damage was analyzed as strand breaks by the comet assay and levels of formamidopyrimidine (FPG-) and human 8-oxoguanine DNA glycosylase 1 (hOGG1)-sensitive sites There was an association between age and levels of FPG-sensitive sites for women, but not for men. The same tendency was observed for the level of hOGG1-sensitive sites, whereas there was no association with the level of strand breaks. The effect of age on oxidatively damaged DNA in women disappeared in multivariate models, which showed robust positive associations between DNA damage and plasma levels of triglycerides, cholesterol and glycosylated hemoglobin (HbA1c). In the group of men, there were significant positive associations between alcohol intake, HbA1c and FPG-sensitive sites in multivariate analysis. The levels of metabolic risk factors were positively associated with age, yet only few subjects fulfilled all metabolic syndrome criteria. In summary, positive associations between age and levels of oxidatively damaged DNA appeared mediated by age-related increases in metabolic risk factors.

In 11 680 individuals (18-85 years) maximal oxygen consumption (VO2max) was estimated indirectly in a maximal cycle test using a prediction model developed in a young population (15-28 years). A subsample of 182 individuals (23-77 years) underwent 2 maximal cycle tests with VO2max estimated indirectly in both tests and measured directly in one test. Agreement between the direct measurement and the indirect estimate of VO2max and repeatability of the indirect estimates of VO2max were examined by Bland-Altman plots, limits of agreement (LOA) and coefficient of repeatability (CR). The indirect method (mean VO2max=3 132 ml · min(-1)) underestimated VO2max as compared to the direct method (mean VO2max=3 190 ml · min(-1)) in men (bias: 58 ml · min(-1) (95% LOA-450 and 565)) and overestimated VO2max in women (mean VO2max=2 328 vs. 2 258 ml · min(-1), bias: - 70 ml · min(-1) (95% LOA-468 and 328)). The mean difference between the 2 indirect estimates was non-significant (men: - 11.9 ml · min(-1), women: 18.3 ml · min(-1)) with a CR of 279 ml · min(-1) (8.9%) in men and 274 ml · min(-1) (11.7%) in women. The validity of the indirect method was good despite minor sex-specific bias. Owing to this bias we suggest a new prediction model of VO2max. The maximal cycle test was highly repeatable., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Several hospitals in Norway provide short self-referral inpatient treatment to patients with severe mental diagnosis. No studies have compared the experiences of patients who have had the opportunity to self-refer to inpatient treatment with patients who have received treatment as usual. This qualitative study was nested within a randomised controlled trial investigating the effect of self-referral to inpatient treatment. The aim was to explore how patients with severe mental diagnosis coped four months after signing a contract for self-referral, as compared to patients receiving treatment as usual., Methods: Data was collected using qualitative individual interviews with patients with severe mental diagnosis, conducted four months after being randomised either to a contract for self-referral (intervention group) or to treatment as usual (control group)., Results: Twenty-five patients participated in interviews - 11 from the intervention group and 14 from the control group. Results four months after randomisation showed that patients with a contract for self-referral appeared to have more confidence in strategies to cope with mental illness and to apply more active cognitive strategies. Patients with a contract also expressed less resignation, hopelessness and powerlessness than patients without a contract. In addition, patients with a contract seemed to be closer to the ideal of living a "normal" life and being a "normal" person., Conclusion: The results indicate that the patients who had a contract for self-referral had come further in the recovery process and should possibly be better off during treatment.

Objective: To investigate the joint association between self-reported physical activity as well as cardiorespiratory fitness and self-rated health among healthy women and men., Method: Data from 10,416 participants in The Danish Health Examination Survey 2007-2008 which took part in 13 Danish municipalities were analyzed. Leisure time physical activity level and self-rated health were based on self-reported questionnaire data. Optimal self-rated health was defined as "very good" or "good" self-rated health. Cardiorespiratory fitness (mL O2·min(-1)·kg(-1)) was estimated from maximal power output in a maximal cycle exercise test., Results: A strong dose-response relation between cardiorespiratory fitness and self-rated health as well as between physical activity level and self-rated health among both women and men was found. Within categories of physical activity, odds ratios for optimal self-rated health increased with increasing categories of cardiorespiratory fitness, and vice versa. Hence, participants who were moderately/vigorously physically active and had a high cardiorespiratory fitness had the highest odds ratio for optimal self-rated health compared with sedentary participants with low cardiorespiratory fitness (odds ratio=12.2, 95% confidence interval: 9.3-16.1)., Conclusion: Although reluctant to conclude on causality, this study suggests that an active lifestyle as well as good cardiorespiratory fitness probably increase self-rated health., (© 2013.)

Aims: To examine the experiences of and preferences for helpful care in situations of mental crisis from the perspective of people with major mental disorders., Methods: Qualitative individual interviews with 19 users with major mental disorder, 13 men and six women, aged 22-60 years. Analysis was conducted with systematic text condensation., Results: The main tendencies among a majority of the users are a clear understanding of their own problems and ways of handling these, and the desire for early help from providers whom they know well and who are open to dialogue and reflection. A clear majority perceived a high threshold for contacting the mental health system due to negative experiences and lack of user involvement in treatment planning and implementation., Conclusion: The findings challenge traditional views of professionalism and describe important implications for mental health services from the user's perspective. Our study provides a clear indication of the importance of becoming an active participant in one's own life, and the need for deeper understanding among the professionals in relation to user experiences and preferences for helpful care in periods of mental health crisis in order to optimize the care.

Objective: To study health-related quality of life (HRQoL) in obese presurgery patients with binge eating disorder (BED) and with subdiagnostic binge eating disorder (SBED) compared to patients without eating disorders or SBED., Method: Participants were patients referred to St. Olavs University Hospital, Norway, for bariatric surgery. Eating Disorders in Obesity (EDO) questionnaire was used to diagnose BED and SBED. Short-Form Health Survey (SF-12) assessed health-related quality of life. Questionnaires were returned by 160 of 209 patients. The present study sample consisted of 143 patients (103 women and 40 men) as 17 patients did not complete the SF-12., Results: Patients with BED and patients with SBED both had significantly lower mental HRQoL, but not physical HRQoL, compared to patients without eating disorders., Discussion: The findings indicate that obese presurgery patients with BED, and also SBED, may have special treatment needs in regard to their mental health.

Background: Occupational heavy lifting is known to impose a high cardiovascular strain, but the risk of ischemic heart disease (IHD) from occupational heavy lifting is unknown. The objective was to investigate the association between occupational heavy lifting and risk of IHD and all-cause mortality, and the influence of occupational and leisure time physical activity on this association., Methods: Data were analyzed from 1987, 1994, and 2000 from the Danish National Health Interview Surveys providing a sample of 6,692 working men and 5,921 working women aged 16-85 years without cardiovascular disease at baseline. Conventional risk factors for the outcomes IHD and all-cause mortality were controlled for in Cox analyses., Results: Among men, heavy lifting was associated with increased risk for IHD (hazard ratio (HR): 1.52, 95% Confidence interval (95% CI): 1.15, 2.02), while a decreased risk was associated with occupational (HR: 0.50, 95% CI: 0.37, 0.68) and leisure time (HR: 0.73, 95% CI: 0.56, 0.95) physical activity. Referencing men with high occupational physical activity and no heavy lifting, men with high occupational physical activity and heavy lifting did not have an increased risk (HR: 1.11, 95% CI:0.68, 1.82), while men with low occupational physical activity and heavy lifting had a substantial increased risk (HR: 2.56, 95% CI:1.52, 4.32). No significant associations were found for all-cause mortality or for females., Conclusion: These findings indicate an excessive risk for IHD from occupational heavy lifting among men, particularly among those with low occupational and leisure time physical activity.

Background: The main aim was to investigate the effect of using two brief feedback scales in mental health out-patient treatment six weeks after starting treatment, compared to treatment as usual. Hypotheses were that use of feedback scales would improve treatment alliance and patient satisfaction., Methods: An open parallel-group randomised controlled trial was conducted in an out-patient unit in a mental health hospital in Central Norway. Eight therapists trained in using the feedback scales in the Partners for Change Outcome Management System (PCOMS) treated the intervention group. Seventeen therapists treated the controls, providing treatment without using feedback scales. The main outcome measures were treatment alliance and patient satisfaction., Results: Seventy-five patients participated. There were no differences between the groups in the intention to treat (ITT) analyses on alliance (mean difference = 0.08, 95% CI -0.44, 0.59, p = 0.760) or satisfaction (mean difference = 0.24, 95% CI -1.85, 2.32, p = 0.819), and no statistically significant differences between the groups in the per protocol (PP, n = 58) analyses on alliance (mean difference = 0.32, 95% CI -0.84, 3.16, p = 0.137) or satisfaction (mean difference = 1.16, 95% CI -0.84, 3.16, p = 0.248) six weeks after the treatment started. The effect size in favour of the PCOMS group increased from 0.07 for alliance and 0.06 for satisfaction in the intention to treat analysis to 0.40 on alliance and 0.31 for satisfaction in the per protocol analysis. Among the other outcomes, the PCOMS group had better motivation for treatment (estimated mean difference ITT: 0.29, 95% CI 0.00 to 0.57, p = 0.05, PP: 0.28, 95% CI 0.04, 0.52, p = 0.024)., Conclusion: Six weeks after starting treatment, there were no effects on alliance and satisfaction from using two brief feedback scales. Since the per protocol analyses showed higher effect sizes, future investigations in a larger study with longer follow-up are warranted.

Objective: This study investigated self-reported levels of depression, anxiety and neuroticism in obese patients waiting for bariatric surgery. The patients who indicated that they might have eating disorders (ED) or subthreshold binge eating disorders (SBED) were compared with those without., Method: The design was cross sectional. Obese patients (n = 160, 117 women, 43 men) returned self-report questionnaires: Eating Disorders in Obesity (EDO) indicated eating disorder status; Hospital Anxiety and Depression Scale (HADS) assessed symptoms and caseness of depression and anxiety; and the Eysenck Personality Questionnaire (EPQ-12) captured neuroticism. Age, BMI and gender were also recorded., Results: Patients with ED (n = 28) presented significantly higher levels of depression, anxiety and neuroticism as well as more HADS-cases for depression and anxiety than those without ED (n = 109). Patients with sub-diagnostic binge eating disorders (SBED, n = 23) also reported significantly more depression symptom levels, and number of HADS-cases of depression, than those without ED. In addition, the SBED group showed significantly more neuroticism than patients without ED. No significant differences were found between men and women, for high/low age, or for high/low BMI., Conclusion: The data displayed that obese pre-surgery patients with eating disorders have more psychological problems than those without. Patients with SBED were more similar to those with full scale eating disorders in their level of depression and neuroticism than those without ED. Clinically, obese patients with SBED should probably be regarded as those who have full scale ED., (© 2012 Asian Oceanian Association for the Study of Obesity . Published by Elsevier Ltd. All rights reserved.)

Objectives: This article is based on a pilot study of Finnmark University College's off-campus bachelor programme (BA) for nurses, organised in rural areas. The objectives were to explore whether these courses had contributed to reduced vacancies; whether the learning outcome of the off-campus courses was the same as the on-campus programme, and how the education had influenced the nurses' professional practice in local health services., Study Design: In the study we used mixed strategies in data collection and analyses., Methods: Data about course completion, average age, average grades and retention effect were collected in 2009/2010 from 3 off-campus classes and their contemporary on-campus classes. Then 7 of the off-campus nurses were interviewed. A content analytical approach to the data was employed., Results: With retention of 93%, the off-campus BA course for nurses has been one of the most effective measures, particularly in rural areas. The employers' support for further education after graduating seems to be an important factor for the high retention rate. Teaching methods such as learning activities in small local groups influenced the nurses' professional development. Local training grants, supervision and a local learning environment were important for where they chose their first job after graduation., Conclusions: The study confirms that nurses educated through off-campus courses remain in the county over time after graduating. The "home-grown" nurses are familiar with the local culture and specific needs of the population in this remote area. The study confirms findings in other studies, that further education is an important factor for nurses' retention.

Oxidatively damaged DNA base lesions are considered to be mainly repaired by 8-oxoguanine DNA glycosylase (OGG1) mediated pathways. We investigated the effect of the OGG1 Ser326Cys polymorphism on the level and repair of oxidatively damaged DNA in mononuclear blood cells (MNBC) by means of the comet assay. We collected blood samples from 1,019 healthy subjects and genotyped for the OGG1 Ser326Cys polymorphism. We found 49 subjects homozygous for the variant genotype (Cys/Cys) and selected same numbers of age-matched subjects with the heterozygous (Ser/Cys) and homozygous wild-type genotype (Ser/Ser). Carriers of the Cys/Cys genotype had higher levels of formamidopyrimidine DNA glycosylase (FPG) sensitive sites in MNBC (0.31 ± 0.03 lesions/10(6)bp) compared to Ser/Ser (0.19 ± 0.02 lesions/10(6)bp, P<0.01). The level of hOGG1 sensitive sites in MNBC from the Ser326Cys carriers (0.19 ± 0.16 lesions/10(6) bp) was also higher compared to the Ser/Ser genotype (0.11 ± 0.09 lesions/10(6) bp, P<0.05). Still, there was no genotype-related difference in DNA repair incision activity of MNBC extracts on nucleoids with oxidatively damaged DNA induced by Ro19-8022/white light (P=0.20). In addition, there were no differences in the expression of OGG1 (P=0.69), ERCC1 (P=0.62), MUTYH (P=0.85), NEIL1 (P=0.17) or NUDT1 (P=0.48) in whole blood. Our results indicate that the OGG1 Ser326Cys polymorphism has limited influence on the DNA repair incisions by extracts of MNBC, whereas the apparent increased risk of cancer in subjects with the Cys/Cys genotype may be because of higher levels of oxidatively damaged DNA., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The aim of this cross-sectional study was to investigate associations between physical activity, stress, and happiness, as well as possible sex and age differences on these variables in a survey of 1,508 adolescent pupils (13 to 18 yr.) in middle Norway. Adolescents who reported they participated in physical activity 2 to 3 times per week or more scored significantly lower on stress and higher on happiness than those who participated in physical activity 1 day per week or less. There was no significant difference on stress and happiness between those being physically active 2 or 3 times a week and those being active almost every day. There was no sex difference in physical activity frequency. Girls had higher mean scores on stress, and boys scored higher on happiness. Adolescents 15 to 16 years old showed higher stress scores than those 17 to 18 years old, but there were no significant differences between the different age groups when looking at happiness and physical activity. A statistically significant two-way interaction of sex by age was found on both stress and happiness.

Aims: The Danish Health Examination Survey (DANHES 2007-2008) was carried out by the National Institute of Public Health, University of Southern Denmark, in 13 Danish municipalities in 2007-2008. The focus of the survey was diet, smoking, alcohol, and physical activity. The aim of the survey was to establish a research database for future cross-sectional and follow-up studies., Methods: DANHES 2007-2008 included internet-based questionnaires and a health examination. There were two different questionnaires: a basic questionnaire on socio-demography, health behaviour, self-reported health status, and living conditions, and a supplementary food frequency questionnaire. The health examination contained measurements of blood pressure, resting heart rate, height, weight, fat percentage, waist and hip circumference, blood and hair samples, spirometry, bone mineral density, physical performance, muscle strength, and aerobic fitness., Results: A total of 76,484 people completed the basic questionnaire, and 18,065 adult individuals participated in the health examination, corresponding to a response rate of 14% and a participation rate of 10%, respectively., Conclusions: The database from DANHES 2007-2008 is unique in its size and diversity of measurements and questionnaire contents. Data can be linked to various registers through the Danish civil registration system, and blood samples are stored in a biobank allowing for genetic analyses. Hence, DANHES 2007-2008 forms the basis for future research projects with a focus on health behaviour and prevention of lifestyle-related diseases.

We compared the effects on glycaemic control of two different exercise protocols in elderly men with type 2-diabetes; one 30-minute session per day (1 x 30) and three 10-minute sessions per day (3 x 10). Cardiopulmonary fitness increased in both groups. Improvement in glycaemic control was only found in the 3 x 10 group. A likely explanation is that the total energy expenditure during training performed as multiple sessions is higher than the expenditure achieved during a single session per day.

We have examined the occurrence of hangovers i Danish men and women. Among 36,228 participants, the occurrence of a list of different hangover symptoms as well as of severe hangovers was higher in women than in men. For example, the odds ratio was 1.53 (95% CI: 1.41-1.66) for experiencing headache and 1.97 (95% CI: 1.75-2.21) for severe hangovers after an episode of binge-drinking in women compared with men. This finding could not be explained by weekly alcohol intake, type of alcohol ingested, frequency of binge drinking episodes or by the proportion of alcohol consumed with meals.

Background: Literature review indicated there is no existing nursing competency framework or instrument for Chinese registered nurses. By virtue of its global leadership role in nursing, the International Council of Nurses (ICN) developed an ICN Framework of Competencies for the Generalist Nurses in 2003. On the basis of the ICN's framework, a qualitative study was conducted to explore the expectations of Chinese nurse professionals on nursing competency in the previous study. A competency framework for Chinese registered nurses was formed. This paper describes the development and testing of the Competency Inventory for Registered Nurses (CIRN)., Methods: A methodological study design was used, consisting of two phases with six steps. A review of literature generated 112 items, which were evaluated by six experts followed by field testing in a purposive sample of 815 Chinese clinical registered nurses. Factor analysis and item analysis were applied to establish the scale's construct validity and reliability., Results: The final scale consists of seven dimensions with 58 items. The overall scale reliability had a Cronbach's alpha of 0.89; the dimensions Cronbach's alpha ranged from 0.79 to 0.86. In addition, evidence for two other kinds of validity was obtained, which included criterion-related validity (r=0.44, p=0.04) and contrasted-group validity (p<0.001)., Conclusion: The CIRN has demonstrated evidence of internal consistency reliability, content validity, and construct validity, and it provides an objective tool for assessing registered nurse competencies in the various areas of clinical practice.

Aim: To report reference intervals for haematological variables during normal pregnancy and postpartum., Material and Methods: The series comprised 434 healthy ethnic Danish women with a normal pregnancy > or =37 wk duration and a normal delivery with newborns weight >2500 g. Blood samples were obtained at 18, 32 and 39 wk gestation and at 8 wk postpartum. The following variables were analysed: Haemoglobin (Hb), haematocrit (Hct), blood erythrocyte count, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, white cell count, platelet count, erythrocyte folate, plasma folate, plasma cobalamin, plasma methylmalonic acid, plasma total homocysteine, serum ferritin, serum soluble transferrin receptor and plasma creatinine. Reference intervals were calculated using log(10)-transformed values (which showed normal distributions) as mean +/- 1.96 x SD., Results: The lower reference value for Hb during pregnancy was 6.45 mmol/L (105 g/L) and 7.3 mmol/L (118 g/L) postpartum. The lower reference value for Hct was 0.31 in pregnancy and 0.35 postpartum. There was a gradual decline in the lower reference value for erythrocyte folate during pregnancy and postpartum from 0.46 to 0.29 micromol/L and in plasma folate from 6 to 4 nmol/L. Lower reference value for plasma cobalamin declined during pregnancy from 96 to 71 pmol/L, but increased postpartum to 148 pmol/L. Upper reference value for plasma homocysteine increased gradually during pregnancy and postpartum from 11.0 to 20.6 micromol/L. Geometric mean serum ferritin at 18 wk gestation was 32 microg/L. Plasma creatinine values were low during pregnancy and displayed a significant increase postpartum., Conclusion: The characteristic changes occurring in haematological indices during pregnancy and postpartum are described in this study. The results may be used as reference values in the assessment of health status of pregnant women with a similar socio-economic and racial background.

Objective: To evaluate by echo- and electrocardiography the cardiac effects of sedation with detomidine hydrochloride, romifidine hydrochloride or acepromazine maleate in horses., Study Design: An experimental study using a cross-over design without randomization., Animals: Eight clinically normal Standardbred trotters., Materials and Methods: Echocardiographic examinations (two-dimensional, guided M-mode and colour Doppler) were recorded on five different days. Heart rate (HR) and standard limb lead electrocardiograms were also obtained. Subsequently, horses were sedated with detomidine (0.01 mg kg(-1)), romifidine (0.04 mg kg(-1)) or acepromazine (0.1 mg kg(-1)) administered intravenously and all examinations repeated., Results: Heart rate before treatment with the three drugs did not differ significantly (p = 0.98). Both detomidine and romifidine induced a significant decrease (p < 0.001) in HR during the first 25 minutes after sedation; while acepromazine had a varying effect on HR. For detomidine, there was a significant increase in LVIDd (left ventricular internal diameter in diastole; p = 0.034) and LVIDs (left ventricular internal diameter in systole; p < 0.001). In addition, a significant decrease was found in IVSs (the interventricular septum in systole; p < 0.001), LVFWs (the left ventricular free wall in systole; p = 0.002) and FS% (fractional shortening; p < 0.001). The frequency of pulmonary regurgitation was increased significantly (p < 0.001). Romifidine induced a significant increase in LVIDs (p < 0.001) and a significant decrease in IVSs (p < 0.001) and FS% (p = 0.002). Acepromazine had no significant effect upon any of the measured values., Conclusions: and clinical relevance The results indicate that sedation of horses with detomidine and to a lesser extent romifidine at the doses given in this study has a significant effect on heart function, echocardiographic measurements of heart dimensions and the occurrence of valvular regurgitation. Although the clinical significance of these results may be minimal, the potential effects of sedative drugs should be taken into account when echocardiographic variables are interpreted in clinical cases.

This study aims to evaluate iron prophylaxis in pregnant women from the individual aspect, i.e. according to serum ferritin levels at the beginning of pregnancy, and to assess which dose of iron would be adequate to prevent iron deficiency (ID) and iron deficiency anaemia (IDA) during pregnancy and postpartum. A randomised, double-blind study comprising 301 healthy Danish pregnant women allocated into four groups taking ferrous iron (as fumarate) in doses of 20 mg (n=74), 40 mg (n=76), 60 mg (n=77) and 80 mg (n=75) from 18 weeks gestation (inclusion) to 8 weeks postpartum. Iron status markers [serum ferritin, serum soluble transferrin receptor (sTfR), haemoglobin] were recorded at 18, 32 and 39 weeks gestation and 8 weeks postpartum. Body iron was calculated using the serum sTfR/serum ferritin ratio. ID was defined by serum ferritin <12 microg/l in pregnancy and <15 microg/l postpartum; IDA as serum ferritin <12 microg/l and haemoglobin <5th percentile in iron-replete pregnant women. Women in the iron supplement groups were stratified according to serum ferritin levels at inclusion; 50.7% had ferritin 70 microg/l. At 32 weeks, women with ferritin 30 microg/l had an ID frequency of: 20-mg group 20.0%, 40 mg 13.9%, 60 mg 5.7%, 80 mg 5.1% (p<0.001). Women with ferritin >70 microg/l had no ID. Postpartum, ID was found in 4.7% in 20-mg group, 2.9% in group 40 mg and 0% in group 60 and 80 mg. IDA: At 32 weeks, women with ferritin 30 microg/l displayed IDA. Body iron at 18 weeks was 10.4 mg/kg, similar in the four iron groups. Later in pregnancy body iron declined significantly, being lower the 20 mg group, and similar in the 40, 60 and 80-mg groups. Postpartum body iron rose to inclusion levels being 9.3 mg/kg in the 20-mg group and 10.5 mg/kg in the 40-, 60- and 80-mg groups. This study gives an estimate of iron dosage in individual iron prophylaxis adjusted to serum ferritin levels in early pregnancy. In the prevention of ID, we suggest 80-100 mg ferrous iron/day to women having ferritin 70 microg/l have no need for iron supplement.

Objectives: To assess cobalamin (vitamin B(12)) status during normal pregnancy and postpartum in a longitudinal setting., Methods: This study was performed in 1995-1996. It comprised 406 healthy, pregnant Danish Caucasian women, living in Copenhagen County. Cobalamin status, i.e. plasma (P-) cobalamin, P-methylmalonic acid and P-homocysteine was measured at 18, 32 and 39 wk gestation and 8 wk postpartum during lactation., Results: P-cobalamin showed a gradual, significant decline during pregnancy (P < 0.0001) followed by a significant increase postpartum (P < 0.0001); at 18, 32, 39 wk gestation and 8 wk postpartum median values were 225, 172, 161 and 319 pmol/L, respectively. P-methylmalonic displayed a gradual, significant increase during pregnancy as well as postpartum (P < 0.001) with median values of 0.11, 0.13, 0.14, and 0.16 micromol/L, respectively. P-homocysteine demonstrated a significant increase during pregnancy and postpartum (P < 0.001). The frequency of P-cobalamin values <150 pmol/L increased during pregnancy from 15% at 18 wk to 43% at 39 wk gestation and subsequently declined to 3% postpartum., Conclusion: Low cobalamin status may occur among pregnant women, especially in late pregnancy. The recommendations for periconceptional vitamin B(12) supplementation should be reconsidered.

Objective: To assess folate and homocysteine status during normal pregnancy and postpartum in a longitudinal setting., Methods: This study, performed in 1995-1996, comprised 404 healthy pregnant Danish Caucasian women residential in Copenhagen County. Women taking folic acid tablets or vitamin B12 injections were not included. Dietary multivitamin supplements containing folic acid 100 microg or vitamin B12 1 microg, taken by 34%, were discontinued at inclusion. Participants had normal renal function. Folate status [erythrocyte (Ery-) folate, plasma (P-) folate, P-homocysteine] was measured at 18, 32 and 39 wk of gestation and 8 wk postpartum when the women were lactating., Results: Through 18, 32 and 39 wk of gestation and postpartum, P-folate demonstrated a significant fall: median values were 14.4, 10.2, 9.3 and 8.9 nmol/L, respectively (P < 0.0001). The prevalence of low P-folate <6 nmol/L increased during pregnancy from 0.7% to 19.0% postpartum (P < 0.0001). Ery-folate displayed a similar, significant fall: median value was 0.84, 0.75, 0.65 and 0.55 micromol/L, respectively (P < 0.0001). The prevalence of low Ery-folate <0.40 micromol/L increased during pregnancy from 0.5% to 17.2% postpartum (P < 0.0001). P-homocysteine demonstrated a significant increase: median value was 6.4, 7.0, 7.7 and 10.8 micromol/L, respectively (P < 0.0001). The prevalence of P-homocysteine >13 micromol/L increased during pregnancy from 0.7% to 20.8% postpartum (P < 0.0001). The prevalence of low folate status (defined as P-folate <6 nmol/L and P-homocysteine >13 micromol/L) was 0%, 0%, 1.2%, and 8.4% at 18, 32 and 39 wk of gestation and 8 wk postpartum, respectively., Conclusion: Low folate status occurs among Danish pregnant women, especially in late pregnancy and postpartum during lactation. Despite new guidelines for folic acid supplement since 1997, only 13% of pregnant women followed the guidelines in 2003. The official recommendations for periconceptional folic acid supplement should be reconsidered and reinforced.

Background: It is a common belief among women that iron compounds have unpleasant gastrointestinal side effects., Objective: To assess the gastrointestinal side effects of iron prophylaxis in pregnancy., Methods: A randomized, double-blind study comprising 404 healthy pregnant women allocated to four groups taking ferrous iron supplement (as fumarate) in doses of 20 (n = 99), 40 (n = 100), 60 (n = 102) and 80 mg (n = 103) daily from 18 weeks of gestation to delivery. Iron supplement was predominantly taken at bedtime. Gastrointestinal symptoms (nausea, vomiting, epigastric pain, eructation, pyrosis, meteorism, borborygmi, colic pain, flatulence, constipation, thin feces, diarrhea), black feces, and use of laxatives were recorded by interview at 18, 32 and 39 weeks of gestation., Results: The frequencies of gastrointestinal symptoms were not significantly different in the four iron supplement groups either at inclusion or at 32 and 39 weeks of gestation and thus not related to the iron dose., Conclusion: This study shows that a supplement of 20-80 mg ferrous iron (as fumarate), taken between meals, has no clinically significant gastrointestinal side effects. The implementation of iron prophylaxis to pregnant women should not be compromised by undue concern of non-existing side effects., (Copyright 2006 S. Karger AG, Basel.)

In vivo depletion of lymphocyte subsets allows investigation of the role of specific subsets in protective immunity. In the present study we evaluated the effects of long-term, low-dose treatment with murine monoclonal antibodies (mAbs) against porcine CD4 and CD8 surface antigens on lymphocyte subsets in pigs. Four-week-old pigs were treated by intramuscular injections of hybridoma cell culture supernatants containing anti-CD mAbs twice a week for a period of 5 weeks. The immunomodulatory effects of the treatments were assessed by flow cytometry (FCM) analysis of peripheral blood lymphocytes. Treatment with the anti-CD4 mAb almost completely eliminated the CD4(+) T-cell subset from the circulation after 2 weeks of therapy. This depletion persisted until the end of the experimental period 5 weeks after initiated therapy. Treatment with the anti-CD8 mAb was less effective, reducing the CD8(+) T-cell subset in peripheral blood by approximately 50% of the initial level after 3 weeks of therapy. Further, the anti-CD8 mAb-treated pigs showed a parallel increase in the CD4(+) T-cell subset from day 7. Two-colour FCM analysis indicated that a shift in phenotype from single-positive CD4(+)/CD8(-) to double-positive CD4(+)/CD8(+) T-cells might have occurred in these pigs. In the present experiment we demonstrated specific modulation of the peripheral blood T-lymphocyte population in pigs with continuous low-dose injections of specific mAb. The ability to modulate individual T-cell subsets should provide a method to elucidate their functionality in protection against infectious disease.