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There is high demand in environmental health for adoption of a structured process that evaluates and integrates evidence while making decisions and recommendations transparent. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework holds promise to address this demand. For over a decade, GRADE has been applied successfully to areas of clinical medicine, public health, and health policy, but experience with GRADE in environmental and occupational health is just beginning. Environmental and occupational health questions focus on understanding whether an exposure is a potential health hazard or risk, assessing the exposure to understand the extent and magnitude of risk, and exploring interventions to mitigate exposure or risk. Although GRADE offers many advantages, including its flexibility and methodological rigor, there are features of the different sources of evidence used in environmental and occupational health that will require further consideration to assess the need for method refinement. An issue that requires particular attention is the evaluation and integration of evidence from human, animal, in vitro, and in silico (computer modeling) studies when determining whether an environmental factor represents a potential health hazard or risk. Assessment of the hazard of exposures can produce analyses for use in the GRADE evidence-to-decision (EtD) framework to inform risk-management decisions about removing harmful exposures or mitigating risks. The EtD framework allows for grading the strength of the recommendations based on judgments of the certainty in the evidence (also known as quality of the evidence), as well as other factors that inform recommendations such as social values and preferences, resource implications, and benefits. GRADE represents an untapped opportunity for environmental and occupational health to make evidence-based recommendations in a systematic and transparent manner. The objectives of this article are to provide an overview of GRADE, discuss GRADE's applicability to environmental health, and identify priority areas for method assessment and development.

Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. The panel included clinicians and investigators representing internal medicine, emergency medicine, microbiology, critical care, surgery, epidemiology, pharmacy, and adult and pediatric infectious diseases specialties. These recommendations address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics.

Abstract Background Motor and cognitive impairments are frequently observed following stroke, but are often managed as distinct entities, and there is little evidence regarding how they are related. The aim of this study was to describe the prevalence of concurrent motor and cognitive impairments 3 months after stroke and to examine how motor performance was associated with memory, executive function and global cognition. Methods The Norwegian Cognitive Impairment After Stroke (Nor-COAST) study is a prospective multicentre cohort study including patients hospitalized with acute stroke between May 2015 and March 2017. The National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission. Level of disability was assessed by the Modified Rankin Scale (mRS). Motor and cognitive functions were assessed 3 months post-stroke using the Montreal Cognitive Assessment (MoCA), Trail Making Test Part B (TMT-B), 10-Word List Recall (10WLR), Short Physical Performance Battery (SPPB), dual-task cost (DTC) and grip strength (Jamar®). Cut-offs were set according to current recommendations. Associations were examined using linear regression with cognitive tests as dependent variables and motor domains as covariates, adjusted for age, sex, education and stroke severity. Results Of 567 participants included, 242 (43%) were women, mean (SD) age was 72.2 (11.7) years, 416 (75%) had an NIHSS score ≤ 4 and 475 (84%) had an mRS score of ≤2. Prevalence of concurrent motor and cognitive impairment ranged from 9.5% for DTC and 10WLR to 22.9% for grip strength and TMT-B. SPPB was associated with MoCA (regression coefficient B = 0.465, 95%CI [0.352, 0.578]), TMT-B (B = -9.494, 95%CI [− 11.726, − 7.925]) and 10WLR (B = 0.132, 95%CI [0.054, 0.211]). Grip strength was associated with MoCA (B = 0.075, 95%CI [0.039, 0.112]), TMT-B (B = -1.972, 95%CI [− 2.672, − 1.272]) and 10WLR (B = 0.041, 95%CI [0.016, 0.066]). Higher DTC was associated with more time needed to complete TMT-B (B = 0.475, 95%CI [0.075, 0.875]) but not with MoCA or 10WLR. Conclusion Three months after suffering mainly minor strokes, 30–40% of participants had motor or cognitive impairments, while 20% had concurrent impairments. Motor performance was associated with memory, executive function and global cognition. The identification of concurrent impairments could be relevant for preventing functional decline. Trial registration ClinicalTrials.gov Identifier: NCT02650531 .

Abstract Background Digital learning designs have the potential to support teaching and learning within higher education. However, the research on digital learning designs within physiotherapy education is limited. This study aims to identify and investigate the effectiveness of digital learning designs in physiotherapy education. Methods The study was designed as a systematic review and meta-analysis of randomized and non-randomized trials. A search of eight databases on digital learning designs and technology was conducted. Study selection, methodology and quality assessment were performed independently by three reviewers. The included studies were mapped according to the types of digital interventions and studies. For similar interventions, the learning effects were calculated using meta-analyses. Results Altogether, 22 studies were included in the review (17 randomized controlled trials and five cohort studies). A blended learning design was used in 21 studies, a flipped classroom model in five and a distance learning design in one. Altogether, 10 of the 22 articles were included in meta-analyses, which showed statistically significant effects for flipped classrooms on knowledge acquisition (standardized mean difference [SMD]: 0.41; 95% confidence interval [CI]: 0.20, 0.62), for interactive websites or applications (apps) on practical skills (SMD: 1.07; 95% CI: 0.71,1.43) and for students self-produced videos on a practical skill in a cervical spine scenario (SMD: 0.49; 95% CI: 0.06, 0.93). Overall, the effects indicated that blended learning designs are equally as or more effective than traditional classroom teaching to achieve learning outcomes. Distance learning showed no significant differences compared to traditional classroom teaching. Conclusions The current findings from physiotherapy education indicate that digital learning designs in the form of blended learning and distance learning were equally or more effective compared to traditional teaching. The meta-analyses revealed significant effects on student learning in favour of the interventions using flipped classrooms, interactive websites/apps and students self-produced videos. However, these results must be confirmed in larger controlled trials. Further, research should investigate how digital learning designs can facilitate students’ learning of practical skills and behaviour, learning retention and approaches to studying as well as references for teaching and learning in digital learning environments.

Sammendrag Covid-19-pandemien fikk massiv mediedekning da den kom til Norge våren 2020. Samspillet mellom helseautoriteter, politikere og medier er i slike tilfeller avgjørende for hvilken forståelse av pandemien som blir etablert i offentligheten. Med utgangspunkt i Briggs & Hallins biomedialiseringsbegrep og tradisjonen fra kritisk diskursanalyse analyserer denne artikkelen nyhetstekster innenfor fire overordnede helsediskurser: den biomedisinske diskursen, forbrukerdiskursen, samfunnsdiskursen og erfaringsdiskursen. Analysetekstene er hentet fra VG og Dagbladet. Hvem som framstår med makt til eller ansvar for å løse koronarelaterte problemer, avhenger av diskursen som er valgt i hvert tilfelle. Samtidig konstruerer tekstene uvilkårlig bestemte forståelser av vitenskap, familiemønstre, smittemekanismer og sykdomshåndtering.

Abstract Background Public or patient versions of guidelines (PVGs) are derivative documents that “translate” recommendations and their rationale from clinical guidelines for health professionals into a more easily understandable and usable format for patients and the public. PVGs from different groups and organizations vary considerably in terms of quality of their reporting. In order to address this issue, we aimed to develop a reporting checklist for developers of PVGs and other potential users. Methods First, we collected a list of potential items through reviewing a sample of PVGs, existing guidance for developing and reporting PVGs or other similar evidence-based patient tools, as well as qualitative studies on original studies of patients’ needs about the content and/or reporting of information in PVGs or similar evidence-based patient tools. Second, we conducted a two-round Delphi consultation to determine the level of consensus on the items to be included in the final reporting checklist. Third, we invited two external reviewers to provide comments on the checklist. Results We generated the initial list of 45 reporting items based on a review of a sample of 30 PVGs, four PVG guidance documents, and 46 relevant studies. After the two-round Delphi consultation, we formed a checklist of 17 items grouped under 12 topics for reporting PVGs. Conclusion The RIGHT-PVG reporting checklist provides an international consensus on the important criteria for reporting PVGs.

Abstract Background Exercise is recommended for patients with subacromial pain. It has been suggested that good exercise adherence improves clinical outcomes. Despite this, little attention has been paid to the need for behavioural frameworks to enhance adherence to home exercise programmes for patients with subacromial pain. Methods A feasibility study with pre-post design was used. Participants aged > 18 years, with subacromial pain, who had received conservative treatment during the past 6 months, were recruited. The Ad-Shoulder intervention consisted of 1–5 individual sessions provided over 3 months and was based on 5 self-management skills, which aimed to enhance the patients’ self-efficacy and adherence to self-managed exercises. The primary objectives were assessed according to predefined progression criteria: (1) the recruitment rate (10 patients enrolled within 12 weeks), (2) follow-up rate (≥ 80% on all self-reported measures), (3) objective physical activity measures (≥ 80% of participants would contribute valid data at each time point), (4) adherence with the self-managed exercises (≥ 80% of the participants would adhere to ≥ 80% of the assigned home exercise programme), (5) fidelity of the delivery of the intervention (the therapists delivered the intervention according to the protocol) and (6) adverse events (

Despite efforts to increase the implementation of active teaching and learning in higher education, teaching approaches based on information transfer are still dominant. The slow adoption has been attributed to reluctance on the part of teachers. Active digital pedagogies, such as the flipped classroom, transfer the responsibility for learning to the students, thus challenging the traditional role of the teacher. The purpose of this study was to investigate how flipped classroom supervision is aligned with conceptions of teaching among teachers working in undergraduate physiotherapy education. Data were collected through a focus-group interview with three teachers who had recently participated in flipped classroom supervision and were analysed using qualitative thematic analysis. Supervision in the flipped classroom was viewed mostly positively by the physiotherapy teachers interviewed. The less defined teaching role and the increased social interaction constituted the most radical departure from their previous experiences in traditional teaching environments. The teachers found that the teaching and learning environment enhanced the quality of students’ work. There was no indication that the student-centred pedagogies conflicted with the teachers’ conceptions of teaching and learning. The findings do not support the idea that the existing teaching culture represents a barrier to technology-supported education.

Introduction: Shoulder pain is one of the most common musculoskeletal complaints and the term ‘subacromial pain syndrome’ is used to describe the most common clinical subgroup. A recent practice guideline for surgery concludes that subacromial decompression should not be offered to patients with subacromial pain. Subsequently, the Norwegian Secretary of State for Health, Bent Høie, in an interview advised that this patient group should receive the most effective treatment, namely physical rehabilitation. Main section: The current paper provides an overview of evidence-based physiotherapy treatment for patients with subacromial pain and discusses relevant evidence. The paper then outlines knowledge gaps, such as the degree of supervision and the content of exercise regimes. Recommendations from leading musculoskeletal research teams suggest an increased focus on self-efficacy and self-management. With this in mind, the authors discuss future directions for treatment of shoulder pain. End section: With the more prominent role physical rehabilitation now has been given, it is necessary for the physiotherapy profession to respond honestly and responsibly. The treatment model should be further developed in line with evidence, and this might challenge the current knowledge-base of physiotherapists.

Femårig masterutdanning for grunnskolelærere ble pilotert ved UiT Norges arktiske universitet fra 2010 og innført i Norge fra 2017. Utdanningen innebærer faglig fordypning i tre fag for lærere i 5.−10. trinn, eller fire fag for lærere i 1.−7. trinn. Masteroppgaven skal være profesjonsrettet, praksisorientert og relevant for skolen. Denne kvalitative studien undersøker hvordan de to første kullene av grunnskolelærere med fullført masterutdanning fra UiT får anvendt sin faglige fordypning, og hvordan de erfarer relevansen av masteroppgaven etter ett år i yrket. Datamaterialet består av semistrukturerte intervjuer med 29 lærere, og som er tematisk analysert i NVivo 11. Resultatene viser at nyutdannede som i hovedsak underviser bare i fag med faglig fordypning eller et ekstra fag, arbeider i ungdomsskolen. Lærere som underviser i fag med faglig fordypning opplever mestring og motivasjon og bruker ulike didaktiske tilnærminger, spesielt i faget hvor de skrev sin fagdidaktiske masteroppgave. Lærere som underviser i fag uten faglig fordypning bruker tid og energi på å lære seg fagkunnskap og didaktikk, men erfarer utilstrekkelighet. Lærere i barneskolen underviser i opptil fire fag uten faglig fordypning. Masteroppgave og faglig fordypning i lærerutdanningen krever at både skoleledere, lærere og forskere er oppmerksomme på fordeling av undervisningsfag mellom lærere generelt og i barneskolen spesielt.

Karbid- og cyanamidfabrikkene i Odda, The North Western Cyanamide Company, var i sin tid verdensledende når det gjaldt produksjon av kalsiumcyanamid. Virksomheten ble etablert fra 1906, med utenlandsk kapital og teknologi. Er det likevel mulig å kalle dette et norsk prosjekt, utover billig fossekraft og arbeidskraft? Dette er spørsmål som gjelder for mye av den kraftkrevende industrien som ble etablert i de første årene av det forrige århundret. I denne artikkelen forsøker vi å bidra til denne diskusjonen, ved å rette oppmerksomheten mot de ringvirkningene prosjektet skapte for henholdsvis den bergenske banknæringen og den østlandske byggebransjen.