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Sleeping difficulties among adolescents constitute a pressing public health issue, and it is of the utmost importance that these are approached from a health-promotion perspective. This study explores adolescents' suggestions on how their sleep could be supported. Data were collected via eight focus group interviews with 43 adolescents aged 15-16, in Sweden, and analyzed using qualitative content analysis. The results describe the adolescents' suggestions on how their sleep could be supported in three themes: being supported by involved parents--routines, engagement, and warmth are vital; being supported to achieve knowledge on the "whys" and "hows" of sleep--increased knowledge gives the ability to make well-grounded sleep choices; and being guided into finding balance--balance in life is difficult to achieve and adolescents desire support. Parents, school nurses, health professionals, and anyone who has the opportunity to improve and promote sleep should consider adolescents' suggestions.

Violence prevention approaches using social-ecological models inform interventions for people with intellectual disability, who often face barriers to accessing generalist courses. This study explores the experiences of healthcare professionals leading a prevention course specifically designed for adults with intellectual disability. Through semistructured interviews, 12 Norwegian course leaders highlighted the importance of raising awareness and comprehension about rights, and the social and individual factors influencing experiences of violence and its prevention. Challenges were encountered in tailoring the course to the diverse lived experiences of participants with disabilities and addressing ongoing support needs for their safety. The study suggests that adopting a pedagogical or didactic model could serve as a foundation to enhance the planning and delivery of the course.

Mycosis fungoides is the most frequent subtype of primary cutaneous T-cell lymphomas. The diagnosis is based on a thorough clinic-pathologic correlation, which can, especially in early-stage disease, be challenging due to similarities with several benign skin disorders such as psoriasis and atopic dermatitis. Here, we present a case of an 81-year-old man with a 20-year-long medical history of skin problems treated as psoriasis with limited effect. Since December 2021, the patient experienced worsening of his skin symptoms with rapidly growing tumors and widespread patches and plaques. Positron emission tomography/computed tomography evaluation revealed markedly metabolic activity related to the skin tumors and increased FDG uptake in several retroperitoneal lymph nodes. Histological assessment of skin biopsies demonstrated a highly proliferative T-cell lymphoma with a γ/δ+ and CD8+ cytotoxic phenotype. The morphology of the tumor cells appeared blastic with an abnormal immunephenotype CD3+, CD2−, CD5dim, CD4−, CD8+, CD56−, and CD30−. Next-generation sequencing detected a likely pathogenic SOCS1 mutation with an allele frequency of 72% as well as a STAT3 variant of unknown significance. This case highlights the diagnostic complexity of an indolent skin lymphoma evolving into an aggressive cytotoxic lymphoma.

Abstract Background The need for advanced home healthcare (HHC) is expected to increase, with registered nurses (RNs) as key figures. Given the difficulties recruiting and retaining RNs in the HHC sector, understanding their work satisfaction is imperative. Aim This study aimed to explore RNs’ experiences of work satisfaction in the municipal HHC. Methods Individual interviews were conducted with RNs (n = 8) in four municipalities in Norway. The data were evaluated using qualitative content analysis. Results Work satisfaction in HHC was organised into one theme ‘alone and together’ under four categories—the patient, the co-worker, the registered nurse, and the organisation—and 15 subcategories, including patient diversity, supportive co-workers and professional environment, appropriate workload and responsibilities, and provision of preconditions for self-management. Conclusions Patients, co-workers, and organisations were identified as crucial areas affecting RNs’ work satisfaction in the municipal HHC. Awareness of these areas is essential to promote RNs’ work satisfaction. Patients’ diversity adds positively to RNs’ work satisfaction. Notably, RNs working alone can affect their work satisfaction not only negatively but also positively.

Abstract Background Circulating total insulin-like growth factor-I (IGF-I) is an established risk factor for prostate cancer. However, only a small proportion of circulating IGF-I is free or readily dissociable from IGF-binding proteins (its bioavailable form), and few studies have investigated the association of circulating free IGF-I with prostate cancer risk. Methods We analyzed data from 767 prostate cancer cases and 767 matched controls nested within the European Prospective Investigation into Cancer and Nutrition cohort, with an average of 14-years (interquartile range = 2.9) follow-up. Matching variables were study center, length of follow-up, age, and time of day and fasting duration at blood collection. Circulating free IGF-I concentration was measured in serum samples collected at recruitment visit (mean age 55 years old; standard deviation = 7.1) using an enzyme-linked immunosorbent assay (ELISA). Conditional logistic regressions were performed to examine the associations of free IGF-I with risk of prostate cancer overall and subdivided by time to diagnosis (≤ 14 and > 14 years), and tumor characteristics. Results Circulating free IGF-I concentrations (in fourths and as a continuous variable) were not associated with prostate cancer risk overall (odds ratio [OR] = 1.00 per 0.1 nmol/L increment, 95% CI: 0.99, 1.02) or by time to diagnosis, or with prostate cancer subtypes, including tumor stage and histological grade. Conclusions Estimated circulating free IGF-I was not associated with prostate cancer risk. Further research may consider other assay methods that estimate bioavailable IGF-I to provide more insight into the well-substantiated association between circulating total IGF-I and subsequent prostate cancer risk.

Introduction and objective: Agenesis of one or more teeth is common among patients who are referred for orthodontic treatment. The most common treatments are orthodontic space closure (SC) and implant replacement (IR), which are widely studied, but the experiences of patients receiving these treatments have received little attention. The aim of this qualitative study is to explore how treatments to address missing maxillary lateral incisors (MMLIs) are experienced by individuals who are treated using either orthodontic SC or IR. Materials and methods: This study is conducted in Sweden and based on semi-structured interviews with 13 individuals who have completed treatment, either orthodontic SC (n = 7) or IR (n = 6), to address the lack of one or two maxillary lateral incisors. Data were analysed in accordance with the grounded theory approach. Results: Findings were classified into the main category of being different during treatment and into three associated sub-categories. The first category, that is being different due to missing teeth, refers to when a person experiences being different because of the anterior spacing The second category, that is being different due to fixed appliance, refers to when the appliance itself makes a person different. The two first categories exemplify being different in terms of appearance. The third identified category, that is being different due to treatment appointments, refers to the need to spend time differently because of having appointments at the clinic for treatment. Conclusion: Patients MMLIs consider their treatment to start at the time of diagnosis. They experience feelings of being different irrespective of whether the type of treatment is orthodontic SC or IR. The experience of being different differs in timing and causes depending on the treatment method.

IntroductionAdolescent autistic girls in mainstream schools experience more loneliness and exclusion than their peers. Swedish schools have a long tradition of working towards inclusion but, despite this commitment, these girls are at higher risk of absenteeism and failing to achieve educational objectives. Bearing this in mind, it is important to understand how autistic girls navigate their everyday school life from a first-hand perspective and develop a broader understanding of what shapes their opportunities for and barriers to participation.MethodsThis qualitative study draws on multiple semi-structured interviews with 11 autistic girls, aged 13–15, exploring how they navigate having an autism diagnosis within a Swedish secondary school context.ResultsWhile on a personal level the diagnosis itself was mostly perceived as positive, the girls expressed ambivalence about making sense of it in the school context. The girls expressed awareness of the perceptions and understanding of autism in their school setting, and their consequences in terms of both support and exclusion and stigmatisation. The sense of being perceived by others as different, accompanied by a desire to belong and an awareness of stigma, seemed to have a strong impact on how they navigated everyday school life. This created field of tension between the social context of school, its values and norms, and the girls’ personal experiences and views about autism.DiscussionThe girls’ accounts illustrate the complex reality of their school lives post diagnosis. Valuable implications for practice include the need to work towards a discourse in schools in which differences are seen as natural, and guidance post diagnosis to build the girls’ awareness and understanding and enable them to develop strategies for successfully navigating school.

Summary: Background: Understanding cellular responses to SARS-CoV-2 immunisations is important for informing vaccine recommendations in patients with inflammatory bowel disease (IBD) and other vulnerable patients on immunosuppressive therapies. This study investigated the magnitude and quality of T cell responses after multiple SARS-CoV-2 vaccine doses and COVID-19 breakthrough infection. Methods: This prospective, observational study included patients with IBD and arthritis on tumour necrosis factor inhibitors (TNFi) receiving up to four SARS-CoV-2 vaccine doses. T cell responses to SARS-CoV-2 peptides were measured by flow cytometry before and 2–4 weeks after vaccinations and breakthrough infection to assess the frequency and polyfunctionality of responding cells, along with receptor-binding domain (anti-RBD) antibodies. Findings: Between March 2, 2021, and December 20, 2022, 143 patients (118 IBD, 25 arthritis) and 73 healthy controls were included. In patients with either IBD or arthritis, humoral immunity was attenuated compared to healthy controls (median anti-RBD levels 3391 vs. 6280 BAU/ml, p = 0.008) after three SARS-CoV-2 vaccine doses. Patients with IBD had comparable quantities (median CD4 0.11% vs. 0.11%, p = 0.26, CD8 0.031% vs. 0.047%, p = 0.33) and quality (polyfunctionality score: 0.403 vs. 0.371, p = 0.39; 0.105 vs. 0.101, p = 0.87) of spike-specific T cells to healthy controls. Patients with arthritis had lower frequencies but comparable quality of responding T cells to controls. Breakthrough infection increased spike-specific CD8 T cell quality and T cell responses against non-spike peptides. Interpretation: Patients with IBD on TNFi have T cell responses comparable to healthy controls despite attenuated humoral responses following three vaccine doses. Repeated vaccination and breakthrough infection increased the quality of T cell responses. Our study adds evidence that, in the absence of other risk factors, this group may in future be able to follow the general recommendations for COVID-19 vaccines. Funding: South-Eastern Norway Regional Health Authority, Coalition for Epidemic Preparedness Innovations (CEPI), Norwegian Institute of Public Health, Akershus University Hospital, Diakonhjemmet Hospital.

Combination therapies in metastatic hormone-sensitive prostate cancer (mHSPC), which include the addition of an androgen receptor signaling inhibitor and/or docetaxel to androgen deprivation therapy, have been a game changer in the management of this disease stage. However, these therapies come with their fair share of toxicities and side effects. The goal of this observational study is to report drug-related adverse events (AEs), which are correlated with systemic combination therapies for mHSPC. Determining the optimal treatment option requires large cohorts to estimate the tolerability and AEs of these combination therapies in “real-life” patients with mHSPC, as provided in this study. We use a network of databases that includes population-based registries, electronic health records, and insurance claims, containing the overall target population and subgroups of patients defined by unique certain characteristics, demographics, and comorbidities, to compute the incidence of common AEs associated with systemic therapies in the setting of mHSPC. These data sources are standardised using the Observational Medical Outcomes Partnership Common Data Model. We perform the descriptive statistics as well as calculate the AE incidence rate separately for each treatment group, stratified by age groups and index year. The time until the first event is estimated using the Kaplan-Meier method within each age group. In the case of episodic events, the anticipated mean cumulative counts of events are calculated. Our study will allow clinicians to tailor optimal therapies for mHSPC patients, and they will serve as a basis for comparative method studies.

Abstract Background Physical activity (PA) promotes health in adults as well as children. At the same time, a large proportion of children do not meet the recommendations for PA, and more school-based efforts to increase PA are needed. This study investigates the effectiveness and feasibility of lesson-integrated PA in a Swedish primary school. Methods We evaluate a new method called ‘Physical Activity and Lesson in Combination’ (abbreviated FALK in Swedish) using a mixed methods approach; a quasi-experimental study followed by qualitative interviews. Two schools participated in the study, one constituting the intervention group (I-school, n = 83) and the other the control group (C-school, n = 81). In addition to regular physical education, the I-school had three 30-minute FALK lessons each week. A total of 164 students aged 7–9 years wore pedometers for a whole week, four times over two semesters, and the number of steps per day (SPD) and the proportion of students with

Summary: Background & Aim: Various initiatives have been taken and recommended to improve foodservice and nutritional care to hospitals patients. However, a broad description and analysis of what has been done to reach a better foodservice is lacking. Consequently, the aim of this paper is to map aspects highlighted as important in scientific articles pertaining to the improvement of foodservice for hospital inpatients. Methods: A scoping review was conducted, including literature searches in four databases (CINAHL, PubMed, Scopus, Web of Science) and an article selection process. Included studies were peer reviewed primary research written in English, published in 2000–2023, focusing on quality and improvement work in organisations and practice concerning provision of food and meals to hospital inpatients. Besides data charting of article characteristics, data were obtained for qualitative synthesis. Results: Out of the 103 included articles, almost all (n=102) contained aspects associated with systems of different kinds. Foremost were systems for ordering, production, delivery and menus. Additionally, there were systems for structures, evaluation, and control. Other frequently occurring aspects concerned patients (n=84), e.g. considering their nutritional requirements, preferences, and cultural habits, as well as empowering patients with freedom of choice, information and guidance. Aspects concerning professional development, e.g. training, competence and teamwork were scarcer (n=46) and even fewer articles entailed aspects regarding leadership (n=21). Conclusions: The broad spectrum of aspects that were identified may provide guidance to quality improvement of hospital foodservice. It also indicated research gaps in this field, foremost concerning relational competence and leadership.

In Mach 2020, the Norwegian schools were closed in response to Covid19. The current study concerns teachers' experiences of distance teaching in April 2020 during the online schooling period in one Norwegian municipality. A survey was sent via e-mail to all teachers in primary and secondary state schools in the explored municipality. Thematic analysis of the data provided the following three themes: (1) Adjustment of teaching context; (2) Involving and supportive management; and (3) A culture of collaboration and sharing. Distance teaching is time-consuming for teachers, increases inequality in learning and increases the needs for adaptive education. Teachers' experience of interaction and collaboration with other professions is generally challenged and reduced due to online schooling.

How do male-dominated populist radical right (PRR) parties relate to and influence norms around women’s political inclusion and leadership in mainstream political parties? While research has focused on describing the male dominance of PRR parties or its influence on mainstream political parties’ policies, particularly immigration, we know less about how PRR parties relate to norms on women’s inclusion or gender-balanced representation in mainstream parties. In a theory-building effort, we posit that PRR parties may seek to (a) adapt to mainstream parties’ norms and include more women in leading positions (positive contagion) or (b) negatively affect or even challenge norms around women’s inclusion in mainstream parties (adverse contagion). Seeking to theorize this relationship further, we explore leadership selection in the Swedish Parliament, where gender balance constitutes a strong norm. Yet, following the 2022 elections, the proportion of women parliamentary leaders dipped below 30% for the first time in decades. At the same time, the Sweden Democrats, a male-dominated PRR party, emerged as the second-largest party in Parliament. Drawing on interviews with nomination committees, party documents, and data on leadership, we empirically investigate continuity and change in committee leadership appointments in the Swedish Parliament and the role of the radical right in this process. We do not find signs of adverse contagion in the short run: as of 2023, norms promoting gender balance appear to remain robust and enjoy widespread support among mainstream parties. Yet, neither do we find signs of positive contagion where the radical right adapts to mainstream norms around gender balance.

Many disabled people cannot live out their sexuality or exercise their sexual citizenship without assistance. There is a lack of knowledge concerning experiences and needs related to personal assistance to live out one’s sexuality and how to support sexual citizenship when living with a disability and receiving personal assistance services in the Norwegian context. This study presents the experiences and attitudes of disabled people in Norway concerning personal assistance services and sexual citizenship. A cross-sectional quantitative survey was answered by 67 disabled people living with personal assistance services. The results show that 67.1% of the respondents would rather avoid sexual activity than receive assistance with these activities, 50% found it uncomfortable to talk about sexual health, and 76% feared that conversations about sexual health would make the personal assistant uncomfortable. Service providers and municipalities should acknowledge the sexual needs of disabled people and organize services to meet these needs without personal assistants feeling uncomfortable or exploited.

Sexual health is a neglected topic in prisons, even though sexual health is a basic human need that includes physical, mental, social and spiritual aspects. There is limited knowledge concerning how to promote and sustain the sexual health of prisoners. The aim of this study was to increase knowledge of sexual health promotion as a health resource in prisons. By conducting a scoping review, we searched for sexual health-promoting activities, approaches or experiences from prisons globally. The findings included sexual health interventions covering conjugal visits and sexual health promotion through education and collaboration. There are connections between mental health and sexual health for prisoners, and sexual health also influences quality of life. In conclusion, it is evident that there is a significant imperative for further research, interventions and measures in this domain to ensure holistic rehabilitation for prisoners.

In celiac disease, intestinal transglutaminase (TG2) produces immunogenic peptides by deamidation of gluten proteins. These products drive the celiac immune response. We have previously identified an interaction between gliadin and a food additive, E304i, which prevents gliadin processing (both deamidation and transamidation) by TG2, in vitro. In this study, we investigated if E304i could prevent TG2 processing of gluten in flours and if the effect was evident after simulated gastrointestinal digestion. We also confirmed the outcome in vivo in a human cross-over intervention study in healthy non-celiac participants. TG2 transamidation experiments (in vitro) of digested wheat and rye flours supplemented with E304i at 30 mg/g indicated full prevention of TG2 processing. In the intervention study, participant serum levels of deamidated gliadin peptides (dGDPs) increased after the intake of reference wheat rolls (80 g per day for a week; 41% ± 4% compared to washout), while the intake of the intervention E304i/zinc sulfate wheat rolls generated a modest response (80 g per day for a week; 8 ± 10% of control). The difference between the groups (32.8 ± 15.6%) was significant (p = 0.00003, n = 9), confirming that E304i /zinc addition to wheat rolls prevented TG2 deamidation of gluten. In conclusion, this study shows that E304i /zinc addition to wheat rolls prevents TG2 deamidation of gluten in non-celiac participants.Clinical trial registrationclinicaltrials.gov, identifier (NCT06005376).