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Abstract Background Speckle tracking echocardiography (STE) provides quantification of left ventricular (LV) deformation and is useful in the assessment of LV function. STE is increasingly being used clinically, and every effort to simplify and standardize STE is important. Manual outlining of regions of interest (ROIs) is labor intensive and may influence assessment of strain values. Purpose We hypothesized that a deep learning (DL) model, trained on clinical echocardiographic exams, can be combined with a readily available echocardiographic analysis software, to automate strain calculation with comparable fidelity to trained cardiologists. Methods Data consisted of still frame echocardiographic images with cardiologist-defined ROIs from 672 clinical echocardiographic exams from a university hospital outpatient clinic. Exams included patients with ischemic heart disease, heart failure, valvular disease, and conduction abnormalities, and some healthy subjects. An EfficientNetB1-based architecture was employed, and different techniques and properties including data set size, data quality, augmentations, and transfer learning were evaluated. DL predicted ROIs were reintroduced into commercially available echocardiographic analysis software to automatically calculate strain values. Results DL-automated strain calculations had an average absolute difference of 0.75 (95% CI 0.58–0.92) for global longitudinal strain (GLS), and 1.16 (95% CI 1.03–1.29) for single-projection longitudinal strain (LS), compared to operators. A Bland–Altman plot revealed no obvious bias, though there were fewer outliers in the lower average LS ranges. Techniques and data properties yielded no significant increase/decrease in performance. Conclusion The study demonstrates that DL-assisted, automated strain measurements are feasible, and provide results within interobserver variation. Employing DL in echocardiographic analyses could further facilitate adoption of STE parameters in clinical practice and research, and improve reproducibility.

Abstract Background To provide evidence-based, up-to-date recommendations for physicians in primary and specialist healthcare setting in diagnosing and treating patients with polymyalgia rheumatica (PMR). Methods The PMR working group conducted a narrative review of the available evidence in the field and wrote the draft guidelines. These guidelines were discussed and revised according to the standard operating procedures within the Norwegian Society of Rheumatology. The European Alliance of Associations for Rheumatology (EULAR) and American College of Rheumatology (ACR) recommendations for the management of PMR, the British Society for Rheumatology (BSR) guidelines for the management for PMR, the treat-to-target recommendations in giant cell arteritis and PMR and the 2023 recommendations for early referral of individuals with suspected polymyalgia rheumatica were used in particular for purpose of harmonization. Results A total of 10 recommendations have been formulated covering initial diagnostic investigations, comorbidity assessment, imaging, specialist referral criteria, treatment involving glucocorticoids and steroid-sparing agents and follow-up care. Conclusion Norwegian recommendations for diagnostics and treatment to improve management and outcome in patients with PMR were developed.

Background Point-of-care ultrasound (POCUS) has long been a diagnostic tool in family medicine, although most Norwegian general practitioners (GPs) who use POCUS, scans infrequently. The broad scope of family medicine, the relatively low prevalence of illnesses and infrequent use of POCUS imply that GPs may experience diagnostic uncertainty regularly.Aim To explore how GPs perceived and managed diagnostic uncertainty when using POCUS.Design and setting A qualitative focus group study among Norwegian GPs using POCUS.Methods Four focus group discussions were conducted. Total number of participants were 21. The interview guide was piloted, the focus group discussions were audio-recorded and transcribed, and Systematic Text Condensation, a thematic cross-case analysis, was used to analyse the data.Results Diagnostic uncertainty using POCUS was considered as aligning to the general clinical uncertainties in family medicine, but there were also POCUS-specific uncertainties in clinical decision-making. We generated six themes: emotional, cognitive, and ethical uncertainty using POCUS, communicating uncertainty to patients, interaction with specialists when using POCUS, and coping strategies of participants. POCUS results were the only results the participants sometimes withheld when communicating with other specialists. POCUS itself stimulated a renewed interest in family medicine. Scanning enough patients was the recommended coping strategy.Conclusion POCUS-using GPs experienced diagnostic uncertainty when using POCUS that aligned with other diagnostic uncertainties they experienced in everyday practice. However, they did not treat the results like other findings, as the GPs at times withheld their POCUS findings when interacting with secondary care specialists. This requires further investigation.

This paper explores teachers' educational values and how they shape their judgements about physically active learning (PAL). Twenty one teachers from four primary schools in Norway participated in focus groups. By conceptualising PAL as a didaktikk approach, the findings indicated that teachers engaged with PAL in a way that reflected their professional identity and previous experiences with the curriculum. Teachers valued PAL as a way of getting to know pupils in educational situations that were different from those when sedentary. These insights illustrate how PAL, as a didaktikk approach to teaching, can shift teachers' perceptions of pupils' knowledge, learning, and identity formation in ways that reflect the wider purposes of education. The paper gives support to a classroom discourse that moves beyond the traditional, sedentary one-way transfer of knowledge towards a more collaborative effort for pupils' development.

Access to books and a rich language environment at home are important for children's language development. In this study we explored self-reported reading practices in families in Norway (N = 1001) to gain insight into the reading habits parents have with their young children, and the factors that best explain book reading in Norwegian homes. By investigating relationships between how many books parents reported reading with their child last week, demographic factors, and orientational variables, we found that book reading is better explained by orientational factors -- such as children's interest in books and having reading routines in the home -- than by demographic factors (such as parents' educational level). The proportion of parents reporting reading no books, or only one book with their child in the last week was unexpectedly large (33%). The implication of these findings for the culture of reading in Norwegian homes is discussed.

Youth Flexible Assertive Community Treatment (Youth Flexible ACT) is a service model for children and young people with severe mental health problems and complex needs aimed at providing integrated, continuous and holistic care. Studies on young people’s experiences of Youth Flexible ACT or similar models are scarce. The present qualitative study aimed to explore and describe how young people with severe mental health problems and complex needs experience follow-up and treatment provided by Youth Flexible ACT teams. Semi-structured interviews were conducted with 14 young people (age range, 15–19 years) who were being followed up by a Youth Flexible ACT team. Qualitative content analysis was used, and the following two overarching themes characterizing the young people’s experiences of follow-up and treatment provided by Youth Flexible ACT teams were identified: (1) trusting and collaborative relationships, and (2) organization matters. The participants experienced a more personal relationship with the staff, who behaved more like friends and paid attention to resources, interests, solutions and their context. The participants emphasized and valued components that coincided with the Youth Flexible ACT model, indicating a match between what the young people needed and wanted and what the model was supposed to provide. The team providing these relationships and youth-friendly and developmentally sensitive care appeared to be facilitated by how the service model was organized, with the teams being flexible and accessible while providing integrated, multifaceted help and systemic follow-up.

PCR-based diagnostics has revealed the previously largely unknown Cryptosporidium transmission and infections in high-income countries. This study aimed to determine domestic and imported subtypes of Cryptosporidium species in Norway, evaluate their demographic distribution, and identify potential small outbreaks. Cryptosporidium-positive human faecal samples were obtained from six medical microbiology laboratories between February 2022 and January 2024, together with 22 Cryptosporidium-positive animal samples. Species and subtypes were identified by sequencing PCR products from gp60 and SSU rRNA genes. Most cryptosporidiosis cases occurred during late summer/early autumn, primarily in children and young adults. Of 550 human samples, 359 were successfully characterized molecularly (65%), revealing infection with 10 different Cryptosporidium species. C. parvum occurred in 245 (68%) human isolates with IIa and IId being major allele families, with distinct regional distribution patterns of common subtypes. A kindergarten outbreak with 5 cases was due to C. parvum IIaA14G1R1. C. mortiferum was identified in 33 (9.2%) human cases of which 24 were known to be of domestic origin, making it the second most common species in human autochthonous cases in Norway. All C. mortiferum isolates were of the same genotype; XIVaA20G2T1, including 13 cases from a suspected small outbreak in Trøndelag. C. hominis occurred in 68 typed cases (19%), but mostly in infections acquired abroad, with allele families Ib and If occurring most often. In conclusion, this study of recent Cryptosporidium spp. and subtypes in Norway, highlights the predominance of C. parvum and the emergence of C. mortiferum among autochthonous cases.

Food waste is a major source of avoidable greenhouse gas emissions. Responsible research and innovation (RRI) should contribute to meeting urgent challenges like climate change. This paper discusses collaborative innovations to reduce food waste and analyses this from the perspective of RRI, understood as purpose and process requirements. We study to what extent the focus on a responsible innovation outcome in Norwegian food supply chain collaboration corresponds with respecting the process dimensions of RRI, based on interviews and a consensus conference process. This contributes to understanding whether an urgent purpose can facilitate or is a barrier to the process dimensions of RRI. We find that besides aiming for a good outcome, the food companies intend to innovate in an inclusive and reflective way. The sustainability agenda as an important purpose for innovation, and the urgency of the goal of reducing food waste, is in our study well aligned with RRI.

Formålet med denne studien var å undersøke relasjonen mellom lærerstøtte, elevers mestringsforventninger og målorienteringer (2×2-modellen), og deres selvregulerte læring i kroppsøving. Betydningen av lærerstøtte ble undersøkt både direkte og gjennom elevenes mestringsforventninger og målorienteringer. I alt 480 elever fra ungdoms- og videregående skole i Norge deltok i en spørreundersøkelse, og dataene ble analysert i en strukturell ligningsmodell (SEM). Resultatene peker på lærerstøtte som den mest betydningsfulle faktoren for elevenes selvregulerte læring, noe som viser at kroppsøvingslærere kan og bør aktivt støtte elevenes læringsbevissthet i faget. Modellen indikerer i tillegg at lærere kan styrke elevers mestringsforventninger i faget, som også bidrar positivt for å fremme selvregulert læring. Til slutt tydeliggjøres det at mestringsmålene blant målorienteringene er det som er positivt assosiert med selvregulert læring, mens prestasjonsmålene ikke viser noen signifikant sammenheng. Resultatene fra denne studien er dermed et bidrag som støtter forståelsen av den viktige rollen læreren kan ha i å støtte elevenes læringsprosesser. ENGLISH ABSTRACT The Impact of Teacher Learning Support on Students Self-Regulated Learning in Norwegian Physical Education – Mediated Through Students’ Self-Efficacy and Goal Orientations The purpose of this study was to investigate the relationship between teacher learning support, students’ self-efficacy and goal orientations (2×2-model), and their self-regulated learning in physical education. The importance of teacher learning support was examined both directly and through students’ self-efficacy and goal orientations. A total of 480 students from Norwegian lower and upper secondary school participated in a cross-sectional questionnaire, and the data were analyzed using a structural equation model (SEM). The results indicate that teacher learning support is the most prominent factor for students’ self-regulated learning, meaning that teachers should actively support students’ awareness of own learning processes in physical education. The structural model also indicates that teachers can enhance students’ self-efficacy, which in turn contributes to their self-regulated learning. Finally, both mastery goals are positively associated with self-regulated learning, while no significant relationship is found with the performance goals. The results from this study contribute to the understanding that teachers may play an important role in students’ learning processes.

Biological maturity significantly impacts youth athletes’ physical performance throughout adolescence. However, how this differs between male and female youth athletes remains unclear. Thus, the present study aimed to assess associations between maturity, physical performance and motor coordination in females and males. Sixty-eight youth athletes (mean age 13.9 ± 0.8 years, 26 females) were included in the present study. Participants performed a 40 m sprint, standing long jump (SLJ), push-ups and a 2,000 m run. Motor coordination was evaluated using the short form of the Körperkoordinationstest für Kinder test. Bone age (BA), assessed by x-ray of the left hand and analyzed with an automated software, was used as a biomarker of biological maturity. Results showed that BA was significantly associated with performance for males on 40 m sprint (r = −.556, p

Operating in urban waters with an autonomous vessel can be challenging. The autonomous vessel must be able to react quickly and detect obstacles to avoid collisions and risky maneuvers. Exteroceptive sensors such as LiDAR and RADAR have typically been used with great success in the maritime domain, but the measurements are often too sparse to represent smaller obstacles during docking and other maritime operations. However, other sensor modalities, such as stereo cameras, can provide both appearance and dense depth information. In this paper, we present a stereo camera-based free space estimation method for the maritime domain. The mapping of navigable areas is crucial for path planning and collision avoidance systems. To robustly estimate the free space, we use vertically oriented rectangular segments known as stixels. We utilized both stereo correspondences and a recent image segmentation network trained on a large, generalized dataset to create the stixels. To validate our approach, we analyzed the estimated free space, evaluating both the accuracy and consistency in the estimated depth over time. We demonstrate the approach using a real dataset recorded with a stereo camera mounted on an autonomous ferry and compare its accuracy against measurements from a LiDAR.

Background:. Patients with major burn injuries are prone to massive blood loss owing to tangential excision of burn wounds and donor skin harvesting. In general, topical application of the antifibrinolytic drug tranexamic acid (TXA) to surgical wounds reduces bleeding; however, its effect on bleeding and re-epithelialization in superficial wounds of burns has not been explored. Methods:. This study aimed to investigate the therapeutic potential of topical TXA in reducing blood loss and its effect on wound re-epithelialization in burn surgery. Split-thickness skin graft donor wounds in burn patients were paired and randomized to topical application of either TXA (25 mg/mL) or placebo. Endpoints were postoperative bleeding as measured by dressing weight gain per cm2 wound area, blood stain area per wound area, and visual evaluation of bleeding in the dressings. Healing time was recorded to analyze the effect on wound re-epithelialization. Results:. There was no significant difference in bleeding or time to re-epithelialization between the TXA and placebo wounds. A post hoc subanalysis of wounds with dressing weight gain above the median, showed a significant difference in favor of TXA. However, use of tumescence may have influenced end points. No significant adverse events related to the study drugs were observed. Conclusions:. This study demonstrates that topical application of TXA (25 mg/mL) to split-thickness skin graft donor wounds does not delay re-epithelialization. Although a reduction in bleeding is suggested, further studies are needed to determine the role of topical TXA in reducing bleeding in burn surgery.

In 2018, the Centre for Physical Active Learning (SEFAL) designed a comprehensive one-year workplace-based continuous professional development (CPD) program for in-service teachers in Norway. The CPD program aimed to enhance the pedagogical feasibility of integrating physically active learning (PAL) within all theoretical subjects by advancing teachers’ competence. This article provides an overview of the SEFAL CPD program’s conceptual framework and design. Although the article does not provide an independent evaluation of the framework, we discuss it based on our continual development during the period from 2018 to 2023, during which 1,363 teachers from 77 schools participated. As the framework continues to inform the SEFAL CPD, the article concludes by identifying prospective directions and potential avenues for further refinement and utilisation of this and similar programs.

Becoming a parent is a vulnerable life transition and may affect parents’ mental health. Depressive symptoms may occur in fathers, as well as mothers, during pregnancy and the postpartum period. The health service is expected to have a family perspective, aiming to support both parents. Despite this goal, mothers traditionally receive more support than fathers. Home visiting programs may provide enhanced guidance for new fathers and increased mental health support. The aim of this study was therefore to assess possible differences in level of depressive symptom in fathers receiving the New Families home visiting program compared with those receiving standard care from the Norwegian Child Health Service. A prospective nonrandomized controlled study with a parallel group design was performed. The Edinburg Postnatal Depression Scale (EPDS) was used to measure depressive symptoms in fathers ( N = 197) at 28 weeks of their partners’ pregnancy (T1), at 6 weeks (T2), and 3 months postpartum (T3), in the intervention and the control group. The results indicate a prevalence of depressive symptoms (EPDS score ≥ 10) in Norwegian fathers of 3.1% at T1, 3.9% at T2, and 2.2% at T3 for the full sample. No significant EPDS score differences were found between the intervention and the control group at six weeks and three months postpartum. This suggests that the intervention had no clear impact on depressive symptoms during this time-period.

ObjectivesTo evaluate relapses in giant cell arteritis (GCA), investigate the utility of vascular ultrasound to detect relapses, and develop and assess a composite score for GCA disease activity (GCAS) based on clinical symptoms, ultrasound imaging activity, and C-reactive protein (CRP).MethodsPatients with GCA were prospectively followed with scheduled visits, including assessment for clinical relapse, protocol ultrasound examination, and CRP. At each visit, patients were defined as having ultrasound remission or relapse. GCAS was calculated at every visit.ResultsThe study included 132 patients, with a median follow-up time of 25 months [interquartile range (IR) 21]. The clinical relapse rate was 60.6%. There were no differences in relapse rates between GCA subtypes (cranial-GCA, large vessel (LV)-GCA, and mixed-GCA) (p = 0.83). Ultrasound yielded a sensitivity of 61.2% and a specificity of 72.3% for diagnosing GCA- relapse in our cohort. In 7.7% of follow-up visits with clinical relapses, neither high CRP nor findings of ultrasound relapse were registered. In comparison, in 10.3% of follow-up visits without symptoms of clinical relapse, there were both a high CRP and findings of ultrasound relapse.ConclusionWe found moderate sensitivity and specificity for ultrasound as a monitoring tool for relapse in this prospective cohort of GCA patients. The extent or subtype of vasculitis at the diagnosis did not influence the number of relapses. Based on a combination of clinical symptoms, elevated CRP, and ultrasound findings, a composite score for GCA activity is proposed.

The organisation and development strategies of youth soccer differ between Norway and Iceland. Whether this affect physical capacity is unknown. Thus, the first aim of the present study is to compare physical capacity between players from Iceland and Norway. Secondary aim is to assess associations between biological maturity and physical capacity in the Icelandic players since an association previously has been shown among the Norwegians. There were 48 U14 players from Iceland included and 103 players from Norway. Bone age (BA), measured with left-wrist x-ray, was used as an indicator of biological maturity. To measure physical capacity, 40 metre (m) linear sprint, standing long jump (SLJ), countermovement jump (CMJ), the Yo-Yo intermittent recovery test (IR1-test) and a maximal oxygen uptake test (VO2max) were used. Training load was assessed by questionnaire. The results showed that the Norwegian players ran faster (5.90 ± 0.38 vs. 6.37 ± 0.44 s, p

Abstract Early embryo mortality has recently been proven to be a significant component of avian reproductive failure. Due to the difficulty in distinguishing eggs, which have suffered early embryo mortality from unfertilised eggs, this cause of reproductive failure has historically been underestimated and overlooked. We describe methods for recognising and collecting early failed, unhatched eggs from wild bird populations, identifying and isolating embryonic material in unhatched eggs, and efficiently extracting DNA from those samples. We test these methods on unhatched hihi (Notiomystis cincta) eggs collected from the field, which have undergone postmortem incubation. We obtained DNA yields from early‐stage embryos that are sufficient for a wide range of molecular techniques, including microsatellite genotyping for parentage analysis and sex‐typing. The type of tissue sample taken from the egg affected downstream DNA yields and microsatellite amplification rates. Species‐specific microsatellite markers had higher amplification success rates than cross‐species markers. We make key recommendations for each stage of the sampling and extraction process and suggest potential protocol improvements and modifications. Genetic and possibly genomic analysis of embryos that die early in development has the potential to advance many fields. The methods described here will allow a more in‐depth exploration of the previously overlooked causes of early embryo mortality in wild populations of birds, including threatened species.

In recent years, the Poisson multi-Bernoulli mixture (PMBM) filter has been established among the state-of-the art methods in target tracking. We present a method for including target-provided measurements in said filter, both when using it to track extended objects and point targets. We use messages from the Automatic identification system as an example of target-provided measurements, and radar and LiDAR as examples of exteroceptive sensors. In the point target case, we utilize several different kinematic models in parallel through the interacting multiple models framework, and compare the presented method to several common trackers and other PMBM filter configurations. The results show that our method outperforms similar methods when target-provided measurements are available. The point target variant is also shown to work in a closed-loop collision avoidance experiment in a maritime environment, demonstrating its feasibility for use in real-world applications. For the extended object tracking case, we expand upon the Gaussian process PMBM filter. The extended object method is evaluated on both simulated and experimental data, and is shown to improve the tracking performance when including target-provided measurements in comparison to when it only uses exteroceptive measurements.

In this introduction we want to bring attention to and provide a contextualization and analysis of the last years burning of the Quran that have taken place and still takes place in the Nordic and Scandinavian context. Whilst many countries around the world still have blasphemy laws or laws against religious hatred that protect “religion” (however defined), or religious sensibilities from being desecrated or mocked, most Western countries, including Sweden, Denmark and Norway have removed blasphemy laws and made it possible to offer critique of religion, including the right to criticize religious texts. While this special issue primarily discusses the contemporary practice of public rituals where a physical copy of the Quran is burnt, we argue that understanding why this practice has become so widespread in the Nordic region requires a historical awareness of how blasphemy, as well as freedom of religion and freedom of expression have been understood and practiced in this very specific cultural and political environment of the far corners of Europe. Besides providing a historical background, the introduction includes an overview to how Muslims have discussed how to handle copies of the Quran that have been worn-out and why the intention is important for understanding the controversy around the burning of the Quran.

Background: Research has indicated that providing women with information about menopause can improve their attitudes towards it and symptom experience. Nevertheless, information shared on the menopause is often arbitrary. Aim: To examine women’s information needs about menopause, and understand if, when, and from whom they want information. Design & setting: A cross-sectional study was undertaken. A questionnaire survey was distributed to women in the waiting room of 54 general practice clinics in South-Eastern Norway in autumn 2022. Method: Medical students recruited women in the clinic waiting rooms. A 1-page study-specific questionnaire was used, focusing on need for information about menopause. A multinominal logistic regression model was used to analyse the association between the desire for information and education level, country of birth, and menopausal status. Results: A total of 625 women were included, with a mean age of 44.4 years (standard deviation [SD] 8.7). In all, 59% answered that they wanted information about menopause, and 81% of these wanted their GP to inform them, from a median age of 45 years. According to the women, only 10% of GPs had initiated a discussion on the menopause. Higher education was a predictor for wanting information. A main driver of information needs was to help oneself in the present and in the future. In all, 33% did not want information. The main reasons were that they already possessed sufficient information, would take menopause as it comes, were too young, or were already postmenopausal. The sex of the GP did not influence the results. Conclusion: Most women wanted information about menopause from their GP. The study emphasises the need for GPs to consider prioritising this discussion, and to keep up to date on recommendations and treatment options.

Abstract Background The transition to motherhood is characterized by physical, psychological, social, and relational changes. Quality of life (QoL) changes substantially during this transition. Higher QoL is associated with social support, essential for coping with the challenges and changes of becoming a mother. An early universal home visiting program (New Families) is developed to strengthen and support families. The study aims to evaluate the impact of New Families on first-time mothers’ QoL and to investigate the association between their QoL, social support, and selected possible predictive factors. Methods A prospective non-randomized controlled study with parallel group design. Child Health Services in five city districts of Oslo were matched in intervention and control groups. First-time mothers were allocated based on the residential area and assessed at pregnancy week 28 (N = 228), six weeks postpartum (N = 184), and three months postpartum (N = 167). Measures of the World Health Organization Quality of Life brief, Perinatal Infant Care Social Support Scale, and background variables were collected from October 2018 to June 2020. Multivariate linear regression models were applied to examine intervention impact and assess associations. Results Our data did not reveal a significant association between New Families intervention and the QoL levels of first-time mothers at three months postpartum. Thus, we analyzed the whole sample together. Emotional support was significantly associated with higher QoL levels in the physical health (B = 0.19, 95%CI [0.04 to 0.34]) and social relationships (B = 0.40, 95%CI [0.20 to 0.60]) domains. Appraisal support was significantly associated with higher QoL levels in the psychological (B = 0.34, 95%CI [0.18 to 0.50]) and environment (B = 0.33, 95%CI [0.19 to 0.48]) domains. QoL levels in pregnancy were significantly associated with QoL levels postpartum, showing small to medium effect size (ES = 0.30 to 0.55), depending on the domain. Conclusions Further research, including qualitative interviews, could provide more insights into the impact of New Families on QoL. A positive association between QoL levels in pregnancy and postpartum suggests that postnatal interventions targeting improved QoL could potentially improve postpartum QoL. Emotional and appraisal support seems beneficial for first-time mothers’ QoL and could be provided and facilitated by public health nurses. Trial registration clinicaltrial.gov NCT04162626.

Abstract Background Raising a child with disabilities requires a significant parental investment that is greater than that required by typically developing children. Previous studies have shown that parents caring for a child with a disability experience a range of health problems, particularly the mothers. However, few of these studies have controlled for maternal health prior to birth. Methods This study used a sample from the Norwegian administrative register that comprised all children born between 2009 and 2015. We followed the mothers and their children for 11 years, between 2009 and 2019. The outcome variable was the mothers’ physical and mental health, which was assessed using specific ICD-10 diagnoses recorded in the Norwegian Patient Register (NPR). The data included information on the mothers’ health before and after the birth of their first child, enabling us to control for maternal health prior to birth in our analysis, in addition to socio-demographic characteristics. The analyses of maternal health were performed using multiple logistic regression, and the results are presented on both a relative scale (odds ratio [OR]) and an absolute scale (average marginal effect [AME]), both with 95% confidence intervals. Results Mothers caring for a child with a disability have higher odds of having a diagnosis of a musculoskeletal disorder, depression, anxiety, sleeping disorder or migraines than mothers of children without a disability. The differences between the two groups of mothers decrease after adjusting for the characteristics of the children, mothers and families, but remain significant for musculoskeletal disorder, depression, anxiety and sleeping disorder, although the absolute differences are modest. Conclusion The findings suggest that mothers caring for a child with a disability are more likely to have health problems than mothers of children without a disability after controlling for maternal health prior to birth. Providing more support for mothers of children with a disability might help to improve their health.

Abstract Meiotic recombination through chromosomal crossovers ensures proper segregation of homologous chromosomes during meiosis, while also breaking down linkage disequilibrium and shuffling alleles at loci located on the same chromosome. Rates of recombination can vary between species, but also between and within individuals, sex and chromosomes within species. Indeed, the Atlantic salmon genome is known to have clear sex differences in recombination with female biased heterochiasmy and markedly different landscapes of crossovers between males and females. In male meiosis, crossovers occur strictly in the telomeric regions, whereas in female meiosis crossovers tend to occur closer to the centromeres. However, little is known about the genetic control of these patterns and how this differs at the individual level. Here, we investigate genetic variation in individual measures of recombination in > 5000 large full-sib families of a Norwegian Atlantic salmon breeding population with high-density SNP genotypes. We show that females had 1.6 × higher crossover counts (CC) than males, with autosomal linkage maps spanning a total of 2174 cM in females and 1483 cM in males. However, because of the extreme telomeric bias of male crossovers, female recombination is much more important for generation of new haplotypes with 8 × higher intra-chromosomal genetic shuffling than males. CC was heritable in females (h2 = 0.11) and males (h2 = 0.10), and shuffling was also heritable in both sex but with a lower heritability in females (h2 = 0.06) than in males (h2 = 0.11). Inter-sex genetic correlations for both traits were close to zero, suggesting that rates and distribution of crossovers are genetically distinct traits in males and females, and that there is a potential for independent genetic change in both sexes in the Atlantic Salmon. Together, these findings give novel insights into the genetic architecture of recombination in salmonids and contribute to a better understanding of how rates and distribution of recombination may evolve in eukaryotes more broadly.

Abstract Background Norwegian school health services received a national best-practice guideline in 2017. To promote healthy life skills and identify adolescents needing support, the guideline includes strong recommendations for individual consultations with all 8th graders and increased collaboration with schools. To help implement the recommendations, a blended implementation strategy (SchoolHealth) was co-created with school nurses, students, and stakeholders. SchoolHealth consists of three implementation elements: Digital dialog and administration tool (audit and feedback +), Dialog support (external consultation), and Collaboration materials (targeted dissemination). This hybrid study will test the main and combined effects of the elements on guideline fidelity and effectiveness. Methods The GuideMe study is a factorial cluster randomized controlled trial examining SchoolHealth's effectiveness on guideline fidelity and guideline effectiveness goals. Forty Norwegian secondary schools will be randomized to eight different combinations of the elements in SchoolHealth. Participants will include school nurses and school personnel from these schools, and 8th grade students (n = 1200). Primary outcomes are school nurses' fidelity to the guidelines and student's ability to cope with their life (i.e., health literacy, positive health behaviors and self-efficacy). Quantitative methods will be used to test effects and mechanisms, while mixed- and qualitative methods will be used to explore mechanisms, experiences, and other phenomena in depth. Participants will complete digital questionnaires at the start and end of the schoolyear, and after the consultation during the schoolyear. The study will run in two waves, each lasting for one school year. The multifactorial design allows testing of interactions and main effects due to equal distribution of all factors within each main effect. Sustainment and scale-up of optimized SchoolHealth elements using national infrastructure are simultaneously prepared. Discussion The study will investigate possible effects of the implementation elements in isolation and in combination, and hypothesized implementation mechanisms. In-depth study of user experiences will inform improvements to elements in SchoolHealth. The results will yield causal knowledge about implementation strategies and the mechanisms through which they assert effects. Mixed-methods will provide insights into how and when the elements work. Optimizing guideline implementation elements can support adolescents in a crucial life phase. Trail registration ISRCTN24173836. Registration date 8 August 2022.

Abstract Background Flexible Assertive Community Treatment (FACT) teams have been implemented in Norwegian health and social services over the last years, partly aiming to reduce coercive mental health treatment. We need knowledge about how service users experience coercion within the FACT context. The aim of this paper is to explore service user experiences of coercive mental health treatment in the context of FACT and other treatment contexts they have experienced. Are experiences of coercion different in FACT than in other treatment contexts? If this is the case, which elements of FACT lead to a different experience? Method Within a participatory approach, 24 qualitative interviews with service users in five different FACT teams were analyzed with thematic analysis. Results Participants described negative experiences with formal and informal coercion. Three patterns of experiences with coercion in FACT were identified: FACT as clearly a change for the better, making the best of FACT, and finding that coercion is just as bad in FACT as it was before. Safety, improved quality of treatment, and increased participation were described as mechanisms that can prevent coercion. Conclusion Results from this study support the argument that coercion is at odds with human rights and therefore should be avoided as far as possible. Results suggest that elements of the FACT model may prevent the use of coercion by promoting safety, improved quality of treatment and increased participation.

Abstract Background Measurement of the left ventricular outflow tract diameter (LVOTd) in echocardiography is a common source of error when used to calculate the stroke volume. The aim of this study is to assess whether a deep learning (DL) model, trained on a clinical echocardiographic dataset, can perform automatic LVOTd measurements on par with expert cardiologists. Methods Data consisted of 649 consecutive transthoracic echocardiographic examinations of patients with coronary artery disease admitted to a university hospital. 1304 LVOTd measurements in the parasternal long axis (PLAX) and zoomed parasternal long axis views (ZPLAX) were collected, with each patient having 1–6 measurements per examination. Data quality control was performed by an expert cardiologist, and spatial geometry data was preserved for each LVOTd measurement to convert DL predictions into metric units. A convolutional neural network based on the U-Net was used as the DL model. Results The mean absolute LVOTd error was 1.04 (95% confidence interval [CI] 0.90–1.19) mm for DL predictions on the test set. The mean relative LVOTd errors across all data subgroups ranged from 3.8 to 5.1% for the test set. Generally, the DL model had superior performance on the ZPLAX view compared to the PLAX view. DL model precision for patients with repeated LVOTd measurements had a mean coefficient of variation of 2.2 (95% CI 1.6–2.7) %, which was comparable to the clinicians for the test set. Conclusion DL for automatic LVOTd measurements in PLAX and ZPLAX views is feasible when trained on a limited clinical dataset. While the DL predicted LVOTd measurements were within the expected range of clinical inter-observer variability, the robustness of the DL model requires validation on independent datasets. Future experiments using temporal information and anatomical constraints could improve valvular identification and reduce outliers, which are challenges that must be addressed before clinical utilization. Graphical Abstract