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BackgroundIntensive inpatient treatment programs have shown robust results in the treatment of post-traumatic stress disorder (PTSD). How patients experience this treatment program and what changes they experience as a result of the treatment have, however, only scarcely been explored through qualitative studies.ObjectiveThis study aimed to explore the lived experience of participants in an intensive inpatient trauma treatment program. Our research questions were as follows: how do patients experience intensive trauma-focused treatment? How do they experience possible changes related to participating in the treatment program?MethodsSix patients diagnosed with PTSD with significant comorbidities, who recently participated in an intensive 2-week (4 + 4 days) inpatient trauma treatment program with prolonged exposure (PE), eye movement desensitization and reprocessing (EMDR), and therapist rotation (TR), were interviewed with a semi-structured qualitative interview. Transcripts were analyzed using a thematic analysis approach.ResultsOur analysis resulted in five main themes: (1) the need to feel safe; (2) the benefits of many and different therapeutic encounters; (3) variable experience with elements of treatment; (4) intensity; and (5) experienced change. Our results suggest that feeling safe within the framework of the treatment program facilitated the treatment process. Many and different therapeutic encounters, both through TR and with ward staff, contributed to experienced change. All participants described the intensity as facilitative to trauma processing. However, most participants also describe often feeling too overwhelmed to benefit from all elements of the treatment program.ConclusionsOur findings suggest that participants experience the overall treatment program as beneficial and contributing to experienced change. Participants described the intensity of the program as exhausting, but necessary. Most did, however, report at times of being too overwhelmed to benefit from elements of the program. Consequently, our results prompt us to question the optimal level of intensity.Trial registrationClinicalTrials.gov identifier: NCT05342480. Date of registration: 2022-04-22.

Many Norwegian teachers in Food and Health (Home Economics) do not have any formal subject-specific education. This study aims to explore potential differences between teachers with formal versus no formal Food and Health education. In 2018, Food and Health teachers in all primary and lower secondary schools in Norway were invited to answer a web-based questionnaire. In total, 1170 Food and Health teachers completed the questionnaire. We found several differences between the groups. Most importantly, 49% of the teachers at the secondary school level had formal Food and Health education despite national requirements. Also, a higher proportion of the formally educated group showed more contentment with teaching and reported to a greater extent mastering teaching (p[less than or equal to]0.001) compared to the non-educated group. With higher coverage of formally educated teachers in Food and Health, the subject can be strengthened towards fulfilling its potential of being influential for motivation, knowledge and life skills related to food and health.

Avalanche decision-making falls into two general categories; probabilistic approaches and analytical approaches. Analytical approaches have traditionally been considered applicable to experts only, as they require assessing risk factors precisely and understanding their relevance in each situation. In this study we question this assumption. We asked 1, 220 amateur backcountry recreationalists how relevant they rated and how precisely they could assess 11 avalanche risk factors. We investigated how their avalanche education and experience with avalanche incidents influenced their judgment of precision and relevance, and if avalanches become more predictable with more knowledge. Most recreationalists considered avalanches as predictable. These five factors were judged as highly relevant: signs of instability, distinguishing avalanche terrain from non-avalanche terrain, slope inclination, terrain traps, and distribution of weak layers. Relevance was independent of avalanche education and experience of incidents for all factors but danger level. Amateur recreationalists rated the relevance of the factors like that of experts. Rating of precision increased with more avalanche education, in particularly for these factors: distribution of the weak layers, terrain traps, avalanche size, recognizing avalanche terrain and stopping at safe spots. We recommend adopting an analytical approach for amateur backcountry recreationalists and discuss implications for avalanche forecasting and education.

Current curriculum guidelines emphasise the importance of both nutrition education and the development of practical cooking skills in the school subject Food and Health (FH). This study aimed to explore teachers' and students' perspectives and experiences of current classroom practices in FH. Focus group discussions (FGDs) with teachers and students at three schools in Southern Norway were conducted and thematically analysed. Our findings suggest there is a mismatch between curriculum guidelines and teaching practices. Although teachers understood the benefits of nutrition education, practical cooking activities were prioritised. Three key themes were identified; "students and teachers value cooking" and "limited time," which both explain this mismatch from the perspectives of students and teachers, and pedagogical solutions to "resolve the mismatch," which summarises novel learning activities suggested by students and teachers as a solution for this mismatch. There needs to be a focus on comprehensive nutrition education in FH classes, to improve its pedagogical implications and meet the demands of the curriculum. These findings can be used to inform educators and policymakers on how to strengthen nutrition education in FH.

The objective of the study was to assess the concordance and ranking ability of a non-quantitative 33-item dietary screener developed to assess the diet of young adults in Norway, ‘MyFoodMonth 1.1’, compared to a semi-quantitative food frequency questionnaire (FFQ). Data were collected in a cross-sectional dietary survey evaluating the diets of students at the University of Agder, in southern Norway. The students were asked to complete both a dietary screener and an FFQ. Data collection was carried out from September to December 2020. Participants were first-year university students aged ≥18 years familiar with Scandinavian language. Almost half of the eligible sample (n 344) was excluded due to not completing the FFQ, compared to 1⋅7 % not completing the dietary screener, resulting in 172 (66 % female) participants with a median age of 21 years. For most items of the dietary screener (n 27/33, 82 %), all aspects of diet quality and components of the Diet Quality Score showed moderate-to-strong concordance with the FFQ evaluated using Kendall's tau-b analyses (t > 0⋅31), supported by visual inspection of box and whisker plots and descriptive ranking ability in a cross-tabulation. There was little evidence to suggest that concordance was dependent on sex. The concordance and ranking ability of ‘MyFoodMonth 1.1’ is considered satisfactory compared to a semi-quantitative FFQ. This rapid dietary assessment instrument presents a valuable addition to traditional instruments and a possible solution to recruit hard-to-reach parts of the population.

Due to the possibilities in miniaturization and wearability, photoplethysmography (PPG) has recently gained a large interest not only for heart rate measurement, but also for estimating heart rate variability, which is derived from ECG by convention. The agreement between PPG and ECG-based HRV has been assessed in several studies, but the feasibility of PPG-based HRV estimation is still largely unknown for many conditions. In this study, we assess the feasibility of HRV estimation based on finger PPG during rest, mild physical exercise and mild mental stress. In addition, we compare different variants of signal processing methods including selection of fiducial point and outlier correction. Based on five minutes synchronous recordings of PPG and ECG from 15 healthy participants during each of these three conditions, the PPG-based HRV estimation was assessed for the SDNN and RMSSD parameters, calculated based on two different fiducial points (foot point and maximum slope), with and without outlier correction. The results show that HRV estimation based on finger PPG is feasible during rest and mild mental stress, but can give large errors during mild physical exercise. A good estimation is very dependent on outlier correction and fiducial point selection, and SDNN seems to be a more robust parameter compared to RMSSD for PPG-based HRV estimation.

Background/objectivesPolyphenols are plant secondary metabolites with a large variability in their chemical structure and dietary occurrence that have been associated with some protective effects against several chronic diseases. To date, limited data exist on intake of polyphenols in populations. The current cross-sectional analysis aimed at estimating dietary intakes of all currently known individual polyphenols and total intake per class and subclass, and to identify their main food sources in the European Prospective Investigation into Cancer and Nutrition cohort.MethodsDietary data at baseline were collected using a standardized 24-h dietary recall software administered to 36,037 adult subjects. Dietary data were linked with Phenol-Explorer, a database with data on 502 individual polyphenols in 452 foods and data on polyphenol losses due to cooking and food processing.ResultsMean total polyphenol intake was the highest in Aarhus-Denmark (1786 mg/day in men and 1626 mg/day in women) and the lowest in Greece (744 mg/day in men and 584 mg/day in women). When dividing the subjects into three regions, the highest intake of total polyphenols was observed in the UK health-conscious group, followed by non-Mediterranean (non-MED) and MED countries. The main polyphenol contributors were phenolic acids (52.5-56.9 %), except in men from MED countries and in the UK health-conscious group where they were flavonoids (49.1-61.7 %). Coffee, tea, and fruits were the most important food sources of total polyphenols. A total of 437 different individual polyphenols were consumed, including 94 consumed at a level >1 mg/day. The most abundant ones were the caffeoylquinic acids and the proanthocyanidin oligomers and polymers.ConclusionThis study describes the large number of dietary individual polyphenols consumed and the high variability of their intakes between European populations, particularly between MED and non-MED countries.

Current curriculum guidelines emphasise the importance of both nutrition education and the development of practical cooking skills in the school subject Food and Health (FH). This study aimed to explore teachers’ and students’ perspectives and experiences of current classroom practices in FH. Focus group discussions (FGDs) with teachers and students at three schools in Southern Norway were conducted and thematically analysed. Our findings suggest there is a mismatch between curriculum guidelines and teaching practices. Although teachers understood the benefits of nutrition education, practical cooking activities were prioritised. Three key themes were identified; students and teachers value cooking and limited time, which both explain this mismatch from the perspectives of students and teachers, and pedagogical solutions to resolve the mismatch, which summarises novel learning activities suggested by students and teachers as a solution for this mismatch. There needs to be a focus on comprehensive nutrition education in FH classes, to improve its pedagogical implications and meet the demands of the curriculum. These findings can be used to inform educators and policymakers on how to strengthen nutrition education in FH.

Background: Left vocal cord paralysis (LVCP) is a known complication of patent ductus arteriosus (PDA) surgery in extremely preterm (EP) born neonates; however, consequences of LVCP beyond the first year of life are insufficiently described. Both voice problems and breathing difficulties during physical activity could be expected with an impaired laryngeal inlet. More knowledge may improve the follow-up of EP-born subjects who underwent PDA surgery and prevent confusion between LVCP and other diagnoses.Objectives: Examine the prevalence of LVCP in a nationwide cohort of adults born EP with a history of PDA surgery, and compare symptoms, lung function, and exercise capacity between groups with and without LVCP, and vs. controls born EP and at term.Methods: Adults born EP (

Portion size images are advantageous in dietary assessment. The aim of the present study was to develop and validate new culturally specific image-series for portion size estimation to be used in a new Norwegian version of a British web-based dietary assessment tool (myfood24). Twenty-three image-series of different foods, each containing seven portion size images, were created and validated in a group of adults (n 41, 58 % female) aged 19–44 (median 23), out of which 63 % had higher (tertiary) education. The participants compared 46 portions of pre-weighed foods to the portion size images (1886 comparisons in total). Portion size estimations were either classified as correct, adjacent or misclassified. The weight discrepancy in percentage between the chosen and the correct portion size image was also calculated. Mann–Whitney U tests were used to explore if portion size estimation accuracy differed across sample characteristics, or if it depended on how the foods were presented. For thirty-eight of the forty-six presented food items, the participants selected the correct or adjacent portion size image 98 % on average. The remaining eight food items were on average misclassified by 27 % of the participants. Overall, a mean weight discrepancy of 2⋅5 % was observed between the chosen and the correct portion size images. Females estimated portion size more accurately than males (P = 0⋅019). No other significant differences in estimation accuracy were observed. In conclusion, the new image-series performed satisfactorily, except for the image-series depicting bread, caviar spread and marzipan cake, which will be altered. The present study demonstrates the importance of validating portion size estimation tools.

College students constitute a significant proportion of the young adult population in Norway. They are in their reproductive years, which is of interest regarding diet and preconception health. Our objective was to assess young college students’ diet and nutrient intake in relation to national dietary recommendations and assess the probability of inadequate micronutrient intake for both genders using the Nordic Nutrition Recommendations, and also to evaluate its consequences on preconception health and create a groundwork for future interventions on this group. At the University of Agder (UiA), we enrolled 622 students aged 18–40 years for a cross-sectional study of student's diet, StudentKost. The students completed a food frequency questionnaire, including questions of supplement use, over the past 4 weeks. Intake of fruits, vegetables, oily fish, and whole grain was lower than recommended, as were mean intake of folate, iron, and iodine. Our main findings are that students have a somewhat suboptimal diet compared to the Norwegian dietary guidelines. Male students had generally lower diet quality than females. Compared to the Nordic Nutrition Recommendations (NNR), we also saw a relatively high probability of inadequate intake of several micronutrients and a very high probability for some micronutrients in a significant portion of the sample. Public health effort should be directed towards improving students and young adults’ diet in general, and interventions towards improving preconception health should be explored. The low participation rate limits the generalizability of our findings. Our findings encourage further investigation into young adults’ diet.

Male fertility has been declining globally over the past several decades, advancing from a personal issue to a public health problem. Beyond any doubt, a reduction in fertility (often characterized by low sperm count or motility) can severely threaten reproductive health and lifecourse framework in a long-term fashion. Aside from uncovering the currently unknown etiology of modern-day male infertility, the scientific and medical community faces a double burden: finding an efficient biomarker of impaired fertility and exploring any intervention that can act to enhance fertility. A plethora of nutritional compounds have been recognized as possible modulators of semen quality, and specific dietary patterns and nutrients appear to be accompanied by a lower risk of male infertility. Creatine, a conditionally essential nutrient, has caught attention as a male fertility-promoting candidate due to its role in sperm energy metabolism. This mini-review describes the creatine-related bioenergetics of spermatozoa, explores a connection between creatine levels and sperm quality in men, and critically examines available evidence for interventional studies with creatine to affect sperm viability.

Like many other mountainous countries, Norway has experienced a rapid increase in both recreational winter activities and fatalities in avalanche terrain during the past few decades: during the decade 2008–2017, 64 recreational avalanche fatalities were recorded in Norway. This is a 106 % increase from that of the previous decade. In 2013, Norway therefore launched the National Avalanche Warning Service (NAWS), which provides avalanche warnings to transport and preparedness authorities and to the public. Previous studies suggest that avalanche warnings are used extensively in trip and preparedness planning and have a relatively strong influence on the decisions people make in order to reduce risk. However, no evaluation concerning how efficiently the warnings are communicated and understood has been done to date in Norway. Avalanche warnings communicate complex natural phenomena with a variable complexity and level of uncertainty about both the future and the present. In order to manage avalanche risk successfully, it is fundamental that the warning message can be understood and translated into practice by a wide range of different user groups. Users with little or no avalanche competence may need simple information to decide when to stay away from avalanche terrain, while professional users may need advanced technical details in order to make their decisions. To evaluate how different modes of communication are understood, and how efficiently the informational content is communicated, we designed and implemented a web-based user survey. The modes of presentation were based on the Varsom.no 2017 version (Varsom.no being the national portal for natural hazard warnings in Norway). We first used a panel of 110 experts from NAWS to answer the survey, and used their answers to establish the indented message of the avalanche warning. We thereafter received responses from 264 users and compared their answers to those of the NAWS experts for the different modes of communication. We developed a method, the comprehension effectiveness score, to test the comprehension. Our empirical analyses suggest that most users find the warning service to be useful and well suited to their needs. However, the effectiveness of a warnings seems to be influenced by the competency of the user and the complexity of the scenarios. We discuss the findings and make recommendations on how to improve communication of avalanche warnings.

Glaciological and geodetic methods provide independent observations of glacier mass balance. The glaciological method measures the surface mass balance, on a seasonal or annual basis, whereas the geodetic method measures surface, internal, and basal mass balances, over a period of years or decades. In this paper, we reanalyse the 10 glaciers with long-term mass-balance series in Norway. The reanalysis includes (i) homogenisation of both glaciological and geodetic observation series, (ii) uncertainty assessment, (iii) estimates of generic differences including estimates of internal and basal melt, (iv) validation, and, if needed, (v) calibration of mass-balance series. This study comprises an extensive set of data (484 mass-balance years, 34 geodetic surveys, and large volumes of supporting data, such as metadata and field notes). In total, 21 periods of data were compared and the results show discrepancies between the glaciological and geodetic methods for some glaciers, which are attributed in part to internal and basal ablation and in part to inhomogeneity in the data processing. Deviations were smaller than 0.2 m w.e. a−1 for 12 out of 21 periods. Calibration was applied to 7 out of 21 periods, as the deviations were larger than the uncertainty. The reanalysed glaciological series shows a more consistent signal of glacier change over the period of observations than previously reported: six glaciers had a significant mass loss (14–22 m w.e.) and four glaciers were nearly in balance. All glaciers have lost mass after the year 2000. More research is needed on the sources of uncertainty to reduce uncertainties and adjust the observation programmes accordingly. The study confirms the value of carrying out independent high-quality geodetic surveys to check and correct field observations.