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The body of evidence on child and adolescent psychotherapy outcomes has now grown to more than 500 studies. Here we summarize key findings, focusing on effectiveness and efficacy research. Research is sparse on the effectiveness of treatment in everyday practice, but available evidence suggests little benefit. By contrast, extensive research on efficacy of structured treatments administered under controlled conditions shows very substantial evidence of benefit. We note several specific treatments for which evidence is encouraging, and we offer suggestions for future research. Particularly important will be research on treatment models most often used in practice settings, tests of outcome mediators and moderators, tests employing a broadened range of treatment delivery models, and research bridging the gap between lab-tested treatments and the conditions of real-world practice. [ABSTRACT FROM AUTHOR]

Non-communicable diseases such as chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2D) represent major challenges for health systems all over the world. In an interview study, we explored patient experiences and perspectives of being diagnosed and living with COPD or T2D in Greenland. Participants ( n  = 24) were selected by purposeful sampling and recruited by phone. We conducted individual semi-structured interviews at the National Hospital in Nuuk and the four regional hospitals. Interviews were audio-recorded, transcribed verbatim, and analysed using interpretive description. Three themes emerged: shock and shame on receiving the diagnosis, coping with a changed life, and varying needs for care and communication. We found that being diagnosed with COPD or T2D required a rapid change in the participants' everyday lives and lifestyle behaviours. Some self-managed their disease well and were able to transfer their knowledge and integrate it into their daily lives, while others struggled to make lifestyle changes. Additionally, living with COPD or T2D could be related to silence and shame. The findings contribute to a better understanding of living with COPD or T2D in the Arctic region and the development of future, culturally-adapted patient education initiatives.

Objective: To examine early school leaving in a longitudinal cohort of all high school students treated for substance use disorder (SUD) and their demographic counterparts in Norway., Method: From the National Patient and National Population Registries, we extracted (a) all high school students born in 1991-1992 who received SUD treatment during 2009-2010 ( N = 648; n alcohol = 95, n cannabis = 327, and n other drugs = 226) and (b) their age-and-gender matched counterparts ( n = 647). From the National Educational Database, we obtained enrollment and graduation status for these two cohorts throughout the designated school period of 5 years. We estimated the hazards of early school leaving as a function of students' treatment for alcohol, cannabis, and other drug use disorders and other known risk factors., Results: Nine out of 10 adolescents receiving SUD treatment left high school early (89%) compared with one in four (27%) from the matched cohort; 422 (73.5%) of these left high school during or after the treatment year. Multivariate discrete-time models revealed significant and ordered associations between receiving SUD treatment and early school leaving, HR alcohol = 3.09 [1.96, 4.89], HR cannabis = 3.83 [2.64, 5.56], HR other drugs = 5.16 [3.32, 8.03], even after accounting for individual-level (sex, immigrant background, criminal charges, and mental health treatment), family-level (family structure, parental education, and family income), and structural risk factors (municipal size, county employment, and dropout rates)., Conclusion: Adolescents receiving SUD treatment remain especially vulnerable for early school leaving. These findings underscore the importance of improving and coordinating health and educational services for youth in SUD treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Healthcare research emphasises involvement of patients in the research process, recognizing that this can enhance the relevance, quality, and implementation of research. This article highlights the need for more systematic planning to successfully involve patients in research projects and provides guidance on key aspects that researchers should consider in the planning of involving patients in research. The article accentuates the importance of establishing clear frameworks and guidelines to promote transparency and facilitate implementation., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Background: Acute phase proteins are a group of vital constituents of the innate immune system, which may also serve as circulatory biomarkers of inflammation. The major acute phase protein serum amyloid A (SAA) is a reliable and sensitive biomarker in cows, allowing for rapid detection of inflammatory disease. A multispecies automated immunoturbidimetric assay (VET-SAA, Eiken) has been validated for horses, dogs, and cats, and it has been used to measure SAA concentrations in bovine samples., Objectives: The aim of the present study was to perform an analytical validation of the VET-SAA immunoturbidometric assay based on monoclonal antihuman SAA antibodies for the measurement of SAA in clinical samples from cows., Methods and Results: The validation included an assessment of imprecision, inaccuracy, and detection limit, as well as an evaluation of the overlap performance, using banked serum from healthy and sick cows with or without inflammatory disease. Intra- and interassay variation ranged from 0.91% to 2.9% and 2.5% to 5.8%, respectively. The assay was performed with acceptable accuracy within a clinically relevant range of SAA, although minor signs of inaccuracy were detected. Overlap performance was acceptable, with the VET-SAA assay able to differentiate between healthy cows and cows with inflammatory and noninflammatory conditions. The automated VET-SAA assay is considered acceptable for the measurement of SAA in cows., (© 2024 The Authors. Veterinary Clinical Pathology published by Wiley Periodicals LLC on behalf of American Society for Veterinary Clinical Pathology.)

Background: Living with type 1 diabetes is challenging, and to support self-management, repeated consultations in specialist outpatient care are often required. The emergence of new digital solutions has revolutionized how health care services can be patient centered, providing unprecedented opportunities for flexible, high-quality care. However, there is a lack of studies exploring how the use of digital patient-reported outcome measures (PROMs) for flexible specialist care affects diabetes self-management. To provide new knowledge on the relevance of using PROMs in standard care, we have designed a multimethod prospective study., Objective: The overall aim of this protocol is to describe our prospective multimethod observational study designed to investigate digital PROMs in a routine specialist outpatient setting for flexible patient-centered diabetes care (DigiDiaS)., Methods: This protocol outlines the design of a multimethod prospective observational cohort study that includes data from electronic health records, self-reported questionnaires, clinical consultation field observations, and individual in-depth interviews with patients and diabetes health care personnel. All patients with type 1 diabetes at a designated outpatient clinic were invited to participate and use the digital PROM implemented in clinical care. Both users and nonusers of the digital PROM were eligible for the prospective study, allowing for a comparison of the two groups. Data were collected at baseline and after 12 months, including self-management as the primary outcome assessed using the Patient Activation Measure, along with the secondary outcomes of digital health literacy, quality of life, health economy, and clinical variables such as glycated hemoglobin., Results: The digital solution was implemented for routine clinical care in the department in November 2021, and data collection for the prospective study started in October 2022. As of September 6, 2023, 84.6% (186/220) of patients among those in the digital PROM and 15.5% (34/220) of patients among the nonusers have consented to participate. We expect the study to have enough participants by the autumn of 2023. With 1 year of follow-up, the results are expected by spring 2025., Conclusions: In conclusion, a multimethod prospective observational cohort study can offer valuable insights into the relevance, effectiveness, and acceptability of digital tools using PROMs in diabetes specialist care. Such knowledge is crucial for achieving broad and successful implementation and use of these tools in a large diabetes outpatient clinic., International Registered Report Identifier (irrid): DERR1-10.2196/52766., (©Astrid Torbjørnsen, Ingeborg Spildo, Maria Aadland Mollestad, Annesofie Lunde Jensen, Tone Singstad, Nina Mickelson Weldingh, Pål Joranger, Lis Ribu, Heidi Holmen. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 05.03.2024.)

Background: The aim of the present study was to assess to what extent risky substance use (RSU) acts as an important risk factor for school dropout from upper secondary school in a prospective study of Norwegian adolescents, and how externalising and internalising mental health problems influenced this association. Methods: We used data from a large population-based survey (the youth@hordaland-survey), which included adolescents aged 16-19 years. The predictor variables were self-reported RSU. The survey was linked with prospective data from the Norwegian Education Database, following the adolescents to 21-23 years of age. The outcome variable was registry-based school dropout within five years after starting upper secondary school. The analyses were adjusted for sex, age, socioeconomic status, and externalising and internalising problems. Results: After adjustment for sociodemographic variables, all indicators of RSU were prospectively associated with school dropout (adjusted odds ratios 1.26-2.25; all p values <.01). While internalising problems only slightly changed these estimates, the associations were substantially attenuated by externalising problems. Still, all measures of RSU, except frequent alcohol intoxication, remained positively associated with school dropout in the fully adjusted models. For the youngest students, all associations between RSU and school dropout were significant. Conclusions: Adolescent RSU is a strong predictor for school dropout, and externalising problems explained a considerable proportion of this effect. Prevention efforts to reduce student substance could improve academic outcomes among upper secondary school students, and such efforts may benefit from also targeting co-occurring externalising problems., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Patient-reported outcome (PRO) measures are increasingly used in clinical diabetes care to increase patient involvement and improve healthcare services. The objectives were to identify instruments used to measure PROs in outpatient diabetes clinics and to investigate the use of these PRO measures alongside the experiences of patients and healthcare personnel in a clinical setting., Research Design and Methods: A scoping review was conducted according to the framework of Arksey and O'Malley with scoping searches of Cinahl, EMBASE, Medline and Health and Psychosocial Instruments. Studies reporting on adults with diabetes in a clinical setting where the PRO measure response directly affected patient care were eligible for inclusion., Results: In total, 35 197 citations were identified, of which 7 reports presenting 4 different PRO measures were included in the review. All four of the included items measured psychosocial aspects of diabetes, and three included elements of the Problem Areas in Diabetes scale. All the patients were satisfied with the use of PRO measures in clinical care, whereas the level of satisfaction among healthcare personnel with PRO measures varied within and among studies., Conclusions: The limited number of eligible studies in this review suggests that research on PRO measures for diabetes outpatient care is scarce. Patients welcome the opportunity to express their concerns through the systematic collection of PRO measures, and some healthcare personnel value the broader insight that PRO measures provide into the impact of diabetes on patients' lives. However, the heterogeneity among services and among patients challenges the implementation of PRO measures. Research is needed to explore how PRO measures in clinical outpatient care affect healthcare personnel workflow., Review Registration: https://doi.org/10.17605/OSF.IO/46AHC., Competing Interests: Competing interests: ALJ was part of the Danish DiabetesFlex study, and thus there may be potential bias. The remaining authors declare that they have no competing interests., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Red blood cell distribution width (RDW) and visual assessments of anisocytosis assess variability in erythrocyte size. Veterinary studies on the correlation between the two methods and on observer agreement are scarce. The objectives were to assess the correlation of the grading of anisocytosis by means of conventional microscopy of canine blood smears to RDW, and to assess intra- and inter-observer variation in assessing the degree of anisocytosis. The study included 100 canine blood samples on which blood smear examination and RDW measurement were performed. RDW was measured on the Advia 2120i analyzer. The degree of anisocytosis was based on a human grading scheme assessing the ratio between the size of the representative largest red blood cell and that of the representative smallest red blood cell (1+ if <2x, 2+ if 2-3x, 3+ if 3-4x, and 4+ if >4x). Three observers participated and assessed the blood smears by conventional microscopy twice, 3 weeks apart by each observer. The correlation was assessed for each observer on each occasion using Kendahl-tau-b analysis. Intra-observer agreement was assessed using quadratically weighted kappa. Inter-observer agreement was assessed using free-marginal multi-rater kappa. Anisocytosis graded on blood smears correlated significantly with RDW values as assessed by Kendahl-tau-b ranging between 0.37 and 0.51 ( p < 0.0001). Intra-observer agreement ranged from weak to moderate with resulting kappa-coefficients being 0.58, 0.68, and 0.75, respectively. Inter-observer agreement was weak (Kappa-values 0.44). The weak to moderate observer agreement in the visual assessment of anisocytosis indicates that the more precise and more repeatable RDW measurement should be used for clinical decision-making., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Jensen, Krogh and Nielsen.)

Background: Successful diabetes management requires collaboration between patients and healthcare professionals and should be aligned with an individual's condition and resources. We developed a flexible, individualised, patient-reported outcome (PRO)-based telehealth intervention called "DiabetesFlex Care" in which patients completed an annual self-reported questionnaire from home, one required face-to-face appointment, and two optional outpatient consultations. In this study, we investigated patients' experiences using DiabetesFlex Care., Methods: We conducted a qualitative, interpretive descriptive (ID) study based on semi-structured interviews with a purposeful sample of 36 patients with type 1 diabetes (T1D) who had used DiabetesFlex Care. Recorded audio data were transcribed and analysed inductively using the constant comparative method., Results: DiabetesFlex Care changed participants' perspectives on living with diabetes. Patients became more involved in their own care and found that DiabetesFlex Care helped to make their conversations with healthcare professionals more relevant. Furthermore, participants appreciated the ability to both choose the format of their appointments (face-to-face vs. phone call) and cancel unnecessary appointments., Conclusion: DiabetesFlex Care was a flexible and inclusive health service that enabled patients to take more responsibility for their own diabetes management. The questionnaire-based approach in DiabetesFlex Care can help healthcare professionals systematically account for patients' perspectives and support user involvement and self-management. By extension, this approach can also help minimise healthcare-related disruptions in patients' lives. Further studies are needed to determine whether flexible PRO-based telehealth is an acceptable solution for all patients., (© 2023 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

Gonadal sex steroids are important regulators of energy balance in adult rodents, and gonadectomy (GDX) has opposing effects on weight gain in sexually mature males and females. Puberty is associated with the emergence of sex differences in weight, body composition, and feeding behaviors, yet the role of gonadal hormones at puberty remains unclear. To address this, we performed GDX or sham surgery in male and female C57Bl/6 mice at postnatal day (P)25 (prepubertal) or P60 (postpubertal) timepoints and measured weight and body composition for 35 days, after which ad libitum and operant food intake was measured using Feeding Experimentation Device 3 (FED3s) in the home cage. Consistent with previous studies, postpubertal GDX caused weight gain in females and weight loss in males and increased adiposity in both sexes. However, prepubertal GDX decreased weight gain and altered body composition across the adolescent transition (P25 to P60) in males but had no effect in females. Despite the varied effects on weight, GDX decreased food intake and motivation for food as assessed in operant tasks regardless of sex or timing of surgery relative to puberty. Our findings indicate that GDX interacts with both sex and age at surgery to influence weight, body composition, and feeding behavior., (Published by Elsevier Inc.)

Background: Patient-reported Outcome (PRO) measures may be used as the basis for out-patient follow-up instead of fixed appointments. The patients attend follow-up from home by filling in questionnaires developed for that specific aim and patient group (telePRO). The questionnaires are handled in real time by a specific algorithm, which assigns an outcome color reflecting clinical need. The specific questionnaires and algorithms (named solutions) are constructed in a consensus process with clinicians. We aimed to describe AmbuFlex' telePRO solutions and the algorithm outcomes and variation between patient groups, and to discuss possible applications and challenges., Methods: TelePRO solutions with more than 100 processed questionnaires were included in the analysis. Data were retrieved together with data from national registers. Characteristics of patients, questionnaires and outcomes were tabulated for each solution. Graphs were constructed depicting the overall and within-patient distribution of algorithm outcomes for each solution., Results: From 2011 to 2021, 29 specific telePRO solutions were implemented within 24 different ICD-10 groups. A total of 42,015 patients were referred and answered 171,268 questionnaires. An existing applicable instrument with cut-off values was available for four solutions, whereas items were selected or developed ad hoc for the other solutions. Mean age ranged from 10.7 (Pain in children) to 73.3 years (chronic kidney disease). Mortality among referred patients varied between 0 (obesity, asthma, endometriosis and pain in children) and 528 per 1000 patient years (Lung cancer). There was substantial variation in algorithm outcome across patient groups while different solutions within the same patient group varied little., Discussion: TelePRO can be applied in diseases where PRO can reflect clinical status and needs. Questionnaires and algorithms should be adapted for the specific patient groups and clinical aims. When PRO is used as replacement for clinical contact, special carefulness should be observed with respect to patient safety., (© 2023. The Author(s).)

Background: Within pediatric health care services, Patient-reported Outcomes (PROs) regarding the patient's health status are mainly used for research purposes in a chronic care setting. However, PROs are also applied in clinical settings in the routine care of children and adolescents with chronic health conditions. PROs have the potential to involve patients because they 'place the patient at the center' of his or her treatment. The investigation of how PROs are used in the treatment of children and adolescents and how this use can influence the involvement of these patients is still limited. The aim of this study was to investigate how children and adolescents with type 1 diabetes (T1D) experience the use of PROs in their treatment with a focus on the experience of involvement., Results: Employing Interpretive Description, 20 semi-structured interviews were conducted with children and adolescents with T1D. The analysis revealed four themes related to the use of PROs: Making room for conversation, Applying PROs under the right circumstances, Questionnaire structure and content, and Becoming partners in health care., Conclusions: The results clarify that, to some extent, PROs fulfill the potential they promise, including patient-centered communication, detection of unrecognized problems, a strengthened patient-clinician (and parent-clinician) partnership, and increased patient self-reflection. However, adjustments and improvements are needed if the potential of PROs is to be fully achieved in the treatment of children and adolescents., (© 2023. The Author(s).)

Objective: The objective of this review is to identify available patient-reported outcome instruments used to assess the involvement of children and adolescents with type 1 diabetes in their treatment. Specifically, this review will examine the content, structure, and application of these instruments., Introduction: It is considered meaningful to involve children and adolescents living with a chronic health condition, such as type 1 diabetes, in their own treatment. Despite a growing interest in patient involvement within pediatric health care, including the use of patient-reported outcomes, only a few patient-reported outcome instruments have been developed and are used to evaluate the experiences of children and adolescents with type 1 diabetes of being involved in their own treatment., Inclusion Criteria: This scoping review will examine patient-reported outcome instruments used to assess the experiences of children and adolescents (11 to 18 years of age) with type 1 diabetes of being involved in their own care. Patient-reported outcome instruments measuring parents' or clinicians' experiences of involvement will be excluded., Methods: The proposed review will follow JBI guidelines and all stages will involve 2 or more reviewers. PubMed, Embase, CINAHL, PsycINFO, JSTOR, and MedNar will be searched without limitations on the year or language of publication. Literature that is not written in English will be translated. Data extraction, charting, and analysis will be guided by a template developed for this review that focuses on the content, structure, and application of the patient-reported outcome instruments. Any modifications to the extraction template will be detailed in the review, and data will be presented in a descriptive format., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 JBI.)

Purpose: People with type 1 diabetes have an increased risk of disordered eating (DE) and eating disorders (ED). Screening is recommended however little is known about patients' perspectives on screening questionnaires. This paper reports qualitative analyses of patients' perspectives on the questionnaire Diabetes Eating Problem Survey Revised (DEPS-R), including acceptability, attitudes, and cognitive understanding., Research Design and Methods: 15 adolescents with type 1 diabetes between 11 and 18 years, were interviewed. A semi-structured format and a qualitative Interpretive Descriptive (ID) methodology was chosen., Results: The analyses identified four themes: (1) The Questionnaire, (2) Reframing Diabetes Visits, (3) This is (not) for me, and (4) Out in the Open. The DEPS-R was completed with-in 5-10 min. with no technical difficulties. The questionnaire altered the diabetes visit for some, creating a new dialog, and time for self-reflection. Adolescents appreciated the direct approach in the questionnaire, and showed willingness to complete the questionnaire, when presented to them by a health care professional (HCP). One item in the DEPS-R proved difficult to understand for some participants., Conclusion: The study highlights DEPS-R as a clinically relevant screening questionnaire. Completing DEPS-R prior to a consultation opens the door to a consultation that invites the adolescent to address matters of eating behavior. Our findings suggest that systematic screening of DE/ED using the DEPS-R is both accepted and welcomed by adolescents with type 1 diabetes. Future research should focus on a potential update of selected items in DEPS-R., Level of Evidence: V - qualitative study., (© 2023. The Author(s).)

Background: People who inject drugs (PWID) have a high risk of premature death due to fatal overdoses. Newly emerged fentanyls, much more potent than heroin and other opioids, may increase this risk further. Therefore, precise information on injected drugs is critical to improving prevention strategies., Aims: This study aimed to analyse drug residues in used injection equipment in order to determine drug and drug combinations and compare and complement findings with self-reported information., Methods: Used syringes and needles ( n =766) were collected at the supervised drug consumption facilities, the needle exchange service and two low-threshold health services for problem drug users in Oslo, Norway. The material was collected every third month from June 2019 to June 2020 and analysed for 64 substances using highly specific analytical methods (ultra-high performance liquid chromatography tandem mass spectrometry). Additionally, a street-recruited sample of PWID was interviewed from 2017 to 2019 regarding their drug injection habits ( n =572)., Results: Heroin (65.5%) or amphetamines (59.8%), often in combination (30.5%), were commonly detected in drug residues. Other opioids, stimulants or benzodiazepines were rarely detected (6.1%). Fentanyl was detected in only one syringe. Heroin was the most reported drug (77.6% during the past four weeks, 48.3% daily/almost daily), followed by amphetamines (57.5% during the past four weeks, 23.1% daily or almost daily). Injection of methadone, buprenorphine and dissolved tablets was self-reported more frequently than determined in drug residue findings., Conclusions: Analysis of the injection equipment proved useful as a non-invasive, rapid and accurate means to obtain detailed information on injected drugs in Oslo and supplement traditional PWID survey information.

Objective: The purpose of this study was to examine attitudes toward legalization of cannabis use and openness to legal use among Norwegian partygoers., Method: We examined a combined sample ( N = 4,790; 46.2% female) of young partygoers ( M age = 23.7, SD = 7.3) from three Norwegian studies on substance use in various settings: music festivals ( n = 1,312), nightlife ( n = 2,005), and high school graduation ( n = 1,473). Through onsite surveys, the participants were asked if they thought cannabis use should be legal in Norway and whether they themselves would use the drug if legalized. These responses ( yes/no/don't know ) were examined in relation to participants' characteristics and cannabis use history using summary statistics and multinomial regression models., Results: Although 46.1% of participants reported having used cannabis at least once, only 1/3 (32.6%) favored legalization and 1/4 (25.6%) stated they would themselves use cannabis if legalized. Yet, even among never-users, we observed non-opposition to legalization (16.4% in favor; 14.9% don't know) and openness to legal use (8.2% would use; 12.4% don't know). Histories of cannabis, tobacco, or any other drug use, sex (male), and age younger than 21 years (vs. 30 or older) were consistently associated with affirmative responses to both questions. Openness to legal use was strongly associated with favorable legalization attitudes and age younger than 21, even after accounting for lifetime cannabis use history., Conclusions: Favoring cannabis legalization and openness to legal use were relatively low in this sample of young Norwegian partygoers. Yet, prevalence of cannabis use may increase after legalization among its supporters and among those younger than 21, especially if "don't know" responses are considered.

Background: Diabetes self-management is crucial for patients with type 1 diabetes, and digital services can support their self-management and facilitate flexible follow-up. The potential of using digital patient-reported outcome (PRO) measures in routine outpatient care is not fully used owing to a lack of adapted PRO measures., Objective: This study presents the process of identifying and adapting a digital PRO measure for use in clinical diabetes practice and describes the preferred item topics of the adapted PRO measure, as reported by patients and diabetes specialist nurses., Methods: With the involvement of patients, diabetes specialist nurses, management, and researchers, we hosted a series of workshops and 2 dialogue conferences. Scoping searches to identify relevant PRO measures formed the foundation for the process. An in-person dialogue conference was conducted with diabetes specialist nurses as participants, and a digital dialogue conference was conducted with patients with type 1 diabetes as participants. A diabetes-specific PRO measure was translated and adapted to our digital platform. Notes and summaries from the dialogue conferences were imported into NVivo (QSR International) and thematically analyzed as a single combined data set., Results: The thematic analysis of the 2 dialogue conferences aimed to explore the views of patients with type 1 diabetes and diabetes specialist nurses on the outcomes necessary to measure. An overarching theme, Ensuring that the PRO measure captures the patients' needs precisely and accurately, in a way that facilitates care and communication with health care personnel, was identified and supported with data from both the patients and diabetes specialist nurses. This theme contained four categories: The need for explanatory text after questions to ensure understanding and accurate response, Capturing individual needs in standardized questions, getting to the heart of the patient's problem, and The questions increase patient reflection., Conclusions: We successfully conducted an iterative process that identified a PRO measure aligned with the topics raised by the diabetes specialist nurses. Similarly, the patients found the PRO measure to be relevant and one that was addressing their needs. Only minor adjustments were necessary when programming the PRO measure in the digital platform. Our management, patients, and diabetes specialist nurses had a valuable impact on the results. User involvement facilitated a specific focus on the clinical requests to be met by PRO measures and how they must be adapted to local and digital platforms. Overall, this has facilitated the current implementation of the adapted digital PRO measure., (©Heidi Holmen, Tone Singstad, Lis Ribu, Annesofie Lunde Jensen, Nina Mickelson Weldingh, Astrid Torbjørnsen. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 15.11.2022.)

Background: Nurse managers are often at the forefront of implementing organizational changes. Studies suggest that conflicting pressures and stress are high during such times, though little is known of how nurse managers experience the continuing run of change initiatives., Aims: To explore nurse managers' experience of large-scale organizational changes and its impact on their working lives and conditions., Design: A qualitative phenomenological hermeneutical study utilizing a Ricœur-inspired method of interpretation., Methods: Semi-structured interviews were conducted with 12 nurse managers at a public sector university hospital that had recently undergone large-scale organizational changes. Interviews were conducted in 2021 during the covid-19 pandemic. The analysis is based on the three-stage Ricœur-inspired analysis method by Pedersen and Dreyer., Results: Three themes emerged outlining the nurse managers experiences of large-scale organizational change: The need for support structures to be incorporated in the change process, The need for a guiding star, and The challenge of the values embedded in the Nurse Manager mindset. These themes were consistent across both predominantly positive as well as mainly negative experiences., Conclusion: This study reveals the potential that receiving support from management, staff and peers has to positively influence the experiences of nurse managers during large-scale organizational changes. However, lacking a clear vision for the process negatively influences their ability to support high-level quality care within their wards, potentially increasing their feelings of stress and conflicting pressure., Impact: Participants offered important insight into the sparsely explored subject of nurse managers' experiences of organizational change, the complexity they face and the potentially high personal costs. The study highlights the detrimental effects of not providing support to all managers in organizations undergoing change, and the parallels to the covid-19 pandemic. No Patient or Public Contribution was required for this study due to its aim., (© 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: Patient-reported outcome (PRO) measures may be used in telehealth for the clinical assessment of mental health and diabetes distress, which are important aspects in diabetes care, but valid and reliable instruments on these topics are necessary. We aimed to evaluate the test-retest reliability and measurement error of the Danish versions of the WHO-Five Well-being Index (WHO-5) and Problem Areas in Diabetes (PAID) questionnaires used in a PRO-based telehealth intervention among patients with type 1 diabetes. A further aim was to evaluate the test-retest reliability of single items concerning patients' symptom burden and general health status., Methods: Outpatients with type 1 diabetes from the Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark, were enrolled from April 2019 to June 2020. Patients aged ≥ 18 who had type 1 diabetes for > 1 year, internet access, and the ability to understand, read, and write Danish were included. Intraclass correlation coefficients (ICC) and weighted Kappa values were used to assess test-retest reliability, and measurement error was assessed by estimating the minimal detectable change (MDC)., Results: A total of 146/255 (57%) patients completed the web questionnaire twice. The median response time between the two-time points was five days. The ICC of the WHO-5 scale was 0.87 (95% CI 0.82-0.90), and MDC was 18.56 points (95% CI 16.65-20.99). The ICC of the PAID scale was 0.89 (95% CI 0.84-0.92), and MDC was 11.86 points (95% CI 10.46-13.70). Overall, test-retest reliability of single symptoms and general health status items was substantial., Conclusions: The WHO-5 and PAID questionnaires, and single symptoms and general health status items showed substantial test-retest reliability among patients with type 1 diabetes. Measurement error of the PAID questionnaire was considered acceptable; however, a larger measurement error of the WHO-5 questionnaire was observed. Further research is recommended to explore these findings., (© 2022. The Author(s).)

Background: Obesity in pregnant women is increasing worldwide, affecting the health of both mother and baby. Obesity may be associated with inadequate health literacy, a central competence when navigating antenatal health information and services. This study explores women's health literacy by examining their knowledge, motivation and skills to access, understand and evaluate health information and the related behaviour among a sample of pregnant women with a prepregnant body mass index (BMI) > 25 kg/m 2 ., Methods: An inductive, qualitative study using an interpretive description methodology. Data was collected through ten semi-structured interviews with pregnant women with a prepregnancy BMI > 25 kg/m 2 attending antenatal care at the midwifery clinic at Aarhus University Hospital in the Central Denmark Region., Results: Pregnant women with obesity understand general health information provided by health professionals, but translating this knowledge into specific healthy behaviours presents a challenge. Although difficulties navigating booking systems and available digital services contribute to this problem, apps can help facilitate navigation. However, successful navigation may depend on adequate e-health literacy. Conflicting information from health professionals, social media and families also present a challenge for pregnant women, requiring a broad skillset for critical evaluation and resolution., Conclusions: Adequate health literacy is necessary for pregnant women receiving antenatal care to (i) translate general health information into personalised healthy behaviour, (ii) access and navigate complex and digitalised systems, and (iii) critically evaluate conflicting information. Person-centred differentiation in the organisation of antenatal care may benefit vulnerable pregnant women with inadequate health literacy., Trial Registration: The study was registered cf. General Data Protection Regulation, Aarhus University Journal number 2016-051-000001, serial number 1934., (© 2022. The Author(s).)

Background: Although interest in Patient and Public Involvement in health-related research is growing, there seems to be a lack of guidance supporting researchers in deciding on methods and levels for Patient and Public Involvement in health-related research throughout the research process. Furthermore, the numerous definitions, methods, and frameworks make it challenging for researchers new to this field to decide on the most appropriate approach for their project., Methods: This study aimed to develop and test guidance for researchers deciding on approaches, levels, and methods for engaging patient partners in health-related research. A group of 11 researchers in Patient and Public Involvement in health-related research participated in six workshops to develop the guidance. The feasibility and acceptability of the guidance were tested in a survey of 14 researchers using the System Usability Scale plus two elaborative questions. The guidance was also tested by five PhD students engaging patient partners in their projects., Results: The guidance developed consisted of two resources: Resource I outlined five international approaches to Patient and Public Involvement in health-related research, and Resource II described the different levels and methods for engaging patient partners in research. The System Usability Scale score (at the 50th percentile) was 80, indicating excellent usability. Qualitative data showed that the two resources supported reflections regarding different approaches, levels, and methods., Conclusion: The researchers found the guidance to be supportive of their reflective thinking about engaging patient partners in their research. The testing provided knowledge about when and how to use the guidance but also raised questions about the usefulness of the guidance in communications with patients., (© 2022. The Author(s).)

Aim: The objective of this study was to assess the impact of health care-initiated visits versus patient-controlled flexible visits on clinical and patient-reported outcomes in people with type 1 diabetes., Methods: The DiabetesFlex trial was a randomized controlled, pragmatic non-inferiority 15-month follow-up study comparing standard care (face-to-face visits every 4 months) with DiabetesFlex (patient-controlled flexible visits using patient-reported, outcome-based telehealth follow-up). Of 343 enrolled participants, 160 in each group completed the study. The primary outcome was mean change in HbA 1c from baseline to 15-month follow-up. Secondary outcomes were blood pressure, lipid levels, frequency of visits, the World Health Organization score-five well-being-index (WHO-5), the Problem Areas In Diabetes (PAID) scale and experience of participation in own care (participation score)., Results: The adjusted mean difference in HbA 1c between standard care and DiabetesFlex was similar and below the predefined non-inferiority margin of 0.4% (-0.03% [95%CI: 0.15, 0.11]/-0.27 mmol/mol [-1.71, 1.16]). No intergroup mean changes in lipid or blood pressure were observed. Conversely, DiabetesFlex participants presented an increased mean WHO-5 index of 4.5 (1.3, 7.3), participation score of 1.1 (0.5, 2.0), and decreased PAID score of -4.8 (-7.1, -2.6) compared with standard care. During follow-up, DiabetesFlex participants actively changed 23% of face-to-face visits to telephone consultations, cancelled more visits (17% vs. 9%), and stayed away without cancellation less often (2% vs. 8%)., Conclusion: Compared with standard care, flexible patient-controlled visits combined with patient-reported outcomes in participants with metabolic controlled type 1 diabetes and good psychological well-being further improved diabetes-related well-being and decreased face-to-face visits while maintaining safe diabetes management., (© 2022 Diabetes UK.)

Background: Improved knowledge regarding socio-demographic correlates of people with substance use disorders (SUDs) is essential to better plan and provide adequate services for SUD patients and their families, and to improve our understanding of the complex mechanisms underlying progression into and development of various SUDs. This study aimed to: i) describe demographic, economic, and social correlates of people with SUDs in comparison with those of the general population and ii) compare these correlates across SUDs from licit versus illicit substances, as well as across specific SUDs., Methods: A national population-based case-control study included all SUD patients enrolled in specialized drug treatment in Norway in 2009-2010 (N = 31 245) and a population control sample, frequency-matched on age and gender (N = 31 275). Data on education level, labour market participation, income level and sources, and family/living arrangement were obtained by linkages to national registers., Results: Demographic, economic, and social correlates of SUD patients differed substantially from those of the general population, and across specific SUDs. Among SUD patients, those with illicit - as compared to licit - SUDs were younger (mean quotient = 0.72 [0.71-0.72]), more often had low education level (RR = 1.68 [1.63-1.73]), were less often in paid work (RR = 0.74 [0.72-0.76]) and had lower income (mean quotient = 0.61 [0.60-0.62]). Comparison of patients with different SUD diagnoses revealed substantial demographic differences, including the relatively low mean age among cannabis patients and the high share of females among sedatives/hypnotics patients. Opioid patients stood out by being older, and more often out of work, receiving social security benefits, and living alone. Cocaine and alcohol patients were more often better educated, included in the work force, and had a better financial situation., Conclusion: Findings revealed substantial and important differences in socio-demographic correlates between SUD patients and the general population, between SUD patients with illicit and with licit substance use, and across specific SUD patient groups., (© 2022. The Author(s).)

Introduction: Worldwide healthcare policy highlights patient involvement and participation. Older people with chronic diseases and comorbidities are in need of complex healthcare. Even though these issues have been highlighted, there is a need to investigate older patients' perspective on discharge planning in order to ensure quality in the healthcare system., Aim: The aim was to explore how older medical patients experience their own involvement in discharge planning from a medical department., Methodological Design: A qualitative study using semi-structured interviews with 20 patients aged 60+. Interviews were conducted 1 week after discharge in the patients' homes., Ethical Approval: The study was approved by the Danish Data Protection Agency, and ethical principles were applied while the study was being conducted. All participants provided informed consent., Results: The participants had individual needs and various experiences of being involved in their discharge planning. One main category emerged from the study, "Different levels of rapport," as well as three subcategories, "A lot of information-mostly from healthcare professionals to patients," "The distribution of roles between healthcare professionals and patients" and "The meaning of having relatives.", Conclusion: The participants had various experiences and preferences based on their involvement in discharge planning. In general, older people wished to be involved in discharge planning. Healthcare professionals should thus be aware of the involvement levels of such patients and adjust nursing to these levels during hospitalisation., (© 2021 Nordic College of Caring Science.)

In the early-diverging protozoan parasite Plasmodium , few telomere-binding proteins have been identified and several are unique. Plasmodium telomeres, like those of most eukaryotes, contain guanine-rich repeats that can form G-quadruplex structures. In model systems, quadruplex-binding drugs can disrupt telomere maintenance and some quadruplex-binding drugs are potent anti-plasmodial agents. Therefore, telomere-interacting and quadruplex-interacting proteins may offer new targets for anti-malarial therapy. Here, we report that P. falciparum GBP2 is such a protein. It was identified via 'Proteomics of Isolated Chromatin fragments', applied here for the first time in Plasmodium . In vitro , Pf GBP2 binds specifically to G-rich telomere repeats in quadruplex form and it can also bind to G-rich RNA. In vivo , Pf GBP2 partially colocalises with the known telomeric protein HP1 but is also found in the cytoplasm, probably due to its affinity for RNA. Consistently, its interactome includes numerous RNA-associated proteins. Pf GBP2 is evidently a multifunctional DNA/RNA-binding factor in Plasmodium ., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Edwards-Smallbone, Jensen, Roberts, Totañes, Hart and Merrick.)

Introduction: In previous research projects and clinical settings, alcohol analysis in oral fluid (saliva) has been used as an alternative to breath or blood alcohol testing. In this study we examined whether it is possible to obtain clinically relevant data regarding alcohol consumption in individuals who recently consumed alcohol by analysing oral fluid samples when the recommended rinsing of the mouth is impossible before sample collection., Materials and Methods: We conducted a study of 89 nightclub patrons in Norway. Before collecting oral fluid samples and performing breath alcohol testing, participants were required to drink a glass of water to remove residual alcohol from the mouth. Oral fluid samples were collected with the Quantisal oral fluid collection device and analysed using an enzymatic method for alcohol. The alcohol concentration in the neat (undiluted) oral fluid was then calculated. Breath alcohol testing was performed using Lion Alcolmeter 500 instruments., Results: No false-negative or false-positive results for alcohol were detected in the oral fluid when compared with those in the breath. The Intraclass Correlation Coefficient of 0.40 indicated a poor correlation between alcohol concentrations in the two sample types., Conclusions: The procedure for collecting oral fluid was suitable for the qualitative determination of alcohol intake but not for quantitative assessment. We recommend that oral fluid samples should not be used for estimating blood or breath alcohol concentrations in people who have recently consumed alcohol or non-alcoholic beverages, as recommended in the instructions for use., Competing Interests: Potential conflict of interest None declared., (Croatian Society of Medical Biochemistry and Laboratory Medicine.)

Introduction: Wastewater-based epidemiology (WBE) has emerged as a timely, non-invasive, and cost-effective indicator of illicit drug consumption. It is increasingly used by international organizations as a proxy measure for estimates of drug prevalence and related trends. Nevertheless, the literature exploring the limitations of WBE remains limited. This paper aims to shed further light on important shortcomings of WBE with recommendations on moving forward., Method: Utilizing case study and statistical analysis, the paper critically reviews methodological challenges associated with WBE results related to (i) levels, (ii) trends, and (iii) between-city comparisons of drug use. Data from raw influent wastewater samples from wastewater plants in the cities of Oslo, Bergen and Stavanger/Sandnes were analysed for amphetamine, methamphetamine, MDMA, and cocaine (benzoylecgonine) over a 3-year period. Normalized population loads were calculated and variation in daily loads analysed with plots and estimation of means, confidence intervals, and coefficient of variation. Linear regression models examined trends and between-city differences., Results: Plots and statistical analyses revealed extensive variation in daily loads, with min/max values of 6.1/453.9 mg/day per 1,000 inhabitants 15-64 years for amphetamine and correspondingly 9.4/675.9 mg for methamphetamine. Substantial differences in load levels and patterns across time and plants were also observed. A carefully designed sampling procedure and a relatively large number of daily samples are required to obtain estimates of sufficient precision for determining trends in space or time. Cross-referencing with alternative trend variables can improve the interpretation of WBE trend indicators. Finally, when using mean load levels for different wastewater-treatment plants to assess spatial variation in drug use, the representativeness of the catchment area should be evaluated before interpreting observed changes as city differences., Conclusion: Although WBE is a useful supplementary indicator of illicit drug consumption, important methodological issues and potential shortcomings should be taken into account when designing sampling procedures and interpreting the analytical results., (© 2022 S. Karger AG, Basel.)

Background: Incarcerations are associated with an increased risk of morbidity and mortality among people who use drugs (PWUD). In a sample of 884 PWUD, we examine and estimate the risk of incarcerations (i.e., number, duration, and most serious offense)., Methods: In this prospective cohort study, PWUD were recruited from street- and low-threshold services in seven Norwegian cities in 2013 (Sept-Nov), and followed through the Correctional Service Registry until 20.12.2018. The risk of incarceration during follow-up was examined with multivariable logistic (no incarceration vs. at least one) and multinomial regression models ("no incarcerations", vs. "1″, "≥2″), while accounting for gender, age, homelessness/shelter use, opioid substitution treatment, illegal income sources, injecting behaviours, previous incarcerations, and recruitment city., Results: During follow-up, there were in total 662 incarceration episodes, and 44.7% of the participants were incarcerated at least once. Overall, 37.5% of those incarcerated had at least one episode due to a drug offense. The average incarceration duration was 65.2 days with 3.5% of the episodes lasting ≥one year. Gender (male), homelessness/shelter use, illegal income sources, injecting stimulants, and previous incarcerations increased the odds of incarceration, while older age decreased the odds. Gender (male), younger age, self-reported theft or theft and dealing, injecting stimulants or heroin and stimulants and previous incarcerations increased the risk of multiple incarcerations., Conclusion: In a five-year prospective study of PWUD, incarcerations were common, and short-term sentences and recidivism were the norm. This is of concern as incarcerations add to an already elevated morbidity and mortality risk in this population., Competing Interests: Declarations of Interest None., (Copyright © 2021. Published by Elsevier B.V.)