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Mariusz Jaworski,1 Marta Rzadkiewicz,1 Miroslawa Adamus,1 Joanna Chylinska,1 Magdalena Lazarewicz,1 Gørill Haugan,2 Monica Lillefjell,3 Geir Arild Espnes,2 Dorota Wlodarczyk1 1Department of Medical Psychology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland; 2Department of Public Health and Nursing, 3Department of Neuromedicine and Movement Science, NTNU Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway Introduction: There is evidence that meeting patients’ expectations toward health care correlates with involvement in the treatment they receive. The most important patient expectations concern certain types of information: explanation of disease and treatment, health promotion, and improvement in quality of life. Other demands include proper rapport and emotional support. The aim of this paper was to examine different patient groups over the age of 50 years and their expectations toward medical visits, evaluated before a visit and after the visit.Patients and methods: The study group consisted of 4,921 primary health-care patients. The patients received self-administered questionnaires that they filled in before and after the appointment with the doctor. Interviews with patients were conducted individually by specially trained interviewers. The PRACTA Patient Expectations Scale was used to measure the appointment-related expectations of the patients.Results: We observed differences related to age in patients’ expectations before medical visits regarding the following factors: disease explanation, treatment explanation, quality of life, rapport, and emotional support. The same differences were not observed on health promotion. Evaluation of patients’ appointment-related experiences after the visit showed that there were significant differences between the age-groups regarding all types of expectations included in the study. Differences between previsit and postvisit measurements were statistically significant in all age-groups. Patients who received less than they expected from doctors outnumbered those who received what they expected or more in all the groups.Conclusion: Patients’ expectations toward medical visits are conditioned by age. Therefore, doctors should pay more attention to requirements related to age in their effort to identify and satisfy expectations. This is particularly important in light of the discrepancy between previsit expectations and the actual experiences of patients evaluated after the visit. Keywords: primary care, patients expectations, medical appointment, experiences, PRACTA

Linda Ernstsen,1 Monica Lillefjell2 1Faculty of Nursing, Sør-Trøndelag University College, Trondheim, Norway; 2Department of Occupational Therapy, Faculty of Health Education and Social Work, Sør-Trøndelag University College, Trondheim, Norway Background: The aim of this investigation was to assess whether measures of physical functioning after multidisciplinary rehabilitation are associated with return to work among individuals with chronic musculoskeletal pain conditions and comorbid depressive symptoms. Methods: Included were 92 employees with chronic musculoskeletal disorders who had participated in a 57-week multidisciplinary rehabilitation program. Their ages ranged from 25–59 years. The Hospital Anxiety and Depression Scale was used to assess depressive symptoms. Different aspects of physical functioning (muscle strength, mobility, endurance capacity, and balance) were measured with single-item visual analog scales, and physical fitness was measured with the validated COOP/WONCA charts. Being on "active work strategies," such as receiving rehabilitation benefit/vocational rehabilitation or being reported partly or completely fit, was defined as "on their way into/in work". Cross-sectional associations were measured using logistic regression models, estimating odds ratio with 95% confidence intervals. Results: There were no differences between the "on their way into/in work" group (n=70) and the "on their way out/out of work" group (n=22) regarding age, sex, or levels of anxiety or pain. Surprisingly, regression analyses showed that those with higher levels of physical functioning had significantly lower odds of returning to work. Conclusion: The findings of an inverse relationship between self-reported physical function and returning to work in this sample illustrate that the return-to-work process among employees with chronic musculoskeletal pain and comorbid depressive symptoms is multifactorial and influenced by factors other than physical functioning at the individual level. Further research, especially longitudinal studies, is needed to assess the occupational trajectories among employees with chronic musculoskeletal pain and comorbid depressive symptoms after participation in a multidisciplinary rehabilitation program. Keywords: chronic musculoskeletal pain, multidisciplinary rehabilitation, physical functioning, depression, return to work

Abstract Background The prevalence of chronic musculoskeletal pain is high, with widespread negative economic, psychological, and social consequences for the individual. It is therefore important to find ways to predict the outcome of rehabilitation programmes in terms of function in daily life. The aims of this study were to investigate the improvements over time from multidisciplinary rehabilitation in terms of pain and function, and analyse the relative impact of individual and psychosocial factors as predictors of function in daily life in individuals with chronic musculoskeletal pain. Methods A prospective study was conducted among one hundred and forty three (N = 143) musculoskeletal pain patients. Measures of pain, function, and functional health status were obtained at baseline, after 5 weeks of intensive training, at the end of the 57-week rehabilitation programme, and at a 1 year follow-up, using validated self-administrated measures. Linear regression analysis was applied to investigate the relative impact of musculoskeletal pain, individual-, and psychosocial factors in function. Results The participants studied showed a significant increase in function during the 57 weeks rehabilitation period. There was also a significant increase in function from the end of the rehabilitation period (57th week) to the one year follow-up measures. Pain intensity associated significantly with pain experience over all measurement periods. High levels of pain intensity (β = .42**) and pain experience (β = .37*), and poor psychological capacity (β = -.68*) at baseline, as well as poor physiological capacity (β = -.44**) and high levels of anxiety (β = .48**) and depression (β = .58***) at the end of the rehabilitation program were the most important prognostic factors of variance in functioning over the 4 measurement periods. Conclusion The data suggest that physical capacity, emotional distress and coping skills should be priority areas in rehabilitation programmes to improve functioning in daily life.

Background: The study had two aims: first, to investigate trends in socioeconomic inequalities in psychological distress and loneliness among Norwegian adolescents, and second, to study variation and covariation of psychological distress and loneliness within adolescents and between siblings within families., Methods: Multivariate mixed models were used to investigate trends in socioeconomic inequality in psychological distress and loneliness using three separate cohorts of Norwegian adolescents from the Young-HUNT study conducted in 1995-1997 (Young-HUNT1, n  = 8980), 2006-2008 (Young-HUNT3, n  = 8199) and 2017-2019 (Young-HUNT4, n  = 8066). Register data on parental education level was used as a marker of socioeconomic position (SEP), and a unique family number was used to identify adolescents belonging to the same family. A three-level multivariate mixed model was created, consisting of the outcomes at level 1, adolescents at level 2 and families at level 3., Results: No statistically significant difference in scores on loneliness and psychological distress was observed between low and high parental education level in Young-HUNT1, whereas in Young-HUNT4, low parental education level was associated with a higher score on both psychological distress (β = 0.09; 95% confidence interval (CI), 0.03-0.14) and loneliness (β = 0.12; 95% CI 0.07-0.17). Analyses of covariation between psychological distress and loneliness showed that they were correlated within adolescents and strongly correlated within families across all timepoints., Conclusions: Increasing socioeconomic inequalities in psychological distress and loneliness among Norwegian adolescents is worrisome. Further, the family seems to be an important arena for potential prevention of psychological distress and loneliness among adolescents, regardless of parental education level ., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The centrality of human resources in the provision of healthcare suggests that Human Resource (HR) management and the use of Human Resource analytics - use of digital data to better understand, assess, plan and organize the workforce - can play an important role in this. However, data driven decision making in the field of human resource management is lagging, and the appropriation of HR analytics in the healthcare sector is limited., Aim: The current study explores the role of HR departments and the adoption of Human Resource analytics in four municipalities in Norway to obtain insights into what influences the use or lack of use of HR analytics., Methods: Empirical data were generated through qualitative interviews with fourteen individuals working in HR departments, the municipal administration, and the healthcare services. Structurational theory guided the analysis. The findings show that none of the municipalities made extensive use of data to inform decision making related to human resource management or workforce planning., Results and Conclusion: Three conditions hampered or made irrelevant the use of HR analytics: a decoupling between the services and HR, a weak data-culture, and HR and decision-making processes involving a plurality of stakeholders. However, there were changes underway in all municipalities related to the role of HR and HR analytics., (© 2024. The Author(s).)

Aim: To explore what municipal actors consider as inhibiting and promoting adolescents' involvement in public health measures in municipalities., Methods: A qualitative study with individual and group interviews was conducted among 15 municipal actors who were central in involving adolescents from five Norwegian municipalities participating in the National Programme for Public Health Work in Municipalities (2017-2027). In addition, participatory observation of project activities was done in two municipalities. A data-driven thematic analysis was applied to analyse data., Results: In the analysis, we developed four themes, including both inhibitors and promoters for adolescent involvement: (a) Timeframe challenges in adolescent involvement; (b) Lack of necessary knowledge and awareness among adolescents; (c) Limited competencies and resources in the project groups; and (d) Facilitators' attitudes on and perceptions of adolescent involvement., Conclusions: This study reports factors that are important to consider when facilitating involvement processes with young people. Findings suggest that further work should be done to ensure involvement of adolescents in public health measures in municipalities, and actors involving adolescents must be provided with competence and resources to ensure such participation., Competing Interests: Declaration of conflicting interestsThe author(s) declare that there is no conflict of interests.

Background: Reablement is a municipal service given to patients at home. The purpose of the service is to assist recovery after hospital discharges or other sudden changes in a patient's functional level. The service is often provided by a team of nurses, physiotherapists, and occupational therapists. The purpose of this paper is to compare users of this service to users who receive traditional home care services. Outcomes to be measured are risk of long-term care and mortality., Methods: All users of health and care services in a Norwegian municipality were eligible for inclusion. Data was extracted from the local user administrative database. Users were divided in two groups: those who received reablement and those home care users who did not receive reablement service. Propensity score matching was used to match users based on age, sex, and level of functioning in activities of daily living (ADL). Survival analysis was deployed to test if the reablement users had different risk of becoming long-term care users, and whether the mortality rate differed for this group., Results: 153 reablement users were included in the study. These were matched to 153 non-reablement home care users. The groups had similar distributions of age, sex, and level of functioning when starting their service trajectories. Regressions showed that reablement users had lower risk of using long-term care services in the study period (time at risk up to 4 years), and lower mortality. However, none of these estimates were statistically significant., Conclusions: The study indicates that the reablement users in one municipality had lower use of long -term care and lower mortality when properly estimated, but numbers were too small for statistical significance to be found., (© 2021. The Author(s).)

Aims: Children and young adults are in general characterised by good health, but evidence shows increasing mental-health problems. Numerous interventions have been developed to target their mental health, but the effectiveness of these interventions remains varied. In this scoping review, we investigated factors associated with the effectiveness of interventions. Methods: A scoping review based on a three-block search strategy was performed to review the current literature of effective interventions. Each block (interventions, mental health and children and young adults) were operationalised to search terms. Systematic searches were conducted in three electronic databases and supplemented with citation searches, resulting in 51 studies in total. All studies were critically analysed, and a standardised extraction chart was used to systemise the data. Results: Our scoping review revealed a range of factors influencing the effectiveness of interventions. These factors were (a) characteristics of the target group (age, sex and level of baseline symptoms), (b) factors linked to implementation (use of manuals, training of implementers and context) and (c) characteristics of the interventions (universal versus indicated delivery, multiple-domain approaches, level of theory and adjustment to age and socio-economic status). Elements are discussed for each factor. Conclusions: Based on this review, it can be concluded that the use of stepwise, multi-domain approaches incorporating the social networks of the target group, adjusting activities to specific age groups and the social context, training implementers well and using stringent implementation manuals will improve the effectiveness of interventions targeting the mental health of children and young adults.

Human consumption and activity are damaging the global ecosystem and the resources on which we rely for health, well-being and survival. The COVID-19 crisis is yet another manifestation of the urgent need to transition to more sustainable societies, further exposing the weaknesses in health systems and the injustice in our societies. It also underlines that many of the factors leading to environmental degradation, ill health and social and health inequities are interlinked. The current situation provides an unprecedented opportunity to invest in initiatives that address these common factors and encourage people to live more healthily and sustainably. Such initiatives can generate the positive feedback loops needed to change the systems and structures that shape our lives. INHERIT (January 2016-December 2019), an ambitious, multisectoral and transnational research project that involved 18 organisations across Europe, funded by the European Commission, explored such solutions. It identified, defined and analysed promising inter-sectoral policies, practices and approaches to simultaneously promote environmental sustainability, protect and promote health and contribute to health equity (the INHERIT "triple-win") and that can encourage and enable people to live, move and consume more healthfully and sustainably. It also explored the facilitators and barriers to working across sectors and in public private cooperation. The insights were brought together in guidelines setting out how policy makers can help instigate and support local "triple-win" initiatives that influence behaviours as an approach to contributing to the change that is so urgently needed to stem environmental degradation and the interlinked threats to health and wellbeing. This article sets out this guidance, providing timely insights on how to "build back better" in the post pandemic era.

Background: Adolescents' mental health, and its consistent relationship with their socioeconomic background, is a concern that should drive education, health, and employment policies. However, information about this relationship on a national scale is limited. We explore national overall trends and investigate possible socioeconomic disparities in adolescents' mental health, including psychological distress and symptoms of depression, anxiety, and loneliness in Norway during the period 2014-2018., Methods: The present study builds on data retrieved from five waves of the national cross-sectional Ungdata survey (2014-2018). In total 136,525 upper secondary school students (52% girls) completed the questionnaire during the study period. Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII)., Results: The prevalence of students with moderate to high symptoms score and mean symptoms scores of psychological distress (in terms of symptoms of depression, anxiety, and loneliness) increased among girls and boys during 2014-2018, with girls showing higher rates. Our results suggest distinct, but stable, inequalities between socioeconomic groups, both in absolute and relative terms, among girls and boys during the study period., Conclusion: Rising rates of adolescents' psychological distress, particularly among girls, may have long-term consequences for individuals involved and the society as a whole. Future studies should investigate the causes of these results. We did not find evidence of any change in inequalities in adolescents' mental health between socioeconomic groups, suggesting current strategies are not sufficiently addressing mental health inequalities in the adolescent population and therefore a significant need for research and public health efforts., (Copyright © 2020 Myhr, Anthun, Lillefjell and Sund.)

Green space areas offer several benefits that support our physical, psychological, and social health. However, the level of engagement with green space areas may not be the same across population groups. Using a mixed-method research design, we investigated the use of a green space area and whether and how the area was beneficial for health, social inclusion, and physical activity for all socioeconomic groups in a suburban area in Norway. The study showed significantly increased use of the area from 2015-2018 and that users belonged to different socioeconomic groups. The motivation for using the area was the opportunity to experience nature and to interact socially. While no significant changes in self-rated health, life satisfaction, or levels of physical activity were found, the study indicates that factors such as location, availability, and designated places for social interaction are important motivating factors for use. Users from the lower socioeconomic groups were among the frequent users but were also the least satisfied with the quality and availability of the path. Our findings call for closer consideration of the location and availability of green spaces and that including places for social interaction and relaxation can contribute to increased use of green spaces.

The world's challenges of climate change, damage to ecosystems, and social and health inequalities require changes in human behaviours at every level of organisation, among governments, business, communities, and individuals. An important question is how behaviour change can be enabled and supported at the scale and speed required. The research reported in this paper describes important lessons for good practice in changing contexts to modify behaviours for a triple win for health, equity and environmental sustainability. Authors synthesised learning from qualitative, quantitative and cost benefit evaluations of 15 case studies conducted in 12 countries in Europe. The case studies address ways of living (green spaces and energy efficient housing), moving (active transport) and consuming (healthy and sustainable diets) that support the triple win. Ten lessons for good practice were identified. These include bringing a triple win mindset to policy and practice in planning interventions, with potential to improve environmental sustainability, health and equity at the same time. The lessons for good practice are intended to support governmental and non-governmental actors, practitioners and researchers planning to work across sectors to achieve mutual benefits for health and environmental sustainability and in particular to benefit poorer and more socio-economically disadvantaged groups., Competing Interests: The authors declare no conflict of interest. The funding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Objective: This report examined whether a change in the perceived communication behaviour (PeCoBe) of general practitioners (GPs) influenced the effect of the Promoting Active Aging (PRACTA) intervention on activation of older patients as perceived by GPs., Methods: Pre- and post-intervention questionnaires were filled out by 225 GPs, who were assigned to three groups, e-learning, pdf-article, and control. GPs self-reported their communication behaviour and their perceptions of the attitudes of older patients toward treatment and health., Results: Participation in the e-learning intervention showed an increase in the PeCoBe of GPs, while reading the pdf-article resulted in a decrease of such behaviours. An increase in the PeCoBe of GPs was positively related to an increase in their perception of an active attitude among older patients. The indirect effects observed for e-learning and pdf-article interventions had opposite directions., Conclusion: Both types of PRACTA intervention exerted an impact on GPs' perception of the attitudes of older patients, and change in PeCoBe of GPs could be considered as a mechanism driving this effect., Practical Implications: The methods based on a combination of knowledge delivery and modelling of communication skills are strongly recommended forms of teaching for GPs on how to communicate with and activate seniors., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Aims: Patients' attitude towards treatment and health (ATH) is crucial for compliance at all stages of treatment. This study examined the psychometric properties of the developed PRACTA Attitude Towards Treatment and Health questionnaire, designed to measure ATH as perceived by seniors (PRACTA-ATH) and doctors (PRACTA-ATH-D) in primary health care., Methods: The data were collected in two waves of the Polish-Norwegian PRACTA project. Exploratory factor analyses (EFAs) were conducted on wave 1 data from senior patients ( n = 3392) and their general practitioners ( n = 491). Confirmatory factor analyses (CFAs) were conducted on wave 2 data. This was a new sample of senior patients ( n = 2765) and a follow-up sample of doctors ( n = 393)., Results: The EFAs showed that the 16-item four-factor solution is the best solution reflecting the structure of both seniors and doctors' ATH questionnaires. The CFAs conducted to establish the best unified model for PRACTA-ATH and PRACTA-ATH-D indicated three comparatively good solutions: the 16-item four-factor solution, the 12-item four-factor solution and the 12-item five-factor solution., Conclusions: The questionnaire is found appropriate for use among patients and doctors, and can be used as a good tool to monitor older patients' ATH and concordance between doctors and patients' perspectives.

Background: Multi-sectoral governance of population health is linked to the realization that health is the property of many societal systems. This study aims to contribute knowledge and methods that can strengthen the capacities of municipalities regarding how to work more systematically, knowledge-based and multi-sectoral in promoting health and health equity in the population., Methods: Process evaluation was conducted, applying a mixed-methods research design, combining qualitative and quantitative data collection methods., Results: Processes strengthening systematic and multi-sectoral development, implementation and evaluation of research-based measures to promote health, quality of life, and health equity in, for and with municipalities were revealed. A step-by-step model, that emphasizes the promotion of knowledge-based, systematic, multi-sectoral public health work, as well as joint ownership of local resources, initiatives and policies has been developed., Conclusions: Implementation of systematic, knowledge-based and multi-sectoral governance of public health measures in municipalities demand shared understanding of the challenges, updated overview of the population health and impact factors, anchoring in plans, new skills and methods for selection and implementation of measures, as well as development of trust, ownership, shared ethics and goals among those involved.

Background: School non-completion and early work disability is a great public health challenge in Norway, as in most western countries. This study aims to investigate how medically based disability pension (DP) among young adults varies geographically and how municipal socioeconomic conditions interact with non-completion of secondary education in determining DP risk., Methods: The study includes a nationally representative sample of 30% of all Norwegians (N = 350,699) aged 21-40 in 2010 from Statistic Norway's population registries. Multilevel models incorporating factors at the individual, neighbourhood and municipal levels were applied to estimate the neighbourhood and municipality general contextual effects in DP receipt, and detect possible differences in the impact of municipal socioeconomic conditions on DP risk between completers and non-completers of secondary education., Results: A pattern of spatial clustering at the neighbourhood (ICC = 0.124) and municipality (ICC = 0.021) levels are clearly evident, indicating that the underlying causes of DP receipt have a systematic neighbourhood and municipality variation in Norway. Non-completion of secondary education is strongly correlated with DP receipt among those younger than 40. Socioeconomic characteristics of the municipality are also significantly correlated with DP risk, but these associations are conditioned by the completion of secondary education. Living in a socioeconomically advantageous municipality (i.e. high income, high education levels and low unemployment and social security payment rates) is associated with a higher risk of DP, but only among those who do not complete their secondary education. Although the proportion of DPs was equal in rural and urban areas, it is evident that young people living in urban settings are more at risk of early DP than their counterparts living in rural parts of the country when controlling for other risk factors., Conclusion: The association between school non-completion and DP risk varies between municipalities and local socioeconomic environments. The interplay between personal characteristics and the local community is important in DP risk among young adults, implying that preventive measures should be directed not only at the individual level, but also include the educational system and the local community.

Background: Activating older adults in medical practice can benefit patients' health and quality of life, as well as the economy and burden of the healthcare system. Placing general practice in the public healthcare system gives the elderly population easy access to the promotion of active attitudes toward health, provided that the doctors have and use relevant activating tools. The aim of this study was to verify the possibility of activating senior patients through an educational intervention for doctors., Methods: Two waves of data collection from primary care patients and their doctors were separated by an intervention for doctors. The intervention took the form of an e-learning programme or article and was developed so as to improve general practitioners' (GP) communication and activation skills, especially when working with older adults. The outcome variable was the change between the waves in patients' scores on the PRACTA Attitude Toward Treatment and Health (ATH) Scale and PRACTA Self-efficacy Scale. Data from patients aged 50 + (n = 2175; 55.6% women; age: M = 69.56, SD = 9.10) appointed at the primary care facilities were analysed., Results: The analysis revealed the effect of doctors' e-learning and, to a lesser extent, the effect of article reading on patients' attitudes toward treatment and health as well as on their self-efficacy. In facilities in which the intervention was implemented, patients' attitudes were more active on follow-up than at baseline when compared with facilities without the intervention., Conclusions: Educational intervention among doctors can result in patients' ATH becoming more active. The form of intervention might diversify the impact., (© The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Providing individuals with psychosocial resources such as sense of coherence (SOC) seems a beneficial strategy for health promotion in the neighborhood. In order to become a supporting theory for health promotion, Salutogenesis should renew its focus on resources for health, and explore how the development of a strong SOC can be facilitated., Methods: Relevant issues were explored using a Grounded Theory- approach. Three focus-group-sessions and three in-depth interviews were conducted with strategically sampled participants. The transcripts of the focus groups were initially analyzed line-by-line to ensure that insights emerged from the data. We then applied focused and systemic analyses to achieve axial coding, and to include insights into how social interactions during focus groups may reveal social processes in real-life-neighborhoods. The data from the in-depth interviews were used to validate and fill emerging categories, as well as to ensure data-saturation., Results: Findings indicate the importance of repeated experiences with resources and every-day-challenges to develop a strong SOC. Active engagement with resources is a favorable condition for significant experiences, which enhance the internalization of resources. Core experiences are characterized by a re-organization of resources. Participation in intellectual meaning-making through equal power dialogue seems to broaden perspectives and promote the strengthening of SOC. A strong SOC can also be described as a deeper understanding of how and why resources work, which allows for a more flexible use of resources, including replacing missing resources., Conclusion: A new understanding of SOC as an intuitive understanding of how, why and under which circumstances resources work, as well as a new focus on everyday life and repeated experiences might facilitate new approaches to a purposeful strengthening of SOC through the planning and implementation of public measures.

Background: Demographic changes over the past decades call for the promotion of health and disease prevention for older patients, as well as strategies to enhance their independence, productivity, and quality of life., Objective: Our objective was to examine the effects of a computer-based educational intervention designed for general practitioners (GPs) to promote active aging., Methods: The Promoting Active Aging (PRACTA) study consisted of a baseline questionnaire, implementation of an intervention, and a follow-up questionnaire that was administered 1 month after the intervention. A total of 151 primary care facilities (response rate 151/767, 19.7%) and 503 GPs (response rate 503/996, 50.5%) agreed to participate in the baseline assessment. At the follow-up, 393 GPs filled in the questionnaires (response rate, 393/503, 78.1%), but not all of them took part in the intervention. The final study group of 225 GPs participated in 3 study conditions: e-learning (knowledge plus skills modelling, n=42), a pdf article (knowledge only, n=89), and control (no intervention, n=94). We measured the outcome as scores on the Patients Expectations Scale, Communication Scale, Attitude Toward Treatment and Health Scale, and Self-Efficacy Scale., Results: GPs participating in e-learning demonstrated a significant rise in their perception of older patients' expectations for disease explanation (Wald χ 2 =19.7, P<.001) and in perception of motivational aspect of older patients' attitude toward treatment and health (Wald χ 2 =8.9, P=.03) in comparison with both the control and pdf article groups. We observed additional between-group differences at the level of statistical trend. GPs participating in the pdf article intervention demonstrated a decline in self-assessed communication, both at the level of global scoring (Wald χ 2 =34.5, P<.001) and at the level of 20 of 26 specific behaviors (all P<.05). Factors moderating the effects of the intervention were the number of patients per GP and the facility's organizational structure., Conclusions: Both methods were suitable, but in different areas and under different conditions. The key benefit of the pdf article intervention was raising doctors' reflection on limitations in their communication skills, whereas e-learning was more effective in changing their perception of older patients' proactive attitude, especially among GPs working in privately owned facilities and having a greater number of assigned patients. Although we did not achieve all expected effects of the PRACTA intervention, both its forms seem promising in terms of enhancing the competencies of doctors in communication with and activation of older patients., (©Dorota Wlodarczyk, Joanna Chylińska, Magdalena Lazarewicz, Marta Rzadkiewicz, Mariusz Jaworski, Miroslawa Adamus, Gørill Haugan, Monica Lillefjell, Geir Arild Espnes. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 22.02.2017.)

Background: Completion of secondary education is important for individuals' future health and health behaviour. The fundamental purpose of this study is to investigate the variation and clustering of school completion in families and neighbourhoods. Secondly, we aim to examine the impact of individuals' family structure and neighbourhood of residence and examine to what extent parental education level moderates these associations., Methods: Longitudinal register data for 30% of the entire Norwegian population aged 21-27 years in 2010 (N = 107,003) was extracted from Statistic Norway´s event database. Three-level logistic regression models, which incorporated individual, family, and neighbourhood contextual factors, were applied to estimate the family and neighbourhood general contextual effects and detect possible educational differences in the impact of family structure and urban place of residence in school completion., Results: Completion rates were significantly higher within families with higher education level (79% in tertiary educated families vs. 61% and 48% in secondary and primary educated families respectively) and were strongly correlated within families (ICC = 39.6) and neighbourhoods (ICC = 5.7). Several structural factors at the family level negatively associated with school completion (e.g., family disruption, large family size, and young maternal age) were more prevalent and displayed more negative impact among primary educated individuals. Urban residence was associated with school completion, but only among the tertiary educated., Conclusions: Investment in the resources in the individuals' immediate surroundings, including family and neighbourhood, may address a substantial portion of the social inequalities in the completion of upper secondary education. The high intra-familial correlation in school completion suggests that public health policies and future research should acknowledge family environments in order to improve secondary education completion rates among young people within lower educated families.

Neighborhood social capital has repeatedly been linked to favorable health-outcomes and life satisfaction. However, it has been questioned whether it's impact on health has been over-rated. We aim to investigate relationships between neighborhood social capital and self-rated health (SRH) and life satisfaction (LS) respectively, both directly and indirectly mediated via Sense of Coherence and self-esteem. Based on a cross-sectional population-survey (N=865) in a medium size Norwegian municipality, we specified a structural equation model (SEM) including the above-listed variables, while controlling for gender, age, education, income, and employment status. The applied model explains more variance in LS (46%) than in SRH (23%). Social capital has a stronger impact on life satisfaction than on health. The indirect pathway via SOC had the highest impact on life satisfaction, but no significant relationship to SRH. Self-rated health was more tightly linked to personal background variables. Enhancing social capital in the neighborhood might be a beneficial strategy to promote life satisfaction, as well as strengthening sense of coherence even in healthy communities., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aims: The aim of this article is to describe and discuss how the search conference can be used as a method for planning health promotion actions in local communities. Design and methods: The article draws on experiences with using the method for an innovative project in health promotion in three Norwegian municipalities. The method is described both in general and how it was specifically adopted for the project. Results and conclusions: The search conference as a method was used to develop evidence-based health promotion action plans. With its use of both bottom-up and top-down approaches, this method is a relevant strategy for involving a community in the planning stages of health promotion actions in line with political expectations of participation, ownership, and evidence-based initiatives., Competing Interests: the authors declare no potential conflict of interest.

Objectives: Lack of work-participation and early disability pensions (DP's) among young adults are increasing public health problems in most western European countries. The present study investigated determinants of early DP in young adults in vocational rehabilitation., Methods: Data from 928 young adults (aged 18-40 years) attending a vocational rehabilitation program was linked to DP's recorded in the Norwegian Labor and Welfare Organization registries (1992-2010) and later compared to a group of 65 employees (workers). We used logistic regression to estimate the odds ratio for entitlement to DP following rehabilitation, adjusting for socio-demographical, psychosocial and health-behavior factors., Results: Significant differences in socio-demographical, psychosocial and health-behavior factors were found between the rehabilitation group and workers. A total of 60 individuals (6.5%) were granted a DP during follow-up. Increase in age, teenage parenthood, single status, as well as low education level and not being employed were found to be the strongest independent determinants of DP., Conclusion: Poor social relations (being lone), early childbearing and weak connection to working life contributed to increase in risk of DP's among young adults in vocational rehabilitation, also after adjusting for education level. These findings are important in the prevention of early disability retirements among young adults and should be considered in the development of targeted interventions aimed at individuals particularly at risk of not being integrated into future work lives.

Background: Health promotion, with a focus on multidimensional upstream factors and an ecological, life-course approach, is establishing itself as the guiding philosophy for addressing public health. Action at the political and programmatic level on the Social Determinants of Health has proven effective for promoting and building public health at all levels but has been particularly evident at the national and international levels - due in large part to available documents and guidelines. Although research and experience establish that health promotion is most effective when settings-based, the development of health promoting policies and programs at the local level is still difficult. This study intended to investigate available knowledge on the development and implementation of health promoting policies and programs at the local level and identify factors most important for facilitating capacity building and outcome achievement., Methods: We used a scoping review in order to review the current literature on local policy development and program implementation. Keywords were chosen based on results of a previous literature review. A total of 53 articles were divided into two categories: policy and implementation. Critical analysis was conducted for each article and a summary assembled. Data was charted with specific focus on the aims of the study, data acquisition, key theories/concepts/frameworks used, outcome measures, results, and conclusions., Results: The articles included in this study primarily focused on discussing factors that facilitate the development of health promoting policy and the implementation of health promotion programs. Most significant facilitators included: collaborative decision-making, agreement of objectives and goals, local planning and action, effective leadership, building and maintaining trust, availability of resources, a dynamic approach, a realistic time-frame, and trained and knowledgeable staff. Within each of these important facilitating factors, various elements supporting implementation were discussed and highlighted in this study., Conclusion: Our results indicate that clear and consistent facilitators exist for supporting health promoting policy development and program implementation at the local level. These results offer a starting point for local action on the Social Determinants of Health and have the potential to contribute to the development of a framework for improving action at the local level.

Background: Although a strong sense of coherence, described as the dimensions of a person's response to a stressful situation, improves the prospects of coping with health problems, more knowledge is required about the association between initial anxiety levels and physical functioning after rehabilitation in relation to individuals' own experiences of their health-resources., Objective: To investigate if the associations between anxiety, pain, and functional health status differ with a strong and weak sense of coherence in employees with chronic musculoskeletal pain in rehabilitation., Methods: One thousand six hundred and sixty-five employees (mean age=45.2/SD=9.1) were included in the study. Self-reported sense of coherence (SOC), personal characteristics, anxiety, functional status, and pain were collected at the start (T1) and at the end of the rehabilitation period (12 weeks) (T2). Based on validated cut-off values the employees were divided into strong (> 75) (n=280) and weak (< 57) (n =433) SOC samples., Results: The strong SOC sample reported lower levels of anxiety (p < 0.001) and higher levels on functional health status(p < 0.001) at T1 and T2, compared to the weak SOC sample. Baseline anxiety predicted low functional health status in the weak SOC sample at T2. Anxiety had less negative consequences for function after rehabilitation in the strong SOC compared to the weak SOC sample., Conclusions: The data suggest that appropriate interventions would strengthen the level of SOC in the most vulnerable, as well as resources that encourage SOC.

Background: Loneliness is negatively related to good health and wellbeing, especially among girls. There is little research, however, on factors that may ease the burdens of loneliness in the school setting. Thus, we explored the relationship between girls' loneliness and later school wellbeing adjusted for other adversities. Furthermore, we assessed the significance of having someone whom the girl trusted by investigating possible modifying influences on the addressed association., Methods: Altogether, 119 girls in grades 1-8 provided baseline data and answered the same set of questions two years later. Logistic regression models including perceived academic problems, victimisation by bullying, loneliness and trusted others were tested with bad versus good school wellbeing two years later as outcome using SPSS., Results: In the multivariable analysis of loneliness, academic problems, and victimisation, loneliness was the only variable showing a strong and negative contribution to later school wellbeing. Next, demonstrated in separate models; the inclusion of having a trusted class advisor fully attenuated the association of loneliness with later school wellbeing. In contrast, other trusted teachers, trusted parents, or trusted students did not affect the association., Conclusions: Loneliness in girls strongly predicted school wellbeing two years later. However, having a class advisor whom the girl trusted to contact in hurtful situations clearly reduced the burden of loneliness. This finding highlights the clinical importance of stability, long-lasting relations, and trust that main teachers may represent for lonely girls.

Background: Health and conditions for health are unevenly distributed across neighbourhoods. Within a salutogenic perspective, neighbourhood-resources can be internalised, and become generalised resistance resources. This paper aims to examine whether the neighbourhood could be a supportive arena for health-promotion, and for whom., Design and Methods: A cross-sectional study, based on register data from the population-survey in Malvik, Norway, (N=865) was conducted. Using multiple regression analysis, total sample and sub-group analyses (men/women, low/high earners, employed/unemployed) of 5 independent neighbourhood-measures (overall satisfaction, neighbourhood Social Capital, satisfaction with availability and quality of neighbourhood-resources, and neighbourhood participation) on Sense of Coherence (SOC) and health respectively were obtained., Results: Overall satisfaction (β=0.153) and neighbourhood social capital (β=0.134) emerged as the most consistent partial correlates of SOC across groups. In turn, SOC was the strongest coefficient for health-outcomes (β=0.238). Neighbourhood participation had more consistent correlations with health than SOC across groups. Group-differences became visible in proportions of explained variance in SOC (varying from 7 to 23.7%) and health (varying from 6.7 to 20.6%), and in the relative importance of neighbourhood-variables. Satisfaction with quality of neighbourhood-resources was significantly related to SOC in non-workers (β=0.451) and low-earners (β=0.261), and health-outcomes in women (β=0.143)., Conclusions: Health might be promoted in the neighbourhood mainly through strengthening SOC, and deprived groups, especially non-workers, may benefit most from health-promotion in the neighbourhood. Findings suggest that high satisfaction with quality can contribute to better health-outcomes for groups with weaker average SOC. The proposed theoretical framework is only partly supported. Significance for public healthThe creation of health-promoting settings has been outlined as one of the main strategies ahead by the Ottawa-charter. Findings from this study suggest that health can be promoted through the neighbourhood, both through strengthening Sense of coherence (SOC), and providing resources for health-promotion. It is suggested that the neighbourhood might be of benefit for promoting health in groups which might be otherwise hard to reach, such as people outside the work-force. Moreover, investigating the relationships between various perceptions of neighbourhood-resources and SOC/health across groups allows for developing strategies for positive change, including improving quality of neighbourhood-resources, and facilitating neighbourhood participation.

Purpose: The purpose of this paper is to examine the contribution of modern correctional service in health promotion exemplified by the case study of Norwegian health promotion policies in prison settings., Design/methodology/approach: This paper applies a two-fold methodology. First a narrative systematic literature review based on the Norwegian policy documents relevant for correctional settings is conducted. This is followed by a general review of the literature on the principles of humane service delivery in offender rehabilitation., Findings: Alongside the contribution of the Risk-Need-Responsivity Model in corrections and prevention of reoffending, the findings demonstrate an evident involvement of Norway in health promotion through authentic health promoting actions applied in prison settings. The actions are anchored in health policy's overarching goals of equity and "health in all public policy" aiming to reduce social inequalities in population health., Originality/value: In order to achieve a potential success of promoting health in correctional settings, policy makers have much to gain from endorsing a dialogue that respects the unique contributions of correctional research and health promotion. Focussing on inter-agency partnership and interdisciplinary collaboration between humane services may result in promising outcomes for individual, community and public health gain. The organizational factors and community involvement may be a significant aspect in prisoner rehabilitation, reentry and reintegration.

Objective: Efforts have been made to explain the inability to return to work (RTW) due to employees' chronic musculoskeletal pain. Knowledge of factors facilitating the RTW process is however still limited. Based on the experiences of employees and employers, this study aims to identify factors promoting a successful return process for persons with chronic musculoskeletal pain., Methods: The findings from interviews, involving six employees with musculoskeletal pain, and five employers with various work experience, were analysed by Giorgi's phenomenological analysis through four stages., Results: The major themes underlying the employees' comments for a successful RTW were identifying and mobilizing their personal resources, adapting a balanced daily life, and requiring a positive dialogue with family and their employer, while the employers underlined the need for a helpful adjustment at work and how they wanted to become more involved in the rehabilitation process., Conclusions: In conclusion our findings underline the need for extended collaboration between the employees, employer, and rehabilitation staff, and should encourage occupational therapists to direct even more of their expertise towards the situation at the workplace.

Background: Musculoskeletal pain (MSP) is one of the most frequent causes of sick leave from work, and is a common and potentially disabling condition. This study is based on the salutogenic perspective and investigates the relationship between personal, social, and functional health resources and work participation in a population reporting MSP., Method: Analysis was performed on cross sectional data from the Nord-Trøndelag Health Study, HUNT 3, in Norway. The sample of n= 6702 was extracted from HUNT 3, including a total of N= 50807 participants. Self-reported health (SRH) and, personal, social, and functional resources were assessed by a questionnaire. Reported sick leave was collected by interview at the point of time when the data were collected, from October 2006 until June 2008., Results: Logistic regression analysis demonstrated statistically significant differences between the work group and sick leave group in self-rated health, work support, work control, work load, and feeling strong, and the model predicted 68% of the cases correctly. Females had a lower statistically significant probability (B= -.53) to be in the work group then men when suffering from MSP, with odds of 41%., Conclusion: There was a statistically significant relationship between health promoting resources such as SRH, feeling strong, absence of neuroticism, work load, work control, and work participation in MSP population.

Unlabelled: The present paper investigates possible gender and age differences on emotional states (state depression and state anxiety) and sense of coherence (SOC) as well as the association between SOC and emotional states. The cross-sectional sectional sample consists of 1209 adolescents 13-18 years from public elementary and secondary schools in Mid-Norway. The results showed that girls reported higher scores on state anxiety and state depression, whereas boys consistently scored higher on SOC in all age groups. SOC was inversely associated with both state depression and state anxiety. An interaction effect of gender by SOC was found on both state depression and state anxiety, where the association was stronger for girls than for boys., Conclusions: The associations found give support for the implications of salutogenic factors in relation to emotional health in adolescents., (Copyright © 2011 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Background: The prevalence of chronic musculoskeletal pain is high, with widespread negative economic, psychological, and social consequences for the individual. It is therefore important to find ways to predict the outcome of rehabilitation programmes in terms of function in daily life. The aims of this study were to investigate the improvements over time from multidisciplinary rehabilitation in terms of pain and function, and analyse the relative impact of individual and psychosocial factors as predictors of function in daily life in individuals with chronic musculoskeletal pain., Methods: A prospective study was conducted among one hundred and forty three (N = 143) musculoskeletal pain patients. Measures of pain, function, and functional health status were obtained at baseline, after 5 weeks of intensive training, at the end of the 57-week rehabilitation programme, and at a 1 year follow-up, using validated self-administrated measures. Linear regression analysis was applied to investigate the relative impact of musculoskeletal pain, individual-, and psychosocial factors in function., Results: The participants studied showed a significant increase in function during the 57 weeks rehabilitation period. There was also a significant increase in function from the end of the rehabilitation period (57th week) to the one year follow-up measures. Pain intensity associated significantly with pain experience over all measurement periods. High levels of pain intensity (beta = .42**) and pain experience (beta = .37*), and poor psychological capacity (beta = -.68*) at baseline, as well as poor physiological capacity (beta = -.44**) and high levels of anxiety (beta = .48**) and depression (beta = .58***) at the end of the rehabilitation program were the most important prognostic factors of variance in functioning over the 4 measurement periods., Conclusion: The data suggest that physical capacity, emotional distress and coping skills should be priority areas in rehabilitation programmes to improve functioning in daily life.

This study investigated the association between sense of coherence (SOC) and work reentry. One hundred and fifty-three patients with musculoskeletal pain (mean age=45.6 years, SD=9.1) were included. SOC, demographics, personal characteristics, work status, pain intensity, pain experience, anxiety, and depression were collected during a 57-week rehabilitation period. SOC significantly improved, and pain experience, anxiety, and depression significantly decreased during the rehabilitation period. SOC was found to significantly predict anxiety and depression in the nonwork reentry subsample (n=44). No significant association was found between SOC and work reentry. These data clarify the role of SOC in chronic pain and emotional distress and question the role of SOC in predicting work reentry in long-term chronic musculoskeletal pain conditions., (Copyright 2007 APA)

Introduction: This study aimed to investigate the outcome and outcome predictors of multidisciplinary rehabilitation in terms of working ability., Methods: One hundred and forty three (n=143) patients with musculoskeletal pain (mean age=45.7, SD=8.9) were included. Work status, pain, functional health status and psychosocial factors were collected previous to treatment, after a 5 week intensive training and a 52 week follow-up period. Demographics and data on personal characteristics were also collected., Results: Workability increased from 57.4 to 80% during treatment period. Stepwise multivariate logistic regression indicated that age, sleeplessness, cognitive function, overall health, pain experience, and anxiety were the strongest predictors of work ability. Pain severity and depression were not found to be significant predictors of work ability., Conclusions: These data suggest that emotional distress, cognitive function and overall health are important priority areas in rehabilitation programmes to improve work ability.

Introduction: This study aimed to investigate gender differences in rehabilitation outcomes and how psychosocial factors may interact to influence rehabilitation outcome in work-disabled with chronic musculoskeletal pain., Methods: One hundred and sixty eight (n=168) persons (mean age = 45.5/SD=9.0) participating in a multidisciplinary rehabilitation program, were included. Data on pain, functional health and psychosocial factors were collected previous to treatment, after 5 week intensive training and after 52 week follow-up period. Demographics, socio-economics and data on personal characteristics were also collected., Results: Significant (p<.05) gender differences were found on sleeplessness, meaningfulness and manageability. No significant gender differences were found on pain or functional health status variables. Gender differences (p<.001) were found in how socio-demographic and psychosocial factors influence rehabilitation outcomes in terms of functional health status., Conclusions: These data suggests that knowledge of gender differences and the way psychosocial factors influence rehabilitation outcomes must be taken into account in designing rehabilitation intervention.