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Mari Nordbø Gynnild,1,2 Steven HJ Hageman,3 Jannick AN Dorresteijn,3 Olav Spigset,4,5 Stian Lydersen,6 Torgeir Wethal,1,2 Ingvild Saltvedt,1,7 Frank LJ Visseren,3 Hanne Ellekjær1,2 1Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU – Norwegian University of Science and Technology, Trondheim, Norway; 2Department of Stroke, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; 3Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; 4Department of Clinical Pharmacology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; 5Department of Clinical and Molecular Medicine, NTNU – Norwegian University of Science and Technology, Trondheim, Norway; 6Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, Norway; 7Department of Geriatrics, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, NorwayCorrespondence: Mari Nordbø GynnildDepartment of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, NorwayEmail mari.nordbo.gynnild@ntnu.noPurpose: Suboptimal secondary prevention in patients with stroke causes a remaining cardiovascular risk desirable to reduce. We have validated a prognostic model for secondary preventive settings and estimated future cardiovascular risk and theoretical benefit of reaching guideline recommended risk factor targets.Patients and Methods: The SMART-REACH (Secondary Manifestations of Arterial Disease-Reduction of Atherothrombosis for Continued Health) model for 10-year and lifetime risk of cardiovascular events was applied to 465 patients in the Norwegian Cognitive Impairment After Stroke (Nor-COAST) study, a multicenter observational study with two-year follow-up by linkage to national registries for cardiovascular disease and mortality. The residual risk when reaching recommended targets for blood pressure, low-density lipoprotein cholesterol, smoking cessation and antithrombotics was estimated.Results: In total, 11.2% had a new event. Calibration plots showed adequate agreement between estimated and observed 2-year prognosis (C-statistics 0.63, 95% confidence interval 0.55– 0.71). Median estimated 10-year risk of recurrent cardiovascular events was 42% (Interquartile range (IQR) 32– 54%) and could be reduced to 32% by optimal guideline-based therapy. The corresponding numbers for lifetime risk were 70% (IQR 63– 76%) and 61%. We estimated an overall median gain of 1.4 (IQR 0.2– 3.4) event-free life years if guideline targets were met.Conclusion: Secondary prevention was suboptimal and residual risk remains elevated even after optimization according to current guidelines. Considerable interindividual variation in risk exists, with a corresponding variation in benefit from intensification of treatment. The SMART-REACH model can be used to identify patients with the largest benefit from more intensive treatment and follow-up.Keywords: secondary prevention, ischemic stroke, risk factors, risk assessment, risks and benefits, cardiovascular diseases

Jasmine Pani,1,2 Line S Reitlo,1,2 Hallvard Røe Evensmoen,2 Stian Lydersen,3 Ulrik Wisløff,4,5 Dorthe Stensvold,4,6 Asta K Håberg1,2 1Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU (Norwegian University of Science and Technology), Trondheim, Norway; 2Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; 3Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU (Norwegian University of Science and Technology), Trondheim, Norway; 4Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU (Norwegian University of Science and Technology), Trondheim, Norway; 5School of Human Movement & Nutrition Sciences, University of Queensland, Queensland, Australia; 6Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, NorwayCorrespondence: Asta K HåbergDepartment of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU (Norwegian University of Science and Technology), Trondheim, N-7491, NorwayTel +47 90 25 91 47Email asta.haberg@ntnu.noPurpose: The aim was to examine the effect of a 5-year exercise intervention at different intensities on brain structure in older adults from the general population partaking in the randomized controlled trial Generation 100 Study.Participants and Methods: Generation 100 Study participants were invited to a longitudinal neuroimaging study before randomization. A total of 105 participants (52 women, 70– 77 years) volunteered. Participants were randomized into supervised exercise twice a week performing high intensity interval training in 4× 4 intervals at ∼ 90% peak heart rate (HIIT, n = 33) or 50 minutes of moderate intensity continuous training at ∼ 70% of peak heart rate (MICT, n = 24). The control group (n = 48) followed the national physical activity guidelines of ≥ 30 min physical activity daily. Brain MRI at 3T, clinical and cardiorespiratory fitness (CRF), measured as peak oxygen uptake, were collected at baseline, and after 1, 3, and 5 years of intervention. Brain volumes and cortical thickness were derived from T1 weighted 3D MRI data using FreeSurfer. The effect of HIIT or MICT on brain volumes over time was investigated with linear mixed models, while linear regressions examined the effect of baseline CRF on brain volumes at later time points.Results: Adherence in each group was between 79 and 94% after 5 years. CRF increased significantly in all groups during the first year. Compared to controls, the HIIT group had significantly increased hippocampal atrophy located to CA1 and hippocampal body, though within normal range, and the MICT group greater thalamic atrophy. No other effects of intervention group were found. CRF across the intervention was not associated with brain structure, but CRF at baseline was positively associated with cortical volume at all later time points.Conclusion: Higher baseline CRF reduced 5-year cortical atrophy rate in older adults, while following physical activity guidelines was associated with the lowest hippocampal and thalamic atrophy rates.Keywords: CNS, aging, limbic, brain reserve, morphometry

Bodil Røyset,1 Bente A Talseth-Palmer,2–4 Stian Lydersen,5 Per G Farup6,7 1Department for Medicine and Rehabilitation, Møre og Romsdal Hospital Trust, Ålesund, Norway; 2Department for Research, Innovation, Education and Competence Development, Møre og Romsdal Hospital Trust, Molde, Norway; 3Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; 4School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia; 5Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; 6Department of Research, Innlandet Hospital Trust, Brumunddal, Norway; 7Unit for Applied Clinical Research, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway Purpose: Falls are a common adverse event experienced by elderly in hospitals. This study assessed the effects of a fall prevention program on the rate of fallers, the patient safety culture, and patient-perceived safety.Materials and methods: Two orthopedic departments in different towns in Norway participated in the study. A comprehensive, multifactorial fall prevention program was implemented in one of the departments, the other one was used for control. The changes in the outcomes in the two departments from before to after the intervention were compared. All patients above 64 years of age admitted to the two departments in a 1-year period before and after the intervention were included. All employees at the two departments were invited to participate in surveys measuring the patient safety culture, and a selection of the patients reported patient-perceived safety. The primary outcome was the rate of fallers. Secondary outcomes were the employees’ perceived patient safety culture (measured with the Safety Attitudes Questionnaire) and patient-perceived safety (measured with Norwegian Patient Experience Questionnaire).Results: Falls were registered in 114 out of 3,143 patients (3.6%) with 17,006 days in the hospital. Ten patients had two falls, giving a fall rate of 7.3 falls/1,000 days in the hospital. The number of fallers before and after the intervention in the intervention department were 37/734 (5.04%) and 31/735 (4.22%), P=0.46, and in the control department, 25/811 (3.08%) and 21/863 (2.43%), P=0.46. The difference between the changes in the two departments was not statistically significant; 0.17% (95% CI: -2.49 to 2.84; P=0.90). There were also no significant differences in the changes in patient safety culture and patient-perceived safety.Conclusion: The fall prevention program revealed no significant effect on the rate of fallers, the patient safety culture, or patient-perceived safety. Keywords: accidental falls, accident prevention, adverse effects, patient safety, safety culture

Jannike Kaasbøll,1,2 Stian Lydersen,2 Ingunn Ranøyen,2,3 Wendy Nilsen,4 Marit S Indredavik2,3 1Department of Health Research, SINTEF, Trondheim, Norway; 2Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology (NTNU), Trondheim, Norway; 3Department of Children and Youth, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; 4The Work Research Institute, OsloMet – Oslo Metropolitan University, Oslo, Norway Background: A growing body of research suggests that the children of parents with chronic pain are at risk for internalizing symptoms. The mechanisms of such associations have not been as thoroughly examined. The aim of the present study was to investigate whether adolescents’ social competence mediates the association between parental chronic pain and offspring internalizing symptoms as well as whether these associations are moderated by adolescent gender. Methods: The current study was based on cross-sectional data from the Nord-Trøndelag Health Study (HUNT 3), a Norwegian population-based health survey conducted in 2006–2008. The present sample comprised adolescents who had both parents participating (n=9,681). Structural equation modeling was used for the data analysis. Results: Our results indicated that the association between concurrent maternal and paternal chronic pain and offspring’s symptoms of anxiety and depression was partly mediated by low social competence for girls (b(SE)=0.060 [0.030], P=0.043) but not for boys (b(SE)=−0.059 [0.040], P=0.146). This suggests that these associations are moderated by offspring gender. Conclusion: The study extends the existing literature on the possible pathways between parental chronic pain and internalizing symptoms in the offspring. Identifying protective factors in the pathways between parental chronic pain and mental distress in children could guide measures that promote the wellbeing of the child and family of chronic pain sufferers. Keywords: chronic pain, adolescents, social competence, anxiety, depression, sex differences

Martina Reiten Bovim,1 Bent Indredavik,1,2 Anne Hokstad,1,2 Stian Lydersen,3 Torunn Askim1,2 1Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; 2Stroke Unit, St. Olavs Hospital, Trondheim, Norway; 3Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Background: The reported prevalence of pain after stroke varies considerably, depending on how pain is measured, time after stroke, and characteristics of the selected population. The aims of this study were to investigate the prevalence and distribution of new-onset pain initially and three months after stroke in a general Norwegian cohort, and to examine whether symptoms of anxiety or depression were associated with new-onset pain after stroke. Material and methods: Stroke patients were included from eleven different hospitals within 14 days after stroke onset. Pain was assessed at inclusion and three months after stroke, and the distribution of pain was marked on a body map. New-onset pain was defined as pain reported by the patients to have occurred after the stroke. Symptoms of anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale. Results: A total of 390 patients were included. Pain data were available in 142 patients at both inclusion and follow-up, while 245 patients had available data for the regression analysis. In patients with follow-up data, new-onset pain occurred in 14 (9.9%) patients at inclusion and in 31 (21.8%) patients three months later, P=0.005. New-onset pain in the affected upper limb and bilaterally in the lower limbs was more common at three months than initially after stroke. Symptoms of anxiety were associated with new-onset pain (OR=1.13, 95% CI 1.01–1.27, P=0.030). Conclusion: This study shows that new-onset pain occurs in one out of ten patients initially after stroke and in one out of five patients three months after stroke, and it was associated with symptoms of anxiety. This raises the question of whether easing symptoms of anxiety might help to prevent or treat new pain after stroke. Keywords: stroke, pain, cerebral infarction, complication, anxiety

Jannike Kaasbøll,1 Stian Lydersen,1 Marit S Indredavik1,2 1Regional Centre for Child and Youth Mental Health and Child Welfare of Central Norway, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; 2Department of Child and Adolescent Psychiatry, St Olav's Hospital, Trondheim University Hospital Trondheim, Norway Purpose: The aim of the present study was to investigate possible associations between parental chronic pain and smoking, alcohol, and drug use in adolescent offspring. Methods: Cross-sectional data from Nord-Trøndelag Health Study (HUNT 3), a Norwegian population-based health survey conducted in the period 2006–2008 was utilized. The present sample consisted of adolescents aged 13–18 years (n=3,227) for whom information was available on maternal and paternal health statuses. Results: Results from multivariable ordinal and binary logistic regression analyses, adjusting for potential confounding factors (child age, parental age, education, and organ specific illness) indicated that the estimated odds ratios (OR) for smoking (OR =1.72, 95% confidence interval [CI] [1.00, 3.05], P=0.049) and alcohol intoxication (drunkenness) (OR =1.56, 95% CI [1.05, 2.33], P=0.029) were higher for boys whose mother and father had chronic pain, compared with boys for whom neither parent had chronic pain. These associations were slightly attenuated by additional adjustment for pain-related factors, such as parental smoking and symptoms of anxiety and depression. Parental chronic pain was not significantly associated with girls' levels of substance use. There were significant interaction effects between parental chronic pain and child sex on offspring's alcohol and smoking. Conclusion: The present study expands on existing knowledge and provides groundwork for preventive and specific measures targeting substance use in families burdened with parental chronic pain. Keywords: adolescents, chronic pain, smoking, alcohol, drugs

Internalizing problems may be associated with poor academic performance and school absenteeism among youth. This study investigated the impact of the EMOTION: "Coping Kids" Managing Anxiety and Depression Program on academic achievement and school adaptation in children. Data were collected in a national cluster-randomized controlled trial at three time points in Norway. Children (N = 688, 8-12 years), who had elevated levels of anxiety or depressive symptoms from 36 schools participated. There were no significant differences between the intervention and control groups post-intervention or at 12-month follow-up regarding academic achievement and school adaptation. Likewise, no significant intervention effects were identified for school-related variables in the anxiety-only, depression-only, or combined (anxiety and depression) groups. The intervention did not have an impact on school functioning. Thus, focusing on school-related challenges and enhanced collaboration with teachers, possibly through a tailored version of the EMOTION program, could be an interesting adaptation of the intervention.

In toddlers, the transition from home to childcare might elicit high levels of the stress hormone cortisol. Measuring cortisol may give an indicator for children's experience and hence, may help improve this transition. We applied linear mixed model analyses to investigate the cortisol levels of 119 toddlers during their transition to childcare across time of day (morning, afternoon, and evening) and phase (accompanied by parents, separated from parents, and after four to six weeks in childcare). The influence of age, gender, number of siblings, and childcare group size was analyzed. Time of day and phase influenced cortisol levels significantly. On average, children had elevated cortisol levels in the afternoon throughout transition, with the peak coming in the separation phase. Cortisol levels declined significantly toward the evening. Children younger than 14 months showed higher evening levels and higher afternoon levels after 4-6 weeks in childcare. The findings suggest that the onset of childcare -- particularly separation from parents -- may be demanding for toddlers. Low evening levels indicate relief of tension at home. Higher levels of afternoon cortisol of under 14-months-old children at the follow-up measurement may indicate that younger children need more time to settle in at childcare.

BackgroundThe aim is to examine associations between bullying involvement in adolescence and mental health problems in adulthood.MethodsInformation on bullying-involvement (being bullied, bully-victim, aggressive toward others) and non-involved was collected from 2464 adolescents in Mid-Norway at mean age 13.7 and again at mean age 14.9. Information about mental health problems and psychosocial functioning was collected about 12 years later at mean age 27.2 (n = 1266).ResultsAll groups involved in bullying in young adolescence had adverse mental health outcomes in adulthood compared to non-involved. Those being bullied were affected especially regarding increased total sum of depressive symptoms and high levels of total, internalizing and critical symptoms, increased risk of having received help for mental health problems, and reduced functioning because of a psychiatric problem in adulthood. While those being aggressive toward others showed high levels of total and internalizing symptoms. Both those being bullied and bully-victims showed an increased risk of high levels of critical symptoms. Lastly, all groups involved in bullying on adolescence had increased risk of psychiatric hospitalization because of mental health problems.ConclusionInvolvement in bullying in adolescence is associated with later mental health problems, possibly hindering development into independent adulthood.

Internalizing problems may be associated with poor academic performance and school absenteeism among youth. This study investigated the impact of the EMOTION: "Coping Kids" Managing Anxiety and Depression Program on academic achievement and school adaptation in children. Data were collected in a national cluster-randomized controlled trial at three time points in Norway. Children (N = 688, 8–12 years), who had elevated levels of anxiety or depressive symptoms from 36 schools participated. There were no significant differences between the intervention and control groups post-intervention or at 12-month follow-up regarding academic achievement and school adaptation. Likewise, no significant intervention effects were identified for school-related variables in the anxiety-only, depression-only, or combined (anxiety and depression) groups. The intervention did not have an impact on school functioning. Thus, focusing on school-related challenges and enhanced collaboration with teachers, possibly through a tailored version of the EMOTION program, could be an interesting adaptation of the intervention. [ABSTRACT FROM AUTHOR]

Background: Studies regarding adequacy of secondary stroke prevention are limited. We report medication adherence, risk factor control and factors influencing vascular risk profile following ischaemic stroke. Methods: A total of 664 home‐dwelling participants in the Norwegian Cognitive Impairment After Stroke study, a multicenter observational study, were evaluated 3 and 18 months poststroke. We assessed medication adherence by self‐reporting (4‐item Morisky Medication Adherence Scale) and medication persistence (defined as continuation of medication(s) prescribed at discharge), achievement of guideline‐defined targets of blood pressure (BP) (<140/90 mmHg), low‐density lipoprotein cholesterol (LDL‐C) (<2.0 mmol L−1) and haemoglobin A1c (HbA1c) (≤53 mmol mol−1) and determinants of risk factor control. Results: At discharge, 97% were prescribed antithrombotics, 88% lipid‐lowering drugs, 68% antihypertensives and 12% antidiabetic drugs. Persistence of users declined to 99%, 88%, 93% and 95%, respectively, at 18 months. After 3 and 18 months, 80% and 73% reported high adherence. After 3 and 18 months, 40.7% and 47.0% gained BP control, 48.4% and 44.6% achieved LDL‐C control, and 69.2% and 69.5% of diabetic patients achieved HbA1c control. Advanced age was associated with increased LDL‐C control (OR 1.03, 95% CI 1.01 to 1.06) and reduced BP control (OR 0.98, 0.96 to 0.99). Women had poorer LDL‐C control (OR 0.60, 0.37 to 0.98). Polypharmacy was associated with increased LDL‐C control (OR 1.29, 1.18 to 1.41) and reduced HbA1c control (OR 0.76, 0.60 to 0.98). Conclusion: Risk factor control is suboptimal despite high medication persistence and adherence. Improved understanding of this complex clinical setting is needed for optimization of secondary preventive strategies. [ABSTRACT FROM AUTHOR]