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Abstract Aims To identify maternal food‐avoidance diets and dietary supplement use during breastfeeding, and to explore factors associated with food avoidance diets. Design A prospective mother–child birth cohort study. Methods Electronic questionnaires were answered by 1,462 breastfeeding mothers 6 months postpartum in the Preventing Atopic Dermatitis and Allergies in Children (PreventADALL) study from 2014–2016. Demographic and antenatal factors were analysed for associations with food avoidance diets in 1,368 women by multiple logistic regression. Results Overall, 289 breastfeeding women (19.8%) avoided at least one food item in their diet, most commonly cow's milk in 99 women (6.8%). Foods were most often avoided due to conditions in the child, maternal factors or lifestyle choice. The odds for food avoidance diets were 2.1 (95% CI: 1.3, 3.4) for food allergy (presumed or diagnosed) and 19.4 (5.4, 70.1) for celiac disease in the mother. Dietary supplements were reported by nearly 80%, most commonly cod liver oil.

IntroductionDespite the high prevalence and detrimental consequences of cognitive and executive dysfunction in ADHD, the evidence base of cognitive remediation in the adult ADHD population is sparse. Executive problems can increase both anxiety and depression in ADHD. Thcus, it is important to develop treatment options for adults with ADHD, aiming to improve goal-directed behavior and mood. Goal Management Training (GMT) is an intervention that has received empirical support in improving executive functions and mood in normal aging and for various neurological and psychiatric conditions. The present randomized controlled trial investigated the effects of a goal-focused intervention combining 1) group-based GMT incorporating psychoeducation about ADHD and 2) guidance in implementing individual goals for coping with executive problems in everyday life, compared to treatment as usual (TAU). The primary outcome was perceived executive functioning in everyday life. Secondary outcomes included psychological well-being (anxiety, depression, and coping with ADHD symptoms).MethodsWe recruited 81 adult participants with a verified ADHD diagnosis (Mage = 31 years). Inclusion was based upon the presence of executive functioning complaints. The participants were randomly assigned to either the intervention or TAU. The intervention group (n = 41) received 16 hours of GMT and psychoeducation, in addition to 4 individual sessions focusing on formulating goals. The goals were assessed in 6 bi-weekly phone calls in the first three months following the group sessions. Participants in the TAU group (n = 40) received standard, individually-adapted follow-up in an outpatient psychiatric health care setting. All participants were assessed at baseline, post-intervention, and at 8-month follow-up (main measurement time point).ResultsSignificant improvements in everyday executive functioning, psychological wellbeing, and symptoms of ADHD from baseline to 8-month follow-up were reported in both groups. The intervention group reported a significantly higher reduction in symptoms of anxiety compared to TAU. Conclusions. Our findings provide support for considering cognitive remediation as a treatment option for patients with ADHD.Clinical Trial Registration: https://clinicaltrials.gov/study/NCT04638283?term=NCT04638283&rank=1, identifier: NCT04638283.

Abstract Background Back pain is an extensive burden to our healthcare system, yet few studies have explored modifiable prognostic factors associated with high costs related to healthcare utilization, especially among older back pain patients. The aims of this study were to identify modifiable prognostic factors for high costs related to healthcare utilization among older people seeking primary care with a new episode of back pain; and to replicate the identified associations in a similar cohort, in a different country. Methods Data from two cohort studies within the BACE consortium were used, including 452 and 675 people aged ≥55 years seeking primary care with a new episode of back pain. High costs were defined as costs in the top 25th percentile. Healthcare utilization was self-reported, aggregated for one-year of follow-up and included: primary care consultations, medications, examinations, hospitalization, rehabilitation stay and operations. Costs were estimated based on unit costs collected from national pricelists. Nine potential modifiable prognostic factors were selected based on previous literature. Univariable and multivariable binary logistic regression models were used to identify and replicate associations (crude and adjusted for selected covariates) between each modifiable prognostic factor and high costs related to healthcare utilization. Results Four modifiable prognostic factors associated with high costs related to healthcare utilization were identified and replicated: a higher degree of pain severity, disability, depression, and a lower degree of physical health-related quality of life. Kinesiophobia and recovery expectations showed no prognostic value. There were inconsistent results across the two cohorts with regards to comorbidity, radiating pain below the knee and mental health-related quality of life. Conclusion The factors identified in this study may be future targets for intervention with the potential to reduce high costs related to healthcare utilization among older back pain patients. Trial registration ClinicalTrials.gov NCT04261309, 07 February 2020. Retrospectively registered.

Abstract Introduction Although the learning environment influences students’ motivation, learning outcomes, and satisfaction with the study program, less is known about how these factors change as the students’ progress through the study program. Aim The aim of this study was to examine changes in occupational therapy students’ perceptions of the academic learning environment during their three-year study program and to examine factors associated with the students’ perceptions of the learning environment. Materials and methods A longitudinal cohort study was conducted throughout the three-year study program. Data were collected annually using the Course Experience Questionnaire (CEQ). In total, 263 students from six occupational therapy programs participated in at least one data gathering point. The number of participants was 186 in the first year, 168 in the second year and 200 in the third year. Of the 263 students who participated in the study, 87 participated in only one point of data collection, 58 at two points and 118 at all three points of the data collection. Data were analyzed with linear mixed models. Results The results showed statistically significant temporal changes on the “Emphasis on independence”, “Good teaching” and “Generic skills” scales. There was a significant decrease in scores from the first to the second year of study and the scores remained at this level in the third study year on both the “Emphasis on independence” and “Good teaching” scales. In addition, associations were found between study effort and educational institution related to the “Appropriate workload” scale, as well as between age and the “Generic skills” scale. Conclusion The temporal changes of the students’ perceptions of the “Emphasis on independence” as well as “Good teaching” scales are noteworthy. Both scales indicated a significant decrease in scores, indicating that the students perceived that they were less independent from first to second and third year, as well as a perceived decline in the quality of teaching from first to second and third year. The results of this study are central when planning to facilitate learning, especially related to independence and perceptions of good teaching for students in occupational therapy programs.

Abstract Aim To assess occurrence of pain during the first 6 days of intensive care unit (ICU) stay and evaluate associations between occurrence of pain and selected patient‐related variables. Design A longitudinal study. Methods Adult ICU patients from three units were included. Patients' pain was assessed with valid pain assessment tools every 8 hr during their first 6 days in ICU. Possible associations between occurrence of pain and selected patient‐related variables were modelled using multiple logistic regression. Results When pain was assessed regularly with pain assessment tools, 10% of patients were in pain at rest and 27% were in pain during turning. The proportions of patients who were in pain were significantly higher for patients able to self‐report pain, compared with patients not able to self‐report (p

Abstract Aim To investigate the effect of a communication tool about diet used in public health nurse consultations with parents compared with standard consultations concerning the 2‐year‐old child's diet. Design A cluster randomized controlled trial. Methods Ten municipalities were selected randomly and matched in pairs. In each pair, the control or intervention group was randomly allocated. Parents were recruited to participate from January 2015 to January 2017. In intervention clusters, a communication tool about diet was used to help the parents (N = 140) to focus on a healthy diet for their child. In the control clusters, parents (N = 110) attended standard consultations. The participants completed semi‐quantitative food frequency questionnaires at baseline and end point. Results No effect of the intervention was seen on the child's daily intake of vegetables or saturated fat, or body mass index. Significantly fewer parents desired more information about food for toddlers in the intervention than in the control group.

Abstract Background Little research exists on the effectiveness of motivational interviewing (MI) on return to work (RTW) in workers on long term sick leave. The objectives of this study protocol is to describe a randomized controlled trial (RCT) with the objectives to compare the effectiveness and cost-effectiveness of usual case management alone with usual case management plus MI or usual case management plus stratified vocational advice intervention (SVAI), on RTW among people on sick leave due to musculoskeletal (MSK) disorders. Methods A multi-arm RCT with economic evaluation will be conducted in Norway with recruitment of 450 participants aged 18–67 years on 50–100% sick leave for > 7 weeks due to MSK disorders. Participants will be randomized to either usual case management by the Norwegian Labour and Welfare Administration (NAV) alone, usual case management by NAV plus MI, or usual case management by NAV plus SVAI. Trained caseworkers in NAV will give two MI sessions, and physiotherapists will give 1–4 SVAI sessions depending upon risk of long-term sick leave. The primary outcome is the number of sick leave days from randomization to 6 months follow-up. Secondary outcomes are number of sick leave days at 12 months follow-up, time until sustainable RTW (≥4 weeks of at least 50% of their usual working hours) at 12 months, proportions of participants receiving sick leave benefits during 12 months of follow-up, and MSK symptoms influencing health at 12 months. Cost-utility evaluated by the EuroQoL 5D-5L and cost-benefit analyses will be performed. Fidelity of the interventions will be assessed through audio-recordings of approximately 10% of the intervention sessions. Discussion The results from this RCT will inform stakeholders involved in supporting RTW due to MSK disorders such as staff within NAV and primary health care. Trial registration ClinicalTrials.gov ID: NCT03871712 registered March 12th 2020.

Occupational therapy students need to develop self-efficacy for therapeutic use of self in practice. This longitudinal study examined Norwegian occupational therapy students’ self-efficacy for therapeutic use of self over a 16-month period and investigated predictors of their end-point self-efficacy. One hundred and eleven students from two universities completed a self-efficacy questionnaire related to the use of self after a workshop, and at 3-month, 10-month, and 16-month follow-up. The students’ self-efficacy development was analyzed with linear mixed effect models, while factors associated with self-efficacy were investigated with linear regressions. The students from both universities showed a linear increase in self-efficacy for therapeutic mode use (p < 0.001), recognizing clients’ interpersonal characteristics (p < 0.001), and managing interpersonal events (p < 0.001). However, for the students from University 1 the largest increase occurred in an early phase, whereas for the students from University 2 the largest increase occurred in a late phase. Only baseline scores were associated with the end-point measure at 16-month follow-up. The study indicates that students’ self-efficacy for therapeutic use of self increased during the follow-up period and adds to the knowledge about occupational therapy students’ self-efficacy development related to understanding and managing client-therapist interactions.

Students’ approaches to studying are generally viewed as essential for their learning outcomes and are often described as being either deep, strategic or surface. However, research on associations between study approaches and academic outcomes among occupational therapy students are rare, as are studies that include cross-cultural comparisons. The objective of this study was to assess the degree to which the deep, strategic, and surface approaches to studying were associated with occupational therapy students’ grade point average, in the total sample and when stratified by country, while controlling for age, gender and time spent on independent study. Seven hundred and twelve students from four countries (Australia, Norway, Hong Kong, and Singapore) completed the Approaches and Study Skills Inventory for Students, and sum scores were calculated for the deep, strategic, and surface scales. Linear regression analyses were used to investigate associations between scale scores and grade point average, in the total sample and within each of the four sub-samples. The results showed that in the total sample, and in the Australia and Singapore sub-samples, none of the scales was associated with grade point average. In Hong Kong, lower deep approach scores and higher strategic approach scores were associated with higher grade point average. In Norway, higher strategic approach scores and lower surface approach scores were associated with higher grade point average. The study found that the approaches to studying scales were relevant for understanding academic performance among occupational therapy students in Norway and Hong Kong, but appeared less useful in the Australian and Singapore contexts.

Whether higher education students' approaches to studying are amenable to change, is disputed. In this study, Norwegian occupational therapy students' (n = 263) approaches to studying were assessed annually across the three-year course, with the aim of exploring changes during the undergraduate study program. Sociodemographic information and the "Approaches and Study Skills Inventory for Students" were completed. Changes during the follow-up period were analyzed using linear mixed models for repeated measures. A significant increase in deep approach scores and a decrease in surface approach scores during the study program was revealed. The strategic approach remained unchanged, but with a difference between education institutions. Overall, the study suggests that the students' approaches to studying changed in a positive direction during the study program. Attention should be given to students at risk of adopting a surface approach to studying and to the individual and contextual elements influencing study behaviors.

ObjectivesWe aimed to assess prevalence of left ventricular (LV) systolic and diastolic function in stable cohort of COPD patients, where LV disease had been thoroughly excluded in advance.Methods100 COPD outpatients in GOLD II-IV and 34 controls were included. Patients were divided by invasive mean pulmonary artery pressure (mPAP) in COPD-PH (≥25 mmHg) and COPD-non-PH (ResultsLV MPI ≥0.51 was found in 64.9% and 88.5% and LV strain ≤-15.8% in 62.2.% and 76.9% in the COPD-non-PH and COPD-PH patients, respectively. Similarly, LV MPI and LV strain were impaired even in patients with mPAP ConclusionsSubclinical LV systolic dysfunction was a frequent finding in this cohort of COPD patients, even in those with normal pulmonary artery pressure. Evidence of LV diastolic dysfunction was hardly present as measured by conventional echo indices.