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Simen Svendsen Vatn,1,2,* Jonas Christoffer Lindstrøm,3,4,* Aina EF Moen,1,4,5 Stephan Brackmann,1,2 Tone M Tannæs,1,5 Christine Olbjørn,1,6 Daniel Bergemalm,7 Åsa V Keita,8 Fernando Gomollon,9 Trond Espen Detlie,1,2 Torben Lüders,5 Rahul Kalla,10 Alex Adams,10,11 Jack Satsangi,10,11 Jørgen Jahnsen,1,2 Morten H Vatn,1 Jonas Halfvarson,7 Petr Ricanek,2 Hilde Nilsen1,5 On behalf of IBD-CHARACTER consortium1Department of Clinical Molecular Biology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; 2Department of Gastroenterology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; 3Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway; 4Department of Methods Development and Analytics, Division of Infectious Disease Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway; 5Section for Clinical Molecular Biology (EpiGen), Akershus University Hospital, Lørenskog, Norway; 6Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway; 7Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; 8Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; 9Digestive Diseases Unit, IIS Aragón, Zaragoza, Spain; 10Gastrointestinal Unit, Centre for Genomics and Molecular Medicine, Division of Medical and Radiological Sciences, University of Edinburgh, Edinburgh, UK; 11Translational Gastroenterology Unit, Medical Sciences/ Experimental medicine Division, University of Oxford, Oxford, UK*These authors contributed equally to this workCorrespondence: Simen Svendsen Vatn, Akershus University Hospital, Postbox 1000, Lørenskog, 1478, Norway, Tel +47 94277594, Email bikkjas@hotmail.comBackground: Studies of the mucosal transcriptomic landscape have given new insight into the pathogenesis of inflammatory bowel disease (IBD). Recently, the predictive biomarker potential of gene expression signatures has been explored. To further investigate the mucosal gene expression in IBD, we recruited a cohort of treatment naïve patients and compared them to both symptomatic and healthy controls.Methods: Altogether, 323 subjects were included: Crohn’s disease (N = 75), ulcerative colitis (N = 87) and IBD unclassified (N = 3). Additionally, there were two control groups: symptomatic controls (N = 131) and healthy controls (N = 27). Mucosal biopsies were collected during ileocolonoscopy and gene expression in inflamed and non-inflamed mucosa was explored. Gene expression profiling was performed using Agilent G3 Human Gene Expression 860K v3 One-Color microarray. We recorded information about treatment escalation to anti-TNF agents or surgery, and anti-TNF response, to explore predictive opportunities of the mucosal transcriptome.Results: Gene expression profiles in symptomatic controls in whom IBD had been excluded resembled that of IBD patients and diverged from that of healthy controls. In non-inflamed Crohn’s disease and ulcerative colitis, gene set enrichment analysis revealed dysregulation of pathways involved in basic cellular biological processes. Mitochondria-associated pathways were dysregulated both in non-inflamed and inflamed Crohn’s disease and ulcerative colitis (> 2.6 normalized enrichment scores

Sixteen volunteers each drank 700 ml sugar-containing soft drink during two successive periods and the blood sugar was measured at 10 min intervals together with electrical impedance spectroscopy and near infrared spectroscopy (NIR). A maximum correlation of 0.46 was found for the electrical measurements but no clear separation between low and high blood glucose levels were found in the NIR measurements. The latter was attributed to the experimental design where the NIR probe was removed from the skin between each measurement.

Fikadu Balcha Hailu,1,2 Anne Moen,1 Per Hjortdahl1 1Institute for Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; 2School of Nursing and Midwifery, Jimma University, Jimma, EthiopiaCorrespondence: Fikadu Balcha HailuInstitute for Health and Society, Faculty of Medicine, University of Oslo, Oslo, NorwayTel +251 911 00 4133Fax +251 471 111450Email fikadubalcha@gmail.comPurpose: Diabetes patients must be equipped with the necessary knowledge to confidently undertake appropriate self-care activities. We prepared a diabetes self-management education (DSME) intervention and assessed how it affected patients’ self-reported levels of diabetes knowledge, self-care behaviors, and self-efficacy.Patients and methods: A before-and-after, two-group intervention study was conducted at Jimma University Medical Centre among adult patients with type 2 diabetes. At baseline, we randomly assigned 116 participants to the DSME intervention and 104 to a comparison group. Six interactive DSME sessions supported by an illustrative handbook and fliers, experience-sharing, and take-home activities were administered to the intervention group by two nurses during a six-month period. Diabetes knowledge, self-care behaviors, and self-efficacy were measured at baseline and at nine months following the commencement of DSME intervention (endpoint) in both groups.Results: At the endpoint, data from 78 intervention group participants and 64 comparison group participants were included in final analysis. The difference in the mean Diabetes Knowledge Scale scores before and after the DSME intervention was significantly greater in the intervention group (p = 0.044). The measured self-care behaviors included diet, exercise, glucose self-monitoring, footcare, smoking, alcohol consumption, and khat chewing. The mean number of days per week on which the intervention group participants followed general dietary recommendations increased significantly at the endpoint (p = 0.027). The intervention group followed specific dietary recommendations (p = 0.019) and performed footcare (p = 0.009) for a significantly greater number of days. There were no significant differences within or between the groups in other self-reported diabetes self-care behavior regimens or in diabetes self-efficacy.Conclusion: Our study found significant improvements in the intervention participants’ diabetes knowledge scores and in their adherence to dietary and footcare recommendations. This demonstrates that our DSME intervention may be of clinical importance in developing countries such as Ethiopia.Trial registration: ClinicalTrials.gov, Identifier NCT03185689, retrospectively registered on June 14, 2017: https://clinicaltrials.gov/ct2/show/NCT03185689.Keywords: nurse-led DSME, diabetes knowledge, self-care behavior, self-efficacy

Christine Olbjørn,1,2 Milada Cvancarova Småstuen,3 Espen Thiis-Evensen,4 Britt Nakstad,1,2 Morten Harald Vatn,5 Jørgen Jahnsen,2,6 Petr Ricanek,2,6 Simen Vatn,2,6 Aina EF Moen,5 Tone M Tannæs,5 Jonas C Lindstrøm,7 Johan D Söderholm,8 Jonas Halfvarson,9 Fernando Gomollón,10 Christina Casén,11 Magdalena K Karlsson,11 Rahul Kalla,12 Alex T Adams,12,13 Jack Satsangi,12,13 Gøri Perminow14 1Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway; 2Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway; 3Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; 4Department of Gastroenterology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; 5Department of Clinical Molecular Biology (EpiGen), Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Oslo, Norway; 6Department of Gastroenterology, Akerhus University Hospital, Lørenskog, Norway; 7Institute of Clinical Medicine, University of Oslo, Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway; 8Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; 9Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; 10Digestive Diseases Unit, IIS Aragón, Zaragoza, Spain; 11Genetic-Analysis AS, Oslo, Norway; 12Gastrointestinal Unit, Centre for Genomics and Molecular Medicine, University of Edinburgh, Edinburgh, UK; 13Translational Gastroenterology Unit, Experimental Medicine Division, University of Oxford, Oxford, UK; 14Department of Pediatrics, Oslo University Hospital, Ullevål, Oslo, Norway Purpose: Imbalance in the microbiota, dysbiosis, has been identified in inflammatory bowel disease (IBD). We explored the fecal microbiota in pediatric patients with treatment-naïve IBD, non-IBD patients with gastrointestinal symptoms and healthy children, its relation to IBD subgroups, and treatment outcomes.Patients and methods: Fecal samples were collected from 235 children below 18 years of age. Eighty children had Crohn’s disease (CD), 27 ulcerative colitis (UC), 3 IBD unclassified, 50 were non-IBD symptomatic patients, and 75 were healthy. The bacterial abundance of 54 predefined DNA markers was measured with a 16S rRNA DNA-based test using GA-Map™ technology at diagnosis and after therapy in IBD patients.Results: Bacterial abundance was similarly reduced in IBD and non-IBD patients in 51 of 54 markers compared to healthy patients (P

Tram T Vuong,1 Sissel B Rønning,1 Henri-Pierre Suso,2 Ralf Schmidt,2 Kristian Prydz,3 Marlene Lundström,3 Anders Moen,3 Mona E Pedersen1 1Department of Raw Materials and Process Optimisation, Nofima AS, Ås, 2Biovotec AS, 3Department of Biosciences, University of Oslo, Oslo, Norway Abstract: Avian eggshell membrane (ESM) is a natural biomaterial that has been used as an alternative natural bandage on burned and cut skin injuries for >400 years in Asian countries, and is available in large quantities from egg industries. Our aim was to characterize ESM that was separated and processed from egg waste, and to study whether this material possesses anti-inflammatory properties, making it suitable as an ingredient in industrial production of low cost wound healing products. Our results show that the processed ESM particles retain a fibrous structure similar to that observed for the native membrane, and contain collagen, and carbohydrate components such as hyaluronic acid and sulfated glycosaminoglycans, as well as N-glycans, mostly with uncharged structures. Furthermore, both processed ESM powder and the ESM-derived carbohydrate fraction had immunomodulation properties in monocytes and macrophage-like cells. Under inflammatory conditions induced by lipopolysaccharide, the ESM powder and the isolated carbohydrate fraction reduced the activity of the transcription factor nuclear factor-κB. The expression of the immune regulating receptors toll-like receptor 4 and ICAM-1, as well as the cell surface glycoprotein CD44, all important during inflammation response, were down-regulated by these fractions. Interestingly, our experiments show that the two fractions regulated cytokine secretion differently: ESM depressed inflammation by increased secretion of the anti-inflammatory cytokine IL-10 while the carbohydrate fraction reduced secretions of the pro inflammatory cytokines IL-1β and IL-6. Also, the phosphorylation of p65 and p50 subunits of nuclear factor-κB, as well as nuclear localization, differed between processed ESM powder and carbohydrate fraction, suggesting different down-stream regulation during inflammation. In conclusion, processed ESM powder and its soluble carbohydrate components possess anti-inflammatory properties, demonstrating the potential of ESM as a novel biological wound dressing for treatment of chronic inflammatory wounds. Keywords: eggshell membrane, anti-inflammation, cytokine secretions, signal transduction pathways, NF-κB, THP-1 cells, wound healing, carbohydrates, hyaluronic acid

Abstract Background More than 35 000 refugees from Ukraine applied for temporary collective protection in Norway during 2022. Previous studies have shown that the refugees have poor health in several domains, and crude reports have suggested that those fleeing Ukraine at later stages have even poorer health. However, more systematic knowledge is lacking. This study aimed to analyse trends in self-reported health in a sample of adult refugees from Ukraine, by month of arrival to Norway during 2022. Methods Data were collected via an online, digital questionnaire, in a cross-sectional study design between 28.10.22–31.01.23. Recruitment was via multiple physical and social media contact points, including asylum reception centres, municipalities, non-profit organisations, and Facebook groups for refugees in Norway. The survey included the following self-reported health outcomes: overall health, oral health, presence of long-term illnesses or disabilities, and a short version of the Hopkins Symptom Checklist (HSCL-5). Results Among the 727 respondents, 82% were female, 65% were aged 30–49 years, 69% had higher education and 53% were responsible for children in Norway. There were 383 respondents who arrived between February-April (T1), 200 between May-August (T2) and 144 between September-December (T3). Compared to T1, respondents who arrived in the two later time periods were more often male, had younger age distributions, and were less likely to have completed higher education. The proportions of respondents reporting poor/very poor overall health, presence of long-term illnesses and long-term disabilities were highest in T3. Oral health and HSCL-5 showed the opposite trend, with lower proportions reporting poorer health among respondents in both later periods. Respondents in T3 were still more likely to report poor/very poor health and long-term illnesses after adjusting for sex, age group and education (adjusted odds ratio, aOR: 2.71 [95%CI 1.51–4.89]) and 1.74 [1.14–2.65], respectively). Conclusions Respondents who arrived later in 2022 generally reported poorer long-term health, but less psychological distress than those who arrived earlier in the year. These findings may help inform the planning of health services for refugees from Ukraine, especially in areas receiving large numbers of refugees.

Abstract The emergence of the SARS-CoV-2 virus led to a global pandemic, prompting extensive research efforts to understand its molecular biology, transmission dynamics, and pathogenesis. Recombination events have been increasingly recognized as significant contributor to the virus’s diversity and evolution, potentially leading to the emergence of novel strains with altered biological properties. Indeed, recombinant lineages such as the XBB variant and its descendants have subsequently dominated globally. Therefore, continued surveillance and monitoring of viral genome diversity are crucial to identify and understand the emergence and spread of novel strains. Through routine genomic surveillance of SARS-CoV-2 cases in Norway, we discovered a SARS-CoV-2 recombination event in a long-term infected immunocompromised COVID-19 (coronavirus disease) patient. A deeper investigation showed several recombination events between two distinct lineages of the virus, namely AY.98.1 and BA.5, that resulted in a single novel recombinant viral strain with a unique genetic signature. Our data is consistent with the presence of several concomitant recombinants in the patient, suggesting that these events occur frequently in vivo. This study underscores the importance of continued tracking of viral diversity and the potential impact of recombination events on the evolution of the SARS-CoV-2 virus.

Abstract Perinatal traits are influenced by fetal and maternal genomes. We investigate the performance of three strategies to detect loci in maternal and fetal genome-wide association studies (GWASs) of the same quantitative trait: (i) the traditional strategy of analysing maternal and fetal GWASs separately; (ii) a two-degree-of-freedom test which combines information from maternal and fetal GWASs; and (iii) a one-degree-of-freedom test where signals from maternal and fetal GWASs are meta-analysed together conditional on estimated sample overlap. We demonstrate that the optimal strategy depends on the extent of sample overlap, correlation between phenotypes, whether loci exhibit fetal and/or maternal effects, and whether these effects are directionally concordant. We apply our methods to summary statistics from a recent GWAS meta-analysis of birth weight. Both the two-degree-of-freedom and meta-analytic approaches increase the number of genetic loci for birth weight relative to separately analysing the scans. Our best strategy identifies an additional 62 loci compared to the most recently published meta-analysis of birth weight. We conclude that whilst the two-degree-of-freedom test may be useful for the analysis of certain perinatal phenotypes, for most phenotypes, a simple meta-analytic strategy is likely to perform best, particularly in situations where maternal and fetal GWASs only partially overlap.

Abstract Social network analysis and shared-patient physician networks have become effective ways of studying physician collaborations. Assortative mixing or “homophily” is the network phenomenon whereby the propensity for similar individuals to form ties is greater than for dissimilar individuals. Motivated by the public health concern of risky-prescribing among older patients in the United States, we develop network models and tests involving novel network measures to study whether there is evidence of homophily in prescribing and deprescribing in the specific shared-patient network of physicians linked to the US state of Ohio in 2014. Evidence of homophily in risky-prescribing would imply that prescribing behaviors help shape physician networks and would suggest strategies for interventions seeking to reduce risky-prescribing (e.g., strategies to directly reduce risky prescribing might be most effective if applied as group interventions to risky prescribing physicians connected through the network and the connections between these physicians could be targeted by tie dissolution interventions as an indirect way of reducing risky prescribing). Furthermore, if such effects varied depending on the structural features of a physician’s position in the network (e.g., by whether or not they are involved in cliques—groups of actors that are fully connected to each other—such as closed triangles in the case of three actors), this would further strengthen the case for targeting groups of physicians involved in risky prescribing and the network connections between them for interventions. Using accompanying Medicare Part D data, we converted patient longitudinal prescription receipts into novel measures of the intensity of each physician’s risky-prescribing. Exponential random graph models were used to simultaneously estimate the importance of homophily in prescribing and deprescribing in the network beyond the characteristics of physician specialty (or other metadata) and network-derived features. In addition, novel network measures were introduced to allow homophily to be characterized in relation to specific triadic (three-actor) structural configurations in the network with associated non-parametric randomization tests to evaluate their statistical significance in the network against the null hypothesis of no such phenomena. We found physician homophily in prescribing and deprescribing. We also found that physicians exhibited within-triad homophily in risky-prescribing, with the prevalence of homophilic triads significantly higher than expected by chance absent homophily. These results may explain why communities of prescribers emerge and evolve, helping to justify group-level prescriber interventions. The methodology may be applied, adapted or generalized to study homophily and its generalizations on other network and attribute combinations involving analogous shared-patient networks and more generally using other kinds of network data underlying other kinds of social phenomena.

Abstract Background Given increased interest and investment in guaranteed income initiatives across North America, it is critical to understand the impact of guaranteed income on health, an understudied outcome. As part of Baltimore, Maryland’s guaranteed income pilot, we conducted formative research to understand the influence of increased income on health and develop concrete recommendations for implementation and evaluation of the pilot. Methods We conducted semi-structured in-depth interviews with Baltimore community residents (n = 8) and community collaborators (n = 8), probing on familiarity with guaranteed income; effect of guaranteed income on overall health and specific health outcomes (e.g., mental health, nutrition); and recommendations for program structure (e.g., eligibility, target population). Data were analyzed thematically using a framework analysis approach. Results Respondents agreed that guaranteed income could have beneficial effects on health though some were unsure of specific mechanisms. Respondents emphasized pathways through which guaranteed income could improve health: (1) reduced financial-related stress; (2) improved nutrition through purchase of healthier foods; (3) improved family well-being including child health and parent-child relationships; (4) increased utilization of health services; (5) improved community health through increased community cohesion and decreased violence. Respondents described decreased feelings of time scarcity as a social determinant of health. Most respondents reported that Baltimore’s guaranteed income program should prioritize young, low-income families with $1,000/month or more for at least one year. Conclusions This formative research on the potential health impacts of guaranteed income in Baltimore highlights important health outcomes and pathways, such as social cohesion and decreased feelings of time scarcity, to prioritize for evaluation.

Abstract Background The iron and steel industries are among the most dangerous workplaces in the world compared to other manufacturing industries. Workers are exposed to multiple occupational hazards, which predispose them to high risks of both fatal and non-fatal injuries. Currently, the data on the global prevalence and associated risk factors for occupational injuries in the iron and steel industries is fragmented and incomplete. This study was undertaken to address this issue by pooling data relating to the prevalence of occupational injuries and its associated factors among workers in iron and steel industries studies around the world. Methods The search was conducted systematically using PubMed, HINARI, EMBASE and Google Scholar for published studies in English that reported on occupational injuries and associated risk factors among workers in iron and steel industries. MetaXL version 5.3 software was used in the meta-analysis to estimate the pooled prevalence of occupational injuries and associated risk factors among workers in the iron and steel industries. The study protocol has been registered with PROSPERO, number CRD42022344258. Results Of the 447 articles identified, 15 studies from 9 countries met the inclusion criteria. The pooled prevalence estimate of occupational injury was 0.55 (95% CI: 0.15, 0.93). The pooled results indicated that the odds of having an occupational injury were 4.06 times higher among workers who did not use personal protective equipment compared to those who used such equipment. Likewise the odds of occupational injuries was increased by 1.65 among night shift workers compared to the counterpart. Conclusions The global prevalence of occupational injuries in iron and steel industries was 55%. The results indicate that night work shift and the lack of use of personal protective equipment has a higher impact than other factors in the occurrence of occupational injuries in the iron and steel industries.

Abstract In this article, we analyze the relationship between class sizes and examination results in higher education. Data from the University of Stavanger, collected in the Common Student System (FS) in the period from 2011 to 2021, shows that there is a negative correlation between the number of students enrolled on courses and examination results. An increase in the number of students taking a course reduces the average scores. We also show that the difference in examination results for different class sizes decreases when the course level increases.

Violence prevention approaches using social-ecological models inform interventions for people with intellectual disability, who often face barriers to accessing generalist courses. This study explores the experiences of healthcare professionals leading a prevention course specifically designed for adults with intellectual disability. Through semistructured interviews, 12 Norwegian course leaders highlighted the importance of raising awareness and comprehension about rights, and the social and individual factors influencing experiences of violence and its prevention. Challenges were encountered in tailoring the course to the diverse lived experiences of participants with disabilities and addressing ongoing support needs for their safety. The study suggests that adopting a pedagogical or didactic model could serve as a foundation to enhance the planning and delivery of the course.

Interest in media literacy education is increasing across the United States and around the world but little is still known about the prevalence of various instructional practices used to implement it in elementary and secondary schools. Surveys and semi-structured interviews with a statewide quota sample of education stakeholders included school leaders, educators, librarians, elected public officials, parents, and members of the community in all 24 school districts in Rhode Island. Results show that only a few instructional practices are implemented with most or nearly all students in the state. However, the implementation of various media literacy instructional practices varied considerably from one community to another but these differences were not due to the size of the community, its geographic location, or its socioeconomic status. Nearly half the variance in instructional practices can be accounted for by obstacles including technology limitations, school policies, academic priorities, perceptions of students, and educator response.

All students at Norwegian universities and colleges have the right to complain about ordinary grading decisions. When an appeal is made, two new examiners are appointed, at least one of whom should be external. The handling of appeals in the current system is to be blind, meaning that the examiners handling the complaint should not be aware of the original grade. It also means that they are not to receive information regarding the examiners' reasoning for the original grade or the student's reasoning for the complaint. In this article, we discuss whether the current appeal grading system with blind grading is appropriate when ordinary appeal grading is conducted by two examiners. We argue that the students' legal rights are not in conflict with the principle that good decision-making processes should be well-informed before decisions are made. We conclude that, in cases where two assessors are used for the ordinary examination, we ought to abolish the blind aspect in the current appeal grading system.

SARS-CoV-2 variants of concern (VOCs) emerged during the COVID-19 pandemic. Here, we used unbiased systems approaches to study the host-selective forces driving VOC evolution. We discovered that VOCs evolved convergent strategies to remodel the host by modulating viral RNA and protein levels, altering viral and host protein phosphorylation, and rewiring virus-host protein-protein interactions. Integrative computational analyses revealed that although Alpha, Beta, Gamma, and Delta ultimately converged to suppress interferon-stimulated genes (ISGs), Omicron BA.1 did not. ISG suppression correlated with the expression of viral innate immune antagonist proteins, including Orf6, N, and Orf9b, which we mapped to specific mutations. Later Omicron subvariants BA.4 and BA.5 more potently suppressed innate immunity than early subvariant BA.1, which correlated with Orf6 levels, although muted in BA.4 by a mutation that disrupts the Orf6-nuclear pore interaction. Our findings suggest that SARS-CoV-2 convergent evolution overcame human adaptive and innate immune barriers, laying the groundwork to tackle future pandemics.