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Pragmatics refers to the ability to effectively use and interpret language in different contexts. Pragmatic abilities develop and refine through childhood, and they are essential for socialization, academic achievement and wellbeing. The scarcity of assessment tools in this field makes it challenging to provide a comprehensive assessment of pragmatic abilities. The Pragma test, originally developed for Finnish and also adapted into Italian, consists of a battery of tasks assessing children's pragmatic abilities. In this study, a first evaluation of the psychometric qualities of a Norwegian adaptation of this test is presented. In addition, we investigated pragmatic development between ages 5 and 7, and explored possible gender-based differences. Altogether 119 Norwegian-speaking children participated in the study. The children were tested with the Pragma test and parents completed the Children's Communication Checklist-2. The children were allocated into three groups: 5-year-olds, 6-year-olds and 7-year-olds. The psychometric qualities of this Norwegian adaptation supported its use as a tool for assessing pragmatics in children aged 5-7. Strong and significant growth in pragmatic competence was observed from age 5-6, subsequently flattening out between age 6 and 7, and gender differences in favour of girls were identified. These findings indicate that pragmatic ability, as measured by the Pragma test, shows similar age effects in a Norwegian setting as in Finnish and Italian contexts, paving the way for further cross-cultural and cross-linguistic studies.

In the initial phase of the pandemic caused by the coronavirus (SARS-CoV-2), schools were closed, forcing most students to stay home on school days. In this chaotic and stressful situation, facing a potential life-threatening disease, parents needed to handle their family life, their own work, in addition to being teachers of their children. This situation may have been especially stressful for parents of children in need of special education. In this study, we examined possible determinants of parental satisfaction with the school during the lockdown using a sample of parents (N = 476) with children in need of special education. By applying a multivariate regression model, we found that the strongest predictor of parental satisfaction with the school during the lockdown was good communication between the parents and the school (r = 0.38), followed by how often the teachers were in contact with the children (r = 0.18) and how well the teachers guided the parents regarding home-schooling (r = 0.17). Notably, the degree of the children's difficulties, family climate or socioeconomic status was not related to parental satisfaction with the school during the lockdown.

Within the higher education sector, the principle of student-active and research-based education are established in strategy documents and action plans, but at the same time there is an ongoing debate about what is meant by research-based learning and how it can be applied in practical teaching contexts. The aim of this empirical study is to explore inclusion of research elements in higher education. The study introduces the concept of using systematic literature review (SLR) and digital collaboration as a learning method, and addresses how to succeed with digital collaborative systematic literature review as a research-like learning activity in higher education. An exploratory multiple case design is used, with participatory observation technique and thematic analysis. A practical contribution of this study is an example of how SLR is well-suited to do collective research-like learning activities. The main contribution is that the higher education teacher needs integrated knowledge, including research competence in addition to the traditional link between professional, didactic and technological competence. A model for research-like learning is proposed, which illustrates the need for research knowledge in relation to the technological pedagogical content knowledge.

Meta-analyses and international large-scale assessments (ILSA) are key sources for informing educational policy, research, and practice. While many critical research questions could be addressed by drawing evidence from both of these sources, meta-analysts seldom integrate ILSAs, and current integration practices lack methodological guidance. The aim of this methodological review is therefore to synthesize and illustrate the principles and practices of including ILSA data in meta-analyses. Specifically, we (a) review four ILSA data inclusion approaches (analytic steps, potential, challenges); (b) examine whether and how existing meta-analyses included ILSA data; and (c) provide a hands-on illustrative example of how to implement the four approaches. Seeing the need for meta-analyses on educational inequalities, we situated the review and illustration in the context of gender differences and socioeconomic gaps in student achievement. Ultimately, we outline the steps meta-analysts could take to utilize the potential and address the challenges of ILSA data for meta-analyses in education.

The public spaces in Analco neighborhood in the historic center of Puebla show a lack of appropriation on the part of its users, are invaded by the informal commerce and the streets, gardens and pedestrian zones are in inadequate conditions, all of which contributes to their deterioration and insecurity. This article presents a proposal of a participatory management model that contributes to achieve the appropriation and humanization of public spaces and the historical, cultural and landscape heritage of the neighborhood. Understanding the logic of territorial problems implies an epistemological thought that, through a methodology based on action research, promotes the qualitative evaluation of the problem using successive approaches. By doing so, will be able to promote complex thinking and systemic approaches for the construction of knowledge and to understand the process of the neighborhood’s evolution where different interests and needs converge for the common well-being.

Abstract Background The COVID-19 pandemic necessitated a swift transition to e-learning, significantly impacting nursing education due to its reliance on practical, hands-on experiences and the critical role nurses play in healthcare. Nursing students need to achieve high levels of clinical competence through experiences traditionally obtained in clinical settings, which e-learning had to replicate or supplement. Understanding the unique challenges faced by nursing students in e-learning environments is crucial for developing educational strategies that enhance learning outcomes and contribute to improved patient care. This study aimed to explore the experiences of nursing students and newly qualified nurses (as students) with e-learning during the COVID-19 lockdown, focusing on how it influenced their learning and professional development. Method This exploratory and descriptive study employed qualitative interviews with 31 participants, including full-time nursing students, part-time nursing students, and newly qualified nurses (as nursing students). Conducted online via Zoom during February and March 2022. Results The findings suggest that integrating small group interactions and employing strategic pedagogical support can enhance e-learning effectiveness. However, barriers such as technological difficulties, psychological challenges, and social isolation were also identified. Understanding these unique opportunities and challenges can help educational institutions optimize e-learning strategies, ensuring nursing students are well-prepared for their crucial roles in healthcare. Conclusion The rapid shift to e-learning due to the COVID-19 pandemic presented challenges such as technological, psychological and social aspects, but also opportunities to rethink and enhance nursing education delivery. Implementing appropriate pedagogical e-learning strategies, such as scaffolding and small group learning, can better prepare nursing students for their essential roles in healthcare. This study contributes to the body of knowledge on digital education and provides a foundation for future research aimed at optimizing e-learning in nursing education.

Abstract Background Individuals with non-celiac gluten/wheat sensitivity (NCGWS) experience improvement in gastrointestinal symptoms following a gluten-free diet. Although previous results have indicated that fructo-oligosaccharides (FOS), a type of short-chain fructans, were more likely to induce symptoms than gluten in self-reported NCGWS patients, the underlying mechanisms are unresolved. Methods Our main objective was therefore to investigate whether FOS-fructans and gluten affect the composition and diversity of the faecal microbiota (16S rRNA gene sequencing), faecal metabolites of microbial fermentation (short-chain fatty acids [SCFA]; gas chromatography with flame ionization detector), and a faecal biomarker of gut inflammation (neutrophil gelatinase-associated lipocalin, also known as lipocalin 2, NGAL/LCN2; ELISA). In the randomised double-blind placebo-controlled crossover study, 59 participants with self-reported NCGWS underwent three different 7-day diet challenges with gluten (5.7 g/day), FOS-fructans (2.1 g/day), and placebo separately (three periods, six challenge sequences). Results The relative abundances of certain bacterial taxa were affected differently by the diet challenges. After the FOS-fructan challenge, Fusicatenibacter increased, while Eubacterium (E.) coprostanoligenes group, Anaerotruncus, and unknown Ruminococcaceae genera decreased. The gluten challenge was primarily characterized by increased abundance of Eubacterium xylanophilum group. However, no differences were found for bacterial diversity (α-diversity), overall bacterial community structure (β-diversity), faecal metabolites (SCFA), or NGAL/LCN2. Furthermore, gastrointestinal symptoms in response to FOS-fructans were generally not linked to substantial shifts in the gut bacterial community. However, the reduction in E. coprostanoligenes group following the FOS-fructan challenge was associated with increased gastrointestinal pain. Finally, correlation analysis revealed that changes in gastrointestinal symptoms following the FOS-fructan and gluten challenges were linked to varying bacterial abundances at baseline. Conclusions In conclusion, while FOS-fructans induced more gastrointestinal symptoms than gluten in the NCGWS patients, we did not find that substantial shifts in the composition nor function of the faecal microbiota could explain these differences in the current study. However, our results indicate that individual variations in baseline bacterial composition/function may influence the gastrointestinal symptom response to both FOS-fructans and gluten. Additionally, the change in E. coprostanoligenes group, which was associated with increased symptoms, implies that attention should be given to these bacteria in future trials investigating the impact of dietary treatments on gastrointestinal symptoms. Trial registration Clinicaltrials.gov as NCT02464150.

Abstract Background Mental health problems represent a large and growing public health concern. Primary care handles most of the patients with mental health problems, but there are many barriers to detection and treatment in this setting, causing under-recognition and under-treatment of patients. The service delivery model Primary Care Behavioral Health (PCBH) shows promise to manage mental health problems in primary care, but more research is needed regarding its effects on multiple levels. Methods This project investigates the effectiveness and implementation of a large-scale implementation of PCBH in Region Östergötland, Sweden. The aim is to generate new knowledge concerning the impact of a real-world implementation and use of PCBH in routine primary care. A Pragmatic Stepped-Wedge Cluster Trial will be used: 24 PCBH primary care centres in one region will be compared with 48 standard care centres in three other regions. The model will be implemented sequentially at the PCBH centres according to a staggered timetable. Results will be investigated at patient, staff and organization levels and various forms of data will be collected: (1) local and national registry data; (2) questionnaire data; (3) interview data; and (4) document data. Discussion This project investigates the effectiveness and implementation of PCBH in routine primary care. The project could result in improved mental health care for the included patients and contribute to the general good for a wider population who have mental health problems. The project’s study design will make it possible to assess many important effects of the PCBH service delivery model at different levels, providing evidence of the effectiveness (or not) of the PCBH model under routine conditions in primary care. The project has the potential to generate clinically meaningful results that can provide a basis for decisions concerning further implementation and use of the model and thus for future development of mental health care provision in primary care. Trial registration NCT05633940, date of registration: 2021–04-21.

Objective Private health insurance is becoming more common in Norway. The aim of this study was to investigate GPs’ opinions on private health insurance, and their experiences from consultations where health insurance can affect decisions about referring.Design A web based cross-sectional survey.Setting Norwegian general practice.Subjects All GPs in Norway were in 2019 invited to participate in an online survey.Main outcome measures The GPs’ opinions and experiences regarding health insurance were reported as proportions. Multiple logistic regression was used to test associations between how frequently GPs refer patients without further considerations and variables concerning their characteristics, opinions, and experiences.Results Of 1,309 GPs (response rate 27%), 93% stated that private health insurance raises the risk of overtreatment and 90% considered such insurance to contribute to inequality in health. Frequently being pressured to refer in the absence of a medical indication was reported by 42%. Moreover, 28% often or always chose to refer patients without further consideration, and this was associated with perceptions of pressure with an adjusted odds ratio (AOR) of 3.80, 95% confidence interval (CI) 2.73–5.29, and unpleasant reactions from patients following refusals (AOR 1.63, 95% CI 1.14–2.33).Conclusion Although most participating GPs associated private health insurance with overtreatment and inequality in health, more than one in four choose to refer without further consideration. GPs’ experience of pressure to refer and negative reactions from patients when they consider referrals not to be medically indicated, raises the risk of medical overuse for patients holding private health insurance.

Abstract Background Social isolation and loneliness are urgent public health concerns associated with negative physical and mental health outcomes. Understanding effective remedies is crucial in addressing these problems. This umbrella review aimed to synthesize and critically appraise scientific evidence on the effectiveness of social isolation and loneliness interventions overall and across subgroups. We focused on systematic reviews (SRs) of randomized controlled trials (RCTs). Methods We searched seven databases (June 2022 and updated June 2023) and supplemented the search with grey literature and reference screening to identify SRs published since 2017. Screening, data extraction, and quality assessment using the AMSTAR2 tool were conducted independently by author pairs, with disagreements resolved through discussion. Results We included 29 SRs, 16 with meta-analysis and 13 with narrative synthesis. All SRs focused on loneliness, with 12 additionally examining social isolation. Four SRs focused on young people, 11 on all ages, and 14 on older adults. The most frequently examined intervention types were social (social contact, social support), psychological (therapy, psychoeducation, social skills training), and digital (e.g., computer use and online support). Meta-analyses indicated small-to-moderate beneficial effects, while narrative synthesis demonstrated mixed or no effect. Social interventions for social isolation and psychological interventions for loneliness were the most promising. However, caution is warranted due to the effects’ small magnitude, significant heterogeneity, and the variable quality of SRs. Digital and other interventions showed mixed or no effect; however, caution is advised in interpreting these results due to the highly diverse nature of the interventions studied. Conclusions This overview of SRs shows small to moderate effectiveness of social interventions in reducing social isolation and psychological ones in tackling loneliness. Further rigorously conducted RCTs and SRs are needed to guide policy decisions regarding the implementation of efficacious and scalable interventions. Evaluation should focus on both preventive structural interventions and tailored mitigating strategies that address specific types and causes of loneliness.

Abstract Major vault protein (MVP) is the main component of the vault complex, which is a highly conserved ribonucleoprotein complex found in most eukaryotic organisms. MVP or vaults have previously been found to be overexpressed in multidrug-resistant cancer cells and implicated in various cellular processes such as cell signaling and innate immunity. The precise function of MVP is, however, poorly understood and its expression and probable function in lower eukaryotes are not well characterized. In this study, we report that the Atlantic salmon louse expresses three full-length MVP paralogues (LsMVP1-3). Furthermore, we extended our search and identified MVP orthologues in several other ecdysozoan species. LsMVPs were shown to be expressed in various tissues at both transcript and protein levels. In addition, evidence for LsMVP to assemble into vaults was demonstrated by performing differential centrifugation. LsMVP was found to be highly expressed in cement, an extracellular material produced by a pair of cement glands in the adult female salmon louse. Cement is important for the formation of egg strings that serve as protective coats for developing embryos. Our results imply a possible novel function of LsMVP as a secretory cement protein. LsMVP may play a role in structural or reproductive functions, although this has to be further investigated.

Abstract Background Fundamental motor skills (FMS) and physical fitness (FIT) play important roles in child development and provide a foundation for lifelong participation in physical activity (PA). Unfortunately, many children have suboptimal levels of PA, FMS, and FIT. The Active Learning Norwegian Preschool(er)s (ACTNOW) study investigated the effects of a staff-led PA intervention on FMS, FIT, and PA in 3–5-year-old children. Methods Preschools in Western Norway having ≥ six 3–4-year-old children were invited (n = 56). Of these, 46 agreed to participate and were cluster-randomized into an intervention (n = 23 preschools [381 children, 3.8 yrs., 55% boys]) or a control group (n = 23 [438, 3.7 yrs., 52% boys]). Intervention preschools participated in an 18-month PA intervention involving a 7-month staff professional development between 2019 and 2022, amounting to 50 h, including face-to-face seminars, webinars, and digital lectures. Primary outcomes in ACTNOW were cognition variables, whereas this study investigated effects on secondary outcomes. FMS was measured through 9 items covering locomotor, object control, and balance skills. FIT was assessed as motor fitness (4 × 10 shuttle-run test) and upper and lower muscular strength (handgrip and standing long jump). PA was measured with accelerometers (ActiGraph GT3X +). All measures took place at baseline, 7-, and 18-month follow-up. Effects were analysed using a repeated measures linear mixed model with child and preschool as random effects and with adjustment for baseline scores. Results Participants in the intervention preschools showed positive, significant effects for object control skills at 7 months (standardized effect size (ES) = 0.17) and locomotor skills at 18 months (ES = 0.21) relative to controls. A negative effect was found for handgrip strength (ES = -0.16) at 7 months. No effects were found for balance skills, standing long jump, or motor fitness. During preschool hours, sedentary time decreased (ES = -0.18), and light (ES = 0.14) and moderate-to-vigorous PA (ES = 0.16) increased at 7 months, whereas light PA decreased at 18 months (ES = -0.15), for intervention vs control. No effects were found for other intensities or full day PA. Conclusions The ACTNOW intervention improved some FMS outcomes and increased PA short-term. Further research is needed to investigate how to improve effectiveness of staff-led PA interventions and achieve sustainable improvements in children’s PA, FMS, and FIT. Trial registration Clinicaltrials.gov, identifier NCT04048967 , registered August 7, 2019. Funding ACTNOW was supported by the Research Council of Norway (grant number 287903), the County Governor of Sogn og Fjordane, the Sparebanken Sogn og Fjordane Foundation, and the Western Norway University of Applied Sciences.

Objective: We aimed to present our 12-year experiences for tenosynovial giant cell tumors (TGCTs) of tendon sheath by summarizing the demographic characteristics and clinicopathological features of 95 cases who underwent excision of localized TGCT in a single institution to investigate the factors associated with gender and tumor location among the patients. Method: The medical records of 95 patients with TGCT were reviewed. Demographic characteristics and clinicopathological findings were collected and compared according to gender and tumor location. Results: Females were predominantly involved (78.95%). The mean age was 41.09±14.26 years. The majority of patients had TGCT in their hands (75.79%) and most predominantly involved tumors in D1 and D2 (n=21 and 25, respectively). The tumor invaded into the bone/joint of 5 patients (5.26%), and 4 recurrences (4.21%) were determined over the mean follow-up period of 84.3 months (range: 14-136). No significant difference was found in demographics and clinicopathological features between two genders (p>0.05). However, there was a significant increase in the median tumor size of male patients compared with that of females (p=0.011). There was also no significant difference in demographics and clinicopathological features among digits of hands (p>0.05). Conclusion: Our study provides a comprehensive analysis of 95 patients who underwent surgical resection for localized TGCTs over 12 years at a single tertiary care hospital. TGCTs pose unique challenges in management because of their diverse clinical presentations and variable recurrence rates. Despite being predominantly benign, TGCTs exhibit recurrence and bone/joint invasion, necessitating meticulous follow-up and evaluation.

Abstract Background Public health and working life are closely related. Even though Norway is one of the world’s most equality-oriented countries, working life is still divided by gender. Women have a lower rate of participation in working life than men, they work more part-time and they have a higher sickness absence. Research has mostly focused on structural and cultural reasons for gender differences, rather than on the fact that women and men have different biology and face different health challenges. The aim of this project was to explore experienced associations between women’s health and female participation in working life. Methods Qualitative methods were chosen for investigating women’s experiences. We carried out in-depth interviews with 11 female high school teachers and supplemented the material with a focus group with five managers from the same organisation. The interviews were recorded and transcribed verbatim. We used the six steps of reflexive thematic analysis for consistency in the analysis process. Results The teachers shared a variety of experienced health issues within the field of women’s health and perceived barriers in the work environment. Four main themes were identified: (1) invisibility of women’s health at work, (2) complexity and lack of recognition of women’s health at work, (3) women’s health in work environment and (4) women’s health and role conflicts. There were few contradictions between the two informant groups. We found that health, work and total life intertwine and that complexity, lack of recognition and invisibility of women’s health appear at different levels in a mutual influence: for the women themselves, in the organisation and in society. Conclusion Lack of recognition and invisibility of women’s health in the work environment is suggested to influence women’s work participation. The complexity of female health is not captured by gender-neutral structures in the work environment meant to protect and promote employees’ occupational health. Recognition of women’s health in the work context can therefore contribute to a gender-equal, health-promoting and sustainable working life.

Anita Nilsen,1 Siren Eriksen,2 Bjørn Lichtwarck,3 Adelheid Hummelvoll Hillestad,2 Signe Gunn Julnes,1 Signe Tretteteig,4 Anne Marie Mork Rokstad1,4 1Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway; 2Lovisenberg Diaconal University College, Oslo, Norway; 3The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; 4Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, NorwayCorrespondence: Anita Nilsen, Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway, Email anita.nilsen@himolde.noPurpose: Coronavirus disease 2019 (COVID-19) placed a significant strain on nursing homes, leading to numerous outbreaks and high mortality rates. This situation created considerable stress and challenges for residents, their physicians and nurses, as well as family caregivers. By understanding these challenges, we can gain new insights and learn valuable lessons. Thus, the purpose of this study is to examine the treatment and care provided to nursing home residents with COVID-19, as experienced by physicians, nurses, and family caregivers.Participants and Methods: This study is a secondary analysis of 35 interviews with physicians, nurses, and family caregivers, each with personal experience caring for nursing home residents diagnosed with COVID-19. The interviews took place from December 2020 to April 2021. We analyzed the transcriptions based on Braun and Clarke’s reflexive thematic analysis model and followed a qualitative descriptive design as outlined by Sandelowski.Findings: The analysis produced three themes: 1) Balancing medical treatment, 2) The need for increased systematic monitoring of vital functions, and 3) Determining the treatment level for nursing home residents. These themes were explored through the unique perspectives of the three participant groups: physicians, nurses, and family caregivers. The findings revealed several challenges related to treatment and care for nursing home residents diagnosed with COVID-19. This applied both to relief of symptoms, monitoring of vital functions, assessment of treatment level and use of advance care planning.Conclusion: Drawing from the experiences of physicians, nurses, and family caregivers, there should be a unified plan at the municipal or national level for competency development in nursing homes to prepare for future crises like pandemics or epidemics. Additionally, the safe engagement of family caregivers and relatives should be given priority.Keywords: alleviation, nursing homes, palliative care, pandemic, safekeeping, systematic mapping

Abstract Background Severe epidermolysis bullosa (EB) is caused by premature termination codons (PTCs) in a significant minority of the patients. Topical gentamicin has been shown to increase wound healing and can restore protein translation in patients with EB through PTC suppression. However, only intensive treatment of limited wound areas have been reported previously. Objectives The objectives of this study is to investigate whether nonintensive topical gentamicin therapy is an effective wound‐healing treatment in patients with severe EB caused by PTCs. Methods A randomized, open‐controlled, single‐centre, single‐arm clinical trial designed to determine effectiveness at an individual level was performed. Each patient served as their own control and received topical 0.1% gentamicin ointment once daily for 6 weeks on all wounds on one body half. Wound areas were measured at Weeks 0 and 6. Change in wound areas at Week 6 compared with baseline was calculated and the changes in treated areas were compared with control areas. Immunohistochemistry was performed at Weeks 0 and 6. Results Four patients were included. One patient withdrew before completion. No significant effect on wound healing was seen. Immunohistochemistry analysis supported successful PTC suppression in two patients. Conclusions Our data suggest that nonintensive topical treatment with 0.1% gentamicin ointment for 6 weeks does not improve wound healing.

Christian Nilsen,1 Morten Gundersen,1 Per Graae Jensen,1 Kjell Gunnar Gundersen,1 Richard Potvin,2 Øygunn A Utheim,3– 5 Bjørn Gjerdrum1 1Ifocus Eye Clinic, Haugesund, Norway; 2Science in Vision, Frisco, TX, USA; 3Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; 4Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; 5The Norwegian Dry Eye Clinic, Oslo, NorwayCorrespondence: Christian Nilsen, Ifocus Eye Clinic, Strandgaten 203, Bergen, 5004, Norway, Tel +47 97189598, Email christian@ifocusstord.noPurpose: The primary objective was to investigate if treatment with artificial tears affected the variability of keratometry measurements for subjects with dry eyes prior to cataract surgery. The secondary objectives were to investigate whether treatment with artificial tears improved refractive precision and whether subjects with non-dry eyes had better refractive precision than subjects with dry eyes.Design: Prospective randomized controlled trial with three arms.Patients and methods: Dry eye diagnostics according to DEWS II were performed, and subjects with dry eyes were randomized to no treatment (group A1) or treatment with artificial tears two weeks prior to cataract surgery (group A2), with the third group (Group B, non-dry eyes) as a control. Keratometry was performed twice at baseline and twice after two weeks at the time of cataract surgery with three different optical biometers. The change in mean variability of keratometry (average K and magnitude of vector differences) and percentages of outliers after two weeks versus baseline were compared for group A2. The refractive and astigmatism prediction errors were calculated eight weeks after cataract surgery and compared for all three groups.Results: One hundred thirty-one subjects were available for analysis. There was no statistically significant difference in the mean variability of keratometry or percentages of outliers for group A2 from baseline to the time of cataract surgery. There was no statistically significant difference in refractive precision (absolute error and astigmatism prediction error) between any groups.Conclusion: Subjects with dry eyes (treated and non-treated) achieved the same refractive precision and percentages of outliers as subjects with non-dry eyes. Treatment with artificial tears for two weeks appeared inadequate to significantly affect variability in biometric measurements for patients with dry eyes prior to cataract surgery. DEWS II criteria for DED may not be optimal in a cataract setting.Keywords: Cataract surgery, non-invasive keratography tear break-up time, ocular surface staining, osmolarity, artificial tears

Abstract Background Alcohol screening and brief intervention (SBI) is an evidence-based intervention recommended by the World Health Organization. This study applied the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers of SBI implementation in primary care settings in Hong Kong, China. Methods This was a sequential mixed-method study. In-depth interviews of 21 physicians and 20 nurses working in the primary care settings from the public and private sectors were first conducted to identify CFIR constructs that were relevant to SBI implementation in the Chinese context and potential factors not covered by the CFIR. A questionnaire was then developed based on the qualitative findings to investigate factors associated with SBI implementation among 282 physicians and 295 nurses. Results The in-depth interviews identified 22 CFIR constructs that were facilitators or barriers of SBI implementation in Hong Kong. In addition, the stigmatization of alcohol dependence was a barrier and the belief that it was important for people to control the amount of alcohol intake in any situation was mentioned as a facilitator to implement SBI. In the survey, 22% of the participants implemented SBI in the past year. Factors associated with the SBI implementation echoed most of the qualitative findings. Among physicians and nurses in both sectors, they were more likely to implement SBI when perceiving stronger evidence supporting SBI, better knowledge and self-efficacy to implement SBI, more available resources, and clearer planning for SBI implementation in the clinics but less likely to do so when perceiving SBI implementation to be complicated and of higher cost, and drinking approved by the Chinese culture. Participants were more likely to implement SBI when perceiving SBI fit better with the existing practice and better leadership engagement in the public sector, but not in the private sector. Perceiving a stronger need and greater importance to implement SBI were associated with higher likelihood of SBI implementation among physicians, but not among nurses. Perceiving better organizational culture supporting SBI was positively associated with SBI implementation among nurses, but not among physicians. Conclusions There was a significant gap between SBI evidence and its implementation. Some strategies to improve SBI implementation may be different between physicians and nurses and between those in the public and private sectors. The CFIR is a useful framework for understanding facilitators and barriers of SBI implementation in primary care settings.

Usikkerhet i verdenssituasjonen har satt fokus på matforsyning globalt så vel som lokalt på den offentlige politiske dagsordenen. Situasjonen for dem som produserer maten, bøndene, settes dermed i fokus. Denne artikkelen drøfter særegenheter ved bondeyrket i forhold til temporale dimensjoner. Mens kalender- og klokketiden danner standarder for virksomheten i samfunnet generelt som også bønder må forholde seg til, er bondeyrket bundet til naturtiden. Det er preget av krav fra årstidens rytmer for såing og høsting, og fra dyreholdets døgnrytme for fjøsstell. Vår overordnede problemstilling utforsker hvilke utfordringer samfunnets standardtidsstrukturer gir for synkronisering av temporale aspekter ved bønders forhold til naturtiden og bondeyrkets hverdag. Mer spesifikt adresserer vi kjønnede dimensjoner i bondeyrket i forhold til synkronisering av biografisk timing, familietid og samfunnstid innenfor rammene av naturtiden. Med utgangspunkt i en biografisk livsløpstilnærming med fokus på begreper om tid analyserer vi intervjuer med hovedvekt på kvinnelige bønder.