Search

Abstract Background Acute chest pain has a high hospital referral rate due to the limited ability to exclude acute myocardial infarction (MI) in primary care. We aimed to evaluate the effectiveness of implementing the European Society of Cardiology (ESC) 0/1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT) testing in emergency primary care. Methods In a prospective study (April-October 2023), the ESC 0/1-hour algorithm for hs-cTnT was implemented at the main emergency primary care clinic in Oslo, Norway. All consecutive patients ≥ 18 years with acute non-traumatic chest pain having hs-cTnT measurements done were registered. The patients were assigned to MI rule-out, rule-in, or further observation using the algorithm. Patients in the observation group had a 4-hour hs-cTnT measurement done. The outcome measures were the proportion of patients conclusively assessed by the protocol, personnel adherence, reduction in length of stay (LOS) compared to the previous 0/4-hour protocol (historical cohort), and disposition. Results During six months, hs-cTnT measurements were conducted in 32.6% (995/3053) of chest pain patients (median age 58 years (IQR 45–68); 50.6% female). A single hs-cTnT measurement assigned 24.1% (n = 240/995) towards MI rule-out, suitable for early discharge, increasing to 63.8% after adding a 1-hour measurement. The observation group (319/995, 32.1%) was reduced to 23.0% (229/995) after a 4-hour measurement. A total of 77.0% of the patients were conclusively assigned to either rule-out or rule-in group. The personnel adhered well to the new protocol, with a median 1-hour sampling interval of 63 min (IQR 60–66) and 4.6 h (IQR 4.1–5.5) for the 4-hour sample. The protocol was misinterpreted or overruled in 8.6% of the cases. Compared to the previous 0/4-hour protocol, LOS was reduced by -2.2 h (95% confidence intervals − 2.6 to -1.7). After completed assessment at the clinic, 14.8% were transferred to hospital, where 20 patients were diagnosed with an MI. The remaining patients were sent home or managed in the outpatient setting; any occurrence of MIs in this group is unknown. Conclusions The ESC 0/1-hour algorithm effectively assesses low-risk acute chest pain in emergency primary care, reinforcing its gatekeeper role by managing these patients at a lower level of care.

Abstract Background Although there is clear evidence supporting the beneficial effects of regularly assessing patient-reported outcomes (PROs), the comprehensive integration of patient-reported outcome measures (PROMs) into routine cancer care remains limited. This study aimed to explore the facilitators and barriers encountered by principal investigators (PIs) (oncologists) and study nurses during the implementation of the Eir ePROM within a cluster randomized trial (c-RCT) in cancer outpatient clinics. Additionally, we sought to examine the influence of Eir on the working routines of the participants. Methods Individual semi-structured interviews and a focus group were conducted with nine oncologists and study nurses involved in the implementation of the ePROM tool Eir. Interviews elucidated their experiences of barriers and facilitators when implementing Eir through a cluster randomized trial. Data were analysed according to Framework Analysis, using both an inductive and deductive approach. The Consolidated Framework for Implementation Research (CFIR) was used in the deductive stages of analysis. Results Three overarching themes were identified from the data: (1) Willingness to invest; accepting that new eras come with a cost, (2) Management anchoring; changes start at the top, and (3) Creation of a cohesive framework; fostering collective comprehension. We found a notable disparity between oncologists and nurses in their willingness to invest time and effort in implementing the tool. While participants recognized the need to transform patient consultation methods to benefit from digital symptom management, opinions varied on whether the potential benefits justified the associated cost. Furthermore, the degree of management anchoring at various levels significantly impacted the implementation process. At the local level, it was seen as either a facilitator or a barrier, influencing the outcome of the implementation. Additionally, establishing a cohesive framework was crucial, as this fostered a collective understanding among those involved in the implementation. Conclusions Our study underscores the importance of considering the diverse perspectives of health care professionals and fostering interprofessional collaboration for the successful implementation of ePROMs in healthcare settings. Future research should explore strategies to bridge professional disparities and promote a shared understanding of the value provided by ePROMs.

Background: Poor dietary quality has been described as a contributor to symptoms in subjects with functional gastrointestinal (GI) symptoms. Hitherto, the focus in dietary evaluation and treatment in this patient group has mainly been on avoiding individual nutrient deficiencies, and less attention has been given to the dietary pattern and the overall food quality. Hence, we aim to describe and evaluate the dietary quality in patients with functional GI symptoms. Methods: Patients with GI symptoms and a diagnosis of irritable bowel syndrome or inflammatory bowel disease in remission, consecutively referred to a clinical dietitian for nutritional guidance, were included. All participants completed a 7-day weighed food record. The intake of foods, energy, macro- and micronutrients was computed. Dietary quality was evaluated by intake frequencies based on a predefined food index, combined with assessing achievement of nutrient intake recommendations. Results: A total of 35 patients were included. Intake frequencies of red meat, cheese and sweets were high, whereas intake frequencies of green leafy vegetables, berries, nuts, whole grain and legumes were low. The total intake of vegetables, fruit, berries, fish and nuts was lower than current recommendations, and the intake corresponded to intake below recommendations for several micronutrients, including vitamins D, C and A; iodine; folate; potassium; and selenium. Conclusion: The group of patients with GI symptoms had overall inadequate dietary quality. Low intake of nutrient-dense food groups considered as beneficial for health corresponded with insufficient intake of several micronutrients. We recommend that dietary evaluation should focus on the intake of food groups, rather than nutrients, in the treatment of patients with functional GI symptoms, to ensure a better evaluation of dietary quality.

(Series Information) European Papers - A Journal on Law and Integration, 2024 9(2), 685-694 | Article | (Table of Contents) I. Introduction. – II. Basic principles in the negotiations. – III. Negotiating the issues deriving from Opinion 2/13. – III.1. EU-specific mechanisms of the procedure before the ECtHR. – III.2. Inter-state applications and advisory opinions. – III.3. Mutual trust and mutual recognition. – III.4. CJEU competence over EU acts in the field of CFSP. – IV. Other issues. | (Abstract) I. Introduction. – II. Basic principles in the negotiations. – III. Negotiating the issues deriving from Opinion 2/13. – III.1. EU-specific mechanisms of the procedure before the ECtHR. – III.2. Inter-state applications and advisory opinions. – III.3. Mutual trust and mutual recognition. – III.4. CJEU competence over EU acts in the field of CFSP. – IV. Other issues.

Purpose: This study investigates how physical therapists and daycare staff together contribute to enabling children with severe motor disabilities to play in daycare settings. Design, Material, and Method: The study employs a qualitative design where data is collected through interviews with physical therapists and daycare staff, and observations of physical therapy treatments and play events in the daycare. The analysis is inspired by phenomenological thematic analysis with connections to play theories and enactive theory. Findings: Children with severe motor disabilities can play and want to play. The adults work to promote interactive play, but their understanding of play, the body, and physical therapy influences how play unfolds. Attentiveness, creativity, and interaction support play, while practical tasks and rules governance limit it. Adapting play to the child's body as is facilitates play on the child's terms. Conclusion: Adults can support the child's play through creative adjustments and adaptations, combined with attention and curiosity about the child's own sense-making.

Inquiry is central in science education and therefore also in pre-service teacher (PST) education. In this systematic review of 142 empirical articles, we examine research on inquiry-based science education (IBSE) in teacher education between 2000 and 2022. The aim is to investigate how and with what outcomes IBSE is used in PST education. The included articles were categorised according to whether the PSTs worked with inquiry in the role of learner or in the role of teacher and also according to the cognitive domains of inquiry (epistemic, procedural, conceptual, social, pedagogical, or affective). The review shows that IBSE is used for PSTs to learn science concepts and processes and how to teach science through inquiry; however, few studies highlight the transition between these. In terms of cognitive domains, the procedural, conceptual, pedagogical, and affective domains dominated, whereas fewer articles addressed the epistemic or social domains. Favourable outcomes of IBSE for science understanding, teaching competence and improved attitudes or self-efficacy were reported. Challenges were noted, for example with implementing IBSE in school placement after having learned about it in campus-based courses. Finally, we offer recommendations for fruitful ways of implementing IBSE in PST education and suggest areas for future research.

Objective To investigate the antecedents to episodes of aggression and the use of coercive measures in inpatient mental health settings, organize and explore their relationships and patterns through thematic analysis, identify gaps in the literature and provide insights for future research.Introduction The use of coercive measures in inpatient mental health settings remains controversial and ethically challenging. Despite an international consensus on the need to reduce their use, the antecedents to aggression and episodes involving coercive measures remain insufficiently explored. This review seeks to address this gap by systematically mapping the evidence of these antecedents and exploring their relationship, providing a foundation for future research.Inclusion criteria Studies included were those published from 2014 to the present in the English language, focusing on either adult mental health inpatients or mental healthcare professionals aged 18 years or older involved in episodes of aggression or exposure to coercive measures in both acute and long-term inpatient mental health settings. Included studies must address antecedents to aggression or the use of coercive measures. Exclusions apply to studies focusing exclusively on behaviours unrelated to aggression or coercive measures, studies conducted in non-inpatient settings and those involving child, adolescent, geriatric or forensic populations.Methods The review will follow the Joanna Briggs Institute methodology for scoping reviews. The search strategy will cover key databases, including Ovid Medline, APA PsycINFO and Scopus, with reference list screening to ensure comprehensive coverage. Initial exploratory searches were conducted in June 2024, with the formal searches updated in January 2025. Studies will be screened against the inclusion criteria, and data will be extracted using a standardised form adapted to the review objectives. Grey literature will be excluded, focusing on peer-reviewed evidence. The analysis will include descriptive mapping of the antecedents to aggression and the use of coercive measures, supplemented by thematic analysis to organize and explore patterns and relationships between them. Results will be presented in a descriptive summary, supported by thematic analysis and descriptive statistics.Ethics and dissemination Ethical approval is not required since this study uses existing published literature. The results will be disseminated through a peer-reviewed journal and presented at relevant international conferences.

Abstract Background Acute health and social services for children and adolescents often struggle with youth aggression and violence. Early identification of violence risk during institutional stay can help prevent violent incidents. As such, this study assessed the predictive accuracy of the Violence Risk Assessment Checklist for Youth (V-RISK-Y) aged 12–18 in two different juvenile settings providing 24-hour services for youth. Institutions were included from child and adolescent inpatient psychiatry and residential youth care under child protective services. Methods A prospective, naturalistic observational study design was employed. V-RISK-Y was administered for youth admitted to four acute inpatient psychiatric units and four acute residential youth care institutions. Incidents of violence and threats during the youth’s stay were registered by institutional staff. In total, 517 youth were included in analyses, 59 of whom were registered with at least one incident of violence or threats during their stay. Area under curve (AUC) and logistic regression analyses were used to assess predictive accuracy and validity of V-RISK-Y. Results For the overall sample, V-RISK-Y had good predictive accuracy, and the sum score of V-RISK-Y significantly predicted registered violent incidents. Stratified analyses indicated good predictive accuracy of V-RISK-Y for the inpatient units, but not for the residential youth care institutions. Conclusions Findings imply that V-RISK-Y is accurate in identifying violence risk for youth admitted to inpatient psychiatric units but has limited predictive accuracy in residential youth care institutions. Future research should explore approaches to correctly identify violence risk in residential care settings.

Abstract Persistent organic pollutants (POPs) are environmental contaminants that can accumulate in human tissues and pose potential health risks. Despite global efforts to reduce their prevalence, follow‐up studies are needed to see if the measures are successful. Since most infants in Norway are breastfed for the first 6 months of life, monitoring POP contamination in breastmilk is important for children's health and development. This study aims to evaluate the current levels of various POPs in women's breastmilk in Innlandet County, Norway. A cross‐sectional study was conducted measuring concentrations of 35 different POPs, including polychlorinated biphenyls (PCBs), chlordanes (ChlDs), hexachlorocyclohexanes (HCHs), dichlorodiphenyltrichloroethanes (DDTs), Mirex, and brominated flame retardants in 120 breastmilk samples. The study analysed the impact of maternal age, parity, pre‐pregnancy BMI, and infant age on POPs levels and compared the estimated daily intake per body weight of infants to existing health guidelines. The detected percentages for PCBs were 100%, for DDTs 98.3%, and for ChlDs 98.3%. The highest median concentration was found for ΣPCBs (26.9 ng/g lw). Maternal age, parity, and infant age were significant determinants of POP concentrations. Most infants exceeded the health‐based guidance values for ΣPCB, and 6.4% percent did so for ΣHCHs. Despite lower POPs concentrations in breastmilk than in earlier studies, many breastfed infants are still exposed to levels exceeding health‐based guidance values. Although the study's design had limitations, the study provides updated population‐based data on POPs in breastmilk. Continued monitoring and research are necessary to understand and mitigate potential health risks associated with POPs.

Introduction: The aim of the present study was to summarize and evaluate previously published scientific studies examining whether computed tomography (CT) of the thorax can predict the COVID-19 prognosis. The purpose is to clarify whether CT can predict the COVID-19 prognosis, and also if a CT examination can predict whether the patient will be admitted to the intensive care unit (ICU) or not. Method: Traditional digital literature searches were performed in the Medline, Pubmed and Embase databases. Subsequent back- and forward citation-based searches were then conducted. A total of 17 studies were included according to preset inclusion and exclusion criteria. Results: All 17 included articles were retrospective studies. The mean number of patients included was 219 (range: 28-901). Overall, the studies showed that CT-findings of abnormalities in the lung tissue may provide a possible COVID-19 prognosis determination. A total of 11 studies used a quantitative scoring system to evaluate the lung images. Based on the percentage of lung involvement, the ICU patients had a higher score compared with patients not admitted to the ICU. The pathology type with the highest predictive value was crazy paving pattern followed by vascular enlargement and air bronchogram. Pleural effusion and pleural thickening can help estimating the prognosis according to some of the studies. Conclusion: The present study shows that CT can contribute to early diagnosis and predict the prognosis when using scoring systems or qualitative assessment of certain radiologic features which are more prevalent in critically ill COVID-19 patients.

Girls and boys might differ in autistic symptoms and associated cognitive difficulties such as executive function (EF). We investigated sex differences in the relationship between parent rated EF and autistic symptoms in 116 children and adolescents (25 girls) aged 5-19 years with an intelligence quotient above 70 and an autism spectrum disorder (ASD) diagnosis. They were rated with the behavior rating inventory of executive function (BRIEF) and the autism diagnostic interview revised (ADI-R). We found a positive association between EF and the ADI-R domains of reciprocal social interaction (p < 0.001) and communication (p = 0.001) in girls, while these relationships were small and non-significant in boys. Our results provide a greater understanding of the sex-specific characteristics of children and adolescents with ASD.

Background With improvements in cancer treatment and early detection, the number of people living with cancer is increasing.Objective This study aimed to investigate the association between combined prediagnostic lifestyle factors, assessed by a Healthy Lifestyle Index (HLI) score, and mortality among women diagnosed with breast cancer (BC), colorectal cancer (CRC) and lung cancer (LC).Design Prospective cohort.Setting Women residing in Norway, general population.Participants Our analysis included 5032, 2468 and 1594 women from the Norwegian Women and Cancer study diagnosed with BC, CRC and LC, respectively, who responded to a questionnaire between 1996 and 2014.Exposure measures HLI score measured prior to cancer diagnosis. The HLI combines physical activity level, body mass index, smoking behaviour, alcohol consumption and dietary habits.Outcome measures We estimated HRs and 95% CIs using Cox proportional hazard models for all-cause and site-specific cancer mortality.Results After median follow-up times of 9.8, 7.1 and 5.9 years for BC, CRC and LC cases, respectively, there were 912, 902 and 1094 all-cause deaths; and 509 BC deaths, 679 CRC deaths and 961 LC deaths. For women diagnosed with BC, a 1-point HLI score increment was associated with a 6% lower all-cause mortality rate (HR: 0.94, 95% CI: 0.92 to 0.97). The data were compatible with no association for the estimated 3% lower BC mortality rate (HR: 0.97, 95% CI: 0.94 to 1.00) among women diagnosed with BC, and for the estimated 3% lower all-cause (HR: 0.97, 95% CI: 0.95 to 1.00) and 2% lower CRC mortality rates (HR: 0.98, 95% CI: 0.95 to 1.01) among women diagnosed with CRC. For women diagnosed with LC, prediagnostic HLI score was not associated with all-cause (HR: 1.00, 95% CI: 0.98 to 1.02) or LC mortality rates (HR: 1.00, 95% CI: 0.98 to 1.03).Conclusions We observed that a higher HLI score measured before cancer diagnosis was associated with lower all-cause and, possibly, lower BC mortality among Norwegian women diagnosed with BC; and a possible lower all-cause and CRC mortality among those diagnosed with CRC. Smoking was likely responsible for the observed associations.

Negative school integration experiences can compromise the healthy development of newcomer youth. Little research has explored what affects their experiences; even less has engaged youth in the research process. This study investigated the school integration experiences of French-speaking newcomer youth in a predominantly anglophone Canadian province using the Arts-Based Engagement Ethnography research method. We explored: (1) How do newcomer youth experience a public francophone school? and (2) How do these experiences influence their positive integration into the francophone school system in a predominantly anglophone province? Data from artifacts, interviews, and planned group discussions were organized into four structures: (a) navigating school integration challenges, (b) negotiating identity, (c) confronting biases, and (d) helping other newcomer youth. Underlying patterns painted a rich portrait of newcomer youth school integration experiences, which informed their emerging identity. Findings point to needed changes to supports and services offered to newcomer youth integrating into the francophone school system in a predominantly anglophone province.

Cancer is one of the leading causes of mortality, with new cases expected to rise. Medical advances increase cure rates and prolong patient lives, but survivorship involves high symptom burden, loss of function and emotional distress. Improving patient-centred care (PCC) and quality of life throughout the care process is essential. Key to this improvement are systematic use of patient-reported outcome measures (PROMs) and patient-centred care pathways (PCCPs). Despite established benefits, current cancer care focuses on tumour-centred care approaches often neglecting the patient perspective. Evidence-based PCC guidelines fail to be routinely incorporated into clinical practices. The Horizon 2020-funded European MyPath project aims to address these gaps by developing, implementing and evaluating digital PCCPs with PROMs. MyPath will be tailored to enhance the organisational contexts of cancer centres across Europe through the application of implementation science strategies. This paper describes the current state of applying PCC in routine cancer care and presents a forward-looking perspective on how the MyPath project can successfully adopt and implement digital PROMs across countries. A literature search was conducted to provide the state-of-the art.

Denne artikkelen er en del av et større forskningsprosjekt (Literacies for Health and Life Skills) om folkehelse og livsmestring i skolen (FoL). Vi har i denne artikkelen tatt utgangspunkt i det potensialet som ligger i en interprofesjonell utdanning med lærer- og helsesykepleierstudenter. Formålet med artikkelen er å undersøke hva lærer- og helsesykepleierstudenter anser som sentrale kilder til helseinformasjon i hverdagen, og hvordan de reflekterer rundt disse kildenes troverdighet. På bakgrunn av dette vil vi utforske studentenes forståelse av helsebegrepet. Datamaterialet er samlet inn ved bruk av visuelle metoder; 51 karttegninger der studentene viser hvor de lærer noe om helse, samt lydopptak fra studentenes gruppesamtaler. Analysen av datamaterialet viser at begge studentgruppene vektlegger offentlige nettsider som troverdige kilder til helseinformasjon i hverdagen. Lærerstudentene argumenterer derimot også for at ikke-forskningsbaserte kilder som sosiale medier og podkaster kan gi nyttig helseinformasjon. Dette underbygger tidligere forskning, som viser at lærer- og sykepleierprofesjonen representerer forskjellig syn på hva som er troverdig kunnskap. Resultatene viser at helsesykepleierstudentene vektlegger en helhetlig helseforståelse, mens lærerstudentene i større grad vektlegger fysisk helse gjennom trening og kosthold. Vi argumenterer for et styrket tverrprofesjonelt samarbeid i utviklingen av FoL i skolen. Det helhetlige perspektivet på helse i helsesykepleierutdanningen kan bidra til å motvirke den dominerende «helseisme» diskursen, hvor barn og unge ansees som ansvarlige for egen helse, og som formidler at god helse er lett å oppnå gjennom individuell innsats, disiplin og moral.

This study contributes to advancing the field of automatic fish event recognition in natural underwater videos, addressing the current gap in studying fish interaction and competition, including predator-prey relationships and mating behaviors. We used the corkwing wrasse (Symphodus melops) as a model, a marine species of commercial importance that reproduces in sea-weed nests built and cared for by a single male. These nests attract a wide range of visitors and are the focal point for behavior such as spawning, chasing, and maintenance. We propose a deep learning methodology to analyze the movement trajectories of the nesting male and classify the associated events observed in their natural habitat. Our approach leverages unsupervised pre-training based on diffusion models, leading to improved feature learning. Additionally, we introduce a dataset comprising 16,937 trajectories across 12 event classes, making it the largest in terms of event class diversity. Our results demonstrate the superior performance of our method compared to several deep architectures. The code for the proposed method and the trajectories can be found at https://github.com/NoeCanovi/Fish_Behaviors_Generative_Models.

Aquaculture technology is on the move, enabling production in more open and exposed ocean environments around the world. These new systems offer solutions to environmental challenges facing conventional aquaculture, yet new technologies also create new social challenges while potentially exacerbating, or at minimum recreating, others. Offshore aquaculture research and governance are still in early stages, as is our understanding of the social repercussions and challenges associated with development. This paper provides an evaluation and reflection on offshore aquaculture from a social science perspective and is based on findings from a modified World Café group discussion method including the thoughts and experiences of social science experts. Key challenges and uncertainties including a lack of an appropriate regulatory framework, societal perceptions of offshore aquaculture, and offshore aquaculture’s contribution to society were identified. The governance implications of these challenges are discussed as well as the need for social sciences to address these challenges through transformative and transdisciplinary approaches that bridge science and society.

Excessive and incorrect use of antibiotics contributes to the rise of antimicrobial resistance (AMR). Given that pharmacists act as final checkpoint before antibiotics is handled over to patients, they play a crucial role in promoting proper antibiotic use and ensuring treatment adherence. However, there is often a gap between the patients’ needs and perceptions, and what the pharmacists provide. Improving pharmacists’ training is essential for enhancing patient-centered care. The aim of this research was to evaluate the suitability of academic detailing (AD) for improving Norwegian pharmacists’ knowledge and practice on adherence promoting counseling of antibiotic patients. Key insights from prior qualitative research regarding community pharmacists’ position in promoting optimized antibiotic use were incorporated in a tailored AD program. The AD’s suitability was evaluated using the validated “Provider Satisfaction with Academic Detailing” (PSAD) and “Detailer Assessment of Visit Effectiveness” (DAVE) instruments. Additionally, participants preferred knowledge updates method were assessed. Eighty-one of 86 visits completed PSAD (94% response rate). Satisfaction summary score for PSAD was 40.03 (of maximum 45) and scale summary score for DAVE 12.45 (of maximum 15). One-sample t -test (P

The forest sector faces complex societal demands that require a workforce with the desired composition of competence. It is also a primary, rural, and male-dominated industry based on gendered norms and culture. There are knowledge gaps in how gender influences work-related satisfaction and experiences in the forest sector and how women manage to work in male-dominated workplaces. We fill part of these voids by studying job satisfaction and women's strategies using the Norwegian forest sector as a case study. By combining surveys and group interviews, we unveil statistical gender differences and individual experiences. We found that while most men and women are satisfied with the social aspects of the workplace, men are more satisfied than women. Women report considerably less gender equality and more use of suppression techniques than men. Thirty-two percent of the women report being sexually harassed during their most important job position. Being exposed to harassment, most women choose not to report it to management, but instead handle the situation themselves. Forestry is a gendered sector, and to change attitudes for improving the work environment and opportunities for all employees, gender-related issues must be raised and handled in a suitable manner by managers and organizations. Key words: forestry, primary industry, work-life culture, gender equality, mixed methods, Introduction Among university-educated foresters, females have been found to leave the forest sector more than men and more often due to dissatisfaction with the work (Andersson and Johansson 2022). Several [...]