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Bakgrunn: Å få en kronisk sykdom som diabetes er utfordrende og stiller krav til ungdommer som rammes. Eksempler er svingende blodsukkerverdier og psykososiale utfordringer som kan påvirke etterfølgelse av behandlingen. Formål: Å få kunnskap om ungdommers tidlige erfaringer med å få diabetes 1 og deres hverdag og livskvalitet etter diagnosen, for å kunne bidra til et godt helsetjenestetilbud for denne pasientgruppen. Metode: Kvalitative semistrukturerte intervjuer av åtte ungdommer med nyoppdaget diabetes, analysert med innholdsanalyse. Funn: Gjennom analysene kom vi frem til fire hovedtemaer: Det første er starten på livet med diabetes der ungdommene beskriver sine erfaringer ved diagnostisering og møtene med helsepersonell. Det andre er et nødvendig og utfordrende forhold som omhandler deres erfaringer med foreldrenes rolle og egen rolle. Det tredje er omverden og selvbilde basert på hvordan ungdommene ser på seg selv, bl.a. gjennom hvordan de forteller andre om sykdommen. Og det fjerde er den nye hverdagen hvor de beskriver sykdommens innvirkning på dagligliv og livskvalitet. Konklusjon: Tilpasningen til diabetes oppleves som en prosess. Helsepersonell kan bidra ved å støtte ungdommers positive erfaringer noe som kan styrke motivasjonen for en tilfredsstillende diabetesbehandling, samtidig som det kan bidra til å opprettholde et positivt selvbilde og fremme livskvalitet hos ungdommer.

Background: Sleep and Colic problems in infancy have been linked to adverse health outcome, but there is limited knowledge of the association between sleep and colic problems in infancy and subsequent development, emotional and behavior problems in young children. The aim of the present study was to examine whether there is an associations between infants’ crying and sleep problems at 6 months and behavioral and development problems at 18 months, 3 and 5 years Methods: A population-based longitudinal study, using data from the Norwegian Mother and Child Cohort Study conducted at the Norwegian Institute of Public Health from June 1999, to December 2008. A total of 86,724 children were included. Colic and sleep (sleep duration, nocturnal awakenings and easy to put to bed) was assessed by mother-reports. Z-scores were used to assess differences between groups of children (e.g. having colic or not, having a sleep problem or not). Emotional and behavioral problems were measured with items from the Child Behavior Checklist. Development problems were measured with items from The Ages and Stages Questionnaire. Results: Infants with colic scored significantly lower on development at 5 years (B=-0.10, CI [-0.14-; - 0.06]) and higher on internalizing problems both at 18 months (B=-0.06 .CI [-0.09-; - 0.03]) and 3 years (B=-0.05 .CI [0.08-; - 0.01]) than the reference population. Children who awoke frequently (≥ 3 times) and were more difficult to put to bed at 6 months scored significantly lower on development at 18 months and 3 and 5 years, and higher on internalizing behavior problems at 18 months and 3 years (B=0.18 and B=0.16), and children with shorter sleep duration (≤ 10 hours) at 6 months had more internalizing behavior problems at 18 months (B=-0.14. CI [0.07; - 0.02]) and 3 years (B=-0.15 .CI [0.05-; - 0.25]) than the reference population.Conclusions: Colic and disruptive sleep early in life are risk factors for development, emotional and behavioral problems within the first five years of a child’s life. It is important to be aware that disruptive sleep and colic in infancy may have long-term negative consequences.

Background Colic and sleep problems are common among infants, constitute challenges and distress for parents, and are often reasons for seeking help from health professionals. The literature debates whether infant colic and sleep problems are linked together or not. Further, limited evidence exists on how colic impacts on child temperament and sleep during early childhood. Thus, the purpose of this study was to increase our knowledge of the characteristics of infants with a history of colic compared to infants without, and to study how infant colic is associated with the development of child temperament and sleep over time. Methods The study is based on The Norwegian Mother, Father and Child Cohort Study (MoBa), a population-based cohort study conducted by the Norwegian Institute of Public Health. This sample contains 88,186 mothers and children. Data was retrieved from questionnaires distributed to mothers at recruitment (in pregnancy) and when the child was 6 months, 18 months, 3 years, and 5 years. Data was analysed using linear mixed models and GLM models for repeated measures. Results At 6 months, infants with reported colic are described as fussier, present more sleeping problems, are breastfed less, and the families visit the child health centre more often when compared to the non-colic group. Mothers of children with reported colic perceive their children’s temperament significantly more challenging from the age of 6 months to 5 years. Further, children with reported colic were more likely to sleep less than recommended (22%) and to have more frequent night awakenings (14%) than usual for their age (6 months to 5 years). Conclusion Infant colic often occurs together with other signs of regulatory problems which may amplify the load on the parents. Moderate differences in temperament and sleep-problems across time, between those with colic and those without, indicate that the diagnosis of colic is moderately associated with later behavioural difficulties. However, it is demanding for the parents, and important to be aware of and act upon symptoms of colic in the child health centres to reduce the parents’ load and prevent adverse long-term outcomes.

Adolescence is a sensitive period in life and a time to redefine and learn new skills. In Norway, school health services provide individual health-promoting consultations with all eighth-grade students. As an aid to support these consultations, a dialogue tool called SchoolHealth was developed using a co-creation approach. SchoolHealth consists of a web-based health information form designed to be completed by the students and generates individual feedback reports to help the school nurses to prepare for the consultation and tailor it to the individual student’s need. Our aims were to evaluate the feasibility and user experiences of SchoolHealth among students and school nurses using a mixed methods approach. A total of 79 eighth-grade students (69% of those invited) and four school nurses from three schools participated. Analyses indicated that SchoolHealth was feasible, promoted reflection among students, and helped prepare students and school nurses for the consultation.

Background: Having good Quality of Life (QoL) is essential, particularly for women after childbirth. However, little is known about the factors associated with maternal QoL after giving birth. We aimed to investigate the relationship between characteristics of the mother (socio-demographic variables), selected symptoms (depression and joy/anger), health perception (perception of birth) and possible characteristics of the environment (infant temperament, colic, sleep, parental relationship), with mothers’ overall quality of life when the child is six months of age.Methods: This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa), conducted at the Norwegian Institute of Public Health from June 1999 to December 2008, which included a total of 86,724 children. Maternal QoL was assessed by the Satisfaction With Life Scale. Joy and anger were measured using the Differential Emotional Scale, mothers’ mental health was assessed using the Edinburgh Postnatal Depression Scale and satisfaction with relationship was measured using the Relationship Satisfaction Scale. Child temperament was measured using the Infant Characteristics Questionnaire and colic, sleep duration and feelings related to childbirth were assessed by mothers’ reports. The associations between life satisfaction and selected variables were analysed using stepwise multiple linear regression models.Results: Maternal feelings of joy of having a baby (B=0.35, CI [0.79 to 0.83]), high relationship satisfaction (B= 0.02, CI [0.28 to 0.60]), as well as having a baby with normal sleep (B=0.32, CI [0.21 to 0.22]), are factors associated with higher maternal overall QoL. Postnatal depression was negatively associated with mothers’ QoL, and infant colic or child’s temperament (fussiness) showed no such association with mothers’ QoL.Conclusions: Health professionals and clinicians should focus on these issues when they develop health interventions or provide counselling to new mothers and their families.

Bullying has negative consequences for health and quality of life of students. This study is part of a pilot project, “School Health,” which included a web-based questionnaire completed by students before a consultation with the school nurse. The aim of this study was to explore how students experience answering questions about bullying before an individual consultation and how they talk about bullying with the school nurse. This study had qualitative design with individual and focus group interviews and involved 38 students aged 13–14 years, both boys and girls, from three schools. Data were analyzed according to Kvale’s three levels of interpretation within a phenomenological and hermeneutic perspective. The students found it difficult to report being bullied. They expressed confidence in the school nurse and liked talking with her. Some complained about the school environment and reported that having a friend was important.

There are important ethical issues to be examined before launching any public health intervention, particularly when targeting vulnerable groups. The aim of this article is to identify and discuss ethical concerns that may arise when intervening for health behavior change among adolescents identified as overweight. These concerns originate from an intervention designed to capacitate adolescents to increase self-determined physical activity. Utilizing an ethical framework for prevention of overweight and obesity, we identified three ethical aspects as particularly significant: the attribution of responsibility for health behavior, liberty to choose, and the effect on the participants’ psychosocial well-being. It is discussed whether and how measures can be taken to deal with these aspects. It seems evident that the ethical aspects are mainly concerned with the vulnerability of adolescents identified as overweight. However, we claim that when individual feedback and counseling is provided, tailored interventions have a unique potential to empower adolescents to make ethically anchored decisions about their own health behavior.

Aims and objectives To gain a better understanding of school nurses’ perceptions of the challenges involved in implementing national guidelines on managing overweight and obesity in adolescents. Background National guidelines for the management of childhood overweight and obesity are developed in many countries to translate scientific knowledge into practice. However, several challenges are involved in their implementation. Design and methods A qualitative design with focus group interviews was chosen for data collection. Six focus group interviews with 21 school nurses were conducted. Data were analysed by qualitative content analyses. Results National guidelines provided new directions for managing overweight and obesity in school health services. School nurses were assigned new tasks and responsibilities, which they felt they were not sufficiently prepared for, nor were they supported by extra resources. Challenges in implementation of the guidelines were identified at various levels: system level (implementation strategy, available resources, training and support, professional collaboration, referral options); individual school nurse level (perceived competence, burden of responsibility, attitudes and emotions); subject level (sensitivity of weight-related issues); and professional level (scepticism to a body mass index cut-off of 25 kg/m2 as the starting point for intervention). Conclusions School nurses felt overwhelmed in terms of implementing the guidelines. This indicates barriers not being sufficiently identified or acted upon during implementation. Further, the nurses’ scepticism about the body mass index cut-off for intervention, and their experience that measuring and follow-up of adolescents’ weight development was their responsibility alone, indicates that important discussions are needed on this as an adequate measure as well as on the professional division of responsibilities. Relevance to clinical practice Having a proper strategy for implementation, and ensuring that necessary clinical structures and resources are available, is crucial. Including school nurses in developing and implementing such strategies is vital for success in implementing national guidelines.

Randi Andenæs,Sølvi Helseth,Nina Misvær,Milada C Småstuen,Lis Ribu Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Oslo, Norway Objective: The aim of this study was to examine how neuroticism, stressful life events, self-rated health, life satisfaction, and selected lifestyle factors were related to insomnia both by sex and among users and nonusers of prescribed sleep medication (PSM).Design: Cross-sectional data from the Norwegian Nord-Trøndelag Health Study (HUNT3, 2006–2008), a population-based health survey, were linked to individual data from the Norwegian Prescription Database.Methods: Logistic regression analyses were used to investigate the associations between the selected variables and insomnia in both males and females and among subjects using and not using PSM. Individuals were considered to have a presumptive diagnosis of insomnia disorder if they reported difficulty with sleep initiation, sleep maintenance, or early morning awakening several days per week for the last 3months. PSMs were categorized as anxiolytics or hypnotics; the dose was estimated according to defined daily dose (DDD).Results: Of the total 50,805 participants, 6,701 (13.2%) used PSM. The proportions of PSM users were larger among elderly participants. Increased risk of insomnia was strongly associated with poor self-rated health and higher level of neuroticism. These associations were evident for both sexes and were similar among both users and nonusers of PSM. Low satisfaction with life was strongly related to insomnia, but only among nonusers of PSM. Increased doses of PSM were not associated with reduced likelihood of insomnia.Conclusion: Insomnia is a problem among both users and nonusers of PSM and is associated with psychosocial factors. Our findings suggest that successful treatment for sleep problems should take individual variation into account, such as age, sex, personality traits, satisfaction with life, and health perception. Keywords: prescription sleep medication, hypnotics, anxiolytics, insomnia, life satisfaction, self-rated health, neuroticism, sex, HUNT

Aim. The aim of this study is to explore and describe adolescents’ own perceptions of quality of life; what it is and what matters. Background. Quality of life has become an important concept in evaluating health care, in both child and adult populations. As nurses concerned with quality of life and well-being, it is important for us to identify the main factors that contribute to the promotion and sustenance of young people’s well-being. Design. A qualitative hermeneutic design was chosen. Method. The method was in-depth interviews with 31 healthy adolescents (14–15 years) in the school health service. The interviews were taped, transcribed and analysed as text according to Kvale’s three contexts of interpretation: self-understanding, critical common sense and theory. Results. According to the adolescents, quality of life is about the positive cycles of life. Feeling good, being satisfied with oneself and having an overall positive attitude are in most cases described as the starting points of a positive cycle. To get into and stay in the positive cycle, a positive self-image, good friends and good family relations are important. Consequently, adolescents’ quality of life is threatened when these factors are negative. Friends seem to be the most significant factor. It is extremely difficult to be without friends and none of the adolescents would admit that they were, not even to themselves, although it was rather obvious in some cases. Self-image and popularity are factors associated with the ability to get friends. Conclusions. Understanding the adolescents’ view of quality of life emphasises the importance of focusing on their psychosocial health and in particular their peer relations, to promote and sustain their quality of life. Relevance to clinical practice. Knowledge about the factors most significant to adolescents’ quality of life is applicable to all clinical settings where nurses meet adolescents; i.e., hospitals, outpatient clinics and school health services.

Swedish couples' perceptions of their marital quality when their firstborn was 6 months old and then 4 years later were studied in 2002 and 2006, respectively. The results show that almost half of the 368 responding parents were satisfied with their marital relationship both in 2002 and 2006 as assessed by a modified Dyadic Adjustment Scale. However, a study of the various dimensions showed a significant decrease in marital quality. Housework and child care were perceived as having a greater strain on the relationship between couples who had had additional children during this period. Dyadic Sexuality and Dyadic Cohesion were the most significant predictors of marital quality. Covariates of marital quality in the group with additional children were “partner relation and parenthood perceived as a strain” and “perceived social support.” The results emphasize the need for supportive interventions for parents with children aged 0 to 4 years.

Aim: To examine the relationship between cardiorespiratory fitness (CRF) and health-related quality of life (HRQoL) among overweight adolescents and to test whether this relationship is mediated by body image (BI) and self-determined motivation for physical activity (PA) and exercise. Methods: One hundred and twenty adolescents identified as overweight or obese were recruited through the school health service. The participants completed self-report instruments measuring HRQoL, BI and self-determined motivation for physical activity and exercise in addition to a 20 m shuttle-run test, and body mass index was calculated. Confirmatory factor analysis was conducted to evaluate the hypothesised five-dimensional structure of the Behavioural Regulation in Exercise Questionnaire-2 (BREQ-2) used to measure self-determined motivation. Associations between the study variables were explored using univariate linear regression. Mediation was tested by a multistage regression approach. Results: The five-dimensional model of BREQ-2 showed acceptable fit for the data. We revealed a statistically significant association between cardiorespiratory fitness and HRQoL (4.16 [0.3–8.02]; p < .05). CRF failed to affect BI in the first mediation equation. Hence, body image was excluded from further analyses. However, self-determined motivation proved to mediate the relationship between CRF and HRQoL. Conclusions: The results of this study suggest that the motivational mechanisms related to fitness can contribute to explain the association between CRF and HRQoL in overweight adolescents. The findings are important from a public health point of view and should be taken into account in the development of PA interventions for overweight and obese adolescents for the potential enhancement of their physical and psychosocial well-being.

Background (i) to describe oral health counselling in Norway to parents with infants and toddlers, ii) to assess existing collaboration and routines in oral health matters between nurses and personnel in the PDS, iii) to evaluate to what extent oral health was integrated in the basic educational curriculum of public health nurses. Methods This study was based on two separate surveys: the sample of Study I was 98 randomly selected child health clinics. A questionnaire covering oral health promotion counselling of parents with young children was returned by 259 nurses. Study II was a telephone survey addressing teachers of public health nurses at the eight educational institutions in Norway. Results The response rate in Study I was 45%. Nutrition (breast feeding, diet) was the health subject most often prioritized in the counselling targeting parents of young children (by 60% of the nurses). Oral health was not among the first priority counselling subjects. The subject was seldom spontaneously mentioned by parents. Seventy percent of respondents reported (agreed or totally agreed) that they managed to provide information parents needed and 72% believed that the information they gave influenced parents' health behaviours. Seven nurses (5.2%) responded that they agreed with the statement that the information they gave only slightly influenced parents' health behaviour. Lack of time was mentioned as being a problem. Approximately half of the nurses (48%) had regular contact with the PDS for the 0-3 year-old children, but only a quarter of the nurses claimed that children's teeth were routinely examined at the child clinics. Some forms of previously established contact with the PDS enhanced the likelihood of nurses' referrals. Oral health was a minor part of the educational curriculum for public health nurses; at three institutions, the subject was totally absent. Conclusion Collaboration between nurses and the PDS in Norway could be improved. Oral health should have a bigger place in the basic educational curriculum.