Registered nurses’ exposure to high stress of conscience in long-term care

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Meanings of troubled conscience in nursing homes: nurses’ lived experience

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‘Ethics between the lines’ – nurses’ experiences of ethical challenges in long-term care

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Årsaker til forsinkelser ved elektive operasjoner: En prospektiv studie

Forsinkelser og strykninger under elektive operasjoner hindrer optimal drift og kan være en påkjenning for pasienter. Målet med studien var å identifisere og beskrive de faktiske årsaker til forsinkelser ved elektive operasjoner, samt omfang, varighet og andre kjennetegn ved slike forsinkelser. Studien har et flermetodisk prospektivt studiedesign. I en periode på to måneder ble alle elektronisk registrerte forsinkelser fulgt opp med strukturerte intervju. I løpet av studieperioden ble halvparten av elektive operasjoner registrert med en eller flere forsinkelser (N = 402). Informantene anga 60 ulike rotårsaker som en forklaring på forsinkelsene. I 72% av alle forsinkelser var årsaken knyttet til organisering/administrering av operasjonsplanleggingen. Forsinkelser ved elektive operasjoner skyldes i stor grad utilstrekkelig planlegging og organisering. Mer presis planlegging, informasjonsutveksling og forbedret dataverktøy kan redusere forsinkelser ved elektive operasjoner. Causes of delays in elective surgery: A prospective study Abstract Delays and cancellations in elective surgery prevent optimal services and can be stressful for patients. This study aimed to identify and describe the actual causes of delays in elective surgery, and the extent, duration and other characteristics of these delays. The study has a multi-method prospective study design. For two months, all electronically recorded delays in a Norwegian hospital were followed up with structured interviews to identify their true causes. Half of the elective surgeries recorded had one or more delays (N = 402). The delays had 60 different root causes; using qualitative content analysis, these were interpreted into 13 subcategories and four main categories, namely patient-related (17%), staff-related (10%), related to surgical ward/equipment (2%) or organizational (71%). Most delays were due to poor planning and organization of surgery. The study indicates that more precise planning, better information exchange and an improved electronic tool can reduce delays in elective surgery. &nbsp

Underestimation of Overweight and Health Beneficial Outcomes in Two Adolescent Cohorts in Norway - The HUNT Study

Purpose: Underestimating overweight may prevent efforts toward reducing weight, but simultaneously benefit mental health and well-being. The magnitude of underestimation of overweight and obesity in adolescents is largely unknown, and so is to what extent this underestimation is associated with dieting behaviors, mental distress, and life satisfaction. As overweight has become more common during the past decades, associations between body size underestimation and mental health may have changed. Methods: Overweight (iso–body mass index, iso-BMI ≥25) adolescents (aged 13–19 years) who participated in The Young-HUNT1 (1995–97, n = 1,338) or The Young-HUNT3 (2006–08, n = 1,833) surveys were included. Being overweight, but perceiving oneself as average-weighted or underweighted was defined as underestimation. Results were based on clinical examinations and self-report questionnaires. Multivariable logistic regression models were used to examine associations between body size underestimation, dieting behaviors, and symptoms of anxiety, depression, and life satisfaction. Results: Among adolescents with overweight and obesity (iso-BMI ≥25), the prevalence of obesity (iso-BMI ≥30), body size underestimation, and having symptoms of anxiety and depression had increased from the first survey to the next. At both time points, body size underestimation was more common among boys than girls. In 2006–08, body size underestimation was negatively associated with symptoms of anxiety and depression in both sexes, and overall associated with higher life satisfaction equally over time. Dieting behavior was negatively associated with underestimation of body size. Conclusions: Body size underestimation in adolescents with overweight/obesity has become more prevalent and a phenomenon associated with less dieting, better life satisfaction and mental health in both boys and girls.publishedVersionPaid Open Acces

Factors Associated with Enhanced Gross Motor Progress in children with Cerebral Palsy : A Register-based Study

Author's accepted version (post-print).This is an Accepted Manuscript of an article published by Taylor & Francis in Physical & Occupational Therapy In Pediatrics on 01/05/2018, available online: http://www.tandfonline.com/10.1080/01942638.2018.1462288.Available from 02/05/2019.acceptedVersio

Pubertal timing – antecedent to risk or resilience? : Epidemiological studies on growth, maturation and health risk behaviours; The Young HUNT study, Nord-Trøndelag, Norway

<b>Background</b>: The timing of pubertal milestones influences the tempo and progression of growth and maturation, which in turn have consequences for boys’ and girls’ body size, shape and composition. Early sexual maturation has been associated with overweight and a shorter adult stature. The biological mechanisms underlying these associations are not clear, but since adipose children tend to mature earlier than leaner children, subsequent changes in height and weight could be attributed to nutrition in childhood rather than to early sexual maturation. The rapid bodily changes and the timing of these changes may also have an impact on boys’ and girls’ self-concepts, their social functioning, roles and behaviours. Early maturation is considered a risk factor for early initiation and advancement in use of alcohol and tobacco in adolescence, but is not clear if these differences persist over time. It has also been unclear whether adolescents’ perceptions of their own pubertal timing play an important role for how they actually act. Most studies concerned with pubertal timing as antecedent to risk or resilience, have been conducted on girls. <b>The main aims of this thesis are:</b> • To estimate the prevalence of advanced (risky) alcohol drinking and cigarette smoking in late adolescence related to the timing of sexual maturation and gender (Paper I and II). • To investigate whether the timing of sexual maturation in both genders, independently or in concert with early central adiposity, affects final height (Paper IV) or the prevalence of overweight (Paper III) as assessed in late adolescence. <b>Material and method: </b>To address these questions we used data from the Young HUNT 1 study (1995-1997) (Paper I,II,III,IV), and the Young HUNT 2 study carried out about four years later (Paper I, III, IV), in addition to data from the Medical Birth Registry of Norway and the adult part of the HUNT 2 study (Paper IV). A total of 9097 students (92%) from all middle and high schools in Nord-Trøndelag county participated in the Young HUNT 1 study and 8950 students completed the questionnaire. Among those, 2399 boys and girls were followed from early (baseline) to late adolescence (follow-up). Both the baseline and follow-up study included questionnaire data and physical examinations of height, weight, and waist and hip circumference. Age at menarche (AAM), the Pubertal Developmental Scale (PDS) and perceived pubertal timing were used to classify the timing of sexual maturation (SM timing). Baseline waist circumference was used to classify central adiposity (Paper III and IV), and body mass index (BMI) was used to classify overweight. Descriptive statistics as well as multivariate logistic regression modelling (Paper I, II and III) and general linear modelling (Paper III and IV) were applied to study the associations between exposures and outcomes. <b>Results</b>: Girls, who had matured early (OR 1.7, CI 1.2-2.4) or late (OR, 1.5, CI 1.1-2.2) were both more likely to report advanced drinking in late adolescence, compared to on time matured counterparts. Late matured boys were less likely (OR 0.5, CI 0.3-0.8) to engage in advanced drinking. Daily smoking was also more common among girls who had matured early (OR 1.5, CI 1.1-2.2), than among girls who were on time (Paper I). Boys and girls who perceived themselves as early matured were more likely to report risky drinking than those who perceived themselves as being on time, both in middle school and high school. A nearly identical pattern was found for smoking (Paper II). Early sexual maturation in girls, but not in boys, was associated with overweight. This association, however, was restricted to girls with high waist circumference (&gt;median) at baseline (OR, 2.7, CI 1.5-4.9). Early matured boys and girls with high waist were on average 5.7 cm and 3.6 cm taller than early maturing boys and girls with low waist circumference. Height was lowest in early matured boys (176.6 cm) and girls (163.8 cm) with a lean body composition at baseline. Height gain during follow-up was closely related to SM timing, but independent of central adiposity. Differences in height and weight related to central adiposity were more pronounced among those who matured early, compared to those who were intermediate or late matured (Paper III and IV). <b>Conclusions</b>: • Early (or rapid) maturation in girls constitutes a risk factor for advanced alcohol drinking and cigarette smoking not only in early adolescence, but also in late adolescence. • Perceptions of being earlier matured than same aged peers may increase the risk of alcohol drinking and cigarette smoking, especially in combination with high pubertal status. • The combination of early age at menarche and central adiposity increases girls’ likelihood of being overweight in late adolescence. • The combination of early sexual maturation and leanness yields short adult stature.<b>Tidlig eller sein pubertet – beskyttelse eller risiko?</b> Epidemiologiske studier med fokus på vekst, overvekt og helserelatert atferd fra UNG-HUNT, Helseundersøkelsen i Nord-Trøndelag (HUNT) <b>Bakgrunn</b>: De hurtige forandringene i puberteten, og spesielt timingen av disse, har innvirkning på kroppens størrelse og fasong, og på de unges selvbilde, sosiale roller og atferd. Tidlig pubertet blant jenter har vært forbundet med lav voksen høyde (slutthøyde) og overvekt. De underliggende årsaker er uklare, men siden overvektige barn har en tendens til å utvikle seg tidligere enn normalvektige, kan høyde- og vektforskjeller være uttrykk for vekstavvik allerede tidlig i livet. Noen forskere mener allikevel at det å begynne å menstruere tidlig utgjør en forskjell. Tidlig pubertet øker også risikoen for tidlig og mer avansert bruk av alkohol og tobakk, men det har vært uklart om denne risikoen avtar med økende alder. Det har også vært uklart hvorvidt det å selv oppfatte seg som relativt tidlig eller sein, har betydning for røyke- og drikkevanene i tenårene. De fleste studier innefor dette fagfeltet er gjennomført på jenter. <b>Formål</b>: Å studere forskjeller i alkohol- og røykevaner knyttet til pubertetens timing blant gutter og jenter, som tverrsnitt (Paper II) og over tid (Paper I), og for begge kjønn undersøke om pubertetens timing, i seg selv eller i kombinasjon med tidlig sentral fedme, har betydning for slutthøyde (Paper IV) og/eller overvekt (Paper III) i ung voksen alder.<b> Materiale og metode</b>: For å undersøke dette ble data fra ungdomsdelen (UNG-HUNT 1) av Helseundersøkelsen i Nord-Trøndelag (1995-97) brukt og kombinert med data fra Medisinsk Fødselsregister, foreldredata fra HUNT 2 (1995-97) og fra oppfølgingsstudien UNG-HUNT 2 (2000-2001). Totalt 9097 (92%) elever fra alle ungdoms-og videregående skoler i Nord-Trøndelag fylke deltok i UNG-HUNT 1 (T1), hvorav 8950 fylte ut spørreskjemaet. Av disse deltok 2399 ungdommer på nytt ca fire år seinere (T2). Ved begge undersøkelsene fylte ungdommene ut spørreskjema og fikk målt høyde, vekt og midje- og hofteomkrets. Menstruasjonsalder, pubertetsstatus (PDS) og selvoppfattet pubertal timing (Paper II) ved T1 ble brukt for å klassifisere deltagerne som tidlige eller seine i forhold til andre jevnaldrende. For å måle sentral fedme (T1) og overvekt (T2) ble henholdsvis midjeomkretsen (&gt;median= høy) og kroppsmasseindeks (tilsvarende BMI ≥ 25 kg/m²) etter alder og kjønn brukt. <b>Resultater</b>: Mot slutten av tenårene rapporterte jenter som var tidlig (OR 1.7, CI 1.2-2.4) eller seint fysisk utviklet (OR, 1.5 CI 1.1-1.2) mer risikofylt bruk av alkohol enn andre jevnaldrende jenter, mens det blant guttene var de som var seint utviklet som drakk minst alkohol. Røyking var generelt mer vanlig blant jenter, og mest vanlig blant tidlig utviklede jenter. Som unge voksne oppga halvparten av disse at de røykte av og til eller daglig. Hos begge kjønn var det å selv oppfatte seg som relativt tidlig fysisk utviklet assosiert med mer helserelatert risikoatferd både i ungdomsskolen og i videregående. Tidlig menstruasjon (&lt; 12.5 år) var forbundet med overvekt hos jenter, men bare blant de som ved T1 hadde midjeomkrets over median (OR 2.7, CI 1.5-4.9). Som unge voksne var tidlig fysisk modne gutter og jenter med høy midjeomkrets ved T1 i gjennomsnitt 5,7 cm (gutter) og 3,6 cm (jenter) høyere, enn tidlig modne gutter og jenter med lav midjeomkrets (≤ median). Forskjellene i høyde (begge kjønn) og overvekt (jenter) knyttet til sentral fedme ved T1, var mer uttalt blant de som var tidlig modne enn blant de som var ”on-time” eller seinere fysisk moden. <b>Konklusjoner</b>: Tidlig fysisk modning er forbundet med mer risikofylt alkoholbruk og røyking ikke bare tidlig i tenårene, men også opp mot ung voksen alder. Kombinasjonen av tidlig modning og tidlig sentral fedme hos jenter øker sannsynligheten for overvekt i ung voksen alder. Denne kombinasjonen er hos begge kjønn forbundet med normal slutthøyde