How to create good tnteraction processes for vulnerable children and young people? : normalization process theory as a tool to understand implementation processes

I denne artikkelen anvender vi normaliseringsprosessteori (NPT) som et kvantitativt analyseredskap i evalueringen av implementeringen av en ny intervensjon. Vi viser på denne måten hvordan NPT kan brukes for å analysere og evaluere implementeringen av et nytt samhandlingsforløp for barn og unge. NPT strukturerer både analyse, presentasjon av funn og konklusjoner. Studiens funn er viktige når intervensjonen skal videreutvikles. Ved å bruke NPT som en ramme kan vi systematisk avdekke både hemmende og fremmende faktorer som vil kunne påvirke i hvilken grad det nye samhandlingsforløpet kan etableres som en del av praksis for alle tjenestene som jobber sammen med å skape et samordnet hjelpetilbud for barn og unge. Nøkkelord: utsatte barn og unge, samhandlingsforløp, psykisk helse, implementeringsteori, normaliseringsprosessteoriThe article describes the implementation of a new integrated care pathway in specialist care and in four municipalities, aimed at children and youngsters in need of coordinated care. The purpose of the pathway was to develop better routines for co-operation between families, municipality and specialist care. The approach of the analysis is the Normalization Process Theory. Questionnaire data were collected among leaders and employees. The main results show great willingness for change and commitment towards the integrated care pathway, and the respondents experience a great benefit from using the care pathway. However, there is also a need for critical assessment of which measures can further strengthen the implementation process. Critical conditions are how leaders in the participating organizations can provide for a collective implementation effort through strengthening of competence, guidance and resource allocations, supported by systematic assessments, training and exchange of experience.publishedVersio

Chronic CaMKII inhibition blunts the cardiac contractile response to exercise training

Activation of the multifunctional Ca2+/calmodulin-dependent protein kinase II (CaMKII) plays a critical role modulating cardiac function in both health and disease. Here, we determined the effect of chronic CaMKII inhibition during an exercise training program in healthy mice. CaMKII was inhibited by KN-93 injections. Mice were randomized to the following groups: sham sedentary, sham exercise, KN-93 sedentary, and KN-93 exercise. Cardiorespiratory function was evaluated by ergospirometry during treadmill running, echocardiography, and cardiomyocyte fractional shortening and calcium handling. The results revealed that KN-93 alone had no effect on exercise capacity or fractional shortening. In sham animals, exercise training increased maximal oxygen uptake by 8% (p < 0.05) compared to a 22% (p < 0.05) increase after exercise in KN-93 treated mice (group difference p < 0.01). In contrast, in vivo fractional shortening evaluated by echocardiography improved after exercise in sham animals only: from 25 to 32% (p < 0.02). In inactive mice, KN-93 reduced rates of diastolic cardiomyocyte re-lengthening (by 25%, p < 0.05) as well as Ca2+ transient decay (by 16%, p < 0.05), whereas no such effect was observed after exercise training. KN-93 blunted exercise training response on cardiomyocyte fractional shortening (63% sham vs. 18% KN-93; p < 0.01 and p < 0.05, respectively). These effects could not be solely explained by the Ca2+ transient amplitude, as KN-93 reduced it by 20% (p < 0.05) and response to exercise training was equal (64% sham and 47% KN-93; both p < 0.01). We concluded that chronic CaMKII inhibition increased time to 50% re-lengthening which were recovered by exercise training, but paradoxically led to a greater increase in maximal oxygen uptake compared to sham mice. Thus, the effect of chronic CaMKII inhibition is multifaceted and of a complex nature

Cardiomyocyte function and calcium handling in animal models of inborn and aquired maximal oxygen uptake

Hjertemuskelcellefunksjon og kalsiumhåndtering i dyremodeller med medfødt og ervervet maksimalt oksygenopptak Hjerte-karsykdommer er i dag årsaken til flest dødsfall i Europa. Selv om det er kjent at et høyt maksimalt oksygenopptak kan virke beskyttende mot hjerte-karsykdom både hos friske og de med økt risiko, vil studier av de underliggende mekanismene bidra med verdifull informasjon til utvikling av fremtidige retningslinjer for behandling og forebygging av hjertekarsykdom. Maksimalt oksygenopptak er hos de fleste av oss avhengig av hjertets slagvolum som igjen bestemmes av hjertemuskelcellenes kontraksjonsevne. For at hjertemuskelcellene skal kunne kontrahere kraftig er kalsiumhåndteringen i cellene avgjørende. Ett av de proteinene som er med bidrar til å styre dette er kalsium/ kalmodulin avhengig protein kinase II (CaMKII). CaMKII aktiviteten øker når hjertefrekvensen øker og det ser ut til at den økte aktiviteten er viktig for treningsresponsen i hjertemuskelcellene, mens hos hjertesvikt er det motsatt og den økte aktiviteten fører til funksjonsnedsettelse. De overordnede formålene med denne doktorgradsavhandlingen var å undersøke betydningen av et høyt medfødt oksygenopptak på hjertets remodellering etter infarkt, eventuelle forskjeller i treningsrelaterte tilpasninger i hjertemuskelceller fra rotter med ulik medfødt evne til å respondere på trening og om CaMKII er nødvendig for treningsrelaterte forbedringer i maksimalt oksygenopptak, hjertemuskelcellens kontraksjon og kalsiumhåndtering. Resultatene viste at rotter med høyt og rotter med lavt medfødt maksimalt oksygenopptak fikk like stor remodellering av hjerte og funksjonsnedsettelse etter infarkt, men at et høyt utgangspunkt fungerte som en ”buffer” på funksjonsnedsettelsen. Videre fant vi at høy intensitets aerobe intervaller ikke forbedret maksimalt oksygenopptak, hjertemuskelcellefunksjon eller kalsiumhåndtering i rotter med lav medfødt respons til trening. Dette indikerer at mangel på plastisitet i hjertet bidro til å hindre treningsrespons på maksimalt oksygenopptak. Det siste studiet viste at i friske mus er CaMKII nødvendig for å opprettholde kalsiumhomeostase i hjertemuskelcellene og for å oppnå optimal treningsrespons på hjertemuskelcellehypertrofi, funksjon og kalsiumhåndtering. Men paradoksalt nok førte CaMKII inhibering allikevel til en større økning i maksimalt oksygenopptak

Health-related quality of life and intensity-specific physical activity in high-risk adults attending a behavior change service within primary care.

ObjectivesHealth-related quality of life (HRQoL) is an important outcome for health interventions, such as physical activity (PA) promotion among high-risk populations. The aim of this study was to investigate levels of PA and HRQoL, and associations between PA and HRQoL, in participants attending a behavior change service within primary care in Norway.MethodsAdult participants (≥ 18 years) from 32 Healthy Life Centers (HLCs) in four regions of Norway, who provided valid data on HRQoL (SF-36) and PA (ActiGraph accelerometer) were included (N = 835). HRQoL scores were compared to normative data by independent sample t-tests. Associations between eight dimensions of HRQoL and time spent sedentary (SED), in light PA (LPA) or in moderate to vigorous PA (MVPA) were determined using general linear models adjusted for relevant confounders.ResultsNineteen percent of the participants (mean age 50; body mass index 32) met PA recommendations of > 150 min MVPA per week. SF-36 scores were 10 to 28 points lower than the norm (all p ConclusionsIndividuals attending a Norwegian behavior change service within primary care had low PA level and low HRQoL compared to the general population. Our study suggest there is a positive dose-response relationship between PA and HRQoL, and a negative relationship between SED and HRQoL. Furthermore, that specific PA intensities and SED are related to different dimensions of HRQoL

Health-related quality of life and intensity-specific physical activity in high-risk adults attending a behavior change service within primary care

Objectives Health-related quality of life (HRQoL) is an important outcome for health interventions, such as physical activity (PA) promotion among high-risk populations. The aim of this study was to investigate levels of PA and HRQoL, and associations between PA and HRQoL, in participants attending a behavior change service within primary care in Norway. Methods Adult participants (≥ 18 years) from 32 Healthy Life Centers (HLCs) in four regions of Norway, who provided valid data on HRQoL (SF-36) and PA (ActiGraph accelerometer) were included (N = 835). HRQoL scores were compared to normative data by independent sample t-tests. Associations between eight dimensions of HRQoL and time spent sedentary (SED), in light PA (LPA) or in moderate to vigorous PA (MVPA) were determined using general linear models adjusted for relevant confounders. Results Nineteen percent of the participants (mean age 50; body mass index 32) met PA recommendations of > 150 min MVPA per week. SF-36 scores were 10 to 28 points lower than the norm (all p < 0.001). Positive associations were found between MVPA and the SF-36 dimensions physical functioning, role physical, general health and vitality, (all p < 0.045). LPA was positively associated with physical functioning, role physical, general health, vitality and role emotional (all p < 0.046). Time spent SED was negatively associated with physical functioning, general health, vitality, social functioning and mental health (all p < 0.030). Conclusions Individuals attending a Norwegian behavior change service within primary care had low PA level and low HRQoL compared to the general population. Our study suggest there is a positive dose-response relationship between PA and HRQoL, and a negative relationship between SED and HRQoL. Furthermore, that specific PA intensities and SED are related to different dimensions of HRQoL