Sexual functioning, sexual enjoyment, and body image in Norwegian breast cancer survivors: a 12-year longitudinal follow-up study and comparison with the general female population.

BACKGROUND: Given the scarcity of evidence concerning the long-term sexual health of breast cancer (BC) survivors (BC-Pop), we aimed to assess how BC treatments affect short- and long-term sexual functioning, sexual enjoyment, and body image, and compare with aged-matched women in the Norwegian general population (F-GenPop). MATERIAL AND METHODS: The 349 patients in BC-Pop treated at Trondheim University Hospital in 2007-2014, were assessed in clinical controls at the hospital; before starting radiotherapy (T1, baseline), immediately after ending radiotherapy (T2), and after 3, 6, and 12 months (T3-T5), and at a long-term follow-up 7-12 years after baseline (T6). Meanwhile, F-GenPop included 2254 age-matched women in the Norwegian general population. The impact of BC treatment on sexual functioning was examined using a Linear Mixed Model. Sexual functioning, sexual enjoyment, and body image were assessed with the EORTC's QLQ-BR23 scales and compared between the populations in the four age groups (30-49, 50-59, 60-69, and 70+ years) using means with 95% confidence intervals and Student t-test. Linear regression, adjusted for age and comorbidity was applied to estimate individual scores. RESULT: BC survivors treated with mastectomy had overall lower sexual functioning than patients who had received breast-conserving surgery (p = 0.017). Although BC survivors treated with chemotherapy had lower sexual functioning than those treated without chemotherapy at T1-T5 (p = 0.044), both groups showed the same level of functioning at T6. BC-Pop exhibited significantly poorer sexual functioning (p < 0.001), lower sexual enjoyment (p < 0.05), and better body image (p < 0.001) than F-GenPop in all age groups. CONCLUSION: The impact of specific BC treatments on sexual functioning was modest; only mastectomy had a persistent negative influence. Nevertheless, all age groups in BC-Pop displayed significantly poorer sexual functioning than F-GenPop at both 12 months and up to 12 years after treatment.

Validation of the WHOQOL-Bref: psychometric properties and normative data for the Norwegian general population.

BACKGROUND: The World Health Organization's Quality of Life Questionnaire (WHOQOL-Bref) is a frequently used instrument to assess the quality of life in both healthy and ill populations. Inquiries of the psychometric properties of the WHOQOL-Bref report that the validity and reliability is generally satisfactory. However, some studies fail to support a four-factor dimensionality; others report poor reliability of the social and environmental domain; and there may be some challenges of supporting construct validity across age. This paper evaluates the psychometric properties of the Norwegian WHOQOL-Bref and extends previous research by testing for measurement invariance across age, gender and education level. In addition, we provide updated normative data for the Norwegian population. METHODS: We selected a random sample of the Norwegian population (n = 654) aged 18-75 years. Participants filled out the WHOQOL-Bref, the Utrecht Work Engagement Scale and various sociodemographic variables. RESULTS: We found an acceptable convergent and discriminate validity and internal consistency of the physical, psychological and environmental domains, but a marginal reliability was found for the social domain. The factor loadings were invariant across gender, education and age. Some items had low factor loadings and explained variance, and the model fit for the age group 60-75 years were less satisfactory. CONCLUSIONS: The original four-factor dimensionality of the WHOQOL-Bref displayed a better fit to the data compared to the one-factor solution and is recommended for use in the Norwegian population. The WHOQOL-Bref is suitable to use across gender, education and age, but for assessment in the oldest age group, the WHOQOL-Old module could be a good supplementary, but further studies are needed.

'To give or not to give medication, that is the question.' Healthcare personnel's perceptions of factors affecting pro re nata medication in sheltered housing for older adults - a focus-group interview study.

BACKGROUND: Residents living in sheltered housing depend on help from healthcare personnel (HCP) with medication management, regarding regular long-term and pro re nata (PRN) medication. The HCP assess the need for PRN medication prior to administration to the residents. The purpose of this study was to describe HCP's perceptions of factors affecting PRN medication management in sheltered housing for older adults. METHOD: This was a qualitative study with five focus-group interviews with 22 HCP working in sheltered housing for older adults. The HCP were heterogenous regarding scholarly education and experiences, working in four different municipalities in mid-Norway, representing urban, sub-urban and rural districts. The analysis was inductive, based on qualitative, manifest, content analysis. The main outcome was HCP perceptions of the factors affecting PRN medication management in sheltered housing. RESULTS: Four main factors affecting the PRN medication management were identified in the data and were related to either: 1) the medication; 2) the resident; 3) the HCP; or 4) the organisation. These categories included 14 subcategories. Overall, the HCP described the management of PRN medication as a complex process, where the above factors all have impact on the residents' health and safety. CONCLUSION: HCP working in sheltered housing describe that PRN medication management is affected by numerous human factors, that consequently may affect patient outcomes and safety. HCP involved in PRN medication management should be aware of factors that affect their decision-making, and safe management requires a professional practice built on medicines competence, practical skills and experience.

Effects of suspended drill cuttings on the coral Lophelia pertusa using pulsed and continuous exposure scenarios.

This study aimed at providing confidence in the predictability of the impacts of drill cuttings (DC) discharge on the cold-water coral Lophelia pertusa. L. pertusa was exposed to DC from offshore exploration in the lab with the goal to assess precautionary thresholds of effects. Two exposure scenarios with DC were tested: a long-term (LT) pulsed exposure (12 weeks, peak concentrations: 2-50 mg/L, mean concentrations: 1-25 mg/L) and a short-term (ST) continuous exposure (2.5 weeks, mean concentrations: 4-42 mg/L). After exposure, a recovery period of 16 and 4 weeks was maintained in LT and ST, respectively. While there was an assumption that DC might result in an increase in respiration, decrease in growth, enhanced mucus production, reduced fatty acid content, only a significant rise was noted in skeleton growth at DC 4 mg/L and a significant increase of mucus particulate organic carbon at 25 mg/L at end of the exposure. DC did not markedly reduce prey capture rate consecutive to DC exposure. However, the effect of DC produced an increase of coral polyp activity during exposure and a return to pre-exposure conditions after cessation of DC, and coenosarc was smothered from DC even after a long recovery period (4 weeks). Overall, a DC concentration of 10 mg/L seems to represent a threshold above which changes in coral conditions were observed however with no apparent physiological consequences for the coral within the experimental time scale.

Physiological responses and lipid storage of the coral Lophelia pertusa at varying food density.

Despite the importance of the cold-water coral Lophelia pertusa to deep-sea reef ecosystem functioning, current knowledge of key physiological responses to available food resources is scarce. Scenarios with varying food density may help to understand how corals deal with seasonal variations in the dark ocean and might be used to study consequences of anthropogenic activities potentially affecting food availability. Thus, the physiological responses of L. pertusa to varying food (Artemia salina nauplii) concentration, ranging from 20% to 300% of carbon equivalent turned over by basal coral respiration, were investigated. A starvation group was also included. Measurements of respiration, growth, mucus production, and energy reserves (storage fatty acids) were performed at several time intervals over 26 weeks. In general, data showed a stronger effect of experimental time on measured responses, but no significant influence of food density treatment. In starved corals, respiration rate declined to 52% of initial respiration, while skeleton growth rate was maintained at the same rate as Artemia-fed corals throughout the investigation. Mucus production measured as the sum of dissolved organic carbon (DOC) and particulate organic carbon (POC) was also similar across food treatments, but POC production exceeded that of DOC at the highest food density. No marked effect was observed on storage fatty acids. These results confirm that L. pertusa is highly resilient to environmental conditions with suboptimal food densities over a time scale of months. Regulation of several physiological processes, including respiration and mucus production, possibly in combination with an opportunistic feeding strategy, contributed to this tolerance to maintain viable corals. Thus, it appears that L. pertusa is well adapted to life in the deep sea.

Effects of chronic crude oil exposure on early developmental stages of the Northern krill (Meganyctiphanes norvegica).

Rising oil and gas activities in northern high latitudes have led to an increased risk of petroleum pollution in these ecosystems. Further, seasonal high UV radiation at high latitudes may elevate photo-enhanced toxicity of petroleum pollution to marine organisms. Zooplanktons are a key ecological component of northern ecosystems; therefore, it is important to assess their sensitivity to potential pollutants of oil and gas activity. As ontogenetic development may be particularly sensitive, the aim of this study was to examine the impact of chronic exposure to oil water dispersion (OWD) on development and feeding of early life stages of the Northern krill, Meganyctiphanes norvegica. In a range of experiments, embryonic, nonfeeding, and feeding larval stages were exposed to concentrations of between 0.01 and 0.1 mg/L of oil or photo-modified oil for 19 and 21 d. No significant effects on egg respiration, hatching success, development, length and larval survival were observed from these treatments. Similarly, evolution of fatty acid composition patterns during ontogenetic development was unaffected. The results indicates a high degree of resilience of these early developmental stages to such types and concentrations of pollutants. However, feeding and motility in later calyptopis-stage larvae were significantly impaired at exposure of 0.1 mg/L oil. Data indicate that feeding larval stage of krill was more sensitive to OWD than early nonfeeding life stages. This might be attributed to the narcotic effects of oil pollutants, their direct ingestion, or accumulated adverse effects over early development.

Norwegian Community Pharmacists' Experiences with COVID-19 Vaccination-A Qualitative Interview Study.

BACKGROUND: Immunising the population became important during the COVID-19 pandemic. Community pharmacies in Norway collaborated with municipalities to offer a vaccination services to increase the vaccination rate. Only some pharmacies were allowed to offer this service in the pandemic's early phase. This study learns about pharmacists' experiences during this first period of COVID-19 vaccination services in community pharmacies, which is relevant for informing policy and organisational decision makers about the feasibility and acceptability of pharmacy vaccination. METHODS: Individual interviews were conducted with 13 pharmacists in community pharmacies offering a COVID-19 vaccination service. Informants were recruited from the eleven pharmacies that first offered COVID-19 vaccinations. The key themes in the interview were COVID-19 vaccination, what the pharmacists think about the vaccination service, and how it is performed. The data were analysed using systematic text condensation. RESULTS: Three main themes and eight subthemes were identified. The main themes were creative solutions, organising and making resources available, and professionally satisfying and an important mission. The interviewed pharmacists experienced the COVID-19 vaccination service as hectic but something important that they would prioritise. They experienced their efforts to be substantial in the pandemic's early phase. CONCLUSIONS: Pharmacists in community pharmacies were a resource for increasing the vaccination rate during the COVID-19 pandemic. The pharmacies' easy accessibility and the pharmacists' ability to adjust their daily workflow for a new service should be considered when an expanded healthcare service is needed.

Association of anxiety and depression to headache, abdominal- and musculoskeletal pain in children.

The comorbidity between recurrent pain, anxiety, and depression among children is frequent and well documented. However, only a few studies of the predictive effect of anxiety and depression on pain have adjusted for symptoms of the other disorder when examining the respective relations to different pain locations, rendering the unique contribution from anxiety and depression undetermined. In the current investigation we explore the strength of associations between pain at different locations with symptoms of anxiety and depression in a community sample of 10-year-old children (n = 703). The children were interviewed about the frequency of pain during the last 3 months. Parents and children were interviewed separately about symptoms of anxiety and depression using a semi-structured diagnostic interview. Results of three multivariate regression models for each of headache, abdominal and musculoskeletal pain revealed that depression was associated with musculoskeletal pain and headache, whereas anxiety was not. The associations for depression were not significantly stronger compared to anxiety. Gender-specific models found that depression was related to headache only among girls, but the association was not statistically different compared to boys. These results may, in turn, influence our interpretation of different forms of pain in children, with less weight given to abdominal symptoms viewed as a strong correlate with psychological problems, compared to for instance headache. The results provided no clear support for neither a differential relationship between anxiety and pain and depression and pain nor gender differences.

Older Adults Living in Sheltered Housing's Experiences of Involvement in Pro Re Nata Decisions. A Narrative Positioning Analysis.

Decisions regarding pro re nata medications might be challenging due to the complex nature of the practice. The aim of this study was to expand our understanding of the experiences of older people living in sheltered housings with regard to shared decision-making concerning pro re nata medications. In this study, we conducted in-depth interviews with residents living in Norwegian sheltered housings. The analysis was inductive, based on a narrative positioning analysis. Twelve residents were interviewed, and three narratives representing participants' variation are presented. People take different positions in shared decision-making of pro re nata medication, and they position themselves variously at different levels and situations. Prevailing master narratives affect the residents' positions in shared decision-making. Contrasts in older adults' experiences indicate that shared decision-making is not straightforward and is highly reliant on the context. Seemingly, they wish to be involved and not involved at the same time, a contradiction that healthcare providers need to consider.

Meaning Making for Psychological Adjustment and Quality of Life in Older Long-Term Breast Cancer Survivors.

Objectives: This study aims to explore in depth the meaning and meaning discrepancies among older Norwegian breast cancer survivors in light of the meaning making model by Park (2013). Design: We utilized a qualitative design collecting data using semi-structured interviews of 23 elderly breast cancer survivors 7-8 years after treatment. The interviews followed an interview guide structured along three main themes: "everyday life activities," "follow-up-care experiences" and "health status and QoL." Results: Several health problems were reported by the women in the aftermaths of the disease, such as sleeping problems, pain, and fatigue-including cognitive and emotional impairments. Meaning discrepancies were concentrated on six main themes: shifting perspectives and priorities, growing sense of autonomy, widening the limits of normality, dissociating oneself from the disease, embracing alternative health services, and feeling lucky. The women engaged in a wide range of coping techniques as efforts to change global meaning, and to develop a more positive view on the cancer experience. Common coping efforts across the six main themes were social comparison, denial, positive reappraisal, problem-focused coping, and revaluing ordinary events. Conclusion: Many cancer patients report on unmet needs for help with their meaning making, and the facilitation of meaning making processes is rarely included in the follow-up care of cancer survivors. The findings of the present study may help health care professionals provide care for women who have experienced breast cancer. The concrete knowledge of common coping efforts in the meaning making process may contribute to the development of future interventions and for gaining a deeper understanding for older survivors of breast cancer.

A new high resolution screening method for study of phenotype stress responses of Saccharomyces cerevisae mutants.

A high resolution high throughput screening method has been developed for stress response phenotyping of the global Saccharomyces cerevisiae knock out mutant collection. Stress causing agent is added at three concentrations to individual mutant cultures growing in early exponentially phase in 384-well microplates, and the dynamic effect of stress agent exposure is measured by following subsequent growth profiles of individual mutants with a resolution of three optical density measurements per hour. Software was written for calculation of sensitivity coefficients and efficient visual inspection of the growth and inhibition curves. Three DNA damage response causing agents were chosen to explore the feasibility of the new screening method: methyl methanesulphonate, 5-fluorouracil and cisplatin. They were tested in three biological replicas on a 1400 mutant large sub-library of the homozygote diploid S. cerevisiae gene knock out collection. The sub-library consisted of only mutants with a human ortholog to the inactivated gene. Almost 400 mutants were found more sensitive to one or more of the agents. Forty-nine mutants were sensitive to all three agents. One of the mutants, ERK5, sensitive to all three agents was chosen for follow-up human cell experiments to verify that such yeast screens can be used as hypothesis generator for human cell studies. Similar to yeast, HeLa cells became more sensitive against all three DNA damaging agents when co-treated with the ERK5 inhibitor BIX21088, thus supporting the result from the yeast phenotype screen.