Food Habits and Forms of Food Insecurity among International University Students in Oslo: A Qualitative Study.

A growing number of studies indicate that university students and especially international students are prone to experiencing food insecurity (FI). Still, few studies have investigated forms of FI among international students in Europe. Thus, this qualitative study aims to explore experiences regarding FI among international university students in Oslo. Sixteen semi-structured interviews were conducted between May and June 2022 and analyzed using a thematic approach. The sustainable livelihood approach (SLA) was used as a framework for analyzing and interpreting the data. The students experienced food prices as being high and found food variety at the grocery stores to be low, resulting in struggles to fulfil their food preferences and keep a varied diet. Particularly, social aspects of eating were affected due to high dining prices or inadequate cooking facilities in student homes. However, no student openly reported skipping meals and many mentioned attention for healthy eating. Considering our results, it seems of importance to give more attention to cultural and social aspects related to FI when assessing FI among international students. As the number of international students is increasing, knowing more about this phenomenon can support the promotion of initiatives addressing FI in this population.

Unpacking the Public Health Triad of Social Inequality in Health, Health Literacy, and Quality of Life-A Scoping Review of Research Characteristics.

Social inequalities in health, health literacy, and quality of life serve as distinct public health indicators, but it remains unclear how and to what extent they are applied and combined in the literature. Thus, the characteristics of the research have yet to be established, and we aim to identify and describe the characteristics of research that intersects social inequality in health, health literacy, and quality of life. We conducted a scoping review with systematic searches in ten databases. Studies applying any design in any population were eligible if social inequality in health, health literacy, and quality of life were combined. Citations were independently screened using Covidence. The search yielded 4111 citations, with 73 eligible reports. The reviewed research was mostly quantitative and aimed at patient populations in a community setting, with a scarcity of reports specifically defining and assessing social inequality in health, health literacy, and quality of life, and with only 2/73 citations providing a definition for all three. The published research combining social inequality in health, health literacy, and quality of life is heterogeneous regarding research designs, populations, contexts, and geography, where social inequality appears as a contextualizing variable.

Is Interprofessional Learning Only Meant for Professions Within Healthcare? - A Qualitative Analysis of Associations with the Term Interprofessional Collaborative Learning Among Professional Students.

Purpose: The main goal of interprofessional learning (IPL) is to help students from different professions develop a common understanding of how to work together in future interprofessional collaboration (IPC). When IPL courses are extended beyond healthcare study programmes to include students from education and social care study programmes, the complexity increases. Since lack of communication and collaboration among professionals is a major challenge in welfare services, there is a need to explore professional students' associations with IPL. Thus, this study aims to explore what students in healthcare, teaching education and social care study programmes associate with the term "interprofessional collaborative learning". Participants and Methods: The study used student data from an ongoing IPL study at one of the largest state universities in Norway. Students from healthcare, social care and educational teaching bachelor programmes answered the following open-ended question in an online cross-sectional evaluation survey: "What do you associate with the term interprofessional collaborative learning?" We analysed data qualitatively from first- (n = 261) and second-year students (n = 97) collected during December 2019 and 2020. Most second-year students took an IPL course during their first year of study. Results: Overall, the students across all professions expressed positive associations with IPL. The most eminent category was that students associated IPL with collaboration, followed by learning and learning how to collaborate. First-year students were also associated with gaining and sharing knowledge and competencies with IPL. Understanding roles was eminent among second-year students in teaching education. Conclusion: This study supports the importance of IPL across different educational backgrounds since students seemed to have positive associations with the term and a common understanding that IPL involves several professions. The finding that teacher students highlighted the understanding of roles when working with children, young adults and their families, further supports expanding IPL beyond specialised professions within healthcare.

Multidisciplinary Student Groups Support Digital Education as a Public Health Precautional Action to Prevent Spread of COVID-19 Infection: A Mixed Methods Study.

Background: Health personnel had greater odds of contracting COVID-19 during its first wave in Norway, compared with all working-age individuals. Students in health care, but also in social care and teacher education programs may be exposed to the risk of being infected themselves and to infect others through their mandatory practical training. Online education may reduce their risk of becoming patients and spreaders both in their private lives and during their mandatory training. Aim: To explore the extent to which unvaccinated professional students fear transmission of SARS-CoV-2 from fellow students and from public transportation during the third wave. Materials and Methods: In this cross-sectional study, 3148 students in health care, social care, and teacher education programs and 32 supervisors completed online questionnaires consisting of open and closed questions (mixed methods) after participating in digital interprofessional learning (IPL) small-group seminars (49.6% and 65% response rates, respectively). On a 6-point Likert scale (0-5), all means concerning fear were around 3, with overlapping confidence intervals. Fear of infecting high-risk individuals seemed higher than fear of contracting the virus themselves. High levels of loyalty to and trust in state and health authorities were expressed. Medical-related terminology was frequently used, such as the one-meter distance rule, infection tracking, national guidelines, and hand sanitizer, which implies high levels of health literacy. They expressed strong support for online course delivery (mean 4.5) ahead of practical training as a precautionary public health action. Conclusion: These students did not have high levels of fear of contracting the virus from other students or public transport. They expressed a higher fear of infecting others than being infected themselves. The major implication for the public and the educational system is that students, even in a country with low death rates, support digital education as a public health precautional action to prevent the spread of infection.

Children as Next of Kin in Higher Education: An Exploratory Cross-Sectional Study Among Health, Social Care, and Teacher Education Programs.

INTRODUCTION: Children who are "next of kin" (ie, sick/dying/addicted/imprisoned close relatives) are at increased risk for health consequences. Health professionals in Norway are required by law to help such children, and professional educations should focus on this issue. AIM: To assess the extent to which students attending health, social care, and teacher education felt their uni-professional education and a mandatory interprofessional learning (IPL) course had taught them about children as next of kin. To explore variations in student responses according to age and educational background. METHODS: This was a cross-sectional study. Students (n = 2811) completed questionnaires relating to IPL courses delivered in 2019 and 2020 (hybrid case-based learning). Students discussed issues relating to interprofessional collaboration targeting children, young people and their families in small IPL groups. FINDINGS: The response rates ranged from 25.8% to 36.0%. All but 5.2% of the students agreed that it was important to learn about children as next of kin. Although 61.9% reported that their education had not taught about such children, 73.8% had gained increased insight from the IPL course (difference 35.7% 95% CI (29.0; 42.0), p < 0.001). The teacher and child welfare students had gained greater insight than the health and social care students. Significant pre- to post-course increases were found among the physiotherapy (p < 0.001), Mensendieck physiotherapy (p < 0.001), teacher education (p < 0.001), early childhood education (p < 0.001), and teacher education in art and design (p = 0.042) students. CONCLUSION: Nearly 2/3 reported that they had not been taught about children as next of kin at their own educations, but more than 2/3 had gained greater insight from the IPL course. The health and social care students reported the least gain. Although the law has existed for a decade, the topic of children as next of kin is still omitted from most educational programs.

Core Competencies for Interprofessional Collaborative Practice Among Teacher Education, Health and Social Care Students in a Large Scaled Blended Learning Course.

INTRODUCTION: Society's demands for better coordination of services for children are increasing. Interprofessional learning (IPL) has been suggested to achieve the triple aim of better services, better outcomes and reduced costs. The aims were to assess 1) to what extent students taking teacher education, health and social care programmes agreed that blended learning was a suitable approach in a mandatory IPL course, 2) to what extent they had learnt about the WHO's core IPL competencies (roles and responsibilities, values and ethics, interprofessional communication, and teams and teamwork), and 3) the students' ranking of the learning outcomes from different components of the IPL course. METHODS: This was a quantitative cross-sectional study. Students completed an online course evaluation after a two-day combination of online and face-to-face IPL small-group training. FINDINGS: The response rate was 25.8% (n=363). Among the students, 60.6% strongly agreed that blended learning was suitable, while 8.9% strongly disagreed. Among the respondents, 46.8%, 50.2%, 56.8% and 62.3% gained increased insight into roles and responsibilities, values and ethics, interprofessional communication, and teams and teamwork, respectively. In ascending order, students were most satisfied with the learning outcomes from the supervision (16.0%), the syllabus (28.6%), the submission assignment (42.4%), the digital learning content of Canvas (43.8%), the combination of everything (43.8%), and the IPL group discussions (78.6%). In stratified analyses, 'teacher education and child welfare students' were significantly more likely to gain better insight into the WHO competencies than "health and social care students", and they were also more overall satisfied. CONCLUSION: Students agreed that blended learning was a suitable approach, although the learning outcomes from the face-to-face discussions were markedly higher than from other course components. While the majority had learnt something about the WHO competencies, the teacher and child welfare students achieved the best learning outcomes, including new knowledge about the WHO competencies.

Student's experiences with online teaching following COVID-19 lockdown: A mixed methods explorative study.

BACKGROUND: The COVID-19 pandemic lead to a sudden shift to online teaching and restricted campus access. AIM: To assess how university students experienced the sudden shift to online teaching after closure of campus due to the COVID-19 pandemic. MATERIAL AND METHODS: Students in Public Health Nutrition answered questionnaires two and 12 weeks (N = 79: response rate 20.3% and 26.6%, respectively) after the lockdown in Norway on 12 March 2020 and participated in digital focus group interviews in May 2020 (mixed methods study). FINDINGS AND DISCUSSION: Two weeks into the lockdown, 75% of students reported that their life had become more difficult and 50% felt that learning outcomes would be harder to achieve due to the sudden shift to online education. Twelve weeks into the lockdown, the corresponding numbers were 57% and 71%, respectively. The most pressing concerns among students were a lack of social interaction, housing situations that were unfit for home office purposes, including insufficient data bandwidth, and an overall sense of reduced motivation and effort. The students collaborated well in digital groups but wanted smaller groups with students they knew rather than being randomly assigned to groups. Most students agreed that pre-recorded and streamed lectures, frequent virtual meetings and student response systems could improve learning outcomes in future digital courses. The preference for written home exams over online versions of previous on-campus exams was likely influenced by student's familiarity with the former. The dropout rate remained unchanged compared to previous years. CONCLUSION: The sudden shift to digital teaching was challenging for students, but it appears that they adapted quickly to the new situation. Although the concerns described by students in this study may only be representative for the period right after campus lockdown, the study provide the student perspective on a unique period of time in higher education.

Iron Status of Vegans, Vegetarians and Pescatarians in Norway.

Although plant-based diets provide well-established physical and environmental health benefits, omitting meat or meat products has also been associated with a risk of being deficient in specific nutrients, such as iron. As data on the iron status among Norwegian vegans, vegetarians and pescatarians are lacking, the present study aimed to assess iron status in these groups of healthy adults. Blood markers for iron status were measured in 191 participants (18-60 years old) comprising 106 vegans, 54 vegetarians and 31 pescatarians: serum-ferritin (S-Fe), serum-iron (S-Iron) and serum-total iron binding capacity (S-TIBC). Serum-transferrin-saturation (S-TSAT) was estimated (S-Iron/S-TIBC × 100). The median concentration of blood markers for iron status were within the normal range with no difference between the different dietary practices. In total, 9% reported iron supplement use the last 24 h. S-Fe concentrations below reference (<15 µg/L) were found in 8% of the participating women, of which one participant reported iron supplement use. In multiple regression analysis, duration of adherence to dietary practices and the female gender were found to be the strongest predictors for decreased S-Fe concentration. In conclusion, although the participants were eating a plant-based diet, the majority had sufficient iron status. Female vegans and vegetarians of reproductive age are at risk of low iron status and should have their iron status monitored.

Students' top 10 priorities of research uncertainties on students' sleep: a pragmatic James Lind Alliance approach.

OBJECTIVES: Inspired by the James Lind Alliance (JLA) user involvement approach, the aim of the present study was to identify the top 10 uncertainties for sleep research raised by students in higher education, and to discuss our experiences with adapting the JLA method to a student population. DESIGN: The study design is a pragmatic JLA approach, including a priority setting partnership within the field of sleep, collection of sleep-related research uncertainties as reported by students in higher education, sorting of the uncertainties and a final identification of the top 10 uncertainties through collaborative work between researchers, students, stakeholders and experts in the field. Uncertainties were collected using a one-question online survey: 'as a student, which question(s) do you consider to be important with regards to sleep?'. A variety of approaches were applied to promote the survey to the students, including social media, radio, the university website, stands in university cafeterias and a sleep stunt. NVivo V.12 was used to code and sort the questions. SETTING: A higher education institution in Norway. PARTICIPANTS: 555 students. RESULTS: The data collection provided 608 uncertainties, and the following prioritised top 10: (1) screen time, (2) stress, (3) educational achievements, (4) social relations, (5) mental health, (6) physical activity, (7) indoor environment, (8) substance abuse, (9) shift work and (10) sleep quality. Despite successful data collection, we found sleep to be a broad topic, and defining specific questions throughout the sorting and verification process proved difficult. CONCLUSIONS: We identified the prioritised top 10 research uncertainties as reported by students in higher education, ranking screen time first. However, the process was time and resource consuming. The research uncertainties addressed by the students showed great diversity, characterised by heterogeneity and a lack of specificity, making verification of the uncertainties challenging.

A Gap Between Children's Rights and Curricular Content in Health, Social Care, and Teacher Education Programs: An Exploratory Cross-Sectional Study.

INTRODUCTION: Exposure to child maltreatment is a social and public health challenge that will require interprofessional collaboration to overcome. Evidence indicates that professional students in health, social care, and teacher education programs receive inadequate training in recognizing and responding to child maltreatment. The aims are to 1) assess the extent to which these students found that their uniprofessional education and a large-scale interprofessional learning (IPL) course had taught them about children in general, children's rights, and vulnerable/at-risk children; and 2) explore differences in student responses according to age and educational background. METHODS: A cross-sectional study. Students (n=2811) completed questionnaires prior to or after IPL courses held in 2019 and 2020 (hybrid case-based, small-group, on-campus courses targeting children, young people, and their families as end users). FINDINGS: The majority (>90%) agreed that it was important to learn about child-related topics. Only 4.3% disagreed that it was important to learn about vulnerable/at-risk children. Health and social care students enhanced their insight into all the child-related topics (p<0.001) after the IPL course. Teacher education and child welfare students reported decreased insight into children in general (p<0.001 in 2019 and p=0.008 in 2020) but increased insight into vulnerable/at-risk children in 2020 (p=0.001). According to stratified analyses, there was a significantly increased insight into all child-related topics among physiotherapy and Mensendieck physiotherapy students (p<0.001), decreased insight into children in general among teacher education students (p<0.02), and increased insight into vulnerable/at-risk children among teacher education students (p ≤ 0.001) in both 2019 and 2020. Age was of minor importance. The response rates ranged from 16.0% to 36.0%. CONCLUSION: After the IPL course, the health and social care students significantly enhanced their insight into child-related topics, whereas the students in teacher education and child welfare gained increased insight into vulnerable/at-risk children.

Evidence of validity for the Norwegian version of the interprofessional collaborative competency attainment survey (ICCAS).

This was a validation study of the Norwegian version of The Interprofessional Collaborative Competency Attainment Survey (ICCAS). ICCAS consists of 20 retrospective pre- and post-questions, where respondents rate their agreement with regard to self-assessed competencies after participating in interprofessional education courses. It has been validated across various settings. The questionnaire was translated using the back-translation technique. We investigated evidence of validity regarding content, response process, and internal structure. Data were obtained from health and social care students (n = 1440, response rate 42.8%) participating in 12 different interprofessional courses in seven education institutions in Norway using a cross-sectional design. Exploratory factor analysis indicated one retracted factor for pre-scores and one retracted factor for post-scores. High McDonald's omega values indicated good internal consistency. Item deletion did not improve the scale's overall consistency on pre- or post-scores. We observed higher mean post-scores than pre-scores with moderate-to-large effect sizes, indicating a positive change in self-assessed interprofessional capabilities after training. Our findings indicate that the Norwegian version of ICCAS is a valid tool that may be implemented across a wide range of interprofessional education courses. Finally, our findings support earlier recommendations that ICCAS should be analyzed at an overall level to address change in interprofessional capabilities.

Experiences of self-management support in patients with diabetes and multimorbidity: a qualitative study in Norwegian general practice.

AIM: The purpose of this study was to explore how patients with diabetes and multimorbidity experience self-management support by general practitioners (GPs), nurses and medical secretaries in Norwegian general practice. BACKGROUND: Self-management support is recognised as an important strategy to improve the autonomy and well-being of patients with long-term conditions. Collaborating healthcare professionals (cHCPs), such as nurses and medical secretaries, may have an important role in the provision of self-management support. No previous study has explored how patients with diabetes and multimorbidity experience self-management support provided by cHCPs in general practice in Norway. METHODS: Semi-structured interviews with 11 patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) with one or more additional long-term condition were performed during February-May 2017. FINDINGS: Patients experienced cHCPs as particularly attentive towards the psychological and emotional aspects of living with diabetes. Compared to GPs, whose appointments were experienced as stressful, patients found cHCPs more approachable and more likely to address patients' questions and worries. In this sense, cHCPs complemented GP-led diabetes care. However, neither cHCPs nor GPs were perceived to involve patients' in clinical decisions or goal setting during consultations.

The roles of healthcare professionals in diabetes care: a qualitative study in Norwegian general practice.

Objective: To explore the experiences of general practitioners (GPs), nurses and medical secretaries in providing multi-professional diabetes care and their perceptions of professional roles.Design, setting and subjects: Semi-structured interviews were conducted with six GPs, three nurses and two medical secretaries from five purposively sampled diabetes teams. Interviews were analysed thematically.Main outcome measures: Healthcare professionals' (HCPs') experiences of multi-professional diabetes care in general practice.Results: The involvement of nurses and medical secretaries (collaborating health care professionals) was mainly motivated by GPs' time pressure and their perception of diabetes care as easy to standardize. GPs reported that diabetes care had become more structured and continuous after the involvement of collaborating health care professionals (cHCPs). cHCPs defined their role differently from GPs, emphasizing that their approach included acknowledging patients' need for diabetes education, listening to their stories and meeting their need for emotional support. GPs appeared less involved in patients' emotional concerns and more focused on the biomedical aspects of illness. There was little emphasis on teamwork among GPs and cHCPs, and none of the practices used care plans to involve patients in decisions or unify treatment among professionals. Participants stated that institutional structures including a discriminatory remuneration system, lack of role descriptions and missing procedures for collaborative approaches were an obstacle to MPC.Conclusions: cHCPs worked independently under delegated leadership of the GPs. Although cHCPs had a complementary role, HCPs in general practice may not take full advantage of the potential of sharing patient responsibility and learning with, from and about each other. Contextual barriers for team-based care approaches should be addressed in future research.KEY POINTSIt has been suggested that multi-professional approaches improve quality of care in people with long-term conditions.In this study, nurses and medical secretaries perceived to have a complementary role to general practitioners (GPs) in diabetes care, focusing on patient education, building trusting relationships and providing patients with emotional support.As multi-professional collaboration was minimal, GPs, nurses and medical secretaries in the included practices may not take full advantage of the potential of sharing care responsibility and learning with, from and about each other.

Involving nursing students into clinical research projects: Reliability of data and experiences of students?

AIMS: To examine reliability of the screening data collected by nursing students. Furthermore, to examine students' evaluations of participation in nutritional screening of older hospitalised patients. BACKGROUND: In cross-sectional study on nutritional risk and care in older hospitalised patients, the prevalence for undernutrition was 45%, a finding corresponding with other international studies. In this study, nursing students (n = 173) screened older patients (n = 508) for malnutrition, while they were in hospital practice. The validity of the results thus depends on the quality of the students screening. METHODS: Agreement in measurements on age, weight, height and nutritional risk scoring by students using Nutritional Risk Screening (NRS 2002) was assessed for 30 randomly selected hospitalised patients (≥70 years), with data collected by students in the study and two additional students. Bland-Altman analysis was used for continuous measurements, while kappa statistic was used to assess agreement between the NRS 2002 scores. Experiences of all included students were described. A STROBE checklist was completed. RESULTS: No significant bias was found among the students. Questionnaire data showed that 70.5% of the students agreed that the NRS 2002 was easy to use and 59.0% found it easier to measure the patients' height than weight. It was 70.5% who found it difficult to find previously recorded information on the patients' weight in the electronic records. Only 13% found it easy to find information on patients' nutritional status. 37.0% agreed that participating in the screening was instructive, and 34.0% gained increased interest in nutritional care. CONCLUSION: Collaborating with students in screening older patients for nutritional risk and undernutrition gave reliable data and increased the students' interest in nutritional care among hospitalised patients. RELEVANCE TO CLINICAL PRACTICE: Collaborating with students contributes with valuable data for practice and research. Moreover, it increases students' engagement for improved care practices for older patients.

Documentation and communication of nutritional care for elderly hospitalized patients: perspectives of nurses and undergraduate nurses in hospitals and nursing homes.

BACKGROUND: Nutritional care is a basic human right for all people. Nevertheless, undernourishment is known to be a frequent and serious health care problem among elderly hospitalized patients in Western Europe. Nutritional documentation contributes to ensuring proper nutritional treatment and care. Only a few studies have explored how nurses document nutritional care in hospitals, and between hospitals and nursing homes. Available research suggests that documentation practices are unsatisfactory. The aim of this study was to explore how nurses document nutritional treatment and care for elderly patients in hospitals and how nurses and undergraduate nurses communicate information about patients' nutritional status when elderly patients are transferred between hospital and nursing homes. METHODS: A qualitative study was conducted using a phenomenological-hermeneutic approach. Data was collected in focus group interviews with 16 nurses in one large university hospital, and 11 nurses and 16 undergraduate nurses in five nursing homes associated with the university hospital. Participants from the university hospital represented a total of seven surgical and medical wards, all of which transferred patients to the associated nursing homes. The catchment area of the hospital and the nursing homes represented approximately 10% of the Norwegian population in heterogenic urban and rural municipalities. Data were coded and analysed thematically within the three contexts: self-understanding, critical common sense, and theoretical understanding. RESULTS: The results were summarized under three main themes 1) inadequate documentation of nutritional status on hospital admission, 2) inadequate and unsystematic documentation of nutritional information during hospital stay, 3) limited communication of nutritional information between hospital and nursing homes. The three main themes included seven sub-themes, which reflected the lack of nutritional screening and unsystematic documentation on admission and during hospital stay. Further the sub-themes elucidated poor exchange of information between hospital and nursing homes regarding the nutritional status of patients. CONCLUSION: Overall, the documentation of nutritional treatment and care for elderly patients was inadequate in the hospital and between health care settings. Inappropriate documentation can create a negative nutritional spiral that leads to increased risk of severe health related complications for elderly patients. Moreover, it hinders nutritional follow-up across health care settings.

Prevalence of nutritional risk in the non-demented hospitalised elderly: a cross-sectional study from Norway using stratified sampling.

There is a lack of accurate prevalence data on undernutrition and the risk of undernutrition among the hospitalised elderly in Europe and Norway. We aimed at estimating the prevalence of nutritional risk by using stratified sampling along with adequate power calculations. A cross-sectional study was carried out in the period 2011 to 2013 at a university hospital in Norway. Second-year nursing students in acute care clinical studies in twenty hospital wards screened non-demented elderly patients for nutritional risk, by employing the Nutritional Risk Screening 2002 (NRS2002) form. In total, 508 patients (48·8 % women and 51·2 % men) with a mean age of 79·6 (sd 6·4) years were screened by the students. Mean BMI was 24·9 (sd 4·9) kg/m(2), and the patients had been hospitalised for on average 5·3 (sd 6·3) d. WHO's BMI cut-off values identified 6·5 % as underweight, 48·0 % of normal weight and 45·5 % as overweight. Patients nutritionally at risk had been in hospital longer and had lower average weight and BMI compared with those not at risk (all P < 0·001); no differences in mean age or sex were observed. The prevalence of nutritional risk was estimated to be 45·4 (95 % CI 41·7 %, 49·0) %, ranging between 20·0 and 65·0 % on different hospital wards. The present results show that the prevalence of nutritional risk among elderly patients without dementia is high, suggesting that a large proportion of the hospitalised elderly are in need of nutritional treatment.

Barriers to nutritional care for the undernourished hospitalised elderly: perspectives of nurses.

AIMS AND OBJECTIVES: To identify what nurses experience as barriers to ensuring adequate nutritional care for the undernourished hospitalized elderly. BACKGROUND: Undernutrition occurs frequently among the hospitalised elderly and can result in a variety of negative consequences if not treated. Nevertheless, undernutrition is often unrecognised and undertreated. Nurses have a great responsibility for nutritional care, as this is part of the patient's basic needs. Exploring nurses' experiences of preventing and treating undernourishment among older patients in hospitals is therefore highly relevant. DESIGN: A focus group study was employed based on a hermeneutic phenomenological methodological approach. METHODS: Four focus group interviews with totally 16 nurses working in one large university hospital in Norway were conducted in spring 2012. The nurses were recruited from seven somatic wards, all with a high proportion of older (≥70 years) inpatients. The data were analysed in the three interpretative contexts: self-understanding, a critical common-sense understanding and a theoretical understanding. RESULTS: We identified five themes that reflect barriers the nurses experience in relation to ensuring adequate nutritional care for the undernourished elderly: loneliness in nutritional care, a need for competence in nutritional care, low flexibility in food service practices, system failure in nutritional care and nutritional care is being ignored. CONCLUSIONS: The results imply that nutritional care at the university hospital has its limits within the hospital structure and organisation, but also regarding the nurses' competence. Moreover, the barriers revealed that the undernourished elderly are not identified and treated properly as stipulated in the recommendations in the national guidelines on the prevention and treatment of undernutrition. RELEVANCE TO CLINICAL PRACTICE: The barriers revealed in this study are valuable when considering improvements to nutritional care practices on hospital wards to enable undernourished older inpatients to be identified and treated properly.

Effect of different degrees of hydrogenated fish oil on intestinal carcinogenesis in Min/+ mice.

UNLABELLED: Intake of trans fatty acids from hydrogenated fish oils has been related to increased risk of coronary heart diseases. The possible effect on colorectal carcinogenesis is unclear. MATERIALS AND METHODS: Multiple intestinal neoplasia (Min/+) mice were fed one of four experimental diets: either raw fish oil (FO), low (LHFO)-, high (HHFO)- or fully-hydrogenated fish oil (FFHO), from 0 to 9 weeks of age. The number and size of intestinal tumors were recorded. RESULTS: There was no difference between the intervention groups in the numbers of developed intestinal tumors. The tumor size was statistically significantly lower in HHFO vs. the FO-group in male Min/+ mice. The HHFO and FHFO groups had lower weight gain than did the FO group (p=0.008 and p=0.04, respectively), but gender differences, due to effect of dietary intervention on weight gain, were found in Min/+ mice. CONCLUSION: When compared with raw fish oil, different degrees of hydrogenation of the fish oil had no effect on intestinal carcinogenesis in Min/+ mice.

Daily intake of cod or salmon for 2 weeks decreases the 18:1n-9/18:0 ratio and serum triacylglycerols in healthy subjects.

Intake of fish and omega-3 (n-3) fatty acids is associated with a reduced concentration of plasma triacylglycerols (TAG) but the mechanisms are not fully clarified. Stearoyl-CoA desaturase-1 (SCD1) activity, governing TAG synthesis, is affected by n-3 fatty acids. Peripheral blood mononuclear cells (PBMC) display expression of genes involved in lipid metabolism. The aim of the present study was to estimate whether intake of lean and fatty fish would influence n-3 fatty acids composition in plasma phospholipids (PL), serum TAG, 18:1n-9/18:0 ratio in plasma PL, as well as PBMC gene expression of SCD1 and fatty acid synthase (FAS). Healthy males and females (n = 30), aged 20-40, consumed either 150 g of cod, salmon, or potato (control) daily for 15 days. During intervention docosahexaenoic acid (DHA, 22:6n-3) increased in the cod group (P < 0.05), while TAG concentration decreased (P < 0.05). In the salmon group both eicosapentaenoic acid (EPA, 20:5n-3) and DHA increased (P < 0.05) whereas TAG concentration and the 18:1n-9/18:0 ratio decreased (P < 0.05). Reduction of the 18:1n-9/18:0 ratio was associated with a corresponding lowering of TAG (P < 0.05) and an increase in EPA and DHA (P < 0.05). The mRNA levels of SCD1 and FAS in PBMC were not significantly altered after intake of cod or salmon when compared with the control group. In conclusion, both lean and fatty fish may lower TAG, possibly by reducing the 18:1n-9/18:0 ratio related to allosteric inhibition of SCD1 activity, rather than by influencing the synthesis of enzyme protein.

Body fat and fat-free mass measured by bioelectric impedance spectroscopy and dual-energy X-ray absorptiometry in obese and non-obese adults.

The aim of the present study was to compare body fat mass (FM) and fat-free mass (FFM) estimates by bioelectric impedance spectroscopy (BIS), with respective estimates by dual-energy X-ray absorptiometry (DXA), in obese and non-obese subjects. Body composition was measured in ninety-three obese and non-obese men and women by BIS device, BodyScout (Fresenius Kabi, Bad Homburg, Germany) and DXA device, Lunar iDXA (GE Healthcare, Madison, WI, USA). Mean difference between the methods was analysed by t tests, and Bland-Altman plots were generated to further examine the differences between the methods. Mean difference between the estimates by DXA and BIS (ΔDXA - BIS and Bland-Altman 95 % limits of agreement) were as follows: FM 4·1 ( - 2·9, 11·2) kg and 4·5 ( - 2·9, 11·8) %, FFM - 4·1 ( - 11·2, 2·9) kg and - 4·5 ( - 11·9, 2·9) %, indicating large inter-individual variation and statistically significant underestimation of FM and overestimation of FFM by BIS, as compared to DXA. The underestimation of FMkg (FM measured in kg) and overestimation of FFMkg (FFM measured in kg) were more pronounced in men than in women, and the underestimation of FM% (FM measured in percent) and overestimation of FFM% (FFM measured in percent) were more pronounced in normal weight (BMI = 20·0-24·9 kg/m2) than in overweight and obese (BMI ≥ 25·0 kg/m2) subjects. BIS may be suitable for classification of a population into groups according to FM and FFM. However, the large inter-individual variation suggests that this BIS device with the proprietary software is insufficient for estimation of single individual body FM and FFM.