Ingunn Pernille Mundal

• Jacobsen, Kaya Kvarme; Børte, Sigrid; Laborie, Lene Bjerke; Kristiansen, Hege; Schäfer, Annette & Martinsen, Amy [Show all 30 contributors for this article] (2023). COL11A1 is associated with developmental dysplasia of the hip and secondary osteoarthritis in the HUNT study. Osteoarthritis and Cartilage Open. ISSN 2665-9131. 6(1), p. 1–7. doi: 10.1016/j.ocarto.2023.100424. Full text in Research Archive Show summary

  Objective: Developmental dysplasia of the hip (DDH) is a congenital condition affecting 2-3% of all infants. DDH increases the risk of osteoarthritis, is the cause of 30% of all total hip arthroplasties (THAs) in adults <40 years of age and can result in loss of life quality. Our aim was to explore the genetic background of DDH in order to improve diagnosis, management and longterm outcome. Design: We used the large, ongoing, longitudinal Trøndelag Health Study (HUNT) database. Case definition was based on ICD-9/-10 diagnoses of DDH, or osteoarthritis secondary to DDH. Analyses were performed using SAIGE software, with covariates including sex, batch, birth year and principal components. We included only single nucleotide polymorphisms (SNPs) with minor allele frequency (MAF) 0.01, R2 0.8 and Hardy-Weinberg equilibrium (HWE) P-value 0.0001. Significance level was set at p < 5x10-8. Meta-analysis using data from DDH and primary osteoarthritis genome-wide association studies (GWASs) was done using METAL software. The study was approved by the regional ethical committee. Results: Analysis included 69,500 individuals, of which 408 cases, and 8,531,386 SNPs. Two SNPs near COL11A1 were significantly associated with DDH; rs713162 ( = -0.43, SE = 0.07, p = 8.4x10-9) and rs6577334 ( = -0.43, SE = 0.08, p = 8.9x10-9). COL11A1 has previously been associated with acetabular dysplasia and osteoarthritis. Meta-analysis supported previous GWAS findings of both DDH and primary osteoarthritis. Conclusions: This large, genome-wide case-control study indicates an association between COL11A1 and DDH and is an important contribution to investigating the etiology of DDH, with further research needed.

• Bachmann, Liv; Ødegård, Atle & Mundal, Ingunn Pernille (2023). A comprehensive examination of research instruments utilized for assessing the attitudes of healthcare professionals towards the use of restraints in mental healthcare: A systematic review. Journal of Advanced Nursing. ISSN 0309-2402. p. 1–18. doi: 10.1111/jan.16015. Show summary

  Aim: This systematic review aimed to identify, describe and evaluate questionnaires measuring health professionals’ attitudes towards restraints in mental healthcare. Design: A systematic review was undertaken in accordance with the COSMIN protocol for systematic review and the relevant sections of the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data Sources: OVID Medline, OVID nursing, Psychinfo, Embase and Cinahl were systematically searched from databases inception, with an initial search in December 2021 and updated in April 2022. Review Methods: The inclusion criteria compromised articles reporting on self-reported instruments of attitudes or perceptions, development or validation of instruments and the evaluation of one or more measurement properties. Articles using multiple instruments in one study or not published in English were excluded. Two researchers independently extracted the data and appraised the methodological quality using the COSMIN guidelines and standards (consensus-based standards for the selection of health measurement instrument). A narrative synthesis without meta-analysis was performed. The systematic review was registered in PROSPERO Protocol ID CRD42022308818. Results: A total of 23 studies reporting ten instruments were included. The findings revealed a broad variation in the content of the questionnaires, the use of terms/constructs and the context in which the various instruments measure attitudes towards coercive measures. Many studies lacked sufficient details on report of psychometric properties. Finally, the results were not summarized and the evidence not GRADED. Conclusions: There is a need for updated and adapted instruments with origins in theory and clear joint definitions such that attitudes towards coercive measures can be reliably assessed regarding the validity and reliability of instruments, which will be of importance to facilitate the use of instruments in research and clinical settings. Impact: Reviews addressing surveys, self-reported attitudes towards restraints in mental healthcare and examination of psychometric properties seem limited. We highlight distinct complexity, psychometric limitations and broad variation in the context and content measuring attitudes towards coercive measures, and their various use of terms/constructs in the existing questionnaires. These findings contribute to further research regarding the development of questionnaires and the need of representing the concept well – carefully denoted by the indicators, likewise the importance of applying questionnaires with properly reported measurement properties in terms of validity and reliability to ensure the use in research and clinical settings.

• Mundal, Ingunn Pernille; Schei, Jorun; Lydersen, Stian; Thomsen, Per Hove; Nøvik, Torunn Stene & Kvitland, Levi Røstad (2023). Prevalence of chronic and multisite pain in adolescents and young adults with ADHD: a comparative study between clinical and general population samples (the HUNT study). European Child and Adolescent Psychiatry. ISSN 1018-8827. doi: 10.1007/s00787-023-02249-x. Show summary

  Attention-deficit/hyperactivity disorder (ADHD) and chronic pain are prevalent and associated. We examined the prevalence and distribution of chronic pain in adolescents and young adults with ADHD using 9-years longitudinal data (from T1:2009–2011 to T3:2018–2019) with three time points from a clinical health survey compared to two age-matched reference population-based samples. Mixed-effect logistic regression and binary linear regression were used to estimate the probability for chronic and multisite pain at each time point and to compare the prevalence of chronic pain with the reference populations. The prevalence of chronic and multisite pain was high in those with ADHD, especially in female young adults, with highly prevalent chronic pain at 9 years of follow-up (75.9%) compared to 45.7% in females in the reference population. The probability of having pain was only statistically significant for chronic pain in males at 3 years of follow-up (41.9%, p = 0.021). Those with ADHD were at higher risk of reporting single-site and multisite pain compared to the general population at all measurement points. Longitudinal studies should be tailored to further understand the complex sex differences of comorbid chronic pain and ADHD in adolescents, exploring predictive factors of pain assessing long-term associations with bodyweight, psychiatric comorbidities, and possible mechanisms of stimulant use effects on pain.

• Mundal, Ingunn Pernille; Laake, Petter; Bjørkly, Stål & Lara Cabrera, Mariela Loreto (2023). Factor structure and internal consistency of the parent patient activation measure (P-PAM) in parents of children with ADHD in norwegian paediatric mental health. BMC Psychiatry. ISSN 1471-244X. 23(1), p. 1–10. doi: 10.1186/s12888-023-04550-0. Full text in Research Archive Show summary

  Background: This study aimed to explore the internal consistency and factor validity of the 13-item self-report questionnaire Parent-Patient Activation Measure (P-PAM) in a sample of parents of children with Attention-deficit/hyperactivity disorder. Methods: In a cross-sectional study, 239 parents were recruited from four outpatient clinics of the Child and Adolescent Mental Health Services and completed the P-PAM along with demographic variables. The factor structure of the P-PAM was examined through exploratory factor analysis, and internal consistency was estimated with the use of both Cronbach’s alpha and McDonald’s omega. A confirmatory factor analysis was used to estimate and test individual parameters. Results: The fit indices suggest an acceptable two-factor model of P-PAM and show high internal consistency and reliability for both factors, indicating that the scale measures two concepts. Conclusions: Our findings provide evidence for an acceptable factor structure and a high reliability of P-PAM as a measure of parent activation, suggesting that the theoretical factors reflect the construct of parent activation as intuitively compiled into an inner cognitive factor and an outer behavioral factor, which are related.

• Mundal, Ingunn Pernille; Ytreland, Kristin & Kaasbøll, Jannike (2022). Måleegenskaper ved den norske versjonen av Symptom Checklist-90-Revidert (SCL-90-R). PsykTestBarn. ISSN 1893-9910. 12(1), p. 1–17. doi: 10.21337/0079. Full text in Research Archive Show summary

  Symptom Checklist-90 Revised (SCL-90-R) er et bredspektret screeningverktøy for psykiske plager hos personer over 13 år. SCL-90 ble utviklet av Derogatis og kolleger i 1973 og revidert i 1976 til SCL-90-R. Instrumentet ble oversatt til norsk på 1980-tallet, og i 2010 utga Pearson Inc. en norsk autorisert utgave med instrukser for skåring og administrering. Autoriserte psykologer og leger kan administrere, skåre og tolke testen. Testen er et selvutfyllingsskjema og består av 90 spørsmål som kartlegger symptombelastning innenfor ni forskjellige symptomskalaer. I denne kunnskapsoppsummeringen ønsket vi å undersøke hvilke måleegenskaper som er rapportert for SCL-90-R i skandinaviske studier med ungdom og unge voksne i alderen 13–26 år. Av 1359 referanser inkluderte vi 13 studier i oppsummeringen. Ti studier var basert på kliniske utvalg (f.eks. pasienter med atferdsforstyrrelser, depresjon og spiseforstyrrelser). Ikke-kliniske utvalg inkluderte bl.a. studenter, adopterte barn og barn av skilte foreldre. Ingen av de inkluderte studiene var valideringsstudier. De fleste målte effekt av behandling eller andre tiltak. Det er rapportert gjennomsnitt, standardavvik og indre konsistens. Ingen av de inkluderte studiene inneholdt utfyllende informasjon om for SCL-90-Rs måleegenskaper for ungdom og unge voksne i alderen 13–26 år. Kunnskapsgrunnlaget for SCL-90-R er ikke tilstrekkelig for å kunne si noe om bruken av instrumentet hos denne gruppen.

• Bachmann, Liv; Vatne, Solfrid & Mundal, Ingunn Pernille (2022). Safeguarding patients while implementing mechanical restraints : a qualitative study of nurses and ward staff’s perceptions and assessment. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 32(3/4), p. 438–451. doi: 10.1111/jocn.16249. Full text in Research Archive Show summary

  Aims and Objectives: To explore nurses’ and ward staff's perceptions and assessments of patient care while implementing mechanical restraints. Background: To prevent the risks associated with the use of restraints in psychiatry and ensure safe mental health care, it is necessary to know more about how the nursing staff experiences, comprehends and intervenes in managing patients subjected to coercive measures. Design: This study employed a qualitative descriptive design, in accordance with the COREQ guidelines. Methods: Semi-structured interviews were conducted with 18 nurses and ward staff aged between 22 and 45 years old, who had experience implementing mechanical restraints. Data were digitally audio-recorded and transcribed verbatim. Inductive thematic analysis was conducted using NVivo 12. Results: The participants believed that mechanical restraints should be used as a last resort and that safeguarding patients during implementation is important; however, their assessments of the patients’ physical and mental conditions varied. A clear difference emerged in how management qualified professionals handled situations prior to and during the implementation of mechanical coercive measures. Conclusions: The findings emphasise the need to focus on the assessment of patients prior to and during restraint, ensure the quality of safe implementation in a risk-of-harm situation, prioritise competence in education, and practice, and improve management. Relevance to clinical practice: The findings highlight the importance of assessing the physical and mental condition of patients while implementing restraints, as well as aiding the management, nurses and ward staff in tailoring safety procedures.

• Muñoz-Rubilar, C Amparo; Carrillos, Carolina Pezoa; Mundal, Ingunn Pernille; De Las Cuevas, Carlos & Lara Cabrera, Mariela Loreto (2022). The duty to care and nurses' well-being during a pandemic. Nursing Ethics. ISSN 0969-7330. 29(3), p. 527–539. doi: 10.1177/09697330211041746. Full text in Research Archive Show summary

  Background: The coronavirus disease 2019 pandemic is impacting the delivery of healthcare worldwide, creating dilemmas related to the duty to care. Although understanding the ethical dilemmas about the duty to care among nurses is necessary to allow effective preparation, few studies have explored these concerns. Aim: This study aimed to identify the ethical dilemmas among clinical nurses in Spain and Chile. It primarily aimed to (1) identify nurses’ agreement with the duty to care despite high risks for themselves and/or their families, (2) describe nurses’ well-being and (3) describe the associations between well-being and the duty to care. Research design: Cross-sectional self-reported anonymous data were collected between May and June 2020 via electronic survey distribution (snowball sampling). Ethical considerations: The Institutional Ethical Review Committees in both countries approved the study (CHUC_2020_33 and 27/2020). Findings: In total, 345 clinical nurses answered the primary question about the duty to care for the sick. Although in the total sample 77.4% agreed they have a duty to care for the sick, significant differences were found between the Spanish and Chilean samples. Overall, 53.6% of the nurses reported low levels of well-being; however, among those reporting low well-being, statistically significant differences were found between Spanish and Chilean nurses as 19.4% and 37.8%, respectively, disagreed with the statement regarding the duty to care. Discussion: Participants in both countries reported several ethical dilemmas, safety fears, consequent stress and low well-being. These results suggest that prompt actions are required to address nurses’ ethical concerns, as they might affect their willingness to work and psychological well-being. Conclusion: Our findings shed light on the ethical dilemmas nurses are facing related to the duty to care. Not only has the coronavirus disease 2019 pandemic given rise to ethical challenges, but it has also affected nurses’ well-being and willingness to work during a pandemic. Keywords: attitudes of health personnel, COVID-19 pandemic, duty to care, ethical issues nurses, psychological well-being, willingness to work

• Freidin, Maxim B.; Tsepilov, Yakov A.; Stanaway, Ian B.; Meng, Weihua; Hayward, Caroline & Smith, Blair H. [Show all 36 contributors for this article] (2021). Sex- and age-specific genetic analysis of chronic back pain. Pain. ISSN 0304-3959. 162(4), p. 1176–1187. doi: 10.1097/j.pain.0000000000002100. Show summary

  Sex differences for chronic back pain (cBP) have been reported, with females usually exhibiting greater morbidity, severity, and poorer response to treatment. Genetic factors acting in an age-specific manner have been implicated but never comprehensively explored. We performed sex- and age-stratified genome-wide association study and single nucleotide polymorphism-by-sex interaction analysis for cBP defined as “Back pain for 3+ months” in 202,077 males and 237,754 females of European ancestry from UK Biobank. Two and 7 nonoverlapping genome-wide significant loci were identified for males and females, respectively. A male-specific locus on chromosome 10 near SPOCK2 gene was replicated in 4 independent cohorts. Four loci demonstrated single nucleotide polymorphism-by-sex interaction, although none of them were formally replicated. Single nucleotide polymorphism-explained heritability was higher in females (0.079 vs 0.067, P = 0.006). There was a high, although not complete, genetic correlation between the sexes (r = 0.838 ± 0.041, different from 1 with P = 7.8E-05). Genetic correlation between the sexes for cBP decreased with age (0.858 ± 0.049 in younger people vs 0.544 ± 0.157 in older people; P = 4.3E-05). There was a stronger genetic correlation of cBP with self-reported diagnosis of intervertebral disk degeneration in males than in females (0.889 vs 0.638; P = 3.7E-06). Thus, the genetic component of cBP in the UK Biobank exhibits a mild sex- and age-dependency. This provides an insight into the possible causes of sex- and age-specificity in epidemiology and pathophysiology of cBP and chronic pain at other anatomical sites.

• Khoury, Samar; Parisien, Marc; Thompson, Scott J.; Vachon-Presseau, Etienne; Roy, Mathieu & Mitchell, Amy [Show all 32 contributors for this article] (2021). Genome-wide analysis identifies impaired axonogenesis in chronic overlapping pain conditions. Brain. ISSN 0006-8950. 145(3), p. 1111–1123. doi: 10.1093/brain/awab359. Full text in Research Archive Show summary

  Chronic pain is often present at more than one anatomical location, leading to chronic overlapping pain conditions (COPC). Whether COPC represents a distinct pathophysiology from the occurrence of pain at only one site is unknown. Using genome-wide approaches, we compared genetic determinants of chronic single-site vs. multisite pain in the UK Biobank. We found that different genetic signals underlie chronic single-site and multisite pain with much stronger genetic contributions for the latter. Among 23 loci associated with multisite pain, 9 loci replicated in the HUNT cohort, with the DCC netrin-1 receptor (DCC) as the top gene. Functional genomics identified axonogenesis in brain tissues as the major contributing pathway to chronic multisite pain. Finally, multimodal structural brain imaging analysis showed that DCC is most strongly expressed in subcortical limbic regions and is associated with alterations in the uncinate fasciculus microstructure, suggesting that DCC-dependent axonogenesis may contribute to COPC via cortico-limbic circuits. Keywords: chronic overlapping pain conditions, netrin, uncinate fasciculus

• Rahman, Shafiqur; Winsvold, Bendik K S; Chavez, Sergio; Børte, Sigrid; Tsepilov, Vakov & Sharapov, Sodbo Zh [Show all 32 contributors for this article] (2021). Genome-wide association study identifies RNF123 locus as associated with chronic widespread musculoskeletal pain. Annals of the Rheumatic Diseases. ISSN 0003-4967. 80(9), p. 1227–1235. doi: 10.1136/annrheumdis-2020-219624. Full text in Research Archive Show summary

  Background and objectives Chronic widespread musculoskeletal pain (CWP) is a symptom of fibromyalgia and a complex trait with poorly understood pathogenesis. CWP is heritable (48%–54%), but its genetic architecture is unknown and candidate gene studies have produced inconsistent results. We conducted a genome-wide association study to get insight into the genetic background of CWP. Methods Northern Europeans from UK Biobank comprising 6914 cases reporting pain all over the body lasting >3 months and 242 929 controls were studied. Replication of three independent genome-wide significant single nucleotide polymorphisms was attempted in six independent European cohorts (n=43 080; cases=14 177). Genetic correlations with risk factors, tissue specificity and colocalisation were examined. Results Three genome-wide significant loci were identified (rs1491985, rs10490825, rs165599) residing within the genes Ring Finger Protein 123 (RNF123), ATPase secretory pathway Ca 2+ transporting 1 (ATP2C1) and catechol-O-methyltransferase (COMT). The RNF123 locus was replicated (meta-analysis p=0.0002), the ATP2C1 locus showed suggestive association (p=0.0227) and the COMT locus was not replicated. Partial genetic correlation between CWP and depressive symptoms, body mass index, age of first birth and years of schooling were identified. Tissue specificity and colocalisation analysis highlight the relevance of skeletal muscle in CWP. Conclusions We report a novel association of RNF123 locus and a suggestive association of ATP2C1 locus with CWP. Both loci are consistent with a role of calcium regulation in CWP. The association with COMT, one of the most studied genes in chronic pain field, was not confirmed in the replication analysis.

• Mundal, Ingunn Pernille; Lara Cabrera, Mariela Loreto; Betancort, Moisés & De las Cuevas, Carlos (2021). Exploring patterns in psychiatric outpatients’ preferences for involvement in decision-making : a latent class analysis approach. BMC Psychiatry. ISSN 1471-244X. 21:133, p. 1–12. doi: 10.1186/s12888-021-03137-x. Full text in Research Archive Show summary

  Background: Shared decision-making (SDM), a collaborative approach that includes and respects patients’ preferences for involvement in decision-making about their treatment, is increasingly advocated. However, in the practice of clinical psychiatry, implementing SDM seems difficult to accomplish. Although the number of studies related to psychiatric patients’ preferences for involvement is increasing, studies have largely focused on understanding patients in public mental healthcare settings. Thus, investigating patient preferences for involvement in both public and private settings is of particular importance in psychiatric research. The objectives of this study were to identify different latent class typologies of patient preferences for involvement in the decision-making process, and to investigate how patient characteristics predict these typologies in mental healthcare settings. Methods: We conducted latent class analysis (LCA) to identify groups of psychiatric outpatients with similar preferences for involvement in decision-making to estimate the probability that each patient belonged to a certain class based on sociodemographic, clinical and health belief variables. Results: The LCA included 224 consecutive psychiatric outpatients’ preferences for involvement in treatment decisions in public and private psychiatric settings. The LCA identified three distinct preference typologies, two collaborative and one passive, accounting for 78% of the variance. Class 1 (26%) included collaborative men aged 34–44 years with an average level of education who were treated by public services for a depressive disorder, had high psychological reactance, believed they controlled their disease and had a pharmacophobic attitude. Class 2 (29%) included collaborative women younger than 33 years with an average level of education, who were treated by public services for an anxiety disorder, had low psychological reactance or health control belief and had an unconcerned attitude toward medication. Class 3 (45%) included passive women older than 55 years with lower education levels who had a depressive disorder, had low psychological reactance, attributed the control of their disease to their psychiatrists and had a pharmacophilic attitude. Conclusions: Our findings highlight how psychiatric patients vary in pattern of preferences for treatment involvement regarding demographic variables and health status, providing insight into understanding the pattern of preferences and comprising a significant advance in mental healthcare research. Keywords: community mental health services, latent class analysis, mental disorders, preferences, private mental health service, psychiatry, shared decision-making

• Nygård, Linda Anette Kornstad; Mundal, Ingunn Pernille; Dahl, Lisbeth; Saltyte Benth, Jurate & Rokstad, Anne Marie Mork (2021). Limited benefit of marine protein hydrolysate on physical function and strength in older adults: a randomized controlled trial. Marine Drugs. ISSN 1660-3397. 19(2), p. 1–14. doi: 10.3390/md19020062. Full text in Research Archive Show summary

  Age-related muscle wasting can compromise functional abilities of the elderly. Protein intake stimulates muscle protein synthesis; however, ageing muscle is more resistant to stimuli. This double-blinded, randomized, controlled trial is one of the first registered studies to evaluate the effects of a supplement of marine protein hydrolysate (MPH) on measures of physical function and strength. Eighty-six older adults received nutritional supplements containing 3 g of MPH or a placebo for up to 12 months. Short Physical Performance Battery (SPPB), grip strength and gait speed were measured, and dietary intake was registered at baseline, 6 months, and 12 months. No difference was found between the intervention and control groups in mean change in SPPB (independent sample t-test, p = 0.41) or regarding time trend in SPPB, grip strength, or gait speed (linear mixed model). The participants in our study were well functioning, causing a ceiling effect in SPPB. Further, they had sufficient protein intake and were physically active. Differences in physical function between those completing the intervention and the dropouts might also have created bias in the results. We recommend that future studies of MPH be carried out on a more frail or malnourished population. Keywords: hydrolysate, fish protein, ageing, physical function, dietary assessment, seafood intake, healthy ageing

• Mundal, Ingunn Pernille; Laake, Petter; Mezzich, Juan; Bjørkly, Stål & Lara Cabrera, Mariela Loreto (2021). Assessment of the quality of life in parents of children with ADHD : validation of the Multicultural Quality of Life in Norwegian pediatric mental health settings. Frontiers in Psychology. ISSN 1664-1078. 12:638006, p. 1–10. doi: 10.3389/fpsyg.2021.638006. Full text in Research Archive Show summary

  Background: The brief generic Multicultural Quality of Life Index (MQLI) is a culturally informed self-report 10-item questionnaire used to measure health-related quality of life (QoL). QoL is an important outcome measure in guiding healthcare and is held as a substantial parameter to evaluate the effectiveness of healthcare. Attention Deficit Hyperactivity Disorder (ADHD) in children might negatively influence the parents’ QoL. Having a validated questionnaire to measure QoL for this population will therefore be a vital first step in guiding healthcare for parents of children with ADHD. We aimed to examine the reliability and validity of the Norwegian version of the MQLI in a sample of parents of children with ADHD. Methods: In a cross-sectional study, 128 parents of children with ADHD were recruited from four outpatient clinics within the Child and Adolescents Mental Health Services (CAMHS) in Norway. They completed the MQLI along with an alternative well-being scale, the Five-item World Health Organization Well-being Index (WHO-5), and a form including demographic variables. Reliability and validity of the MQLI were examined. We conducted a factor analysis and calculated internal consistency and the correlation between the MQLI and the WHO-5. Results: Factor analysis of the parents reported MQLI yielded a one-factor solution. For the MQLI, Cronbach’s alpha was 0.73. The correlation between the two measures of MQLI and WHO-5 was high (r = 0.84), reflecting convergent validity since the association between the two measures was strong. Conclusion: Results from this study support the reliability and validity of the Norwegian version of the MQLI for assessment of quality of life in parents of children with ADHD with good psychometric properties. Study findings support the use of the questionnaire in CAMHS.

• Engelseth, Per; White, Brian Emery; Mundal, Ingunn Pernille; Eines, Trude Fløystad & Kritchanchai, Duangpun (2020). Systems modelling to support the complex nature of healthcare services. Health and Technology. ISSN 2190-7188. 11(1), p. 193–209. doi: 10.1007/s12553-020-00504-8. Full text in Research Archive Show summary

  Healthcare is a service commonly associated with lacking performance in relation to output and the economy of production. Contingency theory and complex systems thinking are approaches here combined to study the logistics of healthcare service fows. Contingency theory directs attention to networked interdependencies while complex systems thinking concerns process emergence and fexible resource use in supporting logistics. This hybrid form of analysis gives conceptual direction to information technology development and use to support the logistics of healthcare services. Three small examples of healthcare service as logistics processes in their as-is state are provided and analysed based on the developed analytical framework. These illustrate in detail what exemplifes complexity in this industry. Given the inherently complex nature of many types of healthcare services, this discussion concerns how to conceptually model information systems in healthcare services as a complex system. This chosen complexity-sensitive approach of service logistics constitutes a basis for information technology enabled healthcare service development sensitive to this type of service provision directing focus to the emergent features of healthcare service needs. It is also a basis for further investigation into this topic of information technology use to support the inherent logistical complexity of healthcare services.

• Nygård, Linda Anette Kornstad; Dahl, Lisbeth; Mundal, Ingunn Pernille; Saltyte Benth, Jurate & Rokstad, Anne Marie Mork (2020). Protein intake, protein mealtime distribution and seafood consumption in elderly Norwegians : associations with physical function and strength. Geriatrics (Basel). ISSN 2308-3417. 5(4), p. 1–14. doi: 10.3390/geriatrics5040100. Full text in Research Archive Show summary

  Protein intake is considered important in the maintenance of muscle health in ageing. However, both the source and mealtime distribution of protein might affect the intake of protein and its effect on muscle protein synthesis. In this study, protein intake, mealtime distribution of protein, and seafood consumption were assessed in 92 older adults (aged 65+), and associations with physical performance (Short Physical Performance Battery (SPPB)), grip strength and gait speed were assessed in a multiple linear regression analysis. The participants had a mean age of 73 ± 8.9 years. Mean protein intake was 1.1 g/kg body weight. Protein intake was well distributed, with coefficient of variance between meals (CV meals) 0.6 ± 0.3. However, dinner had the highest protein intake. No associations were found between the nutrition factors and physical performance or strength; however, this result might have been caused by a ceiling effect in the chosen test batteries, as the mean score on SPPB was 10.3 ± 2.7, and 48.9% of the participants reached the top score of 12 points. Mean grip strength was 44.4 ± 9.4 kg (men) and 26.2 ± 6.8 kg (women). Mean gait speed was 1.0 ± 0.3 m/s. The interaction analysis suggests that there might be gender differences in the effect of seafood consumption on gait speed. Keywords: nutrition, protein, fish, older adults, physical performance, hand grip strength, sarcopenia, frailty

• Mundal, Ingunn Pernille; Gråwe, Rolf W.; Hafstad, Hege; De Las Cuevas, Carlos & Lara Cabrera, Mariela Loreto (2020). Effects of a peer co-facilitated educational programme for parents of children with ADHD : a feasibility randomised controlled trial protocol. BMJ Open. ISSN 2044-6055. 10(12), p. 1–9. doi: 10.1136/bmjopen-2020-039852. Full text in Research Archive Show summary

  Introduction: Significant numbers of children with attention deficit hyperactivity disorder (ADHD) display problems that cause multiple disabilities, deficits and handicaps that interfere with social relationships, development and school achievement. They may have multiple problems, which strain family dynamics and influence the child’s treatment. Parent activation, described as parents’ knowledge, skills and confidence in dealing with their child’s health and healthcare, has been shown to be an important factor in improving health outcomes. Research suggests that parents need edification to learn skills crucial to the treatment and management of their children’s healthcare. Promoting positive parenting techniques may reduce negative parenting factors in families. This study aims to assess the acceptability, feasibility and estimated sample size of a randomised controlled trial (RCT) comparing an ADHD peer co-led educational programme added to treatment as usual (TAU). Methods and analysis: Using a randomised waitlist controlled trial, parents of children aged 6–12 years newly diagnosed with ADHD, and referred to a child mental health outpatient clinic in Mid-Norway, will receive TAU concomitant with a peer co-facilitated parental engagement educational programme (n=25). Parents in the control group will receive TAU, and the educational programme treatment within a waitlist period of 3–6 months (n=25). Parent activation, satisfaction, well-being, quality of life and treatment adherence, will be assessed at baseline (T0), 2 weeks (T1) pre–post intervention (T2, T3) and at 3 months follow-up (T4). Shared decision making, parents preferred role in health-related decisions and involvement, parent-reported symptoms of ADHD and child’s overall level of functioning will be assessed at T0 and T4. Such data will be used to calculate the required sample size for a full-scale RCT. Ethics and dissemination: Approval was obtained from the Regional Committee for Medicine and Health Research Ethics in Mid-Norway (ref: 2018/1196). The findings of this study are expected to provide valuable knowledge about how to optimise family education and management of ADHD and will be disseminated through presentations at conferences and publication in peer-reviewed journals.

• De las Cuevas, Carlos; Mundal, Ingunn Pernille; Betancort, Moisés & Lara Cabrera, Mariela Loreto (2020). Assessment of shared decision-making in community mental health care : validation of the CollaboRATE. International Journal of Clinical and Health Psychology. ISSN 1697-2600. 20(3), p. 262–270. doi: 10.1016/j.ijchp.2020.06.004. Full text in Research Archive Show summary

  Background/Objective: CollaboRATE is a 3-item self-report measure of the patient experience of shared decision-making (SDM) process. The objective of this study is to assess the psychometric properties of CollaboRATE in community mental health care. Method: A cross-sectional study was conducted at a Community Mental Health Center of the Canary Islands Health Service. Two hundred and fifty consecutive psychiatric outpatients were invited to participate. Of those, 191 accepted (76.40% of response rate) and completed the CollaboRATE, the Control Preferences Scale (CPS), and a form with sociodemographic and clinical variables. Results: Exploratory factor analysis ratified the unidimensionality of the measure. High internal consistency was found (α Cronbach = .95, Guttman's λ = .93, and ω = .95). Strong positive correlations (p < .0001) were found between the CollaboRATE and the CPS. Only 39.80% of respondents gave the best possible score on CollaboRATE. Conclusions: This study provides evidence for the reliability and validity of the Spanish version of the CollaboRATE as a measure of SDM. The measure is quick to complete and feasible for use in outpatient mental health care. At present, a significative number of psychiatric outpatients are not involved in SDM. The use of this measure in psychiatric routine care can be a key tool in assessing and implementing SDM. Keywords: CollaboRATE measure, mental disorders, shared decision-making, instrumental study

• Lara Cabrera, Mariela Loreto; Bjørkly, Stål; De las Cuevas, Carlos; Pedersen, Sindre Andre & Mundal, Ingunn Pernille (2020). Psychometric properties of the Five-item World Health Organization Well-being Index used in mental health services : protocol for a systematic review. Journal of Advanced Nursing. ISSN 0309-2402. 76(9), p. 2426–2433. doi: 10.1111/jan.14445. Show summary

  Aims: To synthesize evidence of the psychometric properties of the Five‐item World Health Organization Well‐being Index in mental health settings and critically appraise the methodologies of the included studies. Design: Protocol for a systematic psychometric review. Methods: The review protocol has been registered in the International Prospective Register for Systematic Reviews. The bibliographic databases MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, and Web of Science will be searched for relevant studies. The psychometric properties of each study will be evaluated according to the Consensus‐based Standards for the Selection of Health Measurements Instruments. Discussion: The results of our psychometric review will synthesize the psychometric properties of the Five‐item World Health Organization Well‐being Index in mental health settings and identify possible gaps in the literature regarding methodological quality and its reliability, validity, and responsiveness to change. Impact: The evaluation of patient well‐being is important, and the Five‐item World Health Organization Well‐being Index is an increasingly used patient‐reported outcome measure. It is simple to collect, free to use, and consists of five questions using positive health statements. Although the number of studies assessing the validity, reliability, and responsiveness of the questionnaire is increasing worldwide, there is a need to summarize the existing evidence of the psychometric properties of this questionnaire. The proposed study's findings will contribute to future research recommendations and help midwives and nurses in different settings pick an effective, appropriate questionnaire to evaluate patient well‐being. Keywords: assessment, mental health, mental health services, midwifery nurse, patient‐reported outcomes, protocol systematic review, psychometric properties, well‐being, WHO‐5

• Lara Cabrera, Mariela Loreto; Mundal, Ingunn Pernille & De Las Cuevas, Carlos (2020). Patient-reported well-being : psychometric properties of the world health organization well-being index in specialised community mental health settings. Psychiatry Research. ISSN 0165-1781. 291(September), p. 1–8. doi: 10.1016/j.psychres.2020.113268. Show summary

  The Five-item World Health Organization Well-being Index (WHO-5) is an increasingly used measure of generic well-being, but there is no evidence to support whether outpatients consider the questionnaire valuable. As the WHO-5 has not yet been psychometrically evaluated in specialised community mental health settings, an evaluation of its validity seems warranted. The aim of this cross-sectional study was to examine the psychometric properties of the WHO-5 in this type of setting. Data was collected from an outpatient center (N = 191 adults). Results indicate that the questionnaire was feasible to administer (n = 57 patients), it reported low mean Burden-scores and high Positive-Value scores, and had excellent internal consistency. No evidence of floor or ceiling effects was found. Results supported the unidimensional structure of the questionnaire. Significant differences were found concerning patients’ diagnoses, with patients with schizophrenia diagnoses reporting higher scores and patients with depression and personality disorders reporting lower ones. When comparing the WHO-5 total score and patients’ attitudes toward medication, negative correlations were observed with psychological reactance, as well as positive aspects of psychiatric medication. The present study demonstrates that the WHO-5 is feasible to administer and has robust psychometric properties in specialised community mental health centres. Keywords: mental disorders, psychiatric outpatients, psychological well-being, reliability, validity, WHO-5

• Mundal, Ingunn Pernille; Bjørngaard, Johan Håkon; Nilsen, Tom Ivar Lund; Nicholl, Barbara I; Gråwe, Rolf W. & Fors, Egil Andreas (2016). Long-Term Changes in Musculoskeletal Pain Sites in the General Population: The HUNT Study. Journal of Pain. ISSN 1526-5900. 17(11), p. 1246–1256. doi: 10.1016/j.jpain.2016.08.006.
• Mundal, Ingunn Pernille; Gråwe, Rolf W.; Bjørngaard, Johan Håkon; Linaker, Olav Morten & Fors, Egil Andreas (2014). Psychosocial factors and risk of chronic widespread pain: An 11-year follow-up study - The HUNT study. Pain. ISSN 0304-3959. 155(8), p. 1555–1561. doi: 10.1016/j.pain.2014.04.033.
• Mundal, Ingunn Pernille; Gråwe, Rolf W.; Bjørngaard, Johan Håkon; Linaker, Olav Morten & Fors, Egil Andreas (2014). Prevalence and long-term predictors of persistent chronic widespread pain in the general population in an 11-year prospective study: the HUNT study. BMC Musculoskeletal Disorders. ISSN 1471-2474. 15(1). doi: 10.1186/1471-2474-15-213. Full text in Research Archive

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• Mundal, Ingunn Pernille & Dolonen, Kari Anne (2023). Ingunn Pernille Mundal er en rykende fersk professor i sykepleie. [Journal]. Sykepleien.
• Eines, Trude Fløystad; Mundal, Ingunn Pernille & Grønvik, Cecilie K Utheim (2021). Kan tjenestedesign bidra til økt medvirkning og involvering for pasienter og brukere på individnivå i helse- og omsorgstjenestene? Nordisk tidsskrift for helseforskning. ISSN 1504-3614. 17(1), p. 1–13. doi: 10.7557/14.5482. Show summary

  Pasient – og brukermedvirkning er en lovfestet rettighet som skal sikre pasienter og brukere økt innflytelse i helse og omsorgstjenesten. Forskning viser imidlertid at helsepersonell anvender en paternalistisk tilnærming i sin yrkesutøvelse, noe som truer pasienters rettigheter. Helsepersonell anbefales derfor å ta i bruk tjenestedesign som metodikk for å øke den reelle medvirkningen og involveringen av pasienter og brukere. Formålet med økt bruker- og pasientmedvirkning og involvering er å utvikle tjenester av høy kvalitet med utgangspunkt i brukernes behov. Behovsdrevne tjenester vil oppleves som nyttige og meningsfulle for brukerne. Det er derfor viktig at helsepersonell forstår verdien av brukermedvirkning i kvalitetsarbeid og tilegner seg kunnskap om tjenestedesign. Emneord (Nøkkelord): user participations, user involvement, service design, quality, evidence-based practice, brukermedvirkning, brukerinvolvering, tjenestedesign, kvalitet, kunnskapsbasert praksis

• Kjøl, Jenny; Melbye, Lise Merete & Mundal, Ingunn Pernille (2020). NEWS-målinger trygger sykepleiere i den tverrprofesjonelle kommunikasjonen. Tidsskriftet sykepleien. ISSN 0806-7511. 108:83082, p. 1–13. doi: 10.4220/Sykepleiens.2020.83082.
• Nygård, Linda Anette Kornstad; Mundal, Ingunn Pernille; Dahl, Lisbeth; Saltyte Benth, Jurate & Rokstad, Anne Marie Mork (2018). Nutrition and physical performance in older people—effects of marine protein hydrolysates to prevent decline in physical performance : a randomised controlled trial protocol . BMJ Open. ISSN 2044-6055. 8(10), p. 1–7. doi: 10.1136/bmjopen-2018-023845. Full text in Research Archive Show summary

  Introduction: Age-related loss of muscle mass, muscle strength and muscle function (sarcopenia) leads to a decline in physical performance, loss of independence and reduced quality of life. Nutritional supplements may delay the progression of sarcopenia. The aim of this randomised, double-blinded controlled trial including 100 participants (≥65 years) is to assess the effect of a marine protein hydrolysate (MPH) on sarcopenia-related outcomes like hand grip strength, physical performance or gait speed and to study the associations between physical performance and nutritional intake and status. Method and analysis: The intervention group (n=50) will receive 3 g of MPH per day in 12 months. The control group (n=50) receive placebo. Assessments of Short Physical Performance Battery (SPPB), hand grip strength, anthropometric measurements, nutritional status as measured by the Mini Nutritional Assessment, dietary intake, supplement use, biomarkers of protein nutrition and vitamin D, and health-related quality of life (EQ-5D), will be performed at baseline and after 6 and 12 months of intervention. Linear mixed models will be estimated to assess the effect of MPH on SPPB, hand grip strength and quality of life, as well as associations between physical performance and nutrition. Ethics and dissemination: The study has been approved by the Regional Committee in Ethics in Medical Research in Mid-Norway in September 2016 with the registration ID 2016/1152. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, broadcast media and print media.

• Mundal, Ingunn Pernille; Bjørngaard, Johan Håkon; Nilsen, Tom Ivar Lund; Nicholl, Barbara I; Gråwe, Rolf W. & Fors, Egil Andreas (2017). Langsiktige endringer i muskel og skjelettsmerter. Revmatologi BestPractice. Mai.
• Mundal, Ingunn; Fors, Egil; Bjørngaard, Johan Håkon; Gråwe, Rolf W. & Linaker, Olav Morten (2013). Psykososiale faktorer og livsstil som risikofaktorer for utvikling av kronisk utbredt smerte: En 11 år prospektiv studie av 28.000 personer. En HUNT studie.

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