Folkehelseinstituttet
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To neutrally offer or strongly recommend? General practitioners’ perspectives on screening for gestational diabetes according to the national guideline in Norway
Get PDFObjective To explore general practitioners’ experiences and reflections on how the current Norwegian guideline for screening for gestational diabetes affects their clinical practice. Design A qualitive study in which data were collected through semi-structured focus group interviews and analyzed thematically. Setting and subjects Five focus groups conducted in 2020 among GPs in Norway; three interviews took place face-to-face and two were held digitally. The total number of participants was 31. Results GPs acknowledged the potential benefits of more extensive screening, but had concerns about the medicalization of pregnancy, stating that some women experienced considerable anxiety. The GPs expressed doubts about the guideline’s evidence base but differed in how they interpreted what the guideline was asking them to do. Some offered eligible women the opportunity to be screened, while other set up a screening appointment without consulting the women first. For some, fear of incrimination made them recommend screening without being convinced that it was the right thing for the patient. Conclusions It is unclear whether the guideline for gestational diabetes requires GPs to recommend screening to pregnant women or if they should provide neutral information about the availability of screening. This ambiguity should be addressed, and the guideline evaluated against the core principles of general practice.publishedVersio
Post-injury long-term sickness absence and risk of disability pension: The role of socioeconomic status
Get PDFIntroduction Previous research has identified low socioeconomic status (SES) as a risk factor for long-term sickness absence (LTSA) and disability pension (DP) following trauma. However, most studies lack information on medical diagnoses, limiting our understanding of the underlying factors. To address this gap, we retrieved information about diagnostic causes for receipt of welfare benefits to explore the role of SES in the transition from post-injury LTSA to permanent DP among the working population in Norway. Materials and methods We conducted a population-based cohort study of all Norwegian residents aged 25–59 years registered with a spell of LTSA due to injury commencing in the period 2000–2003. This cohort was followed through 2014 by linking information on receipt of welfare benefits with sociodemographic data from administrative registers. SES was defined as a composite measure of educational attainment and income level. We used flexible parametric survival models to estimate hazard ratios (HR) with 95 % confidence intervals (CI) for all-cause and diagnosis-specific DP according to SES, adjusting for sex, age, marital status, immigrant status and healthcare region of residence. Results Of 53,937 adults with post-injury LTSA, 9,665 (18 %) transferred to DP during follow-up. The crude risk of DP was highest for LTSA spells due to poisoning and head injuries. Overall, individuals in the lowest SES category had twice the risk of DP compared to those in the highest SES category (HR = 2.25, 95 % CI 2.13–2.38). The difference by SES was greatest for LTSA due to poisoning and smallest for LTSA due to head injuries. A majority (75 %) of DP recipients had a non-injury diagnosis as the primary cause of DP. The socioeconomic gradient was more pronounced for non-injury causes of DP (HR = 2.47, 95 % CI 2.31–2.63) than for injury causes (HR = 1.73, 95 % CI 1.56–1.92) and was especially steep for DP due to musculoskeletal diseases and mental and behavioural disorders. Conclusions The relationship between SES and DP varied by both the type of injury that caused LTSA and the diagnosis used to grant DP, highlighting the importance of taking diagnostic information into account when investigating long-term consequences of injuries.publishedVersio
Less inflammatory response in the direct anterior than in the direct lateral approach in patients with femoral neck fractures receiving a total hip arthroplasty: exploratory results from a randomized controlled trial
Get PDFBackground and purpose: It is still debatable which is the least invasive approach to the hip joint in arthroplasty for a femoral neck fracture (FNF). We compared the traditional direct lateral approach (DLA) with the direct anterior approach (DAA) regarding creatine kinase (CK), C-reactive protein (CRP), and hemoglobin (Hb). Methods: In a randomized controlled trial, 130 elderly patients with dislocated FNFs treated with total hip arthroplasty (THA) were included. CK, CRP, and Hb were measured preoperatively and on postoperative days 1 to 4 and were compared between the DAA and DLA groups using repeated measures mixed-effect models. Results: The CK level was significantly higher on the 1st postoperative day in the DLA group, 597 U/L (95% confidence interval [CI] 529–666) vs 461 U/L (CI 389–532), estimated mean difference (MD) 136 U/L (CI 38–235). The CRP levels were significantly higher on postoperative days 3 and 4 in the DLA group, 207 mg/L (CI 189–226) vs 161 mg/L (CI 143–180), estimated MD 46 mg/L (CI 19–72) and 162 mg/L (CI 144–181) vs 121 (CI 102–140), estimated MD 41 mg/L (CI 15–68). Blood loss, expressed as difference in Hb, did not differ between the groups. Conclusion: In an elderly population with FNFs, we found that the DAA, compared with the DLA, results in less CK and CRP increase, but no change in Hb.publishedVersio
Changes in intrahost genetic diversity according to lesion severity in longitudinal HPV16 samples
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Social inequalities in child mental health trajectories: a longitudinal study using birth cohort data 12 countries
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Maternal gluten, cereal, and dietary fiber intake during pregnancy and lactation and the risk of islet autoimmunity and type 1 diabetes in the child
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Accumulation and removal of Streptococcus mutans biofilm on enamel and root surfaces in vitro
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Sex differences in early-onset atrial fibrillation in Norwegian primary care: a retrospective national database analysis
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Mass cytometry reveals cellular correlates of immune response heterogeneity to SARS-CoV-2 vaccination in the elderly
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Assessment of risks posed by import of live medicinal leeches to biodiversity in Norway
Get PDFImport av blodigler til medisinsk bruk og hobbyhold medfører lav risiko for negative effekter på norsk biologisk mangfold. Det er hovedbudskapet i en risikovurdering av to arter blodsugende igler, som VKM har gjort for Miljødirektoratet. Bakgrunn De to artene med blodigler (Hirudo medicinalis og H. verbana) har i nyere tid blitt vanligere å benytte innen vestlig medisin i forbindelse med ulike inngrep der det er viktig å opprettholde god blodgjennomstrømning. Hirudo medicinalis regnes som hjemmehørende i Norge og finnes nå i spredte populasjoner i Sør-Norge. Det er spesielt genetisk påvirkning av disse populasjonene det er knyttet usikkerhet til om vil slå negativt ut dersom importerte igler kommer ut i naturen. Hirudo verbana finnes antagelig ikke i Norge. Begge artene er listet under Vedlegg I, liste B under den norske CITES-forskriften. Dette har VKM gjort VKM har gått gjennom vitenskapelig litteratur for å finne frem informasjon om mulige negative effekter i lys av iglenes økologi. VKM har også undersøkt hvordan handelen med levende igler foregår, hvor disse stammer fra, og kartlagt mulige risikoreduserende tiltak. VKM vurderte at følgende fire faktorer kan være av potensiell relevans mhp. negativ påvirkning på det biologiske mangfoldet, og gjennomførte risikovurdering til hver av disse: -hybridisering eller annen negativ genetisk påvirkning av lokale populasjoner -konkurranse med andre iglearter -parasittisme eller predasjon på amfibiepopulasjoner -overføring av sykdommer I tillegg har VKM vurdert omfanget av slik import, og sannsynligheten for at importerte igler ender opp i norsk natur. Resultater VKM har konkludert med at det er moderat sannsynlig at H. medicinalis vil påvirke de norske populasjonene genetisk, men at dette vil ha minimal negativ effekt. Hybridisering mellom H. verbana og H. medicinalis antas å være usannsynlig og eventuelt ha liten effekt. - Iglene som alt finnes i Norge stammer i all hovedsak fra igler som ble importert fra Europa på 1800-tallet. Tilførsel av nye gener fra de samme områdene nå vil derfor ha minimal påvirkning. Risikoen blir derfor lav, sier Lawrence Kirkendall, faglig leder av arbeidet. For parasittisme eller predasjon, er det hovedsakelig amfibier som i teorien vil kunne påvirkes negativt av iglene. VKM konkluderer med at slike negative effekter er svært usannsynlig, og at effekten vil være liten eller minimal. Dette innebærer altså en lav risiko. Når det gjelder konkurranse og overføring av sykdommer vurderer VKM at dette er faktorer som har liten eller minimal effekt på biodiversiteten, og er svært usannsynlige. -Vi vurderer at effektene på biologisk mangfold i Norge, dersom importerte igler skulle havne i et miljø der de trives, er svært lave. Samtidig er det svært usannsynlig at igler brukt til medisinske inngrep havner i naturen. Den samlede vurderingen blir da at begge artene er forbundet med lav risiko for negativ påvirkning av det biologiske mangfoldet, sier Kirkendall. Risikovurderingen er godkjent av VKMs faggruppe for biologisk mangfold.Assessment of risks posed by import of live medicinal leeches to biodiversity in NorwayacceptedVersio