Folkehelseinstituttet
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Menns bruk av primærhelsetjenester
Get PDFMenns helsetjenestebruk skiller seg fra kvinners. I dette notatet dokumenterer vi forskjeller mellom kjønnene i bruk av primærhelsetjenester (fastlege og legevakt), særlig med vekt på de som ikke bruker primærhelsetjenesten. Metode Ved å ta i bruk koblede data fra KUHR (Kontroll og utbetaling av helserefusjoner) sammen med demografiske kjennetegn fra SSBs registre beskriver vi antall konsultasjoner per år og andelen som ikke bruker primærhelsetjenester for menn, og sammenligner mønstrene med kvinner. Konsultasjoner i forbindelse med prevensjon og graviditet er ikke tatt med i undersøkelsen. Resultat Vi finner betydelige forskjeller i både antall konsultasjoner per år og sannsynligheten for ikke å ha hatt en konsultasjon i løpet av de tre siste årene. Det er rundt 1,25 færre konsultasjoner årlig for menn enn kvinner når vi tar høyde for demografiske kjennetegn, som utgjør i underkant av 30%, og i underkant av 8 prosentpoeng høyere sannsynlighet for ikke å ha hatt konsultasjon i primærhelsetjenesten de siste tre årene for menn. Forskjellene mellom menn og kvinner er større i enkelte grupper, slik som blant personer med innvandringsbakgrunn og personer uten registrert partner. Diskusjon Undersøkelsene vi har gjort kan ikke si noe om årsakene til de betydelige forskjellene mellom menn og kvinners helsetjenestebruk vi observerer. For å kunne påvise årsaker er det behov for andre metoder og mer forskning. Mulige årsaker kan være mange og sammensatt, og kan gjenspeile en lang rekke forhold, eksempelvis barrierer i helsetjenesten, ulike behov som følge av forskjeller i underliggende helse, forskjeller i normer eller forskjeller i valg og preferanse. Denne undersøkelsen kan heller ikke si noe om følgene av forskjeller i helsetjenestebruk og om dette påvirker helsen negativt eller ei. FHI ser et tydelig behov for mer kunnskap både om hvordan de betydelige forskjellene er fordelt i undergrupper av menn og kvinner, hva som er årsakene til forskjellene og hvilke tiltak som kan utjevne de forskjellene som eventuelt bidrar til dårligere helse.publishedVersio
Effect modification of air pollution on the association between heat and mortality in five European countries
No full textEvidence suggests that air pollution modifies the association between heat and mortality. However, most studies have been conducted in cities without rural data. This time-series study examined potential effect modification of particulate matter (PM) and ozone (O3) on heat-related mortality using small-area data from five European countries, and explored the influence of area characteristics.publishedVersio
Cohort profile: the WHO Child Mortality Risk Stratification Multi-Country Pooled Cohort (WHO-CMRS) to identify predictors of mortality through early childhood
Get PDFPurpose: To provide details of a pooled data set that will be used to estimate absolute and relative mortality risks and other outcomes among children less than 59 months of age and the predictive performance of common risk exposures, both individually and in combination. Participants: Children from birth to 5 years of age recruited at health facilities or community settings into 33 longitudinal observational or intervention studies in 17 low- and middle-income countries. Findings to date: The data set includes 75 287 children with a median age of 3 months (IQR 1-12) at first measurement. In the pooled sample, 2805 (3.7%) of the study children died. Data on birth weight was recorded in 19 studies, and gestational age in 13 studies. Among these, 14% of the included children were reported as having low birth weight, and 14% had preterm birth. At first measurement, 33% of the children were stunted, 24% were wasted and 35% underweight. 13% and 7% of caregivers reported that their child had acute diarrhoea or acute lower respiratory tract infection before the study visit, respectively. The proportion of children reported as breastfed at any study visit decreased from 99% at age <6 months to 77% in the age group 12-23 months. Child characteristics differed considerably between studies in the community and healthcare settings. The median study period was 15 months (IQR 7.6-18.4 months). Future plans: Planned analyses will examine knowledge gaps with the aim of informing global guidelines and their derivatives such as clinical management tools and implementation guidance, and to inform future research agendas. We aim to estimate absolute mortality risks associated with child age, anthropometry, birth characteristics and feeding practices as planned by the WHO-Risk Stratification Working Group. In the future, other data sets may be added and further questions on survival and growth will be investigated.publishedVersio
Air pollution mixture complexity and its effect on PM2.5-related mortality: A multicountry time-series study in 264 cities
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COVID-19 vaccine uptake among children and adolescents in Norway: A comprehensive registry-based cohort study of over 800,000 individuals
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Adverse events after colonoscopy in a randomised colorectal cancer screening trial
Get PDFObjective: Colonoscopy-related adverse events increase the burden of colorectal cancer (CRC) screening. This cross-sectional study evaluates adverse events during and after colonoscopy in a large, randomised CRC screening trial in Norway comparing sigmoidoscopy to immunochemical testing for faecal blood. Methods: We included all individuals who underwent colonoscopy at two screening centres between 2012 and 2020. From medical records, we retrieved data on adverse events during and within 30 days after colonoscopy and classified them according to the American Society for Gastrointestinal Endoscopy lexicon for endoscopic adverse events. Multivariable logistic regression models were fitted to identify risk factors for adverse events. Results: Of the 10 244 included individuals, 242 (2.4%) had at least one adverse event that was possibly, probably, or definitively related to the colonoscopy. 188 (1.8%) had mild adverse events, 50 (0.49%) had moderate, 3 (0.03%) had severe, and 1 had a fatal adverse event. The mAdverse events after colonoscopy in a randomised colorectal cancer screening trialpublishedVersio
Sex differences in childhood cancer risk following ART conception: a registry-based study
Get PDFStudy question: Does the risk of childhood cancer following ARTs vary by sex? Summary answer: In this registry-based study, some childhood cancers showed positive sex- and age-specific associations in children conceived using certain ART modalities, which were not evident in overall combined analyses. What is known already: The relationship between ART and risk of childhood cancer has shown diverse outcomes in prior research. Studies examining whether there are sex differences in childhood cancer risk after ART conception are lacking. Study design, size, duration: This registry-based cohort study included all children born in Norway between 1984 and 2022 (n = 2 255 025), followed until 31 December 2023. Participants/materials, setting, methods: Children were identified via the Medical Birth Registry of Norway, and information was extracted on whether they were conceived via ART (defined as IVF/ICSI). Of the 2 255 025 children included in the study, 53 694 were ART-conceived. Birth records were linked to the Cancer Registry of Norway. Childhood cancer was defined as a cancer diagnosis according to the International Classification of Childhood Cancer Third Edition (ICCC-3) before the age of 18 years. Cox regression models were used to estimate the age- and sex-specific risk of cancer for ART-conceived children compared to children not conceived via ART. Main results and the role of chance: Among all children, 0.25% had a cancer diagnosis before the age of 18 years. The cumulative incidence of cancer was higher in children conceived by ART (IVF/ICSI) than in those not conceived via ART (21.5 vs 17.5 per 100 000 person-years, P = 0.04), and especially higher in boys conceived with ICSI or after cryopreserved embryo transfer. When combining all age groups, both sexes and all cancer types, there was little evidence of increased cancer risk with ART (adjusted hazard ratio (aHR) 1.13, 95% CI 0.94-1.36). However, differences were found when stratifying by age and sex. From age 5-9 years, ART-conceived children had a higher overall risk of cancer (aHR 1.53, 95% CI 1.06-2.20), with a slightly higher estimate in boys (aHR 1.73, 95% CI 1.09-2.74), than in girls (aHR 1.28, 95% CI 0.70-2.33). The risk was not higher up to age 5 years, or after age 10 years. In combined analyses, there was no overall increased risk after ICSI. When stratifying by sex, a higher risk was seen after ICSI for boys (aHR 1.69, 95% CI 1.18-2.42), but not for girls (aHR 0.65, 95% CI 0.37-1.16). The combined risk after cryopreservation (aHR 1.42, 95% CI 0.95-2.13) was driven by a higher risk in boys (aHR 1.79, 95% CI 1.09-2.94), while no evidence of an association was found in girls (aHR 1.01, 95% CI 0.50-2.03). No increased risk was seen with IVF or after fresh transfer for either boys or girls. Limitations, reasons for caution: Childhood cancer is a rare outcome, and some analyses of cancer subtypes were likely underpowered. Wider implications of the findings: Results from this large registry-based study suggest that addressing age- and sex-specific differences in the risk of childhood cancer following ART conception reveals increased risks for certain groups. Our findings require further study with consideration of possible underlying sex-specific mechanisms related to ART and different childhood cancers. Study funding/competing interest(s): This work was funded by: the Research Council of Norway through its Centres of Excellence Funding Scheme (project number 262700); the Norwegian Cancer Association (project number 244291); and the Norwegian Institute of Public Health. The funding agencies had no role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript. The authors declare no conflict of interests.Sex differences in childhood cancer risk following ART conception: a registry-based studypublishedVersio
Changes associated with the COVID-19 pandemic on postpartum screening results in Ontario, Canada: The healthy babies healthy children screening tool
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Geographic and socioeconomic variation in treatment of elderly prostate cancer patients in Norway – a national register-based study
Get PDFPurpose The aim of this study was to examine geographic and socioeconomic variation in curative treatment and choice of treatment modality among elderly prostate cancer (PCa) patients. Methods This register-based cohort study included all Norwegian men ≥ 70 years when diagnosed with non-metastatic, high-risk PCa in 2011–2020 (n = 10 807). Individual data were obtained from the Cancer Registry of Norway, the Norwegian Prostate Cancer Registry, and Statistics Norway. Multilevel logistic regression analysis was used to model variation across hospital referral areas (HRAs), incorporating clinical, demographic and socioeconomic factors. Results Overall, 5186 (48%) patients received curative treatment (radical prostatectomy (RP) (n = 1560) or radiotherapy (n = 3626)). Geographic variation was found for both curative treatment (odds ratio 0.39–2.19) and choice of treatment modality (odds ratio 0.10–2.45). Odds of curative treatment increased with increasing income and education, and decreased for patients living alone, and with increasing age and frailty. Patients with higher income had higher odds of receiving RP compared to radiotherapy. Conclusions This study showed geographic and socioeconomic variation in treatment of elderly patients with non-metastatic, high-risk PCa, both in relation to overall curative treatment and choice of treatment modality. Further research is needed to explore clinical practices, the shared decision process and how socioeconomic factors influence the treatment of elderly patients with high-risk PCa.publishedVersio
Assessment of risks posed by the import of live crabs intended for human consumption
Get PDFImport av fremmede krabber til bruk i mat- og restaurantbransjen kan medføre en høy risiko for negative effekter på norsk biologisk mangfold. Det er hovedbudskapet i en risikovurdering av åtte arter krabber, som VKM har gjort for Miljødirektoratet. Tre av disse artene er tidligere blitt beslaglagt av Tollvesenet, og disse var med høy sannsynlighet ment for mat-, og restaurantbransjen. Krabbene var levende da de ble forsøkt innført til Norge fra Sverige. På bakgrunn av beslagene besluttet Miljødirektoratet å få gjennomført en vurdering av hvilken risiko slik import kan medføre for biologisk mangfold i Norge. Ytterligere fem arter, identifisert av Havforskningsinstituttet som aktuelle for import som mat, inngikk i VKMs oppdrag. Dette har VKM gjort: VKM har gått gjennom tilgjengelig vitenskapelig litteratur om de aktuelle artene, og vurdert hvilke negative effekter disse kan føre til dersom de kommer ut i norsk natur. VKM har også gjort en vurdering av hvor sannsynlig det er at artene vil kunne etablere seg i Norge. Risikoen som krabbene utgjør bestemmes dermed av effekter og sannsynlighet. I tillegg har VKM foreslått mulige risikoreduserende tiltak. Effekter og sannsynlighet utgjør til sammen risikoen hver art medfører. VKM identifiserte tre faktorer som kan påvirke det biologiske mangfoldet negativt. Vi har gjennomførte risikovurderinger for hver av disse faktorene: konkurranse med hjemmehørende arter predasjon og beiting på hjemmehørende arter overføring av sykdommer I tillegg kan etablering av enkelte av artene, spesielt kinesisk- og japansk ullhåndskrabbe, og deres adferd med å grave ganger i elvebredden, føre til strukturelle endringer i økosystemene. Resultater_ VKMs risikovurderingen indikerer varierende risikonivåer for de ulike faktorene og artene. Vi konkludere med at det er høy risiko for negative effekter som følge av konkurranse og predasjon for to av artene, og middels risiko for ytterligere fem. Når det gjelder sykdomsspredning, er det høy risiko knyttet til de to ullhåndskrabbe-artene, og mulig høy risiko knyttet til amerikansk steinkrabbe. Sykdommene som utgjør den største trusselen, er krepsepest og gaffkemi, som rammer ferskvannslevende edelkreps og hummer hardest. VKM vurderer også at tre av artene utgjør en moderat risiko knyttet til gravende adferd. ‑ Fremmede krabber som importeres levende som mat har et betydelig potensial for å etablere seg i sjø og ferskvann. Sannsynligheten for etablering er høy fordi artene er tilpasningsdyktige, fordi enkelte arter kan tolerere miljøforhold lik det som finnes i store deler av Norge i dag, og fordi artene har høy reproduksjonsrate, sier Gaute Velle som har vært faglig ansvarlig for vurderingen. VKM har også gjort en totalvurdering av hvilken risiko de åtte artene utgjør dersom de importeres levende som mat. ‑ Spesielt sykdommer, som også kan spres av døde eller døende krabber, er en bekymring sier Velle. Potensialet for spredning av sykdommer har derfor veid tung når de åtte artene er rangert. Totalt sett er det lav risiko for kun to av de åtte artene, mens det er høy-, eller muligens høy risiko for tre arter og moderat risiko for tre arter, dersom artene importeres levende til bruk i mat-, og restaurantbransjen. Risikovurderingen er godkjent av VKMs faggruppe for biologisk mangfold.Assessment of risks posed by the import of live crabs intended for human consumptionacceptedVersionacceptedVersio