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A televised, web-based randomised trial of an herbal remedy (valerian) for insomnia.
No full textBACKGROUND: This trial was conducted as part of a project that aims to enhance public understanding and use of research in decisions about healthcare by enabling viewers to participate in research and to follow the process, through television reports and on the web. Valerian is an herbal over-the-counter drug that is widely used for insomnia. Systematic reviews have found inconsistent and inconclusive results about its effects. METHODS: Participants were recruited through a weekly nationally televised health program in Norway. Enrolment and data collection were over the Internet. 405 participants who were 18 to 75 years old and had insomnia completed a two week diary-keeping run-in period without treatment and were randomised and mailed valerian or placebo tablets for two weeks. All participants and investigators were blind to treatment until after the analysis was completed. FINDINGS: For the primary outcome of a minimally important improvement in self-reported sleep quality (>/=0.5 units on a 7 point scale), the difference between the valerian group (29%) and the placebo group (21%) was not statistically significant (difference 7.5%; 95% CI-0.9 to 15.9; p = 0.08). On the global self-assessment question at the end of the treatment period 5.5% (95% CI 0.2 to 10.8) more participants in the valerian group perceived their sleep as better or much better (p = 0.04). There were similar trends favouring the valerian group for night awakenings (difference = 6.0%, 95% CI-0.5 to 12.5) and sleep duration (difference = 7.5%, 95% CI-1.0 to 16.1). There were no serious adverse events and no important or statistically significant differences in minor adverse events. INTERPRETATION: Based on this and previous studies, valerian appears to be safe, but with modest beneficial effects at most on insomnia compared to placebo. The combined use of television and the Internet in randomised trials offers opportunities to answer questions about the effects of health care interventions and to improve public understanding and use of randomised trials. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN72748991
The Oslo Health Study: Is bone mineral density higher in affluent areas?
No full textABSTRACT: BACKGROUND: Based on previously reported differences in fracture incidence in the socioeconomic less affluent Oslo East compared to the more privileged West, our aim was to study bone mineral density (BMD) in the same socioeconomic areas in Oslo. We also wanted to study whether possible associations were explained by socio-demographic factors, level of education or lifestyle factors. METHODS: Distal forearm BMD was measured in random samples of the participants in The Oslo Health Study by single energy x-ray absorptiometry (SXA). 578 men and 702 women born in Norway in the age-groups 40/45, 60 and 75 years were included in the analyses. Socioeconomic regions, based on a social index dividing Oslo in two regions - East and West, were used. RESULTS: Age-adjusted mean BMD in women living in the less affluent Eastern region was 0.405 g/cm2 and significantly lower than in West where BMD was 0.419 g/cm2. Similarly, the odds ratio of low BMD (Z-score </= -1) was 1.87 (95% CI: 1.22-2.87) in women in Oslo East compared to West. The same tendency, although not statistically significant, was also present in men. Multivariate analysis adjusted for education, marital status, body mass index, physical inactivity, use of alcohol and smoking, and in women also use of post-menopausal hormone therapy and early onset of menopause, did hardly change the association. Additional adjustments for employment status, disability pension and physical activity at work for those below the age of retirement, gave similar results. CONCLUSION: We found differences in BMD in women between different socioeconomic regions in Oslo that correspond to previously found differences in fracture rates. The association in men was not statistically significant. The differences were not explained by socio-demographic factors, level of education or lifestyle factors
Klagesaker etter sosialtjenesteloven 2006 – sammenstilling av fylkesmennenes rapportering
No full textNORSK SAMMENDRAG: Fylkesmannen er klageinstans for klager etter sosialtjenesteloven. I 2006 behandlet landets fylkesmenn 5351 slike klager. Rapporten omhandler hva slags saker dette er, utfallet av klagebehandlingen, begrunnelser for utfall og tiden det tar fra Fylkesmannen mottar klager til de er ferdig behandlet. I rapporten er det sammenligninger mellom fylkene/fylkesmennene, vurdert ut fra befolkningsgrunnlag, og i lys av tidligere års klagebehandling.\ud
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Sosialtjenesteloven trådde i kraft i 1993. Klagesaksstatistikken gjelder fra 1995. Antallet innkomne og behandlede klagesaker har gått ned i 2006. Med unntak av år 2000 har fylkesmennene aldri behandlet så få klagesaker etter sosialtjenesteloven. Tre av fire klager gjelder økonomisk stønad. Eksempler på saker om økonomisk stønad kan være klage på størrelsen på stønaden eller mer spesifi kk klage knyttet til boligutgifter, klær, tannbehandling, medisiner, inventar, reise eller andre kostnader. Klage kan også gjelde vilkår stilt til utbetalingen, at hjelpen blir gitt som lån eller at kommunen tar refusjon i etterbetalt trygd. I over ¾ av klagesakene om økonomisk stønad blir det kommunale vedtaket stadfestet.\ud
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Under 1/5 av klagesakene gjelder sosiale tjenester. Saker om sosiale tjenester er i hovedsak klage på omsorgslønn og praktisk bistand, for eksempel at omfanget hjemmehjelp er redusert eller at det ikke blir tildelt brukerstyrt personlig assistanse. Andre klagetema er utilstrekkelige støttekontakt- og avlastningstjenester, eller avslag på dekning av behandlingsutgifter for rusmiddelmisbrukere. I bortimot halvparten av sakene ble det kommunale vedtaket enten opphevet og saken sendt tilbake til ny behandling eller omgjort. Sannsynligheten for å få medhold er dermed langt større for klage på sosiale tjenester enn klage på økonomisk stønad.\ud
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85 prosent av klagesakene ble behandlet innen tre måneder. Ved utgangen av året var det 871 ubehandlede saker.\ud
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Rapporten er primært utarbeidet for at fylkesmennene og overordnede instanser skal ha oversikt over saksomfang og utviklingen på klagesaksområdet etter sosialtjenesteloven. Den kan også være av interesse for andre som ønsker innsikt i dette saksområdet eller som er opptatt av Fylkesmannens rolle som rettssikkerhetsinstans.SUMMARY IN ENGLISH: The Office of the County Governor is the administrative appeal body for complaints according to the Social Services Act. In 2006, these offices dealt with 5 351 complaints. This report describes the types of cases dealt with, the results of the complaints, the reasons for the decisions, and the time taken from when the complaints were received at the Office of the County Governor until the administrative procedures were completed. The report presents comparisons of the counties/the Offices of the County Governors in relation to the population, and the trends over the last few years.\ud
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The Social Services Act came into force in 1993. Statistics about cases of complaint are available from 1995. Fewer cases of complaint were received and dealt with in 2006 than in 2005. With the exception of 2000, in 2006 the Offices of the County Governors dealt with fewer cases of complaint according the Social Services act than in any other year.\ud
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Three of four cases of complaint were about economic assistance. Examples of such cases are complaints about the amount of economic assistance and more specific complaints about economic assistance for accommodation, clothes, dental treatment, medicine, furniture, travelling expenses and other expenses. There were also complaints about the conditions for receiving payment, that economic assistance was given as a loan, and that the municipality demanded reimbursement of social security benefits. In over three quarters of cases regarding economic assistance, the decision of the municipality was affirmed.\ud
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Less than one fifth of cases of complaint were about social services. Complaints about social services were mainly complaints about economic assistance for carers and practical assistance, for example reduction in home help services and lack of allocation of client-managed personal assistance. Other causes for complaint were inadequate support contact and respite care services, and rejection of application for reimbursement of expenses for treatment for alcohol and drug abusers. In about half of the cases, the decision of the municipality was either revoked and the case sent back to the municipality to be dealt with again, or the decision was reversed. The chance for the complaint being upheld is thus much greater for complaints regarding social services than for complaints about economic assistance.\ud
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Eighty-five per cent of complaints were dealt with within three months. At the end of the year there were 871 cases pending.\ud
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The report is primarily prepared to give the Offices of the County Governors and the higher authorities an overview of the amount of administrative work that is carried out and the trends in the area of complaints according to the Social Services Act. The report is also of interest for people who wish to obtain a greater insight in this area, or who are concerned about the role of the Offices of the County Governors as a body with responsibility for legal safeguards
Leisure time physical activity in middle age predicts the metabolic syndrome in old age: results of a 28-year follow-up of men in the Oslo study.
No full textBACKGROUND: Data are scarce on the long term relationship between leisure time physical activity, smoking and development of metabolic syndrome and diabetes. We wanted to investigate the relationship between leisure time physical activity and smoking measured in middle age and the occurrence of the metabolic syndrome and diabetes in men that participated in two cardiovascular screenings of the Oslo Study 28 years apart. METHODS: Men residing in Oslo and born in 1923-32 (n = 16 209) were screened for cardiovascular diseases and risk factors in 1972/3. Of the original cohort, those who also lived in same area in 2000 were invited to a repeat screening examination, attended by 6 410 men. The metabolic syndrome was defined according to a modification of the National Cholesterol Education Program criteria. Leisure time physical activity, smoking, educational attendance and the presence of diabetes were self-reported. RESULTS: Leisure time physical activity decreased between the first and second screening and tracked only moderately between the two time points (Spearman's rho = 0.25). Leisure time physical activity adjusted for age and educational attendance was a significant predictor of both the metabolic syndrome and diabetes in 2000 (odds ratio for moderately vigorous versus sedentary/light activity was 0.65 [95% CI, 0.54-0.80] for the metabolic syndrome and 0.68 [0.52-0.91] for diabetes) (test for trend P < 0.05). However, when adjusted for more factors measured in 1972/3 including glucose, triglycerides, body mass index, treated hypertension and systolic blood pressure these associations were markedly attenuated. Smoking was associated with the metabolic syndrome but not with diabetes in 2000. CONCLUSION: Physical activity during leisure recorded in middle age prior to the current waves of obesity and diabetes had an independent predictive association with the presence of the metabolic syndrome but not significantly so with diabetes 28 years later in life, when the subjects were elderly
Meat, vegetables and genetic polymorphisms and the risk of colorectal carcinomas and adenomas.
No full textBACKGROUND: The risk of sporadic colorectal cancer (CRC) is mainly associated with lifestyle factors, particularly dietary factors. Diets high in red meat and fat and low in fruit and vegetables are associated with an increased risk of CRC. The dietary effects may be modulated by genetic polymorphisms in biotransformation genes. In this study we aimed to evaluate the role of dietary factors in combination with genetic factors in the different stages of colorectal carcinogenesis in a Norwegian population. METHODS: We used a case-control study design (234 carcinomas, 229 high-risk adenomas, 762 low-risk adenomas and 400 controls) to test the association between dietary factors (meat versus fruit, berries and vegetables) genetic polymorphisms in biotransformation genes (GSTM1, GSTT1, GSTP1 Ile105Val, EPHX1 Tyr113His and EPHX1 His139Arg), and risk of colorectal carcinomas and adenomas. Odds ratio (OR) and 95% confidence interval (95% CI) were estimated by binary logistic regression. RESULTS: A higher ratio of total meat to total fruit, berry and vegetable intake was positively associated with both high and low-risk adenomas, with approximately twice the higher risk in the 2nd quartile compared to the lowest quartile. For the high-risk adenomas this positive association was more obvious for the common allele (Tyr allele) of the EPHX1 codon 113 polymorphism. An association was also observed for the EPHX1 codon 113 polymorphism in the low-risk adenomas, although not as obvious. CONCLUSION: Although, the majority of the comparison groups are not significant, our results suggest an increased risk of colorectal adenomas in individuals for some of the higher ratios of total meat to total fruit, berry and vegetable intake. In addition the study supports the notion that the biotransformation enzymes GSTM1, GSTP1 and EPHX1 may modify the effect of dietary factors on the risk of developing colorectal carcinoma and adenoma
Hva er en god død i sykehjem?
No full textAbout 40 percent of all deaths\ud
in Norway take place in nursing\ud
homes. The proportion will\ud
probably increase, and a majority\ud
will need end-of-life care/\ud
palliative care in the final days\ud
or weeks of their life. In Norway\ud
we know little about what constitutes\ud
a good death in nursing\ud
homes and how end-of-life care\ud
is practised. The project aimed\ud
at exploring what professionals\ud
working face-to-face with dying\ud
elderly persons defined as a\ud
good death and the necessary\ud
preconditions.\ud
A strategic sample of 14 professionals,\ud
working in five nursing\ud
homes in four different health\ud
regions, was interviewed. The\ud
interviews focused on the informants’\ud
working experience with\ud
dying nursing homes patients.\ud
Four main topics were emphasized:\ud
adequate pain and other\ud
symptom relief, not to be alone\ud
in the final days and hours,\ud
taking care of relatives and\ud
preventing unnecessary lifeprolonging\ud
treatment. Paying\ud
respect to the patient and her/\ud
his relatives was considered an\ud
essential prerequisite to attain a\ud
good and dignified death. Other\ud
conditions that have to be fulfilled\ud
were adequate routines\ud
of observatio
Assessing equity in clinical practice guidelines.
No full textRecognition of the need for systematically developed clinical practice guidelines (CPGs) has increased dramatically over the past 20 years. CPGs have focused primarily on the effectiveness of interventions, explicitly or implicitly addressing the following question: Will adherence to a recommendation do more good than harm? At times they have also focused on the cost-effectiveness of interventions: Are the net benefits worth the costs? They rarely have focused on equity: Are the recommendations fair? The Knowledge Plus Project of the International Clinical Epidemiology Network attempts to improve the process of CPG development by formulating strategies to consider not just technical issues (effectiveness, and efficiency) but sociopolitical dimensions as well (equity and local appropriateness). This article discusses a proposed lens for users to evaluate how well CPGs address issues of equity
Det norske drikkemønsteret. En studie basert på intervjudata fra 1973-2004
No full textNORSK SAMMENDRAG: Horverak har gjort en omfattende studie av det norske drikkemønsteret fra 1970-tallet til i dag. Ved å gå gjennom spørreundersøkelser om drikkevaner avdekker han endringene i det norske folks drikkemønster knyttet til bl.a. klasse, alder, generasjoner og kjønn.\ud
Forbruket vil øke - Dagens eldste drikker mindre enn generasjonene som kommer etter dem. Derfor vil alkoholforbruket i Norge med all sannsynlighet fortsette å øke i årene framover. Hvor lenge økningen vedvarer er avhengig av hvilket forbruksnivå yngre generasjoner legger seg på, sier Horverak.\ud
Økningen i alkoholforbruket fra 1979 til 2004, skyldes at nye generasjoner drikker mer enn generasjonene før dem gjorde da de var på deres alder. Nye generasjoner drikker seg også oftere beruset enn generasjonene før dem.\ud
Nordmenns foretrukne drikkested er hjemme eller hjemme hos andre. Unntaket er de yngste aldersgruppene. Fra 1991 til 2004 økte antall ganger 26-30 åringene besøkte utesteder med 70 %, og en noe svakere økning på de mellom 18 og 25 år. For aldersgruppene over 30 år har derimot besøket vært stabilt. I samme periode har antall skjenkesteder økt med ca 50 %. Det økte antall utesteder tiltrekker seg derfor i hovedsak et ungt publikum.\ud
Fra hjemmebrent til taksfri og grensehandel\ud
Hjemmebrent og til dels hjemmelaget vin dominerte på 70-tallet den alkoholen som ikke ble kjøpt inn på Vinmonopolet og i norske butikker og skjenkesteder. Nå er det derimot taksfri og grensehandel som dominerer det uregistrerte forbruket. Andelen som har handlet taksfri har økt fra 29 til 55 % fra 1979 til 2004, og andelen som har handlet i Sverige ble økte fra 9 til 22 % fra 1994 til 2004. Derimot var det kun 15 % som drakk hjemmebrent i 2004 mot 50 % i 1973.\ud
Det er en klar sammenheng mellom sosial klasse og drikkemønster. Funksjonærer drikker hyppigst, mens arbeidere drikker mer når de drikker. De drakk seg beruset ca hver fjerde gang de drakk, mens funksjonærene gjorde det ca hver sjette gang. Sosial tilhørighet har også betydning for om man foretrekker øl eller vin. Arbeidere har tradisjonelt drukket mer øl og funksjonærer mer vin. For alle grupper unntatt studenter har vinforbruket økt i perioden 1994 til 2004, mens brennevinforbruket har gått ned. Studenter har et mer ruspreget drikkemønster enn andre grupper: de drikker sjeldnere, men mer hver gang.ENGLISH SUMMARY: Since 1962 the Norwegian Institute for Alcohol and Drug Research has collected data about drinking habits from representative samples of the Norwegian population. The surveys have been carried out approximately every five years; last time in 2004. The first studies were limited to questions about drinking frequencies, but since 1973 people have been asked how much they usually drink of different types of alcoholic beverages during a drinking session. On the basis of questions about frequencies and quantities consumed, it was possible to estimate average alcohol consumption during the last year, and to give a description of changes in average alcohol consumption per year from 1973 to 2004.\ud
Since 1973 the respondents have also answered questions about quantity of alcohol consumed during the last drinking occasion. Based on the assumption that these last drinking occasions were representative for the way Norwegians used to drink alcoholic beverages, it was possible to analyse changes in the drinking pattern from 1973 to 2004.\ud
It is a well-known fact that quantity of alcohol consumed during a drinking occasion is linked to the context of the occasion. Therefore, questions about where the last drinking occasion took place, and the number of participating persons were included in the survey instrument. This gave us an opportunity to analyse in which way the amount consumed is linked to contextual variables.\ud
The first part of the report, chapters 1-4, discusses the content of the term “drinking pattern”, in relation to terms like drinking culture, drinking customs and drinking habits. In this part we draw on Bourdieu’s theories of the structure and formation of society. We reserve the term drinking pattern as a quantitative measure suitable to describe the way alcohol is consumed among a group of people; i.e. the drinking pattern consists of a set of values on a number of defined variables: average drinking frequency, average amount per drinking occasion, the share of the drinking occasions, which may be termed binge drinking, the distribution of the consumption among the different alcoholic beverages, weekly drinking rhythm, and some contextual variables.\ud
In chapter 5 the data base is described, while an analysis of the changes in the number of non-drinkers (people who have not consumed alcohol last year) is described in chapter 6. The share of non-drinkers fell from 32% in 1956 to 17% in 1966, and decreased further to 13% in 2004. It was a little bit more usual to drink alcohol among men than women, but the differences between genders tended to be smaller and smaller during the whole period. In 2004, 15% of women and 11% of men said that they had not consumed any alcoholic beverage during the last year.\ud
During the rest of the report we discuss the drinking pattern among those who declared they had drunk alcohol last year, i.e. the part of the population that forms the drinking pattern.\ud
In chapters 7-9 we analyse how different characteristics - i.e. sex, age, education, marital status, occupation, income, place of living, and year of the study - affected the preference for different alcoholic beverages, the incidence of binge drinking, and the amount of alcohol consumed during last year.\ud
The analyses showed that characteristics such as sex, occupation, and age affected the preference of beer during the last drinking occasion. Beer was most popular among young, male blue-collar workers. The data showed that the popularity of beer had increased over the years.\ud
Sex, age, education, place of living, and year of interview were factors that influenced the choice of wine. Well educated women in their 40s and 50s living in big cities were most likely to prefer wine. The popularity of wine showed a strong increase over time.\ud
The preferences for liquor were influenced by sex, education, occupation, and place of living. Liquor was most often preferred by male blue-collar workers living in rural areas. Contrary to beer and wine, the popularity of liquor showed a marked decrease over time.\ud
Alcopops were first and foremost preferred by female adolescents aged 15-20 years. Consumption of alcopops was almost non-existing among the older age groups.\ud
Home-made spirits were most often consumed by young, male blue-collar workers living in rural areas, while home-made wine was most often consumed by well-educated people living in small towns and in the country-side. The popularity of home-made wine and spirits had decreased over time.\ud
Binge drinking occasions were mainly influenced by sex, age, marital status, type of alcoholic beverage and the place where the drinking took place. Situations in which young, single men drank liquor outside their own home were most likely to lead to binge drinking.\ud
When it comes to the quantity of alcoholic beverages consumed over the last year, the data showed that men on average consumed 2.5 times more than women. The alcohol consumption decreased by age, while it seemed to increase with income, education and over time. People who lived in the Oslo area consumed more alcoholic beverages than people living in small towns and rural areas.\ud
Chapter 10 consists of a cohort analysis of the data of yearly consumption and binge drinking. We tried to separate the effects of aging, time period and introduction of new generations and found that the increasing alcohol consumption was mainly due to the fact that new generations drank more than the generations before them, while there had been no changes due to time period or changes in the effect of aging. However, binge drinking was affected by changes in the effect of aging in addition to a generation effect; binge drinking had become somewhat more common among older people than it was in the 70ies. This tendency was stronger among men than among women.\ud
In chapters 11-18 we take a closer look at the characteristics we use to describe the Norwegian drinking pattern. We separated the population into four groups: blue-collar workers; white-collar workers; students, pupils and apprentices, and retirees and social insurance recipients. The characteristics we studied were choice of alcoholic beverage, quantity consumed per drinking occasion and during last year, binge drinking, weekly drinking rhythm, location of drinking, and drinking company. We also analysed the consumption of so-called unregistered alcohol, i.e. home-made spirits, home-made-wine, smuggled spirits, alcoholic beverages bought in tax-free shops, and border trade with alcoholic beverages. Finally, we discussed if any of the groups had changed their drinking habits in such a way that it became more like the way alcohol is used in the Mediterranean countries (i.e. wine to meals). The data showed no such development for any of the different social groups.\ud
In chapter 19 we give a summary of the Norwegian alcohol policy during the period 1970-2004, while we summarize the results of the study in the last chapter.\ud
Appendix 2 contains the figures which are the basis of the diagrams reproduced in the report
Omfang av sprøytemisbruk i Norge
No full textNORSK SAMMENDRAG: Rapporten presenterer beregninger av omfang av sprøytemisbruk i Norge og hvordan dette har utviklet seg fra 1997 til 2004. Beregningene viser følgende:\ud
Antall sprøytemisbrukere i Norge nådde en topp i 2001, for så å gå ned til 2003. Etter dette har det skjedd en utflating til 2005. Det er ett sted mellom 8 200 og 12 500 misbrukere i Norge i 2005. Den viktigste årsaken til fallet er trolig at mange sprøytemisbrukere ble tatt inn i legemiddelassistert rehabilitering (LAR).\ud
Debutalderen har økt, nå er gjennomsnittet 26,9 år. Det er større aldersspredning på de som begynner nå enn tidligere. Det er ingen tegn til økt rekruttering til sprøytemisbruk.\ud
Gjennomsnittsalderen blant misbrukerne er økende. Ved sprøyteutdelingen i Oslo økte snittalderen fra 29 år i 1993 til 36 år i 2006. Årsaken er trolig at flere starter senere og at mange av de som startet tidlig fremdeles er misbrukere.\ud
Kvinneandelen blant misbrukerne er synkende. I dag er den mellom 25-30 prosent mot rundt 30-35 prosent på begynnelsen av 1990-tallet.\ud
Oslos andel av sprøytemisbrukere har sunket etter 1999. Men antall sprøytemisbrukere pr innbygger er fortsatt større i Oslo enn landet ellers.\ud
Det er ikke mulig å gi eksakte tall over sprøytemisbruk, fordi dette er en tabubelagt og illegal aktivitet som ikke fanges opp av vanlige spørreundersøkelser. Tallberegningene i rapporten bygger bl.a. på oversikter over narkotikadødsfall, dødelighet blant sprøytemisbrukere, funn av morfin i blodet hos bilførere, pasienter i legemiddelassistert behandling og rapporter om sprøytemisbruk fra sosialtjenesten i kommunene og lokale politikamre.ENGLISH SUMMARY: This report details estimates carried out to assess the number of injecting drug users in Norway, including prevalence by age, sex and place of residence. Injecting drug users are widely considered to constitute one of the most vulnerable segments of the drug using population, exhibiting higher mortality and morbidity rates compared with other drug users and the wider public. They are more socially distressed, and problems associated with substance dependency appear to be more severe than among other drug users. Information on the size of the injecting population is essential for capacity planning in the health and social services and for interventions aimed at mitigating drug use.\ud
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Three methods are used to estimate the size of the injecting population: a mortality multiplier; a community-level survey; and a multiple-indicator method. They were selected in light of available Norwegian data. There are not many good indicators for estimating prevalence and trends in the injecting population.\ud
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Our estimates suggest that the 2004 population of injecting drug users in Norway ranged between 8,200 and 12,500. The upper limit is slightly higher than that obtained with the mortality multiplier method. The estimates provided by the other two methods are probably over-generous. As our indicators are relatively stable for the 2004-2005 period, our inferred estimate of the 2005 population also lies within the 8,200-12,500 range.\ud
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Estimates derived from the mortality multiplier show a rising number of active injectors 1997-2000, followed by a dip in 2003 and a plateau 2004/5. Our estimates give therefore fewer active injectors today than around the turn of the century. The rise in the number of patients in substitution treatment (LAR) could explain the fall 2001-2003. Patient numbers continued to grow however in 2003-2005, without a concomitant reduction in the injecting population. This discrepancy could be explained either by substitution treatment drop outs, reverting to active drug use, or a higher influx of new injectors. Available data do not indicate, however, rising recruitment. There is a paucity of information on other therapies in Norway targeting drug injectors, but capacity here has probably remained stable while substitution treatment was being established.\ud
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The female injecting population has probably fallen slightly since the early 1990s, from about 30-35 per cent to 25-30 per cent. Over the same period, average age has risen. Age of debut (first injection) has also increased, with newcomers exhibiting a wider age range than previously.\ud
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The number of injecting drug users in Oslo did not rise from 1999 to 2001, contrary to the rest of Norway. And the estimated number of Oslo-based injectors also fell more sharply than in other areas after 2001, in compliance with the falling proportion of the injecting population in Oslo. In the rest of Norway, divided into three areas, the growth of 1999-2001 and decline of 2001-2005 were comparable with national trends. Although Oslo’s share of injectors fell after 1999, prevalence and associated problems are still more prominent here than elsewhere in the country
Understanding the implementation of complex interventions in health care: the normalization process model.
No full textBACKGROUND: The Normalization Process Model is a theoretical model that assists in explaining the processes by which complex interventions become routinely embedded in health care practice. It offers a framework for process evaluation and also for comparative studies of complex interventions. It focuses on the factors that promote or inhibit the routine embedding of complex interventions in health care practice. METHODS: A formal theory structure is used to define the model, and its internal causal relations and mechanisms. The model is broken down to show that it is consistent and adequate in generating accurate description, systematic explanation, and the production of rational knowledge claims about the workability and integration of complex interventions. RESULTS: The model explains the normalization of complex interventions by reference to four factors demonstrated to promote or inhibit the operationalization and embedding of complex interventions (interactional workability, relational integration, skill-set workability, and contextual integration). CONCLUSION: The model is consistent and adequate. Repeated calls for theoretically sound process evaluations in randomized controlled trials of complex interventions, and policy-makers who call for a proper understanding of implementation processes, emphasize the value of conceptual tools like the Normalization Process Model