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Background The association between highly stressful life experiences and morbid obesity is well documented internationally, but this knowledge is not incorporated to any great extent in Norwegian clinical practices. We have studied the reports of previous life stresses from a sample of Norwegian patients under assessment for morbid obesity at a centre where the topic of life experiences was included during the recording of patient histories. Material and method In the summer of 2018, an invitation to participate in the study was distributed to the last 200 patients to have been examined at the Regional Centre for Morbid Obesity in Bodo. Information on lifetime adversity was collected in clinical interviews. Data were retrieved from the patient's discharge summaries, and these texts were analysed using a qualitative approach. Stressful life experiences were divided into twelve categories. Results The study recruited 70 participants (57 women) with morbid obesity. Of these, 64 (91 %) related at least one significant and stressful life experience, and 39 (56 %) reported three or more different types. The most frequent types included serious relationship ruptures, parental neglect and other negative childhood experiences. Interpretation In a sample of Norwegian patients who were undergoing examination for morbid obesity there were many who reported distressing life histories. Lack of existential security in childhood, often linked to complex traumas, was prominent. In light of international research on the association between trauma and obesity, our results indicate that the patient's life history should be included in an assessment of patients with morbid obesity.

Background The contract GP scheme in Norway has been a success, but the scheme's sustainability has been weakened. In summer 2017, the so-called Tronder rebellion arose among GPs who wished to analyse the situation. In order to obtain a better understanding of their total daily workload, all GPs in Norway were invited to record all their activity on a typical day in their practices. This included 22 pre-defined, currently relevant issues that form the basis of this article. Material and method In 2018, all of Norway's 4 784 registered GPs received a web-based questionnaire survey. Altogether 1 032 doctors responded to the survey. The dataset elucidates more than 20 000 consultations throughout the country and more than 44 000 issues. Results On average, the GPs carried out 20 consultations addressing 43 different issues on a typical day in their practices. There were small differences between men and women doctors. Multimorbidity was a factor in 29 % of the consultations, mental disorders in 22 % and stress and life strains in 18 %. The GPs felt that they had a key role in providing support or life coaching in 15 % of the consultations. Interpretation The study documents that complex and demanding issues are a frequent occurrence. The GPs play a key role in the treatment of multimorbid patients, prevention of disease and detection and follow-up of cancer. The study underscores the importance of broad-based knowledge and fundamental continuity in the doctor-patient relationship.

Systems medicine, which is based on computational modelling of biological systems, is emerging as an increasingly prominent part of the personalized medicine movement. It is often promoted as ‘P4 medicine’ (predictive, preventive, personalized, and participatory). In this article, we test promises made by some of its proponents that systems medicine will be able to develop a scientific, quantitative metric for wellness that will eliminate the purported vagueness, ambiguity, and incompleteness—that is, normativity—of previous health definitions. We do so by examining the most concrete and relevant evidence for such a metric available: a patent that describes a systems medicine method for assessing health and disease. We find that although systems medicine is promoted as heralding an era of transformative scientific objectivity, its definition of health seems at present still normatively based. As such, we argue that it will be open to influence from various stakeholders and that its purported objectivity may conceal important scientific, philosophical, and political issues. We also argue that this is an example of a general trend within biomedicine to create overly hopeful visions and expectations for the future.

Objectives: Multimorbidity is prevalent, and knowledge regarding its aetiology is limited. The general pathogenic impact of adverse life experiences, comprising a wide-ranging typology, is well documented and coherent with the concept allostatic overload (the long-term impact of stress on human physiology) and the notion embodiment (the conversion of sociocultural and environmental influences into physiological characteristics). Less is known about the medical relevance of subtle distress or unease. The study aim was to prospectively explore the associations between existential unease (coined as a meta-term for the included items) and multimorbidity. Setting: Our data are derived from an unselected Norwegian population, the Nord-Trøndelag Health Study, phases 2 (1995–1997) and 3 (2006–2008), with a mean of 11 years follow-up. Participants: The analysis includes 20 365 individuals aged 20–59 years who participated in both phases and was classified without multimorbidity (with 0–1 disease) at baseline. Methods: From HUNT2, we selected 11 items indicating ‘unease’ in the realms of self-esteem, well-being, sense of coherence and social relationships. Poisson regressions were used to generate relative risk (RR) of developing multimorbidity, according to the respondents' ease/unease profile. Results: A total of 6277 (30.8%) participants developed multimorbidity. They were older, more likely to be women, smokers and with lower education. 10 of the 11 ‘unease’ items were significantly related to the development of multimorbidity. The items ‘poor self-rated health’ and ‘feeling dissatisfied with life’ exhibited the highest RR, 1.55 and 1.44, respectively (95% CI 1.44 to 1.66 and 1.21 to 1.71). The prevalence of multimorbidity increased with the number of ‘unease’ factors, from 26.7% for no factor to 49.2% for 6 or more. Conclusions: In this prospective study, ‘existential unease’ was associated with the development of multimorbidity in a dose–response manner. The finding indicates that existential unease increases people's vulnerability to disease, concordant with current literature regarding increased allostatic load. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Objective To study potential changes in attendance at emergency departments (ED) in Reykjavik immediately following the swift economic meltdown in Iceland in October 2008. Methods Using electronic medical records of the National University Hospital in Reykjavik, a population-based register study was conducted contrasting weekly attendance rates at Reykjavik ED (cardiac and general ED) during 10-week periods in 2006, 2007 and 2008. The weekly number of all ED visits (major track), with discharge diagnoses, per total population at risk were used to estimate RR and 95% CI of ED attendance in weeks 41–46 (after the 2008 economic collapse) with the weekly average number of visits during weeks 37–40 (before the collapse) as reference. Results Compared with the preceding weeks (37–40), the economic collapse in week 41 2008 was associated with a distinct increase in the total number of visits to the cardiac ED (RR 1.26; 95% CI 1.07 to 1.49), particularly among women (RR 1.41; 95% CI 1.17 to 1.69) and marginally among men (RR 1.15; 95% CI 0.96 to 1.37). A similar increase was not observed in week 41 at the general ED in 2008 or in either ED in 2007 or 2006. In week 41 2008, visits with ischaemic heart disease as discharge diagnoses (ICD-10: I20–25) were increased among women (RR 1.79; 95% CI 1.01 to 3.17) but not among men (RR 1.07; 95% CI 0.71 to 1.62). Conclusion The dramatic economic collapse in Iceland in October 2008 was associated with an immediate short-term increase in female attendance at the cardiac ED.

Summary Background. Human beings are reflective, meaning-seeking, relational and purposeful organisms. Although experiences associated with such traits are of paramount importance for the development of health and disease, medical science has so far failed to integrate these phenomena into a coherent theoretical framework. Material and method. We present a theory-driven synthesis of new scientific knowledge from a number of disciplines, including epigenetics, psycho-neuro-endocrino-immunology, stress research and systems biology, based on articles in recognised scientific journals and other academic works. The scientific sources have been deliberately chosen to provide insight into the interaction between existential conditions in the widest sense (biography) and biomolecular processes in the body (biology). Results. The human organism literally incorporates biographical information which includes experienced meaning and relations. Knowledge from epigenetics illustrates the fundamental biological potential for contextual adaptation. Intriguingly, different types of existential stresses can enhance disease susceptibility through disturbances to human physiological adaptation systems, mediated in part through structural influences on the

BACKGROUND Blood pressure monitoring is one of the most common procedures in clinical medicine. Evaluation and treatment of hypertension are costly and have considerable implications for the individuals involved. Mercury manometers have been dominant for a century, but are currently being replaced by other types of equipment. No national guidelines/recommendations exist on types of blood pressure monitors to be used. The aim of this study was to assess the types of blood pressure monitors used in Norwegian general practice, and to what extent routines have been established for control and calibration of the equipment. MATERIAL AND METHODS In 2007, a questionnaire was distributed to 65 university-affiliated primary healthcare centres in Mid-Norway. The questions included what type of blood pressure monitors are in use and whether routines exist for calibration of them. RESULTS 45 healthcare centres with a total of 173 general practitioners (corresponding to 74 % of the doctors) responded. 18 (6 %) of the 320 monitors identified were of the mercury type, the rest were aneroid or oscillometric. Many centres had 24-hour monitors. Two healthcare centres (4 % of the doctors) had established routines for calibration of their blood pressure monitors. INTERPRETATION Routines should be established for quality assurance of blood pressure monitors in Norwegian primary healthcare services.

We endorse Timms and Bird’s preference for lifestyle adjustments as the first issues to discuss over “active treatment.”1 2 However, GPs often don’t have enough time, making it attractive to resort to medicalisation. Few patients succeed in lowering blood pressure or blood lipids below recommended values through lifestyle changes, at least in the longer term. We’re glad that Dr Timms has not experienced stigmatisation …

Providing information to enable informed choices about healthcare sounds immediately appealing to most of us. But Minna Johansson and colleagues argue that preventive medicine and expanding disease definitions have changed the ethical premises of informed choice and our good intentions may inadvertently advance overmedicalisation

Medical resources are increasingly shifting from making patients better to preventing them from becoming ill. Genetic testing is likely to extend the list of conditions that can be screened for. Is it time to stop and consider whom we screen and how we approach it Most medical experts and health authorities consider consultations in primary health care ideal for opportunistic health promotion and disease prevention. Doctors are thus expected to discuss preventive measures even when they are not among the reasons for contact. But are such opportunistic initiatives ethically justifiable in contemporary Western medicine? We argue that doctors should maintain a clear focus on each patient's reasons for seeking help rather than be distracted by an increasing list of standardised preventive measures with unpredictable relevance to the individual. The cornerstone of medical practice is the consultation between a patient who seeks help and a doctor whomthe person trusts.1 Several theoretical models have been developed to analyse and improve the quality of the consultation. In 1979, Stott and Davis presented an influential model that elicited four potentials of the encounter between patient and doctor: management of presenting problems, modification of help seeking behaviour, management of continuing problems, and opportunistic health promotion.2 Since then, opportunistic preventive initiatives have become considered to be part of good medical practice. From a moral point of view, preventive medicine– that is, initiatives to improve health among people who are currently free of symptoms–is fundamentally different from curative medicine, which is offered to patientswho seek medical help. The two disciplines imply different promises and have different obligations to the individuals whose lives they modify.3 When Stott and Davis developed their model, the number of relevant opportunistic initiatives was limited and seemed both technically feasible and ethically justifiable. However, interest in risk factors in healthy …

Linn Getz and colleagues describe how a Norwegian king beat Freud to the talking cure by more than 700 years In the face of another person’s suffering, a listener can offer to be a competent, dedicated, and attentive co-thinker—not pretending to know the solution, but trusting the healing power inherent in an empathetic relationship. In an atmosphere saturated with diagnostic labels, antidepressants, and standardised cognitive therapy schemes, we want to highlight the therapeutic potential of dialogue. We present an anecdote written around the year 1220 in the Icelandic saga Morkinskinna.1 2 3 4 There, we meet the Norwegian king Eysteinn, who ruled in Norway 1103–1123, and an Icelandic skald (highly respected court poet), Ivar Ingimundarson. Ivar has become deeply melancholic and the king seeks to find out what troubles him and how to help. Finally, Ivar’s grief is resolved by daily conversations between the two men. Sigmund who? #### Morkinskinna—a king’s saga with an unruly touch Morkinskinna, which means “mouldy parchment,” was originally the name of a book sent from Iceland to Copenhagen’s Royal Library in 1662, where it is still preserved (numbered as 1009 fol⇓). The saga was written in Iceland around the year 1220. It describes the history of the Norwegian kings from 1030 until 1157, when the text ends abruptly, as the last part of the manuscript has been lost. The author is unknown, but Morkinskinna was evidently a central source for the later and far more renowned saga Heimskringla.4 A distinctive feature of Morkinskinna is its numerous inserted anecdotes. Many of these describe the relationship between a Norwegian king and an Icelandic guest or man of court. The literary format of Morkinskinna has long been considered unwieldy and of lesser quality than other more stringent sagas, but literary scholars have recently been captivated by its charm and distinctive human touch.4 …

Objective To estimate the high risk group for cardiovascular disease in a well defined Norwegian population according to European guidelines and the systematic coronary risk evaluation system. Design Modelling study. Setting Nord-Trondelag health study 1995-7 (HUNT 2), Norway. Participants 5548 participants of the Nord-Trondelag health study 1995-7, aged 40, 50, 55, 60, and 65. Main outcome measures Distribution of risk categories for cardiovascular disease, with emphasis on the high risk group. Main results At age 40, 22.5% (95% confidence interval 19.3% to 25.7%) of women and 85.9% (83.2% to 88.6%) of men were at high risk of cardiovascular disease. Corresponding numbers at age 50 were 39.5% (35.9% to 43.1%) and 88.7% (86.3% to 91.0%) and at age 65 were 84.0% (80.6% to 87.4%) and 91.6% (88.6% to 94.1%). At age 40, one out of 10 women and no men would be classified at low risk for cardiovascular disease. Conclusion Implementation of the 2003 European guidelines on prevention of cardiovascular disease in clinical practice would classify most adult Norwegians at high risk for fatal cardiovascular disease.