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We aim to estimate the incidence rates (IRs) of SARS-CoV-2 infections stratified by disease severity and comorbidities in pediatric population and to describe the COVID-19 vaccination coverage in children with and without comorbidities. A population-based cohort study was conducted in 6 electronic healthcare records databases from Italy, Spain, and Norway. The study lasted from 1 January 2020 to the latest databases' available data in each site, i.e., in Italian ARS Tuscany and PEDIANET: December 2021, in Spanish BIFAP: February 2022; SIDIAP: June 2022, and VID: December 2021. Finally, in Norwegian Health Registries: December 2021. Children and adolescents were included and stratified into three age categories (< 5, 5- < 12, and 12- < 18 years old). IRs (95% confidence intervals) per 100 person-years (PY) for non-severe (positive SARS-CoV-2 test or diagnosis without hospitalization) and severe COVID-19 (hospitalization, intensive care unit admission, and death after COVID-19) are reported. The cumulative COVID-19 vaccination rollout was stratified by population with and without comorbidities. The study population comprised 5,654,040 individuals < 18 years of age (51% females) across the six European databases (median age: 6 years), with 1.4 to 8.5% of them having at least one at-risk comorbidity for severe COVID-19. Incidence rates of severe COVID-19 were low (0-1 per 100 PY) but 3 to 4 times higher among children and adolescents with comorbidities during Omicron BA.1-2 wave in December 2021-January 2022. Percentages of vaccination rollout in the general population were between 13% in PEDIANET-IT and 64% in BIFAP-ICU-ES. In ARS-IT and SIDIAP-IT, vaccination rate in children with comorbidities was slightly lower than that in the general population., Conclusion: Severe COVID-19 was rare across databases, but up to 3 to 4 times higher in children with comorbidities during the predominance of Omicron BA.1-2 variant in winter 2021-2022. COVID-19 vaccination coverage was slightly lower in children with comorbidities in ARS (Tuscany) and SIDIAP (Catalonia) data sources. Our findings will inform future public policies aimed to protect the pediatric population, both within these countries and globally., What Is Known: • Pediatric population is susceptible to SARS-CoV-2 infection. • COVID-19 severity rates in children vary across study settings and context., What Is New: • This study confirms the low severity rates of COVID-19 in the pediatric population based on a large cohort of children and adolescents residing in Spain, Italy, and Norway. • Incidence of severe COVID-19 in children and adolescents with comorbidities was up to 3 to 4 times higher than in the general pediatric population during the SARS-CoV-2 high transmission wave of Omicron BA.1-2 variant in winter 2021-2022 in Italy and Spain., Competing Interests: Declarations Ethics approval Most data partners that provided data for the herein-presented results had passed the local ethical review process for the whole COVID-19 Vaccine Monitor study (EUPAS42467); Norwegian data (NHR): Regional Committee for Research Ethics (approval number 155294/REK Nord) and the Data Protection Officer at the University of Oslo (approval number 523275); Valencian data (VID): Comité Ético de Investigación con Medicamentos del Hospital General Universitario de Elche (approval number: PI-90/2021); Catalonian data (SIDIAP): Comitè Ètic d'Investigació amb medicaments (CEIm) de l'IDIAP Jordi Gol (approval number: 21/199-PCV); and BIFAP (several Spanish regions): Comité de Ética de la Investigación con Medicamentos del Hospital Universitario de la Princesa and Comité Científico de BIFAP (approval number: CEIm 14/21). There was no need of ethical committee approval for Italian databases (ARS and PEDIANET). This research adhered to the rules and principles of the European Network of Centers of Pharmacoepidemiology and Pharmacovigilance (ENCePP) Code of Conduct. Consent to participate This research was conducted using secondary heathcare data. Informed consent to participate was not obtained. The whole COVID-19 Vaccine Monitor study (EUPAS42467) was conducted following the ENCePP Code of Conduct. Competing interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: In community settings, relatives often provide care to their older family members, which is sometimes perceived as a high burden, overwhelming and stressful, contributing to an increased risk of elder abuse. In most countries, relatives have no legal obligation to provide care when family members are admitted to nursing homes; nevertheless, studies have shown that relatives continue to provide emotional, instrumental, and personal care after admission, often related to the understaffing and high workload of nursing staff. Despite the growing interest in elder abuse in nursing homes, most studies have concentrated on the abuse perpetrated by nursing staff or co-residents, but few studies have explored the abuse that relatives may perpetrate., Methods: This study was a cross-sectional survey of 3,693 nursing staff members recruited from 100 nursing homes in Norway, to examine the extent of relative-to-resident abuse in Norwegian nursing homes, as observed by nursing staff., Results: The findings indicate that 45.6% of the nursing staff had observed one or more episodes of relative-to-resident abuse during the past year. Among the subtypes of abuse, 44.8% of the nursing staff had observed psychological abuse, 8.4% had observed physical abuse, 2.7% had observed financial/material abuse, and 0.7% had observed sexual abuse at least once during the past year., Conclusions: This is the first large study exploring the extent of relative-to-resident abuse in nursing homes, which is a phenomenon that is significantly less addressed than abuse committed by staff and co-residents. The findings in our study illustrate that abuse committed by relatives needs more awareness and attention to improve the well-being of nursing home residents. Further research is recommended to enhance our understanding of such abuse and should include other approaches measuring the proportion of relative-to-resident abuse, as relying solely on staff observations is insufficient for determining the prevalence in this case. Future studies should also examine the cumulative impact of victimization in nursing homes and should include an analysis of how cases of abuse are reported and handled., (© 2024. The Author(s).)

Background: The use of medication for Attention-Deficit/Hyperactivity Disorder (ADHD) increased globally throughout the early 2000s. This study examine trends in prevalences and incidences of medication use in Norway from 2006 to 2022., Methods: Data from the Norwegian Prescription Database were used to present one-year-prevalence and incidence rates of ADHD medication (ATC-group N06BA and C02AC02) for the overall population (ages 6-64) and within sex and age subgroups of children (ages 6-17) and adults (ages 18-64). Incident use was defined as the dispensing of medication, with no recorded use in the previous two calendar years., Results: The overall prevalence of ADHD medication use in 6- to 64-year-olds increased from 5.2 to 19.4 per 1000 in the period, most pronounced from 2020 and onwards. While males experienced a nearly threefold increase in use (from 7.3 to 20.6 per 1000), the use among females increased almost sixfold during the study period (from 3.0 to 18.1 per 1000). Consequently, the male-to-female prevalence-ratio decreased from 2.4 to 1. Children exhibited a higher prevalence of use compared to adults throughout the period, although the largest relative increase was observed in adults, particularly in female adults. In children the male-to-female ratio decreased from 3.2 to 2.0, primarily due to an increasing use in 13-17-year-old females. Among adults, prevalences were similar across most age groups, with the highest rates observed among those aged 18-24, where female use exceeded male use by the end of the period. The male-to-female prevalence-ratio in adults decreased from 1.6 to 0.9 during the period. Parallel to prevalent use, overall incident use increased from 1.4 to 5.0 per 1000 during the period, with the most pronounced increase occurring from 2020 and onwards. From this point, incident use among females aged 13-17, 18-24, and 25-34, exceeded that of males. The male-to-female incidence-ratio decreased from 1.8 to 0.9. The overall incidence to prevalence ratio remained similar throughout the period, being 0.27 in 2006 and 0.25 in 2022., Conclusion: A sustained increase in the prevalence of ADHD medication use was observed, with the most pronounced rise occurring among females and adults from 2020 and onwards. By 2022, the overall gender disparity in ADHD medication use had diminished, which should be considered in the context of a steep increase in incident use among adolescent and young adult females starting from 2020., (© 2024. The Author(s).)

Background: The alcohol harm paradox (APH) posits that alcohol harms are more prevalent in low socioeconomic position (SEP) groups compared to high SEP groups, when adjusted for alcohol consumption volume., Aim: We explored whether APH is valid for self-reported alcohol harms and whether SEP differences in hazardous drinking patterns may explain SEP differences in alcohol harms, accounting for consumption volume., Data and Methods: We applied cross-sectional data from national population surveys in Norway, restricted to a subsample of past month drinkers aged 25-79 years (n = 8 171). Two binary outcome measures of self-reported alcohol-related harms were constructed from the AUDIT-10 items 4 through 10; alcohol dependence symptoms and alcohol related consequences. We separated two SEP groups based on education level: low versus high. Employing logistic regression models, we examined the extent to which SEP differences in alcohol-related harms were attributable to a more hazardous drinking pattern in terms of: (i) heavy episodic drinking and (ii) proportion of consumption volume by spirits, adjusting for consumption volume and demographic characteristics., Results: In the low SEP group, alcohol-related harms were significantly more prevalent as compared to the high SEP group when adjusted for gender and age, and more so after adjustment for consumption volume. Measures of hazardous drinking pattern and having a spouse could only to a minor extent account for the elevated risk of alcohol-related harm in the low SEP group. The findings were robust across various sensitivity analyses., Conclusion: Low SEP was associated with alcohol-related harm and a more hazardous drinking pattern but also with lower consumption volume. The findings support the validity of the alcohol harm paradox for self-reported alcohol harms., (© 2024. The Author(s).)

Background: This study investigated the prevalence of pain, depressive symptoms, and their co-occurrence in Norwegian adolescents. Additionally, we investigated if perceived achievement pressure and coping with pressure were associated with pain, depressive symptoms and co-occurrent pain and depressive symptoms., Methods: Cross-sectional data from the Norwegian Ungdata Survey (2017-2019) were analysed. Adolescents from across Norway completed an electronic questionnaire including questions on perceived achievement pressure, coping with pressure, pain, and depressive symptoms. Descriptive statistics presented prevalence rates, and multinominal regression reported in relative risk ratios (RR) was employed to estimate associations, adjusted for gender (boys/girls), school level, and socioeconomic status., Results: The analyses included 209,826 adolescents. The prevalence of pain was 33%, 3% for depressive symptoms, and 14% reported co-occurring pain and depressive symptoms. The prevalence of co-occurring symptoms was higher in girls (22%) than boys (6%). Significant associations were found between perceived achievement pressure and pain (RR 1.11, 95% CI 1.10-1.11), depressive symptoms (RR 1.27, 95% CI 1.27-1.28), and co-occurring symptoms (RR 1.34, 95% CI 1.33-1.34). Struggling to cope with pressure was associated with pain (RR 2.67 95% CI 2.53-2.81), depressive symptoms (RR 16.68, 95% CI 15.60-17.83), and co-occurring symptoms (RR 27.95, 95% CI 26.64-29.33)., Conclusion: The prevalence of co-occurring pain and depressive symptoms is high among Norwegian adolescents. Perceived achievement pressure and struggling to cope with pressure were associated with isolated and, more strongly, co-occurring pain and depressive symptoms. Enhancing adolescents' ability to cope with pressure could be a crucial target in treating pain and depressive symptoms., (© 2024. The Author(s).)

Background: Menopausal hormone therapy (MHT) is associated with an increased risk of postmenopausal breast cancer, predominantly the luminal A-like subtype. The impact of MHT on deaths from breast cancer subtypes is less understood. This study aimed to explore associations between MHT use and the incidence, mortality, and survival of intrinsic-like breast cancer subtypes., Methods: Data from 160,881 participants with self-reported MHT use from the prospective Norwegian Women and Cancer Study were analyzed. Among them, 7,844 incident breast cancer cases, and 721 breast cancer-specific deaths occurred. Cox proportional hazard regression was performed to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between MHT use and the incidence, mortality, and survival of breast cancer subtypes., Results: MHT use was associated with increased risk of overall, luminal A-like, and luminal B-like breast cancer, with respective HRs of 1.44 (95% CI 1.36-1.52), 1.41 (95% CI 1.31-1.52), and 1.23 (95% CI 1.09-1.40) among current estrogen-progestin therapy (EPT) users compared with never users. The risk increased by 4%, 4%, and 2% per year of EPT use for overall, luminal A-like, and luminal B-like breast cancers, respectively. MHT use was also associated with increased risk of overall and luminal A-like breast cancer mortality, with HRs 1.61% (95% CI 1.36-1.91) and 2.15% (95% CI 1.51-3.05) increased risk among current EPT users compared with non-users. Among patients with breast cancer, pre-diagnostic MHT use was not associated with worse survival from overall breast cancer but was inversely associated with survival from triple-negative breast cancer (TNBC; HR death 0.41; 95% CI 0.24-0.73 among current users). Results varied significantly according to tumor subtype (p heterogeneity  = 0.02)., Conclusions: Our study suggests that MHT use increases the risk of incident and fatal overall and luminal A-like, and incident luminal B-like breast cancer but does not decrease overall survival among patients with breast cancer. Further research is needed to elucidate the mechanisms underlying MHT use and breast cancer lethality, and to explore whether MHT use among patients with TNBC is indeed free from harm., (© 2024. The Author(s).)

Background: Pre-hospital incidents involving pediatric and neonatal patients are infrequent, and clinical characteristics and care for these patients differ from the adult population. Lack of knowledge, guidelines, and experience can make pre-hospital pediatric care challenging, and there is limited research on the epidemiology and best practice of care for this population. We examined the pre-hospital pediatric population in the county of Sør-Trøndelag, Norway, to improve our understanding of this population in our region., Methods: We conducted a retrospective observational cohort study of emergency incidents involving children under twelve years of age with dispatch of Emergency Medical Services (EMS) in Sør-Trøndelag between 2018 and 2022. Incidents and patient characteristics were extracted from the Emergency Medical Communication Center (EMCC) database. In addition, data on patient characteristics and interventions for more serious incidents seen by the Helicopter Emergency Medical Service (HEMS) were included from the database LABAS. We provided descriptive statistics and estimated population incidences using Poisson regression., Results: The catchment area of EMCC Sør-Trøndelag has a population of approximately 43,000 children under the age of twelve years. During the five-year study period, there were 7005 emergency calls concerning this patient population, representing 6% of all emergency calls (total no. 108,717). Of these, 3500 (50%) resulted in the dispatch of an ambulance and/or HEMS, yielding an annual incidence of EMS dispatches of 17 per 1000 children. The three most common primary medical problems were respiratory distress, altered consciousness, and trauma. Among the 309 HEMS patients, 131 (42%) received advanced interventions from the HEMS physician. Assisted ventilation was the most frequent intervention., Conclusions: Pediatric and neonatal patients make up a small proportion of pre-hospital patient dispatches in Sør-Trøndelag. Consequently, each EMS provider infrequently encounters children in the pre-hospital environment, resulting in less experience with pediatric advanced medical interventions. This study identifies some clinical characteristics and interventions regarding pediatric and neonatal patients that have been pointed out as focus areas for pediatric pre-hospital research., (© 2024. The Author(s).)

BackgroundHepatitis C virus (HCV) infection is targeted for elimination as a public health threat by 2030. The World Health Organization goal for treatment uptake is ≥ 80% among cases diagnosed with an active HCV infection (RNA- or core antigen-positive), maintained for 2 years.AimTo calculate treatment uptake, time from diagnosis to treatment start and complete treatment dispensation among notified cases of HCV infection in Norway.MethodWe linked national data on notified cases diagnosed from 1990-2022 to dispensed prescriptions for HCV treatment from January 2004-February 2023 and data on residence status at the end of 2022. We described treatment uptake by demographic and epidemiological characteristics. We calculated the median number of months from diagnosis to treatment start by year. For direct-acting antiviral treatment periods, complete dispensation was based on the treatment and number of defined daily doses.ResultsAmong 12,178 notified cases that had an active infection at diagnosis and were still resident, 10,091 (83%) had received treatment. Uptake among resident cases was > 80% in 2021 and 2022. The median number of months from diagnosis to treatment decreased over time to 3 (interquartile range: 1-5) among cases diagnosed in 2021 and 2022. From 2015-22, 89-93% of direct-acting antiviral treatment periods annually had complete treatment dispensed.ConclusionNorway has achieved the elimination goal for treatment uptake among notified cases diagnosed with an active HCV infection. This highlights the benefit of a strategy that includes unrestricted, simplified and integrated treatment options.

Background: Chronic rhinosinusitis (CRS) decreases the quality of life and affects the working life of sufferers. There is a scarcity of studies of how CRS affects sick leave at the population level, particularly for women., Materials and Methods: Data from questionnaires were collected in Telemark, Norway in 2013 (N = 15,484) and again in 2018 (N = 13,966). Odds ratios with 95% confidence intervals (CI) for having sick leave in the last 12 months, adjusted for sex, asthma, smoking and age, were calculated, as well as the relationship to occupational groups. Comparisons were made between women and men., Results: Subjects with CRS had 64% increased odds for taking sick leave compared to subjects without CRS (OR 1.64, 95% CI 1.45-1.85) in 2013, with similar results in 2018 (OR 1.60, 95% CI 1.41-1.81). Women with CRS were almost twice as likely to take sick leave than men with CRS (OR 1.96, 95% CI 1.56-2.46) in 2013. Sick leave was more common in subjects with CRS in some occupational groups., Conclusion: CRS is a chronic and debilitating disease that appears to affect sick leave on a population level, with women being more affected than men. Optimised treatment for CRS might reduce sick leave and associated costs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Clarhed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Highly pathogenic avian influenza (HPAI) poses a substantial threat to several raptors. Between 2021 and 2023, HPAI viruses (HPAIVs) of the Goose/Guangdong lineage H5 clade 2.3.4.4b became widespread in wild birds in Norway, and H5N1 and H5N5 viruses were detected in 31 white-tailed eagles ( Haliaeetus albicilla , WTEs). Post-mortem examinations of four WTEs revealed no macroscopic pathological findings. Microscopic examinations showed the presence of myocardial and splenic necroses and a few lesions in the brain. In situ hybridization revealed the presence of the virus in several organs, suggesting a multisystemic infection. The detection of HPAIV H5N5 in a WTE in February 2022 marked the first recorded occurrence of this subtype in Norway. Since then, the virus has persisted, sporadically being detected in WTEs and other wild bird species. Phylogenetic analyses reveal that at least two distinct incursions of HPAIV H5N1 Eurasian (EA) genotype C affected WTEs, likely introduced by migratory birds from Eurasia and seabirds entering from Western and Central Europe. Some WTE isolates from 2021 to 2022 clustered with those from Canada and Ireland, aligning with the transatlantic spread of H5N1. Others were related to the 2021 mass mortality of great skuas in the UK or outbreaks in seabird populations, including gannets, gulls and terns, during 2022 in the North Sea region. This suggests that the WTEs were likely preying on the affected birds. Our study highlights that WTEs can act as sentinels for some HPAIV strains, but the absence of several known circulating genotypes in WTEs suggests varying pathogenic effects on this species.

Background: Without treatment, nearly 50 % of tuberculosis (TB) patients die. World Health Organization's definition of TB deaths does not take into consideration whether the cause of death was TB or other non-TB co-morbid conditions. We aimed to improve our knowledge of the causes of death in patients with TB., Methods: Single-center retrospective study conducted at Gade Institute of Pathology, Haukeland University Hospital, Bergen, Norway. Autopsy data of 269 patients with TB was collected from autopsy journals, and epidemiological data was collected from Norwegian Official Statistics books for period 1931-1947., Results: Of all TB deaths reported in epidemiological reports, pulmonary TB accounted for 81 % and extrapulmonary TB for 19 %. However, in autopsy records, only 21 % of cases with active pulmonary TB died because of TB. Extrapulmonary involvement was significantly associated with higher mortality (OR EPTB as compared to PTB; 3.27, CI 1.91 - 5.61) and constituted 79 % of deaths attributable to TB. A significant burden of extrapulmonary TB was found in autopsy records (63 %), while in epidemiological records, only 4 % of cases were reported., Conclusions: Extrapulmonary involvement was a predictor of mortality due to TB in hospitalized TB patients. The contribution of extrapulmonary TB to TB mortality seems to be underestimated because extrapulmonary TB largely remains underdiagnosed and underreported in epidemiological data., Competing Interests: Declaration of Competing Interest All authors declare no conflict of interest., (Copyright © 2024 University of Bergen, Norway. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To explore the differences in mental health symptom profiles, trauma profiles, childhood trauma and comorbidities in patients with PTSD and those without PTSD., Materials and Methods: A cross-sectional study was carried out on 110 adult patients with trauma backgrounds attending a mental health outpatient clinic in Southern Oslo, Norway. In addition to self- report questionnaires, several standardized validated diagnostic tools were used to assess mental disorders. Multiple linear regression models were used to assess the association between trauma history, the mental health symptom profile of the patients, and PTSD diagnosis. Bivariate logistic regression was used to examine if childhood trauma/adversities were associated with PTSD., Results: Patients diagnosed with PTSD had significantly higher rates of comorbid major depressive disorder, panic disorder, agoraphobia disorder, and social phobia compared to those without PTSD. We also found a positive association between PTSD diagnosis and all the different mental health symptoms domains of the Symptom Checklist-90-Revised instrument. When adjusted for age, gender, education, smoking habits, immigration, relationship, and employment status, these associations persisted with varying effects. We did not find any association between PTSD and childhood trauma/adversities, however, sexual abuse trended towards an association., Conclusion: Adult trauma patients with PTSD may have more comorbid disorders and mental health symptoms. Childhood trauma may be less critical for the PTSD diagnosis in this group. In clinical practice, personalized treatment plans addressing both the symptom burden and its comorbidities may be beneficial.

Background: Young adults with residential youth care (RYC) background have often endured various forms of child maltreatment, impacting education, employment, health, mortality, and quality of life. There is limited research on the onset and duration of exposure to maltreatment before placement, as well as the prevalence of maltreatment occurring after children have been placed into out-of-home care., Objective: This study aims to investigate: (1) The sex-specific prevalence and age chronology of self-reported exposure to child maltreatment, and (2) whether the rate of these maltreatment forms differ between the year before and after first out-of-home placement by the Child Welfare Service., Participants and Setting: This study is a part of VINGO, a Norwegian nation-wide 10-year follow-up examining the health and welfare of 157 (107 females) adults with RYC background., Methods: The Maltreatment and Abuse Chronology of Exposure Scale was administered as an online questionnaire, and mean scores and percentages of maltreatment forms were compared. Differences between groups were examined using t-tests and Pearson's Chi-Squared test., Results: Most participants, 154 of 157 (98 %), reported at least one form of child maltreatment. Females reported higher rates of sexual abuse than males (53 % vs. 22 %, p < .001). No other sex differences were found. A majority of participants (63 %) reported decreased maltreatment rates post-placement, while 37 % had stable or increasing rates., Conclusions: Young adults with RYC background report high child maltreatment rates. Although out-of-home care provides protection, further development and improvement of initiatives aimed at reducing the risk of revictimization is likely needed., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Lyme borreliosis (LB), the most common tick-borne disease in Europe, is endemic to southern coastal Norway. LB commonly presents as erythema migrans, which can disseminate, resulting in more severe disease such as Lyme neuroborreliosis or arthritis. In Norway, public health LB surveillance is conducted via mandatory reporting of laboratory-confirmed disseminated cases. From 2012 to 2022, Norway's surveillance-reported incidence of laboratory-confirmed disseminated LB increased by 78%. Although surveillance provides estimates of the incidence of disseminated LB, this study sought to estimate the incidence of symptomatic LB to better understand Norway's LB disease burden. Two studies were identified that, when combined, estimated an LB seroprevalence of 6.8% in the general adult population in southern Norway. Utilizing data from these seroprevalence studies, public health surveillance, and results from literature searches indicating that 37% of seroconverted LB cases are symptomatic and that the duration of LB antibody detection ranges from 10 to 20 years, we estimated that there were 315-630 symptomatic LB cases per 100,000 adult population in five southern coastal counties in Norway in 2022 and 24-48 cases of symptomatic LB for every public health surveillance-reported LB case in adults in these five counties in Norway., (© 2024 The Author(s). APMIS published by John Wiley & Sons Ltd on behalf of Scandinavian Societies for Pathology, Medical Microbiology and Immunology.)

We aimed to estimate the prevalence of potentially diarrhoeagenic microbes (PDMs) in faecal samples from asymptomatic individuals in a high-income country, identify risk factors for carriage and to identify microbial factors that differ between PDMs in asymptomatic versus symptomatic individuals. Samples from 1000 asymptomatic participants were collected, together with a questionnaire, between 2015 and 2020 and examined by PCR for 11 PDMs. Isolates were characterised and potential risk factors were registered. Atypical enteropathogenic Escherichia coli (aEPEC), Yersinia enterocolitica, Shiga toxin-producing E. coli (STEC), enterotoxigenic E. coli (ETEC) and Campylobacter spp. were found in 163 (16%), 20 (2.0%), 17 (1.7%), 12 (1.2%) and 11 (1.1%) asymptomatic individuals, respectively. Other PDMs were rare. Only low virulent STEC, with stx1c, stx2b or stx2f, was detected. Travels outside Europe was a significant risk factor for detecting Campylobacter spp. (odds ratio (OR) 6.99; 95% CI 1.12-43.6) and ETEC (OR 11.4; 95% CI 1.26-102). Individuals ≥65 years of age had lower odds of carrying STEC (OR 0.11; 95% CI 0.02-0.57) or EPEC (OR 0.09; 95% CI 0.05-0.16) than individuals ≤5 years of age. The common finding of PDMs in asymptomatic individuals could have implications for the interpretation of positive findings in clinical samples and infection control measures., (© 2024 The Author(s). APMIS published by John Wiley & Sons Ltd on behalf of Scandinavian Societies for Pathology, Medical Microbiology and Immunology.)

Objective: To investigate the gender differences and the disparities between infected and noninfected patients with type 2 diabetes (T2D) regarding patient-reported experiences during the COVID-19 pandemic in Norway., Method: Register study using questionnaires sent electronically to patients with T2D, June 2022. The questionnaire included 82 questions covering COVID-19 disease, symptoms, medications, comorbidities, hospital care, possibility of working from home and information received from health authorities. Clinical and demographic data were collected from the Norwegian diabetes registry for adults., Results: A total of 29,079 T2D patients participated, of whom 38.1% were women. Patients infected with COVID-19 were younger, had shorter diabetes duration and less comorbidities than noninfected (p < 0.01). Women reported significantly more anxiety, depression and fear of not getting their diabetes medication than men did. Most patients were vaccinated against COVID-19 (98.3%), whereas approximately 60% had received seasonal flu vaccine, and only 27.2% the pneumococcal vaccine. Women described more vaccine adverse effects and long Covid symptoms. Overall, 14% experienced vaccine complications and 27.3% of infected individuals reported long Covid symptoms. 2.4% of the infected patients needed hospital admission. Patients were satisfied with the follow-up of their diabetes, and with information from the government during the pandemic., Conclusion: Female patients were more likely to experience a prolonged Covid course, and higher degree of adverse effects from the COVID-19 vaccine than male patients. Also, long Covid symptoms were significantly more often reported among female patients, while men were more prone to be hospitalised when infected. Hospitalised patients, both men and women, had significantly higher HbA1C than those who were not hospitalised. T2D patients had a surprisingly low pneumococcal vaccination coverage, despite recommendations in national guidelines., (© 2024 The Author(s). Endocrinology, Diabetes & Metabolism published by John Wiley & Sons Ltd.)

Objectives: This study assessed associations of three theoretically different occupational class schemes with all-cause and cardiovascular mortality in Norwegian men and women., Study Design: Pooled survey and register data from four Norwegian cohort studies., Methods: We pooled survey data from four general population cohorts (N = 97,469) linked to national mortality registries with follow-up over 45 years. Survival was modelled using accelerated failure time models stratified by sex for three class schemes: The European Socio-Economic Classification (ESeC), The Oslo Register Data Class scheme (ORDC) and The International Socio-Economic Index (ISEI). Main analyses were adjusted for age, birth cohort, and study. Secondary analyses included smoking behaviour as a mediator., Results: During median 27.6 years of observation, 37,488 participants had died (13,243 from cardiovascular disease). Hazard ratios for male all-cause mortality were lowest in the highest occupational class categories ORDC 2: 0.68 (0.65-0.72), ESeC 1: 0.76 (0.73-0.79) and ISEI 5th quintile: 0.80 (0.77-0.82) compared to working class reference categories. Female mortality risks were lowest for Cultural Lower Middle class ORDC 7: 0.84 (0.72-0.98), Small Employers and Self-employed ESeC4: 0.70 (0.50-0.97) and ISEI 5th quintile: 0.79 (0.70-0.90). Patterns for cardiovascular mortality were similar to all-cause mortality. Including smoking behaviour as a mediator attenuated associations, but overall mortality patterns according to occupational class remained unchanged., Conclusion: The results underline that mortality inequalities do not simply consist of higher risks in the most disadvantaged groups. The association of occupational class with mortality is found across different categories of occupational class schemes, illustrating their continued relevance for studying social determinants of health., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The aim of this study was to explore the prevalence of likely pathogenic or pathogenic variants and assess the diagnostic yield from genetic testing for cardiac arrhythmias in Norway since 2003. Data from 1991 probands and 2782 relatives were retrospectively collected from the laboratory information management system at Unit for Cardiac and Cardiovascular Genetics, Oslo University hospital. Of 1991 probands, 57.4% were females, age at genetic testing was 33.1 (±22.7) years, and 32.5% were under the age of 18. A likely pathogenic or pathogenic variant (including 14 novel) was detected in 15.4% in total. Of the 2782 relatives, 53.7% were females, age at genetic testing was 35.6 (±22.5) years, 27.3% were under the age of 18, and 45.3% carried the family variant. Probands and relatives combined, 1/3356 persons in the Norwegian population were heterozygous for an arrhythmia-causing variant. The founder variant p.Q530X (NM&#95;000218.2: c.1588C>T) in KCNQ1 accounted for 34% of all variants in Norway. In conclusion, genetic testing provided a genetic basis of the arrhythmia in 15.4% of the probands. Familial cascade screening identified four times as many variant-positive relatives, allowing early detection and prompt stratification of arrhythmic risk of those variant carriers., (© 2024 The Author(s). Clinical Genetics published by John Wiley & Sons Ltd.)

Examining fracture dynamics by socioeconomic status may inform healthcare and prevention. We found a higher risk of hip fracture in men and women with lower educational level in Norway. However, by age 90 + years, the cumulative incidence was higher in those with higher education, due to their higher life expectancy., Purpose: Socioeconomic gradients are seen for several health outcomes in high-income countries. We aimed to examine possible educational gradients in risk of hip fracture in Norway and to describe the cumulative incidence of hip fracture by educational level., Methods: In a population-wide cohort of Norwegians aged ≥ 50 years, information on attained education from Statistics Norway was linked to hospital-treated hip fractures and deaths during 2002-2019. We estimated relative fracture risk by educational level (primary, secondary or tertiary) in Cox proportional hazards regression. We also examined the cumulative incidence over attained age by gender and educational level in competing risk regression., Results: The population included N = 1,389,858 individuals with 135,938 incident hip fractures. Compared with men who had attained tertiary education, hazard ratios (95% confidence intervals) for hip fracture were 1.44 (1.40, 1.49) in men with primary education only and 1.26 (1.22, 1.29) in men with secondary education. In women, the corresponding estimates were 1.28 (1.25, 1.31) and 1.16 (1.13, 1.19). In the age range 50 to 90 years, the highest cumulative incidence of hip fracture was seen in those with primary education. The gradient gradually diminished with advancing age and was reversed in the oldest (> 90 years) in both genders., Conclusions: There was a clear educational gradient in hip fracture incidence in both men and women in Norway, with a higher risk in people with lower education. Despite this, the cumulative incidence of hip fracture in old age was highest among people with higher education, due to their higher life expectancy., (© 2024. The Author(s).)

Background: To describe the frequency of primary care seeking for neck or back-related conditions among people with chronic neck and low back pain and to develop prediction models of primary care seeking and frequent visits., Methods: We included participants of the Trøndelag Health Study (HUNT4, 2017-19) in Norway who self-reported chronic neck and/or low back pain in the preceding year, and extracted data of primary care visits from the Norwegian primary healthcare registry. We investigated a total of 23 potential predictors and used multivariable logistic regression models to predict primary care seeking for neck or back-related conditions and frequent visits by healthcare provider (i.e., the highest quartile of number of visits)., Results: Among the 15,352 HUNT4 participants with chronic neck and/or low back pain, 6231 participants (40.6%) sought primary care for neck or back-related conditions (median = 5 visits, IQR 2-15) within 2 years after the study. Participants who consulted physical therapists sought care the most frequently (median = 10 visits, IQR 3-26). Discrimination of the best-fit prediction model of primary care seeking and frequent visits by healthcare provider, assessed by C-statistic, ranged from 0.66-0.76. Participants who made frequent primary care visits in the preceding year were highly likely to continue frequent care seeking in the following 2 years., Conclusions: Around 40% of people seek primary care for chronic neck and low back pain, and frequent care seeking may continue for years. Future studies should investigate strategies to reduce recurrent primary care visits, especially seeking physical therapist care, and promote self-management of chronic pain., Significance: People with chronic neck and low back pain who seek physical therapist care had the highest frequency of care seeking, underscoring the significant burden on healthcare systems. The high frequency of visits and associated healthcare expenditures highlight the critical need for effective and valuable primary care for chronic pain management. To mitigate recurrent visits and reduce costs, it is essential to provide patients with evidence-based treatments and self-management interventions., (© 2024 The Author(s). European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC ®.)

Background and Objectives: More knowledge is needed to identify and reach those at overdose risk with preventive measures. We examined past 12-month health service utilization, identified the most frequently utilized service, explored this utilization in more detail, and examined correlates of overdose death., Methods: A population-based nested case-control registry study including all drug overdose deaths (1 January 2010 to 31 December 2018) in Norway through the Cause of Death Registry (n = 2388). The year-, age- and gender-matched controls included through a population registry (n = 21,465). Data cross-linked with population and patient registries. Multivariable conditional logistic regression analyses estimated the likelihood of overdose death., Results: The cases (vs. controls) attended a higher median number of services (3 vs. 1). The General Practitioner (GP) was the most utilized service. The majority (55.7%) of cases had 11-50 encounters, while the majority (60.7%) of the controls had 1-5 encounters. No high school diploma, no employment, urban living, social welfare benefits/disability pension, single-person household, recent incarceration, multiple health service utilization and frequent GP encounters, as well psychological and certain physical diagnoses were correlates of overdose death among the GP attenders., Discussion and Conclusions: The cases had utilized more services than the controls and the GP was the most frequently utilized service. In addition to low socioeconomic status, psychological and certain physical diagnoses were correlates of overdose death., Scientific Significance: This is the first national case-control registry study to document the high utilization of multiple primary and secondary health care services before drug overdose death, as well as reasons for attendance and correlates of overdose death., (© 2024 The Author(s). The American Journal on Addictions published by Wiley Periodicals LLC on behalf of The American Academy of Addiction Psychiatry (AAAP).)

Objectives: Assess the association of hearing on sex-specific overall mortality and death from acute cardiovascular disease and evaluate if these effects are modulated by postural balance., Study Design: Cohort study., Setting: Otolaryngology department at an academic hospital., Methods: Patients underwent standard clinical examination, laboratory examination including stabilometry and audiometry. Pure tone average on the best hearing ear was calculated from 0.5, 1, 2, and 3 kHz. Cause of death was retrieved from the Norwegian Cause of Death Registry., Results: A total of 1036 patients (58.8% women) were followed for 26 ± 3 years. In Cox regression analyses for overall mortality adjusted for age, past medical history, and vestibular disease, 10 dB increase in hearing threshold was associated with a 14% increase in mortality among men (hazard ratio 95% confidence interval: 1.02-1.28, P = .02), but no significant association was seen between hearing and mortality in women (0.92-1.15, P = .60). The same analyses for acute cardiovascular death found that a 10 dB increase in hearing threshold was associated with a 57% increase in hazard ratio in men (1.21-2.05, P < .001), but no significant effect of hearing on survival was seen in women (P = .71). Adjusting for postural balance did not change the association between hearing and mortality., Conclusion: This study finds hearing threshold is associated with overall mortality and acute cardiovascular death among men, with no such association observed among women. Our findings indicate important differences between men and women and suggest that such differences should be taken into consideration in audiological research., (© 2024 The Author(s). Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objective: We aimed to assess the association between occupational noise exposure and tinnitus. Further, to assess whether the association depends on hearing status., Design: In this cross-sectional study, tinnitus (>1 h daily) was regressed on job exposure matrix (JEM)-based or self-reported occupational noise exposure, adjusted for confounders., Study Sample: The 14,945 participants (42% men, 20-59 years) attended a population-based study in Norway (HUNT4, 2017-2019)., Results: JEM-based noise exposure, assessed as equivalent continuous sound level normalised to 8-h working days (LEX 8 h), over the working career or as minimum 5 years ≥85 dB) was not associated with tinnitus. Years of exposure ≥80 dB (minimum one) was not associated with tinnitus. Self-reported high noise exposure (>15 h weekly ≥5 years) was associated with tinnitus overall and among persons with elevated hearing thresholds (prevalence ratio (PR) 1.3, 1.0-1.7), however not statistically significantly among persons with normal thresholds (PR 1.1, 0.8-1.5)., Conclusions: Our large study showed no association between JEM-based noise exposure and tinnitus. This may to some extent reflect successful use of hearing protection. High self-reported noise exposure was associated with tinnitus, but not among normal hearing persons. This supports that noise-induced tinnitus to a large extent depends on audiometric hearing loss.

Objectives: RA patients have an increased risk for cardiovascular diseases, including atrial fibrillation (AF), but the impact of RA on ischaemic stroke risk in the context of AF remains unknown. We explored whether the risk of ischaemic stroke after diagnosis of AF is further increased among patients with RA compared with non-RA patients., Methods: In the nationwide Norwegian Cardio-Rheuma Register, we evaluated cumulative incidence and hazard rate of ischaemic stroke after the first AF diagnosis (2750 individuals with RA and 158 879 without RA between 2010 and 2017) by using a competing risk model with a 3-month delayed entry., Results: The 5-year unadjusted cumulative incidence of ischaemic stroke was 7.3% (95% CI: 5.9-8.7%) for patients with RA and 5.0% (95% CI: 4.9-5.2%) for patients without RA. Unadjusted univariate analyses indicated that AF patients with RA had a HR of 1.36 (95% CI: 1.13, 1.62) for ischaemic stroke compared with those without RA. Sex- and age-adjusted HR for ischaemic stroke in RA patients with AF was 1.25 (95% CI: 1.05, 1.50), and the effect size remained unchanged after adjustment for diabetes, hypertension, atherosclerotic cardiovascular disease and oral anticoagulant (OAC) treatment. RA patients were less likely to receive OAC treatment than non-RA patients (adjusted odds ratio 0.88, 95% CI: 0.80, 0.97)., Conclusion: RA patients diagnosed with AF are at a further increased risk for stroke compared with non-RA patients with AF, and less likely to receive OAC treatment, emphasizing the need to improve stroke prevention in AF patients with RA., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Background: Hospital-acquired pneumonia (HAP) is the most common hospital-acquired infection (HAI). HAP is associated with a high burden of morbidity and mortality, but the diagnosis is difficult to establish and the incidence uncertain., Methods: Patients aged ≥ 18 years hospitalised with radiologically verified non-ventilator hospital acquired pneumonia (NV-HAP) during 2018 were retrospectively identified at Drammen Hospital, a Norwegian general hospital. Infectious Diseases Society of America and the American Thoracic Society's definition of HAP was used., Results: In total 119 cases of NV-HAP were identified among 27,701 admissions. The incidence was 4.3 per 1000 admissions and 1.2 per 1000 patient-days. The median age was 74 years, 63% were male and median Charlson comorbidity index was 5. Coronary heart disease (42%) was the most common comorbidity. Median length of stay was 17.2 days. A blood culture was obtained in 53.8% of patients, while samples from lower airways were seldom obtained (10.9%). In-hospital mortality was 21%, accumulated 30-day mortality was 27.7% and accumulated 1-year mortality was 39.5%. Thirty-day readmission rate among survivors was 39.4%., Conclusion: NV-HAP was present in approximately 1 in 250 hospitalisations, most had multiple comorbidities, and 1 in 5 died in hospital. Although thorough microbiological sampling is recommended when NV-HAP is suspected, our data indicate that airway sampling is infrequent in clinical practice. Our findings underscore the need to develop microbiological diagnostic strategies to achieve targeted antimicrobial treatment that may improve patient outcomes and reduce broad-spectrum antibiotic usage.

Background: Burnout is frequent among intensive care unit (ICU) healthcare professionals and may result in medical errors and absenteeism. The COVID-19 pandemic caused additional strain during working hours and also affected off-duty life. The aims of this study were to survey burnout levels among ICU healthcare professionals during the first year of COVID-19, describe those who reported burnout, and analyse demographic and work-related factors associated with burnout., Methods: This was a national prospective longitudinal cohort study of 484 nurses, physicians and leaders working in intensive care units with COVID-19 patients in Norway. Burnout was measured at 6- and 12-month follow-up, after a registration of baseline data during the first months of the COVID epidemic. The Copenhagen Burnout Inventory (CBI), was used (range 0-100), burnout caseness defined as CBI ≥50. Bi- and multivariable logistic regression analyses were performed to examine baseline demographic variables and work-related factors associated with burnout caseness at 12 months., Results: At 6 months, the median CBI score was 17, increasing to 21 at 12 months (p = .037), with nurses accounting for most of the increase. Thirty-two per cent had an increase in score of more than 5, whereas 25% had a decrease of more than 5. Ten per cent reported caseness of burnout at 6 months and 14% at 12 months (n.s.). The participants with burnout caseness were of significantly lower age, had fewer years of experience, reported more previous anxiety and/or depression, more moral distress, less perceived hospital recognition, and more fear of infection in the bivariate analyses. Burnout was the single standing most reported type of psychological distress, and 24 out of 41 (59%) with burnout caseness also reported caseness of anxiety, depression and/or post-traumatic stress disorder (PTSD) symptoms. Multivariate analysis showed statistically significant associations of burnout caseness with fewer years of professional experience (p = .041) and borderline significance of perceived support by leader (p = .049)., Conclusion: In Norway, a minority of ICU nurses, physicians and leaders reported burnout 1 year into the pandemic. A majority of those with burnout reported anxiety, depression and/or PTSD symptoms combined. Burnout was associated with less years of professional experience., (© 2024 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

Objective: Norwegian health registries covering entire population are used for administration, research, and emergency preparedness. We harmonized these data onto the Observational Medical Outcomes Partnership common data model (OMOP CDM) and enrich real-world data in OMOP format with COVID-19 related data., Methods: Data from six registries (2018-2021) covering birth registrations, selected primary and secondary care events, vaccinations, and communicable disease notifications were mapped onto the OMOP CDM v5.3. An Extract-Transform-Load (ETL) pipeline was developed on simulated data using data characterization documents and scanning tools. We ran dashboard quality checks, cohort generations, investigated differences between source and mapped data, and refined the ETL accordingly., Results: We mapped 1.5 billion rows of data of 5,673,845 individuals. Among these, there were 804,277 pregnancies, 483,585 mothers together with 792,477 children, and 472,948 fathers. We identified 382,516 positive tests for COVID-19 in 380,794 patients. These figures are consistent with results from source data. In addition to 11 million source codes mapped automatically, we mapped 237 non-standard codes to standard concepts and introduced 38 custom concepts to accommodate pregnancy-related terminologies that were not supported by OMOP CDM vocabularies. A total of 3,700/3,705 (99.8%) checks passed. The 5 failed checks could be explained by the nature of the data and only represent a small number of records., Discussion and Conclusion: Norwegian registry data were successfully harmonized onto OMOP CDM with high level of concordance and provides valuable source for federated COVID-19 related research. Our mapping experience is highly valuable for data partners with Nordic health registries., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Nhung TH Trinh reports was provided by European Health Data & Evidence Network. Jared Houghtaling reports financial support was provided by European Health Data & Evidence Network. Jared Houghtaling reports a relationship with EdenceHealth that includes: employment. Fabian Bernal reports was provided by European Health Data & Evidence Network. Saeed Hayati reports was provided by European Health Data & Evidence Network. Luigi Maglanoc reports was provided by European Health Data & Evidence Network. Angela Lupattelli reports was provided by European Health Data & Evidence Network. Lars Halvorsen reports financial support was provided by European Health Data & Evidence Network. Lars Halvorsen reports a relationship with EdenceHealth that includes: employment. Hedvig ME Nordeng reports financial support was provided by European Health Data & Evidence Network]., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Abdominal aortic aneurysm (AAA) screening has been offered to 65-year-old men living in Oslo, Norway, since May 2011. A significant number of AAA-related deaths occurred in individuals who are not eligible for screening. The primary aim of this study was to describe the group of patients admitted to Oslo University Hospital with a ruptured AAA after the implementation of the local AAA screening project. The following parameters were investigated: AAA detection before rupture, surveillance status, eligibility for screening, and comorbidities. We also sought to compare outcomes (repair rates and 30-day mortality) between patients with and without an incidentally detected AAA prior to rupture., Methods: This cohort study included patients admitted acutely to Oslo University Hospital due to a symptomatic or ruptured AAA in the period January 2011 to December 2022. Data on demographics, prior AAA detection, surveillance status, treatment, and mortality were collected retrospectively through electronic medical records., Results: We identified 200 patients with a symptomatic or ruptured AAA, among which 79 (40%) had an AAA detected before rupture-one (1%) through screening and 78 (39%) incidentally. Up to 30% of the incidentally detected AAAs were not under any surveillance. Six patients were found eligible for screening: one had attended, three were non-attenders, and two had not been invited. Patients with an incidentally detected AAA before rupture had a more advanced age and a significantly higher degree of comorbidities than patients without a previously detected AAA, and the repair rates in these groups were 56% and 84%, respectively (P < 0.001). Adjusted for comorbidities and risk factors, the odds ratio for repair among patients with incidentally detected AAA was 0.56 (P = 0.292). The 30-day mortality was not significantly different between the two groups (P = 0.097)., Conclusions: Most patients with a ruptured AAA were not eligible for screening, but 39% of the patients had an incidentally detected AAA prior to rupture. Standardized reporting and follow-up of incidentally detected AAAs is thus identified as an additional measure to organized screening in the effort to reduce AAA-related mortality., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Fatigue and pain are both prevalent and frequently co-occur. No standard measure of fatigue exists, but most definitions include a continuum between high levels of energy and fatigue. There is limited knowledge about the course of fatigue in the general population and its association with functioning and other health outcomes. Our main aim was to identify trajectories of energy and fatigue in the general population and to investigate whether chronic pain is related to a negative prognosis of chronic fatigue., Methods: Longitudinal latent class analysis was performed to classify 4771 individuals into trajectory groups based on five quarterly repeated measures., Results: A five-cluster solution was identified: 'much energy' (n = 1471, [31%]), 'varying energy' (n = 1445, [30%]), 'some energy' (n = 921, [19%]), 'low energy' [chronic moderate fatigue] (n = 852, [18%]) and 'no energy' [chronic severe fatigue] (n = 82, [2%]). Individuals with chronic moderate fatigue who reported chronic pain had reduced probability of improvement over the following 3 years (OR = 0.67, 95% CI [0.52, 0.88])., Conclusions: Chronic fatigue is highly prevalent in the general population and a small proportion have chronic severe fatigue. When chronic pain co-occurs with chronic fatigue, improvement of chronic fatigue is less likely, indicating that these symptoms may perpetuate each other., Significance Statement: Understanding the close relationship between chronic pain and chronic fatigue is important as they both contribute to suffering and loss of functioning, may be related to the same underlying diseases, or in the absence of disease, may share common mechanisms. This study highlights the important role of chronic pain in relation to chronic fatigue, both by showing a strong association between the prevalence of the two conditions, and by showing that chronic pain is associated with a negative prognosis of chronic fatigue., (© 2024 The Author(s). European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC ®.)

Background: With rapidly rising life expectancy and ageing populations, interest has grown in the survival patterns and ages at death at the highest ages. In Scandinavia, the accumulation of very old population segments coupled with long-established, high-quality population registers permit meaningful analysis., Methods: This study is based on individual level data from extinct Norwegian birth cohorts using data obtained from the Norwegian Civil Register System. We assess trends in the ages at death of centenarians in Norway for cohorts born between 1870 and 1904 for evidence of any secular increase using quantile regression., Results: We observed that there is no upward trend in centenarian lifespans, in line with recent observations in Sweden, but contrary to the upward trend at the very highest percentiles as observed in Denmark., Conclusions: The available evidence suggests that the stagnation in centenarian lifespans may be partly due to the failure to find ways of dealing with neurodegenerative diseases ., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Early diagnosis and antibiotic therapy in patients with sepsis reduce morbidity and mortality, thus pre-hospital management is likely to affect patient outcomes. Pre-hospital administration may increase the risk of unnecessary use of broad-spectrum antibiotics, but identification of an infectious focus enables more targeted antibiotic therapy. The aim of this study was to investigate how paramedics, with or without the assistance of general practitioners, can administer empiric intravenous antibiotic treatment against sepsis in a timely manner., Methods: Cohort study of patients with suspected sepsis that received pre-hospital intravenous antibiotics and were transported to hospital. The setting was mainly rural with long average distance to hospital. Patients received targeted antibiotic treatment after an assessment based on clinical work-up supported by scoring systems. Patients were prospectively included from May 2018 to August 2022. Results are presented as median or absolute values, and chi-square tests were used to compare categorical data., Results: We included 328 patients. Median age was 76 years (IQR 64, 83) and 48.5% of patients were female. 30-days all-cause mortality was 10.4%. In cases where a suspected infectious focus was determined, the hospital discharge papers confirmed the pre-hospital diagnosis focus in 195 cases (79.3%). The presence of a general practitioner during the pre-hospital assessment increased the rate of correctly identified infectious focus from 72.6% to 86.1% (p = 0.009). Concordance between pre-hospital identification of a tentative focus and discharge diagnosis was highest for lower respiratory tract (p = 0.02) and urinary tract infections (p = 0.03). Antibiotic treatment was initiated 44 min (median) after arrival of ambulance, and median transportation time to hospital was 69 min. Antibiotic therapy was started 76 min (median) before arrival at hospital., Conclusions: Pre-hospital identification of infectious focus in suspected sepsis was feasible, and collaboration with primary care physicians increased level of diagnostic accuracy. This allowed initiation of intravenous focus-directed antibiotics more than one hour before arrival in hospital in a rural setting. The effect of pre-hospital therapy on timing was much stronger than in previous studies from more urban areas., (© 2024. The Author(s).)

The emergence of the SARS-CoV-2 virus led to a global pandemic, prompting extensive research efforts to understand its molecular biology, transmission dynamics, and pathogenesis. Recombination events have been increasingly recognized as significant contributor to the virus's diversity and evolution, potentially leading to the emergence of novel strains with altered biological properties. Indeed, recombinant lineages such as the XBB variant and its descendants have subsequently dominated globally. Therefore, continued surveillance and monitoring of viral genome diversity are crucial to identify and understand the emergence and spread of novel strains. Through routine genomic surveillance of SARS-CoV-2 cases in Norway, we discovered a SARS-CoV-2 recombination event in a long-term infected immunocompromised COVID-19 (coronavirus disease) patient. A deeper investigation showed several recombination events between two distinct lineages of the virus, namely AY.98.1 and BA.5, that resulted in a single novel recombinant viral strain with a unique genetic signature. Our data is consistent with the presence of several concomitant recombinants in the patient, suggesting that these events occur frequently in vivo. This study underscores the importance of continued tracking of viral diversity and the potential impact of recombination events on the evolution of the SARS-CoV-2 virus., (© 2024. The Author(s).)

Background: Streptococcus pneumoniae is a major cause of mortality globally. The introduction of pneumococcal conjugate vaccines (PCVs) has reduced the incidence of the targeted serotypes significantly, but expansion of non-targeted serotypes, serotype replacement, and incomplete vaccine-targeting contribute to pneumococcal disease in the vaccine era. Here, we characterize the changing population genetic landscape of S. pneumoniae in Norway over a 41-year period (1982-2022)., Methods: Since 2018, all cases of invasive pneumococcal disease have undergone whole-genome sequencing (WGS) at the Norwegian Institute of Public Health. In order to characterize the changing population over time, historical isolates were re-cultured and sequenced, resulting in a historical WGS dataset. Isolates were assigned to global pneumococcal sequence clusters (GPSCs) using PathogenWatch and assigned to serotypes using in silico (SeroBA) and in vitro methods (Quellung reaction). Temporal phylogenetic analyses were performed on GPSCs of particular interest., Results: The availability of WGS data allowed us to study capsular variation at the level of individual lineages. We detect highly divergent fates for different GPSCs following the introduction of PCVs. For two out of eight major GPSCs, we identified multiple instances of serotype switching from vaccine types to non-vaccine types. Dating analyses suggest that most instances of serotype switching predated the introduction of PCVs, but expansion occurred after their introduction. Furthermore, selection for penicillin non-susceptibility was not a driving force for the changing serotype distribution within the GPSCs over time., Conclusions: PCVs have been major shapers of the Norwegian disease-causing pneumococcal population, both at the level of serotype distributions and the underlying lineage dynamics. Overall, the introduction of PCVs has reduced the incidence of invasive disease. However, some GPSCs initially dominated by vaccine types escaped the effect of vaccination through expansion of non-vaccine serotypes. Close monitoring of circulating lineages and serotypes will be key for ensuring optimal vaccination coverage going forward., (© 2024. The Author(s).)

Background: The utilization patterns of opioid analgesics and the proportion of long-term opioid use after surgery in Norway is largely unknown., Methods: This study aimed to estimate the proportion of one-year long-term prescription opioid use among all Norwegian postoperative opioid users. Complete data from central health registries (NPR, NorPD, Statistics Norway, CoDR) were linked via the personal identification number unique to all citizens. The study period was January 1st 2010 until December 31st 2019. Long-term opioid use was defined as at least two opioid dispensings within two subsequent 90-day periods, with a minimum average use of 10 MME/day for the first 90 days., Results: The study population consisted of 693 495 post-operative opioid users (53.6% women), whereof 73.2% had not used opioids the year before surgery (new users). Among the postoperative opioid users, 3.8% were one-year long-term opioid users. The corresponding figures for new and previous opioid users were 0.4% and 13.1%, respectively. The highest proportions of long-term opioid use were found after transluminal endoscopy, eye surgery and assessments related to surgical procedures. In previous opioid users, the proportion of one-year long-term use was higher among women than men in all age groups, a difference that increased with age., Conclusions: The proportion of postoperative long-term opioid use in Norway is generally low. We detected higher proportions of long-term opioid use after certain types of surgery, but our crude surgery definition warrants further examination. Previous opioid users pose a particular challenge in the management of postoperative pain., Trial Registration: The study used national health registry data from the period 2010-2019. A pre-registered analysis plan is available at Open Science Framework., (© 2024. The Author(s).)

Aims: This study aims to describe health literacy for people at risk of type 2 diabetes and people with type 2 diabetes using the HLS-EU-Q12, and further examine the association between sociodemographic and clinical characteristics, well-being, overall health and quality of life, and health literacy., Material and Methods: We performed a cross-sectional study among 142 people at risk of type 2 diabetes and 75 people with type 2 diabetes from four primary care clinics in Norway. These data are baseline data from a randomized controlled trial which seeks to evaluate an interprofessional follow-up intervention. Multiple regression analysis was applied to explore associations to health literacy., Results: Inadequate health literacy (sum score <33) was found among 30.2% of people at risk of type 2 diabetes and among 25.7% of people with type 2 diabetes. For people at risk of type 2 diabetes, higher level of education was significantly associated with higher health literacy. Better well-being and quality of life was significantly associated with higher health literacy for both groups., Conclusions: The primary health care services should pay greater attention to assessing HL, well-being, and quality of life to facilitate the identification of people at risk of type 2 diabetes with insufficient self- management strategies to prevent or delay the development of manifest disease and its complications., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Vågenes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The COVID-19 pandemic had a global impact on daily lives, and this study aimed to assess the effects on broader aspects of health in the general population of Norway. This population-based cohort study assessed changes in health of the Norwegian general population from 3 months before to 9 months during the COVID-19 pandemic. Sampling was based on the results of Norwegian surveys designed for collecting general population norms for health measurement instruments. In December 2019, 12,790 randomly selected adults aged ≥18 years received a postal questionnaire. The 3,200 respondents received a similar follow-up postal questionnaire including the EQ-5D-5L, PROMIS-29 instruments, and questions about respondents having or having had COVID-19. Score changes were compared to estimates for the minimal important change (MIC) and age-related change. Association of instrument change scores with baseline characteristics, health problems, and having had COVID-19 was determined using multivariable linear regression. Of 3101 respondents with unchanged addresses, 2423 (78.1%) responded to the second survey. For all respondents, EQ VAS and PROMIS-29 scores for 6 of 8 domains were slightly poorer (p<0.01) than before COVID-19, and the mean change was below the MIC. In multivariable analyses, the greatest number of poorer outcomes were associated with being female, 18-29 years, or ≥80 years of age (p<0.01); > MIC for ≥ 80 years of age and EQ-5D index, PROMIS-29 physical function and social participation. Respondents who had COVID-19 had poorer outcomes for PROMIS-29 social participation (> MIC). Those reporting COVID-19 in their partner/family and not themselves, had poorer outcomes for PROMIS-29 anxiety and social participation. About 9 months into the COVID-19 pandemic, EQ-5D-5L and PROMIS-29 domain scores showed slightly poorer health in the Norwegian adult general population compared to 1 year earlier in the same respondents. The overall changes were less than expected for age-related change. Relatively poor outcomes defined as important, included general health and social participation for the elderly, and the latter for those having had COVID-19. In conclusion, this study found no evidence for a decline in important aspects of adult general population health in Norway that might be attributed to the pandemic at approximately 9 months., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Garratt, Stavem. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

We aimed to investigate the risk of hip fracture associated with zoledronic acid treatment compared to alendronate on a population level. The risk of hip fracture was lower in women using zoledronic acid and higher in women who had discontinued treatment. The findings support the effectiveness of intravenous bisphosphonate., Purpose: To investigate whether zoledronic acid (ZOL) was associated with a lower risk of the first hip fracture than alendronate (ALN) in Norway using real-world data., Methods: Nationwide data on drugs dispensed in outpatient pharmacies were individually linked with all hospital-treated hip fractures. Individuals aged 50-89 years without previous hip fracture were included at their first filling of a prescription for ALN or ZOL during 2005-2016. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) for first hip fracture by time-varying exposure to ZOL versus ALN were estimated in sex-stratified flexible parametric survival analyses. Covariates included time-varying accumulated ALN exposure and comorbidity level expressed by the prescription-based Rx-Risk Comorbidity Index, marital status, education, and residential urbanity., Results: Of 75,250 women who initiated treatment, 72,614 (96.5%) were exposed to ALN and 6366 (8.5%) to ZOL. Of 12,739 men who initiated treatment, 12,311 (96.6%) were exposed to ALN and 784 (6.2%) to ZOL. In women, the HR for first hip fracture was 0.75 (95% CI: 0.61-0.91) for ZOL versus ALN. In men, the corresponding HR was 0.59 (95% CI: 0.32-1.07). Discontinued treatment was associated with increased risk compared with current ALN treatment in women (HR: 1.33; 95% CI: 1.24-1.42, men: HR 1.13 (95% CI: 0.95-1.35))., Conclusions: In women, the risk of first hip fracture when treated with ZOL was 25% lower than when treated with ALN. Discontinued treatment was associated with a 33% increase in hip fracture risk. Similar, albeit statistically non-significant, results were observed in men., (© 2024. The Author(s).)

We have previously demonstrated an association between increased abundance of Phascolarctobacterium and colorectal cancer (CRC) and adenomas in two independent Norwegian cohorts. Here we seek to verify our previous findings using new cohorts and methods. In addition, we characterize lifestyle and sex specificity, the functional potential of the Phascolarctobacterium species, and their interaction with other microbial species. We analyze Phascolarctobacterium with 16S rRNA sequencing, shotgun metagenome sequencing, and species-specific qPCR, using 2350 samples from three Norwegian cohorts-CRCAhus, NORCCAP, and CRCbiome-and a large publicly available data set, curatedMetagenomicData. Using metagenome-assembled genomes from the CRCbiome study, we explore the genomic characteristics and functional potential of the Phascolarctobacterium pangenome. Three species of Phascolarctobacterium associated with adenoma/CRC were consistently detected by qPCR and sequencing. Positive associations with adenomas/CRC were verified for Phascolarctobacterium succinatutens and negative associations were shown for Phascolarctobacterium faecium and adenoma in curatedMetagenomicData. Men show a higher prevalence of P. succinatutens across cohorts. Co-occurrence among Phascolarctobacterium species was low (<6%). Each of the three species shows distinct microbial composition and forms distinct correlation networks with other bacterial taxa, although Dialister invisus was negatively correlated to all investigated Phascolarctobacterium species. Pangenome analyses showed P. succinatutens to be enriched for genes related to porphyrin metabolism and degradation of complex carbohydrates, whereas glycoside hydrolase enzyme 3 was specific to P. faecium .IMPORTANCEUntil now Phascolarctobacterium has been going under the radar as a CRC-associated genus despite having been noted, but overseen, as such for over a decade. We found not just one, but two species of Phascolarctobacterium to be associated with CRC- Phascolarctobacterium succinatutens was more abundant in adenoma/CRC, while Phascolarctobacterium faecium was less abundant in adenoma. Each of them represents distinct communities, constituted by specific microbial partners and metabolic capacities-and they rarely occur together in the same patients. We have verified that P. succinatutens is increased in adenoma and CRC and this species should be recognized among the most important CRC-associated bacteria., Competing Interests: The authors declare no conflict of interest.

Background: Partially driven by public concerns about modern food production practices, organic food has gained popularity among consumers. However, the impact of organic food consumption during pregnancy on offspring health is scarcely studied. We aimed to investigate the association between maternal intake of organic food during pregnancy and symptoms of attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in offspring at 8 years of age., Methods: This study was based on the Norwegian Mother, Father and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway (MBRN). The total study sample included 40,707 mother-child pairs (children born 2002-2009). Organic food consumption during pregnancy was assessed by six questions from a food frequency questionnaire in mid-pregnancy (sum score 0-18). Symptoms of ADHD and ASD in the offspring aged 8 years were measured by ADHD (0-54) and ASD (0-39) symptom scores based on the Parent/Teacher Rating Scale for Disruptive Behaviour disorders and the Social Communication Questionnaire. Associations between maternal intake of organic food during pregnancy and symptoms of ADHD and ASD in the offspring were analyzed using regression models with adjustment for covariates such as maternal anxiety and depression, including sibling analysis., Results: Mean ADHD and ASD symptom scores in the offspring differed only slightly by maternal intake of organic food. The covariate-adjusted unstandardized regression coefficient (adjusted(Adj)beta) with 95% confidence interval for the ADHD symptom score with one unit increase in organic food sum score was 0.03 (0.01, 0.05). Similarly, Adjbeta for autism symptom score was 0.07 (0.04, 0.10). For ADHD, the adjusted estimates weakened when adjusting for maternal symptoms of ADHD. The sibling analyses showed no significant results with Adjbeta - 0.07 (- 0.15, 0.01) and - 0.001 (- 0.12, 0.12) for ADHD and ASD outcomes, respectively., Conclusions: We observed weak positive associations between frequent maternal organic food consumption during pregnancy and offspring ADHD and ASD symptom levels at 8 years of age. This trend weakened or disappeared after adjusting for maternal symptoms of ADHD, and in sibling analyses, suggesting that the associations mainly reflect genetic confounding. Our study indicates that consumption of organic food during pregnancy should neither be considered a risk factor nor protective against symptoms of ADHD and ASD in offspring., (© 2024. The Author(s).)

Objectives: Investigate associations between body height and cardiovascular disease risk factors at several time points in women and men across educational levels in Norway., Design: Population-based longitudinal study., Setting: The Tromsø Study, a population-based study with six surveys conducted between 1979 and 2016 in the municipality of Tromsø, Norway., Primary and Secondary Outcome Measures: Body height, systolic blood pressure, diastolic blood pressure, serum total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides and self-reported educational level., Participants: 23 512 women and men (49.6% women), aged 30-49 years at first participation in The Tromsø Study. Participants who attended more than one survey contributed with repeated measurements for blood pressure and lipids.Blood pressure and lipid values were used as dependent variables in sex specific age-adjusted linear mixed models. Body height at first participation was the independent variable, while survey time point and educational level were used as covariates., Results: Overall effect models showed inverse associations between body height and systolic blood pressure (reg. coefficients: -0.88 (95% CI -1.1, -0.6)), diastolic blood pressure (-0.41 (95% CI -0.6, -0.3)), serum total cholesterol (-0.12 (95% CI -0.1, -0.1)) and triglycerides (-0.06 (95% CI -0.1, -0.0)) in women. Inverse associations between body height and lipid variables were also observed in men (serum total cholesterol: -0.12 (95% CI -0.1, -0.1) triglycerides -0.05 (95% CI -0.1, -0.0)). Regression coefficients for associations between body height and cardiovascular risk factors varied across surveys. Overall, there were no associations between body height and cardiovascular risk factors based on educational level and survey., Conclusion: The overall effect models support previous findings of inverse associations between body height and cardiovascular risk factors in women, and inverse associations between body height and lipids in men. Our study showed varied degrees of associations between body height and cardiovascular risk factors at different time points in Norway., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction: This study investigates the individual and combined impacts of loneliness and social isolation on 20-year mortality risks among older men and women., Methods: Utilizing data from the Norwegian Life Course, Ageing, and Generation study (NorLAG) carried out in 2002, 2007 and 2017, we assessed loneliness via direct and indirect questions, and social isolation through factors like partnership status and contact frequency with family and friends. Yearly information on mortality was derived from the national registries and was available until November 2022. Gender-stratified Cox regression models adjusted for age and other risk factors were employed., Results: Of the 11,028 unique respondents, 9,952 participants were included in the study sample, 1,008 (19.8%) women and 1,295 (26.6%) men died. In the fully adjusted models including indirectly assessed loneliness, social isolation increased the 20-year mortality risk by 16% (HR = 1.16, 95% CI 1.09-1.24) for women and 15% (HR = 1.15, 95% CI 1.09-1.21) for men. This effect was primarily driven by the absence of a partner and little contact with children for both genders. Loneliness measured with indirect questions lost its significant association with mortality after adjusting for social isolation and other factors in both genders. However, for men, reporting loneliness via a direct question was associated with a higher mortality risk, even in the fully controlled models (HR = 1.20, 96% CI 1.06-1.36). Interactions between loneliness and social isolation were not, or only borderline significantly, associated with mortality risks in the fully controlled models., Discussion: Social isolation, but not loneliness measured with indirect questions are associated with a 15-16% higher mortality risk in both men and women. However, loneliness assessed with a direct question is associated with increased mortality in men, even after controlling for social isolation and other relevant factors, which might suggest that men may deny loneliness, unless it is (very) severe. These findings emphasize the importance of methodological precision in the measurement of loneliness and social isolation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Aartsen, Vangen, Pavlidis, Hansen and Precupetu.)

Objective: To evaluate the association between paternal metformin use and risk of congenital malformations in offspring., Design: Population based, cross national cohort study., Setting: Norway and Taiwan., Participants: 619 389 offspring with paternal data during the period of sperm development (three months before pregnancy) in the Norwegian cohort during 2010-21 and 2 563 812 in the Taiwanese cohort during 2004-18., Main Outcome Measures: The primary outcome was any congenital malformation, and the secondary outcome was organ specific malformations, classified according to the European surveillance of congenital anomalies guidelines. Relative risks were estimated with an unadjusted analysis and with analyses restricted to the cohort of men with type 2 diabetes mellitus and those using overlap propensity score weighting to control for severity of diabetes and other potential confounders. Sibling matched comparisons were conducted to account for genetic and lifestyle factors. Relative risk estimates for Norwegian and Taiwanese data were pooled using a random effects meta-analytical approach., Results: Paternal data on metformin use during the period of sperm development was available for 2075 (0.3%) offspring in Norway and 15 276 (0.6%) offspring in Taiwan. Among these offspring, 104 (5.0%) in Norway and 512 (3.4%) in Taiwan had congenital malformations. Increased risks of any congenital malformation associated with paternal metformin use were observed in the unadjusted analysis and attenuated with increasing control of confounding. The relative risks of any malformations with paternal metformin use were 1.29 (95% confidence interval 1.07 to 1.55) in Norway and 1.08 (0.99 to 1.17) in Taiwan in the unadjusted analysis and 1.20 (0.94 to 1.53) and 0.93 (0.80 to 1.07), respectively, in the analysis restricted to fathers with type 2 diabetes mellitus. In the overlap propensity score weighting analysis restricted to fathers with type 2 diabetes mellitus, the relative risks were 0.98 (0.72 to 1.33) in Norway and 0.87 (0.74 to 1.02) in Taiwan, resulting in a pooled estimate of 0.89 (0.77 to 1.03). No associations were observed between paternal metformin use and any organ specific malformations. These findings were consistent in sibling matched comparisons and sensitivity analyses., Conclusions: The findings suggest that paternal use of metformin during the period of sperm development is not associated with congenital malformations in offspring, including organ specific malformations. Metformin can therefore continue to be considered a suitable initial oral agent for managing glucose levels in men with type 2 diabetes mellitus who plan on having children., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/ and declare: this work was supported by the Norwegian Research Council and by the National Science and Technology Council of Taiwan; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. The authors had full access to all the data in this study and take responsibility for the integrity of the data and the accuracy of the data analysis., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To perform an extensive investigation of the clinical features and long-term complications among the n = 134 adults and children with nucleic acid amplification test (NAAT) verified SARS-CoV-2-infection in the immunologically naïve population of Ulvik, Norway, during the single variant B.1.1.7 outbreak in late January through February 2021., Methods: Every infected person regardless of whether symptoms of COVID-19 were present was invited to answer a web-based questionnaire at two- and seven months after testing positive. The period from initial infection to the first questionnaire was assessed retrospectively, and the time points at two- and seven months were assessed prospectively., Results: A total of 87 of 134 (65%) NAAT-positive persons answered the first questionnaire, of which 35/87 (40%) were children, and 74 of 87 (85%) answered the second questionnaire. Children experienced symptoms less often than adults during the acute phase of infection (51% (18/35) versus 81% (42/52) (p = .004)). At two-months follow-up 88% (53/60) of participants with symptoms during the acute phase, including all children, reported no longer having symptoms. Among those with persisting symptoms at seven months, fatigue (18/25) and insomnia (16/24) were common., Conclusion: In an immunologically naïve population infected with the SARS-CoV-2 B.1.1.7 variant, the clinical features of acute phase symptoms were similar to previous studies. Children underwent asymptomatic infection more often than adults, and adults more often experienced persisting symptoms. Insomnia and fatigue were common complaints among those with persisting symptoms seven months after infection., (© 2024. The Author(s).)

Background: Calling for help is the first link in the chain of survival; however, few studies have investigated the challenges faced by frequent callers (FCs) to emergency medical communication centres (EMCCs). This study aimed to explore the characteristics of FCs and the nature of their calls to the Bergen EMCC, Norway., Methods: This was a retrospective analysis of all emergency calls to the Bergen EMCC over three consecutive years (2019-2021). Bergen is the second-largest city in Norway, and the Bergen EMCC and ambulance services are part of the specialist medical service, covering a population of 460,000. The Bergen EMCC receives approximately 60,000 emergency calls per year. The study population comprised all adults identified during emergency medical calls. FCs were defined as individuals who registered five or more calls over 12 consecutive months during the three-year period., Results: The analysis included approximately 50,000 individuals, who made > 90,000 calls during the study period. Of those, 1,594 (3.2%) were FCs, accounting for approximately one in four (21,339 of 90,085, 23.7%) calls. The FCs included more men (882 of 1,594 (55.3%) vs. 24,204 of 47,564 (50.9%)) and registered a lower proportion of calls with an acute degree of urgency (6,051 of 21,339 calls (28.4%) vs. 30,276 of 68,746 calls (44.0%)). Calls from FCs showed an even occurrence throughout the week, peaking between 19:00 h and 20:00 h. Compared with calls from non-FCs, calls from FCs had a higher proportion of 'no response/verbal referral to local emergency medical department' and involved a lower proportion of hospital transfers. The EMCC most frequently used the medical criterion 'Mental health problems/suicide' for calls from FCs., Conclusions: FCs were common, and more often men. The EMCC dispatched ambulances or admitted patients to hospitals less frequently following these calls. Many of these situations could be handled in other parts of the healthcare system, reducing the burden on EMCCs, and providing more suitable services for FCs. Thus, EMCCs should identify and adjust patient management to match their actual needs., (© 2024. The Author(s).)

Background: The global increase in forcibly displaced populations highlights the importance of understanding their health needs. Chronic pain is prevalent among refugees, poses significant personal and public health challenges, and complicates their integration into new home countries. Understanding refugees' pain post-migration and how it is being managed is crucial for ensuring adequate and timely interventions and fostering health equity. This paper explores the associations between pain levels and the use of painkillers, healthcare services, and long-term impairment among Syrian refugees with chronic pain, one year after their resettlement in Norway., Methods: This cross-sectional study is based on survey data collected from 353 quota refugees in 2018-19, one year after resettlement in Norway. The primary outcomes were the use of painkillers, the use of healthcare services, and long-term impairment, according to reported chronic pain levels. Associations between these outcomes and chronic pain levels were studied using Poisson regression, adjusted by sociodemographic variables and trauma experience., Results: Of the 353 adults included, 52% were women, and the median age was 36 years. A total of 5% reported very mild/mild, 10% moderate, and 12% strong/very strong chronic pain over the last four weeks. Significant associations were found between all chronic pain levels and use of non-prescription painkillers (adjusted relative risks (aRR) (95% CI)); mild (3.1 (2.0-4.7)), moderate (1.8 (1.1-2.8)), strong (1.7 (1.1-2.6)), and prescription painkillers; mild (4.6 (2.2-9.5)), moderate (5.6 (3.2-10.0)), strong (6.7 (3.9-11.3)), compared to those without chronic pain. Use of emergency rooms, specialist care, and hospitalization were significantly associated with strong chronic pain, with aRR (95% CI) of 2.0 (1.2-3.5), 3.9 (2.1-7.0) and 2.4 (1.3-4.4), respectively. Long-term impairment was strongly associated with chronic pain across all pain levels; mild (8.6 (5.6-13.49)), moderate (6.7 (4.3-10.5)) and strong (6.6 (4.3-10.4))., Conclusion: Despite their young age, more than a quarter of the Syrian refugees in our study reported chronic pain one year after resettlement in Norway. High levels of pain were related to the use of medication, healthcare services, and long-term impairment. Understanding the dynamics of pain among refugees is crucial to ensure adequate and timely management., (© 2024. The Author(s).)

Background: Few randomized trials of public health and social measures were carried out during the COVID-19 pandemic. We report on the major barriers we faced when we tried to run such trials., Methods: We reviewed all randomized trials proposed and initiated by the Centre for Epidemic Interventions Research in Norway during the COVID-19 pandemic., Results: Of the 18 proposed trials, 11 trials were not implemented. One of the key legal and ethical barriers to conducting the trials was the Norwegian Health Research Act, which demands informed consent from all participants who are exposed to an intervention. A lack of sufficient political support was also a challenge, as was unpredictability, due to shifting disease incidence and changing recommendations from the authorities., Conclusion: Strengthening the evidence base for public health and social measures in pandemics will require political and public understanding and support and a legal framework that allows for the conduct of such trials., (© 2024. The Author(s).)

Background: Previous studies of the incidence and case fatality of acute myocardial infarction in Norway are based on administrative data that do not distinguish between myocardial infarction with ST segment elevation (STEMI) and without ST segment elevation (NSTEMI). The aim of this study was to investigate the incidence, case fatality and patient characteristics for different types of myocardial infarction in the period 2013-2021., Material and Method: The Norwegian Myocardial Infarction Registry, the Norwegian Patient Registry and the Norwegian Cause of Death Registry were linked in order to identify all patients with myocardial infarction. We calculated age-adjusted incidence and 30-day case fatality., Results: Incidence of all types of myocardial infarction in total fell by 3.8 % per year on average (95 % CI 3.6-4.1). There was a reduction of 2.3 % (95 % CI 1.8-2.8) for STEMI, 3.1 % (95 % CI 2.8-3.4) for NSTEMI, and 6.5 % (95 % CI 5.9-7.1) for out-of-hospital deaths from myocardial infarction. Thirty-day case fatality for all types of myocardial infarction in total was 21.3 % in 2013 and 17.5 % in 2021. Case fatality for all infarctions fell by an average of 2.8 % per year (95 % CI 2.3-3.3), case fatality for NSTEMI fell by 4.4 % per year (95 % CI 3.3-5.5) per year, while case fatality for STEMI was unchanged., Interpretation: Incidence of all types of myocardial infarction declined in the period 2013-2021. Thirty-day case fatality remains high, despite a fall in case fatality for all myocardial infarctions in total and for NSTEMI. There was no change in case fatality for STEMI.

Background: Older people with diabetes who live at home and receive home care services (HCS) are vulnerable, which may result in a need for more care than the HCS can provide. In this study we aimed to explore associations between pharmacologically treated diabetes and the risk of short-term and long-term nursing home stays (NHS) among older people receiving HCS., Methods: This nationwide registry study included older people ≥ 65 years receiving HCS, as registered in the Norwegian Information System for the Nursing and Care Sector (IPLOS) (2010-2014). Data from IPLOS were merged with data from the Norwegian Prescription Database and the Norwegian Patient Registry. Pharmacologically treated diabetes (hereafter referred to as diabetes) was defined based on prescriptions of glucose-lowering drugs (GLD) (≥ 1 prescription in the current or previous year). Persons not prescribed GLD were defined as not having diabetes. Based on Anatomical Therapeutic Chemical (ATC) codes we identified the following subgroups: persons without diabetes, persons using "non-insulin GLD only", "insulin and non-insulin GLD" and "insulin only". An NHS was defined as at least one stay during a given calendar year, where a short-term NHS is temporary, and a long-term NHS is permanent. Log-binomial regression was used to test for differences in NHS and results are reported as risk ratios (RR) with 95% CIs., Results: Both insulin-treated subgroups had a higher risk of a short-term NHS ("insulin only" users RR 1.06 (CI 1.03-1.09) and "insulin and non-insulin GLD" users RR 1.04 (CI 1.02-1.06)) compared to those without diabetes. In general, persons with diabetes had a lower risk of a long-term NHS than those without diabetes (RR 0.92 (CI 0.89-0.94)). The subgroup using "insulin and non-insulin GLD" had the lowest risk of a long-term NHS (RR 0.86 (CI 0.81-0.91))., Conclusion: Despite a lower risk of a long-term NHS among older people with diabetes, we found an increased risk of a short-term NHS among persons with insulin-treated diabetes who live at home and receive HCS. This calls for attention when planning health care, in order to provide coordinated and individualized care to prevent short-term NHS's., (© 2024. The Author(s).)

Purpose: This study explores the protective capabilities of bicycle helmets on serious head injury among bicyclists hospitalized in a Norwegian level 1 trauma centre., Method: Information on helmet use, demographic variables, Abbreviated Injury Scale (AIS) and surgical procedure codes was retrieved from the Oslo University Hospital Trauma Registry for patients with bicycle-related injuries from 2005 through 2016. Outcomes were serious head injury defined as maximum AIS severity score ≥ 3 in the AIS region Head, any cranial neurosurgical procedure, and 30-day mortality., Results: A total of 1256 hospitalized bicyclists were included. The median age was 41 years (quartiles 26-53), 73% were male, 5.3% had severe pre-injury comorbidities, and 54% wore a helmet at the time of injury. Serious head injury occurred in 30%, 9% underwent a cranial neurosurgical procedure, and 30-day mortality was 2%. Compared to non-helmeted bicyclists, helmeted bicyclists were older (43 years, quartiles 27-54, vs. 38 years, quartiles 23-53, p = 0.05), less often crashed during night-time (21% vs. 38%, p < 0.001), less frequently had serious head injury (22% vs. 38%, OR 0.29, 95% CI 0.22-0.39), and less often underwent cranial neurosurgery (6% vs. 14%, OR 0.36, 95% CI 0.24-0.54). No statistically significant difference in 30-day mortality between the two groups was found (1.5% vs. 2.9%, OR 0.50, 95% CI 0.22-1.11)., Conclusion: Helmet use was associated with fewer and less severe head injuries and fewer neurosurgical procedures. This adds evidence to the protective capabilities of bicycle helmets., (© 2024. The Author(s).)