Norwegian Counties Research Articles

The role of the district medical officer after the pandemic - a qualitative study.

While district medical officers' role was described as unclear and lacking visibility before the COVID-19 pandemic, their community medicine expertise became highly significant in the management of the pandemic. We wished to investigate district medical officers' perceptions of their role after the pandemic was over. The study was designed as a theory-driven qualitative interview study. Twelve district medical officers in the Norwegian county of Innlandet were interviewed in the autumn of 2022. The data were subjected to thematic analysis. The study identified a number of factors associated with the capabilities, motivation, and structural and organisational framework of district medical officers that were assumed to impact on the execution of their role and participation in decision-making processes in the local authorities. The district medical officers found that their role had become clearer and more visible during the pandemic, but they had low expectations of being more involved and having a stronger voice in the development of future health services in the municipalities. One proposed measure is to devise a guide for the district medical officer function, such that the local authorities are given clear guidelines on the district medical officers' areas of responsibility and the issues in which they should be involved. The district medical officers felt that 'the pandemic effect is over', and that they had to fight their way back into important decision-making arenas. Measures at individual and organisational level can help ensure the optimal use of district medical officers' community medicine expertise in the municipalities.

Experiences with regular testing of students for SARS-CoV-2 in primary and secondary schools: results from a cross-sectional study in two Norwegian counties, autumn 2021

BackgroundTo allow for normal school attendance during the COVID-19 pandemic, regular testing of students was introduced in the autumn 2021 in Norway to manage COVID-19 transmission. We mapped the experiences of five stakeholders (parents, students, school staff and administration, contact tracing teams) regarding the implementation of regular testing in primary and secondary schools in Oslo and Viken counties, to assess the acceptability through different indicators and improve future guidelines.MethodsA cross-sectional survey was conducted between October and November 2021 to explore experiences of implementation, compliance, satisfaction, difficulties, concerns, confidence in regular testing, quality of teaching and school attendance. Five stakeholder groups were invited to participate: contact tracing teams; school administrators and employees in primary, lower secondary, and upper-secondary school; students in upper-secondary school and parents of primary and lower secondary students. Bivariate analyses were performed for students, parents, and school employees groups. Descriptive analyses were done for contact tracing teams and school administrators.ResultsFour thousand five hundred sixty-five participants were included in our study. School attendance increased for most of the students in primary and lower secondary schools in Oslo and Viken after the implementation of regular testing. Students across all school levels reported high testing compliance and satisfaction with the implementation. Compliance was significantly associated with an increasing number of weekly tests across all school levels up to two weekly tests. Contact tracing teams were less satisfied with the cooperation with the educational authorities compared to the school employees. Higher educational level of parents was significantly associated with decreased concern of their children getting infected at school after regular testing implementation. Concerned parents were more likely to keep children at home from school, to protect all household members from becoming infected. Lack of time and communication were reported as challenging factors to implementation.ConclusionCompliance, satisfaction, and confidence in regular testing of COVID-19 were high among stakeholders. An acceptable testing regime for a future regular testing implementation would be a home-based, bi-weekly test. Increased awareness of the importance of school attendance, safety of regular testing along with good communication and role clarification should be prioritized for stakeholders involved in regular testing.

Rettigheter og tvang i kommunale hjelpetilbud til personer med alvorlige samtidige rus- og psykiske lidelser: erfaringer med regelverket, i lys av menneskerettigheter.

Rights and coercion in municipal services for persons with co-occurring severe mental illness and substance use disorders - experiences with legal framework, in light of human rights. Aims: Persons with co-occurring severe mental illness and substance use disorders can have a considerable need for municipal health and care services but can be difficult to reach with such services. In Norway, there are known perceived ambiguities and obscurities in the legal framework for such services. This study aims to further examine these legal issues in a Norwegian context, by examining what challenges service providers experience in the practice of the current legal framework in this field. Design: The data consists of 13 qualitative interviews with strategically selected service providers from Norwegian municipalities and county governors' offices. The interviews were analyzed through systematic text condensation. Results: The participants reflections resulted in three especially salient perceived challenges in the practice of the current legal framework in this field: 'being dependent upon extra efforts that exceed the legal minimum requirements', 'lacking a legal basis and tools' and 'a complex and composite legal framework'. Conclusions: When seen in light of human rights, the three identified challenges in legal framework should be considered more closely both from a research perspective and from a policy making perspective. It should be investigated further whether human rights oblige the state beyond setting forth minimum requirements, how different human rights impact one another, especially with a view to service providers' rights v. service recipients' rights, and lastly if it is feasible to simplify or clarify the current legal framework to ensure adherence to the law and to promote equal practice among service providers.

Dementia and mild cognitive impairment in older people in Trøndelag.

The number of people with dementia is expected to triple by 2050. We present figures showing the prevalence of dementia and mild cognitive impairment in Trondheim, and show how weighting for non-response and nursing home residency affects these figures when comparing Trondheim with Nord-Trøndelag. In the fourth data collection in the Trøndelag Health Study (HUNT4) in the Norwegian county of Trøndelag, people aged 70 and over in Trondheim were invited to participate in HUNT4 Trondheim 70+. The participants were interviewed and underwent cognitive testing. A diagnostic team diagnosed dementia and mild cognitive impairment. Weights adjusting for non-response bias were used in the comparison of Trondheim and Nord-Trøndelag. The prevalence of dementia in Trondheim was estimated at 16.2% for the age group 70 years and over, after weighting for non-response bias with regard to age, sex, education and proportion of nursing home residents. Unadjusted dementia prevalence was 21.0% in Trondheim and 15.7% in Nord-Trøndelag. After weighting, the prevalence was almost identical in the two samples. Weighting for non-response is crucial for obtaining representative figures in prevalence studies of dementia.

Universal Transfers, Tax Breaks and Fertility: Evidence from a Regional Reform in Norway

The relatively high fertility in the Nordic countries has attracted considerable academic and political interest. Still, the causal relationship between economic circumstances and fertility in the Nordic context is poorly understood. This paper estimates the effect of tax breaks and universal transfers on fertility in the Nordic context. We analyze the fertility effects of a regional child benefit and tax reform implemented in the northern municipalities of the Norwegian county Troms, using the southern municipalities of the same county as a plausible and empirically similar control group. We use a difference-in-difference/event study design, and estimate multivariate models on individual-level data from administrative registers for the full population. The reform increased fertility among women in their early 20 s. The effects are concentrated among unmarried women, who received the largest subsidies. Our findings suggest that favorable economic conditions have contributed to the relatively high fertility in the Nordic countries.

Prolonged breastfeeding and dental caries in preschool children

Purpose To explore breastfeeding from 6 to 18 months of age and to study the association between breastfeeding and caries prevalence at 5 years of age. Methods The study included 1088 children from one Norwegian county and was based on the Norwegian Mother, Father and Child Cohort Study (MoBa). The children had clinical dental examination at 5 years of age, and parents answered a questionnaire, which included information on breastfeeding, oral health behaviour and child characteristic. Multivariate logistic regressions were performed. The study was ethically approved. Results Of the studied children, 77% were breastfed at 6 months of age and 16% were still breastfed at 18 months of age. Few children (6%) were breastfed during night at 18 months of age, while 11% received sugary drink during night. No association was found between breastfeeding up to 18 months of age and caries prevalence at 5 years of age (p > .05). Children who at 18 months of age had their teeth brushed less than twice daily (OR 2.4, CI 1.5–3.9), consumed sugary drink once a week or more often (OR 1.7, CI 1.1–2.7) and had non-Western parents (OR 3.4, CI 1.5–8.1) were more likely to have caries experience at 5 years of age than other children. Conclusion Breastfeeding up to 18 months of age was not associated with caries development during preschool age.

Built Environment Accessibility and Disability as Predictors of Well-Being among Older Adults: A Norwegian Cross-Sectional Study.

Knowledge about the influence environmental factors have on well-being is important to deliver policies supporting healthy ageing and sustainable health equity. An under-researched question is whether and how the built environment plays a role on well-being among older adults with disabilities. This study explores the relationship between built environment accessibility and disability on psychosocial well-being among older adults. Data were used from the Norwegian Counties Public Health Survey collected during February 2021 in Møre and Romsdal county (N = 8274; age = 60-97, mean = 68.6). General linear modelling was performed to examine the relationship and interaction between built environment accessibility (services, transportation, and nature) and disability on psychosocial well-being (quality of life, thriving, loneliness, and psychological distress). Higher levels of disability and poorer accessibility were each significantly related to lower psychosocial well-being across all variables (p < 0.001). Significant interaction effects were observed between disability and built environment accessibility on thriving (F(8, 5936) = 4.97, p < 0.001, η2 = 0.006) and psychological distress (F(8, 5957) = 3.09, p = 0.002, η2 = 0.004). No significant interaction effects were found for quality of life and loneliness. These findings indicate good built environment accessibility is associated with thriving and reduces psychological distress among older adults with disabilities. This study supports and extends previous findings on the importance of accessible and equipped environments for well-being and may aid policy makers when planning built environments to foster healthy ageing among this population group.

Caregiving + Migrant Background = Double Jeopardy? Associations between Caregiving and Physical and Psychological Health According to Migrant Backgrounds in Norway.

Informal caregiving can have detrimental consequences for physical and psychological health, but the impacts are highly heterogenous. A largely ignored question is whether these impacts differ with migrant backgrounds, and whether caregiving and a migrant background combine to create double jeopardy. We explored these questions using large-scale data that allows stratification by sex, regional background, and types (inside vs. outside of household) of caregivers. We used cross-sectional 2021 data collected from two Norwegian counties as part of the Norwegian Counties Public Health Survey (N = 133,705, RR = 43%, age 18+). The outcomes include subjective health, mental health, and subjective well-being. The findings show that both caregiving, especially in-household caregiving, and a migrant background relate to lower physical-psychological health. In bivariate analysis, non-Western caregivers, women particularly, reported poorer mental health and subjective well-being (but not physical health) than other caregiver groups. After controlling for background characteristics, however, no interaction exists between caregiver status and migrant background status. Although the evidence does not suggest double jeopardy for migrant caregivers, caution is warranted due to the likely underrepresentation of the most vulnerable caregivers of migrant backgrounds. Continued surveillance of caregiver burden and distress among people of migrant backgrounds is critical to develop successful preventive and supportive intervention strategies for this group, yet this aim hinges on a more inclusive representation of minorities in future surveys.

Comparing the effects of reduced social contact on psychosocial wellbeing before and during the COVID-19 pandemic: a longitudinal survey from two Norwegian counties

PurposeTo determine changes to people’s social contact during COVID-19, and whether reduced social contact was associated with changes to psychosocial wellbeing.MethodsQuestionnaire data were collected from a sample of adult respondents (18 years or more) in two Norwegian counties participating pre-COVID-19 (September 2019–February 2020; n = 20,196) and at two time points during COVID-19 (June [Mid] and November/December [Late] 2020; n = 11,953 and n = 10,968, respectively). The main outcome measures were participants' self-reported changes to social contact, loneliness, psychological distress, and life satisfaction.ResultsThe proportion of respondents reporting less social contact due to COVID-19 decreased from 62% in Mid-2020 to 55% in Late-2020. Overall, reported psychological wellbeing remained unchanged or improved from pre-COVID-19 to Mid-2020. From Mid-2020 to Late-2020, however, a reduction in psychological wellbeing was observed. Poorer psychological wellbeing was found for those with less social contact during the pandemic compared with people reporting unchanged social contact. This effect increased over time and was observed for all age groups at Late-2020. At Mid-2020, the importance of change in social contact for change in psychological wellbeing was greatest among young adults (< 30 years), while no significant differences were found for the oldest age group.ConclusionThe association between COVID-19-era changes to social contact and loneliness, psychological distress, and life satisfaction is complex and appears to be age-dependent. Future studies should consider the quality of social contact and cultural contexts in which social restrictions are imposed.

Examining activity-friendly neighborhoods in the Norwegian context: green space and walkability in relation to physical activity and the moderating role of perceived safety

BackgroundDespite the well-known health benefits of regular physical activity, inactivity remains a major public health concern. Understanding how the built environment can encourage physical activity is therefore important to inform current policy strategies for creating activity-friendly neighborhoods. This study aimed to examine whether neighborhood walkability and greenness were associated with physical activity, and if perceived safety moderated any such relations, among adult citizens in Norway.MethodsThis cross-sectional study included a sample of 5670 adults aged ≥ 18 years living in urban areas of Stavanger. Information on physical activity (PA) levels, perceived neighborhood safety, and socio-demography were obtained from questionnaire data collected in the Norwegian county public health survey of Rogaland. Geographic information systems were utilized to compute walkability, vegetation scores and proportion of green space within postcode areas, which subsequently were linked to the survey data. Hierarchical linear regression models were fitted to examine associations between walkability, amount of vegetation, proportion of green space and weekly minutes of PA, and to estimate main and interaction effects of perceived safety on these relationships.ResultsThe adults were on average physically active 148.3 min/week. The amount of green vegetation in the neighborhood was positively related to physical activity when adjusting for potential confounders. No such relations were observed for proportion of green space and walkability. Perceived neighborhood safety was significantly related to increased levels of physical activity, but no moderating role of perceived safety was observed.ConclusionAlthough our findings should be interpreted with caution, the results point towards the importance of policymakers, planners, and public health professionals to advocate for safe environments with green vegetation for physical activity in the neighborhood.

Lower education and immigrant background are associated with lower participation in a diabetes education program – Insights from adult patients in the Outcomes & Multi-morbidity In Type 2 diabetes cohort (OMIT)

ObjectivesDiabetes educational programmes should be offered to patients with type 2 diabetes mellitus (T2DM). We assessed the proportion of diabetes educational program participation among adults with T2DM, and its associations with place of residence in Norway, education, and immigrant background. MethodsWe identified 28,128 diagnosed with T2DM (2008–2019) in the Outcomes & Multi-morbidity In Type 2 diabetes cohort. To examine associations between sociodemographic factors and participation in diabetes start courses (yes/no), we computed adjusted risk ratios (95% CI) using log-binomial regression. ResultsOverall, 18% participated on the diabetes start course, but partaking differed by Norwegian counties (range:12–34%). Individuals with an immigrant background were 29% less likely to participate (RR 0.71, CI 0.65–0.79). Similarly, those with a lower educational level were 23% less likely to participate (RR 0.77, CI 0.72–0.83) than those with the highest education. The association between education and start course participation was not significant in the subgroup of immigrant individuals (RR 0.88 CI 0.70–1.12). ConclusionsWe found that diabetes start course participation was overall low, especially in individuals with low education and immigrant background. Practice implicationsMore efforts are needed to promote diabetes start courses in patients with T2DM.

Meetings as an Arena for Coordination in Crisis: The County Governor’s Contingency Coordination through the County Emergency Council in Norway

This article aims to study how Norwegian county governors (CGs) performed their coordination tasks shortly after the lockdown in March by emphasizing the use of the County Emergency Council (CEC) as a meeting arena for coordination in times of crisis management more generally and the challenges the CGs had to face in this particular situation. We ask (1) what kind of meeting arena is the CEC and (2) how does the CEC as a meeting arena facilitate coordination at this level of government? In order to analyze the dynamics of the CEC meetings, we will refer to two theoretical approaches, i.e., meetings science and coordination. The present study is based upon an exploratory research strategy to analyze how the CGs responded to the challenges and performed coordination through the CEC. We found that the CEC meetings could be seen as hybrids of organization, institution and network, and even a network of networks, where several CG offices established thematic networks. These smaller networks have the advantage of establishing personal relationships more easily than the larger networks; however, they may lack the comprehensive overview that is necessary in a crisis that cuts across sectors.

Mental health problems, low economic capability, and social marginalization among 28,047 adults

Abstract Background Mental health problems and low economic capability increase the risk of social marginalization. However, few larger studies with a broad age group have investigated how the cumulative effect of having both these difficulties may affect social life. The purpose of this study was to examine the associations between having mental health problems or having low economic capability or reporting both, and social marginalization. Methods The study is based on responses from 28 047 adults (&amp;gt; 18 years old) from the general population participating in The Norwegian Counties Public Health Survey 2019. The study had a cross-sectional design and included respondents’ evaluation of own economic capability, mental health problems (HSCL-5) and social marginalization measured as lack of social support, low participation in organized social activities, low participation in other activities, missing someone to be with, feeling excluded and feeling isolated. Multivariable logistic regression was adjusted for sex and age. Results Findings showed that having mental health problems or low economic capability were both associated with various measures of social marginalization with odds ratio [OR] 95% confidence interval [CI] ranging from OR 1.33; CI 1.23-1.43 to OR 12.63; CI 10.90-14.64. However, the odds of social marginalization strongly increased for respondents having both mental health problems and low economic capability compared to respondents without both these difficulties, with OR ranging from OR 2.08; CI 1.90-2.27 to OR 29.46; CI 25.32-34.27. Findings are preliminary. Conclusions Having both mental health problems and low economic capability strongly increases the risk of social marginalization, far beyond the effect of each factor alone. Key messages • Having both mental health problems and low economic capability strongly increases the risk of social marginalization, far beyond the effect of each factor alone. • Services should aim to develop multi-faceted approaches to meet multiple life-challenges to prevent social marginalization.

The significance of the social and material environment to place attachment and quality of life: findings from a large population-based health survey

BackgroundThere is an international public health interest in sustainable environments that promote human wellbeing. An individual’s bond to places, understood as place attachment (PA), is an important factor for quality of life (QoL). The material environment, such as access to nature (AtN), access to amenities (AtA), or noise, and the social environment, such as social support or loneliness, has the potential to influence PA. The aim of the present study was to explore the relationship between these factors and QoL.MethodsThe study relied on data from 28,047 adults from 30 municipalities in Southern Norway obtained from the Norwegian Counties Public Health Surveys in 2019. Latent regression analyses were used to examine the relationship between the material and social environmental factors and QoL, mediated by PA.ResultsWe found a relationship between social and material environmental factors and PA. Higher AtN and AtA scores were related to an increase in PA, whereas higher perception of noise problems was related to decreased PA scores. When social environment factors were added to the model, they were even stronger predictors of PA and, in turn, QoL through mediated effects. We also found a strong positive association between PA and QoL (unstandardized β = 0.88, 95% CI = 0.87–0.90, p < 0.001). The whole model explained 83% of the variance in PA and 65% of the variance in QoL.ConclusionsTaken together, the findings suggest the relevance of material and social environmental factors for PA and QoL. Therefore, research on public health and QoL should include place-sensitive variables.

Community services during the COVID-19 pandemic in a Norwegian county: impact on users with multiple, complex needs and their service providers – a qualitative study

PurposeThe purpose of this paper is to investigate how users with particularly complex needs including intellectual disability (ID) reacted to the changes and restrictions during the COVID-19 pandemic in 2020.Design/methodology/approachAs few studies of changes during the pandemic include users with ID and multiple, complex needs, the authors adopted a qualitative approach, using a semistructured interview guide. Ten participants were leading ID nurses in residential facilities in community settings. The interviews were taped, transcribed and analyzed using a thematic analysis.FindingsThe thematic analysis generated six main themes, including both user and staff perspectives: daily routines, activities, facilitation of tasks and well-being, from the users perspectives, and use of working hours and positive staff experiences, from the staff perspectives.Research limitations/implicationsTen residential facilities constituted a convenience sample of services for users with multiple, complex needs. Thus, the authors do not know whether the findings are representative. Further research should include user opinions based on the findings of this study.Practical implicationsThe users represented in this study appeared to experience less stress during the pandemic, contrary to the expectations of professional caregivers. The findings indicated more well-being among users. It was noted that receiving services at home, largely flexible schedules, staying in bed a little longer in the morning and avoiding stressful situations, such as travelling in minibuses, was appreciated by the users.Social implicationsDaily schedules with activities throughout the day should be considered for users as represented in this study. Stressful events should also be considered.Originality/valueThe knowledge about pandemic experiences of users with ID and additional complex conditions and hence comprehensive needs is still sparse. This study may add to this knowledge.

Evidence in Norwegian child protection interventions – Analysing cases of familial violence

AbstractHow is expert evidence used in care order proceedings when children are considered for foster care placement because of familial violence? What are important factors and how do the decision‐makers use and evaluate evidence from specialists and experts? In this in‐depth analysis of 104 published care order decisions from the Norwegian County Boards, I investigate how decision‐makers use and evaluate evidence from expert witnesses to determine whether a care order may be granted. The analysis shows that the evidence largely revolves around social functioning, care context and topics about how parents and children relate to each other. Led by the law, the decision‐makers use this evidence to determine whether the child's situation is harmful, whether support services are viable and whether a care order is in the child's best interests. I find that decision‐makers draw unevenly on evidence with regards to these legal requirements, and that the use predominantly defers to expert authority. However, there is also evidence of independent reasoning, where deferral to the epistemic authority of the experts is weakened. This is shown through evaluative and critical assessments and scrutiny of the disciplinary evidence.

Incidence, recurring admissions and mortality of severe bacterial infections and sepsis over a 22-year period in the population-based HUNT study

Severe bacterial infections are important causes of hospitalization and loss of health worldwide. In this study we aim to characterize the total burden, recurrence and severity of bacterial infections in the general population during a 22-year period. We investigated hospitalizations due to bacterial infection from eight different foci in the prospective population-based Trøndelag Health Study (the HUNT Study), where all inhabitants aged ≥ 20 in a Norwegian county were invited to participate. Enrollment was between 1995 and 1997, and between 2006 and 2008, and follow-up ended in February 2017. All hospitalizations, positive blood cultures, emigrations and deaths in the follow-up period were captured through registry linkage. A total of 79,393 (69.5% and 54.1% of the invited population) people were included, of which 42,237 (53%) were women and mean age was 48.5 years. There were 37,298 hospitalizations due to infection, affecting 15,496 (22% of all included) individuals. The median time of follow-up was 20 years (25th percentile 9.5-75th percentile 20.8). Pneumonia and urinary tract infections were the two dominating foci with incidence rates of 639 and 550 per 100,000 per year, respectively, and with increasing incidence with age. The proportion of recurring admissions ranged from 10.0% (central nervous system) to 30.0% (pneumonia), whilst the proportion with a positive blood culture ranged from 4.7% (skin- and soft tissue infection) to 40.9% (central nervous system). The 30-day mortality varied between 3.2% (skin- and soft tissue infection) and 20.8% (endocarditis). In this population-based cohort, we observed a great variation in the incidence, positive blood culture rate, recurrence and mortality between common infectious diseases. These results may help guide policy to reduce the infectious disease burden in the population.

Changes in life expectancy and disease burden in Norway, 1990–2019: an analysis of the Global Burden of Disease Study 2019

SummaryBackgroundGeographical differences in health outcomes are reported in many countries. Norway has led an active policy aiming for regional balance since the 1970s. Using data from the Global Burden of Disease Study (GBD) 2019, we examined regional differences in development and current state of health across Norwegian counties.MethodsData for life expectancy, healthy life expectancy (HALE), years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) in Norway and its 11 counties from 1990 to 2019 were extracted from GBD 2019. County-specific contributors to changes in life expectancy were compared. Inequality in disease burden was examined by use of the Gini coefficient.FindingsLife expectancy and HALE improved in all Norwegian counties from 1990 to 2019. Improvements in life expectancy and HALE were greatest in the two counties with the lowest values in 1990: Oslo, in which life expectancy and HALE increased from 71·9 years (95% uncertainty interval 71·4–72·4) and 63·0 years (60·5–65·4) in 1990 to 81·3 years (80·0–82·7) and 70·6 years (67·4–73·6) in 2019, respectively; and Troms og Finnmark, in which life expectancy and HALE increased from 71·9 years (71·5–72·4) and 63·5 years (60·9–65·6) in 1990 to 80·3 years (79·4–81·2) and 70·0 years (66·8–72·2) in 2019, respectively. Increased life expectancy was mainly due to reductions in cardiovascular disease, neoplasms, and respiratory infections. No significant differences between the national YLD or DALY rates and the corresponding age-standardised rates were reported in any of the counties in 2019; however, Troms og Finnmark had a higher age-standardised YLL rate than the national rate (8394 per 100 000 [95% UI 7801–8944] vs 7536 per 100 000 [7391–7691]). Low inequality between counties was shown for life expectancy, HALE, all level-1 causes of DALYs, and exposure to level-1 risk factors.InterpretationOver the past 30 years, Norway has reduced inequality in disease burden between counties. However, inequalities still exist at a within-county level and along other sociodemographic gradients. Because of insufficient Norwegian primary data, there remains substantial uncertainty associated with regional estimates for non-fatal disease burden and exposure to risk factors.FundingBill & Melinda Gates Foundation, Research Council of Norway, and Norwegian Institute of Public Health.

Fatigue in multiple sclerosis is associated with socioeconomic factors

ObjectivesFatigue is one of the leading causes of reduced quality of life and inability to work in people with multiple sclerosis (pwMS). Currently, no treatment effectively ameliorates fatigue. We still know little about what causes fatigue and which factors may contribute to fatigue. Knowledge about socioeconomic factors’ role in fatigue might help us recognize strategies for the management of fatigue. Our aim was to explore whether socioeconomic factors are associated with the presence or level of perceived fatigue. MethodsThis is a cross-sectional study of the MS population in three Norwegian counties. We used the Fatigue Scale for Motor and Cognitive Functions to assess self-reported fatigue, and obtained socioeconomic data from Statistics Norway and questionnaires. To assess self-reported anxiety and depression, we employed the Hospital Anxiety and Depression Scale. Clinical data were gathered from the hospital record system. ResultsThe response rate was 64% (1599/2512). Seventy percent of the respondents were female, and the mean age was 52 years. Higher levels of education were associated with lower levels of fatigue. Receiving a disability pension, being divorced and having children were all factors associated with higher levels of fatigue, as were low parental education, low income, current smoking, and autoimmune comorbidities. We found a higher prevalence of anxiety and depression in pwMS with fatigue compared to those without fatigue ConclusionFemale sex, high level of disability, anxiety, depression and socioeconomic factors were independently associated with fatigue in contemporary patients with MS. These factors should be considered when devising management strategies.

Vocational rehabilitation augmented with cognitive behavioral therapy or cognitive remediation for individuals with schizophrenia: a 5-year follow-up study

Introduction Although employment is an important part of recovery for individuals with schizophrenia spectrum disorders, the employment rate for this group remains low. Increasing evidence supports the use of augmented vocational rehabilitation (VR) programs to improve occupational outcome. The aim of this study is to explore 5-year follow-up registry data from the JUMP study, a VR program for individuals with schizophrenia spectrum disorders, specifically with regard to competitive employment outcome and predictors of competitive employment. The VR was augmented with either cognitive remediation (CR) or elements from cognitive behavior therapy (CBT). Methods One hundred and forty eight participants with schizophrenia spectrum disorders from six Norwegian counties received 10 months VR augmented with either CR (n = 64) or CBT (n = 84). Both competitive and sheltered workplaces were used. Assessments were conducted at baseline, at post intervention and at 2-year follow-up. Data on employment status at 5-year follow-up was obtained by registry. Results At 5-year follow-up 55.4% were engaged in working activity, of which 22.3% had obtained competitive employment. A further 18.2% had work placements in competitive workplaces. Number of received intervention hours and competitive employment at 2-year follow-up emerged as significant predictors of competitive employment. IQ and intervention type in marginal favor of CBT were predictors on trend level. Conclusion To the best of our knowledge, this is the first study investigating competitive employment at 5-year follow-up for individuals with schizophrenia spectrum disorders. The results add to existing evidence that competitive employment is attainable for this group.