Norwegian Directorate Of Health Research Articles

Skandinaviske retningslinjer for behandling av psykisk lidelse hos barn og unge: En kvalitetsvurdering

Children and young people with untreated mental health disorders can develop chronic disorders and severe somatic diseases later in life. The right treatment at the right time is therefore important to promote good mental health. Healthcare personnel are required to follow national guidelines, and high-quality guidelines are thus important for patient safety. We wanted to assess the quality of Norwegian national guidelines for the treatment of mental disorders in children and young people and compare these with corresponding guidelines in Sweden and Denmark. We conducted manual searches in the relevant national health authorities’ websites and selected five Norwegian guidelines (treatment of ADHD, bipolar disorders, psychosis, suicide and eating disorders), three Danish guidelines (ADHD, anorexia and bulimia) and one Swedish guideline (ADHD). For the purpose of quality assessment, we used an internationally recognised checklist (AGREE II), on which Norwegian guidelines must be developed in accordance with the Norwegian Directorate of Health’s own guide for developing guidelines. The checklist consists of 23 items divided into six domains: scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence. We found that the overall quality of the Danish and Swedish guidelines was very high and met most of the 23 criteria organised within six domains. The Norwegian guidelines met the criteria for scope and purpose and stakeholder involvement, but had major shortcomings in terms of rigour of development, clarity of presentation, applicability, and transparency of editorial independence. Keywords: evidence-based practice, national guidelines, children and adolescents, mental disorders

Effectiveness of a Smartphone App (Heia Meg) in Improving Decisions About Nutrition and Physical Activity: Prospective Longitudinal Study.

Obesity is a prevalent and serious chronic condition associated with abnormal or excessive fat buildup that poses significant health risks. The rates of overweight and obesity in adults and children continue to rise, with global rates of children with overweight or obesity aged 5-19 years growing from 4% to 18% between 1975 and 2016. Furthermore, in 2017, nearly 4 million people died due to complications arising from being overweight or obese. This study aims to investigate the potential impact of the mobile app Heia Meg on promoting healthier lifestyle choices regarding nutrition and physical activity. A prospective longitudinal study was conducted in collaboration with the Norwegian Directorate of Health. Participants were recruited through the Heia Meg app and were asked to complete a questionnaire before and after using the app. A total of 199 responses were included in the first (preintervention) questionnaire, while 99 valid responses were obtained in the second (postintervention) questionnaire. The majority (159/199, 79.9%) of participants were female, and their age ranged from 18 years to 70 years and older. The results show a reduction in BMI after the digital intervention. However, some variables influence the BMI reduction effect: sex, age, education, and smoking. The group that obtained the most benefit from the intervention consisted of those who were male, aged 30-39 years, highly educated, and nonsmokers. Although positive, some of the findings are slightly above the statistical significance threshold and therefore should be interpreted carefully. Our study found weak evidence to support the effectiveness of the Heia Meg app in promoting healthier lifestyle choices. However, limitations and confounding factors suggest that further research in different populations with larger sample sizes is needed to confirm or disprove our findings.

Building and maintaining trust through the early phase of the COVID-19 pandemic: A content analysis of communiques delivered by the Norwegian Minister of health and care services

The COVID-19 pandemic presented not only a challenge to leaders' decision-making, but also to their ability to demonstrate effective crisis and emergency communication. This study examines the communication delivered by the Norwegian Minister of Health and Care services during the first six months of the COVID-19 pandemic, corresponding to the first wave of infection timeframe. Communiques were analysed through a process of coding to identify 15 Crisis and Emergency Risk Communication (CERC) themes, in addition to word cloud analyses and KWIC-analyses. The results were aligned with policy stringency, public health measures from the Norwegian Institute of Public Health (NIPH) and trust data from the Norwegian Directorate of Health (NDH) over timeframe to examine changes in communication. The study revealed that the communication delivered by the Minister included many of the CERC features, although communication failures could be observed, coinciding with reduction in the public's trust in the health authorities. Despite reduced trust, however, compliance with the precautionary measures against COVID-19 was still high. A likely explanation might be that the inherent trust in the health authorities was high, and that the simple, repeated efficacy messages was understood by the public—‘wash your hands and keep a distance’. These findings indicate that keeping communication science-based, transparent, accurate, and consistent, and never compromise with honesty and truthfulness, are keys in crisis and emergency situations. Being a leader in an organization with high inherent trust may also help.

The effect of the association between food budget and food quality on adherence to national guidelines in kindergartens, and the impact of budget limit on the food quality.

In Norway, almost 97% of children attend kindergartens. Most of the daily food intake happens during the day in kindergartens, and the quality of food and meals being served is essential to promote healthy food habits. There is variation in the food that kindergartens provide, and kindergartens can ask for additional payment from parents to cover the food. There are no rules neither across kindergartens for the food offering nor how much additional payment kindergarten can request. Our main objective is to investigate possible associations between the food budget and the quality of food offered in kindergartens. We specifically aimed to identify budget levels that were associated with better adherence to national guidelines, thereby the quality of the food provided, as recommended by the Norwegian Directorate of Health. A cross-sectional study design, based on kindergarten pedagogical leaders' answers to a web-based questionnaire. Private and public kindergartens across Norway are included in this present study. A total of 324 kindergarten staff attending on behalf of kindergartens participated. The food budget thresholds over NOK 199 are associated with higher quality of served food, in adherence to national guidelines of food and meals (odds ratio 5.2, CI = [1.5, 16.5]), compared to thresholds under 199 NOK. However, increasing the monthly food budget per child to low (200-299 NOK), medium (300-399 NOK), high (400-499 NOK), or very high (>500 NOK) levels did not lead to an improvement in food quality. The main results reveal that budget plays a limited role in the quality of food and meals served as long as it is above 'very low' (199 NOK) food budget threshold. We assume that other contextual factors can influence the quality of food and meals in a more prominent role.

Variations in wait times for imaging services: a register-based study of self-reported wait times for specific examinations in Norway

BackgroundWhile the number of medical images has increased substantially, the demand has outpaced access, resulting in long wait times in many countries. Long wait times are a key problem for patient safety and quality of care as they can result in prolonged suffering, delayed diagnosis and treatment, as well as poorer prognosis and loss of lives. Surprisingly, little is known about wait times for imaging services.ObjectiveInvestigate wait times for specific imaging services in Norway and to compare wait times with the total number of examinations and their development over time.MethodsData from the wait time registry at the Norwegian Directorate of Health from 2018 to 2021 as well as data on outpatient imaging provided by the Norwegian Health Economics Administration (HELFO) and in-patient data afforded by fourteen hospital trusts and hospitals in Norway were analysed. Data include the total number of imaging examinations according to the Norwegian Classification of Radiological Procedures (NCRP). Analyses were performed with descriptive statistics.ResultsWait times vary through the months of the year. Conventional X-ray (XR) had the shortest wait times (3.0-4.4 weeks), and Magnetic Resonance Imaging (MRI) and ultrasound (US) had the lengthiest (8.7–12.0 and 7.9–11.4 weeks respectively). The wait times were lengthiest during the summer and winter holidays. Variations in wait times were also found for specific examination types between Norway’s four public health regions. In addition, there was variation over time within the health regions. The wait times with the private health providers were substantially lower than with the public health providers. From 2018 to 2021, the wait time for MRIs increased by 6.6%, while the number of examinations (per 10,000) increased by 8.6%. Those regions with the highest number of examinations per 1,000 inhabitants per year had the lowest wait times.ConclusionWait times for diagnostic imaging procedures varied with time, region, and modality in Norway from 2018 to 2021. Long wait times may entail many negative consequences for patients, professionals, and the healthcare system. Reducing long wait times is an obvious way to improve the quality, safety, and efficiency of care.

Can the guidelines from the Norwegian Directorate of Health be trusted?

Can the guidelines from the Norwegian Directorate of Health be trusted?

National digital strategies and innovative eHealth policies concerning older adults’ dignity: a document analysis in three Scandinavian countries

BackgroundScandinavian countries are internationally recognised for leading the way in older adult care and in digitally transforming healthcare. Dignity has become a central value in care for older adults in all three Scandinavian countries. Investigating documents about digitalisation in these countries can offer insights into how the dignity of older adults is impacted by digitally transforming healthcare. This study aims to provide knowledge about digital strategies and eHealth policies concerning older adults’ dignity in three Scandinavian countries: Norway, Sweden and Denmark.MethodsNational-level documents by the Norwegian Directorate of eHealth, the Norwegian Directorate of Health, the Swedish Ministry of Health and Social Affairs and the Danish Ministry of Health concerning older adults were used as data sources. In addition, a systematic search of databases, informed by the Joanna Briggs Institute framework for systematic reviews of text and opinion papers, was undertaken to find relevant papers. All extracts concerning national digital strategies or innovative eHealth policies were deductively coded. Thereafter, extracts concerning older adults were inductively coded using a thematic analytic approach.ResultsA total of 26 sources satisfied the inclusion criteria, 14 governmental papers and 12 other papers. The three countries’ national digital strategies focused on access to digital technologies and continuous learning for digital skills. The included papers describing national eHealth policies underlined the importance of placing the patient at the centre of healthcare and how digital systems can increase feelings of safety. Both types of documents concerned access to data, digital device security and the human dimension of care.ConclusionThe findings present evidence on Scandinavian countries’ national digital strategies and innovative eHealth policies concerning older adults’ dignity. The documents describe a lack of digital competence among older adults, resulting disengagement may put their well-being and human dignity at risk. Findings also underline the importance of security and at the same time the human dimension of care: Use of new digital systems must be meaningfully integrated into digital strategies and eHealth policies. All three Scandinavian countries strategies and policies underline the importance of equal access to healthcare services, as thus they promote a stance of dignified care.

Convalescent plasma from Norwegian blood donors to treat COVID-19.

At the start of the pandemic, the Norwegian Directorate of Health and Norwegian blood banks initiated the production of COVID-19 convalescent plasma within the framework of clinical studies. In this article we describe the blood donors who participated. Blood donors who had recovered from COVID-19 were recruited to donate single donor plasma for the purpose of patient treatment. Data on the course of infection, leukocyte antibodies and antibody level against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) per plasma unit were registered after informed consent was obtained. We calculated a disease score defined as the total number of self-reported symptoms/findings and hospitalisation where relevant (score 0-⁠11). A total of 1644 plasma units were collected from 266 plasma donors at 12 blood banks. Median disease score was 5 (interquartile range 3-⁠6), and 15 donors had recovered from pneumonia and/or been hospitalised. A total of 599/1644 plasma units from 106/266 donors met our requirement for SARS-CoV-2 antibody content (>60% inhibition of virus binding to angiotensin-converting enzyme 2 (ACE2)) or positive virus neutralisation test. The antibody level in donors waned over time following infection, and showed no clear correlation with disease score. The number of symptoms and findings in blood donors could not predict antibody response at individual level, and antibody testing was crucial for the production of effective convalescent plasma.

Polysubstance use and its correlation with psychosocial and health risk behaviours among more than 95,000 Norwegian adolescents during the COVID-19 pandemic (January to May 2021): a latent profile analysis.

Polysubstance use represents an adolescent health risk; however, large-scale studies investigating this issue during the COVID-19 pandemic are scarce. We aim to (i) characterise substance use profiles among adolescents and (ii) identify correlates of such substance use profiles. Norwegian nationwide survey data from 2021 were analysed using latent profile analysis. Participants were 97,429 adolescents aged 13-18. We assessed cigarette, e-cigarette and snus use, alcohol consumption, and cannabis and other illicit drug use. Correlates included psychosocial variables, health risk behaviours, and COVID-19-related problems. We identified three adolescent profiles; those who use no substances (n=88,890; 91%); those who use snus and alcohol (n=6546; 7%); and those who use multiple substances (i.e., polysubstance profile; n=1993; 2%). Boys, older adolescents, adolescents with lower socio-economic status, and those reporting low levels of parental control, and higher parental alcohol use, mental health problems, pain-related variables, and other health risk behaviours were most likely to be in the polysubstance profile. Adolescents with social and mental health issues related to COVID-19 were more at risk of being in the polysubstance profile. Adolescents who use snus and alcohol showed similar patterns of risk factors, but on a somewhat lower level than those in the polysubstance profile. Adolescents who use multiple substances have an unhealthier lifestyle, are at a higher risk of experiencing psychosocial impairments, and report more problems related to the COVID-19 pandemic. Preventative strategies to reduce polysubstance use might help promote psychosocial well-being in adolescents across various life domains. This study was funded by two grants from the Research Council of Norway (project #: 288083 and 300816). The Norwegian Directorate of Health has funded the data collection. The Research Council of Norway and the Norwegian Directorate of Health have not had any role in study design, data collection, data analysis, interpretation, and writing of the report.

Relationship between the Prevalence of Glaucoma (Estimated Through Prescribed Antiglaucomatous Medication) and Access to Ophthalmologists in Norway

Purpose The relationship between supply and demand in health-care is a challenge. The purpose of the present study is to evaluate to what extent glaucoma prevalence is influenced by local access to eye health-care service in Norway. Methods Population-based cross-sectional study. Data from The Norwegian Prescription Database was used to find the number of users of topical glaucoma medication, grouped by age and county, giving an estimate of glaucoma prevalence. The number of registered ophthalmologists and opticians was obtained from The Norwegian Society of Ophthalmologists and The Norwegian Directorate of Health. Results In total, 75733 persons were treated with IOP-lowering drugs in Norway in 2018, suggesting an overall glaucoma prevalence of 1.43%. In the age group 70-89 years, the nationwide prevalence was 7.60%, the lowest prevalence being in Oppland (5.98%) and highest in Aust-Agder (9.28%) counties. The number of ophthalmologists per 100000 inhabitants varied from 2.63 to 14.65 in the various counties. A statistically significant correlation was found between glaucoma prevalence in the age group 70-89 years and access to ophthalmological services. Furthermore, the increase in glaucoma prevalence plateaus at roughly 10 ophthalmologists per 100000 inhabitants, indicating that this could cover population demands. This relationship did not apply for opticians. Conclusions There is a clear correlation between glaucoma prevalence and availability of ophthalmologists in various counties in Norway. Our study indicates a direct relationship between the number of ophthalmologists in the area and the number of people being treated for glaucoma, with prevalence plateauing once a threshold of approximately 10 ophthalmologists per 100000 inhabitants is reached. This finding suggests that low glaucoma prevalence in some regions could be due to limited access to ophthalmological services.

The Norwegian Directorate of Health is concerned with good, adequate information

The Norwegian Directorate of Health is concerned with good, adequate information

Arbeidsrettet behandling ved alvorlig psykisk lidelse i spesialisthelsetjenesten

Employment is an important focus area in the treatment of severe mental illness and substance use disorders. Health and welfare services are instructed to collaborate closely on implementing evidence-based practices of vocational rehabilitation such as Individual Placement and Support (IPS) in treatment guidelines, clinical pathways and the current national healthcare plan (2020–2023). Although evidence of the effectiveness of IPS continues to grow and there is broad political commitment to finance and implement IPS, challenges remain. System-level cooperation between services and legislative issues on integrating employment specialists in mental health services poses potential implementation barriers that need clarification to allow successful provision of IPS. In this paper, we describe how IPS is integrated in specialized mental health treatment. The empirical and practical basis for the current article comes from five different research groups. New directions, challenges and opportunities in IPS implementation are also discussed in light of new regulations from the Norwegian Directorate of Health. Keywords: Individual Placement and Support, employment, health and welfare services, integration, employment specialist, implementation

Family medicine and international cooperation in the North: A step ahead

International cooperation contributed to the development of family medicine in the North of Russia, it was characterized by a system approach and interdisciplinary interaction. The article presents the results of Russian-Norwegian projects that were developed with the active participation of the Department of Family Medicine of NSMU (Arkhangelsk), as well as the main aspects of the projects: significance for practical health care, research, and educational components.
 Several complementary projects aimed at the development of primary health care, such as Reform of Arkhangelsk Region Health Care System with a special emphasis on primary care, System approach to NCD prevention and Suicide prevention in the Arkhangelsk region were implemented together with the Norwegian Directorate of Health. The POMOR Program specialist training in general practice in Northern Russia project (together with the University of Troms The Arctic University of Norway, Norwegian Medical Association, and Norwegian Centre for Rural Medicine) facilitated the development of tutorship in family medicine in the Arkhangelsk and Murmansk regions. Better interaction between psychiatrists and general practitioners in the mental health sphere became an essential area of international collaboration (Integrating mental health into primary care in the Arkhangelsk County, Russia: the Pomor model in psychiatry project together with the University of Troms The Arctic University of Norway and University Hospital of North Norway, Troms). The education component of the projects got a sequel in the continued medical education system of NSMU while the scientific one was continued in the form of publications in international and Russian journals, and masters thesis defense of public health degrees. The project's results were consistently presented at the international and Russian forums. General practitioners education is a cross-cutting theme for the cooperation on the path from a beginner to an expert and plays a special role in support of GPs during the COVID-19 pandemic.

Cohort Profile: The Norwegian Life Course, Ageing and Generation Study (NorLAG).

The NorLAG survey data collections have been financed by the Research Council of Norway, four Norwegian Government Ministries, the Norwegian Directorate of Health, the Norwegian State Housing Bank, Statistics Norway and NOVA at Oslo Metropolitan University.

Metabolic Profiling of 713 Newborns and Parents in the Norwegian Mother, Father and Child Cohort Study

Background: Lipids are important for fetal development, but the determinants of cord blood lipids have scarcely been studied. We therefore aimed to describe the associations between newborn cord blood lipid and metabolic profile, and maternal and paternal lipid and metabolic profile. Methods: This study is based on 713 mother-father-newborn trios from the Norwegian Mother, Father and Child Cohort Study (MoBa) and uses data from the Medical Birth Registry of Norway. Sixty-four cord blood metabolites detected by nuclear magnetic resonance spectroscopy were analyzed. The false discovery rate (FDR) procedure was used to correct for multiple testing. Findings: We found positive associations between maternal and newborn high-density lipoprotein (HDL) cholesterol, omega 3 and 6 fatty acids, glutamine, isoleucine, leucine, valine, phenylalanine, tyrosine, glucose, citrate, creatinine, and particle concentration of medium and small HDL (0·001 ≤ qFDR ≤ 0·049). Paternal and newborn total-, low-density lipoprotein (LDL)-, HDL3-, remnant-, esterified- and free cholesterol, phosphoglycerides, cholines, phosphatidylcholines, sphingomyelins, apolipoprotein B and A1, total fatty acids, and particle concentration of intermediate-density lipoprotein, large- and medium LDL were positively associated (0·004 ≤ qFDR ≤ 0·047). Sex differences were found for many cord blood lipids. Interpretation: Several cord blood metabolites were associated with maternal and paternal metabolites and newborn sex. This may potentially affect pregnancy- and long-term outcomes. Funding: The University of Oslo; the National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital; the Throne Holst Foundation for Nutrition Research; the Norwegian Health Association; Eckbos Legate; the Freia Corporation Medical Fund; and the Blix Foundation for the Promotion of Medical Research, Norway. Declaration of Interests: During the past five years, MPB reports grants and personal fees from Amgen, grants and personal fees from Sanofi, personal fees from MSD, personal fees from Boehringer Ingelheim, grants and personal fees from Mills AS, and grants from Kaneka, none of which are related to the content of this manuscript. JJC reports grants or personal fees from Mills DA and Amgen, none of which are related to the content of this manuscript. SMU has received research grants and/or personal fees from Mills AS, Tine DA, and Olympic Seafood, none of which are related to the content of this manuscript. KR reports personal fees from Amgen, personal fees from Mills AS, personal fees from The Norwegian Medical Association, personal fees from The Norwegian Directorate of Health, personal fees from Sanofi, personal fees from Takeda, personal fees from Chiesi, personal fees from Bayer, and personal fees from MSD, none of which are related to the content of this manuscript. JRVL has received research grants from Amryt, which are not related to the content of this manuscript. KBH has received research grants or honoraria from Mills AS, Tine SA, Olympic Seafood, Amgen, Sanofi, and Pronova, none of which are related to the content of this manuscript. LKLO, ALB, HKB, TMM, TH, PMM, and MBV declare no conflicts of interest. Ethics Approval Statement: The current study was approved by the Regional Committees for Medical and Health Research Ethics (no. 2017/1285). The study was conducted according to the principles of the Declaration of Helsinki, and all MoBa participants gave written informed consent at the time of inclusion.

Out-of-hours workload among Norwegian general practitioners \u2013 an observational study

BackgroundRepeated studies of working hours among Norwegian regular general practitioners (RGPs) have shown that the average total number of weekly working hours has remained unchanged since 1994 and up until 2014. For both male and female RGPs, the mean total weekly working hours amounted to almost 50 h in 2014.In recent years, Norwegian RGPs have become increasingly dissatisfied. They experience significantly increased workload without compensation in the form of more doctors or better payment. A study from the Norwegian Directorate of Health in 2018 (the RGP study) showed that Norwegian RGPs worked 55.6 h weekly (median 52.5). 25% of the respondents worked more than 62.2 h weekly.Based on data from the RGP study we investigated Norwegian RGP’s out-of-hours (OOH) work, how the working time was distributed, and to what extent the OOH work affected the regular working hours.MethodsIn early 2018, an electronic survey was sent to all 4640 RGPs in Norway. Each RGP reported how many minutes that were spent that particular day on various tasks during seven consecutive days. Working time also included additional tasks in the municipality, other professional medical work and OOH primary health care. Differences were analysed by independent t-tests, and regression analyses.ResultsOne thousand eighty hundred seventy-six RGPs (40.4%) responded, 640 (34.1%) had registered OOH work. Male RGPs worked on average 1.5 h more doing regular work than did females (p = 0.001) and on average 2.3 h more OOH work than females (p = 0.079). RGPs with no OOH work registered a mean of 1.0 h more clinical work than RGPs working OOH (p = 0.043). There was a large variation in OOH working hours. A linear regression analysis showed that male RGPs and RGPs in rural areas had the heaviest OOH workload.ConclusionsOne in three Norwegian RGPs undertook OOH work during the registration week in the RGP study. OOH work was done in addition to a sizeable regular workload as an RGP. We found small gender differences. OOH work was not compensated with reduced regular RGP work.

12 Weeks Of Maximal Strength Training Restores Muscle Force-generating Capacity In Patients With Schizophrenia

Patients with schizophrenia spectrum disorders (ICD-10) suffer from impaired muscle force-generating capacity (MFGC) and functional performance of the lower extremities. PURPOSE: To investigate if 12 weeks of maximal strength training (MST) would restore MFGC and functional performance. METHODS: Forty-eight outpatients (28 men, 35±10 yrs; 20 women, 35±12 yrs) were randomized to a training group (TG) or control group (CG). Forty-eight age and gender matched healthy controls (28 men/20 women, 35±11 yrs) were tested to establish reference values. TG performed leg press MST (4x4 repetitions) 2d/week for 12 weeks at ~90% one repetition maximum (1RM). CG received two sessions of MST and encouragement to follow traditional physical activity guidelines. RESULTS: 17/24 patients in the TG (12 men/5 women, 34±11 years) completed 79% of training sessions and 19/22 patients in the CG (9 men/10 women, 37±12 years) completed the study. TG improved 1RM (28%, 12.6±4.1 to 16.2±5.0 Kg·mb-0.67, p<0.01) and rapid force development (20%, 18.6±8.6 to 22.4±10.8 N·m·s-1·mb-0.67,p<0.01), reaching 106% and 85% of healthy reference values, respectively. TG improvements differed from CG (p<0.01) where no changes occurred (1RM; 11.4±3.0 to 12.0±2.7 Kg·mb-0.67, rapid force development 16.4±6.9 to 17.3±6.5 N·m·s-1·mb-0.67). Both TG and CG improved 30-second sit-to-stand test (30sSTS) performance (15±3 to 17±4 stands and 13±3 to 14±3 stands, respectively, p<0.05). Changes were not apparent as between group difference nor close the gap to reference levels (27±5 stands). CONCLUSION: MST restored the patients’ lower extremity MFGC and improved 30sSTS performance. Supported by grants from the Norwegian ExtraFoundation for Health and Rehabilitation, The Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology, and The Norwegian Directorate of Health.

Process evaluation of Prompt Mental Health Care (PMHC): the Norwegian version of Improving Access to Psychological Therapies

BackgroundPrompt Mental Health Care (PMHC) is the Norwegian adaptation of Improving Access to Psychological Therapies (IAPT). Thus far, evaluations of PMHC have mostly focused on the effectiveness, rather than on contextual and implementation processes. Therefore, the objective of this study was to do a process evaluation and examine: 1) To what extent do the services follow guidelines provided by the Norwegian Directorate of Health (NDH), 2) what the therapists experienced as important barriers and facilitators in implementing the service, and 3) client treatment satisfaction and its associations with baseline variables.MethodThe present study uses data from 526 clients who received PMHC treatment in the municipalities of Sandnes and Kristiansand. The therapists completed questionnaires about each client’s course of treatment. We conducted semi-structured interviews with the therapists and analysed them using thematic analysis. Data from client questionnaires were used to report descriptive sample statistics including symptom severity and treatment satisfaction. Linear regression was adopted to examine the associations between client treatment satisfaction and baseline characteristics.ResultsSeveral aspects of PMHC were implemented in line with the guidelines provided by NDH. Importantly, both services reached out to the intended target group, and could further be characterized as low-threshold with relatively short waiting times (median waiting time between initial contact and treatment start was 27 days, IQR 18–39), no waiting lists, and frequent use of self-referral (33.3%). From the client perspective, results indicated a high degree of treatment satisfaction (Mean = 3.93 (SD = .71, range 1–5)), and this was true across demographic characteristics and symptom severity at baseline (all p > .05). Most notable challenges that came forward were; the low provision of guided self-help (received by only 1.0% of clients), the lack of focus on work participation (low to some degree of focus in 70.8% among sick-listed clients), the collaboration with other services (no collaboration in 85.3% of the clients), and some aspects regarding future development of the service.ConclusionBoth sites managed to implement key aspects of PMHC in line with the guidelines, but further development of the program is warranted. Discussion of challenges and future recommendations are presented.

SARS-CoV-2 in children and adolescents in Norway: confirmed infection, hospitalisations and underlying conditions.

Children and adolescents are at lower risk of disease caused by SARS-CoV-2. We describe the incidence of confirmed infection and hospitalisation of children and adolescents under the age of 20 in Norway, and specifically among those with underlying conditions. The Norwegian Directorate of Health has collaborated with the Norwegian Institute of Public Health on the establishment of a data extraction system to monitor the coronavirus outbreak. Data from the specialist health service (Norwegian Patient Registry, NPR), and the primary health service (Norwegian Registry for Primary Health Care, NRPHC) are linked to data on positive SARS-CoV-2 tests from the Surveillance System for Communicable Diseases (MSIS). This covers all persons living in Norway as of 1 March 2020, with data on confirmed infection up to and including 13 May 2020 and on hospitalisations up to and including 30 April 2020. Of 8 125persons with confirmed SARS-CoV-2 in the whole population, 493 (6.1%) were under 20 years old. The median age of the under-20s was 15 years, and 252 (51%) were girls. 3% were hospitalised. No deaths were registered among patients aged under 20 in Norway. We found a somewhat larger share with confirmed SARS-CoV-2 in the group with diseases of the neuromuscular system. Few children and adolescents have had SARS-CoV-2 confirmed, and only a very few have been hospitalised. Underlying conditions may result in a lower threshold for testing, and hence a higher incidence of confirmed infection in this group, although higher risk cannot be excluded.

Epistemology of epidemiology: the case of Ungdata

One of the most significant epidemiological tools for the perceived truth about contemporary Norwegian youth is in Ungdata, Youth Data. This is a continuous online-based survey grounded upon several and varying investigations of youth in Norwegian high schools, now extending to primary schools as well. The knowledge bases, epidemiological practices, technicalities, economic premises for the work and also data publishing is handled by social scientists at Norwegian Social Research, NOVA, located at Oslo Metropolitan University. State bureaucracies, e.g. ministries and directorates, municipalities etc. can ask for investigations and overviews. NOVA has an annual income for running the Youth Data through the Norwegian Directorate of Health of 3,3 mill. NOK (2018). The Youth Data registry has become a leading force in opinions, policies, polities and resource allocations for youth at municipal and state levels for several intended purposes. Based upon NOVA reports, media comments and interviews this article reflects upon some theoretical and methodological approaches to this unique epidemiological tool concerning youth, health and welfare. Questions arise such as: Is epidemiology a taken for granted neutral and objective kind of knowledge? Should there be ethical concerns for youth and their researchers as creators of knowledge, theory and policy – other than the normal ethical rules of scientific conduct?