[Vaccine hesitancy during the COVID-19 pandemic among young people with an ethnic background in east Oslo ­ a qualitative study]. / Vaksinenøling under koronapandemien blant unge med etnisk minoritetsbakgrunn i Oslo øst ­ en kvalitativ studie.

Background: Few studies have been conducted on young people's attitudes to the COVID-19 vaccine during the pandemic. We wished to examine how young people with an ethnic minority background decided whether to have the COVID-19 vaccine, based on the concept of vaccine hesitancy. Vaccine hesitancy involves uncertainty with regard to vaccination, irrespective of the decision taken. Material and method: Fourteen qualitative in-depth interviews with young people aged 16-25 years with an ethnic minority background and from the east side of Oslo were analysed and categorised into main themes. The participants also had links to the Middle East, South Asia and Africa. Results: Several of the study participants were hesitant to be vaccinated. Their hesitation was linked to the impression that the vaccine had been developed rapidly, false rumours, long travel times to vaccination centres and fear of adverse effects. A number called for better information. Vaccination through the school was described as a facilitating factor. Family and friends were less crucial in their assessment of whether to have the COVID-19 vaccine. The majority had trust in the authorities. Interpretation: Insufficient knowledge about the vaccine and fear of adverse effects, as well as practical barriers associated with undergoing vaccination, appears to contribute to vaccine scepticism among young people with an ethnic minority background. The authorities and healthcare personnel should provide young people with better vaccine information. Information should be provided by personnel they already trust, such as the school nurse.

[120 years of contact tracing for sexually transmitted infections in Norway] / Smittesporing ved seksuelt overførbare infeksjoner i Norge gjennom 120 år.

BAKGRUNN: Smittesporing har fått ny aktualitet grunnet covid-19, men har lenge vært viktig i bekjempelsen av seksuelt overførbare infeksjoner. I denne artikkelen vil vi belyse hvordan smittesporingen ved seksuelt overførbare infeksjoner i Norge har endret seg de siste 120 årene. MATERIALE OG METODE: Kildegrunnlaget er årsberetninger fra Kristiania Sundhetskommission og Oslo Helseråd, årsrapporter fra Meldingssystem for smittsomme sykdommer ved Folkehelseinstituttet (MSIS), skjema for innkalling av pasienter, et originalt maskinskrevet manuskript av helseinspektør Harald Christian Gjessing (1896-1988) samt personlige meddelelser fra Øivind Jul Nilsen, seniorrådgiver ved Folkehelseinstituttet. RESULTATER OG FORTOLKNING: Smittesporing er i varierende grad dokumentert i årsberetningene fra Kristiania Sundhetskommission fra slutten av 1800-tallet og fram til dagens MSIS-rapporter. Politiet var sterkt involvert i kontrollen av kjønnssykdommene på slutten av 1800-tallet, men legene overtok mer av ansvaret ut over 1900-tallet. Under den annen verdenskrig ble igjen politiet mer involvert i kontroll og smittesporing. I 1947 kom lov om åtgjerder mot kjønnssykdommer, som stadfestet behandlende leges plikt til å utføre smittesporing. Denne loven ble erstattet av smittevernloven i 1995. Kvaliteten på smittesporingen over tid er noe vanskelig å vurdere, da datagrunnlaget for statistikken har endret seg. Fra å være et moralsk anliggende, med sterke elementer av tvang og hjelp fra sedelighetspolitiet, ble smittesporing etter hvert basert på frivillighet og samarbeid mellom lege og pasient.

Temporal technologies of epidemics.

The COVID-19 pandemic has largely been made sense of as a crisis However, using crisis as a temporal-analytical category arguably obscures the complexity of the different temporalities at work in the pandemic. In this article, we examine how the pandemic outbreak led to numerous acts of synchronisation and de-synchronisation-between humans and viruses, between social groups and even between historical ages. In order to make sense of the temporal consequences of an epidemic, we introduce the concept of 'temporal technologies', understood as a set of procedures that control, regulate, produce and assemble time in relational networks of both human and non-human actors. This article thus attempts to create a framework for understanding the epidemic experience in temporal terms by using 'temporal technologies' as an analytical tool.

Patient Rationales Against the Use of Patient-Accessible Electronic Health Records: Qualitative Study.

BACKGROUND: Patient-accessible electronic health records (PAEHRs) enable patients to access their health records through a secure connection over the internet. Although previous studies of patient experiences with this kind of service have shown that a majority of users are positive toward PAEHRs, little is known about why some patients occasionally or regularly choose not to use them. A better understanding of why patients may choose not to make use of digital health services such as PAEHRs is important for further development and implementation of services aimed at having patients participate in digital health services. OBJECTIVE: The objective of the study was to explore patients' rationales for not embracing online access to health records. METHODS: Qualitative interviews were conducted with 40 patients in a department of internal medicine in a Norwegian hospital in 2018-2019. Interview transcripts were subjected to thematic content analysis. In this paper, we focus on the subject of nonuse of PAEHRs. RESULTS: We identified 8 different rationales that study participants had for not embracing PAEHRs. When patients reflected on why they might not use PAEHRs, they variously explained that they found PAEHRs unnecessary (they did not feel they were useful), impersonal (they preferred oral dialogue with their doctor or nurse over written information), incomprehensible (the records contained medical terminology and explanations that were hard to understand), misery oriented (the records solely focused on disease), fear provoking (reading the records could cause unwanted emotional reactions), energy demanding (making sense of the records added to the work of being a patient), cumbersome (especially among patients who felt they did not have the necessary digital competence), and impoverishing (they were skeptical about the digital transformation of individual and social life). CONCLUSIONS: It is often assumed that the barriers to PAEHR use are mostly practical (such as lack of hardware and access to the internet). In this study, we showed that patients may have many other valid reasons for not wanting to adopt this kind of service. The results can help guide how PAEHRs and other digital health services are promoted and presented to patients, and they may suggest that the goal of a given new digital health service should not necessarily be full uptake by all patients. Rather, one should recognize that different patients might prefer and benefit from different kinds of "analog" and digital health services.

Deservingness: migration and health in social context.

This article brings the social science concept of 'deservingness' to bear on clinical cases of transnational migrant patients. Based on the authors' medical social science research, health delivery practice and clinical work from multiple locations in Africa. Europe and the Americas, the article describes three clinical cases in which assumptions of deservingness have significant implications for the morbidity and mortality of migrant patients. The concept of deservingness allows us to maintain a critical awareness of the often unspoken presumptions of which categories of patients are more or less deserving of access to and quality of care, regardless of their formal legal eligibility. Many transnational migrants with ambiguous legal status who rely on public healthcare experience exclusion from care or poor treatment based on notions of deservingness held by health clinic staff, clinicians and health system planners. The article proposes several implications for clinicians, health professional education, policymaking and advocacy. A critical lens on deservingness can help global health professionals, systems and policymakers confront and change entrenched patterns of unequal access to and differential quality of care for migrant patients. In this way, health professionals can work more effectively for global health equity.

Criteria for involuntary psychiatric admission ­ changes from 1848 until today. / Kriterier for tvangsinnleggelse ­ endringer fra 1848 til i dag.

BACKGROUND: Coercion and involuntary psychiatric admission have been the subject of heated debate in recent years. A new Act was proposed in the summer of 2019, the Act on limitation of coercion, which aims to collect all legislation on coercion within a single legislative Act. If the Act is adopted, the framework for the use of coercion will be the same for both somatic illness and psychiatry. Against this backdrop, we wished to investigate how involuntary admissions have been critically examined, debated and enshrined in law previously. MATERIAL AND METHOD: We have examined the three main Acts (and the preparatory work on these) that have been adopted in the psychiatric healthcare service in Norway. We have paid particular attention to the criteria for involuntary admissions, which we have attempted to understand in light of their contemporary times. RESULTS AND INTERPRETATION: The legislation on coercion retained many basic features from 1848, through 1961 until 1999, even though the attitudes to coercion changed. However, the change in legislation from 2017 shows a significant change in how coercion in the mental healthcare service is viewed. If the Act on limitation of coercion is adopted, coercive mental health care will no longer be regulated by separate legislation.

Infectious diseases among patients at the Health Centre for Undocumented Migrants in Oslo. / Smittsomme sykdommer blant pasienter ved Helsesenter for papirløse migranter i Oslo.

BACKGROUND: Undocumented migrants probably fall outside the scope of public infectious disease control schemes. The article aims to describe the extent of undetected highly hazardous communicable diseases among patients at the Health Centre for Undocumented Migrants in Oslo. MATERIAL AND METHOD: We reviewed the records of all patients who attended the Health Centre for the first time in 2016 or 2017, with a view to age, sex, period of stay in Norway, country category and infection test results from the period 1 January 2016-31 December 2017. RESULTS: There were four new cases of hepatitis B among 139 patients tested, and four cases of chlamydia infection among 38 patients tested. There were no new cases of active pulmonary tuberculosis, syphilis, HIV infection or hepatitis C. INTERPRETATION: There were fewer cases of highly hazardous communicable diseases than what might be expected based on the countries from which the patients originated.

From disease to criminality ­ changes in how substance dependency is viewed. / Fra sykdom til kriminalitet ­ endringer i synet på rusavhengighet.

BACKGROUND: The policy on drug use is currently undergoing significant change. This article examines how the view of addiction to illegal drugs changed in the first 30 years after the advent of 'the drug problem' in Norway. MATERIAL AND METHOD: We performed a search in Oria, bokhylla.no and various databases on the history of illegal drugs in Norway, with an emphasis on the period from 1960-90, with white papers from 1976 and 1986. RESULTS: Until the mid-1960s, Norway had very few opiate abusers. This generally concerned abuse of medically prescribed drugs, and was perceived as an internal problem for the health services. The youth counterculture in the late 1960s brought the recreational use of illegal substances to Norway, leading to major concern on the part of the public authorities. 'The drug problem' was now perceived as a significant societal problem, with social and societal causal explanations, and was therefore the subject of a white paper (1976). The next white paper (1986) put forward the ideal of a 'drug-free society' for the first time, with the purpose of general deterrence and strict sentencing as important instruments. INTERPRETATION: From the early 1960s until the late 1980s, the 'drug problem' was perceived in different ways. At the start of the period, it was formulated primarily as a medical problem. From the late 1960s, it was seen first and foremost as a social problem caused by changes in society, whereas from the late 1970s until the late 1980s, control measures constituted the most important instrument to address the problem.

Less Is More: Norwegian Drug Regulation, Antibiotic Policy, and the "Need Clause".

Policy Points The current crisis of antibiotic resistance calls for policy reforms locally and globally. Historical insight in different regulatory systems can inform current decision making. A strong regulatory control implementing antimicrobial resistance concerns can ensure the combined objective of promoting access and limiting excess use by letting only certain drugs onto the market in compliance with public health needs. Regulation at this level also has powerful effects on consumption and needs to be considered as a tool for curbing antibiotic resistance. The Norwegian drug regulatory procedures was an example of how national drug regulatory authorities can promote innovation of new drugs that meet public health needs indirectly by accepting only drugs of added therapeutic value. CONTEXT: Antibiotic resistance is an increasingly serious threat to global health that requires coordinated action. Most current policy efforts address the lack of medicines. There is also a need for new thinking on promoting access to all who are in need of antibiotics, while simultaneously curbing inappropriate use. As the situation calls for new approaches, we examined one drug regulatory system in which antimicrobial resistance (AMR) has been on the agenda for a long time. The Norwegian drug regulatory system, and particularly its "need clause," has been invoked in international debates but not previously studied in detail. METHODS: We conducted a historical review of the Norwegian drug regulatory system by examining the archives of the Norwegian health authorities, the Norwegian Medicines Agency, and policy debates in the period. FINDINGS: The Norwegian drug regulatory system focused on the rational use of drugs, tied closely to public health needs. It was originally written to address unnecessary consumption of drugs, not consumer protection and safety. The most flexible element within this system stated that a drug must be "needed" in order to be registered. When antibiotic resistance became a concern, it limited the market entry of drugs considered to promote resistance, such as combination and broad-spectrum products. This was a powerful and flexible regulatory device that also influenced drug consumption. CONCLUSIONS: The need clause has lately been promoted as an alternative to address the current situation. The solutions to the problem of antibiotic resistance cannot be the same everywhere, and we do not argue that this drug regulatory system should be adopted globally. However, the current situation calls for consideration of many different aspects. This historical case demonstrates how regulatory procedures can be used to limit market entrance and promote appropriate use simultaneously.

Acting by persuasion- values and rhetoric in medical certificates of work incapacity: A qualitative document analysis.

When the patient applies for disability benefit in Norway, the general practitioner (GP) is required by the National Insurance Administration (NAV) to confirm that the patient is unfit for work due to disease. Considering the important social role of medical certificates, they have been given surprisingly little attention by the medical critique. They may make essential differences to peoples' lives, legitimise large social costs and, in addition, the GPs report that issuing certificates can be problematic. This article explores values, attitudes and persuasive language in a selection of medical certificates written by GPs. We direct attention to such texts as significant social actors using a mixed rhetoric including certain values and attitudes. When arguing for granting the patient disability benefit, some GPs emphasised the 'worthiness' of the patient by pointing to positive attitudes approved by the national insurance: a will to work and participate, to cooperate and be motivated. Others pointed out the patient's positive character in terms of universally accepted values, called for the reader's (the NAV official) sympathy , understanding and helpfulness or appealed to his/her willingness to be realistic and pragmatic and grant disability benefit (DB). The dialogic style varied: some certifiers-although they argued for disability benefit-showed openness to possible opposing or alternative voices by displaying their own uncertainty. Others addressed the reader to share responsibility, demanding or urging for DB. This shifting rhetoric, we believe, mirrors that the GPs see themselves as the patient's advocate, and that they may find themselves conflicted. We propose further studies within qualitative research to investigate the effect of this rhetoric on the reader, the decision-makers. In addition, to improve the quality and accuracy of these important documents, we suggest that medical schools introduce students to the making of text as a specific skill of medical practice.