The double-edged sword of becoming a caregiver: dynamic impact on four dimensions of well-being in Norway.

BACKGROUND: Becoming a caregiver can be a transformative journey with profound, multifaceted implications for well-being. However, existing research predominantly emphasizes the negative aspects of caregiving, paying less attention to the positive sides. This study aims to explore the impact of transitioning into a caregiving role on various well-being indicators, such as negative hedonic, positive hedonic, eudaimonic, and social well-being. METHODS: We use Norwegian panel data (2019-2021) and employ a combination of nearest-neighbour matching and a difference-in-differences approach to analyse well-being trajectories among new caregivers (n = 304) and non-caregivers (n = 7822). We assess ten items capturing the dimensions of negative hedonic (anxiousness, sadness, and worriedness), positive hedonic (happiness and life satisfaction), eudaimonic (contributing to others' happiness, engagement, and meaning), and social (strong social relations and loneliness) well-being. RESULTS: Our results show a general increase in negative hedonic well-being and a decline in positive hedonic well-being for new caregivers. These impacts are larger for caregivers providing daily care, compared to those providing weekly and monthly care, and for those providing care inside rather than outside their own household. We observe only minor differences regarding gender and age. Interestingly, we also notice neutral or beneficial changes for eudaimonic aspects of well-being; of note, caregivers generally experience an increased sense of contributing to others' happiness. CONCLUSION: Our study reveals that adopting a caregiving role often leads to significant psychosocial challenges, especially in intensive caregiving situations. However, it also uncovers potential positive influences on eudaimonic aspects of well-being. Future research should explore underlying explanatory mechanisms, to inform strategies that enhance caregivers' well-being.

Emerging costs in a "hidden" workforce: The longitudinal psychosocial effects of caregiving during the COVID-19 pandemic among Norwegian adults.

During COVID-19 many informal caregivers experienced increased caregiving load while access to formal and informal support systems and coping resources decreased. Little is known about the psychosocial costs of these challenges for an essential yet vulnerable and "hidden" frontline workforce. This study explores and compares changes in psychosocial well-being (psychological well-being, psychological ill-being, and loneliness) before and across up to three stages of the COVID-19 pandemic among caregivers and non-caregivers. We also examine predictors of psychosocial well-being among caregivers during the peak of the pandemic. We use longitudinal data collected online in the Norwegian Counties Public Health Survey (age: 18-92) in four counties and up to four data points (n = 14,881). Caregivers are those who provide care unpaid, continuous (≥ monthly across all time points) help to someone with health problems. Findings show that levels of psychosocial well-being first remained stable but later, during the peak stages of the pandemic, dropped markedly. Caregivers (13-15% of the samples) report lower psychosocial well-being than non-caregivers both before and during the pandemic. Caregivers seem especially vulnerable in terms of ill-being, and during the peak of the pandemic caregivers report higher net levels of worry (OR = 1.22, p < 0.01) and anxiety (OR = 1.23, p < 0.01) than non-caregivers. As expected, impacts are graver for caregivers who provide more intensive care and those reporting health problems or poor access to social support. Our study findings are valuable information for interventions to support caregivers during this and future pandemics.

Health care use after severe respiratory tract infections in children aged 0 to 5 years.

AIM: To explore whether children in specialist care with COVID-19 have increased post-discharge health care use when compared with children in specialist care with 1) respiratory syncytial virus (RSV) infection, and 2) other respiratory tract infections (RTIs). METHODS: In 34,214 children aged 1 month to 5 years who were registered as having one or more hospital visit (outpatient or inpatient) with a diagnosis of COVID-19 (N = 128), RSV infection (N = 4,009), or other RTIs (N = 34,458) from 2017 to 2021, we used a difference-in-differences study design to investigate individual all-cause primary and specialist health care use from 12 weeks prior to 12 weeks after the hospital visit, stratified by infants (1 to 11 months) and children (1 to 5 years). RESULTS: We found a slight increase in primary health care use in the first 4 weeks after the hospital visit for infants with COVID-19 when compared with infants with RSV infection (6 per 10,000; 95% CI [2, 13], a 0.52% relative increase). For infants diagnosed with COVID-19, we found a similar post-visit increase in inpatients when compared with infants with RSV infection, which lasted for 12 weeks. CONCLUSIONS: Our findings imply a slightly increased health care use among infants after a hospital visit for COVID-19 than among infants with other RTIs, the potential etiological mechanisms of which deserve future clinical research. Severe COVID-19 in young children will not represent any markedly increased burden on the health services.

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.

Third dose mRNA vaccination against SARS-CoV-2 reduces medical complaints seen in primary care: a matched cohort study.

BACKGROUND: SARS-CoV-2 mRNA vaccination has been associated with both side effects and a reduction in COVID-related complaints due to the decrease in COVID-19 incidence. We aimed to investigate if individuals who received three doses of SARS-CoV-2 mRNA vaccines had a lower incidence of (a) medical complaints and (b) COVID-19-related medical complaints, both as seen in primary care, when compared to individuals who received two doses. METHODS: We conducted a daily longitudinal exact one-to-one matching study based on a set of covariates. We obtained a matched sample of 315,650 individuals aged 18-70 years who received the 3rd dose at 20-30 weeks after the 2nd dose and an equally large control group who did not. Outcome variables were diagnostic codes as reported by general practitioners or emergency wards, both alone and in combination with diagnostic codes of confirmed COVID-19. For each outcome, we estimated cumulative incidence functions with hospitalization and death as competing events. RESULTS: We found that the number of medical complaints was lower in individuals aged 18-44 years who received three doses compared to those who received two doses. The differences in estimates per 100,000 vaccinated were as follows: fatigue 458 less (95% confidence interval: 355-539), musculoskeletal pain 171 less (48-292), cough 118 less (65-173), heart palpitations 57 less (22-98), shortness of breath 118 less (81-149), and brain fog 31 less (8-55). We also found a lower number of COVID-19-related medical complaints: per 100,000 individuals aged 18-44 years vaccinated with three doses, there were 102 (76-125) fewer individuals with fatigue, 32 (18-45) fewer with musculoskeletal pain, 30 (14-45) fewer with cough, and 36 (22-48) fewer with shortness of breath. There were no or fewer differences in heart palpitations (8 (1-16)) or brain fog (0 (- 1-8)). We observed similar results, though more uncertain, for individuals aged 45-70 years, both for medical complaints and for medical complaints that were COVID-19 related. CONCLUSIONS: Our findings suggest that a 3rd dose of SARS-CoV-2 mRNA vaccine administered 20-30 weeks after the 2nd dose may reduce the incidence of medical complaints. It may also reduce the COVID-19-related burden on primary healthcare services.

Lower transmissibility of SARS-CoV-2 among asymptomatic cases: evidence from contact tracing data in Oslo, Norway.

BACKGROUND: Asymptomatic COVID-19 cases have complicated the surveillance and tracking of the pandemic. Previous studies have estimated that 15-25% of all infectees remain asymptomatic. METHODS: Based on contact tracing data from Oslo, Norway, we estimated transmission and susceptibility dynamics among symptomatic and asymptomatic cases and their contacts as identified by manual contact tracing between September 1, 2020, and September 1, 2021. RESULTS: Among 27,473 indexes and 164,153 registered contacts, the secondary attack rate (SAR-14) was estimated to be 28% lower through asymptomatic exposure (13%) compared to symptomatic exposure (18%). Furthermore, those infected by asymptomatic cases were almost three times more likely to be asymptomatic compared to those infected by symptomatic cases. CONCLUSIONS: Symptomatic cases spread the virus to a greater extent than asymptomatic, and infectees are more likely to be asymptomatic if their assumed infector was asymptomatic.

Pandemic trends in health care use: From the hospital bed to self-care with COVID-19.

AIM: To explore whether the acute 30-day burden of COVID-19 on health care use has changed from February 2020 to February 2022. METHODS: In all Norwegians (N = 493 520) who tested positive for SARS-CoV-2 in four pandemic waves (February 26th, 2020 -February 16th, 2021 (1st wave dominated by the Wuhan strain), February 17th-July 10th, 2021 (2nd wave dominated by the Alpha variant), July 11th-December 27th, 2021 (3rd wave dominated by the Delta variant), and December 28th, 2021 -January 14th, 2022 (4th wave dominated by the Omicron variant)), we studied the age- and sex-specific share of patients (by age groups 1-19, 20-67, and 68 or more) who had: 1) Relied on self-care, 2) used outpatient care (visiting general practitioners or emergency ward for COVID-19), and 3) used inpatient care (hospitalized ≥24 hours with COVID-19). RESULTS: We find a remarkable decline in the use of health care services among COVID-19 patients for all age/sex groups throughout the pandemic. From 83% [95%CI = 83%-84%] visiting outpatient care in the first wave, to 80% [81%-81%], 69% [69%-69%], and 59% [59%-59%] in the second, third, and fourth wave. Similarly, from 4.9% [95%CI = 4.7%-5.0%] visiting inpatient care in the first wave, to 3.6% [3.4%-3.7%], 1.4% [1.3%-1.4%], and 0.5% [0.4%-0.5%]. Of persons testing positive for SARS-CoV-2, 41% [41%-41%] relied on self-care in the 30 days after testing positive in the fourth wave, compared to 16% [15%-16%] in the first wave. CONCLUSION: From 2020 to 2022, the use of COVID-19 related outpatient care services decreased with 29%, whereas the use of COVID-19 related inpatient care services decreased with 80%.

COVID-19 infection among bartenders and waiters before and after pub lockdown.

OBJECTIVE: To assess how different bans on serving alcohol in Norwegian bars and restaurants were related to the detection of SARS-CoV-2 in bartenders and waiters and in persons in any occupation. METHODS: In 25 392 bartenders and waiters and 1 496 328 persons with other occupations (mean (SD) age 42.0 (12.9) years and 51.8% men), we examined the weekly rates of workers tested and detected with SARS-CoV-2, 1-10 weeks before and 1-5 weeks after implementation of different degrees of bans on serving alcohol in pubs and restaurants, across 102 Norwegian municipalities with: (1) full blanket ban, (2) partial ban with hourly restrictions (eg, from 22:00 hours) or (3) no ban, adjusted for age, sex, testing behaviour and population size. RESULTS: By 4 weeks after the implementation of ban, COVID-19 infection among bartenders and waiters had been reduced by 60% (from 2.8 (95% CI 2.0 to 3.6) to 1.1 (95% CI 0.5 to 1.6) per 1000) in municipalities introducing full ban, and by almost 50% (from 2.5 (95% CI 1.5 to 3.5) to 1.3 (95% CI 0.4 to 2.2) per 1000) in municipalities introducing partial ban. A similar reduction within 4 weeks was also observed for workers in all occupations, both in municipalities with full (from 1.3 (95% CI 1.3 to 1.4) to 0.9 (95% CI 0.9 to 1.0)) and partial bans (from 1.2 (95% CI 1.1 to 1.3) to 0.5 (95% CI 0.5 to 0.6)). CONCLUSION: Partial bans on serving alcohol in bars and restaurants may be similarly associated with declines in confirmed COVID-19 infection as full bans.

Transmission of SARS-CoV-2 into and within immigrant households: nationwide registry study from Norway.

BACKGROUND: Minority groups and immigrants have been hit disproportionally hard by COVID-19 in many developed countries, including Norway. METHODS: Using individual-level registry data of all Norwegian residents, we compared infections across all multiperson households. A household with at least one member born abroad was defined as an immigrant household. In households where at least one person tested positive for SARS-CoV-2 from 1 August 2020 to 1 May 2021, we calculated secondary attack rates (SARs) as the per cent of other household members testing positive within 14 days. Logistic regression was used to adjust for sex, age, household composition and geography. RESULTS: Among all multiperson households in Norway (n=1 422 411), at least one member had been infected in 3.7% of the 343 017 immigrant households and 1.4% in the 1 079 394 households with only Norwegian-born members. SARs were higher in immigrant (32%) than Norwegian-born households (20%). SARs differed considerably by region, and were particularly high in households from West Asia, Eastern Europe, Africa and East Asia, also after adjustment for sex and age of the secondary case, household composition and geography. CONCLUSION: SARS-CoV-2 is more frequently introduced into multiperson immigrant households than into households with only Norwegian-born members, and transmission within the household occurs more frequently in immigrant households. The results are likely related to living conditions, family composition or differences in social interaction, emphasising the need to prevent introduction of SARS-CoV-2 into these vulnerable households.

Occupational risk of COVID-19 in the first versus second epidemic wave in Norway, 2020.

BackgroundThe occupational risk of COVID-19 may be different in the first versus second epidemic wave.AimTo study whether employees in occupations that typically entail close contact with others were at higher risk of SARS-CoV-2 infection and COVID-19-related hospitalisation during the first and second epidemic wave before and after 18 July 2020, in Norway.MethodsWe included individuals in occupations working with patients, children, students, or customers using Standard Classification of Occupations (ISCO-08) codes. We compared residents (3,559,694 on 1 January 2020) in such occupations aged 20-70 years (mean: 44.1; standard deviation: 14.3 years; 51% men) to age-matched individuals in other professions using logistic regression adjusted for age, sex, birth country and marital status.ResultsNurses, physicians, dentists and physiotherapists had 2-3.5 times the odds of COVID-19 during the first wave when compared with others of working age. In the second wave, bartenders, waiters, food counter attendants, transport conductors, travel stewards, childcare workers, preschool and primary school teachers had ca 1.25-2 times the odds of infection. Bus, tram and taxi drivers had an increased odds of infection in both waves (odds ratio: 1.2-2.1). Occupation was of limited relevance for the odds of severe infection, here studied as hospitalisation with the disease.ConclusionOur findings from the entire Norwegian population may be of relevance to national and regional authorities in handling the epidemic. Also, we provide a knowledge foundation for more targeted future studies of lockdowns and disease control measures.

Hospital Admissions for Respiratory Tract Infections in Children Aged 0-5 Years for 2017/2023.

Aim: To compare hospital admissions across common respiratory tract infections (RTI) in 2017-21, and project possible hospital admissions for the RTIs among children aged 0-12 months and 1-5 years in 2022 and 2023. Methods: In 644 885 children aged 0-12 months and 1-5 years, we plotted the observed monthly number of RTI admissions [upper- and lower RTI, influenza, respiratory syncytial virus (RSV), and COVID-19] from January 1st, 2017 until October 31st, 2021. We also plotted the number of RTI admissions with a need for respiratory support. We used the observed data to project four different scenarios of RTI admissions for the rest of 2021 until 2023, with different impacts on hospital wards: (1) "Business as usual," (2) "Continuous lockdown," (3) "Children's immunity debt," and (4) "Maternal and child immunity debt." Results: By October 31st, 2021, the number of simultaneous RTI admissions had exceeded the numbers usually observed at the typical season peak in January, i.e., ~900. Based on our observed data and assuming that children and their mothers (who transfer antibodies to the very youngest) have not been exposed to RTI over the last one and a half years, our scenarios suggest that hospitals should be prepared to handle two to three times as many RTI admissions, and two to three times as many RTI admissions requiring respiratory support among 0-5-year-olds as normal, from November 2021 to April 2022. Conclusion: Scenarios with immunity debt suggest that pediatric hospital wards and policy makers should plan for extended capacity.