Stigma related to contraceptive use and abortion in Kenya: scale development and validation.

BACKGROUND: Stigma related to abortion and contraceptive use is a serious public health threat for young people, and validated scales to measure this stigma are scarce. The purposes of the study were to validate a newly constructed scale to measure the stigma of contraceptive use and to adapt a scale to measure the stigma of abortion. METHODS: A study nested in a cluster-randomised trial. In 2017, data was collected from 633 secondary school youths, in a semi-urban setting in western Kenya. A qualitative pre-phase (face-validity) were initially utilised to draft and validate a seven-item scale to capture contraceptive use stigma (CUS) and to adapt the Stigmatizing Attitudes, Beliefs and Actions (SABA) scale (18 items), which captures aspects of abortion stigma. Statistical tests used included test-retest reliability analysis, Pearson's correlation coefficients, Wilcoxon signed-rank test, Factor Analysis, Principal Component Analysis, interclass correlation and Cronbach's alpha. RESULTS: For the CUS scale, paired t-test and Wilcoxon signed-rank test showed no significant score changed between time points (p = 0.64; 0.67). CUS had similar patterns between time points, with two relevant components: promiscuity and lack of autonomy. Cronbach's alpha indicated acceptable internal consistency between time points (0.71;0.7). The confirmatory factor loadings for each item in the modified three subscales of SABA had a similar pattern to the original SABA scale, in particularly regarding negative stereotyping and, excluding and discriminating factors. The Cronbach's alpha was adequate, although lower for the modified SABA (0.74) as compared to the original SABA (0.9). The SABA scale was renamed into Adolescents Stigmatizing Attitudes, Beliefs and Action (ASABA) scale. CONCLUSIONS: The CUS scale is considered valid and reliable for measuring contraceptive use stigma, and the ASABA scale was rated as reliable for capturing abortion stigma based on negative stereotyping and excluding and discriminating factors. The CUS, up to date the first ever proposed CUS scale, and the ASABA scale can be used to measure effects of stigma reduction interventions with the aim of preventing unintended pregnancies, motherhood and unsafe abortion among adolescents in Kenya and similar low-resource settings.

Self-Reported Negative Influence of Gambling Advertising in a Swedish Population-Based Sample.

This study investigated the negative influence of gambling advertising, that is, gambling more often or for more money than intended. We analyzed data from wave four of the Swedish Longitudinal Gambling Study (Swelogs), in which the self-perceived negative influence of gambling advertising was measured by responses to three survey questions. Few gamblers reported having been negatively influenced by gambling advertising. Among those who reported such influence, problem gamblers were overrepresented. Those who had set limits for their gambling reported a negative influence from advertising more often than others, which likely was caused by a perception that advertising is detrimental to efforts to cut down on excessive gambling. A multivariate regression analysis showed that negative influence from gambling advertising was positively associated with problem gambling, gambling at least monthly, participation in online gambling, and being in the age group 30-49 years. We conclude that although few gamblers are negatively influenced by gambling advertising, the adverse effects on those that are should not be neglected. For a considerable number of people, gambling advertising substantially contributes to problem gambling.

Factors Associated with Enhanced Gross Motor Progress in Children with Cerebral Palsy: A Register-Based Study.

AIM: To examine associations between interventions and child characteristics; and enhanced gross motor progress in children with cerebral palsy (CP). METHODS: Prospective cohort study based on 2048 assessments of 442 children (256 boys, 186 girls) aged 2-12 years registered in the Cerebral Palsy Follow-up Program and the Cerebral Palsy Register of Norway. Gross motor progress estimates were based on repeated measures of reference percentiles for the Gross Motor Function Measure (GMFM-66) in a linear mixed model. Mean follow-up time: 2.9 years. RESULTS: Intensive training was the only intervention factor associated with enhanced gross motor progress (mean 3.3 percentiles, 95% CI: 1.0, 5.5 per period of ≥3 sessions per week and/or participation in an intensive program). Gross motor function was on average 24.2 percentiles (95% CI: 15.2, 33.2) lower in children with intellectual disability compared with others. Except for eating problems (-10.5 percentiles 95% CI: -18.5, -2.4) and ankle contractures by age (-1.9 percentiles 95% CI: -3.6, -0.2) no other factors examined were associated with long-term gross motor progress. CONCLUSIONS: Intensive training was associated with enhanced gross motor progress over an average of 2.9 years in children with CP. Intellectual disability was a strong negative prognostic factor. Preventing ankle contractures appears important for gross motor progress.

Prevalence and correlates of successful aging in a population-based sample of older adults: the HUNT study.

BACKGROUND: The factors influencing successful aging (SA) are of great interest in an aging society. The aims of this study were to investigate the prevalence of SA, the relative importance across age of the three components used to define it (absence of disease and disability, high cognitive and physical function, and active engagement with life), and its correlates. METHODS: Data were extracted from the population-based cross-sectional Nord-Trøndelag Health Study (HUNT3 2006-2008). Individuals aged 70-89 years with complete datasets for the three components were included (N = 5773 of 8,040, 71.8%). Of the respondents, 54.6% were women. Univariate and multivariate regression analyses were used to analyze possible correlates of SA. RESULTS: Overall, 35.6% of the sample met one of the three criteria, 34.1% met combinations, and 14.5% met all of the three criteria. The most demanding criterion was high function, closely followed by absence of disease, while approximately two-thirds were actively engaged in life. The relative change with age was largest for the high cognitive and physical function component and smallest for active engagement with life. The significant correlates of SA were younger age, female gender, higher education, weekly exercise, more satisfaction with life, non-smoking, and alcohol consumption, whereas marital status was not related to SA. CONCLUSIONS: The prevalence of SA in this study (14.5%) is comparable to previous studies. It may be possible to increase the prevalence by intervention directed toward more exercise, non-smoking, and better satisfaction with life.

Does surgical technique influence clinical outcome after lumbar spinal stenosis decompression? A comparative effectiveness study from the Norwegian Registry for Spine Surgery.

INTRODUCTION: The aim of this study was to compare the clinical outcome of spinal process osteotomy with two other midline-retaining methods, bilateral laminotomy and unilateral laminotomy with crossover, among patients undergoing surgery for lumbar spinal stenosis. METHODS: This cohort study was based on data from the Norwegian Registry for Spine Surgery (NORspine). Patients were operated on between 2009 and 2013 at 31 Norwegian hospitals. The patients completed questionnaires at admission for surgery, and after 3 and 12 months. The Oswestry Disability Index (ODI) was the primary outcome. Secondary outcomes were duration of surgery and hospital stay, Numeric Rating Scale (NRS) for back pain and leg pain, and EQ-5D and EQ-VAS. The patients were classified into one of three treatment groups according to the surgery they had received, and a propensity score was utilized to minimize bias. The three treatment groups were divided into subgroups based on Propensity Scores, and the statistical analyses were performed with and within the Propensity Score stratified subgroups. RESULTS: 103 patients had spinal process osteotomy, 966 patients had bilateral laminotomy, and 462 patients had unilateral laminotomy with crossover. Baseline clinical scores were similar in the three groups. There were no differences in improvement after 3 and 12 months between treatment groups. At 12 months, mean ODI improvement was 15.2 (SD 16.7) after spinous process osteotomy, 16.9 (SD 17.0) after bilateral laminotomy, and 16.7 (SD 16.9) after unilateral laminotomy with crossover. There were no differences in the secondary clinical outcomes or complication rates. Mean duration of surgery was greatest for spinal process osteotomy (p < 0.05). Length of stay was 2.1 days (SD 2.1) in the bilateral laminotomy group, 3.5 (SD 2.4) days for unilateral laminotomy, and 6.9 days (SD 4.1) for spinous process osteotomy group (p < 0.05). CONCLUSION: In a propensity scored matched cohort, there were no differences in the clinical outcome 12 months after surgery for lumbar spinal stenosis performed using the three different posterior decompression techniques. Bilateral laminotomy had shortest duration of surgery and shortest length of hospital stay. Surgical technique does not seem to affect clinical outcome after three different midline-retaining posterior decompression techniques.

Study-protocol for a randomized controlled trial comparing clinical and radiological results after three different posterior decompression techniques for lumbar spinal stenosis: the Spinal Stenosis Trial (SST) (part of the NORDSTEN Study).

BACKGROUND: There are several posterior decompression techniques for lumbar spinal stenosis (LSS). There is a trend towards performing less invasive surgical procedures, but no multicentre randomized controlled trials have evaluated the relative efficacy of these techniques at short and long-term. METHOD/DESIGN: A multicentre randomized controlled trial [the Spinal Stenosis Trial (SST) (part of the NORDSTEN study)] including 465 patients aged 18-80 years with neurogenic claudication or radiating pain and MRI findings indicating lumbar spinal stenosis without spondylolisthesis is performed to compare three posterior decompression techniques: unilateral laminotomy with crossover, bilateral laminotomy and spinous process osteotomy. The primary outcome is change in Oswestry Disability Index (ODI 2 years postoperatively). Secondary outcomes are change in EQ-5D, Zurich Claudication Questionnaire, and Numeric Rating Scale for leg-pain and back-pain. Also recorded were Global Perceived Effect score, complications, length of hospital stay, reoperation rate 2 years postoperatively, difference in recurrence of symptoms or postoperative instability, and MRI change in the dural sac area. Further, a 5 and 10 years follow-up is planned with the same outcome measures. DISCUSSION: Newer and less invasive techniques are increasingly favoured in surgery for LSS. This trial will compare the clinical and radiological results of three different techniques, and may contribute to better clinical decision making in the surgical treatment of LSS. TRIAL REGISTRATION: ClinicalTrials.gov reference: NCT02007083 (November 22, 2013).

Underestimation of Patient Breathlessness by Nurses and Physicians during a Spontaneous Breathing Trial.

RATIONALE: Breathlessness is a prevalent and distressing symptom in intensive care unit patients. There is little evidence of the ability of healthcare workers to assess the patient's experiences of breathing. Patient perception of breathing is essential in symptom management, and patient perception during a spontaneous breathing trial (SBT) might be related to extubation success. OBJECTIVES: To assess mechanically ventilated patients' experiences of breathlessness during SBT. METHODS: This was a prospective observational multicenter study of 100 mechanically ventilated patients. We assessed the agreement between nurses, physicians, and patients' 11-point Numerical Rating Scales scores of breathlessness, perception of feeling secure, and improvement of respiratory function at the end of an SBT (most performed with some level of support). We also determined the association between breathlessness and demographic factors or respiratory observations. MEASUREMENTS AND MAIN RESULTS: Sixty-two patients (62%) reported moderate or severe breathlessness (Numerical Rating Scales ≥ 4). The median intensity of breathlessness reported by patients was five compared with two by nurses and physicians (P < 0.001). Patients felt less secure and reported less improvement of respiratory function compared with nurses' and physicians' ratings. About half of the nurses and physicians underestimated breathlessness (difference score, ≤-2) compared with the patients' self-reports. Underestimation of breathlessness was not associated with professional competencies. There were no major differences in objective assessments of respiratory function in patients with moderate or severe breathlessness, and no apparent relationship between breathlessness during the SBT and extubation outcome. CONCLUSIONS: Patients reported higher breathlessness after SBT compared with nurses and physicians. Clinical trial registered with www.clinicaltrials.gov (NCT 01928277).

Physical activity in adolescents who later developed schizophrenia: A prospective case-control study from the Young-HUNT.

BACKGROUND: Adults suffering from schizophrenia and other psychiatric disorders report low levels of physical activity. In addition, these patients have an increased risk of overweight and poor nutritional habits. Less is known about patterns and levels of physical activity before the onset of disease. AIMS: The purpose of the study was to investigate whether there were specific patterns of physical activity in the premorbid phase of schizophrenia and whether these participants differed from those with bipolar disorder (BD). A group of healthy controls (HC) was also included. METHODS: The study was a prospective, longitudinal, comparative cohort design in which 15 adolescents who later developed schizophrenia and 18 with later BD were compared with HC. Data were analysed using non-parametric statistical tests. RESULTS: Patients with a diagnosis of schizophrenia were less physically active with fewer days per week (p < 0.05) and fewer hours per week (p < 0.05) in the premorbid phase than both BD and HC. They also participated less in team sports than HC (p < 0.05). CONCLUSION: Our results suggest that individuals who develop schizophrenia in their teens may be at risk of establishing a lifestyle harmful to health. From a preventive perspective it is important to gain more knowledge about the connections between health habits and later development of disease.

The Incidence of Problem Gambling in a Representative Cohort of Swedish Female and Male 16-24 Year-Olds by Socio-demographic Characteristics, in Comparison with 25-44 Year-Olds.

We aimed to estimate the incidence of a first episode of problem gambling among Swedish 16-24 year-olds by demographic and socio-economic characteristics, and to compare the incidence between 16-24 and 25-44 year-olds, and between young women and men. Other aims were to estimate the proportions of recovery and incidence in recurrent problem gambling, and prevalence of problem gambling among 16-44 year-olds in Sweden. We selected 4,358 participants aged 16-44 from the nationally representative Swedish Longitudinal Gambling Study in 2008/2009 and 2009/2010. The primary outcome measure was a first episode of problem gambling during 12 months before the follow-up as measured by the Problem Gambling Severity Index among participants without a history of problem gambling at baseline. The incidence proportion of a first episode of problem gambling among 16-24 year-olds was 2.26% (95% confidence interval 1.52-3.36); three times lower among females (1.14; 0.42-3.07%) than males (3.32; 2.19-5.01%). Young age and household financial problems were associated with first episode problem gambling among young women. Among 25-44 year-olds, the incidence proportion of a first episode of problem gambling was 0.81% (0.41-1.56). Recovery from problem gambling was high, in particular among females. Individual transitions from problem gambling to recovery and to recurrent problem gambling, between baseline and follow-up, were common regardless of age. This study adds further evidence to research suggesting that there is a high mobility in and out of problem gambling over time on an individual level. The high incidence of first episode problem gambling among youth in Sweden stresses the importance of prevention of problem gambling at an early age.

Gambling and problem gambling in Sweden: changes between 1998 and 2009.

Gambling participation and rates of problem gambling change over time in response to a variety of factors including gambling availability, demographic changes and adaptation at individual and societal levels. These relationship are complex and only partially understood. The major aim of the present study was to provide general population estimates of gambling participation and problem gambling for Sweden and compare these estimates with estimates from a previous national study. The study was also designed to identify risk factors for problem gambling including change in these factors over time. Data are from the first phase of the Swedish Longitudinal Gambling Study (Swelogs) in which a representative sample of 8,165 people was assessed using validated problem gambling and other measures to facilitate comparison with findings from the 1997/1998 Swedish Gambling Study (Swegs). Overall, it was found that gambling participation reduced markedly, although in some population sectors increases were evident for some forms including poker and electronic gaming machines. Lifetime prevalence of probable pathological gambling increased; however, past 12 months probable pathological and problem gambling prevalence did not. Males, younger adults and people born outside Sweden were at high risk in both studies. Significant prevalence increases were evident for people aged 18-24 and those with low levels of education. The results indicate that relationships between gambling exposure, participation and problems are dynamic with shifting implications for public health and social policy.

Perceived decisional responsibility for mechanical ventilation and weaning: a Norwegian survey.

AIM: To explore variability in perceptions of nurse managers and physician directors regarding roles, responsibilities and clinical-decision making related to mechanical ventilator weaning in Norwegian intensive care units (ICUs). BACKGROUND: Effective teamwork is crucial for providing optimal patient care in ICU. More knowledge on nurses' and physicians' perceptions of responsibility in clinical decision-making for mechanical ventilation is needed. METHODS: Self-administered survey of mechanical ventilation and weaning responsibilities was sent to nurse managers and physician directors of Norwegian adult ICUs. Nurses' decisional influence and autonomy were estimated on a numeric rating scale (NRS) from 0 to 10 (least to most). RESULTS: Response rate was 38/60 (63%) nurses and 38/52 (73%) physicians. On the NRS nurse managers perceived the autonomy and influence of nurses' ventilator decisions higher than physician directors: median of 7 (IQR 5-8) (nurses) versus 5 (3-6) (physicians), (p < 0·01), and 8 (7-9) (nurses) versus 7 (5-8) (physicians), (p < 0·01) respectively. Respondents agreed that nurses collaborated in assessment of patient response to ventilator changes and titrating ventilator settings: 92% of nurses and 87% of physicians, (p = 0·46), and recognizing weaning failure 84% of nurses and 84% of physicians, (p = 0·96). Physician directors perceived significantly less collaborative decision-making on weaning method (p = 0·01), weaning readiness (p = 0·04) and readiness to extubate (p < 0·01) than nurse managers. Both groups acknowledged the importance of 'knowing the patient' for weaning success, and agreed that the assessment of work of breathing, well-being, and clinical deterioration were important for determining weaning tolerance. CONCLUSIONS: Nurse managers perceived nurses to have greater autonomy, influence and collaborative interaction regarding decisions on mechanical ventilation than physician directors. Greater awareness and acknowledgment of nurses' role may promote interprofessional collaboration and improve patient care.

Urinary incontinence and risk of functional decline in older women: data from the Norwegian HUNT-study.

BACKGROUND: The main objective of the present study was to determine whether UI is an independent predictor of ADL decline and IADL decline in elderly women. We also aimed to find out whether incontinent subjects were at higher risk of needing help from formal home care or home nursing care during 11 year follow-up. METHODS: A prospective cohort study conducted as part of the North-Trøndelag Health Study 2 and 3. Women aged 70-80 years when participating in the HUNT 2 study, who also participated in the HUNT 3 study, were included in this study. Analyses on self-reported urinary incontinence at baseline and functional decline during a11-year period were performed for incontinent and continent subjects. RESULTS: Baseline prevalence of urinary incontinence was 24%. At on average eleven year follow up, logistic regression analysis showed a significant association between incontinence and decline in activities of daily living (ADL) (OR =2.37, 95% CI =1.01-5.58) (P=0.04). No association between urinary incontinence and instrumental activities of daily living (IADL) in incontinent women compared with continent women was found (OR=1.18, CI=.75-1.86) (P=.46). Data were adjusted for ADL, IADL and co morbid conditions at baseline. No significant differences in need of more help from formal home care and home nursing care between continent and incontinent women were found after 11 years of follow-up. CONCLUSIONS: Urinary incontinence is an important factor associated with functional decline in women aged 70-80 years living in their own homes. At eleven years of follow up, no significant differences in need of more help from formal home care and home nursing care between continent and incontinent women were found.

Association of personality, neighbourhood, and civic participation with the level of perceived social support: the HUNT study, a cross-sectional survey.

AIM: The aim of the current study was to examine the association of personality, neighbourhood, and civic participation with the level of perceived social support if needed. METHODS: The sample consists of a total of 35,797 men (16,035) and women (19,762) drawn from the Nord-Trøndelag Health Study 3 (HUNT3), aged 20-89, with a fully completed short version of the Eysenck Personality Questionnaire (EPQ) including a complete response to questions regarding perceived social support. A multinomial logistic regression model was used to investigate the association between the three-category outcomes (high, medium, and low) of perceived social support. RESULTS: The Chi-square test detected a significant (p < 0.001) association between personality, sense of community, civic participation, self-rated health, living arrangement, age groups, gender, and perceived social support, except between perceived social support and loss of social network, in which no significance was found. The crude and adjusted multinomial logistic regression models show a relation between medium and low scores on perceived social support, personality, and sources of social support. Interactions were observed between gender and self-rated health. CONCLUSIONS: There is an association between the level of perceived social support and personality, sense of community in the neighbourhood, and civic participation. Even if the interaction between men and self-reported health decreases the odds for low and medium social support, health professionals should be aware of men with poor health and their lack of social support.

The concerned significant others of people with gambling problems in a national representative sample in Sweden - a 1 year follow-up study.

BACKGROUND: Research into the impact of problem gambling on close social networks is scarce with the majority of studies only including help-seeking populations. To date only one study has examined concerned significant others (CSOs) from an epidemiological perspective and it did not consider gender. The aim of this study is to examine the health, social support, and financial situations of CSOs in a Swedish representative sample and to examine gender differences. METHODS: A population study was conducted in Sweden in 2008/09 (n = 15,000, response rate 63%). Respondents were defined as CSOs if they reported that someone close to them currently or previously had problems with gambling. The group of CSOs was further examined in a 1-year follow up (weighted response rate 74% from the 8,165 respondents in the original sample). Comparisons were also made between those defined as CSOs only at baseline (47.7%, n = 554) and those defined as CSOs at both time points. RESULTS: In total, 18.2% of the population were considered CSOs, with no difference between women and men. Male and female CSOs experienced, to a large extent, similar problems including poor mental health, risky alcohol consumption, economic hardship, and arguments with those closest to them. Female CSOs reported less social support than other women and male CSOs had more legal problems and were more afraid of losing their jobs than other men. One year on, several problems remained even if some improvements were found. Both male and female CSOs reported more negative life events in the 1 year follow-up. CONCLUSIONS: Although some relationships are unknown, including between the CSOs and the individuals with gambling problems and the causal relationships between being a CSO and the range of associated problems, the results of this study indicate that gambling problems not only affect the gambling individual and their immediate close family but also the wider social network. A large proportion of the population can be defined as a CSO, half of whom are men. While male and female CSOs share many common problems, there are gender differences which need to be considered in prevention and treatment.

Increased prevalence of depression in cohorts of the elderly: an 11-year follow-up in the general population - the HUNT study.

BACKGROUND: Depression is a common disorder in late life. As the elderly population continues to grow worldwide, depression is also likely to become an increasing health problem. The aim of this study was to examine changes in prevalence of depression in various age cohorts over an 11-year period. METHODS: This study involved two cross-sectional studies (HUNT 2 and HUNT 3) of all adult inhabitants of the Norwegian county of Nord-Trøndelag with an 11 year-interval between the two studies. The participants aged 45 years or above at HUNT 2 and with a valid depression rating at both HUNT 2 (baseline) and HUNT 3 (follow-up) (N = 16517), were included and divided into five-year age cohorts. Depression was measured by the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). RESULTS: A significant increase in depression was found in all age cohorts from 76 years at follow-up, with the greatest increase (9.6%) in the oldest age cohort (86-90 years at follow-up). The incidence of depression is increasing with age, with over 10% new cases in all age cohorts aged 81 years and above at follow-up. About 5% of the participants in all age cohorts reported depression at both measure points, and there is a decrease in recovery from depression from baseline to follow-up with increasing age. CONCLUSIONS: We found increased prevalence of depression and a large number of new cases of depression in the oldest age cohorts.

Association between social support and depression in the general population: the HUNT study, a cross-sectional survey.

AIM: The aim was to investigate the associations between perceived social support and depression in a general population in relation to gender and age. BACKGROUND: Social support is seen as one of the social determinants for overall health in the general population. Studies have found higher probability of experiencing depression among people who have a lack of social support; evidence from the general population has been more limited. Subjective perception that support would be available if needed may reduce and prevent depression and unnecessary suffering. DESIGN: A cross-sectional survey with self-reported health was used. METHOD: A total of 40,659 men and women aged 20-89 years living in Nord-Trøndelag County of Norway with valid ratings of depression subscale of the Hospital Anxiety and Depression Scale in the The Nord-Trøndelag Health Study 3 were used. Logistic regression was used to quantify associations between two types of perceived support (emotional and tangible) and depression. Gender, age and interaction effects were controlled for in the final model. RESULTS: The main finding was that self-rated perceived support was significantly associated with Hospital Anxiety and Depression Scale-defined depression, even after controlling for age and gender; emotional support (OR = 3·14) and tangible support (OR = 2·93). The effects of emotional and tangible support differ between genders. Interaction effects were found for age groups and both emotional and tangible support. CONCLUSION: Self-rated perceived functional social support is associated with Hospital Anxiety and Depression Scale-defined depression. In the group of older people who have a lack of social support, women seem to need more emotional support and men tangible support. RELEVANCE TO CLINICAL PRACTICE: Health care providers should consider the close association between social support and depression in their continuing care, particularly in the older people.

The relationship among neuroticism, extraversion, and depression in the HUNT Study: in relation to age and gender.

The purpose of this study was to examine the relationship between personality and depression in a general population in relation to gender and age. The Nord-Trøndelag Health Study (2006-2008), a large cross-sectional survey, was used. The sample consists of 35,832 men (16,104) and women (19,728) aged 20-89 years, living in the Nord-Trøndelag County of Norway, with valid ratings on the depression subscale of the Hospital Anxiety and Depression Scale (HADS) and Eysenck Personality Questionnaire (EPQ). This study demonstrates a relationship between depression and both neuroticism and extraversion in a general population. Older people score low more often on Extraversion (E) than younger people. Interactions were observed between neuroticism and age, gender, and extraversion with depression. The interaction term indicates a high score on Neuroticism (N) enhanced by introversion, older age, and being a male with depression. The findings suggest that health professionals may need to put extra effort into the care of patients with low extraversion and high neuroticism, in order to help those patients avoid depression.

Anxiety and depression lowers blood pressure: 22-year follow-up of the population based HUNT study, Norway.

BACKGROUND: For decades, symptoms of anxiety and depression have been included among psychological factors associated with development of hypertension. Although this has been questioned in recent studies, most findings have been based on a single assessment of mental distress at baseline. We examined these associations using repeated assessments of anxiety, depression and blood pressure. METHODS: Data on 17,410 men and women aged 20 to 67 participating in the Nord-Trøndelag Health Study (HUNT) in Norway in 1984-86 were re-examined 11 and 22 years later. The main outcome was change in mean blood pressure (mm Hg) during follow-up. RESULTS: We found that a high symptom level score (≥80th percentile) of combined anxiety and depression at baseline, as compared to a lower symptom level, was associated with lower mean systolic (-0.67 mm Hg, p = 0.044) and diastolic (-0.25 mm Hg, p = 0.201) blood pressure at year 22. A high symptom level present at all three examinations was associated with a stronger decrease in mean systolic (-1.59 mm Hg, p = 0.004) and diastolic (-0.78 mm Hg, p = 0.019) blood pressure and with a 20% (p = 0.001) lower risk of developing hypertension (BP ≥140/90 mm Hg) at year 22. The associations were only slightly attenuated in multivariate analyses, with no evidence of a mediating effect of alteration in heart rate. CONCLUSIONS: This study do not support previous hypothesis that emotional stress may be a cause of hypertension. Our findings indicate that symptoms of anxiety and depression are associated with decrease in blood pressure, particularly when a high symptom level can be detected over decades.

[Evaluation of the compulsory practice period for doctors in Norwegian hospitals]. / Evaluering av turnustjenesten i sykehus.

BACKGROUND: The Norwegian Internship Council has uncovered weaknesses associated with the compulsory practice period in hospitals for doctors, both on a national basis and for North Trøndelag County. MATERIAL AND METHODS: In 2007 and 2008, 79% (859) of all interns in Norwegian hospitals participated in the Council's national evaluation of the practice period. We compared the results from interns serving at hospitals in Levanger and Namsos (North Trøndelag) (n = 39) with those from interns serving at the other hospitals in Norway (n = 820). RESULTS: At the surgical and medical departments in Levanger, the training in clinical procedures and acute medical conditions (simulator training) was similar or better than that in the other hospitals in Norway, but the guidance given to candidates in these departments was neither considered to be especially useful (12% and 17%) nor did it focus on problems related to ethics (0-8%). In general the guidance was perceived as more useful and systematic in psychiatric wards than in somatic ones. Fewer candidates in Namsos had experience with patient rounds (69%) and writing of case reports (79%) than those in hospitals in the rest of the country, and no interns in psychiatry reported that they had received thorough training in cooperation with the primary health services or in psychopharmacology. INTERPRETATION: National data from the Internship Council conceal important variations between hospitals, and to be useful for local improvement work they have to be reanalysed. The identified weaknesses for interns in North Trøndelag led to implementation of new routines for guidance, training in simulation and law before start of the practice period.