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Recent research has suggested that across Western developed societies, the influence of genetics on educational outcomes is relatively constant. However, the degree to which family environment matters varies, such that countries with high levels of intergenerational mobility have weaker associations of family background. Research in this vein has relied on twin-based estimates, which involve variance decomposition, so direct assessment of the association of genes and environments is not possible. In the present study, we approach the question by directly measuring the impact of child genotype, parental genetic nurture, and parental realized education on educational achievement in primary and secondary school. We deploy data from a social democratic context (Norway) and contrast our findings with those derived from more liberal welfare state contexts. Results point to genetics only confounding the relationship between parent status and offspring achievement to a small degree. Genetic nurture associations are similar to those in other societies. We find no, or very small, gene-environment interactions and parent-child genotype interactions with respect to test scores. In sum, in a Scandinavian welfare state context, both genetic and environmental associations are of similar magnitude as in societies with less-robust efforts to mitigate the influence of family background.
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Logro , Relações Pais-Filho , Adolescente , Criança , Escolaridade , Interação Gene-Ambiente , Humanos , Gêmeos/genéticaRESUMO
BACKGROUND: The global incidence target for the elimination of hepatitis C among people who inject drugs (PWID) is <2/100. In Norway, the hepatitis C epidemic is concentrated in PWID. Immigrants are the second most important risk group for chronic infection. We modelled the incidence of hepatitis C among active PWID, and the prevalence of chronic infection among active PWID, ex-PWID and immigrants in Norway until 2022. METHODS: We built a stochastic compartmental model, which was informed using data from national data sources, literature, and expert opinion. We report median values with 95% credible intervals (CrI). RESULTS: The model estimated 30 (95% Crl: 13-52) new infections among active PWID in 2022, or 0.37/100 (95% Crl: 0.17-0.65), down from a peak of 726 (95% Crl: 506-1,067) in 2000. Across all groups, the model estimated 3,202 (95% Crl: 1,273-6,601) chronically infected persons in 2022. Results were robust in sensitivity analyses. CONCLUSIONS: Norway provides an example of the feasibility of hepatitis C elimination in a setting with a concentrated epidemic, high coverage of harm reduction services and no treatment restrictions. Continued momentum is needed to further reduce the transmission and burden of hepatitis C in Norway.
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Using a unique 8-year data set (2010-2017) of phloem data, we studied the effect of temperature and precipitation on the phloem anatomy (conduit area, widths of ring, early and late phloem) and xylem-ring width in two coexisting temperate tree species, Picea abies and Fagus sylvatica, from three contrasting European temperate forest sites. Histometric analyses were performed on microcores taken from tree stems in autumn. We found high interannual variability and sensitivity of phloem anatomy and xylem-ring widths to precipitation and temperature; however, the responses were species- and site-specific. The contrasting response of xylem and phloem-ring widths of the same tree species to weather conditions was found at the two Slovenian sites generally well supplied with precipitation, while at the driest Czech site, the influence of weather factors on xylem and phloem ring widths was synchronised. Since widths of mean annual xylem and phloem increments were narrowest at the Czech site, this site is suggested to be most restrictive for the radial growth of both species. By influencing the seasonal patterns of xylem and phloem development, water availability appears to be the most important determinant of tissue- and species-specific responses to local weather conditions.
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Abies , Fagus , Picea , Pinus , Picea/fisiologia , Floema , Clima , Árvores/fisiologiaRESUMO
Examining fracture dynamics by socioeconomic status may inform healthcare and prevention. We found a higher risk of hip fracture in men and women with lower educational level in Norway. However, by age 90 + years, the cumulative incidence was higher in those with higher education, due to their higher life expectancy. PURPOSE: Socioeconomic gradients are seen for several health outcomes in high-income countries. We aimed to examine possible educational gradients in risk of hip fracture in Norway and to describe the cumulative incidence of hip fracture by educational level. METHODS: In a population-wide cohort of Norwegians aged ≥ 50 years, information on attained education from Statistics Norway was linked to hospital-treated hip fractures and deaths during 2002-2019. We estimated relative fracture risk by educational level (primary, secondary or tertiary) in Cox proportional hazards regression. We also examined the cumulative incidence over attained age by gender and educational level in competing risk regression. RESULTS: The population included N = 1,389,858 individuals with 135,938 incident hip fractures. Compared with men who had attained tertiary education, hazard ratios (95% confidence intervals) for hip fracture were 1.44 (1.40, 1.49) in men with primary education only and 1.26 (1.22, 1.29) in men with secondary education. In women, the corresponding estimates were 1.28 (1.25, 1.31) and 1.16 (1.13, 1.19). In the age range 50 to 90 years, the highest cumulative incidence of hip fracture was seen in those with primary education. The gradient gradually diminished with advancing age and was reversed in the oldest (> 90 years) in both genders. CONCLUSIONS: There was a clear educational gradient in hip fracture incidence in both men and women in Norway, with a higher risk in people with lower education. Despite this, the cumulative incidence of hip fracture in old age was highest among people with higher education, due to their higher life expectancy.
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Climate change is projected to increase the frequency and severity of droughts, possibly causing sudden and elevated tree mortality. Better understanding and predictions of boreal forest responses to climate change are needed to efficiently adapt forest management. We used tree-ring width chronologies from the Swedish National Forest Inventory, sampled between 2010 and 2018, and a random forest machine-learning algorithm to identify the tree, stand, and site variables that determine drought damage risk, and to predict their future spatial-temporal evolution. The dataset consisted of 16,455 cores of Norway spruce, Scots pine, and birch trees from all over Sweden. The risk of drought damage was calculated as the probability of growth anomaly occurrence caused by past drought events during 1960-2010. We used the block cross-validation method to compute model predictions for drought damage risk under current climate and climate predicted for 2040-2070 under the RCP.2.6, RCP.4.5, and RCP.8.5 emission scenarios. We found local climatic variables to be the most important predictors, although stand competition also affects drought damage risk. Norway spruce is currently the most susceptible species to drought in southern Sweden. This species currently faces high vulnerability in 28% of the country and future increases in spring temperatures would greatly increase this area to almost half of the total area of Sweden. Warmer annual temperatures will also increase the current forested area where birch suffers from drought, especially in northern and central Sweden. In contrast, for Scots pine, drought damage coincided with cold winter and early-spring temperatures. Consequently, the current area with high drought damage risk would decrease in a future warmer climate for Scots pine. We suggest active selection of tree species, promoting the right species mixtures and thinning to reduce tree competition as promising strategies for adapting boreal forests to future droughts.
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Picea , Pinus sylvestris , Secas , Mudança Climática , Adaptação Fisiológica , Estações do AnoRESUMO
AIMS: Norway and Sweden had different early pandemic responses that may have impacted mental health management. The aim was to assess the impact of the early COVID-19 pandemic on mental health-related care. METHODS: We used national registries in Norway and Sweden (1 January 2018-31 December 2020) to define 2 cohorts: (i) general adult population; and (ii) mental health adult population. Interrupted times series regression analyses evaluated step and slope changes compared to prepandemic levels for monthly rates of medications (antidepressants, antipsychotics, anxiolytics, hypnotics/sedatives, lithium, opioid analgesics, psychostimulants), hospitalizations (for anxiety, bipolar, depressive/mood, eating and schizophrenia/delusional disorders) and specialist outpatient visits. RESULTS: In Norway, immediate reductions occurred in the general population for medications (-12% antidepressants to -7% hypnotics/sedatives) except for antipsychotics; and hospitalizations (-33% anxiety disorders to -17% bipolar disorders). Increasing slope change occurred for all medications except psychostimulants (+1.1%/month hypnotics/sedatives to +1.7%/month antidepressants); and hospitalization for anxiety disorders (+5.5%/month), depressive/mood disorders (+1.7%/month) and schizophrenia/delusional disorders (+2%/month). In Sweden, immediate reductions occurred for antidepressants (-7%) and opioids (-10%) and depressive/mood disorder hospitalizations (-11%) only with increasing slope change in psychostimulant prescribing of (0.9%/month). In contrast to Norway, increasing slope changes occurred in specialist outpatient visits for depressive/mood disorders, eating disorders and schizophrenia/delusional disorders (+1.5, +1.9 and +2.3%/month, respectively). Similar changes occurred in the pre-existing mental health cohorts. CONCLUSION: Differences in early COVID-19 policy response may have contributed to differences in adult mental healthcare provision in Norway and Sweden.
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COVID-19 , Hospitalização , Análise de Séries Temporais Interrompida , Transtornos Mentais , Humanos , COVID-19/epidemiologia , Suécia/epidemiologia , Noruega/epidemiologia , Adulto , Hospitalização/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Feminino , Transtornos Mentais/epidemiologia , Transtornos Mentais/tratamento farmacológico , Assistência Ambulatorial/estatística & dados numéricos , Idoso , Sistema de Registros , Adulto Jovem , SARS-CoV-2 , Saúde Mental/estatística & dados numéricos , Psicotrópicos/uso terapêuticoRESUMO
Chronic wasting disease (CWD), a prion disease affecting cervids, has been known in North America (NA) since the 1960s and emerged in Norway in 2016. Surveillance and studies have revealed that there are different forms of CWD in Fennoscandia: contagious CWD in Norwegian reindeer and sporadic CWD in moose and red deer. Experimental studies have demonstrated that NA CWD prions can infect various species, but thus far, there have been no reports of natural transmission to non-cervid species. In vitro and laboratory animal studies of the Norwegian CWD strains suggest that these strains are different from the NA strains. In this work, we describe the intracerebral transmission of reindeer CWD to six scrapie-susceptible sheep. Detection methods included immunohistochemistry (IHC), western blot (WB), enzyme-linked immunosorbent assay (ELISA), real-time quaking-induced conversion (RT-QuIC) and protein misfolding cyclic amplification (PMCA). In the brain, grey matter vacuolation was limited, while all sheep exhibited vacuolation of the white matter. IHC and WB conventional detection techniques failed to detect prions; however, positive seeding activity with the RT-QuIC and PMCA amplification techniques was observed in the central nervous system of all but one sheep. Prions were robustly amplified in the lymph nodes of all animals, mainly by RT-QuIC. Additionally, two lymph nodes were positive by WB, and one was positive by ELISA. These findings suggest that sheep can propagate reindeer CWD prions after intracerebral inoculation, resulting in an unusual disease phenotype and prion distribution with a low amount of detectable prions.
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Príons , Rena , Doença de Emaciação Crônica , Animais , Doença de Emaciação Crônica/transmissão , Ovinos , Príons/metabolismo , Noruega , Encéfalo/metabolismo , Fenótipo , Doenças dos Ovinos/transmissãoRESUMO
Historical climate data indicate that the Earth has passed through multiple geological periods with much warmer-than-present climates, including epochs of the Miocene (23-5.3 mya BP) with temperatures 3-4°C above present, and more recent interglacial stages of the Quaternary, for example, Marine Isotope Stage 11c (approx. 425-395 ka BP) and Middle Holocene thermal maximum (7.5-4.2 ka BP), during which continental glaciers may have melted entirely. Such warm periods would have severe consequences for ice-obligate fauna in terms of their distribution, biodiversity and population structure. To determine the impacts of these climatic events in the Nordic cryosphere, we surveyed ice habitats throughout mainland Norway and Svalbard ranging from maritime glaciers to continental ice patches (i.e. non-flowing, inland ice subjected to deep freezing overwinter), finding particularly widespread populations of ice-inhabiting bdelloid rotifers. Combined mitochondrial and nuclear DNA sequencing identified approx. 16 undescribed, species-level rotifer lineages that revealed an ancestry predating the Quaternary (> 2.58 mya). These rotifers also displayed robust freeze/thaw tolerance in laboratory experiments. Collectively, these data suggest that extensive ice refugia, comparable with stable ice patches across the contemporary Norwegian landscape, persisted in the cryosphere over geological time, and may have facilitated the long-term survival of ice-obligate Metazoa before and throughout the Quaternary.
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Rotíferos , Animais , Regiões Árticas , Noruega , Rotíferos/genética , Rotíferos/classificação , Svalbard , Camada de Gelo , Filogenia , DNA Mitocondrial/genética , EcossistemaRESUMO
The aims of the present study were to assess secular trends in breast-feeding and to explore associations between age at introduction of solid foods and breast-feeding duration. Data from three national dietary surveys in Norway were used, including infants born in 1998 (Spedkost 1, n 1537), 2006 (Spedkost 2, n 1490) and 2018 (Spedkost 3, n 1831). In all surveys, around 80 % of the infants were breastfed at 6 months of age. At 12 months of age, breast-feeding rate was 41 % in Spedkost 1, increasing to 48 % in Spedkost 2 and 51 % in Spedkost 3. Compared with earlier introduction, introduction of solid foods at ≥ 5 months of age was associated with a lower risk of breast-feeding cessation during the first year of life in the two most recent Spedkost surveys. In Spedkost 2, the adjusted hazard ratio for breast-feeding cessation during the first year of life for those introduced to solid foods at ≥ 5 months of age was 0·43 (95 % CI (0·31, 0·60)), P < 0·001, while the corresponding number in Spedkost 3 was 0·44 (95 % CI (0·29, 0·67)), P < 0·001. In conclusion, breast-feeding at infant age 12 months increased over time. Introduction of solid foods at ≥ 5 months of age was positively associated with breast-feeding duration in the two most recent Spedkost surveys. As breast-feeding contributes to numerous health benefits for infant and mother, and possibly improved dietary sustainability in infancy, findings point to the importance of continued protection, support and promotion of breast-feeding.
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Aleitamento Materno , Alimentos Infantis , Lactente , Feminino , Humanos , Adulto , Comportamento Alimentar , Inquéritos e Questionários , Noruega , Fenômenos Fisiológicos da Nutrição do LactenteRESUMO
BACKGROUND: Prior studies on maternal cardiovascular disease (CVD) mortality and hypertensive disorders of pregnancy (HDP) have focused only on a woman's first birth and have not accounted for successive affected pregnancies. OBJECTIVES: The objective of this study is to identify mothers' risk of CVD mortality considering lifetime reproductive history. METHODS: We used data from the Medical Birth Registry of Norway, the Norwegian Cause of Death Registry, and the Norwegian National Population Register to identify all mothers who gave birth from 1967 to 2020. Our outcome was mothers' CVD death before age 70. The primary exposure was the lifetime history of HDP. The secondary exposure was the order of HDP and gestational age at delivery of pregnancies with HDP. We used Cox regression models to estimate hazard ratio (HR) and 95% confidence interval (CI), adjusting for education, mother's age, and year of last birth. These models were stratified by the lifetime number of births. RESULTS: Among 987,378 mothers, 86,294 had HDP in at least one birth. The highest CVD mortality, relative to mothers without HDP, was among those with a pre-term HDP in their first two births, although this represented 1.0% of mothers with HDP (HR 5.12, 95% CI 2.66, 9.86). Multiparous mothers with term HDP in their first birth only had no increased risk of CVD relative to mothers without HDP (36.9% of all mothers with HDP; HR 1.12, 95% CI 0.95, 1.32). All other mothers with HDP had a 1.5- to 4-fold increased risk of CVD mortality. CONCLUSIONS: This study identified heterogeneity in the risk of CVD mortality among mothers with a history of HDP. A third of these mothers are not at higher risk compared to women without HDP, while some less common patterns of HDP history are associated with severe risk of CVD mortality.
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Doenças Cardiovasculares , Hipertensão Induzida pela Gravidez , Pré-Eclâmpsia , Gravidez , Feminino , Humanos , Idoso , Doenças Cardiovasculares/etiologia , Mães , Hipertensão Induzida pela Gravidez/epidemiologia , História Reprodutiva , Fatores de Risco , Pré-Eclâmpsia/epidemiologiaRESUMO
For people living with HIV (PLHIV) who can access lifesaving treatment, HIV has become a chronic lifelong condition; however, PLHIV have more mental and somatic comorbidities than their HIV-negative peers. In this cross-sectional study, we assessed the prevalence of mental distress and identified factors associated with major depression among 244 well-treated PLHIV residing in Norway. Participants completed validated questionnaires covering mental and somatic health. The prevalence of mental distress, defined as a score on the Hopkins Symptom Check List-25 >1.75, was 32%, and that of symptoms of major depression, defined as a score on the Beck Depression Inventory-II ≥20, was 15%. The factors associated with major depressive symptoms identified using logistic regression were risk of drug abuse (adjusted odds ratio (AOR) 15.1, 95% confidence interval (CI) 3.28, 69.3), fatigue (AOR 12.5, 95% CI 3.90, 40.0), trouble sleeping (AOR 7.90, 95% CI 2.85, 21.9), African origin (AOR 3.90, 95% CI 1.28, 11.9), low education (AOR 3.31, 95% CI 1.18, 9.30), and non-disclosure (AOR 3.22, 95% CI 1.04, 10.0). Our findings indicate that the prevalence rates of mental distress and major depressive symptoms are higher among well-treated PLHIV residing in Norway than in the general population. These conditions are under-diagnosed and under-treated, and increased awareness is needed.
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Transtorno Depressivo Maior , Infecções por HIV , Humanos , Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/complicações , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Prevalência , Estudos TransversaisRESUMO
BACKGROUND: The chronically ill as a group has on average lower probability of employment compared to the general population, a situation that has persisted over time in many countries. Previous studies have shown that the prevalence of chronic diseases is higher among those with lower levels of education. We aim to quantify the double burden of low education and chronic illness comparing the differential probabilities of employment between the chronically ill with lower, medium, and high levels of education and how their employment rates develop over time. METHODS: Using merged Norwegian administrative data over a 11-year period (2008-2018), our estimations are based on multivariable regression with labour market and time fixed effects. To reduce bias due to patients' heterogeneity, we included a series of covariates that may influence the association between labour market participation and level of education. To explicitly explore the 'shielding effect' of education over time, the models include the interaction effects between chronic illness and level of education and year. RESULTS: The employment probabilities are highest for the high educated and lowest for chronically ill individuals with lower education, as expected. The differences between educational groups are changing over time, though, driven by a revealing development among the lower-educated chronically ill. That group has a significant reduction in employment probabilities both in absolute terms and relative to the other groups. The mean predicted employment probabilities for the high educated chronic patient is not changing over time indicating that the high educated as a group is able to maintain labour market participation over time. Additionally, we find remarkable differences in employment probabilities depending on diagnoses. CONCLUSION: For the chronically ill as a group, a high level of education seems to "shield" against labour market consequences. The magnitude of the shielding effect is increasing over time leaving chronically ill individuals with lower education behind. However, the shielding effect varies in size between types of chronic diseases. While musculoskeletal, cardiovascular and partly cancer patients are "sorted" hierarchically according to level of education, diabetes, respiratory and mental patients are not.
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Emprego , Ocupações , Humanos , Escolaridade , Doença CrônicaRESUMO
The impact of air pollution on forests, especially in urban areas, has been increasingly discussed recently. Many pollutants, including heavy metals, are released into the atmosphere from various sources, such as mining, non-ferrous metal processing plants, and fossil fuel combustion. These pollutants can adversely affect not only tree growth but also other species, including humans. This study compared the concentrations of several elements in tree-ring wood from two conifer species (Silver fir, Abies alba; Norway spruce, Picea abies) growing in polluted and unpolluted areas. Two regions in northern Romania (Bicaz and TarniÈa) that were subjected to historical pollution changes were selected. Two chemical analyses were used: inductively coupled plasma mass spectrometry (ICP-MS) and X-ray fluorescence spectrometry (XRF). The silver fir trees from the intensively polluted area in the TarniÈa region were negatively impacted by industrial pollution: the Mn concentrations were, on average, three times higher in polluted areas than in unpolluted areas (ca. 30 vs. 10 mg kg-1). This finding was consistent for both ICP-MS and XRF analyses. However, in Norway spruce, this difference was found only in the XRF data, which detected Mn concentrations seven times higher in trees from polluted areas than those from unpolluted areas (ca. 700 vs. 100 mg kg-1). In the TarniÈa region, Norway spruce accumulated more heavy metals than silver fir, but the most pronounced differences between polluted and unpolluted areas were found in silver fir. The two analytical methods are commonly used to determine metal concentrations in wood, and they complement each other, with ICP-MS having a low detection limit for some elements and XRF having higher detection limits and better accuracy. Each method has its advantages and disadvantages, and the optimal method depends on many factors, such as the type of heavy metal analyzed, its concentration in wood, sample type, cost, analysis time, and sample preparation.
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Monitoramento Ambiental , Florestas , Metais Pesados , Picea , Madeira , Metais Pesados/análise , Monitoramento Ambiental/métodos , Romênia , Picea/química , Madeira/química , Abies/química , Espectrometria por Raios X , Espectrometria de Massas/métodos , Poluentes Atmosféricos/análiseRESUMO
PURPOSE: Motherhood affects women's mental health, encompassing aspects of both wellbeing and illbeing. This study investigated stability and change in wellbeing (i.e., relationship satisfaction and positive affect) and illbeing (i.e., depressive and anxiety symptoms) from pregnancy to three years postpartum. We further investigated the mutual and dynamic relations between these constructs over time and the role of genetic propensities in their time-invariant stability. DATA AND METHODS: This four-wave longitudinal study included 83,124 women from the Norwegian Mother, Father, and Child Cohort Study (MoBa) linked to the Medical Birth Registry of Norway. Data were collected during pregnancy (30 weeks) and at 6, 18 and 36 months postpartum. Wellbeing and illbeing were based on the Relationship Satisfaction Scale, the Differential Emotions Scale and Hopkins Symptoms Checklist-8. Genetics were measured by the wellbeing spectrum polygenic index. Analyses were based on random intercept cross-lagged panel models using R. RESULTS: All four outcomes showed high stability and were mutually interconnected over time, with abundant cross-lagged predictions. The period of greatest instability was from pregnancy to 6 months postpartum, followed by increasing stability. Prenatal relationship satisfaction played a crucial role in maternal mental health postpartum. Women's genetic propensity to wellbeing contributed to time-invariant stability of all four constructs. CONCLUSION: Understanding the mutual relationship between different aspects of wellbeing and illbeing allows for identifying potential targets for health promotion interventions. Time-invariant stability was partially explained by genetics. Maternal wellbeing and illbeing develop in an interdependent way from pregnancy to 36 months postpartum.
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INTRODUCTION: A pregnancy can be evaluated as high-risk for the woman and/or the fetus based on medical history and on previous or ongoing pregnancy characteristics. Monitoring high-risk pregnancies is crucial for early detection of alarming features, enabling timely intervention to ensure optimal maternal and fetal health outcomes. Home-based telemonitoring (HBTM) is a marginally exploited opportunity in antenatal care. The aim of this study was to illuminate healthcare providers' and users' expectations and views about HBTM of maternal and fetal health in high-risk pregnancies before implementation. MATERIAL AND METHODS: To address diverse perspectives regarding HBTM of high-risk pregnancies, four different groups of experienced healthcare providers or users were interviewed (n = 21). Focus group interviews were conducted separately with midwives, obstetricians, and women who had previously experienced stillbirth. Six individual interviews were conducted with hospitalized women with ongoing high-risk pregnancies, representing potential candidates for HBTM. None of the participants had any previous experience with HBTM of pregnancies. The study is embedded in a social constructivist research paradigm. Interviews were analyzed using a thematic approach. RESULTS: The participants acknowledged the benefits and potentials of more active roles for both care recipients and providers in HBTM. Concerns were clearly addressed and articulated in the following themes: eligibility and ability of women, availability of midwives and obstetricians, empowerment and patient safety, and shared responsibility. All groups problematized issues crucial to maintaining a sense of safety for care recipients, and healthcare providers also addressed issues related to maintaining a sense of safety also for the care providers. Conditions for HBTM were understood in terms of optimal personalized training, individual assessment of eligibility, and empowerment of an active patient role. These conditions were linked to the importance of competent and experienced midwives and obstetricians operating the monitoring, as well as the availability and continuity of care provision. Maintenance of safety in HBTM in high-risk pregnancies was crucial, particularly so in situations involving emerging acute health issues. CONCLUSIONS: HBTM requires new, proactive roles among midwives, obstetricians, and monitored women, introducing a fine-tuned balance between personalized and standardized care to provide safe, optimal monitoring of high-risk pregnancies.
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Amino Álcoois , Motivação , Gravidez de Alto Risco , Feminino , Gravidez , Humanos , Cuidado Pré-Natal , Pesquisa Qualitativa , Pessoal de SaúdeRESUMO
OBJECTIVE: Implementation of school meal guidelines is often inadequate, and evidence for effective implementation strategies for school-based nutrition interventions is limited. The aim of the present study was to examine the implementation and effectiveness of a multi-strategy implementation intervention to increase adherence to the Norwegian national school meal guideline. DESIGN: The study was a school-based hybrid implementation effectiveness trial with a pre-post non-equivalent control group design, testing three implementation strategies: internal facilitation, training and an educational meeting. SETTING: Primary schools and after-school services in two counties in south-east Norway. PARTICIPANTS: School principals, after-school leaders and class teachers from thirty-three schools in the intervention county and principals and after-school leaders from thirty-four schools in a comparison county. RESULTS: There was a significant difference of 4 percentage points in change scores between the intervention and the comparison groups at follow-up, after adjusting for baseline adherence (B = 0·04, seB = 0·01, t = 3·10, P = 0·003). The intervention effect was not associated with the school's socio-economic profile. School-level fidelity was the implementation dimension that was most strongly correlated (r s = 0·48) with the change scores in the intervention group, indicating that principals' support is important for gaining the largest intervention effects. CONCLUSIONS: A school-based intervention with low intensity, based on trained teachers as internal facilitators, can increase adherence to the national school meal guideline among Norwegian primary schools, irrespective of local socio-economic conditions. Implementation fidelity, at an organisational level, may be a useful predictor for intervention outcomes in schools.
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Refeições , Instituições Acadêmicas , Humanos , Promoção da Saúde , Noruega , Serviços de Saúde EscolarRESUMO
OBJECTIVE: Monitoring time trends in salt consumption is important for evaluating the impact of salt reduction initiatives on public health outcomes. There has so far not been available data to indicate if salt consumption in Norway has changed during the previous decade. We aimed to assess whether average 24-h salt intake estimated from spot urine samples in the adult population of mid-Norway changed from 2006-2008 to 2017-2019 and to describe variations by sex, age and educational level. DESIGN: Repeated cross-sectional studies. SETTING: The population-based Trøndelag Health Study (HUNT). PARTICIPANTS: In each of two consecutive waves (HUNT3: 2006-2008 and HUNT4: 2017-2019), spot urine samples were collected from 500 men and women aged 25-64 years, in addition to 250 men and women aged 70-79 years in HUNT4. Based on spot urine concentrations of Na, K and creatinine and age, sex and BMI, we estimated 24-h Na intake using the International Cooperative Study on Salt and Blood Pressure (INTERSALT) equation for the Northern European region. RESULTS: Mean (95 % CI) estimated 24-h salt intakes in men were 11·1 (95 % CI 10·8, 11·3) g in HUNT3 and 10·9 (95 % CI 10·6, 11·1) g in HUNT4, P = 0·25. Corresponding values in women were 7·7 (95 % CI 7·5, 7·9) g and 7·7 (95 % CI 7·5, 7·9) g, P = 0·88. Mean estimated salt intake in HUNT4 decreased with increasing age in women, but not in men, and it did not differ significantly across educational level in either sex. CONCLUSIONS: Estimated 24-h salt intake in adult men and women in mid-Norway did not change from 2006-2008 to 2017-2019.
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Cloreto de Sódio na Dieta , Humanos , Masculino , Noruega , Feminino , Pessoa de Meia-Idade , Adulto , Estudos Transversais , Idoso , Cloreto de Sódio na Dieta/administração & dosagem , Cloreto de Sódio na Dieta/urina , Sódio/urina , Sódio na Dieta/urina , Sódio na Dieta/administração & dosagem , Potássio/urina , Creatinina/urinaRESUMO
BACKGROUND: Smoking among immigrants varies by country background and is high in some groups. More detailed information about smoking prevalence by country background and sociodemographic factors is needed to target interventions. METHODS: Data from the Survey on Living Conditions among immigrants 2016 were used, including immigrants from 12 countries and with ⩾2 years of residence (N = 3565). Data on smoking (daily and occasional) by country of birth, sex, age group, education, duration of residence, age at immigration, proficiency in the Norwegian language, and social support were reported. RESULTS: The highest proportions of daily smokers were seen among immigrants from Turkey (36%), Poland (34%), and Vietnam (29%) for men, and from Turkey (22%), Bosnia-Herzegovina (18%), and Poland (17%) for women. Differences in smoking by sociodemographic factors varied with country background, but for several groups of men, the lowest proportions of smokers were seen among those with the highest educational level, those who were employed, and those who immigrated during childhood or adolescence. CONCLUSIONS: Policies are warranted that target smoking among immigrant men in general, and particularly among men from Turkey, Poland, and Vietnam, as well as for women from Turkey, Bosnia-Herzegovina, and Poland.
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AIMS: There are signs of increased stress at work among Norwegian physicians over the last decades, not least among general practitioners (GPs). In this review, we identify trends in both occupational stress and adverse work-related predictors of such stress and burnout in Norwegian physicians. METHODS: We performed an extensive literature search using MEDLINE, Embase and PsycINFO. We included prospective and repeated cross-sectional studies of work stress among Norwegian physicians published in 2007-2019. RESULTS: Nine studies with observation periods of 1-20 years were included. Occupational stress (global measure) among all doctors decreased gradually from medical school to 20 years later. The prevalence of an effort-reward imbalance increased fourfold among GPs during the period 2010-2019. Five studies reported higher levels of occupational stress among female physicians than among their male colleagues. Work-home conflict levels increased after graduation until 10 years after leaving medical school and plateaued thereafter. Physicians who graduated in a later cohort reported lower levels of work-home conflict and less workplace violence. Work-home conflict, low colleague support, number of work hours and workload/low autonomy were all independent predictors of occupational stress. CONCLUSIONS: The reduction in occupational stress during the years after leaving medical school may result from increased competency in clinical work and decreased on-call work. The Co-ordination Act implemented in 2012 may explain the increase in occupational stress among GPs. These findings suggest that both reducing work-home conflict and increasing colleague support are important for doctors' well-being.
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AIMS: Immigrant women in Norway have lower cervical cancer screening participation than non-immigrant women. Our aim in this study was to assess whether the observed increase in screening participation during 2012-2017 was different between Norwegian-born women and immigrant women. METHODS: Data were collected from three national registries. The study included 1,409,561 women, categorized according to country of birth and immigrant background: (i) Norway, Norwegian parents; (ii) Norway, immigrant parent(s); (iii) Europe, excluding Norway; (iv) Africa; (v) Asia, including Turkey; and (vi) other countries. Trends and differences between groups were analyzed using Poisson regression analyses with adjustments for variables other studies have found to influence screening participation. Trends were assessed by including half-years as a continuous variable in the models and reported as prevalence ratios with 95% confidence intervals. RESULTS: Screening participation increased in all groups, but was not statistically significant among women from Africa in the adjusted model. The highest increase was among Norwegian women, with a 2.2% increase per year. Interaction tests showed significantly smaller increases in screening among women born in Europe (p interaction < 0.0001), Africa (p interaction < 0.0001), Asia (p interaction < 0.0001), and countries in the "Other" category (p interaction = 0.004). There was also a smaller increase among Norwegian-born women with one or more immigrant parent(s), but this was not significant (p interaction = 0.178). CONCLUSIONS: The gap in screening participation and the increasing differences in trends suggest that healthcare services do not reach all women in Norway to the same extent. One should attempt to improve this while working toward further increasing screening participation for all.