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1.
PLoS One ; 15(2): e0229234, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32074126

RESUMO

The obesity epidemic is dynamic with varying secular trends and differences between countries and ethnic groups. The objective of this study was to describe the age- and sex-specific longitudinal changes in weight and waist circumference in a rural Norwegian population with a high proportion of the indigenous Sami population. Based on two population-based surveys, SAMINOR 1 (2003-2004) and SAMINOR 2 (2012-2014), we present longitudinal changes in weight and waist circumference according to age at baseline in the SAMINOR 1 Survey and sex during the 10-year period. The analyses included 1538 men and 1958 women aged 36 to 69 at baseline (birth year 1934 to 1967). Forty-one percent of the population were Sami. Both weight and waist circumference were measured. The mean weight increased 0.8 kg (95% confidence interval: 0.5, 1.1) in men and 0.3 kg (95% confidence interval: 0, 0.5) in women. In both men and women, younger individuals gained significantly more weight during the 10-year follow-up than older participants (p < 0.001). The mean weight showed a statistically significant increase in men aged 36-54 and women aged 36-49 at baseline and was statistically significantly reduced in men and women aged 60-69. The mean waist circumference increased by 6.3 cm (95% confidence interval: 6.0, 6.6) in men and 8.4 cm (95% confidence interval 8.1, 8.8) in women. The mean waist circumference increased statistically significantly from SAMINOR 1 to SAMINOR 2 in all age groups, and there was an inverse relationship between age at baseline and change in waist circumference (p < 0.001). Waist circumference increased more than can be explained by changes in weight and age during the 10-year period. The inverse relationships between age at baseline in SAMINOR 1 and the 10-year change in weight and waist circumference were found in both Sami and non-Sami participants. The findings underline the need for prevention of obesity, particularly in younger people, as it is difficult to achieve permanent weight loss.

2.
BMC Complement Altern Med ; 19(1): 341, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31783842

RESUMO

BACKGROUND: Traditional and complementary medicine (T&CM) is commonly used by cancer patients in Northern Norway, in particular spiritual forms like traditional healing. T&CM is mainly used complementary to conventional cancer treatment and is rarely discussed with conventional health care providers, increasing the risk of negative interaction with conventional cancer care. The aim of this study was to investigate the use of T&CM among cancer patients in Tromsø, and to investigate the differences in T&CM use between people living with cancer, people with cancer previously, and people without a history of cancer. METHOD: Data was drawn from the seventh survey of the Tromsø study conducted in 2015-2016. All inhabitants of Tromsø aged 40 and above were invited to participate (n = 32,591) of whom n = 21,083 accepted the invitation (response rate 65%). Data was collected thorough three self-administered questionnaires and a comprehensive clinical examination. Pearson chi-square tests, Fisher exact tests and one-way ANOVA tests were used to describe differences between the groups while binary logistic regressions were used for adjusted values. RESULTS: Eight percent of the participants (n = 1636) reported to have (n = 404) or have had (n = 1232) cancer. Of the participants with cancer at present 33.4% reported use of T&CM within the last year, 13.6% had consulted a T&CM provider, 17.9% had used herbal medicine/natural remedies and 6.4% had practiced self-help techniques. The participants with cancer at present were more likely to have visited a T&CM provider than participants with cancer previously (13.6% vs. 8.7%, p = 0.020). Among the participants with cancer at present, 6.4% reported to have consulted a TM provider, 5.8% had consulted an acupuncturist, while 4.7% had consulted other CM providers. Women were significantly more likely than men to have used acupuncture and self-help techniques. No significant gender differences were found regarding visits to other CM providers, TM providers nor use of herbal medicine/natural remedies. CONCLUSION: The findings are in line with previous research suggesting that both men and women use TM complementary to other CM modalities outside the official health care system. As herbal medicine might interact with conventional cancer treatment, health care providers need to discuss such use with their patients.


Assuntos
Terapias Complementares/estatística & dados numéricos , Neoplasias/epidemiologia , Neoplasias/terapia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Medicina Tradicional/estatística & dados numéricos , Pessoa de Meia-Idade , Noruega/epidemiologia , Inquéritos e Questionários
3.
BMC Complement Altern Med ; 19(1): 305, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711478

RESUMO

BACKGROUND: Patient-centered culturally sensitive health care (PC-CSHC) has emerged as a primary approach to health care. This care focuses on the cultural diversity of the patients rather than the views of the health care professionals. PC-CSHC enables the patient to feel comfortable, respected, and trusted in the health care delivery process. As users of traditional and complementary medicine (T&CM) rarely inform their conventional health care providers of such use, the providers need to identify the users of T&CM themselves to avoid negative interaction with conventional medicine and to be able to provide them with PC-CSHC. Since the patterns of traditional medicine (TM) use are different to those of complementary medicine (CM), the aim of this study was to investigate the prevalence, and the health- and sociodemographic associations for visits to TM- and CM providers in an urban population. METHOD: The data were collected through two self-administrated questionnaires from the seventh survey of the Tromsø Study, a population-based cohort study conducted in 2015-2016. All inhabitants of Tromsø aged 40 or above were invited (n = 32,591) and n = 21,083 accepted the invitation (response rate 65%). Pearson chi-square tests and one-way ANOVA tests were used to describe differences between the groups whereas binary logistic regressions were used for adjusted values. RESULTS: The results revealed that 2.5% of the participants had seen a TM provider, 8.5% had seen a CM provider whereas 1% had visited both a TM and a CM provider during a 12-month period. TM users tended to be older, claim that religion was more important to them, have poorer economy and health, and have lower education compared to CM users. We found that more than 90% of the participants visiting T&CM providers also used conventional medicine. CONCLUSION: A considerable number of the participants in this study employed parallel health care modalities including visits to conventional, traditional, and complementary medicine providers. To offer patient-centered culturally sensitive health care that is tailored to the patients' treatment philosophy and spiritual needs, conventional health care providers need knowledge about, and respect for their patients' use of parallel health care systems.


Assuntos
Terapias Complementares/psicologia , Medicina Tradicional/psicologia , Pacientes/psicologia , Adulto , Idoso , Assistência Ambulatorial/psicologia , Assistência Ambulatorial/estatística & dados numéricos , Estudos de Coortes , Terapias Complementares/estatística & dados numéricos , Demografia , Feminino , Pessoal de Saúde/psicologia , Humanos , Masculino , Medicina Tradicional/estatística & dados numéricos , Pessoa de Meia-Idade , Noruega , Pacientes/estatística & dados numéricos , Prevalência , Religião , Confiança
4.
BMJ Open ; 9(11): e031810, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31722948

RESUMO

OBJECTIVES: Underestimation of overweight/obesity may prevent weight loss attempts, resulting in further weight gain and maintenance of overweight. Mental health benefits may nevertheless surpass negative consequences. Our main objective was to study the association between underestimation of overweight/obesity and symptoms of anxiety and depression in Sami and non-Sami populations. DESIGN: Population-based cross-sectional study. SETTING: The SAMINOR 2 Clinical Study with participants from 10 municipalities in Northern Norway enrolled between 2012 and 2014. PARTICIPANTS: The study included 3266 adults of multiethnic rural origin with overweight/obesity (body mass index (BMI) ≥25 kg/m2) whereof 1384 underestimated their weight (42%). PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measure was symptoms of anxiety and depression and secondary outcome measures were BMI and the demographic variables: sex, age, education and marital status. RESULTS: A higher proportion of Sami men compared with non-Sami men were obese, and reported more symptoms of anxiety and depression. More men than women, and a higher proportion of Sami women compared with non-Sami women, underestimated their weight. Multivariable-adjusted analyses showed that women were less likely to underestimate their weight compared with men (OR 0.43, 95% CI 0.33 to 0.55 in Sami and OR 0.33, 95% CI 0.26 to 0.42 in non-Sami), higher BMI was protective against weight underestimation (OR 0.72, 95% CI 0.69 to 0.75 in Sami and OR 0.63, 95% CI 0.60 to 0.67 in non-Sami), slightly higher odds of weight underestimation were observed with increasing age in both ethnic groups (OR 1.03, 95% CI 1.01 to 1.05 in Sami and OR 1.02, 95% CI 1.00 to 1.03 in non-Sami), while higher education lowered the odds in non-Sami (OR 0.69, 95% CI 0.55 to 0.87). Weight underestimation was protectively associated with anxiety and depression in Sami men (OR 0.48, 95% CI 0.27 to 0.84) and in non-Sami women (OR 0.44, 95% CI 0.25 to 0.78) adjusted for age, BMI, education and marital status. CONCLUSIONS: Independent of ethnicity, more men than women underestimated their weight. Underestimation of weight was protectively associated with anxiety and depression in Sami men and non-Sami women.

5.
BMJ Open ; 9(7): e028939, 2019 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-31326934

RESUMO

OBJECTIVE: To describe changes in cardiovascular risk factors and in the estimated 10-year risk of acute myocardial infarction (AMI) or cerebral stroke (CS) between SAMINOR 1 (2003-2004) and SAMINOR 2 (2012-2014), and explore if these changes differed between Sami and non-Sami. DESIGN: Two cross-sectional surveys. SETTING: Inhabitants of rural Northern Norway. PARTICIPANTS: Participants were aged 40-79 years and participated in SAMINOR 1 (n=6417) and/or SAMINOR 2 (n=5956). PRIMARY OUTCOME MEASURES: Generalised estimating equation regressions with an interaction term were used to estimate and compare changes in cardiovascular risk factors and 10-year risk of AMI or CS between the two surveys and by ethnicity. RESULTS: Mean cholesterol declined by 0.50, 0.43 and 0.60 mmol/L in women, Sami men and non-Sami men, respectively (all p<0.001). Sami men had a small decline in mean high-density lipoprotein (HDL) cholesterol and an increase in mean triglycerides (both p<0.001), whereas non-Sami showed no change in these variables. Non-Sami women had an increase in mean HDL cholesterol (p<0.001) whereas Sami women had no change. Triglycerides did not change in non-Sami and Sami women. Systolic and diastolic blood pressure declined by 3.6 and 1.0 mm Hg in women, and 3.1 and 0.7 in men, respectively (all p<0.01). Mean waist circumference increased by 6.7 and 5.9 cm in women and men, respectively (both p<0.001). The odds of being a smoker declined by 35% in women and 46% in men (both p<0.001). Estimated 10-year risk of AMI or CS decreased in all strata of sex and ethnicity (p<0.001), however, Sami women had a smaller decline than non-Sami did. CONCLUSIONS: Independent of ethnicity, there was a decline in mean cholesterol, blood pressure, smoking, hypertension (women only) and 10-year risk of AMI or CS, but waist circumference increased. Relatively minor ethnic differences were found in changes of cardiovascular risk factors.

6.
BMC Endocr Disord ; 19(1): 66, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234837

RESUMO

BACKGROUND: The aim of the study was to estimate and compare the 8-year cumulative incidence of diabetes mellitus (DM) among Sami and non-Sami inhabitants of rural districts in Northern Norway. METHODS: Longitudinal study based on linkage of two cross-sectional surveys, the SAMINOR 1 Survey (2003-2004) and the SAMINOR 2 Clinical Survey (2012-2014). Ten municipalities in rural Northern Norway were included in the study. DM-free participants aged 30 and 36-71 years in SAMINOR 1 were followed from 2 years after SAMINOR 1 to attendance in SAMINOR 2. The average follow-up time was 8.1 years. Of 5875 subjects who had participated in SAMINOR 1 and could potentially be followed to SAMINOR 2, 3303 were included in the final analysis. Self-reported DM and/or HbA1c ≥ 6.5% were used to identify incident cases of DM. RESULTS: At baseline, body mass index (BMI) and waist-to-height ratio (WHtR) were higher among Sami than among their non-Sami counterparts. After 8 years of follow-up, 201 incident cases of DM were identified (6.1% both Sami and non-Sami subjects). No statistically significant difference was observed in the cumulative incidence of DM between the Sami and non-Sami. CONCLUSIONS: No statistically significant difference in the 8-year cumulative incidence of DM among Sami and non-Sami was observed, although Sami men and women had higher baseline BMI and WHtR.


Assuntos
Diabetes Mellitus/epidemiologia , Adulto , Idoso , Índice de Massa Corporal , Estudos Transversais , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , População Rural , Razão Cintura-Estatura
7.
Scand J Public Health ; : 1403494819845574, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060480

RESUMO

Background Globally, there is a huge lack of relevant research about widespread lifestyle diseases and living conditions in indigenous communities. Northern and Middle Norway have a history of multiple ethnic groups and the Sami has been acknowledged as the indigenous people of Norway by the Norwegian State. The SAMINOR 2 Clinical Survey, a part of the SAMINOR Study, was carried out to provide health information about the Sami population in Norway. Methods The cross-sectional population-based SAMINOR 2 Clinical Survey consists of both questionnaires and a clinical examination performed in 10 municipalities during 2012-2014. Results In total, 6004 men and women (participation rate 48%) aged 40-79 years took part in this study. In inland Finnmark, the Sami are in the majority (80-90%) as opposed to the coastline of Troms and Nordland, where the Sami population form a minority (20%). More women than men participated (54% versus 43%, respectively). Obesity was prevalent in this sample and a high mean glycated haemoglobin was observed. Conclusions: This article describes the methods and data collection of the SAMINOR 2 Clinical Survey and presents some characteristics of the sample. The definition of ethnic groups is a core question in the survey and includes several criteria. To ensure that indigenous values and priorities are reflected in the research themes, we recommend that future research projects be directed in close collaboration with the Sami Parliament and the local communities.

8.
Public Health Nutr ; : 1-15, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30767841

RESUMO

OBJECTIVE: To investigate serum 25-hydroxyvitamin D (S-25(OH)D) concentration in a multi-ethnic population of northern Norway and determine predictors of S-25(OH)D, including Sami ethnicity. DESIGN: Cross-sectional data from the second survey of the Population-based Study on Health and Living Conditions in Regions with Sami and Norwegian Populations (the SAMINOR 2 Clinical Survey, 2012-2014). S-25(OH)D was measured by the IDS-iSYS 25-Hydroxy Vitamin DË¢ assay. Daily dietary intake was assessed using an FFQ. BMI was calculated using weight and height measurements. SETTING: Ten municipalities of northern Norway (latitude 68°-70°N).ParticipantsMales (n 2041) and females (n 2424) aged 40-69 years. RESULTS: Mean S-25(OH)D in the study sample was 64·0 nmol/l and median vitamin D intake was 10·3 µg/d. The prevalence of S-25(OH)D<30 nmol/l was 1·9 % and <50 nmol/l was 24·7 %. In sex-specific multivariable linear regression models, older age, blood sample collection in September-October, solarium use, sunbathing holiday, higher alcohol intake (in females), use of cod-liver oil/fish oil supplements, use of vitamin/mineral supplements and higher intakes of vitamin D were significantly associated with higher S-25(OH)D, whereas being a current smoker and obesity were associated with lower S-25(OH)D. These factors explained 21-23 % of the variation in S-25(OH)D. CONCLUSIONS: There were many modifiable risk factors related to S-25(OH)D, however no clear ethnic differences were found. Even in winter, the low prevalence of vitamin D deficiency found among participants with non-Sami, multi-ethnic Sami and Sami self-perceived ethnicity was likely due to adequate vitamin D intake.

9.
Rural Remote Health ; 18(4): 4623, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30543755

RESUMO

INTRODUCTION: This study aimed to compare the prevalence of diabetes mellitus (DM) between Sami and non-Sami inhabitants of Northern Norway participating in the SAMINOR 1 Survey and the SAMINOR 2 Clinical Survey, and to track DM prevalence over time. METHODS: SAMINOR 1 (2003-2004) and SAMINOR 2 (2012-2014) are cross-sectional, population-based studies that each recruited Sami and non-Sami inhabitants. The data used in this article were restricted to participants aged 40-79 years in 10 municipalities in Northern Norway. Participants completed self-administered questionnaires and underwent clinical examination and blood sampling. Both questionnaire information and non-fasting/random plasma glucose levels were used to ascertain DM. The study included 6288 and 5765 participants with complete data on DM and outcomes, ie 54.6% and 46.3% of the invited samples, respectively. RESULTS: No difference in the prevalence of DM between Sami and non-Sami participants was observed, in either survey. Women had a statistically significantly lower DM prevalence than men in SAMINOR 2. Mean waist-to-height ratio and waist circumference increased substantially in both sexes; mean body mass index increased only slightly in men and remained unchanged in women. The total, age-standardized DM prevalence in SAMINOR 1 and 2 was 10.0% (95% confidence interval (CI) 9.2-10.7) and 11.2% (95%CI 10.4-12.0), respectively, and the proportion of self-reported (ie known) DM increased from 49.2% to 73.0%. In almost the same time span (2004-2015), the use of oral glucose-lowering agents increased. CONCLUSION: Overall, no ethnic difference was observed in DM prevalence. Overall DM prevalence was high, but did not change significantly from SAMINOR 1 to SAMINOR 2. The percentage of known versus unknown cases of DM increased, as did the prescription of medication for DM between 2004 and 2015.


Assuntos
Diabetes Mellitus/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Prevalência , Inquéritos e Questionários
10.
Int J Circumpolar Health ; 77(1): 1463786, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29697016

RESUMO

The aim of this study was to determine and compare the prevalence of pre-diabetes and type 2 diabetes mellitus (T2DM) among Sami and non-Sami men and women of rural districts in Northern Norway. The SAMINOR 2 Clinical Survey is a cross-sectional population-based study performed in 2012-2014 in 10 municipalities of Northern Norway. A total of 12,455 Sami and non-Sami inhabitants aged 40-79 years were invited to participate and 5878 were included in the analyses. Participants with self-reported T2DM and/or a glycated haemoglobin (HbA1c) result ≥6.5% were categorised as having T2DM. Those with 5.7%≤HbA1c<6.5% were categorised as pre-diabetics. In men, the total age-standardised prevalence of pre-diabetes (37.9% vs 31.4%) and T2DM (10.8% vs 9.5%) were higher in Sami compared with non-Sami; the ethnic difference was statistically significant for both pre-diabetes (OR 1.42, p < 0.001) and T2DM (OR 1.31, p = 0.042). In women, pre-diabetes (36.4% vs 33.5%) and T2DM (8.6% vs 7.0%) were also more common in Sami than non-Sami; the differences in both pre-diabetes (OR 1.20, p = 0.025) and T2DM (OR 1.38, p = 0.021) were also statistically significant. The observed ethnic difference in the waist-to-height ratio (WHtR) was a plausible explanation for the ethnic difference in the prevalence of pre-diabetes and T2DM.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Estado Pré-Diabético/epidemiologia , Adulto , Idoso , Regiões Árticas/epidemiologia , Feminino , Hemoglobina A Glicada/análise , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Circunferência da Cintura
11.
Int J Circumpolar Health ; 77(1): 1459145, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29656696

RESUMO

OBJECTIVE: The aim of this study was to examine the associations between changes in leisure time physical activity and changes in cardiovascular risk factors over 16 years and whether they differ between two ethnic groups in Norway. METHODS: Data were extracted from two population-based studies. Altogether, 3671 men and women participated in both surveys, and 30% reported being of Sami ethnicity. Leisure time physical activity was self-reported, and cardiovascular risk factors were measured. ANCOVA analysis was used to examine associations between changes in physical activity and changes in cardiovascular risk factors. RESULTS: After adjustment for age, sex, smoking, ethnicity and respective baseline values, favourable changes in body mass index (BMI) and levels of triglycerides were most pronounced in those who were active in both surveys (p < 0.05) whereas the opposite was the situation for cholesterol levels (p = 0.003). Changes in systolic blood pressure, diastolic blood pressure and resting heart rate were not significantly associated with change in physical activity. Ethnicity did not influence the associations between physical activity and cardiovascular risk factors. CONCLUSION: Traditional cardiovascular risk factors were to a small extent associated with change in leisure time physical activity. Persistent physical activity was associated with beneficial changes in BMI and triglycerides.


Assuntos
Doenças Cardiovasculares/etiologia , Grupos Étnicos/estatística & dados numéricos , Exercício , Atividades de Lazer , Adulto , Pressão Sanguínea , Índice de Massa Corporal , Grupos Étnicos/psicologia , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Fatores de Risco , Fumar/epidemiologia , Adulto Jovem
12.
Public Health Nutr ; 21(6): 1094-1105, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29223188

RESUMO

OBJECTIVE: The present study aimed to investigate disordered eating (DE) among Sami compared with non-Sami residing in northern Norway. DESIGN: In a cross-sectional design, stratified by sex and ethnicity, associations were tested between DE (Eating Disturbance Scale; EDS-5) and age, education level, BMI category, anxiety and depression, physical activity and consumption of snacks. SETTING: The SAMINOR 2 Clinical Survey (2012-2014) based on the population of ten municipalities in northern Norway. SUBJECTS: Adults aged 40-69 years; 1811 Sami (844 male, 967 female) compared with 2578 non-Sami (1180 male, 1398 female) individuals. RESULTS: No overall significant ethnic difference in DE was identified, although comfort eating was reported more often by Sami individuals (P=0·01). Regardless of ethnicity and sex, symptoms of anxiety and depression were associated with DE (P<0·001). Furthermore, DE was more common at lower age and higher BMI values. Education levels were protectively associated with DE among Sami men (P=0·01). DE was associated (OR, 95% CI) with low physical activity in men in general and in non-Sami women (Sami men: 2·4, 1·4, 4·0; non-Sami men: 2·2, 1·4, 3·6; non-Sami women: 1·8, 1·2, 2·9) and so was the consumption of snacks (Sami men: 2·6, 1·3, 5·0; non-Sami men: 1·9, 1·1, 3·1; non-Sami women: 2·1, 1·3, 3·4). CONCLUSIONS: There were no significant differences regarding overall DE comparing Sami with non-Sami, although Sami more often reported comfort eating. There were significant sex and ethnic differences related to DE and physical activity, snacking and education level.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Inquéritos Epidemiológicos , Grupos Populacionais/estatística & dados numéricos , Adulto , Idoso , Ansiedade , Estudos Transversais , Depressão , Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Obesidade
13.
BMC Complement Altern Med ; 17(1): 530, 2017 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-29233186

RESUMO

BACKGROUND: In Northern Norway, traditional medicine (TM) is shaped by both Christianity and traditional Sami nature worship. The healing rituals may include prayer and the use of tools such as moss, water, stones, wool and soil. Examples of TM modalities offered is cupping, blood-stemming, laying on of hands, healing prayers, and rituals. The purpose of this study was to investigate the prevalence of the use of TM in areas with predominantly Sami and Norwegian populations, and the influence of ethnicity, geography, gender, age, education, household income, religiosity and self-reported health on such use. METHODS: The study is based on data collected in the first SAMINOR Survey (SAMINOR 1) conducted in 2003/2004, including three self-administered questionnaires, clinical measures, and blood analyses. Data was collected in 24 municipalities in Norway known to have a substantial population of Sami. All residents aged 30 and 36-78/79 years in the predefined regions were invited regardless of ethnic background (N = 27,987). Of these, 16,865 (60.3%) accepted to participate and gave their consent to medical research. RESULTS: Of the 16,544 people responding to the question about TM use, 2276 (13.8%) reported to have used TM once or more during their lifetime. The most outstanding characteristic of the TM users was the affiliation to the Laestadian church, where 34.3% (n = 273) reported such use, followed by an inner Finnmark residence (31.1%, n = 481) and a Sami ethnicity (25.7%, n = 1014). Women were slightly more likely to use TM compared to men (15.9% and 11.5% accordingly, p < 0.001), and the TM users were slightly younger than the non-TM users (mean age 52.3 versus 54.3 years, p < 0.001). The TM users also had lower income (p < 0.001) than the non-TM users. We found no significant differences between the TM users and the non-TM users concerning years of education, and whether the participants were living with a spouse/partner or not. CONCLUSION: Further studies are necessary to examine the development of TM use in Norway over time, and use in areas with mainly Norwegian inhabitants. There is also a lack of studies quantifying TM use among Sami people in Sweden, Finland and Russia.


Assuntos
Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Medicina Tradicional/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Prevalência , Autoavaliação
14.
BMC Health Serv Res ; 17(1): 177, 2017 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-28270128

RESUMO

BACKGROUND: The assessment of quality of care is an integral part of modern medicine. The referral represents the handing over of care from the general practitioner to the specialist. This study aimed to assess whether an improved referral could lead to improved quality of care. METHODS: A cluster randomized trial with the general practitioner surgery as the clustering unit was performed. Fourteen surgeries in the area surrounding the University Hospital of North Norway Harstad were randomized stratified by town versus countryside location. The intervention consisted of implementing referral templates for new referrals in four clinical areas: dyspepsia; suspected colorectal cancer; chest pain; and confirmed or suspected chronic obstructive pulmonary disease. The control group followed standard referral practice. Quality of treatment pathway as assessed by newly developed quality indicators was used as main outcome. Secondary outcomes included subjective quality assessment, positive predictive value of referral and adequacy of prioritization. Assessment of outcomes was done at the individual level. The patients, hospital doctors and outcome assessors were blinded to the intervention status. RESULTS: A total of 500 patients were included, with 281 in the intervention and 219 in the control arm. From the multilevel regression model the effect of the intervention on the quality indicator score was insignificant at 1.80% (95% CI, -1.46 to 5.06, p = 0.280). No significant differences between the intervention and the control groups were seen in the secondary outcomes. Active use of the referral intervention was low, estimated at approximately 50%. There was also wide variation in outcome scoring between the different assessors. CONCLUSIONS: In this study no measurable effect on quality of care or prioritization was revealed after implementation of referral templates at the general practitioner/hospital interface. The results were hindered by a limited uptake of the intervention at GP surgeries and inconsistencies in outcome assessment. TRIAL REGISTRATION: The study was registered under registration number NCT01470963 on September 5th, 2011.


Assuntos
Assistência Ambulatorial/normas , Dor no Peito/terapia , Dispepsia/terapia , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade da Assistência à Saúde/normas , Encaminhamento e Consulta/normas , Análise por Conglomerados , Neoplasias Colorretais/terapia , Feminino , Medicina Geral/normas , Hospitais Universitários/normas , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Indicadores de Qualidade em Assistência à Saúde
15.
BMJ Open ; 6(11): e012717, 2016 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-27903562

RESUMO

OBJECTIVE: Updated knowledge on the validity of self-reported myocardial infarction (SMI) and self-reported stroke (SRS) is needed in Norway. Our objective was to compare questionnaire data and hospital discharge data from regions with Sami and Norwegian populations to assess the validity of these outcomes by ethnicity, sex, age and education. DESIGN: Validation study using cross-sectional questionnaire data and hospital discharge data from all Norwegian somatic hospitals. PARTICIPANTS AND SETTING: should read '16 865 men and women aged 30 and 36­79 years participated in the first survey of the Population-based Study on Health and Living Conditions in Sami and NorwegianPopulations (the SAMINOR 1 Survey) in 2003­2004. Information on SMI and SRS was available from self-administered questionnaires for 15 005 and 15 088 of these participants, respectively. We compared this information with hospital discharge data from 1994 until SAMINOR 1 Survey attendance. PRIMARY AND SECONDARY OUTCOMES: Sensitivity, specificity, positive predictive value (PPV), negative predictive value and κ. RESULTS: The sensitivity and PPV of SMI were 90.1% and 78.9%, respectively; the PPV increased to 93.1% when all ischaemic heart disease (IHD) diagnoses were included. The SMI prevalence estimate was 2.3% and hospital-based 2.0%. The sensitivity and PPV of SRS were 81.1% and 64.3%, respectively. The SRS prevalence estimate was 1.5% and hospitalisation-based 1.2%. Moderate to no variation was observed in validity according to ethnicity, sex, age and education. CONCLUSIONS: The sensitivity and PPV of SMI were high and moderate, respectively; for SRS, both of these measures were moderate. Our results show that SMI from the SAMINOR 1 Survey may be used in aetiological/analytical studies in this population due to a high IHD-specific PPV. The SAMINOR 1 questionnaire may also be used to estimate the prevalence of acute myocardial infarction and acute stroke.


Assuntos
Infarto do Miocárdio/mortalidade , Autorrelato , Acidente Vascular Cerebral/mortalidade , Adulto , Distribuição por Idade , Idoso , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Prevalência , Medição de Risco , População Rural , Distribuição por Sexo , Condições Sociais
16.
BMJ Open ; 6(10): e011651, 2016 10 24.
Artigo em Inglês | MEDLINE | ID: mdl-27797992

RESUMO

OBJECTIVES: To evaluate if a referral intervention improves the patient experience of the referral and treatment process. SETTING: Interface between 14 primary care surgeries and a district general hospital. PARTICIPANTS: The 14 general practitioner (GP) surgeries (7 intervention, 7 control) in the area around the University Hospital of North Norway Harstad were randomised and all completed the study. Consecutive individual patients were recruited at their hospital appointment. A total of 500 patients were recruited with 281 in the intervention and 219 in the control arm. INTERVENTIONS: Dissemination of referral templates for 4 diagnostic groups (dyspepsia, suspected colorectal cancer, chest pain and chronic obstructive pulmonary disease) coupled with intermittent surgery visits by study personnel. The control arm continued standard referral practice. The intervention was in use for 2.5 years. OUTCOME: The main outcome was a quality indicator score. This paper reports a secondary outcome, the patient experience, as measured by self-report questionnaires. GPs in the intervention group could not be blinded. Patients were blinded to intervention status. Analysis was based on single-question comparison with a questionnaire subscore used to assess the effect of clustering. RESULTS: On the individual questions, overall satisfaction was very high with minor differences between the intervention and control group. Interestingly, the most negative responses, in both groups concerned questions relating to patient interaction and information. Very little evidence of clustering was found with an estimated intracluster correlations coefficient at 1.21e-11. CONCLUSIONS: In total, this indicates no clear effect of the implementation of referral templates on the patient experience, in a setting of generally high patient satisfaction. TRIAL REGISTRATION NUMBER: NCT01470963; Results.


Assuntos
Clínicos Gerais , Satisfação do Paciente , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Encaminhamento e Consulta , Adulto , Idoso , Dor no Peito , Neoplasias Colorretais , Dispepsia , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Relações Médico-Paciente , Doença Pulmonar Obstrutiva Crônica , Melhoria de Qualidade , Inquéritos e Questionários
17.
Int J Circumpolar Health ; 75: 31697, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27507149

RESUMO

OBJECTIVE: The aim of this study was to measure the prevalence of pre-diabetes and diabetes mellitus in rural populations of Norway, as well as to explore potential ethnic disparities with respect to dysglycaemia in Sami and non-Sami populations. DESIGN: Cross-sectional population-based study. METHODS: The SAMINOR1 study was performed in 2003-2004. The study took place in regions with both Sami and non-Sami populations and had a response rate of 60.9%. Information in the SAMINOR1 study was collected using two self-administered questionnaires, clinical examination and laboratory tests. The present analysis included 15,208 men and women aged 36-79 years from the SAMINOR1 study. RESULTS: Age-standardised prevalence of pre-diabetes and diabetes mellitus among Sami men was 3.4 and 5.5%, respectively. Corresponding values for non-Sami men were 3.3 and 4.6%. Age-standardised prevalence of pre-diabetes and diabetes mellitus for Sami women was 2.7 and 4.8%, respectively, while corresponding values for non-Sami women were 2.3 and 4.5%. Relative risk ratios for dysglycaemia among Sami participants compared with non-Sami participants were significantly different in different geographical regions, with the southern region having the highest prevalence of pre-diabetes and diabetes mellitus among Sami participants. CONCLUSION: We observed a heterogeneity in the prevalence of pre-diabetes and diabetes mellitus in different geographical regions both within and between different ethnic groups.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Estado Pré-Diabético/epidemiologia , Adulto , Distribuição por Idade , Regiões Árticas , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Noruega , Prevalência , Distribuição por Sexo
18.
Lancet ; 388(10040): 131-57, 2016 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-27108232

RESUMO

BACKGROUND: International studies of the health of Indigenous and tribal peoples provide important public health insights. Reliable data are required for the development of policy and health services. Previous studies document poorer outcomes for Indigenous peoples compared with benchmark populations, but have been restricted in their coverage of countries or the range of health indicators. Our objective is to describe the health and social status of Indigenous and tribal peoples relative to benchmark populations from a sample of countries. METHODS: Collaborators with expertise in Indigenous health data systems were identified for each country. Data were obtained for population, life expectancy at birth, infant mortality, low and high birthweight, maternal mortality, nutritional status, educational attainment, and economic status. Data sources consisted of governmental data, data from non-governmental organisations such as UNICEF, and other research. Absolute and relative differences were calculated. FINDINGS: Our data (23 countries, 28 populations) provide evidence of poorer health and social outcomes for Indigenous peoples than for non-Indigenous populations. However, this is not uniformly the case, and the size of the rate difference varies. We document poorer outcomes for Indigenous populations for: life expectancy at birth for 16 of 18 populations with a difference greater than 1 year in 15 populations; infant mortality rate for 18 of 19 populations with a rate difference greater than one per 1000 livebirths in 16 populations; maternal mortality in ten populations; low birthweight with the rate difference greater than 2% in three populations; high birthweight with the rate difference greater than 2% in one population; child malnutrition for ten of 16 populations with a difference greater than 10% in five populations; child obesity for eight of 12 populations with a difference greater than 5% in four populations; adult obesity for seven of 13 populations with a difference greater than 10% in four populations; educational attainment for 26 of 27 populations with a difference greater than 1% in 24 populations; and economic status for 15 of 18 populations with a difference greater than 1% in 14 populations. INTERPRETATION: We systematically collated data across a broader sample of countries and indicators than done in previous studies. Taking into account the UN Sustainable Development Goals, we recommend that national governments develop targeted policy responses to Indigenous health, improving access to health services, and Indigenous data within national surveillance systems. FUNDING: The Lowitja Institute.


Assuntos
Transtornos da Nutrição Infantil/etnologia , Macrossomia Fetal/etnologia , Disparidades nos Níveis de Saúde , Mortalidade Infantil/etnologia , Expectativa de Vida/etnologia , Mortalidade Materna/etnologia , Obesidade Pediátrica/etnologia , Grupos Populacionais/etnologia , Pobreza/etnologia , Adulto , Criança , Escolaridade , Saúde Global , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Obesidade/etnologia , Grupos Populacionais/estatística & dados numéricos , Fatores Socioeconômicos
19.
BMJ Open ; 6(4): e009474, 2016 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-27105711

RESUMO

OBJECTIVES: Metabolic syndrome (MetS) is recognised as a reliable long-term predictor of adverse health outcomes. Elevated prevalence rates of MetS and chronic lifestyle diseases have been documented in different indigenous groups. We aimed to evaluate the prevalence of MetS and diabetes mellitus in relation to ethnicity in Northern Norway. In addition, we discussed different cut-off values for waist circumference (WC) and what impact this has on the prevalence of MetS. MATERIALS AND METHODS: SAMINOR is a population-based study of health and living conditions in areas home to Sami and non-Sami populations. The survey was carried out in 2003-2004. All eligible residents in specific age groups were invited. In total, 16,538 males and females aged 36-79 years participated and gave informed consent for medical research. RESULTS: This study involved a total of 7822 female and 7290 male participants. Sami affiliation was reported by 5141 participants (34%). The prevalence of MetS was high in both ethnic groups independent of which WC cut-off value was used. No ethnic differences in prevalence of diabetes mellitus were demonstrated. However, ethnicity appeared to affect diabetes treatment, which was more prevalent among Sami than non-Sami women. CONCLUSIONS: In this study, there was no ethnic difference in diabetes prevalence, but ethnicity appeared to affect diabetes treatment. Tablet treatment was more commonly in use among Sami women than among non-Sami women. We demonstrated a high share of negative metabolic components. These metabolic components have important health implications. Therefore, determining preventive initiatives is important in the primary and specialist healthcare system. These initiatives must be made culture and linguistic specific, in order to reduce differences and improve health status in the whole population.


Assuntos
Diabetes Mellitus/etnologia , Nível de Saúde , Estilo de Vida/etnologia , Síndrome Metabólica/etnologia , Grupos Populacionais/etnologia , Adulto , Distribuição por Idade , Idoso , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Noruega/etnologia , Distribuição por Sexo , Inquéritos e Questionários , Circunferência da Cintura
20.
BMC Health Serv Res ; 15: 353, 2015 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-26318734

RESUMO

BACKGROUND: The referral letter is an important document facilitating the transfer of care from a general practitioner (GP) to secondary care. Hospital doctors have often criticised the quality and content of referral letters, and the effectiveness of improvement efforts remains uncertain. METHODS: A cluster randomised trial was conducted using referral templates for patients in four diagnostic groups: dyspepsia, suspected colorectal cancer, chest pain and chronic obstructive pulmonary disease. The GP surgery was the unit of randomisation. Of the 14 surgeries served by the University Hospital of North Norway Harstad, seven were randomised to the intervention group. Intervention GPs used referral templates soliciting core clinical information when initiating a new referral in one of the four clinical areas. Intermittent surgery visits by study personnel were also carried out. A total of 500 patients were included, with 281 in the intervention and 219 in the control arm. Referral quality scoring was performed by three blinded raters. Data were analysed using multi-level regression modelling. All analyses were conducted on intention-to-treat basis. RESULTS: In the final multilevel model, referrals in the intervention group scored 18% higher (95% CI (11%, 25%), p < 0.001) on the referral quality score than the control group. The model also showed that board certified GPs and GPs in larger surgeries produced referrals of significantly higher quality. CONCLUSION: In this study, the dissemination of referral templates coupled with intermittent surgery visits produced higher quality referrals. TRIAL REGISTRATION: This trial has been registered at ClinicalTrials.gov. The trial registration number is NCT01470963.


Assuntos
Atenção Primária à Saúde , Indicadores de Qualidade em Assistência à Saúde , Encaminhamento e Consulta/normas , Atenção Secundária à Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Dispepsia , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Doença Pulmonar Obstrutiva Crônica , Adulto Jovem
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