How Has Living with Intimate Partner Violence Affected the Work Situation? A Qualitative Study among Abused Women in Norway

A qualitative study was conducted among 18 abused women from different parts of Norway to explore what paid work means for women exposed to partner violence and how living with an abusive partner affected their working life. Based on systematic text condensation analyses of their experiences as described in individual and focus group interviews, the study’s findings reveal two major themes. The first is about recovery and survival, and the other about the spillover of problems caused by a violent partner into paid work. Work was important to the women, as it represented time off from violence, contact with others who cared for them, and maintenance of self-esteem and self-confidence. Having their own money provided security and strengthened the belief that they could manage on their own. The spillover of intimate partner violence problems appeared through feelings of fear, shame and guilt at work.publishedVersio

Continuity of care and mortality for patients with chronic disease: an observational study using Norwegian registry data

Background Research on continuity of care (CoC) is mainly conducted in primary care and has received little acknowledgment in other levels of care. This study sought to investigate CoC across care levels for patients with selected chronic diseases, along with its association with mortality. Methods In a registry-based cohort study, patients with ≥1 consultation in primary or specialist healthcare or hospital admission with asthma, chronic obstructive pulmonary disease (COPD), diabetes mellitus, or heart failure in 2012 were linked to disease-related consultation data in 2013–2016. CoC was measured by Usual Provider of Care index (UPC) and Bice–Boxermann continuity of care score (COCI). Values equal to one were categorized into one group and the rest into three equal groups (tertiles). The association with mortality was determined by Cox regression models. Results The highest mean UPCtotal was measured for patients with diabetes mellitus (0.58) and the lowest for those with asthma (0.46). The population with heart failure had the highest death rate (26.5). In adjusted Cox regression analyses for COPD, mortality was 2.6 times higher (95% CI 2.25–3.04) for patients in the lowest tertile of continuity compared to those with UPCtotal = 1. Patients with diabetes mellitus and heart failure showed similar results. Conclusion CoC was moderate to high for disease-related contacts across care levels. A higher mortality associated with lower CoC was observed for patients with COPD, diabetes mellitus, and heart failure. A similar, but not statistically significant trend was found for patients with asthma. This study suggests that higher CoC across levels of care can decrease mortality.publishedVersio

Young adults with depression: A registry-based longitudinal study of work-life marginalisation. The Norwegian GP-DEP study

Aims: To explore the association between a depression diagnosis in young adulthood and risk of marginalisation at age 29 years, among those who had completed upper secondary school and those who had not completed at age 21. Methods: In a longitudinal cohort study based on nationwide registers we followed 111,558 people from age 22–29 years. Outcomes were risk of marginalisation and educational achievement at age 29. Exposure was a diagnosed depression at ages 22–26 years. Comorbid mental and somatic health conditions, gender and country of origin were covariates. Relative risks were estimated with Poisson regression models, stratified by educational level at age 21. Results: For people who had not completed upper secondary school at age 21 years, a depression diagnosis at age 22–26 increased the risk of low income (relative risk = 1.33; 95% confidence interval = 1.25–1.40), prolonged unemployment benefit (1.46; 1.38–1.55) and social security benefit (1.56; 1.41–1.74) at age 29 compared with those with no depression. Among those who had completed upper secondary school at age 21 years, depression increased the risk of low income (1.71; 1.60–1.83), prolonged unemployment benefit (2.17; 2.03–2.31), social security benefit (3.62; 2.91–4.51) and disability pension (4.43; 3.26–6.01) compared with those with no depression. Mental comorbidity had a significant impact on risk of marginalisation in both groups. Conclusions: Depression in one’s mid-20s significantly increases the risk of marginalisation at age 29 years, and comorbid mental health conditions reinforce this association. Functional ability should be given priority in depression care in early adulthood to counteract marginalisation.publishedVersio

Utilization of Norwegian crisis shelters before and during the COVID-19 pandemic

Background: The measures introduced to control the COVID-19 pandemic, including lockdowns and physical distancing, exerted considerable influence on society. Objectives: The aims of this study were to examine (1) the prevalence of people seeking Norwegian crisis shelters for domestic violence during the first period of the COVID-19 pandemic (2020) compared to the year before, (2) the demography and type of violence among first-time visitors and (3) to compare the utilization of the crisis shelters and characteristics of the users between shelters in the capital and the other shelters throughout Norway. Design: Observational study. Method: The study was based on data from each crisis shelter in 2019 and 2020. Comparison between the 2 years were based on corresponding periods (12 March until 31 December) and analysed with t-test and chi-square tests. Results: Total use of crises centres, residential stays and daytime visits were lower during the pandemic (n = 7102) compared to the pre-pandemic period (n = 11 814). There was a shift from daytime visits to phone contacts when the restrictions were established. There was a higher proportion of residential stays versus daytime visits during the pandemic (21.5%) compared to the pre-pandemic period (15.4%) (p ⩽ 0.001). The proportion of first-time users was higher during the pandemic compared to pre-pandemic period both for residents (52.4% vs 47.1%) and daytime visitors (10.9% vs 9.0%). Among first-time crisis shelter residents during the pandemic period, fewer reported having children at home compared to the pre-pandemic period. The background of the crisis-shelter users did not differ between the capital and rest of Norway, but the capital had relatively more residents with psychological violence and threats during the pandemic. Conclusion: The utilization of Norwegian crisis shelters, especially daytime visits was lower during the pandemic. There was a shift in daytime contacts from visits to phone contact at the pandemic outbreak. To ensure that information about available crisis shelters reaches the total population, these shelters should be prepared for a higher volume of phone contacts in a future pandemic situation.publishedVersio

Variation in general practitioners’ depression care following certification of sickness absence: a registry-based cohort study

Background Depression is more prevalent among women and people with low socio-economic status. Uncertainties exist about how general practitioner (GP) depression care varies with patients’ social position. Objective To investigate associations between patients’ gender and educational status combined and GP depression care following certification of sickness absence. Methods Nationwide registry-based cohort study, Norway, 2012–14. Reimbursement claims data from all consultations in general practice for depression were linked with information on socio-demographic data, social security benefits and depression medication. The study population comprised all individuals aged 25–66 years with taxable income, sick-listed with a new depression diagnosis in general practice in 2013 (n = 8857). We defined six intersectional groups by combining educational level and gender. The outcome was type of GP depression care during sick leave: follow-up consultation(s), talking therapy, medication and referral to secondary care. Associations between intersectional groups and outcome were estimated using generalized linear models. Results Among long-term absentees (17 days or more), highly educated women were less likely to receive medication compared to all other patient groups [relative risk (RR) ranging from 1.17 (95% confidence interval 1.03–1.33) to 1.49 (1.29–1.72)] and more likely to receive talking therapy than women with medium [RR = 0.90 (0.84–0.98)] or low [RR = 0.91 (0.85–0.98)] education. Conclusions Our findings suggest that GPs provide equitable depression care regarding consultations and referrals for all intersectional groups but differential drug treatment and talking therapy for highly educated women. GPs need to be aware of these variations to provide personalized care and to prevent reproducing inequity.publishedVersio

Primary care doctors in acute call-outs to severe trauma incidents in Norway–associations with factors related to patients and doctors

Objective Severe trauma patients need immediate prehospital intervention and transfer to a specialised trauma hospital. In Norway, primary care doctors (PCDs) are an integrated part of the prehospital trauma care. The aim of this study was to investigate the degree to which PCDs were involved in prehospital care of severe trauma patients and how factors related to patients and doctors were associated with call-outs to these incidents. Design This was a registry-based study in Norway on severe trauma patients with acute hospital admission during the period 2012–2018. Setting Data was obtained from three Norwegian official registries. Subjects By linking the registries, we studied the actions taken by the PCDs, whether they called out to severe trauma incidents. Main outcome measures In multivariable regression models, we investigated whether factors related to the PCDs (age, sex, specialisation in general practice (GP)) and patients (age, sex, duration of hospital stay, type of injury) were associated with call-outs. Results Out of 4342 severe trauma incidents, PCDs had documented involvement in 1683 (39%) and called out to 644 (15%). Increased proportions of PCD call-outs to severe trauma incidents were significantly associated with lower age of PCD, being a GP specialist, lower patient age, being a male patient, increased length of hospital stay and injuries to the head and the neck. Conclusions PCDs called out to a relatively low proportion of severe trauma patients. Several factors related to patients and doctors were associated with call-outs to severe trauma incidents in Norway.publishedVersio

Risk factors for knee replacement due to primary osteoarthritis, a population based, prospective cohort study of 315,495 individuals

Background: Osteoarthritis (OA) of the knee is a common and disabling condition. We wanted to investigate the modifiable risk factors Body Mass Index (BMI) and physical activity, using knee replacement (KR) as a marker for severely symptomatic disease, focusing on the interaction between these risk factors. Methods: 315,495 participants (mean age 43.0 years) from national health screenings were followed prospectively with respect to KR identified by linkage to the Norwegian Arthroplasty Register. Data were analysed by Cox proportional hazard regression. Results: During 12 years of follow up 1,323 individuals received KR for primary OA. There was a dose–response relationship between BMI and heavy labour, and later KR. Comparing the highest versus the lowest quarter of BMI, the relative risk was 6.2 (95% CI: 4.2-9.0) in men and 11.1 (95% CI: 7.8-15.6) in women. Men reporting intensive physical activity at work had a relative risk of 2.4 (95% CI: 1.8-3.2) versus men reporting sedentary activity at work, the corresponding figure in women being 2.3 (95% CI: 1.7-3.2). The effect of BMI and physical activity at work was additive. The heaviest men with the most strenuous work had a RR of 11.7 (95% CI: 5.9-23.1) compared to the ones with the lowest BMI and most sedentary work. For women the corresponding RR was 15.8 (95% CI: 8.2-30.3). There was no association between physical activity during leisure and KR. Conclusion: We found that a high BMI and intensive physical activity at work both contribute strongly to the risk of having a KR. As the two risk factors seem to act independently, people with strenuous physical work with a high BMI are at particularly high risk for severely disabling OA of the knee, and should be targeted with effective preventive measures.publishedVersio

Practice characteristics influencing variation in provision of depression care in general practice in Norway; a registry-based cohort study (The Norwegian GP-DEP study)

Background There is growing evidence of variation in treatment for patients with depression, not only across patient characteristics, but also with respect to the organizational and structural framework of general practitioners’ (GPs') practice. However, the reasons for these variations are sparsely examined. This study aimed to investigate associations of practice characteristics with provision of depression care in general practices in Norway. Methods A nationwide cohort study of residents aged ≥ 18 years with a new depression episode in general practice during 2009–2015, based on linked registry data. Exposures were characteristics of GP practice: geographical location, practice list size, and duration of GP-patient relationship. Outcomes were talking therapy, antidepressant medication and sick listing provided by GP during 12 months from date of diagnosis. Associations between exposure and outcome were estimated using generalized linear models, adjusted for patients’ age, gender, education and immigrant status, and characteristics of GP practice. Results The study population comprised 285 113 patients, mean age 43.5 years, 61.6% women. They were registered with 5 574 GPs. Of the patients, 52.5% received talking therapy, 34.1% antidepressant drugs and 54.1% were sick listed, while 17.3% received none of the above treatments. Patients in rural practices were less likely to receive talking therapy (adjusted relative risk (adj RR) = 0.68; 95% confidence interval (CI) = 0.64–0.73) and more likely to receive antidepressants (adj RR = 1.09; 95% CI = 1.04–1.14) compared to those in urban practices. Patients on short practice lists were more likely to receive medication (adj RR = 1.08; 95% CI = 1.05–1.12) than those on long practice lists. Patients with short GP-patient relationship were more likely to receive talking therapy (adj RR = 1.20; 95% CI = 1.17–1.23) and medication (adj RR = 1.08; 95% CI = 1.04–1.12), and less likely to be sick-listed (RR = 0.88; 95% CI = 0.87–0.89), than patients with long GP-patient relationship. Conclusions Provision of GP depression care varied with practice characteristics. Talking therapy was less commonly provided in rural practices and among those with long-lasting GP-patient relationship. These differences may indicate some variation, and therefore, its reasons and clinical consequences need further investigation.publishedVersio

Comparison of depression care provided in general practice in Norway and the Netherlands: registry-based cohort study (The Norwegian GP-DEP study)

Background Depression is highly prevalent in general practice, and organisation of primary health care probably affects the provision of depression care. General practitioners (GPs) in Norway and the Netherlands fulfil comparable roles. However, primary care teams with a mental health nurse (MHN) supplementing the GP have been established in the Netherlands, but not yet in Norway. In order to explore how the organisation of primary mental care affects care delivery, we aimed to examine the provision of GP depression care across the two countries. Methods Registry-based cohort study comprising new depression episodes in patients aged ≥ 18 years, 2011–2015. The Norwegian sample was drawn from the entire population (national health registries); 297,409 episodes. A representative Dutch sample (Nivel Primary Care Database) was included; 27,362 episodes. Outcomes were follow-up consultation(s) with GP, with GP and/or MHN, and antidepressant prescriptions during 12 months from the start of the depression episode. Differences between countries were estimated using negative binomial and Cox regression models, adjusted for patient gender, age and comorbidity. Results Patients in the Netherlands compared to Norway were less likely to receive GP follow-up consultations, IRR (incidence rate ratio) = 0.73 (95% confidence interval (CI) 0.71–0.74). Differences were greatest among patients aged 18–39 years (adj IRR = 0.64, 0.63–0.66) and 40–59 years (adj IRR = 0.71, 0.69–0.73). When comparing follow-up consultations in GP practices, including MHN consultations in the Netherlands, no cross-national differences were found (IRR = 1.00, 0.98–1.01). But in age-stratified analyses, Dutch patients 60 years and older were more likely to be followed up than their Norwegian counterparts (adj IRR = 1.21, 1.16–1.26). Patients in the Netherlands compared to Norway were more likely to receive antidepressant drugs, adj HR (hazard ratio) = 1.32 (1.30–1.34). Conclusions The observed differences indicate that the organisation of primary mental health care affects the provision of follow-up consultations in Norway and the Netherlands. Clinical studies are needed to explore the impact of team-based care and GP-based care on the quality of depression care and patient outcomes.publishedVersio

Preparedness and management during the first phase of the COVID-19 outbreak - a survey among emergency primary care services in Norway

Background The emergency primary care (EPC) services in Norway have been at the frontline of the COVID-19 pandemic. Knowledge about the EPC services’ management of the COVID-19 outbreak can be used to prepare for future outbreaks and improve patient management. The objectives of this study were to identify pandemic preparedness and management strategies in EPC centres in Norway during the COVID-19 outbreak. Methods Questions regarding patient management of the COVID-19 outbreak were included in data collection for the National Out-Of-Hours Services Registry. The data collection was web-based, and an invitation was sent by email to the managers of all EPC services in Norway in June 2020. The EPC services were asked questions about pre-pandemic preparedness, access to personal protective equipment (PPE), organizational measures taken, and how staffing was organized during the onset of the pandemic. Results There were 169 municipal and inter-municipal EPC services in Norway in 2020, and all responded to the questionnaire. Among the EPC services, 66.7% (n = 112) had a pandemic plan, but only 4.2% had performed training for pandemic preparedness. Further, fewer than half of the EPC centres (47.5%) had access to supplies of PPE, and 92.8% answered that they needed extra supplies of PPE. 75.3% of the EPC services established one or more respiratory clinics. Staffing with other personnel than usual was done in 44.6% (n = 74) of the EPC services. All EPC services except one implemented new strategies for assessing patients, while about half of the wards implemented new strategies for responding to emergency calls. None of the largest EPC services experienced that their pandemic plan was adequate, while 13.3% of the medium-sized EPC services and 48.9% of the small EPC services reported having an adequate pandemic plan. Conclusions Even though the EPC services lacked well-tested plans and had insufficient supplies of PPE at the outbreak of the COVID-19 pandemic, most services adapted to the pandemic by altering the ways they worked and by hiring health care professionals from other disciplines. These observations may help decision makers plan for future pandemics.publishedVersio