A shift to something better? A longitudinal study of work schedule and prescribed sleep medication use in nurses

Objectives To explore whether a change in work schedule was associated with a change in the probability of prescribed sleep medication use. Methods A longitudinal study with annual questionnaire data (2008/2009–2021, except 2019) on work schedule (day work only, shift work without nights and shift work with nights) and prescribed sleep medication use from 2028 Norwegian nurses (mean age 31.7 years, 90.5% women at baseline) who participated in the ongoing Survey of Shift work, Sleep and Health (SUSSH). Associations were estimated using a random effects model, and a fixed effects regression model in which nurses were included as their own control to account for potential unobserved confounding. Results In both models, day work was associated with a more than 50% lower probability of sleep medication use compared with shift work with nights (adjusted OR (aOR) 0.50, 95% CI 0.27 to 0.93 in the random effects model, and an aOR 0.32, 95% CI 0.14 to 0.70 in the fixed effects regression model). Shift work without nights was associated with a non-statistically significant reduction in sleep medication use within nurses in the fixed effects regression model when compared with shift work with nights (aOR 0.66, 95% CI 0.37 to 1.20). Conclusions Day work was associated with a significant reduced probability of prescribed sleep medication use compared with shift work with nights. This indicates that quitting night work will improve sleep and thereby reduce hypnotic use.publishedVersio

Sleep medication and melatonin use among Norwegian nurses – A cross-sectional study

Aim To estimate the prevalence of sleep medication and melatonin use among nurses and to assess if factors related to work, sleep or mental health, were associated with such use. Design A cross-sectional study. Methods A questionnaire survey including 2,798 Norwegian nurses. Associations were estimated using a modified Poisson regression model. Results In total, 7.5%, 4.6% and 2.0% of the nurses included in the present study reported prescribed sleep medication, over-the-counter sleep medication or melatonin use in the last year, respectively. Short sleep duration, sleep problems and psychological conditions were strongly associated with both prescribed and over-the-counter sleep medication use. Nurses who worked more than 60 night shifts in the last year were at increased risk of sleep medication use.publishedVersio

Parental education and the risk of cerebral palsy for children:an evaluation of causality

Aim To explore whether increasing parental education has a causal effect on risk of cerebral palsy (CP) in the child, or whether unobserved confounding is a more likely explanation. Method We used data from Norwegian registries on approximately 1.5 million children born between 1967 and 2011. We compared results from a traditional cohort design with results from a family‐based matched case–control design, in which children with CP were matched to their first cousins without CP. In addition, we performed a simulation study to assess the role of unobserved confounding. Results In the cohort design, the odds of CP were reduced in children of mothers and fathers with higher education (adjusted odds ratio [OR] 0.67, 95% confidence interval [CI] 0.60–0.75 for maternal education, and adjusted OR 0.75, 95% CI 0.67–0.85 for paternal education). In the family‐based case–control design, only an association for maternal education remained (adjusted OR 0.80, 95% CI 0.64–0.99). Results from a simulation study suggested that this association could be explained by unobserved confounding. Interpretation A causal effect of obtaining higher education on risk of CP in the child is unlikely. Results stress the importance of continued research on the role of genetic and environmental risk factors that vary by parents’ educational level.publishedVersio

Søvnforstyrrelser og forskrivning av hypnotika i allmennpraksis – en PraksisNett-studie

Source at https://helse-bergen.no/nasjonal-kompetansetjeneste-for-sovnsykdommer-sovno/tidsskriftet-sovn.Søvnforstyrrelser er svært utbredt i befolkningen. Insomni er den vanligste søvnforstyrrelsen med en forekomst på omkring 10-20 % [1, 2]. Forekomsten ser ut til å være økende i befolkningen [1]. Blant pasienter på venterommet hos norske fastleger er forekomsten så høy som rundt 50 % ifølge to tidligere studier [3, 4]. Insomni utgjør en risikofaktor for utvikling av psykiske lidelser [5] og er identifisert som en mulig kausal årsaksfaktor for en rekke negative helseutfall [6]. Selv om sovemedisiner kun er anbefalt ved akutte søvnplager [7], er forskrivning av sovemedisiner også for langvarige plager svært vanlig [8]. Medikamentgruppen hypnotika inkluderer benzodiazepiner, benzodiazepinlignende sovemidler (z preparater) og melatoninpreparater. I klinisk praksis benyttes av og til også andre preparater enn hypnotika mot søvnproblemer, inkludert antidepressiva, antihistaminer og antipsykotika [9]

Association of sweetened carbonated beverage consumption during pregnancy and ADHD symptoms in the ofspring: a study from the Norwegian Mother, Father and Child Cohort Study (MoBa)

Purpose Intrauterine exposures influence offspring health and development. Here we investigated maternal intake of sweetened carbonated beverages (SCB) during pregnancy and its association with ADHD symptoms in the offspring. Methods This study was based on the Norwegian Mother, Father and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway. Maternal diet mid-pregnancy was assessed using a food frequency questionnaire (FFQ). All mothers who responded to the FFQ and a questionnaire when their child was 8 years of age were included (n = 39,870). The exposure was defined as maternal intake (daily servings) of SCB, using no daily intake as reference. Outcome was offspring ADHD symptoms, evaluated as a continuous standardized ADHD score and as a binary outcome of six or more ADHD symptoms vs. five symptoms or less. Associations were analysed using log-binomial regression and linear mixed regression models with adjustment for covariates. Results The adjusted regression coefficients for the standardized ADHD offspring symptom score were 0.31 [95% confidence intervals (0.001, 0.62)] and 0.46 (0.15, 0.77) for maternal daily intake of ≥ 1 glasses of SCB, when the models included adjustments for total energy intake or energy intake from other sources than SCBs and sweet drinks, respectively. The corresponding adjusted relative risks were 1.16 (1.004, 1.34) and 1.21. (1.05, 1.39) for drinking ≥ 1 glasses daily. Conclusion In a large pregnancy cohort with offspring followed until 8 years of age, we found an association between maternal daily intake of SCB and offspring ADHD symptoms. These results suggest a weak positive relationship between prenatal exposure to SCB and offspring ADHD.publishedVersio

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Dobbeltarbeidshypotesen - gir omsorg for barn økt sykefravær blant yrkesaktive kvinner?

Formålet med denne oppgaven er å undersøke om en kombinasjon av store familieforpliktelser (målt ved antall barn) og høy yrkesdeltakelse gir økt sykefravær blant norske kvinner. I litteraturen er dette omtalt som dobbeltarbeidshypotesen. Det er gjort få studier på dobbeltarbeidshypotesen i Norge og resultatene fra tidligere studier gir lite støtte til hypotesen. En viktig metodisk utfordring er å undersøke om det finner sted en seleksjonsprosess, ved at de kvinnene som finner dobbeltarbeid mest problematisk trekker seg delvis eller helt ut av arbeidsmarkedet. Dette vil i så fall gi en underestimering av effekten av antall barn på sykefraværet. I oppgaven benyttes data fra forløpsdatabasen (FD-Trygd). Datamaterialet er tilrettelagt for forskning av Statistisk sentralbyrå. Utvalget består av et panel kvinner født mellom 1953-1968, som følges fra 1993-2006. I den deskriptive analysen finner vi en negativ sammenheng mellom antall barn og sykefravær blant yrkesaktive kvinner. Samtidig finner vi at kvinner reduserer sin yrkesdeltakelse ved økende antall barn. I den økonometriske analysen estimeres både sannsynligheten for å ha et sykepengetilfelle og antall erstattede sykefraværsdager. For å ta hensyn til uobserverbar heterogenitet mellom individene estimeres en fast effekt modell. Statistikkprogrammet STATA 11 er brukt i beregningene. Resultatene viser at sykefraværet avtar med antall barn under 18 år. Antall barn under 6 år har en positiv effekt på antall erstattede sykefraværsdager, når vi tar hensyn til uobserverbar heterogenitet mellom individene. Videre finner vi at kvinner som kombinerer en fulltidsjobb med omsorg for barn, er en selektert gruppe kjennetegnet ved noen uobserverbare egenskaper som gir dem høyere sannsynlighet for å arbeide fulltid og lavere sannsynlighet for å ha erstattet sykefravær

Associations between excessive fatigue and pain, sleep, mental-health and work factors in Norwegian nurses.

AimTo investigate whether pain, sleep duration, insomnia, sleepiness, work-related factors, anxiety, and depression associate with excessive fatigue in nurses.BackgroundFatigue among nurses is a problem in the context of ongoing nursing shortages. While myriad factors are associated with fatigue not all relationships are understood. Prior studies have not examined excessive fatigue in the context of pain, sleep, mental health, and work factors in a working population to determine if associations between excessive fatigue and each of these factors remain when adjusting for each other.MethodsA cross-sectional questionnaire study among 1,335 Norwegian nurses. The questionnaire included measures for fatigue (Chalder Fatigue Questionnaire, score ≥4 categorized as excessive fatigue), pain, sleep duration, insomnia (Bergen Insomnia Scale), daytime sleepiness (Epworth Sleepiness Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and work-related factors. Associations between the exposure variables and excessive fatigue were analyzed using chi-square tests and logistic regression analyses.ResultsIn the fully adjusted model, significant associations were found between excessive fatigue and pain severity scores for arms/wrists/hands (adjusted OR (aOR) = 1.09, CI = 1.02-1.17), hips/legs/knees/feet (aOR = 1.11, CI = 1.05-1.18), and headaches/migraines (aOR = 1.16, CI = 1.07-1.27), sleep duration of ConclusionExcessive fatigue was associated with pain, sleep- and mental health-factors in a fully adjusted model

Sleep medication and melatonin use among Norwegian nurses – A cross-sectional study

Aim To estimate the prevalence of sleep medication and melatonin use among nurses and to assess if factors related to work, sleep or mental health, were associated with such use. Design A cross-sectional study. Methods A questionnaire survey including 2,798 Norwegian nurses. Associations were estimated using a modified Poisson regression model. Results In total, 7.5%, 4.6% and 2.0% of the nurses included in the present study reported prescribed sleep medication, over-the-counter sleep medication or melatonin use in the last year, respectively. Short sleep duration, sleep problems and psychological conditions were strongly associated with both prescribed and over-the-counter sleep medication use. Nurses who worked more than 60 night shifts in the last year were at increased risk of sleep medication use

Prevalence of insomnia and hypnotic use in Norwegian patients visiting their general practitioner

Background Sleep problems are common in the general population, but there are few studies on the prevalence of sleep problems and hypnotic use among patients in general practice. Objectives To estimate the prevalence of insomnia (based on the Diagnostic and Statistical Manual of Mental Disorders [DSM], version 5), self-reported sleep problems and hypnotic use among patients in general practice, and explore whether the prevalence depended on patient characteristics. Methods A cross-sectional study with questionnaire data collected by 114 final-year medical students while deployed in different general practices in Norway during 2020. A total of 1,848 consecutive and unselected patients (response rate 85.2%) visiting their general practitioners (GPs) completed a one-page questionnaire, that included the validated Bergen Insomnia Scale (BIS), questions on for how long they have had a sleep problem, hypnotic use, and background characteristics. Associations were estimated using a modified Poisson regression model. Results The prevalence of chronic insomnia according to BIS was 48.3%, while 46.9% reported chronic sleep problems (sleep problems of ≥3 months) and 17.8% reported hypnotic use. Females, patients with low compared with higher education, and patients who slept shorter or longer than 7–8 h, had higher risk of chronic insomnia disorder (CID), chronic self-reported sleep problems (CSP), and hypnotic use. The oldest age group (≥65 years) had lower risk of chronic insomnia compared with the youngest (18–34) but twice the probability of hypnotic use. Conclusions CID, CSP, and hypnotic use were prevalent among patients visiting their GP. Insomnia can be effectively treated and deserves more attention among GPs.publishedVersio