All the years from 2012 to 2015 showed a higher number of consultations with regular GPs and emergency departments in May than in all other calendar months for 19-year-olds. We observed no such pattern for other cohorts, and for other calendar months than May, there were no striking differences between 19-year-olds and the cohorts immediately below and above. The single diagnosis acute upper respiratory tract infection showed an almost fourfold increase in consultations in May for 19-year-olds compared with March. We further found that the number of consultations for 19-year-olds was high in both the first and second half of May as regards both the total number of consultations and the single diagnosis acute upper respiratory tract infection. For injuries, however, we observed only an increase in the first half of May.
The study is based on data from the Directorate of Health’s system for the control and payment of reimbursements to health service providers – KUHR. This database is not organised as a health register. Importantly, the KUHR database is almost complete, in the sense that it contains data from all consultations where Norwegian GPs have claimed reimbursement.
We know little about diagnostic quality, but assume that there is variation among diagnoses. A study from Canadian general practice has shown good data quality for the diagnoses epilepsy, Parkinson’s disease and dementia, but more moderate results for chronic obstructive pulmonary disease and depression (10). An earlier Norwegian study (data from 1992 – 2008) showed that often the correct codes are not used in reporting (11). In our study, some of the uncertainty was reduced by combining diagnostic codes into large diagnostic groups. Youth Health Centres are not included in the source data, and for this reason we have been unable to capture all contact that would probably relate to sexual health and less serious mental problems.
Previous studies from the Norwegian Institute of Public Health have shown an increase in the use of antibiotics (5) and in the number of injuries treated by the specialist health service (4) in May for 19-year-olds. We assume that a large proportion of the increase in the use of antibiotics and in injuries, as well as the increase we now observe in the general practitioner services, can be associated with the russ period. The number of consultations for the russ cohort increased in the first half of May prior to the start of the examination period.
For most of those participating in these celebrations, May is nevertheless also examination time. Exam grades are important for further qualification for higher education and work, and illness during an examination that can be documented by a medical certificate gives an entitlement to take a new examination later (12). The strong increase in GP consultations also in the second half of May can probably be explained to some extent by a need for treatment for infections during examination time or to document an illness in order to secure examination rights. However, the data do not enable us to analyse the prevalence of medical certificates linked to exemption from exams.
The relative increase in consultations in May among 19-year-olds was greatest in relation to consultations with emergency departments, but the numerical increase was greatest for consultations with GPs. This concurs with the findings of a study on the influenza pandemic in 2009, in which the authors concluded that the general practitioner services were flexible, and could respond to increased need in the population (13).
Russ celebrations ahead of an important examination period are, to the best of our knowledge, a unique Norwegian tradition. Similar celebrations among adolescents and young adults in other countries are more often linked to the start of studies or take place during holiday periods (14, 15). Buddy scheme arrangements at Norwegian higher education institutions take place at the commencement of studies and are considered small-scale in comparison with russ celebrations (16, 17).
Suggestions have been put forward several times to move these celebrations to the post-examination period, or alternatively to move the examinations forward to take place before these celebrations. Last year a new committee was appointed to examine the reorganisation of the school year (18).