Editorial

Less food, but more alcohol

Editorial

16.01.2023: Most people eat less after bariatric surgery. But some drink more. Bariatric surgery for morbid obesity is a potent form of treatment that can lead to long-term weight loss and other beneficial effects, but it is also associated with a risk of complications. Norwegian registry data show an average reduction in body mass index (BMI) from 42.7 pre-operatively to 31.0 five years after surgery (1). The majority of bariatric patients have obesity-related comorbidities. Two years after surgery, the incidence of sleep apnoea, type 2 diabetes, hypertension and musculoskeletal pain is significantly...

Therapeutics + diagnostics = theranostics

Editorial

09.01.2023: Theranostics is the combination of therapeutics and diagnostics. Based on principles of nuclear medicine, theranostics is enabling steadily more possibilities within personalised cancer treatment. Theranostics is an emerging field of medicine that involves targeted therapy based on the identification and verification of a biological target. In nuclear medicine, theranostics entails diagnostic imaging using radioactively labelled tracers to identify a biological target structure, followed by internal radiation therapy using the same tracer. This ensures selective and targeted treatment of...

A gas causing laughter and harm

Editorial

06.01.2023: Misuse of nitrous oxide among partying young people has remained under the radar for several years. Good old pathophysiology can explain the dangers of this misuse. The recreational drug market is creative and constantly evolving. The latest drug on the scene is nitrous oxide – both an anaesthetic that is being phased out and a domestic gas used to whip up cream quickly. It can also 'whip up' your mood and is therefore being increasingly misused. Nitrous oxide as a recreational drug is not illegal, and there is no age limit in Norway. The combination of an uncontrolled increase in use and a...

New search-and-rescue helicopter and useful activity data

Editorial

12.12.2022: The New SAR Queen helicopter has already been in use at the Ørlandet air rescue base since May 2021. The experience gained there is valuable when the helicopter is put into operation at other bases. As a PhD candidate, I had the following mantra inculcated into me by my wise supervisor: 'Show me your data!' To highlight a problem, win a discussion or have a budget approved, there is only one thing that works – to show the activity by presenting activity data. The procurement project for new search-and-rescue helicopters (referred to as Norwegian All-Weather Search and Rescue Helicopter...

When paediatric patients are critically ill

Editorial

12.12.2022: Some sick children need closer monitoring than can be provided in a paediatric ward. For many, a paediatric high dependency unit may represent a more appropriate level of care. In this edition of the Journal of the Norwegian Medical Association, Dahle-Andersen et al. report on the experiences from the first five years of the paediatric high dependency unit (PHDU) at Haukeland University Hospital (1). The unit treats children aged 0–18 years with paediatric medical conditions requiring a high level of care. Similar units are planned for other paediatric wards, and it is therefore of great...

70 years of the Cancer Registry of Norway

Editorial

12.12.2022: Since 1952, the Cancer Registry of Norway has promoted science, spread knowledge and helped reduce the cancer burden. Based on statutory notification of cancer, the Cancer Registry of Norway first opened its doors in 1952 with a staff of three. This marked the start of a remarkable series of decades and an unbroken collaboration with the health services, NGOs and central authorities. The Registry's main focus was on the establishment and quality assurance of a database of incident cancer cases, in addition to production of statistics, overviews and reports (1). In the post-war years, Norwegian...

Pregnancy in women born abroad

Editorial

21.11.2022: Immigrant women are at higher risk of pre-, intra- and post-natal complications. Caesarean section is a standard surgical procedure throughout the world, but the frequency varies considerably between countries and regions. Caesarean section performed without a clear medical indication can be more harmful than beneficial for the mother and child. The World Health Organization has concluded that the caesarean section rate is unnecessarily high in many middle- and high-income countries, while many low-income countries have insufficient access to the procedure (1). A caesarean section should be...

The district medical officer's placement

Editorial

07.11.2022: Having the district medical officer closely linked to the municipal administration makes for good emergency preparedness. Compared to many other countries, Norway coped well with the pandemic. This is partly thanks to district medical officers who stood firm during the tempest. They handled the media, coordinated contact tracing and vaccinations, and provided advice to municipal leaders, services, businesses and the public. Hardly any other profession was as exposed during the pandemic, and municipal leaders have seen how important it is to have the backing of expertise in community medicine...

Moles and melanoma

Editorial

24.10.2022: How clear really are the boundaries between cancer, precursors to cancer and harmless pigment spots? Cutaneous melanoma is the fastest growing cancer in Norway, as well as large areas of Europe and North America (1). The increase is often attributed to increased exposure to ultraviolet radiation due to changes in sun habits. However, in 2021, Welch et al. demonstrated that, even in a hypothetical extreme scenario, increased sun exposure can only explain a small proportion of the increased incidence of melanoma in the United States (2). There must be other contributory causes. The fact that...

Doctors, coercion and the law

Editorial

11.10.2022: Giving the population better healthcare is contingent on effective regulation. This work cannot be left to the legal profession alone. Doctors are educated and trained in assessing patients' health and in making decisions about the investigation and treatment of illnesses on a medical basis. However, many young doctors find that decision-making processes in health care are often also based on a number of factors other than the purely medical. For example, questions about resources are becoming increasingly relevant. Do we have beds? Do we have staff? Can we afford it? Likewise, the legal and...

General practitioners – strong but vulnerable

Editorial

05.09.2022: The Norwegian General Practice (GP) service is in crisis. Large numbers of general practitioners (GPs) are leaving and few are willing to take their place. More research-based knowledge is needed to improve the service. The GP service is a cost-effective cornerstone of today's health service – and that is how it should remain. But whether it will survive is anyone's guess. The service is in crisis, with high drop-out rates among GPs and a poor supply of new ones to take their place. Meanwhile, private institutions are queuing up to take over large parts of the GPs' work. GPs' ability to adapt...

We must learn from the COVID-19 pandemic

Editorial

27.06.2022: Experiences of nursing home doctors during the COVID-19 pandemic should lead to strengthening of the role of the district medical officer. The managing of the COVID-19 pandemic is now in the evaluation phase. The Norwegian Coronavirus Commission has presented its second evaluation report (1), and researchers are contributing with several studies that are providing a great deal of useful information. In situations where the best interests of the community are not necessarily the same as the best interests of the individual, it is particularly challenging to bear decision-making responsibility...

Encephalitis with herpes simplex virus

Editorial

10.06.2022: Encephalitis caused by herpes simplex virus can occur as a result of viral reactivation from the central nervous system, spread from other organs and as an immune reaction. Encephalitis is an acute or subacute inflammation of brain tissue. Symptoms include fever, altered behaviour, altered consciousness, confusion, headache, seizures and neurological deficit. Viral infections in the central nervous system are notifiable diseases to the Norwegian Surveillance System for Communicable Diseases (MSIS), along with a number of other microbial infections. These infections usually involve meningitis...

How dangerous is MDMA?

Editorial

25.05.2022: Use of MDMA seems to be increasing in Norway. But how dangerous is the drug really? The Journal of the Norwegian Medical Association is now publishing a study by Jamt et al. in which an increase has been observed in the number of cases with findings of 3,4-methylenedioxymethamphetamine (MDMA) in blood in post-mortems on fatalities and in arrested drug drivers, at the same time as seizures of MDMA by the police and customs have also increased (1). The article thus draws attention to an increasing incidence of MDMA in criminal cases in parallel with an apparent increasing exposure to MDMA in...

COVID-19 – a rare cause of death in nursing homes

Editorial

23.05.2022: Only 1.3 % of all deaths in nursing homes in 2020 were attributable to COVID-19. Infection monitoring is a cornerstone in analyses of endemic, epidemic and pandemic infectious diseases. During the coronavirus pandemic, the main focus has been on COVID-19, also among nursing home residents. Danielsen et al. have estimated the incidence of COVID-19 as well as the number of hospitalisations and deaths related to the disease in the Norwegian nursing home population in 2020 (1). These analyses are based on the Beredt C19 emergency preparedness register. Out of a total of just over 80 000 included...

Prenatal testing – universal access?

Editorial

23.05.2022: First trimester prenatal testing is now accessible to women who do not have an elevated risk or need. But the access is not standardised. In May 2020, the Norwegian Parliament (the Storting) decided to make changes to maternity care in Norway. Access to non-invasive prenatal testing (NIPT) to screen for chromosomal abnormalities by analysing cell-free DNA in maternal blood is now a statutory right for pregnant women with an indication for prenatal diagnostics and for other pregnant women with an increased trisomy risk due to their age. The lower age limit for NIPT is 35 years, which...

Say yes to medical certificates for older drivers

Editorial

01.04.2022: The requirement for a medical certificate for drivers over the age of 80 will be abolished if the government acts on a decision by the Storting. Whether the requirement for a medical certificate for drivers over the age of 80 should be retained or scrapped has been the subject of considerable, often heated, debate in recent years. Matters came to a head following a discussion in the Storting where it was decided to abolish the requirement for the mandatory medical certificate. The discussion in the Storting forms the basis for Anette Bringedal Houge's analysis of the parliamentary debate in...

Autism or autisms?

Editorial

22.03.2022: The cause of autism is biological, but the diagnosis is made on the basis of observed behaviour. Autism populations are highly heterogeneous. Autism is characterised by difficulties with communication and social interaction as well as repetitive and stereotypical behaviours. Medical treatment has no direct effect on the core symptoms, and autism is primarily treated through education and behavioural services. Neither biological tests nor blood tests can confirm the diagnosis, which is made on the basis of a thorough clinical examination and identifying the patient's behavioural profile. Early...

Hyperkalaemia as a differential diagnosis in chest pain

Editorial

22.03.2022: The treatment of patients with suspected acute myocardial infarction generally works well. Sometimes other suspected diagnoses become so urgent that treatment must be initiated rapidly. When acute myocardial infarction is suspected, the standard treatment protocol is immediate transportation to a hospital able to offer percutaneous coronary intervention, called a PCI centre. If the patient's condition necessitates it or the time required for transportation is too long, the shortest journey to a local hospital for thrombolytic treatment is chosen (1, 2). The Journal of the Norwegian Medical...

Patient-centred care – is it possible?

Editorial

14.02.2022: We need more than simply good results from clinical trials to provide patient-centred care. 'Reporting and treating oral cavity problems is not something we do as a part of routine clinical practice, unfortunately. We should do it – but there are so many other important things that need to be done in a hectic cancer ward.' We recently overheard this conversation between a nurse and doctor. It is probably representative of the prioritisation in many areas of the Norwegian specialist health service. A Norwegian study has shown that the situation is not much better at Norwegian nursing homes (1)...

Are pregnant women and unborn children being forgotten in the pandemic?

Editorial

07.02.2022: The COVID-19 pandemic poses a biopsychosocial health risk to pregnant women, women in labour and infants throughout the world. COVID-19 is affecting pregnant women, women in labour and infants to a greater extent than we thought. In addition to the risk of serious maternal illnesses, there is also an increased risk of severe pregnancy complications, such as premature birth, preeclampsia and stillbirth (1, 2). In an article in this edition of the Journal of the Norwegian Medical Association, Eberhard-Gran et al. describe how one-third of their sample of women who gave birth in Norway during the...

Remember the interpreter!

Editorial

26.01.2022: The Interpreting Act entered into force on 1 January. This is an important step in the fight for equal health services for all inhabitants. In 2020, interpreters carried out a total of 723 000 assignments in the Norwegian public sector (1) – many of them in the health services. Most healthcare workers are well used to booking and using interpreters. The Patients and Users Rights Act states that information provided to patients must be 'adapted to the recipient's individual prerequisites, such as (...) cultural and language background' (2). In other words and according to the law, help from an...

District Medical Officers are doing the splits

Editorial

21.01.2022: Local authorities should make better use of their District Medical Officers' expertise. District medical officers have received much attention during the coronavirus pandemic. We have seen that when combined with local knowledge, public health expertise has ensured efficient handling of the pandemic at the local level. However, infection control is only one of several jobs assigned to district medical officers. Municipal executives have paid tribute to the efforts of infection control specialists during the pandemic, but they tend to be less familiar with the benefits that the localised public...

Three waves in Bærum

Editorial

13.01.2022: Knowledge about the outcomes among COVID-19 patients admitted to a local hospital in the Oslo area provides key information preparing us for the next wave of coronavirus infections. In this issue of the Journal of the Norwegian Medical Association, Myrstad and colleagues present the course of illness and treatment for the 300 COVID-19 patients who were admitted to Bærum Hospital during the first three 'waves' of coronavirus infection in 2020 and 2021 (1). Bærum Hospital is a relatively large local hospital that caters to nearly 200 000 inhabitants. For a department with approx. 90 beds, eight...

Don't put your fingers in the socket

Editorial

13.01.2022: Electrical shock should be avoided, even though low-voltage shock is not as dangerous as previously thought. It is hard to fit your fingers, big or small, in a socket. Even a knitting needle can no longer be easily inserted after the introduction of new child-proof sockets with special barriers. It works if you use two knitting needles at the same time, but even then the earth-leakage circuit breaker will usually shut off the current so you don't notice anything. However, if the earth leakage circuit breaker does not trip, your fingers will clamp around the knitting needles in each hand and...

Doctors in rural areas – make the most of the opportunities presented

Editorial

10.01.2022: Better planning and the restructuring of medical studies and specialist training can help in the recruitment of general practitioners to rural areas. How are healthcare personnel recruited to jobs in rural areas? We know that healthcare professionals with a rural affiliation and who have had positive experiences from general practice and rural exposure during their studies and clinical placements are more likely to settle outside the cities (1). The Norwegian Centre for Rural Medicine has participated in a seven-year international collaboration with Sweden, Iceland, Canada and Scotland on a...

COVID-19, vaccines and immigrants

Editorial

05.01.2022: We need more knowledge about migrant health as well as a high level of professional reflection to prevent the stigmatisation of particularly vulnerable groups. Those of us who work with migrant health often say that migrant background is an independent health determinant (1). The association between migrant background and health differs in the various migrant groups. Consequently, the effects of specific measures to improve health services for these groups must be evaluated before implementation. For several years, researchers have been calling for systematic data on migrant background to be...

Kidney transplantation past and present

Editorial

13.12.2021: Norway's kidney transplant programme is of a high quality thanks to the close cooperation between Oslo University Hospital and the other Norwegian hospitals. The main challenge is the gap between the need for organs and organ availability. The first human-to-human kidney transplant was performed in 1933 in Ukraine, but it was not until 1954 that the first successful kidney transplant was carried out. The operation was performed in Boston, led by Joseph Murray (1919–2012) (1). It was just two years later that Professor Leif Efskind (1904–87) at Rikshospitalet carried out Norway's first kidney...

Where did all the doctors go?

Editorial

08.11.2021: How can it be that Norway has a growing shortage of doctors while the number of professionally active doctors is increasing? According to figures from the Norwegian Medical Association for July this year, Norway has 27 924 professionally active doctors under 70 years of age, of whom 15 502 are certified as specialists (1). The number has tripled since 1985, when there were 10 134 doctors. Currently, we have one doctor for every 200 inhabitants. In Europe, only Greece, Lithuania and Austria have a higher doctor density (2). Medicine is one of the most attractive courses of study in Norway, and...

Restless legs syndrome is a public health problem

Editorial

08.11.2021: Many patients who have sleep disruptions, irritable bowel syndrome and chronic pain also suffer from restless legs. Restless legs syndrome (RLS) is one of the most common neurological disorders in general practice (1). Although the condition is relatively easy to diagnose, RLS is probably both under-diagnosed and under-treated. Bjorvatn et al. are currently in the process of publishing a survey of how many of the patients at a sample of GP offices in Western and Southern Norway met the criteria for RLS (2). The patients were asked to complete a questionnaire on symptoms while waiting for their...