28.08.2023: All municipalities are required by law to have a district medical officer (1). The person appointed will serve as a medical adviser to all sectors and entities in the municipality and play a crucial coordinating role in the local authority's dialogue with general practitioners (GPs). District medical officers also have specific duties as defined in the Control of Communicable Diseases Act, the Public Health Act, the Health and Social Preparedness Act and the Compulsory Mental Health Care Act (2). Meanwhile, it is the local authorities themselves that determine how the district medical officer...

26.06.2023: Dementia is a chronic condition characterised by reduced cognitive function and changed behaviour to such an extent that it leads to a reduced ability to perform activities of daily living. The most common cause is Alzheimer's disease (1). Mild cognitive impairment can be a precursor to dementia. In mild cognitive impairment, cognitive functions have changed from previous levels, but not to the extent that they affect daily life functions (2). Over 55 million people in the world have dementia, and this number is expected to triple by 2050 (3). Systematic reviews have shown that the prevalence...

31.05.2023: Uncertainty is an unavoidable aspect of medicine that can arise in many different situations (1). It can arise due to a lack of knowledge and awareness. This awareness leads to emotional, cognitive and behavioural responses in healthcare personnel and patients (2). Common reactions to uncertainty are fear, anxiety, indecisiveness and a feeling of vulnerability (3). In patient interaction, knowledge is generated from conversations about the patient's medical history, clinical examinations and tests. In a qualitative study of 22 doctors with varying experience, Han et al. called the process of...

08.05.2023: In order to ensure a standardised process for the investigation and treatment of breast cancer, a patient pathway was introduced in 2015. The aim was to clarify the division of responsibilities between the primary care service and the specialist health service and specify time frames (1), whilst giving cancer patients security and predictability (2). In 2021, SINTEF evaluated the cancer patient pathway in Norway (3). In the report, they concluded that the system had been a qualified success, where the prioritisation of patients in the pathway had increased the pressure on the specialist health...

25.04.2023: Antimicrobial resistance is a threat to global public health and is driven mainly by use of antibiotics (1). One of the key goals of the 'Action Plan against Antibiotic Resistance in the Norwegian Health Service' was therefore to reduce the use of five selected groups of broad-spectrum antibiotics in Norwegian hospitals by 30 % between 2012 and 2020 (2). This goal was included in the clinical commissioning documents for hospitals in Norway. Neither the action plan nor the commissioning documents for the period in question specified which indicator should be used to evaluate whether the goal...

24.04.2023: Emergency laparotomies are associated with higher mortality, more postoperative complications, and longer hospital stays than elective laparotomies (1–4). The most common abdominal surgical conditions requiring emergency laparotomy are perforation and obstruction of the gastrointestinal tract (5). In recent years, much has been done to improve the outcomes of elective surgery, whereas similar progress has yet to be made for emergency surgery (6). In 2012, the National Emergency Laparotomy Audit launched an extensive project in England and Wales aimed at improving the management of patients...

08.02.2023: The prevalence of overweight and obesity in the Norwegian population is rising dramatically (1). There is therefore a need in society to prevent this through a concerted and strengthened effort (1–3). One of the goals of the Coordination Reform is for GPs to be more active in the prevention of lifestyle diseases (2). Greater efforts to prevent weight gain and the associated health risks in people who are overweight can have a major impact on the individual, and can also benefit society considerably (1, 4). For many patients, getting support and help from their GP at an early stage will be...

30.01.2023: Sepsis is one of the most common causes of death in hospital, and at least one in eight patient deaths in hospital in Norway are from sepsis (1). Incidence increases with advancing age, and more cases of sepsis are expected in coming years due to the ageing population (2, 3). Rapid diagnosis and initiation of antibiotic treatment are the most important steps in severe infections (4). Early detection of sepsis has been a key area of focus for the Norwegian Board of Health Supervision, which conducted a nationwide inspection in 2016–2018 into the management of patients with sepsis in emergency...

16.01.2023: In Norway, gentamicin is the most common aminoglycoside used for the treatment of serious bacterial infections in children (1). Aminoglycosides have a concentration-dependent bactericidal effect, particularly on Gram-negative aerobic bacteria (2, 3), but also on staphylococci (4, 5). Gentamicin in combination with a beta-lactam antibiotic is recommended for empirical treatment in cases of sepsis, febrile neutropenia and pyelonephritis (6, 7). Aminoglycosides are eliminated via the kidneys. They have little effect on anaerobic intestinal flora and are ecologically beneficial antibiotics that do...

06.01.2023: Over the past 40–50 years, obesity and overweight have become a growing public health challenge in Norway (1). Bariatric surgery can be a suitable treatment for people with morbid obesity whose attempts at conservative treatment have failed and who have a BMI ≥ 35 kg/m2 with comorbidities or BMI < 40 kg/m2 (2). Gastric bypass is roughly as common as sleeve gastrectomy, and these two procedures accounted for nine out of ten operations in 2021 (3). Several literature reviews show an increased risk of alcohol use disorders (AUDs) and problematic alcohol consumption following bariatric surgery (4...

12.12.2022: High dependency or intermediate units in hospitals provide close monitoring and treatment for patients who are too ill to be cared for in a general ward, but do not require intensive care. This includes step-down care for patients who are discharged from intensive care units (ICUs) and step-up care in cases of acute deterioration in general wards (1, 2). This type of care for adult patients was introduced many years ago (3). The medical profession in Norway identified a need some time ago for similar high dependency care tailored for acutely and seriously ill children (4). This issue has...

07.11.2022: The COVID-19 pandemic is an example of what Ritter and Webber refer to as wicked problems (1, 2) (in Norwegian called 'gjenstridige problemer (3)). Wicked problems are by their nature unique, unpredictable and complex, with no simple solution and spanning organisational boundaries, administrative levels and sectors (1, 4). To address such problems, cooperation and coordination between different actors, organisations and administrative levels are deemed necessary (5). In Norway, municipalities have played a key role in the crisis management of the pandemic (6, 7), with responsibility for...

01.09.2022: Little was known about the SARS-CoV-2 virus at the start of the pandemic, and knowledge was lacking about the routes of infection, the potential severity of illness and what infection control measures would be appropriate. There were no national codes of practice or guidelines, and the authorities' recommendations were constantly changing. GPs' patients were contacting their practice for advice, and in the first few months of the pandemic the GP service spent considerable time reassuring patients. Meanwhile, GPs had to reorganise their practices in order to meet the population's need for...

28.06.2022: Almost half of the COVID-19 deaths in Europe from the start of the pandemic until January 2021 occurred in nursing homes (1). In Norway, the majority of COVID-19 deaths in 2020 were in the over-80s, and many of these people died in nursing homes (2). Norwegian nursing home residents have an average age of 84 years, a high burden of disease, and 8 out of 10 have dementia (3, 4). These factors increase their vulnerability to a serious clinical course of COVID-19. Early in the pandemic, it was decided that nursing home residents had to be protected through measures such as restrictions on visits...

19.05.2022: MDMA (3,4-methylenedioxymethamphetamine), also known as ecstasy, has been used as a recreational drug since the 1980s. Ecstasy can also contain other, related compounds (1). Its use in Norway peaked in around 2000 (2), and there were reports of numerous deaths and potentially long-term neurotoxic effects (3–5). Use then fell until 2010, but has increased steadily, and is now higher than in the early 2000s (2, 6). MDMA is a potent central nervous system (CNS) stimulant. Single intake of a common user dose is associated with low acute toxicity, but long-term use is associated with higher...

04.05.2022: Vaccination is critical to curb the COVID-19 pandemic and prevent hospital admissions and deaths. Norway secured access to vaccines through collaboration agreements with the EU and the EEA, and began vaccinating the population in late 2020/early 2021. Initial access to vaccines was limited, and priority was given to the elderly, clinically vulnerable groups and healthcare personnel, followed by municipalities and local districts with a persistently high infection rate. In July and August 2021, the vaccines were recommended for and offered to everyone over the age of 18, including pregnant...

04.02.2022: The COVID-19 pandemic – with lockdowns, infection control measures, rising unemployment and general uncertainty – has impacted on the entire population. Figures from the Norwegian Institute of Public Health suggest an increase in impaired mental health among the general population during the pandemic (1). International studies indicate that pregnant and postnatal women have been a particularly vulnerable group (2). It is unclear to what extent this also applies to Norway, although some clinicians have noted an increase in cases of anxiety among birthing mothers (3). Ten years ago, the Ahus...

17.01.2022: After the introduction of the Norwegian Care Coordination Reform and the Public Health Act in 2012, several tasks have been transferred from the specialist health service to the primary health service, and local authorities have been given a wider disease prevention remit. This development has led to growing needs for professional medical advice and management (1–3), both in respect of individual cases in clinical settings and vis-à-vis local authorities. Municipalities have a statutory duty to employ a District Medical Officer as their chief medical advisor (4). Local authorities are free to...

13.01.2022: The 2019 report of the Grimstad committee concluded that medical education capacity in Norway was too low and recommended increasing it by 440 medical students annually (1). Offering medical studies at more health institutions was proposed as a strategy for increasing the number of students. Studies of decentralised programmes of medical education in Canada, the United States and Australia show that where a student grew up, specialty preferences and a desire to work in rural areas prior to the start of their studies are decisive factors for recruitment to rural areas when they have completed...

13.01.2022: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic with more than 255 million confirmed infections and more than 5 million deaths (1). As of 17 November 2021, there were more than 232 000 confirmed infections, and 995 deaths had been caused by COVID-19 in Norway (2). The spread of infection through Norway has come in waves. The first wave from March to June 2020 was followed by three months of low infection rates. The second wave started in September 2020, with the number of infections falling from January 2021. From the end of February 2021, the...

13.01.2022: High levels of vaccination coverage in the population are important to limit COVID-19-related hospitalisations and deaths. Vaccination coverage in Norway is high, but varies among different sectors of the population. Parts of the immigrant population in Norway have been hard hit by the pandemic and are overrepresented both in terms of confirmed infections and hospitalisations, also after adjusting for socioeconomic status and medical risk factors (1, 2). In a number of countries, minority groups have shown greater vaccine hesitancy and lower COVID-19 vaccination coverage than the majority...