10.01.2022: In Norway, there is a broad consensus that all inhabitants should be entitled to equal access to health services, irrespective of factors such as place of residence. This entitlement is challenged by problems in recruiting and retaining health personnel in rural communities and smaller hospitals. We are aware of various solutions for meeting the demand for doctors, for example frequent use of locums and international recruitment. Norway has joined the World Health Organization's Global Code of Practice on the International Recruitment of Health Personnel. This obligates us to build an...

12.05.2021: In 2019, a total of 14 354 patients in Norway were registered as receiving treatment in an intensive care unit (ICU), of whom 59.2 % received mechanical ventilation (1). Mechanically ventilated patients in the ICU are vulnerable to wasting of skeletal and respiratory muscles as part of ICU-acquired weakness (2, 3). Muscle wasting may begin only a few hours after the start of intensive care treatment, and the degree of wasting can affect the hospital length of stay, survival, and the duration and outcomes of rehabilitation (2). In recent times there has been a move in intensive care medicine...

01.02.2021: The percentage of pregnant women with an immigrant background is increasing in Norway, and in 2019, 28 % of all new-borns had a mother with an immigrant background (1). The risk of an adverse pregnancy outcome is higher among immigrant women than among the host population (2). A report from the Norwegian Directorate of Health in 2020 describes immigrant women as an especially vulnerable group within prenatal care (3). An immigrant is defined as a person born outside of Norway with two foreign-born parents and four foreign-born grandparents (4). The term 'country background' refers to a woman's...

23.11.2020: The reliability of research findings may be weakened in several ways. Trials that have positive and statistically significant findings and that support the hypotheses of the authors or editors have a greater probability of being published (publication bias) (1, 2). Other common sources of bias are selective reporting (incomplete reporting of predefined clinical outcome measures) and change of outcome measure between the protocol and the published article (3–6). This type of dishonest research practice is astonishingly common and may result in exaggerated or simply incorrect assertions about...

19.05.2020: Colorectal cancer is the most prevalent form of cancer among Norwegian men and woman, with 4 428 new cases in 2018 (1). Since the 1940s there has been a doubling of incidence, but also of five-year relative survival, which is now at about 70 % (1). Higher survival is attributed partly to new treatment methods and enhanced surgical techniques, particularly for rectal cancer, and to adjuvant therapy (2). Adjuvant chemotherapy is administered after surgery to prevent metastases and local recurrence. The Norwegian guidelines recommend three to six months of treatment with different combinations of...

05.12.2018: Infertility affects about 10 % of all couples (1) and its incidence is increasing. The need for and use of fertility treatment is increasing in parallel, and the number of children conceived after fertility treatment has now surpassed eight million worldwide (2). In Norway, assisted reproduction is defined by the Biotechnology Act, and includes techniques for both fertilisation of eggs outside the body and for insemination. Fertilisation of eggs outside the body can occur via in vitro fertilisation (IVF) or microinjection (intracytoplasmic sperm injection, ICSI) (3). Both techniques entail...

26.11.2018: Mycobacteria are aerobic, non-spore-forming rod bacteria, are non-motile and acid-fast, i.e. they cannot be decolourised by acid-alcohol in special staining. Their growth rate is generally low, but varies. This forms the basis for their subdivision into fast- and slow-growing species, defined as growth in a solid medium before or after seven days, when spread from a liquid bacterial culture. Non-tuberculous mycobacteria (NTM) have varying pathogenicity and are normally found in the environment, e.g. in soil and water, but can cause infections in both humans and animals. The bacteria may also...

26.11.2018: Dystonia is a movement disorder characterised by persistent and intermittent muscle contractions that cause involuntary repetitive movements, and that can lead to abnormal posture in affected parts of the body (1). Classic dopa-responsive dystonia typically begins in childhood or adolescence, most often with walking difficulties. Symptoms worsen towards the evening and improve in the morning after sleep, and show a highly positive and sustained response to levodopa (2–4). The aim of this article is to provide general practitioners, neurologists, paediatricians and other interested parties with...

12.11.2018: In the 1950s and 60s, the classic psychedelic drugs lysergic acid diethylamide (LSD) and psilocybin were tested in numerous clinical trials. The results suggested efficacy against anxiety and depression in cases of life-threatening illness, unipolar depression and addiction (1–3). An open study of LSD in cancer patients demonstrated improvement in symptoms such as pain, anxiety and depression and a greater acceptance of death in approximately 70 % of the sample (1). A review of open studies examining the efficacy of psychedelic drugs in unipolar depression showed an improvement in...

12.10.2018: Myocardial fibrosis arises when the heart's fibroblasts produce collagenous scar tissue. This process may primarily be reparative, but over time often has negative consequences for the patient in the form of function impairment, morbidity and mortality. Cardiovascular disease is still the dominant cause of death in the Western world (1), and myocardial fibrosis arises in the course of many heart diseases. This review article first presents the pathophysiology and classification of myocardial fibrosis and methods for its detection. Some conditions in which myocardial fibrosis can be detected...

13.09.2018: The umbrella term frontotemporal dementia encompasses several neurodegenerative diseases that lead to neuronal loss in the frontal and/or temporal lobes (1). Frontotemporal dementia can be divided into two phenotypic groups on the basis of changes in either behaviour or language. The behavioural variant accounts for about half of all cases and includes changes in behaviour and personality (2). This variant is characterised by focal and prominent frontal atrophy. The language variant is called primary progressive aphasia and consists of three subtypes: a non-fluent variant (known as progressive...

28.05.2018: Neonates that fail to breathe for themselves and/or have a slow heart rate immediately after birth should, according to Norwegian and international guidelines, undergo cardiopulmonary resuscitation in accordance with clearly defined algorithms (1). These are divided into various steps: drying, warming and stimulation, bag-valve-mask ventilation, cardiopulmonary resuscitation with chest compressions and ventilations, and possibly adrenaline (1–3). Approximately 10 % of infants born at or near term require tactile stimulation to begin breathing (2), while 3 % will require respiratory support...

05.03.2018: Of all musculoskeletal pain, knee pain is among the most frequently occurring. The majority of the patients have an atraumatic knee disorder (1). Pain receptors cannot be detected in joint cartilage, but are abundantly present in other structures, including joint ligaments, the synovium, the subchondral bone and surrounding soft tissue. Experience shows, however, that there will often be doubt regarding the origin of pain in atraumatic knee disorders, even after a thorough examination. Symptoms that often accompany knee pain include stiffness, knee locking, muscle weakness and instability. In...

19.02.2018: Migraine is a common neurological disease, and with a prevalence of 15 % in the adult population, the source of a major social, economic and psychological burden (1–3). Women are more frequently affected than men. Onset is often in the teens, and prevalence is highest in the ages 20 to 50 years (2, 4). Comorbidity can contribute significantly to the morbidity of the migraine population. A number of studies have shown an increased risk of cerebral infarction in migraine sufferers, particularly among young and middle-aged women (5). The purpose of this article is to provide an updated review of...

28.11.2017: In a culturally complex society such as that of Norway, the requirement for equal treatment irrespective of age, sex and ancestry is particularly important, as significant differences have been detected between various ethnic groups with regard to both disease prevalence and response to drug therapy (1). The proportion of patients in one particular population group who respond positively to a drug may differ from the proportion who respond positively in another group. This variation in drug response is to some extent genetically determined (1). It is therefore conceivable that these...

02.10.2017: The symptoms of heart failure are reduced exercise tolerance, breathlessness and dependent oedema, due to reduced cardiac output or elevated filling pressures (1). Cardiac output depends on both adequate contractility (systolic function) and effective filling between contractions (diastolic function). In the classical form of heart failure, the contractility of the left ventricle is substantially reduced, and this is accompanied by ventricular dilation and reduced ejection fraction (1). This type of heart failure is therefore called "heart failure with reduced ejection fraction" (HFrEF) (1)...

18.09.2017: Injury to internal organs is a leading cause of death and disability in children and adolescents (1). Among older children and teenagers, almost half of all fatalities are caused by external events; the most common mechanisms are traffic accidents, violence and falls. Of all injuries, those occurring most frequently in children are head trauma and extremity injury, and abdominal injuries comprise only about 10 % of the total share (2). A Norwegian study found that among injuries with a fatal outcome, head trauma results in four of five fatalities, and bleeding is the next most frequent cause...

23.05.2017: Cardiovascular diseases are a leading cause of morbidity and mortality, globally as well as in Norway (1, 2). It has been well documented that a Mediterranean diet prevents development of these diseases (3) – (5). The Mediterranean diet is characterised by a high intake of fruits, legumes, vegetables, olive oil, cereals and nuts, a moderate intake of fish, lean dairy products and red wine and a low intake of red meat (6). It is questionable, however, whether a single type of regional diet should be recommended world-wide – because of the cost, limited access to relevant ingredients and...

08.11.2016: Inflammatory bowel disease is comprised mainly of ulcerative colitis and Crohn’s disease – both of which are chronic inflammatory conditions that often present in early adulthood and have a relapsing-remitting course. Typical symptoms include bloody diarrhoea, abdominal pain and weight loss (1). Many in this patient population report significant problems with fatigue (2). «Fatigue» can be defined as an overwhelming feeling of tiredness, exhaustion and lack of energy (3). It is seen commonly in a number of chronic inflammatory diseases, affecting quality of life (4) and in many cases reducing...

27.09.2016: Congenital thrombotic thrombocytopenic purpura (TTP) was first described by Irving Schulman in 1960 in a young girl with haemolytic anaemia, recurrent thrombocytopenia and bleeding tendency (1). Jefferson D. Upshaw later described a similar case and suggested that deficiency of an unidentified plasma factor was responsible for the disorder, as administration of plasma-containing blood products resolved the thrombocytopenia in both his own patient and Schulman’s (2). For many years the condition was known as Upshaw-Schulman syndrome. These patients were subsequently found to have ultra-large...

03.05.2016: In all hospital departments one comes into contact with disinfectants (used for technical disinfection) and antiseptics (used on skin and mucosa) on a daily basis. Chlorhexidine is one of the most commonly used antiseptic solutions in Norway. It should be used with caution in premature infants because of the risk of skin irritation and chemical burns. This applies in particular to premature infants weighing less than 1000 grams during their first seven days of life (1). There is thus a need for other antiseptics that are suitable for this group. Disinfection of methicillin-resistant...

06.10.2015: Epilepsy is one of the most common neurological disorders and strikes people of all ages (1). An epilepsy diagnosis will often imply far more than recurring unprovoked epileptic seizures. The diagnosis may have an impact on the choice of education and profession, family, social contact and mental health (2, 3). As a result, this patient group has complex needs for health and social services. Updated knowledge on the prevalence of epilepsy is important for the planning of such programmes. It has been estimated that 30 000 – 40 000 people in Norway have this diagnosis (4, 5), but this estimate...

06.10.2015: The modern use of therapeutic hypothermia can trace its roots back to the early 1800s, when the French surgeon Dominique Jean Larrey realised that cooled body tissue had greater hypoxia tolerance (1). Nevertheless, clinical use of hypothermia for neuroprotection did not become common until the latter half of the twentieth century, and the first reported use of hypothermia after cardiac arrest was published in 1958 (2). Today, therapeutic hypothermia is widely used in the treatment of cardiac arrest survivors who remain comatose after cardiopulmonary resuscitation (3), and also in surgical...

25.08.2015: Adverse childhood experiences, such as abuse, neglect or poverty, are associated with increased morbidity and mortality in adulthood (1) – (3). Low socioeconomic status, either as a child or as an adult, has long been recognised as such a risk factor (4, 5). In children, severe stress has been linked to changes in brain structure, stress responsivity and immunity (5), as well as to increased risk-taking behaviours such as smoking and substance abuse in adulthood (6). In recent years, research has examined whether – and if so how – telomeres might be one of the links between adverse childhood...

30.06.2015: The scaphoid bone (os scaphoideum) is one of eight bones in the wrist. About half of the bone is covered with cartilage. It articulates with the radius, lunate, capitate, trapezoid and trapezium bones. Earlier cadaver studies revealed the major blood supply to the scaphoid to be retrograde, with entry into the bone around the distal pole. It was assumed to result in vulnerable circulation in the proximal part of the bone (1), like the femoral head in adults. In more recent cadaver studies, however, less vulnerable circulation has been found, with anastomoses to all parts of the scaphoid (2)...

16.06.2015: Weight-loss surgery (bariatric surgery) has become more common, and around 3 000 individuals undergo such surgery in Norway each year (1, 2). Quality of life and obesity-related health problems improve significantly after pronounced weight loss (3), but many patients also experience new physical and psychological impairments due to large amounts of excess skin. This review considers indications for treatment, choice of post-bariatric plastic surgery procedures, results and complications as well as the treatment options that are available. Method A literature search in PubMed on 19 November...

19.05.2015: The prevalence of multiple sclerosis is increasing and it is estimated that about 10 000 people in Norway have the disease (1). Multiple sclerosis reduces the lifespan by 5 – 10 years and is a frequent cause of neurological disability. Despite improved treatment, there is therefore still a need for information that could help to prevent the disease. Research in epidemiology, genetics and immunology has provided greater insight into the factors that can cause multiple sclerosis. The aim of the current article is to discuss environmental impact on disease risk and disease progression. Method The...

24.03.2015: Prostate cancer is the most commonly occurring type of cancer in men in Norway, and 4 978 men received the diagnosis in 2011 (1). Prostatectomy and radiotherapy are the only two treatment modalities regarded internationally as having curative potential for localised disease. Despite improvements in both diagnosis and treatment, mortality in Norway has not been reduced accordingly (2). The prognosis is related to a number of clinical factors: extent of primary tumour (T-stage), prostate-specific antigen (PSA) and the degree of differentiation and aggressiveness of the tumour (Gleason score)...

25.11.2014: Chronic obstructive pulmonary disease (COPD) is defined as a disease characterised by airflow limitation that is not fully reversible, that is progressive and associated with a pathological inflammatory response to exposure to noxious particles and gases (1). Work-related COPD is caused or exacerbated by exposure to particles and gases in the workplace (2). The main known risk factors for COPD are cigarette smoking, workplace exposure, air pollution, fumes from the burning of biomass fuels, recurrent respiratory infections, low socioeconomic status and chronic airflow limitation resulting from...