The effect of employment support integrated in substance use treatment: A health economic cost-effectiveness simulation of three different interventions.

Background: Unemployment rates for individuals in treatment for substance use disorder (SUD) are high, with Norwegian estimates in the range of 81%-89%. Although Individual Placement and Support (IPS) represents a promising method to improved vocational outcome, cross-disciplinary investigations are needed to document implementation benefits and address reimbursements needs. The aim of this study was to model the potential socioeconomic value of employment support integrated in SUD treatment. Methods: Based on scientific publications, an ongoing randomised controlled trial (RCT) on employment support integrated in SUD treatment, and publicly available economy data, we made qualified assumptions about costs and socioeconomic gain for the different interventions targeting employment for patients with SUD: (1) treatment as usual (TAU); (2) TAU and a self-help guide and a workshop; and (3) TAU and IPS. For each intervention, we simulated three different outcome scenarios based on 100 patients. Results: Assuming a 40% employment rate and full-time employment (100%) for 10 years following IPS, we found a 10-year socioeconomic effect of €18,732,146. The corresponding effect for the more conservative TAU + IPS simulation assuming 40% part-time positions (25%) for five years, was €2,519,906. Compared to the two alternative interventions, IPS was cost-effective and more beneficial after six months to two years. Discussion: This concept evaluation study suggests that integrating employment support in the health services is socioeconomically beneficial. Our finding is relevant for decision makers within politics and health. Once employment rates from our ongoing RCT is available, real-life data will be applied to adjust model assumptions and socioeconomic value assumptions.

Enabling Guidelines for the Adoption of eHealth Solutions: Scoping Review.

BACKGROUND: Globally, public health care is under increasing pressure, an economic burden currently amplified by the COVID-19 outbreak. With the recognition that universal health coverage improves the health of a population and reduces health inequalities, universal health coverage has been acknowledged as a priority goal. To meet the global needs in a population with increased chronic illness and longer life expectancy, the health care system is in dire need of new, emerging technologies. eHealth solutions as a method of delivery may have an impact on quality of care and health care costs. As such, it is important to study methods previously used to avoid suboptimal implementation and promote general guidelines to further develop eHealth solutions. OBJECTIVE: This study aims to explore and thematically categorize a selected representation of early phase studies on eHealth technologies, focusing on papers that are under development or undergoing testing. Further, we want to assess enablers and barriers in terms of usability, scaling, and data management of eHealth implementation. The aim of this study to explore early development phase and feasibility studies was an intentional effort to provide applicable guidelines for evaluation at different stages of implementation. METHODS: A structured search was performed in PubMed, MEDLINE, and Cochrane to identify and provide insight in current eHealth technology and methodology under development and gain insight in the future potential of eHealth technologies. RESULTS: In total, 27 articles were included in this review. The clinical studies were categorized thematically by illness comparing 4 technology types deemed relevant: apps/web-based technology, sensor technology, virtual reality, and television. All eHealth assessment and implementation studies were categorized by their focus point: usability, scaling, or data management. Studies assessing the effect of eHealth were divided into feasibility studies, qualitative studies, and heuristic assessments. Studies focusing on usability (16/27) mainly addressed user involvement and learning curve in the adoption of eHealth, while the majority of scaling studies (6/27) focused on strategic and organizational aspects of upscaling eHealth solutions. Studies focusing on data management (5/27) addressed data processing and data sensitivity in adoption and diffusion of eHealth. Efficient processing of data in a secure manner, as well as user involvement and feedback, both throughout small studies and during upscaling, were the important enablers considered for successful implementation of eHealth. CONCLUSIONS: eHealth interventions have considerable potential to improve lifestyle changes and adherence to treatment recommendations. To promote efficient implementation and scaling, user involvement to promote user-friendliness, secure and adaptable data management, and strategical considerations needs to be addressed early in the development process. eHealth should be assessed during its development into health services. The wide variation in interventions and methodology makes comparison of the results challenging and calls for standardization of methods.

Acceptability, usability and utility of a personalised application in promoting behavioural change in patients with osteoarthritis: a feasibility study in Norway.

OBJECTIVE: The dynamic and interactive mobile application Vett was designed to help change behaviour and is based on cognitive, motivational and visual techniques. Our aim is to investigate the acceptability, usability and utility of Vett as a personalised application for goal achievement. SETTING: The trial took place at the rheumatology clinic at Diakonhjemmet Hospital, Oslo, Norway from January to June 2015. PARTICIPANTS: Twelve participants with osteoarthritis were recruited from a 3.5-hour multidisciplinary group-based educational programme (osteoarthritis school). INTERVENTIONS: With the help of a physician, each participant followed a customised 12-week mixed-mode goal achievement plan with digital support based on preset goals, self-monitoring and individual feedback. Acceptability was measured as the perceived degree of goal achievement using a validated habit questionnaire scaled from 0 to 100. Utility and usability were assessed via 10 weekly questions and adherence by fulfilment of predetermined tasks. RESULTS: Mean goal achievement was 73 (95% CI 68 to 78), an increase of 22 (95% Cl 17 to 26, p<0.01), which equals 48% improvement (95% CI 32% to 59%). Mean user satisfaction was 81 (95% CI 76 to 85), and technical usability was 80 (95% CI 75 to 84), which both increased during the study period. CONCLUSION: The high levels of acceptability, usability and utility support the feasibility of the personalised application Vett as a viable goal achievement tool.

The Effectiveness of Smartphone Apps for Lifestyle Improvement in Noncommunicable Diseases: Systematic Review and Meta-Analyses.

BACKGROUND: Noncommunicable diseases (NCDs) account for 70% of all deaths in a year globally. The four main NCDs are cardiovascular diseases, cancers, chronic pulmonary diseases, and diabetes mellitus. Fifty percent of persons with NCD do not adhere to prescribed treatment; in fact, adherence to lifestyle interventions is especially considered as a major challenge. Smartphone apps permit structured monitoring of health parameters, as well as the opportunity to receive feedback. OBJECTIVE: The aim of this study was to review and assess the effectiveness of app-based interventions, lasting at least 3 months, to promote lifestyle changes in patients with NCDs. METHODS: In February 2017, a literature search in five databases (EMBASE, MEDLINE, CINAHL, Academic Research Premier, and Cochrane Reviews and Trials) was conducted. Inclusion criteria was quantitative study designs including randomized and nonrandomized controlled trials that included patients aged 18 years and older diagnosed with any of the four main NCDs. Lifestyle outcomes were physical activity, physical fitness, modification of dietary habits, and quality of life. All included studies were assessed for risk of bias using the Cochrane Collaboration`s risk of bias tool. Meta-analyses were conducted for one of the outcomes (glycated hemoglobin, HbA1c) by using the estimate of effect of mean post treatment with SD or CI. Heterogeneity was tested using the I2 test. All studies included in the meta-analyses were graded. RESULTS: Of the 1588 records examined, 9 met the predefined criteria. Seven studies included diabetes patients only, one study included heart patients only, and another study included both diabetes and heart patients. Statistical significant effect was shown in HbA1c in 5 of 8 studies, as well in body weight in one of 5 studies and in waist circumference in one of 3 studies evaluating these outcomes. Seven of the included studies were included in the meta-analyses and demonstrated significantly overall effect on HbA1c on a short term (3-6 months; P=.02) with low heterogeneity (I2=41%). In the long term (10-12 months), the overall effect on HbA1c was statistical significant (P=.009) and without heterogeneity (I2=0%). The quality of evidence according to Grading of Recommendations Assessment, Development and Evaluation was low for short term and moderate for long term. CONCLUSIONS: Our review demonstrated limited research of the use of smartphone apps for NCDs other than diabetes with a follow-up of at least 3 months. For diabetes, the use of apps seems to improve lifestyle factors, especially to decrease HbA1c. More research with long-term follow-up should be performed to assess the effect of smartphone apps for NCDs other than diabetes.

Association of excessive daytime sleepiness with migraine and headache frequency in the general population.

BACKGROUND: Some previous studies have postulated an association between migraine and excessive daytime sleepiness (EDS). This study evaluated the association of EDS with migraine and headache frequency in a general population, after adjusting for potential confounding variables. METHODS: The study was a postal survey of a random age and gender-stratified sample of 40,000 persons aged 20 to 80 years old drawn by the National Population Register in Norway. The questionnaire included questions about migraine, headache, the Epworth sleepiness scale (ESS) and various comorbidities. EDS was defined as ESS > 10. The association of EDS and migraine/headache were analysed by bivariate and multivariable logistic regression analyses. RESULTS: A total of 21,177 persons responded to the ESS and were included in the analyses. The odds ratio (OR) for EDS was increased for migraineurs (1.42 (95% CI 1.31─1.54), p < 0.001) compared to non-migraineurs; however, this finding was not significant after adjustment for a number of possible confounders. EDS increased with increasing headache frequency, with an OR of 2.74 (95% CI 2.05─3.65), p < 0.001) for those with headache on >179 days per year compared to those without headache in multivariable analysis. CONCLUSIONS: In a general population, the odds for EDS increased significantly with the headache frequency, irrespective of migraine status. EDS was not associated with reported migraine in multivariable analysis.

Improved Clinical Efficacy with Wound Support Network Between Hospital and Home Care Service.

OBJECTIVE: The aim of this study was to test the efficacy of a wound support network model between the primary home care service and the hospital. The impact on wound healing rate, cost benefit, and transfer of knowledge was investigated. INTERVENTION: The intervention group was exposed to a wound support network (n = 32), and the control group continued standard organization of treatment (n = 21). DESIGN: Nonrandomized controlled study; observations were made before (baseline) and after the implementation of the intervention (12 weeks). PATIENTS: Patients with chronic wounds (lasting >6 weeks and with wound area >1 cm) in Oslo, Norway. MAIN OUTCOME MEASURES: Closure of the observation wound; wound size; total number of wounds; presence of eczema, edema, and pain; number of dressings per week; time spent per dressing; and number of control appointments at the hospital. The economic impact is calculated for the hospital and for the community of Oslo, Norway. MAIN RESULTS: The number of control appointments (t = 3.80, P < .001) was significantly decreased, and the number of completed treatments (P = .02) was significantly increased after 12 weeks in the intervention group compared with the control group. A significant improvement was evident in the intervention group in terms of eczema (P = .02), edema (P = .03), and closing of the observational wound (46.7% cases in the intervention group versus 25.0% in the control group). CONCLUSIONS: A wound support network between the primary home care service and the hospital is cost-effective, improves clinical efficacy of the home care services' work, and reduces the need for consultations at the hospital.

Obstructive sleep apnea in younger school children with Down syndrome.

OBJECTIVE: We aimed to assess the prevalence of obstructive sleep apnea (OSA) in 8 year old school children with Down syndrome (DS). While the prevalence in otherwise healthy children is below 5%, the prevalence estimates in children with DS are uncertain (30-80%). OSA directly affects cognitive development and school performance. STUDY DESIGN: Population based cross sectional study in a limited geographical area. METHODS: Polysomnography (PSG) with video and audio recordings was performed in 8-year-old children with DS in a pediatric sleep unit according to the guidelines of American Academy of Sleep Medicine. Twenty-nine of all 32 children with DS within a restricted area comprising >50% of the Norwegian population and 54% of the children with DS born in Norway in 2002 were enrolled. RESULTS: This study reports an apnea hypopnea index AHI>1.5 in 28 of 29 children and an obstructive apnea index (OAI)>1 in 24 of 29 children. 19 children (66%) had an AHI>5 and 17 children (59%) had an OAI>5 which indicated moderate to severe OSA. No correlation was found between OSA and obesity or gender. CONCLUSION: The high prevalence of disease found in these previously undiagnosed 8-year-old children underlines the importance of performing OSA diagnostics in children with DS throughout childhood. These findings suggest that the prevalence of OSA remains high up to early school years. In contrast to earlier publications, this current study has the advantage of being population based, the study is performed on children of a narrow age band to estimate prevalence of disease and the diagnostic gold standard of PSG is applied.

Otitis media with effusion in children with in Down syndrome.

OBJECTIVE: To determine the prevalence of otitis media with effusion (OME) in children with Down syndrome (DS), and the associated to hearing loss at the age of 8 years. STUDY DESIGN: A national population based clinical study of all children with DS born in Norway in 2002. RESULTS: OME was found in 20 out of 52 (38%) children. Those with OME had a significant lower hearing level with a mean pure tone average (PTA) of 33.4 dB HL compared to children with no OME whose mean PTA was 21.7 dB HL (p < 0.0001). Verified hearing loss above 25 dB HL in the better hearing ear was found in 12 out of the 20 with OME, compared to 5 out 31 without OME. CONCLUSION: The findings of this present study uncover the increased risk of OME in eight year old children with DS as current otitis media was found in one of three. This reduced hearing ability in children with DS due to OME at age of 8 strongly emphasizes the need for optimal treatment and follow up to optimize hearing rehabilitation. The findings are further supported by the population based study design, the focus on the narrow age band and the high response rate.

Hearing level in children with Down syndrome at the age of eight.

This study examines the prevalence of hearing loss in children with Down syndrome at the age of 8. All children were examined in the ENT-departments of public hospitals in Norway and the study population consisted of children born in Norway in 2002 with Down syndrome. Hearing loss was defined as pure-tone air-conduction reduction by on average more than 25 dB HL in the best hearing ear. A cross sectional clinical and audiological population based study was chosen as study design. Hearing loss more than 25 dB HL in the best hearing ear was found in 17/49 children (35%). Mild hearing loss was found in 13 children (26%), moderate in 3 (6%) children and severe hearing loss in 1 child (2%). Conductive hearing loss was found in 8 children (16%), 9 children (18%) had a sensory-neural hearing loss, and mixed hearing loss was found in 3 children. Mean hearing level among boys and girls were 30.0 dB HL (SD 15.7) and 25.5 dB HL (SD13.7) respectively, a non-significant difference (p=0.139). In conclusion this study indicates that both conductive and sensorineural hearing loss, is still common in children with Down syndrome children at the age of eight and as much as two thirds of the children may have a bilateral impairment. The study population was under diagnosed in terms of hearing loss and thus our findings underline the importance of continuous audiological follow up of this group of children throughout childhood.

Hospitalization for acute otitis media as a useful marker for disease severity.

BACKGROUND: An increase in severe complications to otitis media is a potential threat to antibiotic restrictions and is difficult to measure due to its low-prevalent nature. Easily accessible indicators sensitive to illness change are needed to benchmark the judicious use of antibiotics. OBJECTIVE: To investigate whether there has been a constant increase of hospital admissions for acute otitis media after the year 2000. METHODS: Registry-based study with complete data on hospitalization for acute otitis media and acute mastoiditis in Norway during 1999 to 2006. RESULTS: Mean incidence rate for acute otitis media hospitalization was 22.4 per 10,000 children and peak incidence in the second year of life 52.2 per 10,000 children. Corresponding mean incidence rate and peak incidence for acute mastoiditis were 1.5 and 3.5 per 10,000 children in the second year of life, respectively. There was a gradient increase of the incidence rates of acute otitis media hospitalization from the year 2000 to 2006 considering the Poisson regression model with a significant test of linear trend. CONCLUSIONS: Hospital admission for acute otitis media is prevalent enough to be a useful marker for otitis media severity and its distribution proportionate to that of acute mastoiditis.

Panel 1: Epidemiology, natural history, and risk factors.

BACKGROUND: The First International Symposium on Recent Advances in Otitis Media (OM) with Effusion was held in Columbus, Ohio, in 1975. The symposium has been organized in the United States every 4 years since, followed by a research conference to (a) assess major research accomplishments, (b) identify important research questions and opportunities, (c) develop consensus on definitions and terminology, and (d) establish priorities with short- and long-term research goals. One of the principal areas reviewed quadrennially is Epidemiology, Natural History, and Risk Factors. OBJECTIVE: To provide a review of recent literature on the epidemiology, natural history, and risk factors for OM. DATA SOURCES AND REVIEW METHODS: A search of OM articles in English published July 2007 to June 2011 was conducted using PubMed and related databases. Those with findings judged of importance for epidemiology, public health, and/or statistical methods were reviewed. RESULTS: The literature has continued to expand, increasing understanding of the worldwide burden of OM in childhood, complications from treatment failures, and comorbidities. Novel risk factors, including genetic factors, have been examined for OM susceptibility. Population-based studies in Canada, the United States, and other countries confirmed reductions in OM prevalence. Although most studies concentrated on acute OM (AOM) or OM with effusion (OME), a few examined severe chronic suppurative OM (CSOM), a major public health problem in developing countries and for certain indigenous populations around the world. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Recent publications have reinforced earlier epidemiological findings, while extending our knowledge in human population groups with high burden of OM.

Sleep apnoea headache in the general population.

BACKGROUND: The objective was to investigate the prevalence and clinical characteristics of sleep apnoea headache. METHODS: A postal questionnaire was received by 40,000 Norwegians from the general population. A total of 376 and 157 persons with high and low risk of sleep apnoea according to the Berlin Questionnaire had a polysomnography, and a clinical interview and examination by physicians. RESULTS: Sleep apnoea headache was diagnosed in 11.8% of the participants with obstructive sleep apnoea (OSA), while morning headache with similar symptomatology was diagnosed in 4.6% of the participants without OSA (p = 0.002). After adjusting for potential confounders the odds ratio for OSA remained significantly increased among participants with morning headache with an adjusted odds ratio of 2.92 (1.31-6.51). When using a cut-off of moderate (apnoea hypopnea index, AHI ≥ 15) and severe (AHI ≥ 30) OSA, the prevalence of sleep apnoea headache was 11.6% and 13.3%, respectively. Average oxygen desaturation and lowest oxygen saturation was not significantly different in participants with OSA with and without morning headache. CONCLUSION: Morning headaches were significantly more frequent among participants with OSA than those without OSA. Sleep apnoea headache is less common in the general population than has previously been reported in clinic populations. The relation of hypoxia and morning headache is questioned.

Tension-type headache and sleep apnea in the general population.

The main objective of this study is to investigate the relationship between tension-type headache and obstructive sleep apnea in the general population. The method involves a cross-sectional population-based study. A random age and gender stratified sample of 40,000 persons aged 20-80 years residing in Akershus, Hedmark or Oppland County, Norway were drawn by the National Population Register. A postal questionnaire containing the Berlin Questionnaire was used to classify respondents to be of either high or low risk of obstructive sleep apnea. Included in this study were 297 persons with high risk and 134 persons with low risk of sleep apnea, aged 30-65 years. They underwent an extensive clinical interview, a physical and a neurological examination by physicians, and in-hospital polysomnography. Those with apnea hypopnoea index (AHI) ≥5 were classified with obstructive sleep apnea. Tension-type headache was diagnosed according to the International Classification of Headache Disorders. Results showed the prevalence of frequent and chronic tension-type headache was 18.7 and 2.1% in the participants with obstructive sleep apnea. The logistic regression analyses showed no significant relationship between tension-type headache and obstructive sleep apnea, with adjusted odds ratios for frequent tension-type headache of 0.95 (0.55-1.62) and chronic tension-type headache of 1.91 (0.37-9.85). The results did not change when using cut-off of moderate (AHI ≥15) and severe (AHI ≥30) obstructive sleep apnea. Thus, we did not find any significant relationship between tension-type headache and the AHI. The presence and severity of sleep apneas seem not to influence presence and attack-frequency of tension-type headache in the general population.

Migraine and sleep apnea in the general population.

Objective is to investigate the relationship between migraine and obstructive sleep apnea in the general population. A cross-sectional population-based study. A random age and gender stratified sample of 40,000 persons aged 20-80 years residing in Akershus, Hedmark or Oppland County, Norway, were drawn by the National Population Register. A postal questionnaire containing the Berlin Questionnaire was used to classify respondents to be of either high or low risk of obstructive sleep apnea. 376 persons with high risk and 157 persons with low risk of sleep apnea aged 30-65 years were included for further investigations. They underwent an extensive clinical interview, a physical and a neurological examination by physicians, and in-hospital polysomnography. Those with apnea hypopnoea index (AHI) ≥5 were classified with obstructive sleep apnea. Migraine without aura (MO) and migraine with aura (MA) was diagnosed according to the International Classification of Headache Disorders. MO and MA occurred in 12.5 and 6.8% of the participants with obstructive sleep apnea. The logistic regression analyses showed no relationship between the two types of migraine and obstructive sleep apnea, with adjusted odds ratios for MO 1.15 (0.65-2.06) and MA 1.15 (0.95-2.39). Further, estimates using cutoff of moderate (AHI ≥ 15) and severe (AHI ≥ 30) obstructive sleep apnea, did not reveal any significant relationship between migraine and the AHI. Migraine and obstructive sleep apnea are unrelated in the general population.

Otitis media history, surgery and allergy in 60-year perspective: a population-based study.

OBJECTIVES: To assess the relationship between recurrent otitis media (OM), OM surgery and allergy in a 60-years perspective in the general population. METHODS: A cross-sectional questionnaire study of 40,000 randomly selected Norwegians aged 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75 and 80 years stratified by age and gender in 2005, i.e. each age group 30-60 years included 2000 and the remaining age groups 1000 persons of each gender. Main outcome measures were recurrent childhood OM, childhood myringotomy, ventilation tubes or adenoidectomy and lifetime allergy. RESULTS: The prevalence of recurrent OM was 24.3% (n=4823) and OM surgery 12.4% (n=2499). An increase in the proportion of OM surgery by age cohort was found, with the highest surgery rate of 0.52 for the 1955 age cohort, followed by a gradual decrease until the 1980 age cohort, when surgery stabilized at 0.42. Recurrent OM and OM surgery was more common in respondents with allergy. Among the latter, the probability for OM surgery was almost threefold when the age cohort 1945 was compared to 1920, OR(adj) at 2.95 (1.59-5.48). The latter tendency remained strong until 1965. Among non-allergics, the increase in surgery probability by age cohort showed the same tendency, but the relationship was less strong than for those with allergy. CONCLUSIONS: Despite a twofold increase in recurrent OM and OM surgery from 1925 to 1945, the proportion of OM and OM surgery have been stable since 1945. Our findings suggest a shift in clinical practice, most likely indicating a change in surgery from acute infections to otitis media with effusion (OME).

Epidemiology, natural history, and risk factors: panel report from the Ninth International Research Conference on Otitis Media.

The 2007 Recent Advances in Otitis Media Research Conference Panel Report provides an update on otitis media (OM) research published from 2003 to 2007. This report summarizes important trends in disease incidence and prevalence, describes established and newly identified risk factors for acute and chronic OM and OM with effusion, and conveys information on newly discovered genetic factors. In this report, researchers have described declining rates of OM diagnosis, antibiotic prescriptions, offices visits for OM, and middle ear surgery since the licensure and routine use of pneumococcal conjugate vaccine in infants. The panel report also recommends short and long term goals for current and future OM research.

Surgery for otitis media and infectious susceptibility in 10-year old school children.

OBJECTIVES: Assess infectious susceptibility in children previously operated for otitis media and evaluate reliability of parental reported otitis media surgery in the same group of children. METHODS: Population based, cross-sectional survey of 10-year olds in the city of Oslo, Norway studying otitis media and surgical intervention in n=3406 with reliability assessments in a subset of n=2027. RESULTS: Ten percent of children had otitis media surgery. Peak age was 2.5 years for adenoidectomy and tympanostomy tubes and 3 years for myringotomy. The crude odds ratio (cOR) with 95% confidence interval (95% CI) for one or more episodes of otitis media at 10 years in children with previous otitis media surgery was 3.4 (2.7-4.4). Intervention after the child was 4 years increased the risk further, crude odds ratio 4.2 (2.9-6.1). Kappa coefficients for agreement in answers to questions on otitis media surgery performed in children between 0 and 4 years were 0.9 for adenoidectomy, 1.0 for tympanostomy tubes, and 0.6 for myringotomy. CONCLUSION: Otitis media in 10-year old children was associated with previous surgical intervention, particularly when performed after 4 years of age. Parental reports of tympanostomy tubes and adenoidectomy in early childhood were found reliable.

Lessons learned: no increase despite clinical suspicion of acute mastoiditis.

Based on clinical information from one Norwegian hospital in 2005, an increase in childhood acute mastoiditis was postulated, but later nationally disproved. Our purpose was to explore the discrepancy between the clinically raised suspicion and Norwegian treatment data. Complete Norwegian data on children aged 0-16 hospitalized for acute mastoiditis in the period 1999-2005 was analyzed to study national variation in incidence by hospital, treatment region and age of hospitalization. In children below age 16 hospitalization rates for acute mastoiditis ranged from 4.9 to 6.3 from 1999 to 2005 and did not did not show an increase. The proportion of children below age two was stable throughout the study period. Although the number of children at Rikshospitalet (the National Hospital) varied from 6 to 21 during the study period, the pattern of childhood hospitalizations for acute mastoiditis in the region showed no variation in the same period of time. In conclusion, our study did not find evidence for an increase in acute mastoiditis hospitalizations. The postulated increase is likely a result of the reduction of otolaryngologic university departments from two to one in Oslo in 2004 and corresponding work-load increase at the remaining hospital, Rikshospitalet. In our opinion, health information presented as popular science may contribute to confusion rather than increasing understanding of complicated health issues.

Benchmarking surgery: secondary post-tonsillectomy hemorrhage 1999-2005.

CONCLUSIONS: We found no evidence that the reported increase in otolaryngologic surgery in Norway in recent years has affected post-tonsillectomy hemorrhage rates, and suggest that the latter is a valuable benchmark for the quality of the tonsillectomies and adenotonsillectomies nationwide. OBJECTIVES: To estimate the incidence of post-tonsillectomy hemorrhage and assess the distribution of hospitalizations for post-hemorrhage bleeding and surgery. MATERIALS AND METHODS: This was a national study using data from the Norwegian Patient Registry 1999-2005 with complete information on the incidence of post-hemorrhage hospitalizations, rebleeding surgery, and (adeno)tonsillectomy rates. RESULTS: One patient per 200 tonsillectomies was hospitalized and 1 per 1000 operated for post-tonsillectomy hemorrhage during the study period. Of the 328 patients hospitalized, 64 (20%) required surgery under general anesthesia. Peak age was 5-9 years; 194 (59%) with post-tonsillectomy hemorrhage were males. The mean rebleeding rate was 0.5% (confidence interval (CI)=0.5-0.6) when secondary rebleeding was estimated as the proportion of all tonsillectomies. While tonsillar surgery was more frequent in the non-adult population, post-tonsillectomy surgery was equally common in the ages below and above 16 years. Seasonal variation in post-tonsillectomy hemorrhages was not found.

A cross-sectional population-based survey of migraine and headache in 21,177 Norwegians: the Akershus sleep apnea project.

The objective was to investigate the prevalence and interrelation of migraine and headache in the general population. Forty thousand men and women aged 20-80 years from the Norwegian general population received a mailed questionnaire with questions about migraine and headache. The questionnaire response rate was 54.5%. The lifetime prevalence of migraine was 26.5% (95% CI 25.9-27.1%), i.e., 18.1% (95% CI 17.3-18.9%) in men and 34.1% (95% CI 33.2-35.0%) in women. The prevalence of migraine decreased slightly in both men and women after an age of 45. The 1 year prevalence of headache was 77.2%, i.e., 69.6% (95% CI 68.7-70.6%) in men and 84.0% (95% CI 83.3-84.7%) in women. The frequency of headache decreased with age, but some of the elders aged 70 or above experienced more frequent headache. The prevalence of being headache free increased from 19.1% (95% CI 14.2-25.6%) to 74.7% (95% CI 70.0-78.8%) in 20 and 80 years old men without co-occurrence of migraine, and from 5.1% (95% CI 2.9-8.8%) to 61.4% (95% CI 54.9-67.6%) in 20 and 80 years old women without co-occurrence of migraine. Co-occurrence of migraine significantly increased the frequency of headache and decreased the prevalence of being headache free.