Suchergebnisse

ObjectivesThe objective for this systematic review was to examine how the record linkage process was reported and to understand challenges related to accessing, linking, and analysing linked routinely collected data used for multimorbidity research.
ApproachA systematic search for relevant studies was conducted in three online databases (Medline, Web of Science and Embase) in May 2021 using predefined search terms, and inclusion and exclusion criteria. Studies using linked routinely collected data for multimorbidity research were included. Information was extracted on how the linkage process was reported, which conditions were studied together, which data sources were used, as well as challenges encountered during the linkage process or with the linked dataset.
The findings from this study will feed into further guidance to understand and minimise bias due to linkage error in medical research.
ResultsTwenty studies were included, of which seventeen looked at the relationship between two specified long-term conditions. Fourteen studies received the linked dataset from an external data linkage provider. Hospital Episode Statistics was the most common source of data (n=5). Eight studies reported variables used for the data linkage, while only two studies reported pre-linkage checks. The quality of the linkage was assessed by three studies, of which two reported linkage rate and one reported raw linkage figures. Only one study checked for bias by comparing patient characteristics of linked and non-linked records.
ConclusionsThe linkage process was poorly reported in multimorbidity research, even though this might introduce bias and potentially lead to inaccurate inferences drawn from the results. There is therefore a need for increased awareness of linkage bias and transparency of the linkage processes, which could be achieved through better adherence to reporting guidelines.

- ; Objective: The main objective of the Norwegian air ambulance service is to provide advanced emergency medicine to critically ill or severely injured patients. The government has defined a time frame of 45 minutes as the goal within which 90% of the popula- tion should be reached. The aims of this study were to document accurate flying times for rotor wing units to the scene and to determine the rates of acute primary missions in Norway. Methods: We analyzed operational data from every acute primary mission from all air ambulance bases in Norway in 2011, focusing on the flying time taken to reach scene, the municipality request- ing the flight, and the severity score data. Results: A total of 5,805 acute primary missions were completed in Norway in 2011. The median flying time was 19 minutes (25%- 75% percentiles: 13-28). The mean mission rate for the 17 bases was 7.5 (95% confidence interval, 7.4-7.8 per 10,000 inhabitants). The overall mean (standard deviation) National Committee on Aeronautics score for all missions was 4.07 (1.30). Conclusion: The government's expectation of serving the entire population via HEMS within 45 minutes appears to be achieved on a national level. However, vast differences remain in the flying times and rates between bases.

Objective The main objective of the Norwegian air ambulance service is to provide advanced emergency medicine to critically ill or severely injured patients. The government has defined a time frame of 45 minutes as the goal within which 90% of the population should be reached. The aims of this study were to document accurate flying times for rotor wing units to the scene and to determine the rates of acute primary missions in Norway. Methods We analyzed operational data from every acute primary mission from all air ambulance bases in Norway in 2011, focusing on the flying time taken to reach scene, the municipality requesting the flight, and the severity score data. Results A total of 5,805 acute primary missions were completed in Norway in 2011. The median flying time was 19 minutes (25%-75% percentiles: 13-28). The mean mission rate for the 17 bases was 7.5 (95% confidence interval, 7.4-7.8 per 10,000 inhabitants). The overall mean (standard deviation) National Committee on Aeronautics score for all missions was 4.07 (1.30). Conclusion The government's expectation of serving the entire population via HEMS within 45 minutes appears to be achieved on a national level. However, vast differences remain in the flying times and rates between bases.

Objective. The main objective of the Norwegian air ambulance service is to provide advanced emergency medicine to critically ill or severely injured patients. The government has defined a time frame of 45 minutes as the goal within which 90% of the population should be reached. The aims of this study were to document accurate flying times for rotor wing units to the scene and to determine the rates of acute primary missions in Norway. Methods. We analyzed operational data from every acute primary mission from all air ambulance bases in Norway in 2011, focusing on the flying time taken to reach scene, the municipality requesting the flight, and the severity score data. Results. A total of 5,805 acute primary missions were completed in Norway in 2011. The median flying time was 19 minutes (25%-75% percentiles: 13-28). The mean mission rate for the 17 bases was 7.5 (95% confidence interval, 7.4-7.8 per 10,000 inhabitants). The overall mean (standard deviation) National Committee on Aeronautics score for all missions was 4.07 (1.30). Conclusion. The government's expectation of serving the entire population via HEMS within 45 minutes appears to be achieved on a national level. However, vast differences remain in the flying times and rates between bases. Helicopter emergency medical services (HEMS) are an integral part in many health care systems in the developed world. The effect of HEMS is still subject to debate although they have several theoretical advantages, such as bringing advanced medical care and medical competence to the scene, shortening the transport time, providing access to remote areas, and reducing the time elapsed until definitive care is available. Several outcome studies have found positive associations with increased survival under the care of HEMS, whereas the opposite effects have also been well documented. However, many of these studies have been subject to methodological limitations, selection bias, and noncomparable study settings or designs. A position paper by several American air medical societies initiated the process of establishing national guidelines to facilitate the beneficial effects of HEMS implementation. The paper stated that clinical benefit could be provided by minimizing the time to definitive care in time-sensitive medical conditions, providing necessary competence and equipment on the scene, and accessing patients who are otherwise inaccessible by other modes of transport.4 These objectives are consistent with national guidelines in other countries. Based on international experiences, a Norwegian national air ambulance (AA) service was established in 1988. A paramount principle in Norwegian health legislation is that all citizens should have equal access to publicly funded health care regardless of their residential pattern. In that sense, well-developed air emergency services have a compensatory effect that adjusts for geographic dispersion and potential unequal access to advanced emergency medical care. A time frame of 45 minutes, including up to a 15-minute reaction time from alarm to takeoff, has been defined as the national goal to reach 90% of the population. In 2002, Heggestad and Børsheim published results on the accessibility and distribution of the Norwegian national air emergency service. In their study, the mean reaction time was 8 minutes in acute missions (from alarm until takeoff), and the mean total response time from alarm until scene arrival was 26 minutes. Nearly 98% of the population was reached within 60 minutes. Within the last decade, the population has increased, enhanced medical capabilities have been developed, and additional helicopter bases have been implemented. Hence, the aims of this study were to document the accurate flying times of rotor wing units to the scene as well as the rates of acute primary missions in Norway. ; publishedVersion

Variations within and between opioid maintenance programmes have been identified in other countries such as US and the UK. The aim of this study was to assess possible differences in treatment organisation, practices and outcomes between 14 regional centres within the Norwegian Opioid Maintenance Treatment programme, which were subject to the same government standards. This was a national ecological study conducted in November 2008 in Norway. Marked variations between the centres in caseload, choice of agonists, prescribing doctor, as well as in the use of supervised dispensing and urine drug screening were found. Only prescribed agonist dose was consistent across all centres. Centres in which patients had more illicit drug use had fewer patients with long-term living arrangements, more unemployment, and more patients who reported social security benefits as main income. The differences occurred despite government regulations, policies and guidelines, and frequent national meetings between centre managers. These findings show how government standards may be interpreted and implemented differently

Everyday life consists of hundreds of choices of which many may have an impact on our health. The citizens of the modern Nordic welfare states are in general well-educated and thus can be assumed to know what is best for them. Despite this our health care systems face an increasing burden of lifestyle related diseases and there is a difference across the social gradient. Here building public health knowledge through communication is key. The reason for people making unhealthy choices are many and can be that; they do not know what is good for them (lack information) or do not understand (lack understanding) or do not care (carelessness). However it seems likely that it is more complex than that. Maybe they do not receive the information, because gets conveyed through channels that they do not consult or maybe the format of the message does not 'click'? Could it be, that 'one media message or channel does not fit all'? Over the last decades there has been an increased focus from both scientists themselves and politicians to scientific and practical field of 'science communication'. Consequently, various advanced modes of communicating e.g. health issues to the general populations have been developed, and today scholars of Mass Media term this development the 'scientification' of media. Furthermore, media and information availability has exploded since the emergence of the Internet in the early 1990s. Research has indicated that social gradient also is a factor affecting a person's media consumption and habit. In the healthy choices project we aim through novel methods to learn more about these challenges and at the develop new methods of conveying public health knowledge to enable people to make healthier choices across the social gradient. We have so far built a framework for this including a science group, consisting of public health experts, and a communication group consisting of experienced science communicators. The Science group is consulted about risk factors and health endpoints and what to prioritize. Two PhD students will be involved in; 1) assessing media consumption and usage related to health issues across social classes (Low social gradient versus high social gradient) and across the generational gap (young and elderly) and 2) develop and test various media message formats for target groups including considerations of the social gradient. This project will provide new understanding on how to communicate public health messages and reduce social inequalities in health.