KITH (Norway)

Collaboration between healthcare services is essential for the quality and continuity of care for persons with chronic pain. Collaboration meetings using digital solutions can be useful in overcoming collaboration challenges. However, there is a scarcity of studies on conducting digital collaboration meetings across services, particularly across healthcare levels for patients with chronic pain. Therefore, the aim of the study was to develop recommendations for how to plan and conduct digital collaboration meetings across care levels and services for patients with chronic pain. A qualitative study collecting data from a development process for digital collaboration meeting recommendations was conducted between October 2022 and June 2023. Data were collected at workshops, discussions in the clinic and research group meetings. The analysis focused on topics that generated the most discussions during the development process. The discussions leading to the recommendations were categorised into three themes: ‘Patient-centeredness in the digital collaboration meeting’, ‘A common action plan’ and ‘Good meeting climate’. The main discussions included what it meant to place the patient at the centre of the activities, whether the patient should be present when professionals discussed the interprofessional assessments, whether clinical notes and suggestions for action should be distributed before the digital collaboration meeting, and how to ensure well-led meetings with clear agendas. A set of recommendations for how to plan and conduct digital collaboration meetings across care levels and services for patients with chronic pain was developed. Due to practical issues and differing opinions, the final recommendations offer flexible approaches to meet different levels of preparedness before the meeting. The recommendations are ready to be further tested as collaboration meetings are implemented more widely.

Although dental fear and anxiety are common in children and adolescents, they are not well-defined constructs and may not capture critical clinical aspects. Dental phobia (DP) is more well-defined as a specific phobia that includes the criteria of functional impairment. To investigate the prevalence and covariates of DP. A representative sample from two birth cohorts in Trondheim, Norway (n = 666) was assessed at age 16. A diagnostic interview using the Kiddie Schedule for Affective Disorders and Schizophrenia was conducted with both parent and adolescent. Personality traits, intelligence, and executive functioning were also assessed. The prevalence of DP was estimated to 3.7% (95% CI: 2.7%-5.1%), whereas 8.0% (95% CI: 6.5%-9.9%) had intra-oral injection phobia (I-OIP). Generally, DP was not associated with anxiety, depressive disorders, personality traits, or poor executive functioning. However, DP was comorbid with social anxiety disorder and had more symptoms of ADHD, hyperactivity-impulsivity, and lower verbal intelligence than those without DP. Dental phobia is prevalent in adolescence and exists independently from other anxieties, although persons with DP more often experience social anxiety, hyperactivity, impulsivity, and difficulties understanding advanced language. These tendencies could lead to challenges with interaction and comprehension during dental visits.

BackgroundStudies show that oral health problems are common among older adults. However, population estimates of oral health problems are largely restricted to individual subgroups. Thus, we aimed to estimate the prevalence of oral health problems in an older adult population comprised of both community dwellers and nursing home residents, and to assess differences between sexes, age groups, and these living situations.MethodsThis cross-sectional study used data from HUNT4 Trondheim 70 + , a part of the fourth Trøndelag Health Study (HUNT4), Norway. Oral health was assessed using the Revised Oral Assessment Guide – Jönköping (ROAG-J). Dental status and use of dentures were evaluated as part of the oral health assessment. A total of 1562 participants aged ≥ 70 years had complete data on ROAG-J and were included for analysis. Prevalence estimates were standardised using inverse probability weighting.ResultsThe standardised prevalence of oral health problems and severe oral health problems were 56.1% (95% CI 53.5–58.7) and 9.4% (95% CI 8.0–10.9). The three most common problems were related to teeth (31.9%), dentures (22.0%), and tongue (16.3%). A total of 9.2% were edentulous and 29.6% used full or partial dentures. Differences in prevalences between sexes were found for oral health problems, edentulism, and the use of dentures. The prevalence of having oral health problems, few or no teeth, and using dentures increased with age, and was higher among nursing home residents than community dwellers.ConclusionMore than half of the population ≥ 70 years of age had oral health problems that indicated the need for preventive measures or further clinical assessment. This was especially apparent among the oldest and nursing home residents.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12903-025-06683-y.

BackgroundMost studies on the prevalence of oral mucosal lesions (OMLs), including those from Norway, focus on patient populations. This study aimed to estimate the overall prevalence of OMLs and its types across different age groups and to examine their association with selected risk factors in a general adult population of Norway.MethodsThis cross-sectional study included a random sample of 4,909 individuals aged 19 years and older who completed questionnaires and underwent a standardized clinical examination for OMLs in the HUNT Oral Health Survey (2017–2019). The classification of OMLs was based on the World Health Organization and NHANES III guidelines. Odds Ratio (OR) with 95% confidence intervals (CI) were calculated using multivariable logistic regression to assess associations between OMLs and potential risk factors, adjusting for relevant confounders.ResultsThe overall prevalence of OMLs was 7.5%, with a higher proportion observed in individuals aged 60 and older. The most prevalent oral lesions were exophytic lesions (3.1%) and white lesions (1.5%). Notably, individuals with a low/middle level of education had higher odds of having an OMLs than those with a higher level of education (OR, 1.27, 95% CI: 1.00-1.61) in the fully adjusted model. Exploratory analyses of lesion types found a positive association between smoking status and white lesions (OR, 1.77, 95% CI:1.05–2.97), as well as between a history of cancer and red-blue lesions (OR, 2.17, 95% CI, 1.14–4.11).ConclusionIn this population-based study, 7.5% of Norwegian adults had one or more OMLs, with higher prevalence in participants aged 60 years and older. Further research is needed to confirm these findings in similar populations.

ABSTRACTObjectivesTo report oral health‐related quality of life (OHRQoL) in a sample rehabilitated with dental implants and assess the influence of self‐reported implant complications and clinical peri‐implant status. A secondary aim was to investigate associations between OHIP‐14 scores and patient‐related variables.Materials and MethodsThe Norwegian National Insurance Scheme registry for implant rehabilitation in 2014 was searched, and patients (n = 3083) were mailed a survey including OHIP‐14, questions about peri‐implant status, and patient‐related variables. A subsample was examined clinically (n = 242). Associations of self‐reported implant complications and clinical peri‐implant status with OHIP‐14 scores were evaluated by the Kruskal–Wallis test and logistic regression models.ResultsThe OHIP‐14 mean sum score reported by the 1299 survey respondents was 4.1 (± 6.4). Self‐report of complications was associated with higher OHIP‐14 scores in a dose‐dependent manner. Lower education (OR 1.54, 95% CI 1.05–2.22), female sex (OR 1.75, 95% CI 1.23–2.56), technical complication(s) (OR 1.58, 95% CI: 1.07–2.34), biological complication(s) (OR 2.41, 95% CI 1.67–3.49) and poor cleansability (OR 2.94, 95% CI 1.64–5.37) were associated (p < 0.05) with higher OHIP‐14 mean sum scores in the adjusted regression model. For the 242 patients examined clinically, the OHIP‐14 mean sum score was 3.8 (± 6.5). Peri‐implant soft tissue dehiscence (OR 2.53, 95% CI 1.17–5.49) was associated with higher OHIP‐14 mean sum scores in the adjusted regression model.ConclusionsOHIP‐14 scores were low in this study, indicating good OHRQoL following implant rehabilitation in Norway. Complications lowered OHRQoL in a dose–response manner, confirmed by self‐reports of complications and by the presence of peri‐implant soft tissue dehiscence.

Serum 25-hydroxyvitamin D (25(OH)D), a marker of vitamin D status influenced by sunlight exposure and diet, may affect various health conditions. This study investigates the tracking of serum 25(OH)D levels over 11 years in a general adult Norwegian population and identifies factors influencing future 25(OH)D levels. Serum 25(OH)D was measured in 3511 adults participating in both second and third surveys of the Trøndelag Health Study (HUNT2: 1995-1997, HUNT3: 2006-2008). Serum 25(OH)D was measured using a chemiluminescent assay and calibrated for batch effect and seasonal variation. Tracking was evaluated using correlation coefficients, intraclass correlation coefficient (ICC), and coefficient of variation (CV). Multivariable linear regression examined relations between factors in HUNT2 and 25(OH)D in HUNT3. The correlation coefficient between 25(OH)D levels in HUNT2 and HUNT3 was 0.50 (95% CI: 0.47 to 0.52), with an ICC of 0.64 (95% CI: 0.56 to 0.70) and a CV of 18%. An average of 43% (range: 20.4%-54.9%) of participants remained in the same vitamin D category (<30.0, 30.0-49.9, 50.0-74.9 and ≥75.0 nmol/L) across both surveys. Male sex, vitamin D-decreasing polygenic score, higher body mass index and current smoking were associated with lower 25(OH)D levels, while higher education, moderate alcohol intake and vitamin D supplementation were associated with higher levels. Serum 25(OH)D levels demonstrated moderate reliability over 11 years, suggesting that a single measurement may be insufficient for assessing long-term vitamin D status. Repeated measurements are recommended for accurate evaluation of vitamin D's role in chronic disease risk.

BackgroundWith increasing focus on patient-reported outcome measures (PROMs) in chronic rheumatic diseases, we aimed to evaluate the self-reported physical and psychosocial health in children with juvenile idiopathic arthritis (JIA) compared to matched population-based controls. Furthermore, we aimed to study the association of patient- and physician-reported outcome measures in JIA with patient-reported physical disability.MethodsWe used data from a Norwegian JIA cohort study (NorJIA), including clinical characteristics and outcome measures in participants with JIA and sex- and age-matched population-based controls. Self-reported physical and psychosocial health were assessed using the generic Child Health Questionnaire (CHQ). Comparisons between children with JIA and controls were performed by test of proportions for categorical variables and t-test for continuous variables. To evaluate the association of patient- and physician-reported outcome measures with patient-reported physical disability, assessed with the Child Health Assessment Questionnaire (CHAQ) in children with JIA, we used logistic regression to estimate adjusted odds ratio (OR) with 95% confidence interval (CI).ResultsIn total, 221 participants with JIA (59.3% females, median age 12.7 years) and 207 controls with available data were included. In the JIA group, 24.3% scored below the norm for physical health (CHQ PhS < 40) and 8.7% scored below the norm for psychosocial health (CHQ PsS < 40). The corresponding numbers for the control group were 0.5% and 1.9%, respectively. In the JIA group, 57.9% reported physical disability (CHAQ > 0). Several patient-reported outcome measures, such as poor physical health (CHQ PhS < 40), disease-related pain, and the patient’s global assessment of disease impact on wellbeing, were strongly associated with self-reported physical disability (CHAQ > 0), adjusted OR 19.0 (95% CI 5.6, 64.1), 14.1 (95% CI 6.8, 29.2), and 14.0 (95% CI 6.2, 31.6), respectively.Associations were also found for active disease according to Wallace (adjusted OR 36.3, 95% CI 10.3, 128.1), and physician-reported global assessment of disease activity (adjusted OR 6.2, 95% CI 3.1, 12.6).ConclusionsThe strong association between patient- and physician-reported outcome measures and patient-reported physical disability strengthens the importance of including the patient’s voice in a comprehensive evaluation of patient outcome in JIA.Trial registrationClinicalTrials.gov (No: NCT03904459).

Dental phobia (DP) and injection phobia (IP) are common in children and adolescents and are considered some of the biggest obstacles to successful treatment in pediatric dentistry. Cognitive behavioral therapy (CBT) is an evidence-based treatment for anxiety and phobias. As the availability of CBT in dentistry is low, internet-based CBT (ICBT) was developed. Open trials have shown that ICBT is a promising intervention, but randomized trials are lacking. This randomized controlled trial tests whether therapist-guided ICBT supported by a parent could reduce fear, allowing children and adolescents with DP or IP to receive dental treatment. We enrolled 33 participants (mean age 11.2, SD 1.9 y) whom a clinical psychologist had diagnosed with DP, IP, or both. After inclusion, participants were randomized to either ICBT (17/33, 52%) or a control group of children on a waitlist (16/33, 48%). ICBT was based on exposure therapy and comprised a 12-week at-home program combined with visits to their regular dental clinic. Participants corresponded weekly with their therapist after completing each module, and 1 parent was designated as a coach to support the child in the assignments during treatment. All participants completed measurements of the outcome variables before treatment start and after 12 weeks (at treatment completion). The measurements included a structured diagnostic interview with a clinical psychologist. Our primary outcome measure was the Picture-Guided Behavioral Avoidance Test (PG-BAT), which assesses the ability to approach 17 dental clinical procedures, and a positive clinical diagnosis. Secondary outcome measures included self-report questionnaires that measured self-efficacy and levels of dental and injection anxiety. The children and their parents completed the questionnaires. All participants underwent the 12-week follow-up. After treatment, 41% (7/17) of the participants in the ICBT group no longer met the diagnostic criteria for DP or IP, whereas all participants in the control group did (P=.004). Repeated-measure ANOVAs showed that ICBT led to greater improvements on the PG-BAT compared with the control group; between-group effect sizes for the Cohen d were 1.6 (P<.001) for the child-rated PG-BAT and 1.0 (P=.009) for the parent-rated PG-BAT. Reductions in our secondary outcomes-dental fear and anxiety (P<.001), negative cognitions (P=.001), and injection fear (P=.011)-as well as improvements in self-efficacy (P<.001), were all significantly greater among children in the ICBT group than in the controls. No participants reported adverse events. ICBT seems to be an effective treatment for DP and IP in children and adolescents. It reduced fear and anxiety and enabled participants to willingly receive dental treatment. ICBT should be seriously considered in clinical practice to increase accessibility; this therapy may reduce the need for sedation and restraint and lead to better dental health in children and adolescents. ClinicalTrials.gov NCT02588079; https://clinicaltrials.gov/study/NCT02588079.

IntroductionWomen with a history of gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Recommendations for postpartum follow-up include targeted lifestyle advice to lower the risk.The aim of this study was to compare postpartum lifestyle behaviours and perceptions among women with and without a history of GDM. In addition, we examined whether lifestyle behaviours of women with a history of GDM participating in a lifestyle intervention study differed from lifestyle behaviours of women with a history of GDM in the general population.Research design and methodsWe linked data from the fourth survey of the population-based Trøndelag Health Study (HUNT4) to information from the Medical Birth Registry of Norway for women with registered births between 2000 and 2019. Using logistic regression, we compared lifestyle behaviours in women with and without GDM. In secondary analyses, lifestyle behaviours in women with GDM participating in a postpartum lifestyle intervention study were compared with HUNT participants with GDM using Fisher’s exact tests/t-tests.ResultsA high proportion of the women in our population, regardless of GDM history, reported several unhealthy lifestyle behaviours. We found no significant association between history of GDM and lifestyle behaviours. The lifestyle intervention study for women with a history of GDM appeared to recruit women with more favourable lifestyle behaviours.ConclusionsWomen, regardless of GDM history, could potentially benefit from further support for lifestyle improvement, but it may be especially important in women with a history of GDM given their increased risk of T2DM and CVD. Interventions targeting women with GDM might not reach the women with the unhealthiest lifestyle behaviours, and measures to reach out to all women should be further investigated.

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