Norwegian Institute of Public Health

Background Depression and anxiety disorders are highly prevalent among young adults, with evidence suggesting sleep problems as key risk factors. Objective This study aimed to examine the association between insomnia and sleep characteristics with major depressive episode (MDE) and anxiety disorders, and the association after accounting for baseline mental health symptoms. Methods We conducted a prospective cohort study using data from the Students’ Health and Wellbeing Study (SHoT), surveying Norwegian higher education students aged 18 to 35 (N = 53,362). A diagnostic assessment of 10,460 participants was conducted in 2023. Self-reported insomnia, sleep duration, sleep onset latency, and wake after sleep onset were recorded in 2022. MDE and five types of anxiety disorders were assessed after one year using a self-administered CIDI 5.0. Analyses adjusted for age, sex, baseline mental health symptoms, and somatic conditions. Results Insomnia in young adults was associated with a significantly increased risk of MDE (adjusted RR = 3.50, 95 % CI = 3.18–3.84) and generalized anxiety disorder (GAD) (adjusted RR = 2.82, 95 % CI = 2.55–3.12) one year later. Sleep duration showed a reversed J-shaped association with mental disorders, with both short and, to a lesser extent, long sleep durations linked to elevated risks, even after adjusting for baseline mental health symptoms and somatic conditions. Although the associations were attenuated after adjustment, they remained statistically significant. Conclusion Sleep disturbances, including insomnia and abnormal sleep durations, predict mental health issues in young adults, even after accounting for baseline mental health and somatic health. Addressing sleep problems early may help prevent subsequent mental health conditions in this population.

Introduction Evidence syntheses are crucial in healthcare and elsewhere but are resource‐intensive, often taking years to produce. Artificial intelligence and machine learning (AI/ML) tools may improve production efficiency in certain review phases, but little is known about their impact on entire reviews. Methods We performed prespecified analyses of a convenience sample of eligible healthcare‐ or welfare‐related reviews commissioned at the Norwegian Institute of Public Health between August 1 2020 (first commission to use AI/ML) and January 31 2023 (administrative cut‐off). The main exposures were AI/ML use following an internal support team's recommendation versus no use. Ranking (e.g., priority screening), classification (e.g., study design), clustering (e.g., documents), and bibliometric analysis (e.g., OpenAlex) tools were included, but we did not include or exclude specific tools. Generative AI tools were not widely available during the study period. The outcomes were resources (person‐hours) and time from commission to completion (approval for delivery, including peer review; weeks). Analyses accounted for nonrandomized assignment and censored outcomes (reviews ongoing at cut‐off). Researchers classifying exposures were blinded to outcomes. The statistician was blinded to exposure. Results Among 39 reviews, 7 (18%) were health technology assessments versus systematic reviews, 19 (49%) focused on healthcare versus welfare, 18 (46%) planned meta‐analysis, and 3 (8%) were ongoing at cut‐off. AI/ML tools were used in 27 (69%) reviews. Reviews that used AI/ML as recommended used more resources (mean 667 vs. 291 person‐hours) but were completed slightly faster (27.6 vs. 28.2 weeks). These differences were not statistically significant (relative resource use 3.71; 95% CI: 0.36–37.95; p = 0.269; relative time‐to‐completion: 0.92; 95% CI: 0.53–1.58; p = 0.753). Conclusions Associations between AI/ML use and the outcomes remains uncertain. Multicenter studies or meta‐analyses may be needed to determine if these tools meaningfully reduce resource use and time to produce evidence syntheses.

Background Vitamin D is metabolised throughout the male reproductive system, suggesting a direct regulatory role of vitamin D in male reproduction. Objectives To investigate the association between plasma vitamin D levels at sperm ejaculation and during spermatogenesis and biomarkers of male fecundity in young men. Materials and methods From the Fetal Programming of Semen Quality cohort, Denmark, 2017–2019, 1047 young men provided a semen and a blood sample, and self‐measured their testes volume at a clinical visit. Plasma levels of vitamin D (25(OH)D 3 ) and reproductive hormones were measured in the blood sample. Relative percentage differences in semen characteristics, testes volume and reproductive hormone levels were analysed according to measured vitamin D levels (categorised, continuous and as restricted cubic splines) at sperm ejaculation. Additionally, we used the seasonal variation in endogenous vitamin D synthesis to estimate individual vitamin D levels 3 months prior to sperm ejaculation (at initiation of spermatogenesis) in addition to 2 and 1 month before. This was analysed following the same strategy. Results Compared to measured vitamin D levels >75 nmol/L, levels <25 nmol/L at sperm ejaculation were associated with lower total sperm count (‒15% [95% confidence interval: ‒33%; 8%]), and a higher proportion of non‐progressive and immotile spermatozoa (11% [95% confidence interval: 0%; 24%]). Lower measured vitamin D levels were also associated with higher oestradiol, lower sex hormone‐binding globulin and lower follicle‐stimulating hormone, in dose‐dependent manners. Vitamin D levels estimated before and during spermatogenesis yielded similar associations as vitamin D levels measured at sperm ejaculation. Discussion By using the seasonal variation in endogen vitamin D synthesis, we were able to estimate individual vitamin D levels during spermatogenesis. Conclusion Lower vitamin D levels before and during spermatogenesis and at sperm ejaculation were associated with lower total sperm count and sperm motility and an altered reproductive hormone profile.

Dose rate is an important factor influencing the biological outcomes of environmental ionizing radiation exposure. This study aimed to investigate genotoxic and phenotypic effects of dose rate while keeping the total dose constant (3 Gy). Using the Figaro facility, CBA/CaOla and C57BL/6N mice were exposed to gamma radiation (60Co) at low (2.5 mGy/h for 54 d) and higher dose rates (10 mGy/h for 14 d and 100 mGy/h for 30 h). Cellular stress was assessed through micronuclei in reticulocytes, DNA damage (comet assay), mitochondrial DNA copy number variation and common deletions (digital droplet PCR), and protein carbonylation in plasma. Micronucleus formation in reticulocytes proved to be a highly sensitive and specific dose rate predictor, shown by a log-linear dose rate response (R2 = 0.98). Mitochondrial DNA copy number increased in a strain- and dose rate-dependent manner, while no significant effects on common deletions or protein carbonylation were detected. Chronic low dose rate exposure led to an approximate 60 % reduction in testis weights, other phenotypic results were not evident. Benchmark dose analysis of liver transcriptomic data revealed shared radiation responses across functional categories and transcriptional points of departure for DNA damage-related pathways. The BMD analysis of MN-RETs demonstrated a BMDL far below the lowest dose, indicating that the MN-RET-assay is suitable for lower dose rates and total doses. Integrating adverse effect analysis with BMDL estimations improves dose rate-response characterization and contributes to more refined risk assessment, reducing reliance on high dose rate extrapolation.

Aims Independent living among older adults is a global political goal aimed at reducing government spending on health and care services. This study investigates the prevalence of having someone to rely on for help when needed among community-dwelling adults aged 70 and older. Methods The study sample comprised population-based data from 24,289 adults aged 70 or older participating in the Trøndelag Health Study (HUNT4). Standardized prevalence of having someone to rely on for help if needed in total, and from family, friends, or neighbors was estimated using Trøndelag county as the standard population. Prevalences were additionally stratified by gender, age, living situation, activities of daily living (ADL), and utilization of home-based services. Results Standardized results showed that overall, 97.3% reported having someone to ask for help if needed, of whom 92.5% relied on family, 31.7% on friends, 23.1% on neighbors. The youngest men living alone had fewer to rely on compared to those living with others. Moreover, living alone was associated with relying less on family and more on friends and neighbors. Factors associated with relying on family members were female gender, younger age, cohabitation, no ADL problems, and no home-based services. Along with education, these factors also correlated with relying on friends for help. Conclusions Nearly all those aged 70 and older in Norway have someone to ask for help, which is positive for aging in place policies. However, those living alone, especially men, are at a higher risk of not having anyone to rely on for help when needed.

Background The frequency and mechanisms of persistent health complaints attributed to tick bites or tick-borne diseases are unknown. We evaluate such complaints in Norwegian cases and controls. Methods People older than 18 years with persistent health complaints of six months or more attributed to tick bites or tick-borne diseases (cases) were recruited into a nationwide cross-sectional study between October 2016 and January 2021. Demographic data, tick bites, antibiotic use, and tick-borne pathogen serology were recorded. We evaluated somatic symptoms (PHQ-15), fatigue (Fatigue Severity Scale), mental and physical health (RAND-36), affective symptoms (HAD Scale) and modern health worries (MHW Scale) as outcome measures. Serological tests included IgG antibodies against B. burgdorferi (Bb) and other tick-borne pathogens. The control population (n = 2803) was recruited from a tick-endemic region in Søgne, southern Norway. Differences between cases and controls were evaluated. Results A total of 500 responses were collected through general practitioners (n = 14), by invitation (n = 94), and by Short Message Service (SMS) (n = 392). The estimate of prevalence is based on 392 of 270.000 included by SMS (0.15%). The SMS cohort reported better physical health than those recruited by invitation. Cases had significantly more somatic and affective symptoms, fatigue, comorbidities, and reduced quality of life related to health than controls. The differences in fatigue and physical health between cases and controls were not related to previous tick exposures. Bb IgG and other antibodies against tick-borne pathogens were more prevalent in cases than controls. In multivariable analyses, cases that were never treated did not exhibit higher somatic symptom scores compared to those treated multiple times. Seropositive Bb cases had worse mental health (p < 0.001) and more depressive symptoms (p = 0.017) than seronegative cases. Conclusions The crude prevalence of persistent health complaints in Norway attributed to tick bites or tick-borne diseases is 0.15%. The cases reported significantly poorer physical health, including increased fatigue, when compared to the controls. These relationships were not affected by tick exposures. However, poorer mental health in cases may be associated with Bb seropositivity, especially for the ones with comorbidities. In conclusion, no clear associations were found between tick bites, tick-borne diseases and persistent health complaints.

Knowledge about the somatic health of young adults born to immigrant parents is lacking. This study aims to assess the risk of receiving somatic diagnoses among Norwegian-born young adults with immigrant parents compared to their counterparts with two Norwegian-born parents. Data from Medical Birth Registry of Norway and Statistics Norway were linked to data from Norwegian Patient Registry on 37 diagnostic categories of somatic conditions given in specialist health care between 2008 and 2022. Norwegian-born individuals aged 16–30 years between 2008 and 2022 were included (N = 1 522 597). Hazard ratios (HR) of diagnoses by immigrant background were assessed by Cox regressions adjusted for sex, birth year, and parental education. Individuals with two immigrant parents had lower risk of receiving any somatic diagnosis [HR (95% confidence interval) 0.91 (0.90, 0.93)], as well as any infectious, medical or neurological diagnosis, than counterparts with two Norwegian-born parents. Those with an immigrant mother only had lower risk of any somatic diagnosis [HR 95% CI 0.94 (0.92, 0.95)] and of any medical or neurological diagnosis. These differences were not seen after adjustment for parental duration of residence and education. Those with an immigrant father only had higher risk of any somatic diagnosis [HR 95% CI 1.03 (1.02, 1.04)], as well as any infectious or neurological diagnosis. Norwegian-born young adults with two immigrant parents or an immigrant mother had lower risk than those with two Norwegian-born parents of receiving somatic diagnoses in specialist health care before adjustment for parental duration of residence and education, while those with an immigrant father only, had higher risk.

Background Mammographic density is known to decrease over time in postmenopausal women. Longitudinal changes in mammographic density prior to breast cancer diagnosis have been widely discussed and less density reduction has been observed for breast developing versus not developing cancer. We aimed to verify these findings among participants of BreastScreen Norway. Methods In this retrospective cohort study, data from 78,182 women aged 50–69 years who attended three consecutive screening rounds between 2007 and 2020 were included. Among those women, 970 were diagnosed with screen-detected and 308 with interval cancer. Mammographic density data was obtained from an automated software and included absolute (cm³) and percent (%) dense volume for each breast and for each woman, per examination. A linear mixed-effects regression model estimating differences in density between the breast developing and not developing cancer was applied to evaluate longitudinal changes, separately for absolute and percent dense volume. The model was adjusted for age at first screening examination, breast volume, follow-up time, history of benign breast disease, body mass index, family history, hormone therapy, use of alcohol and smoking. Results were presented as linear regression coefficient estimates with 95% confidence intervals (CI). Results Mean age at the third screening examination for women without breast cancer was 62.5 (standard deviation, SD: 5.1) years, while mean age at diagnosis was 62.3 (SD: 4.4) years for women with screen-detected cancer and 61.9 (SD: 4.8) years for women with interval cancer. In our model, absolute and percent dense volume decreased with follow-up time, estimate=-0.010 (95%CI -0.010; -0.009) and estimate=-0.013 (95%CI -0.014; -0.013), respectively, indicating the overall negative effect of time on mammographic density. The interaction between time and development of breast cancer was positive for absolute and percent dense volume, estimate = 0.009 (95%CI 0.004; 0.014) for both, which implied that mammographic density in breasts developing cancer was stable or slightly decreasing. Conclusions Less reduction in longitudinally assessed mammographic density was observed for breasts developing versus not developing cancer in our study. This difference might be used for more precise 4–6 years breast cancer risk prediction and screening personalization.

Background Hypochondriacal disorder involves persistent anxiety about suffering from an undetected serious medical condition, despite medical reassurance. Hypochondriacal disorder significantly affects social relationships, occupational functioning and personal well-being. In university settings, where mental health concerns are prevalent, insights into prevalence of hypochondriacal disorder and associations with depression and other health challenges are essential. AimsThis study examines the prevalence and correlates of hypochondriacal disorder among Norwegian university students, focusing on its associations with depression, mental distress and somatic symptom burden. Method The 2022 Students’ Health and Wellbeing Study, a national survey of Norwegian higher education students, included 59 536 participants aged 18–35. Participants were categorised based on a pre-defined diagnostic list of mental and somatic concerns, and participants were grouped as follows: hypochondriacal disorder only, depression only, comorbid hypochondriacal disorder and depression and controls. Validated instruments included the Somatic Symptom Scale-8, the Hopkins Symptoms Checklist, the Satisfaction With Life Scale, an abbreviated version of the University of California, Los Angeles, Three-Item Loneliness Scale and four items on suicidal ideation. ResultsHypochondriacal disorder was reported by 0.86% (n = 457) of participants, with 52% also reporting depression. Those with hypochondriacal disorder had significantly worse mental and somatic health outcomes, especially when comorbid with depression, including elevated distress, suicidality, insomnia and poor quality of life. Conclusion Although uncommon, hypochondriacal disorder is linked to severe mental and somatic health burdens, particularly when co-occurring with depression. These findings highlight the need for integrated mental health strategies in academic settings to address hypochondriacal disorder and its frequent comorbidities.

The aim was to estimate all-cause and cause-specific mortality in long-term prescription opioid users compared to the general population. This nationwide registry–based cohort study used data of patients aged 15 to 69 years with no previous cancer diagnosis and a recorded episode of long-term opioid analgesics use (anatomical therapeutic chemical [ATC] group N02A; N = 116,006) in Norway between 2011 and 2019. Sex-specific crude mortality rates (CMR) and age-standardized mortality ratios (SMRs) were calculated for all-cause and cause-specific mortality, ie, natural and unnatural causes for the whole study population and for different age groups (15-34, 35-54, and 55-69 years). Overall, 4.6% (2491/54,535) of men and 2.7% (1680/61,471) of women died during the follow-up period. Crude mortality rates for all-cause mortality were 1194 and 724 deaths per 100,000 person-years (PY) in men and women, respectively. Men had higher CMRs across all causes, particularly unnatural causes (221 and 101 deaths per 100,000 PY in men and women, respectively). Patients with long-term opioid use had a 4 times higher all-cause mortality (SMR = 3.8 [95% CI = 3.6-3.9] in men and 3.7 [3.5-3.9] in women aged 15-69 years) compared to the general Norwegian population of the same age. Excess mortality was observed across all causes, particularly suicide, accidents, and accidental poisoning. Standardized mortality ratios decreased with age and were highest for the youngest age group (15-34 years), particularly among men. Long-term prescription opioid use is associated with an increased risk of death. Clinicians should weigh the risks of long-term opioid use against the benefits.

Background Scales for the measurement of mental wellbeing and psychological distress are often used as if they measure different underlying concepts. This assumption is addressed in the present study by examining the discriminant validity of the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) with respect to the Patient Health Questionnaire (PHQ-9). Methods The present study is based on data (n = 1690) from a baseline data collection which was carried out as part of the evaluation of ‘Prompt Mental Health Care’ (PMHC), the Norwegian Version of the British ‘Improving Access to Psychological Therapies’ (IAPT) services. PMHC offers low-threshold treatment for patients with mild to moderate depression or anxiety. Three out of four of the sample were women and three out of four were in the age range 21–50 years. Data were examined by means of structural equation- and latent variable modeling, including bifactor analysis and MIMIC models. Both the 7-item and 14-item versions of the WEMWBS were considered. Results (i) The correlations between PHQ-9 and the WEMWBS scales were strong and negative, approaching -0.80 in the latent model analyses with the full (14 items) WEMWBS scale. (ii) Psychometric indices derived from the bifactor models suggested that the WEMWBS-7 and PHQ-9 jointly, and the WEMWBS-14 and PHQ-9 jointly were essentially unidimensional. (iii) The associations between PHQ-9 and a set of demographic variables were similar to associations between the WEMWBS scales and the same set of demographic variables, only with reversed signs. (iv) Associations between the residual WEMWBS scales and a set of demographic variables decreased strongly when removing the reliable variance accounted for by the general depressive symptoms factor. Conclusion The results of our study suggest that the WEMWBS may lack discriminant validity with regard to the PHQ-9 in a sample of primary care patients with mild-to-moderate anxiety and/or depression.

Aim The aim of this study was to evaluate the effects of the Informed Health Choices secondary school intervention on the ability of students in Rwanda to think critically and make informed health choices after 1 year. Methods This was a two-arm cluster-randomized trial conducted in 84 lower secondary schools from 10 districts representing five provinces of Rwanda. We used stratified randomization to allocate schools 1:1 to the intervention or control arm. One class in each intervention school had ten 40-min lessons taught by a trained teacher in addition to the usual curriculum. Control schools followed the usual curriculum. The primary outcome was a passing score (≥ 9 out of 18 questions answered correctly) for students on the Critical Thinking about Health Test completed 1 year after the intervention. We conducted an intention to treat analysis using generalized linear mixed models, accounting for the cluster design using random intercepts. Results After 1 year, 35 of 42 teachers (83.3%) and 1181 of 1556 students (75.9%) in the control arm completed the test. In the intervention arm, 35 of 42 teachers (83.3%) and 1238 of 1572 students (78.8%) completed the test. The proportion of students who had a passing score in the intervention arm was 625/1238 (50.5%) compared to 230/1181 (19.5%) in the control arm (adjusted odds ratio 7.6 [95% CI: 4.6–12.6], p < 0.0001). The adjusted difference in the proportion of students with a passing score was 32.2% (95% CI 24.5–39.8%). Conclusions The IHC secondary school intervention was effective after 1 year. However, the size of the effect was smaller than immediately after the intervention (adjusted difference 32.2% vs 37.2%) due to decay in the proportion of students in intervention schools with a passing score (50.5% vs 58.2%). Trial registration Pan African Clinical Trial Registry (PCTR), trial identifier: PACTR202203880375077. Registered on February 15, 2022.

Increased exposure to social media and societal pressures to conform to idealized body standards may have amplified feelings of inadequacy among youth, notably in body weight perception. This study describes secular trends in body weight perception in Norwegian adolescents from 1994 to 2022, both before and during a period of technologically transformative changes proposed to influence body weight perception. To investigate trends in body weight perception, data across eight survey years from the Norwegian part of the repeated cross-sectional Health Behaviour in School-Aged Children study were used. Body weight perception was categorised as “Too thin”, “About right”, and “Too fat” among 11-, 13-, 15-, and 16-year-olds. The analyses showed stability in body weight perception across the 28-year period, with some gender and age differences observed. Small fluctuations were noted, most pronounced in the oldest age groups. The only significant change observed from 1994 to 2022, was an increase in the proportion of 16-year-old girls perceiving their body as “About right”. Between 2018 and 2022, there was an increase in the proportion of 11-year-old girls perceiving their body as “Too fat”. Stability in body weight perception was observed from 1994 to 2022, despite the assumed impact of certain technologically transformative changes, such as social media. However, the study highlights a concerning rise in 11-year-olds perceiving their bodies as “Too fat” between 2018 and 2022, underlining the continued need for regular monitoring of body weight perception in the adolescent population.

Background Medication use during pregnancy for attention‐deficit/hyperactivity disorder (ADHD) is increasing, but evidence on its safety in pregnancy for foetal health is limited, with little attention to time‐related biases in observational research. Objective To determine the association between ADHD medication use in early and late pregnancy and the risk of preterm birth. Methods This population‐based cohort study utilised data from national registers, including records on births, prescription medications, specialist healthcare visits, hospitalisations and educational attainment, to account for relevant potential confounders. We included singleton births delivered between 22 and 44 gestational weeks among pregnant individuals with ADHD medication use in the year before conception from Norway (2009–2020) and Sweden (2007–2019). ADHD medications (amphetamine, dexamphetamine, methylphenidate, atomoxetine, lisdexamfetamine and guanfacine) were assessed during early (conception to 21 gestational weeks) and late pregnancy (22–36 gestational weeks). The main outcome was preterm birth, defined as a live birth before 37 completed weeks of pregnancy. Risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals (CI) were estimated using log‐binomial regression and flexible parametric survival modelling to determine the risk of preterm birth in early and late pregnancy, respectively. Results Among 11,075 pregnancies, early pregnancy ADHD medication use was associated with higher preterm birth risk with ≥ 2 filled prescriptions (aRR 1.29, 95% CI 1.08, 1.53), but not as ≥ 1 prescription (aRR 1.08, 95% CI 0.93, 1.25). Any medication use in late pregnancy increased preterm birth risk (aHR 1.15, 95% CI 0.95, 1.39). For every 30 days of cumulative exposure to ADHD medication, the risk of preterm birth increased in late pregnancy (aHR 1.07, 95% CI 1.02, 1.12), but not in early pregnancy (aHR 1.01, 95% CI 0.97, 1.05). Conclusions ADHD medication may modestly increase the risk of preterm birth, especially with atomoxetine early and methylphenidate late in pregnancy, and with longer durations of use.

Emerging evidence suggests that exposure to air pollutants and road traffic noise triggers stress responses, which mediate physiological responses in multiple organs and tissues. However, epidemiological study in children is sparse. We aimed to evaluate whether outdoor air pollution and road traffic noise are associated with physiological response measured by allostatic load in children. We studied 919 children aged 6–11 years from the HELIX (Human Early Life Exposome) cohort in 6 European countries with 19 biomarkers assessed in four physiological systems—cardiovascular, metabolic, immune/inflammation, and neuroendocrine systems. We then calculated both count-based and continuous scores for each physiological system and generated allostatic load scores (range 0–19). Exposure to air pollution (NO2, PM2.5, PM10, PM2.5absorbance) and road traffic noise (LDEN) based on participants’ home, school, and commuting route addresses were estimated for the year prior to outcome assessment. Higher exposure to all air pollutants was associated with a higher allostatic load, although only the association of PM10 survived correction for multiple testing (for count-based allostatic load score: RR = 1.27, 95%CI: 1.08, 1.48; for continuous allostatic load score: β = 0.56, 95% CI: 0.27–0.84, per each 10 µg/m³ increase in PM10). Examining physiological systems separately, higher exposure to air pollution was mainly associated with higher allostatic load in the immune/inflammatory and metabolic systems. No associations between road traffic noise and allostatic load were observed. Our findings suggest that air pollution act as a chronic stressor in manifesting multi-systemic physiological dysregulation in childhood, which may be a precursor of air pollution-related diseases.

Quantile regression, a robust method for estimating conditional quantiles, has advanced significantly in fields such as econometrics, statistics and machine learning. In high-dimensional settings, where the number of covariates exceeds sample size, penalized methods like lasso have been developed to address sparsity challenges. Bayesian methods, initially connected to quantile regression via the asymmetric Laplace likelihood, have also evolved, though issues with posterior variance have led to new approaches, including pseudo/score likelihoods. This paper presents a novel probabilistic machine learning approach for high-dimensional quantile prediction. It uses a pseudo-Bayesian framework with a scaled Student-t prior and Langevin Monte Carlo for efficient computation. The method demonstrates strong theoretical guarantees, through PAC-Bayes bounds, that establish non-asymptotic oracle inequalities, showing minimax-optimal prediction error and adaptability to unknown sparsity. Its effectiveness is validated through simulations and real-world data, where it performs competitively against established frequentist and Bayesian techniques.

Background School nurses perform a unique role by providing health care to all children and adolescents. In Norway, their activities are regulated by the National Professional Guidelines for Health Promotion and Prevention Work in Health Centers, School Health Services and Youth Health Clinics. However, a large part of their workday involves independently planning and prioritizing activities. Understanding how they allocate this time is limited. Filling this knowledge gap is important, both for central authorities in their planning and staffing of the service, and for the continuous development of school health services. This study aims to describe how school nurses spend their time within the Norwegian school health services. Methods Over a period of 10 days, 104 school nurses documented all activities spent in school health services for a cross-sectional time study. An activity list was developed that encompassed 25 activities, 10 of which were directly devoted to interactions with children, adolescents, and/or their guardians. Time was measured at 10-minute intervals and analysed via descriptive statistics. Results Administrative work constituted the largest proportion of the registered time (22.1%), followed by individual consultations (15.9%) and meetings (10.9%). Minimal time was allocated to group activities for pupils and guardians, comprising 2.8%. The time dedicated to direct interaction with children, adolescents, and/or guardians accounted for 36% of the time, whereas the remaining 64% was spent on activities not involving direct interaction. Conclusion This study provides insights into how school nurses spend their time within Norwegian school health services and indicates a large variation in the time spent on different tasks. Future research should investigate the reasons behind these variations and analyze the content and interventions used in various activities. Although the study is conducted in a Norwegian context, the methods for describing time usage are applicable to other health sectors and countries.

Estimating the contributions of genetic and environmental factors is key to understanding differences in socioeconomic status (SES). However, the heritability of SES varies by measure, method, and context. Here, we estimate genetic and environmental sources of variance and commonality in the ‘big four’ SES indicators. We use high-quality administrative data on educational attainment, occupational prestige, income, and wealth, and employ four family-based and unrelated genotype-based heritability methods, all drawn from the same population-wide cohort of >170,000 Norwegians aged 35-45. By drawing subsamples from a consistent sample and using registry-based data, we reduce differences in estimates due to population characteristics and measurement error. Our results show that genetic variation consistently explains more for educational attainment and occupational prestige. Family-shared environmental contributions explained more for educational attainment and wealth. Our results highlight considerable common influences on the four SES indicators among genetic and shared environmental factors, but not among non-shared environmental factors. Overall, we show how the relative importance of genetic and environmental factors to SES differences in Norway varies by method and type of socioeconomic attainment. This study is a reliable source for comparing heritability methods, and for comparing SES indicators and their genetic and environmental commonality in a social-democratic welfare state.

New immune evasive variants of SARS‐CoV‐2 may increase infections and hospitalizations in risk groups, such as the elderly. In this study, we evaluated neutralizing antibodies against KP.3.1.1 and XEC, virus variants that were either widely distributed or on the rise globally in the fall of 2024, in sera from a cohort of seniors aged 68–82 years collected in April/May 2024. Neutralizing responses were low against both KP.3.1.1 and XEC, also in XBB.1.5 boosted individuals and people with recent break‐through infections, supporting the recommendation of an updated COVID‐19 vaccine booster in this age group.

Assessing traffic patterns is important for many applications such as rush hour traffic management, cross-border commuting statistics, transportation disruption assessment, and crisis management. We present a method for detecting commuting patterns from time-detailed traffic sensor data. Our method uses Gaussian mixture models to identify morning peaks that also exhibit expected variation patterns over weekends and holidays as corresponding to commuting. We apply the method to detect the variation in commuting between countries in the Nordics during the disruptions caused by the COVID-19 pandemic. Results show that the commuting traffic experienced a smaller decrease (42–71%) than the total traffic (87–92%) during the pandemic. For Finland and Sweden, both types of traffic have in 2023 returned to approximately the same level as before the pandemic, while the traffic between Norway and Sweden has only recovered to about 73% of the pre-pandemic level. Our methods can be applied in real-time to provide useful information for applications.