Mette Christophersen Tollånes

Background: Porphyria cutanea tarda (PCT) is a skin disorder caused by a defect in the liver enzyme uroporphyrinogen decarboxylase and is associated with hepatitis C virus infection, high alcohol intake, smoking and iron overload. Data on the long-term morbidity of PCT is lacking.Methods: We conducted a nationwide matched cohort study over a 24-year period. The study sample included 534 persons aged 18–67 years with a biochemically confirmed PCT diagnosis and a sample of 21,360 persons randomly selected from the working age population, matched on age, sex and educational attainment. We investigated if persons with sporadic and familial PCT had an increased risk of long-term sick leave (LTSL) or disability pension. We further assessed risk before (pre-PCT), during (during-PCT) and after (post-PCT) the typical period of first onset to diagnosis, treatment and remission.Results: Overall, persons with PCT had a 40% increased risk (hazard ratio [HR] = 1.4, 95% confidence interval [CI] = 1.3, 1.5) of LTSL and a 50% increased risk (HR = 1.5, CI = 1.3, 1.7) of disability pension. Risk of disability pension was increased pre-PCT (HR = 1.3, CI 1.3 (1.0, 1.6), during-PCT (HR 1.5, CI 1.0, 2.2) and post-PCT (HR = 2.0, CI 1.5, 2.6). For LTSL, risk was increased pre-PCT (HR = 1.3, CI 1.1, 1.4) and during-PCT (HR = 1.5, CI 1.1, 2.1), but not post-PCT. Risk was greatest in persons with sporadic than familial PCT. Diagnostic reasons for disability pension that were increased compared to matched controls were PCT or skin disease in 11 of 199 cases (PCT: n = 7, incident rate ratios [IRR] = 49.2, CI = 38.8, 62.4; diseases of the skin and subcutaneous tissue, n = 4, IRR = 4.2, CI = 1.6, 11.0). The vast majority of diagnostic reasons for accessing disability pension were related to comorbidities, PCT susceptibility factors and more general health issues such as: malignant neoplasms (n = 12, IRR = 2.4, CI = 1.4, 4.2), substance and alcohol dependence (n = 7, IRR = 5.0, CI = 2.5, 10.1), neurotic and mood—disorders (n = 21, IRR = 1.7, CI = 1.1, 2.6), and diseases of the musculoskeletal system and connective tissue (n = 71, IRR = 2.5, CI = 1.9, 3.2).Conclusions: Persons with PCT have an increased risk of LTSL and disability pension indicating significant morbidity in this patient group. Appropriate long-term follow-up and monitoring for relapses and co-morbid diseases are recommended.

INTRODUCTION: Disparities in health by adult income are well documented, but we know less about the childhood origins of health inequalities. This study examined the association between parental income in childhood and health in adulthood. METHODS: We used administrative data on seven complete Norwegian birth cohorts born 1967-1973 (N = 429, 886) to estimate the association between parental income from birth to age 18, obtained from tax records available from 1967, linked with administrative registries on health. Health measures, observed between ages 39 to 43, were taken from registry data on consultations at primary health care services and hospitalizations and out-patient specialist consultations registered in the National Patient Registry. RESULTS: Low parental income during childhood was associated with a 10, 2 percentage-point higher risk of overall disorders between the 5% highest (66.8%, CI 66.2-67.3) and lowest (77.2%, CI 76.6-77.8) parental income vigintiles. Absolute differences were largest for disorders related to musculoskeletal pain, injuries, and depression (7-9 percentage-point difference). There were also differences for hypertension (8%, CI 7.9-8.5 versus 4%, CI 4.1-4.7) and diabetes (3.2%, CI 3.0-3.4 versus 1.4%, CI 1.2-1.6), but smaller differences in consultations related to respiratory disorders (20.9% CI 20.4-21.5 versus 19.7% CI 19.2-20.3). Stratified analyses by other parental characteristics (education and marital status) and own adult characteristics (education and income) still showed a parental income gradient. CONCLUSIONS: Low parental income in childhood was typically associated with a two-to-threefold increase in somatic and psychological disorders measured in adulthood, even in a setting with universal health care. This indicates that access alone is not enough to break intergenerational patterns of socioeconomic differences in health. WHAT IS KNOWN: It is well documented that higher incomes among adults is positively associated with health and longevity, however, less is known about how childhood parental income is related to adult health. WHAT THIS STUDY ADDS: We used administrative data on seven full Norwegian birth cohorts with information on parental income covering the whole childhood and a broad set of adult health measures taken from primary and secondary health service consultations. We demonstrate substantial associations between childhood parental income and overall measures of adult health, as well as for a large number of specific diagnoses, within a societal context where access to high-quality health care is universal. These gradients in adult health by childhood parental income did not vary substantively by other childhood circumstances, such as health at birth, mother’s marital status, and parental education. Despite individuals’ own completed education and adult income being strongly related to adult health, we found remaining adult health gradients by childhood parental income within all subpopulations stratified by own level of adult socioeconomic attainment.

Background: General practitioners (GPs) in Norway increasingly use spirometry diagnostically as well as in follow up of patients with respiratory complaints, but little is known about their skills and knowledge in this area. The aim of the present study was to investigate how GPs interpret a case history and spirometry recordings of a patient with chronic obstructive pulmonary disease (COPD), and their knowledge about their own spirometer.Methods: A web-based survey, consisting of a case history and spirometry recordings of a patient with COPD, was distributed to the 4700 members of the Norwegian GP Association. In addition to background information about themselves and their spirometer, topics included whether they requested, and how they interpreted, a spirometry reversibility-test, identification of the of most likely diagnosis, and recognition of the spirometry parameters used to diagnose COPD and grade airway obstruction. Immediate feedback was provided for educational purposes.Results: Six hundred thirty GPs responded. Twenty six percent would not request a reversibility test, but 81% identified COPD as the most likely diagnosis. Less than 50% correctly identified the spirometry parameters used for diagnosis of COPD and grading the airway obstruction. One in five (21%) did not know which spirometer was used in their own practice, and 49 and 61% did not know which reference values were used for adults and children, respectively. Participants evaluated the survey as useful (average 74 points on a 0–100 scale) and would like more case-based surveys concerning use of spirometry in the future (average 91 points).Conclusion: In this cohort of self-selected GPs, probably more interested in respiratory medicine than the average GP, we identified several problem areas and gaps in knowledge regarding the use of spirometry.

Objectives: SARS-CoV-2, causing COVID-19, has emerged to cause a human pandemic. Detection of SARS-CoV-2 in respiratory samples by using PCR is the standard laboratory diagnostic tool. Our aim was to perform a limited evaluation of the diagnostic performance and user-friendliness of eleven rapid tests for detection of antibodies against SARS-CoV-2. Methods: All participants were tested with PCR against SARS-CoV-2 at a clinical microbiology laboratory. Comparing with results from PCR tests, we evaluated the rapid tests’ performances in three arms; 1) 20 hospitalized patients with PCR-confirmed COVID-19, 2) 23 recovered outpatients with former PCR-confirmed COVID-19, and 3) 49 participants with suspected COVID-19 presenting at a primary care emergency room. Results: All eleven tests detected antibodies in hospitalized COVID-19 patients, though with varying sensitivities. In former outpatients recovered from COVID-19, there were differences between tests in the immunoglobulin type G (IgG) sensitivity, with five tests having a sensitivity below 65%. In participants with suspected COVID-19 infection, the rapid tests had very low sensitivities. Most rapid tests were easy to perform and interpret. Conclusions: Rapid tests were not suited as stand-alone tests to detect present infection in a Norwegian primary care emergency room population. All the rapid tests were able to detect SARS-CoV-2 antibodies, although sensitivities varied and were generally higher in the study arm of more severely affected participants. Rapid tests with high IgG sensitivity (and specificity) may be useful for confirmation of past infection. An independent evaluation should be performed in the intended population before introducing a rapid test.

Background: It is not clear if point-of-care (POC) testing for hemoglobin A_1c (HbA_1c) is associated with glycemic control in type 2 diabetes. Methods: In this cross-sectional study, we linked general practitioner (GP) data on 22,778 Norwegian type 2 diabetes patients to data from the Norwegian Organization for Quality Improvement of Laboratory Examinations. We used general and generalized linear mixed models to investigate if GP offices’ availability (yes/no) and analytical quality of HbA_1c POC testing (average yearly “trueness score”, 0–4), as well as frequency of participation in HbA_1c external quality assurance (EQA) surveys, were associated with patients’ HbA_1c levels during 2014–2017. Results: Twenty-eight out of 393 GP offices (7%) did not perform HbA_1c POC testing. After adjusting for confounders, their patients had on average 0.15% higher HbA_1c levels (95% confidence interval (0.04–0.27) (1.7 mmol/mol [0.5–2.9]). GP offices participating in one or two yearly HbA_1c EQA surveys, rather than the maximum of four, had patients with on average 0.17% higher HbA_1c levels (0.06, 0.28) (1.8 mmol/mol [0.6, 3.1]). For each unit increase in the GP offices’ HbA_1c POC analytical trueness score, the patients’ HbA_1c levels were lower by 0.04% HbA_1c (−0.09, −0.001) (−0.5 mmol/mol [−1.0, −0.01]). Conclusions: Novel use of validated patient data in combination with laboratory EQA data showed that patients consulting GPs in offices that perform HbA_1c POC testing, participate in HbA_1c EQA surveys, and maintain good analytical quality have lower HbA_1c levels. Accurate HbA_1c POC results, available during consultations, may improve diabetes care.

Background: Acute hepatic porphyria (AHP) consists of three rare metabolic disorders. We investigated the risk of long-term sick leave, disability pension, and premature death in individuals with AHP compared to the general population. Methods: In a nationwide cohort study from 1992 to 2017, records of 333 persons (total person-years = 6728) with a confirmed AHP diagnosis were linked to several national compulsory registries (reference population = 5,819,937). We conducted survival analyses to assess additional risk. Results: Persons with AHP had higher risks of accessing long-term sick leave (adjusted hazard ratio (aHR): 1.5, 95% confidence interval (CI): 1.3, 1.7) and disability pension (aHR: 1.9, CI: 1.5, 2.4). The risk was highest in persons who had been hospitalised for acute attacks, while no additional risk was observed in asymptomatic AHP gene mutation carriers. The median age when accessing disability pension was 45 years, 21 years younger than the general population. AHP was associated with increased risk of mortality due to hepatocellular carcinoma (adjusted mortality rate ratio (aMRR): 84.4, CI: 37.8, 188.2), but no overall increased risk of premature death was observed. Conclusions: Persons with symptomatic AHP were at increased risk of accessing long-term sick leave and disability pension but not of premature death.