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The 2017 reports published by Diabetesforbundet Norway showed an estimated 378 000 people living with diabetes (28 000 with Type 1 and 350 000 with Type 2). Mealey et al. (2006) showed that diabetes increases the risk for periodontitis, influenced by inflammatory processes. The formation of inflammatory molecules (e.g. Advanced glycation end products) leads to gingival attachment loss, periodontal pockets, bleeding; and in prolonged situation, it results in alveolar bone defects and subsequent tooth mobility/loss. On the contrary, a study by Kowall et al. (2015) observed that people with pre-diabetes and well-controlled diabetes are not at risk for periodontitis. Due to an insufficient number of studies for diabetes-periodontitis relationship especially in Northern Norway, this cross-sectional study aims to examine the association between diabetes and periodontitis, among those who participated for dental examination of Tromsø 7 study.

Introduction: Information on self-reported health (SRH) with a simple question on “How do you rate your health?” provides sufficient information to be a reasonable proxy of health. Socioeconomic inequalities in health are often monitored via SRH. Individuals with better socioeconomic status (SES) more likely to rate their SRH as good. The part of the effect of SES (income level and education) operates through lifestyle factors along with the physical environment, social environment, social support, and psychological (cognitive, emotional, and social capabilities) development. The extent of the mediation on the relation between SES and SRH with the individual lifestyle factor’s impact will provide more insights into the relationship between SES and SRH through lifestyle factors. Material and methods: Data were extracted from the Norwegian Women and Cancer Study (NOWAC). After the inclusion/exclusion criteria, 53,941 participants were included in the analytical study sample. The descriptive statistics were presented for different education and income levels, using percentages, mean and standard deviation, and chi-square tests to test the difference. Logistic regression was used to establish the association between SES and SRH and reported with Odds Ratios (ORs) with 95% confidence interval (CI) using the statistical software SPSS, version 26. Mediation analysis was performed using the Medflex package in R applying a counterfactual approach, which was reported with ORs with 95% bootstrap CI along with the proportion of mediation. Results: The odds of reporting poor SRH were nearly half with a higher household income level compared to the lowest household income level. Furthermore, in the highest income level, the odds of poor SRH were lowered by 80% compared to the lowest household income level. The odds of reporting poor SRH with a high level of education compared to the lowest education level were about 35% less. With the highest education level, the odds of reporting poor SRH were 53% less compared to the lowest education group. About 20% of the association between income level and SRH was identified to go through an indirect path via lifestyle factors (smoking, body mass index (BMI), physical activity (PA)), whereas this was 20%-30% when investigating the model with education. Smoking and BMI contributed more to the indirect effect in the model with education, where PA contributed relatively less. Whereas in the model with income, PA had the greatest contribution, followed by BMI and smoking. The proportion of mediation by all the lifestyle factors (smoking, BMI, and PA) on the association between income level and SRH was statistically significant and quite similar across different income levels. There was an increasing gradient in the proportion of mediation across increasing education levels in the model with education and lifestyle factors (smoking, BMI, and PA). Conclusion: SES (education and income level) had a prominent and statistically significant effect on SRH. Better SRH was observed with both higher income levels and years of education. Household income level shows a more prominent effect than years of education on differentiating across groups of SES. Each lifestyle factors (smoking, BMI, and PA) individually and jointly mediated the association between SES and SRH. Any interventions focusing on improving the healthy lifestyle of the population should comprehend the impact of SES.

Bakgrunn: Multippel sklerose (MS) er en progressiv, kronisk og kompleks autoimmun sykdom i sentralnervesystemet som påvirker flere nevrologiske funksjoner. En stor andel av pasientgruppen angir nedsatt balanse og gangfunksjon som den største utfordringen i hverdagen. Studier viser at fysioterapibehandling kan gi både bedre balanse og gangfunksjon. Likevel opplever ikke alltid pasientene endring i balanse, og har liten tiltro til sin egen balanse etter intervensjonen. Dette kan være fordi de har trent innendørs i sikre og superviserte omgivelser, mens balanseutfordringer oppstår i ulike omgivelser, inkludert utendørs. Det overordnede målet ved å bedre balanse og gangfunksjon, er å bedre pasientens forutsetning for å kunne utføre dagligdagse oppgaver og kunne delta i sosiale aktiviteter. Desto mer likt omgivelsene i behandlingen er i forhold til de faktiske hverdagslige omgivelsene, jo bedre vil overførbarheten være. Da det ikke foreligger forskning på utendørs trening hos personer med MS, er det relevant å undersøke om en utendørs fysioterapibehandling i gruppe kan påvirke både balanse, gangfunksjon og mestringstro til egen balanse. Hensikt: Hensikten med studien er å undersøke om utendørs fysioterapibehandling i gruppe påvirker balanse, gangfunksjon og mestringstro til egen balanse hos personer med MS. Metode: To personer med moderat MS deltok i studien. Det ble brukt Single Subject Experimental Design, med A-B-A-A struktur. A representerer fase uten behandling og B representerer fase med behandling. To- minutters gangtest, Balance Evalutation Systems Test og Activities-specific Balance Confidence Scale ble benyttet som måleinstrumenter for å evaluere balanse, gangfunksjon og mestringstro til egen balanse. Det ble totalt utført 19 målinger, 6 målinger ved Baseline (A1), 5 målinger ved intervensjonsfase (B), og 4 målinger i hver oppfølgingsfase (A2 og A3). Det ble utført 12 behandlinger á 60 minutter over 6 uker. Resultat: Begge deltakerne fikk statistisk signifikant endring på samtlige tester. De vedlikeholdt eller bedret alle resultater i begge oppfølgingsfasene. Konklusjon: Resultatet fra studien indikerer at en utendørs fysioterapibehandling i gruppe kan ha innvirkning på balanse, gangfunksjon og mestringstro til egen balanse hos personer med MS. Resultatet kan ikke generaliseres og overføres direkte til klinisk praksis. Det er behov for større randomiserte forsøk for å evaluere effekt av denne typen behandling for pasientgruppen. Nøkkelord: Multippel Sklerose, utendørs trening, gangfunksjon, postural kontroll, mestringstro

Objective: The purpose of this thesis is to identify and investigate risk factors associated with childhood leukemia, formulated by the research question: Which risk factors are associated with parental exposure and childhood leukemia in the offspring? Methods: A systematic literature search was performed in three databases Embase, Medline and Cochrane. The articles found were selected and included when related to the research question. All articles were evaluated for risk of bias and level of evidence using the quality assessment system Grading of Recommendation, Assessment, Development and Evaluation (GRADE). The exposures were divided into several categories, all relevant to parental exposure: air pollution, use of alcohol and medications, occupational exposure, pesticides, socio-economic status (SES) and smoking. Results/Discussion: 27 articles were found and included in the systematic review. Exposure to petroleum and hydrocarbons as well as pesticides appears to increase the risk of childhood leukemia. A high risk of bias was found in several of the studies and GRADE level varied from very low to medium with no studies in the high category. Heterogeneity was high between the studies, both in way of exposure measurement and in exposure category. The lack of differentiation in the outcome between different subtypes of leukemia in childhood was problematic and new research must consider this. Conclusion: There is not enough evidence to support that smoking, use of alcohol or medications and SES are risk factors for childhood leukemia. What we can determine is that pesticides, solvents and petroleum-derivates can be considered as potential risk factors and that timing of exposure is crucial for the development of childhood cancer. However, we cannot conclude that there is any causality between the risk factors and childhood leukemia, nor any of its subtypes. Register-based cohorts with global cooperation, with focus on subgroups, should be performed to better understand the impact of parental exposure and risk of childhood leukemia.

Background: A universal coverage characterises Scandinavian healthcare systems. The system is financed through taxation. Immigrants with legal residence in Norway, Sweden or Denmark are entitled to the same health coverage as the native population. However, research has shown that despite legal residency, immigrants’ utilization of regular healthcare services is low compared to the native population, while the use of emergency services is higher among them. The increased use of emergency services has been associated with various barriers to access to healthcare services. However, there exist a few studies on the issue of access barriers regarding immigrants living in the three Scandinavian countries. This scoping review aims to identify, map, and discuss existing evidence on the barriers to accessing healthcare services by immigrants in Scandinavia. Methods: This scoping review was conducted based on Arksey and O’Malley methodology framework for undertaking scoping reviews. A search for articles published from 2007 to 2017 in the English language was performed in PubMed, MEDLINE, CINAHL, EMBASE and PsycINFO. The reference lists of the reviewed studies were examined for potentially relevant studies. Results: A total of 418 articles were identified through searching the literature databases. Fourteen studies were reviewed, and the results were reported using six interrelated themes or concepts identified from the articles. Among the six themes identified, communication and language barriers and culture were the most common barriers impeding access to healthcare services. Further, healthcare providers attitude or response limited access to available information. Unfamiliarity with the healthcare system made navigating the health systems difficult and created distrust in the healthcare providers and systems resulting in increased utilisation of emergency care. Some immigrants were reluctant to seek attention because of fear of stigmatisation, prejudice and deportation due to their health status. Immigrants with a low level of education had reduced understanding or lack of access to available information. Conclusions: This review has identified and mapped six thematic categories of barriers to accessing healthcare services that may impede access to healthcare by immigrants with legal residence in Scandinavia. Although 78% of studies indicated that communication and language barriers hindered access to healthcare, and interpreters were often unable bridged the communication gaps, cultural barriers further complicated interactions with care providers. In light of the interrelationship between these barriers, this review recommends that cultural competency is incorporated into the practices of healthcare professionals and systems. Keywords: Scoping review, healthcare services, access, barriers, immigrants, migrants and Scandinavia

Background: Musculoskeletal disorders (MSDs) appear relatively frequent and are costly for society each year, yet they are poorly understood. Four commonly occurring MSDs are Chronic Fatigue Syndrome (CFS), Back Pain (BP) of unknown origin, Fibromyalgia (FM), and muscle pain/Myalgia. There are few Norwegian epidemiologic data on these four outcomes. Physical activity (PA) has been internationally recognized as having a protective effect against chronic disease. The association between PA and these four outcomes is not well understood and the main aim of this study was to investigate this relationship in a large prospective cohort of Norwegian women. Methods: Self-reported data were gathered from 76 367 women in the nationally representative cohort study the Norwegian Women and Cancer study. Data were gathered on total amount of PA at enrolment and of the four outcome conditions during follow-up, in addition to covariate information. We calculated incidence rate and total prevalence. The association between PA and the four outcomes was assessed using multivariate logistic regression analysis. Prevalent cases were excluded from logistic regression analysis. PA was assessed for trend and as a categorical variable. Results: Incidence densities per 100 000 person years were calculated to be as follows: CFS 411, BP 1268, FM 287, and myalgia 1509. Total prevalence was found to be 2.58% for CFS, 13.65% for BP, 5.02% for FM, and 17.87% for myalgia. These were comparable to age-standardized rates for the corresponding Norwegian female population. There was a significant trend (p < 0.001) that increasing levels of PA were associated with a reduced risk CFS, BP and FM. Compared to moderate PA level, very low levels of PA was significantly associated with increased risk of CFS (OR 1.61 (CI 1.38-1.88)), BP (OR 1.17(CI 1.04-1.31)), and FM (OR 1.30(CI 1.07-1.58)). For CFS, PA levels low (OR 1.31 (CI 1.19-1.44)) and very high (OR 1.18 (CI 1.01-1.38)) were also associated with an increased risk of PA. The results showed no significant associations between PA and mylagia. Conclusion: Our study found nationally representative data for incidence and prevalence of CFS, BP, FM, and myalgia in Norwegian women. When compared to moderate levels of total PA, very low PA was associated with an increased risk of CFS, BP, and FM. Low and very high levels of PA were associated with an increased risk of CFS. More studies are needed to confirm the incidence for these outcomes in the Norwegian population, and to investigate the association between these and different types of PA.