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It is useful to divide medical research into three areas: biomedical, clinical, and health services research. The areas partly overlap, and health services research is also related to social services research. Research is carried out to solve problems and is an instrument for change. Health services research has developed over the last ten years in response to increasing problems in many health services. Superficially, these problems are caused by insufficient resources, but no service can hope to pay its way out of them. Some may be fairly accurately investigated, like need, demand, and utilization of care. Others are more complicated, e.g. evaluation of care, defining standards, and cost--benefit analyses. A few deal with fundamental values, like quality of life and responsibility of individuals and societies. So far, health services research has led to greater emphasis on primary care, but it is fair to say that it has not managed to infiltrate the service and influence people's attitudes and ambitions. In the future, one must bring health services research inside the service and involve the professionals more deeply. One must support prevention studies, attack the ethical and clinical problems related to quality of life, study the potential of non-professional support in the community, and promote rational attitudes among professions, patients, people and politicians. The task is never-ending and health services research, therefore, must be part of the programme of all medical schools.

Published version, also available at http://dx.doi.org/10.1186/s12913-015-1146-z Background: Overall, men are less likely than women to seek health care services for mental health problems, but differences between genders in higher age groups are equivocal. The aim of the current study was to investigate the association between gender and the use of psychiatric outpatient specialist services in Norway, both in a general population and in a subpopulation with self-reported anxiety and/or depression. Methods: Using questionnaires from 12,982 participants (30–87 years) in the cross-sectional sixth Tromsø Study (2007-8) we estimated proportions reporting anxiety/depression, and proportions using psychiatric outpatient specialist services in a year. By logistic regressions we studied the association between gender and the use of psychiatric outpatient specialist services. Analyses were adjusted for age, marital status, income, education, selfreported degree of anxiety/depression, and GP visits last year. Analyses were also performed for genders separately. Results: Anxiety/depression was reported by 21.5 % of women and 12.3 % of men in the general population. Visits to psychiatric outpatient services during one year were reported by 4.6 % of women and 3.3 % of men. The general population’s probability of a visit was significantly lower among men compared to women in ages 30–49 years (odds ratio [OR] 0.58, confidence interval [CI] 0.39–0.84, p-value [p] = 0.004), whereas men used services slightly more than women in ages 50 years and over (OR 1.36, CI 1.00–1.83, p = 0.047). Among those with anxiety/depression 13.5 % of women and 10.5 % of men visited psychiatric outpatient services in a year. We found no statistically significant gender differences in the use of services in this subgroup. Other factors associated with services use in women with anxiety/depression were higher education, more severe anxiety/ depression, and GP visits the last year, whereas in men only a more severe anxiety/depression was associated with psychiatric outpatient visits. Overall, the use of services decreased with higher age. Conclusions: Most people with self-reported anxiety/depression did not visit specialist outpatient clinics. This applies in particular to men aged 30–49 years, older individuals, and individuals with lower education. Gender differences in the use of services in the general population were dependent on age, whereas in the subgroup with anxiety/depression gender differences were not confirmed.

Users of clinical practice guidelines and other recommendations need to know how much confidence they can place in the recommendations. Systematic and explicit methods of making judgments can reduce errors and improve communication. We have developed a system for grading the quality of evidence and the strength of recommendations that can be applied across a wide range of interventions and contexts. In this article we present a summary of our approach from the perspective of a guideline user. Judgments about the strength of a recommendation require consideration of the balance between benefits and harms, the quality of the evidence, translation of the evidence into specific circumstances, and the certainty of the baseline risk. It is also important to consider costs (resource utilisation) before making a recommendation. Inconsistencies among systems for grading the quality of evidence and the strength of recommendations reduce their potential to facilitate critical appraisal and improve communication of these judgments. Our system for guiding these complex judgments balances the need for simplicity with the need for full and transparent consideration of all important issues.