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Background: Fee-for-service is a common payment model for remunerating general practitioners (GPs) in OECD countries. In Norway, GPs earn two-thirds of their income through fee-for-service, which is determined by the number of consultations and procedures they register as fees. In general, fee-for-service incentivises many and short consultations and is associated with high service provision. GPs act as gatekeepers for various treatments and interventions, such as addictive drugs, antibiotics, referrals, and sickness certification. This study aims to explore GPs' reflections on and perceptions of the fee-for-service system, with a specific focus on its potential impact on gatekeeping decisions. Methods: We conducted six focus group interviews with 33 GPs in 2022 in Norway. We analysed the data using thematic analysis. Results: We identified three main themes related to GPs' reflections and perceptions of the fee-for-service system. First, the participants were aware of the profitability of different fees and described potential strategies to increase their income, such as having shorter consultations or performing routine procedures on all patients. Second, the participants acknowledged that the fees might influence GP behaviour. Two perspectives on the fees were present in the discussions: fees as incentives and fees as compensation. The participants reported that financial incentives were not directly decisive in gatekeeping decisions, but that rejecting requests required substantially more time compared to granting them. Consequently, time constraints may contribute to GPs' decisions to grant patient requests even when the requests are deemed unreasonable. Last, the participants reported challenges with remembering and interpreting fees, especially complex fees. Conclusions: GPs are aware of the profitability within the fee-for-service system, believe that fee-for-service may influence their decision-making, and face challenges with remembering and interpreting certain fees. Furthermore, the fee-for-service system can potentially affect GPs' gatekeeping decisions by incentivising shorter consultations, which may result in increased consultations with inadequate time to reject unnecessary treatments. [ABSTRACT FROM AUTHOR]

Background: General practitioners (GPs) have an important gatekeeping role in the Norwegian sickness insurance system. This role includes limiting access to paid sick leave when this is not justified according to sick leave criteria. 85% of GPs in Norway operate within a fee-for-service system that incentivises short consultations and high service provision. In this qualitative study, we explore how GPs practise the gatekeeping role in sickness absence certification. Methods: Qualitative data was collected through six focus group interviews with 33 GPs, working in practices with a minimum of four practising GPs, in different geographical regions across Norway, including both urban and rural areas. Data was analysed using Braune and Clarke's thematic analysis approach. Results: Our results indicate that GPs' sick-listing decisions are largely driven by patient demand and preferences for sick leave. GPs reported that they rarely overrule patient requests for sickness absence, including in cases where such requests conflict with the GPs' opinion of whether sick leave is justified or benefits the patient. The degree of effort made to limit unjustified or non-beneficial sick leave seems to depend on the GPs' available time and perceived risk of conflict with the patient. GPs generally expressed dissatisfaction with their role as certifiers of sickness absence. Conclusion: Our study suggests that GPs' decisions about sickness certification is largely driven by patient preferences. The GPs' gatekeeping function is limited to negotiations about grade and duration of absence spells. [ABSTRACT FROM AUTHOR]

Studies have suggested that some minority groups tend to have lower vaccination rates than the overall population. This study aims to examine COVID-19 vaccination rates among healthcare workers in Norway, according to immigrant background.We used individual-level, nation-wide registry data from Norway to identify all healthcare workers employed full time at 1 December 2020. We examined the relationship between country of birth and COVID-19 vaccination from December 2020 to August 2021, both crude and adjusted for, for example, age, sex, municipality of residence and detailed occupation codes in logistic regression models.Among all healthcare workers in Norway, immigrants had a 9 percentage point lower vaccination rate (85%) than healthcare workers without an immigrant background (94%) at 31 August 2021. The overall vaccination rate varied by country of birth, with immigrants born in Russia (71%), Serbia (72%), Lithuania (72%), Romania (75%), Poland (76%), Eritrea (77%) and Somalia (78%) having the lowest crude vaccination rates. When we adjusted for demographics and detailed occupational codes, immigrant groups that more often worked as healthcare assistants, such as immigrants from Eritrea and Somalia, increased their vaccination rates. Substantial differences in vaccination rates among immigrant groups employed in the healthcare sector in Norway indicate that measures to improve vaccine uptake should focus on specific immigrant groups rather than all immigrants together. Lower vaccination rates in some immigrant groups appear to be largely driven by the occupational composition, suggesting that some of the differences in vaccine rates can be attributed to variation in vaccine access. [ABSTRACT FROM AUTHOR]

This study presents a novel approach for investigating the shrinkage dynamics of 3D‐printed nanoarchitectures during isothermal pyrolysis, utilizing in situ electron microscopy. For the first time, the temporal evolution of 3D structures is tracked continuously until a quasi‐stationary state is reached. By subjecting the 3D objects to different temperatures and atmospheric conditions, significant changes in the resulting kinetic parameters and morphological textures of the 3D objects are observed, particularly those possessing varying surface‐to‐volume ratios. Its results reveal that the effective activation energy required for pyrolysis‐induced morphological shrinkage is approximately four times larger under vacuum conditions than in a nitrogen atmosphere (2.6 eV vs. 0.5–0.9 eV, respectively). Additionally, a subtle enrichment of oxygen on the surfaces of the structures for pyrolysis in nitrogen is found through a postmortem electron energy loss spectroscopy study, differentiating the vacuum pyrolysis. These findings are examined in the context of the underlying process parameters, and a mechanistic model is proposed. As a result, understanding and controlling pyrolysis in 3D structures of different geometrical dimensions not only enables precise modification of shrinkage and the creation of tensegrity structures, but also promotes pyrolytic carbon development with custom architectures and properties, especially in the field of carbon micro‐ and nano‐electromechanical systems. [ABSTRACT FROM AUTHOR]

• COVID-19 vaccination among adolescents varied with immigrant background and age. • There was great variation in vaccination rates by country background. • Household income and parental education were positively associated with vaccination. • Sociodemographic associations were stronger among the younger adolescents. Lower COVID-19 vaccination rates have been observed among some adult immigrant populations in Norway, and there appears to be an association with sociodemographic factors. However, knowledge is lacking on the distribution of vaccination rates and role of sociodemographic factors among adolescents. This study aims to describe COVID-19 vaccination rates among adolescents according to immigrant background, household income, and parental education. In this nationwide registry study, we analyzed individual-level data on adolescents (12–17 years) from the Norwegian Emergency preparedness register for COVID-19 until September 15th, 2022. We estimated incidence rate ratios (IRR) for receiving at least one COVID-19 vaccine dose by country background, household income and parental education, using Poisson regression, adjusting for age, sex, and county. The sample comprised 384,815 adolescents. Foreign-born and Norwegian-born with foreign-born parents, had lower vaccination rates (57 % and 58 %) compared to adolescents with at least one Norwegian-born parent (84 %). Vaccination rates by country background varied from 88 % (Vietnam) to 31 % (Russia). Variation and associations by country background, household income, and parental education were greater among 12–15-year-olds than 16–17-year-olds. Household income and parental education were positively associated with vaccination. Compared to the lowest income and education category, IRRs for household income ranged from 1.07 (95 % CI 1.06–1.09) to 1.31 (95 % CI 1.29–1.33) among 12–15-year-olds, and 1.06 (95 % CI 1.04–1.07) to 1.17 (95 % CI 1.15–1.18) among 16–17-year-olds. For parental education, from IRR 1.08 (95 % CI 1.06–1.09) to 1.18 (95 % CI 1.17–1.20) among 12–15-year-olds, and 1.05 (95 % CI 1.04–1.07) to 1.09 (95 % CI 1.07–1.10) among 16–17-year-olds. COVID-19 vaccination rates varied by immigrant background and age group, with lower rates especially among adolescents with background from Eastern Europe and among younger adolescents. Household income and parental education were positively associated with vaccination rates. Our results may help target measures to increase vaccination rates among adolescents. [ABSTRACT FROM AUTHOR]