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Background Problem gambling is a public health issue affecting both the gamblers, their families, their employers, and society as a whole. Recent law changes in Sweden oblige local and regional health authorities to invest more in prevention and treatment of problem gambling. The economic consequences of gambling, and thereby the potential economic consequences of policy changes in the area, are unknown, as the cost of problem gambling to society has remained largely unexplored in Sweden and similar settings. Methods A prevalence-based cost-of-illness study for Sweden for the year 2018 was conducted. A societal approach was chosen in order to include direct costs (such as health care and legal costs), indirect costs (such as lost productivity due to unemployment), and intangible costs (such as reduced quality of life due to emotional distress). Costs were estimated by combining epidemiological and unit cost data. Results The societal costs of problem gambling amounted to 1.42 billion euros in 2018, corresponding to 0.30% of the gross domestic product. Direct costs accounted only for 13% of the total costs. Indirect costs accounted for more than half (59%) of the total costs, while intangible costs accounted for 28%. The societal costs were more than twice as high as the tax revenue from gambling in 2018. Direct and indirect costs of problem gambling combined amounted to one third of the equivalent costs of smoking and one sixth of the costs of alcohol consumption in Sweden. Conclusions Problem gambling is increasingly recognized as a public health issue. The societal costs of it are not negligible, also in relation to major public health issues of an addictive nature such as smoking and alcohol consumption. Direct costs for prevention and treatment are very low. A stronger focus on prevention and treatment might help to reduce many of the very high indirect and intangible costs in the future.

Background: A public health initiative that is common across jurisdictions is provision of advice to people to limit the frequency, amount of time and amount of money spent gambling in order to reduce the risk of gambling-related harm. The purpose of this study is to use consistent methodology with existing population-based prevalence surveys of gambling and related harms from different countries to identify quantitative limits for lower and higher risk gambling. Risk limits from different countries and for men and women are compared. Methods: Risk curve analyses were conducted with eleven high quality data sets from eight Western countries to identify optimal limits for predicting increased risk of gambling-related harms. Gambling indicators were monthly expenditure, percentage of income spent on gambling, monthly frequency, duration of gambling sessions, and number of different types of gambling. Harm indicators included financial, emotional, health, and relationship impacts. Findings: The limit ranges were remarkably consistent across harm indicators, cross nationally and between men and women. Reliable results were obtained for all gambling indicators except gambling session duration. Risk of gambling-related harm is likely to increase if an individual gambles at these levels of greater: $60 to $120 CAD per month, five to eight times per month, spends more than 1 to 3% of gross monthly income or plays three to four different gambling types. Interpretation: This study provides evidence that lower-risk gambling guidelines can be based upon empirically derived lower-risk limits, which are relatively consistent across Western countries. Funding Statement: La Fondation Mise sur Toi Declaration of Interests: DH, MA, RB, NB, JMC, MD, SK, DOUR, AS, RV, LN, and SC report receiving personal fees from the Canadian Centre for Substance Use and Addiction during this project. MY, CP, and MCFP have no conflicts to report.

This study investigated the negative influence of gambling advertising, that is, gambling more often or for more money than intended. We analyzed data from wave four of the Swedish Longitudinal Gambling Study (Swelogs), in which the self-perceived negative influence of gambling advertising was measured by responses to three survey questions. Few gamblers reported having been negatively influenced by gambling advertising. Among those who reported such influence, problem gamblers were overrepresented. Those who had set limits for their gambling reported a negative influence from advertising more often than others, which likely was caused by a perception that advertising is detrimental to efforts to cut down on excessive gambling. A multivariate regression analysis showed that negative influence from gambling advertising was positively associated with problem gambling, gambling at least monthly, participation in online gambling, and being in the age group 30-49 years. We conclude that although few gamblers are negatively influenced by gambling advertising, the adverse effects on those that are should not be neglected. For a considerable number of people, gambling advertising substantially contributes to problem gambling.

AIMS To estimate the prevalence, incidence and gender and age-specific incidence of problem gambling in the Swedish adult population. DESIGN Longitudinal cohort study with linkage to register data. SETTING Sweden. PARTICIPANTS Stratified random sample aged 16-84 years at baseline (n = 8165) re-assessed a year later (n = 6021). MEASUREMENTS Problem gambling (life-time and past 12 months) was measured by the South Oaks Gambling Screen-Revised (SOGS-R). Past 12-month (current) problem gambling was also measured by the Problem Gambling Severity Index (PGSI). FINDINGS The SOGS-R combined current pathological and problem gambling prevalence rate (PR) was 2.1 [95% confidence interval (CI) = 1.8-2.4] at baseline and 1.7 (1.4-2.0) at follow-up, approximately half the corresponding life-time estimates.[Correction added on 22 Dec 2017, after first online publication: In the preceding sentence, the SOGS-R combined current pathological and problem gambling prevalence rate (PR) was incorrectly reported as being double the corresponding life-time rate. It has been corrected in this version.] PGSI combined current problem and moderate-risk gambling PRs were 2.2 (1.9-2.5) at baseline and 1.9 (1.6-2.2) at follow-up. Combined incidence rates (IRs) were 1.0 (0.8-1.3) (SOGS-R) and 1.4 (1.1-1.7) (PGSI), with more than three-quarters being new cases. While first-time IRs did not vary by gender, males had a higher relapse IR and proportionately more females were new cases. The young adult IR was more than double the older adult IR; similar proportions were new cases. CONCLUSIONS The actual incidence of problem gambling relapse in Sweden is likely to be higher than estimated. The profile of problem gambling in Sweden is likely to change over time, with increased proportions of women and older adults.

The purpose of this study was to explore the association between problem gambling (PG) and participation in different forms of gambling in order to elucidate relationships between PG, gambling invo...

Background Stigma related to abortion and contraceptive use is a serious public health threat for young people, and validated scales to measure this stigma are scarce. The purposes of the study were to validate a newly constructed scale to measure the stigma of contraceptive use and to adapt a scale to measure the stigma of abortion. Methods A study nested in a cluster-randomised trial. In 2017, data was collected from 633 secondary school youths, in a semi-urban setting in western Kenya. A qualitative pre-phase (face-validity) were initially utilised to draft and validate a seven-item scale to capture contraceptive use stigma (CUS) and to adapt the Stigmatizing Attitudes, Beliefs and Actions (SABA) scale (18 items), which captures aspects of abortion stigma. Statistical tests used included test-retest reliability analysis, Pearson’s correlation coefficients, Wilcoxon signed-rank test, Factor Analysis, Principal Component Analysis, interclass correlation and Cronbach’s alpha. Results For the CUS scale, paired t-test and Wilcoxon signed-rank test showed no significant score changed between time points (p = 0.64; 0.67). CUS had similar patterns between time points, with two relevant components: promiscuity and lack of autonomy. Cronbach’s alpha indicated acceptable internal consistency between time points (0.71;0.7). The confirmatory factor loadings for each item in the modified three subscales of SABA had a similar pattern to the original SABA scale, in particularly regarding negative stereotyping and, excluding and discriminating factors. The Cronbach’s alpha was adequate, although lower for the modified SABA (0.74) as compared to the original SABA (0.9). The SABA scale was renamed into Adolescents Stigmatizing Attitudes, Beliefs and Action (ASABA) scale. Conclusions The CUS scale is considered valid and reliable for measuring contraceptive use stigma, and the ASABA scale was rated as reliable for capturing abortion stigma based on negative stereotyping and excluding and discriminating factors. The CUS, up to date the first ever proposed CUS scale, and the ASABA scale can be used to measure effects of stigma reduction interventions with the aim of preventing unintended pregnancies, motherhood and unsafe abortion among adolescents in Kenya and similar low-resource settings.

BACKGROUND AND AIMS In psychiatric diagnosis, different symptoms of gambling problems are usually aggregated into a single indicator of disorder severity, which has resulted in a knowledge gap on the specific roles of the different issues with which some gamblers struggle. This study estimated the association between baseline symptoms of gambling problems and (i) other symptoms, (ii) the overall severity of gambling problems after 12 months, and the estimated stability rates of various gambling problems after (iii) 12 months and (iv) 5 years. Design and Setting Secondary analysis of data derived from the Swedish Longitudinal Gambling Study (SWELOGS), a prospective representative cohort study conducted between 2008 and 2014 in Sweden. PARTICIPANTS A total of 8165 respondents from 16-84 years of age recruited in a stratified random sampling procedure. Among them, 6021 answered the 1-year follow-up survey and 3559 answered the 5-year follow-up survey. MEASUREMENTS Nine symptoms related to gambling were assessed using the Problem Gambling Severity Index (excessive gambling, tolerance, chasing, loans, insight, health problems, criticism, financial problems, and guilt). FINDINGS Excessive gambling, tolerance, chasing, loans and guilt significantly increased the risk of a range of other symptoms. Chasing and tolerance also tripled the risk of transitioning to more severe gambling problems (OR = 2.9, 95% CI = [1.5-5.5], P = 0.001 and OR = 2.7, 95% CI = [1.6-4.5], P

Aims: To identify which occupational groups have elevated levels of regular gambling participation and at-risk and problem gambling, and to explore job-specific factors associated with elevated levels. Methods: Statistical analyses were performed on data from the 2015 Swedish population study on gambling and health. The principal registry variable was occupation, classified according to the Swedish version of the International Standard Classification of Occupations (ISCO-08). Two gambling variables were studied: regular gambling participation and at-risk and problem gambling, as measured by the Problem Gambling Severity Index (PGSI). For statistical regression analyses, socio-demographic data were used such as gender, income, and country of origin. Results: We found significant differences between occupational groups with regard to the two gambling variables. In general, manual jobs with predominantly male workers scored high, especially when there was no fixed workplace. Several significant differences remained when we controlled for gender. We also found support for three types of workers having elevated levels on the gambling variables: (1) building, construction and service, mobile, (2) vehicle drivers, and (3) monotonous manual indoor work. These results were confirmed by comparisons with propensity score matched controls. Conclusion: A policy implication of this study is that some occupational groups should be prioritised in the prevention of problem gambling. Theoretically, the study shows that occupational categories represent real-life cultures and contexts of gambling and non-gambling as distinct from the abstract socio-demographic factors that are usually considered in relation to gambling participation and problem gambling.

Background:The factors influencing successful aging (SA) are of great interest in an aging society. The aims of this study were to investigate the prevalence of SA, the relative importance across age of the three components used to define it (absence of disease and disability, high cognitive and physical function, and active engagement with life), and its correlates.Methods:Data were extracted from the population-based cross-sectional Nord-Trøndelag Health Study (HUNT3 2006–2008). Individuals aged 70–89 years with complete datasets for the three components were included (N = 5773 of 8,040, 71.8%). Of the respondents, 54.6% were women. Univariate and multivariate regression analyses were used to analyze possible correlates of SA.Results:Overall, 35.6% of the sample met one of the three criteria, 34.1% met combinations, and 14.5% met all of the three criteria. The most demanding criterion was high function, closely followed by absence of disease, while approximately two-thirds were actively engaged in life. The relative change with age was largest for the high cognitive and physical function component and smallest for active engagement with life. The significant correlates of SA were younger age, female gender, higher education, weekly exercise, more satisfaction with life, non-smoking, and alcohol consumption, whereas marital status was not related to SA.Conclusions:The prevalence of SA in this study (14.5%) is comparable to previous studies. It may be possible to increase the prevalence by intervention directed toward more exercise, non-smoking, and better satisfaction with life.

The aim of this study was to compare the clinical outcome of spinal process osteotomy with two other midline-retaining methods, bilateral laminotomy and unilateral laminotomy with crossover, among patients undergoing surgery for lumbar spinal stenosis. This cohort study was based on data from the Norwegian Registry for Spine Surgery (NORspine). Patients were operated on between 2009 and 2013 at 31 Norwegian hospitals. The patients completed questionnaires at admission for surgery, and after 3 and 12 months. The Oswestry Disability Index (ODI) was the primary outcome. Secondary outcomes were duration of surgery and hospital stay, Numeric Rating Scale (NRS) for back pain and leg pain, and EQ-5D and EQ-VAS. The patients were classified into one of three treatment groups according to the surgery they had received, and a propensity score was utilized to minimize bias. The three treatment groups were divided into subgroups based on Propensity Scores, and the statistical analyses were performed with and within the Propensity Score stratified subgroups. 103 patients had spinal process osteotomy, 966 patients had bilateral laminotomy, and 462 patients had unilateral laminotomy with crossover. Baseline clinical scores were similar in the three groups. There were no differences in improvement after 3 and 12 months between treatment groups. At 12 months, mean ODI improvement was 15.2 (SD 16.7) after spinous process osteotomy, 16.9 (SD 17.0) after bilateral laminotomy, and 16.7 (SD 16.9) after unilateral laminotomy with crossover. There were no differences in the secondary clinical outcomes or complication rates. Mean duration of surgery was greatest for spinal process osteotomy (p

Aims This study describes five groups of gamblers and changes in their gambling involvement and gambling problems over four years with a particular focus on whether gambling problems among men and women develop differently within the five groups. Design The study sample is a subset of participants from the Swedish Longitudinal Gambling Study (Swelogs). Six different clusters of past-year gambling, based on frequency of participation in the nine most common forms of gambling in Sweden (lotteries, horses, number games, sports games, bingo, poker, slot machines, casino games or TV contests) were identified in Two-Way Cluster Analysis after the first wave of data collection in 2008/09. There were 2,508 individuals identified in EP1 (n=5,012) who then also participated in waves EP2 and EP3 and were selected for the present analysis. Methods Statistical analysis was done in SPSS 22.0 using Pearson's Chi-Square test of Independence (or Fisher's Exact test when the requirements or expected frequency were not met for Pearson's Test), Mann-Whitney U-test and logistic regression. P-values below 0.05 were regarded as significant. Results Gambling remains gendered in Sweden. Even though the clusters are based on gambling activities, there are differences between men and women within the clusters as regards the gambling participation patterns. Conclusions Men and women gamble differently, but they may still be equals in their total experience of gambling and in relation to how their gambling problems develop. All differences need to be taken into consideration when preventive actions or messages are created.

Breathlessness is a prevalent and distressing symptom in intensive care unit patients. There is little evidence of the ability of healthcare workers to assess the patient's experiences of breathing. Patient perception of breathing is essential in symptom management, and patient perception during a spontaneous breathing trial (SBT) might be related to extubation success.To assess mechanically ventilated patients' experiences of breathlessness during SBT.This was a prospective observational multicenter study of 100 mechanically ventilated patients. We assessed the agreement between nurses, physicians, and patients' 11-point Numerical Rating Scales scores of breathlessness, perception of feeling secure, and improvement of respiratory function at the end of an SBT (most performed with some level of support). We also determined the association between breathlessness and demographic factors or respiratory observations.Sixty-two patients (62%) reported moderate or severe breathlessness (Numerical Rating Scales ≥ 4). The median intensity of breathlessness reported by patients was five compared with two by nurses and physicians (P0.001). Patients felt less secure and reported less improvement of respiratory function compared with nurses' and physicians' ratings. About half of the nurses and physicians underestimated breathlessness (difference score, ≤-2) compared with the patients' self-reports. Underestimation of breathlessness was not associated with professional competencies. There were no major differences in objective assessments of respiratory function in patients with moderate or severe breathlessness, and no apparent relationship between breathlessness during the SBT and extubation outcome.Patients reported higher breathlessness after SBT compared with nurses and physicians. Clinical trial registered with www.clinicaltrials.gov (NCT 01928277).

Aim: To examine associations between interventions and child characteristics; and enhanced gross motor progress in children with cerebral palsy (CP). Methods: Prospective cohort study based on 2048 assessments of 442 children (256 boys, 186 girls) aged 2–12 years registered in the Cerebral Palsy Follow-up Program and the Cerebral Palsy Register of Norway. Gross motor progress estimates were based on repeated measures of reference percentiles for the Gross Motor Function Measure (GMFM-66) in a linear mixed model. Mean follow-up time: 2.9 years. Results: Intensive training was the only intervention factor associated with enhanced gross motor progress (mean 3.3 percentiles, 95% CI: 1.0, 5.5 per period of ≥3 sessions per week and/or participation in an intensive program). Gross motor function was on average 24.2 percentiles (95% CI: 15.2, 33.2) lower in children with intellectual disability compared with others. Except for eating problems (–10.5 percentiles 95% CI: –18.5, –2.4) and ankle contractures by age (–1.9 percentiles 95% CI: –3.6, –0.2) no other factors examined were associated with long-term gross motor progress. Conclusions: Intensive training was associated with enhanced gross motor progress over an average of 2.9 years in children with CP. Intellectual disability was a strong negative prognostic factor. Preventing ankle contractures appears important for gross motor progress.

BACKGROUND: Leaders and co-workers in Swedish public sector organizations are exposed to demanding psychosocial working conditions; more knowledge about workplace-based interventions in this sector of working life is needed. OBJECTIVE: To compare co-workers’ and leaders’ self-ratings of health and psychosocial working conditions, and investigate how prevention and rehabilitation in Swedish public sector workplaces affects these ratings. METHOD: The longitudinal panel data consisted of 311 individuals (20 leaders, 291 co-workers) at 19 workplaces. Based on questionnaire data, statistical analyses were performed using Mann-Whitney U-Test, pair-wise Spearman correlations, a mixed between-within subjects ANOVA and Friedman’s test. RESULTS: Results indicate differences in how the leaders and the co-workers judge their health and psychosocial working conditions. Leaders report work content that is more varied and interesting as well as more possibilities for personal development through work, yet they also report more tiredness, concern over managing their work situation and time pressure at work. Comparisons of mean values for used indicators show some improvements after one year, but also several non-significant or negative time trends two years after the interventions were initiated. CONCLUSION: The study provides some support for experienced differences between co-workers’ and leaders’ health and psychosocial working conditions in public sector workplaces, indicating the importance of different workplace-oriented prevention and rehabilitation interventions for these two categories of employees.

To estimate the prevalence, incidence and gender and age-specific incidence of problem gambling in the Swedish adult population.Longitudinal cohort study with linkage to register data.Sweden.Stratified random sample aged 16-84 years at baseline (n = 8165) re-assessed a year later (n = 6021).Problem gambling (life-time and past 12 months) was measured by the South Oaks Gambling Screen-Revised (SOGS-R). Past 12-month (current) problem gambling was also measured by the Problem Gambling Severity Index (PGSI).The SOGS-R combined current pathological and problem gambling prevalence rate (PR) was 2.1 [95% confidence interval (CI) = 1.8-2.4] at baseline and 1.7 (1.4-2.0) at follow-up, approximately half the corresponding life-time estimates.[Correction added on 22 Dec 2017, after first online publication: In the preceding sentence, the SOGS-R combined current pathological and problem gambling prevalence rate (PR) was incorrectly reported as being double the corresponding life-time rate. It has been corrected in this version.] PGSI combined current problem and moderate-risk gambling PRs were 2.2 (1.9-2.5) at baseline and 1.9 (1.6-2.2) at follow-up. Combined incidence rates (IRs) were 1.0 (0.8-1.3) (SOGS-R) and 1.4 (1.1-1.7) (PGSI), with more than three-quarters being new cases. While first-time IRs did not vary by gender, males had a higher relapse IR and proportionately more females were new cases. The young adult IR was more than double the older adult IR; similar proportions were new cases.The actual incidence of problem gambling relapse in Sweden is likely to be higher than estimated. The profile of problem gambling in Sweden is likely to change over time, with increased proportions of women and older adults.

Source at: https://doi.org/10.1186/s12891-017-1491-7 Background: There are several posterior decompression techniques for lumbar spinal stenosis (LSS). There is a trend towards performing less invasive surgical procedures, but no multicentre randomized controlled trials have evaluated the relative efficacy of these techniques at short and long-term. Method/design: A multicentre randomized controlled trial [the Spinal Stenosis Trial (SST) (part of the NORDSTEN study)] including 465 patients aged 18–80 years with neurogenic claudication or radiating pain and MRI findings indicating lumbar spinal stenosis without spondylolisthesis is performed to compare three posterior decompression techniques: unilateral laminotomy with crossover, bilateral laminotomy and spinous process osteotomy. The primary outcome is change in Oswestry Disability Index (ODI 2 years postoperatively). Secondary outcomes are change in EQ-5D, Zurich Claudication Questionnaire, and Numeric Rating Scale for leg-pain and back-pain. Also recorded were Global Perceived Effect score, complications, length of hospital stay, reoperation rate 2 years postoperatively, difference in recurrence of symptoms or postoperative instability, and MRI change in the dural sac area. Further, a 5 and 10 years follow-up is planned with the same outcome measures. Discussion: Newer and less invasive techniques are increasingly favoured in surgery for LSS. This trial will compare the clinical and radiological results of three different techniques, and may contribute to better clinical decision making in the surgical treatment of LSS. Trial registration: ClinicalTrials.gov reference: NCT02007083 (November 22, 2013).

High quality gambling participation and prevalence studies are important to monitor and manage risks associated with an ever changing gambling environment. Such studies are expensive and choices must be made to balance precision and cost constraints. Common approaches include not screening infrequent gamblers and/or gamblers with low gambling expenditure, on the assumption that these gamblers are unlikely to be problem gamblers. Some studies combine moderate risk and problem gamblers to obtain robust groups for analysis. The resultant methodological variations compromise comparability and interpretation of changes over time and across jurisdictions. The Victorian Gambling Study 2008–2012 (VGS) and the Swedish Longitudinal Gambling Study 2008–2014 (Swelogs) are large jurisdiction-wide surveys with sample sizes of 15,000 and 8,165 respectively. Both studies screened all past-year gamblers. This paper reports on the modelling of some common methodological variants. Understanding the impact of these different variations enables better design of future studies and facilitates comparisons between existing prevalence studies within and across jurisdictions.

We aimed to estimate the incidence of a first episode of problem gambling among Swedish 16–24 year-olds by demographic and socio-economic characteristics, and to compare the incidence between 16–24 and 25–44 year-olds, and between young women and men. Other aims were to estimate the proportions of recovery and incidence in recurrent problem gambling, and prevalence of problem gambling among 16–44 year-olds in Sweden. We selected 4,358 participants aged 16–44 from the nationally representative Swedish Longitudinal Gambling Study in 2008/2009 and 2009/2010. The primary outcome measure was a first episode of problem gambling during 12 months before the follow-up as measured by the Problem Gambling Severity Index among participants without a history of problem gambling at baseline. The incidence proportion of a first episode of problem gambling among 16–24 year-olds was 2.26 % (95 % confidence interval 1.52–3.36); three times lower among females (1.14; 0.42–3.07 %) than males (3.32; 2.19–5.01 %). Young age and household financial problems were associated with first episode problem gambling among young women. Among 25–44 year-olds, the incidence proportion of a first episode of problem gambling was 0.81 % (0.41–1.56). Recovery from problem gambling was high, in particular among females. Individual transitions from problem gambling to recovery and to recurrent problem gambling, between baseline and follow-up, were common regardless of age. This study adds further evidence to research suggesting that there is a high mobility in and out of problem gambling over time on an individual level. The high incidence of first episode problem gambling among youth in Sweden stresses the importance of prevention of problem gambling at an early age.

This study aimed to investigate, from a gender perspective, how different features of problem gambling present in men and women who gamble regularly in Sweden were distributed in four domains based on gambling type (chance or strategy) and setting (public or domestic). Problem gambling features were based on the nine items in the Problem Gambling Severity Index (PGSI). It was hypothesized that men and women gamble in different domains. Further, it was hypothesized that male gamblers overall experienced more problems with gambling than female gamblers, although in the same domains they would report the same level of problems. A further hypothesis predicted that regular female gamblers would experience more health and social problems and men would experience more financial difficulties. Interviews with a subsample of gamblers (n = 3191) from a Swedish nationally representative sample (n = 8179) was used to examine how features of problem gambling correspond with gender and the domains. Only the first hypothesis was fully supported. Men were more likely to participate in forms of gambling requiring strategy in a public setting, and women were more likely to participate in chance-based gambling in a domestic setting. Male and female gamblers had similar levels of problem gambling in the bi-variate analysis, but if controlling for age and gambling in multiple domains, women were more at risk than men. Additionally, men and women presented similar health and economic situations. The differences between male and female gamblers in Sweden have implications for research and prevention.

AIM To explore variability in perceptions of nurse managers and physician directors regarding roles, responsibilities and clinical-decision making related to mechanical ventilator weaning in Norwegian intensive care units (ICUs). BACKGROUND Effective teamwork is crucial for providing optimal patient care in ICU. More knowledge on nurses' and physicians' perceptions of responsibility in clinical decision-making for mechanical ventilation is needed. METHODS Self-administered survey of mechanical ventilation and weaning responsibilities was sent to nurse managers and physician directors of Norwegian adult ICUs. Nurses' decisional influence and autonomy were estimated on a numeric rating scale (NRS) from 0 to 10 (least to most). RESULTS Response rate was 38/60 (63%) nurses and 38/52 (73%) physicians. On the NRS nurse managers perceived the autonomy and influence of nurses' ventilator decisions higher than physician directors: median of 7 (IQR 5-8) (nurses) versus 5 (3-6) (physicians), (p < 0·01), and 8 (7-9) (nurses) versus 7 (5-8) (physicians), (p < 0·01) respectively. Respondents agreed that nurses collaborated in assessment of patient response to ventilator changes and titrating ventilator settings: 92% of nurses and 87% of physicians, (p = 0·46), and recognizing weaning failure 84% of nurses and 84% of physicians, (p = 0·96). Physician directors perceived significantly less collaborative decision-making on weaning method (p = 0·01), weaning readiness (p = 0·04) and readiness to extubate (p < 0·01) than nurse managers. Both groups acknowledged the importance of 'knowing the patient' for weaning success, and agreed that the assessment of work of breathing, well-being, and clinical deterioration were important for determining weaning tolerance. CONCLUSIONS Nurse managers perceived nurses to have greater autonomy, influence and collaborative interaction regarding decisions on mechanical ventilation than physician directors. Greater awareness and acknowledgment of nurses' role may promote interprofessional collaboration and improve patient care.

Background The link between compulsive exercise and eating disorders is well known, but research with clinical samples has been limited. The purpose of the study was to investigate changes in attitudes towards compulsive exercise and its impact on outcome at follow-up in female adult hospitalised patients with eating disorders. Methods The sample consisted of 78 patients: Diagnostic distribution: anorexia nervosa 59 % (n = 46), approximately 22 % (n = 16) in bulimia nervosa, and Eating Disorder not Otherwise Specified respectively. The average follow-up period was 26 months (SD =15 months). Compulsive exercise was measured by the Exercise and Eating Disorder (EED) questionnaire. Other measures were the Eating Disorder Inventory (EDI-2), Body Attitude Test (BAT), Symptom Checklist (SCL-90), Inventory of Interpersonal Problems (IIP 64), Beck Depression Inventory (BDI), and body mass index (BMI). Outcome measures were EDI-2 and BMI (patients with admission BMI ≤ 18.5). Paired sample t-tests and mixed model regression analysis were conducted to investigate changes in compulsive exercise and predictors of outcome respectively. Results All measures revealed significant improvements (p

The purpose of this study was to examine the relationship between personality and depression in a general population in relation to gender and age. The Nord-Trøndelag Health Study (2006-2008), a large cross-sectional survey, was used. The sample consists of 35,832 men (16,104) and women (19,728) aged 20-89 years, living in the Nord-Trøndelag County of Norway, with valid ratings on the depression subscale of the Hospital Anxiety and Depression Scale (HADS) and Eysenck Personality Questionnaire (EPQ). This study demonstrates a relationship between depression and both neuroticism and extraversion in a general population. Older people score low more often on Extraversion (E) than younger people. Interactions were observed between neuroticism and age, gender, and extraversion with depression. The interaction term indicates a high score on Neuroticism (N) enhanced by introversion, older age, and being a male with depression. The findings suggest that health professionals may need to put extra effort into the care of patients with low extraversion and high neuroticism, in order to help those patients avoid depression.

Summary Background Tape blisters are common in orthopaedic patients. The method used for covering the surgical field may be an independent risk factor for the development of blisters. Methods The present randomised clinical trial was conducted to compare two different methods of draping at hip replacement surgery. Patients were randomized to receive the standard or the new procedure. Presence of tape blisters after surgery along with their number, size and location was recorded for 100 patients. Results Tape blisters developed in 30% of the patients. Women were more likely to develop tape blisters compared to men (38.6% vs. 18.6%; p =0.03). Age, surgical procedure, operating time, BMI, nutritional status, smoking history, medication, comorbidity and type of surgical incision were not significantly associated with the risk of developing tape blisters. Tape blisters were more common amongst patients treated according to the standard method (35.5% vs. 24.5%; p =0.24). However, this difference was not statistically significant. Conclusion Women are more likely to develop tape blisters after hip surgery than men. The method used for draping might be an important factor in the development of tape blisters. Further research is required.

Urinary incontinence is a multi-factorial condition that has a high impact on older persons living in nursing homes. While urinary incontinence is common, only a small percentage of nursing home residents have an official diagnosis. Factors influencing urinary incontinence in this population are poorly understood. The aim of this study was to evaluate the prevalence of urinary incontinence in Norwegian nursing home residents and to study the factors associated with urinary incontinence in this population. Residents from six different nursing homes were included in this study. Data on sex, age, medication, comorbid illnesses, urinary incontinence and the use of absorbent pads was collected. Barthel`s Index of Activities of Daily Living (ADL) was used to estimate residents’ functional levels. Post-voiding residual urine was measured by means of a portable ultrasound. A questionnaire was completed by the nursing staff for each of the residents. In total, 173 residents participated in the study. One hundred and twenty-two residents (69%) were incontinent for urine and 144 used absorbent pads (83%). Fourteen percent of residents used absorbent pads ‘just to make sure’. They did not have a history of urinary incontinence. Low ADL score, dementia and urinary tract infection were significantly associated with incontinence for urine. The prevalence of urinary incontinence in Norwegian nursing homes is high. Absorbent products are frequently used without a history of urinary incontinence. Physical impairment, dementia and urinary tract infections are significantly associated with urinary incontinence.

This study analyzes the latent demand to outdoor recreation participation and identifies what factors are constraining people from realizing this demand. In Sweden, recreation in the outdoors is seen as a public right as articulated in public policy and much of the outdoor recreation centre around forested landscapes—over 60 percent of the land area is classified as forest. Using data from a nationwide survey of 43 recreation activities, the study takes a time-contextual approach to reveal variations in recreation constraints across weekdays, weekends and holidays. Results show that almost half the population has a latent demand to increase their participation in outdoor recreation. Three categories of time contextual constraints are identified and several of the constraints studied show variations across outdoor activities and socio-economic factors. Practical implications for the promotion of outdoor recreation participation by public agencies, recreation managers and tourism businesses are discussed based on the study findings.

In the present study, Internet gambling was studied with data from the first two waves of the Swedish longitudinal gambling study. Self-reported gambling problems, alcohol consumption, smoking, mental health, social support, gender and other socio-demographic factors were evaluated with respect to the prevalence of Internet gambling in 2008 and 2009 and the incidence in 2009. Multivariate logistic regression was used. In 2009 most Internet gamblers (72%) were men. However, women seem to have become more involved in Internet gambling. In 2009, 62.5% of new Internet gamblers since 2008 were men. Mental health, alcohol, smoking and social support were not predictive factors for incident Internet gambling. Self-reported gambling on regulated Internet sites showed higher prevalence rates of problem gamblers than gambling on land-based forms in 2008, but not in 2009. At both time-points, unregulated sites had the highest rates of problem gambling. The findings suggest that a gender perspective on Internet gambl...

Aim. The aim was to investigate the associations between perceived social support and depression in a general population in relation to gender and age. Background. Social support is seen as one of the social determinants for overall health in the general population. Studies have found higher probability of experiencing depression among people who have a lack of social support; evidence from the general population has been more limited. Subjective perception that support would be available if needed may reduce and prevent depression and unnecessary suffering. Design. A cross-sectional survey with self-reported health was used. Method. A total of 40,659 men and women aged 20–89 years living in Nord-Trondelag County of Norway with valid ratings of depression subscale of the Hospital Anxiety and Depression Scale in the The Nord-Trondelag Health Study 3 were used. Logistic regression was used to quantify associations between two types of perceived support (emotional and tangible) and depression. Gender, age and interaction effects were controlled for in the final model. Results. The main finding was that self-rated perceived support was significantly associated with Hospital Anxiety and Depression Scale-defined depression, even after controlling for age and gender; emotional support (OR = 3·14) and tangible support (OR = 2·93). The effects of emotional and tangible support differ between genders. Interaction effects were found for age groups and both emotional and tangible support. Conclusion. Self-rated perceived functional social support is associated with Hospital Anxiety and Depression Scale-defined depression. In the group of older people who have a lack of social support, women seem to need more emotional support and men tangible support. Relevance to clinical practice. Health care providers should consider the close association between social support and depression in their continuing care, particularly in the older people.

The study examines two Swedish replication prevalence studies (n = 10,000 and n = 15,000) with the aim of exploring evidence for a feminization of gambling in Sweden between 1997/1998 and 2008/2009 ...

BACKGROUND The Norwegian Internship Council has uncovered weaknesses associated with the compulsory practice period in hospitals for doctors, both on a national basis and for North Trondelag County. MATERIAL AND METHODS In 2007 and 2008, 79% (859) of all interns in Norwegian hospitals participated in the Council's national evaluation of the practice period. We compared the results from interns serving at hospitals in Levanger and Namsos (North Trondelag) (n = 39) with those from interns serving at the other hospitals in Norway (n = 820). RESULTS At the surgical and medical departments in Levanger, the training in clinical procedures and acute medical conditions (simulator training) was similar or better than that in the other hospitals in Norway, but the guidance given to candidates in these departments was neither considered to be especially useful (12% and 17%) nor did it focus on problems related to ethics (0-8%). In general the guidance was perceived as more useful and systematic in psychiatric wards than in somatic ones. Fewer candidates in Namsos had experience with patient rounds (69%) and writing of case reports (79%) than those in hospitals in the rest of the country, and no interns in psychiatry reported that they had received thorough training in cooperation with the primary health services or in psychopharmacology. INTERPRETATION National data from the Internship Council conceal important variations between hospitals, and to be useful for local improvement work they have to be reanalysed. The identified weaknesses for interns in North Trondelag led to implementation of new routines for guidance, training in simulation and law before start of the practice period.

Rationale, aims and objectives: Secondary prevention programmes reduce cardiovascular risk, but few studies have evaluated whether a nurse-led intervention for patients discharged early after myocardial infarction (MI) promotes self-management behaviour. The aim of this study was to evaluate the effect of an individual nurse-led counselling programme combined with usual care versus usual care alone on self-management behaviour of patients discharged early after MI. Methods: Seventy-one patients were randomised to either the usual care (control group) or to the usual care combined with a 6-month follow-up individual nurse-led counselling programme (intervention group). The latter consisted of 3 face-to-face sessions and 2 telephone contacts over 6 months, starting 2 weeks after discharge. Primary outcome measures at 6- and 12-month follow-up was the difference in self-management behaviour assessed by the patient activation measure (PAM). Secondary outcomes included physical activity and diet habit. Results: The median age of patients was 63 years and 70% were males. The intervention group had a greater effect on their PAM scores and had higher average intensity and longer duration of physical activity at 6-months and a higher summary index of weekly physical activity at 6- and 12-month follow-up compared to the control group. There was a clinically relevant effect on diet score within the intervention group at 6- and 12-month follow-up. Conclusions: An individual nurse-led counselling programme combined with usual care for post-MI treatment, had an effect on self-management behaviour at 6-month follow-up. The results also indicate an effect on health behaviour at 12-month follow-up.

A wide range of methods exists for on-site visitor monitoring in parks and recreation areas. Self-registration methods have proven to be popular because of their low cost and relative ease of administration, but little is known about the extent to which the data collected from self-registration boxes are representative of the population of visitors, and the degree that bias exists as a result of non-compliance. This article examines these concerns based on research at Fulufjallet National Park in Sweden. On-site registration card and follow-up mail survey data from a sample of visitors who did not voluntarily register were compared with the same kind of data for visitors who did register voluntarily. In total, 10 registration card items and 284 mail survey items were tested for variations between compliant and non-compliant visitors. Of these, one third of the card items, 12% and 3% of the survey items for Swedish and German visitors, respectively, yielded statistically significant differences. I...

Adults suffering from schizophrenia and other psychiatric disorders report low levels of physical activity. In addition, these patients have an increased risk of overweight and poor nutritional habits. Less is known about patterns and levels of physical activity before the onset of disease.The purpose of the study was to investigate whether there were specific patterns of physical activity in the premorbid phase of schizophrenia and whether these participants differed from those with bipolar disorder (BD). A group of healthy controls (HC) was also included.The study was a prospective, longitudinal, comparative cohort design in which 15 adolescents who later developed schizophrenia and 18 with later BD were compared with HC. Data were analysed using non-parametric statistical tests.Patients with a diagnosis of schizophrenia were less physically active with fewer days per week (p0.05) and fewer hours per week (p0.05) in the premorbid phase than both BD and HC. They also participated less in team sports than HC (p0.05).Our results suggest that individuals who develop schizophrenia in their teens may be at risk of establishing a lifestyle harmful to health. From a preventive perspective it is important to gain more knowledge about the connections between health habits and later development of disease.

Objectives: An increasing part of the population is affected by disordered eating (DE) even though they do not meet the full eating disorder (ED) criteria. To improve treatment in the range of weight-related disorders, there is a need to improve our knowledge about DE and relevant correlates of weight problems such as underweight, overweight and obesity. However, studies investigating DE and weight problems in a wide range of ages in the general population have been lacking. This paper explores DE, weight problems, dieting and weight dissatisfaction among women in a general population sample. Design: Cross-sectional study. Setting: The third survey of the Nord-Trøndelag Health Study (HUNT3). Participants: The population included 27 252 women, aged 19–99 years, with information on DE outcomes and covariates. Outcomes: DE was assessed with an 8-item version of the Eating Attitude Test and the Eating Disorder Scale-5. Body mass index (BMI) was objectively measured. Data on dieting and weight dissatisfaction were collected from self-reported questionnaires and analysed across weight categories. Crude and adjusted logistic and multinomial logistic regression models were used. Results: High rates of overweight (38%) and obesity (23%) were found. DE was associated with weight problems. In women aged 30 years. In those of younger ages (19–29 years), lower weight predicted DE, while increasing weight predicted DE in older aged women (30–99 years). The majority of women were dissatisfied with their weight (58.8%), and 54.1% of the women reported dieting. Neither BMI status nor age was associated with dieting or weight dissatisfaction. Conclusions: A high prevalence of DE was observed, and findings suggest that weight problems and DE are not distinct from one another. Dieting was associated with women's weight dissatisfaction, rather than with actual weight. This requires further investigations about directionality of effects. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Published article Background Comparison of survival and quality of life in a mixed ICU population of patients 80 years of age or older with a matched segment of the general population. Methods We retrospectively analyzed survival of ICU patients ≥80 years admitted to the Haukeland University Hospital in 2000–2012. We prospectively used the EuroQol-5D to compare the health-related quality of life (HRQOL) between survivors at follow-up and an age- and gender-matched general population. Follow-up was 1–13.8 years. Results The included 395 patients (mean age 83.8 years, 61.0 % males) showed an overall survival of 75.9 (ICU), 59.5 (hospital), and 42.0 % 1 year after the ICU. High ICU mortality was predicted by age, mechanical ventilator support, SAPS II, maximum SOFA, and multitrauma with head injury. High hospital mortality was predicted by an unplanned surgical admission. One-year mortality was predicted by respiratory failure and isolated head injury. We found no differences in HRQOL at follow-up between survivors (n = 58) and control subjects (n = 179) or between admission categories. Of the ICU non-survivors, 63.2 % died within 2 days after ICU admission (n = 60), and 68.3 % of these had life-sustaining treatment (LST) limitations. LST limitations were applied for 71.3 % (n = 114) of the hospital non-survivors (ICU 70.5 % (n = 67); post-ICU 72.3 % (n = 47)). Conclusions Overall 1-year survival was 42.0 %. Survival rates beyond that were comparable to those of the general octogenarian population. Among survivors at follow-up, HRQOL was comparable to that of the age- and sex-matched general population. Patients admitted for planned surgery had better short- and long-term survival rates than those admitted for medical reasons or unplanned surgery for 3 years after ICU admittance. The majority of the ICU non-survivors died within 2 days, and most of these had LST limitation decisions. © 2015 Andersen et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

The aim of this investigation was to study self-related health, physical activity and level of exertion, as well as body complaints in Swedish high school students. A total of 993 high school students aged 16–19 years participated in the study. A questionnaire was completed at school and included questions about self-related health, physical activity behavior, type of physical activity/sport, intensity, duration, possible injuries or complaints, and absence from physical training at school, during the last 3 months. The results showed that 26% of the high school students participated in sports on a regular basis. Males reported significantly better health than females (p< 0.0005). A significantly higher number of females participated in physical activities at a lower level of effort (p< 0.0005) and a higher number of males trained at a higher level of effort (p< 0.005). Sixtyone percent reported body pain during the last 3 months, representing a higher number of females than males (p= 0.03). A higher number of females than males reported complaints from the back (p= 0.002), the knees (p= 0.015), the neck (p= 0.001), and the hip (p= 0.015). Females with body complaints reported poorer health than those without complaints. There was a correlation between poor self-related health and a lower level of physical effort (0.219;p< 0.001). The results showed that the prevalence of musculoskeletal symptoms was high in this population and demonstrated a certain association with self-related health. Therefore, it is important to make it easy for adolescents to perform physical activity at school and during their leisure time in order to prevent chronic diseases.

Gambling participation and rates of problem gambling change over time in response to a variety of factors including gambling availability, demographic changes and adaptation at individual and societal levels. These relationship are complex and only partially understood. The major aim of the present study was to provide general population estimates of gambling participation and problem gambling for Sweden and compare these estimates with estimates from a previous national study. The study was also designed to identify risk factors for problem gambling including change in these factors over time. Data are from the first phase of the Swedish Longitudinal Gambling Study (Swelogs) in which a representative sample of 8,165 people was assessed using validated problem gambling and other measures to facilitate comparison with findings from the 1997/1998 Swedish Gambling Study (Swegs). Overall, it was found that gambling participation reduced markedly, although in some population sectors increases were evident for some forms including poker and electronic gaming machines. Lifetime prevalence of probable pathological gambling increased; however, past 12 months probable pathological and problem gambling prevalence did not. Males, younger adults and people born outside Sweden were at high risk in both studies. Significant prevalence increases were evident for people aged 18–24 and those with low levels of education. The results indicate that relationships between gambling exposure, participation and problems are dynamic with shifting implications for public health and social policy.

Aim: The aim of the current study was to examine the association of personality, neighbourhood, and civic participation with the level of perceived social support if needed. Methods: The sample consists of a total of 35,797 men (16,035) and women (19,762) drawn from the Nord-Trøndelag Health Study 3 (HUNT3), aged 20–89, with a fully completed short version of the Eysenck Personality Questionnaire (EPQ) including a complete response to questions regarding perceived social support. A multinomial logistic regression model was used to investigate the association between the three-category outcomes (high, medium, and low) of perceived social support. Results: The Chi-square test detected a significant ( p < 0.001) association between personality, sense of community, civic participation, self-rated health, living arrangement, age groups, gender, and perceived social support, except between perceived social support and loss of social network, in which no significance was found. The crude and adjusted multinomial logistic regression models show a relation between medium and low scores on perceived social support, personality, and sources of social support. Interactions were observed between gender and self-rated health. Conclusions: There is an association between the level of perceived social support and personality, sense of community in the neighbourhood, and civic participation. Even if the interaction between men and self-reported health decreases the odds for low and medium social support, health professionals should be aware of men with poor health and their lack of social support.

Background: The main objective of the present study was to determine whether UI is an independent predictor of ADL decline and IADL decline in elderly women. We also aimed to find out whether incontinent subjects were at higher risk of needing help from formal home care or home nursing care during 11 year follow-up. Methods: A prospective cohort study conducted as part of the North-Trøndelag Health Study 2 and 3. Women aged 70–80 years when participating in the HUNT 2 study, who also participated in the HUNT 3 study, were included in this study. Analyses on self-reported urinary incontinence at baseline and functional decline during a 11-year period were performed for incontinent and continent subjects. Results: Baseline prevalence of urinary incontinence was 24%. At on average eleven year follow up, logistic regression analysis showed a significant association between incontinence and decline in activities of daily living (ADL) (OR =2.37, 95% CI =1.01-5.58) (P=0.04). No association between urinary incontinence and instrumental activities of daily living (IADL) in incontinent women compared with continent women was found (OR=1.18, CI=.75-1.86) (P=.46). Data were adjusted for ADL, IADL and co morbid conditions at baseline. No significant differences in need of more help from formal home care and home nursing care between continent and incontinent women were found after 11 years of follow-up. Conclusions: Urinary incontinence is an important factor associated with functional decline in women aged 70–80 years living in their own homes. At eleven years of follow up, no significant differences in need of more help from formal home care and home nursing care between continent and incontinent women were found publishedVersion

Background: Research into the impact of problem gambling on close social networks is scarce with the majority of studies only including help-seeking populations. To date only one study has examined concerned significant others (CSOs) from an epidemiological perspective and it did not consider gender. The aim of this study is to examine the health, social support, and financial situations of CSOs in a Swedish representative sample and to examine gender differences. Methods: A population study was conducted in Sweden in 2008/09 (n = 15,000, response rate 63%). Respondents were defined as CSOs if they reported that someone close to them currently or previously had problems with gambling. The group of CSOs was further examined in a 1-year follow up (weighted response rate 74% from the 8,165 respondents in the original sample). Comparisons were also made between those defined as CSOs only at baseline (47.7%, n = 554) and those defined as CSOs at both time points. Results: In total, 18.2% of the population were considered CSOs, with no difference between women and men. Male and female CSOs experienced, to a large extent, similar problems including poor mental health, risky alcohol consumption, economic hardship, and arguments with those closest to them. Female CSOs reported less social support than other women and male CSOs had more legal problems and were more afraid of losing their jobs than other men. One year on, several problems remained even if some improvements were found. Both male and female CSOs reported more negative life events in the 1 year follow-up. Conclusions: Although some relationships are unknown, including between the CSOs and the individuals with gambling problems and the causal relationships between being a CSO and the range of associated problems, the results of this study indicate that gambling problems not only affect the gambling individual and their immediate close family but also the wider social network. A large proportion of the population can be defined as a CSO, half of whom are men. While male and female CSOs share many common problems, there are gender differences which need to be considered in prevention and treatment.

Swelogs (Swedish Longitudinal Gambling Study) epidemiological (EP-) track is a prospective study with four waves of data-collection among Swedish citizens aged 16–84 years at baseline. The major objectives of this track are to provide general population estimates of the prevalence and incidence of problem and at-risk gambling and enable comparisons with the first Swedish national study on gambling and problem gambling (Swegs) conducted in 1997/1998. The overall study (Swelogs) comprises three tracks of data collection; one epidemiological, one in-depth and one follow-up. It is expected to provide information that will inform the development of evidence-based methods and strategies to prevent the development of gambling problems. This paper gives an overview of the design of the epidemiological track, especially of its two first waves. The baseline wave, performed between October 2008 and August 2009, included 8165 subjects, of whom 6021 were re-assessed one year later. A stratified random sampling procedure was applied. Computer-supported telephone interviews were used as the primary method. Postal questionnaires were used to follow-up those not reached by telephone. The response rate was 55% in the first wave and 74% in the second. The interview and questionnaire data are supplemented by register data. © 2014 The Authors. International Journal of Methods in Psychiatric Research published by John Wiley & Sons Ltd.

The aim was to investigate the associations between perceived social support and depression in a general population in relation to gender and age.Social support is seen as one of the social determinants for overall health in the general population. Studies have found higher probability of experiencing depression among people who have a lack of social support; evidence from the general population has been more limited. Subjective perception that support would be available if needed may reduce and prevent depression and unnecessary suffering.A cross-sectional survey with self-reported health was used.A total of 40,659 men and women aged 20-89 years living in Nord-Trøndelag County of Norway with valid ratings of depression subscale of the Hospital Anxiety and Depression Scale in the The Nord-Trøndelag Health Study 3 were used. Logistic regression was used to quantify associations between two types of perceived support (emotional and tangible) and depression. Gender, age and interaction effects were controlled for in the final model.The main finding was that self-rated perceived support was significantly associated with Hospital Anxiety and Depression Scale-defined depression, even after controlling for age and gender; emotional support (OR = 3·14) and tangible support (OR = 2·93). The effects of emotional and tangible support differ between genders. Interaction effects were found for age groups and both emotional and tangible support.Self-rated perceived functional social support is associated with Hospital Anxiety and Depression Scale-defined depression. In the group of older people who have a lack of social support, women seem to need more emotional support and men tangible support.Health care providers should consider the close association between social support and depression in their continuing care, particularly in the older people.

Background: Depression is a common disorder in late life. As the elderly population continues to grow worldwide, depression is also likely to become an increasing health problem. The aim of this study was to examine changes in prevalence of depression in various age cohorts over an 11-year period.Methods: This study involved two cross-sectional studies (HUNT 2 and HUNT 3) of all adult inhabitants of the Norwegian county of Nord-Trøndelag with an 11 year-interval between the two studies. The participants aged 45 years or above at HUNT 2 and with a valid depression rating at both HUNT 2 (baseline) and HUNT 3 (follow-up) (N = 16517), were included and divided into five-year age cohorts. Depression was measured by the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D).Results: A significant increase in depression was found in all age cohorts from 76 years at follow-up, with the greatest increase (9.6%) in the oldest age cohort (86–90 years at follow-up). The incidence of depression is increasing with age, with over 10% new cases in all age cohorts aged 81 years and above at follow-up. About 5% of the participants in all age cohorts reported depression at both measure points, and there is a decrease in recovery from depression from baseline to follow-up with increasing age.Conclusions: We found increased prevalence of depression and a large number of new cases of depression in the oldest age cohorts.