Mette Brekke

• Stai, Elise; Brekke, Mette; Skjelland, Didrik & Vallersnes, Odd Martin (2026). Endringer i rusrelaterte forgiftninger ved Oslo legevakt etter flyttingen ut av sentrum. Utposten. ISSN 0800-5680. 55(4), p. 16–22. Full text in Research Archive
• Dalaker, Vivian Moe; Bjørnaas, Mari Asphjell; Øiestad, Elisabeth Leere; Brekke, Mette & Vallersnes, Odd Martin (2026). Covert administration of drugs in drug facilitated sexual assault: A prospective observational study from Oslo, Norway. Forensic Science International: Reports. 14. doi: 10.1016/j.fsir.2026.100489. Full text in Research Archive Show summary

  Objective To identify drugs in blood and urine samples from victims of sexual assault suspecting exposure to covert administration of drugs, and compare with substances reported taken by the victim. Methods We analyzed forensic blood and urine samples from patients 16 years or older presenting at the Oslo Sexual Assault Centre, Norway, suspecting exposure to covert administration of drugs in relation to the sexual assault. We recorded psychoactive substances reported taken before suspected exposure. Blood samples were analyzed for 64 drugs using ultra-high performance liquid chromatography – tandem mass spectrometry (UHPLC-MS/MS) and an automated enzymatic method for ethanol. Urine samples were analyzed for 39 drugs using liquid chromatography – tandem mass spectrometry (LC-MS/MS), and an additional nine drugs using immunoassay methods. Results We included 50 patients, median age 23 years, 49 were women. Median time from suspected exposure to toxicological sampling was 22 h. Drugs not reported taken were found in 17 (34%) patients, combined with drugs reported taken in nine. In 15 patients we only found drugs reported taken. Unreported drugs found in blood were cocaine in three patients, alprazolam in two, methylenedioxymethamphetamine/methylenedioxyamphetamine (MDMA/MDA) in two, tetrahydrocannabinol (THC) in one, and amphetamine in one. Unreported drugs found in urine were cocaine in eleven patients, MDMA/MDA in three, alprazolam in two, codeine in two, cannabis in one, oxazepam in one, amphetamine in one, and zolpidem in one. Gammahydroxybutyrate (GHB) was not detected in either matrix. Conclusion Unreported drugs were found in 34% of sexual assault victims suspecting covert administration of drugs.

• Natvik, Marianne; Brekke, Mette; Vangen, Siri & Skjeie, Holgeir (2026). Finding sense of coherence in the menopause transition - A qualitative interview study with menopausal women in Norway. Women's Health. ISSN 1745-5057. 22. doi: https:/journals.sagepub.com/doi/10.1177/17455057261459816. Full text in Research Archive Show summary

  Background Women express lack of knowledge about the menopause transition, finding it hard to understand and navigate symptoms. This period may negatively influence quality of life and level of functioning. Objectives To explore menopausal women’s experiences, perspectives and coping strategies to comprehend, manage and find meaning in the menopausal transition. Design Individual interviews of women with different backgrounds and menopausal experiences, recruited by hairdressers in Norway. Methods Semi-structured in-depth interviews were conducted with 11 women in 2024. Data were analysed using reflexive thematic analysis. The theory of Salutogenesis and Sense of Coherence developed by Antonovsky, was used as guiding theoretical lens. Results Three main themes were developed, incorporating the intercorrelated aspects of Sense of Coherence : Comprehensibility, Manageability and Meaningfulness. 1. A transition from the unknown to normalisation – without knowledge, understanding menopausal changes was challenged, but normalisation of menopause gave comprehension. 2. From distress and silence to empowerment – manageability increased with comprehension, discussions with other women and knowledge dissemination, but was challenged by inadequate health care. 3. Finding meaning in the change menopause brings – meaningfulness motivated to seek understanding and coping strategies, and gave acceptance and value to this transition, although often accompanied by an undesirable sense of aging. Conclusions This study shows the importance of enhancing knowledge among women, the public and general practitioners to understand and manage menopause, and to improve menopausal care and women’s quality of life.

• Ruud, Torleif; Rugkåsa, Jorun; Haavet, Ole Rikard; Dahli, Mina Piiksi; Hanssen-Bauer, Ketil & Brekke, Mette [Show all 9 contributors for this article] (2025). A collaborative primary and mental health care model with psychologist and psychiatrist working in GP practices: process evaluation of the implementation, challenges, and sustainability. BMC Health Services Research. 25(1). doi: 10.1186/s12913-025-13408-y. Full text in Research Archive
• Larsen, Karen Sørbø; Brekke, Mette & Vallersnes, Odd Martin (2025). Drug and alcohol poisonings treated at Oslo Accident and Emergency Outpatient Clinic 2019–23. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145. doi: 10.4045/tidsskr.25.0128. Full text in Research Archive Show summary

  Bakgrunn Behandling av rusrelatert forgiftning fordrer kunnskap om hvilke rusmidler som forekommer. Vi beskriver rusrelaterte forgiftninger ved Legevakten i Oslo i perioden 2019–23. Materiale og metode Rusrelatert forgiftning behandlet ved Legevakten i Oslo i perioden 2019–23 ble retrospektivt inkludert fra legevaktens journalsystem. Vi inkluderte tilfeller, ikke unike pasienter. Diagnose var basert på den behandlende legens journalførte kliniske vurdering. Insidenstall ble regnet ut basert på antall innbyggere i Oslo kommune ≥ 12 år. Resultater Fra 2019 til 2023 ble 18 402 tilfeller av rusrelatert forgiftning behandlet ved Legevakten i Oslo, hvorav 8 981 (49 %) var ren etanolforgiftning. Den totale insidensen av rusrelatert forgiftning steg fra 6,32 per 1 000 innbyggere i 2019 til 6,68 i 2023, med et bunnpunkt på 5,36 i 2021. Insidensen av ren etanolforgiftning var 3,10 i 2019 og 3,06 i 2023, med et bunnpunkt på 2,53 i 2020. Gjennom femårsperioden steg insidensen av kokainforgiftninger fra 0,28 til 0,70 og ketaminforgiftninger fra 0,01 til 0,12. Kvinneandelen steg fra 33 % til 39 % ved ren etanolforgiftning, og fra 20 % til 31 % ved øvrig rusrelatert forgiftning. Fortolkning Insidensen av rusrelaterte forgiftninger behandlet ved Legevakten i Oslo steg fra 2019 til 2023, med en forbigående nedgang under koronapandemien.

• Skjelland, Didrik; Jørgenrud, Benedicte Marie; Gundersen, Karsten; Bjørnaas, Mari Asphjell; Brekke, Mette & Dalaker, Vivian Moe [Show all 8 contributors for this article] (2025). Gamma-hydroxybutyrate poisoning: clinical diagnosis versus laboratory findings. Clinical Toxicology. ISSN 1556-3650. 63(4), p. 253–260. doi: 10.1080/15563650.2025.2463700. Full text in Research Archive Show summary

  Introduction Patients poisoned with gamma-hydroxybutyrate may need urgent medical treatment. The clinical manifestations are heterogeneous, and the level of consciousness is often unstable, with fluctuations between agitation and coma. We aimed to investigate the accuracy of the clinical diagnosis of gamma-hydroxybutyrate poisoning compared to laboratory findings in blood samples. Methods We did a prospective observational study, including patients ≥16 years of age admitted to hospital with a clinical diagnosis of gamma-hydroxybutyrate poisoning. The diagnosis was established by the doctor treating the patient based on the clinical information and/or information from the patient and/or the patient’s companions. Blood samples were taken at admission and analyzed using ultra high-performance liquid chromatography–tandem mass spectrometry. Results There were 87 patients with a median age of 35 years (IQR: 30–42 years), and 58.6% (51/87) were male. Gamma-hydroxybutyrate was found in blood samples taken from 60 (69.0%) patients. The median Glasgow Coma Scale of all patients on arrival at hospital was 6 (IQR: 3–10), and 53.3% of the patients who tested positive for gamma-hydroxybutyrate presented with a Glasgow Coma Scale of 3. The Glasgow Coma Scale was significantly lower (P <0.001) among patients who tested positive for gamma-hydroxybutyrate, and was inversely correlated with gamma-hydroxybutyrate concentrations. Among the 60 patients testing positive for gamma-hydroxybutyrate, 28 (46.7%) needed treatment in an intensive care unit, and three (5.0%) required endotracheal intubation. In 58 (96.7%) of the 60 patients who tested positive for gamma-hydroxybutyrate, other drugs were also found, most frequently amfetamines, cocaine, and benzodiazepines. Discussion The frequent co-consumption of other psychoactive drugs makes the clinical diagnosis of gamma-hydroxybutyrate challenging, and poisoning with other central nervous system depressants was frequently observed among those patients testing negative for the gamma-hydroxybutyrate. Conclusions In only two out of three patients with clinically suspected gamma-hydroxybutyrate poisoning was gamma-hydroxybutyrate found in a blood sample, indicating that clinicians might overdiagnose gamma-hydroxybutyrate poisoning.

• Rosendahl, Alexander; Vanaveski, Anet; Pilv-Toom, Liina; Blumfelds, Jānis; Siliņa, Vija & Brekke, Mette [Show all 11 contributors for this article] (2025). General practitioners’ clinical decision-making in patients that could have cancer: a vignette study comparing the Baltic states with four Nordic countries. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 43(2), p. 403–410. doi: 10.1080/02813432.2025.2451653. Full text in Research Archive
• Myklestul, Hans-Christian; Skjeie, Holgeir; Brekke, Mette & Skonnord, Trygve (2024). ‘Shades of grey’: a focus group study on diagnostic uncertainty among general practitioners using point-of-care ultrasound. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. doi: 10.1080/02813432.2024.2423242. Full text in Research Archive Show summary

  Background Point-of-care ultrasound (POCUS) has long been a diagnostic tool in family medicine, although most Norwegian general practitioners (GPs) who use POCUS, scans infrequently. The broad scope of family medicine, the relatively low prevalence of illnesses and infrequent use of POCUS imply that GPs may experience diagnostic uncertainty regularly. Aim To explore how GPs perceived and managed diagnostic uncertainty when using POCUS. Design and setting A qualitative focus group study among Norwegian GPs using POCUS. Methods Four focus group discussions were conducted. Total number of participants were 21. The interview guide was piloted, the focus group discussions were audio-recorded and transcribed, and Systematic Text Condensation, a thematic cross-case analysis, was used to analyse the data. Results Diagnostic uncertainty using POCUS was considered as aligning to the general clinical uncertainties in family medicine, but there were also POCUS-specific uncertainties in clinical decision-making. We generated six themes: emotional, cognitive, and ethical uncertainty using POCUS, communicating uncertainty to patients, interaction with specialists when using POCUS, and coping strategies of participants. POCUS results were the only results the participants sometimes withheld when communicating with other specialists. POCUS itself stimulated a renewed interest in family medicine. Scanning enough patients was the recommended coping strategy. Conclusion POCUS-using GPs experienced diagnostic uncertainty when using POCUS that aligned with other diagnostic uncertainties they experienced in everyday practice. However, they did not treat the results like other findings, as the GPs at times withheld their POCUS findings when interacting with secondary care specialists. This requires further investigation.

• Skjeie, Holgeir; Brekke, Mette & Skonnord, Trygve (2024). General practitioners’ reflections on prescribing addictive hypnotics to elderly: a qualitative study. British Journal of General Practice Open. 8(4), p. 1–9. doi: 10.3399/BJGPO.2024.0157. Full text in Research Archive
• Dalaker, Vivian Moe; Furuhaugen, Håvard; Brekke, Mette; Bjørnaas, Mari Asphjell; Krpo, Maja & Øiestad, Elisabeth Leere [Show all 7 contributors for this article] (2024). Drugs in blood and urine samples from victims of suspected exposure to drink spiking: A prospective observational study from Oslo, Norway. PLOS ONE. 19(7), p. 1–14. doi: 10.1371/journal.pone.0306191. Full text in Research Archive Show summary

  Objective People regularly contact emergency medicine services concerned that they have been exposed to drink spiking, i.e., exposure to drugs without their knowledge or permission. We identified drugs in blood and urine samples from patients suspecting exposure to drink spiking, with special consideration for drugs not reported taken by the patient (unreported drugs). Methods From September 2018 to May 2019, we collected blood and urine samples from patients 16 years or older presenting at an emergency clinic in Oslo, Norway, within 48 hours of suspected exposure to drink spiking. We also collected information on ethanol ingestion and drugs taken. Blood samples were analyzed for 20 classical recreational drugs using ultra-high performance liquid chromatography–tandem mass spectrometry (UHPLC-MS/MS) and an automated enzymatic method for ethanol. Urine samples were analyzed using immunoassay methods and a specific gas chromatography mass spectrometry (GCMS) method for gammahydroxybutyrate (GHB). Results From 100 included patients (median age 24 years, 62 females), we collected 100 blood samples and 72 urine samples. Median time since exposure was 5 hours. Unreported drugs were found in 15 patients. Unreported drugs in the blood samples were clonazepam in 3, methylenedioxymethamphetamine (MDMA) in 3, amphetamine in 2, tetrahydrocannabinol (THC) in 2, tramadol in 1, cocaine in 1, and methamphetamine in 1. Unreported drugs in the urine samples were cocaine in 5, amphetamine in 4, ecstasy in 3, and cannabis in 2. Ethanol was found in 69 patients, all reporting ethanol ingestion. Median blood ethanol concentration was higher in patients with no unreported drugs detected, 1.00‰ (interquartile range (IQR) 0–1.52) vs. 0‰ (IQR 0–0.46) (p<0.001). GHB was not detected. Conclusion Unreported drugs, possibly used for drink spiking, were found in 15% of patients. Blood ethanol concentration was higher when no unreported drugs were found. GHB was not detected in any patient.

• Berge, Siri Dalsmo; Brekke, Mette; Meland, Eivind & Mildestvedt, Thomas (2024). How patients experience discussing couple relationship problems with GPs: an interview study. British Journal of General Practice Open. 8(4), p. 1–12. doi: 10.3399/BJGPO.2024.0044. Full text in Research Archive Show summary

  Background Couple relationship satisfaction is related to good physical health, good mental health, and longevity. Many patients have discussed or wish to discuss their couple relationship with their GP and look for personalised care and support when discussing topics they perceive as sensitive. Aim To explore patient experiences of discussing couple relationship problems in GP consultations. Design & setting Qualitative study employing semi-structured interviews with patients from general practice in Norway. Method Individual interviews with 18 patients who had discussed their couple relationship with their GP. Participants were recruited through both social media and traditional media, and all interviews were digitally recorded. The purposive sample comprised 13 women and five men, representing diverse age groups, backgrounds, and relationship problems. All participants identified as heterosexual. We analysed interview data thematically using systematic text condensation. Results Three main themes emerged: 1) GPs in a facilitating role, not on an assembly line; 2) navigating the 'elephant in the room'; and 3) GPs as biomedically competent life witnesses. GP continuity was vital in fostering the trust required to discuss sensitive topics, such as relationship issues. Participants valued a biopsychosocial approach that incorporated knowledge of close relationships into medical consultations. They appreciated both GP support and constructive challenges that prompted them to take responsibility for relationship improvements. Conclusion Patients value their GPs’ holistic, supportive, and direct approach in addressing couple relationship problems, although they perceive that GPs do not always have sufficient time. They welcome relevant challenges that can drive positive change.

• Smedsland, Solveig Katrine; Vandraas, Kathrine Flørenes; Falk, Ragnhild Sørum; Horn, Julie; Reidunsdatter, Randi Johansen & Kiserud, Cecilie E. [Show all 9 contributors for this article] (2023). Sexual health in long-term breast cancer survivors: a comparison with female population controls from the HUNT study. Breast Cancer Research and Treatment. ISSN 0167-6806. 201(3), p. 479–488. doi: 10.1007/s10549-023-07021-y. Full text in Research Archive
• Smedsland, Solveig Katrine; Falk, Ragnhild Sørum; Reinertsen, Kristin Valborg; Kiserud, Cecilie E.; Brekke, Mette & Bøhn, Synne-Kristin Hoffart [Show all 8 contributors for this article] (2023). Burden of late effects in a nationwide sample of long-term breast cancer survivors. Cancer. ISSN 0008-543X. doi: 10.1002/cncr.35019. Full text in Research Archive
• Natvik, Marianne; Gjelsvik, Bjørn E.; Vangen, Siri; Skjeie, Holgeir & Brekke, Mette (2023). Women's information needs about menopause: a cross-sectional survey in Norwegian general practice. British Journal of General Practice Open. 8(1), p. 1–8. doi: 10.3399/BJGPO.2023.0127. Full text in Research Archive Show summary

  Background Research indicates that providing women with information about menopause can improve their attitude towards menopause and symptom experience. Nevertheless, information shared on this topic is often arbitrary. Aim Examine women’s information needs about menopause, and understand if, when, and from whom they want information. Design &amp; setting A cross-sectional study among women in the waiting room of 54 general practice clinics in South-Eastern Norway, autumn 2022. Method Medical students recruited women in the clinics waiting room. A one-page study specific questionnaire was used, focusing on need for information about menopause. Results A total of 625 women were included, with a mean age of 44.4 years (SD 8.7). In all, 59% answered that they wanted information about menopause, and 81% of these wanted their general practitioner (GP) to inform them, from a median age of 45. According to the women, only 10% of GPs had addressed the topic. Higher education was a predictor for wanting information. A main driver of information needs was to help oneself in the present and in the future. In all, 33% did not want information. The main reasons were that they already possessed sufficient information, would take menopause as it comes, were too young, or were already postmenopausal. The gender of the GP did not influence the results. Conclusion Most women wanted information about menopause from their GP. The study emphasises the need for GPs to consider prioritising this discussion, and to keep up to date on recommendations and treatment options.

• Hajdarevic, Senada; Brekke, Mette & Harris, Michael (2023). Exploring why European primary care physicians sometimes do not think of, or act on, a possible cancer diagnosis. A qualitative study. British Journal of General Practice Open. 7(4). doi: 10.3399/BJGPO.2023.0029. Full text in Research Archive
• Eikeland, Siri Asheim; Smeland, Knut Bjøro; Brekke, Mette; Kiserud, Cecilie E. & Fosså, Alexander (2022). Late-effect awareness and follow-up of cancer in general practice. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. doi: 10.1080/02813432.2022.2139457. Full text in Research Archive Show summary

  Objective With increasing cancer incidence and survival rates, follow-up care becomes a major healthcare concern, placing increased demands on general practitioners (GPs). We explored GPs’ awareness of late effects (LEs) after cancer treatment. Their degree of involvement and attitudes towards follow-up care was studied separately for solid cancers and Hodgkin’s lymphoma (HL). Design and setting Mailed questionnaire study in Norwegian general practice. Subjects 185 responding GPs with responsibility for HL survivors, more than 10 years since diagnosis. Main outcome measures and results All GPs reported some awareness of LEs. Increasing awareness of LEs was associated with female sex, being a specialist, having experience from hospital-based cancer care and familiarity with official guidelines on LEs after treatment. The majority of GPs were involved in follow-up care, which increased with patients’ time since treatment and was associated with higher awareness of LEs. GPs with work experience in hospital-based cancer care were more likely to be engaged in HL follow-up. Most GPs were willing to provide follow-up care at some point after treatment. Older and more experienced GPs, and those satisfied with the collaboration with hospital specialists, were more likely to provide follow-up earlier. Conclusion GPs’ awareness of LEs and their willingness to provide follow-up care were related to familiarity with guidelines and experience. GPs more involved in follow-up care also had higher knowledge of LEs. Distribution of guidelines on LEs and follow-up care, and improving collaboration with hospital specialists, might increase GPs’ knowledge and willingness to become involved in follow-up care, especially early in their careers. GPs’ involvement and attitude towards follow-up of survivors of common solid cancers and HL, a rare malignant disease, were similar.

• Tzanis, George; Harris, Michael; Brekke, Mette; Marzo-Castillejo, Mercè; Cifcili, Saliha Serap & Wawrzynek, Wojciech [Show all 20 contributors for this article] (2022). What factors empower general practitioners for early cancer diagnosis? A 20-country European Delphi Study. Primary Health Care Research and Development. ISSN 1463-4236. 23, p. e76–e76. doi: 10.1017/S1463423622000652. Full text in Research Archive Show summary

  Background: Some symptoms are recognised as red flags for cancer, causing the General Practitioner (GP) to refer the patient for investigation without delay. However, many early symptoms of cancer are vague and unspecific, and in these cases, a delay in referral risks a diagnosis of cancer that is too late. Empowering GPs in their management of patients that may have cancer is likely to lead to more timely cancer diagnoses. Aim: To identify the factors that affect European GPs’ empowerment in making an early diagnosis of cancer. Methods: This was a Delphi study involving GPs in 20 European countries. We presented GPs with 52 statements representing factors that could empower GPs to increase the number of early cancer diagnoses. Over three Delphi rounds, we asked GPs to indicate the clinical relevance of each statement on a Likert scale. The final list of statements indicated those that were considered by consensus to be the most relevant. Results: In total, 53 GPs from 20 European countries completed the Delphi process, out of the 68 GPs who completed round one. Twelve statements satisfied the pre-defined criteria for relevance. Five of the statements related to screening and four to the primary/secondary care interface. The other selected statements concerned information technology (IT) and GPs’ working conditions. Statements relating to training, skills and working efficiency were not considered priority areas. Conclusion: GPs consider that system factors relating to screening, the primary-secondary care interface, IT and their working conditions are key to enhancing their empowerment in patients that could have cancer. These findings provide the basis for seeking actions and policies that will support GPs in their efforts to achieve timely cancer diagnosis.

• Ingebrigtsen, Erlend; Persett, Per Sverre; Brekke, Mette; Heyerdahl, Fridtjof; Hovda, Knut Erik & Vallersnes, Odd Martin (2022). Poisoning with central stimulant drugs: an observational study from Oslo, Norway. International Journal of Emergency Medicine. ISSN 1865-1372. 15(1). doi: 10.1186/s12245-022-00457-x. Full text in Research Archive Show summary

  Background The use of central stimulant drugs causes significant morbidity. We describe poisonings with central stimulant drugs and compare the different central stimulants concerning combinations with other drugs, treatment, and clinical course.  Methods Patients presenting from 1 October 2013 to 31 March 2016 with poisoning related to the recreational use of central stimulant drugs were retrospectively included at a primary care emergency outpatient clinic and at a hospital emergency department in Oslo, Norway. Diagnosis of toxic agents was mainly based on the clinical assessment of the doctor treating the patient. Amphetamine and methamphetamine were co-categorized as amphetamine. Results Among the 1131 cases of acute poisoning with central stimulant drugs at the outpatient clinic, amphetamine was involved in 808 (71.4%), cocaine in 252 (22.3%) methylenedioxymethamphetamine (MDMA) in 104 (9.2%), and methylphenidate in 13 (1.1%). Among the 211 cases at the hospital, amphetamine was involved in 167 (79.1%), cocaine in 60 (28.4%), and MDMA in 38 (18.0%). Amphetamine was frequently combined with opioids (40.1% at the outpatient clinic and 41.9% at the hospital) and benzodiazepines (28.3% and 45.5%), while MDMA often was combined with ethanol (64.4% and 71.1%), as was cocaine (62.7% and 61.7%). Sedation was given in 5.2% and 38.4% of cases, naloxone in 9.4% and 37.0%, and flumazenil in 0.1% and 28.0%. In total, 16.5% of the cases at the outpatient clinic were transferred to a hospital for medical review and 8.5% to a psychiatric hospital. Among the hospital patients, 92.9% were admitted to intensive care. Conclusion Amphetamine was the most common central stimulant drug involved in acute poisoning in Oslo, often combined with opioids and benzodiazepines.

• Vandraas, Kathrine Flørenes; Falk, Ragnhild Sørum; Bøhn, Synne-Kristin Hoffart; Kiserud, Cecilie E.; Lie, Hanne Cathrine & Smedsland, Solveig Katrine [Show all 10 contributors for this article] (2022). Work ability 8 years after breast cancer: exploring the role of social support in a nation-wide survey. Breast Cancer Research and Treatment. ISSN 0167-6806. 193, p. 685–694. doi: 10.1007/s10549-022-06599-z. Full text in Research Archive Show summary

  Introduction As the 5-year survival rate after breast cancer in Norway is 92%, the population of breast cancer survivors (BCSs) is increasing. Knowledge of work ability in this population is scarce. In a population-based cohort of BCSs, we explored work ability 8 years after diagnosis and the association between work ability and social support, and cancer-related variables including late effects and lifestyle factors. Methods In 2019, all Norwegian women < 59 years when diagnosed with stage I–III breast cancer in 2011 or 2012, were identified by the Cancer Registry of Norway and invited to participate in a survey on work life experiences. Work ability was assessed using the Work Ability Index (scale 0–10). Factors associated with excellent work ability (score ≥ 9) were identified using univariate and multivariate logistic regression analyses, and adjusted for socioeconomic-, health- and cancer-related variables. Results Of the 1951 eligible BCSs, 1007 (52.8%) responded. After excluding survivors with relapse (n = 1), missing information on work ability score (n = 49), or work status (n = 31), the final sample comprised 926 BCSs within working age at survey (< 67 years). Mean age at survey was 56 years and 8 years (SD 0.7) had passed since diagnosis. Work ability had been reduced from 8.9 (SD 2.3) at diagnosis to 6.3 (SD 3.1). One in three BCSs reported poor work ability (WAS ≤ 5), and seven out of ten reported that their physical work ability had been reduced due to cancer. Social support from colleagues during cancer therapy was associated with excellent work ability, which was not observed for social support provided by supervisors or the general practitioner. Cognitive impairment and fatigue were inversely associated with work ability. None of the cancer-related variables, including treatment, were associated with work ability 8 years after diagnosis. Conclusion In this population-based sample, one in three BCSs reported poor work ability 8 years after diagnosis. Collegial social support during cancer therapy appears to be a protective factor for sustained work ability, whilst survivors struggling with fatigue and cognitive impairments may represent a particularly vulnerable group for reduced work ability.

• Berge, Siri Dalsmo; Brekke, Mette; Meland, Eivind & Mildestvedt, Thomas (2022). How do general practitioners handle couple relationship problems in consultations? A focus group study. Family Practice. ISSN 0263-2136. 39(5), p. 913–919. doi: 10.1093/fampra/cmac010. Full text in Research Archive Show summary

  Background Couple relationship problems are common and associated with health problems. The aim of this study was to explore general practitioners’ (GPs’) experiences, expectations, and educational needs when dealing with couple relationship problems in consultations. Methods We conducted an exploratory qualitative study by carrying out 3 semistructured focus group interviews with 18 GPs. We used systematic text condensation for the analyses. Results Participants shared their experiences of handling couple relationship problems in consultations. Three main themes emerged: (i) pragmatic case-finding: golden opportunities to reveal patients’ couple relationship problems; (ii) conceptual and role confusion; (iii) professional competence and personal experience. While issues in relationships could serve as an explanation for relevant clinical problems, some GPs questioned whether relationship issues are strictly medical. All participants had engaged in individual supportive therapy, but none saw themselves as therapists. The interviews revealed that an individual supportive focus might lead to a consolidation of 1 partner’s view, rather than challenging their position. Long-term doctor–patient relationships made it easier to talk about these issues. Conclusions This study revealed several paradoxes. GPs are confident in offering individual supportive therapy for couple relationship issues but should be aware of substantial pitfalls such as side-taking and constraining change. Despite dealing with relationship problems, GPs do not see themselves as therapists. They use professional and personal experience but would benefit from increasing their skills in cognitive restructuring promoting behavioural flexibility facing relationship problems.

• Iqbal, Zahra Zeineb; Nguyen, Thanh Mai Thi; Brekke, Mette & Vallersnes, Odd Martin (2022). Unspecified opioids among opioid overdoses in Oslo, Norway. BMC Research Notes. 15. doi: 10.1186/s13104-022-06022-2. Full text in Research Archive Show summary

  Objective Since 2017, an increasing number of opioid overdoses in Oslo, Norway, has been categorized as involving unspecified opioids, as noted in the patient records by the doctor treating the patient. In this study we compare the characteristics of overdoses involving unspecified opioids, long-acting opioids, and heroin. Data on patients presenting with opioid overdose was retrospectively collected from 1 October 2013 to 31 December 2019 at the Oslo Accident and Emergency Outpatient Clinic. Results Among 2381 included cases, 459 (19.3%) involved unspecified opioids, 134 (5.6%) long-acting opioids, and 1788 (75.1%) heroin. Overdoses involving unspecified opioids needed longer observation, median 5 h 29 min vs. 4 h 54 min (long-acting opioids) and 4 h 49 min (heroin) (p < 0.001), and had a lower Glasgow coma scale score, median 10 vs. 13 in both the other groups (p < 0.001). Naloxone was given in 23.3% of cases involving unspecified opioids, vs. 12.7% involving long-acting opioids and 30.2% involving heroin (p < 0.001). A larger proportion of patients were transferred to hospital care when unspecified or long-acting opioids were involved compared to heroin, 16.3% and 18.7% respectively vs. 10.1% (p < 0.001). Our results indicate that the category “unspecified opioids” encompasses a substantial proportion of opioids acting longer than heroin.

• Skjælaaen, Katarina; Nesvold, Helle; Brekke, Mette; Sare, Miriam; Landaas, Elisabeth Toverud & Mdala, Ibrahimu [Show all 8 contributors for this article] (2022). Sexually transmitted infections among patients attending a sexual assault centre: a cohort study from Oslo, Norway. BMJ Open. 12:e064934(12), p. 1–9. doi: 10.1136/bmjopen-2022-064934. Full text in Research Archive Show summary

  Objectives We estimate the prevalence of sexually transmitted infection (STI) among patients after sexual assault, assess the possible value of azithromycin prophylaxis, and identify risk factors for assault-related STI and for not presenting at follow-up. Design Prospective observational cohort study. Setting Sexual assault centre in Oslo, Norway. Participants 645 patients, 602 (93.3%) women and 43 (6.7%) men, attending the centre from May 2017 to July 2019. Outcome measures Microbiological testing at the primary examination and at follow-up consultations after 2, 5 and 12 weeks. Estimated relative risk for assault-related STI and for not presenting at follow-up. Results At primary examination, the prevalence of genital chlamydia was 8.4%, Mycoplasma genitalium 6.4% and gonorrhoea 0.6%. In addition, the prevalence of bacterial STI diagnosed at follow-up and possibly from the assault was 3.0% in total: 2.5% for M. genitalium, 1.4% for genital chlamydia and 0.2% for gonorrhoea. This prevalence did not change when azithromycin was no longer recommended from January 2018. There were no new cases of hepatitis B, hepatitis C, HIV or syphilis. We found no specific risk factors for assault-related STI. Patients with previous contact with child welfare service less often presented to follow-up (relative risk (RR) 2.0 (95% CI 1.1 to 3.5)), as did patients with a history of sex work (RR 3.6 (1.2 to 11.0)) or substance abuse (RR 1.7 (1.1 to 2.7)). Conclusions Most bacterial STIs were diagnosed at the primary examination, hence not influenced by prophylaxis. There was no increase in bacterial STI diagnosed at follow-up when azithromycin prophylaxis was not routinely recommended, supporting a strategy of starting treatment only when infection is diagnosed or when the patient is considered at high risk. Sex work, substance abuse and previous contact with child welfare services were associated with not presenting to follow-up.

• Renaa, Therese & Brekke, Mette (2022). GPs' experiences of the COVID-19 pandemic - a focus group study. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(12), p. 1–7. doi: 10.4045/tidsskr.22.0069. Full text in Research Archive Show summary

  BACKGROUND The working day of Norwegian GPs was turned on its head during the COVID-19 pandemic due to the extreme, ongoing pressure the GP service was under. We conducted a qualitative study of the GPs' perceptions of the challenges they faced and of how they coped during the pandemic. MATERIAL AND METHOD Focus group interviews were conducted with 19 GPs from four medical practices in the county of Innlandet. The interviews were analysed using the systematic text condensation method. RESULTS The GPs described how they have coped with the extremely challenging demands on them. They expressed an expectation of rapid adaptability, and considered this a fundamental characteristic of the role of the GP. They felt an enormous responsibility for their own patients and that in a time of crisis this responsibility was extended to include the entire population. They saw themselves as an important part of the local authority's public health preparedness, even though they had not reflected on this to any great extent prior to the pandemic. INTERPRETATION The GP service's adaptability during times of crisis depends on the GPs' strong individual and collective sense of responsibility and their ability to cope. The latter is the GP service's great strength, but it also represents a vulnerability due to the camouflaging of the overburdening of the service. This can lead to local authorities failing to take responsibility for their statutory duties.

• Dahli, Mina Piiksi; Haavet, Ole Rikard; Ruud, Torleif & Brekke, Mette (2022). GPs’ identification of patients with mental distress: a coupled questionnaire and cohort study from norwegian urban general practice. BMC Primary Care. 23(1). doi: 10.1186/s12875-022-01865-x. Full text in Research Archive Show summary

  Background Mental health problems are one of the leading causes of disease burden worldwide, and are mainly diagnosed and treated in general practice. It is unclear however, how general practitioners (GPs) identify mental health problems in their patients. The aim of this study was to explore how patients’ self-reported levels of mental distress correspond with psychological diagnoses made by their GPs, and associations with sex, age, number of consultations, and somatic symptom diagnoses. Methods A questionnaire study coupled with retrospective and prospective cohort data from 553 patients aged 16–65 years in six GP offices in Oslo, Norway during 21 months in 2014–2016. Results We found that 73.3% of patients with self-reported high levels of mental distress versus only 13.3% of the patients with low levels of mental distress had received a psychological diagnosis (p < 0.01). We found an increase in number of consultations for the group with high levels of mental distress regardless of having received a psychological diagnosis (p < 0.01). There was also an increase in number of somatic symptoms (p = 0.04) and higher number of females (0.04) in this group. 35% of patients had received one or more psychological diagnosis by their GP. Mean CORE-10 score, being female and a high number of consultations was associated with having received a psychological diagnosis. In the adjusted analyses high CORE-10 score and a high number of consultations still predicted a psychological diagnosis. Conclusions We found a clear association between self-reported mental distress and having received a psychological diagnosis amongst the participants, and the probability for being identified increased with increasing levels of mental distress, and increasing number of visits to their doctor. This suggests that GPs can identify patients with high levels of mental distress in general practice in an adequate way, even though this can sometimes be a complex issue. Trial registration Trial registration The main study was retrospectively registered in ClinicalTrials.gov on August 10 2019 with identification number NCT03624829.

• Smedsland, Solveig Katrine; Vandraas, Kathrine Flørenes; Bøhn, Synne-Kristin Hoffart; Dahl, Alv A; Kiserud, Cecilie E. & Brekke, Mette [Show all 8 contributors for this article] (2022). Sexual activity and functioning in long-term breast cancer survivors; exploring associated factors in a nationwide survey. Breast Cancer Research and Treatment. ISSN 0167-6806. 193(1), p. 139–149. doi: 10.1007/s10549-022-06544-0. Full text in Research Archive Show summary

  Abstract Purpose Sexual health is a key quality of life issue. Knowledge concerning sexual health in long-term breast cancer survivors (BCSs) is limited. Within a nationwide sample, we aimed to assess the prevalence of sexual inactivity and to explore factors associated with sexual inactivity and reduced sexual functioning among long-term BCSs. Methods Long-term BCSs aged 20–65 years when diagnosed with early-stage breast cancer in 2011–2012 were identified by the Cancer Registry of Norway in 2019 ( n  = 2803) and invited to participate in a nationwide survey. Sexual health was measured using the multidimensional Sexual Activity Questionnaire. Factors associated with sexual inactivity and reduced sexual functioning were explored using multivariable logistic- and linear regression analyses with adjustments for relevant sociodemographic, health-, and cancer-related variables. Results The final sample consisted of 1307 BCSs with a mean age of 52 years at diagnosis. Fifty-two percent of the BCSs were sexually inactive. Lack of interest was the most common reason for sexual inactivity. Treatment with aromatase inhibitor (OR 1.73, 95% CI 1.23, 2.43) and poor body image (OR 0.99, 95% CI 0.99, 0.995) were associated with sexual inactivity. Among sexually active BCSs, depression (B − 1.04, 95% CI − 2.10, − 0.02) and physical inactivity (B − 0.61, 95% CI − 1.21, − 0.02) were inversely related to sexual pleasure. Treatment with aromatase inhibitor (B 0.61, 95% CI 0.20, 1.01), sleep problems (B 0.37, 95% CI 0.04, 0.70), breast symptoms (B 0.01, 95% CI 0.003, 0.02), and chronic fatigue (B 0.43, 95% CI 0.05, 0.81) were associated with sexual discomfort. Chemotherapy (OR 1.91, 95% CI 1.23, 2.97), current endocrine treatment (OR 1.98, 95% CI 1.21, 3.25), and poor body image (OR 0.98, 95% CI 0.98, 0.99) were associated with less sexual activity at present compared to before breast cancer. Conclusion Treatment with aromatase inhibitor seems to affect sexual health even beyond discontinuation. Several common late effects were associated with sexual inactivity and reduced sexual functioning. To identify BCSs at risk of sexual dysfunction, special attention should be paid to patients treated with aromatase inhibitor or suffering from these late effects.

• Klem, Nicolai; Skjerven, Håvard Ove; Nilsen, Beate; Brekke, Mette & Vallersnes, Odd Martin (2021). Treatment for acute bronchiolitis before and after implementation of new national guidelines: A retrospective observational study from primary and secondary care in Oslo, Norway. BMJ Paediatrics Open. 5(1), p. 1–6. doi: 10.1136/bmjpo-2021-001111. Full text in Research Archive Show summary

  Background Acute bronchiolitis treatment guidelines changed in Norway in 2013, no longer recommending the use of nebulised epinephrine. We aimed to assess whether these changes were successfully implemented in both primary and secondary care. Secondary aims were to compare the difference in management of acute bronchiolitis patients in primary and secondary care between 2009 and 2017. Methods We retrospectively registered data on demographics, clinical features and management from electronic medical records of all infants (&lt;12 months of age) diagnosed with acute bronchiolitis at a primary care centre (Oslo Accident and Emergency Outpatient Clinic) and a secondary care centre (Oslo University Hospital) in Norway in 2009, 2014 and 2017. All patient records were individually reviewed to ensure data accuracy. Results We included 680 (36.3%) patients from primary care and 1195 (63.7%) from secondary care. There was a reduction in the use of nebulised epinephrine from 2009 to 2017 from 66.9% to 16.1% of cases (p&lt;0.001) in primary care and from 59.1% to 4.9% (p&lt;0.001) in secondary care. In parallel, there was an increase in the use of nebulised saline treatment, from 0.8% to 53.8% (p&lt;0.001) in primary care and from 39.3% to 65.3% (p&lt;0.001) in secondary care. The decrease in the use of nebulised racemic epinephrine occurred earlier in secondary care than in primary care; 13.4% vs 56.1%, respectively, in 2014. Conclusions Implementation of the new guidelines on the treatment of acute bronchiolitis was successfully implemented in both primary and secondary care.

• Vibeto, Jon Hjellum; Vallersnes, Odd Martin; Dobloug, Andrea; Brekke, Mette; Jacobsen, Dag & Ekeberg, Øivind [Show all 7 contributors for this article] (2021). Treating patients with opioid overdose at a primary care emergency outpatient clinic: a cost-minimization analysis. Cost Effectiveness and Resource Allocation. 19(1), p. 1–12. doi: 10.1186/s12962-021-00303-6. Full text in Research Archive Show summary

  Background Treating patients with acute poisoning by substances of abuse in a primary care emergency clinic has previously been shown to be a safe strategy. We conducted an economic evaluation of this strategy compared to hospital treatment, which is the usual strategy. Methods Assuming equal health outcomes, we conducted a cost-minimization analysis. We constructed a representative opioid overdose patient based on a cohort of 359 patients treated for opioid overdose at the Oslo Accident and Emergency Outpatient Clinic (OAEOC) from 1.10.2011 to 30.9.2012. Using a health care system perspective, we estimated the expected resources used on the representative patient in primary care based on data from the observed OAEOC cohort and on information from key informants at the OAEOC. A likely course of treatment of the same patient in a hospital setting was established from information from key informants on provider procedures at Drammen Hospital, as were estimates of hospital use of resources. We calculated expected costs for both settings. Given that the treatments usually last for less than one day, we used undiscounted cost values. Results The estimated per patient cost in primary care was 121 EUR (2018 EUR 1.00 = NOK 9.5962), comprising 97 EUR on personnel costs and 24 EUR on treatment costs. In the hospital setting, the corresponding cost was 612 EUR, comprising 186 EUR on personnel costs, 183 EUR on treatment costs, and 243 EUR associated with intensive care unit admission. The point estimate of the cost difference per patient was 491 EUR, with a low-difference scenario estimated at 264 EUR and a high-difference scenario at 771 EUR. Conclusions Compared to hospital treatment, treating patients with opioid overdose in a primary care setting costs substantially less. Our findings are probably generalizable to poisoning with other substances of abuse. Implementing elements of the OAEOC procedure in primary care emergency clinics and in hospital emergency departments could improve the use of health care resources.

• Renaa, Therese & Brekke, Mette (2021). Driftsomlegging ved et fastlegekontor under covid-19-pandemien – en fokusgruppestudie. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(2). doi: 10.4045/tidsskr.20.0713. Full text in Research Archive Show summary

  BAKGRUNN Utenfor de store byene er legetjenesten i kommunen ofte lokalisert til ett legekontor. Den lokale legetjenesten er sentral i kommunens helseberedskap. Vi ønsket å undersøke hvordan hjelpepersonellet ved legekontoret opplevde omlegging av driften ved legekontoret under covid-19-utbruddet i mars 2020, og hvilke faktorer som underlettet og vanskeliggjorde prosessen. MATERIALE OG METODE Artikkelen bygger på et fokusgruppeintervju som ble gjennomført med åtte sykepleiere og helsesekretærer ved Otta legekontor i juni 2020. Intervjuet ble transkribert og analysert ved systematisk tekstkondensering. RESULTATER Informantene beskrev en kaotisk og krevende situasjon, der de måtte takle egen og pasienters frykt. De opplevde håndteringen av krisen som vanskelig når kommuneledelsen ikke var bevisst legekontorets utfordringer. Manglende retningslinjer fra myndighetene i starten av utbruddet ga større usikkerhet. Gjennom samarbeid og omstillingsevne fant legekontoret frem til nye arbeidsmåter for å ivareta driften. Dette ga stor mestrings- og fellesskapsfølelse og en sterkere bevissthet om egen betydning i krisehåndteringens frontlinje. FORTOLKNING Studien belyser hjelpepersonellets rolle når fastlegekontoret møter en krise. Kompetente medarbeidere med handlingsrom og verktøy til å takle utfordringene førte i løpet av kort tid legekontoret fra kaos til en ny hverdag. Kommunen kunne ha støttet prosessen ved å sørge for nødvendige ressurser og overordnede føringer for oppgaveprioritering.

• Dahli, Mina Piiksi; Benth, Jurate Saltyte; Haavet, Ole Rikard; Ruud, Torleif & Brekke, Mette (2021). Somatic symptoms and associations with common psychological diagnoses: a retrospective cohort study from Norwegian urban general practice. Family Practice. ISSN 0263-2136. 38(6), p. 766–772. doi: 10.1093/fampra/cmab038. Full text in Research Archive Show summary

  Abstract Background Patients with mental health problems often present with somatic symptoms when visiting their general practitioner (GP). Somatic presentations may challenge correct diagnosing of mental health disorders in general practice, where most of these disorders are treated. Objective Explore the associations between common psychological diagnoses and somatic symptom diagnoses in Norwegian urban general practice. Methods A retrospective cohort study including electronic medical data from 15 750 patients aged 16–65 years from 35 GPs in six GP offices in Oslo, Norway, during 12 months in 2014–2015. We explored prevalences and associations between anxiety-, depression-, and stress-related diagnoses, and somatic symptom diagnoses. Results Patients with anxiety-, depression- and stress-related diagnoses had a mean number of 2.9±3.6 somatic symptom diagnoses during the 12 months, compared to 1.9±2.5 for patients without any psychological diagnoses (P &amp;lt; 0.001). The mean number of somatic symptoms was significantly higher for the different psychological diagnoses viewed separately, for both sexes and different age groups. There was an increase in probability for anxiety, depression, or stress-related diagnoses with an increasing number of somatic symptom diagnoses during the 12 months. We found a significant increase in somatic symptom diagnoses from ICPC-2 chapters: General and unspecified, digestive, cardiovascular, musculoskeletal, neurological, urological, female genital disorders and social problems. Associated symptom patterns were different for each of the included psychological diagnoses. Conclusions This study shows that patients with anxiety, depression- and stress-related diagnoses present with increased and characteristic somatic symptoms compared to patients without these diagnoses in general practice.

• Brodwall, Anne & Brekke, Mette (2021). General practitioners’ experiences with children and adolescents with functional gastro-intestinal disorders: a qualitative study in Norway. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 39(4), p. 543–551. doi: 10.1080/02813432.2021.2012347. Full text in Research Archive Show summary

  Objective: Functional gastrointestinal disorders (FGIDs) are common in children and adolescents. During 2016 and 2019, we investigated the experiences among parents of children with FGIDs and interviewed their children and adolescents during 2020. The aim of the present study was to explore the experiences among general practitioners (GPs) who treat this patient group. Design: Individual interviews with open-ended questions were audio recorded and transcribed, and subsequently analysed using descriptive content analysis. Setting: Urban and rural areas in two municipalities in Southern Norway. Participants: Twelve GPs practicing in the region were interviewed. Results: GPs generally feel competent treating these patients without referring them to hospital or specialists. Having known the patients and their families over time is important. Providing psycho-educational resources to the patients and parents is essential for their understanding that the pain is not dangerous. The importance of attending school was emphasised. Conclusions: The GPs' biopsychosocial focus and long-term follow-up care are essential in treating children and adolescents with FGIDs and their parents.

• Skonnord, Trygve; Fetveit, Arne; Skjeie, Holgeir; Brekke, Mette; Grotle, Margreth & Klovning, Atle [Show all 7 contributors for this article] (2021). Cost-effectiveness analysis of acupuncture compared with usual care for acute non-specific low back pain: secondary analysis of a randomised controlled trial. Acupuncture in Medicine. ISSN 0964-5284. 40(2), p. 123–132. doi: 10.1177/09645284211055747. Full text in Research Archive Show summary

  Objective: To assess the cost-effectiveness of a single treatment session of acupuncture, when applied in addition to usual care for acute low back pain (ALBP). Methods: Secondary analysis of a multicentre randomised controlled trial in Norwegian general practice. In total, 171 participants with ALBP ⩽14 days were randomised to a control group (CG) receiving usual care or to an acupuncture group (AG) receiving one additional session of Western medical acupuncture alongside usual care. Primary outcome measures for this cost-effectiveness analysis were quality-adjusted life years (QALYs), health care costs and societal costs at days 28 and 365, the incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). The NMB was calculated on the basis of the Norwegian cost-effectiveness threshold of NOK 275,000 (USD 35,628) per QALY gained. Missing data were replaced by multiple chained imputation. Results: Eighty-six participants in the CG and 81 in the AG were included in the analysis. We found no QALY gain at day 28. At day 365, the incremental QALY of 0.035 was statistically significant. The differences in health care costs and societal costs were not statistically significant. Three out of four calculations led to negative ICERs (cost saving) and positive NMBs. For the health care perspective at day 365, the ICER was USD –568 per QALY and the NMB was USD 1265, with 95.9% probability of acupuncture being cost-effective. Conclusion: To our knowledge, this is the first cost-effectiveness analysis of acupuncture for ALBP. The findings indicate that acupuncture may be cost-effective from a 1-year perspective, but more studies are needed. Trial registration number: NCT01439412 (ClinicalTrials.gov).

• Brodwall, Anne & Brekke, Mette (2021). Children's and adolescents' experiences with functional abdominal pain: A qualitative study in Norway. BMJ Open. 11(9), p. 1–7. doi: 10.1136/bmjopen-2021-048949. Full text in Research Archive Show summary

  Objective Functional gastrointestinal disorders (FGIDs) are common during childhood and adolescence. When a somatic diagnosis is excluded, the healthcare system often terminates contact with the patient. The aim of the present study was to learn more about children’s and adolescents’ experiences with, and reflections on, the causes of their abdominal pain and what could possibly help them. Design The study has a qualitative design. Interviews with open questions were carried out by the first author. The conversations were audiotaped, transcribed and analysed by means of qualitative content analysis. Setting Children and adolescents referred from general practitioners located in urban and rural regions in two municipals in Norway. In 2016 and 2019, we had interviewed these children’s parents about their child’s abdominal pain. In spring 2020, the children and adolescents were interviewed. Participants Twelve children and adolescents aged 10–18 years with FGIDs. Results Eight of the children and adolescents had recovered from their abdominal pain, while four still had symptoms. They felt frustrated by not having a diagnosis and by the lack of available treatment. Some who had been absent from school for weeks to months felt isolated and depressed. Focusing on positive thoughts and activities was reported to improve the pain. The abdominal pain could be considered a manifestation of mental problems. Conclusions Thinking differently about the symptoms reduced the FGIDs for the children and adolescents. The treating physicians as well as parents and teachers need to help the child focus on changing the mindset of pain.

• Tran, Jenny Victoria; Brekke, Mette & Vallersnes, Odd Martin (2021). Rusrelaterte forgiftninger ved Legevakten i Oslo i 2014–18. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141, p. 646–651. doi: 10.4045/tidsskr.20.0751. Full text in Research Archive
• Brekke, Mette & Brodwall, Anne (2020). Understanding parents' experiences of disease course and influencing factors: a 3-year follow-up qualitative study among parents of children with functional abdominal pain. BMJ Open. doi: 10.1136/bmjopen-2020-037288. Full text in Research Archive Show summary

  Objective Functional abdominal pain is a common symptom in children and adolescents. Three years ago, we investigated the experiences among parents whose children had chronic abdominal pain but no somatic diagnosis. The aim of the present follow-up study was to explore those families’ current situations. Design Interviews with open questions about the families’ current pain situations were carried out by the first author. Interviews were audio-recorded and transcribed, and subsequently analysed using descriptive content analysis. Setting Urban and rural areas in two municipalities in Southern Norway. Participants Parents of children with abdominal pain who had been referred to a local hospital by their general practitioner and had been discharged without a somatic diagnosis. Fifteen parents of 14 children aged 8–17 years who had also been interviewed in 2016. Results Nine of the children had recovered from their abdominal pain. During the pain period, the parents reported frustration with not having a diagnosis nor a specific treatment for their child’s abdominal pain. The siblings in some families received less attention and were afraid that something serious might happen to their sister or brother. The parents wished that their child’s school cared more about the child when they had weeks of absence. All parents maintained that their child’s pain was physical, although they thought that psychological aspects might have influenced the symptoms. The parents stated that they, as well as their children, needed guidance from professionals to understand the complex pain situation.

• Berge, Siri Dalsmo; Meland, Eivind; Brekke, Mette; Bondevik, Gunnar Tschudi; Thuen, Frode & Mildestvedt, Thomas (2020). Couple relationship problems-a task for the general practitioner? A cross-sectional survey from Norway. Family Practice. ISSN 0263-2136. 38(2). doi: 10.1093/fampra/cmaa093. Full text in Research Archive Show summary

  Background: A healthy couple relationship is a predictor of good health. There is a lack of knowledge about what role family and couples counselling should have in general practice. Objectives: To identify the prevalence of patients who have talked, or want to talk, with their general practitioner (GP) about their couple relationship, to investigate what characterizes these patients and to explore whether they believe that couple relationship problems should be dealt with in general practice. Methods: We conducted a cross-sectional survey in 70 general practices in Norway during spring 2019. A questionnaire was answered by 2178 consecutive patients (response rate 75%) in GP waiting rooms. Data were examined using frequencies and linear and logistic regression models. Results: We included 2097 responses. Mean age was 49.0 years and 61.3% were women. One in four (25.0%) had already talked with their GP about couple relationship problems, while one in three (33.5%) wanted to talk with their GP about their couple relationship problems. These patients more frequently had experience of divorce, poor self-rated health, an opinion that their couple relationship had a significant impact on their health and lower couple relationship quality when adjusted for age, sex, present marital status and children living at home. We found that 46.4% of patients believed that GPs should be interested in their couple relationship problems. Conclusion: Relationship problems are frequently addressed in general practice. GPs should be prepared to discuss this issue to facilitate help for couples earlier than they might otherwise expect.

• Myklestul, Hans-Christian; Skonnord, Trygve T. & Brekke, Mette (2020). Point-of-care ultrasound (POCUS) in Norwegian general practice. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. doi: 10.1080/02813432.2020.1753385. Full text in Research Archive Show summary

  Objective: To assess the use of point-of-care ultrasound (POCUS) in Norwegian general practice. Design: Retrospective register study based on general practitioners’ (GPs’) reimbursement claims. Setting: Norwegian general practice excluding out-of-hours clinics in 2009, 2012 and 2016. Subjects: GPs who scanned patients for a given set of symptoms and medical conditions. Main outcome measures: Number and characteristics of GPs performing POCUS. Number and type of scans carried out. Results: The number of scanning GPs increased from 479 in 2009 to 2078 in 2016. The number of registered scans increased from 8962 to 55921. In 2016, approximately 30% of Norwegian GPs sent at least one reimbursement claim for POCUS. Seven out of 10 GPs did not scan every month. The gender distribution of scanning GPs was equal to that of the total GP population. Male GPs scanned four times more frequent than female GPs. Specialist in family medicine scanned twice as much as non-specialist. The use of POCUS among GPs in different counties varied from 31.6 to 198.5 per 10,000 citizens. Conclusions: The number of Norwegian GPs using POCUS and the number of scans have increased substantially from 2009 to 2016. The use of the various scans, based on the use of reimbursement claims, have evolved differently. The reasons for this are not known. The low number of scans carried out by most GPs raises a concern when it comes to the quality of the performed scans.

• Dahli, Mina Piiksi; Brekke, Mette; Ruud, Torleif & Haavet, Ole Rikard (2020). Prevalence and distribution of psychological diagnoses and related frequency of consultations in Norwegian urban general practice. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. doi: 10.1080/02813432.2020.1783477. Full text in Research Archive Show summary

  Objective: To investigate the prevalence and distribution of psychological diagnoses made by general practitioners (GPs) in urban general practice and the related frequency of consultations during 12 consecutive months in Norwegian general practice. Design: A cross-sectional study with data extracted from 16,845 electronic patient records in 35 urban GP practices Setting: Six GP group practices in Groruddalen, Norway. Subjects: All patients aged 16–65 with a registered contact with a GP during 12 months in 2015. Main outcome measures: Frequency and distribution of psychological diagnoses made by GPs, and the number of patients’ consultations. Results: GPs made a psychological diagnosis in 18.8% of the patients. The main diagnostic categories were depression symptoms or disorder, acute stress reaction, anxiety symptoms or disorder and sleep disorder, accounting for 67.1% of all psychological diagnoses given. The mean number of consultations for all patients was 4.09 (95% CI: 4.03, 4.14). The mean number of consultations for patients with a psychological diagnosis was 6.40 (95% CI: 6.22, 6.58) compared to 3.55 (95% CI 3.50, 3.51) (p<0.01) for patients without such a diagnosis. Seven percent of the diagnostic variation was due to differences among GPs. Conclusions: Psychological diagnoses are frequent in urban general practice, but they are covered using rather few diagnostic categories. Patients with psychological diagnoses had a significantly higher mean number of GP consultations regardless of age and sex. Implications: The knowledge of the burden of psychological health problems in general practice must be strengthened to define evidence-based approaches for detecting, diagnosing and treating mental disorders in the general practice population.

• Skonnord, Trygve T.; Skjeie, Holgeir; Brekke, Mette; Klovning, Atle; Grotle, Margreth & Aas, Eline [Show all 8 contributors for this article] (2020). Acupuncture for acute non-specific low back pain: a randomised, controlled, multicentre intervention study in general practice—the Acuback study. BMJ Open. 10. doi: 10.1136/bmjopen-2019-034157. Full text in Research Archive Show summary

  Objectives: The aim of this study was to evaluate whether a single treatment session of acupuncture, when applied in addition to standard treatment for acute low back pain (ALBP), reduces the time to recovery compared with standard treatment alone. Design: A multicentre, randomised, controlled trial. Setting: Conducted at 11 Norwegian general practitioners’ (GPs’) offices. Participants: 171 adults aged 20–55 years seeking their GP for ALBP (≤14 days) between March 2014 and March 2017. Patients with secondary back pain and previous sick leave and acupuncture treatment was excluded. Interventions: The participants were randomised to either the control group (CG) or the acupuncture group (AG) by online software. The CG received standard treatment according to the Norwegian guidelines, while the AG received one session of Western medical acupuncture treatment in addition to standard treatment. The statistician was blinded to group status. Primary and secondary outcome measures: The primary outcome was median days to recovery. Secondary outcomes were pain intensity, global improvement, back- specific functional status, sick leave, medication and adverse effects. Results: 185 participants were randomised, 95 in the CG and 90 in the AG. 14 participants did not receive the allocated intervention and 4 were excluded from the analysis. Thus, 167 participants were included in the analysis, 86 in the CG and 81 in the AG. The groups were similar according to baseline characteristics. The median time to recovery was 14 days for the CG and 9 days for the AG, HR 1.37 (95% CI 0.95 to 1.96), (p=0.089). No serious adverse effects were reported. Conclusions: We did not find any statistically significant reduction in time- to- recovery after a single session of acupuncture for ALBP compared with standard care.

• Harris, Michael P.; Brekke, Mette; Dinant, Geert-Jan; Esteva, Magdalena; Hoffman, Robert A. & Vedsted, Peter [Show all 9 contributors for this article] (2020). Primary care practitioners' diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries. BMJ Open. doi: 10.1136/bmjopen-2019-035678. Full text in Research Archive Show summary

  Objectives Cancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence primary care practitioners’ (PCPs) referral decisions in patients who could have cancer. This study aimed to explore PCPs’ diagnostic actions (whether or not they perform a key diagnostic test and/or refer to a specialist) in patients with symptoms that could be due to cancer and how they vary across European countries. Design A primary care survey. PCPs were given vignettes describing patients with symptoms that could indicate cancer and asked how they would manage these patients. The likelihood of taking immediate diagnostic action (a diagnostic test and/or referral) in the different participating countries was analysed. Comparisons between the likelihood of taking immediate diagnostic action and physician characteristics were calculated. Setting Centres in 20 European countries with widely varying cancer survival rates. Participants A total of 2086 PCPs answered the survey question, with a median of 72 PCPs per country. Results PCPs’ likelihood of immediate diagnostic action at the first consultation varied from 50% to 82% between countries. PCPs who were more experienced were more likely to take immediate diagnostic action than their peers. Conclusion When given vignettes of patients with a low but significant possibility of cancer, more than half of PCPs across Europe would take diagnostic action, most often by ordering diagnostic tests. However, there are substantial between-country variations.

• Andersson, Jon Andreas; Brekke, Mette & Vallersnes, Odd Martin (2020). Akutt forgiftning ved rusrelatert bruk av benzodiazepiner. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 140, p. 1027–1030. doi: 10.4045/tidsskr.20.0035. Full text in Research Archive Show summary

  BAKGRUNN Benzodiazepiner brukes også som rusmidler. Dette kan være farlig, særlig ved blandingsrus. Vi beskriver akutte forgiftninger ved rusrelatert bruk av benzodiazepiner hos pasienter på Legevakten i Oslo. MATERIALE OG METODE Vi inkluderte alle pasienter behandlet for rusrelatert forgiftning med benzodiazepiner og/eller z-hypnotika ved Legevakten i Oslo fra 1.10.2013 til 30.9.2015. Pasientene ble funnet ved retrospektiv gjennomgang av Legevaktens innskrivingslister. Data ble registrert fra journal. Diagnostikk av forgiftningsagens var basert på behandlende leges journalførte kliniske vurdering. RESULTATER Blant 1 037 tilfeller var 787 (76 %) menn. Median alder var 36 år (interkvartilområde 28–46, spenn 14–78). Klonazepam (Rivotril) var det hyppigst forekommende medikamentet med 575 (55 %) tilfeller, fulgt av diazepam (Stesolid, Valium, Vival) 158 (15 %), alprazolam (Xanor) 125 (12 %) og oksazepam (Sobril) 94 (9 %). Zopiklon (Imovane, Zopitin) og zolpidem (Stilnoct) forekom sjelden, henholdsvis i 25 (2 %) og 11 (1 %) tilfeller. Benzodiazepiner var kombinert med andre rusmidler i 936 (90 %) tilfeller, hyppigst heroin 484 (47 %), etanol 321 (31 %) og amfetamin 199 (19 %). FORTOLKNING Ved rusrelatert forgiftning var benzodiazepiner oftest kombinert med andre rusmidler, hyppigst opioider, etanol og/eller amfetamin.

• Aronsen, Aron; Brekke, Mette & Vallersnes, Odd Martin (2020). Akutt forgiftning med gammahydroksybutyrat. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 140, p. 1023–1026. doi: 10.4045/tidsskr.19.0780. Full text in Research Archive
• Grimsrud, Marit Mæhle; Brekke, Mette; Syse, Victoria Lykke & Vallersnes, Odd Martin (2019). Acute poisoning related to the recreational use of prescription drugs: an observational study from Oslo, Norway. BMC Emergency Medicine. 19. doi: 10.1186/s12873-019-0271-0. Full text in Research Archive Show summary

  Background Recreational use of prescription drugs is widespread. We describe acute poisonings related to the recreational use of prescription drugs. Methods Retrospective observational study. We retrospectively registered all patients presenting from October 2013 through March 2015 at a primary care emergency outpatient clinic in Oslo, Norway, with an acute poisoning related to recreational drug use. We registered demographic data, toxic agents taken, clinical course and treatment. From this data set we extracted the 819/2218 (36.9%) cases involving one or more prescription drugs. Results Among the 819 included cases, 190 (23.2%) were female. Median age was 37 years. The drugs most commonly involved were benzodiazepines in 696 (85.0%) cases, methadone in 60 (7.3%), buprenorphine in 53 (6.5%), other opioids in 56 (6.8%), zopiclone/zolpidem in 26 (3.2%), and methylphenidate in 11 (1.3%). Prescription drugs were combined with other toxic agents in 659 (80.5%) cases; heroin in 351 (42.9%), ethanol in 232 (28.3%), amphetamine in 141 (17.2%), cannabis in 70 (8.5%), gamma-hydroxybutyrate (GHB) in 34 (4.2%), cocaine in 29 (3.5%), and other illegal drugs in 46 (5.6%). The patient was given naloxone in 133 (16.2%) cases, sedation in 15 (1.8%), and flumazenil in 3 (0.4%). In 157 (19.2%) cases, the patient was sent on to hospital. Conclusions One in three acute poisonings related to recreational drug use involved prescription drugs. Benzodiazepines were by far the most common class of drugs. Prescription drugs had mostly been taken in combination with illegal drugs or ethanol.

• Brekke, Mette & Wisborg, Torben (2019). Hvor ble det av solidariteten? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 139(16). doi: 10.4045/tidsskr.19.0489. Full text in Research Archive Show summary

  Vi kan være stolte av dagens norske helsevesen. Det er bygget opp gjennom flere generasjoner og betales av fellesskapets midler. Dagens tilbud innebærer at hver innbygger har sin fastlege som spesialiserer seg, følger faglige retningslinjer og er opptatt av å unngå overdiagnostikk. Blir vi alvorlig syke, har vi adgang til avansert spesialisthelsetjeneste, uavhengig av inntekt eller hvor i landet vi bor – uten å måtte selge huset eller risikere barnas skolegang for å betale.

• Fidjeland, Heidi Lidal; Vistad, Ingvild; Gjelstad, Svein & Brekke, Mette (2019). Exploring why patients with cancer consult general practitioners: A 1-year data extraction. British Journal of General Practice Open. 3(4), p. 1–9. doi: 10.3399/BJGPOPEN19X101663. Full text in Research Archive Show summary

  Background Survival rates of patients with cancer are increasing owing to improvements in diagnostics and therapies. The traditional hospital-based follow-up model faces challenges because of the consequent increasing workload, and it has been suggested that selected patients with cancer could be followed up by GPs. The hypothesis of the study was that, regardless of the hospital-based follow-up care, GPs see their patients with cancer both for cancer-related problems as well as for other reasons. Thus, a formalised follow-up by GPs would not mean too large a change in GPs’ workloads. Aim To explore to what extent patients with cancer consult their GPs, and for what reasons. Design & setting A 1-year explorative study was undertaken, based on data from 91 Norwegian GPs from 2016–2017. Method The data were electronically extracted from GPs' electronic medical records (EMR). Results Data were collected from 91 GPs. There were 11 074 consultations in total, generated by 1932 patients with cancer. The mean consultation rate was higher among the patients with cancer compared with Norwegian patients in general. In one-third of the consultations, cancer was the main diagnosis. Apart from cancer, cardiovascular and musculoskeletal diagnoses were common. Patients with cancer who had multiple diagnoses or psychological diagnoses did not consult their GP significantly more often than patients with cancer without such comorbidity. Conclusion This study confirms that patients with cancer consult their GP more often than other patients, both for cancer-related reasons and for various comorbidities. A formalised follow-up by GPs would probably be feasible, and GPs should prepare for this responsibility.

• Harris, Michael P.; Thulesius, Hans; Neves, Ana Luísa; Harker, Sophie; Koskela, Tuomas H. & Petek, Davorina [Show all 24 contributors for this article] (2019). How European primary care practitioners think the timeliness of cancer diagnosis can be improved – a thematic analysis. BMJ Open. 9:e030169(9), p. 1–10. doi: 10.1136/bmjopen-2019-030169. Full text in Research Archive Show summary

  National European cancer survival rates vary widely. Prolonged diagnostic intervals are thought to be a key factor in explaining these variations. Primary care practitioners (PCPs) frequently play a crucial role during initial cancer diagnosis; their knowledge could be used to improve the planning of more effective approaches to earlier cancer diagnosis.This study sought the views of PCPs from across Europe on how they thought the timeliness of cancer diagnosis could be improved.In an online survey, a final open-ended question asked PCPs how they thought the speed of diagnosis of cancer in primary care could be improved. Thematic analysis was used to analyse the data.A primary care study, with participating centres in 20 European countries.A total of 1352 PCPs answered the final survey question, with a median of 48 per country.The main themes identified were: patient-related factors, including health education; care provider-related factors, including continuing medical education; improving communication and interprofessional partnership, particularly between primary and secondary care; factors relating to health system organisation and policies, including improving access to healthcare; easier primary care access to diagnostic tests; and use of information technology. Re-allocation of funding to support timely diagnosis was seen as an issue affecting all of these.To achieve more timely cancer diagnosis, health systems need to facilitate earlier patient presentation through education and better access to care, have well-educated clinicians with good access to investigations and better information technology, and adequate primary care cancer diagnostic pathway funding.

• Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind & Brekke, Mette (2019). Mortality and repeated poisoning after self-discharge during treatment for acute poisoning by substances of abuse: a prospective observational cohort study. BMC Emergency Medicine. 19. doi: 10.1186/s12873-018-0219-9. Full text in Research Archive Show summary

  Background Though substance use is a known risk factor for self-discharge, patients self-discharging during treatment for acute poisoning have not previously been described. We charted characteristics of patients self-discharging during treatment for acute poisoning by substances of abuse looking for associations between self-discharge, repeated poisoning, and death. Methods All patients 12 years and older treated for acute poisoning by substances of abuse at an emergency outpatient clinic in Oslo, Norway, were included consecutively from October 2011 through September 2012. We collected data on gender, age, main toxic agent, suicidal intention, homelessness, history of severe mental illness, and self-discharge. Information on deaths was retrieved from the National Cause of Death Register. We did a multiple logistic regression analysis to look for associations between self-discharge and repeated poisoning and a Cox regression analysis for associations between self-discharge and death. Results During one year, 1731 patients were treated for 2343 episodes of acute poisoning by substances of abuse. Two-hundred-and-sixty-six (15%) patients self-discharged during at least one poisoning episode. Self-discharging patients were older, median age 39 years vs 32 years (p <  0.001), more frequently homeless, 20/266 (8%) vs 63/1465 (4%) (p = 0.035), and the main toxic agent more frequently was an opioid, 82/266 (31%) vs 282/1465 (19%) (p <  0.001). Self-discharge was an independent risk factor for repeated poisoning. The adjusted odds ratio for two or more poisoning episodes during one year among self-dischargers was 3.0 (95% CI 2.2–4.1). The association was even stronger for three or more poisoning episodes, adjusted odds ratio 5.0 (3.3–7.5). In total, there were 34 deaths, 9/266 (3.4%) among self-discharging patients and 25/1465 (1.7%) among patients not self-discharging (p = 0.12). The adjusted hazard ratio for death among self-discharging patients was 1.6 (0.75–3.6). Conclusions Self-discharge was associated with frequent poisonings by substances of abuse. Short-term mortality was doubled among self-discharging patients, though this increase was not statistically significant. Still, the increased risk of repeated poisoning marks self-discharging patients as a vulnerable group who might benefit from targeted post-discharge follow-up measures.

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• Skonnord, Trygve; Vøllestad, Nina Køpke; Heggen, Kristin Margrete & Brekke, Mette (2024). GPs of the future as agents of sustainability. Full text in Research Archive
• Sætre, Ingrid; Brekke, Mette & Vallersnes, Odd Martin (2024). Overdose involving opioid agonist treatment opioids in Oslo, Norway. Full text in Research Archive
• Setsaas, Erle J. B.; Brekke, Mette & Vallersnes, Odd Martin (2024). Use of naloxone in patients treated for opioid overdose at a primary care emergency clinic in Oslo, Norway, 2014–2021. Full text in Research Archive
• Dalaker, Vivian Moe; Furuhaugen, Håvard; Brekke, Mette; Bjørnaas, Mari Asphjell; Krpo, Maja & Øiestad, Elisabeth Leere [Show all 7 contributors for this article] (2024). Rusmidler i blod- og urinprøver ved mistanke om påført rus. Full text in Research Archive
• Skjælaaen, Katarina; Nesvold, Helle; Brekke, Mette; Sare, Miriam; Landaas, Elisabeth Toverud & Mdala, Ibrahimu [Show all 8 contributors for this article] (2024). Seksuelt overførbare infeksjoner etter seksuelt overgrep. Full text in Research Archive
• Brekke, Mette (2024). Roterende allmennleger. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(14). doi: 10.4045/tidsskr.24.0548. Full text in Research Archive
• Myklestul, Hans-Christian; Skonnord, Trygve; Andersen, Camilla Aakjær; Jensen, Martin Bach & Brekke, Mette (2024). Clinical impact of point-of-care ultrasound in general practice: a prospective observational study. Full text in Research Archive
• Aasgaard, Viktoria T.; Abrahamsen, Maria; Brekke, Mette & Vallersnes, Odd Martin (2023). Factors associated with hospitalization for acute recreational drug toxicity. Full text in Research Archive
• Skjelland, Didrik; Jørgenrud, Benedicte Marie; Gundersen, Karsten; Bjørnaas, Mari Asphjell; Brekke, Mette & Dalaker, Vivian Moe [Show all 8 contributors for this article] (2023). Gamma-hydroxybutyrate (GHB) intoxication: clinical diagnosis versus laboratory findings. Full text in Research Archive
• Vøllestad, Nina Køpke; Brekke, Mette; Skonnord, Trygve & Heggen, Kristin (2023). Fremtidens fastleger som bærekraftsagenter. 143(15), p. 1–5. doi: 10.4045/tidsskr.23.0520. Full text in Research Archive
• Vandraas, Kathrine Flørenes; Smedsland, Solveig Katrine; Engan, Harald Kåre; Kiserud, Cecilie E.; Naume, Bjørn & Brekke, Mette [Show all 7 contributors for this article] (2023). Seneffekter etter behandling av brystkreft. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(11). doi: 10.4045/tidsskr.23.0017. Full text in Research Archive Show summary

  Brystkreft er den vanligste kreftsykdommen blant norske kvinner. Ni av ti vil bli langtidsoverlevere. Å være kreftfri er ikke ensbetydende med å føle seg frisk, og mange opplever plagsomme seneffekter, som fatigue, smerter og frykt for tilbakefall. Fastlegen er den viktigste medisinske støttespilleren for majoriteten av disse kvinnene. Denne kliniske oversiktsartikkelen oppsummerer oppdatert kunnskap om seneffekter etter behandling av brystkreft. Ikke-farmakologiske tiltak kan ha positiv virkning på mange av de vanligste seneffektene.

• Eliassen, Knut Eirik Ringheim & Brekke, Mette (2023). Allmennlegen som veileder – dugnadstiden er forbi. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(11). doi: 10.4045/tidsskr.23.0406. Full text in Research Archive
• Slagstad, Ketil; Malterud, Kirsti; Brekke, Mette & Lie, Anne Kveim (2023). Medisinens biopsykososiale kjønnsbegrep. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(3). doi: 10.4045/tidsskr.23.0001. Full text in Research Archive
• Iqbal, Zahra Zeineb; Nguyen, Thanh Mai Thi; Brekke, Mette & Vallersnes, Odd Martin (2022). Unspecified opioids among opioid overdoses in Oslo, Norway. Full text in Research Archive
• Myklestul, Hans-Christian; Skjeie, Holgeir; Brekke, Mette & Skonnord, Trygve (2022). Fifty shades of grey and clinical uncertainty; a focus group study among general practitioners using point-of-care ultrasound as a part of clinical decision making. Full text in Research Archive
• Klem, Nicolai; Skjerven, Håvard Ove; Nilsen, Beate; Brekke, Mette & Vallersnes, Odd Martin (2022). Treatment for acute bronchiolitis before and after implementation of new national guidelines: a retrospective observational study from primary and secondary care in Oslo, Norway. Full text in Research Archive
• Renaa, Therese & Brekke, Mette (2022). The experiences of Norwegian general practitioners during the Covid-19 pandemic - a focus group study. Full text in Research Archive
• Renaa, Therese & Brekke, Mette (2022). Restructuring of a GP practice during the Covid-19 pandemic - a focus group study. Full text in Research Archive
• Myklestul, Hans-Christian; Skjeie, Holgeir; Brekke, Mette & Skonnord, Trygve (2022). Fifty shades of grey and clinical uncertainty; Focus group study among general practitioners using point-of-care ultrasound (POCUS) as a part of clinical decision making. Full text in Research Archive
• Harris, Michael & Brekke, Mette (2022). Clinical decision making in patients that can have cancer: A vignette study comparing the Baltic states with the Nordic countries. Full text in Research Archive
• Ebbing, Cathrine & Brekke, Mette (2022). Are pregnant women and unborn children being forgotten in the pandemic? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.21.0701. Full text in Research Archive
• Myklestul, Hans-Christian; Skonnord, Trygve & Brekke, Mette (2022). Point-of-care ultrasound (POCUS) in Norwegian general practice. Full text in Research Archive
• Brekke, Mette (2022). Utposten i livet. p. 16–17. Full text in Research Archive
• Berge, Siri Dalsmo; Brekke, Mette; Meland, Eivind & Mildestvedt, Thomas (2022). Exploring patients' experiences from revealing couple relationship issues with their general practitioner. A qualitative study. Full text in Research Archive
• Klem, Nicolai; Skjerven, Håvard Ove; Brekke, Mette & Vallersnes, Odd Martin (2022). Treatment of acute bronchiolitis before and after implementation of new national guidelines: a retrospective observational study from primary and secondary care in Norway. Full text in Research Archive
• Berge, Siri Dalsmo; Brekke, Mette; Meland, Eivind & Mildestvedt, Thomas (2022). Samlivsproblemer på fastlegekontoret. Full text in Research Archive
• Berge, Siri Dalsmo; Brekke, Mette; Meland, Eivind & Mildestvedt, Thomas (2021). How do general practitioners handle couple relationship problems? A focus-group study from Norway. Full text in Research Archive
• Brekke, Mette; Ebbing, Cathrine & Wisborg, Torben (2021). Legeutdanning under en pandemi. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(11), p. 1–3. doi: 10.4045/tidsskr.21.0548. Full text in Research Archive
• Ingebrigtsen, Erlend; Brekke, Mette & Vallersnes, Odd Martin (2021). Poisoning by central stimulant drugs in Oslo, Norway. Full text in Research Archive
• Slørdahl, Johannes Thomassen; Persett, Per Sverre; Brekke, Mette; Heyerdahl, Fridtjof; Hovda, Knut Erik & Vallersnes, Odd Martin (2021). Acute poisoning from concurrent use of opioids and amphetamine. Full text in Research Archive
• Møllerløkken, Marianne L; Brekke, Mette & Vallersnes, Odd Martin (2021). Psychosis associated with acute recreational drug toxicity. Full text in Research Archive
• Nørstebø, Jørgen F; Brekke, Mette & Vallersnes, Odd Martin (2021). Acute poisonings involving cannabis in Oslo, Norway. Full text in Research Archive
• Stenbeck, Ingrid M; Brekke, Mette & Vallersnes, Odd Martin (2021). Acute recreational drug toxicity among young patients. Full text in Research Archive
• Brekke, Mette; Bjørke, Jeanette Solheimslid & Wisborg, Torben (2021). Hvor blir det av alle legene? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.21.0701. Full text in Research Archive
• Brekke, Mette; Bjørke, Jeanette Solheimslid & Wisborg, Torben (2021). Where did all the doctors go? Tidsskr nor legeforen. doi: 10.4045/tidsskr.21.0701. Full text in Research Archive
• Dalaker, Vivian; Furuhaugen, Håvard; Brekke, Mette; Bjørnaas, Mari Asphjell & Vallersnes, Odd Martin (2020). Analysis of drugs in blood and urine samples from suspected spiked drink victims. Full text in Research Archive
• Aronsen, Aron C; Brekke, Mette & Vallersnes, Odd Martin (2020). Gamma-hydroxybutyrate (GHB) poisoning in a primary care emergency setting. Full text in Research Archive
• Vibeto, Jon Hjellum; Vallersnes, Odd Martin; Dobloug, Andrea; Brekke, Mette; Jacobsen, Dag & Ekeberg, Øivind [Show all 7 contributors for this article] (2020). Treating patients with opioid overdose at a primary care emergency outpatient clinic: a cost-minimization analysis. Full text in Research Archive
• Andersson, Jon Andreas; Brekke, Mette & Vallersnes, Odd Martin (2020). Acute poisoning related to the recreational use of benzodiazepines. Full text in Research Archive
• Ebbing, Cathrine & Brekke, Mette (2020). Pasientsamtykke i pandemiforskningen. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.20.0245. Full text in Research Archive
• Hoffman, Robert A.; Brekke, Mette; tzanis, george; Petek, Davorina; Harris, Michael P. & Smyrnakis, Emmanouil (2020). Factors that Empower GPs for Early Cancer Diagnosis. A Delphi Study Protocol. Full text in Research Archive
• Myklestul, Hans-Christian; Skonnord, Trygve T. & Brekke, Mette (2019). The UNG study: Ultrasound in Norwegian General practice, a prevalence study. Full text in Research Archive
• Brekke, Mette (2019). Forskning basert på spørreskjema – hvordan lage et godt spørreskjema? Full text in Research Archive
• Brekke, Mette (2019). Om å skaffe seg tid og penger til forskning: Allmennmedisinsk forskningsutvalg (AFU) og Allmennmedisinsk forskningsfond (AMFF). Full text in Research Archive
• Brekke, Mette (2019). Klinisk arbeid og forskning - lar det seg kombinere? Full text in Research Archive
• Myklestul, Hans-Christian; Skonnord, Trygve T. & Brekke, Mette (2019). AFU-prosjektbeskrivelse. Full text in Research Archive
• Brekke, Mette (2019). Får mennesket plass i pakken? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 139(2). doi: 10.4045/tidsskr.18.0884. Full text in Research Archive
• Syse, Victoria Lykke; Brekke, Mette; Grimsrud, Marit Mæhle; Persett, Per Sverre; Heyerdahl, Fridtjof & Hovda, Knut Erik [Show all 7 contributors for this article] (2019). Acute recreational drug toxicity in women: a case series from Oslo, Norway. Full text in Research Archive
• Grimsrud, Marit Mæhle; Brekke, Mette; Syse, Victoria Lykke & Vallersnes, Odd Martin (2019). Acute poisoning related to recreational use of prescription drugs. Full text in Research Archive
• Skonnord, Trygve T.; Skjeie, Holgeir; Brekke, Mette; Klovning, Atle; Grotle, Margreth & Aas, Eline [Show all 8 contributors for this article] (2019). The ACUBACK study: Acupuncture for acute non-specific low back pain. Full text in Research Archive
• Skonnord, Trygve T.; Skjeie, Holgeir; Brekke, Mette; Klovning, Atle; Grotle, Margreth & Aas, Eline [Show all 8 contributors for this article] (2019). Acupuncture for acute nonspecific low back pain: A randomised, controlled, multicentre intervention study in general practice — the Acuback study. Full text in Research Archive
• Skonnord, Trygve T.; Skjeie, Holgeir; Brekke, Mette; Klovning, Atle; Grotle, Margreth & Aas, Eline [Show all 8 contributors for this article] (2019). The ACUBACK study: Acupuncture for acute non-specific low back pain. Full text in Research Archive
• Fidjeland, Heidi Lidal; Gjelstad, Svein; Vistad, Ingvild & Brekke, Mette (2019). Do cancer patients consult their general practitioners, and why? Full text in Research Archive
• Stenbeck, Ingrid M.; Subi, Lüsette A.; Brekke, Mette & Vallersnes, Odd Martin (2025). Acute recreational drug and ethanol poisoning among adolescents: An observational study from Oslo, Norway 2014–2023. Elsevier. doi: 10.1016/j.toxrep.2025.102134. Full text in Research Archive Show summary

  Aims To keep track on trends and changes over time, we describe drugs taken, clinical course, and incidence of recreational drug and ethanol poisoning among adolescents in Oslo, Norway, from 2014 to 2023. Methods We included all patients ≤ 20 years presenting to the city’s main emergency primary care clinic with recreational drug poisoning in 2014–2023, from 2018 also including sole ethanol poisoning. Data were retrospectively collected from local patient records. Incidences were estimated per 1000 inhabitants in Oslo aged 10–20 years per year. Results There were 1209 recreational drug poisonings, 51.1 % among girls. Cannabis was taken in 37.1 % of the cases, benzodiazepines in 22.2 %, heroin in 17.1 %, cocaine in 14.6 %, amphetamine in 13.1 %, and methylenedioxymethamphetamine (MDMA) in 12.2 %. More than one drug was taken in 406 (33.6 %) cases. There were 1675 sole ethanol poisonings, 59.9 % among girls. During the pandemic years 2020 and 2021 there was a temporary decrease in the incidence of sole ethanol poisoning, accompanied by an increase in recreational drug poisoning. Otherwise, the incidences were stable, except a marked increase for recreational drugs in 2023: recreational drug poisoning 1.20 (95 % CI 0.97–1.50) in 2014 and 3.55 (3.16–3.99) in 2023; sole ethanol poisoning 3.94 (3.50–4.42) in 2018 and 3.96 (3.54–4.42) in 2023. The incidence of recreational drug poisoning among girls were lower than among boys early in the study period, but higher from 2021. Conclusions Recreational drug poisoning in Oslo among adolescents was dominated by ethanol, cannabis, benzodiazepines, and heroin.

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