Anja Maria Lyche Brænd

• Skow, Marius; Brænd, Anja Maria; Emilsson, Louise; Høye, Sigurd; Straand, Jørund & Fossum, Guro Haugen (2026). Antibiotic treatment for acute sinusitis and subsequent health care use and work absence: a nationwide registry study from Norway. Family Practice. ISSN 0263-2136. 43(2). doi: 10.1093/fampra/cmag001. Fulltekst i vitenarkiv Vis sammendrag

  Background Acute sinusitis is common in general practice. Although typically self-limiting, antibiotics are frequently prescribed despite guideline recommendations to restrict use. It remains unclear whether antibiotic treatment reduces subsequent health care use or work absence. Objective T o assess how initial treatment with or without antibiotics for acute sinusitis is associated with subsequent health care use and work absence, and to compare phenoxymethylpenicillin (PcV) versus other antibiotics. Methods Nationwide registry-based observational cohort study of adults with acute sinusitis (ICPC-2: R75) diagnosed in Norwegian general practice 2012–2019. We compared GP visits, Ear, Nose, and Throat (ENT) specialist visits, repeat antibiotic prescriptions, and sick leave days in antibiotic-treated and untreated episodes. We estimated adjusted differences in outcomes between groups using linear regression (daily outcomes) and negative binomial regression (weekly counts). Results We included 627 211 episodes from 413 449 patients. Antibiotics were prescribed in 59% of episodes; 53% received PcV. During the index week, antibiotic use was associated with 1.7 fewer GP visits, 0.1 fewer ENT visits, and 25.1 more sick leave days per 100 episodes. Corresponding figures for the following 4 weeks were: 0.9 fewer GP contacts, 10.7 fewer sick leave days, and 0.6 more antibiotic prescriptions. PcV was associated with slightly more GP visits and re-prescribing than other antibiotics. Conclusions Acute sinusitis is followed by a short-term increase in health care use and work absence. Initial antibiotic use was associated with modest short-term differences, but no meaningful reduction in overall follow-up. Findings are consistent with recommendations for restrictive prescribing and narrow-spectrum use when appropriate.

• Skoglund, Ingmarie; Heltveit-Olsen, Silje Rebekka; Brænd, Anja Maria Lyche; Fossum, Guro Haugen; Straand, Jørund & Sundvall, Sofia [Vis alle 8 forfattere av denne artikkelen] (2026). In uncharted territory: managing the COVID-19 pandemic in Swedish regions and municipalities from a primary health care perspective. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 44(1). doi: 10.1080/02813432.2026.2660327. Fulltekst i vitenarkiv Vis sammendrag

  Objective To explore experiences and challenges faced by regional and municipal health care leaders during the COVID-19 pandemic, with a focus on primary health care and care of older adults. Design A longitudinal qualitative study based on two rounds of semi-structured interviews 2–3 months apart. Setting and participants Fifteen health care leaders strategically recruited from regions and municipalities across Sweden. The first interviews took place in November–December 2020, the second in January–March 2021. Results Four themes were identified. The first captured the challenge of navigating uncharted territory during an unprecedented crisis. The second addressed ethical dilemmas arising from public health priorities. The third highlighted the growing significance and evolving role of infection prevention and control. Finally, the fourth illustrated how initially productive and solution-oriented local collaboration and communication gradually gave way to tensions and conflicting responsibilities. Conclusions In the early phases of the pandemic, the Swedish Public Health Agency’s leadership and measures were generally appreciated, although the initial response was widely perceived as slow and insufficient. The high mortality among older adults was regarded as a major failure, raising ethical concerns and exposing tensions in collaboration between actors. Pandemic work was experienced as exhausting yet meaningful, and the field of infection prevention and control gained increased recognition and status. Some distinctive features of Sweden’s pandemic response – such as decentralised decision-making and an emphasis on individual responsibility – may have been shaped by the constitutional prohibition of ministerial rule and the substantial autonomy granted to regional and local authorities.

• Skonnord, Trygve; Schei, Edvin; Brænd, Anja Maria; Bondevik, Gunnar Tschudi; Fossum, Guro Haugen & Rebnord, Ingrid Keilegavlen [Vis alle 9 forfattere av denne artikkelen] (2026). Patients' experiences of consultations involving medical students in general practice. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 146. doi: 10.4045/tidsskr.25.0269. Fulltekst i vitenarkiv Vis sammendrag

  Background and aim The aim of the study was to investigate patients' attitudes to and experiences of consultations in general practice where medical students acted as observers or conducted independent consultations. Participants were also asked about the advantages and disadvantages of student involvement. Material and method We conducted a cross-sectional study in which patients completed an online questionnaire in general practitioners' (GPs') waiting rooms, having been invited to participate by medical students in a clinical placement. The results are presented descriptively. Results A total of 2263 out of 5576 (41 %) invited patients participated. Of these, 1287/2263 (57 %) experienced consultations involving students. Of these, 890/1277 (70 %) reported that they valued the experience and 1009/1248 (81 %) agreed that it was a positive experience. Of the 847 patients who clearly recalled a consultation involving a student, 763/837 (91 %) reported feeling safe and 806/846 (95 %) felt they received adequate care. Interpretation Although the vast majority of patients in the study felt well cared for in consultations involving medical students in clinical placement in general practice, special attention should be paid to vulnerable patient groups.

• Shakeel, Nilam; Jenum, Anne Karen; Waage, Christin; Mdala, Ibrahimu; Werner, Erik Lønnmark & Natvig, Bård [Vis alle 7 forfattere av denne artikkelen] (2025). Symptom burden in middle-aged women, the role of immigrant status. BMC Public Health. 25. doi: 10.1186/s12889-025-25093-x. Fulltekst i vitenarkiv Vis sammendrag

  Background Subjective health complaints (SHCs) are symptoms from various organs that do not have an obvious explanation. Immigrants in Western countries are often exposed to multiple stressors that may trigger SHCs. Increased symptom load may reflect subjective health and functioning in the present and in the future. We, therefore, aimed to identify symptom load and distribution of subjective health complaints among middle-aged women by immigrant status. Methods This is a cross-sectional study which uses 11-year follow-up data from the STORK Groruddalen Cohort Study of 823 healthy pregnant women enrolled in primary antenatal care in a multi-ethnic city district in Oslo from 2008 to 2010. 11 years later, 379 women (53% of the eligible) provided questionnaire data on subjective health complaints drawn from the Subjective Health Complaints Inventory (SHCI) and regarding demographics and health issues collected through interviews. Participants were divided into three immigrant status groups: born in Norway by Norwegian parents (reference), born in Norway with one or two foreign born parents, and born abroad. The primary outcomes were the total score and the scores for each of the five domains in the SHCI: musculoskeletal pain, pseudo-neurology and gastrointestinal problems, allergy and flu. In addition, we studied the distribution of the 29 health complaints from the SHCI. Results Musculoskeletal symptoms were most severe and prevalent in all three immigrant-status groups. Compared to women born in Norway with Norwegian parents (reference), women born abroad had significantly higher total scores (median: 11.0 (IQR: 14.82–21.45) vs. 7.6 (9.38–12.78) (p = 0.002)). For musculoskeletal pain, the crude median scores were 4.3 (0.92–4.36) for women born abroad and 2.1 (3.81–5.72) for women born in Norway with Norwegian parents (p < 0.001). The following health complaints, headache, migraine, dizziness, pain in feet on exertion, bloating, constipation, chest pain, breathing difficulties and asthma, were more prevalent in women born abroad than in the reference group, before and after adjusting for age and education. Conclusion SHCs were more frequent and severe among women born abroad compared to the reference group. This knowledge is essential to identify women at risk and target appropriate interventions. Trial registration The study (STORK G 2) was prospectively registered at ClinicalTrials.gov (registration number: NCT03870724), registration date: 08.03.2019.

• Svaland, Malene; Brænd, Anja Maria; Heltveit-Olsen, Silje Rebekka; Rørtveit, Guri; Høye, Sigurd & Straand, Jørund [Vis alle 7 forfattere av denne artikkelen] (2025). Fear of the Unknown: Pandemic Concerns Among Non-hospitalized COVID-19 Infected or Quarantined Norwegian Adults. Disaster Medicine and Public Health Preparedness. ISSN 1935-7893. 19. doi: 10.1017/dmp.2025.10117. Fulltekst i vitenarkiv Vis sammendrag

  Objective We aimed to explore concerns and feeling of safety among quarantined and non-hospitalized COVID-19 patients. Methods We conducted a qualitative study of free text answers from participants of an online survey. The survey was conducted between March 2020 and June 2021. COVID-19 positive adults in home isolation and adults in quarantine were eligible for participation. 698 participants answered one or more of three open-ended questions about concerns and safety. We analyzed free-text answers using thematic analysis according to Braun and Clarke with an inductive approach. Results Analysis of the free-text answers from all participants identified three main themes: (1) Fear of the unknown, (2) Views on personal care and public health measures, and (3) Concern for the future of a country in crisis. Participants’ feelings revolved around health-related concerns and societal related concerns. They were concerned about their own and other’s health, and possible long-term consequences of COVID-19 infection. Some participants were satisfied with the health care system, others thought follow-ups, testing, vaccination, and information would increase their feeling of safety. Conclusions People quarantined and isolated due to the COVID-19 pandemic had concerns regarding personal health and societal consequences of infection control measures. Health care follow-ups and individualized information would increase participants’ feeling of safety.

• Toftemo, Ingun; Brænd, Anja Maria; Jenum, Anne Karen & Sletner, Line (2025). Overweight prevalence increases from 2 to 8 years of age among children with immigrant background in a Norwegian multiethnic population. Scandinavian Journal of Public Health. ISSN 1403-4948. 53(8), s. 889–897. doi: 10.1177/14034948251356059. Fulltekst i vitenarkiv Vis sammendrag

  Aims: Little is known about ethnic disparities in childhood obesity in Europe. We explored the development of ethnic differences in overweight (including obesity) from age 2 to 8 years. Methods: We collected routine weight and height measures for 604 children from the Norwegian multiethnic, population-based STORK Groruddalen pregnancy and birth cohort (52.6% European, 26.8% south Asian, and 20.5% Middle East/north African ethnic background). Using chi-square tests for trend and binominal logistic regression analyses adjusted for sex and maternal factors, we explored the development of ethnic differences in overweight. For children with south Asian origin, we performed body mass index adjustments considering their relatively higher adiposity. Results: From age 2 to 8 years, prevalence of overweight was stable in European children (13.1% at 2 years, and 15.1% at 8 years). In children with immigrant background, prevalence increased; from 5.4% to 17.2% in children with south Asian origin, and from 16.2% to 35.8% in children with Middle East/north African background ( p for trend < 0.001 in both groups). At age 8 years, the latter group had almost a threefold higher risk of overweight (odds ratio (OR) 2.89; 95% confidence interval 1.54–5.42) compared with European-origin children, while ethnic south Asian children had a double risk (OR 2.07; 1.19–3.59) after adjustments for body composition. Conclusions: From 2 to 8 years of age, prevalence of childhood overweight increased in children with immigrant background but remained stable in ethnic Europeans. To reduce ethnic disparities in health, effective efforts to prevent obesity in children with immigrant background should start very early in life.

• Waage, Christin; Jenum, Anne Karen; Mdala, Ibrahimu; Lee-Ødegård, Sindre; Brænd, Anja Maria & Sletner, Line [Vis alle 8 forfattere av denne artikkelen] (2025). Diabetes and prediabetes among women universally screened for gestational diabetes: a multi-ethnic, population-based, prospective study with eleven years follow-up. BMC Public Health. 25(1). doi: 10.1186/s12889-025-22493-x. Fulltekst i vitenarkiv Vis sammendrag

  Background Gestational diabetes (GDM) is a strong risk factor for later development of diabetes. However, data are scarce on the long-term risk for diabetes or prediabetes diagnosed by HbA1c, in non-selected, multi-ethnic populations universally screened for GDM using the WHO2013 criteria. We aimed to investigate the development of diabetes or prediabetes eleven years after the index pregnancy and identify risk factors in pregnancy or shortly after. Methods A population-based cohort study of 360 women with complete eleven years follow-up data for diabetes (HbA1c≥48 mmol/mol) or prediabetesADA (HbA1c 39–47 mmol/mol). Women were enrolled in gestational week 15 and universally screened with an oral glucose tolerance test in week 28. We performed least absolute shrinkage and selection operator (LASSO) regression to identify predictors of future diabetes or prediabetesADA and constructed a nomogram to predict individual risks. Results Diabetes or prediabetesADA combined, was found in 26.9%, and the prevalence was slightly higher in previous GDM compared with non-GDM women (35.6% versus 23.5%; p=0.019). The relative risk (RR) for developing diabetes or prediabetesADA was moderately elevated in GDM compared with non-GDM women (1.4 [1.0, 1.9], p=0.035). Seven women (1.9%) had diabetes and all of these except for one, had previous GDM. Hence, the crude prevalence was 5.8% among GDM women vs. 0.4% among non-GDM women. The RR for developing diabetes was substantially higher in GDM vs. non-GDM women (14.8 [2.6, 277.1], p=0.012). PrediabetesADA was found in 25% and the RR for prediabetesADA was not significantly increased for GDM compared to non-GDM women (1.3 [0.9, 1.8], p=0.143). Among Europeans, 17.0% had diabetes or prediabetesADA, compared to 43.0% among South Asians (p<0.001) and 34.4% among other ethnicities (p=0.002). The most significant predictors identified from the LASSO were HbA1c measured in early pregnancy, ethnicity, and a family history of diabetes. Conclusions The risk for developing diabetes was low, overall and among GDM women. Still GDM represented a strong risk for diabetes, but not for prediabetesADA. HbA1c early in pregnancy, non-European ethnicity, and a family history of diabetes were the strongest risk factors for developing diabetes or prediabetesADA.

• Heltveit-Olsen, Silje Rebekka; Lunde, Lene; Brænd, Anja Maria; Spehar, Ivan; Høye, Sigurd & Skoglund, Ingmarie [Vis alle 10 forfattere av denne artikkelen] (2024). Local management of the COVID-19 pandemic in Norway: a longitudinal interview study of municipality chief medical officers. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 42(1), s. 214–224. doi: 10.1080/02813432.2023.2301562. Fulltekst i vitenarkiv Vis sammendrag

  Objective - To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses.<p> <p>Design - Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data.<p> <p>Results - Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality.<p> <p>Conclusions - The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience.

• Bjerke, Kristin Nordey; Brænd, Anja Maria & Fossum, Guro Haugen (2024). Parents’ concerns when children get sick during a pandemic: A study of Norwegian online forums. Journal of Pediatric Health Care. ISSN 0891-5245. 38(5), s. 695–702. doi: 10.1016/j.pedhc.2024.05.007. Fulltekst i vitenarkiv Vis sammendrag

  Introduction We aimed to explore the concerns of parents when their children had symptoms of infection during the COVID-19 pandemic. Method Two Norwegian internet forums were searched for parents’ experiences when their children had upper respiratory infection symptoms in 2020–2021. A total of 197 posts were included and analyzed using thematic analysis. Results Parents described COVID-19-related and general worries regarding their children with upper respiratory infection symptoms. The first theme, “It is not ‘just a cold’ during the pandemic,” captures how infection control measures influenced parents’ concerns. The second theme, “Concerns and consequences of fever and cold symptoms,” describes general parental worries. Varying levels of worries regarding health care services, limitations of family life, and concerns for relatives were highlighted. Discussion Knowledge of parents’ concerns about cold symptoms may help primary health care providers target individual patient counseling and provide background information when policymakers develop information material for infection prevention and treatment.

• Esgård, Veronica Frey; Lindman, Ida; Brænd, Anja Maria; Fossum, Guro Haugen; Lundberg, Thorbjörn & Moberg, Anna [Vis alle 9 forfattere av denne artikkelen] (2024). Diagnostic methods and written advice for acute otitis media in primary health care. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 42(4), s. 532–537. doi: 10.1080/02813432.2024.2352444. Fulltekst i vitenarkiv Vis sammendrag

  Background Otomicroscopy and pneumatic methods are superior to otoscopy alone in diagnosing acute otitis media (AOM). There is a lack of knowledge regarding the use of different diagnostic methods for AOM in primary health care in Sweden and Norway. Methods This cross-sectional study included a questionnaire completed by general practitioners (GPs) and specialist trainees (STs/residents/registrars) working in primary care in Sweden and Norway. Multivariable binary logistic regressions were performed to evaluate the use of diagnostic methods and written advice adjusted for educational level, sex and country. Results Otoscopy was the most frequently used method. Sweden had greater access to the more accurate diagnostic methods. In Norway, the following methods were used to a lesser extent: pneumatic otoscopy, adjusted OR 0.15 (95% CI 0.10–0.23; p < .001), otomicroscopy, adjusted OR 0.013 (95% CI 0.070–0.027; p < .001), pneumatic otomicroscopy, adjusted OR 0.028 (95% CI 0.010–0.078; p < .001) and tympanometry, adjusted OR 0.31 (95% CI 0.21–0.45; p < .001). Written advice was used to a greater extent in Norway, adjusted OR 4.5 (95% CI 3.1–6.7; p < .001). The STs used pneumatic otoscopy and pneumatic otomicroscopy to a lesser extent, adjusted OR 0.65 (95% CI 0.45–0.93; p = .019) and 0.63 (95% CI 0.43–0.92; p = .016). Conclusions Swedish physicians both used and had greater access to the significantly better diagnostic methods compared with Norwegian physicians while the opposite applied to the use of written information. The GPs used pneumatic otoscopy and pneumatic otomicroscopy to a greater extent than STs. Compared with 2012, the Swedish physicians now more frequently used pneumatic otoscopy.

• Skonnord, Trygve; Brænd, Anja Maria & Fossum, Guro Haugen (2024). Pasienterfaringer med fastlegetjenesten under covid-19-pandemien – en tverrsnittsstudie. Tidsskrift for velferdsforskning. ISSN 0809-2052. 27(1), s. 1–11. doi: 10.18261/tfv.27.1.3. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Pasientenes legesøkningsatferd under covid-19-pandemien er lite studert. Formålet med studien var å undersøke norske pasienters erfaringer med fastlegenes tilgjengelighet og endringer i legesøkning og egenomsorg under pandemien. Materiale og metode: I denne tverrsnittsstudien delte medisinstudenter ut spørreskjemaer til pasienter på fastlegers venterom høsten 2021. Vi mottok 639 anonyme svar. Resultater: 78% av deltakerne opplevde tilgjengeligheten til fastlegekontoret som før, mens 74% oppgav egen terskel til å ta kontakt som uendret. 16% utsatte kontakt med helsetjenesten for sine plager, hvorav halvparten opplevde negative konsekvenser. Konklusjon: Selv om erfaringene fra covid-19-pandemien er at fastlegetjenesten i stor grad var omstillingsdyktig og leverte tilpassede tjenester, er det rom for å gi tydeligere informasjon om tilgjengelighet til fastlegetjenesten ved framtidige pandemier.

• Skow, Marius; Fossum, Guro Haugen; Høye, Sigurd; Straand, Jørund; Emilsson, Louise & Brænd, Anja Maria (2023). Antibiotic treatment of respiratory tract infections in adults in Norwegian general practice. JAC-Antimicrobial Resistance (JAC-AMR). 5(1). doi: 10.1093/jacamr/dlac135. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To analyse the prevalence of respiratory tract infection (RTI) episodes with and without antibiotic prescriptions in adult patients in Norwegian general practice during the period 2012–2019. Methods Observational study linking data from the Norwegian Control and Payment for Health Reimbursements Database and the Norwegian Prescription Database. Episodes of acute RTIs in patients aged 18 years or older were identified and linked to antibiotic prescriptions dispensed within 7 days after diagnosis. We analysed annual infection rates and antibiotic prescription rates and antibiotics prescribed for the different RTI conditions. Results RTI episode rate per 1000 inhabitants was 312 in 2012 and 277 in 2019, but showed no linear trend of change during the study period (P = 0.205). Antibiotic prescription rate decreased from 37% of RTI episodes in 2012 to 23% in 2019 (P < 0.001). The reduction in prescribing was most pronounced for episodes coded with ICPC-2 symptom diagnoses, as well as upper RTIs, influenza, acute bronchitis and sinusitis. Prescriptions for phenoxymethylpenicillin decreased from 178 746 in 2012 to 143 095 in 2019, but increased as proportion of total antibiotic prescriptions from 40% in 2012 to 53% in 2019 (P < 0.001). Conclusions This study demonstrates stable RTI episode rates and reduced antibiotic prescription rates for RTIs for adults in Norwegian general practice 2012–2019. We also observed a shift towards relatively more use of phenoxymethylpenicillin and less broad-spectrum antibiotics. These changes are in line with the aims of the Norwegian strategy against antibiotic resistance.

• Mohn, Cathrine Helene; Blix, Hege Salvesen; Brænd, Anja Maria; Nafstad, Per & Halvorsen, Jon Anders (2023). Prevalence of Isotretinoin Therapy in Adolescents and Young Adults With and Without Atopic Dermatitis: A Nationwide Prescription-based Population Study. Acta Dermato-Venereologica. ISSN 0001-5555. 103, s. 1–7. doi: 10.2340/actadv.v103.9424. Fulltekst i vitenarkiv Vis sammendrag

  Although isotretinoin has anti-inflammatory and immunomodulatory properties, it can exacerbate atopic dermatitis. National estimates of the extent to which patients with atopic dermatitis are affected by severe acne and isotretinoin tolerability are lacking. The aim of this study is to investigate isotretinoin therapy in patients with atopic dermatitis and to compare the nationwide prevalence with individuals without atopic dermatitis. All Norwegian residents were followed for 17 years until age 20–22 years in 2020. Approximately 28% of patients with atopic dermatitis had been treated for acne, and 8% had received isotretinoin before age 23 years. In those over 17 years old, significantly more patients with atopic dermatitis were treated with isotretinoin than those without. At age 22 years, 2.21% (95% confidence interval 1.92–2.49) of patients with atopic dermatitis were treated with isotretinoin, compared with 1.55% (95% confidence interval 1.44–1.65) of those without, representing 42.8% (1.43; 95% confidence interval 1.24–1.65) higher use in patients with atopic dermatitis. Patients who received long-term treatment (probable severe atopic dermatitis) tolerated isotretinoin similarly to patients who received short-term treatment (probable mild atopic dermatitis). There was significantly higher use of topical corticosteroids during isotretinoin therapy in patients with atopic dermatitis. Conclusively, severe acne (isotretinoin therapy) was associated with atopic dermatitis at the population level in young adults.

• Fossum, Guro Haugen; Brænd, Anja Maria; Heltveit-Olsen, Silje Rebekka; Rørtveit, Guri; Høye, Sigurd & Straand, Jørund (2023). Symptoms, symptom severity, and contact with primary health care among nonhospitalized COVID-19 patients: a Norwegian web-based survey. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 41(4), s. 427–434. doi: 10.1080/02813432.2023.2266477. Fulltekst i vitenarkiv Vis sammendrag

  Objective Dependent on clinical setting, geography and timing during the pandemic, variable symptoms of COVID-19 have been reported. Our aim was to describe self-reported symptom intensity and contact with primary health care among nonhospitalized COVID-19 patients. Design Web-based survey. Setting Norway between March 2020 and July 2021. Subjects Adults in home isolation. Main outcome measures Participants reported possible COVID-19 symptoms, duration of symptoms, score of symptom severity (Likert scale 0–3), risk factors, comorbidity, and questions regarding follow-up and information from primary health care. Results Of 477 participants, 379 (79%) had PCR-confirmed COVID-19, 324 (68%) were females, and 90% were younger than 60 years. Most common symptoms were “fatigue and/or muscle ache” (80%), nasal symptoms (79%), and headache (73%). The mean severity of symptoms was generally low. Symptoms with the highest mean scores were “fatigue and/or muscle ache” (1.51, SD 1.02) and headache (1.27 (SD 1.00). Mean scores for severity ranged from 0.28 (nausea) to 1.51 (fatigue and/or muscle ache). Women reported higher symptom scores than men. For “affected sense of smell and/or taste”, patients either reported a high symptom score (24%) or no affliction at all (49%). A third of the participants (32%) were followed-up by primary care health personnel, and almost 40% had sought or received information about COVID-19 from general practitioners. Conclusion The mean severity of symptoms among nonhospitalized adult COVID-19 patients was generally low. We found large variations in the occurrence and severity of symptoms between patients.

• Skow, Marius Andre Hybbestad; Fossum, Guro Haugen; Høye, Sigurd; Straand, Jørund; Brænd, Anja Maria & Emilsson, Louise (2023). Hospitalizations and severe complications following acute sinusitis in general practice: a registry-based cohort study. Journal of Antimicrobial Chemotherapy. ISSN 0305-7453. 78(9), s. 2217–2227. doi: 10.1093/jac/dkad227. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To investigate complication rates of acute sinusitis in general practice, and whether antibiotic prescribing had an impact on complication rate. Methods All adult patients diagnosed with sinusitis in Norwegian general practice between 1 July 2012 and 30 June 2019 were included. GP consultation data from the Norwegian Control and Payment for Health Reimbursements Database were linked with antibiotic prescriptions (Norwegian Prescription Database) and hospital admissions (Norwegian Patient Registry). Main outcomes were sinusitis-related hospitalizations and severe complications within 30 days. Logistic regression was used to estimate associations between antibiotic prescriptions, prespecified risk factors, individual GP prescribing quintile, and outcomes. Results A total of 711 069 episodes of acute sinusitis in 415 781 patients were identified. During the study period, both annual episode rate (from 30.2 to 21.2 per 1000 inhabitants) and antibiotic prescription rate (63.3% to 46.5%; P < 0.001) decreased. Yearly hospitalization rate was stable at 10.0 cases per 10 000 sinusitis episodes and the corresponding rate of severe complications was 3.2, with no yearly change (P = 0.765). Antibiotic prescribing was associated with increased risk of hospitalization [adjusted OR 1.8 (95% CI 1.5–2.1)] but not with severe complications. Individual GP prescribing quintile was not associated with any of the outcomes, whereas risk factors such as previous drug abuse, or head injury, skull surgery or malformations, and being immunocompromised were significantly associated with increased risk of both outcomes. Conclusions Severe complications of acute sinusitis were rare and no protective effect of high prescribing practice among GPs was found. Recommendations to further reduce antibiotic prescribing are generally encouraged, except for high-risk groups.

• Lunde, Lene; Moen, Anne; Jakobsen, Rune Bruhn; Møller, Britta; Rosvold, Elin Olaug & Brænd, Anja Maria (2022). A preliminary simulation‑based qualitative study of healthcare students’ experiences of interprofessional primary care scenarios. Advances in Simulation. 7(1). doi: 10.1186/s41077-022-00204-5. Fulltekst i vitenarkiv Vis sammendrag

  Background: Introducing interprofessional education (IPE) in healthcare curricula can prepare students for healthcare practices that have become increasingly complex. The use of simulation is promoted to support IPE. This study explores healthcare students’ experiences of participating in common, sub-acute patient scenarios that routinely occur in clinical practice in primary care. More specifically, it looks at how sub-acute patient scenarios from primary care can help develop interprofessional collaborative competence. Methods: Medical students (N=10), master’s students in advanced geriatric nursing (N=8) and bachelor’s students in nursing (N=9) participated in the simulations. The students were in their last or second-to-last year of education. We conducted five semi-structured focus group interviews with the participants’ directly after the simulation training to elicit experiences related to the scenarios, the simulation and interprofessional collaboration. The transcripts were analysed using systematic text condensation. To supplement the focus group interviews, the students also completed the interprofessional collaborative competency attainment survey (ICCAS), which measures the students’ self-assessed interprofessional competence. Results: Three main themes emerged from the analysis of the focus group interviews: Realism, Uncertainty, and Reflection. The students emphasised the importance of authentic and recognisable scenarios. They said the vague and unspecific patient symptoms created uncertainty in the situation, making it difficult to understand the patient’s diagnosis. Despite that uncertainty, they described the experience as positive. Further, the students expressed that the simulation increased their confidence in interprofessional collaboration and prepared them for future work. The results from the ICCAS questionnaire showed that the students reported a subjective positive change in their interprofessional competence after participating in the scenarios. Conclusions: This study showed that simulation-based IPE with sub-acute primary care scenarios contributes to develop interprofessional collaborative competence in healthcare education. Sub-acute scenarios can supplement the more common approaches with acute-care scenarios and aid in developing the collaborative competence required to work in healthcare teams.

• Heltveit-Olsen, Silje Rebekka; Lunde, Lene; Brænd, Anja Maria Lyche; Spehar, Ivan; Høye, Sigurd & Skoglund, Ingmarie [Vis alle 10 forfattere av denne artikkelen] (2022). Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: a longitudinal interview study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. doi: 10.1080/02813432.2022.2142796. Fulltekst i vitenarkiv Vis sammendrag

  Objective: When the COVID-19 pandemic reached Norway, primary health care had to reorganize to ensure safe patient treatment and maintain infection control. General practitioners (GPs) are key health care providers in the municipalities. Our aim was to explore the experiences and management strategies of Norwegian GPs during the COVID-19 pandemic - over time, and in the context of a sudden organizational change.<p> <p>Design: Longitudinal qualitative interview study with two interview rounds. The first round of interviews was conducted from September–December 2020, the second round from January–April 2021. In the first interview round, we performed eight semi-structured interviews with GPs from eight municipalities in Norway. In the second round, five of the GPs were re-interviewed. Consecutive interviews were performed 2–4 months apart. To analyze the data, we used thematic analysis. <p>Results: The COVID-19 pandemic required GPs to balance several concerns, such as continuity of care and their own professional efforts. Several GPs experienced challenges in the collaboration with the municipality and in relation to defining their own professional position. Guided by The Norwegian Association of General practitioners, The Norwegian College of General Practice and collegial support, they found viable solutions and ended up with a feeling of having adapted to a new normal. <p>Conclusions: Although our study demonstrates that the GPs adapted to the changing conditions, the current municipal health care models are not ideal. There is a need for clarification of responsibilities between GPs and the municipality to facilitate a more coordinated future pandemic response.

• Mohn, Cathrine Helene; Blix, Hege Salvesen; Brænd, Anja Maria; Nafstad, Per; Nygård, Ståle & Halvorsen, Jon Anders (2022). Treatment Patterns of Atopic Dermatitis Medication in 0–10-Year-Olds: A Nationwide Prescription-Based Study. Dermatology and Therapy. ISSN 2193-8210. 12(7), s. 1639–1657. doi: 10.1007/s13555-022-00754-6. Fulltekst i vitenarkiv Vis sammendrag

  Introduction The literature on treatment patterns for paediatric atopic dermatitis (AD) is scarce and is rarely based on real-world data. Using national registers, we sought to establish up-to-date, population-based prevalence estimates, predictors of risk and disease burden and a comprehensive overview of treatment patterns and course for paediatric patients with AD. Methods Dispensed prescriptions for the entire Norwegian child population aged 0–10 years from 2014 to 2020 were analysed. Results There were 176,458 paediatric patients with AD. Of these, 99.2% received topical corticosteroids, 5.1% received topical calcineurin inhibitors, 37.1% received potent topical corticosteroids and 2.1% received systemic corticosteroids. Of the 59,335 live births in Norway (2014), 14,385 [24.8%; 95% confidence interval (CI) 24.5–25.1] paediatric patients were treated for AD before the age of 6 years, and of these, only 934 (6.5%; 95% CI 6.1–6.9) received medication annually for 5 years or more. Compared with girls, 17.9% (95% CI 6.5–27.9) more boys were treated for at least 5 years, receiving 6.4% (95% CI 1.2–11.3) more potent topical corticosteroids and 12.4% (95% CI 6.5–18.0) more were treated for skin infections. Compared with patients with late-onset treatment, 18.9% (95% CI 7.5–29.0) more paediatric patients with early-onset treatment were still receiving treatment at 5 years of age, 15.7% (95% CI 7.1–23.4) more paediatric patients received potent topical corticosteroids and 44.4% (95% CI 36.5–51.2) more paediatric patients were treated for skin infections. Conclusion Most paediatric patients were treated for a mild disease for a limited period. Although the prevalence of AD is higher at a younger age, these paediatric patients were the least likely to receive potent topical corticosteroids. Male sex and early-onset AD are associated with and are potential predictors of long-term treatment and treatment of potent topical corticosteroids, antihistamines and skin infections, which may have clinical utility for personalised prognosis, healthcare planning and future AD prevention trials.

• Farrell, Karen; Tandan, Meera; Santiago, Virginia Hernandez; Gagyor, Ildiko; Brænd, Anja Maria & Skow, Marius [Vis alle 10 forfattere av denne artikkelen] (2021). Treatment of uncomplicated UTI in males: a systematic review of the literature. British Journal of General Practice Open. 26(2). doi: 10.3399/bjgpopen20X101140. Fulltekst i vitenarkiv Vis sammendrag

  Background Urinary tract infections (UTIs) affect around 20% of the male population in their lifetime. The incidence of UTIs in men in the community is 0.9–2.4 cases per 1000 aged &lt;55 years and 7.7 per 1000 aged ≥85 years. Aim To evaluate the outcomes of randomised controlled trials (RCTs) comparing the effectiveness of different antimicrobial treatments and durations for uncomplicated UTIs in adult males in outpatient settings. Method A systematic literature review of RCTs of adult male patients with an uncomplicated UTI treated with oral antimicrobials in any outpatient setting. The outcomes were symptom resolution within 2 weeks of starting treatment, duration until symptom resolution, clinical cure, bacteriological cure, and frequency of adverse events. Results From the 1052 abstracts screened, three provided sufficient information on outcomes. One study compared trimethoprim-sulfamethoxazole for 14 days (21 males) with 42 days (21 males). Fluoroquinolones were compared in the two other RCTs: lomefloxacin (10 males) with norfloxacin (11 males), and ciprofloxacin for 7 days (19 males) and 14 days (19 males). Combining the results from the three RCTs shows that for 75% males with a UTI (76/101) bacteriological cure was reported at the end of the study. Of the 59 patients receiving a fluoroquinolone, 57 (97%) reported bacteriological and clinical cure within 2 weeks after treatment. Conclusion The evidence available is insufficient to make any recommendations in relation to type and duration of antimicrobial treatment for male UTIs. Sufficiently powered RCTs are needed to identify best treatment type and duration for male UTIs in primary care.

• Eide, Torunn Bjerve; Straand, Jørund & Brænd, Anja Maria (2021). Good communication was valued as more important than accessibility according to 707 Nordic primary care patients: a report from the QUALICOPC study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 39(3), s. 296–304. doi: 10.1080/02813432.2021.1928837. Fulltekst i vitenarkiv Vis sammendrag

  Objective To explore Nordic patients’ ranking of the importance of different aspects of general practice. Design Patients ranked the importance of 47 statements reflecting five quality domains: communication, involvement, accessibility, continuity, and comprehensiveness. Setting Nordic general practice. Subjects Patients ≥18 years in general practitioners waiting rooms. Main outcome measures Items rated as important or very important by ≥ 90% in all countries were identified. Associations with patient characteristics were analysed by logistic regression. Results 209 Danish, 175 Norwegian, 129 Finnish, 112 Swedish and 82 Icelandic patients responded. Ten statements were ranked as important or very important by ≥90% in each country. Six pertained to communication, three to patient involvement and one to the comprehensiveness of care. No items regarding accessibility or continuity exceeded the 90% limit. The item most frequently rated as very important was ‘I understand what the GP explains’’. Female patients were more likely to value personal treatment (OR = 2.9; 95%CI 1.5–5.5) and receiving instructions if things went wrong (1.7; 1.2–2.2). Older patients >65 years put less emphasis than those <35 on whether the GP takes them seriously (0.4; 0.3–0.5) and on the importance of instructions (0.5; 0.4–0.7). Patients with chronic diseases were less concerned (0.6; 0.4–0.8) with receiving instructions, but valued strongly that a GP knows when to refer (2.2; 1.5–3.3). Conclusion Patients in all countries assigned high value to good communication. Availability was deemed important but came secondary to good communication.

• Lunde, Lene; Moen, Anne; Jakobsen, Rune Bruhn; Rosvold, Elin Olaug & Brænd, Anja Maria (2021). Exploring healthcare students' interprofessional teamwork in primary care simulation scenarios: collaboration to create a shared treatment plan. BMC Medical Education. 21. doi: 10.1186/s12909-021-02852-z. Fulltekst i vitenarkiv Vis sammendrag

  Background Primary care providers assume responsibility for patients with increasingly complex problems requiring interprofessional collaboration. Introducing interprofessional education in healthcare curricula prepares healthcare students for this reality. Solving simulation scenarios as an educational strategy is promoted to support interprofessional education in health care, and is mostly used in acute clinical situations. This paper aims to explore how healthcare students’ actions influence interprofessional collaboration and treatment plan identification when they solve common, sub-acute patient scenarios in primary care situations. Methods Interaction analysis of video recordings from the simulation scenarios was performed with a focus on the students’ joint actions; specifically how these actions unfold and how productive the students were in terms of developing treatment plans. Results We found variation in the groups’ interactions, the paths they followed, and the quality of their knowledge output in their shared treatment plan. The groups with the capacity to collaborate and engage in sharing information, and explain and elaborate on concepts, were more successful in developing comprehensive treatment plans. Furthermore, these groups managed the duality of defining and solving the immediate problem and collaboratively preparing for future care. Conclusions Analysis of the activities in our scenarios showed the students’ potential to practice interprofessional collaboration. Our study illustrates that simulation of sub-acute scenarios in primary care is an underexplored but suitable arena to train communication and teamwork in complex situations. The simulation scenarios are also feasible for use on-site in an educational facility or in practice with minimal equipment and resources.

• Høye, Sigurd; Brænd, Anja Maria & Spehar, Ivan (2020). Quality improvement and antimicrobial stewardship in general practice – the role of the municipality chief medical officer. A qualitative study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 38(3), s. 352–359. doi: 10.1080/02813432.2020.1794400. Fulltekst i vitenarkiv Vis sammendrag

  Aims This study aimed to explore the conditions for the Municipal Chief Medical Officers’ (MCMOs) involvement in quality improvement in general practice, specifically concerning antibiotic prescribing practices. Methods This qualitative study consisted of semi-structured in-depth telephone interviews and group interviews with MCMOs (n = 12). The interview guide aimed to explore the MCMOs’ views on their role and responsibilities regarding the quality of care in general practice. The data were analysed using systematic text condensation. Results Three main themes were identified: 1) the relationship between the municipality and the general practitioner (GP), with the MCMO acting as an intermediary, 2) influencing the GPs’ work and 3) antibiotic use and infection control. The MCMOs perceived themselves as liaisons between the municipalities and the GPs. They emphasized building trust, showing respect and sharing common values in their interactions with the GPs, upholding the GPs’ professional autonomy. Working for quality improvement was considered a priority; however, MCMOs expressed a need for external support to establish a permanent quality improvement framework. The informants were positive about engaging in improving antibiotic prescribing practices because this combined the municipality’s responsibilities for quality improvement and communicable disease control. Conclusions The MCMOs considered themselves as well-suited agents for quality improvement in general practice, as liaisons between the municipalities and the GPs. Quality improvement in general practice would benefit from a clearer structure in terms of the MCMOs’ roles and responsibilities. Within communicable diseases control, the MCMOs have a clear mandate, which places antimicrobial stewardship initiatives in a favourable position amongst other areas of quality improvement.

• Brænd, Anja Maria; Straand, Jørund & Klovning, Atle (2017). Clinical drug trials in general practice: how well are external validity issues reported? BMC Family Practice. 18(1). doi: 10.1186/s12875-017-0680-7. Fulltekst i vitenarkiv Vis sammendrag

  Background When reading a report of a clinical trial, it should be possible to judge whether the results are relevant for your patients. Issues affecting the external validity or generalizability of a trial should therefore be reported. Our aim was to determine whether articles with published results from a complete cohort of drug trials conducted entirely or partly in general practice reported sufficient information about the trials to consider the external validity. Methods A cohort of 196 drug trials in Norwegian general practice was previously identified from the Norwegian Medicines Agency archive with year of application for approval 1998–2007. After comprehensive literature searches, 134 journal articles reporting results published from 2000 to 2015 were identified. In these articles, we considered the reporting of the following issues relevant for external validity: reporting of the clinical setting; selection of patients before inclusion in a trial; reporting of patients’ co-morbidity, co-medication or ethnicity; choice of primary outcome; and reporting of adverse events. Results Of these 134 articles, only 30 (22%) reported the clinical setting of the trial. The number of patients screened before enrolment was reported in 61 articles (46%). The primary outcome of the trial was a surrogate outcome for 60 trials (45%), a clinical outcome for 39 (29%) and a patient-reported outcome for 25 (19%). Clinical details of adverse events were reported in 124 (93%) articles. Co-morbidity of included participants was reported in 54 trials (40%), co-medication in 27 (20%) and race/ethnicity in 78 (58%). Conclusions The clinical setting of the trials, the selection of patients before enrolment, and co-morbidity or co-medication of participants was most commonly not reported, limiting the possibility to consider the generalizability of a trial. It may therefore be difficult for readers to judge whether drug trial results are applicable to clinical decision-making in general practice or when developing clinical guidelines.

• Gran, Sarah Frandsen; Brænd, Anja Maria; Lindbæk, Morten & Frich, Jan C (2016). General practitioners’ and students’ experiences with feedback during a six-week clerkship in general practice: A qualitative study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 34(2), s. 172–179. doi: 10.3109/02813432.2016.1160633. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Feedback may be scarce and unsystematic during students' clerkship periods. We wanted to explore general practitioners' (GPs) and medical students' experiences with giving and receiving supervision and feedback during a clerkship in general practice, with a focus on their experiences with using a structured tool (StudentPEP) to facilitate feedback and supervision. Design: Qualitative study. Setting: Teachers and students from a six-week clerkship in general practice for fifth year medical students were interviewed in two student and two teacher focus groups. Subjects: 21 GPs and nine medical students. Results: We found that GPs first supported students' development in the familiarization phase by exploring the students' expectations and competency level. When mutual trust had been established through the familiarization phase GPs encouraged students to conduct their own consultations while being available for supervision and feedback. Both students and GPs emphasized that good feedback promoting students' professional development was timely, constructive, supportive, and focused on ways to improve. Among the challenges GPs mentioned were giving feedback on behavioral issues such as body language and insensitive use of electronic devices during consultations or if the student was very insecure, passive, and reluctant to take action or lacked social or language skills. While some GPs experienced StudentPEP as time-consuming and unnecessary, others argued that the tool promoted feedback and learning through mandatory observations and structured questions. Conclusion: Mutual trust builds a learning environment in which supervision and feedback may be given during students' clerkship in general practice. Structured tools may promote feedback, reflection and learning.

• Brænd, Anja Maria; Straand, Jørund; Jakobsen, Rune Bruhn & Klovning, Atle (2016). Publication and non-publication of drug trial results: A 10-year cohort of trials in Norwegian general practice. BMJ Open. 6(4). doi: 10.1136/bmjopen-2015-010535. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Previously, we identified a 10-year cohort of protocols from applications to the Norwegian Medicines Agency 1998–2007, consisting of 196 drug trials in general practice. The aim of this study was to examine whether trial results were published and whether trial funding and conflicts of interest were reported. Design Cohort study of trials with systematic searches for published results. Setting Clinical drug trials in Norwegian general practice. Methods We performed systematic literature searches of MEDLINE, Embase and CENTRAL to identify publications originating from each trial using characteristics such as test drug, comparator and patient groups as search terms. When no publication was identified, we contacted trial sponsors for information regarding trial completion and reference to any publications. Main outcome measures We determined the frequency of publication of trial results and trial characteristics associated with publication of results. Results Of the 196 trials, 5 were never started. Of the remaining 191 trials, 71% had results published in a journal, 11% had results publicly available elsewhere and 18% of trials had no results available. Publication was more common among trials with an active comparator drug (χ2 test, p=0.040), with a larger number of patients (total sample size≥median, p=0.010) and with a longer trial period (duration≥median, p=0.025). Trial funding was reported in 85% of publications and increased over time, as did reporting of conflicts of interest among authors. Among the 134 main journal articles from the trials, 60% presented statistically significant results for the investigational drug, and the conclusion of the article was favourable towards the test drug in 78% of papers. Conclusions We did not identify any journal publication of results for 29% of the general practice drug trials. Trials with an active comparator, larger and longer trials were more likely to be published.

• Brænd, Anja Maria Lyche; Jensen, Kaspar Buus; Klovning, Atle & Straand, Jørund (2013). Clinical drug trials in general practice: a 10-year overview of protocols. Trials. 14. doi: 10.1186/1745-6215-14-162. Fulltekst i vitenarkiv Vis sammendrag

  Background Drugs predominantly prescribed in general practice should ideally be tested in that setting; however, little is known about drug trials in general practice. Our aim was to describe drug trials in Norwegian general practice over the period of a decade. Methods The present work concerns a 10-year retrospective study of protocols submitted to the Norwegian national medicines agency (1998 to 2007) identifying all studies involving general practitioners (GPs) as clinical investigator(s). We analyzed the number of trials, drug company involvement, patients, participating doctors, payment, medications tested and main diagnostic criteria for inclusion. We also analyzed one trial in greater detail. Results Out of 2,054 clinical drug trials, 196 (9.5%) were undertaken in general practice; 93% were multinational, 96% were industry funded and 77% included patients both from general practice and specialist care. The trials were planned to be completed in the period 1998 to 2012. A total of 23,000 patients in Norway and 340,000 patients internationally were planned to be included in the 196 trials. A median of 5 GPs participated in each trial (range 1 to 402). Only 0.7% of 831 GP investigators had general practice university affiliations. Median payment for participating investigators was €1,900 (range €0 to 13,500) per patient completing the trial. A total of 30 pharmaceutical companies were involved. The drugs most commonly studied were antidiabetics (21%), obstructive airway disease medications (12%), agents acting on the renin-angiotensin system (10%), and lipid modifying agents (10%). One trial, presented in more detail, had several characteristics of a seeding or marketing trial. Conclusions Only one in four drug trials involving general practice were solely general practice trials and almost all were industry initiated without input from academic general practice. There was a large variation in the number of patients, participating doctors, and economic compensation for trial investigators, with some investigators receiving substantial payments.

• Gran, Sarah Frandsen; Brænd, Anja Maria Lyche & Lindbæk, Morten (2010). Triangulation of written assessments from patients, teachers and students: Useful for students and teachers? Medical Teacher. ISSN 0142-159X. 32(12), s. E552–E558. doi: 10.3109/0142159X.2010.528808. Fulltekst i vitenarkiv
• Brænd, Anja Maria Lyche; Gran, Sarah Frandsen; Frich, Jan C & Lindbæk, Morten (2010). Medical students' clinical performance in general practice - Triangulating assessments from patients, teachers and students. Medical Teacher. ISSN 0142-159X. 32(4), s. 333–339. doi: 10.3109/01421590903516866. Fulltekst i vitenarkiv Vis sammendrag

  Background: Formative assessment of medical students' clinical performance during general practice clerkship is necessary to learn consultation skills. Aims: Our aim was to triangulate feedback using patient questionnaires, written self-assessment and teachers' observation-based assessment, and to describe the content of this feedback. Method: We developed StudentPEP, a 15-item version of EUROPEP, a tool for measuring patients' evaluation of quality in general practice. The teacher and student forms consisted of five StudentPEP-items and open-ended questions asking for approval and improvement needed on four aspects. Quantitative scores were analyzed statistically. Free-text comments were analyzed and categorized into 'specific and concrete' versus 'general and unspecific'. Results: One hundred seventy-three students returned data from 2643 consultations. Mean patients' scores for 15 items were 4.3-4.8 on a five-point Likert scale. Mean teacher scores were 4.4 on five items, while students' mean self-assessments were 3.6-3.8. In an analysis of 380 consultations, students were more specific and concrete in their self-evaluation compared with teachers (p < 0.01). Conclusion: Patients scored students' performance high compared with students' self-assessments. Teachers' scores were in accordance with patients' scores. Teachers' written evaluations of students were often general. There is a potential for improving teachers' feedback in terms of more specific and concrete comments.

• Gran, Sarah Frandsen; Brænd, Anja Maria Lyche & Lindbæk, Morten (2008). Praksisperiode i allmennmedisin under medisinstudiet. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 128, s. 2443–2445. Fulltekst i vitenarkiv
• Brænd, Anja Maria Lyche; Gran, Sarah Frandsen & Lindbæk, Morten (2006). Pasienter - nyttig ressurs ved evaluering av medisinstudenters kliniske praksis? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 126, s. 2122–2125. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Misvær, Nina & Brænd, Anja Maria Lyche (2024). Håndbok for helsestasjoner 0-5 år. Kommuneforlaget AS. ISBN 9788244624459. 533 s. Fulltekst i vitenarkiv
• Hunskaar, Steinar; Brænd, Anja Maria; Halvorsen, Peder Andreas & Skjellegrind, Håvard Kjesbu (2023). Allmennmedisin. Gyldendal Norsk Forlag A/S. ISBN 9788205579866. 1072 s. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Brænd, Anja Maria; Fossum, Guro Haugen; Romøren, Maria; Eliassen, Knut Eirik Ringheim; Werner, Erik Lønnmark & Skonnord, Trygve (2026). Patient experiences with student consultations in Norwegian general practice: a questionnaire study. Fulltekst i vitenarkiv
• Skonnord, Trygve; Schei, Edvin; Brænd, Anja Maria; Bondevik, Gunnar Tschudi; Fossum, Guro Haugen & Rebnord, Ingrid Keilegavlen [Vis alle 9 forfattere av denne artikkelen] (2025). Patients’ experiences of meeting a medical student. A cross-sectional study from general practitioners’ waiting rooms. Fulltekst i vitenarkiv
• Skonnord, Trygve; Fossum, Guro Haugen; Romøren, Maria; Eliassen, Knut Eirik Ringheim; Werner, Erik Lønnmark & Brænd, Anja Maria (2025). The experience of meeting a medical student at the GP's office. Fulltekst i vitenarkiv
• Skow, Marius; Emilsson, Louise; Høye, Sigurd; Straand, Jørund; Brænd, Anja Maria & Fossum, Guro Haugen (2024). BIHULEBETENNELSE I ALLMENNPRAKSIS: PÅVIRKER ANTIBIOTIKA RISIKOEN FOR LANGVARIGE OG KOMPLISERTE PASIENTFORLØP? Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Akutt bihulebetennelse er en vanlig tilstand i allmennpraksis, hvor antibiotika ofte foreskrives, til tross for økende dokumentasjon som viser at ukompliserte tilfeller sjelden har nytte av slik behandling. Risikoen for alvorlige komplikasjoner er lav, og tidligere studier fra norsk allmennpraksis har ikke vist noen vesentlig beskyttende effekt av antibiotika når det gjelder å forhindre sykehusinnleggelser eller alvorlige komplikasjoner etter akutt bihulebetennelse. Denne studien fokuserer på såkalte milde komplikasjoner av akutt bihulebetennelse, med vekt på antall konsultasjoner i allmennpraksis, bruk av spesialisthelsetjenester, sykefravær og antibiotikabruk. Målet med studien er å undersøke forekomsten av forlengede og kompliserte pasientforløp ved akutt bihulebetennelse som behandles utenfor sykehus, og å sammenligne utfallet blant pasienter som behandles med antibiotika, med de som ikke gjør det. Metode: Ved å koble data fra flere nasjonale helseregistre, analyserer vi episoder av akutt bihulebetennelse hos voksne pasienter diagnostisert i allmennpraksis i perioden 2012–2019. For hver episode samler vi inn opplysninger om antibiotikaresepter, legekonsultasjoner, sykemeldinger og kontakter hos øre-nese-hals-spesialister og poliklinikker. Vi bruker en «difference-in-difference»-metode for å sammenligne utfallet av episoder behandlet med og uten antibiotika, ved å undersøke forekomsten av de ulike utfallsmålene i 12 uker etter en akutt bihulebetennelsesepisode, sammenlignet med 12 uker før episoden. Resultater: Vår kohort består over 600 000 episoder av akutt bihulebetennelse. Analysene er ikke ferdige på tidspunktet for innsending av sammendraget, men foreløpige resultater vil bli presentert på møtet. Konklusjoner: Konklusjonene er foreløpig ikke klare og vil bli trukket basert på den endelige analysen av våre data.

• Brigtsen, Anne Karin & Brænd, Anja Maria Lyche (2024). Barnemedisin. I Misvær, Nina & Brænd, Anja Maria Lyche (Red.), Håndbok for helsestasjoner 0-5 år. Kommuneforlaget AS. ISSN 9788244624459. s. 449–519. Fulltekst i vitenarkiv
• Brænd, Anja Maria Lyche (2024). Somatisk undersøkelse. I Misvær, Nina & Brænd, Anja Maria Lyche (Red.), Håndbok for helsestasjoner 0-5 år. Kommuneforlaget AS. ISSN 9788244624459. s. 157–169. Fulltekst i vitenarkiv
• Skow, Marius Andre Hybbestad; Brænd, Anja Maria; Emilsson, Louise; Høye, Sigurd; Straand, Jørund & Fossum, Guro Haugen (2024). Complicated courses of sinusitis in general practice in an era of antibiotic stewardship. Fulltekst i vitenarkiv
• Waage, Christin; Toftemo, Ingun; Brænd, Anja Maria; Sletner, Line; Sommer, Christine & Birkeland, Kåre Inge [Vis alle 10 forfattere av denne artikkelen] (2023). Cohort profile update: the Norwegian STORK Groruddalen (STORK G) pregnancy and birth cohort—the role of ethnicity and causal pathways for obesity, type 2 diabetes, cardiovascular disease and other health issues. BMJ Open. 13(10), s. 1–11. doi: 10.1136/bmjopen-2023-076251. Fulltekst i vitenarkiv Vis sammendrag

  Purpose The STORK Groruddalen cohort was set up in 2008 to explore ethnic differences in: (1) maternal health, primarily gestational diabetes (GDM) and related health issues during pregnancy and post partum, and effects of exposures on risk for type 2 diabetes, cardiovascular disease and other health issues, and (2) offspring’s growth and body composition, overweight/obesity and effects of early life exposures. Participants 823 women (74% of invited) were followed from gestational week (GW) 15. Data were collected from 618 fathers. In total, 59% of women and 53% of fathers had origin from non-Western countries. Maternal mean age was 29.9 years (SD 4.9), and body mass index (BMI) 25.3 kg/m 2 (4.9). Data were obtained from 772 women (94%) at GW 28, and 662 women (80%) 14 weeks post partum. Eleven years post partum, 385 women (53% of eligible/47% of original cohort) attended, age was 42.0 years (4.8) and BMI 27.1 kg/m 2 (5.1). We have data for 783 children at birth, and for 586 at last time point, mean age 8.6 (0.5) years, weight 30.7 (6.8) kg and length 133.9 (6.3) cm. Findings to date We collected questionnaire data from parents, clinical measurements and blood samples from mothers, and data on children’s growth (mid-pregnancy to 8 years). Our biobank includes maternal blood and urine samples, biopsy material from placentas and umbilical venous cord blood. We found several clinically important differences in maternal health, with higher risk in ethnic minority groups for GDM, insulin resistance, vitamin D and iron deficiency, depressive symptoms and physical inactivity. Contrasting patterns of fetal growth and risk of overweight/thinness at preschool age were observed across ethnic groups. Maternal GDM, obesity and high gestational weight gain were associated with children’s BMI trajectories. Future plans We will examine the impact of maternal and fetal health and development during pregnancy on long- term outcomes for mothers and offspring.

• Skow, Marius; Fossum, Guro Haugen; Høye, Sigurd; Straand, Jørund; Brænd, Anja Maria & Emilsson, Louise (2023). Luftveisinfeksjoner og antibiotikaforskrivning i allmennpraksis. Fulltekst i vitenarkiv
• Brænd, Anja Maria (2023). Barn og barndom. I Hunskaar, Steinar (Red.), Allmennmedisin. Gyldendal Norsk Forlag A/S. ISSN 9788205579866. Fulltekst i vitenarkiv
• Waage, Christin; Mdala, Ibrahimu; Brænd, Anja Maria; Jenum, Anne Karen & Birkeland, Kåre Inge (2023). Prediabetes and diabetes 11 years after pregnancy in ethnic minority groups with and without gestational diabetes. Fulltekst i vitenarkiv
• Emilsson, Louise; Brænd, Anja Maria Lyche; Dahli, Mina; Johannessen, Tonje Rambøll & Skonnord, Trygve (2023). Designing a new elective subject for third-year medical students on navigating medical guidelines. Fulltekst i vitenarkiv Vis sammendrag

  Background: Understanding how to navigate medical guidelines is an essential skill for future doctors. Recent emphasis has been placed on the importance of prioritization and time management when implementing guidelines into clinical practice. However, traditional medical education is offered topic by topic, with less emphasis given to patient-centred care, grading of recommendations and sometimes conflicting guidelines. Methods: Our objective was to develop a two-week elective subject titled "The Medical Profession: Navigating Medical Guidelines" for third-year medical students in Oslo. Through an intensive application of the nominal group technique (NGT), a group of five experienced primary care physicians and teachers collaborated during a two-day session to design the subject and its curriculum. Initially, we had concerns about the complexity of this topic for students at the third-year level due to their limited clinical experience. To assess the subject, the examination was designed to include an individual reflection note and a group presentation. Out of 16 students, 14 consented to having their reflection notes used for educational research purposes. Results: The NGT process led to development of a subject with interactive lectures, group and plenary discussions, as well as a clinical rotation day. Key topics included research guidelines, sensible choices and sustainability, patient-centered care, medical uncertainty, multi-morbidity, and navigating conflicting guidelines. A longitudinal patient-case video presentation accompanied the teaching with increasing complexity each day. Students were divided into two groups for the clinical rotation day at out-of-hour emergency care and nursing home facilities. Two teachers were present each day of the course to facilitate skill development and discussions. Students provided positive feedback, appreciating the reflection on their future professional roles. Conclusion(s): The NGT process proved effective in creating an elective subject well-received by both teachers and students. We encourage others to consider using similar models when designing new curricula.

• Emilsson, Louise; Brænd, Anja Maria Lyche; Johannessen, Tonje Rambøll; Dahli, Mina & Skonnord, Trygve (2023). Development of a new elective subject for third-year students on navigating medical guidelines. Fulltekst i vitenarkiv
• Fossum, Guro Haugen; Brænd, Anja Maria Lyche; Heltveit-Olsen, Silje Rebekka; Høye, Sigurd; Rørtveit, Guri & Straand, Jørund (2022). CovidNor - The Patient Study. Fulltekst i vitenarkiv
• Svaland, Malene; Brænd, Anja Maria Lyche & Fossum, Guro Haugen (2022). CovidNor - The Patient Study. Fulltekst i vitenarkiv
• Heltveit-Olsen, Silje Rebekka; Lunde, Lene; Brænd, Anja Maria; Spehar, Ivan; Høye, Sigurd & Skoglund, Ingmarie [Vis alle 10 forfattere av denne artikkelen] (2022). Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: A longitudinal interview study. Fulltekst i vitenarkiv
• Toftemo, Ingun; Jenum, Anne Karen; Sletner, Line; Richardsen, Kåre Rønn & Brænd, Anja Maria (2022). Does exposure to gestational diabetes cause obesity in pre-pubertal children? Fulltekst i vitenarkiv
• Skonnord, Trygve; Brænd, Anja Maria & Fossum, Guro Haugen (2022). Patient experiences from the COVID-19 pandemic regarding health care seeking, self-care, concern for disease, and delayed diagnosis and treatment; a cross-sectional study in general practice. Fulltekst i vitenarkiv
• Skow, Marius; Fossum, Guro Haugen; Høye, Sigurd; Straand, Jørund; Emilsson, Louise & Brænd, Anja Maria (2022). Antibiotic treatment of adult patients with respiratory tract infections in Norwegian general practice: A nationwide registry-based study. Fulltekst i vitenarkiv
• Brænd, Anja Maria (2021). Norwegian Research School for General Practice 2013-2021. Fulltekst i vitenarkiv
• Brænd, Anja Maria (2021). Clinical drug trials in Norwegian general practice. A study of a 10-year cohort of trials identified from applications to the Norwegian Medicines Agency 1998-2007. Michael. ISSN 1893-9651. 18, s. 172–172. Fulltekst i vitenarkiv
• Brænd, Anja Maria (2021). Nytt og nyttig - behandling av vanlige hudsykdommer hos barn. Fulltekst i vitenarkiv
• Brænd, Anja Maria (2021). Nasjonal forskerskole i allmennmedisin (NAFALM). Fulltekst i vitenarkiv
• Brænd, Anja Maria (2021). Fra forskningsresultater til kliniske retningslinjer. Fulltekst i vitenarkiv
• Brænd, Anja Maria (2021). Arbeidet som helsestasjonslege under pandemien. Fulltekst i vitenarkiv
• Brænd, Anja Maria & Nilsen, Lisbeth (2020). Hun leser norske studier med falkeblikk. [Journal]. Utposten. Fulltekst i vitenarkiv
• Lunde, Lene; Brænd, Anja Maria; Jakobsen, Rune Bruhn; Moen, Anne & Rosvold, Elin Olaug (2020). Simulation strengthens interprofessional collaboration for healthcare students in primary care. Fulltekst i vitenarkiv Vis sammendrag

  Background Primary healthcare providers are responsible for patients with increasingly complex problems. Introducing interprofessional collaboration in healthcare curricula prepares students to meet these challenges. Simulation-based learning may be a powerful facilitator for active and safe learning, but is mostly used in acute clinical situations. We explore simulation as a strategy to train students in interprofessional collaboration in sub-acute clinical scenarios in primary healthcare. Summary of work We tested two low-fidelity simulation scenarios with common, sub-acute patient situations from primary healthcare: An older patient stays at a nursing home after having a hip fracture and surgery, and he develops a urinary tract infection or a pneumonia. Healthcare students (n=27) in their final stage of education (medical students, master students in advanced geriatric nursing and bachelor students in nursing) were allocated to ten groups. The groups were assigned to do a clinical assessment, agree on a probable diagnosis and develop a treatment plan during both scenarios. The facilitators guided the groups from briefing through to debriefing with focus on collaboration and communication. The study is an exploratory, qualitative study with interaction analysis of segments from video recordings of the simulations. Summary of results Different forms of interaction and communication affected interprofessional collaboration, especially during the development of a care plan. The content and structure of the care plan and the team’s efficiency in settling a plan as a team depended on 1) the ability to recognize each other’s contribution, 2) mutual knowledge development and 3) the awareness of setting and roles. This emerged through dialogue, gestures, gaze and body language. During debriefing, several groups reflected on clarifying concepts such as close monitoring and deterioration of the patient. Discussion and conclusions The sub-acute scenarios show potential to identify interactions and communication affecting collaboration. Using the scenarios in healthcare education may help students to develop productive interactions strengthening interprofessional collaboration. Furthermore, the simulation scenarios are feasible to use on-site in an education facility with minimal technical equipment. Take home message Low-fidelity, on-site simulation scenarios based on common, sub-acute clinical situations shows promise in training students in interprofessional collaboration preparing for the complexity of primary healthcare.

• Lunde, Lene; Moen, Anne; Jakobsen, Rune Bruhn; Brænd, Anja Maria & Rosvold, Elin Olaug (2020). Simulering styrker tverrfaglig samarbeid i helsefaglig utdanning. Fulltekst i vitenarkiv
• Brænd, Anja Maria (2019). Nasjonal forskerskole i allmennmedisin (NAFALM). Fulltekst i vitenarkiv
• Brænd, Anja Maria (2019). Legemiddelforskning i allmennpraksis. Utposten. ISSN 0800-5680. 48(4), s. 38–39. Fulltekst i vitenarkiv
• Brænd, Anja Maria (2019). Kliniske retningslinjer i allmennpraksis. Fulltekst i vitenarkiv
• Fossum, Guro Haugen; Brænd, Anja Maria; Høye, Sigurd & Minge, Christina (2019). European Treatment Guidelines for Otitis, Sinusitis and Tonsillitis in Primary Care. Fulltekst i vitenarkiv
• Brænd, Anja Maria (2019). Nasjonal forskerskole i allmennmedisin. Fulltekst i vitenarkiv
• Brænd, Anja Maria (2018). Kort orientering om Nasjonal forskerskole i allmennmedisin (NAFALM). Fulltekst i vitenarkiv
• Brænd, Anja Maria (2018). Kliniske retningslinjer i allmennpraksis. Fulltekst i vitenarkiv
• Lagerløv, Per & Brænd, Anja Maria (2018). Somatisk undersøkelse. I Misvær, Nina & Lagerløv, Per (Red.), Håndbok for helsestasjoner 0-5 år. Kommuneforlaget AS. ISSN 9788244623452. Fulltekst i vitenarkiv
• Brænd, Anja Maria (2018). Legemiddelutprøvinger i norsk allmennpraksis. Fulltekst i vitenarkiv
• Brænd, Anja Maria; Straand, Jørund & Klovning, Atle (2017). Clinical drug trials in general practice: How well are external validity issues reported? Fulltekst i vitenarkiv
• Brænd, Anja Maria (2015). Standards for writing manuscripts for specific study types (The Scandinavian Journal of Primary Health Care Workshop). Fulltekst i vitenarkiv
• Brænd, Anja Maria; Straand, Jørund & Klovning, Atle (2015). Clinical drug trials in Norwegian general practice: Publication output and missing trial data. Fulltekst i vitenarkiv
• Brænd, Anja Maria; Straand, Jørund & Klovning, Atle (2014). Non-publication of results from clinical drug trials in Norwegian general practice. Fulltekst i vitenarkiv
• Brænd, Anja Maria & Straand, Jørund (2014). A.M. Brænd & J. Straand svarer:. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(20), s. 1918–1918. doi: 10.4045/tidsskr.14.1169. Fulltekst i vitenarkiv
• Straand, Jørund & Brænd, Anja Maria (2014). Det du ikke vet kan skade. Fulltekst i vitenarkiv
• Brænd, Anja Maria & Straand, Jørund (2014). Sant om legemidler? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(16), s. 1542–1542. doi: 10.4045/tidsskr.14.0851. Fulltekst i vitenarkiv
• Brænd, Anja Maria Lyche; Jensen, Kaspar Buus; Klovning, Atle & Straand, Jørund (2013). Clinical drug trials in Norwegian general practice: a ten-year overview of protocols. Fulltekst i vitenarkiv
• Fosse, Anette; Austad, Bjarne; Eid, John-Tore; Bell, Hege Therese; Brænd, Anja Maria Lyche & Fidjeland, Heidi Lidal [Vis alle 14 forfattere av denne artikkelen] (2013). Primærhelsetjenesten - fremtidens forskningsfront. s. 20–21. Fulltekst i vitenarkiv
• Brænd, Anja Maria (2013). Legemiddelutprøvninger i allmennpraksis. Utposten. ISSN 0800-5680. 42(5), s. 24–27. Fulltekst i vitenarkiv
• Brænd, Anja Maria (2013). Oversiktlig og god lærebok i dermatologi og venerologi. Utposten. ISSN 0800-5680. 42(7), s. 42–42. Fulltekst i vitenarkiv
• Brænd, Anja Maria (2013). Forskningsresultater gjemt i skuffen. LVS-info. s. 12–13. Fulltekst i vitenarkiv
• Brænd, Anja Maria (2013). Faglig tiårsdugnad: Allmennmedisin. Utposten. ISSN 0800-5680. 42(4), s. 41–41. Fulltekst i vitenarkiv
• Brænd, Anja Maria & Gran, Sarah Frandsen (2010). Tilbakemeldinger til studenter i allmennpraksis. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 130, s. 1006–1006. doi: 10.4045/tidsskr.10.0446. Fulltekst i vitenarkiv
• Brænd, Anja Maria Lyche; Gran, Sarah Frandsen & Lindbæk, Morten (2007). From EuroPEP to StudPEP: Using a GP quality improvement tool for educational purposes. Fulltekst i vitenarkiv
• Brænd, Anja Maria Lyche; Gran, Sarah Frandsen & Lindbæk, Morten (2006). Are patients useful in evaluating medical students? Fulltekst i vitenarkiv
• Brænd, Anja Maria (2006). Førstehjelp. I Helmersen, Helge (Red.), Bransje, fag og miljø. Gyldendal Norsk Forlag A/S. ISSN 9788258405570. s. 137–144. Fulltekst i vitenarkiv
• Brænd, Anja Maria (2018). Clinical drug trials in Norwegian general practice. A study of a 10-year cohort of trials identified from applications to the Norwegian Medicines Agency 1998-2007. Universitetet i Oslo. ISSN 9788283772753. Fulltekst i vitenarkiv

Se alle arbeider i NVA