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Objectives  To compare 2 educational pro- grammes for teaching evidence-based medicine (EBM).Design  Prospective randomised controlled trial accompanied by a qualitative evaluation.Setting  University of Oslo, Norway, 2002–03.Participants  A total of 175 students entered the study. All tenth semester medical students from 3 semesters were eligible for inclusion if they completed baseline assessment and consent forms and either attended teaching on the first day of the semester or gave reasons for their absence on the first day in advance.Interventions  One intervention was based on computer-assisted, self-directed learning (self-directed intervention), whilst the other was organised as workshops based on social learning theory (directed intervention). Both educational interventions consisted of 5 half-day sessions.Main outcome measures  The primary outcomes were knowledge about EBM and skills in critical appraisal. A secondary outcome measured attitudes to EBM. Outcomes were compared on an intention-to-treat basis using a stratified Wilcoxon rank-sum test.Results  There were no differences in outcomes for the 2 study groups in terms of EBM knowledge (mean deviation 0.0 [95% confidence interval − 1.0, 1.0], P = 0.8), critical appraisal skills (MD 0.1 [95% CI − 0.9, 1.1], P = 0.5), or attitudes to EBM (MD − 0.3 [95% CI − 1.4, 0.8], P = 0.5). Follow-up rates were 96%, 97% and 63%, respectively.Conclusions  This trial and its accompanying qualitative evaluation suggest that self-directed, computer-assisted learning may be an alternative format for teaching EBM. However, further research is needed to confirm this and investigate alternative educational models.

Background: Using the conceptual framework of shared decision-making and evidence-based practice, a web portal was developed to serve as a generic (non disease-specific) tailored intervention to improve the lay public's health literacy skills.

A gap exists between evidence and practice regarding the management of cardiovascular risk factors. This gap could be narrowed if systematically developed clinical practice guidelines were effectively implemented in clinical practice. We evaluated the effects of a tailored intervention to support the implementation of systematically developed guidelines for the use of antihypertensive and cholesterol-lowering drugs for the primary prevention of cardiovascular disease.

Objectives: To explore why public health physicians seldom use research-based information and to develop an intervention to remedy this on the basis of this study, other research literature and suitable theories of informationseeking and professional behaviour change.

Abstract. Objectives. To describe types of diabetes treatment in a total, adult population, including those on no antidiabetic medication, and to evaluate use of the defined daily doses in estimation of diabetes prevalence.Design. Cross-sectional epidemiologic survey applying patient-based questionnaires and clinical examinations approaching all inhabitants of ≥ 20 years (85 100).Setting. Nord-Trøndelag county in the middle part of Norway.Subjects. All known diabetic patients in the county (2242) amongst all participants of ≥ 20 years (76855), registered in 1984-86.Interventions. Questionnaire data on type of diabetes treatment including drug doses, measurement of height and weight.Main outcome measures. Distribution of types of treatment and of mean drug doses.Results. Of the diabetic patients of ≥ 20 years of age, 20% used insulin, 39% oral hypoglycaemic agents and 41% no antidiabetic medication. Corresponding prevalence figures were 0.6%, 1.1% and 1.2%. Mean daily insulin dose per kg body weight was significantly higher in women than in men. Women with no antidiabetic medication stated a more restricted diet than men. The mean prescribed insulin dose was 14% higher than the defined daily dose, but the corresponding oral agent dose was lower than the defined daily dose.Conclusions. Sales figures is a bad estimate of total diabetes prevalence due to the high proportion of diabetic patients using no antidiabetic medication. Correction is also necessary when the defined daily dose system is used to estimate the prevalence of medically treated diabetes.

Objective: To explore whether there is a potential for greater use of research-based information in public health practice in a local setting. Secondly, if research-based information is relevant, to explore the extent to which this generates questioning behaviour.

This qualitative study aims to interpret the results of a randomized controlled trial comparing two educational programs (directed learning and self-directed learning) in evidence-based medicine (EBM) for medical students at the University of Oslo from 2002 to 2003. There is currently very little comparative educational research in this field. In the trial, no statistically significant differences between the study groups were shown for any outcomes considered (EBM knowledge, skills, and attitudes). Further analysis suggests that main reason for the negative trial results was that the majority of students learned equally effectively, whichever program they received, although implementation of the educational programs was not complete because of varying attendance. This study illustrates a stepwise evaluation model that might be useful in evaluating other socially complex interventions.

Objective-To investigate factors associated with visiting a general practitioner (GP) for non-inflammatory musculoskeletal pain, and to examine whether these factors were aVected by duration (chronic v non-chronic) or location (widespread v regional) of pain. Methods-From a cross sectional postal survey of 20 000 (response rate 59%) randomly selected adults in two counties of Norway, 6408 subjects who had experienced musculoskeletal pain during the past month were included. Patients who reported inflammatory rheumatic diagnoses made by a doctor were excluded. Results-2909 (45%) had consulted a GP for their musculoskeletal pain during the past 12 months. The odds of consulting were significantly increased by being a woman, by having a higher age and lower education, and by being a pensioner or on sick leave. Patients with widespread pain were more likely to consult than those with regional pain, as were patients with chronic compared with non-chronic pain. Greater than median pain intensity was the factor most prominently associated with consultation for men (odds ratio (OR)=2.4; 95% confidence interval (95% CI) 2.0 to 2.9) and for women (OR=2.6; 95% CI 2.3 to 2.9). Overall, consultation was significantly associated with mental distress for women but not for men. Subgroup analyses showed that consultation for chronic pain was significantly associated with greater than median mental distress for both women (OR=1.3; 95% CI 1.1 to 1.6) and men (OR=1.2; 95% CI 1.0 to 1.4), whereas consultation for non-chronic pain was not.

Previous studies have shown that Norwegian public health physicians do not systematically and explicitly use scientific evidence in their practice. They work in an environment that does not encourage the integration of this information in decision-making. In this study we investigate whether a theoretically grounded tailored intervention to diffuse evidence-based public health practice increases the physicians' use of research information.

The main aims of this study are to document whether an intervention for promoting evidencebased public health practice had been delivered as intended and to explore the reasons for its lack of impact. Process data from the implementation of the program and data from interviews with 40 public health physicians are analyzed. Although they expressed satisfaction with the service, the doctors experienced the program as rather irrelevant for their daily work. They did not perceive that they dealt with many issues relevant for the use of research information, and if they did, referring to research would not make any difference to the way others perceived their advice. There is a need to develop more overlying strategies for integrating evidence into decision making than addressing the individual level.

To study the association between smoking habits and the incidence of hip fracture, adjusted for leanness and physical inactivity, a cohort study with 3 years follow-up was conducted. Subjects were 34,856 adults aged 50 years or older who attended a health screening in Nord-Trøndelag County in Norway in 1984–1986 (91% of eligible subjects in 1986, n = 38,356). Of these, 421 suffered a hip fracture during the years 1986–1989. Using Cox regression models, the relative risk (with 95% confidence interval) of suffering a hip fracture for female smokers versus nonsmokers was 1.5 (1.0–2.4). These results refer to females when the female body mass index (BMI) was set at 25 kg/m2 in the female model (the mean BMI for the smoking female population in this study). Among thinner females, however, smoking had a much stronger effect. For instance, if the female BMI was set at 20 kg/m2, the relative risk was 3.0 (1.8–5.0). The relative risk of hip fracture for male smokers versus nonsmokers was 1.8 (1.2–2.9) irrespective of BMI. Smoking is associated with incidence of hip fracture in both sexes and also after adjusting for body mass index and physical inactivity (the effect of physical inactivity was adjusted for self-reported ill health because ill health was included in the model). For lean females, the association with current smoking was large, as large as if they added 10 years to their age.

The underlying reasons for differences between clinical practice and systematically developed guidelines vary from one clinical problem to another. It is therefore logical to tailor strategies to support the implementation of guidelines to address identified barriers to change. The objective of this trial is to evaluate the effects of a tailored intervention to support the implementation of systematically developed guidelines for the use of antihypertensive and cholesterol-lowering drugs for the primary prevention of cardiovascular disease.