SMIL

The research group SMIL is affiliated with the Department of Global Public Health and Primary Care with close cooperation with Haukeland University Hospital where several of its members are also employed.

Current projects

ABINOR - Respiratory infections and urinary tract infections in primary care 2006-2025
(Knut Erik Emberland, Guri Rørtveit, Ingrid Rebnord, Knut Eirik Eliassen, Lars Haugom, Leo Larsen)

Respiratory infections and urinary tract infections in primary care is a registry-based project in which we investigate the prevalence of respiratory infections and urinary infections in primary care (GPs and out-of-hours services) over a 10-year period from 2006-2025. We study how the health services have been used, in addition to the use of antibiotics, as well as changes over time. Two scientific publications have been published, and two medical students’ medical theses are currently in progress. 

Sleep problems and infections in general practice 
(Bjørn Bjorvatn, Guri Rørtveit, Knut Erik Emberland, Ingrid Rebnord, Siri Waage)

It is well-known that sleep problems frequently occur along with somatic conditions. On the other hand, there is little knowledge about the degree of overlap between the occurrence of sleep problems and infection in primary care. The aim of this longitudinal  study is to map the prevalence of infections and sleep problems, and to investigate the extent to which there is an overlap between these conditions in an unselected group of adult patients who visit their GP. Data collection is completed, and two scientific publications from baseline data are published. 

The use of hypnotics in general practice 
(Bjørn Bjorvatn, Ragnhild Stokke Lundetræ, Linn N. Evanger, Guri Rørtveit)

Many patients in general practice use hypnotics. We have compared two different types of written information materials on patients’ use of hypnotics and sleep. Patients using hypnotics were recruited by their GPs (PraksisNett-study) to complete an online questionnaire on sleep, mental health, and frequency of sleep medication use. Patients were divided into two groups, of which the groups were sent different types of materials (randomized controlled trial). Thereafter, patients were followed up after 3-6 months to investigate whether sleep and hypnotic use have changed. One scientific paper has been submitted for publication. 

Fatigue in nurses 
(Stand Hiestand, Bjørn Bjorvatn, Siri Waage, Ståle Pallesen, Ingeborg Forthun) 

Fatigue among nurses is examined using the Survey of Shiftwork, Sleep and Health (SUSSH) in this PhD project. Associations between fatigue and shift work schedules (for example night work) are explored along with other factors including physical and psychological problems and the relationship between fatigue and sleep. In a longitudinal study, factors that may explain what causes fatigue recovery or development are under investigation. 

Obstructive sleep apnea: Treatment outcomes, influence on other sleep disorders, and the impact on inflammatory and metabolic biomarkers
(Ragnhild Stokke Lundetræ, Bjørn Bjorvatn)

Obstructive sleep apnea (OSA) is a common sleep disorder with serious health implications, and it often co-occurs with other sleep, somatic and psychiatric disorders. The project uses data from the Register of Sleep Medicine at Haukeland University Hospital and includes patients with suspected OSA. In the present project we aim to address the associations between OSA and comorbid sleep disorders such as parasomnias, and inflammatory and metabolic biomarkers such as CRP, blood lipids and HbA1c in a large, clinical sample of patients with OSA. Moreover, we aim to address the effect of continuous positive airway pressure (CPAP) treatment on symptoms of insomnia in patients with OSA. 

Effects of delayed school start times on sleep, mental health, and academic performance among Norwegian adolescents 
(Linn N. Evanger, Bjørn Bjorvatn)

Adolescents worldwide sleep less than recommended on school days, partly due to a biologically based delay in the timing for sleep. Internationally, studies indicate that later school start times may improve adolescents’ sleep and daytime functioning. In this study, we will compare whether later school start times on Mondays and Tuesdays are better for Norwegian adolescents’ sleep and daytime functioning, relative to ordinary school start time all weekdays.

The Campylobacter outbreak on Askøy
(Knut Erik Emberland, Guri Rørtveit, Nadia Pristaj)

The campylobacter outbreak in Askøy in June 2019 affected around 2,000 people. More than 70 people were hospitalized and two people died, probably related to the outbreak. Askøy municipality has about 29000 inhabitants. Issues explored in this project are the extent of the outbreak, the clinical course of the patients, biological factors and the use of the health services. We use data from questionnaires, hospitals, GPs, out-of-hours services and registries, as well as biological material. Patients are recruited primarily through the municipality's SMS notification, but also via doctors and websites. The questionnaire is answered on a website and data is stored on a secure server at UiB. We follow a cohort of Askøy inhabitants at the start of the outbreak, and after 3, 7 and 12 months. One scientific publication from baseline data has been published, and two medical students’ medical theses have been completed. PhD candidate Nadia Pristaj is affiliated with the project.

The Covid-19 outbreak in Norway - Epidemiology, use of the health care services and patient management in the primary health care service – CONOPRI
(Knut Erik Emberland, Knut Eirik R Eliassen, Ingrid Rebnord, Guri Rørtveit, Jonas Dale, Lars Haugom, Leo Larsen)

The Covid-19 pandemic is largely handled in the primary health care service by GPs and the emergency services. The purpose of the project is to investigate how the primary health care service has handled the covid-19 outbreak, patients' use of the health care service during the pandemic and risk factors for serious outcomes among patients during/in the aftermath of the pandemic. The knowledge can be used to prepare for future outbreaks and make patient management more efficient. One scientific publication has been submitted, and two articles are ready for submission. PhD candidates Lars Haugom and Leo Larsen are affiliated with the project.

FAMFIB 2024
(Knut Erik Emberland, Bjørn Bjorvatn, Mette Tollånes, Ingrid Rebnord, Guri Rørtveit, Ragnhild Stokke Lundetræ, Leo Larsen)

Since 2014, the academic general practice environment at the University of Bergen has involved 6th year medical students in research related to their general practice period. These student-involved research projects on general practice topics are named “Felles allmennmedisinsk forskning i Bergen - FAMFIB. The FAMFIB 2024 project consists of three main thematic areas: Obstructive sleep apnea (OSA), respiratory infections and antibiotic use, as well as overdiagnosis. 

The purpose of the survey is to investigate, in an unselected group of adult patients who see their GP: 

• occurrence and possible underdiagnosis of OSA
• incidence of respiratory tract infections and possibly associated antibiotic treatment in the last three months 
• association between OSA and infections 
• knowledge of and perceptions about the topics 'overdiagnosis' and 'antibiotic resistance'  

Data collection was completed in the fall of 2024.

Sleep and sleepiness among shift workers in the air ambulance service
(Tine Almenning Flaa, Bjørn Bjorvatn, Siri Waage)

Shift work involves activity during the biological night, resulting in reduced sleep and increased sleepiness. Numerous studies have established a connection between shift work and adverse effects on health, performance, and safety. Employees in the air ambulance service work seven consecutive night shifts, performing missions at all hours of the day. The tasks performed by these employees are safety-sensitive in nature, where the consequences of reduced performance can have fatal outcomes. Therefore, the purpose of this study is to examine the effects of long working hours and consecutive work periods on the sleep and sleepiness of employees in the air ambulance service. This work is an extension of a PhD project that was completed in 2023.

Importance of Diagnostics in Antibiotic Prescribing
(Knut Erik Emberland)

This is a collaborative project between the primary medical infection research environments at UiB and UiO, represented by SMIL from UiB and the Department of General Practice and the Antibiotic Center for Primary Care (ASP) at the University of Oslo (UiO). The project is part of the EU project ECRAID (https://www.ecraid.eu/ecraid-base): 'Perpetual Observational Study (POS) of Acute Respiratory Infections (ARI) in primary care settings (PC) across Europe – Adherence to guidelines in antibiotic prescribing and the use of diagnostic tests in Norwegian general practice.' The project studies the management of respiratory infections in primary care, including antibiotic use and the use of diagnostic tools such as rapid tests and clinical examinations. In 2024, the project collected data from Norway and will also contribute in a new round in 2025 with 150-200 observations from 15-20 general practitioners recruited via PraksisNett.

Completed Projects

Enhancing medical laboratory quality to ensure that patient test results are reliable and reflect the patient’s health status.
(Gro Gidske, Anne Stavelin, Mette Tollånes, Sverre Sandberg)

Laboratory tests are essential in diagnosis and treatment of patients. The doctoral work consists of three articles that focus on improving laboratory quality both before, during and after the testing process. 

Restless legs in general practice 
(Bjørn Bjorvatn)

The study aimed at identifying the prevalence of restless legs syndrome in Norwegian general practice. The association between restless legs, fatigue and gastrointestinal disorders was also investigated. The study was conducted in an unselected group of adult patients in the waiting room of the GP. The data collection is complete, and the article was recently accepted in the Journal of the Norwegian Medical Association.

Gastroenteritis in primary care 
(Knut Erik Emberland, Guri Rørtveit)

Gastroenteritis in primary care is a registry-based project in which we investigate the prevalence of gastroenteritis in primary care (GPs and out-of-hours services) over a 10-year period from 2006-2015. We study how the health services have been used, in addition to use of antibiotics, as well as changes over time.

The Giardia outbreak in Bergen 
(Guri Rørtveit)

The 2004 Giardia outbreak in Bergen affected around 5,000 people. A group of primary care researchers, infectious medicine practitioners and statisticians have worked together over the years to investigate short-term and long-term complications. Particular focus has been on post-infectious irritable bowel syndrome and chronic fatigue. Several doctoral projects have been completed based on this project, and one is still ongoing.

Annual reports

Annual report for 2024 (in Norwegian)
Annual report for 2023 (in Norwegian)
Annual report for 2022 (in Norwegian)
Annual report for 2021 (in Norwegian)
Annual report for 2020 (in Norwegian)
Annual report for 2019 (in Norwegian)

PhDs

2023 
Tine Almenning Flaa: Sleep and sleepiness among shift workers in the air ambulance service 

2022 
Gunhild Hunskår: Senfølger etter Giardia-epidemien i Bergen

2021 
Tone Bukve: External quality assurance of point-of-care testing: Participant performance and commutability of control material 

2021
Knut Erik Emberland: Gastroenteritis in Norwegian primary care - Time trends and a large waterborne outbreak 

2020

Hogne Vikanes Buchvold: «Shift Work: Weight change and lifestyle factors» 

Mari Knapstad: «A clinical study of patients with concurrent dizziness and neck pain»

The Norwegian Primary Care Research Network - PraksisNett

The Norwegian Primary Care Research Network (in Norwegian: PraksisNett) is a research infrastructure that provides a foundation for enhancing the quality of primary care research in Norway. The infrastructure facilitates recruitment of primary care patients to clinical studies and increases the power and predictability of these studies.  

The Norwegian PCRN will motivate researchers to conduct clinical studies by facilitating reliable and secure access to GPs, patients and clinical data. It is organised as a two-layer interdependent model: A human, resource-based infrastructure consisting of a coordinating node and four interlinked regional research networks with associated clinical practices; and an advanced, secure IT infrastructure connecting the coordinating node, the regional research networks and the clinical practices, and providing users with individual access for data extraction and processing.

Photo:

PraksisNett