Background: The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction. Aim: Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway. Research design: A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020. Ethical considerations: Ethical approval granted by the Regional Research Ethics Committee in Western Norway (131421). Findings: Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful. Discussion: By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority. Conclusion: Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms.

OBJECTIVES: To investigate the association between maternal pre-pregnancy BMI and risk of cerebral palsy (CP) in offspring. METHODS:The study population consisted of 188 788 children in the Mothers and Babies in Norway and Denmark CP study, using data from 2 population-based, prospective birth cohorts: the Norwegian Mother and Child Cohort Study and the Danish National Birth Cohort. Prepregnancy BMI was classified as underweight (BMI <18.5), lower normal weight , upper normal weight ), overweight , and obese (BMI ≥30). CP diagnoses were obtained from the national CP registries. Associations between maternal prepregnancy BMI and CP in offspring were investigated by using logbinomial regression models. RESULTS:The 2 cohorts had 390 eligible cases of CP (2.1 per 1000 live-born children). Compared with mothers in the lower normal weight group, mothers in the upper normal group had a 40% excess risk of having a child with CP (relative risk [RR], 1.35; 95% confidence interval [CI], 1.03-1.78). Excess risk was 60% (RR, 1.56; 95% CI, 1.21-2.01) for overweight mothers and 60% (RR, 1.55; 95% CI 1.11-2.18) for obese mothers. The risk of CP increased ∼4% for each unit increase in BMI (RR, 1.04; 95% CI, 1.02-1.06). Estimates changed little with adjustment for mother's occupational status, age, and smoking habits. CONCLUSIONS:Higher prepregnancy maternal BMI was associated with increased risk of CP in offspring.a Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; b Department of Pediatrics, Haukeland University Hospital, Bergen, Norway; c Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina; d Ms Forthun was responsible for the analysis and interpretation of data, and the drafting of the manuscript; Dr Wilcox participated in the analysis and interpretation of data and reviewed and revised the manuscript; Drs Lie and Moster provided advice regarding study design, participated in the interpretation of data, and reviewed and revised the manuscript; Drs Strandberg-Larsen, Nohr, and Surén participated in the interpretation of data and reviewed and revised the manuscript; Dr Tollånes proposed the study, participated in the analysis and interpretation of data, and reviewed and revised the manuscript; and all authors approved the fi nal manuscript as submitted. The prevalence of overweight and obesity among pregnant women is increasing worldwide with adverse effects on maternal and child health. 6 Obese pregnant women (BMI >29.9) have increased risk of gestational diabetes, hypertension, and preeclampsia, and their offspring are at increased risk of preterm birth, macrosomia, complications during delivery, and perinatal death. 6 -9 Maternal obesity is also associated with birth defects, in particular neural tube defects. 10 We used pooled data from 2 large prospective Nordic birth cohorts to investigate the association between BMI before pregnancy and risk of CP in offspring, both overall and for variou...

BackgroundWe investigated whether the risk of cerebral palsy (CP) in the child varies by parents’ socioeconomic status, in Denmark and Norway.MethodsWe included almost 1.3 million children born in Demark during 1981–2007 and 2.4 million children born in Norway during 1967–2007, registered in the Medical Birth registries. Data on births were linked to Statistics Denmark and Norway to retrieve information on parents’ education and relationship status and, in Denmark, also income. CP diagnoses were obtained from linkage with national registries. We used multivariate log-binominal regression models to estimate relative risk (RR) of CP according to parental socioeconomic status.ResultsThere was a strong trend of decreasing risk of CP with additional education of both the mother and the father. These trends were nearly identical for the two parents, with a one-third reduction in risk for those with the highest education compared with parents with the lowest education. When both parents had high education, risk of CP was further reduced (RR 0.58, 0.53–0.63). Women with partners had a reduction in risk (RR 0.79, 0.74–0.85) compared with single mothers overall. Risk patterns were stable over time, across countries and within spastic bilateral and unilateral CP. Household income was not associated with risk of CP.ConclusionsRisk of CP in two Scandinavian countries was lower among educated parents and mothers with a partner, but unrelated to income. Factors underlying this stable association with education are unknown, but could include differences in potentially modifiable lifestyle factors and health behaviours.