{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T04:04:38Z","timestamp":1751515478352,"version":"3.41.0"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"NTNU Norwegian University of Science and Technology"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>In Norway\u2019s welfare system, General Practitioners (GPs) issue sickness certificates (SCs) to document patient\u2019s inability to work. These documents serve a dual role as medical evidence and as a basis for social welfare decisions. The language used in SCs can shape how non-medical stakeholders perceive a patient\u2019s work capacity. This study examines how SC language constructs narratives of work ability, focusing on how it portrays patients\u2019 limitations and prospects for recovery.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We conducted a qualitative discourse analysis of 155 SCs written by Norwegian GPs for patients under 35\u00a0years old with common mental health conditions. We focused on certificates issued around week 39 of the patient\u2019s sick leave. Using discourse analysis techniques, we examined linguistic features that convey the patient\u2019s work capacity and functional limitations.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>SCs predominantly emphasized incapacity and the necessity of work absence through discursive choices such as definitive language, amplified descriptions, and rhetorical strategies reinforcing limitations. Recovery potential was presented with tentative language, reflecting uncertainty in prognosis, while the temporal dimension of treatment was frequently framed as a barrier to returning to work. Additionally, the use of specialized terminology, generalized label, and elliptical constructions placed a significant interpretative burden on non-medical readers. Furthermore, SCs largely lacked explicit recommendations for workplace accommodations or interdisciplinary collaboration, limiting their utility in facilitating structured return-to-work strategies.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Time constraints, administrative pressures, and the dual roles of GPs as clinicians and bureaucrats shape the entire production of SCs. In turn, these discursive choices often reinforce narratives of incapacity. Enhancing SC relevance through structural modifications and interdisciplinary collaboration, including employer involvement in evaluating workplace accommodations, could improve welfare assessments and support tailored reintegration strategies. Positioning SCs as collaborative tools \u2013 rather than standalone assessments \u2013 may better align clinical evaluations with workplace realities and foster shared accountability for recovery and return-to-work efforts. SCs seem to place a disproportionate burden on GPs to translate medical conditions into work-related recommendations, often without the support or expertise required for such interdisciplinary evaluations.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12913-025-12902-7","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T09:50:34Z","timestamp":1747734634000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Legitimizing incapacity: discursive choices in Norwegian sickness certificates"],"prefix":"10.1186","volume":"25","author":[{"given":"Egidio Niclas","family":"D\u2019Angelo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralf","family":"Kirchhoff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin","family":"Halvorsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"issue":"1","key":"12902_CR1","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1136\/medhum-2018-011496","volume":"45","author":"G Aarseth","year":"2019","unstructured":"Aarseth G, Natvig B, Engebretsen E, Lie AK. Acting by persuasion- values and rhetoric in medical certificates of work incapacity: A qualitative document analysis. Med Humanit. 2019;45(1):60\u20136. https:\/\/doi.org\/10.1136\/medhum-2018-011496.","journal-title":"Med Humanit"},{"key":"12902_CR2","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/1471-2296-13-10","volume":"13","author":"LD Winde","year":"2012","unstructured":"Winde LD, Alexanderson K, Carlsen B, Kjeldg\u00e5rd L, Wilteus AL, Gjesdal S. General practitioners\u2019 experiences with sickness certification: a comparison of survey data from Sweden and Norway. BMC Fam Pract. 2012;13:10. https:\/\/doi.org\/10.1186\/1471-2296-13-10.","journal-title":"BMC Fam Pract"},{"issue":"1","key":"12902_CR3","doi-asserted-by":"publisher","first-page":"117","DOI":"10.3233\/WOR-2012-1416","volume":"45","author":"M Sturesson","year":"2013","unstructured":"Sturesson M, Edlund C, Fjellman-Wiklund A, Falkdal AH, Bernsp\u00e5ng B. Work ability as obscure, complex and unique: Views of Swedish occupational therapists and physicians. Work. 2013;45(1):117\u201328. https:\/\/doi.org\/10.3233\/WOR-2012-1416.","journal-title":"Work"},{"issue":"4","key":"12902_CR4","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1080\/14034940510005798","volume":"33","author":"E S\u00f6derberg","year":"2005","unstructured":"S\u00f6derberg E, Alexanderson K. Sickness certificates as a basis for decisions regarding entitlement to sickness insurance benefits. Scand J Public Health. 2005;33(4):314\u201320. https:\/\/doi.org\/10.1080\/14034940510005798.","journal-title":"Scand J Public Health"},{"issue":"1","key":"12902_CR5","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s12875-017-0627-z","volume":"18","author":"G Aarseth","year":"2017","unstructured":"Aarseth G, Natvig B, Engebretsen E, Lie AK. \u201cWorking is out of the question\u201d: a qualitative text analysis of medical certificates of disability. BMC Fam Pract. 2017;18(1):55. https:\/\/doi.org\/10.1186\/s12875-017-0627-z.","journal-title":"BMC Fam Pract"},{"issue":"5","key":"12902_CR6","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1017\/S1463423616000074","volume":"17","author":"M Gabbay","year":"2016","unstructured":"Gabbay M, Shiels C, Hillage J. Sickness certification for common mental disorders and GP return-to-work advice. Primary Health Care Res Dev. 2016;17(5):437\u201347. https:\/\/doi.org\/10.1017\/S1463423616000074.","journal-title":"Primary Health Care Res Dev"},{"issue":"1","key":"12902_CR7","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1093\/fampra\/cmm076","volume":"25","author":"K O'Brien","year":"2008","unstructured":"O\u2019Brien K, Cadbury N, Rollnick S, Wood F. Sickness certification in the general practice consultation: the patients\u2019 perspective, a qualitative study. Fam Pract. 2008;25(1):20\u20136. https:\/\/doi.org\/10.1093\/fampra\/cmm076.","journal-title":"Fam Pract"},{"unstructured":"Tikkanen R, Osborn R, Mossialos E, Djordjevic A, Wharton G. International Profiles of Health Care Systems. 2020. https:\/\/www.commonwealthfund.org\/sites\/default\/files\/2020-12\/International_Profiles_of_Health_Care_Systems_Dec2020.pdf.","key":"12902_CR8"},{"unstructured":"Carlsen B, Nyborg K. The gate is open: Primary care physicians as social security gatekeepers. Memorandum; 2009. https:\/\/www.researchgate.net\/publication\/46470243_The_Gate_Is_Open_Primary_Care_Physicians_as_Social_Security_Gatekeepers.","key":"12902_CR9"},{"issue":"1","key":"12902_CR10","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s12875-019-0952-5","volume":"20","author":"ER Svedahl","year":"2019","unstructured":"Svedahl ER, Pape K, Toch-Marquardt M, Skarshaug LJ, Kaspersen S-L, Bj\u00f8rngaard JH, Austad B. Increasing workload in Norwegian general practice\u2013 a qualitative study. BMC Fam Pract. 2019;20(1):68. https:\/\/doi.org\/10.1186\/s12875-019-0952-5.","journal-title":"BMC Fam Pract"},{"issue":"1","key":"12902_CR11","doi-asserted-by":"publisher","first-page":"100676","DOI":"10.1016\/j.ssaho.2023.100676","volume":"8","author":"EN D'Angelo","year":"2023","unstructured":"D\u2019Angelo EN, Hara KW, Halvorsen K, Kirchhoff R. General practitioners\u2019 description of functioning in sickness certificates. Social Sciences & Humanities Open. 2023;8(1):100676. https:\/\/doi.org\/10.1016\/j.ssaho.2023.100676.","journal-title":"Social Sciences & Humanities Open"},{"issue":"4","key":"12902_CR12","doi-asserted-by":"publisher","first-page":"227","DOI":"10.3109\/02813432.2011.628235","volume":"29","author":"M Engblom","year":"2011","unstructured":"Engblom M, Nilsson G, Arrel\u00f6v B, L\u00f6fgren A, Sk\u00e5n\u00e9r Y, Lindholm C, Hinas E, Alexanderson K. Frequency and severity of problems that general practitioners experience regarding sickness certification. Scand J Prim Health Care. 2011;29(4):227\u201333. https:\/\/doi.org\/10.3109\/02813432.2011.628235.","journal-title":"Scand J Prim Health Care"},{"issue":"2","key":"12902_CR13","doi-asserted-by":"publisher","first-page":"67","DOI":"10.3109\/02813431003696189","volume":"28","author":"G Wynne-Jones","year":"2010","unstructured":"Wynne-Jones G, Mallen CD, Main CJ, Dunn KM. What do GPs feel about sickness certification? A systematic search and narrative review. Scand J Prim Health Care. 2010;28(2):67\u201375. https:\/\/doi.org\/10.3109\/02813431003696189.","journal-title":"Scand J Prim Health Care"},{"unstructured":"Gee JPHM. The Routledge handbook of discourse analysis. London: Routledge; 2012. https:\/\/www.taylorfrancis.com\/books\/9780415551076.","key":"12902_CR14"},{"key":"12902_CR15","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1186\/1472-6963-8-231","volume":"8","author":"CA Thorstensson","year":"2008","unstructured":"Thorstensson CA, Mathiasson J, Arvidsson B, Heide A, Petersson IF. Cooperation between gatekeepers in sickness insurance - The perspective of social insurance officers. A qualitative study. BMC Health Serv Res. 2008;8:231. https:\/\/doi.org\/10.1186\/1472-6963-8-231.","journal-title":"BMC Health Serv Res."},{"issue":"5","key":"12902_CR16","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1177\/1403494811399954","volume":"39","author":"E Nilsing","year":"2011","unstructured":"Nilsing E, \u00d6berg B, S\u00f6derberg E, Normelli H. Description of functioning in sickness certificates. Scand J Public Health. 2011;39(5):508\u201316. https:\/\/doi.org\/10.1177\/1403494811399954.","journal-title":"Scand J Public Health"},{"issue":"4","key":"12902_CR17","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-054436","volume":"12","author":"P Nordling","year":"2022","unstructured":"Nordling P, Jakobsson A, Hensing G. The Capacity Note: a communication facilitator in the sick leave process of patients with common mental disorders - a qualitative study of user perceptions. BMJ Open. 2022;12(4): e054436. https:\/\/doi.org\/10.1136\/bmjopen-2021-054436.","journal-title":"BMJ Open"},{"issue":"5","key":"12902_CR18","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1093\/occmed\/kqu037","volume":"64","author":"CTB Vivian","year":"2014","unstructured":"Vivian CTB. Biopsychosocial incapacity assessments: a survey of occupational physicians\u2019 opinions. Occup Med. 2014;64(5):337\u201340. https:\/\/doi.org\/10.1093\/occmed\/kqu037.","journal-title":"Occup Med"},{"issue":"3","key":"12902_CR19","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1093\/eurpub\/5.3.215","volume":"5","author":"T Timpka","year":"1995","unstructured":"Timpka T, Hensing G, Alexanderson K. Dilemmas in sickness certification among Swedish physicians. Eur J Public Health. 1995;5(3):215\u20139.","journal-title":"Eur J Public Health"},{"unstructured":"Lipsky M. Street-Level Bureaucracy: the Dilemmas of the Individual in Public Service. New York: Russel Sage Foundation; 1980. https:\/\/muse.jhu.edu\/book\/15025\/.","key":"12902_CR20"},{"issue":"7","key":"12902_CR21","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1111\/j.0141-9889.2004.00424.x","volume":"26","author":"K Checkland","year":"2004","unstructured":"Checkland K. National Service Frameworks and UK general practitioners: street-level bureaucrats at work? Sociol Health Illn. 2004;26(7):951\u201375. https:\/\/doi.org\/10.1111\/j.0141-9889.2004.00424.x.","journal-title":"Sociol Health Illn"},{"issue":"6","key":"12902_CR22","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1111\/j.1540-6210.2012.02657.x","volume":"72","author":"EZ Brodkin","year":"2012","unstructured":"Brodkin EZ. Reflections on Street-Level Bureaucracy: Past, Present, and Future. Public Admin Rev. 2012;72(6):940\u20139. https:\/\/doi.org\/10.1111\/j.1540-6210.2012.02657.x.","journal-title":"Public Admin Rev"},{"doi-asserted-by":"crossref","unstructured":"Zacka B. When the state meets the street: Public service and moral agency. Harvard university press; 2017. https:\/\/www.hup.harvard.edu\/books\/9780674545540.","key":"12902_CR23","DOI":"10.4159\/9780674981423"},{"issue":"2","key":"12902_CR24","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1080\/02813432.2017.1333309","volume":"35","author":"S Nilsen","year":"2017","unstructured":"Nilsen S, Malterud K. What happens when the doctor denies a patient\u2019s request? A qualitative interview study among general practitioners in Norway. Scand J Prim Health Care. 2017;35(2):201\u20137. https:\/\/doi.org\/10.1080\/02813432.2017.1333309.","journal-title":"Scand J Prim Health Care"},{"issue":"3","key":"12902_CR25","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1007\/s10728-021-00432-2","volume":"29","author":"M Shutzberg","year":"2021","unstructured":"Shutzberg M. The doctor as parent, partner, provider\u2026 or comrade? Distribution of power in past and present models of the doctor\u2013patient relationship. Health Care Anal. 2021;29(3):231\u201348.","journal-title":"Health Care Anal"},{"issue":"2","key":"12902_CR26","first-page":"63","volume":"21","author":"R Woodward-Kron","year":"2020","unstructured":"Woodward-Kron R. Let\u2019s talk about discourse analysis for health professional education: what, why and how. Focus Health Prof Educ Multi Prof J. 2020;21(2):63\u201374.","journal-title":"Focus Health Prof Educ Multi Prof J"},{"issue":"2","key":"12902_CR27","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1111\/j.1753-6405.1992.tb00043.x","volume":"16","author":"D Lupton","year":"2010","unstructured":"Lupton D. Discourse analysis: a new methodology for understanding the ideologies of health and illness. Aust J Public Health. 2010;16(2):145\u201350.","journal-title":"Aust J Public Health"},{"key":"12902_CR28","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1146\/annurev-anthro-091908-164450","volume":"38","author":"JM Wilce","year":"2009","unstructured":"Wilce JM. Medical Discourse. Ann Rev Anthropol. 2009;38:199\u2013215. https:\/\/doi.org\/10.1146\/annurev-anthro-091908-164450.","journal-title":"Ann Rev Anthropol"},{"issue":"3","key":"12902_CR29","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1177\/1527154416669355","volume":"17","author":"RA Evans-Agnew","year":"2016","unstructured":"Evans-Agnew RA, Johnson S, Liu F, Boutain DM. Applying Critical Discourse Analysis in Health Policy Research: Case Studies in Regional, Organizational, and Global Health. Policy Polit Nurs Pract. 2016;17(3):136\u201346. https:\/\/doi.org\/10.1177\/1527154416669355.","journal-title":"Policy Polit Nurs Pract"},{"key":"12902_CR30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-020-06021-8","volume":"21","author":"RA Pedersen","year":"2021","unstructured":"Pedersen RA, Petursson H, Hetlevik I, Thune H. Stroke follow-up in primary care: a discourse study on the discharge summary as a tool for knowledge transfer and collaboration. BMC Health Serv Res. 2021;21:1\u201312.","journal-title":"BMC Health Serv Res"},{"issue":"6","key":"12902_CR31","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1177\/0957926504046503","volume":"15","author":"J Sidnell","year":"2004","unstructured":"Sidnell J. There\u2019s risks in everything: Extreme-case formulations and accountability in inquiry testimony. Discourse Soc. 2004;15(6):745\u201366.","journal-title":"Discourse Soc"},{"key":"12902_CR32","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1007\/BF00148128","volume":"9","author":"A Pomerantz","year":"1986","unstructured":"Pomerantz A. Extreme case formulations: A way of legitimizing claims. Hum Stud. 1986;9:219\u201329.","journal-title":"Hum Stud"},{"issue":"8","key":"12902_CR33","doi-asserted-by":"publisher","first-page":"1379","DOI":"10.1111\/1467-9566.12481","volume":"38","author":"G Aarseth","year":"2016","unstructured":"Aarseth G, Natvig B, Engebretsen E, Maagero E, Lie AH. Writing the patient down and out: the construal of the patient in medical certificates of disability. Sociol Health Illn. 2016;38(8):1379\u201395. https:\/\/doi.org\/10.1111\/1467-9566.12481.","journal-title":"Sociol Health Illn"},{"issue":"1","key":"12902_CR34","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1186\/s12913-019-4283-y","volume":"19","author":"T Morken","year":"2019","unstructured":"Morken T, Rebnord IK, Maartmann-Moe K, Hunskaar S. Workload in Norwegian general practice 2018 - an observational study. BMC Health Serv Res. 2019;19(1):434. https:\/\/doi.org\/10.1186\/s12913-019-4283-y.","journal-title":"BMC Health Serv Res"},{"issue":"5","key":"12902_CR35","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1016\/j.socscimed.2006.03.033","volume":"63","author":"T Greenhalgh","year":"2006","unstructured":"Greenhalgh T, Robb N, Scambler G. Communicative and strategic action in interpreted consultations in primary health care: A Habermasian perspective. Soc Sci Med. 2006;63(5):1170\u201387. https:\/\/doi.org\/10.1016\/j.socscimed.2006.03.033.","journal-title":"Soc Sci Med"},{"issue":"20","key":"12902_CR36","doi-asserted-by":"publisher","first-page":"7650","DOI":"10.3390\/ijerph17207650","volume":"17","author":"S Guo","year":"2020","unstructured":"Guo S, Yu X, Okan O. Moving Health Literacy Research and Practice towards a Vision of Equity, Precision and Transparency. Int J Environ Res Public Health. 2020;17(20):7650. https:\/\/doi.org\/10.3390\/ijerph17207650.","journal-title":"Int J Environ Res Public Health."},{"key":"12902_CR37","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1186\/1471-2458-12-702","volume":"12","author":"A Kiessling","year":"2012","unstructured":"Kiessling A, Arrel\u00f6v B. Sickness certification as a complex professional and collaborative activity\u2013a qualitative study. BMC Public Health. 2012;12:702. https:\/\/doi.org\/10.1186\/1471-2458-12-702.","journal-title":"BMC Public Health"},{"issue":"11","key":"12902_CR38","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1080\/09638280410001672517","volume":"26","author":"GS Pransky","year":"2004","unstructured":"Pransky GS, Shaw WS, Franche R-L, Clarke A. Disability prevention and communication among workers, physicians, employers, and insurers\u2014current models and opportunities for improvement. Disabil Rehabil. 2004;26(11):625\u201334. https:\/\/doi.org\/10.1080\/09638280410001672517.","journal-title":"Disabil Rehabil"},{"key":"12902_CR39","first-page":"119","volume":"23","author":"J Gee","year":"1998","unstructured":"Gee J, Green J. Discourse analysis, learning, and social practice: A methodological study. Rev Res Educ. 1998;23:119\u201369.","journal-title":"Rev Res Educ"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-025-12902-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-025-12902-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-025-12902-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T08:49:13Z","timestamp":1751446153000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-025-12902-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,20]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["12902"],"URL":"https:\/\/doi.org\/10.1186\/s12913-025-12902-7","relation":{},"ISSN":["1472-6963"],"issn-type":[{"type":"electronic","value":"1472-6963"}],"subject":[],"published":{"date-parts":[[2025,5,20]]},"assertion":[{"value":"26 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 May 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 July 2025","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This article has been updated to amend the license information.","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The project was reviewed and approved by the Research Council of Norway and the Norwegian Labor and Welfare Administration and underwent internal review at NTNU. In addition, the study was submitted to the Regional Committee for Medical and Health Research Ethics (REK), which determined that formal ethical approval falls outside their mandate (ref. 111284). All data was handled in accordance with applicable regulations. As the study involved only secondary analysis of anonymized data, informed consent was not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"725"}}