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S Hunskaar

Publications and source records attributed to S Hunskaar.

At least 37 records · Page 2Linked to original sources
PubMed2000

Violence in an urban community: a population-based interview study.

BACKGROUND: This study aimed to estimate the proportion of an unselected population in an urban community (Bergen, Norway) that was exposed to physical violence during the preceding year, and to determine the proportion seeking medical treatment and pressing legal charges. METHOD: A structured telephone interview was performed as part of monthly opinion polls. RESULTS: During a one-year period in 1997/1998, 3,005 residents of Bergen were interviewed. Of these, 41 (1.4%) had been exposed to physical violence during the preceding year; 10 (24%) of them had sought medical treatment, and 16 (39%) had pressed legal charges. The majority of the victims had been treated at Bergen Accident and Emergency Department. The interviewees knew about a total of 347 other people who had been assaulted during the preceding year. Of these assault victims, 224 (65%) sought medical treatment and 181 (52%) pressed legal charges, according to the respondents. CONCLUSION: A high proportion of the assault victims did not seek medical treatment and did not press legal charges.

Adolescent↗
PubMed2000

Female urinary incontinence--the role of the general practitioner.

SUBJECT: Urinary incontinence is a frequent disorder among adult females, but very few of the incontinent women have consulted a doctor. DISCUSSION: This paper reviews and discusses the possible roles of the general practitioner in the diagnostic and therapeutic work with women with urinary incontinence. Some characteristics of general practice and the selection process from primary care to the specialist level are described. The selection process (gatekeeper function) of patients from community to hospitals may introduce bias into research and hamper the generalization of hospital-based research back to general practice. Recommendations and guidelines for diagnosis or therapy developed at secondary or tertiary care levels may be inappropriate at the primary care level, with a significantly different clinical picture of this condition. RESULTS: Several studies show that most women seeking help in general practice can be satisfactorily treated at this level of care with fairly simple treatments, and that treatment is effective also in the long term. Some women with urinary incontinence need to be referred primarily to a specialist, or later if the response to treatment is disappointing. RECOMMENDATIONS: Based on literature studies and the authors' own experiences from clinical work and research, recommendations are presented for a basic evaluation and treatment of women with urinary incontinence who seek help in general practice.

Adult↗
PubMed1999

Equal symptomatic outcome after antibacterial treatment of acute lower urinary tract infection and the acute urethral syndrome in adult women.

OBJECTIVE: To compare symptomatic outcome after antibacterial treatment in patients with acute lower urinary tract infection and the acute urethral syndrome. DESIGN: A multipractice study; patients registering symptoms prospectively for 3 days by means of a diary. SETTING: General practices in western Norway. SUBJECTS: 153 adult women with acute lower urinary tract symptoms. MAIN OUTCOME MEASURE: Patient's prospective registration of symptom distribution and duration after starting antibacterial treatment. RESULTS: Fifty-one patients with acute lower urinary tract infection and 58 patients with the acute urethral syndrome were included. There were no differences in age, history of urinary tract infection, actual symptoms, or symptom duration between the groups. Symptom duration was nearly identical in the two groups among those who became asymptomatic during the 3 days of registration, ranging from 1.2 days for urgency to 1.6 days for dysuria. Almost half of the patients in each group still had some symptom left after 3 days. CONCLUSIONS: Symptomatic outcome was equal after antibacterial treatment whether the patient was classified as having acute cystitis or the acute urethral syndrome. Consequently, the general practitioner may rely on symptoms alone when starting antibacterial treatment in adult women with suspected cystitis.

Acute Disease↗
PubMed1999

Anaemia and iron deficiency screening in adolescence: a pilot study of iron stores and haemoglobin response to iron treatment in a population of 14-15-year-olds in Norway.

Screening for haemoglobin (Hb) and s-ferritin, in 176 of all 189 (93%) pupils at 8th grade (14-15-years-old) in one Norwegian community was performed in order to map the prevalence of anaemia and depleted iron stores. In order to determine the clinical significance of the findings, a questionnaire aimed at detecting symptoms or risk factors for iron deficiency was completed by all participants, and a 3 mo therapeutic trial with iron was offered to subjects with s-ferritin values below 15 microg/l. Four percent of girls and 8% of boys were anaemic according to WHO cut-off levels. S-ferritin <15 microg/l was found in 25% of girls and 30% of boys. Forty-four of 48 pupils with s-ferritin <15 microg/l completed the therapeutic trial. Only three pupils had a clinically significant increase in Hb, representing less than 2% of the population. The questionnaire gave no clues that could identify subjects with depleted iron stores. To increase Hb in one 14-15-y-old with depleted iron stores, 59 (95% CHI: 20-285) had to be screened and 16 (6-76) had to be given iron treatment. This pilot study suggests that functional iron deficiency is rare in Norwegian adolescents despite a high frequency of low iron stores. A double blind, placebo controlled study covering the entire span of pubescence is needed to confirm these results.

Adolescent↗
PubMed1999

Are resistance patterns in uropathogens published by microbiological laboratories valid for general practice?

During 7 months from August 1994, 171 urine samples were collected consecutively in general practice in Western Norway from female patients with suspected lower urinary tract infection. For each of the 171 samples, 2 samples from adult females received from general practice at the microbiological laboratory on the same day were selected using a predetermined system. Samples noted as treatment controls and samples from pregnant patients were discarded. Bacteriuria was found in 101/171 (59.1%) vs 220/342 (64.3%) of the samples. The general practice material contained more bacteriuric samples with Escherichia coli (83.2% vs 71.8%, p<0.05) and Staphylococcus saprophyticus (11.9 vs 6.4%), and fewer with other Gram-negative rods (4.0% vs 15.9%, p<0.01) and enterococci (1.0% vs 5.9%, p<0.01). The frequency of resistant isolates was substantially lower in the samples from general practice for all antibacterial agents tested: amoxycillin 18.9% vs 23.9%, mecillinam 1.1% vs 4.7%, trimethoprim 12.9% vs 18.5%, cotrimoxazole 12.0% vs 15.4%, sulphonamide 20.0% vs 28.4%, nitrofurantoin 3.0% vs 9.7% (p<0.05). Data from local laboratories exaggerate the resistance problems among uropathogens found in urine samples in general practice.

Adult↗
PubMed1998

Prevalence, 1-year incidence and factors associated with urinary incontinence: a population based study of women 50-74 years of age in primary care.

OBJECTIVES: To study prevalence, incidence, remissions and factors associated with urinary incontinence in women 50-74 years of age. METHODS: Cross-sectional study of prevalence and associated factors and a 1-year prospective study of incidence and remissions. A random sample of 698 women were invited for a gynecological examination in general practice in three municipalities in Northern Norway in 1994-1995. Five hundred and seven (73%) met for the first consultation, 489 of them for the second one. Questionnaires were answered by women and doctors during consultations at inclusion and 1 year later. Prevalence was estimated at three levels of evidence. RESULTS: Any leakage was reported by 47% and regularly by 31%. For 19%, leakage was objectively demonstrated and claimed to be a social or hygienic problem. Incontinence was associated with high body weight, with poor ability to contract pelvic floor muscles and with previous gynecological operations excluding hysterectomy. Three women (0.6%) developed regular incontinence during the year of investigation. There was no convincing case of spontaneous remission. CONCLUSION: Urinary incontinence is very frequent in women aged 50-74 years and about one in five are potential patients needing treatment. Urinary incontinence is an enduring condition with little tendency for remission without treatment.

Aged↗
PubMed1998

Female urinary incontinence: long-term follow-up after treatment in general practice.

BACKGROUND: Several reports have been published showing that women with urinary incontinence (UI) can be taken care of and treated satisfactorily in general practice. AIM: To find out whether the treatment of women with UI in general practice is effective also in the long term. METHOD: One hundred and five women with UI who consulted their general practitioner (GP) were examined and treated according to a treatment protocol. Treatment options were pelvic floor exercises, electrical stimulation, oestrogen supplements, bladder training, and protective pads. Three to six years after inclusion, all women received a postal questionnaire to evaluate the long-term effectiveness of treatment. Women who had been referred to a specialist were excluded. RESULTS: Eighty out of 82 eligible patients answered the questionnaire after a mean follow-up period of 56 months. Twenty-seven per cent were continent, 26% much better, 23% a little better, 21% unchanged, and 3% were worse compared with before the treatment. The median score on a 100 mm visual analogue scale was 16 compared with 31 before treatment, and the percentage of women that were 'much' or 'a great deal' bothered by UI was reduced from 35% to 12%. The percentage of women with severe UI was reduced from 59% to 30%, and the number of women using pads was reduced from 62% to 39%. CONCLUSION: This study confirms that management of female UI in general practice is effective also in the long term.

Adult↗
PubMed1997

A new primary care rostering and capitation system in Norway: lessons for Canada?

Providing every patient with a personal primary care physician or, from the physician's perspective, establishing a stable roster or list of patients is currently being actively debated in Canada. Norway's system of primary care medicine, similar to Canada's, faces many of the same problems. In 1992 a trial rostering system with blended funding (capitation, fee-for-service and user fees) was established in 4 Norwegian municipalities. After 3 years of close monitoring, the results of system evaluations have attracted strong interest. This article reports on the benefits and problems encountered with the new rostering system in Norway. If Canada is moving in the same direction, some of the lessons learned may be helpful.

Canada↗
PubMed1997

Management in general practice significantly reduced psychosocial consequences of female urinary incontinence.

Urinary incontinence is a common health problem among women, and a spectrum of psychosocial problems is associated with this disorder. We have investigated how psychosocial impact changed during a management programme for urinary incontinence in general practice. One hundred and five women seeking help for urinary incontinence were treated with conservative treatment options. Psychosocial consequences, grouped as mental distress (nine items), practical inconveniences (five items), and social restrictions (11 items) were noted before treatment, and after 3, 6 and 12 months follow-up. Urge symptoms, high degree of severity, and long duration were associated with higher psychosocial impact. During treatment, psychosocial impact was significantly reduced and the degree of impact in the three consequence groups was reduced to about one third compared with before treatment. In conclusion, changes in psychosocial impact during a management programme occur as a response to successful treatment. These findings support the view that female urinary incontinence can be successfully treated in general practice.

Activities of Daily Living↗
PubMed1997

Iron supplementation in pregnancy: is less enough? A randomized, placebo controlled trial of low dose iron supplementation with and without heme iron.

BACKGROUND: The purpose of the present study was to evaluate the efficacy of low dose iron supplementation with and without a heme component, prescribed for women in the second half of pregnancy. METHOD: A randomized, double-blind, placebo controlled trial. Thirty-one women received a daily dose of 27 mg elemental iron in a product containing both heme iron and non-heme iron (Hemofer), 30 women received the same dose as pure non-heme iron with vitamin C (Collets jern med vitamin C), and 29 women received placebo. A double dummy technique was used to mask tablets. The women were tested for red cell indices and iron status markers (s-ferritin, s-iron, Total Iron Binding Capacity and erythrocyte protoporphyrin) throughout pregnancy and 8 and 24 weeks postpartum. The results were analyzed according to the 'intention to treat' principle. RESULTS: The hematological effects were equal in the two treatment groups. 25% of the supplemented women fell below 110 g/l in Hb vs 52% in the placebo group (p < 0.05); none fell below 100 g/l in the supplemented groups, 14% in the placebo group. Iron status was significantly better for all measured parameters in the heme iron group compared to placebo at the end of pregnancy. Differences between the other groups were only shown for some parameters, probably due to the small sample size. In the heme iron group there were fewer women with empty iron stores postpartum than at the start of pregnancy (from 14% to 8%), in the non-heme iron group there was a significant increase (from 3% to 27%), and in the placebo group the percentage of women with empty iron stores was more than doubled (from 21% to 52%). CONCLUSIONS: A daily dose of 27 mg elemental iron, containing a heme component, given in the second half of pregnancy, prevents depletion of iron stores after birth in most women. An equivalent dose of pure inorganic iron seems less effective, but the sample size in this study was too small to demonstrate significant differences between the two treatment groups.

Anemia, Iron-Deficiency↗
PubMed1997

Focus groups as a path to clinical knowledge about the acutely and severely ill child.

OBJECTIVE: To identify elements of clinical information beyond the area of knowledge presented in medical textbooks, but used by the general practitioner when confronted with the acutely and severely ill child. DESIGN: Focus group approach. SETTING: A course for teachers in General Practice at the Division for General Practice, University of Bergen, Norway. SUBJECTS: 25 experienced general practitioners serving as clinical teachers at the Division for General Practice. MAIN OUTCOME MEASURES: Clinical descriptions arising from incident-based anecdotes and experiences. RESULTS: Issues were reported concerning the doctor's emotional reactions, cues from the parents of the child, atypical contact between doctor and child, cognitive discrepancies, and difficulties in acting on cues. CONCLUSION: This material identifies elements of tacit clinical knowledge which may provide a basis for further analysis and shared action.

Acute Disease↗
PubMed1996

Treatment of urinary incontinence in women in general practice: observational study.

OBJECTIVE: To examine what is attainable when treating urinary incontinence in women in general practice. DESIGN: Observational study with 12 months' follow up. Interview and clinical examination before, during, and after treatment of women seeking help for urinary incontinence in general practice. SETTING: General practice in the rural district of Rissa, Norway. SUBJECTS: 105 women aged 20 or more with urinary incontinence. INTERVENTIONS: Treatment with pelvic floor exercises, electrostimulation, oestrogen, anticholinergic drugs, bladder training, and protective pads. MAIN OUTCOME MEASURES: Subjective and objective measures of urinary incontinence; number of patients referred to a specialist. RESULTS: After 12 months' follow up 70% (69/99) of the women were cured or much better; the mean score on a 100 mm visual analogue scale decreased from 37 to 20 mm; and the proportion of women who were greatly bothered by their incontinence decreased by 62%. 20% (20/98) of women became continent, and the percentage of women with severe incontinence decreased from 64% (63/99) to 28% (27/98). Mean leakage per 24 hours measured by a pad test decreased from 28 g at the start of treatment to 13 g after 12 months. The number of light weight pads or sanitary towels decreased from 1.6 to 0.6 a day. In all, 17/105 (16%) patients were referred to a specialist. CONCLUSIONS: Urinary incontinence in women can be effectively managed in general practice with fairly simple treatment. Most women will be satisfied with the results.

Adult↗
PubMed1996

The journey of incontinent women from community to university clinic; implications for selection bias, gatekeeper function, and primary care.

BACKGROUND: The selection process of patients from community to hospitals may introduce bias into research and hamper the generalization of hospital-based research back to general practice. OBJECTIVE: The objective of this study was to use female urinary incontinence as a model in an attempt to provide empirical support for selection bias. METHOD: The analyses are based on three populations of incontinent women: community level (epidemiological survey, 535 women), primary care level (general practice, prospective clinical study, 105 women), and secondary care level (university hospital, prospective clinical study, 228 women). RESULTS: The general practice patients were older and the hospital patients younger than those in the community. From community via general practice to hospital, there was an increase in duration, frequency of leakage, amount of leakage, severity and perceived impact of incontinence. Help-seeking at the primary care level was associated with increasing age and severity, and with urge symptoms and substantial impact. Referral from general practice to hospital level was only associated with age and urge symptoms. CONCLUSION: The study provides empirical evidence to support the existence of selection bias. This phenomenon must not be overlooked when recommendations developed at the consultant level are presented at a level with a significantly different clinical picture of a condition.

Adult↗
PubMed1996

Validity of a scored urological history in detecting detrusor instability in female urinary incontinence.

BACKGROUND: Kauppila and co-workers published in 1982 a detrusor instability score (DIS) for women with urinary incontinence. The aim of this study was to determine the validity of the DIS in an outpatient clinic for urogynecology. METHODS: The DIS questionnaire was incorporated as part of an independent history at the first consultation. The DIS was compared with clinical diagnosis in 250 patients consecutively referred for evaluation. Sensitivity, specificity. positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of the DIS in diagnosing genuine stress incontinence (GSI) were calculated using the gynecologist's clinical diagnosis based on urodynamic findings as the gold standard. An ROC-curve was constructed for determining the optimum cut-off point for the DIS for women with GSI. RESULTS: A cut-off point at 7 for the DIS, yielded sensitivity = 0.77, specificity = 0.52, PPV = 0.74, NPV = 0.52 and an overall accuracy = 0.68. Optimum cut-off point for GSI according to the ROC-curve was at a DIS-value of 5, yielding sensitivity = 0.60, specificity = 0.77, PPV = 0.82, NPV = 0.52 and overall accuracy = 0.66. CONCLUSIONS: A cut-off point at 7 diagnosed 159 women (64%) as having GSI, 41 of them (16% of 250) having a false positive DIS. Similarly, a cut-off point at 5 diagnosed 112 women (45%) as having GSI, 20 of them (8% of 250) having a false positive DIS. These women, if otherwise feasible and indicated, might perhaps undergo continence surgery without preoperative urodynamics. A lower cut-off point than originally proposed ought therefore to be used if the DIS is to become a useful preoperative tool for this kind of surgery.

Adolescent↗
PubMed1996

A study of female urinary incontinence in general practice. Demography, medical history, and clinical findings.

The aim of this study was to provide valid data on the demography, medical history and clinical findings among adult women presenting with urinary incontinence to general practitioners. In a rural community in Norway, all women > 20 years who consulted their general practitioner for urinary incontinence during a 3 year period were included in a prospective study. A thorough medical history and both a general and focused clinical examination were undertaken. Gynecological examination, stress provocation test, and 48 h frequency/volume chart and pad weighing test were also performed. 105 women were included (4.4% of women > 20 years in the total population). Mean age was 57 years, 64% were postmenopausal. A lot of comorbidity was reported. Duration of incontinence was > 5 years in 49%. By a severity index, 64% were classified as severe, 28% as moderate and 8% as having slight incontinence. 59% were using protective pads or garments. Mean leakage per 24 h was 31 g. 38% had significant genital prolapse. Contractility of the pelvic floor muscles was weak in 28%. Diagnostic classification revealed 50% stress incontinence, 10% urge and 40% mixed incontinence. 42% of the patients were a great deal or much bothered by their incontinence. Patients with stress incontinence were less bothered than others. Women presenting with urinary incontinence at a primary care level are prevalent, and often have significant incontinence. It is a challenge for the general practitioners to investigate and treat these patients optimally.

Adult↗
PubMed1996

Direct mailing of consensus recommendations did not alter GPs' knowledge and prescription of oestrogen in the menopause.

OBJECTIVE: To investigate the impact of an information-package (direct mailing) concerning oestrogen therapy, deriving from a consensus conference in 1990, on general practitioners' (GPs') attitudes and knowledge. DESIGN AND SUBJECTS: Controlled randomised study. Two groups of Norwegian GPs. The Intervention group received an information-package consisting of the recommendations from the consensus conference, some headline questions with answers, and a classification of the oestrogens available in Norway, including a table and a graphical presentation of the costs of the different treatments. GPs stated their views on prescribing oestrogen on a five step scale, related to nine short case histories, each containing cues on complaints, smoking, family history suggesting risk for cardiovascular disease, and osteoporosis. MAIN OUTCOME MEASURES: GPs' views on prescribing oestrogen, relation to age, sex, practice type (solo/group) and practice location. RESULTS: The differences in answer distributions between the Intervention (n = 193) and Control (n = 181) groups did not reach statistical significance for any of the nine case histories. The answers indicate a more liberal attitude towards replacement therapy in 1992 compared to a study performed in 1990. The views on contraindications was fundamentally unaltered. CONCLUSION: The study did not reveal any significant effect of direct mailing as means of disseminating consensus conference recommendations to GPs.

Adult↗
PubMed1995

Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity.

Diagnostic questions about stress and urge incontinence were validated against a final diagnosis made by a gynecologist after urodynamic evaluation. Thereafter, an epidemiological survey was performed, using similar questions, and correcting the answers for lack of validity. Included were 250 incontinent women at the out-patient clinic and 535 women who reported incontinence in the epidemiological survey. The sensitivity for stress incontinence was 0.66 (95% confidence interval +/- 0.08), specificity 0.88 (+/- 0.06). The corresponding values for urge incontinence were 0.56 (+/- 0.15) and 0.96 (+/- 0.03), and for mixed incontinence 0.84 (+/- 0.10) and 0.66 (+/- 0.07). Using these indices of validity as corrective measures for the diagnostic distribution reported in the epidemiological survey, the percentage of stress incontinence increased from 51 to 77%, while mixed incontinence was reduced from 39 to 11%. Pure urge incontinence increased from 10 to 12%. Mixed incontinence will be overreported in epidemiological surveys. Correction for validity indicates that a larger majority than hitherto reported may have pure stress incontinence.

Adult↗