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PubMed2003

Indications for cesarean deliveries in Norway.

OBJECTIVE: The purpose of this study was to investigate the indications for cesarean deliveries in Norway, related to type of operation, parity, and gestational age. STUDY DESIGN: This was a prospective survey that used information provided by clinicians at 24 maternity units. Two thousand seven hundred seventy-eight cesarean deliveries were included, which represents 69.7% of all cesarean deliveries in Norway during the study period. RESULTS: The cesarean delivery rate varied by maternal and gestational age, parity, and hospital of delivery. Seven indications accounted for 77.7% of the operations: fetal stress (21.9%), failure to progress (20.7%), previous cesarean delivery (8.9%), breech presentation >or=34 weeks of gestation (8.4%), maternal request (7.6%), preeclampsia (6.2%) and failed induction (4.0%). Of the total deliveries, 64.3% were emergency operations. CONCLUSION: Accurate information about indications for cesarean deliveries in Norway has been obtained. Two thirds of all deliveries were emergency operations; the most important indications were fetal stress and failure to progress. In the elective cesarean delivery group, the two most important indications were previous cesarean delivery and maternal request.

Adult↗
PubMed2005

Caries preventive methods in child dental care reported by dental hygienists, Norway, 1995 and 2004.

Dental hygienists are used as first-line personnel in child dental care in Norway, and have an increasing influence on the delivery of preventive dental services. The purpose of this study was to describe: (1) preventive methods reported by hygienists in child dental care in Norway and (2) changes in preventive care during the 9-year period 1995 to 2004. Questionnaires were sent to all dental hygienists in the public dental services in Norway in 1995 and 2004; 70% (199 of 286) were returned in 1995 and 71% (210 of 297) in 2004. The hygienists considered one-third of children to be at risk of caries and spent 45 min of preventive care on these children every 16th month, while the remaining children were given 15 min of prevention every 20th month. One-third of the hygienists provided fluoride varnish for all children and one-fourth placed sealants routinely. Ninety percent of the hygienists reported that all children were given information on diet, hygiene, and fluoride. Most of the preventive practices of dental hygienists reflected limited changes in the period 1995 to 2004. However, the hygienists had reduced the use of fluoride varnishes and less often recommended fluoride tablets. The majority of hygienists reported that they individualized clinical prevention, while individual oral health information was standardized and given to all children. The results indicate that in 2004 a preventive approach combining individual information for all with intensified clinical prevention for children considered at risk was followed in child dental care.

Adult↗
PubMed2000

The clinical expression of hemochromatosis in Oslo, Norway. Excessive oral iron intake may lead to secondary hemochromatosis even in HFE C282Y mutation negative subjects.

BACKGROUND: The prevalence of hereditary hemochromatosis in Norway is one of the highest reported in the world. However, the clinical presentation in patients with hemochromatosis in Norway seems to be different compared with recent studies elsewhere. The aim of this study was to investigate patients with hemochromatosis in one community hospital in Norway and to study the prevalence of the C282Y mutation. METHODS: One hundred and twenty patients were consecutively admitted to one medical department in Oslo. Serum transferrin and ferritin concentrations were measured in all patients, and a percutaneous liver biopsy was obtained in 108 of 120 (90%) patients. Stainable iron (Perls stain) in hepatocytes was graded from 0 to 4+ and fibrosis from 1 to 4. Genotyping for the C282Y and H63D mutation in the HFE gene was performed by PCR-RFLP. RESULTS: Forty-eight (40%) of the patients suffered from tiredness and astenia and 29 (24%) had typical arthropathy. Only 5 of 105 (4.5%) had biopsy confirmed cirrhosis and 5 had diabetes mellitus. Patients referred from a blood bank had significantly less symptoms and signs compared with other patients. Twenty-one of 120 (17.5%) patients were C282Y mutation negative. Seventeen (81%) of these patients (16 women and 1 man) had a history of extensive oral iron intake lasting from 5 to 50 years. When excluding those with extensive oral iron intake (n = 17), 92 of 103 (89%) were homozygous for the C282Y mutation, 7 (7%) were heterozygous including 3 compound heterozygous and 4 (4%) were mutation negative. CONCLUSIONS: Only a minority of our patients with hemochromatosis had a far advanced disease at the time of diagnosis (less than 5% had cirrhosis) and hemochromatosis in a majority of the C282Y mutation negative patients was associated with excessive oral iron intake for several years.

Adult↗
PubMed2004

Incidence, clinical features, treatment and outcome of primary central nervous system lymphoma in Norway.

The incidence of primary central nervous system lymphoma (PCNSL) has been reported to increase in some parts of the world, while being stable in other regions. In an attempt to characterize the incidence rate, clinical features, treatment, outcome, and prognostic factors of PCNSL in Norway, we report our experience in a large unselected series of patients. Clinical features, histological diagnosis, radiological findings, treatment, and outcome of all patients diagnosed with PCNSL in Norway in the years 1989-1998 were registered. During the 10-year period 58 new cases of histologically verified PCNSL were registered in Norway. The annual incidence rate of PCNSL was on average 1.34 cases per million people with a non-significant increasing trend (p=0.069). For patients diagnosed before death (n=45) the estimated survival following histological diagnosis was 55%, 47%, and 23% at 1, 2, and 5 years, respectively. In Cox-regression analysis age, WHO performance status and treatment had independent prognostic impact on survival. In the studied decade, there was a non-significant trend towards increased incidence of PCNSL, perhaps due to increased availability of diagnostic imaging, especially magnetic resonance imaging.

Adolescent↗
PubMed1999

Occupational exposure to styrene in Norway, 1972-1996.

Occupational exposure to styrene has been of special concern in Norway since the beginning of the 1970s, especially the exposure in the reinforced plastic industry. Campaigns have been carried out by the Norwegian Directorate of Labour Inspection and various measures have been set forth to reduce the workers' exposure to styrene. Alongside the campaigns, extensive monitoring programs were carried out. The measurement results are compiled in the database EXPO at the National Institute of Occupational Health (Norway). This article presents a statistical analysis of the measurement data to assess the occupational exposure to styrene in Norway since the 1970s. Results from 7,011 measurements carried out in 234 enterprises covering the period 1972-1996 are included in the database. The analyses show occupational exposure to styrene of 33.0 ppm (median) (mean: 49.4 ppm) for this period. The analyses show a decrease from a median of 62 ppm in the 1970s to 7.1 ppm in the 1990s. The analyses do not disclose any crucial impact from any single preventive measure implemented by the authorities to reduce exposure level. The reduction in the level is probably due to a contribution from different measures. The decline in the styrene exposure coincides with a similar reduction in other countries, and it may be that international concern and technical improvements in the manufacturing process have been an important factor in the exposure level reduction in the Norwegian plastic reinforced industry as well.

Air Pollutants↗
PubMed2005

Changes in food habits among Pakistani immigrant women in Oslo, Norway.

OBJECTIVE: South Asians are generally known to have high prevalence of diabetes type 2 and coronary heart diseases. The Pakistani immigrant group in Norway constitute a high-risk subgroup of the population that needs a selective prevention approach. The main objective of this study was to provide information on dietary change and factors leading to these changes in Pakistani women after migration from Punjab, Pakistan to Oslo, Norway. Such information is important in designing appropriate strategies for dietary counselling. DESIGN: Twenty-five Pakistani immigrant women, recruited through the Oslo Health Study 2000-2001, participated in focus group interviews. Each group met four times, aided by a moderator and professional interpreters. A model developed by Koctürk was tested for its usefulness in analysing the dietary changes. PRECEDE was used to organise and structure the factors that were found to cause the changes. RESULTS: According to the women, life in Norway has led to several changes in meal pattern, meal composition and intake of different foods. In accordance with the Koctürk model, the cultural importance of breakfast and lunch has diminished, and dinner has become the most important meal. Meals on weekends tend to be more traditional than on working days. The study gives limited support to the hypothesis that changes occur predominantly among the accessory foods and least among staples. The focus group interviews revealed a rich variety of factors influencing dietary change: health aspects, children's preferences, work schedules, social relations, stress, traditional beliefs, climate, season and access of foods. CONCLUSION: To develop effective intervention strategies, it is vital to understand both how changes do occur and how different factors influence dietary habits. The Koctürk model was useful to structure the various foods and changes that may occur. Strategies for dietary counselling should not only include dietary advice but also focus on the multitude of factors causing dietary changes.

Adult↗
PubMed2006

Integrative care and bridge building among health care providers in Norway and Denmark.

BACKGROUND: Patients in Norway and Demmark with the medical diagnoses of cancer, multiple sclerosis (MS), and HIV/AIDS use complementary and alternative treatment (CAT) in growing numbers, most often in addition to receiving conventional treatment. At the same time, the interest and demand from patients for more holistic-oriented care is strongly increasing. Following this, there is a desire and need for better communication and cooperation among the conventional medical establishment, CAT practitioners, and patients. This development raises new demands on research designs to incorporate complexity and diversity concerning the intervention, effect mechanisms, and outcomes. DISCUSSION: This article outlines different models used to combine conventional, complementary, and alternative treatment (CCAT), describing various degrees of integration among therapies. The authors are closely involved in three current and planned research projects in Norway and Denmark focusing on cancer, MS, and HIV/AIDS. These research projects are briefly introduced as examples of bridge-building efforts dealing with integrative care. Despite explicit political good will in Norway and Denmark, initiatives to enhance integration face challenges connected to lack of knowledge; resistance toward CCAT; lack of time, space, and economic resources; and patients left without any claim on insurance in the case of treatment failure. These challenges are outlined based on the researchers' experience from being involved in the research projects. CONCLUSIONS: To optimize treatment outcomes in the future, it is argued that the need for closer cooperation among conventional and alternative therapists across professional boundaries in an interactive partnership with patients is evident. Researchers have to rethink research design and methods in meeting the new trend toward bridge building based on integrative health care.

Complementary Therapies↗
PubMed2000

Associations between the use of antimicrobial agents for growth promotion and the occurrence of resistance among Enterococcus faecium from broilers and pigs in Denmark, Finland, and Norway.

This study compares the susceptibility of Enterococcus faecium isolated from pigs and poultry in Denmark, Finland, and Norway to antimicrobial agents used for growth promotion. E. faecium was isolated from 211 broilers and 55 pigs in Denmark in 1997, from Norwegian 55 poultry farms (turkey and broiler farms) and 4 swine farms between 1995 and 1997, and Finnish poultry (52) and swine (43) in 1996 and examined for susceptibility to avilamycin, avoparcin, bacitracin, flavomycin, monensin, salinomycin, spiramycin, tylosin, and virginiamycin. Only a limited number of isolates were categorized as resistant to monensin or salinomycin. In general, an association between the usage of antimicrobial agents in the respective countries and the occurrence of associated resistance was observed. Resistance to avilamycin was frequently observed among isolates from broilers in Denmark, where avilamycin has been used, whereas all isolates from Finland and Norway, where these drugs have not been used, were susceptible. The same phenomenon could be observed for avoparcin, bacitracin, tylosin, and virginiamycin; resistance was frequently observed among isolates from where these antimicrobials have been widely used, but rarely among isolates from where the use has been limited. Also for avoparcin and bacitracin, an association between usage and occurrence of resistance was observed. All isolates categorized as avoparcin resistant contained the vanX gene; isolates from broilers had the T variant in position 8,234 and isolates from pigs the G variant. Three (1%) of the 222 isolates resistant to tylosin contained the ermA gene and 196 (88%) ermB. Sixteen (11%) of the 146 virginiamycin-resistant isolates from broilers and two (7%) of the 27 virginiamycin-resistant isolates from pigs in Denmark contained the satA gene, whereas satA was not observed among any of the virginiamycin-resistant isolates from Finland. A total of 72% of the virginiamycin-resistant E. faecium from broilers in Denmark and all nine virginiamycin-resistant E. faecium from Finland contained satG. This gene was also observed among two (7%) of the virginiamycin-resistant isolates from pigs in Denmark. This study indicates that the use of antimicrobial agents for growth promotion in Denmark, Finland, and Norway have selected for resistance to most of these drugs among E. faecium in food animals.

Animals↗
PubMed2003

Legal access to needles and syringes/needle exchange programmes versus HIV counselling and testing to prevent transmission of HIV among intravenous drug users: a comparative study of Denmark, Norway and Sweden.

BACKGROUND: Countries have adopted different strategies to prevent the transmission of HIV among intravenous drug users. Legal access to needles and syringes/needle exchange programmes as part of such a strategy has been heavily debated. HIV counselling and testing has also been part of prevention strategies. The objective of this study was to discuss the effectiveness of legal access to needles and syringes/ needle exchange programmes versus HIV counselling and testing among intravenous drug users (IDUs) as part of HIV prevention strategies. METHODS: Differences in HIV prevention strategies in Denmark, Norway and Sweden among IDUs are described. Outcome variables of effectiveness were HIV incidence rates over time. These were estimated by back calculation methods from 1980 through 1996, using data from the national HIV and AIDS registers. RESULTS: A comparison of HIV prevention strategies in Denmark, Norway and Sweden suggests that a high level of HIV counselling and testing might be more effective than legal access to needles and syringes/needle exchange programmes. Sweden and Norway, with higher levels of HIV counselling and testing, have had significantly lower incidence rates of HIV among IDUs than Denmark where there was legal access to needles and syringes and a lower level of HIV counselling and testing. In Sweden there was no legal access to drug injection equipment. CONCLUSION: Promotion and accessibility of HIV counselling and testing among intravenous drug users should be considered in countries where such a strategy is not adopted or has low priority.

AIDS Serodiagnosis↗
PubMed2002

East-West gradient in semen quality in the Nordic-Baltic area: a study of men from the general population in Denmark, Norway, Estonia and Finland.

BACKGROUND: Denmark and Norway have a three-fold higher incidence of testicular cancer than Estonia and Finland. Groups of young men from Denmark, Norway, Finland and Estonia were investigated to elucidate whether semen parameters and other related parameters follow a gradient between these countries, as does the gradient in incidence of testicular cancer. METHODS: In total, 968 young men from the general population in these four countries were investigated according to the same protocol. Possible confounders were evaluated, and included in the statistical analysis when appropriate. Inter-laboratory differences in assessment of sperm concentrations were controlled by an external quality control programme and morphology assessment was centralized to one person. RESULTS: The Finnish and Estonian men had an adjusted median sperm concentration of 54 and 57 x 10(6)/ml, respectively and the Norwegian and Danish men 41 x 10(6)/ml. The corresponding total sperm counts were 185, 174, 133 and 144 x 10(6). The frequency of normal sperm in men from Finland was 8.9%, Estonia 9.2%, Norway 6.9% and Denmark 6.4%. Within all four groups of men, a relationship between increasing levels of inhibin-B and increasing sperm counts was observed. However, inhibin-B levels were not predictive of sperm count differences between countries. CONCLUSIONS: It is believed that the men examined were representative of the normal population of young men in all four countries as they were recruited from groups attending a compulsory medical examination, and not selected for known fertility or semen quality. Moreover, the majority of participants had no prior knowledge of their fertility potential. It appears that an east-west gradient exists in the Nordic-Baltic area with regard to semen parameters, this being in parallel with the incidences of testicular cancer. Further investigations are required to determine whether these findings are due to genetic differences, to different environments, or perhaps to a combination of both factors.

Adult↗
PubMed2004

Socioeconomic status and risk of infant death. A population-based study of trends in Norway, 1967-1998.

BACKGROUND: The aim of this study was to examine the association between socioeconomic status and risk of infant death in Norway from 1967 to 1998. METHODS: Information from the Medical Birth Registry of Norway on all live births and infant deaths was linked to information from Statistics Norway on parents' education. There were 1777364 eligible live births and 15517 infant deaths. Differences between education groups were estimated as risk differences, relative risks, population attributable fractions, and index of inequality ratios. RESULTS: The risk of infant death decreased in all education groups, and the level of education increased over time. The trends differed for neonatal and postneonatal death. For neonatal death the risk difference between infants whose mothers had high and low education was reduced from 3.5/1000 in the 1970s to 0.9/1000 in the 1990s. The relative index of inequality (RII) for maternal education decreased from 1.72 to1.32. The proportion of neonatal deaths that could be attributed to <13 years of education decreased from 22.3 to 8.4. For postneonatal death the risk difference between infants whose mothers had high and low education increased from 0.7/1000 in the 1970s to 2.0/1000 in the 1990s. The RII for maternal education increased from 1.31 to 4.00. The population attributable fraction increased from 9.7 to 39.5. CONCLUSIONS: An inverse association between socioeconomic status and risk of postneonatal death persists, albeit there was a considerable reduction in risk between 1967 and 1998.

Adult↗
PubMed2006

Health complaints and sickness absence in Norway, 1996-2003.

BACKGROUND: From 1996 to 2003, the total number of sickness absence days increased by 65% in Norway. AIM: To investigate if this could be explained by a corresponding increase in the prevalence of self-reported health complaints in the same period. METHODS: Representative samples of the Norwegian working population in 1996 (n = 838) and 2003 (n = 637) answered the subjective health complaints (SHC) questionnaire. The single items of the SHC questionnaire were matched with the corresponding sickness absence statistics from the National Insurance Administration in 1996 and 2003. RESULTS: The main finding was a poor concordance between the change in prevalence of health complaints and the change in the prevalence of sickness absence for diagnoses corresponding to these complaints. The prevalence of health complaints in Norway was high and relatively stable from 1996 to 2003. The only complaints that increased in prevalence during the period were allergy and severe asthma. Sickness absence for health complaints, however, showed a general increase. The diagnoses with the largest percentage increase in sickness absence were sleep problems, tiredness, anxiety and palpitation, although the absolute number of individuals with sickness absence for these complaints was small. CONCLUSIONS: The increased sickness absence in Norway from 1996 to 2003 cannot be explained by an increase in health complaints in the general population in the same period. The increase in sickness absence is most likely to be explained by multifactorial causes, such as changes in working life and health expectations.

Absenteeism↗
PubMed1978

A fetal-infant life table based on single births in Norway, 1967--1973.

The study is based on 440,452 single births occurring in Norway, 1967--1973, with known gestational age. The information was collected through a notification system known as "Medical Registration of Births," covering all births occurring in Norway, and the data are made available through the Medical Birth Registry of Norway, which allows for linkage between births and infant deaths. The life table describes the experience of women still pregnant at a gestational age of 16 completed weeks, and states for each subsequent week the number of pregnancy terminations, the outcome, and the number of women still pregnant. Seven outcomes of pregnancy are considered: fetal death prior to labor, fetal death during labor, death within 24 hours, death 1--6 days, death 7--27 days, death 28 days--1 year, and survival of one year or more. The data in the life table provide information on the probability of pregnancy termination in each week of gestation (after 16 completed weeks), and the probabilities of the various outcomes. The fetal-infant life table is considered as an extension of descriptive perinatal statistics and is of value in monitoring health changes and in comparing perinatal mortality between populations. It also provides information on time of pregnancy termination and outcome, which has some clinical applications.

Adult↗
PubMed2005

Anaphylaxis during anesthesia in Norway: a 6-year single-center follow-up study.

BACKGROUND: Several studies have recognized neuromuscular blocking agents as the most common cause of anaphylaxis during general anesthesia, but the reported frequencies vary considerably between countries. In Norway, the issue has raised special concern because of reports from the Norwegian Medicines Agency that suggest a high prevalence. This article presents the results from a standardized allergy follow-up examination of 83 anaphylactic reactions related to general anesthesia performed at one allergy center in Bergen, Norway. METHODS: Eighty-three cases were examined during the 6-yr period of 1996-2001. The diagnostic protocol consisted of case history, serum tryptase measurements, specific immunoassays, and skin tests. RESULTS: Immunoglobulin E-mediated anaphylaxis was established in 71.1% of the cases, and neuromuscular blocking agents were by far the most frequent allergen (93.2%). Suxamethonium was the most frequently involved substance, followed by rocuronium and vecuronium. The few reactions in which other allergies could be detected were mainly linked to latex (3.6%). CONCLUSIONS: Neuromuscular blocking agents were the dominating antigens causing immunoglobulin E-mediated anaphylaxis in this study. The data could not be used for estimation of the incidence of allergy toward neuromuscular blocking agents in Norway. Larger patient samples, standardization of reporting, and diagnostic protocols should be pursued by network formation to produce data more suitable for epidemiologic research.

Adult↗
PubMed2004

Hip fracture incidence in central norway: a followup study.

Studies in the 1980s, including one from central Norway, in most cases showed that the incidence of hip fractures was increasing. In the 1990s, however, studies from Sweden and the United States indicated that the increase may have stopped. We report the current incidence of hip fractures in subjects in central Norway and compare it with that previously reported. The number of cervical and trochanteric fractures in a defined region of Central Norway in 1992 to 1993 and in 1997 to 1998 was found by a thorough search and collation of the hand written surgery reports, the reports from radiology departments, and hospital discharge reports. One thousand three hundred twelve hip fractures were sustained during 1997 to 1998, 10% more than in the preceding period. This was almost entirely attributable to aging of the population. In contrast to the highly statistically significant increase in the actual incidence of 2% per year previously reported between 1972 to 1973 and 1983 to 1984, there was no statistically significant increase in incidence between 1983 to 1984 and 1997 to 1998 (0.55% per year). The incidence of hip fractures was 18% higher in subjects in urban areas than in subjects in rural areas in 1992 to 1993, and 33% higher in 1997 to 1998. Whereas the proportion of trochanteric fractures was 32% in 1972 to 1973 and in 1983 to 1984, it increased to 44% in 1992 to 1993 and to 68% in 1997 to 1998. There has been an insignificant increase in hip fracture incidence since 1983 to 1984. The lower incidence of hip fractures in subjects in rural areas persists, and there has been a dramatic increase in the proportion of trochanteric fractures.

Age Distribution↗
PubMed1995

Peptic ulcer patterns in Arctic Norway.

While there are four times as many duodenal as gastric ulcers in Europe and the United States, previous studies have shown gastric ulcers to be more common in the Arctic regions of Norway. To investigate a possible change in the duodenal-to-gastric ulcer ratio, the incidence rate of first-time peptic ulcer in a well defined population in Northern Norway was studied by registration of all examinations of the upper digestive tract from 1983 to 1984. In this population, 5.3% were examined by endoscopy (52.5%) or a barium meal (47.5%). The incidence rates of duodenal and gastric ulcers were 1.4 and 0.8 per 1,000 per year, resulting in a duodenal-to-gastric ulcer ratio of 1.7:1. Although this ratio is higher than in a previous study (1.1:1), the pattern of peptic ulcer disease in northern Norway is still different from that in the rest of Europe.

Arctic Regions↗
PubMed2001

Psychometric critique of acculturation psychology: the case of Iranian migrants in Norway.

The presumptions, terminology, psychometrics, statistical analyses, and ethics of the fourfold acculturation paradigm are criticized in detail. Illustrative data came from Iranian refugees in Norway (N = 80) answering: 1) the Satisfaction with Life Scale (SWLS), 2) Zung's Self-Rating Depression Scale (ZSRDS), 3) ipsative fourfold scales of Integration, Assimilation, Separation, and Marginalization, 4) orthogonal scales of attitudes towards Norwegian and Iranian cultures, measured independently and using balanced reverse-keying, and 5) ipsative forced-choice preferences for cultural practices of Norway, Iran, both, or from other societies as well. Iranians in Norway favored global multiculturalism and, as a group. did not show distress. The SWLS and ZSRDS were correlated, but the measures of acculturation failed to replicate one another. As unconstrained ipsative measures, the fourfold scales showed acquiescence response bias contamination and doubtful operationalization of scale constructs. Recommendations are discussed for improving acculturation research.

Acculturation↗
PubMed1998

Occurrence of mites in Norway and the rest of Scandinavia.

This paper gives a faunistic review of mites that have been recorded in the indoor environment, particularly homes, barns, and stored products, in Norway and the other Scandinavian countries. Some preliminary results are given from unpublished investigations in Norway. Seven species of pyroglyphid mites have been recorded: Dermatophagoides pteronyssinus, D. microceras, D. farinae, D. evansi, Euroglyphus maynei, Gymnoglyphus longior, and Hirstia chelidonis. D. pteronyssinus was the predominant species, followed by D. microceras in Scandinavia and D. farinae in Denmark. D. evansi was detected in poultry houses in Norway. Lepidoglyphus destructor was the predominant species in barn dust, but large populations of Acarus, Tyrophagus, Tydeus, and Tarsonemidae also occurred. In humid homes, Glycyphagus domesticus was found in high numbers. The result of quantification of mites depends on the method for examination of dust. When one proposes limits for the concentration of mites in relation to risk of allergic sensitization and provocation of symptoms, reference should be made to a well-described method for sampling and analyzing dust. The number of mites should be given per area, not only per weight unit of dust. The number of mites per area indicates the number of mites in the home. The number of mites per weight unit of dust describes the concentration of mites in the vacuum cleaner.

Animals↗