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[Suicidal problems in Norway (author's transl)].

The author gibes a review of suicide problems in Norway. The suicide rate has in Norway traditionally been low compared with the other Scandinavian countries, about one third, and has remained so for a century. In the last century the suicide rate increased with increasing age. In this century it has come to a peak in the age groups of 50-69 years for men and 50-59 years for women. There are only small differences in the suicide rate for the different parts of the country, with a slightly higher rate in the most densely populated areas. The ratio male/female is now 3:1, and has changed little. The suicidal methods are discussed, as is also the relation of suicidal acts to alcohol and drug problems. Precipitating factors are discussed, as are also vulnerable groups, among them the sailors, where the suicidal rate is about three times higher than of the average population of the same age and sex. Norwegian follow-up studies on the future fate of suicide attempters are mentioned. Finally, the author gives an outline of the present state of suicidology in Norway.

Adolescent↗

["Now I am humble. Indeed." From Germany to Norway in 1934].

A huge refugee problem arose when the Nazis came to power in Germany in 1933. The most acute stages were just after 1933 and from the summer of 1938. This refugee drama involved all the western countries, including Norway. This paper describes the fate of the German gynaecologist Hans Saenger (1884-1943), professor in Munich, who in 1933 was dispelled by the Nazis because of his Jewish descent. He fled to Norway in 1934 and settled in Fredrikstad. However, the attitude in Norway to refugees in general and Jews in particular was hostile, mainly because of fear of unemployment. Prejudice and xenophobia were of importance, also in the medical profession.

Foreign Medical Graduates↗

[Thalassemia and sickle-cell disease in Norway].

BACKGROUND: Thalassemia is common in the Mediterranean countries, the Middle East, parts of India and South East Asia, with the prevalence of mutations reported to be 2.5-15%. Sickle-cell anaemia is endemic primarily in central parts of Africa, but it also appears in the thalassaemia areas. The purpose of this study was to establish the prevalence of beta-thalassaemia, alfa-thalassaemia and sickle-cell anaemia in Norway. MATERIAL AND METHODS: A questionnaire was sent to 149 departments of paediatrics, gynaecology and medicine in Norway. We asked for numbers registered in 1996 and 1997 of beta-thalassaemia and alfa-thalassaemia with subgroups, and sickle-cell anaemia. RESULTS: The number of patients with thalassaemia was 44 (0.001%) in 1996 and 48 in 1997. In 1996 there were 28 patients with beta-thalassaemia minor, three with intermediary and five major, and six patients with alfa-thalassaemia minor and one with major. In 1996, ten patients were registered with sickle-cell anaemia; in 1997, fifteen patients. INTERPRETATION: The numbers of patients with thalassaemia major or sickle-cell anaemia probably reflect the true prevalence of these diseases. However, for thalassaemia minor and sickle-cell anaemia trait the numbers appear to be too low, as most of these patients do not contact a hospital. The appearance of these diseases in Norway is closely related to immigration from endemic areas.

Anemia, Sickle Cell↗

[Tick-borne encephalitis in Norway].

BACKGROUND: Tick-borne encephalitis is caused by a virus that is transmitted to man by tick-bite. The virus is found in central and eastern parts of Europe and also in Sweden. MATERIAL AND METHODS: We report the first two cases of tick-borne encephalitis resulting from transmission of virus in Norway. RESULTS: Both patients had been to the island of Tromøy on the south coast of Norway. The course of the disease was very different in the two patients. One patient had significant neurological dysfunction. The other patient had intense headache, but no motor dysfunction. Both patients had reduced general health and fever, and leukocytosis and increased protein was found in the spinal fluid. The incubation period is most often 1 to 2 weeks. The disease may have a bi-phasic course with initial fever, headache and muscle pain. One week later symptoms of encephalitis follow. Subclinical infection is common, especially in children. One third of patients get permanent sequelae after encephalitis. Diagnosis is made by demonstration of antibodies in serum. Treatment is symptomatic. INTERPRETATION: These two patients indicate that there may be a reservoir of TBE virus in Norway.

Aged↗

Urinary tract infections in Norway: bacterial etiology and susceptibility. A retrospective study of clinical isolates.

OBJECTIVES: The objective of the present study was to determine bacterial etiology and susceptibility in urinary tract infections. The study was designed as a retrospective study of urine samples from patients both inside and outside hospitals and nursing homes that were received at our laboratory between 1 January 1997 and 31 October 1999. The Telemark Biomedical Center receives all the medical microbiology specimens from hospitals, nursing homes and general practitioners in the County of Telemark (165,000 inhabitants), Norway. All urines fulfilling the criteria for significant bacteriuria [> or =10,000 colony-forming units/mL urine] were included in the study. METHODS: Bacterial susceptibility testing was performed using breakpoint methodology. During the study period, we received 52 350 urine samples, of which 28,066 (53.6%) fulfilled the criteria for significant bacteriuria (pure growth of > or =10,000 CFU/mL urine). RESULTS: Escherichia coli was the most predominant bacterium in the urine from both inpatients (56.7%) and outpatients (68.3%). Coagulase-negative staphylococci and enterococci occurred significantly more often (P < 0.001) in urine samples from inpatients (12.5% and 7.9%) than in urine samples from outpatients (7.5% and 4.7%). Escherichia coli from both outpatients and hospitalised patients was highly susceptible (>93%) to cefalothin, mecillinam and nitrofurantoin, and more than 75% of E. coli isolates were also sensitive to ampicillin. Overall, the susceptibility to nitrofurantoin in bacteria from outpatients was 90% and from hospitalised patients was 85%. The corresponding figures for cefalothin were 92% and 90%, and for trimethoprim were 81% and 76%, respectively. CONCLUSIONS: Bacteria causing urinary tract infections in Norway are less resistant to antibacterial medication than in other western countries and the reason for this may be the low consumption of antibacterials by the Norwegian population. During the period from 1990 to 1999 the mean total annual consumption of antibacterial drugs in Norway was 15.3 defined daily doses per 1000 inhabitants per year.

Anti-Bacterial Agents↗

[Breast cancer surgery in Norway 1990-95 illustrated by data from SINTEF United].

BACKGROUND: Breast-conserving therapy has been shown to be as effective as mastectomy in many cases; hence in many countries more breast cancer patients are offered this type of treatment. This study focuses on the amount and type of surgery used in Norway for breast cancer patients and the possible use of hospital discharge data to evaluate the diffusion of this surgical practice. MATERIAL AND METHODS: Data from the nationwide Register of Hospital Discharges in Norway at SINTEF Unimed for patients operated for breast cancer from 1990 to 1995 were used. RESULTS: 11,041 patients were registered with 11,727 hospital admissions for breast cancer operations from a total of 64 hospitals. The discrepancy in the number of breast cancer patients with the National Cancer Registry was 7%. Breast-conserving surgery was performed in 19.7%. An increase from 17% in 1990 to 21% in 1995 was found, but with variations according to type of hospital, county and age of patients. INTERPRETATION: The percentage of breast conserving surgery is still low in Norway; this indicates that many women are not offered this type of surgery. With some caution, the data from SINTEF Unimed can be used to reflect the clinical practice over time at Norwegian hospitals. Further improvements could be obtained if national identity numbers were added to the database.

Adult↗

[Smallpox and smallpox virus--200 years since the first vaccination in Norway].

In December 1801, the first vaccination against smallpox in Norway took place. Vaccine material came from Denmark, England, Ireland, and other countries; it was also obtained from a few local cowpox cases. What mattered was the effect, not the origin. Several reports indicate that variola virus itself, the cause of smallpox, was also used for human vaccination after passages through cows and horses. A vaccine institute for production of vaccine in calves was established in Kristiania in 1891. Cowpox was once a rare disease in cattle, but a total of 70,985 bovine cases were reported between 1889 and 1928. The source of infection was thought to be humans vaccinated against smallpox. Pox-like diseases were also registered in horses, pigs, sheep, goats and dogs at that time. Compulsory vaccination continued in Norway until 1976; smallpox is now eradicated. During the last decades, however, cowpox virus infections have re-emerged among zoo animals, domestic cats and humans in Western Europe, with small wild rodents and shrews as wildlife reservoirs. Vaccinia virus is also met with new interest as a vector in recombinant vaccines. Given the fact that the human population no longer has immunity against orthopoxviruses and the new possible exposure through pets and wildlife, it may be appropriate to reflect on poxvirus history in Norway in the light of the present situation.

Animals↗

[Tick-borne encephalitis in Norway].

BACKGROUND: The first person reported with tick-borne encephalitis (TBE) in Norway fell ill in 1998; the second patient caught the disease in autumn 1999. Both had been to the island of Tromøy in Aust-Agder county. Searches for TBE antibodies were intensified in persons with encephalitis and a seroprevalence study was carried out. MATERIAL AND METHODS: Sera from persons with encephalitis were tested for IgM and IgG antibodies to TBE virus with enzyme immunoassay and a neutralization test. Stored sera from persons living on Tromøy in 1997-2000 were studied for IgG antibodies. RESULTS: We report three cases of TBE, two had encephalitis in September-October 2000. The third patient, with antibodies to TBE virus found by retrospective testing, had the disease in August 1997. IgG antibodies to TBE virus were found in 3 out of 126 (2.4%) samples from Tromøy. INTERPRETATION: We report the first case of TBE in Norway. Of the first five Norwegian cases, four had been on Tromøy before they fell ill, three of them as tourists. In previous studies, IgG antibodies to TBE virus were found in 0.3-0.4% of persons from different parts of Agder counties. The seroprevalence studies indicate that Tromøy may have a higher incidence of TBE than the rest of the two southern counties. Our results confirm that TBE occurs in the coastal area of southern Norway.

Adult↗

[Experiences with ritual circumcision in Norway].

BACKGROUND: We wanted to provide a survey of the extent and practice of locally performed ritual circumcision of boys born to Muslim parents in Norway. MATERIAL AND METHODS: Newborn boys with Muslim parents in two counties in Norway (Rogaland and Troms) were registered. 56 ritual circumcisions were performed in outpatient departments in the local hospitals during the period under investigation, 11 on newborns, 33 on boys between one and ten, and 12 on boys above ten. RESULTS: The number of circumcised boys in 1999 was 24% of the total number of boys born to Muslim parents that year; in 2000, 48%. Circumcision of boys between one and ten is ten times more time-consuming than circumcision of newborns or boys above ten. INTERPRETATION: An estimated 672 boys are born to Muslim parents in Norway each year. Less than 50% of newborns with Muslim parents are circumcised in local outpatient departments. We recommend that ritual circumcision is restricted to newborns or to boys above ten, and that informed written consent is obtained from boys above ten.

Age Distribution↗

[Genetic analysis of Mycobacterium tuberculosis in Norway 1994-98].

BACKGROUND: This study was undertaken to determine the genetic diversity in the population of Mycobacterium tuberculosis in Norway and to detect the degree of transmission between patients. The quality of the culturing work was ascertained by analysing the data for possible cross-contamination. MATERIAL AND METHODS: Genotypic relationships among 92% of all strains isolated in Norway in 1994-98 were assessed using IS6110-restriction fragment length polymorphism analysis. The strains had been isolated from 717 different patients. For isolates with less than five copies of IS6110 the directly repetitive element was also used. RESULTS: 20 isolates (2.8%) represented false positive samples. The isolates from 14.5% of the native Norwegian patients and 19.7% of the foreign patients were part of one of 35 clusters. INTERPRETATION: The results indicate that the degree of recent transmission of tuberculosis in Norway was low and that transmission between immigrants and native Norwegians was uncommon. The majority of cases were due to reactivation of previous disease.

Adolescent↗

[Cholinesterase inhibitors in Norway--effectiveness and side effects in clinical practice].

BACKGROUND: Naturalistic trials are needed to evaluate whether the results obtained in randomised trials of cholinesterase inhibitors (CEI) can be generalised to clinical practice. We conducted two studies in Norway to address this issue. MATERIAL AND METHODS: We included patients with dementia from 16 centres in Norway who had received treatment with a CEI until November 2001 (study 1, n = 1,167, retrospective case review) or who came to the first evaluation after onset of treatment (study 2; n = 252; prospective enrollment). Adverse events, global effectiveness, and Mini-Mental State Exam scores were recorded. RESULTS: In study 1, 56% of the patients were rated as mildly or markedly improved two to four months after onset of treatment. Side effects were recorded in 23%; 8% discontinued treatment due to side effects. In study 2, 49% were rated as mildly or markedly improved on at least one of the items cognition, psychiatric symptoms, activities of daily living or behaviour. Treatment was discontinued due to lack of effectiveness in 12%. INTERPRETATION: CEI were found to be useful in clinical practice in Norway. The open and uncontrolled design of the study limits the generalisability of the study.

Aged↗

[The epidemic of Caesarean section: has it reached Norway?].

BACKGROUND: Women's right to decide on the mode of delivery is discussed, as well as the management of term breech deliveries. Obstetric practice may have changed as a consequence of ongoing debates. National caesarean section rates were stable at 12-13% during the 1990s, but no information has been provided about the development over the last two years. MATERIAL AND METHODS: Information about deliveries in obstetrical units in Norway, 1999 to 2002, was extracted from the Norwegian Patient Register. The number of deliveries was validated against information from Statistics Norway. The numbers of caesarean sections in 1999 and 2000 were validated against information from the Medical Birth Registry of Norway. RESULTS: The caesarean section rate increased slightly from 12.8% in 1999 to 13.0% in 2000. In 2001, there was a considerable increase to 14.9%; during the first 8 months of 2002, the rate was 15.1%. The change in practice appeared in the last months of 2000, coinciding with the publication of the term breech trial. However, only about one third of the increase can be attributed to a change in breech delivery. COMMENTS. Caesarean section is the most frequent major surgical procedure performed on hospitalised patients. In times of rapid changes in obstetric practice, monitoring of the development without time delay is called for.

Breech Presentation↗

Implementing competition in the pharmacy sector: lessons from Iceland and Norway.

The pharmacy market in many European countries is characterised by individual, privately-owned pharmacies that operate under tight government control regarding barriers to entry, scope of activities and profit margins. In Iceland, many of these restrictions were relaxed in 1996 in the hope of stimulating competition. Similar changes were introduced in Norway in 2001. In both countries, the new structural conditions led to horizontal mergers and coalitions between pharmacies; and in Norway, the emerging pharmacy groups integrated vertically with wholesalers. The number of independent decision units decreased and the markets rapidly transformed into oligopolies with remaining institutional barriers to entry. The rapid change took both governments by surprise, and intervention was needed to prevent monopolies from emerging. Additional intervention to strengthen competition may be needed in the future to prevent unfavourable developments, and the tradition of maintaining equal access of services may prove more difficult to uphold. Experiences in both Iceland and Norway highlight the complexity of reforms that fundamentally influence competitive behaviour.

Delivery of Health Care, Integrated↗

[Are domestic Cryptosporidium and Giardia infections in Norway underdiagnosed?].

BACKGROUND: Cryptosporidium and Giardia are recognised as common causes of waterborne disease in several countries. In order to describe investigative practices for these protozoan parasites in Norway, we surveyed medical microbiology laboratories nationwide for faecal screening policies and methods used for detection of Cryptosporidium and Giardia. MATERIAL AND METHODS: All medical microbiology laboratories in Norway received questionnaires on laboratory methods, indications for screening, and numbers of samples investigated over the 1998-2002 period. RESULTS: Of the 22 laboratories that receive faecal samples, 17 had established diagnostic routines for Giardia detection, 14 for Cryptosporidium. Examination for Giardia cysts was standard procedure in all 17 laboratories, mainly in specimens from immigrants and travellers returning from abroad. Examination for Cryptosporidium was, on the other hand, infrequent. Ten of the 14 laboratories reported less than 10 examinations per year. Giardia was frequently detected, with 1 to 6% positive samples in the various laboratories. Cryptosporidium was seldom detected; all laboratories reported only 0-1 positive sample per year. INTERPRETATION: While laboratories frequently screen faecal samples for Giardia, screening for Cryptosporidium is rare. Little is known about the public health significance of domestic infections with these parasites in Norway; further investigation is needed in order to estimate the burden of disease they cause and to implement control measures if required.

Animals↗

[Water-borne disease outbreaks in Norway].

BACKGROUND: The drinking water in Norway has traditionally been considered being of good quality. However, outbreaks related to drinking water are reported every year. We review waterborne outbreaks in Norway over the last 15 years, and describe the aetiology of and contributory factors in these outbreaks. MATERIALS AND METHODS: We compiled data on waterborne outbreaks reported to the Norwegian Institute of Public Health and Norwegian Food Control Authority during 1988-2002. We included all events in which two or more people fell ill and water was the suspected source of infection. RESULTS: Over the 15-year period. 72 outbreaks were reported, affecting a total of 10 616 persons. Campylobacter was the cause in 26% (19/72) of the outbreaks, norovirus in 18% (13/72). The causative organism was unknown in 46% (33/72). The water came from public waterworks in 32 of the 54 outbreaks for which this information was available (59%); from a private supply in the remaining 22. For 62% (16/26) of the outbreaks related to waterworks, the water was not disinfected before distribution. None of the private water supplies were disinfected. Over the last five years, there were more outbreaks related to private supplies. INTERPRETATION: The most important contributory factor to waterborne outbreaks in Norway is contamination of the raw water combined with missing or faulty disinfecting procedures. To prevent future outbreaks, a continuous upgrading of small and private water supplies is needed. Reporting of outbreaks is important for the implementation of targeted and effective preventive measures.

Disease Outbreaks↗

[The scale of border trade, tax-free import and tobacco smuggling to Norway].

BACKGROUND: There are no studies of the relative significance in Norway of registered sales, tax-free import, border trade or smuggling of tobacco. MATERIAL AND METHODS: The estimated registered sales of tobacco are based on data from the Norwegian customs and excise authorities. The border trade and tax-free import estimates were based on nation-wide, representative surveys of daily smokers aged 16-74 carried out by Statistics Norway for the years 1990-1993 and 1997-2001. There are no detailed data on the scale of smuggling other than confiscation statistics compiled by the customs and excise authorities. It is assumed that confiscations amount to about a tenth of the total amount smuggled into the country. RESULTS: The unregistered consumption of cigarettes and tobacco has been on the rise since the early 1990s; in the years 1997-2001 it accounted for about a quarter of total consumption. Broken down, the figures are as follows: 11% was purchased in Sweden, 5% in Denmark, 9% in other foreign countries; 1% was smuggled into the country. INTERPRETATION: The rise in unregistered tobacco consumption is putting further pressure on the high Norwegian taxes on tobacco. But if taxes were cut, domestic demand would rise, and hence have little or even negative impact on revenue flowing to the government from the legal tobacco market and probably little impact on the levels of imported tobacco through tax-free arrangements or cross-border trade. Hence, although the price gap between Norway and neighbouring countries narrows, we must assume that the motivation to acquire tobacco will remain unaffected while Norwegians continue to travel to Sweden to stock up on inexpensive meat produce.

Crime↗

[Prevalence of refractive errors in Norway].

BACKGROUND: The aim of this study was to determine the prevalence of refractive errors among young and middle-aged adults in Norway. MATERIAL AND METHODS: Refractive errors were measured with an autorefractor in a population-based sample of young (20-25 years) and middle-aged (40-45 years) adults participating in a health study (HUNT) conducted in Nord-Trøndelag county in Norway in 1996-97. RESULTS: A total of 3137 persons (1248 young and 1889 middle-aged adults) with corrected visual acuity >0.5 (in either eye) were included. About half of the population (51.8% among the young and 52.3% among the middle-aged adults) were emmetropic. The prevalence of myopia was 35.0% in the young adult group and 30.3% in the middle-aged group. Myopia was significantly higher in women aged 20-25 years (36.4%) than in men aged 40-45 years (28.1%). Prevalence of hyperopia increased with age from 13.2% (20-25 years) to 17.4% (40-45 years). INTERPRETATION: The results show a relative high prevalence of myopia in the general population of Norway.

Adult↗

[Foreign physicians in Norway. Where do they come from--how do they work--what are their plans for the future?].

In a market with almost 500 vacant positions for doctors it is of considerable interest to obtain more knowledge about immigrant doctors. In a survey of 408 immigrant doctors, the majority came from the Nordic (22%) and other West European countries (37%), whereas the rest came from Eastern Europe (19%), Asia (17%), America and Africa. One third (36%) obtained their first appointment in central Norway and 22% in remote North Norway. The corresponding figure for the present appointment were 40 and 17%. Most doctors (73%) had been well received in Norway. Language problems (21%) and social isolation (16%) were frequently encountered, but professional problems were less common (7%). Doctors from West European countries complained that their medical qualifications tended to be under-rated by their Norwegian colleagues.

Adult↗