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PubMed2002

Completeness and accuracy of registration of ovarian cancer in the cancer registry of Norway.

Completeness of reporting and accuracy of the diagnosis of ovarian cancer from one health region in Norway to the Cancer Registry were examined. Data kept by the Cancer Registry were evaluated against discharge diagnosis data from all 8 hospitals in the health region during the period of 1987-1996. The assessment of the accuracy of the diagnosis recorded in the Cancer Registry was based on review of all medical records in the hospital setting and on slide review of all histologic diagnoses. The overall completeness of reporting ovarian cancer to the Cancer Registry was 99.6%. The organ specific completeness of registration of histologic verified ovarian cancer within the Cancer Registry was 95.3%; 0.9% was erroneously coded and 3.5% had their diagnosis changed to ovarian cancer at re-evaluation. Of all ovarian cancer cases registered at the Cancer Registry, 91% had a primary histologic diagnosis. Among 591 cases identified with a histologic diagnosis in the Cancer Registry, the accuracy of the diagnosis was estimated at 92%. Coding errors were found in 2% of these cases, while in 6% of the cases it was not possible to reproduce the original diagnosis of ovarian cancer at re-evaluation. In order to provide data of high quality for cancer surveillance a cancer registry needs several data providers, such as histopathologic laboratory reports and clinical reports. In addition, assessment of reported data through stringent quality assurance procedures within the registry are necessary for reaching a nearly 100% completeness of registration as found for ovarian cancer in the Cancer Registry of Norway.

Female↗
PubMed1999

Restorative treatment decisions on approximal caries in Norway.

A random sample of dentists in Norway were asked which radiographic criterion for assessing the initiation of restorative treatment of approximal caries they would use, and which type of cavity preparation and filling material they would prefer for a distal lesion on an upper second premolar. Only 19 per cent stated that they would treat approximal lesions confined to enamel, with 81 per cent opting to wait until lesions had reached dentine, compared with 66 per cent in a similar study performed in 1983. The tunnel preparation was cited most often as the preparation of choice (47.3 per cent), while 28.2 per cent preferred traditional class II preparations and 24.3 per cent a saucer shaped preparation. Only 15.5 per cent of the dentists chose amalgam as the restorative, 15.8 per cent composite, 22.3 per cent a conventional glass ionomer cement, 7.2 per cent a resin modified glass ionomer cement and 22.4 per cent a combination of glass ionomer and composite. There has been a shift in operative treatment criteria among the majority of dentists in Norway from 1983 to 1995, with most now waiting until the lesion is diagnosed in dentine radiographically before restoring. Most dentists prefer new preparation techniques for approximal caries using tooth coloured materials. Only every fifth dentist has amalgam as a first choice for approximal restorations in the posterior region.

Adult↗
PubMed2001

The introduction of MR in the Nordic countries with special reference to Norway: central control versus local initiatives.

The introduction of MR technology in Norway differed from that in Denmark, Finland and Sweden. In the latter countries, decisions were made at county or local level while in Norway the process was steered by the government and the national health authorities. For several reasons the steering was not very successful, and the intention of buying one MR unit ended with the purchase of five units. As a counter-reaction, for seven years only university hospitals were allowed to purchase MR equipment. In 1993, the strict regulations were abolished, and during the succeeding years all four Nordic countries experienced similar exponential growth in the number of MR units.

Delivery of Health Care↗
PubMed2002

Gestational trophoblastic tumors in Norway, 1968-1997: patient characteristics, treatment, and prognosis.

OBJECTIVES: The aim of this study was to give an overview of the Norwegian population of gestational trophoblastic tumors (GTT), diagnosed during 1968-1997 and treated with chemotherapy at the Norwegian Radium Hospital (NRH), with regard to patient characteristics, treatment, and prognosis. METHODS: The cases were grouped according to a modified version of the WHO scoring system. Staging was performed retrospectively according to the systems adopted by FIGO. Survival estimates were calculated by the method described by Kaplan and Meier. Cox regression models were used to find the best classification system with regard to prognosis (disease-free survival). RESULTS: A total of 141 cases, 106 invasive moles (IM) and 35 choriocarcinomas (CC), were diagnosed in Norway and treated with chemotherapy at the NRH in the period 1968-1997. Altogether, 56% of the patients were assigned to the low-risk category, 20% to the medium-risk category, and 15% to the high-risk category. Most cases were classified into the clinical stages I (69%) and III (23%). The overall 5-year survival rate was 96%. A more favorable prognosis was seen in patients diagnosed in the 1980s and 1990s compared with those diagnosed in the 1970s (P = 0.04). Five patients had progressive disease and died from the disease. Nine patients relapsed. The prognosis (disease-free survival) was more favorable for IM compared with CC (P < 0.01). The FIGO classification system seemed to be a better predictor of disease-free survival than the WHO scoring system. CONCLUSIONS: This study showed that the prognosis of patients with GTT improved in the 1980s and 1990s in Norway, and that the FIGO system might be the best predictor of disease-free survival.

Adolescent↗
PubMed1995

Mass screening for cervical cancer in Norway: evaluation of the pilot project.

The Norwegian Department of Health and Social Affairs initiated a national screening program for cervical cancer in 1990, with all women aged 25 to 70 years to be offered cervical screening every three years. During the first three years of the program (November 1991-October 1994), all spontaneous cervical cytology in Norway was recorded at the Norwegian Cancer Registry. In addition, women in the counties of Vestfold and Sør-Trøndelag were invited individually to be screened. The aim of the present study was principally to evaluate the organization aspects of a nationwide, population-based screening program for cervical cancer in Norway. Special attention was paid to the coverage, the attendance rate, and the cytologic findings in the two-county study area. A total of 1,581,379 Pap smears were recorded from November 1991 to October 1994. Most smears were taken from women under age 30 years (31.7 percent). About 25 percent of the women aged 25 to 29 years had more than one normal smear. In the study area, a coverage of about 71 percent in the age group 25 to 69 years was achieved. The pilot project also has shown that it is possible to recruit elderly women into screening. However, no difference was noted between the study and the reference area with regard to findings per smear of precursor lesions (CIN 3, modified SNOMED coding system). The experiences from three years of recording and the implementation of the pilot project have provided useful guidelines for the national screening which began in January 1995.

Adult↗
PubMed1997

Establishing social contact in exile: a prospective community cohort study of Vietnamese refugees in Norway.

The social networks of Vietnamese refugees and predictors of their intra- and inter-ethnic social contact after 3 years in Norway were studied. An unselected community cohort of Vietnamese boat refugees was personally interviewed, first on arrival in Norway (n = 145) and again after 3 years (n = 130). By the time of the second interview, the refugees had to a large degree reconstructed social networks and 54% had good contact with other Vietnamese. Only 17% had equally good contact with Norwegians. Female gender, further education after resettlement and having a close confidant on arrival were related to good inter-ethnic social contact. The latter was the only predictor of good intra-ethnic social contact. Competency in the Norwegian language, surprisingly, did not predict good social contact with Norwegians. The refugees were largely successful in re-establishing a social platform in relation to their own ethnic group in their new environment. It was much more difficult to establish good social contact with Norwegians. Educational institutions appear to be important social arenas in this respect. The personal capacity for close attachments during a period of psychosocial transition is also important.

Acculturation↗
PubMed1995

Immunity to diphtheria in northern Norway and northwestern Russia.

A case of diphtheria, which has not been seen in Norway for 30 years, was reported in 1992 in the northern part of the country bordering Russia. An increasing number of cases of diphtheria has been reported in the former USSR, including the northwestern part of Russia. In order to elucidate the potential of an epidemic spread across the Norwegian-Russian border, a seroepidemiological study was performed. A total of 470 sera, 243 from Finnmark, Norway, and 227 from Arkhangelsk, Russia, were examined for antibodies against diphtheria toxin, using an in vitro toxin neutralisation method. No statistically significant difference in the presence of diphtheria antitoxin between the Norwegian and the Russian populations was found. The presence of neutralising antibodies decreased by age, and this decrease was most pronounced among the Russians. Individuals aged 40 to 70 years, and Norwegian women in particular, seem to have an increased risk for diphtheria as judged by the diphtheria antitoxin levels.

Adolescent↗
PubMed1994

Cancer incidence among waitresses in Norway.

Previous studies have found high risk of cancers of the upper aerogastric tract, liver, and lung among waiters. Since approximately 75 percent of those working in the restaurant business in Norway are women, we have analyzed cancer incidence in a cohort of waitresses, to determine whether they have the same high cancer-risk as their male colleagues. The cohort consisted of 5,314 waitresses organized in the Restaurant Workers' Union between 1932 and 1978. The follow-up period was from 1959 to 1991. The standardized incidence ratio (SIR) for all causes of cancer was 1.0 (95 percent confidence interval [CI] = 0.9-1.1), based on 430 observed cases. Cancers of the tongue, mouth, pharynx, larynx, esophagus, and liver were grouped together as alcohol-associated cancers. SIR for these cancers combined was 1.1 (CI = 0.5-2.2). For lung cancer, SIR was 2.3 (CI = 1.6-3.1). Cervical cancer was also more frequent than expected, and breast cancer less frequent than expected. The larger excess of lung cancer and cervical cancer appeared in the sub-cohort working in restaurants with a license to serve alcohol. No excess risk of alcohol-associated cancers could be detected in this cohort of Norwegian waitresses. A longer follow-up period will be necessary to evaluate possible consequences of an increased alcohol consumption among younger waitresses. Waitresses in Norway are, like their male colleagues, at high risk for lung cancer.

Adult↗
PubMed2000

Multiple sclerosis in North Norway, and first appearance in an indigenous population.

This study was performed to determine the prevalence of multiple sclerosis (MS) in 1993 and annual incidence rates 1983-1992, and to examine whether the disease occurs among the Sami people. According to earlier reports the two northernmost counties of Norway, Troms and Finnmark with 225,000 inhabitants, have a relatively low prevalence of MS: 20.6 per 100,000 in 1973 and 31.5 in 1983. Also no person who is of pure Sami heritage (i.e., with both parents speaking Sami natively) has been found with the disease. Except for the introduction of magnetic resonance imaging as a diagnostic tool, there has been no significant change in the neurological service in the area during the past 20 years. Files of patients with the diagnosis of MS were reviewed, and questionnaires were sent to all patients alive on the prevalence day of 1 January 1993. The prevalence in 1993 was 73.0 per 100,000. The mean crude annual incidence rate was 3.5 per 100,000 during the period 1983-1992 compared with 3.0 during 1974-1982. In 1983 there were no pure Sami among the MS patients, but one had a Sami father. On 1 January 1993 there were three patients with both Sami parents and three with only one Sami parent, which is a rate that is still lower than would be expected if the prevalence of MS among the Sami were similar to that in the rest of the Norwegian population. The study shows that the incidence of MS in Troms and Finnmark has been increasing over the past 10 years, but is still lower than on the western coast and in the eastern part of Norway. The lowest incidence is found in Finnmark, where the Sami population is highest. During the past 10 years MS has also been diagnosed among the Sami population.

Adolescent↗
PubMed2002

Population dynamics of sealworm, Pseudoterranova decipienssensu lato, in sculpins, Myoxocephalus scorpius, from two areas in Norway between 1990 and 1996.

The abundance of sealworms (Pseudoterranova decipienss.l.) in sculpins (Myoxocephalus scorpius) was studied at Torbjørnskjaer, southeast Norway, and Vega, northern Norway, in samples from 1990 to 1996. The harbour seal ( Phoca vitulina) population at Torbjørnskjaer declined by 70% during the phocine distemper virus epizootic in 1988, and has increased during the 1990s. The abundance of sealworms in sculpins was relatively stable from 1992 to 1996 and any effect of the reduction in the number of harbour seals on the abundance of sealworms has been short-term. When correcting for size differences, young sculpins (2-4 years) from Torbjørnskjaer had higher abundances than those from Vega, while in old sculpins (5-7 years) the abundances seemed similar and stabilised. This happened at a younger age among the more heavily infected sculpins at Torbjørnskjaer than at Vega, and we interpret this as density dependence in the fish host.

Age Distribution↗
PubMed2002

Serological investigation of canine encephalitozoonosis in Norway.

Encephalitozoon cuniculi, a microsporidian parasite of vertebrates, is considered a health risk to AIDS patients and other immunocompromised human beings. In most hosts, infection with the parasite runs a subclinical course. In some carnivore species, however, clinical disease affecting whole litters arises from intrauterine transmission of the parasite. In both blue foxes ( Alopex lagpus) and dogs ( Canis familiaris), outbreaks of encephalitozoonosis can be severe. Canine encephalitooonosis has been reported from various parts of the world, including South Africa and the United States. In Norway, there have been large outbreaks of the disease in blue fox farms, affecting also mink, but there have been no reports of encephalitozoonosis in dogs. Infection in dogs would represent a zoonotic problem, due to the close social relationship between dog and man. The purpose of the present study was to investigate the possible occurrence of E. cuniculi infection in Norwegian dogs by serological methods. In the study, 1,104 canine serum samples, originally submitted for biochemical analysis by veterinary practitioners throughout Norway, were screened by enzyme-linked immunosorbent assay for antibodies to E. cuniculi. Samples from 237 of the dogs were tested also by the indirect fluorescent antibody test. All samples were concluded as negative. The results indicate that the likelihood of occurrence of E. cuniculi infection in Norwegian dogs is small.

Animals↗
PubMed2005

Explaining bank vole cycles in southern Norway 1980-2004 from bilberry reports 1932-1977 and climate.

Correlations between mast fruiting of bilberry Vaccinium myrtillus and peak levels of Clethrionomys-voles have been reported from both Norway and Finland, but there has been a discussion whether this is a bottom-up or a top-down relationship. In a multiple regression model, 65% of the variation in a bilberry production index calculated from game reports from southern Norway 1932-1977 could be explained by the berry index of the two preceding years and climate factors acting during key stages of the flowering cycle. High vole populations in previous years did not contribute to explain the fluctuation in berry production. I used the selected model and climate data to predict bilberry production for the period 1978-2004. Predicted berry indices of the current and previous year explained 38% and the total amount of precipitation in May-June explained 16% of the variation in a log-transformed snap-trapping index of bank vole Clethrionomys glareolus 1980-2004. The vole index was not related to any of the climate variables used to predict berry production. This pattern supports the hypothesis that vole cycles are generated by changes in plant chemistry due to climate-synchronized mast fruiting.

Animals↗
PubMed2006

Suicide among Indigenous Sami in Arctic Norway, 1970-1998.

Suicide mortality was examined between 1970 and 1998 in a cohort of 19,801 persons categorized as indigenous Sami in Arctic Norway. Standardized mortality ratios (SMR) were calculated using the suicide rates of the rural population of Arctic Norway as reference. There was a significant moderate increased risk for suicide among indigenous Sami (SMR = 1.27, 95% Confidence interval (CI): 1.02-1.56). In the study period, 89 suicides occurred in the cohort (70 men and 19 women) with increased suicide mortality both for indigenous Sami males (SMR = 1.27; 95% CI: 0.99-1.61) and females (SMR = 1.27; 95% CI: 0.77-1.99). Significant increased suicide mortality was found for young Sami aged 15-24 for both males (SMR = 1.82; 95% CI: 1.13-2.78) and females (SMR = 3.17; 95% CI: 1.17-6.91). Significant increased suicide mortality was found for indigenous Sami males residing in Sami core area (SMR = 1.54; 95% CI: 1.04-2.20) and for indigenous Sami males not belonging to semi-nomadic reindeer herding (SMR = 1.30; 95% CI: 1.00-1.65). Clusters of suicides in Sami core area may explain the increased suicide mortality found in subgroups among indigenous Sami.

Adolescent↗
PubMed1991

Effect of outer membrane vesicle vaccine against group B meningococcal disease in Norway.

For more than 15 years, Norway has had the highest incidence of meningococcal disease in northern Europe, with 80% of cases being due to serogroup B meningococci. The case-fatality has remained high, at about 10%. In this study, an outer membrane vaccine, which had previously been shown to induce an increase in bactericidal antibodies to the parent strain, was assessed in a large-scale, randomised, double-blind trial. From October, 1988, 171,800 students in secondary schools volunteered to take part in a double-blind, placebo-controlled, efficacy trial with school as the randomisation unit. Hospitals and clinics that routinely receive patients with infectious disease were asked to report urgently all cases of suspected meningitis and/or septicaemia in 13-21-year-old students in Norway. These cases were registered and further investigated according to a detailed protocol. 89 out of the 221 cases investigated by June 3, 1991, were shown to be severe systemic disease due to group B meningococci. 36 cases in 35 schools took part in the trial (11 schools with vaccinated students and 24 with students given placebo). The calculated rate of protection was thus 57.2% (p = 0.012, one-sided test). The findings suggest that, although the vaccine conferred protection against group B meningococcal disease, the effect was insufficient to justify a public vaccination programme.

Adolescent↗
PubMed1991

EuroQol: health-related quality of life measurement. Valuations of health states by the general public in Norway.

The EuroQol instrument consists of a self administered questionnaire where subjects are asked to value health states on a visual analogue scale. The instrument is playing a role of linking cross-national data in the field of health status measurement. An experiment in Norway with an alternative lay out added little to the feasibility of the instrument. On the other hand, reducing the number of states to be valued did increase the response rate significantly. Valuations in a random sample of Norwegian subjects were quite similar to valuations made by subjects in England, Holland and Sweden. EuroQol valuations may have to undergo a radical transformation before being used as utility weights for life years, but the similarity in valuations across countries is a promising finding in itself. To the extent that these similarities are validated in later studies, authorities in any one of these four countries wishing to use health status indices in medical decision making, may in the future allow themselves to draw on results obtained in any of the other three countries. Particularly for a small country like Norway there is an obvious advantage in this.

Attitude to Health↗
PubMed1994

Treatment of cancer pain in Norway. A questionnaire study.

A questionnaire study was performed in order to clarify knowledge and practice of cancer pain treatment in Norway: a 10% random sample of Norwegian physicians received a questionnaire. Of 800 correctly addressed questionnaires, 549 were returned and 306 were analyzed after exclusion of those doctors who never treated cancer patients. Their knowledge of the principles and methods of cancer pain treatment were evaluated with 8 multiple-choice and 13 open questions. Their ability to apply their knowledge in practice was evaluated by analyzing their suggested treatment of 3 illustrative case histories. The results show that only 25% of Norwegian physicians treating cancer patients appear to have knowledge of the principles of the World Health Organization analgesic ladder strategy. However, the majority (86%) of the physicians were prepared to prescribe strong opioid analgesics, but in the illustrative cases where strong opioids were appropriate, 44% prescribed too small doses and often preferred neuroleptic drugs instead of increasing the analgesic to a sufficiently large dose. Patients needing step two on the analgesic ladder, in Norway often (49%) are treated with a standard combination of paracetamol and codeine. However, when a strong opioid is required, 50% of Norwegian physicians forget to continue the paracetamol or NSAID component. Two hundred seventy-four (97%) of the physicians said they experienced problems when treating cancer pain, ranging from inefficient pain relief (52%) to side effects of opioid analgesics (32%), most often sedation, in combination with nausea and constipation. Only 13% of the physicians had a correct understanding of opioid drug dependence. As many as 72% of Norwegian physicians thought their education in cancer pain treatment was insufficient.

Analgesics↗
PubMed1993

Incidence, survival and mortality in cervical cancer in Norway, 1956-1990.

Long-term trends in incidence, survival and mortality were examined in women with squamous cell carcinoma and adenocarcinoma of the uterine cervix, diagnosed in Norway in the 35-year period 1956-1990. During the 1970s the number of cervical smears increased substantially in Norway, although no organised screening programme was introduced. Special attention was paid to the time period 1971-1990 to evaluate the effect of the extensive spontaneous screening. In addition, the prognostic importance of clinical stage and age was explored. In the squamous cell carcinoma patients the incidence rate peaked in the time period 1971-1975, since when there has been a decrease. In the adenocarcinoma patients the incidence rate rose through the years 1976-1990. Also, the proportion of adenocarcinomas increased in this time period. The mortality rates in both histological types declined modestly through the years 1966-1990. A more favourable stage distribution was noted among the squamous cell carcinomas (P = 0.00), but not among the adenocarcinomas, when comparing the two diagnostic periods 1971-1975 and 1981-1985. The multivariate analysis (GLIM) revealed that stage was the most important prognostic factor in both histological types (P = 0.00). In the squamous cell carcinoma patients the relative rate increased (P = 0.04) in the last period. There was a tendency towards a poorer prognosis in younger women in this group, but age did not prove to be an important prognostic factor (P = 0.08).

Adenocarcinoma↗
PubMed1995

Trends in incidence of testicular cancer in Norway 1955-1992.

The aim of this study was to explore the incidence of testicular cancer (TC) in Norway, and thereby to increase the understanding of aetiological factors. From 1995 to 1992, a total number of 3927 TC cases were recorded in Norway, of which 51% were seminomas, 45% non-seminomas and 4% other and unspecified types. The age-standardised incidence rate increased from 2.7 to 8.5 per 100,000. The age-specific incidence rate increased in all age groups, but was most marked in the younger population. The significance of birth cohort as a risk factor for development of TC was confirmed. The incidence by birth cohorts from 1916 to 1970 showed an increase by later birth cohorts during the whole period, with the exception of a marked fall for the cohort born during the Second World War. The largest increase occurred after the war. We conclude that environmental factors acting very early in life are of significance in the development of TC.

Adolescent↗