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PubMed2001

[Spanish flu in Norway 1918-19].

The Spanish flu pandemic killed between 50-100 million people worldwide in 1918-19. This article discusses Spanish flu in Norway between 1918-19 from three different approaches. How did Spanish flu affect Norway? Spanish flu was probably imported to Norway across the North Sea from Britain. From the middle of June 1918, Spanish flu swept across the country in three different waves: the summer epidemic of 1918, the autumn epidemic of 1918 and the winter epidemic of 1918-19. In Norway 13,000-15,000 died, most of them during the autumn of 1918 and mostly from pneumonia or pulmonary complications. What were the consequences? Most deaths occurred in young adults; many families experienced tragedies. Spanish flu is considered the worst demographic crisis of the twentieth century. The additional costs to the public purse were huge after the epidemic. Why was it that Spanish flu had such devastating effects? The virus causing the pandemic was very virulent and resulted in a higher mortality rate than that experienced during other pandemics. These characteristics may be explained by genetic features of the 1918 virus. This article points at conditions in Norway at the time of Spanish flu that may have contributed to the severity of the outbreak.

Adult↗

PubMed1992

[Tularemia in Norway. A clinical and epidemiological review].

Altogether 105 cases of tularemia were reported to the nationwide notification system for infectious diseases (MSIS) in Norway during the period 1975-90. The zoonosis appears every year in Northern Norway. The first epidemic outbreak was reported from Central Norway in 1984-85. During the nineteen eighties the disease has reappeared in Southern Norway. We review the clinical features and epidemiological patterns of tularemia in Norway. Preliminary investigations indicate that the future drug of choice for treatment of tularemia is one of the gyrase-inhibitors.

Adolescent↗

PubMed2005

[Sickness absence incidence in Norway 1975-2002].

BACKGROUND: The aim of the present paper is to describe the sickness absence incidence in Norway after the introduction of the present sickness absence benefit scheme in 1978. MATERIAL AND METHODS: Data on sickness absence from the National Insurance Administration), Statistics Norway and the Confederation of Norwegian Business and Industry (the employers' federation) are presented and discussed. RESULTS AND INTERPRETATION: The incidence of short-term absence has changed very modestly since the present system with self-certification of absence of 1 to 3 days was introduced. Long-term sickness absence was at its lowest levels in 1983 and 1994, coinciding with peaks of unemployment in Norway. From 1995 there has been a rather steep increase in sickness absence; in 2002 the Insurance Administration recorded the highest figures for sickness absence ever. Mean number of sickness absence days among all employed persons compensated by the Insurance Administration (only spells > 16 days) was 10.6 days for men and 16.7 days for women in 2002. The data from the employers' federation, however, indicate that sickness absence levels for male workers in private sector were still below the levels recorded in the 1970s. Mental disorders are an increasing reason for sickness absence in Norway and have contributed to an increase in mean duration of sickness absence spells. More epidemiological research on sickness absence in Norway is needed.

Adult↗

PubMed1990

[The black death in Norway].

The old Icelandic annals tell that the Black Death came to Bergen, Norway, in 1349 with a ship from England. This was probably at the beginning of September. From Bergen the plague spread rapidly northwards and southwards along the coast and over land to Eastern Norway. The Black Death remained in Norway for approximately six months. The epidemic must have been started by infected black rats and rat fleas in the grain cargo of the ship. The account in the annals, and experiences from other countries, indicate that pneumonic plague was dominant in Bergen at the start of the epidemic. After that the Black Death must have spread partly as pneumonic plague but mainly probably as bubonic plague, transmitted via human fleas from person to person. The rats cannot have played a part except in the initial phase. The annals say that 2/3 of Norway's population died. This is probably a big exaggeration. The mortality in Norway can hardly have been more than 40-50%. Even this is high compared with an estimated mortality of approximately 33% in England and on the continent.

Disease Outbreaks↗

PubMedDate not supplied

Hospital cost control in Norway: a decade's experience with prospective payment.

Under Norway's prospective payment system, which was in existence from 1972 to 1980, hospital costs increased 15.8 percent annually, compared with 15.3 percent in the United States. In 1980 the Norwegian national government started paying for all institutional services according to a population-based, morbidity-adjusted formula. Norway's prospective payment system provides important insights into problems of controlling hospital costs despite significant differences, including ownership of medical facilities and payment and spending as a percent of GNP. Yet striking similarities exist. Annual real growth in health expenditures from 1972 to 1980 in Norway was 2.2 percent, compared with 2.4 percent in the United States. In both countries, public demands for cost control were accompanied by demands for more services. And problems of geographic dispersion of new technology and distribution of resources were similar. Norway's experience in the 1970s demonstrates that prospective payment is no panacea. The annual budget process created disincentives to hospitals to control costs. But Norway's changes in 1980 to a population-based methodology suggest a useful approach to achieve a more equitable distribution of resources. This method of payment provides incentives to control variations in both admissions and cost per case. In contrast, the Medicare approach based on Diagnostic Related Groups (DRGs) is limited, and it does not affect variations in admissions and capital costs. Population-based methodologies can be used in adjusting DRG rates to control both problems. In addition, the DRG system only applies to Medicare payments; the Norwegian experience demonstrates that this system may result in significant shifting of costs onto other payors.

Cost Control↗

PubMed1994

Perinatal and infant mortality: trends and risk factors in Norway 1967-90.

Neither the infant nor the under 24 hours mortality rates in Norway improved in the 1980s. The late neonatal mortality rate did not improve significantly in either the 1980s or the 1970s. The postneonatal mortality rate rose steadily throughout the last 15 years. The major mortality declines for all age groups took place in the 1970s. In the 1980s, only the 1-7-day mortality improved significantly. As a result, Norway fell behind in the international ranking of perinatal and infant mortality. Disparities among the perinatal mortality rates of Norwegian counties diminished throughout the 1970s. In the 1980s, the county disparities intermittently increased. Postneonatal deaths represented an increasing proportion; in the late 1980s, they amounted to half of the infant deaths and one-third of the total perinatal and infant deaths. In 1988, the postneonatal mortality rate was about twice as high in Norway as in Finland, Iceland, or Sweden. Birth injuries and infections almost disappeared as causes of perinatal and infant death. Other perinatal causes also diminished substantially. The incidence of congenital anomalies remained stable. The incidence of sudden infant death syndrome (SIDS), the single cause with continuous rate rise, more than doubled. In the late 1980s, SIDS caused one-quarter of the infant and more than half of the postneonatal deaths. The share of perinatal deaths from placentoumbilical causes (mostly placenta previa and abruptio placentae) and maternal diseases increased substantially. The affluence of Norway surged in the late 1970s and the 1980s, but health care was not given a higher priority. About 80% of fertile women used contraceptives. The use of modern methods increased substantially; oral contraceptives, in particular. About 60,000 confinements and 15,000 legally induced abortions took place in Norway each year. The number of induced abortions increased in women in their twenties, but decreased in all other age groups. As the total fertility decreased, each woman, on average, gave birth to 1.9 children and experienced 0.5 legally induced abortion. Maternal mortality was reduced to nil. Fewer marriages were contracted, and the divorce rate more than doubled. As a result, more than 35% of all births now occur out of wedlock, as compared with 5% in the late 1960s. The individual importance of birth out of wedlock as a risk factor has been reduced substantially. The mean maternal age increased from 26 to 28 years. The proportion of births by teenage mothers dropped from 8 to 3%.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed2001

Differential and age-dependent effects of maternal deprivation on the hypothalamic-pituitary-adrenal axis of brown norway rats from youth to senescence.

In this study, the hypothesis was tested that infants deprived from maternal care show persistent changes in hypothalamic-pituitary-adrenal activity. For this purpose, we studied the effect of maternal deprivation in one cohort of the healthy ageing Brown Norway rat strain showing still more than 80% survival rate at 32 months of age. Three-day-old male Brown Norway rats were either maternally deprived for 24 h or remained with the dam. In 3, 12 and 30-32 months (young, adult, senescent) deprived rats and their nondeprived littermates (controls), we determined basal resting and stress-induced plasma adrenocorticotropic hormone (ACTH) and corticosterone as well as corticotropin releasing hormone (CRH) mRNA expression in the paraventricular nucleus (PVN) of the hypothalamus. Mineralocorticoid (MR) and glucocorticoid receptors (GR) in hippocampus and PVN were also assessed using in vitro cytosol binding and in situ hybridization. The effect of ageing per se showed that in the control nondeprived Brown Norway rats, basal corticosterone and ACTH concentrations did not change during life. However, with age, the corticosterone response to novelty stress became progressively attenuated, but prolonged, while there was an age-related increase in the ACTH response. CRH mRNA expression in PVN decreased with age. Hippocampal MR binding and MR mRNA expression in the dentate gyrus were reduced at senescence, as were the GR binding capacities in hippocampus and hypothalamus. Maternal deprivation did not affect survival rate, body weight, nor adrenal weight of the ageing Brown Norway rats. Basal corticosterone and ACTH levels were not affected by deprivation, except for a rise in basal corticosterone concentrations at 3 months. At this age, the corticosterone output in response to novelty was attenuated in the deprived rats. In contrast, a striking surge in novelty stress-induced corticosterone output occurred at midlife while, at senescence, the corticosterone and ACTH responses were attenuated again in the deprived animals, particularly after the more severe restraint stressor. CRH mRNA expression was reduced only during adulthood in the deprived animals. After maternal deprivation, the MR mRNA in dentate gyrus showed a transient midlife rise. GR binding in hypothalamus and hippocampus GR binding was reduced in young rats while, in the senescent deprived animals, a reduced GRmRNA expression was observed in PVN and hippocampal CA1. In conclusion, in the Brown Norway rat, ageing causes a progressive decline in corticosterone output after stress, which is paralleled at senescence by decreased MR and GR mRNA expression in hippocampus and hypothalamus. The long-term effects of maternal deprivation become manifest differently at different ages and depend on test conditions. The deprivation effect culminates in a midlife corticosterone surge and results at senescence in a strongly reduced corticosterone output.

Adrenocorticotropic Hormone↗

PubMed1995

Adrenocortical hyporesponsiveness and glucocorticoid feedback resistance in old male brown Norway rats.

This study was designed to examine adrenocortical function in old (30 months) and young (6 months) male Brown Norway rats. The following observations were made. First, stress induced a higher pituitary adrenocorticotropic hormone (ACTH) response in the aged male Brown Norway rats than in young rats, while peak circulating corticosterone (CORT) levels were not different. Moreover, this type of "repeated" stress involving subcutaneous injection and blood sampling at various time points by pinching the tail vein, evoked a prolonged ACTH and CORT response in the aged animal. Second, exogenous ACTH1-24 administered to dexamethasone-pretreated Brown Norway rats, used as an in vivo challenge test for adrenocortical function, resulted in a delayed CORT response in the aged rats. The termination of the CORT response to ACTH, however, was not different between young and old rats. Third, ACTH1-24 stimulation of adrenocortical cells in vitro showed a tendency to a reduced CORT output, when these cells were obtained from old animals. Fourth, adrenalectomy (ADX) differentially affected pituitary ACTH release at both ages. The initial post-ADX ACTH surge was more pronounced in the aged animals. Beyond 4 days post-ADX the old Brown Norway rats did not show the pronounced afternoon peak in circulating ACTH as was observed in the young animals. This study demonstrates that during the aging process a deficiency in adrenocortical function develops in the male Brown Norway rat. This deficiency involves a less efficient stress-induced activation of adrenocortical output of CORT having enhanced pituitary ACTH release as one of the consequences.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex↗

PubMed2003

Winter at the alpine timberline. Why does embolism occur in norway spruce but not in stone pine?

Conifers growing at the alpine timberline are exposed to frost drought and freeze-thaw cycles during winter-stress factors known to induce embolism in tree xylem. The two dominant species of the European Central Alps timberline were studied: Norway spruce (Picea abies [L.] Karst) and stone pine (Pinus cembra), which usually reaches higher altitudes. We hypothesized to find embolism only at the timberline and to observe less embolism in stone pine than in Norway spruce due to avoidance mechanisms. Seasonal courses of embolism and water potential were studied at 1,700 and 2,100 m during two winter seasons and correlated to vulnerability (to drought-induced embolism), leaf conductance, and micrometeorological data. Embolism was observed only at the timberline and only in Norway spruce (up to 49.2% loss of conductivity). Conductivity losses corresponded to low water potentials (down to -3.5 MPa) but also to the number of freeze-thaw events indicating both stress factors to contribute to embolism induction. Decreasing embolism rates-probably due to refilling-were observed already in winter. Stone pine did not exhibit an adapted vulnerability (50% loss of conductivity at -3.5 MPa) but avoided critical potentials (minimum -2.3 MPa): Cuticulare conductance was 3.5-fold lower than in Norway spruce, and angles between needles and axes were found to decrease in dehydrating branches. The extent of conductivity losses in Norway spruce and the spectrum of avoidance and recovery mechanisms in both species indicates winter embolism to be relevant for tree line formation.

Acclimatization↗

PubMed1991

The mortality of children with type 1 (insulin-dependent) diabetes mellitus in Norway, 1973-1988.

The mortality status of all individuals in Norway with the onset of Type 1 (insulin-dependent) diabetes mellitus from 1973 through 1982 and age at onset below 15 years was determined as of 1 July 1988. Of the 1908 cases included in the follow-up, 20 had died (15 males and 5 females) and 10 had emigrated. A two-fold increased risk for early mortality was exhibited among this cohort. Life-table analyses did not find sex or age at onset of Type 1 diabetes to be statistically significant predictors of survival when controlling for diabetes duration. A review of death certificates revealed that accidents and suicides accounted for 40% of the deaths in the total cohort and that this cause of death occurred only among male subjects. Acute diabetes related complications were the underlying causes of death for 35% of the subjects. Diabetic renal disease and death by cardiovascular disease were not documented in this young cohort with a maximum age of 30 years and maximum diabetes duration of 15.5 years. This is the first mortality report of a population-based registered cohort of Type 1 diabetic patients for Norway. While still being at increased risk for premature death, this cohort appears to be at decreased risk of early death when compared to a cohort of young diabetic patients from Oslo, Norway diagnosed in 1925-1955, suggesting improvements in the survival of individuals with Type 1 diabetes in Norway.

Adolescent↗

PubMed1975

The measurement of drug consumption. Drugs for diabetes in Northern Ireland, Norway and Sweden.

The consumption of insulin and oral antidiabetic drugs was measured at the gross sales level in Sweden and Norway and at the prescription level in Northern Ireland. ""Agreed daily doses'' were used as units of comparison, which defined as follows: insulin 40 I.U., tolbutamide 1 g, acetohexamide 500 mg etc. Consumption was expressed as the number of ""agreed daily doses'' per 1,000 inhabitants per day. This provided a rough estimate of the number of subjects for whom the drug had been prescribed per 1,000 population. The data were collected during the three months April-June 1971. Marked differences in the consumption of antidiabetic drugs were found between the three countries and also between areas within each country. The consumption of insulin was similar in Norway and Northern Ireland (3.5 and 3.9 agreed daily doses per 1,000 inhabitants per day), but almost twice as high in Sweden. In Norway much lower use was found in certain rural areas. The variation in the consumption of oral antidiabetic drugs was even more marked. Surprisingly, consumption was considerably higher in Sweden (15.8) than in the nearby Norway (7.3), and was even lower in Northern Ireland (4.3). The major use was of sulphonylureas, especially chlorpropamide. Within the countries there was marked regional variation in the choice of individual biguanides and sulphonylureas. The data are discussed in relation to such factors as the incidence of diabetes, the sole use of dietary treatment etc. It is concluded that studies in depth, which link the actual use of drugs by patients to diagnosis, diabetic symptoms and clinical outcome of treatment are necessary in order to explore the reasons behind the marked geographical differences and to define a rational drug policy. However, the methods described in the study may be used for early detection of gross national differences in drug utilization, the further investigation of which may reveal to be of great public health interest.

Diabetes Mellitus↗

PubMed1997

Use of lipid-lowering drugs from 1990 to 1994: an international comparison among Australia, Finland, Italy (Emilia Romagna Region), Norway and Sweden.

OBJECTIVE: To compare the overall utilisation pattern of lipid-lowering drugs between 1990 and 1994 in Australia, Finland, Italy, Norway and Sweden as well as the pattern of use with respect to age and gender in Italy and Sweden. METHODS: Data were retrieved from regulatory authorities in each country for the 5-year period and analysed according to the ATC/DDD methodology (Anatomical Therapeutic Chemical classification/Defined Daily Doses). Utilisation was calculated as the DDDs for 1000 inhabitants per day for all drugs of the ATC category B04 (serum lipid-reducing agents). Data from Sweden and Italy were also compared with respect to gender and age. RESULTS: In 1994, Australia demonstrated the highest degree of utilisation (11.9 DDD) and the Nordic Countries the lowest (Sweden 5.6; Norway 4.9; Finland 4.0). In all countries except Italy, a steady increase was observed; in Italy, utilisation of these drugs reached a maximum in 1992 (11.5 DDD), but then underwent a reduction which was caused by restrictions in the reimbursement status in 1993 (10.4) and 1994 (6.7). Administration of statins increased in all countries, becoming the most used group of the B04 class. In 1988, the number of different drugs listed by each national health service ranged from 4 (Norway) to 16 (Italy); in 1994 it ranged from 6 (Norway) to 9 (Sweden). Analysis with respect to gender showed the opposite pattern in Sweden (males 4.6 and females 3.3 in 1992; 6.2 and 4.5, respectively, in 1994) than in Italy (males 10.8 and females 17.8 in 1992; 6.4 and 9.2, respectively, in 1994). Exposure was highest in people aged 60-69 years in both countries, followed by age group 50-59 in Sweden and 70-79 in Italy. CONCLUSIONS: Large variations in the utilisation of lipid-lowering drugs exist between countries, with Australia and Italy much higher than others. Of the drugs in the ATC category B04, the use of statins predominates in all countries, but to varying degrees. The large difference in the degree of drug utilisation with respect to age and gender between Italy and Sweden suggests major deviations from evidence-based medicine.

Adolescent↗

PubMed2005

Deregulating the pharmacy market: the case of Iceland and Norway.

The pharmacy market in many European countries is characterised by individually owned pharmacies that operate under tight government control regarding barriers to entry, scope of activities and profit margins. Many countries are, however, in the process of introducing pro-competitive policies, including possibilities to own several pharmacies and competition based on price. In Iceland and Norway, restrictions to ownership and competition were relaxed in 1996 and 2001, respectively. In both countries, the new policies quickly led to horizontal integration and concentration of the market, and in Norway the merging pharmacy groups integrated vertically with wholesalers. By 2004, two pharmacy groups in Iceland and three pharmacy groups in Norway controlled 85 and 97% of the markets, respectively. In combination with remaining barriers to entry, this market concentration may call for additional pro-competitive interventions to prevent unfavourable developments. Such policies will simultaneously make it more difficult to uphold traditional social objectives related to pharmacy services. Experiences in both Iceland and Norway highlight the complexity of managing reforms that fundamentally influence competitive behaviour.

Economic Competition↗

PubMed2006

Priority setting at the micro-, meso- and macro-levels in Canada, Norway and Uganda.

UNLABELLED: The objectives of this study were (1) to describe the process of healthcare priority setting in Ontario-Canada, Norway and Uganda at the three levels of decision-making; (2) to evaluate the description using the framework for fair priority setting, accountability for reasonableness; so as to identify lessons of good practices. METHODS: We carried out case studies involving key informant interviews, with 184 health practitioners and health planners from the macro-level, meso-level and micro-level from Canada-Ontario, Norway and Uganda (selected by virtue of their varying experiences in priority setting). Interviews were audio-recorded, transcribed and analyzed using a modified thematic approach. The descriptions were evaluated against the four conditions of "accountability for reasonableness", relevance, publicity, revisions and enforcement. Areas of adherence to these conditions were identified as lessons of good practices; areas of non-adherence were identified as opportunities for improvement. RESULTS: (i) DESCRIPTION: at the macro-level, in all three countries, cabinet makes most of the macro-level resource allocation decisions and they are influenced by politics, public pressure, and advocacy. Decisions within the ministries of health are based on objective formulae and evidence. International priorities influenced decisions in Uganda. Some priority-setting reasons are publicized through circulars, printed documents and the Internet in Canada and Norway. At the meso-level, hospital priority-setting decisions were made by the hospital managers and were based on national priorities, guidelines, and evidence. Hospital departments that handle emergencies, such as surgery, were prioritized. Some of the reasons are available on the hospital intranet or presented at meetings. Micro-level practitioners considered medical and social worth criteria. These reasons are not publicized. Many practitioners lacked knowledge of the macro- and meso-level priority-setting processes. (ii) Evaluation-relevance: medical evidence and economic criteria were thought to be relevant, but lobbying was thought to be irrelevant. Publicity: all cases lacked clear and effective mechanisms for publicity. REVISIONS: formal mechanisms, following the planning hierarchy, were considered less effective, informal political mechanisms were considered more effective. Canada and Norway had patients' relations officers to deal with patients' dissensions; however, revisions were more difficult in Uganda. Enforcement: leadership for ensuring decision-making fairness was not apparent. CONCLUSIONS: The different levels of priority setting in the three countries fulfilled varying conditions of accountability for reasonableness, none satisfied all the four conditions. To improve, decision makers at the three levels in all three cases should engage frontline practitioners, develop more effectively publicized reasons, and develop formal mechanisms for challenging and revising decisions.

Health Personnel↗

PubMed1997

Recent trends in atmospheric deposition of trace elements in Norway as evident from the 1995 moss survey.

Atmospheric trace element deposition in Norway has been evaluated by using data from a national moss survey from 1995, comprising 53 elements in 458 samples of the ground growing moss Hylocomium splendens. The results are compared with similar surveys carried out in 1977, 1985 and 1990 in order to evaluate temporal deposition trends. Atmospheric long-range transport (LRTP) from other parts of Europe is the main source for deposition of V, Zn, As, Mo, Ag, Cd, Sn, Sb, Hg, Tl, Pb and Bi in Norway. Between 1977 and 1990 the levels of most of the LRTP elements monitored (V, Zn, As, Cd, Sb, Pb) were reduced by more than 50%. Between 1990 and 1995, no further decrease has been observed for any of the LRTP elements, except for Pb where a further reduction is evident. The most north-easterly part of Norway is exposed to high levels of Co, Ni and Cu from emission sources from the Kola peninsula, Russia and the levels have not changed significantly since 1977. A new ferro-chrome smelter at Mo i Rana, northern Norway has resulted in a substantially enhanced deposition of Cr in the surrounding area.

Air Pollution↗

PubMed1999

The usage of veterinary antibacterial drugs for mastitis in cattle in Norway and Sweden during 1990-1997.

The prescribing patterns and annual incidence of use of antibacterial drugs for the treatment of mastitis in cattle in Norway and Sweden during the period 1990-1997 were estimated from drug wholesaler statistics. Although the drugs included in this study are also used in other species and/or other indications, mastitis in cattle is by far the most-common indication for their use. We used these sales figures to evaluate trends in the use of antibacterial drugs and changes in the incidence of treatment in bovine mastitis in Norway and Sweden. To facilitate comparisons (correcting for differences in activity and dosage) between the relative proportions of antibacterial drugs used in bovine mastitis, we introduced defined daily dose cow (DDDcow) as unit of measurement. Tentative DDDcow for the various injectable drugs were derived from doses recommended in Norway and Sweden. For intramammary drugs administered in the form of single-dose applicators, one applicator was defined as the DDDcow. The prescribing patterns of antibacterial drugs in bovine mastitis in Norway and Sweden during the study period seemed to be influenced by treatment policies, substances and formulations approved and treatment cost; length of the withdrawal period also seemed to play a role.

Animals↗

PubMed2001

Genetic epidemiology of BRCA1 mutations in Norway.

Familial breast-ovarian cancer has been demonstrated to be frequent but unevenly distributed in Norway. This was assumed to be caused by the reduced population size created by the medieval Bubonic plagues 25 generations ago, and by the following rapid expansion. We have previously reported that four mutations account for 68% of the BRCA1 mutation carriers. Subsequent analysis has resulted in a total of 100 separate families carrying one of these founder mutations. The four mutations occurred on one specific BRCA1 haplotype each. The 1675delA, 816delGT and 3347delAG families originated from the South-West coast of Norway with a few families in the north, while the traceable ancestors of the 1135insA families clustered along the historical inland road from the South-East to mid-Norway. The carriers of each of the four mutations today are descendants of one or a few individuals surviving the plagues. We may identify the majority of BRCA1 mutation carriers in Norway by screening for local founder mutations.

Breast Neoplasms↗

PubMed1998

Survival of breast cancer patients in Lithuania and Norway, 1988-1992.

In Norway, the incidence of breast cancer is almost twice that in Lithuania, whereas the mortality rates of the disease are approximately the same in both countries. The aim of the present study was to compare the survival of breast cancer patients in the two countries according to stage. The material from both countries included cases diagnosed between 1988 and 1992 with complete follow-up of date of death to the end of 1995. The Norwegian data consisted of all 9403 new cases recorded by the Norwegian Cancer Registry. The Lithuanian data included in all 1649 new cases treated at the Oncology Centre in Vilnius, which represents 40% of breast cancer cases in Lithuania--these cases had the same distribution of the disease by age and stage as for the whole country. The overall 5-year relative survival was lower in Lithuania (57.3%) than in Norway (78.4%). Lower survival was observed in Lithuania compared with Norway for all stages. In stage I, the difference was 7.8% in absolute terms which could be explained by a higher proportion of small tumours among the Norwegian cancer cases (63.7% of tumours were 2 cm or less, while in Lithuania the proportion of small stage I tumours was only 27.9%). Therefore, early diagnosis within the stage I category seems relevant. The difference in survival was, however, most pronounced in stage II (20%) and III (29%). In Norway, the better overall survival is partly explained by a more favourable stage distribution. The lower survival of Lithuanian cases within stage categories could be explained by more advanced metastases to regional lymph nodes and by higher proportions of large tumours within stage.

Adult↗