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PubMed2001

[Radiological classification of pituitary adenomas].

Magnetic resonance imaging (MRI) is the modality of choice in the diagnosis of pituitary pathology. A chronological outline and discussion of the radiological classifications of pituitary adenomas applied so far are presented, with a review in depth of the up-to-date classifications based on MRI. SIPAP is an MR classification used in Scandinavia. It is basically a six-figure number describing the extrasellar extension of the adenoma. Together with tumour size, it is a useful and simple method for registration of pituitary adenomas.

Adenoma↗
PubMed2001

Benchmarking initiatives in the water industry.

Customer satisfaction and service care are every day pushing professionals in the water industry to seek to improve their performance, lowering costs and increasing the provided service level. Process Benchmarking is generally recognised as a systematic mechanism of comparing one's own utility with other utilities or businesses with the intent of self-improvement by adopting structures or methods used elsewhere. The IWA Task Force on Benchmarking, operating inside the Statistics and Economics Committee, has been committed to developing a general accepted concept of Process Benchmarking to support water decision-makers in addressing issues of efficiency. In a first step the Task Force disseminated among the Committee members a questionnaire focused on providing suggestions about the kind, the evolution degree and the main concepts of Benchmarking adopted in the represented Countries. A comparison among the guidelines adopted in The Netherlands and Scandinavia has recently challenged the Task Force in drafting a methodology for a worldwide process benchmarking in water industry. The paper provides a framework of the most interesting benchmarking experiences in the water sector and describes in detail both the final results of the survey and the methodology focused on identification of possible improvement areas.

Benchmarking↗
PubMed1975

[Scandinavian world record in physician manpower].

If Denmark, Finland, and Sweden continue to train new doctors at the same rate as they do now, these countries will stand a good chance of holding the world record in the doctor-patient ratio before the year 2000. Then, around 1980, 1990, and 2000, respectively, they will pass the milestones of 20, 30, and 40 doctors per 10,000 population. This means a two-fold increase in the number of doctors in 20 years, the number of doctors in the three countries increasing by between 50 and 100 per cent in the 1970s. In Scandinavia as a whole, there would in the year 2000 be about 95,000 doctors serving a population of just under 24,000,000. What does the situation look like in the global perspective? Calculating optimistically with "only" a twofold increase in the world population over the 30-year period 1970-2000, there would be a need of: 2,000,000 more doctors just to maintain the doctor/patient ratio of 1970, i.e. 7.9 doctors per 10,000 population, a ratio that Finland exceeded in the early sixties; 4,200,000 more doctors so as to keep up the same increase as in the 1960s. End result: 12 doctors per 10,000 population in the year 2000, a level that Iceland, Norway, and Sweden reached in the mid sixties -- in Denmark the doctor-patient ratio was then 14 per 10,000 population. It is most realistic, however, to count on an increase of 3,300,000 doctors in 30 years, which will mean a total number of 10.5 doctors per 10,000 population in the year 2000.

Community Health Services↗
PubMed2001

[Hemorrhagic fever with renal syndrome].

Puumala hantavirus is the most common hantavirus infection in Western Europe. The causative agent, Puumala virus, is a member of the Hantavirus genus in the Bunyaviridae family. The natural hosts of hantaviruses are chronically, but asymptomatic infected rodents, which transmit the virus to human in their excretions. Puumala virus is carried by the bank vole, clethrionomys glareolus. Hemorrhagic fever with renal syndrome (HFRS) caused by Puumala virus in France or Belgium is very similar to the previously described Nephropathia epidemica in Scandinavia. In most severe cases, the disease is clinically characterized by high fever of abrupt onset, headache, loin or abdominal pains, nausea and vomiting, and occasionally acute and transient myopia. Renal involvement results in transient proteinuria and hematuria and acute renal failure. Except for interstitial hemorrhage in the outer medulla, the renal histopathologic findings are unspecific and include prominent changes in the interstitium with interstitial oedema and inflammatory infiltrates. Thrombocytopenia, mild elevation of liver enzymes, and leukocytosis are typical laboratory findings. Spontaneous complete recovery is the rule. Laboratory diagnosis is primarily based on serology such as indirect immunofluorescence or capture enzyme--linked immunosorbent assays which detect IgM antibodies and an increased level of IgG antibodies against Puumala virus. Viral antigen may be demonstrated in the cytoplasm of renal tubular epithelial cells.

Acute Kidney Injury↗
PubMed2001

[Can human papillomavirus testing and vaccination prevent cervical cancer?].

BACKGROUND: Cervical cancer is the third most frequent cancer among women worldwide. Human papillomavirus (HPV) infection is a necessary risk factor and the first step in cervical carcinogenesis. MATERIAL AND METHODS: This article reviews the current literature concerning the possibility of preventing cervical cancer by HPV testing and vaccination. RESULTS: HPV testing cannot replace cytology, but will reduce false negative cytology and may improve the screening programme for cervical neoplasia. It has not yet been incorporated in any national cervical cancer screening program, but trials are ongoing in Scandinavia and in the Netherlands. The cost-effectiveness of HPV testing in screening has to be proven and whether it can affect the recommended screening-intervals. Therapeutic and prophylactic vaccines for HPV associated disease are in progress. Evaluating the clinical trials that are ongoing will take several years. Several anti-HPV vaccines are now in clinical trials; Norway will also participate. Therapeutic vaccines against cervical cancer have so far not been successful, but anogenital dysplasias and condylomas may be more susceptible. Prophylactic vaccines against HPV 6, 11, 16 and 18 have been evaluated in clinical phase I and II trials, and phase III trials are in progress. INTERPRETATION: HPV testing improves the specificity and sensitivity of cervical cytology and it can be used to clarify cases with atypical cells of undetermined significance (ASCUS) and low-grade intraepithelial neoplasia. In the near future it may also be included in the cervical cancer screening programme for women above the age of 30. The first results in clinical vaccine trials are encouraging, and final conclusions about the effectiveness of these vaccines may be achieved in five years' time.

Female↗
PubMed2001

Interstitial lung diseases: an epidemiological overview.

Epidemiological studies on interstitial lung diseases (ILDs) may be schematically subdivided into the following major types: 1) quantifications of disease, broken down into incidence, prevalence and mortality data; 2) identification of aetiological factors; and 3) clinical epidemiological studies. Epidemiological data may be obtained from different sources or population groups, using different study designs such as systematic national statistics, population-based data and registries, and large case series of specific diseases. Differences in results between epidemiological studies may be due to real differences in incidence, but may also be due to changes in disease definitions and classifications, differences in the epidemiological design of the studies, or even registration bias. Comparative epidemiological data of different ILDs are almost limited to the general population study in Bernalillo County and to national mortality statistics, which should be interpreted with great caution. Also, some, mostly national registries of the different ILDs have been carried out by specific medical profession groups (especially pulmonologists), which clearly underestimate the real incidence of ILDs, but in which the comparison of the relative frequencies is probably accurate. Based on all these comparative studies, sarcoidosis and idiopathic pulmonary fibrosis appear to be the most frequent ILDs, followed by hypersensitivity pneumonitis and ILD in collagen vascular disease, when classical pneumoconioses are not included. There is also a relatively large group of nonspecific fibrosis. Much more data have been published on the epidemiology of specific forms of interstitial lung disease. Most information is available on the epidemiology of sarcoidosis, and those data are probably the most accurate. Data on idiopathic pulmonary fibrosis have the disadvantage of the recent changes in definition and classification of this disease. Hypersensitivity pneumonitis has been studied epidemiologically, especially in some exposure groups such as farmers and pigeon breeders, and in some regions in North America, UK, France and Scandinavia. Estimates of frequencies of interstitial lung disease in collagen vascular disease or of drug-induced interstitial lung disease are less accurate and more variable, depending on diagnostic criteria. Notwithstanding the aforementioned problems, this report tries to provide a balanced overview of the epidemiology of different interstitial lung diseases.

Humans↗
PubMedDate not supplied

Efficacy of enalapril for prevention of congestive heart failure in dogs with myxomatous valve disease and asymptomatic mitral regurgitation.

We evaluated the long-term effect of early angiotensin-converting enzyme (ACE) inhibition (enalapril maleate) as monotherapy to postpone or prevent congestive heart failure (CHF) in asymptomatic dogs with mitral regurgitation (MR) attributable to myxomatous valvular disease (MVD) in a prospective, randomized, double-blinded, placebo-controlled multicenter trial involving 14 centers in Scandinavia. Two hundred twenty-nine Cavalier King Charles (CKC) Spaniels with MR attributable to MVD but no signs of CHF were randomly allocated to treatment with enalapril 0.25-0.5 mg daily (n = 116) or to placebo groups (n = 113). Each dog was evaluated by physical examination, electrocardiography, and thoracic radiography at entry and every 12 months (+/-30 days). The number of dogs developing heart failure was similar in the treatment and placebo groups (n = 50 [43%] and n = 48 [42%], respectively; P = .99). The estimated means, adjusted for censored observations, for the period from initiation of therapy to heart failure were 1,150 +/- 50 days for dogs in the treatment group and 1,130 +/- 50 days for dogs in the placebo group (P = .85). When absence or presence of cardiomegaly at the entrance of the trial was considered, there were still no differences between the treatment and placebo groups (P = .98 and .51, respectively). Multivariate analysis showed that enalapril had no significant effect on the time from initiation of therapy to heart failure (P = .86). Long-term treatment with enalapril in asymptomatic dogs with MVD and MR did not delay the onset of heart failure regardless of whether or not cardiomegaly was present at initiation of the study.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2001

[Streptococcus group A infections of skin, soft tissue and blood].

BACKGROUND: Group A streptococcus is one of the most common bacterial pathogens causing infections in tissue and organs, most frequently throat and skin. Since the late 1980s there have been reports from Scandinavia and many other countries documenting a resurgence of highly invasive infections such as puerperal fever, necrotizing fasciitis, myositis and sepsis. MATERIAL AND METHODS: On the basis of relevant studies and reviews and a clinical study of 61 patients between 1992 and 1999 with necrotizing fasciitis and myositis at Haukeland University Hospital, Bergen, Norway, we present an overview of the prevalence, pathogenesis, clinical features and treatment of group A streptococcal infections in skin, soft tissue and blood. RESULTS AND INTERPRETATION: The reason for the increase in severe group A streptococcal infections is unclear. The clinical features depend on the level of infection (superficial skin, subcutis, fascia and muscle): the deeper the initial infection, the more frequent development of bacteraemia and life-threatening disease. Serious infections are associated with shock and multiorgan failure, i.e. streptococcal toxic shock syndrome. Early surgical debridement is essential in necrotizing fasciitis and myositis. Penicillin is still the drug of choice for milder infections. The addition of clindamycin is recommended in cases of more invasive infection.

Adult↗
PubMed2001

[Some aspects of the history of tuberculosis with special reference to Finland].

A popular theory has been that Mycobacterium (M) tuberculosis evolved from M. bovis after cattle domestication. The evidence of M. tuberculosis complex in the Western Hemisphere before Columbus and the paleopathological evidence from the Near East indicate that this relationship between cattle domestication and evolution of tuberculosis might not have been so straightforward. Tuberculosis was already familiar in Scandinavia during the Middle Ages. In Finland consumption was firmly established in both towns and countryside at the end of the 1700s and the epidemic peaked during the following century. Tuberculosis infection must have been an almost universal feature of childhood in many areas of Finland, even in the early decades of the 20th century. After the Second World War, specific and effective chemotherapy and preventive measures rapidly diminished the number of new cases of tuberculosis.

Finland↗
PubMed2001

[Where are all the Viking helmets?].

Based on archaeological finds and old Norse literature, this article describes the Scandinavian helmet tradition from the Bronze Age to the Viking Age, as well as the Viking culture, with special emphasis on weaponry, burial customs, and head protection. Contrary to what is commonly believed, metal helmets must have been used very infrequently by the Vikings. Only one Viking helmet has been retrieved in Scandinavia. Possible reasons for the wide-spread misunderstanding that the Vikings wore helmets are discussed. The archaeological profession must partly bear the responsibility for not correcting this misunderstanding.

Archaeology↗
PubMed2001

[Tuberculosis among immigrants in Scandinavian medical journals].

BACKGROUND: The decline in incidence of tuberculosis in Scandinavia has stagnated in the last decades because of a growing number of immigrants from high incidence countries. The aim of this study was to find out what has been published on tuberculosis among immigrants in Denmark, Norway and Sweden in the main medical journals in these countries from 1995 to 2000. MATERIAL AND METHODS: 23 papers on the topic were identified through PubMed searches. Eight papers were selected for a more detailed description of their content. RESULTS: The main medical journals in Denmark, Norway and Sweden have published papers on epidemiological aspects and clinical traits as well as the challenge for the health services of controlling tuberculosis in immigrants. The majority of patients are under the age of 40 and of African origin. They seldom infect the population of the host country. Extrapulmonary tuberculosis is relatively common. Control on arrival could be improved in all three countries. Considerable doctor's and patient's delay is not uncommon. INTERPRETATION: Medical journals are an important source for knowledge on tuberculosis among immigrants from high incidence countries.

Adult↗
PubMed2002

[Nic Waal--the mother of Norwegian child and adolescent psychiatry].

Nic (Caroline) Waal (1905-60) is said to be the mother of Norwegian child and adolescent psychiatry. She was an engaged and engaging personality, outgoing, at times aggressive and at the same time very sensitive. Her sensitivity caused her suffering but it was an asset in her work with patients. She qualified in medicine in Oslo in 1930 and received her psychoanalytic training in Berlin and Oslo. She was certified as a psychoanalyst in 1933, as a psychiatrist in 1951 and--among the first in Norway--as a child psychiatrist in 1953. From 1953 till her untimely death in 1960 she was head of Nic Waal's Institute, a treatment centre and training institute for all child psychiatric professions. Through the training she provided and her published work she has had considerable influence on the development of child psychiatry in Norway and in Scandinavia. She also developed her own method of psychodiagnosis through the study of patients' pattern of muscular tensions. Her institute is still active and expanding, having included family therapy and neuropsychology and neuropsychiatry.

Adolescent↗
PubMedDate not supplied

[Foetal programming of nutrition-related chronic diseases].

Intrauterine growth retardation, which reflects in large part maternal malnutrition in poorer communities, contributes to chronic disease risk through foetal programming, according to the early origins hypothesis of Barker. Foetal programming implies that during critical periods of prenatal growth, permanent changes in metabolism or structures result from adverse intrauterine conditions. Observational studies first showed an association between lower birth weights and higher rates of coronary disease in the 80s, in England and Scandinavia. The link between low birth weights, or other indicators of small birth size, and cardiovascular disease was later confirmed in many epidemiological studies, including in the USA and in India. Similarly, a reverse relationship of birth weight and systolic blood pressure was shown in men and women, in developed as well as developing countries, and in all age groups, although it was less consistent in adolescents. Insulin resistance and type-2 diabetes have also been found to be independently related to small size at birth in several studies around the world. Insulin resistance associated with small size at birth was frequently shown to be present at a young age. The association of small birth size with chronic disease tends to increase with catch-up growth and obesity, and usually persists after adjusting for confounding factors such as age, family history, and socio-economic status. Several, but not all, twin studies lend support to the hypothesis. There is a tendency for lighter members of twin pairs to have a higher blood pressure, and more diabetes. Observations in people exposed to the Dutch famine while in utero also tend to corroborate the hypothesis. Those who were exposed early in their intrauterine life did not have lower birth weights, but they were prone to becoming obese later on. In contrast, those exposed towards the end of gestation had lower birth weights, and showed a higher rate of impaired glucose tolerance, while having a lower risk of obesity. Dietary manipulations in animal models provide further support and mechanistic explanations, in particular protein deficiency in pregnant rats, which elevates blood pressure, impairs glucose tolerance, and increases the likelihood of obesity in the progeny. Although there are still controversial areas, there is at present sufficient scientific evidence for foetal programming to be regarded as an additional risk factor for chronic disease, in interaction with genetic and lifestyle risk factors. The fact that intrauterine growth retardation may predispose to nutrition-related chronic disease has serious implications for developing countries, particularly those undergoing rapid nutritional transition, as it may further increase the rates of obesity, cardiovascular disease and diabetes when diets and lifestyles are in themselves "atherogenic". The challenge is for programmes to simultaneously combat apparently opposite nutrition problems, malnutrition and "over-nutrition". Improving the nutrition of women is even more imperative when considering that it may contribute to preventing chronic diseases in the next generation, in addition to enhancing health and survival of mothers and children.

Birth Weight↗
PubMed1975

Research policies related to laryngeal cancer in clinical departments of Scandinavian universities.

This review covers ongoing and planned research projects in Scandinavian university ENT facilities concerning laryngeal carcinoma. Scandinavia (Denmark, Finland, Sweden, Norway and Iceland) has a population of fewer than 22 million, and therefore each department has only a few patients with laryngeal carcinoma per year. Clinical surveys of therapeutic results were the most commonly performed investigation. Many departments are interested in cytostatics alone or in combination with radiotherapy. Histopathological classification and malignancy grading of laryngeal carcinoma with multifactor analysis, diagnosis and treatment of precancerous conditions, and whole organ serial sectioning occupy some departments. Etiological factors, diagnostic problems, and postoperative functional disturbances are other fields of interest. Immunology and experimental animal research are both studied to a lesser extent. A very great interest exists for inter-regional and inter-Scandinavian joint projects, which may hopefully become a reality after this survey.

Female↗
PubMed2002

[The cynical game of the tobacco industry. Many years' efforts to deny or cover-up the negative effects of tobacco are revealed by the forced publication of internal documents].

Scrutiny of internal tobacco industry documents, now available on the Internet, reveals that Sweden and Finland were classified as "priority 1" areas in which to intensify efforts to resist tobacco control measures. In the late 1980s Philip Morris increased its activities in Scandinavia in order to counteract penal taxation threats and marketing restrictions. Swedish scientists were engaged by the tobacco industry in the "White Coat" project, a program expected to shed doubt on research linking passive smoking to health risks. The Swedish tobacco company Swedish Match collaborated with Philip Morris in challenging measures to limit tobacco use, including the new, stricter tobacco law proposed in the early 1990s.

Conflict of Interest↗
PubMed2002

[Takayasu's arteritis. An unusual cause of AMI and sudden death in a young man].

The sudden death of a 24-year-old Danish man is reported. Autopsy showed acute myocardial infarction (MI) as the immediate cause of death, together with vasculitis in the aorta and coronary vessels. MI and vascular lesions were attributable to Takayasu's arteritis, which is a well-known cause of cardiovascular disease in Asia. It is rarely seen in Scandinavia and this case represents the first reported MI caused by this disease in Denmark.

Adult↗
PubMed2002

[How an outbreak of MRSA in Gothenburg was eliminated: by strict hygienic routines and massive control-culture program].

The largest single-strain outbreak of methicillin resistant Staphylococcus aureus (MRSA) in Scandinavia so far occurred at Sahlgrenska University Hospital in Western Sweden 1997-2000. The strain identified was identical to the UK EMRSA-16 strain. 147 patients at 36 different wards became colonised or infected. Established routines for infection control had to be revised. The endemic situation necessitated an MRSA screening programme in October 1999 for all former hospital patients on re-admission. Since May 2000 no patient has been found with the outbreak strain at Sahlgrenska University Hospital.

Adolescent↗
PubMed1980

[The Dutch emigration pattern around 1840 in the European perspective].

"In 1850 and 1860 the Netherlands ranked eighth among twelve North-Western European nations that contributed to the transatlantic migration. The Dutch emigration pattern reflecting the agrarian crisis of the 1840's resembled the one of Hanover and Westphalia, be it that like in Scandinavia the ecclesiastical situation played a more important part. Besides the motivating forces, conditions such as information, organization, public and official reactions, and transportation are reviewed." (SUMMARY IN ENG)

Demography↗