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PubMed1996

[The prevalence of bronchial asthma is increasing and mortality varies].

The authors are presenting a review on the prevalence of bronchial asthma (AB) worldwide and in this country in the child and adult population. The cumulative prevalence of AB in children in Europe is 2.8-19.5%, most frequently 5-10%. The highest prevalence is in Australia (as high as 30%). The cumulative and present prevalence of AB in children doubled in the last ten years. A rise is described in most countries (Scandinavia, Spain, Wales, USA, New Zealand, Australia and Czech Republic). In adults the prevalence of AB is lower, but the rise is similar. The mortality from AB is no longer increasing during the last five years, or is even declining. In the Czech Republic the mortality declined from 2.61/100 000 population to 2.05/100 000 population in 1990-93, in 1994 to 1.58/100 000 population. In 1994 in our country 163 people died from AB.

Adolescent↗
PubMed1996

[Embolization of cerebral aneurysms. A new therapeutic possibility].

Treatment of cerebral aneurysms with Guglielmi Detachable Coils (GDC) was performed for the first time in Scandinavia in 1992. The experience at Ullevål University Clinic from 1994 to 1996 comprises 27 surgically inoperable aneurysms. Successful embolization was performed in 20 patients. No complications were seen during the procedure. However, renewed bleeding with fatal outcome occurred in one patient. In accordance with other colleagues we consider this treatment to be unsuitable for wide neck aneurysms (> 5 mm). For this reason seven patients were not treated. We conclude that GDC embolization seems to be an effective therapy for selected inoperable aneurysms. In the near future the method will probably be used to treat some of the surgically operable aneurysms as well.

Adult↗
PubMed1997

[Outbreak of methicillin resistant Staphylococcus aureus in a central hospital].

Until 1994, methicillin resistant Staphylococcus aureus (MRSA) were isolated from less than 60 patients annually in Denmark. We describe an outbreak of MRSA involving eight patients within a timespan of six weeks. Bacteriophage-typing and DNA typing using pulsed field gel electrophoresis revealed that three different strains of MRSA were involved in the outbreak. This emphasizes the importance of typing MRSA in order to clear up the spread in an outbreak. Of the eight patients four died, and in one case MRSA was thought to be the major cause of death. The expenses of the extra hygienic measures i.e. isolation of patients, medication and bacteriological surveillance were estimated to approximately DKK 80.000 pr. patient. Patients, who have been admitted to or worked at a hospital outside Scandinavia within the last six months, are potentially colonized with MRSA. Specific guidelines for hospital hygiene are necessary to prevent the spread of such strains.

Adult↗
PubMed1997

[Cholestasis in pregnancy. A pure cytolytic form].

BACKGROUND: Intrahepatic cholestatic disease in pregnancy is the second most frequent cause of jaundice after viral hepatitis. Elevated serum alkaline phosphatase is always found but is of little aid for diagnosis. CASE REPORT: A 32-year-old woman (third gestation, second parturition) consulted at 31 weeks gestation after progressive development of pruritus then jaundice. Transaminase levels were elevated. The diagnosis of intrahepatic cholestasis was retained despite normal alkaline phosphatase levels throughout the disease course. DISCUSSION: Intrahepatic cholestasis of pregnancy is rare in France compared with its frequency in Latin America and in Scandinavia. The pathogenesis remains uncertain. Diagnosis is based on clinical and laboratory findings as well as morphological arguments. Nevertheless, the results of liver tests vary widely. Transaminase levels may rise greatly but no prior case with normal alkaline phosphatase levels has been reported. Most importantly, clinical course is spontaneously regressive; pruritus and jaundice disappear within a few days after delivery allowing the diagnosis of intrahepatic cholestasis of pregnancy.

Adult↗
PubMed1997

Epidemiology of sexually transmitted diseases in the Baltic countries.

According to the UN definition the Baltic countries belong to the group of countries whose economy is in transition. This transition period has created changes in life-style, priorities and living standards. The objective of this study was to determine the incidence, distribution and control of sexually transmitted diseases (STDs) in the Baltic countries and to draw some comparisons with data from Scandinavia. We have compared the official statistical data concerning STDs from 1991-94 in all three Baltic countries and have attempted to obtain information about the way these reports are collected. We have come to the following conclusions: -the incidence rate of STD in the Baltic countries is increasing, -the average age of patients suffering from STDs is decreasing, -the specificity of the diagnostic methods used for STDs (especially Chlamydia trachomatis) needs to be improved. Facilities for diagnosing HSV and HPV should be made available.

Baltic States↗
PubMed1997

The Losartan Intervention For Endpoint reduction (LIFE) in Hypertension study: rationale, design, and methods. The LIFE Study Group.

The treatment of hypertension mainly with diuretics and beta blockers reduces cardiovascular mortality and morbidity, largely due to a decreased incidence of stroke, whereas the beneficial effects of antihypertensive therapy on the occurrence of coronary events have been less than expected from epidemiological studies. Furthermore, treated hypertensive patients still have a higher cardiovascular complication rate, compared with matched normotensives. This is particularly evident in patients with left ventricular hypertrophy (LVH), a major independent risk indicator for cardiovascular disease. In addition to elevating blood pressure, angiotensin II (A-II) exerts an important influence on cardiac structure and function, stimulating cell proliferation and growth. Thus, to further reduce morbidity and mortality when treating hypertensive patients, it may be important to effectively block the effects of A-II. This can be achieved directly at the A-II receptor level by losartan, the first of a new class of antihypertensive agents. It therefore seems pertinent to investigate whether selective A-II receptor blockade with losartan not only lowers blood pressure but also reduces LVH more effectively than current therapy, and thus improves prognosis. The Losartan Intervention For Endpoint reduction (LIFE) in Hypertension study is a double-blind, prospective, parallel group study designed to compare the effects of losartan with those of the beta-blocker atenolol on the reduction of cardiovascular morbidity and mortality in approximately 8,300 hypertensive patients (initial sitting diastolic blood pressure 95 to 115 mm Hg or systolic blood pressure 160 to 200 mm Hg) with electrocardiographically documented LVH. The study, which will continue for at least 4 years and until 1,040 patients experience one primary endpoint, has been designed with a statistical power that will detect a difference of at least 15% between groups in the incidence of combined cardiovascular morbidity and mortality. It is also the first prospective study with adequate power to link reversal of LVH to reduction in major cardiovascular events. The rationale of the study, which will involve more than 800 clinical centers in Scandinavia, the United Kingdom, and the United States, is discussed, and the major features of its design and general organization are described. On April 30, 1997, when inclusion was stopped, 9,218 patients had been randomized.

Adrenergic beta-Antagonists↗
PubMed1997

[Breath tests in intestinal diseases and functional gastrointestinal diagnosis].

Among the numerous breath tests described for gastroenterological applications, breath hydrogen (H2) tests have emerged during the past two decades as a most sensitive, reliable and feasible method for detecting carbohydrate malabsorption and maldigestion (e. g. lactose maldigestion). Hence they are regarded time honored standards of contemporary gastroenterological function tests. For the diagnosis of the small bowel bacterial overgrowth syndrome the glucose H2 breath test is a feasible tool with moderate sensitivity (approximately 65%), which, however, is not higher with alternative breath test (e. g. the 1 g 14C-D-xylose breath test). Measuring mouth-to-caecum-transit time by the breath H2 response after lactulose is more of scientific interest than clinically informative. Breath tests making use of 14C labeled substrates (usually 5 to 10 microCi) bear a rather low calculated radiation hazard and are thus in routine use in some countries, e. g. in Scandinavia, but they are abandoned in others. At least, however, radioactive 14C breath tests are (partially) dispensible, as these restrictions do not apply for the stable isotope 13C breath tests which are nonradioactive and thus devoid of any radiation hazard. For the purpose of gastroenterological function testing the 13C urea breath test for the detection of Helicobacter pylori infection, quantitative studies of gastric emptying with 13C-acetate or 13C-octanoate and quantitative liver function tests have gained diagnostic use while 13C-breath tests assessing intestinal absorption or exocrine pancreatic function have been found less effective than the respective alternatives, or too expensive. Both, H2-breath tests and 13CO2-breath tests are clinically important, diagnostic methods with well delineated indications in gastroenterology.

Breath Tests↗
PubMed1997

[Chromosomal differences in moose (Mammalia, Artiodactyla, Alces alces L.)].

Earlier studies on differences in moose (Alces alces) chromosome sets concerned only European (Scandinavia, Finland, the Volga region, and western Siberia) and American (the United States and Canada) forms. The first group had a 68-chromosome set, and the second group, a 70-chromosome set. These differences were considered interspecies chromosomal polymorphism. However, the chromosome number in A. alces living in eastern and northeastern Siberia remains unknown, although these data are important for elucidation of the geographical variation of karyotypes of moose from genus Alces. Four moose from different regions of Sakha were studied. It was found that their karyotypes contained 70 chromosomes; i.e., they were similar to the American form. These data indicate a strong differentiation within the species. Two chromosomal forms can be distinguished: the European one (2n = 68) living in Europe and western Siberia and the American one (2n = 70) living in North America, the Far East, and eastern Siberia. The existence of two forms is confirmed by data on their morphology, sound signals, electrophoretic mobility of proteins, and differences in nutrition. These results indicate that long-term isolation of European and American moose led to the high divergence between these two forms; therefore, they can be considered different species.

Animals↗
PubMed1997

[Does the infectious disease, human ehrlichiosis, exist in Sweden? Ticks get a hold of new zoonoses].

Human ehrlichiosis diseases, decently recognised as emerging human infections in the USA, are caused by vector-borne, strictly intracellular bacteria of the family Rickettsiaceae. Human monocytic ehrlichiosis is caused by Ehrlichia schaffeensis, whereas the agent causing human granulocytic ehrlichiosis (HGE) has yet to be identified [1]. The putative increase in the occurrence of these primary zoonoses is dependent on the complex relationship between the infectious agents, the vectors, and the hosts (rodents, deer) which constitute the wild-life reservoir. In Scandinavia, granulocytic ehrlichiosis is well known in veterinary medicine. Pasture fever in cattle and sheep is caused by Ehrlichia phagocytophila, whereas granulocytic ehrlichiosis in horses and dogs is caused by a new, recently characterised Ehrlichia species [2]. All species of Ehrlichia causing granulocytic ehrlichiosis are closely related both genetically and antigenically, and are all transmitted by ticks of the genus Ixodes. In Sweden, veterinary cases of granulocytic ehrlichiosis are characterised by a geographical distribution corresponding well with that of Ixodes ricinus, and a seasonal distribution similar to that of Lyme borreliosis. In Europe, clinical cases of HGE have so far been reported only from Slovenia [5], though seroprevalence figures of 8-17 per cent have been reported for tick-exposed populations [6, 7]. As most cases are probably subclinical, and as clinical symptoms, when present, are non-specific, clinical diagnosis is dependent on the clinician's awareness of the existence of the disease. Laboratory diagnostic tests are now available at Kalmar.

Animals↗
PubMed1997

[Is smoking during pregnancy a cause of testicular cancer?].

Smoking during pregnancy is suggested as a cause of the increasing incidence rates of testis cancer in Denmark, particularly for the age group between 25 and 50. Testis cancer is associated with lower birthweights, as is smoking during pregnancy. Danish women have rates of everyday smoking amongst the highest in Europe, and the highest rate of smoking during pregnancy in Scandinavia, followed by Norway, Sweden and Finland. Incidence rates for testis cancer show the same sequence. The increasing incidence of testis cancer in Copenhagen was temporarily halted among men bom between 1939-1945 during the wartime tobacco shortage. The maternal generation aged about 25 years during the war years shows a corresponding delay in the increasing incidence of lung and bladder cancer, with a lag-time of respectively 20 and 30 years. The author recommends long-term followup of newborn boys prenatally exposed to tobacco.

Adult↗
PubMed1997

[Foreign physicians in Norwegian hospitals].

Because of the increasing number of foreign doctors seeking employment in Norwegian hospitals, a survey was undertaken to estimate their numbers, and to study how they and their chief physicians assess their working situation, and whether it could possibly be improved. 15% of the hospital physicians were foreign, about half of these had other language backgrounds than Swedish or Danish. 55% of the departments employed foreign doctors. The median time in Norway for these doctors was 33 months. Doctors from outside Scandinavia were less satisfied with their working situation than were doctors with a Swedish or Danish background, and this was also reflected in the views of the chief physicians. The language difficulties experienced by the foreign doctors were considered to be greater by their chief physicians than by the foreign doctors themselves. Emphasis should be placed on language and cultural training, building supporting networks, and improving the qualifications of Norwegian physicians to enable them to work in cross-cultural environments.

Communication Barriers↗
PubMed1997

[Competence and work identity--an evaluation of Norwegian continuing education in psychiatric nursing].

Mental health services are in transition. The question is to what extent professional training programmes within the health and social sectors have taken into consideration claims and expectations on professionals following this organizational transition. The purpose of this descriptive study was, by means of a semi-structured questionnaire, to evaluate Norwegian postgraduate programmes of psychiatric nursing with respect to what extent they had met the psychiatric nurses' need for competence in their clinical work. Only few evaluations of this type are reported from Scandinavia, and, consequently, it is important to conduct such studies to elucidate strengths and weaknesses in existing programmes. In all 154 psychiatric nurses participated (response rate 48%). The study revealed that psychiatric nurses perceived their training as significant to their practice--and that their professional identity and competence had been strengthened. This was connected to the possibility of studying their own professional field in depth--and to clarify their field of responsibility. Thus, the respondents regarded an alteration of the postgraduate programme in an interdisciplinary direction as unfortunate. Such an alteration might contribute to a weakening of their specific competence and professional perspective. The respondents held that productive interdisciplinary co-operation presupposes a multi-disciplinary approach. The postgraduate programmes seem definitely to qualify psychiatric nurses for working in psychiatric institutions, but their training is also relevant for working in the community health services.

Adult↗
PubMed1997

Genetic and environmental contributions to smoking.

We estimate the magnitude of genetic and shared environmental contributions to risk of initiation and maintenance of smoking. Genetic models were fitted to data from 2,204 male-male monozygotic and 1,793 male-male dizygotic twin pairs from the Vietnam Era Twin Registry who responded to smoking questions on a 1987 mail and telephone survey. The best fitting model allowed for both genetic and shared environmental effects on smoking initiation, accounting for 50% and 30% of the variance in risk, but allowed for only genetic effects, (accounting for 70% of the variance in risk), on persistence in smoking among those who had become regular smokers. This finding of a major genetic influence on smoking persistence confirms similar results from studies in Scandinavia and Australia. The role of heritable traits such as nicotine sensitivity should be addressed in smoking prevention and cessation efforts.

Adult↗
PubMed1997

[The 'Colon cancer laparoscopic or open resection' (COLOR) trial].

The value of laparoscopic surgery for colorectal malignancy as compared with open surgery will be determined in the COLOR-trial. The disease-free survival time is the primary end point. Twenty-one hospitals in the Netherlands and Scandinavia will participate in the trial. In the COLOR trial 1500 patients with colon carcinoma will be randomised for either a laparoscopic or open colon resection.

Colonic Neoplasms↗
PubMed1998

Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee.

BACKGROUND: Systematic international comparisons of the prevalences of asthma and other allergic disorders in children are needed for better understanding of their global epidemiology, to generate new hypotheses, and to assess existing hypotheses of possible causes. We investigated worldwide prevalence of asthma, allergic rhinoconjunctivitis, and atopic eczema. METHODS: We studied 463,801 children aged 13-14 years in 155 collaborating centres in 56 countries. Children self-reported, through one-page questionnaires, symptoms of these three atopic disorders. In 99 centres in 42 countries, a video asthma questionnaire was also used for 304,796 children. FINDINGS: We found differences of between 20-fold and 60-fold between centres in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema, with four-fold to 12-fold variations between the 10th and 90th percentiles for the different disorders. For asthma symptoms, the highest 12-month prevalences were from centres in the UK, Australia, New Zealand, and Republic of Ireland, followed by most centres in North, Central, and South America; the lowest prevalences were from centres in several Eastern European countries, Indonesia, Greece, China, Taiwan, Uzbekistan, India, and Ethiopia. For allergic rhinoconjunctivitis, the centres with the highest prevalences were scattered across the world. The centres with the lowest prevalences were similar to those for asthma symptoms. For atopic eczema, the highest prevalences came from scattered centres, including some from Scandinavia and Africa that were not among centres with the highest asthma prevalences; the lowest prevalence rates of atopic eczema were similar in centres, as for asthma symptoms. INTERPRETATION: The variation in the prevalences of asthma, allergic rhinoconjunctivitis, and atopic-eczema symptoms is striking between different centres throughout the world. These findings will form the basis of further studies to investigate factors that potentially lead to these international patterns.

Adolescent↗
PubMed1998

[Spotted fever after travel to South Africa].

Three patients developed fever, malaise and a typical maculopapular rash a few days after returning to Norway from South Africa. In South Africa they had been bitten by ticks several times while hunting. Two patients, with lesions compatible with eschar, were hospitalized, and a diagnosis of rickettsial spotted fever was established based on the clinical presentation and positive Rickettsia conorii serology. Rickettsial diseases are extremely rare in Scandinavia, and a survey on rickettsioses is presented in this paper.

Boutonneuse Fever↗
PubMed1998

[Spotted fever imported into Norway in 1997].

Tick-borne rickettsioses are important zoonoses in many tropical and subtropical areas. There has recently been an increase in the number of reported cases among tourists returning to Scandinavia. In this article we present all five serologically confirmed cases of tick-borne rickettsioses imported into Norway in 1997. The patients were Norwegian tourists who had visited South Africa (three cases), Zimbabwe, and Italy. Four cases had typical eschar and three had maculopapular exanthema. The patients were treated with either doxycycline or ciprofloxacin. No complications were reported. The diagnosis of tick-borne rickettsiosis was confirmed by the detection of specific IgM antibodies to Rickettsia conorii using micro-immunofluorescence in serum samples.

Adult↗
PubMed1998

[Surgical treatment of gastroesophageal reflux disease].

Antireflux surgery is successful in 85-90% of eligible patients, with relief of symptoms, cure of oesophagitis and possibly prevention of progression of the dysplasia in a Barrett's oesophagus. The mortality in the latest publications is given as 0.05%. The morbidity, apart from recurrences, is not yet sufficiently known. Some 250 antireflux operations are performed annually in the Netherlands, fewer than 20% of the estimated requirement of 10 operations per 100,000 of the population per year, and also fewer than in Scandinavia. Nissen fundoplication (folding the fundus of the stomach around the entire circumference (360 degrees) of the oesophagus) is generally accepted as the standard primary operation. Nissen fundoplication during laparoscopy seems to be just as good. Results of randomized clinical trials will have to be awaited to prove this assumption. Belsey's operation (folding the fundus around 270 degrees of the circumference of the oesophagus via thoracotomy) is nowadays performed almost exclusively in recurrent reflux disease and in persistent dysphagia after a primary operation.

Female↗