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PubMed2005

Incidence and prevalence of ankylosing spondylitis in Northern Norway.

OBJECTIVE: To determine the incidence and prevalence of ankylosing spondylitis (AS) over a prolonged period in the 2 northernmost counties of Norway, where HLA-B27 has a high prevalence in the population. METHODS: We conducted a cohort study of all patients registered with a diagnosis of AS between 1960 and 1993 at the University Hospital of Northern Norway, which is the sole rheumatology department serving these counties. We registered demographics, year of disease onset (clinical disease), and year of diagnosis (radiograph confirmation) for all patients. The date of onset of clinical disease in patients with AS was used in the calculation of incidence rates. Annual incidence and point/period prevalence rates were expressed per 100,000 adults. Primary AS was defined as AS in the absence of psoriasis or inflammatory bowel disease (IBD). RESULTS: A total of 534 patients (75.1% male, mean age at clinical diagnosis 24.2 years, 93.0% HLA-B27 positive) had a confirmed diagnosis of AS (by the modified New York criteria). Median time from disease onset to radiologic confirmation was 8.0 years. Annual incidence of primary AS (n = 417) was 7.26, while estimated point prevalence rose from 0.036% in 1970 to 0.10% in 1980 and to 0.21% in 1990 with a period prevalence of 0.26%. AS was secondary to psoriasis or IBD in 117 patients (18.1%), with a diagnostic delay similar to that in primary AS. Annual incidence (14.1) and period prevalence in 1982-1993 (0.41%) were significantly higher in the town of Tromsø than in the surrounding rural region (5.21 and 0.22%, respectively). Mortality in patients with AS was low. CONCLUSION: The incidence of AS was relatively stable in the northern part of Norway over a 34-year period. Incidence and prevalence are higher than reported in similar studies from Finland and Minnesota, possibly due to a higher population prevalence of HLA-B27.

Adult↗
PubMed2003

Incidence trends of mesothelioma in Norway, 1965-1999.

Asbestos exposure is considered to be the only important risk factor for malignant mesothelioma. The importation of asbestos to Norway increased after World War II and peaked in 1970. Stringent regulations took effect in 1977, and importation and use of asbestos practically ended in Norway in the late 1970s, until importation was prohibited in 1982. Our study aimed to analyze the incidence of mesothelioma in Norway according to temporal variation, to study the consequences of the use of asbestos and the asbestos ban effectiveness. An age-period-cohort model was used to analyze time trends for pleural mesotheliomas. From 1965-1999, the annual number of pleural mesotheliomas rose gradually both in males and females, and the highest annual number of pleural mesotheliomas was recorded in 1999 with 73 new cases diagnosed. The age-adjusted log linear drift of malignant mesothelioma of the pleura during the observation period rose 31.1% per 5 years among men and 15.9% among women. In 1995-1999, the age-adjusted incidence rate for men was 16.6 per million person-years for men and 2.3 for women. Cohort-specific risks increased for men born up to around 1935. After this the risks seem to stabilize. The rates were determined by age and by birth cohort. The delayed period effect of the asbestos regulation by the late 1970s will probably have its greatest effects on the mesothelioma rates around 2010.

Adult↗
PubMed1993

Incidence pattern of thyroid cancer in Norway: influence of birth cohort and time period.

The incidence of thyroid cancer in Norway increased about 2-fold for both sexes during the period 1955 to 1989 (4691 cases). In the last 5-year period, however, a decline was observed, especially among females. The ratio between age-adjusted incidence rates in Northern Norway compared with Southern Norway was 1.6 for females and 1.5 for males, and the incidence pattern during the period was similar in the 2 regions. The analysis of age-cohort-period models showed a strong cohort effect in both sexes. The reason for this is not clear, although radiation treatment during childhood and dietary habits may possibly be involved. A weaker but statistically significant and transient period effect was also present, giving relatively higher incidence rates, especially in the 1970s. Although this result may be consistent with an influence of radioactive fallout in the northern area, more detailed studies are needed.

Adolescent↗
PubMed1993

A new variant of serosubtype P1.16 in Neisseria meningitidis from Norway, associated with increased resistance to bactericidal antibodies induced by a serogroup B outer membrane protein vaccine.

Based on differences in reaction pattern with monoclonal antibodies against the P1.16 epitope, a new variant of the class 1 protein in Neisseria meningitidis serogroup B was identified in Norway. A single amino acid deletion was revealed when the part of the gene region encoding the second variable region of the protein was sequenced. This new variant was designated P1.16c. About 5% of the B:15:P1.7,16 strains in Norway from the time period 1987-1991 were P1.16c. In a localized area in Southern Norway, 5/8 (62%) of the P1.7,16 strains were P1.16c. The P1.16b mutant, recently described in England, was not found among the Norwegian meningococcal isolates. Strains carrying the P1.16c mutation showed increased resistance to bactericidal killing, not only by P1.16-specific monoclonal antibodies, but also by the sera from individuals immunized with a vaccine based on outer membranes from a B:15:P1.7,16 strain.

Amino Acid Sequence↗
PubMed1985

Validation of observed differences in the utilization of antihypertensive and antidiabetic drugs in Northern Ireland, Norway and Sweden.

The amount of antihypertensive and antidiabetic drugs based of defined daily doses per 1000 inhabitants per day varies two to three fold between Northern Ireland, Norway, and Sweden. We explored whether variations based on the universally applied defined daily doses might be accounted for by national differences in the actual average prescribed daily doses. Use of prescribed daily doses for antihypertensive drugs resulted in Northern Irish and Norwegian consumption figures which were respectively 40 and 21% lower than the Swedish one, compared to 38 and 25% when defined daily doses were used. The effect of population age-sex differences on the gross defined daily doses per 1000 inhabitants per day figures was determined by applying the Northern Irish or Norwegian age-sex group proportions to Swedish age-sex specific sales data. Taking population differences into account would have resulted in antihypertensive drug use being 21 rather than 38% less in Northern Ireland and 18 rather than 25% less in Norway. Also adjustment for prescribed daily doses left an unexplained difference of 23% between Sweden and Northern Ireland and 14% between Sweden and Norway. For oral antidiabetics use of prescribed daily doses resulted in a Northern Irish - Swedish difference of 62% compared to 67% when defined daily doses were used. Simultaneous adjustment for population differences and prescribed to defined daily dose variations left a 52% difference.

Adolescent↗
PubMed1995

Confrontations with reality: crisis intervention services for traumatized families after a school bus accident in Norway.

In August 1988 a Swedish schoolbus with 23 children and 11 adult passengers crashed into a tunnel wall in Norway. Twelve children and four parents died, 18 of the passengers survived. The victims' relatives (parents, spouses, siblings, and others) were transported to Norway and given a "confronting" support program at the University hospital in Bergen. The crisis intervention program is described: how the relatives were helped to confront and actively cope with some of the stressful situations from which traumatized families very often are protected. One year later 42 of the relatives answered a questionnaire evaluating the confronting support program that was offered during their stay in Norway. A majority of the respondents did not regret their participation in the program. The answers indicate that passivity and helplessness can be counteracted through a combination of confrontation with reality and emotional support.

Accidents, Traffic↗
PubMed2004

Changes in referrals to child and adolescent psychiatric services in Norway 1992--2001.

BACKGROUND: The study analyzes changes in types of problems referred to child and adolescent psychiatry in Norway from 1992 to 2001, and investigates if referral practices and media attention account for these changes. METHOD: All referrals to child and adolescent psychiatry in Norway in the period 1992--2001 were analyzed, as well as frequencies of articles in media on psychiatric problems. RESULTS: The shares of referrals for sadness/depression increased from 0.5 % to 15.4 %. Referrals for hyperactivity/attention problems increased from 1.2 % to 13.6 %. The increases could be statistically attributed to decreased use of other referral categories, and/or alternatively to media attention on these and related topics. Convergence between diagnosis and corresponding referral problem increased in the period. CONCLUSIONS: Referrals for sadness/depression and hyperactivity/attention problems increased sharply in Norway during the 1990s. This increase may be attributed to a different understanding of and a sharper look at these problems by referral agencies and by increased media attention.

Adolescent↗
PubMed2006

The Barents project in psychiatry: a systematic comparative mental health services study between Northern Norway and Archangelsk County.

BACKGROUND: There is virtually no readily accessible systematically recorded evidence on how the organization of mental health services in Europe's largest country, Russia, may differ from other national systems. This study systematically compares the mental health services in Archangelsk County and Northern Norway using instruments developed for trans-cultural use. METHODS: The European Service Mapping Schedule (ESMS) and The International Classification of Mental Health Care (ICMHC) were used to describe: (i) resources, organisation and utilisation of the services; (ii) their decentralisation and differentiation; (iii) some interventions delivered by the mental health service units (n = 132) in both regions. RESULTS: The Norwegian services are more decentralised and differentiated, while the Russian services are largely hospital-based. The GPs are of considerable importance to the Norwegian services, functioning as gatekeepers-both centrally and peripherally. In contrast, the GP model is still poorly established in Archangelsk County. There are more units for long term stay in the Russian services than in Norway. General health care and taking over daily living activities are more organised in Archangelsk County, while psychopharmacological treatment and psychosocial interventions are more developed in Norway. CONCLUSION: The study has revealed several differences in resources, organisation and utilisation of the mental health services between the two compared areas. The very large variations indicate that underlying local patterns of service delivering must be further investigated and taken into account in the planning of the services development.

Catchment Area, Health↗
PubMed2004

Forearm bone mineral density in an unselected population of 2,779 men and women--the HUNT Study, Norway.

The fracture incidence in Norway is among the highest in Europe, presumably due to osteoporosis. As part of a multipurpose health study in the county of Nord-Trondelag, Norway (the HUNT study), a 5% randomly selected sample (n=4,646) of the population >19 years of age was invited to undergo single X-ray absorptiometry (SXA) of the forearm. A total of 1,274 men (50.5 years) and 1,505 women (49.9 years) participated (60%). The aim of the study was to describe the variation in bone mineral density (BMD) and the prevalence of forearm BMD 2.5 standard deviations (SD) below the mean value for young adults in an unselected population sample. In women the BMD remained stable until the age of 50 years, whereupon a strong decline in BMD was observed. In men, a BMD increase was observed until about the age of 40 years; the decline after the age of 65 was, however, similar to that in women. Based on age and gender-specific reference values, the age-adjusted prevalence of T-scores <-2.5 SD in women and men aged 50-69 years was 16.0% and 5.6%, respectively. In the age group of 70 years or older the prevalence was 65.8% and 30.6% for women and men, respectively. The accelerated BMD reduction in women aged 50-65 explains the higher prevalence of T-score <-2.5 SD in elderly women than in men. Further studies on bone loss and falls are required to explain the high fracture incidence in Norway.

Absorptiometry, Photon↗
PubMed2006

Changes in risk of death from breast cancer with season and latitude: sun exposure and breast cancer survival in Norway.

The Norwegian counties can conveniently be divided in three groups with different annual UV exposures and different incidence rates of squamous cell carcinoma (SCC) of the skin. In view of the hypothesis that latitude and season of diagnosis may play a role for breast cancer progression, the prognosis of breast cancer as determined for summer and winter diagnosis, were evaluated in the three residential regions. Two age groups were analysed separately (stratification at 50 years). For all regions, and for all ages, the prognosis was best for women diagnosed in the summer season (Relative risk (RR) of death was 15-25% lower for summer diagnosis versus winter diagnosis). There was no significant seasonal variation of the number of new cases. For women diagnosed before the age of 50, a geographical gradient in cancer prognosis was also found (RR of death 0.6, 95% CI: 0.5-0.7 for cases diagnosed in southeast Norway and RR of death 0.8, 95% CI: 0.6-1.1 for diagnosis in the north of Norway). This is in agreement with a 1.5 times larger annual UV exposures and 3-4 times larger incidence rates of SCC in the southeast region when compared with the north region. For women diagnosed after the age of 50, no significant difference was found between the three regions. Despite a 17% higher vitamin D intake from food in north of Norway no difference in cancer survival was found for diagnosis during winter (when no significant differences in the levels of UV exposure can be detected between regions). The overall data support our earlier hypothesis that season of diagnosis and therapy start improves the survival for breast cancer.

Adult↗
PubMed1993

Regional inequalities in health and health care in Finland and Norway.

One of the main health policy goals in Finland and Norway is to decrease regional differences in health status and in accessibility of health services. The purpose of this paper is to analyze how this policy has been implemented, how its goals have been achieved, and what the obstacles are to it. It is of special interest to assess whether the centralized Finnish planning system has been more successful in the implementation of this policy, than the more decentralized system in Norway. Of these two countries, only Norway has applied any objective computing criteria for assessing the relative need of health care resources in each province or municipality. Neither of these two countries is using any relevant statistical indicators to describe the present situation, or time-related trends in regional inequities. According to available data the regional inequalities in health status and in the provision of health services have in both countries remained more or less unchanged over the last two decades. In future a more exact definition of the concept of equity, better methods for assessing the need for services, and an improved system of health statistics and indicators for monitoring progress in equity is needed. Also the potential of the health care policy in decreasing inequities in health should be questioned at a more fundamental level.

Decision Making, Organizational↗
PubMed1983

Research on mental retardation in Norway 1970-1980: a review.

The present paper reviews most of the research on mental retardation in Norway, published in 1970-1980. An important part of this work is represented by Hole's reports of experimental phenylketonuria (PKU) in the rat and studies on peptides and protein-associated peptide complexes in mental disturbances, including experimental studies of effects on brain function and behavior of a peptide fraction (factor 3 b 2). Among studies on diseases with mental retardation, are determinations of arylsulphatase A in cultured amniotic fluid cells and in amniotic fluid as measures of prenatal diagnosis of metachromatic leukodystrophy, reports on screening disorders of tyrosine metabolism and the occurrence of positive dye test in blind children and patients with physical and mental handicaps. Further, studies on the effects of antiepileptics on immunoglobulins are reported. In the fields of social medicine, psychology and psychiatry, only few studies have been published in international journals. Brief reports on Norwegian articles comprise studies on work and disability, social and psychological handicaps in special school pupils, psychosis in mental retardation, and some efforts to design psychological treatment programs for the mentally retarded. The majority of research on mental retardation or with relevance to this field in Norway, has either been supported by the Norwegian Council for Research on Mental Retardation, or the Norwegian Research Council for Science and the Humanities. Based on annual reports of these councils, and correspondence to centers involved in such research, we have collected reports published in the period 1970 to 1980. We have also received unpublished reports, but have chosen not to include most of them in this review, because of the difficulties for the readers to obtain these reports. The institutional and noninstitutional services for the mentally retarded in Norway have no formal connection with university or other research institutes. Nevertheless, most of the research papers have been submitted from such institutes. Most of the reports traced are in the fields of basic neurobiology, medicine, and psychology, and will be dealt with under these headings.

Animals↗
PubMed1991

A dialogue between practitioners of alternative (traditional) medicine and modern (western) medicine in Norway.

This paper tells about a 'dialogue group', consisting of alternative and modern health practitioners, that was started in Norway in 1989, how it works and what has been achieved up to now. WHO has strongly advocated promotion of cooperation between traditional and modern health practitioners. In Botswana, where one of the general practitioners in the group has practiced, 'United Health Committees' have been established aiming at creating a dialogue between the different types of health professionals. In industrialized countries little seems to have been done so far. Many patients in Norway, as in many other countries, consult ordinary doctors as well as alternative practitioners. In Norway, members of these two professions almost never meet, other than as opponents. They receive information about each other mostly through discontented patients who have been unsuccessfully treated by the other part. In this way practitioners get an insufficient and biased report of one another's practices, as well as an unrealistic and distorted picture. If patients know that both parts respect one another, then most of them dare to tell that they use both types of practitioners. Otherwise many patients conceal this.

Acupuncture Therapy↗
PubMed2006

Effects on accidents of periodic motor vehicle inspection in Norway.

An extensive programme of periodic motor vehicle inspection was introduced in Norway after 1995, when the treaty between Norway and the European Union (EU) granting Norway (not a member of the EU) access to the EU inner market took effect (The EEA treaty). This paper evaluates the effects on accidents of periodic inspections of cars. Trucks and buses were not included in the study. Negative binomial regression models were fitted to data on accidents and inspections created by merging data files provided by a major insurance company and by the Public Roads Administration. Technical defects prior to inspection were associated with an increased accident rate. Inspections were found to strongly reduce the number of technical defects in cars. Despite this, no effect of inspections on accident rate were found. This finding is inconsistent with the fact that technical defects appear to increase the accident rate; one would expect the repair of such defects to reduce the accident rate. Potential explanations of the findings in terms of behavioural adaptation among car owners are discussed. It is suggested that car owners adapt driving behaviour to the technical condition of the car and that the effect attributed to technical defects before inspection may in part be the result of a tendency for owners who are less concerned about safety to neglect the technical condition of their cars. These car owners might have had a higher accident rate than other car owners irrespective of the technical condition of the car.

Accidents, Traffic↗
PubMed2004

Colorectal cancer survival trends in Norway 1958-1997.

The purpose of this study was to examine the pattern of survival for colorectal adenocarcinoma (CRC), and to investigate the prognostic factors for the disease. In the analysis, 50993 cases of CRC aged 40-84 years, diagnosed between 1958 and 1997 in Norway, were included. Esteve's relative survival method was used, together with a time trend analysis, conducted by least-squares linear regression. Cox proportional hazards regression analysis was used to examine cause-specific mortality. Five-year relative CRC survival has increased by an estimated 3% per 5-year diagnostic period. In 1958-1962, relative survival was about 40% for both males and females, and increased to 56 and 60%, respectively, in 1993-1997. Rectal cancer had a higher cause-specific mortality (RR 1.26, 95% CI 1.22-1.30) than proximal colon (reference) and distal colon (RR 0.97, 95% CI 0.93-1.00 cancers), while females had a lower cause-specific mortality than males (RR 0.88, 95% CI 0.86-0.90). The increase in the relative survival rate in Norway is probably due to improved treatments and advanced diagnostics. Norway has a higher CRC survival rate than the EUROCARE average.

Adenocarcinoma↗
PubMed2005

Problematic drug use and drug use disorders in EU countries and Norway: an overview of the epidemiology.

OBJECTIVE: To estimate the prevalence of drug use disorders in the European Union and Norway. METHOD: Based on a systematic literature search and an expert survey, publications after 1990 on prevalence of drug use disorders (DUD, defined as drug dependence and drug abuse or harmful use) in EU countries and Norway were reviewed. The search included both direct estimations based on general population surveys using the DSM-IIIR, DSM-IV, or ICD-10 definitions of DUD; and indirect estimates based on other epidemiological methods, such as multiplier procedures based on treatment or legal data and capture-recapture techniques. The indirect methods did not use diagnostic criteria, but criteria based on duration and pattern of use, labelled as problematic drug use as a meaningful approximation. RESULTS: The majority of DUD as estimated from direct methods using general population surveys were cannabis use disorders, usually not included in indirect estimates. The prevalence of thus defined disorders can be as high as 3%. For disorders other than cannabis use disorders (i.e. opioid, cocaine and amphetamine use disorders), indirect estimates of prevalence were consistently higher than those based on direct estimates, and ranged between 0.3% and 0.9% in European Union countries and Norway. Men have higher prevalence rates of DUD than women, but the difference was much less pronounced in general population surveys. Younger age (18-25 years) is the age group with the highest estimates. CONCLUSION: General population surveys typically result in a serious underestimation of the prevalence of DUD other than cannabis use disorders, because many people with DUD are not reached by these surveys (hidden populations). Based on the more valid indirect estimates, it is concluded that problem drug use constitutes a relatively high burden of disease and social problems in Europe.

Adolescent↗
PubMed2005

Outbreak of methicillin-resistant Staphylococcus aureus in two nursing homes in Central Norway.

Until recently, infections with methicillin-resistant Staphylococcus aureus (MRSA) have mainly been associated with hospital outbreaks in Norway. However, increasingly cases are contracted outside hospitals. This paper reports the first two outbreaks of MRSA in two nursing homes in central Norway, affecting 23 residents and five staff members. Pulsed-field gel electrophoresis analysis showed that all strains from nursing home A were identical and that the strains from nursing home B were genotypically similar with one or two band differences. Multi-locus sequence typing (MLST) showed that the strains from the two nursing homes belong to clonal complex 45, with each strain being a single-locus variant of sequence type 45 (ST 45), a well-known European epidemic strain. No evident source of the two outbreaks was found, and there was no obvious connection between the two outbreaks. The latter is also supported by the minor differences observed by MLST, suggesting a connection at some time in the past. The outbreaks led to a heavier workload and economic strain on both nursing homes. The outbreak in nursing home A was brought to an end, whereas two residents remained colonized in nursing home B despite several eradication attempts. These outbreaks show the potential for MRSA spread in a nursing home. If the prevalence of MRSA in Norway continues to increase, nursing home staff and residents may have to be included in the groups to be screened for MRSA upon hospital admission.

Aged↗
PubMed2006

Aluminum dynamics in forest soil waters in Norway.

We report on weekly aluminum (Al) concentration measurements in soil water from forested catchments monitored throughout Norway since 1986. Originating in acidification research, and thus accompanied by many other chemical variables, they constitute a comprehensive data set suited for analysis of short- as well as long-term variations in a geographic perspective. The Al time series at 21 sites are characterized by high temporal variability, seasonal behavior, and episodic events with peak values in the range 200-800 micromol/l, mostly caused by sea salts blown inland in storms, with a subsequent release of Al after cation exchange. Despite a clear south-north gradient in possible acidification over Norway, we found no indication of such south-north trends in Al chemistry, neither in mean values, maximum values, nor time trends. We identified two main drivers for variation in Al concentrations. The first one was sea salts, where Al was released to the soil solution after cation exchange. The second driver was high production of DOC, where Al was driven into the soil solution by complexation with DOC. There appears to be little risk for aluminum toxicity to trees in Norwegian forests. Except during occasional episodes, aluminum concentrations generally lay far below the supposed threshold values for toxic effects on Norway spruce, Scots pine and birch. Much dissolved aluminum was non-labile, and thus relatively non-toxic. Although the Ca2+/labile Al ratio was often below 1.0, considerable doubt exists as to the applicability of this variable in the field.

Aluminum↗