[Show abstract][Hide abstract] ABSTRACT: Objective. To analyse drug use in early pregnancy with special focus on socio-demographic factors associated with psychotropic and analgesic drug use. Design. Cross-sectional study. Setting and subjects. A total of 1765 women were invited via their local health care centres, and 1111 participated at 11–16 weeks of pregnancy by filling out a postal questionnaire concerning socio-demographic and obstetric background, stressful life events, and drug use. Main outcome measures. Drug use prior to and early on in pregnancy, socio-demographic factors, smoking, and adverse life events were investigated. Drug categories screened for were psychotropics (collective term for antidepressants, relaxants, and sleep medication), analgesics, hormones, nicotine, vitamins/minerals, and homeopathic medicine. Results. Drug use from the aforementioned drug categories, excluding vitamins/minerals and homeopathic medicine, was reduced by 18% during early pregnancy, compared with six months prior to conception (49% vs. 60%). Psychotropic drug use during early pregnancy was associated with elementary maternal education (p < 0.5), being unemployed (p < 0.001), being single/divorced/separated (p < 0.01), smoking prior to or during pregnancy (p < 0.01), forced to change job/move house (p < 0.001), and psychotropic drug use six months prior to pregnancy (p < 0.001). No items on the stressful life events scale were associated with increased analgesic use, which increased only with multiparity. Conclusions. Use of analgesics and psychotropic drugs seems common in pregnancy. Our results indicate that lack of a support network, stressful life events, and lower status in society may predispose women to more drug use. GPs and midwives responsible for maternity care could take this into account when evaluating risk and gain for women and foetuses in the primary care setting.
Scandinavian Journal of Primary Health Care 10/2014; DOI:10.3109/02813432.2014.965884 · 1.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to explore women's experiences of antenatal care with focus on the number of visits and continuity of care. Pregnant women who started their antenatal care at a health care centre and participated in the national cohort study ,,Childbirth and Health" answered two questionnaires, the first one shortly after their first visit in antenatal care. Participation was 63% (n=1111) and 765 (69%) answered the second questionnaire 5‒6 months after giving birth. Data was gathered from February 2009 till January 2011. Approximately 69% of the participants were from the capital area and 31% from rural areas. Participants reported they had met a midwife in antenatal care on average 8.9 times. After adjusting for pregnancy length, 28% prim-iparas and 20% multiparas did not meet the set standard of number of meetings in antenatal care. Women living in rural areas were more likely than women in the capital area to reach the set standards of number of visits and women that did so were more often very satis-fied with their physical health controls than those who did not. On average, the women met 1.9 midwives during their antenatal care period and 17% met three midwives or more. The women that met two or more midwives were less likely to be very satisfied with their own health controls and emotional support of health care profes-sionals during pregnancy than women who only met one midwife during antenatal care.
[Show abstract][Hide abstract] ABSTRACT: Objective. To study the prevalence and possible predictors for smoking during pregnancy in Iceland. Design. A cross-sectional study. Setting. Twenty-six primary health care centres in Iceland 2009-2010. Subjects. Women attending antenatal care in the 11th-16th week of pregnancy were invited to participate by convenient consecutive manner, stratified according to residency. A total of 1111 women provided data in this first phase of the cohort study. Main outcome measures. Smoking habits before and during early pregnancy were assessed with a postal questionnaire, which also included questions about socio-demographic background, physical and emotional well-being, and use of medications. Results. The prevalence of smoking prior to pregnancy was 20% (223/1111). During early pregnancy, it was 5% (53/1111). In comparison with women who stopped smoking during early pregnancy, those who continued to smoke had on average a significantly lower level of education, had smoked more cigarettes per day before pregnancy, and were more likely to use nicotine replacement therapy in addition to smoking during pregnancy. A higher number of cigarettes consumed per day before pregnancy and a lower level of education were the strongest predictors for continued smoking during pregnancy. Conclusion. The majority of Icelandic women who smoke stop when they become pregnant, and the prevalence of smoking during pregnancy in Iceland is still about 5%. Our results indicate stronger nicotine dependence in women who do not stop smoking during pregnancy. Awareness of this can help general practitioners (GPs) and others providing antenatal care to approach these women with more insight and empathy, which might theoretically help them to quit.
Scandinavian journal of primary health care 02/2014; DOI:10.3109/02813432.2013.869409 · 1.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective. Referrals to specialists have not been compulsory in Iceland since 1984. In 2006, referrals were again required for patients to receive reimbursement for part of the cost of appointments with cardiologists. The aim of this study was to explore GPs' attitudes to the referral system and possible professional gain by interactive communications. Design. Cross-sectional questionnaire survey. Setting, subjects, and main outcome measures. This is part of a larger study in 2007 on referrals from GPs to cardiologists. A questionnaire was sent to all working GPs in Iceland (n = 201 and responsible for 307 000 inhabitants) regarding the referral process, reasons for referrals, how often a response letter was received, and GPs' attitudes to the referral system. Responses from doctors working in rural areas were compared with those working in Reykjavik and nearby urban areas. Results. The response rate was 63% (126 answers). The mean age of participants was 51; 89% were GP specialists and 60% worked in Reykjavik and nearby urban areas. Almost all respondents (98%) thought that report letters from cardiologists were helpful; 64% (95% confidence interval 53-73) thought that the recently introduced referral system did increase useful information that was beneficial to their patients. There was a statistically significant difference between colleagues working in rural areas and those working in Reykjavik and nearby urban areas regarding several aspects of the referral process. Conclusion. A referral system increases the flow of information and mutual communications between general practitioners and specialists to the benefit of the patients. The geographical location of the health care centre may be of importance regarding the value of the referrals.
Scandinavian journal of primary health care 04/2013; DOI:10.3109/02813432.2013.784543 · 1.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The common history and development of Nordic family medicine is important and interesting. This paper looks back on the aspects and factors influencing academic family medicine in the Nordic countries and especially the central position of the Nordic Congresses and the Scandinavian Journal of Primary Health Care. The importance of pioneers and bringing people together is emphasized. More than 30 years of Nordic academic family medicine has indeed had an incredible impact and has initiated development from only a few people to become world leading.
Scandinavian journal of primary health care 01/2013; 31(1). DOI:10.3109/02813432.2012.762163 · 1.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aims To estimate the potential gain of national screening programmes for colorectal cancer (CRC) by stool occult blood testing in the Nordic countries, with comparative reference to the burden of other causes of premature death. Methods Implementation of national screening programmes for CRC was modelled among people 55-74 years in accordance with the 2011 Cochrane review of biannual screening, using the faecal occult blood test (FOBT) for 10 years, resulting in 15% relative risk reduction in CRC deaths among all those invited [intention-to-treat; relative risk 0.85; confidence interval (CI) 0.78 to 0.92]. Our calculations are based on the World Health Organization and national databanks on death causes (ICD-10) and the mid-year number of inhabitants in the target group. For Finland, Denmark, Norway and Sweden, we used data for 2009. For Iceland, due to the population's small size, we calculated mean mortality for the period 2005-2009. Results Invitation to a CRC screening programme for 10 years could influence 0.5-0.9% (95%CI 0.4-1.2) of all deaths in the age group 65-74 years. Among the remaining 99% of premature deaths, around 50% were caused by lung cancer, other lung diseases, cardiovascular diseases and accidents, with some national variations. Conclusions and implications Establishment of a screening programme for CRC for people aged 55-74 can be expected to affect only a minor proportion of all premature deaths in the Nordic setting. From a public health perspective, prioritizing preventive strategies targeting more prevalent causes of premature death may be a superior approach.
Journal of Evaluation in Clinical Practice 04/2012; DOI:10.1111/j.1365-2753.2012.01845.x · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Rationale, aims and objectives Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total cholesterol is a frequently used variable in the risk estimates. Some studies indicate that the predictive properties of cholesterol might not be as straightforward as widely assumed. Our aim was to document the strength and validity of total cholesterol as a risk factor for mortality in a well‐defined, general Norwegian population without known CVD at baseline.Methods We assessed the association of total serum cholesterol with total mortality, as well as mortality from CVD and ischaemic heart disease (IHD), using Cox proportional hazard models. The study population comprises 52 087 Norwegians, aged 20–74, who participated in the Nord‐Trøndelag Health Study (HUNT 2, 1995–1997) and were followed‐up on cause‐specific mortality for 10 years (510 297 person‐years in total).Results Among women, cholesterol had an inverse association with all‐cause mortality [hazard ratio (HR): 0.94; 95% confidence interval (CI): 0.89–0.99 per 1.0 mmol L−1 increase] as well as CVD mortality (HR: 0.97; 95% CI: 0.88–1.07). The association with IHD mortality (HR: 1.07; 95% CI: 0.92–1.24) was not linear but seemed to follow a ‘U‐shaped’ curve, with the highest mortality −1. Among men, the association of cholesterol with mortality from CVD (HR: 1.06; 95% CI: 0.98–1.15) and in total (HR: 0.98; 95% CI: 0.93–1.03) followed a ‘U‐shaped’ pattern.Conclusion Our study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the ‘dangers’ of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial.
Journal of Evaluation in Clinical Practice 12/2011; 18(1). DOI:10.1111/j.1365-2753.2011.01812.x · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Distribution of body fat is more important than the amount of fat as a prognostic factor for life expectancy. Despite that, body mass index (BMI) still holds its status as the most used indicator of obesity in clinical work.
We assessed the association of five different anthropometric measures with mortality in general and cardiovascular disease (CVD) mortality in particular using Cox proportional hazards models. Predictive properties were compared by computing integrated discrimination improvement and net reclassification improvement for two different prediction models. The measures studied were BMI, waist circumference, hip circumference, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). The study population was a prospective cohort of 62,223 Norwegians, age 20-79, followed up for mortality from 1995-1997 to the end of 2008 (mean follow-up 12.0 years) in the Nord-Trøndelag Health Study (HUNT 2).
After adjusting for age, smoking and physical activity WHR and WHtR were found to be the strongest predictors of death. Hazard ratios (HRs) for CVD mortality per increase in WHR of one standard deviation were 1.23 for men and 1.27 for women. For WHtR, these HRs were 1.24 for men and 1.23 for women. WHR offered the greatest integrated discrimination improvement to the prediction models studied, followed by WHtR and waist circumference. Hip circumference was in strong inverse association with mortality when adjusting for waist circumference. In all analyses, BMI had weaker association with mortality than three of the other four measures studied.
Our study adds further knowledge to the evidence that BMI is not the most appropriate measure of obesity in everyday clinical practice. WHR can reliably be measured and is as easy to calculate as BMI and is currently better documented than WHtR. It appears reasonable to recommend WHR as the primary measure of body composition and obesity.
PLoS ONE 10/2011; 6(10):e26621. DOI:10.1371/journal.pone.0026621 · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To study potential changes in attendance at emergency departments (ED) in Reykjavík immediately following the swift economic meltdown in Iceland in October 2008.
Using electronic medical records of the National University Hospital in Reykjavík, a population-based register study was conducted contrasting weekly attendance rates at Reykjavík ED (cardiac and general ED) during 10-week periods in 2006, 2007 and 2008. The weekly number of all ED visits (major track), with discharge diagnoses, per total population at risk were used to estimate RR and 95% CI of ED attendance in weeks 41-46 (after the 2008 economic collapse) with the weekly average number of visits during weeks 37-40 (before the collapse) as reference.
Compared with the preceding weeks (37-40), the economic collapse in week 41 2008 was associated with a distinct increase in the total number of visits to the cardiac ED (RR 1.26; 95% CI 1.07 to 1.49), particularly among women (RR 1.41; 95% CI 1.17 to 1.69) and marginally among men (RR 1.15; 95% CI 0.96 to 1.37). A similar increase was not observed in week 41 at the general ED in 2008 or in either ED in 2007 or 2006. In week 41 2008, visits with ischaemic heart disease as discharge diagnoses (ICD-10: I20-25) were increased among women (RR 1.79; 95% CI 1.01 to 3.17) but not among men (RR 1.07; 95% CI 0.71 to 1.62).
The dramatic economic collapse in Iceland in October 2008 was associated with an immediate short-term increase in female attendance at the cardiac ED.
Emergency Medicine Journal 09/2011; 29(9):694-8. DOI:10.1136/emermed-2011-200518 · 1.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: At the beginning of the 1800 s neonatal tetanus was a major health hazard on the Westman Islands, an archipelago immediately south of Iceland. Up to 60–70% of newborn babies died in the course of the first two weeks of life, and Danish health authorities were almost helpless in the face of this mysterious disease. In 1847 the young Danish doctor Peter Anton Schleisner (1818-1900) was sent to the islands to investigate the conditions there. He established a maternity hospital, gave advice on hygiene and encouraged breast-feeding and a number of changes in diet. Since there was no known treatment, Schleisner's only option was to resort to preventive measures. He dressed the umbilical stump with balsamum copaivae and tried well-established methods such as opium tincture with saffron and mercurial ointment if there was any sign of infection. By the time he returned to Denmark after nine months, mortality had been halved. Neonatal mortality on the Westman Islands remained at the same low level throughout the rest of the 19th century. According to popular belief this was due to the naflaolian (navel oil) which Schleisner introduced. Nevertheless, it can be partly attributed to generally improved living standards, a relatively higher number of mothers in better social circumstances, a greater urban influence, changed lifestyle and hygienic measures. Schleisner's efforts are considered to have had major significance when conditions are compared with those on the Scottish island of St Kilda where the situation was the same and improved only just before the turn of the century.
Tidsskrift for den Norske laegeforening 04/2011; 131(7):701-7. DOI:10.4045/tidsskr.10.1023
[Show abstract][Hide abstract] ABSTRACT: Previous studies indicate that clinical guidelines using combined risk evaluation for cardiovascular diseases (CVD) may overestimate risk. The aim of this study was to model and discuss implementation of the current (2007) hypertension guidelines in a general Norwegian population.
Implementation of the current European Guidelines for the Management of Arterial Hypertension was modelled on data from a cross-sectional, representative Norwegian population study (The Nord-Trøndelag Health Study 1995-97), comprising 65,028 adults, aged 20-89, of whom 51,066 (79%) were eligible for modelling.
Among individuals with blood pressure >or=120/80 mmHg, 93% (74% of the total, adult population) would need regular clinical attention and/or drug treatment, based on their total CVD risk profile. This translates into 296,624 follow-up visits/100,000 adults/year. In the Norwegian healthcare environment, 99 general practitioner (GP) positions would be required in the study region for this task alone. The number of GPs currently serving the adult population in the study area is 87 per 100,000 adults.
The potential workload associated with the European hypertension guidelines could destabilise the healthcare system in Norway, one of the world's most long- and healthy-living nations, by international comparison. Large-scale, preventive medical enterprises can hardly be regarded as scientifically sound and ethically justifiable, unless issues of practical feasibility, sustainability and social determinants of health are considered.
BMC Family Practice 10/2009; 10:70. DOI:10.1186/1471-2296-10-70 · 1.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: To determine the incidence of herpes zoster (HZ) and frequency of complications, mainly the incidence of postherpetic neuralgia (PHN). Design: Prospective follow-up study. Setting: Primary health care in Iceland. Main outcome measures: Incidence of HZ, age and sex distribution of patients and discomfort or pain 1, 3 and 12 months after the rash. Results: During an observation period of 229,547 person years, 462 episodes of acute zoster developed (incidence equals; 2.0/1,000/year) in 457 patients. End points were gained for all (100%) after 12 months follow up. Those still having pain after 12 months were followed further, 23 to 57 months more. Systemic acyclovir was used in less than 4%. A fourth of all HZ cases occurred in children and teenagers. PHN was rare in patients younger than 60 years of age; 2% and 1% experienced only mild pain at 3 and 12 months respectively. No patient had moderate or severe pain in this age group at these time points. In contrast pain was experienced by 19% and 8% of patients 60 years of age and older at 3 and 12 months respectively. However, after 12 months only two patients (0.4%) had moderate pain, none had severe pain. Potential immuno-modulating conditions (diabetes mellitus, cancer, HIV-infection, steroid treatment) were present in 24 patients (5%), 4 (1%) of whom were diagnosed with a malignancy within 6 months of contracting HZ. Conclusions: HZ is more common in younger age groups than has previously been reported. In patients younger than 60, the probability of PHN is very low. Malignancy is seldom associated with zoster rash in the primary care setting. The use of routine computerised medical records increases the possibility of collecting epidemiological information on the clinical course of a disease.
The European Journal of General Practice 07/2009; 2(1):12-16. DOI:10.3109/13814789609161651 · 0.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: Medical records are and will be more or less computerised in the nearest future. All health care records need regular standard quality checks. A standard for the quality of health care records is a requirement for research and health care planning needs. It is therefore of interest to know how accurate doctors are in recording information in computer-based record systems. Methods: Four community health centres with problem-oriented computerised medical record systems participated in this audit. Prescriptions from all the 23 GPs in the participating health centres were retrieved from the local pharmacy and x-ray requests from the local radiology clinic. The medical records of each participating health centre were then searched for these prescriptions and x-rays requests. Results: A total of 2,011 entries were searched, 1,094 office prescription items, 370 over the phone prescription items, and 547 x-ray requests. Of the office prescription items 163 or 14.8%, of the phone prescription items 80 or 21.0%, and of the x-ray requests 94 or 17.2% were lacking. Variation among the doctors was considerable. GPs entering data themselves and making use of the options on the computer programme had the highest rate of items found. Conclusion: Data entered directly into a computer is more fully recorded than data first written on paper and transferred later into a computer. Well motivated GPs using computer programmes are a valuable source for research and health care planning. The results of this audit are of importance in the continuing development of computer-based record systems, and increase our understanding of how doctors use and respond to computers.
The European Journal of General Practice 07/2009; 1(2):59-62. DOI:10.3109/13814789509160762 · 0.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Clinicians are generally advised to consider several risk factors when evaluating patients' cardiovascular disease (CVD) risk. Our aim was to study whether combined assessment of five traditional risk factors might help doctors demarcate a relatively distinct and manageable group of high-risk individuals. We selected five modifiable risk factors and estimated the proportion of a well-defined population with 'unfavourable' levels of at least two of them, as defined by four internationally renowned guidelines. The impact of including so-called 'prehypertension' among the risk factors was specifically addressed, and the results are discussed in a wider perspective.
Guideline implementation was modelled on data from a cross-sectional Norwegian population study comprising 62 104 adults aged 20-79 years (The Nord-Tröndelag Health Study 1995-7). Total, age- and gender-specific point prevalences of individuals with zero, one, two, three or more factors, in addition to established disease, were calculated.
One single CVD risk factor was exhibited by 12.4% of the population; two factors by 21.5%; and three or more by 49.7%. Established CVD or diabetes mellitus was reported by 12.5%. In total, 83.7% of the population exhibited a risk or disease profile with at least two factors, if prehypertension was included.
If guideline recommendations are literally applied, as many as 84% of adults in Norway could exhibit two or more CVD or risk factors and thus be considered in need of individual, clinical attention. This challenges the widely held presumption that 'the net will close' around a manageable group of individuals-at-risk if several risk factors are jointly considered. As the finding of this study arises in one of the world's most long- and healthy-living populations, it raises several practical as well as ethical questions.
Journal of Evaluation in Clinical Practice 03/2009; 15(1):103-9. DOI:10.1111/j.1365-2753.2008.00962.x · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The relative effects of risk factors on the prevalence of resistant pneumococcal clones are hard to determine. Our aim was to evaluate the effect of risk factors on the prevalence of resistant pneumococci in Iceland in 2003 and compare these data with results of identical studies performed in 1993 and 1998. A randomized sample of 1,107 children was chosen from all 2,532 children 1 to 6 years old living in four communities. Pneumococci were carried by 64% of the 824 children enrolled and 9.5% were penicillin nonsusceptible (PNSP), as opposed to 8.1% (1998) and 8.5% (1993), and multiresistant strains of serotype 6B were 2.5% compared to 7.5% and 7.7% (p < 0.001). Antimicrobial use had declined in 10 years from 1.5 to 1.0 courses/child per year. The only significant risk factor for carriage of PNSP and erythromycin-resistant pneumococci was antimicrobial consumption. The multiresistant type 6B strains disappeared from the areas with the lowest antimicrobial use but maintained unchanged prevalence in the area with the highest use. The number of erythromycin- resistant, penicillin-susceptible strains of all pneumococci (37/475, 7.8%) increased significantly from the previous studies (7/353, 2.0%, 1998, and 2/390, 0.5%, 1993). This observation is associated with increased use of macrolides, especially azithromycin, in one of the study areas. Spread of novel resistant clones appears to be the main reason for rapid and significant changes in pneumococcal resistance rates. The choice of antimicrobial class appears to influence the selective environment favoring particular resistant clones.
Microbial Drug Resistance 09/2006; 12(3):169-76. DOI:10.1089/mdr.2006.12.169 · 2.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To estimate the high risk group for cardiovascular disease in a well defined Norwegian population according to European guidelines and the systematic coronary risk evaluation system.
Nord-Tröndelag health study 1995-7 (HUNT 2), Norway.
5548 participants of the Nord-Tröndelag health study 1995-7, aged 40, 50, 55, 60, and 65.
Distribution of risk categories for cardiovascular disease, with emphasis on the high risk group.
At age 40, 22.5% (95% confidence interval 19.3% to 25.7%) of women and 85.9% (83.2% to 88.6%) of men were at high risk of cardiovascular disease. Corresponding numbers at age 50 were 39.5% (35.9% to 43.1%) and 88.7% (86.3% to 91.0%) and at age 65 were 84.0% (80.6% to 87.4%) and 91.6% (88.6% to 94.1%). At age 40, one out of 10 women and no men would be classified at low risk for cardiovascular disease.
Implementation of the 2003 European guidelines on prevention of cardiovascular disease in clinical practice would classify most adult Norwegians at high risk for fatal cardiovascular disease.