BACKGROUND: Rising numbers of bullous impetigo caused by Staphylococcus aureus resistant to fucidic acid have been seen in Norway over the last few years. MATERIAL AND METHODS: We present a population-based cohort study of an epidemic in an island community in western Norway with approximately 4450 people. The district's doctors agreed upon guidelines for regimes of antibiotic treatment; taking specimens for bacteriological examination was made routine procedure. The patients included in the study were identified from all patient files from all consultations with all doctors in the district. Clinical, therapeutical and bacteriological variables were registered. A comparison with the present Norwegian guidelines developed by a conference of experts is made. RESULTS: 108 patients were diagnosed as having bullous impetigo (2.4% of the population). Bacteriological swabs were taken from 95 (88%) patients. Staphylococcus aureuswas the bacteriologic aetiology in 79 (83%) of these and were found to be resistant to fusidic acid in 67 (85%) isolates. DISCUSSION: Our findings support the hypothesis that the rising numbers of impetigo might be caused by a clone of Staphylococcus aureus that is resistant to fusidic acid.
OBJECTIVE: To examine whether modifiable lifestyle factors such as smoking, obesity, physical activity and intake of alcohol or caffeinated drinks were associated with urinary incontinence in women. DESIGN: Cross sectional population-based study. SETTING: The Norwegian Epidemiology of Incontinence in the County of Nord-Tr?ndelag (EPINCONT) Study is part of a large survey performed in a county in Norway during 1995-1997. POPULATION: Women >/=20 years (n = 34,755, 75% of the invited) attended the first part of the survey and received the questionnaire. There were 27,936 (80% of source population) women who completed the incontinence part of the questionnaire. METHODS: Questionnaire covering several health topics including urinary incontinence was received at a screening station. Logistic regression analysis was used to adjust for confounding and to establish associations with the different outcomes under investigation: any incontinence, severe incontinence and stress, urge and mixed subtypes. MAIN OUTCOME MEASURES: Effect measure were odds ratios with corresponding 95% confidence intervals. RESULTS: Former and current smoking was associated with incontinence, but only for those who smoked more than 20 cigarettes per day. Severe incontinence was weakly associated with smoking regardless of number of cigarettes. The association between increasing body mass index and incontinence was strong and present for all subtypes. Increasing levels of low intensity physical activity had a weak and negative association with incontinence. Tea drinkers were at slightly higher risk for all types of incontinence. We found no important effects of high intensity physical activity, intake of alcohol or coffee. CONCLUSIONS: Several potentially modifiable lifestyle factors are associated with urinary incontinence. Highest odds ratios were found for body mass index, heavy smoking and tea drinking.
GPs play a major role in influenza epidemics, and most patients with influenza-like-illness (ILI) are treated in general practice or by primary care doctors on duty in out-of-hours services (OOH). Little is known about the surge capacity in primary care services during an influenza pandemic, and how the relationship between them changes.
To investigate how general practice and OOH services were used by patients during the 2009 pandemic in Norway and the impact of the pandemic on primary care services in comparison to a normal influenza season.
Data from electronic remuneration claims from all OOH doctors and regular GPs for 2009.
We conducted a registry-based study of all ILI consultations in the 2009 pandemic with the 2008/09 influenza season (normal season) as baseline for comparison.
The majority (82.2%) of ILI consultations during the 2009 pandemic took place in general practice. The corresponding number in the 2008/09 season was 89.3%. Compared with general practice, the adjusted odds ratio for ILI with all other diagnoses as reference in OOH services was 1.23 (95% CI, 1.18, 1.27) for the 2008/2009 season and 1.87 (95% CI, 1.84, 1.91) for the pandemic influenza season. In total there was a 3.3-fold increase in ILI consultations during the pandemic compared to the 2008/09 season. A 5.5-fold increase of ILI consultations were observed in OOH services in comparison to the 2008/09 season. Children and young adults with ILI were the most frequent users of OOH services during influenza periods.
The autumn pandemic wave resulted in a significantly increased demand on primary care services. However, GPs in primary care services in Norway showed the ability to increase capacity in a situation with increased patient demand.
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From around the year 2000, Northern Europe experienced a rise in impetigo caused by Staphylococcus aureus resistant to fusidic acid. A single clone of S. aureus was found to be the bacterial pathogen involved in the impetigo outbreak in Norway, Sweden, the UK and Ireland, termed 'the epidemic European fusidic acid-resistant impetigo clone' (EEFIC). We have followed the incidence of impetigo during the years 2001-2012 based on all patients in general practice in the island community of Austevoll, Western Norway. We previously reported a marked decline of impetigo incidence in Austevoll, from 0.0260 cases per person-year in 2002 to 0.0038 in 2009. This article explores indications of an end to the impetigo epidemic caused by the EEFIC clone.
All four general practitioners (GPs) in the community (mean population = 4400) were asked to diagnose impetigo in a uniform way and to take bacterial specimens from all impetigo cases. Phenotypic characteristics of specimen bacteria were determined for the whole period and molecular analyses were performed on isolates in the period 2008-2012.
We observed a further decline in incidence of impetigo in Austevoll in the study period. The proportion of fusidic acid-resistant S. aureus isolates decreased during the period 2002-2012, with a mean of 80% in the epidemic years of 2002-2004, 55% in 2005-2009, and 6% in 2010-2012. In total, 44 S. aureus isolates from impetigo were subject to molecular analyses in the period 2008-2012, and 11 were found to be related to the EEFIC. All EEFIC isolates were found in 2008-2009, with no new isolates in 2010-2012.
There is an apparent end to the impetigo epidemic related to the EEFIC in this population in Western Norway.
Contradictory results have been reported regarding most delivery parameters as risk factors for urinary incontinence. We investigated the association between the incidence of urinary incontinence six months postpartum and single obstetric risk factors as well as combinations of risk factors.
This study was based on the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health during 1998-2008. This substudy was based on 7561 primiparous women who were continent before and during pregnancy. Data were obtained from questionnaires answered at weeks 15 and 30 of pregnancy and six months postpartum. Data were linked to the Medical Birth Registry of Norway. Single and combined delivery- and neonatal parameters were analyzed by logistic regression analyses.
Birthweight was associated with significantly higher risk of urinary incontinence six months postpartum [3541-4180 g: odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2-1.6; >4180 g: OR 1.6, 95% CI 1.2-2.0]. Fetal presentation, obstetric anal sphincter injuries, episiotomy and epidural analgesia were not significantly associated with increased risk of urinary incontinence. The following combinations of risk factors among women delivering by spontaneous vaginal delivery increased the risk of urinary incontinence six months postpartum; birthweight =3540 g and =36 cm head circumference; birthweight =3540 g and forceps, birthweight =3540 g and episiotomy; and =36 cm head circumference and episiotomy.
Some combinations of delivery parameters and neonatal parameters seem to act together and may increase the risk of incidence of urinary incontinence six months postpartum in a synergetic way.
OBJECTIVES: To assess the proportion of women who visit their doctor because of urinary incontinence and investigate factors associated with help-seeking. DESIGN: Postal invitation, questionnaire covering many health topics including urinary incontinence, received at a screening station. SETTING: The Norwegian EPINCONT Study is part of a large cross-sectional population-based survey performed in the county of Nord-Trøndelag during the period 1995-97. SUBJECTS: 6625 women (out of 27,936 participating women), 20 years or older, categorised as incontinent according to their answers to the questionnaire. RESULTS: 26% of the incontinent women had seen a doctor for their incontinence. Increasing age, impact, severity and duration were all significantly associated with consultation rate, as were urge and mixed types compared with stress incontinence, and having visited any doctor during the previous 12 months. Fifty percent of the women with significant incontinence (moderate/severe incontinence perceived as troublesome) had seen a doctor because of their incontinence. CONCLUSIONS: Only a fourth of the women with any incontinence, and half of the women with significant incontinence had consulted a doctor. Older age and high impact of the symptoms were the factors most strongly associated with help-seeking.
To explore significant experiences of adolescents as next of kin that the general practitioner (GP) should identify and recognize.
Qualitative study with focus-group interviews.
Three focus-group interviews were conducted with a total of 15 Norwegian adolescents each with an ill or substance-abusing parent. The participants were recruited from existing support groups.
The adolescents' days were dominated by unpredictability in their family situation and their own exhausting efforts to keep up an ordinary youth life. Mostly, they consulted GPs for somatic complaints. In encounters with the GP, they wanted to be met both as a unique person and as a member of a family with burdens. Their expectations from the GP were partly negatively formed by their experiences. Some had experienced that both their own and their parent's health problems were not addressed properly. Others reported that the GP did not act when he or she should have been concerned about their adverse life situation. The GP may contribute to better long-term psychosocial outcomes by ensuring that the adolescents receive information about the parent's illness and have someone to talk to about their feelings and experiences. In addition, the GP may help by supporting their participation in relieving activities.
Burdened adolescents seek a GP most often for somatic complaints. The GP has a potential to support them by taking the initiative to talk about their life situation, and by recognizing their special efforts. Key points Little is known about how a general practitioner can support adolescents with ill or substance-abusing parents. Adolescents experience unpredictability in life and strive to find balance between their own needs and the restrictions caused by parental illness. In encounters with adolescents having ill parents, the GP should take the initiative to talk about their family situation. The GP may help them by recognizing their experiences and struggles, give information, offer talks and support coping strategies.
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To investigate whether atopic disease influences the prevalence of irritable bowel syndrome (IBS) and chronic fatigue (CF) after giardiasis.
A questionnaire was sent to all confirmed cases of giardiasis after a Norwegian outbreak, with response rate of 65.3% (817/1252). Controls were randomly selected matched on age and sex, with response rate of 31.4% (1128/3598). Associations were evaluated by use of logistic regression analyses.
In the Giardia exposed group, 47.8% of those with asthma had IBS compared with 45.3% in those without asthma (p = 0.662). For controls, corresponding percentages were 23.9% and 12.2% (p