Calcium antagonists are widely used in the treatment of hypertension. However, few endpoint studies with calcium antagonists have been done to prove reduction in hypertensive complications. Results of the STONE, SYST-EUR and SYST-CHINA studies show that long-acting calcium antagonists are effective compared to placebo, especially in patients with isolated systolic hypertension and diabetes. Ongoing prospective and randomized trials like STOP II, INSIGHT, NORDIL, ALLHAT and ASCOT will clarify whether calcium antagonists are more effective than well-proven diuretics and betablockers. ASCOT will test the hypothesis that amlodipine is more efficacious than atenolol in preventing cardiac complications in 18,000 hypertensive patients with high coronary risk including diabetes (among them, 2,000 in Norway). The study is also randomizing the patients in a factorial design to either atorvastatin or placebo, testing the so-called lipid hypothesis.
BACKGROUND: Great progress has been made in antiviral treatment of HIV disease over the last few years. MATERIAL AND METHODS: The paper is based on relevant literature and our own experience in the largest HIV clinic in Norway. RESULTS AND INTERPRETATION: Generally speaking, therapy with at least three active drugs is necessary in order to obtain maximum viral suppression. It is not established what constitutes the best starting-point for therapy, or what combination of drugs is the most efficacious. Treatment should be initiated before clinical immunodeficiency develops. All patients with CD4 counts
Today, percutaneous transluminal coronary angioplasty (PTCA) is the most important treatment modality for coronary artery disease. However, restenosis occurs in 20-40% of the vessels in spite of the use of stents. Intravascular radiation therapy has reduced the frequency of restenosis in both animal studies and clinical trials. Recent randomized trials have shown a reduction in the order of 30% after irradiation. A number of techniques which use different sources of radiation (beta vs. gamma radiation) are under investigation. This review gives and update of intravascular radiation therapy, including a discussion of ongoing trials. There is a great need, also in Norway, for treatment modalities that reduce the frequency of restenosis after PTCA. It would seem imperative that we start a discussion of whether and when intravascular radiation therapy should be available in Norway. Implementation requires planning on a national level with regard to investment in equipment and training.
BACKGROUND: The prevalence of type 2 diabetes among Norwegian men increased from 2.6% to 3.3% from 1986 to 1997. The most important environmental risk factors for type 2 diabetes are obesity and reduced physical activity. Genetic factors are also strongly involved. Biochemical risk factors are impaired glucose tolerance and decreased insulin response. MATERIAL AND METHODS: Only a few small studies have investigated the possibility of primary prevention of type 2 diabetes. RESULTS: In a six-year intervention study on persons with impaired glucose tolerance in China, diet and/or increased physical activity reduced the risk of type 2 diabetes by 30 to 50%. Similar results were found in a study from Sweden. No drug is shown to prevent type 2 diabetes. Possible candidates are metformin and thiazolidinediones which increase insulin sensitivity, and pancreatic lipase inhibitors which reduce the absorption of fat from the gut. Three large, randomised, prospective studies are investigating whether life style intervention or medication can prevent the disease. The results of these studies will be available in about five years. INTERPRETATION: Present evidence clearly indicates that increased physical activity and diet can prevent the development of type 2 diabetes.
BACKGROUND: Dietary treatment plays an important role in prevention of coronary heart disease. In Norway as in other European countries, patients with established coronary heart disease are advised to follow a cholesterol-lowering diet. However, epidemiological observations have suggested that Mediterranean and other diets may have cardioprotective characteristics beyond their effects on serum total and LDL cholesterol levels. MATERIAL AND METHODS: We describe the results of randomised, controlled clinical trials that have investigated the effect of diet on secondary prevention of coronary heart disease. RESULTS: Diets characterised by high contents of oleic acid (18: 1n-9), alpha-linolenic acid (18: 3n-3) and fish or fish oil and near-vegetarian diets have reduced cardiovascular morbidity and mortality in patients with coronary heart disease. INTERPRETATION: Several characteristics of the Mediterranean diet seem to have additional anti-atherothrombogenic effects beyond those observed with the usually recommended cholesterol-lowering diet. We ask whether Norwegian dietary recommendations for secondary prevention, should emphasise more strongly the type of fat used and fruit and vegetable intake, in line with the principles of the Mediterranean diet. Such dietary advice should be incorporated into the medical treatment given to all patients with coronary heart disease, regardless of their lipid profile.
The objective of the study was to ascertain whether physical activity at the workplace reduces the amount of sick leave. The databases Medline and Spri-line, reference lists, and professional expertise were consulted for information on the subject. We included random controlled trials, and controlled trials studying the effect on sick leave of physical activity at the worksite. Four trials were identified, including one carried out in Norway. The small number of trials limits the value of any conclusions and highlights the need for more research. The results of the four trials do not indicate that physical activity at the workplace reduces sick leave.
Comment In: Tidsskr Nor Laegeforen. 1999 Jan 10;119(1):8510025215
The prevalence of HIV infection among pregnant women is low in Norway (4.5/100,000). HIV screening has been offered on a routine basis in antenatal care since 1987. 96% of all pregnant women are screened for HIV. After the introduction of the screening programme, effective treatment (zidovudin) has become available to pregnant women. This treatment reduces mother-to-child transmission of HIV by two thirds. By screening all pregnant women during a period of two years (95% confidence interval 1-6 years), transmission can be reduced to one child if the HIV positive women are offered and accept treatment. According to a review presented here, doctors and midwives involved in antenatal care do not seem to have good enough routines for giving women information about the screening test and for offering informed choices.
The prevalence of type 2 diabetes is increasing rapidly. In order to reduce the morbidity and mortality of type 2 diabetes, it is important to treat both hyperglycaemia and risk factors for cardiovascular disease. This means that diabetes care is becoming increasingly comprehensive and complicated. Studies in Norway show that diabetes care in general practice could be improved. The primary care system needs more resources and better organisation to be able to meet the demands for improved quality and more comprehensive care. We suggest more active use of nurses and other health care professionals, as well as changes in the remuneration system for general practitioners. Remuneration for an annual review of patients with diabetes will stimulate quality improvement work. The division of work between primary health care and hospital clinics should be clarified.