Hordaland County Research Articles

Prevalence of bladder, bowel and sexual problems among multiple sclerosis patients two to five years after diagnosis

Most multiple sclerosis (MS) patients experience some sexual, bladder and/or bowel dysfunction during the course of the disease - one of MS most disabling features. This study estimated the frequency of these problems among patients, two to five years after diagnosis, and investigated how these problems are associated with health-related quality of life (using the Multiple Sclerosis Quality of Life-54 questionnaire). The study population comprised a cohort of patients (n=56), diagnosed in a three-year period, in Hordaland County, Norway. The patients were examined clinically, including scoring of the Expanded Disability Status Scale (EDSS), and completed questionnaires related to bowel and bladder dysfunction, sexual problems and health-related quality of life. More than half the patients had bladder and sexual problems. The frequency of self-reported bladder problems corresponded to the relatively high levels of residual urine found. The presence of these problems was associated with lower scores on the quality of life scales. Further, the bowel problems reported were markedly associated with the quality of life scores. Since treatments and preventive strategies can manage many of these problems, we suggest increasing the focus on these aspects of the disease when consulting patients, including at early stages.

Lack of recognition and complexity of foetal alcohol neuroimpairments

To obtain the recorded prevalence of foetal alcohol syndrome (FAS) and foetal alcohol spectrum disorders (FASD) in Norway, and evaluate the effect of a general information program to increase the recognition of FAS/FASD for health care and social workers. A questionnaire regarding prevalence of FAS/FASD was sent to all Norwegian paediatric and child psychiatry departments. In the region Hordaland county, an information program was carried out to educate health-care and social workers on symptoms and signs of FAS/FASD, and referral was encouraged for suspected cases. Referred children received a neuropaediatric evaluation, and the effect of the information program on recorded FAS/FASD was recorded. Based on the national survey, a prevalence of 0.3 per 1000 was calculated. After the information program, the estimated prevalence in Hordaland County increased to 1.5 per 1000. In 5 years, 25 children were diagnosed with FAS and 22 with FASD. One-third of all children were mentally retarded. Microcephaly and neuroimpairments were more common among FAS children. Almost all children met the criteria of ADHD. The rate of FAS/FASD may be greatly underestimated because of lack of knowledge. An information program aimed at health-care and social workers is effective.

High Incidence of Infarction in the Left Cerebral Hemisphere Among Young Adults

We hypothesized that left cerebral hemisphere infarction is more frequent than right hemisphere infarction among young adults. Furthermore, we aimed to evaluate possible causes for this asymmetry. Cases were found by computer search from hospital registries at each of the 5 acute-care hospitals in a well-defined population in Hordaland County, western Norway. Important parameters used in the analysis were derived from the patient records. A total of 98 patients had left hemisphere infarctions, and 70 patients had right hemisphere infarctions (P = .037). This difference was due mostly to the higher incidence of infarction in the left middle cerebral artery (MCA) territory compared with the right MCA territory among the male subjects (P = .016). Lacunar infarction was equally distributed, whereas nonlacunar infarction was more frequent in the left MCA territory among the men (P = .016). A high frequency of left MCA infarctions may be associated with more frequent atherosclerosis in the left carotid artery, lateralization of cortical functions, or both in young adults.

Antihypertensive and lipid lowering treatment in 70–74 year old individuals – predictors for treatment and blood-pressure control: a population based survey. The Hordaland Health Study (HUSK)

BackgroundIn an elderly, community based population we aimed at investigating antihypertensive and lipid lowering medication use in relation to own and familiar cardiovascular morbidity and diabetes mellitus, as well as to lifestyle factors and general health. We also examined levels of blood pressure in untreated and treated residents, to investigate factors correlating with blood pressure control.MethodsA health survey carried out in 1997-9 in the county of Hordaland, Norway included a self-administered questionnaire mailed to 4 338 persons born in 1925-7. Drug use the day prior to filling in the questionnaire was reported. A health check-up was carried out, where their systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), and serum-cholesterol level were recorded.ResultsOne third of respondents used one or more antihypertensive drugs, while 13% of men and women were treated with a statin. Diabetes mellitus, own or relatives'cardiovascular disease, having quit smoking, physical inactivity, and overweight correlated with antihypertensive treatment. Mean blood pressure was lower in respondents not on treatment. Among those on treatment, 38% of men and 29% of women had reached a target BP-level of lower than 140/90 mm Hg. Own cardiovascular disease and a low BMI correlated with good BP-control.ConclusionOne third of 70–74 year old individuals living in the community used one or more antihypertensive drugs. Only around one third of those treated had reached a target BP-level of less than 140/90 mm Hg. Own cardiovascular disease and a low BMI correlated with good BP-control.

The Hordaland Homocysteine Study: A Community-Based Study of Homocysteine, Its Determinants, and Associations with Disease

The Hordaland Homocysteine Study (HHS) is a population-based study of more than 18,000 men and women in the county of Hordaland in Western Norway. The first investigation (HHS-I) took place in 1992-93, when the subjects were aged 40-67 y. In 1997-99, a follow-up study (HHS-II) of 7,053 subjects was carried out. In this large population, plasma levels of total homocysteine (tHcy) are associated with several physiologic and lifestyle factors and common diseases. Increasing age, male sex, smoking, coffee consumption, high blood pressure, unfavorable lipid profile, high creatinine, and the MTHFR 677C > T polymorphism are among the factors associated with increased tHcy levels; physical activity, moderate alcohol consumption, and a good folate or vitamin B-12 status are associated with lower tHcy levels. Subjects with raised tHcy levels have increased risk of cardiovascular morbidity, cardiovascular and noncardiovascular mortality, and are more likely to suffer from depression and from cognitive deficit (elderly). Among women, raised tHcy levels are associated with decreased bone mineral density and increased risk of osteoporosis. Women with raised tHcy levels also have an increased risk of having suffered from pregnancy complications and an adverse pregnancy outcome. Significant associations between tHcy and clinical outcomes are usually observed for tHcy levels > 15 micromol/L, but for most conditions, there is a continuous concentration-response relation with no apparent threshold concentration. Overall, the findings from HHS indicate that a raised tHcy level is associated with multiple clinical conditions, whereas a low tHcy level is associated with better physical and mental health.

Self-reported drug utilization, health, and lifestyle factors among 70–74 year old community dwelling individuals in Western Norway. The Hordaland Health Study (HUSK)

BackgroundTo examine the level and patterns of self-reported medication use (prescription and non-prescription drugs) among 70–74 year old individuals living in the community, and to explore self-reported indications for use, and factors possibly predictive of drug use.MethodsA health survey carried out in 1997–99 in the county of Hordaland (Western Norway) in the setting of a population study. A self-administered questionnaire was mailed to 4338 persons born in 1925–27, and a health check-up was offered. Drug use the previous day was reported (point prevalence). 3341 (77.0%) persons who responded, comprise the material for the analyses.ResultsBetween one third (males) and one quarter (females) did not take any drug the previous day. Mean number of drugs among users was 2.8 (men and women). 32% used three or more drugs and 11.5% five or more. Hypertension and other cardiovascular problems were by far the most common reasons for drug use, followed by respiratory, musculoskeletal and mental health problems. Self-reported poor health, a high Body Mass Index (BMI), and being an ex-smoker (but not currently a smoker) correlated with increasing number of drugs taken.ConclusionAmong 70–74-year old individuals living in the community no use of medication was more common than major polypharmacy (5+ drugs). Persons who had fallen ill and were put on regular medication, probably tended to quit smoking, while those who remained healthy, continued to smoke.

Dental and medical injections: prevalence of self‐reported problems among 18‐yr‐old subjects in Norway

The aim of the present study was to evaluate the prevalence of self-reported problems (fear, pain, unpleasantness, fainting) of dental and medical injections, and the extent to which such problems may lead to avoidance of necessary treatment. The study included a representative sample (n = 1385) of 18-yr-old students attending high schools in the county of Hordaland, Norway. Data were collected by use of questionnaires completed in the classrooms. More problems were reported during dental than medical injections. About 17% and 15% of participants reported high fear during their last dental and medical injection, respectively. Fainting had been experienced by 2% during a dental injection and by 7% during a medical injection. Avoidance of treatment when an injection is needed was 6.7% for dental treatment and 5.2% for medical treatment. In multiple regression analyses, fear was the only explanatory factor for the avoidance of dental treatment. It is concluded that self-reported problems of injections are prevalent in this age group, particularly among girls, and that it may lead to the avoidance of necessary treatment in 5-7% of the adolescent population.

A 50-year follow-up of the incidence of multiple sclerosis in Hordaland County, Norway

To assess longitudinal follow-up of the incidence of multiple sclerosis (MS) through five decades and estimate the prevalence rate in Hordaland County, Norway, on January 1, 2003. All patients with MS diagnosed from 1953 to 2003 were identified in the patient records of the Department of Neurology, Haukeland University Hospital, Bergen, Norway. The diagnostic criteria of Poser et al. were applied and only patients with definite and probable MS were included. The study comprises 912 patients, and 666 patients with MS were living in Hordaland on January 1, 2003. The annual incidence rates for the years 1953 to 2003 were calculated. The total crude prevalence rate on January 1, 2003, was 150.8 per 100,000 population: 191.3 per 100,000 among women and 109.8 per 100,000 among men. The annual incidence of MS increased from 1.8 per 100,000 in 1953 to 1957 to 6.0 per 100,000 in 1993 to 1997. Hordaland County, Norway, has changed from a low-risk to a high-risk area for multiple sclerosis (MS) during the last 50 years. During the last 25 years, the incidence of MS has been stable rather than increasing. Systematic longitudinal follow-up studies are essential to calculate reliable prevalence and incidence rates in MS. The results suggest that both methodologic and environmental factors are essential in determining the distribution of MS.

January 24 Highlights

Grytten et al. report an MS prevalence rate of 150.8/100,000, confirming Hordaland County, Norway, as a high-risk area for MS. The incidence increased from the early 1950s to the late 1970s. However, during the past 25 years, the incidence of MS has been stable at 6/100,000. see page 182 Baram and Miller found that visual cues, provided through a portable visual-feedback virtual reality apparatus, improve walking abilities of patients with MS. Both on-line and residual short-term therapeutic effects were measured in patients with gait disturbances (predominantly due to cerebellar ataxia). see page 178 In this 12-week double-blind, placebo-controlled trial, Giuliano et al. assessed the efficacy and tolerability of vardenafil in 418 men with erectile dysfunction due to spinal cord injury. Vardenafil significantly improved erectile function and was generally well tolerated. Ejaculation success rate was significantly greater with vardenafil (19%) vs placebo (10%). see page 210 …

Anabolic Steroid Use in High School Students

A total of 1351 high school students (52.3% males, 47.7% females) with mean age 17.5 years (SD = 2.2) from randomized school classes in Hordaland County, Norway, participated in an Internet survey conducted in 2004 about the lifetime use of anabolic steroids and personal acquaintance with at least one user of anabolic steroids. In addition to questions about anabolic steroids the participants completed the Hospital Anxiety and Depression Scale and the Alcohol Use Disorders Identification Test. They also answered questions about demography, smoking, and narcotic use. The lifetime prevalence for use of anabolic steroids was 3.6% for males and 0.6% for females. In all, 27.9% of the respondents reported having at least one acquaintance that used or had used anabolic steroids. Use of anabolic steroids and having acquaintances using such drugs were strongly related to use of other drugs such as alcohol, nicotine, and narcotics. Implications for prevention are discussed and the study's limitations are noted.

The use of catch statistics to monitor the abundance of escaped farmed Atlantic salmon and rainbow trout in the sea

Abstract Catch statistics and scale samples were collected from a gillnet fishery targeting escaped farmed salmonids between 1 October and 28 February each year from 2001 to 2004 in Hordaland County, western Norway. Fish were classified into different groups, or escape incidents, using catch per unit effort (cpue) and size distribution of the catch from different geographical subregions. Reported escape incidents of both rainbow trout and salmon appeared to be followed by peaks in the cpue lasting four to six weeks, but a large proportion of the catch of escaped salmon appeared to stem from unreported, small-scale escape events. The wide size-range of fish caught suggests that the escapees originated from different escape incidents, and the variability between regions suggests that most catches were of local origin. Genetic comparisons among three groups of escapees indicated that DNA profiling may facilitate identification in monitoring programmes of escapees originating in different genetic groups. A low incidence of wild fish was found in the catches. Provided the conservation status of local wild salmonid stocks is taken into account, a fishery targeting escaped farmed salmonids may reduce the numbers of escapees, thus lowering the risk of introgression with wild salmon populations and removing potential sources of sea lice. Information on the relative abundance of escapees in the sea would also be provided by a fishery targeting escapees.

Multiple sclerosis and lifestyle factors: the Hordaland Health Study

This study compared multiple sclerosis (MS) patients (n=87) with the general population and with people reporting angina pectoris (n=109), asthma (n=1,353) and diabetes (n=219) regarding health-related quality of life (SF-12), working status and lifestyle factors including smoking, alcohol consumption, body mass index (BMI) and leisure physical activity. The study was cross-sectional and included the birth cohorts from 1950 to 1957 living in Hordaland County, Norway in 1997. A total of 22,312 people participated, yielding a response rate of 65%. The MS patients had a high rate of smoking and a low mean BMI, despite lower leisure physical activity compared with the rest of the study population. This suggests that it may be advisable to increase the focus on smoking, physical activity and the balance between energy intake and use.

Seasonal Variations in Mood and Behaviour Associated with Gender, Annual Income and Education: The Hordaland Health Study

To explore the relationship between demographic factors and seasonal changes in mood and behaviour. A health survey was conducted among 40-45 year old inhabitants in Hordaland County, Norway. The Global Seasonality Score, investigating seasonal symptoms, was given to 4299 men and 9983 women. Response rates among those receiving the questionnaire were 79.8% for men (n = 3432) and 81.2% for women (n = 8223). High seasonality was reported by 18.4% of men and 22.2% of women. Female gender, low educational level, high level of affective symptomatology and low household income correlated with high seasonality. Among men, being single was also a determinant factor for high seasonality. Reported seasonality also depended on which month the questionnaire was filled in. In this study, high seasonality was most prevalent among females, being single, having a low annual income and a low education level. The latter two findings are different from expectations which could be drawn from previous studies suggesting an opposite association.

Seizure-related factors and non-verbal intelligence in children with epilepsy: A population-based study from Western Norway

To study the relationship between seizure-related factors, non-verbal intelligence, and socio-economic status (SES) in a population-based sample of children with epilepsy. The latest ILAE International classifications of epileptic seizures and syndromes were used to classify seizure types and epileptic syndromes in all 6-12 year old children (N=198) with epilepsy in Hordaland County, Norway. The children had neuropediatric and EEG examinations. Of the 198 patients, demographic characteristics were collected on 183 who participated in psychological studies including Raven matrices. 126 healthy controls underwent the same testing. Severe non-verbal problems (SNVP) were defined as a Raven score at or <10th percentile. Children with epilepsy were highly over-represented in the lowest Raven percentile group, whereas controls were highly over-represented in the higher percentile groups. SNVP were present in 43% of children with epilepsy and 3% of controls. These problems were especially common in children with remote symptomatic epilepsy aetiology, undetermined epilepsy syndromes, myoclonic seizures, early seizure debut, high seizure frequency and in children with polytherapy. Seizure-related characteristics that were not usually associated with SNVP were idiopathic epilepsies, localization related (LR) cryptogenic epilepsies, absence and simple partial seizures, and a late debut of epilepsy. Adjusting for socio-economic status factors did not significantly change results. In childhood epilepsy various seizure-related factors, but not SES factors, were associated with the presence or absence of SNVP. Such deficits may be especially common in children with remote symptomatic epilepsy aetiology and in complex and therapy resistant epilepsies. Low frequencies of SNVP may be found in children with idiopathic and LR cryptogenic epilepsy syndromes, simple partial or absence seizures and a late epilepsy debut. Our study contributes to an overall picture of cognitive function and its relation to central seizure characteristics in a childhood epilepsy population and can be useful for the follow-up team in developing therapy strategies that meet the individual needs of the child with epilepsy.

Residence arrangements and well‐being: A study of Norwegian adolescents

The purpose of this study was to assess any differences in psychosocial problems among adolescents living with both parents, or with their mother or their father. Any benefits of living with a same-sex parent compared to a parent of the opposite sex, was also analysed. A total of 1,686 adolescents aged 14-15 years participated from 29 schools in Hordaland county, including schools in downtown Bergen and more rural areas. The findings revealed significantly more psychosocial problems among the adolescents living with one parent compared to both parents. Significant differences were also observed between adolescents living in mother custody compared to father custody, indicating more problems among the latter group. Furthermore, girls living with their father had significantly higher levels of psychological symptoms, compared to boys in father custody. Similarly, boys living with their father were involved in more stealing behavior than girls in father custody. However, residence arrangement accounted for only a limited proportion of the variance in the adolescents' psychosocial problems, indicating large within-group variance and overlap between the different custody groups.

Epidemiology of Severely and Fatally Injured Patients in Western Part of Norway

Analysis of the injury mechanism and characteristics of severely and fatally injured patients in the western part of Norway. We did a prospective registration of all severely injured patients hospitalized during a three-year period. The files of severely injured patients that died at scene or during transport were retrospectively retrieved from the Forensic Department. A total of 558 patients with an Injury Severity Score > 15 were included. Four-hundred-forty-four men (79.6 %) and 114 women (20.4 %) with a median age of 36 and 51.5 years respectively were included. The proportion of female patients older than 80 years were 19.3 % compared to 5.6 % for men. A total of 215 (38.5 %) patients died and 149 (69.3 %) of these patients died on scene or during transport. The incidence of severely injured patients in Hordaland County was 30 per 100,000 inhabitants per year. The incidence was lowest among children below 5 years (7/100,000/year) and highest among persons older than 80 years (95/100,000/year). Men had a 3.8 times greater risk of getting seriously injured compared to women. Road traffic accidents were the cause of the injuries in 235 (42.1 %) patients and 35.8 % of these patients died. A total of 215 (38.5 %) patients were injured due to falls and 30.2 % of these patients died. Patients who had sustained falls were significantly older than patents with other injury mechanisms (p < 0.001, CI = 13.0-20.2). The proportion of patients with penetrating injuries was 7.3 %. The incidence of severely injured patients was 30/100000/year. Men and elderly people had a higher risk of getting severely injured. Falls were the dominating injury mechanism among elderly.

Prognostic Impact of Alterations in P-Cadherin Expression and Related Cell Adhesion Markers in Endometrial Cancer

Reduced tumor cell adhesion is associated with invasive growth and unfavorable prognosis. In endometrial carcinoma, the prognostic impact of adhesion markers (E-cadherin, beta-catenin [beta-catenin], P-cadherin, and p120(ctn)) is partly unknown. We wanted to examine the expression pattern and prognostic value of these molecules in a population-based series of endometrial carcinoma patients. All patients diagnosed with endometrial carcinoma between 1981 and 1990 in Hordaland County, Norway, were included. Paraffin-embedded tumor tissue was available for 96% of the patients (n = 286), and was studied immunohistochemically for expression of E-cadherin, beta-catenin, P-cadherin, and p120(ctn). The tissue microarray technique was used for P-cadherin and p120(ctn). Median follow-up time for survivors was 9 years (range, 4 to 16 years) and follow-up was complete. Pathologic expression of P-cadherin, E-cadherin, and beta-catenin was associated with a majority of the clinicopathologic variables. In univariate survival analyses, all adhesion markers influenced survival significantly (P <.05). Tumors with pathologic expression of both E-cadherin (low expression) and P-cadherin (high expression; 19%), and beta-catenin (low expression) and P-cadherin (high expression; 16%), had significantly reduced survival compared with the remaining samples (P <.001 for both). In multivariate models, all markers except E-cadherin showed independent prognostic significance in addition to the traditional tumor features. Differential expression of P-cadherin and beta-catenin seems to be important in endometrial carcinoma and is associated with aggressive subgroups. Our findings also indicate that a shift from E-cadherin to P-cadherin expression (cadherin switch) is an important prognostic feature in these tumors.

Remission of respiratory symptoms by smoking and occupational exposure in a cohort study

Few studies have estimated the remission rates of respiratory symptoms in general populations. No community cohort studies have examined the impact of smoking cessation and previous dust or fumes exposure on the remission of respiratory symptoms. In the Hordaland County Study, an 11-yr community cohort (1985-1996/1997) from Western Norway, data from 2,819 subjects were used to examine the remission of six respiratory symptoms. The measured cumulative remission varied from 42.3% for morning cough to 58.4% for chronic cough. Smoking cessation was a significant predictor of remission of the cough symptoms and wheezing, with odds ratios (OR) (95% confidence intervals (CI)) varying from 2.2 (1.3-3.7) for wheezing to 6.2 (3.5-11.2) for morning cough, after adjustment for sex, age, pack-years smoked, previous dust or fumes exposure, and educational level. In those not previously exposed to dust or fumes, the adjusted OR (95% CI) for the remission of morning cough, phlegm cough, dyspnoea grade 2, attacks of dyspnoea and wheezing varied from 1.5 (0.9-2.5) for attacks of dyspnoea to 2.1 (1.1-3.9) for dyspnoea grade 2, as compared to those previously exposed to dust or fumes. This study suggests a beneficial effect of smoking cessation and an adverse effect of occupational exposure on the remission of respiratory symptoms.

Etiology of and risk factors for cerebral infarction in young adults in western Norway: a population‐based case‐control study

We sought to study the etiology of and risk factors for cerebral infarction in young adults in Hordaland County, Norway. All patients aged 15-49 years living in Hordaland County with a first-ever cerebral infarction during 1988-97 were included. Etiology was analyzed in subgroups defined by sex, age (<40 years versus >/=40 years), circulation territory (anterior versus posterior circulation) and short-term functional outcome [modified Rankin score (mRS) </= 2 versus mRS > 2]. A questionnaire was used to evaluate possible risk factors amongst the patients compared with an age- and sex-matched control group. The distribution of etiology was significantly different in all subgroups. Atherosclerosis was frequent amongst men (22.8% vs. 4.2%) and patients >/= 40 years (20.8% vs. 2.7%). All patients with microangiopathy had favorable short-term outcome. Significant risk factors were smoking more than 15 cigarettes per day (P < 0.001), hypertension (P = 0.001), and myocardial infarction (P = 0.035). Modifiable risk factors were frequent.

Occupation, lifestyle factors and health-related quality of life: the Hordaland Health Study.

Health-related quality of life was estimated using the physical and mental summary scores of the SF-12 Health Survey in a cross-sectional study of a general population of 23,312 individuals aged 40-47 years in Hordaland County, Norway. The mean scores in the main occupational groups were adjusted for lifestyle factors using a six-way analysis of covariance. The category of legislators, senior officials, and managers scored highest on both the physical and the mental components, whereas the drivers scored lowest on the physical health and agricultural and fishery workers scored lowest on mental health. Smoking showed marked dose-response relationships with reduced physical and mental health, and inverse U-shaped relationships were found for alcohol consumption and the body mass index, with the mental scale for body mass index peaking above the recommended range of 18.5 to 25.0 kg/m2. Although selection bias related to the choice of occupation cannot be ruled out, the low scores of the quality of life measure for the agricultural and fishery workers and the drivers most likely reflect the effect of known health stressors for these occupations.