Trends in maternal use of snus and smoking tobacco in pregnancy. A register study in southern Norway.

BACKGROUND: The use of tobacco products including Swedish snus (moist snuff) in pregnancy may cause adverse health outcomes. While smoking prevalence has decreased among fertile women in Norway, snus use has increased during the last years. We investigated whether these trends were reflected also during pregnancy in a population of women in Southern Norway. METHODS: Data on smoking tobacco and snus use at three time points before and during pregnancy for 20,844 women were retrieved from the electronic birth record for the years 2012-2017. The results for the three-year period 2015-2017 were compared with a previously studied period 2012-2014. Prevalence and quit rates of tobacco use within groups of age, parity and education were reported. Within the same groups adjusted quit rates were analyzed using logistic regression. Mean birthweight and Apgar score of offspring were calculated for tobacco-users and non-users. RESULTS: There was an increase of snus use before pregnancy from the period 2012-2014 to the period 2015-2017 from 5.1% (CI; 4.6 to 5.5) to 8.4% (CI; 7.8 to 8.9). Despite this, the use of snus during pregnancy did not increase from the first to the second period, but stabilized at 2.8% (CI; 2.5 to 3.2) in first trimester and 2.0% (CI; 1.7 to 2.2) in third trimester. Cigarette smoking decreased significantly both before and during pregnancy. Snus use and smoking during pregnancy were associated with a reduction in average birthweight, but no significant effects on Apgar scores. Odds ratios for quitting both snus and smoking tobacco during pregnancy were higher for women aged 25-34 years, for the primiparas and for those with a high level of education. Pregnant women were more likely to have quit tobacco use in the last time period compared to the first. CONCLUSIONS: While smoking during pregnancy was decreasing, the use of snus remained constant, levelling off to around 3% in first trimester and 2% in third trimester. Approximately 25% of those that used snus, and 40% that smoked before pregnancy, continued use to the third trimester. This calls for a continuous watch on the use of snus and other nicotine products during pregnancy.

General practitioners' use of ICPC diagnoses and their correspondence with patient record notes. / Allmennlegers bruk av ICPC-diagnoser og samsvar med journalnotatene.

BACKGROUND: The quality of the general practitioners' setting of diagnoses using codes from the International Classification for Primary Care (ICPC) is important, because these codes are used for purposes of quality development, research and public health statistics. It is uncertain, however, to what extent these diagnoses present a correct picture of the content of and reasons for the consultations and the prevalence of illness in the population. The objective of this study was to identify the extent to which the general practitioners' use of diagnostic codes correlates with the content of the patient record notes. MATERIAL AND METHOD: A total of 23 general practitioners from five different medical centres in Agder county participated in the study. The patient record notes from all patient contacts over two working days in 2013 were reviewed by two experienced general practitioners who assessed the degree of correspondence between the content of the patient record notes and the concomitant ICPC diagnostic codes. RESULTS: A total of 1 819 patient contact were assessed, and for 1 591 of these (87.5 %) it was possible to assess the correspondence between the patient record notes and the diagnosis. We found good correspondence for 693 (85.3 %) consultations and 321 (69.9 %) simple contacts with issuance of a prescription. For simple contacts with no issuance of a prescription there was good correspondence for 213 (83.9 %), although 144 of a total of 398 (36.2 %) could not be assessed because the patient record notes were absent, too brief or imprecise. INTERPRETATION: The diagnoses made during consultations corresponded well with the patient record notes examined in this study. The results may indicate that caution should be exercised in including simple contacts in the data on diagnoses in public statistics. The findings should be followed up in larger-scale and more representative national studies.

Use of snus and smoking tobacco among pregnant women in the Agder counties. / Bruk av snus og røyketobakk hos gravide i Agder.

BACKGROUND: The use of snus during pregnancy increases the risk of stillbirths, premature delivery and reduced birthweight. People have been warned against smoking during pregnancy, but less so against the use of snus. We have investigated the use of snus and smoking tobacco among pregnant women in the Agder counties. MATERIAL AND METHOD: Data on pregnant women and 10 583 births for the years 2012, 2013 and 2014 were retrieved from the electronic birth records of Sørlandet Hospital. RESULTS: In the three-year period 2012 ­ 2014, altogether 5 % used snus and 19 % used smoking tobacco before pregnancy and 2 % and 8 % respectively at the end of pregnancy. The use of snus before pregnancy increased from 3.6 % in 2012 to 6.8 % in 2014. The equivalent figures for the first trimester were 1.7 % and 3.4 %, and for the last trimester 1.2 % and 2.1 %. The use of smoking tobacco declined by 2 % over the three-year period. In the age group 16 ­ 24 years, a total of 12 % used snus before pregnancy and 5 % at the end. Of 522 women who used snus before their pregnancy, altogether 57.5 % had quit during the first trimester and 71.4 % during the third trimester. The corresponding figures for those 2 015 women who used smoking tobacco before their pregnancy were 45.2 % and 58.0 % (p < 0.001). INTERPRETATION: The use of snus before and during pregnancy doubled over the three-year period 2012 ­ 2014. The use was especially widespread in the youngest age groups. The proportion of women who quit using snus during their pregnancy was significantly higher than the proportion that quit smoking.

A qualitative description of telemedicine for acute stroke care in Norway: technology is not the issue.

BACKGROUND: To assist small hospitals in providing advanced stroke treatment, the Norwegian Directorate of Health has recommended telemedicine services. Telestroke enables specialists to examine patients via videoconferencing supplemented by teleradiology and to provide decision support to local health care personnel. There is evidence that telestroke increases thrombolysis rates. In Norway, telemedicine has mainly been used in non-critical situations. The first telestroke trials took place in 2008. The aim of this paper is to present an overview of telestroke trials and today's status with telestroke in Norway. Based on the divergent experience from two health regions in Norway, the paper discusses crucial factors for the integration of telestroke in clinical practice. METHODS: This is a descriptive study based on multiple methods to obtain an overview of the practice and experience with telestroke in Norway. A Web and literature search for 'telestroke in Norway' was performed and compared with a survey of telemedicine services at the country's largest hospitals. These findings were supplemented by interviews with key personnel involved in telestroke in two of four health regions, as well as hospital field observations and log data of telestroke transmissions from five of the hospitals involved. RESULTS: In Norway, experience in telemedicine for acute stroke care is limited. At the beginning of 2014, three of four regional health authorities were working with telestroke projects and services. Integration of the service in practice is challenging, with varying experience. The problems are not attributed to the technology in itself, but to organization (availability of staff on duty 24/7 and surveillance of the systems), motivation of staff, logistics (patient delay), and characteristics of the buildings (lack of space). CONCLUSIONS: Prerequisites for successful integration of telestroke in clinical practice include realization of the collaboration potential in the technology with consistent procedures for training and triage, availability of the equipment, and providing advice beyond questions concerning thrombolysis.

Choosing to live with home dialysis-patients' experiences and potential for telemedicine support: a qualitative study.

BACKGROUND: This study examines the patients' need for information and guidance in the selection of dialysis modality, and in establishing and practicing home dialysis. The study focuses on patients' experiences living with home dialysis, how they master the treatment, and their views on how to optimize communication with health services and the potential of telemedicine. METHODS: We used an inductive research strategy and conducted semi-structured interviews with eleven patients established in home dialysis. Our focus was the patients' experiences with home dialysis, and our theoretical reference was patients' empowerment through telemedicine solutions. Three informants had home haemodialysis (HHD); eight had peritoneal dialysis (PD), of which three had automated peritoneal dialysis (APD); and five had continuous ambulatory peritoneal dialysis (CAPD). The material comprises all PD-patients in the catchment area capable of being interviewed, and all known HHD-users in Norway at that time. RESULTS: All of the interviewees were satisfied with their choice of home dialysis, and many experienced a normalization of daily life, less dominated by disease. They exhibited considerable self-management skills and did not perceive themselves as ill, but still required very close contact with the hospital staff for communication and follow-up. When choosing a dialysis modality, other patients' experiences were often more influential than advice from specialists. Information concerning the possibility of having HHD, including knowledge of how to access it, was not easily available. Especially those with dialysis machines, both APD and HHD, saw a potential for telemedicine solutions. CONCLUSIONS: As home dialysis may contribute to a normalization of life less dominated by disease, the treatment should be organized so that the potential for home dialysis can be fully exploited. Pre-dialysis information should be unbiased and include access to other patients' experiences. Telemedicine may potentially facilitate a communication-based follow-up and improve safety within the home setting, making it easier to choose and live with home dialysis.

[Insufficient communication and information regarding patient medication in the primary healthcare]. / Mangelfull kommunikasjon om legemiddelbruk i primaerhelsetjenesten.

BACKGROUND: Medicine management in primary health care involves several participants: the prescribing physicians, various health care personnel involved in drug administration and patients with varying degrees of will and competence to be compliant. Many things can go wrong in this process, resulting in medication errors. This qualitative survey focuses on how information is transferred within primary healthcare and how prescription and administration of medicines are documented. MATERIAL AND METHODS: A random selection of GPs and medical secretaries in nine regular GP practices and a strategic selection of community nurses, personnel in nursing homes and emergency clinics and in hospital departments at the University Hospital of Northern Norway were interviewed in a semi-structured way during the spring of 2005. Observations were undertaken in both nursing homes and units for community nurses. Observations were logged, interviews taped, transcribed and the total material analysed. RESULTS: Necessary information on medication was not easily accessible to health care personnel in charge of patient care. Obtaining the information was time-consuming and the quality was variable and perceived as unreliable. Five out of nine GPs regarded a pharmacy prescription to be sufficient information to community nurses regarding alterations in patient medication. GPs seldom signed prescriptions in the nurses' medication chart. Patient medication information was not present when needed. Community nurses on night duty therefore often did not know what drugs they were handing out during their home visits. Discharge notes from the hospitals were often delayed, they were not sent to community nurses and just three out of nine GPs updated their medication summaries when receiving such information. INTERPRETATION: There is a need for improved communication and handling of information related to patient medication in primary health care. Patients in an ambulatory setting, who are not in charge of their own medication, are especially vulnerable to failure.

[Elevated serum ferritin and hemochromatosis in general practice]. / Forhøyet serum-ferritinnivå og hemokromatose i allmennpraksis.

BACKGROUND: We wanted to examine how many of our patients with elevated serum ferritin had undetected haemochromatosis. MATERIAL AND METHODS: Searches in our patient files showed that 519 persons aged 20-70 had tested positively for elevated serum ferritin over the five-year period 1996-2000. 379 of these (73%) were found suitable for follow up and were offered examination for serum ferritin and transferrin saturation. 291 of these (77%) came in. Patients with elevated transferrin saturation had a gene test for haemochromatosis. RESULTS: 23 of the 291 persons with elevated serum ferritin also had elevated transferrin saturation (8%). 12 out of 23 (52%) were homozygote for the haemochromatosis mutation C282Y. INTERPRETATION: In our opinion, persons with elevated serum ferritin should be offered a control of serum ferritin and transferrin saturation. If both these tests show elevated levels, a gene test for haemochromatosis should be performed. Persons who are homozygote for the haemochromatosis mutation should have a follow up with testing of serum ferritin with some years' intervals in order to secure that venesection is started in due time.