The national web-based outbreak rapid alert system in Norway: eight years of experience, 2006-2013.

In 2005, the Norwegian Institute of Public Health established a web-based outbreak rapid alert system called Vesuv. The system is used for mandatory outbreak alerts from municipal medical officers, healthcare institutions, and food safety authorities. As of 2013, 1426 outbreaks have been reported, involving 32913 cases. More than half of the outbreaks occurred in healthcare institutions (759 outbreaks, 53·2%). A total of 474 (33·2%) outbreaks were associated with food or drinking water. The web-based rapid alert system has proved to be a helpful tool by enhancing reporting and enabling rapid and efficient information sharing between different authorities at both the local and national levels. It is also an important tool for event-based reporting, as required by the International Health Regulations (IHR) 2005. Collecting information from all the outbreak alerts and reports in a national database is also useful for analysing trends, such as occurrence of certain microorganisms, places or sources of infection, or route of transmission. This can facilitate the identification of specific areas where more general preventive measures are needed.

An outbreak of Salmonella Typhimurium infections in Denmark, Norway and Sweden, 2008.

In November-December 2008, Norway and Denmark independently identified outbreaks of Salmonella Typhimurium infections characterised in the multiple-locus variable number of tandem repeats analysis (MLVA) by a distinct profile. Outbreak investigations were initiated independently in the two countries. In Denmark, a total of 37 cases were identified, and multiple findings of the outbreak strain in pork and pigs within the same supply chain led to the identification of pork in various forms as the source. In Norway, ten cases were identified, and the outbreak investigation quickly indicated meat bought in Sweden as the probable source and the Swedish authorities were alerted. Investigations in Sweden identified four human cases and two isolates from minced meat with the distinct profile. Subsequent trace-back of the meat showed that it most likely originated from Denmark. Through international alert from Norway on 19 December, it became clear that the Danish and Norwegian outbreak strains were identical and, later on, that the source of the outbreaks in all three countries could be traced back to Danish pork. MLVA was instrumental in linking the outbreaks in the different countries and tracing the source. This outbreak illustrates that good international communication channels, early alerting mechanisms, inter-sectoral collaboration between public health and food safety authorities and harmonised molecular typing tools are important for effective identification and management of cross-border outbreaks. Differences in legal requirements for food safety in neighbouring countries may be a challenge in terms of communication with consumers in areas where cross-border shopping is common.

Reported sexually transmitted infections in Swedish Internet-using men and women.

Although the Internet has become a forum for making sexual contacts, and has been associated with increased sexually transmitted infection (STI) transmission, we have little information of history of STIs in Internet-based samples. The Internet behaviours that are associated with STI acquisition are poorly understood. We analysed STI histories reported by 904 Swedish men and 931 Swedish women who responded to an Internet-based survey on sexual behaviour in 2002: 16.6% of men and 22.5% of women reported a lifetime history of STIs, with Chlamydia being the most common for both genders. 3% of men and 5% of women who reported an STI, indicated that they had had more than one. Sources of the STI, where known, were Internet-acquired partners in only 3% of cases. There were no differences between men and women with or without an STI history regarding the kind of online sexual activities they engaged in, how they found sexual material online, and the reasons they engage in sexual activities. These rates are similar to those reported in a national random study of sexuality in Sweden. Contrary to prior research, these results suggest no relationship between STI and specific Internet characteristics usage patterns. These data suggest that the Internet is not yet a major source of STIs in Swedish men and women. Given these STI histories, the Internet may be a useful medium to include in STI prevention efforts.

Health-related quality of life in homo- and bisexual men attending a sexually transmitted disease clinic in Sweden.

Men who have sex with men (MSM) have an increased risk of contracting sexually transmitted diseases (STDs) and HIV. Studies of their health-related quality of life (HRQL) are uncommon, though such studies may provide additional knowledge that is of interest in counselling and care. The HRQL in MSM attending a clinic for STD- and HIV testing in Stockholm, Sweden, was investigated in 1996 and 2004, measured by means of the Swedish Health-Related Quality of Life questionnaire. The results were compared with those for men from a general Swedish population sample and with HIV-infected men. The HIV-negative MSM had significantly worse emotional wellbeing, satisfaction with family life, relation to their partner and general health perception, and better physical HRQL compared with the general Swedish population. There were no differences in the emotional and family dimensions between HIV-infected and HIV-negative MSM, but the HIV-negative group scored at a higher level in respect of their physical and general health than the HIV-infected group. No apparent differences over time were seen in the HIV-negative group. This study shows that psychosocial HRQL is lower for MSM than for a general male population sample, which calls for increased attention in the care of MSM patients.

Epidemiology of the reemergence of gonorrhea in Sweden.

BACKGROUND: After many years of decline, the incidence of gonorrhea in Sweden reached an all-time low of 2.4 cases per 100,000 inhabitants in 1996; however, the incidence has been increasing since 1997. GOAL: To describe the reemergence of gonorrhea in Sweden using clinical epidemiologic data and microbiologic characterization of isolated strains of Neisseria gonorrhoeae. STUDY DESIGN: N gonorrhoeae strains isolated in Sweden from February 1998 to January 1999 were serotyped and an epidemiologic data questionnaire was sent to each clinician reporting a case of gonorrhea. RESULTS: Epidemiologic and microbiologic data were obtained for 357 cases (91% of all cases diagnosed during the period). Domestic cases had significantly increased since 1997. Serovar IB-3 was the most common isolate in domestic cases of heterosexually exposed teenagers, and serovar IB-2 was the most frequent isolate in domestic cases of homosexually exposed men. Of the imported cases, 47% were exposed in Asia and 6.5% were exposed in Eastern Europe. CONCLUSION: The increase of gonorrhea in Sweden is due to an increase of domestic cases. Heterosexual teenagers and homosexual men were identified as core groups infected by different serovars of N gonorrhoeae.

[Geographical variation in the occurrence of induced late abortions in Norway 1996-97]. / Geografisk variasjon i forekomsten av induserte senaborter i Norge 1996-97.

BACKGROUND: The aims of this study were to assess i) the geographical variation in the prevalence of request for induced abortion after 12th week of pregnancy and ii) the geographical variation in the probability of refusal of abortion request for other reasons than foetal defects. MATERIAL AND METHODS: All medical records regarding request for induced abortion after 12 weeks of pregnancy during the period 1996-97 in Norway were collected in 1998 by the National Board of Health. RESULTS: There were a total of 1,061 requests for induced abortion, of whom 41 were withdrawn. 303 requests were based on foetal defects. Of the remaining 717 requests, which were included in the analysis, 144 (20%) were refused. The counties Vest-Agder, Møre og Romsdal and Finnmark had the lowest prevalence of induced abortions after the 12th week of pregnancy (< 4 per 10,000 women, 15-45 years of age, during 1996-97) and Oslo, Buskerud and Sør-Trøndelag had the highest (> 10 per 10,000 women). Hospitals in the south-western part of Norway (Vest-Agder/Aust-Agder/Rogaland) were 7.8 (95% confidence intervall 3.5-17.2) times more likely to refuse the requests as compared to hospitals in Østfold/Oslo/Akershus. INTERPRETATION: Cultural differences within Norway may explain, though not excuse, the observed geographical differences in the practice of the abortion act.

The health-related quality of life in a Swedish sample of HIV-infected persons.

The purposes of the present study are (1) to assess the health-related quality of life (HRQOL) and the subjective health status in a sample of human immunodeficiency virus (HIV)-infected persons (2) to relate the results to different population groups and (3) to investigate the relationship of medical and demographic variables with HRQOL. A total of 72 HIV-infected men were included. They answered the Swedish health-related quality of life questionnaire and the health index. Demographic and medical data were obtained from the medical records. The data collection took place before entering a therapeutic HIV vaccine trial. The results showed a more negative impact on the HRQOL and subjective health status in the HIV-positive subjects, compared with male population groups. The dimensions of emotional well-being were most affected. When comparisons were made according to the medical and demographic variables for different subgroups within the HIV sample, differences in the physical-dimension scales were most prominent. Symptomatic HIV infection or acquired immunodeficiency syndrome (AIDS), anti-retroviral treatment, sick leave or disability pension, low income and basic education were associated with worse HRQOL and health status. In conclusion, it is of utmost importance to take into account, aspects of the patients' emotional well-being in nursing, as well as in medical care and interventions. Moreover, individualized caring programs are needed because the disruptions in HRQOL fluctuated within the HIV sample.

[Induced abortion because of fetal abnormality in Norway, 1996-7]. / Svangerskapsavbrudd på grunn av fosterskade i Norge, 1996-97.

BACKGROUND: The objective of this study was to estimate the national and regional rates of induced abortions after the 12th gestational week attributed to fetal maldevelopment in Norway during 1996 and 1997. MATERIALS AND METHODS: In 1998, the National Board of Health requested from all hospitals copies of relevant documents in the medical records of women who had applied for induced abortion after 12th gestational week. RESULTS: There were 303 women in 1996 and 1997 who applied for induced abortion because of diagnosed fetal maldevelopment. For all of these women the application was accepted. One woman did not have an abortion. The national rate of induced abortion attributed to fetal maldevelopment was 2.5 per 1000 births. There were regional differences in the rate of abortion. In 53% of all applications for induced abortion the fetal diagnosis was not reported. Among the reported diagnoses, 28% were chromosomal abnormalities. INTERPRETATION: There is a need for better knowledge of factors influencing the number of induced abortions attributed to fetal malformations. We also need a better understanding of the impact of such abortions on the observed perinatal mortality and occurrence of birth defects.

Personal decontamination after exposure to stimulated liquid phase contaminants: functional assessment of a new unit.

OBJECTIVE: To evaluate the efficacy of a decontamination station following exposure of volunteers to liquids with physical characteristics comparable to sarin and mustard gas. DESIGN: Twenty-four volunteers participated in the experiment which was performed with all staff wearing personal protective equipment including respiratory protection. The clothes, skin, and hair of the volunteers were contaminated with the simulated liquid phase contaminants, ethyl lactate and methyl salicylate. Sulphur hexafluoride gas was used to confirm the ventilation efficacy. Decontamination followed guidelines using a two-stage procedure. In the first chamber, all volunteers received a 3-minute shower with water at 30 degrees C, and their clothes but not their respiratory masks were removed. In the second, they were twice washed thoroughly with soap and water. After decontamination, the volunteers entered a third chamber for first aid measures. RESULTS: The air concentration of sulphur hexafluoride was reduced by 1:10,000 between the first and the third chambers. Ethyl lactate and methyl salicylate were measured in low concentrations in the third chamber. The capacity was 16 volunteers per hour with two-thirds on stretchers. After self-decontamination of the staff, the concentration of ethyl lactate increased significantly in the third chamber, consistent with residual ethyl lactate adsorbed by their underwear. This observation revealed a deficiency in the guidelines for self-decontamination. CONCLUSION: The capacity of the decontamination unit was found to be 16 volunteers per hour. The ventilation system and guidelines of the decontamination unit were demonstrated to be effective under the conditions examined. The self-decontamination of the staff was not optimal.

Ultraviolet-B-radiation-induced changes in nicotinamide and glutathione metabolism and gene expression in plants.

Pea (Pisum sativum L. cv. Greenfeast) plants were exposed to supplementary ultraviolet-B (UV-B) radiation (biologically effective dose rates normalised to 300 nm, UV-B[BE,300]: 0.18, 0.32 or 1.4 W m[-2]). Leaf nicotinamide, trigonelline, GSHtot (total glutathione) and GSSG (oxidised glutathione) levels remained unchanged after exposure to the lowest dose rates. 1.4 W m(-2) UV-B(BE,300) gave rise to 60-fold and 4.5-fold increases in GSSG and GSHtot, respectively. 3.5-fold and 9.5-fold increases were found in nicotinamide and trigonelline, respectively. cab (Chlorophyll-a/b-binding protein) transcript levels decreased and CHS (chalcone synthase) and PAL (phenylalanine ammonia-lyase) mRNA increased after shorter UV-B exposures (hours) to the higher dose rate of UV-B, and after exposure to the intermediate dose rate. CHS and PAL mRNAs also increased after prolonged exposure to the lowest dose rate. cab transcripts completely disappeared, whereas CHS and PAL mRNA levels rose by 60-fold and 17-fold, respectively, after 12 h exposure at the highest dose rate and 12 h of development. Our results indicate that nicotinamide or trigonelline do not function as signalling compounds for CHS and PAL gene expression. Elevated nicotinamide and trigonelline levels occur in response to UV-B, but only at UV-B doses high enough to cause oxidative stress.

UV-B- and oxidative stress-induced increase in nicotinamide and trigonelline and inhibition of defensive metabolism induction by poly(ADP-ribose)polymerase inhibitor in plant tissue.

Nicotinamide and trigonelline contents increased in Catharanthus roseus tissue culture after exposure to 2,2'-azobis(2-amidinopropane)dihydrochloride (AAPH) or vanadylsulfate and in Pisum sativum leaves after exposure to UV-B radiation. Vanadylsulfate increased phenylalanine ammonia-lyase (PAL) activity and the content of reduced and oxidized gluthathione in C. roseus tissue culture. The increases in PAL activity caused by 2 mM AAPH or 0.2mM vanadylsulfate were prevented by 0.1 mM 3-aminobenzamide (3-AB), an inhibitor of poly(ADP-ribose)polymerase. Present results support the hypothesis [Berglund, T., FEBS Lett. (1994) 351, 145-149] that nicotinamide and/or its metabolites may function as signal transmittors in the response to oxidative stress in plants and that poly(ADP-ribose)polymerase has a function in the induction of defensive metabolism.

Plant defense metabolism is increased by the free radical-generating compound AAPH.

Effects of the free radical-generating substance 2,2'-azobis(2-amidinopropane) dihydrochloride (AAPH) on defense systems in plant tissue cultures were investigated. Exposure of Catharanthus roseus, C. tricophyllus, and Pisum sativum cultures to AAPH caused altered levels of reduced and oxidized glutathione. An increased total glutathione content in C. roseus was prevented by the glutathione biosynthesis inhibitor buthionine-sulfoximine. The specific phenylalanine ammonia-lyase activity in a C. roseus culture was increased from 4 to 34 mukat(kg protein)-1 by 1 mM AAPH. 5 mM AAPH increased the excretion of phenolic substances into the culture medium of a Pisum sativum culture, from 18 to 67 micrograms ml-1. The level of thiobarbituric acid reactants in a C. tricophyllus culture was increased from 46 to 93 nmol(g fresh weight)-1 by 0.4 mM AAPH. The present results, which constitute the first report on effects of the radical-generator AAPH on plant tissue, were achieved with cultures of various plant species and various types of tissue differentiation and demonstrate that AAPH is a suitable agent for the stimulation of the defensive and secondary metabolism in plant tissue cultures. It is proposed that the effects caused by AAPH are mediated by the generation of free radicals and oxidative stress, and that this agent may be used as a model substance for ozone and UV-B exposure.

Nicotinamide, a missing link in the early stress response in eukaryotic cells: a hypothesis with special reference to oxidative stress in plants.

A hypothesis is presented suggesting that nicotinamide (NIC) is an initial signal substance in the response of eukaryotic cells to conditions which cause DNA-strand breakage, especially in connection with oxidative stress. In the stressed cell, NIC is released as a result of the activity of poly(ADP-ribose)polymerase (PADPRP). PADPRP is known to be activated by DNA-strand breakage, caused by e.g. oxidative stress or mutagens. NIC and its metabolite trigonelline (N-methylnicotinic acid) can induce defensive metabolism at the gene level. Connections between NIC and DNA-methylation are also considered. This hypothesis is discussed in the light of own observations and literature reports.