The impact on primary care of a large waterborne campylobacter outbreak in Norway: a controlled observational study.

OBJECTIVE: Document the impact of an outbreak of gastroenteritis on local primary health care services, compared to a control period. DESIGN: Controlled observational study with data from the outbreak and a control period. Data obtained from electronic medical records (EMR) of general practitioners (GPs) and the out-of-hours (OOH) service. Telephone data from the OOH service's telephone records. SETTING: Campylobacteriosis outbreak in Askøy municipality, Norway in 2019. Over 2000 individuals were infected. SUBJECTS: Patients in contact with GPs and the OOH service during the outbreak and a control period. MAIN OUTCOME MEASURES: Patient contacts with GPs and the OOH service during the outbreak and a control period. RESULTS: There was a 36% increase in contacts during the outbreak compared to the control period (4798 vs. 3528), with the OOH service handling 78% of outbreak-related contacts. Telephone advice was the dominant method for managing the increase in contacts to primary care, both in OOH services and daytime general practice (OR 3.73 CI: [3.24-4.28]). Children aged 0-4 years had increased use of primary care during the outbreak (OR 1.51 CI: [1.28-1.78]). GPs referred 25% and OOH services referred 75% of 70 hospitalized cases. CONCLUSION: The OOH service handled most of the patients during the outbreak, with support from daytime general practice. The outbreak caused a shift towards telephone advice as a means of providing care. Young children significantly increased their use of primary care during the outbreak.

Clinical features of gastroenteritis during a large waterborne Campylobacter outbreak in Askøy, Norway.

PURPOSE: Outbreaks of Campylobacter infection are common, but studies exploring the clinical features of acute illness in the outbreak setting are scarce in existing literature. The main purpose of the present study was to investigate the clinical features of self-reported acute illness in gastroenteritis cases during a large waterborne Campylobacter outbreak in Askøy municipality, Norway, in 2019. METHODS: A web-based self-administered questionnaire, and invitation to participate was sent by the municipality of Askøy as text message to mobile phones using the municipality's warning system to the inhabitants during the ongoing outbreak. RESULTS: Out of 3624 participants, 749 (20.7%) were defined as cases, of which 177 (23.6%) reported severe gastroenteritis. The most common symptoms were loose stools (90.7%), abdominal pain (89.3%) and diarrhea (88.9%), whereas 63.8% reported fever, 50.2% joint pain and 14.2% bloody stools. Tiredness, a symptom non-specific to gastroenteritis, was the overall most common symptom (91.2%). CONCLUSION: About one in four of the cases reported symptoms consistent with severe gastroenteritis. We found more joint pain and less bloody stools than reported in published studies of laboratory confirmed campylobacteriosis cases. Tiredness was common in the current study, although rarely described in previous literature of acute illness in the outbreak setting.

Postinfectious and sporadic functional gastrointestinal disorders have different prevalences and rates of overlap: results from a controlled cohort study 3 years after acute giardiasis.

BACKGROUND: Irritable bowel syndrome (IBS) is a common complication following gastroenteritis, and a high prevalence of postgiardiasis IBS has previously been reported. This study aims to investigate the prevalence, adjusted relative risk (RRadj), and overlap of different functional gastrointestinal disorders (FGID) according to Rome III criteria following infection with Giardia lamblia. METHODS: All patients ≥18 years of age with verified giardiasis during an outbreak in 2004, and a control group matched by age and gender, were mailed a questionnaire 3 years later. KEY RESULTS: The prevalence of functional dyspepsia (FD) was 25.9% in the exposed and 6.9% in the control group, RRadj: 3.9 (95% confidence intervals [CI]: 3.1-4.8). The prevalence of IBS was 47.9% and 14.3%, respectively, with RRadj: 3.4 (95% CI: 3.0-3.8). Prevalence of other gastrointestinal symptoms ranged from 70.0% vs 39.7% for bloating (RRadj: 1.8) to 8.3% vs 2.9% for nausea (RRadj: 3.0) in the Giardia and the control group, respectively. Among individuals fulfilling criteria for IBS 44% in the exposed group and 29% in the control group also fulfilled criteria for FD. IBS subtypes based on Rome III criteria (stool consistency) showed poor agreement with subtypes based on frequency of bowel movements (Kappa-values: 0.17 and 0.27). CONCLUSIONS & INFERENCES: There were high prevalences and RRs of IBS, FD and other gastrointestinal symptoms following acute giardiasis, and a high degree of overlap between the disorders. The agreement between different IBS subtype criteria varied, and there were also differences between the exposed and control group.

High rate of fatigue and abdominal symptoms 2 years after an outbreak of giardiasis.

The aim of this study was to evaluate the prevalence of fatigue and abdominal symptoms 2 years after Giardia lamblia infection. All 1262 cases who had Giardia-positive stool samples during an outbreak in 2004 in Norway received a questionnaire in 2006 asking about fatigue and abdominal symptoms. Fatigue was reported by 41%, whereas 38% reported abdominal symptoms, and there was a highly significant association between these symptoms. Increasing age was a highly significant risk factor for fatigue. The symptoms were not due to chronic infection in this cohort. Our data warrant further investigations into the late effects of giardiasis.

The effect of urinary incontinence status during pregnancy and delivery mode on incontinence postpartum. A cohort study.

OBJECTIVE: The objectives of this study were to investigate prevalence of urinary incontinence at 6 months postpartum and to study how continence status during pregnancy and mode of delivery influence urinary incontinence at 6 months postpartum in primiparous women. DESIGN: Cohort study. SETTING: Pregnant women attending routine ultrasound examination were recruited to the Norwegian Mother and Child Cohort Study (MoBa). POPULATION: A total of 12,679 primigravidas who were continent before pregnancy. METHODS: Data are from MoBa, conducted by the Norwegian Institute of Public Health. Data are based on questionnaires answered at week 15 and 30 of pregnancy and 6 months postpartum. MAIN OUTCOME MEASURES: Urinary incontinence 6 months postpartum is presented as proportions, odds ratios and relative risks (RRs). RESULTS: Urinary incontinence was reported by 31% of the women 6 months after delivery. Compared with women who were continent during pregnancy, incontinence was more prevalent 6 months after delivery among women who experienced incontinence during pregnancy (adjusted RR 2.3, 95% CI 2.2-2.4). Adjusted RR for incontinence after spontaneous vaginal delivery compared with elective caesarean section was 3.2 (95% CI 2.2-4.7) among women who were continent and 2.9 (95% CI 2.3-3.4) among women who were incontinent in pregnancy. CONCLUSION: Urinary incontinence was prevalent 6 months postpartum. The association between incontinence postpartum and mode of delivery was not substantially influenced by incontinence status in pregnancy. Prediction of a group with high risk of incontinence according to mode of delivery cannot be based on continence status in pregnancy.

Impetigo in epidemic and nonepidemic phases: an incidence study over 4(1/2) years in a general population.

BACKGROUND: Little is known about incidence and natural variation of impetigo in general populations. OBJECTIVES: To investigate the natural course of impetigo in a well-defined population, and to study the resistance pattern of the causal bacteria over time. METHODS: This is a population-based incidence study in Austevoll, an island community of 4457 inhabitants in Norway, in the years 2001-2005. Incidence rates are given as events per person-year. Epidemic periods were identified by statistical process-control analyses. RESULTS: The incidence rate of impetigo for the whole study period was 0.017 events per person-year, corresponding to a total of 334 cases. The incidence rates were 0.009, 0.026, 0.019, 0.016 and 0.009 in the years 2001, 2002, 2003, 2004 and 2005, respectively. Three epidemics were identified, starting in August of 2002, 2003 and 2004, lasting for 11, 11 and 5 weeks, respectively. Incidence rates in these epidemic periods were 0.099, 0.045 and 0.074, respectively. In epidemic periods, Staphylococcus aureus was the causal bacterium in 89% (117/132) of cases, while this proportion was 68% (84/123) in nonepidemic periods (P < 0.01). Staphylococcus aureus was resistant to fusidic acid in 84% (98/117) and 64% (54/84) of impetigo cases in epidemic and nonepidemic periods, respectively (P < 0.01). When investigating all types of infections caused by S. aureus in the study period, the proportion of fusidic acid resistance in impetigo cases (152/201, 76%) differed significantly from fusidic acid resistance in other infections (18/116, 16%) (P < 0.01). CONCLUSIONS: Distinctive epidemic outbreaks occurred during the summer of three of the five follow-up years. In outbreaks, S. aureus was more frequently the causal agent and the sensitivity to fusidic acid decreased significantly.

[Risk, uncertainty and ignorance in medicine]. / Risiko, usikkerhet og uvitenhet i medisinen.

Exploration of healthy patients' risk factors for disease has become a major medical activity. The rationale behind primary prevention through exploration and therapeutic risk reduction is not separated from the theoretical assumption that every form of uncertainty can be expressed as risk. Distinguishing "risk" (as quantitative probabilities in a known sample space), "strict uncertainty" (when the sample space is known, but probabilities of events cannot be quantified) and "ignorance" (when the sample space is not fully known), a typical clinical situation (primary risk of coronary disease) is analysed. It is shown how strict uncertainty and sometimes ignorance can be present, in which case the orthodox decision theoretical rationale for treatment breaks down. For use in such cases, a different ideal model of rationality is proposed, focusing on the patient's considered reasons. This model has profound implications for the current understanding of medical professionalism as well as for the design of clinical guidelines.

Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study.

OBJECTIVE: To investigate the association between parity and urinary incontinence, including subtypes and severity of incontinence, in an unselected sample, with special emphasis on age as a confounder or effect modifier. METHODS: This was a cross-sectional study (response rate 80%) with 27,900 participating women. Data on parity and urinary leakage, type, frequency, amount, and impact of incontinence were recorded by means of a questionnaire. A validated severity index was used. Relative risks (RR) with nulliparous women as reference were used as an effect measure. RESULTS: Incontinence was reported by 25% of participants. Prevalences among nulliparous women ranged from 8% to 32%, increasing with age. Parity was associated with incontinence, and the first delivery was the most significant. The association was strongest in the age group 20-34 years with RR 2.2 (95% confidence interval [CI] 1.8, 2.6) for primiparous women and 3.3 (2.4, 4.4) for grand multiparous women. A weaker association was found in the age group 35-64 years (RRs between 1.4 and 2.0), whereas no association was found among women over 65 years. For stress incontinence in the age group 20-34 years, the RR was 2.7 (2.0, 3.5) for primiparous women and 4.0 (2.5, 6.4) for grand multiparous women. There was an association with parity also for mixed incontinence, but not for urge incontinence. Severity was not clinically significantly associated with parity. CONCLUSION: Parity is an important risk factor for female urinary incontinence in fertile and peri- and early postmenopausal ages. Only stress and mixed types of incontinence are associated with parity. All effects of parity seem to disappear in older age.

A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trøndelag.

OBJECTIVES: The aim was to assess the prevalence of any urinary leakage in an unselected female population in Norway, and to estimate the prevalence of significant incontinence. METHODS: The EPINCONT Study is part of a large survey (HUNT 2) performed in a county in Norway during 1995-97. Everyone aged 20 years or more was invited. 27,936 (80%) of 34,755 community-dwelling women answered a questionnaire. A validated severity index was used to assess severity. RESULTS: Twenty-five percent of the participating women had urinary leakage. Nearly 7% had significant incontinence, defined as moderate or severe incontinence that was experienced as bothersome. The prevalence of incontinence increased with increasing age. Half of the incontinence was of stress type, 11% had urge and 36% mixed incontinence. CONCLUSIONS: Urinary leakage is highly prevalent. Seven percent have significant incontinence and should be regarded as potential patients.

[Should we make a bid for SATS? Evaluation of a new educational project in family practice]. / Bør man satse på SATS? Evaluering av nytt allmennmedisinsk utdanningsprosjekt.

A new method for education of general practitioners and for quality assurance in primary health care has been employed in Norway since 1996. The practitioners collect data from their own practices using computerized medical records. Peer groups of four to ten general practitioners meet regularly to present their results, agree on local standards and plan improvements. They may choose among four medical topics. This article presents an external evaluation of participants' experiences conducted by focus group interviews of five groups. Satisfaction with the project was partly dependent on the topic addressed by the group. Groups of participants who felt that they improved their medical knowledge were most favourable to the project. Data collection from their own practices, presented and discussed in the group, was considered a very good basis for learning. Although the project's aim was not properly clarified, we regard this method as promising.