Early practice of use of video consultations in rehabilitation of hand injuries in children and adults: Content, acceptability, and cost-effectiveness.

BACKGROUND: Video consultation was implemented as a new service in a hospital hand therapy setting. PURPOSE: To describe the first year's practice of video consultations in the rehabilitation of upper extremity injuries, evaluate the acceptability, and investigate economic effects. STUDY DESIGN: Iterative design including economic evaluation. METHODS: Using the framework early health technology assessment, 13 hand therapists described characteristics of 99 video consultations, under predefined headlines: the patients' municipally, adult vs child, time use, technical, content, and usefulness compared to physical consultations. The text was coded and categorized according to 22 techniques or tools used by hand therapists, and challenges were identified. Acceptability was assessed on a three-graded adjectival scale. To illustrate the costs associated with video vs physical consultations, we drafted different scenarios based on the data and stakeholder insights. RESULTS: Of 99 planned video consultations (16 with children), 88 were completed. Techniques or tools most frequently used were the performance of exercises (n = 55), orthoses (n = 26), and daily activities (n = 23). Technical challenges were common, and observation of children could be difficult. Eleven of the completed consultations were rated as not acceptable and 77 as acceptable and as either useful (n = 28) or very useful (n = 49). Four drafted scenarios showed cost savings of video consultations for the health institution and society, highest at longer travel distances and in other cases where the patient could claim refunds related to travel and time away from work and home. CONCLUSIONS: The results show therapeutic possibilities and points to areas for improvements and illustrate settings where the use of video may save costs for the health institution and society.

Sustained reduction of tinnitus several years after sequential cochlear implantation.

OBJECTIVE: This study aimed to explore the short- and long-term effects of a second cochlear implant (CI-2) on the reduction of tinnitus annoyance and tinnitus handicap. DESIGN: In a combined retrospective and prospective cohort study, tinnitus annoyance was measured before receiving the CI-2 (Pre), more than two years after (Post1) and more than seven years after (Post2), using the Tinnitus Handicap Inventory (THI), the Visual Analog Scale for the assessment of perceived tinnitus loudness (VAS-L) and annoyance (VAS-A), and a self-report questionnaire. STUDY SAMPLE: Twenty sequentially bilaterally implanted adults with bothersome tinnitus. RESULTS: CI-2 implantation resulted in a statistically significant reduction of tinnitus handicap from severe at Pre to mild at Post1 (THI mean score reduced from 61.3 [SD = 19.4] to 29.3 [SD = 23.5]). The reduction in tinnitus annoyance was statistically significant from Pre to Post 2 (VAS-A reduced from 7.1 [SD = 1.5] to 3.4 [SD = 2.2]). The reduction in tinnitus loudness was not statistically significant. CONCLUSIONS: The provision of a CI-2 for severely and profoundly hearing-impaired individuals with bothersome tinnitus is an effective method of providing long-term tinnitus relief.

Early assessment of innovation in a healthcare setting.

OBJECTIVES: Early assessment can assist in allocating resources for innovation effectively and produce the most beneficial technology for an institution. The aim of the present study was to identify methods and discuss the analytical approaches applied for the early assessment of innovation in a healthcare setting. METHODS: Knowledge synthesis based on a structured search (using the MEDLINE, Embase, and Cochrane databases) and thematic analysis was conducted. An analytical framework based on the stage of innovation (developmental, introduction, or early diffusion) was applied to assess whether methods vary according to stage. Themes (type of innovation, study, analysis, study design, method, and main target audience) were then decided among the authors. Identified methods and analysis were discussed according to the innovation stage. RESULTS: A total of 1,064 articles matched the search strategy. Overall, thirty-nine articles matched the inclusion criteria. The use of methods has a tendency to change according to the stage of innovation. Stakeholder analysis was a prominent method in the innovation stages and particularly in the developmental stage, as the introduction and early diffusion stage has more availability of data and may apply more complex methods. Barriers to the identified methods were also discussed as all of the innovation stages suffered from lack of data and substantial uncertainty. CONCLUSIONS: Although this review has identified applicable approaches for early assessment in different innovation stages, research is required regarding the value of the available data and methods and tools to enhance interactions between different parties at different stages of innovation.

Headache in sleep apnea syndrome: epidemiology and pathophysiology.

This review investigates the relation between obstructive sleep apnea and sleep apnea headache, migraine and tension-type headache. Focus is made on studies from the general population with interviews conducted by a physician and obstructive sleep apnea confirmed by polysomnography. Obstructive sleep apnea syndrome is observed in 3% of the middle-aged population. The prevalence of sleep apnea headache in this population is 12%-18%, while morning headache with similar symptomatology as sleep apnea headache occur in 5%-8% of the general population. People with sleep apnea headache did have significantly more minutes below 90% oxygen saturation (23.1 min vs. 1.9 min, p = 0.002), higher level of average oxygen desaturation (5.9% vs. 4.5%, p < 0.001) and lower average of the lowest oxygen saturation (80.9% vs. 88.5%, p < 0.001) than people with morning headache. A comparison of those with obstructive sleep apnea with or without sleep apnea headache showed no significant differences. Thus, oxygen desaturation alone cannot explain the pathophysiology of sleep apnea headache. Obstructive sleep apnea and migraine, and obstructive sleep apnea and tension-type headache are not related in the general population. The cause of sleep apnea headache remains to be elucidated.

A Norwegian population-based study on the risk and prevalence of obstructive sleep apnea. The Akershus Sleep Apnea Project (ASAP).

The Berlin Questionnaire (BQ) is a widely used screening tool for obstructive sleep apnea (OSA), but its performance in the general population setting is unknown. The prevalence of OSA in middle-aged adults is not known in Norway. Accordingly, the aims of the current study were to evaluate the utility of the BQ for OSA screening in the general population and to estimate the prevalence of OSA in Norway. The study population consisted of 29,258 subjects (aged 30-65 years, 50% female) who received the BQ by mail. Of these, 16,302 (55.7%) responded. Five-hundred and eighteen subjects were included in the clinical sample and underwent in-hospital polysomnography. Screening properties and prevalence were estimated by a statistical model that adjusted for bias in the sampling procedure. Among the 16,302 respondents, 24.3% (95% confidence interval (CI)=23.6-25.0%) were classified by the BQ to be at high-risk of having OSA. Defining OSA as an apnea-hypopnea index (AHI) ≥5, the positive predictive value of the BQ was estimated to be 61.3%, the negative predictive value 66.2%, the sensitivity 37.2% and the specificity 84.0%. Estimated prevalences of OSA were 16% for AHI≥5 and 8% for AHI≥15. In conclusion, the BQ classified one out of four middle-aged Norwegians to be at high-risk of having OSA, but the screening properties of the BQ were suboptimal. The estimated prevalence of OSA was comparable to previous estimates from general populations in the USA, Australia and Europe.

A Web-Based Communication Platform to Improve Home Care Services in Norway (DigiHelse): Pilot Study.

BACKGROUND: Home care service in Norway is struggling to meet the increasing demand for health care under restricted budget constraints, although one-fourth of municipal budgets are dedicated to health services. The integration of Web-based technology in at-home care is expected to enhance communication and patient involvement, increase efficiency and reduce cost. DigiHelse is a Web-based platform designed to reinforce home care service in Norway and is currently undergoing a development process to meet the predefined needs of the country's municipalities. Some of the main features of the platform are digital messages between residents and the home care service, highlighting information on planned and completed visits, the opportunity to cancel visits, and notifications for completed visits. OBJECTIVE: This study aimed to test the usability and economic feasibility of adopting DigiHelse in four districts in Oslo by applying registry and behavioral data collected throughout a one-year pilot study. Early health technology assessment was used to estimate the potential future value of DigiHelse, including the predictive value of behavior data. METHODS: Outcome measures identified by stakeholder insights and scenario drafting in the project's concept phase were used to assess potential socioeconomic benefits. Aggregated data were collected to assess changes in health consumption at baseline, and then 15 and 52 weeks after DigiHelse was implemented. The present value calculation was updated with data from four intervention groups and one control group. A quasi-experimental difference-in-difference design was applied to estimate the causal effect. Descriptive behavioral data from the digital platform was applied to assess the usability of the platform. RESULTS: Over the total study period (52 weeks), rates increased for all outcome estimates: the number of visits (rate ratio=1.04; P=.10), unnecessary trips (rate ratio=1.37; P=.26), and phone calls (rate ratio=1.24; P=.08). A significant gap was found between the estimated value of DigiHelse in the concept phase and after the one-year pilot. In the present pilot assessment, costs are expected to exceed potential savings by €67 million (US $75 million) over ten years, as compared to the corresponding concept estimates of a potential gain of €172.6 million (US $193.6 million). Interestingly, behavioral data from the digital platform revealed that only 3.55% (121/3405) of recipients actively used the platform after one year. CONCLUSIONS: Behavioral data provides a valuable source for assessing usability. In this pilot study, the low adoption rate may, at least in part, explain the inability of DigiHelse to perform as expected. This study points to an early assessment of behavioral data as an opportunity to identify inefficiencies and direct digital development. For DigiHelse, insight into why the recipients in Oslo have not made greater use of the Web-based platform seems to be the next step in ensuring the right improvement measures for the home care service.

An Evaluation of Motivational Interviewing for Increasing Hearing Aid Use: A Pilot Study.

BACKGROUND: Motivational interviewing (MI) has been used in consultation settings to motivate hearing aid users to increase hearing aid usage. However, the effect of MI on those who use their hearing aids only rarely or not at all has not been explored. PURPOSE: The aims of this pilot study were to evaluate the effect of MI counseling with elderly hearing aid recipients found to have low hearing aid use at a six-month follow-up appointment and to describe clients' subjective assessments of their perceived need for hearing aids three months after MI counseling. RESEARCH DESIGN: The study had a within-subjects pretest-posttest design. STUDY SAMPLE: Forty seven hearing aid recipients who had used their new hearing aids, an average of <90 min/day, were recruited at a follow-up appointment six months after hearing aid fitting. INTERVENTION: Thirty minutes of MI counseling was provided at the six-month follow-up appointment. If needed, hearing aid adjustments and technical support were also provided. DATA COLLECTION AND ANALYSIS: The effect of MI counseling in combination with adjustments and technical support was assessed in relation to datalogged hearing aid use, which was assessed immediately before (at the six-month follow-up) and three months after (at the nine-month follow-up) the intervention. Hearing aid experiences were also assessed three months after MI. RESULTS: Thirty seven participants (79%) returned for the nine-month follow-up visit and had modest but significant increases in datalogged hearing aid use in the three months following MI counseling. Of the 37 participants who returned, 51% had increased their hearing aid use to at least 2 h/day after the MI counseling. Most of the 37 participants who attended the nine-month follow-up reported increased need for (59%) or increased benefit and contentment with (57%) their hearing aid three months after MI; these participants also had significantly higher datalogged hearing aid use following MI. CONCLUSIONS: These findings suggest that follow-up appointments using MI counseling in conjunction with technical support may be useful for increasing hearing aid usage among low-users, and a randomized controlled trial is warranted.

Relationship between Maternal and First Year of Life Dispensations of Antibiotics and Antiasthmatics.

Antibiotics are the most frequent prescription drugs used by pregnant women. Our objective was to investigate if the dispensation of antibiotics and antiasthmatics in children less than 1 year of age is associated with prenatal antibiotic exposure. A secondary aim was to explore the incidence of dispensed antibiotics in pregnancy and dispensed antibiotics and antiasthmatics in children. We conducted an observational study using the Peer Academic Detailing study database to select patients eligible for match in the Medical Birth Registry of Norway, a total of 7747 mother-and-child pairs. Details on antibiotic and antiasthmatic pharmacy dispensations were obtained from the Norwegian Prescription Database. One quarter (1948 of 7747) of the mothers in the study had been dispensed antibiotics during pregnancy. In their first year of life, 17% (1289) of the children had had an antibiotic dispensation, 23% (1747) an antiasthmatic dispensation, and 8% (619) of the children had had both. We found a significant association between dispensed antibiotics in pregnancy and dispensed antibiotics to the child during their first year of life; OR = 1.16 (95% CI: 1.002⁻1.351). The association was stronger when the mothers were dispensed antibiotics at all, independent of the pregnancy period; OR = 1.60 (95% CI: 1.32⁻1.94). We conclude that the probability for dispensation of antibiotics was increased in children when mothers were dispensed antibiotics, independent of pregnancy. Diagnostic challenges in the very young and parental doctor-seeking behavior may, at least in part, contribute to the association between dispensations in mothers and children below the age of one year.

Prescribing antibiotics when the stakes are higher - do GPs prescribe less when patients are pregnant? A retrospective observational study.

BACKGROUND: Most oral antibiotics are prescribed by GPs, and they are therefore the most important influencers with regard to improving antibiotic prescription patterns. Although GPs' prescription patterns in general are well-studied, little is known about antibiotic prescription patterns in pregnancy. AIM: To study GPs' antibiotic prescriptions in respiratory tract infections (RTIs) during pregnancy, and assess differences, if any, between pregnant and non-pregnant patients. DESIGN & SETTING: Retrospective observational study combining prescription data from the Norwegian Peer Academic Detailing (Rx-PAD) study database, pregnancy data from the Norwegian birth registry, and pharmacy dispension data from the Norwegian Prescription Database (NorPD). METHOD: Records of patient contacts with 458 GPs, between December 2004 and February 2007, were screened for RTI episodes. Similar diagnoses were grouped together, as were similar antibiotics. Episodes were categorised according to whether the patient was pregnant or not, and included women aged 16-46 years. Logistic regression models were used to assess odds ratios (ORs), and calculated relative risks (cRRs) were produced. The authors also adjusted for clustering at various levels. RESULTS: Overall prescription rate for RTI episodes was 30.8% (n = 96 830). The cohort was reduced to include only episodes with women pregnant in the study period (n = 18 890). The antibiotic prescription rate in pregnancy was 25.9% versus 34.2% in the time before and after pregnancy (cRR = 0.66 [95% confidence intervals {CI} = 0.68 to 0.81]).During pregnancy, 83.0% of the antibiotic prescriptions were picked up at a pharmacy, compared to an 86.6% filling rate in non-pregnant patients. The difference was not significant when adjusting for clustering at the patient level. CONCLUSION: Norwegian GPs prescribe fewer antibiotics overall when patients are pregnant and, when they do prescribe, choose more narrow spectrum antibiotics for RTIs. This indicates a possible lower target rate for GP prescriptions to females. A low antibiotic dispension rate during pregnancy may represent a discussion topic in the consultation setting, to address possible reasons and avoid under-treatment.

Otitis media referrals - the general practitioner perspective.

OBJECTIVE: Otitis media management involves both primary and specialist health care. The present study used data on GP referrals to estimate the proportion of children with otitis media referred from primary to specialist care, study variation in referral pattern and factors that influence GP behaviour. METHODS: Data on general practitioners' view on collaborative aspects of specialist health care was collected in a cross-sectional questionnaire survey among all Norwegian GPs in 2004 (N=1633). The outcome of interest was referral routines for otitis media at first visit and at follow-up. RESULTS: Mean referral for otitis media was 22%, most commonly at follow-up visit. Twenty-seven percent of children with otitis media were sent to ENT departments and 73% to practicing otolaryngologists. Variation in referral pattern among GPs was moderate. GPs with specialty in general medicine had 6% fewer referrals. Separate analysis on referral to practicing otolaryngologists showed that GP work load and availability to practicing specialists increased referral, whereas availability to hospital services reduced the probability. CONCLUSION: In Norway, otitis media management mainly takes place in primary care. Completed specialty in general medicine reduces referrals and non-medical factors influence referral behaviour. We suggest that learning groups may contribute to update knowledge in primary care and fewer referrals to specialists.

Early acute otitis media: predictor for AOM and respiratory infections in schoolchildren?

OBJECTIVE: It has been reported that acute otitis media (AOM) and respiratory infectious morbidity still are common in schoolchildren. However, the significance of early initiation of AOM on later respiratory infections is not known. The aim of the study was to assess whether early initiation of AOM is a predictor for AOM and other respiratory infections in schoolchildren, and if environmental exposures and host factors in early life predict later AOM. METHODS: A population-based, prospective study of 3754 children born in Oslo in 1992/93, of which 2549 children were followed from birth to 10 years. Main outcome measures were questionnaire-based information on AOM and other respiratory infections at ages 6 months, 1 year and 10 years. RESULTS: Of the 190 (5.3%) children with one or more episodes of AOM before 6 months, 97 (51.1%) remained susceptible the next 6 months. The total number of children with one or more episodes of AOM from 6 to 12 months was 812 (25.1%). Of the 336 (13.2%) with AOM at 10, 95 (28.3%) also had AOM the first year of life. One or more episodes of tonsillopharyngitis or lower respiratory infections were experienced in 624 (24.4%) of the children at 10 years. There was a predominance of boys with AOM the first year of life, while girls were more prone to AOM at age 10. AOM the first year of life was not strongly associated with AOM at age 10 with crude and adjusted odds ratios 1.3 (95% CI 1.0-1.6) and 1.2 (95% CI 0.9-1.5), respectively. A corresponding tendency was found for other respiratory infections (tonsillopharyngitis or lower respiratory infections) at age 10. Tobacco smoke exposure at birth, early life atopic eczema and otitis media surgery increased the risk of AOM at age 10. CONCLUSIONS: We found no strong association between early AOM and AOM and other respiratory infections in schoolchildren. Parental smoking at birth, early life atopic eczema and female gender were only weakly associated with AOM in 10-year olds while otitis media surgery was strongly associated with AOM in schoolchildren.

Acute otitis media in schoolchildren: allergic diseases and skin prick test positivity.

CONCLUSIONS: Single and repeated episodes of acute otitis media (AOM) in 10-year-old children were associated with reported allergic disease. Further, skin prick test (SPT)-negative children with reported asthma and allergic rhinoconjunctivitis had increased risk of AOM. We suggest that optimal treatment of allergic symptoms may have an effect on AOM in school children. OBJECTIVE: The objective of the study was to estimate associations between AOM, allergic diseases and SPT positivity in 10-year-old children. MATERIALS AND METHODS: Population-based cross-sectional study of 3406 10-year-old children living in Oslo. Main outcome measures were questionnaire-based information on AOM and reported physician-diagnosed allergic diseases with symptoms during the last year. In addition, 2657 children were skin prick tested. Logistic regression analyses were performed to estimate associations and control for potential confounders. RESULTS: One or more episodes of AOM were present in 13.8% (n=470) of the children; 9.7% (n=331) had single episodes, while 4.1% (n=139) had two or more infections. We found a statistically significant association between AOM and reported allergic diseases, strongest for AOM and asthma with odds ratio 2.7 (95% confidence interval 1.8-4.0) and 2.3 (95% confidence interval 1.3-4.3) for single and two or more episodes of AOM, respectively. The risk for AOM was increased in asthmatic SPT-negative children compared with asthmatic SPT-positive children, the odds ratios were 3.0 (1.7-5.4) and 1.5 (0.8-2.8), respectively. The same tendency was found for allergic rhinoconjunctivitis.

Lack of ear care knowledge in nursing homes.

BACKGROUND: Rising life expectancy means an increase in the number of elderly people with hearing loss in the population. Many elderly people live in nursing homes, with varying care needs. A substantial proportion of these people will need help with their hearing aids and other hearing devices. OBJECTIVE: The objective of the study has been to assess the knowledge, experience, skills, competence, and need for information of staff at nursing homes in relation to residents' hearing loss and hearing aids. MATERIALS AND METHODS: One hundred and ninety-five employees at seven nursing homes participated in the study. The main approach was a descriptive study, using questionnaires. RESULTS: The main findings are that 73% of informants found that many residents need help with their hearing aids. Only one-tenth report that they know enough about the residents' hearing aids. Almost four out of five informants find that the residents become socially isolated as a result of hearing loss. Seventy-eight percent agree to some extent that more residents would benefit from hearing aids. CONCLUSION: Staff at nursing homes have insufficient knowledge about hearing loss and hearing aids. Increased focus on the elderly with hearing impairment in nursing homes is needed. Contact between nursing homes and audiological specialists should be improved to best followup hearing loss and hearing aids.

[General practitioners' views on the cooperation with nursing homes]. / Fastlegers oppfatning av samarbeidet med sykehjem.

BACKGROUND: In addition to the coordination between primary and secondary health care, the collaboration between the general practitioner (GP) and the community-based nursing services is a challenge. While the GPs are responsible for his or her list patients' needs, the organisational structure and resource allocation of nursing home services is a community-based responsibility. MATERIAL AND METHODS: Data on GPs' view on collaborative aspects of nursing home services was collected in a cross-sectional questionnaire survey among all Norwegian list-patient GPs in 2004 (N=1633). RESULTS: Out of the 1637/3338 (48%) responding GPs, 1180 (72%) performed community-based services; 462 (37%) of the latter as nursing home physicians. Four out of five GPs found physician-based services for their list patients satisfactory. The GPs had an influence on the provision of nursing and care services in approximately 50% of cases. The less satisfied GPs were less frequently informed when their list patients received nursing home beds and less frequently asked to contribute patient information when the need for nursing home facilities was assessed. These latter GPs were more often of the opinion that GPs should play a major role in the decision for home-based versus nursing home services. INTERPRETATION: Although there is a potential for improvement in the exchange of information between nursing homes and GPs, 80% of the GPs were satisfied with physician-based services in nursing homes.

[Hospital discharge information as a communication tool]. / Epikrisen som samhandlingsverktøy.

BACKGROUND: The main objective of the list patient health reform has been to improve the quality of local medical service. In European healthcare systems, there has been a need for coordination between primary and secondary care. It has been claimed that the communication between GPs and specialised health care is insufficient, particularly for patients with an extended need of care. MATERIAL AND METHODS: Data on collaboration and satisfaction with specialised health services was collected in a cross-sectional questionnaire survey comprising all Norwegian GPs in 2004 (N = 633); the response rate was 48%. RESULTS: Median delay in receiving patient information was one week or more for inpatient and outpatient treatment. Overall, GPs were satisfied with the hospitals' discharge reports, except for patients needing extended follow up by GPs after discharge. In these patients, GPs more frequently needed to contact the hospital because of insufficient data or unacceptable delays. Female GPs were less satisfied with information services in patients with increased needs. There were also geographical differences in satisfaction. INTERPRETATION: In patients with an increased need for follow up, GPs are less satisfied with hospital information service.

[Use of incentives to enhance response rates in questionnaire surveys]. / Bruk av incentiver for å øke svarandelen i spørreskjemaundersøkelser.

BACKGROUND: The purpose of this article is to relate response rates in surveys among GPs to the use of conditional and non-conditional incentives. MATERIAL AND METHOD: The data were gathered during a nation-wide survey among all Norwegian general practitioners. RESULTS: There was a higher response rate among respondents who received non-conditional incentives. Although not significant at the 5 percent level, the effect is sufficiently strong to be characterised as interesting. INTERPRETATION: The results indicate that non-conditional incentives are effective in enhancing the response rate in surveys among GPs.

Pulseoximetry: sufficient to diagnose severe sleep apnea.

OBJECTIVES: To assess the clinical value of pulseoximetry in the diagnosis of sleep apnea when satisfactory agreement with polysomnography is obtained. METHODS: This was a prospective clinical study, set in the Department of Otorhinolaryngology, Ullevaal University Hospital, Oslo, Norway. One hundred consecutive patients were investigated for sleep related breathing disorders. The main outcome measurements were: measurement success rate, oxygen desaturation thresholds, sensitivity and specificity at apnea-hypopnea-index (AHI) thresholds of 5 and 15. RESULTS: Pulseoximetry was successfully performed in 93%. When different oxygen desaturation thresholds were calculated, optimal agreement with polysomnography was found at a 3% oxygen desaturation level. The sensitivity and specificity of diagnosing moderate/severe sleep apnea (AHI above 15) were 0.86 and 0.88, respectively. The corresponding figures for milder sleep apnea (AHI above 5) were 0.91 and 0.67. Good agreement was found between the AHI and the oxygen desaturation index (ODI) at the 3% level, with a mean AHI-ODI difference of 2.6 (SD, 7.3), a Pearson correlation of 0.95 and a weighted kappa of 0.86. The best agreement was found for AHI values below 15, where the estimated AHI-ODI difference was only -0.4 (SD, 3.3). CONCLUSIONS: Pulseoximetry is a simple, non-invasive procedure, which is easy to perform and well suited for outpatient registration. When adjusted to polysomnography with high sensitivity of hypopnea registrations, an ODI at the 3% level is optimal to diagnose sleep apnea. In patients with moderate/severe sleep apnea with AHI values above 15, it is sufficient to establish the diagnosis and subsequent treatment. A negative pulseoximetry does not rule out sleep disorders; the patients should complete a full examination.

Otolaryngological surgery and upper respiratory tract infections in children: an epidemiological study.

The objective of the study was to assess the occurrence of different procedures of upper airway surgery and estimate their relationship to specific upper respiratory tract infections and constitutional factors. In a population-based cross-sectional study in Oslo. Norway, of 3,763 preschool children 3 to 4 years of age, the otolaryngological surgeries adenoidectomy, tonsillectomy, myringotomy, ventilation tube insertion, and combinations of these were the outcome measures. The results showed that by 4 years of age, 13% (n = 501) had undergone operation, and approximately two thirds of the operations involved middle ear surgery. Although surgery was related to the occurrence of upper respiratory tract infections, the type of surgery was not related to the specific infection. In the children with operations, the occurrence of recurrent otitis media (> or = 3 infections in the previous 12 months) was almost fivefold higher than in children without operations (adjusted adds ratio [ORadj] = 5.19 [3.15 to 8.54]). A low level of maternal education (ORadj = 1.61 [1.05 to 2.7] compared to the group with a high level of education) and atopy on the part of the child (ORadj = 1.58 [1.20 to 2.07]) increased the probability for upper airway surgery independently of the experience of infections. In conclusion, early pediatric otolaryngological surgery is common. The decisions for surgical treatment vary substantially and are not closely related to the specific infections. The influence of other factors such as maternal education indicates that decisions for surgery are not entirely based on medical evidence.

[Thought-provoking adaptation of otorhinolaryngologic surgery]. / Tankevekkende tilpasning av øre-nese-hals-kirurgi.

BACKGROUND: Global budgeting was partially replaced by activity-based funding in 1999 in order to improve productivity and reduce waiting lists. The aim of this study is to estimate otolaryngologic surgery rates after the introduction of Diagnosis Related Groups funding. MATERIAL AND METHOD: National data on outpatient and inpatient otolaryngologic surgical procedures over the period 1999 to 2002 were provided by the Norwegian Patient Register; an estimate was made of the proportion undergoing uvuloplasty for sleep apnea or snoring. RESULTS: From 1999 to 2002, there was an overall increase in otolaryngologic procedures of 12%. Inter-procedural variation ranged from a 110% increase in uvuloplasties to a 12 % decrease in tonsillectomies. There was a particular increase in procedures requiring neither general anaesthesia nor a highly specialised surgeon. In spite of the increased rates of uvuloplasty, the proportion of patients selected for surgery remained unchanged. INTERPRETATION: The substantial increase in certain procedures may give rise to several interpretations: better medical technology, reallocation of surgical resources to disorders that had been inadequately covered, or a shift towards procedures for which marginal costs do not exceed treatment costs.