08.04.2019: Erlend Roaldsnes, Randi Eikeland and Dag Berild have commented on my article on Lyme borreliosis. They request more information than I can provide within the framework of a comment. The distribution of Borrelia genotypes is different in the USA and Europe. Borrelia burgdoferi sensu stricto is the only type occurring in the USA. It is 'arthritogenic'. In Norway, Borrelia garinii is the source of Bannwarth's syndrome, the most frequent type of neuroborreliosis. Borrelia afzelii causes acrodermatitis, atypical forms of neuroborreliosis (1), and may give rise to diffuse symptoms in the...

30.04.2012: The use of snus cannot be recommended as an alternative to smoking for pregnant women who have difficulty giving up cigarettes. Smoking during pregnancy increases the risk of a number of pregnancy complications. The use of snus has increased among young Norwegian women, whereas the number of smokers is declining. Can snus be recommended to pregnant women as an alternative to smoking? Snus is harmful, it maintains and intensifies addiction, and has no scientifically documented effect as a method for breaking smoking habits. A Swedish review article published in the Läkartidningen in 2011 (1)...

17.04.2012: Each year, several thousand patients are injured and die as an effect of undesired events and medical malpractice in the Norwegian health services. Medical emergency interventions undertaken in the air ambulance services can be regarded as especially risky. A nationwide study of prevailing attitudes to patient safety in the air-ambulance services will be initiated this spring, and this could make an important contribution to improving patient safety. Health personnel have the ideal of not harming their patients. «Primum non nocere» – first, do no harm – is the guiding principle of the...

17.04.2012: A tonometer for home monitoring of intraocular pressure may be a useful aid for some glaucoma patients, but there are also implicit problems. Many patients with diabetes take their own blood sugar readings. This may add to their own understanding of their illness and result in better patient follow-up. Glaucoma also entails life-long follow-up with the patient consulting an ophthalmologist for intraocular pressure measurement, usually several times a year. There are various tonometers that may lend themselves to home monitoring and more accurate and user-friendly instruments are gradually...

27.03.2012: The quality register for joint prostheses at the St. Olavs Hospital could become a useful tool for quality assurance and research. The «fast-track» model, which is a knowledge-based, multimodal treatment model for surgical activities (1), was introduced for elective hip and knee prosthetic surgery at St. Olavs Hospital from September 2010. This reorganisation entailed considerable changes in the treatment sequence. We therefore decided to establish an internal quality register, since it has been proven that such registers permit better quality control (2) and serve as a basis for research. The...

27.03.2012: Norway lacks a comprehensive educational programme for health professionals who teach at universities and university colleges and in training programmes for medical specialists Health professions education at university colleges does not always lead to the ex-pected effect in preparing students for their professional practice (1). Most likely, the same applies to programmes for health professionals at the universities, including medical studies. There is a need for a debate on this matter, and the Directorate of Health and the universities should give serious attention to the issue. Norway...

21.02.2012: Around 2005, life expectancy was 2.5 years higher in Molde than in Arendal. It is remarkable that Norwegian cities that are fairly similar in terms of size, income level and population composition have differing levels of mortality. Could differences in the quality of their health services possibly play a role? Furthermore, is the classification of causes of death sufficiently precise? In a recently published report I have attempted to explain the root causes of the differences in mortality between Norwegian towns and cities (1). One hypothesis could be that the differences in life expectancy...

07.02.2012: Somatocognitive therapy has proved highly effective for treating chronic pelvic pain in women. We believe that this therapy should be tested in more gynaecological departments. Long-term pelvic pain is a common cause of women suffering functional impairment and reporting sick (1, 2). The term is used for pain that persists for more than six months in the lower abdomen and pelvis. The condition may be due to disease in a number of organ systems, including the peritoneum, gastrointestinal tract and urogenital system, but in many cases no specific pathological changes are detected by a...

07.02.2012: Digital volume tomography is a radiological technique for three-dimensional imaging of anatomical structures and pathological changes in the maxillofacial area. We believe it has many advantages over conventional computed tomography. High resolution computed tomography of the type cone beam computed tomography (CBCT) is a technique based on X-ray transmission projection of specific two-dimensional absorption images. The technique is also called digital volume tomography (DVT) and was originally developed for diagnostics in dental and maxillofacial radiology. The method can be used to produce...

24.01.2012: The Department of Addiction Medicine at Haukeland University Hospital is developing an outpatient group-therapy service for those who want help to gradually reduce and finally cease using addictive drugs. The purpose is to replace these medications with more appropriate strategies to be able to deal with various forms of discomfort. Several articles in this journal have indicated the need for appropriate and sufficient treatment services for people who are addicted to medications (1) – (3). The establishment and development of such services are consistent with the intentions of the National...

10.01.2012: The Edmonton Symptom Assessment System (ESAS) is the most widely used instrument for assessing symptoms in palliative medicine. A new, revised version, ESAS-r, has recently been developed, and it is recommended that this be introduced in Norway. The alleviation of distressing symptoms plays a key part in palliative care. Symptoms are subjective, and studies have shown that systematic assessment is an important prerequisite for optimal symptom relief (1). The Edmonton Symptom Assessment System (ESAS) is a tool that was developed to allow repeated measurement of symptom intensity with a minimum...

10.01.2012: The majority of cases of tuberculosis in Norway are diagnosed in individuals coming from high-incidence countries. Immigrants are widely screened, but the follow-up of positive cases is very inadequate. If the screening programme is to be continued, it should either be strengthened or considerably simplified. In 2007, a total of 307 new cases of tuberculosis were reported in Norway. Foreign-born persons have accounted for a gradually increasing proportion, and they currently account for approximately 80 per cent of tuberculosis cases. New infections occur relatively rarely, and it is assumed...

13.12.2011: We were at work at the Blood Bank of Oslo University Hospital one grey summer afternoon when we thought we heard a loud thunderclap. But it wasn’t a thunderclap. «Yellow alert» was rapidly upgraded to «red alert». The Blood Bank of Oslo is the largest in Norway, and is supposed to stock a minimum of 80 erythrocyte concentrates (SAGMAN) of blood type O RhD negative. Following a number of orders for blood just before the explosion, our stocks of O RhD negative blood had fallen below this limit, so that we only had 55 bags of SAGMAN blood. Our stocks of other types of blood were optimal. O RhD...

13.12.2011: The Interaction Reform sets new requirements for cooperation in the field of emergency medicine. This is an excellent opportunity to establish emergency medicine as a separate professional specialisation. Future socio-economic and demographic challenges will necessitate more efficient operations in the Norwegian health and care services. The Interaction Reform (1) sets the course, and the new national healthcare plan (2) provides the guidelines for how the Government wants to ensure effective and adequate care for patients. Whether this will entail any consequences for emergency medicine...

29.11.2011: The accident at the Fukushima nuclear power station in Japan in 2011 is the second biggest nuclear accident in history. Like the Chernobyl accident, it has been assigned the highest severity rating on the International Nuclear Event Scale. Fortunately, it is concluded today that the consequences were far less serious than those seen after the Chernobyl accident. The biological effect of a dose of radiation is measured in sieverts (Sv), whereas radiation levels are often given as dose rates, i.e. doses of radiation per time unit. Background radiation in Norway is approximately 2 – 3 mSv/year, i...

29.11.2011: Haemoglobin is important and necessary for the absorption of oxygen in the lungs. 2,3 DPG (diphosphorglycerate) is necessary for releasing oxygen at capillary level. The precursor to 2,3 DPG is 1,3 DPG. A certain minimum amount of phosphate is necessary to enable the body to make 1,3 DPG (1). 1,3 DPG is also the precursor of ATP (1). A supply of glucose to the body is important, but when a large amount of energy is needed, substantial quantities of glucose bind phosphate in order to make the glucose fat-soluble. The release of large quantities of glucose from the liver can have the same effect...

15.11.2011: It is important to measure troponin levels when acute myocardial infarct is suspected. Many other factors that affect the heart can cause an increase in troponin levels, for example extreme physical exertion. Recent studies have shown that more normal physical activity can also lead to increase in troponin levels in healthy individuals. During the course of acute coronary disease there is first an increase in troponin as a consequence of cell necrosis, followed by a fall. Measurement of troponin T or troponin I in repeated blood samples has become a cornerstone in modern diagnostic procedure...

15.11.2011: The traders are on their way. We should allow the sale of organs. A strictly regulated market for organs can ensure a fair distribution of organs and proper treatment of the donor. Is this true? There is a large and constantly growing need for organs. Transplantations are considerably cheaper than dialysis, and the risk is comparable to that of Caesarean sections, which are widely accepted. The growing need for organs has not been paralleled by a corresponding growth in the number of available donors, and an illegal practice has emerged which is widely seen as undesirable. One suggestion for...

01.11.2011: Health queues and waiting lists are a strain on the public and on health workers alike. The idea of a seminar for patients who are on a waiting list for treatment in the outpatient clinic emerged from a situation involving long waiting periods and a desire to do something actively for the patients who were waiting. An experience from a visit to Madame Tussaud’s in London served as inspiration for taking a more active approach to the waiting lists. For the children, the time spent waiting to get in became the most memorable part of the visit to the wax museum, because somebody had given a...

20.09.2011: A new report from the Norwegian Knowledge Centre for the Health Services sheds light on why and how evidence-based practice should be introduced in the specialist health service. We hope that the Norwegian Medical Association will play a key role in encouraging Norwegian doctors to be willing and able to use evidence from research in a balanced manner in clinical practice. «Evidence-based practice» means integrating current best research evidence with clinical expertise and patient preferences (1). However, the understanding and dissemination of evidence-based practice is low (2). Few are...

20.09.2011: In the hunt for doped athletes, little account is taken of the risk of condemning an innocent athlete. The doping hunters appear to be more concerned with catching all the guilty than with considering the risk that some test results may be false positives. In 2010, a Norwegian athlete (Erik Tysse) tested positive for the banned substance CERA (Continuous Erythropoietin Receptor Activator), according to Laboratorio Antidoping FMSI in Rome. The laboratory maintained that the substance had been found in the athlete’s urine. The method used was isoelectric focusing (IEF). Both the A and the B...

09.08.2011: The research efforts undertaken by Norwegian radiologists are limited in volume and fragmented in character. The funding is limited, and there are few relevant research training courses available. Only six per cent of all Norwegian radiologists have a PhD degree. At its autumn session in 2010, the Norwegian Radiological Association (NoRaFo) adopted a strategy plan for radiological research. The plan is available on the association’s website. During the last decade there has been a large increase in research efforts related to biomedical imaging techniques, and this has radically altered...

09.08.2011: Non-medicinal interventions involving weight loss prevent the development of type 2 diabetes in people with glucose intolerance. Whether medicinal interventions can prevent type 2 diabetes is more controversial, however. In the NAVIGATOR study, published in 2010, it was attempted to prevent type 2 diabetes and cardiovascular incidents with the aid of nateglinide, alternatively valsartan. The authors who participated in the Norwegian branch of the study here discuss the findings in light of previous literature. The NAVIGATOR study (Nateglinide and Valsartan in Impaired Glucose Tolerance...

03.06.2011: In the assessments of risk associated with the intake of nutritional supplements we often see that such supplements are confused with drugs. In Norway, regulations are in place to ensure that nutritional supplements are safe and reliably marketed. Products in which the content of vitamins and minerals exceeds the maximum values defined by the regulations are classified as pharmaceuticals. Nutritional supplements are intended as additions to the diet. The products should contain concentrated sources of vitamins, minerals or other substances with a nutritional or physiological effect...

08.04.2011: It is unrealistic to expect stable motivation for change among patients with a dual diagnosis. They need help with both substance abuse and mental disorders even though they continue their substance abuse, or with the substance abuse even though they refuse other treatment. We therefore never discharge patients who take intoxicants during their stay in our in-patient department. Patients suffering from both serious mental disorders and substance abuse – especially those with extensive functional problems – have for some time been offered extremely unsatisfactory treatment. This recognition...

08.04.2011: In order to improve, one must be able to measure. Prevalence data for hospital infections are imprecise and fraught with uncertainty. South-Eastern Norway Regional Health Authority should concentrate on incidence rates for surgical site infections, which are the type of infections that have the highest impact on mortality, morbidity and costs. Such data are available through the Norwegian Monitoring System for Infections in the Hospital Services (NOIS). Deficiencies in goal achievement should prompt efforts to improve the situation. However, in order to improve, one must be able to measure...

08.04.2011: «Any man’s death diminishes me, be­cause I am involved in Mankind»John Donne (1572 – 1631) The words of the poet John Donne appear as rele­vant to­day as when they were written 400 years ago (1). More than five mil­lion peop­le perish annually as a consequence of trau­ma, while innumerable others remain afflicted by per­man­ent or temporary dis­abil­ities. Trau­ma constitutes a ser­ious and in­creas­ing health pro­blem that causes untold suf­fer­ing for in­di­vid­uals, fa­mi­li­es and societies. The global trau­ma bur­den is heaviest in low-income countries, where primary pre­ven­ti­ve mea­su...

18.03.2011: The number of daily smokers in Norway is in the process of falling to below 20 %. Nevertheless, the number of smokers has only been reduced by about 400 000 males (from 1960) and 150 000 females (from 1975). The socio-demographic composition of today’s daily smokers is very different from what it was in the 1960s and 1970s. In addition many people smoke occasionally, mainly in connection with parties. Is the goal of a smoke-free Norway realistic? A totally tobacco-free society – that is the aim of the Tobacco-free, a coalition of organisations including the Norwegian Medical Association...

04.03.2011: The Norwegian network on climate and health has been established to promote urgently-needed climate change measures. Global warming is described in The Lancet as the greatest threat to global health in the 21st century (1). The serious health consequences predicted include diseases resulting from water shortages, drought and a decline in food production, more extreme weather events, heat waves, floods, sea level rise and migration. Effective measures to prevent climate change are urgently needed to limit harmful impacts on life and health (2). The Norwegian network on climate and health has...

18.02.2011: As a neurologist with an interest in skiing, I have had the opportunity to study a phenomenon that I believe merits broader attention. This phenomenon is skiencephalia – skis on the brain. I have undertaken an observational study of persons in my social circle who I believe are suffering from this syndrome, which in English is termed «ski addiction». It is difficult to estimate exactly how widespread this is, although the affliction is especially prevalent in the Nordic countries. In Norway it occurs most frequently in regions with the best skiing conditions, i.e. Eastern Norway and Trøndelag...