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This paper points to the dilemmas posed by the lack of longitudinal studies of morbidity and mortality, or of side-effects, of several drugs widely used in treatment of asymptomatic risk factors. New drugs and new indications make large groups eligible for treatment, i.e. for mildly elevated blood pressure or cholesterol levels, impaired glucose tolerance and risk of osteoporosis. The treatment of people with asymptomatic elevated risk factors differs in point of principle from the treatment of diseases, symptoms or complaints: The patient has no subjective feeling about his or her condition; the health risk is usually lower; there are no good evaluation measures for the treatment; and the risk that side-effects outweigh the benefits is greater. This makes high quality treatment and good information to patients even more important than in ordinary practice. More knowledge about effects with regard to morbidity and mortality and about long-term side-effects is necessary. Doctors should prefer drugs for which the effects are documented, and give patients with the highest health risk top priority.

The incidence of hip fractures among the elderly is high. Previous studies have revealed considerable geographical differences in Norway with the highest incidence of hip fractures in Oslo. Using hospital registers, we found there was an annual incidence of first-time hip fractures of 583 per 100,000 inhabitants 50 years and older in the county of Nord-Trøndelag. This incidence is about the same as in Troms county in Northern Norway. The number of fractures almost doubled in the winter months of December and January compared to June and July. This study was not designed to explain these seasonal differences, but some of the reasons may be explained as follows: during the light, summer months elderly people are at less risk when moving about, both indoors and out, whereas they are at greater risk in the winter when roads and pavements are slippery. Preventive measures in the community may reduce the incidence of hip fractures.

In the present study medical departments at 57 (83%) of all hospitals in Norway answered a questionnaire about the criteria used to diagnose acute myocardial infarction. One hospital specified a period of chest pain lasting over 30 minutes; 14 hospitals worked on 30 minutes and 36 hospitals based their diagnosis on a period of less than 30 minutes. Six hospitals did not use any particular duration of pain in order to make a positive diagnosis. There were no important differences over the electrocardiogram criteria. Information on the type of enzymes used for diagnosis, enzyme combinations, and threshold values of the different enzymes, did reveal inequalities between the hospitals. In the 46 hospitals using creatine kinase (CK) the threshold for a positive diagnosis varied between 170 and 500 IE/1 for men and 150 and 400 IE/I for women. For aspartate dehydrogenase (ASAT) the variation was between 40 and 100 and 35 and 75 IE/I for men and women respectively. Unequal criteria for the diagnosis of acute myocardial infarction may lead to differences in treatment, variations in the assessment made by the health insurance scheme and could complicate follow-up studies of this disease.

The effect of floor cleaning on bacteria, organic materials and particles in the patients' rooms was studied at Ullevål University Hospital, Oslo, Norway. Four cleaning methods were compared; dust-adhesive (dry), humified, wet mopping, and regular wet washing (RWW) without a mop. The following tests were taken from the floor before and after cleaning: bacterial counts (colony forming units = CFU) and ATP (presence of organic materials), and from the air: CFU/m3 air, and particle counts/m3 air. Humified mopping and dry mopping reduced the bacterial counts from the floor by 75% and 55% respectively (p = 0.005 and p = 0.014, using contact medium). The wet mopping had no statistically significant effect, while the wet washing even increased the CFU on the floor by 35-50% (p = 0.017 with contact medium, and p = 0.028 with petrifilm). The two wet methods were the most effective, however, in removing organic materials from the floor; 65% to 70% reduction (p = 0.051 and p =0.008). The CFU/m3 air was low both before (50-130 CFU/m3) and after (70-110 CFU/m3) cleaning. A slight increase in airborne particles was measured after dry mopping. Combined use of humified mopping and wet mopping is recommended, but is dependent on a well prepared and finished floor surface.

In November 1994 a major outbreak of acute gastroenteritis was experienced in the municipality of Klaebu (4,486 inhabitants). To investigate the course and extent of the epidemic, a questionnaire was mailed to all 1,573 households. The returned questionnaires covered 2,943 persons, of whom 1,640 (56%) were reported ill with the following most common symptoms: Nausea (83%), vomiting (78%), diarrhoea (72%) and abdominal pain (70%). The epidemic curve was typical of a common source epidemic. The incidence of vomiting turned out to have three distinct peaks with an interval of 26 hours, probably due to secondary infections. Two specimens that were examined by electron microscope showed typical Norwalk virus structures, and this virus was assumed to be the etiologic agent. The actual cause of this common-source epidemic was found to be inadequate chlorination. The onset of symptoms in different parts of the municipality showed that time taken for the infection to be transported from the reservoir to the consumers was longer than expected. Such delays allow for information on preventive measures to be communicated via the radio and other media.

This article describes physical inactivity among adults in Nord-Trøndelag who suffer from or have suffered from heart infarction, angina pectoris, stroke, impaired motor ability, impaired vision, impaired hearing or impairment because of psychological complications. Information was collected by questionnaire during the Nord-Trøndelag Health Survey 1984-86. Younger men and younger women with previous heart infarction reported less inactivity than persons with no history of infarction. In contrast, young men and women suffering from impaired hearing were more inactive than people not suffering from impaired hearing. Among the disabled or sick, more women reported physical inactivity than men. This also held good when the results were controlled for age. Among healthy persons, the highest share of physically inactive was found in the oldest age groups, regardless of gender. This survey indicates that, to some degree, physical activity has become an accepted means of improving health after heart infarction in younger men and women. Physical activity has unexploited potential as a means of treating other disabilities and illness.

We have examined mortality from ischaemic heart disease, prevalence of self-reported coronary heart disease and risk factor levels in three towns (Kristiansund, Alesund and Molde) in the county of Møre og Romsdal. The results for mortality were based on vital statistics for the age group 40-69 years, for the periods 1966-76 and 1977-87. Risk factor data and data on self-reported coronary heart disease for the age groups 40-42 years and 65-67 years were obtained from a health screening survey conducted in the county in 1990. According to the official statistics, the towns share important socio-economic characteristics, but Kristiansund is thought to have stronger roots in the coastal culture, with a historically economic basis in fishery and shipbuilding. We observed substantial differences between the three towns, both as regards risk factor levels and mortality from ischaemic heart disease. By far the highest mortality rates were found in Kristiansund, both for men and for women. A similar gradient existed for the levels of main risk factors, including serum cholesterol, systolic blood pressure and prevalence of smokers. We discuss the implications of these findings for prevention strategies.

Screening for cardiovascular disease risk factors was carried out in 14 of Norway's 19 counties in 1986-1990 as part of a prevention programme. All residents aged 40-42 were invited. The attendance was 73.5% for males and 82.6% for females. A total of 87,761 persons were examined. The screening included determination of serum cholesterol and triglycerides, measurement of blood pressure, height and weight, and filling in a questionnaire. Mean serum cholesterol was 5.90 mmol/l for males and 5.55 mmol/l for females, mean systolic blood pressure 135.3 and 126.1 mm, and prevalence of daily smoking 43.5 and 41.8%. The risk factor levels in the 341 municipalities of the 14 counties are shown cartographically. For both sexes, the highest risk score was found in the northernmost county, the lowest in southern counties. The risk was also relatively high in some rural areas in southern Norway. By geographical area there was a strong correlation between the risk factor levels of the two sexes, and a less consistent but marked correlation between the means for the various risk factors.

We have illustrated how cartography can be used in the study of regional mortality. We chose as an example ischaemic heart disease among males aged 30-69 in Norway during the period 1966-87. Choropleth maps (area shading) and circle maps were used to demonstrate regional differences both as regards level of mortality and mortality time trends. A probability map was produced to show the degree of statistical significance for deviation from the national mortality rate. The examples in this study revealed some regional mortality patterns not previously reported. We conclude that mapping is a valuable method in the study of vital statistics

The article describes mortality from ischaemic heart disease, including sudden, unexpected death, among males aged 30-69 years in all 19 Norwegian counties for the period 1966-87. During this period, the age-adjusted mortality rate in Norway for the 30-69 year age group was highest in 1966-70, and declined by 15% until 1983-87. The decline in mortality was greatest in the 40-49 year age group, but was also clearly evident in the 50-59 and 60-69 year groups. In twelve of the counties there was a statistically significant (p less than 0.05) decrease in mortality from 1966-70 to 1983-87. In one county, Oppland, located in central south-eastern Norway, mortality increased by 19% (p less than 0.01). The increased mortality in this county was most prominent in the 50-59 year group (34%, p less than 0.01). The most favourable change in mortality took place in Rogaland, in south-western Norway, where mortality decreased by 29% (p less than 0.001) from 1966-70 to 1983-87. Positive changes in mortality were also seen in Finnmark, a county with traditionally very high mortality rates. This study was not designed to explain the regional differences in mortality, but the authors point to principal explanatory factors. The regional differences in mortality time trends might be an argument for geographical differentiation of preventive measures.