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Purpose: The objective of this open randomized study was to compare the clinical performance of Nova T380 and Gyne T380 Slimline copper intrauterine devices (IUDs)., Materials and Methods: Eligible for analyses were 957 Norwegian parous women aged 18-45 years. Clinical performance was measured upon the removal of IUD due to contraceptive failure, expulsion, bleeding, pain, pelvic inflammatory disease and other medical reasons during a 5-year study period., Results: The discontinuation rate due to contraceptive failure was significantly higher in the first year for Nova T380 users than for Gyne T380 Slimline users, whereas no differences were observed thereafter (the 5-year cumulative failure rates were 4.4% and 2.2%, respectively, per 100 women). However, the partial expulsion rate was significantly higher in the first year for Gyne T380 Slimline users than for Nova T380 users (the 5-year cumulative rates were 3.4% and 1.1,% respectively, per 100 women). No other major differences in reasons for discontinuation were found between the study groups. There was a slight nonsignificant increase in hemoglobin levels for both study groups over the course of the study., Conclusion: Clinical performance was considered satisfactorily high for both devices.

Background: Chlamydia trachomatis (CT) as a risk factor for ectopic pregnancy (EP) has mainly been established through seroepidemiologic cross-sectional studies., Goal: The goal of this study was to obtain EP risk estimates for women diagnosed with CT using women with negative tests as the reference group., Methods: We linked prospectively collected CT laboratory data (1990-2003) to EP hospital data (discharge and outpatient registries) in a nested case-control study. Six hundred sixteen women with CT test(s) before first EP were eligible as cases. Three controls were matched to each case for year of birth, age at first test, and number of prior tests., Results: Previous CT infection was associated with elevated EP risk (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.0-2.0). In stratified analysis, the association was only significant for the youngest women (born 1970-1984) who had a nearly complete CT testing history (OR, 2.1; 95% CI, 1.3-3.2)., Conclusion: A history of diagnosed CT infection is associated with a 2-fold increased EP risk.

Purpose: Although the IUD has been a contraceptive method for about 50 years, how it affects subsequent fertility remains controversial. The aim of our study was to examine time to pregnancy, pregnancy outcome and the need for infertility workup in a cohort of previous copper IUD users., Materials and Methods: From May 1993 to April 1995, 957 women were included in a prospective cohort IUD study in the city of Trondheim, Norway. From this randomized clinical trial, we identified 205 women eligible for study participation. Group A comprised 109 women who removed their IUD for purposes of planning to become pregnant, while Group B comprised 96 women who became pregnant or planned pregnancy after a complicated IUD use. Data were collected through a postal questionnaire. All information from the questionnaires was validated against data kept in the medical record at the general practitioner's office or in the hospital record of women who became pregnant or started an infertility workup. All analyses were done using SPSS., Results: In Group A, 93.6% (102/109) of the women became pregnant. Time to conception was unaffected by parity order, duration of use and age at time for removal of the IUD. Among the seven women who did not conceive, four women cancelled pregnancy plans, while three women started an infertility workup. The distribution of intra-/extrauterine pregnancies did not differ between Groups A and B. However, significantly more pregnancies were terminated as induced abortions in Group B. The two women (2%) who did not conceive in Group B did not start an infertility workup., Conclusion: In line with results from other studies, there is no evidence that prior use of a copper-containing IUD increases the risk for impaired fertility regardless of the reason for removal.

Background: The population of gynecological cancer survivors is growing, yet little is known about the effects of cancer and treatment on pain and quality of life well beyond the completion of therapy. The aims of this study were to investigate quality of life and the prevalence, intensity and presentation of pain in long-term survivors of gynecological cancer compared to a representative group of women from the general population., Methods: The study comprised women aged 32-75, residing in a central part of Norway. Cases were gynecological cancer survivors treated at University Hospital, Trondheim, Norway, between 1987 and 1996, and age-matched women selected at random from the general population served as controls. After 1 reminder, the response rate was 55% (176/319) and 41% (521/1,276) for survivors and controls, respectively. A total of 160 gynecological cancer survivors and 493 controls were eligible for final analyses. Pain was measured by the item 'How often do you have pain?' and marks on a body chart indicating pain sites. Ferrans and Powers' Quality of Life Index (QLI) measured quality of life. The level of statistical significance was set at p< or =0.05. A chi2 test for categorical variables, unpaired t-test for continuous variables, and logistic regression were applied., Results: On average, the long-term gynecological cancer survivors had a complete recurrence-free period of 12 years (range: 7-18). The prevalence of pain was 26%. The results revealed no difference in the prevalence of pain between women who survived gynecological cancer and women without a gynecological cancer history. Women suffering from musculoskeletal disorders or living in households with low income are more likely to suffer pain. The small group of women with a previous history of gynecological cancer and living in a low income household experience more pain, particular if they suffer from edema. Pain shows a clear negative effect on quality of life, especially on the health and functioning domain. There was no difference in the quality of life between cancer survivors and controls., Conclusion: Long-term gynecological cancer survivors do not differ from other women in terms of pain and quality of life. Pain is associated with musculoskeletal disorders and low income.

Background: The study objective was to estimate temporal trends in ectopic pregnancy in a well-defined population., Methods: We identified patients with ectopic pregnancy in hospital discharge registries in Sør-Trøndelag County, Norway, 1970-2004, and retrieved data from medical records. We calculated age-specific ectopic pregnancy incidence, proportions of patients with first ectopic pregnancy/prior infertility treatment, incidence of ectopic pregnancy by birth cohort and age and ratio of ectopic pregnancy to live births (extrauterine ratio) by age and parity., Results: Age-adjusted ectopic pregnancy incidence rates increased from 4.3 to 16.0 per 10 000 women-years over the period 1970-1974 to 1990-1994 and declined to 8.4 per 10 000 women-years in 2000-2004. Incidences were highest among women aged 25-34 years throughout the study period. We observed decreases in proportions of women with previous ectopic pregnancy and with prior infertility treatment after 1990-1994. Incidence rates were the highest for women born between 1960 and 1964 in all age groups. Extrauterine ratio increased with age and was higher for women with two or more previous births compared with women with none or one prior birth., Conclusions: The epidemic increase in ectopic pregnancy towards 1990-1994 was followed by a marked decrease.

Background: Little is documented about Norwegian women's knowledge of human papillomavirus (HPV). The purpose of this study was to investigate young Norwegian women's knowledge of HPV transmission and diseases associated with the virus., Material and Methods: From September 1998 to December 2000, 898 women aged 16 - 24 years were recruited to a study on the natural course of HPV-infections. At the beginning of the study, 323 participants at 8 of the 16 selected health centres answered a questionnaire regarding motivation for and openness about study participation, and knowledge about transmission and diseases associated with the virus. Data were analysed with Chi-quadrate test and logistic regression in SPSS., Results: Only 20 % (63/323) of the women had heard about HPV before they were enrolled in the study. 15 % (49/323) answered questions about causal relationships between HPV, cervical cancer and genital warts correctly. No correlations were found between HPV knowledge and age, sexual behaviour, or previous testing/history of chlamydia infection., Conclusions: Knowledge about viral transmission and diseases associated with HPV is low among young Norwegian women.

Background: Although the association of HPV16 and HPV18 DNA with cervical cancers has been well studied, the prevalence of these types in high-grade cervical intraepithelial neoplasias (CIN2/3) may differ from the prevalence found in cervical cancer specimens., Objective: To determine the prevalence of specific HPV types found in high-grade CIN2/3 biopsy samples., Study Design: One thousand eight hundred and forty-eight cervical biopsy specimens were obtained from Norwegian women. HPV16 and HPV18 type and gene-specific PCR assays were performed amplifying a portion of the E6, E7 and L1 genes. In addition, the reverse line blot assay was performed on a subset of specimens, in which a portion of L1 was amplified and hybridized to strips coated with complimentary HPV sequences., Results: The prevalences of HPV16 and HPV18 in the 1848 biopsy cohort were 32.3% and 6.0%, respectively. HPV16 was detected in 47.5% and HPV18 in 5.9% of diagnosed CIN2/3 specimens. Approximately 12% of the CIN2/3 specimens contained two HPV types and 2.5% contained three HPV types., Conclusions: The prevalence of HPV16 increases from grades CIN1 to CIN2 to CIN3. The prevalence of HPV18 did not change significantly with increasing CIN grade. The majority of infections diagnosed as CIN2/3 contained a single HPV type. The type-specific PCR assay had increased detection sensitivity over the reverse line blot assay.

Human papillomavirus (HPV) infection causes cervical cancer and genital warts. Young women (1106) were randomized to receive one of three formulations of a quadrivalent HPV (Types 6/11/16/18) L1 virus-like particle (VLP) vaccine or one of two placebo formulations. The goal was to assess vaccine safety and immunogenicity in baseline HPV 6/11/16 or 18-naïve and previously infected subjects. All three formulations were highly immunogenic. At Month 2 (postdose 1), among women with vaccine-type antibodies at baseline, vaccine-induced anti-HPV responses were approximately 12- to 26-fold higher than those observed in baseline-naïve women, suggesting an anamnestic response. Following an initial, similar sized decline, anti-HPV responses plateaued and remained stable through end-of-study (3.0 years). No vaccine-related serious adverse experiences were reported.

Objective: To document prescribing patterns of lipid-modifying therapies in hypercholesterolemic patients, cholesterol goal attainment, and factors associated with cholesterol goal attainment in Norway., Method: This was a retrospective, observational study using existing computerized patient records at 11 primary healthcare centers in Norway and the Norwegian Patient Register of hospital data. The study population was 3111 patients identified in the primary care database who were prescribed a lipid-modifying therapy between the dates of July 1987 and May 2003 and who were > or = 18 years of age at the time of the first prescription. Of these patients, 1337 patients had uncontrolled lipid measures at baseline. In the analysis of goal attainment, data were available for 877 (28% of the total study population) and 1144 (37%) patients with baseline and follow-up total cholesterol (TC) and/or low-density lipoprotein-cholesterol (LDL-C) levels after 4 and 12 months' treatment, respectively., Outcome Measures: Initial lipid-modifying therapy (drug and dosage), changes in initial lipid-modifying therapy, cholesterol goal attainment, and factors related to cholesterol goal attainment. Cholesterol treatment goals were defined as LDL-C <3.0 mmol/L and/or TC <5.0 mmol/L (as per the Second Joint Task Force of European Societies on the Prevention of Cardiovascular Disease)., Results: The initial lipid-modifying therapy was a HMG-CoA reductase inhibitor (statin) in 98% of patients, most often simvastatin (42%; mean initial dosage = 18.4 mg/day) or atorvastatin (34%; 12.7 mg/day). The median year of treatment initiation was 1999 and the mean duration of follow-up was 39 months. The initial prescription remained unchanged at year 1 for most patients (69%), whereas 17% discontinued drug treatment. Mean TC levels decreased from 7.36 mmol/L at baseline (n = 1337) to 5.31 mmol/L at 12 months (n = 1144; p < 0.05), whereas mean LDL-C levels decreased from 4.98 (n = 847) to 3.08 mmol/L at 12 months (n = 713; p < 0.05). These mean reductions occurred within 3 months of the initial prescription and did not change subsequently. A total of 32.9% of patients who were not at goal at baseline achieved cholesterol goal 12 months after initiating treatment. The factors related to cholesterol goal attainment at 12 months were: baseline TC level (odds ratio [OR] 0.64; 95% CI 0.58, 0.71), treatment with a statin (OR 8.60; 95% CI 1.13, 65.4), diagnosis of diabetes mellitus (OR 2.91; 95% CI 2.01, 4.21), and age (OR 1.02; 95% CI 1.01, 1.03)., Conclusions: Lipid-modifying therapy in Norway is dominated by statin monotherapy. In this analysis of primary-care patients, maximal reductions in cholesterol levels were seen within the first 3-4 months after therapy initiation. After 12 months of treatment, 67% of patients remained above recommended cholesterol levels. More effective and well tolerated treatment strategies are needed to improve the probability of patients achieving cholesterol treatment goals.

Objective: The study objective was to investigate Chlamydia trachomatis (CT) testing patterns, prevalence, and incidence among men and women in Sør-Trøndelag county, central Norway, 1990-2003., Goal: The goal of this study was to obtain data for recommendations regarding CT screening., Study Design: Laboratory data on CT tests for persons 15 to 24 years old were retrieved and analyzed., Results: Four percent of men and 44% of women had been CT tested at least once by the age of 20. By the age of 25, 44% of men and 84% of women had been tested. Prevalence at first test was at its peak in 2000-2002 (men: 15-19 years 18%, 20-24 years 23%; women: 15-19 years 11%, 20-24 years 9%). Incidence estimates were higher for persons with a positive first test than for persons with a negative first test., Conclusions: More men and more female teenagers need to be tested. Repeat testing is particularly important among people who have been diagnosed with CT.

Background: The aim of this study was to investigate the incidence of gastro-oesophageal antireflux surgery in Norway from 1999 to 2003, in comparison with the 1990 to 1998 period., Material and Methods: Operation codes for laparoscopic and open antireflux surgery were compiled from the Norwegian Patient Registry for analysis of incidence rates, geographic variations, postoperative hospital stay and rates of readmission., Results: The incidence rates of antireflux operation in 1999-2003 were 18.6 per 100,000 men and 10.2 per 100,000 women, a ten-fold increase compared to 1990. There were significant differences in operation rates between the five Norwegian health regions, highest in northern region. In 1999, 85% of the patients had a laparoscopic operation, compared with 89% in 2003. Postoperative hospital stay was significantly shorter after laparoscopic operations. The proportion of laparoscopic procedures varied between the regions (78%-93%). The total rate of readmission within 60 days was 7%. There was no significant difference between readmission rates for patients treated by laparoscopy (6%) compared to patients treated by laparotomy (9%). In one health region, a high proportion of the patients were day surgery cases., Conclusion: The incidence of antireflux operation increased strongly during the 1990s and varies significantly between the Norwegian health regions. Laparoscopy is the leading mode of surgery. Patients treated by open surgery have a significant longer postoperative hospital stay than patients treated by laparoscopy.

Background: Chlamydia notification rates have increased in Norway over the recent years. The increase in notification cannot be interpreted as an increase in chlamydia prevalence since knowledge of testing patterns and prevalence of chlamydia by sex and age is virtually absent., Material and Methods: A data set, applying the woman as unit for analyses, comprising all test activity in one Norwegian county, was created for the period 1990-2003 (women 15-59 years old, resident in Sør-Trøndelag County, n = 56,220). Tests registered within 60 days from the previous test were excluded. Outcome measures are age-specific testing rates (first test), cumulative incidence of first test and incidence of repeated testing, proportion of positive first tests and cumulative incidence of being diagnosed with chlamydia before the age of 25, and 12-month incidence of chlamydia., Results: Testing rates were high among young women throughout the study period. By the age of 25, almost all women had been tested at least once for chlamydia (85-90%). By the end of the year following the first test, one in five women with a negative first test and one in three women with a positive first test had been tested for chlamydia at least once more. The proportion of positive tests was highest among the youngest women (9-11% for women 15-24 years from 2000). Cumulative incidence of diagnosed chlamydia by the age of 25 years was 15% for women born 1976-79. Incidence of chlamydia during the first year after the first test was 2-3%. The relative risk for being diagnosed with chlamydia after the first test was highest for women who initially tested positive, and for teenagers., Interpretation: The prevalence of chlamydia is high among young women. However, many women are not tested within a reasonable time after their first intercourse. Increased testing rates among teenagers can be achieved by focusing on easily available tests implying self-sampling methods.

Background: Increased testing rates for Chlamydia infection among young women can be achieved by more use of self-administered sampling methods. In this study, vulval swabs and urine are compared to conventional cervix samples., Materials and Methods: Vulval swabs, urine and cervix samples from 541 young, healthy women were tested for Chlamydia by polymerase chain reaction technique., Results: The prevalence of Chlamydia infection was 4.1% (22/541). The sensitivity (cervix 22/22, urine 21/22 and vulva 21/22) and specificity (no false negative results) were high for all sampling sites., Interpretation: Urine samples or vulval swabs can replace conventional cervix swabs for the detection of Chlamydia.

Background: The knowledge of testing patterns and prevalence of chlamydia among Norwegian men is sparse., Materials and Methods: Data on chlamydia tests for men were selected from the database at the only laboratory in a Norwegian county carrying out chlamydia tests. 12,633 men aged 15-59 at first test and resident in the county were included in the study., Results: Age-specific rates for first test for young men increased throughout the study period. By the age of 25, one in five men had been tested for chlamydia at least once. One in six of first tests was positive. Chlamydia prevalence at first test was highest among men 20-24 years old (21% in 2003). Men who initially had a positive test more often had a repeated test than men who initially had a negative test. Furthermore, 12-month incidence of chlamydia infection subsequent to the first test was higher among men who initially tested positive (12%) than among men who initially tested negative (7%)., Interpretation: Even though testing rates increased throughout the study period, the proportion of men who had been tested for chlamydia at the age of 25 was low. The prevalence at first test was high throughout the study period. Increased availability of urine-based testing will probably lead to more chlamydia testing among men.

Background: The purpose of this study was to chart changes in surgical treatment of inguinal or femoral hernia in Norway from 1990-91 to 1999-2003., Methods: Data were compiled from the Norwegian Patient Registry based on procedure coding for inguinal and femoral hernia repair., Results: The annual number of femoral hernia repair procedures was constant throughout the study period. From 1990-91 to 2003, the mean age dropped from 66 for both sexes to 63 among men and 62 among women. The female-to-male ratio was constant at 2/1. Emergency admittances went down from 56% to 43% and mean hospitalisation was down from five to four days. The use of mesh repairs increased from 3% (1990-91) to 37% (2003). Incidence rates for inguinal hernia repair increased throughout the period, from 1.8 to 2.3 per 10,000 women and from 20.6 to 32.1 per 10,000 men. Mean age was as down from 63 (both sexes) to 59 among men and 57 among women. The female-to-male ratio remained constant at 1/12. Emergency admittances dropped from 13% to 6%. Mean days of hospitalisation fell from 4 in 1990-91 to 1 in 2003. Two out of three inguinal hernia repairs were done ambulatory in the last year of the study period. The use of mesh repairs increased from 1% in 1990-91 to 78% in 2003. Laparoscopic procedures were rarely used (2% in 2003)., Interpretation: In 2003, the majority of inguinal hernia repairs were performed as day surgery with open mesh techniques, in line with European guidelines.

Background: Cervical intraepithelial neoplasia (CIN) is an established precursor of invasive cervical cancer. Excision procedures such as cold-knife conization, electrodiathermy or laser conization of the cervix are major surgical treatment modalities of CIN., Material and Methods: Women who were treated for CIN 2/3 or suspected invasive cancer with cold-knife conization between 1977 and 1980 (n=212) were compared with women treated with laser conization between 1987 and 1990 (n=439). Outcome parameters were method of anaesthesia, duration of hospital stay, treatment efficacy and postoperative complications such as bleeding, infection or cervical stenosis., Results: General anaesthesia was used in 88 % of women treated with cold-knife conization, while paracervical block anaesthesia was used in 97 % of women treated with laser conization. Mean hospital stay was 7.6 days after cold-knife conization, while laser conization was performed as an outpatient procedure. The overall complication rate was 36.8 % after cold-knife conization and 8.4 % after laser conization. Significantly higher rates of postoperative bleeding (21.1 % v. 5.0 %), infections (2.6 % v. 0.5 %) and cervical stenosis (11.8 % v. 1.6 %) were found after cold-knife conization compared to laser conization. Treatment efficacy was equally high (98 %) with both methods., Conclusion: Laser conization was found to be a significantly less resource consuming procedure and with fewer postoperative complications compared to cold-knife conization.

Background: The purpose of this study was to investigate cholecystectomy incidence and laparoscopy rates in Norway (1990-2002)., Methods: Data were compiled from the Norwegian Patient Registry based on codes for cholecystectomy., Results: From 1990 to 2000-02, age-adjusted incidence rate (per 10,000 inhabitants) for cholecystectomy increased from 2.9 to 4.1 for men and from 7.0 to 11.8 for women. Incidence rates varied between counties. The proportion undergoing laparoscopic surgery increased from 1% in 1990 to 89% in 2000-02. Over the same period the length of postoperative inpatient stay decreased from 7.3 days to 3.3 days. 94% of electively admitted patients were operated by laparoscopic technique in 2000-02. Among patients admitted on an emergency basis, women below 50 were more often operated by laparoscopic technique than older women and men., Conclusion: Substantial changes in the treatment of gallstone disease occurred in Norway over the period 1990 -2002. Increased incidence rates for cholecystectomy and reduced length of postoperative inpatient stay were observed after the introduction of cholecystectomy by laparoscopic technique.

Background: The purpose of this study was to explore pattern of testing and prevalence of C trachomatis among 16 to 19 year old Norwegian high school girls., Material and Methods: The study subjects were 827 girls who participated in a study of oral contraceptives prescribed by public health nurses. The first consultation was an interview about sexual behaviour and other characteristics. The participants were encouraged to test for C trachomatis with their general practitioners. We explored characteristics of those tested and predictors of genital C trachomatis infection., Results: Half of the study population was tested, either before (21%) or during the study period (26%). Girls with risk factors such as change of partner over the last six months, older partner or no regular partner were more likely to be tested than girls with no change of partner or a regular same-age partner. One out of four girls with high-risk behaviour (> or =3 partners) was never tested. The prevalence of infection at first test was 9%. The risk for having a positive test result was three times higher for single girls than for girls with a regular same-age partner., Interpretation: Too few young girls were tested for C trachomatis. Encouragement from public health providers had low influence on the pattern of testing. Alternative strategies such as implementation of do-it-yourself tests by urine or vulvovaginal sampling procedures have to be provided as a low-threshold service.

Background: We wanted to determine the prevalence of Chlamydia trachomatis in a sample of young women and to assess risk factors related to sexual behaviour that are predictive of such infection., Material and Methods: 898 healthy, non-pregnant women aged 16 to 24 years attending primary care centres over a two-year period (September 1998 to December 2000) were recruited for the study. Uterine cervix samples were tested for Chlamydia trachomatis and participants were interviewed about their sexual behaviour. Chlamydia test results from 881 samples were valid., Results: The prevalence of genital Chlamydia trachomatis infection was 2.4% (21/881). In univariable analyses, a high number of lifetime partners (four or more), smoking, previous pregnancy and a previous positive chlamydia test were factors predictive of a positive Chlamydia test. In multivariable analyses, previous pregnancy and a previous positive Chlamydia test were the only significant factors. The number of lifetime partners was higher among women who had been pregnant or previously had tested positively for Chlamydia., Interpretation: The prevalence of Chlamydia was low in this population. Risk behaviour (frequent change of partners) can be expressed by teenage pregnancy and positive Chlamydia test results and these factors can be used for identification of women who should be tested more frequently than others for Chlamydia infection in a low-prevalence population.

Background: The purpose of this study was to analyse trends for Chlamydia trachomatis infection in a population of women seeking termination of pregnancy, and to assess whether socio-demographic characteristics are predictive of such infections., Material and Methods: Since 1983 women seeking abortion in the university hospital in Trondheim have been systematically tested for Chlamydia trachomatis. Data on 11,376 abortions (1985-2000) were included in the study and results were analysed with logistic regression., Results: Age-adjusted prevalence of Chlamydia trachomatis decreased from 9.0% to 5.0% in 1999-2000. The prevalence was highest among the youngest women. Single and cohabiting women had a higher prevalence of chlamydial infections than married women., Interpretation: Women terminating their pregnancy are an excellent population for sentinel surveillance of Chlamydia trachomatis infection because of their young age, high proportion of singles, and relative inconsistent use of contraception. Even though the prevalence of Chlamydia trachomatis has decreased over the 16-year study period, it is still high for women seeking abortion, especially in the youngest age groups.

Objective: In recent years, high-resolution magic angle spinning (HR MAS) has provided the opportunity to explore detailed biochemical composition of intact tissue. Previous studies of intact cervical biopsies with high-resolution magnetic resonance spectroscopy (MRS) have correlated well with histopathology. Lactate level in cervical cancer tissue has been found to correlate to metastatic spread. The purpose of this study was to explore the potential of the HR MAS technique as a tool for chemical characterization of cervical cancer tissue., Materials and Methods: Tissue samples from the cervix were collected after hysterectomy from patients with cervical cancer (n=8) and patients with nonmalignant disease (n=8). The tissue specimens were analyzed using HR MAS MR spectroscopy combined with principal component analysis (PCA)., Results: The resulting spectra showed resolution comparable with high-resolution MR spectra of extracts. Multivariate analysis confirmed that MAS spectra classified according to patient diagnosis., Conclusion: Malignant tissue of the cervix differed from nonmalignant tissue with regard to higher levels of cholines and amino acid residues and lower levels of glucose.

Background: The purpose of this study was to examine the incidence of appendicitis and appendectomy in Norway from 1990 to 2001., Methods: Data were compiled from the Norwegian Patient Registry based on ICD-9 and ICD-10 codes for appendicitis and appendectomy. Re-admissions after appendectomy were selected based on institution and allocation numbers for hospitalisation., Results: Age-adjusted incidence rates for appendectomy were 117 per 100 000 for men and 116 per 100 000 for women. Incidence rates were highest among patients aged 10-29. Diagnostic accuracy increased from 81% to 86% in men and from 60% to 71% in women over the study period. Perforation ratio increased from 12% to 21% in men and from 9% to 17% in women. Appendectomy by laparoscopic technique increased during 1998 to 2001 from 5% to 10% of cases for men and from 9% to 15% of cases for women. The proportion of laparoscopic appendectomy was considerably higher in two counties (50% and 28% in 2000-2001). Length of hospital stay was shorter after laparoscopy (median two days) than after open surgery (median three days), with no difference in the rate of re-admission of 4%., Interpretation: Diagnostic accuracy and perforation ratio increased over the 1990s. Patients operated upon with laparoscopic technique had shorter hospital stays and the same re-admission rate compared to patients undergoing conventional surgery. Though the proportion of appendectomies done by laparoscopy doubled from 1998 to 2001, the procedure is not in commonly use in Norway.

Background: The purpose of this study was to investigate incidence and treatment of ectopic pregnancy in Norway (1990 to 2001)., Materials and Methods: Data were compiled from hospital discharges (1990 to 2001) and hospital outpatient care (2000 to 2001) as reported to the National Patient Registry. Selection was based on ICD-9 and ICD-10 codes for ectopic pregnancy (women, 15-44 years old)., Results: The incidence rate decreased from 17.3 to 9.5 per 10 000 women-years and the ratio to live births decreased from 26.4 to 14.9 per 1000 over the study period. Women aged 25-34 had the highest incidence rate of ectopic pregnancy. Measured as ratio per 1000 live births, ectopic pregnancy increased with age. Laparoscopic treatment was much more used, whereas length of hospital stay fell off continuously. The proportion of patients re-admitted was stable throughout the period (5%). In 2000 and 2001, every third patient had at least one outpatient consultation. There were large variations between counties in the proportion of patients treated by laparoscopy and in the prevalence of outpatient care., Interpretation: The observed decrease of ectopic pregnancy measured as incidence rates and ratio to live births indicates increased fertility. In some counties it might be possible to increase the use of laparoscopy, which might result in shorter hospital stays.

Background: The purpose of this study was to investigate trends in ectopic pregnancy in relation to fertility patterns in general., Materials and Methods: All women hospitalised with ectopic pregnancy in Sør-Trøndelag county 1970-2002 were identified through hospital discharge registries (ICD-8, -9, -10). Medical records were reviewed in order to identify patients who were residents of the county and had ectopic pregnancy verified by histology. Incidence rates were analysed by age, previous ectopic pregnancy and previous infertility treatment. Cumulative incidence rates were analysed by birth cohort. Ectopic pregnancy related to the number of births (extrauterine ratio) was analysed by age and parity., Results: The incidence of ectopic pregnancy (per 10 000 women-years) increased from 4.2 in 1970-74 to 15.1 in 1990-94, then declined to 6.5 in 2000-02. Women 25-34 years old had highest incidence rates throughout the whole study period and the sharpest decline after 1990-94. The proportion of women with previous ectopic pregnancy or previous infertility declined after 1990-94. Cumulative incidence rates by age 30 were lowest for the youngest cohorts. The extrauterine ratio increased by age throughout the whole period and decreased in all age and parity specific groups throughout the 1990s., Interpretation: After the epidemic increase in ectopic pregnancy observed from 1970 to the end of the 1980s, the annual number of cases has declined sharply. The observations indicate better primary treatment for primary ectopic pregnancy and primary infertility and improved female fertility through the 1990s.

Objective: To estimate the risk of being diagnosed with cervical intraepithelial neoplasia (CIN) 2/3 or invasive cervical cancer (ICC) based on diagnostic and screening procedures performed after a diagnosis of atypical squamous cells of undetermined significance (ASCUS) and to compare this risk to that in women with a normal Pap smears., Study Design: A 7-year, prospective, cohort study was performed in the Norwegian population-based, coordinated screening program. After excluding women in the midst of follow-up of an abnormal Pap smear or with a history of CIN 2/3 or ICC, the study population consisted of women 25-69 years of age with a normal (n = 526,661) or ASCUS Pap smear (n = 10,037) in 1995-1996. Risk estimates were calculated by logistic and parametric survival regression., Results: Within 7 years of an ASCUS smear, 1,017 women (10.1%) were diagnosed with CIN 2/3 and 62 (0.62%) with ICC. Women with an ASCUS index Pap smear had a relative risk of 15-30 of being diagnosed with histologically verified CIN 2/3 or ICC within the first 2 years of follow-up as compared to women with a normal index smear. In long-term follow-up, women with an ASCUS index smear followed by a normal smear, which cancelled further clinical follow-up, were at > 3.5 times higher risk of both CIN 2/3 and invasive cancer as compared to women with a normal index smear., Conclusion: Pap smear follow-up of women with an ASCUS smear does not identify all women at higher risk of CIN 2/3 and ICC. Other diagnostic procedures should be implemented to improve the screening program.

Communication about contraception and specific knowledge of oral contraceptives (OCs) were examined in a sample (n = 4,650) of Norwegian high school students. Data were collected through a 44-item questionnaire especially developed for the study. The response rate was 73% and data from a total of 1,714 girls and 1,389 boys were eligible for analyses. More females (83%) than males (54%) discussed contraception at least monthly. Discussions were predominantly held with peers and not adults. Females were far more knowledgeable about OCs than males. Respondents knew more about side effects and the pill's relative efficacy than about risks of cancer and tromboembolism. The most significant predictors of high knowledge scores were gender and OC use (females). Also predictive of high knowledge scores were frequent discussions about contraception with peers. Talks about contraception with health workers were unrelated to knowledge scores.

Completeness of reporting and accuracy of the diagnosis of ovarian cancer from one health region in Norway to the Cancer Registry were examined. Data kept by the Cancer Registry were evaluated against discharge diagnosis data from all 8 hospitals in the health region during the period of 1987-1996. The assessment of the accuracy of the diagnosis recorded in the Cancer Registry was based on review of all medical records in the hospital setting and on slide review of all histologic diagnoses. The overall completeness of reporting ovarian cancer to the Cancer Registry was 99.6%. The organ specific completeness of registration of histologic verified ovarian cancer within the Cancer Registry was 95.3%; 0.9% was erroneously coded and 3.5% had their diagnosis changed to ovarian cancer at re-evaluation. Of all ovarian cancer cases registered at the Cancer Registry, 91% had a primary histologic diagnosis. Among 591 cases identified with a histologic diagnosis in the Cancer Registry, the accuracy of the diagnosis was estimated at 92%. Coding errors were found in 2% of these cases, while in 6% of the cases it was not possible to reproduce the original diagnosis of ovarian cancer at re-evaluation. In order to provide data of high quality for cancer surveillance a cancer registry needs several data providers, such as histopathologic laboratory reports and clinical reports. In addition, assessment of reported data through stringent quality assurance procedures within the registry are necessary for reaching a nearly 100% completeness of registration as found for ovarian cancer in the Cancer Registry of Norway., (Copyright 2002 Wiley-Liss, Inc.)

Background: Cervical cancer is the third most frequent cancer among women worldwide. Human papillomavirus (HPV) infection is a necessary risk factor and the first step in cervical carcinogenesis., Material and Methods: This article reviews the current literature concerning the possibility of preventing cervical cancer by HPV testing and vaccination., Results: HPV testing cannot replace cytology, but will reduce false negative cytology and may improve the screening programme for cervical neoplasia. It has not yet been incorporated in any national cervical cancer screening program, but trials are ongoing in Scandinavia and in the Netherlands. The cost-effectiveness of HPV testing in screening has to be proven and whether it can affect the recommended screening-intervals. Therapeutic and prophylactic vaccines for HPV associated disease are in progress. Evaluating the clinical trials that are ongoing will take several years. Several anti-HPV vaccines are now in clinical trials; Norway will also participate. Therapeutic vaccines against cervical cancer have so far not been successful, but anogenital dysplasias and condylomas may be more susceptible. Prophylactic vaccines against HPV 6, 11, 16 and 18 have been evaluated in clinical phase I and II trials, and phase III trials are in progress., Interpretation: HPV testing improves the specificity and sensitivity of cervical cytology and it can be used to clarify cases with atypical cells of undetermined significance (ASCUS) and low-grade intraepithelial neoplasia. In the near future it may also be included in the cervical cancer screening programme for women above the age of 30. The first results in clinical vaccine trials are encouraging, and final conclusions about the effectiveness of these vaccines may be achieved in five years' time.

Objective: To study the primary care of cervical carcinoma with regard to clinical and pathological factors, treatment decisions, complications and survival., Design: A historical cohort comprising all women hospitalized with invasive cervical carcinoma (n=293) during the period 1987-1996., Results: Median age was 52 years (range 23-90). FIGO stage distribution was 62%, 15%, 18% and 5% in stages I, II, III and IV, respectively. Early stage disease correlated with young age. Histologic types were: squamous cell carcinoma 84%, adenocarcinoma 11%, adenosquamous carcinoma 4% and small cell/anaplastic carcinoma 1%. Primary therapies were: surgery 188 women (64%), radiotherapy 99 women (34%), chemotherapy two women (0.7%); four women not treated (1.3%). Complications after surgery in 25 women (13%), none were fatal. Acute or late complications after primary or postoperative radiotherapy in 39 women (25%), seven (4.6%) were late serious complications. Three women died from complications related to radiotherapy. Mean follow-up of surviving patients was 58 months. Overall disease specific five-year survival was 70%. Five-year survival in stages IA, IB, II and III was 100%, 88%, 58% and 20%, respectively. One-year survival in stage IV was 31%. Median survival in stages III and IV according to curative or palliative aim of treatment was 20 and 6 months, respectively (p<0.005)., Conclusion: Satisfactory quality of diagnosis and therapy have been maintained through regional care for cervical cancer patients.

First-catch urines from 276 asymptomatic male military recruits were screened by polymerase chain reaction for the detection of Chlamydia trachomatis. Eight initially positive specimens were retested by polymerase chain reaction, ligase chain reaction and transcription-mediated amplification. Urine specimens from six (2.2%) subjects were considered to contain C. trachomatis. However, retesting of serially collected urines from five of these six subjects using different nucleic acid amplification methods showed some discrepancy. This may have a major impact on the efficacy of screening programs for C. trachomatis in low prevalence populations.

GB virus C (GBV-C), also called hepatitis G virus (HGV), occurs worldwide, but the clinical significance of this virus is still unclear. Plasma samples from 1,001 blood donors were tested by reverse transcription PCR using primers from the NS5 region and by a commercial enzyme-linked immunosorbent assay (ELISA) for the detection of immunoglobulin G antibodies against the putative envelope of HGV (anti-HGV E2). GBV-C/HGV RNA was present in the plasma from 2.5% of the blood donors, and anti-HGV E2 antibodies could be detected in 10.5% of the samples. Only one of the blood donors with viremia had elevated levels of alanine aminotransferase. Among ELISA-positive donors, there was a significantly higher percentage (16.5%) of individuals who had been treated by acupuncture than individuals who had not been given this treatment (9.4%). No other variables showed significant differences. Screening of medical records from 401 recipients of blood from PCR-positive donors revealed no association with liver disease. Four of 12 partners (33%) were HGV RNA positive, and sequence analyses of the strains showed that four of the couples probably were infected with the same strains, while strains from different couples were not identical. Anti-HGV E2 antibodies were detected in serum samples from four other partners. The prevalence of GBV-C/HGV among blood donors in our region is dramatically higher than the prevalence of hepatitis C virus (0.03%).

Background: There are several methodological problems when studying contraceptive efficacy. The present study focuses on efficacy issues from the use of oral contraceptives (OC)., Methods: Through a computerized system of medical records kept at the Department of Gynecology, Regional Hospital of Trondheim, Norway, 800 OC-failure pregnancies were identified among 8192 women having pregnancy termination from January 1, 1987 to December 31, 1996. Ascertainment of cases was done by validating hospital data on OC failures by data collected by the referring practitioner. Inconsistencies in failure data were found among 257 of the 800 (32%) women who claimed at the hospital that an OC was in use at time for conception. The medical record kept by their practitioners stated that 158 women had stopped using OC before last menstrual period, of the remaining 99 women neither data on actual use nor data on prescription could be confirmed., Results: Over the 10-year study period the proportion of failures by brand of OC was remarkably constant from year to year and reflected the user pattern of OCs in Norway. One-third of the total number of failures (n=523) were claimed to be method failures. The annual overall OC-failure rate was estimated to be 1% during the 10-year study., Conclusion: Case-control studies focusing on efficacy of OCs must be carefully designed and comprise both women carrying a pregnancy to term as well as women terminating their pregnancies. Our study focused on only one segment of the population of women experiencing an OC failure: women having pregnancy termination. The present study has shown that exposure data collected from interviews have to be validated against prescription data.

The incidence and distribution of risk factors in non-pregnant women diagnosed with deep vein thrombosis is not well known and was the target of the present study. The medical records of 102 non-pregnant women aged 15-44 hospitalized with deep vein thrombosis at two major Norwegian hospitals were examined retrospectively. The overall incidence of first event of deep vein thrombosis remained fairly constant over the 10-year study period and was estimated at 10.5 per 100,000 women-years. The incidence increased with age and was found twice as high for women 35-44 years of age when compared with the 15-34 age group. Forty-three (42%) of the patients had no identifiable risk factors. Surgery or trauma was found in 37 (36%) of the patients, eight (8%) had a diagnosis of associated cancer, and five (5%) were drug addicts. Five of eight patients registered with immobilization had immobilizing chronic neurological diseases. Thirty-nine (38%) of the patients used oral contraceptives at the time of diagnosis, and 14 of the 39 users of oral contraceptives were identified with medical risk factors. Over the 10-year study period there was no change in the incidence of venous thromboembolism and the risk profile among cases remained constant.

This study focuses on the situation in Norway after the UK Committee on Safety of Medicines issued an alert on an increased risk of venous thromboembolism with third-generation OCs on 18 October 1995. The Norwegian Medicine Control. Agency immediately issued a press release warning Norwegian women about the health risk associated with third-generation OCs (in Norway, the drug Marvelon only). In this study the effects of the Norwegian warning are evaluated by the use of data on the sale of OCs, number of induced abortions, and births by quarter for the 1992 to 1998 period. From third quarter 1995 to first quarter 1996, sales of Marvelon to pharmacies dropped by 75%, while total sales of OCs were reduced by 5%. From late October 1995 thorough January 1996, approximately 50,000 women stopped taking Marvelon. A maximum increase of 200 induced abortions could be attributed to the negative news on OCs in October and November 1995. There was no subsequent change in the birth pattern. These data confirm that Norwegian women who shifted to another type or stopped taking OCs during the 1995 media crisis avoided unplanned pregnancies.

This article reports on a retrospective study in two major Norwegian hospitals of spontaneous reporting to the Adverse Drug Reaction Committee of the Norwegian Medicines Control Agency of adverse reactions from the use of oral contraceptives (OCs) among patients with a diagnosis of venous thromboembolism. In these two hospitals, 168 women between 15 and 44 were diagnosed with a first event of venous thromboembolism during the ten-year period up to the end og 1997; 69 of them were OC users at the time of diagnosis. Three medical records (4%) kept at the hospital contained information on a report of adverse drug reaction to the Norwegian Medicines Control Agency. The Agency's database of all spontaneous reports on adverse drug reactions contains 112 reports of venous thromboembolism in the context of OC use. These reports came from all over Norway during the ten-year period of our study; four of the reports came from the study hospitals. We conclude that venous thromboembolism during the use of OCs was underreported by more than 90%. This corresponds to estimates of underreporting of other adverse drug reactions from the use of various compounds, in Norway as well as in other countries.

This study focuses on the incidence and risk profile among young women with a diagnosis of pulmonary embolism over the 10-year period 1988-97. A total of 66 non-pregnant women aged 15-44, treated for the first event of pulmonary embolism, were identified by discharge diagnosis at two main Norwegian hospitals (The Regional Hospital of Trondheim and Ullevål Hospital, Oslo). The estimated overall incidence of pulmonary embolism was 6.8 per 100,000 women-years. The crude incidence decreased from 7.5 per 100,000 women-years in 1988-90 to 4.1 per 100,000 women-years in 1996-97 (p < 0.1). 25 (38%) of the 66 patients were identified with at least one medical risk factor, four patients (6%) with a family history of thrombophilia and 30 patients (45%) used oral contraceptives (OC) at the time of diagnosis. 25 (68%) of the 37 patients without registered risk factors used OC. The incidence of pulmonary embolism decreased during the 10-year period, with unchanged risk profile. Two women (3%) died from pulmonary emboli shorter than three weeks after onset of symptoms.

Medical termination of pregnancy in the second trimester is a painful and a time-consuming procedure. This study comprises 110 consecutive second trimester terminations of pregnancy performed 1994-96. In 76 women (69%) the procedure was a legal abortion due to foetal malformations, 25 women (23%) had an intrauterine foetal death, and in 9 (8%) cases pregnancy was terminated because of persisting drainage of amniotic fluid. All cases with intrauterine foetal death and early drainage of amniotic fluid were successfully treated after application of up to five vagitories of gemeprost (mean 2.8 vagitories; mean induction-abortion interval 8.9 hours). In patients undergoing abortion due to foetal malformations, the mean induction-abortion time was longer (mean 22.7 hours, mean 5.2 vagitories) and 20% did not respond adequately to prostaglandin. Our results show that gemeprost is an efficient means of terminating a pregnancy in cases of foetal death or pre-term amniorrhea, but that it is less efficient in inducing abortion.

This study describes the distribution of DQB1genes in Norwegian women treated for high-grade cervical intraepithelial neoplasia (CIN). Formalin-fixed, paraffin-embedded tissue sections from 170 biopsy specimens with diagnoses of CIN II (n = 54) or CIN III (n = 116) were DQB1-typed using allele-specific polymerase chain reaction. The follow-up period for cases was 13 to 15 years. The control material comprised blood samples and endocervical brushes from 213 women without CIN. Both cases and controls had previously been human papillomavirus (HPV)-typed. The DQB1*0301 allele was overrepresented among cases compared with controls (odds ratio [OR] = 1.8). Presence of CIN was related to HPV infection, and HPV 16 positivity was significantly associated with the presence of DQB1*0301 (OR 1.8). The DQBI*0301 allele was significantly more prevalent in CIN III than in CIN II cases. The lesions in two women recurred in the follow-up period, one of whom was carrying the DQB1*0301 allele. Women carrying the HLA-DQB1*0301 allele have an increased risk of developing CIN when infected by HPV 16, although there was not an increased frequency of recurrent disease among women carrying this allele.

The rationale for the diagnosis of Pelvic Inflammatory Disease (PID) was studied among hospitalized patients at the Department of Gynaecology, Regional Hospital of Trondheim, Trondheim. From 1 January 1991 to 31 December 1993, 153 patients were discharged with a diagnosis of Pelvic Inflammatory Disease. In retrospect, the diagnoses were reconsidered applying strict criteria. All 26 patients (17%) who had a diagnosis verified by laparoscopy were classified as suffering from a "true" diagnosis, 83 (54%) patients were reconsidered as suffering from a "more likely" and 44 (29% as suffering from a "less likely" diagnosis of Pelvic Inflammatory Disease. Women who had a laparoscopy verified diagnosis of Pelvic Inflammatory Disease, had higher ESR (erythrocyte sedimentation rate), C-reactive protein and temperature when compared with women reclassified as "less likely" suffering from Pelvic Inflammatory Disease. Only 72% of the patients had microbiological sampling from the cervix. In order to increase diagnostic precision we argue for minimum criteria and a systematic clinical examination, including vaginal ultrasound, when diagnosing Pelvic Inflammatory Disease. We recommend more diagnostic use of laparoscopy especially among women with mild symptoms and few objective signs.

Objective: To assess the risk-of-malignancy index (a scoring system based on menopausal status, ultrasound features, and serum CA 125) at district hospitals for referral of women with suspected malignant pelvic masses for primary surgery at a central gynecologic oncology unit., Methods: All seven hospitals in Health Region IV, Norway, agreed to refer women with pelvic masses and risk-of-malignancy indices of 200 or more for centralized primary surgery. In total, 365 women 30 years of age or older, admitted consecutively at the local hospitals, were enrolled in the study from February 1, 1995, to January 31, 1997., Results: Compliance with the study was satisfactory; 84% (65 of 77) of women with risk-of-malignancy indices of at least 200 were referred for centralized primary surgery. Sensitivity and specificity to malignancy were 71% and 92%, respectively, which is in agreement with previous validation of the risk-of-malignancy index in teaching hospital settings. False negatives were due mainly to stage Ia (18 of 24) ovarian cancer, whereas 27 of 28 stage II-IV ovarian cancer cases were identified correctly., Conclusion: The risk-of-malignancy index identified women with malignant pelvic masses efficiently. Our study showed the risk-of-malignancy index strategy in a practical setting to be able to centralize primary surgery for advanced ovarian cancer from local hospitals to a subspecialty unit. We recommend the risk-of-malignancy index for detection of patients with advanced ovarian cancer for centralized primary surgery.

Objective: The scientific debate on oral contraceptives (OCs) and thrombotic diseases continues unabated. The aim of this survey was to evaluate available scientific data on OCs and thrombotic diseases and to make tentative prescription recommendations of OCs to women with and without various thrombotic risk factors., Consensus: In women 15-29 years old, venous thromboembolism is about twice as common as arterial complications. In women between 30 and 44 years, the number of arterial complications exceeds venous diseases by about 50%. The mortality from arterial diseases is 3.5 times higher than the number of deaths from venous diseases in women below 30 years, and 8.5 times higher in women 30-44 years old. A significant disability is more frequent in women suffering and surviving an arterial complication than in women with venous thromboembolism. Although many important scientific issues still have to be addressed, the available scientific data suggests a differential influence of OCs with second and third generation progestagens on the risk of venous and arterial diseases. OCs with second generation progestagens seem to confer a smaller increase in the risk of venous diseases and a higher increase in risk of arterial complications, compared with OCs containing third generation progestagens. The possible difference on the venous side seems to be smaller than primarily anticipated., Results: Young women without any known risk factor for thrombotic diseases may use any low-dose OC. If OCs are prescribed to women with known risk factors for arterial thrombotic disease; e.g. smoking, diabetes, controlled hypertension, migraine without aura, family disposition of acute myocardial infarction (AMI) or thrombotic stroke, a low-dose pill with a third generation progestagen may have an advantage. If OCs are considered for women with risk factors for venous disease such as severe obesity, varicose veins, family history of VTE or with factor V Leiden mutation, a low-dose combined pill with a second generation progestagen may be preferable. In women above 30 years, OCs with third generation progestagens generally seem to confer less overall thrombotic morbidity, mortality and disability than OCs with second generation progestagens. These women should reconsider, however, the indication of combined OCs in the presence of significant risk factors of thrombotic diseases.

Aims: To examine per- and postoperative complication rates and efficacy of laser conization in the treatment of cervical intraepithelial neoplasia (CIN) grade II-III., Material and Methods: Eligible for analyses were all women treated with their first laser conization because of CIN II-III during the time-period January 1, 1983 to December 31, 1992. The study population comprises 1081 women who were permanent residents of one Norwegian county (Sør-Trøndelag). All analyses were performed in SPSS applying chi-square for trend, Mann-Whitney test, survival analyses and logistic regression., Results: In total 86 women (8.0%) were observed with one or two (4:86) complications. Bleeding was most frequent (n = 66) followed by symptomatic cervical stenosis (n = 18). Most bleeding complications (74.2%) occurred one to two weeks postoperatively. Both bleeding complications and the occurrence of cervical stenosis were associated with cone height. Three emergency hysterectomies, two for bleeding and one for bladder perforation, were performed. Persistent disease was diagnosed in 1.9% (20:1053) of the women. All women with persistent disease were diagnosed among those with CIN III. Persistent disease was more than 20 times more common among women with disease-involved resection margins compared to those with free resection margins., Conclusions: Our evaluation of ten years' consistent use of conization by CO2 laser in the treatment of CIN II-III in an unselected population showed a low overall complication rate (8%) and very high efficacy (CIN II 100%, CIN III 98.1%) of the treatment.

Objective: To study infectious pathology at index ectopic pregnancy and to determine what other factors predispose a woman to repeat ectopic pregnancy., Methods: All women (n = 697) with their first (index) ectopic pregnancy histologically verified between January 1, 1978, and December 31,1993, at the only two hospitals in one Norwegian county were eligible. Included were permanent residents of the county who were 37 years of age or younger and who had not had tubal surgery before the index pregnancy. When the study closed on November 1, 1994, the participants had been observed prospectively for fertility events from approximately 1 to 17 years. Included in the final analyses were 353 women who had from one to five natural conceptions, for a total of 555 pregnancies. Chi-square test was used in univariate analysis, and the generalized estimating equations approach was used to analyze correlated responses and covariates that changed over time., Results: Pregnancy order is the stronger correlate of subsequent ectopic pregnancy. The frequency of repeat ectopic pregnancy decreased by one-third for each pregnancy from the first to the third pregnancy. The odds of having another ectopic pregnancy were nearly three times higher for women with a diagnosis of infectious pathology than for women who had no infectious pathology. Other correlates of repeat ectopic pregnancy include age 24 years or younger at first ectopic pregnancy, history of repeat ectopic pregnancy, initiation of infertility work-up, and conception with an intrauterine device at index pregnancy. Method of surgery was not associated with repeat ectopic pregnancy., Conclusion: The most crucial reproductive event after first ectopic pregnancy is the first event to occur. Women who have experienced two ectopic pregnancies should be considered candidates for assisted reproduction.

Objective: To assess the risk of residual and recurrent disease after carbon dioxide laser conization treatment for high-grade lesions of the cervix uteri, and thus to refine intervals for follow-up., Methods: The study population comprised all women treated for cervical intraepithelial neoplasia grade II-III over a 10-year period (1983-1992). All women who resided within the county for the entire follow-up period were followed for residual or recurrent disease, verified histologically until the closure date of January 31, 1996. The cumulative incidence of recurrent disease was assessed by survival analyses, and logistic regression was used to predict clinical features at initial treatment that were associated with the risk of residual or recurrent disease., Results: Only 19 of 1081 women (1.8%) were lost to follow-up. Residual disease was diagnosed in 20 (1.9%) study participants. The cumulative incidence of recurrent disease was extremely low, increasing nearly linearly with an annual incidence of three per 1000 woman-years observed. Involved resection margins were associated significantly with both residual disease (crude odds ratio [OR] 18.1; 95% confidence interval [CI] 5.2, 64.0) and recurrent disease (adjusted OR 3.0; 95% CI 1.2, 7.5) when compared with disease-free resection margins as reference., Conclusion: We recommend a differential follow-up interval depending upon the histologic evaluation of cone margins. If there is no residual disease, women who have free resection margins should return at a 3-year interval for follow-up. Women who have disease extended to the cone margins are recommended Papanicolaou smears at annual intervals through the fourth postoperative year before returning at a 3-year interval as practiced in the general screening program.

Objective: To assess the risk of ectopic pregnancy by the number of previous induced abortions., Design: Prospective cohort study., Methods: Three thousand seven hundred and fifty-four women, 39 years old or younger, living permanently in one Norwegian county, who had had at least one induced abortion between January 1, 1987 and December 31, 1992, at the University Hospital of Trondheim, Norway were followed prospectively for histologically verified ectopic pregnancies until December 31, 1993. Exposure time was measured from the most recent induced abortion (index abortion) until the ectopic pregnancy, closure date, or the subject's 40th birthday. Statistical analyses were done in SAS applying survival analyses and poisson regression., Results: During the follow-up period of 164,167 women-months, we observed 24 ectopic pregnancies in 3,754 women. The adjusted incidence density ratio (aIDR) for women who had had two or more induced abortions was 1.2 (95% CI: 0.5-3.1) in comparison with the reference group of women who had had one induced abortion. Measuring exposure as increasing number of consecutive induced abortions, no dose-response to ectopic pregnancy was found between two consecutive (aIDR 0.9) and three or more consecutive abortions (aIDR 1.1) in comparison with the reference group., Conclusion: In our setting, no excess risk of ectopic pregnancy was associated with multiple previous induced abortions compared with one previous induced abortion.

Objective: To assess the risk of ectopic pregnancy when using copper intrauterine devices relative to non-use of contraception and female sterilization., Design: Case-control study., Material and Methods: All cases diagnosed with a histologically verified extrauterine pregnancy and who became spontaneously pregnant in one Norwegian county from January 1, 1987 through to December 31, 1990 were eligible. Non-pregnant control women were chosen at random from the Norwegian Population Registry. Eligible for study were sexually active women, from 20 to 39 years of age, and who defined themselves as fecund. Included in the final analyses were 168 cases and 1,169 controls, who had all been previously pregnant., Statistical Methods: Chi square test and unconditional logistic regression., Results: Compared with non-users of contraception, the adjusted odds ratio (aOR) among current users of copper intrauterine devices was 0.09 (95%, confidence intervals (CI); 0.06-0.13). Compared with women who were sterilized, the aOR of having an ectopic pregnancy among current copper IUD users was 1.6 (95% CI; 0.7-3.5)., Conclusion: Relative to non-users of contraception, current copper IUD users had a 91% (95% CI; 87-94%) protection against ectopic pregnancy, while compared with women who had had a tubal sterilization, current copper IUD users had a 60% non-significant increased risk of ectopic pregnancy.

Objective: To determine whether having had one or more induced abortions increases a woman's risk of having an ectopic pregnancy., Methods: We conducted a case-control study of all women admitted to a major metropolitan hospital in Georgia with a surgical diagnosis of ectopic pregnancy during the period of October 1988 to August 1990. Controls were randomly selected from women seeking an induced abortion or delivering an infant at the same hospital. After exclusions, this analysis included 182 cases and 1056 controls. Stratified analysis and unconditional logistic regression were used to control for confounding and to estimate the relative risks., Results: Approximately 90% of cases and controls were non-Hispanic, black women; 34% of the cases and 36% of the controls reported a history of induced abortion. The crude odds ratio for having an ectopic pregnancy associated with a history of induced abortion was 0.9 (95% confidence interval 0.6, 1.3). The odds ratio remained the same after adjusting for selected confounding variables and stratifying by the number of induced abortions, gestational age at the time of abortion, place where the abortion was performed, and the woman's report of medical complications of the abortion., Conclusion: We found no evidence that having one or more induced abortions increases a woman's risk of having an ectopic pregnancy.

Norway had until recently no organized screening programme for cervical cancer, but opportunistic screening was common. This study focuses on the effectiveness of treatment of pre-malignant cervical conditions (CIN III) on cervical-cancer incidence in the county of Sør-Trøndelag in Norway, prior to the introduction of organized mass screening. The study is based on cervical-cancer incidence rates during the years 1965-92 and treatment data for CIN III. The expected number of cervical-cancer cases prevented due to early intervention was expressed in a regression model with 2 unknown parameters: the probability, p, of cancer development in case of CIN III, and the time lag, t, between treatment and when clinical cancer would otherwise have been diagnosed. The estimated probability that a patient treated for CIN III would have developed cervical cancer if not treated was found to be approximately 20%, and the mean time delay was around 16 years. In the last period of study (1988-92), the incidence was reduced by nearly 40% of what would have been expected without early intervention. Based on equal treatment rates as in 1990, parameter estimates were used to predict future incidence reduction. Maximum effectiveness will be achieved around the year 2005, with a nearly 70% reduction. Opportunistic screening and treatment of CIN III seems to have had considerable influence on cervical-cancer incidence. The costs, however, are substantial over-treatment, since our results indicate that 4 of 5 women treated for CIN III would not progress into the invasive state.

Objective: To estimate time trends related to ectopic pregnancy while considering the contribution of repeat ectopic pregnancy and changing treatment for infertile couples over the past 24 years., Methods: Population based incidence data on ectopic pregnancy were collected from the only two hospitals in one Norwegian county from 1970 through 1993. Cases were identified through hospital discharge registries and all medical records were reviewed. Only females, aged 15-44 years, living permanently in the county and having a histologically verified ectopic pregnancy were eligible for the study. Data were analyzed in 5-year periods and 5-year age-groups., Results: The incidence of ectopic pregnancy (per 1,000 woman-years) increased fourfold from the first to the last period. When we restricted the analyses to women with no previous ectopic pregnancy and no previous infertility surgery or treatment, we observed a linear threefold increase in the number of ectopic pregnancies., Conclusions: Repeat ectopic pregnancy and increased infertility treatment in the late 1970s and early 1980s might explain at most 25% of the increase in the incidence of ectopic pregnancy. After 1985, assisted reproduction might contribute to 4-5% of ectopic pregnancies diagnosed. The introduction of laparoscopy might explain some of this increase in the 1970s; however, we doubt that the introduction of more sensitive pregnancy tests or vaginal ultrasound in the 1980s contributed to the observed increase in ectopic pregnancy.