Helicobacter pylori and dyspepsia from a public health perspective : The Sørreisa Gastrointestinal Disorder Study

Paper number 3 of the thesis is not available in Munin due to publisher's restrictions: 3. Anne Mette Asfeldt, Bjørn Straume, Sonja Eriksson Steigen, Maja-Lisa Løchen, Jon Florholmen, Bjørn Bernersen, Roar Johnsen, Eyvind J. Paulssen: 'Changes in the prevalence of dyspepsia and Helicobacter pylori infection after 17 years: The Sørreisa gastrointestinal disorder study' European journal of epidemiology (2008) 23:625–633 (Springer). Available at http://dx.doi.org/10.1007/s10654-008-9275-xDyspepsia is a highly prevalent condition, involving substantial health-care resources. Ever since Marshall and Warren in 1984 discovered that Helicobacter pylori could cause peptic ulcer, it has been discussed to what extend Helicobacter pylori play a role in dyspepsia in general. In 2004 a population based survey was carried out in the municipality of Sørreisa, comprising a questionnaire survey on gastrointestinal disorders and upper endoscopy of a subgroup of the population. The results from this survey were compared with a similar survey in Sørreisa from 1987. Main Results A diagnostic test, the “Amplified IDEIA Hp StAR®” (DakoCytomation, Denmark) was validated and found to be very accurate, also in patients using proton pump inhibitors. The observer variability in upper endoscopy was studied and found to be considerable. A systematic image documentation of the endoscopy findings, regardless of suspicion of pathology, would improve the quality of the procedure. The prevalence of H. pylori has decreased considerably since 1987, whereas the prevalence of dyspepsia has remained constant, thus questioning any relationship between the two. Helicobacter pylori is only a moderate risk factor for peptic ulcer, whereas other risk factors as smoking seems to be just as important. Helicobacter pylori causes inflammation of the gastric mucosa, but plays a minor role in more chronic changes of the gastric mucosa such as atrophy and intestinal metaplasia. Elimination of Helicobacter pylori infection causes regression of inflammation, but not regression of intestinal metaplasia once it has developed. The thesis emanate from the Department of Community and the department of Clinical Medicine, University of Tromsø, Norwa

Fra lokalt til nasjonalt utbrudd av Pseudomonas aeruginosa

Utbrudd som rammer flere sykehus, krever god koordinering. Folkehelseinstituttets rolle i dette arbeidet bør styrkes, og vi trenger bedre systemer for utbruddsovervåking, rask tilgang til genteknologiske verktøy samt metoder for mikrobiologiske undersøkelser av miljø og utstyr.Outbreaks affecting several hospitals require good coordination. The Norwegian Institute of Public Health's role in this work should be strengthened, and we need better systems for monitoring outbreaks, rapid access to genetic engineering tools and techniques for microbiological examinations of equipment and the environment

Countrywide outbreak of Pseudomonas aeruginosa in hospitals caused by premoistened non-sterile washcloths, Norway, 2021-2022

Source at https://www.fhi.no/I november 2021 ble Folkehelseinstituttet varslet om at tre intensivpasienter hadde dødd av blodbaneinfeksjon med bakterien Pseudomonas aeruginosa ved Universitetssykehuset Nord-Norge i Tromsø i løpet av kort tid. De hadde identiske isolater forenlig med et klonalt utbrudd. Helgenomsekvensering viste at det var en ny sekvenstype, ST3875, som ikke har vært påvist i Norge eller andre land. Nye tilfeller uten epidemiologiske sammenhenger, ble etter hvert funnet i flere andre sykehus, noe som indikerte en felles smittekilde. Den 17. januar 2022 var det påvist utbruddstilfeller i tre av fire helseregioner, og det ble 19. januar erkjent som et nasjonalt utbrudd. FHI overtok da koordinering av utbruddsarbeidet, og 20. januar ble det etablert en Sentral utbruddsgruppe med fagpersoner fra alle helseregionene. Den 21. januar var det 23 tilfeller i 9 sykehus i 3 regioner. Kasusdefinisjonen var en person med laboratoriebekreftet P. aeruginosa ST3875 fra oktober 2021 i sykehus i Norge, uavhengig av avdeling. Etter systematiske laboratorieundersøkelser av over 300 produkter påviste Oslo Universitetssykehus 18. mars 2022 utbruddsbakterien i pre-fuktede engangs vaskekluter av merket Oasis BedBath Unperfumed produsert i Lancashire, England. Sykehusene sluttet umiddelbart å bruke produktene. Vaskeklutene er definert som et kosmetisk produkt, og Mattilsynet er tilsynsmyndighet. Mattilsynet avdekket at produsenten og importøren ikke hadde full oversikt over produksjonslinjene og hvilke produkter som var forurenset. Det ble også avdekket at P. aeruginosa var blitt påvist i produkter under den interne kvalitetskontrollen i september 2021, uten at produktene var blitt stanset. Den 14. april tilbakekalte den engelske produsenten Vernacare produktene fra markedet både i Norge og internasjonalt. Per 14. juni 2022 omfattet utbruddet 388 tilfeller i 40 sykehus. Gjennomsnittsalder var 68 år og median alder 70 år (interkvartilområde 59- 79 år). Flertallet (63 %) av tilfellene var menn, og seks sykehus rapporterte Pseudomonas som sterkt medvirkende årsak til død hos totalt 8 tilfeller. Til sammen hadde 15 % av tilfellene ST3875 i blodkultur, 21 % i luftveier, 38 % i urin, 19 % i sår og 7 % i andre prøvematerialer, noe som tydet på flere mulige inngangsporter for bakterien. Antall nye tilfeller falt raskt etter at kilden var identifisert, og bruk av produktet ble stoppet i sykehus

Helicobacter pylori and dyspepsia from a public health perspective : The Sørreisa Gastrointestinal Disorder Study

Dyspepsia is a highly prevalent condition, involving substantial health-care resources. Ever since Marshall and Warren in 1984 discovered that Helicobacter pylori could cause peptic ulcer, it has been discussed to what extend Helicobacter pylori play a role in dyspepsia in general. In 2004 a population based survey was carried out in the municipality of Sørreisa, comprising a questionnaire survey on gastrointestinal disorders and upper endoscopy of a subgroup of the population. The results from this survey were compared with a similar survey in Sørreisa from 1987. Main Results A diagnostic test, the “Amplified IDEIA Hp StAR®” (DakoCytomation, Denmark) was validated and found to be very accurate, also in patients using proton pump inhibitors. The observer variability in upper endoscopy was studied and found to be considerable. A systematic image documentation of the endoscopy findings, regardless of suspicion of pathology, would improve the quality of the procedure. The prevalence of H. pylori has decreased considerably since 1987, whereas the prevalence of dyspepsia has remained constant, thus questioning any relationship between the two. Helicobacter pylori is only a moderate risk factor for peptic ulcer, whereas other risk factors as smoking seems to be just as important. Helicobacter pylori causes inflammation of the gastric mucosa, but plays a minor role in more chronic changes of the gastric mucosa such as atrophy and intestinal metaplasia. Elimination of Helicobacter pylori infection causes regression of inflammation, but not regression of intestinal metaplasia once it has developed. The thesis emanate from the Department of Community and the department of Clinical Medicine, University of Tromsø, Norwa

Non-prescription purchase of antibiotics during travel abroad among a general adult population in Norway: Findings from the seventh Tromsø Study

Background - Non-prescription purchase of antibiotics is undesirable and has not recently been investigated in a representative population in a high-income low-use country during travel abroad. This study examined self-reported prevalence of antibiotic purchase abroad with and without prescription among participants reporting international travel in a general adult population in Norway, and the associations with socio-demographic, lifestyle and health factors. Methods - We analysed questionnaire-data from 19995 participants (10470 women) ≥40 years in the population-based Tromsø Study 7, 2015–2016. Data from the Norwegian Prescription Database were used to examine antibiotic use in Norway. We calculated adjusted odds ratios (AOR) for “travel abroad”, “any antibiotic purchase abroad”, and “antibiotic purchase abroad with” and “without prescription” using multivariable logistic regression. Results - Over half (55.0%, 95%CI 54.3–55.7%) participants reported travel abroad of >1 week duration in the past year. Travelers were more likely than non-travelers to be women (AOR = 2.02, 95%CI 1.42–2.88%) and report high education/income, childhood mostly lived abroad, healthy lifestyle, and good/excellent self-rated health. In total, 17904 travel episodes to 148 countries were reported. Altogether, 3.7% (95% CI 3.4%-4.1%) of travelers had purchased antibiotic abroad in the past year. Non-prescription purchase (1.5%, 95% CI 1.3–1.7) was associated with younger age, being female (AOR 1.41, 1.0–1.97), number of travels (reference: one episode, two: AOR = 1.82, 1.25–2.67, three: 2.60, 1.58–4.28, four: 3.10, 1.40–6.36 and ≥five: 4.70, 2.30–9.62), occurrences of diarrhoea (one: 2.42, 1.50–3.93 and ≥two: 3.08, 1.29–7.35), and antibiotic use in Norway in the past year (1.84, 1.29–2.62), whereas purchase with prescription (2.4%, 2.1–2.7) was associated with low income, growing-up abroad, recent hospital admission, additionally including number of travels/diarrhoea, and antibiotic use in Norway. Thailand (10.7%, 95% CI 7.8–14.3), Turkey (5.5%, 3.8–7.8) and Spain (3.6%, 3.0–4.3) were the countries most commonly associated with any antibiotic purchase. About two in five travelers who bought antibiotics in Thailand had done so without prescription, three in five in Turkey, and less than one in three in Spain. Conclusion - Overall, a small proportion of travelers had bought antibiotics abroad in the past year. Low prevalence of non-prescription purchase may be explained by awareness of the risks associated with self-medication, cultural views, unawareness of the non-prescription availability, and/or few infections. Divergent predictors for purchase abroad with versus without prescription may suggest different reasons for these practices

Bruk av videosamtale i behandling av tuberkulose-sykdom i Nord-Norge

BAKGRUNN - Totalt ble det meldt 261 pasienter med tuberkulose i Norge i 2017, hvorav 90 % fullførte behandlingen. Tuberkulosemedikamenter gis som daglig direkte observert behandling (DOT) til alle pasienter. Vi undersøkte om dette kan gjøres ved videosamtale. MATERIALE OG METODE - Vi gjennomførte en klinisk observasjonsstudie ved Universitetssykehuset Nord-Norge 2016–19, der pasienter ≥ 16 år med tuberkulosesykdom etter minimum to uker daglig direkte observert behandling ved hjemmebesøk fortsatte behandlingen ved videosamtale. Norsk Helsenetts passordbeskyttede krypterte videosamtaletjeneste ble benyttet. Hjemmesykepleien kontaktet pasienten via videosamtale i sanntid og observerte medikamentinntaket via nettbrett, smarttelefon eller pc. RESULTATER - 20 av 30 pasienter oppfylte inklusjonskriteriene, hvorav 17 pasienter (15 utenlandsfødte) med median alder 32 (17–74) år ble inkludert. Gjennomsnittlig observert medikamentinntak per pasient var 86,1 % i perioden med direkte observert behandling ved hjemmebesøk og 75,9 % i perioden ved videosamtale. Median daglig tidsbruk for hjemmesykepleien var 17 (2–40) minutter ved hjemmebesøk og 3 (1–8) minutter ved videosamtale. 14 av 17 pasienter og 14 av 17 hjemmesykepleiere foretrakk videosamtale fremfor hjemmebesøk. 15 pasienter og alle hjemmesykepleiere ville anbefalt videosamtale til andre. Tekniske problemer (8,9 %) var vanligste årsak til at direkte observert behandling ikke ble utført i periode med videosamtale. FORTOLKNING - Direkte observert behandling ved videosamtale var gjennomførbart hos utvalgte pasienter. Videosamtale var tidsbesparende for hjemmesykepleien og ble foretrukket fremfor hjemmebesøk

High Reinfection Rate after Preventive Chemotherapy for Fishborne Zoonotic Trematodes in Vietnam

<div><p>Background</p><p>The World Health Organization aims for complete morbidity control of fishborne zoonotic trematodes (FZT) in endemic areas by 2020. The main intervention tool for achieving this goal is regular use of preventive chemotherapy by offering praziquantel to those at risk in endemic areas. The purpose of this study was to investigate the effectiveness of preventive chemotherapy to control FZT in an endemic area in Northern Vietnam.</p><p>Methodology and principle findings</p><p>We followed a cohort of 396 people who fulfilled the criteria for receiving preventive chemotherapy. Stool samples were examined by Kato-Katz technique for the presence of trematode eggs before, and two, 16, 29 and 60 weeks after preventive chemotherapy. The prevalence of trematode eggs in stool was 40.2% before, 2.3% two weeks after and increased to a cumulative prevalence of 29.8% sixty weeks after preventive chemotherapy.</p><p>Conclusions</p><p>The effectiveness of preventive chemotherapy as a main component in control of FZT is not well documented in most endemic areas. We found a high reinfection rate within the first year after preventive chemotherapy. Since these trematodes are zoonoses, preventive chemotherapy may not have sufficient impact alone on the transmission to have a lasting effect on the prevalence. Animal reservoirs and farm management practices must be targeted to achieve sustainable control of fishborne zoonotic trematode infections, hence control programs should consider a One Health approach.</p></div

Infection intensity.

<p>Number of fishborne zoonotic trematode eggs per gram stool in a cohort of 396 people before and two, 16, 29 and 60 weeks (Before, W2, W16, W29, W60) after preventive chemotherapy. Figures shown are medians with 95% confidence intervals, minimum and maximum value. Number of egg positive persons at each time point is also shown.</p

Cumulative reinfection rate two, 16, 29 and 60 weeks after treatment (preventive chemotherapy).

<p>The group with negative sample before treatment to the left and the group with positive sample before treatment to the right. Dark grey bars are cumulative positive samples. Light grey bars are negative samples. Missing stool samples after treatment were handled with imputation, i.e. a missing stool sample was regarded as negative if the previous test in the timeline was negative.</p

Cumulative prevalence and change in cumulative prevalence.

<p>Cumulative prevalence and change in cumulative prevalence before and two, 16, 29 and 60 weeks after preventive chemotherapy. Change in cumulative prevalence with 95% confidence intervals. *Repeated measure ANOVA.</p