Roar Johnsen

Peptic Ulcer and Non-ulcer Dyspepsia—a Disease and a Disorder

In a cross-sectional survey for coronary risk factors, 14,390 middle-aged men and women answered a questionnaire concerning life-style, diet and disease, including peptic ulcer (PU) and dyspeptic symptoms. The overall lifetime prevalence of reported PU was 5.3% in men and 2.1% in women. The prevalence of reported dyspeptic symptoms, consistent with non-ulcer dyspepsia (NUD), was 22.6% in men and 18.1% in women. Reporting of both PU and NUD was significantly associated with sex and age, NUD less marked than PU. PU and NUD differed substantially with respect to associations with psychologic, social, life-style, and dietary variables. PU was strongly associated with age, a family history of peptic ulcer, body mass index, and smoking. NUD, on the other hand, showed closest association to psychological factors and social conditions. This difference between PU and NUD might be of aetiological and therefore clinical significance, and calls for therapeutic trials in NUD patients with interventions different from the traditional peptic ulcer treatments.

Changes in the prevalence of dyspepsia and Helicobacter pylori infection after 17 years: the Sørreisa gastrointestinal disorder study.

Dyspepsia and Helicobacter pylori infection are two important public health issues in the field of gastroenterology, generating high expenditures in diagnosis and treatment. A causal relationship between H. pylori and dyspepsia is still debated. The aim of this study was to address changes in the prevalence of, and association between, dyspepsia and H. pylori infection in a general population. The study took place in the municipality of Sørreisa in Northern Norway. Data were collected in 1987 and 2004. The study included questionnaires on gastrointestinal disorders and risk factors, as well as H. pylori assessment. The prevalence of dyspepsia in 2004 was 31.9% in men and 31.7% in women (compared with 30.7 and 26.3% in 1987). In 2004, the prevalence of H. pylori infection in men with/without dyspepsia was 20.3/26.7% (compared with 47.0/32.7% in 1987), whereas the prevalence of H. pylori infection in women with/without dyspepsia was 31.3/20.8% (compared with 50.0/40.7% in 1987). Since 1987, the prevalence of H. pylori has decreased independently of dyspepsia, most pronounced in the younger age groups, thus indicating a cohort effect. Our findings of a decreasing prevalence of H. pylori, a persistently high prevalence of dyspepsia, and an uneven distribution of H. pylori infection with regard to dyspepsia in men and women, question the understanding of a causal relationship between dyspepsia and H. pylori.

Erosive Prepyloric Changes in Dyspeptics and Non-Dyspeptics in a Defined Population the Sørreisa Gastrointestinal Disorder Study

In this population-based endoscopic survey we found erosive prepyloric changes (EPC) in 38.5% of dyspeptics and 35.1% of non-dyspeptics. EPC were observed more frequently in men than in women in both groups. Occurrence of Helicobacter pylori was not associated with EPC. No common gastrointestinal symptoms were found to be associated with EPC. Endoscopic duodenitis of the duodenal bulb was found more frequently in subjects with EPC of the two highest grades than in subjects without EPC. Only the highest grade of EPC was associated with chronic gastritis. EPC were associated with cigarette smoking and, among women, also use of alcohol. We conclude that EPC constitute an endoscopic finding without relation to specific symptoms. These changes therefore do not represent a clinical entity, and it is doubtful whether this finding will give the clinician a better understanding of dyspepsia.

Practical Training of Medical Students in Community Medicine: Eight Years Experience from the University of Tromsø

From its beginning, the Medical School at the University of Tromsø aimed at obtaining a better balance between clinical medicine, basic science and community medicine in its curriculum. This was obtained by using the integrated model for teaching, having a separate study-block for community medicine, incorporating field work in local hospitals and with district doctors and requiring the students to write a scientific paper before qualifying. The 8-week field training with a district doctor started in 1978. Evaluations from these eight years have been analysed and show that students, during these eight weeks, are involved in many aspects of family- and community medicine. The programme has been given positive evaluations from both students and teachers. We conclude that the field training given to medical students in Tromsø is an efficient way of preparing the medical students for future clinical work both inside and outside institutions.

Comparison of sick leave patterns between Norway and Denmark in the health and care sector: a register study.

Aims: Sickness absence is of considerable concern in both Norway and Denmark. Labour Force Surveys indicate that absence in Norway is about twice that in Denmark and twice that of the mean reported by the Organisation for Economic Co-operation and Development. This study compares absence patterns according to age, percentage of employment, and occupation between municipal employees in the health and care sectors in two municipalities in Norway and Denmark. Methods: Data recorded in the personnel registers of the municipalities of Kristiansand, Norway and Aarhus, Denmark were extracted for the years 2004 and 2008, revealing 3498 and 7751 employee-years, respectively. We calculated absence rates together with number of sick leave episodes, and their association with the above-mentioned covariates. Gender-specific comparative descriptive statistics and negative binomial regression analysis were performed. Results: The sickness absence rate in women was 11.3% in Norway (95% confidence interval [CI] 11.2–11.4) and 7.0% in Denmark (95% CI 7.0–7.1) whereas mean number of sick leave episodes among women was 2.4 in Denmark, compared to 2.3 in Norway (p = 0.02). Young employees in Denmark had more sick leave episodes than in Norway. Proportion of absentees was higher in Denmark compared to Norway (p < 0.0001). Conclusions: The finding of that more employees in Denmark have more frequent, but shorter sick leave episodes compared to Norway, for whatever reasons, may indicate that more frequent sick leaves episodes prevent higher sick leaves rates.