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.

Use of video directly observed treatment for tuberculosis in Northern Norway. / Bruk av videosamtale i behandling av tuberkulose-sykdom i Nord-Norge.

BACKGROUND: In 2017, a total of 261 patients with tuberculosis were reported in Norway, whereof 90 % completed their therapy. Anti-tuberculosis drugs are administered as daily directly observed treatment (DOT) to all patients. We investigated whether this could be done by video conference. MATERIAL AND METHOD: We conducted a clinical observation study at the University Hospital of North Norway in the period 2016-2019, in which patients ≥ 16 years with tuberculosis after a minimum of two weeks of daily DOT during home visits continued their treatment through video conference (video DOT). The password-protected and encrypted video conference service provided by Norwegian Healthnet was used. The home care service contacted the patient by video conference in real time and observed the intake of drugs via a tablet computer, smartphone or PC. RESULTS: 20 out of 30 patients met the inclusion criteria, whereof 17 patients (15 foreign-born) with a median age of 32 (17-74) were included. The average observed drug intake per patient was 86.1 % in the period with home-based DOT and 75.9 % in the period with video DOT. The median daily time spent by the home care service was 17 (2-40) minutes for home visits and 3 (1-8) minutes for video conferences. Fourteen out of 17 patients and 14 out of 17 home nurses preferred video conferencing over home visits. Fifteen patients and all home care nurses would recommend video conferencing to others. Technical problems (8.9 %) were the most common reason for directly observed treatment not being undertaken during the period with video conferencing. INTERPRETATION: Video DOT was feasible for the selected patients. Video conferencing was time-efficient for the home care service and was preferable to home visits.

The All-Age Prevalence of Helicobacter pylori Infection and Potential Transmission Routes. A Population-Based Study.

BACKGROUND AND AIMS: Previous research on H. pylori epidemiology has mostly focused on adult populations. We have aimed to study H. pylori prevalence in all age groups including children and adolescents and to identify potential routes of transmission. METHODS: Subjects from all age groups (children 0-11 years, adolescents 12-17 years and adults ≥18 years of age), recruited from both an urban and a rural community in Northern Norway, were invited to provide stool samples for the diagnosis of H. pylori antigen and to fill in a questionnaire (adult and adolescents only) on gastrointestinal symptoms, lifestyle factors and biometric data. RESULTS: A total of 1 624 (35.3%) of the invited subjects, including 173 (39.3%) of the children, 46 (19.2%) of the adolescents, and 1 416 (36.1%) of the adults, responded to the invitation. H. pylori infection was nearly undetectable (0.6%) among the children, whereas the prevalence increased from 20% in adolescents toward a peak of 45% in the highest age group. Univariate analyses of possible risk factors of H. pylori infection showed significant associations to private well water, the use of outhouse toilet, and having farm animals in childhood, but the associations waned in multivariate analyses. CONCLUSIONS: In our populations, with apparent high hygienic standards, the transmission of H. pylori infection may start not only in childhood, but also in adolescence, where potential transmission routes may be outdoor toilet use, private well water, and farm animals.

High reinfection rate after preventive chemotherapy for fishborne zoonotic trematodes in Vietnam.

BACKGROUND: 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. METHODOLOGY AND PRINCIPLE FINDINGS: 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. CONCLUSIONS: 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.

Prevalence, comorbidity, and risk factors for functional bowel symptoms: a population-based survey in Northern Norway.

OBJECTIVE: To assess the occurrence of functional bowel (FB) symptoms in Northern Norway, and to describe gender differences, comorbidity, and association to risk factors, including Helicobacter pylori infection. MATERIALS AND METHODS: Adult subjects (18-85 years) from the communities Bodø and Sørreisa were invited to complete a questionnaire on gastrointestinal symptoms, and to provide stool samples for assessment of H. pylori. RESULTS: Of 3927 invited subjects, 1731 (44.1%) responded to the questionnaire and 1416 (36.0%) provided stool samples. Functional bowel symptoms were found in 25%, somewhat more frequent in females (28.6%). Symptom pattern differed between genders only with regard to constipation. Presence of FB symptoms was significantly associated with gastroesophageal reflux symptoms, headache, dizziness, palpitations, sleep disturbances, and musculoskeletal symptoms. Psychometric traits were also more prevalent: feeling of low coping ability, feeling depressed, feeling of time pressure, and a low self-evaluation of health. In a multivariate regression model, factors that influenced the reporting FB symptoms were male gender (OR 0.71, 95% CI (0.52; 0.96)), age 50-69 years or ≥70 years (OR 0.49 (0.30; 0.80) and 0.40 (0.21; 0.79)), obesity (OR 1.61 (1.05; 2.47)), NSAID use (OR 2.50 (1.63; 3.83)), and previous abdominal surgery (OR 1.54 (1.05; 2.26)). The presence of H. pylori was not associated with FB symptoms. CONCLUSIONS: Functional bowel symptoms are prevalent, but our findings may be prone to self-selection bias. FB symptoms carry a significant burden of comorbidity. Female gender and low age are known risk factors for FB symptoms, whereas NSAID use as a risk factor deserves further clarification.

The natural course of Helicobacter pylori infection on endoscopic findings in a population during 17 years of follow-up: the Sørreisa gastrointestinal disorder study.

The natural course of Helicobacter pylori (H. pylori) is poorly understood, as most research in the field has been on patient populations. We studied the natural course of H. pylori and its associations to morphological changes of the gastric mucosa, peptic ulcer, and reflux oesophagitis in a prospective cohort study of subjects with and without dyspepsia. A total of 361 adults (201 men/160 women, mean age 41/42 years) in Sørreisa municipality, Norway who in 1987 were subjected to upper endoscopy and assessed for gastrointestinal symptoms and H. pylori status were followed up in 2004. H. pylori was strongly associated with neutrophilic (odds ratio [OR] 23.79; 95% confidence interval [CI] 11.64:48.61) and mononuclear infiltration (OR 9.43; CI 5.12:17.36), moderately with atrophy of the antrum (OR 1.98; CI 1.17:3.34), but not with atrophy of the gastric body or intestinal metaplasia. Elimination of H. pylori was associated with regression of gastric inflammation and atrophy, whereas intestinal metaplasia progressed. H. pylori was positively associated with peptic ulcer (OR 2.69; CI 1.2:6.02) but not significantly negatively associated with oesophagitis (OR 0.62; CI 0.35:1.09). This is the first prospective study including endoscopic findings of subjects without dyspepsia, to show that the impact of H. pylori on gastric atrophy is only modest, and that eliminating H. pylori does not cause regression of intestinal metaplasia. However, inflammation of the gastric mucosa regresses after H. pylori elimination. H. pylori is only a moderate risk factor for peptic ulcer, and other explanatory factors deserve more attention.

The impact of body mass index and Helicobacter pylori infection on gastro-oesophageal reflux symptoms: a population-based study in Northern Norway.

OBJECTIVE: Increased body mass index (BMI) has been proposed as a risk factor for gastro-oesophageal reflux symptoms. The aim of this study was to evaluate the effect of BMI and Helicobacter pylori on reflux symptoms in an adult population. MATERIAL AND METHODS: For this cross-sectional, population-based study from Bodø and Sørreisa communities in Northern Norway, a total of 3927 adults were invited to complete a questionnaire on gastrointestinal symptoms and to provide stool samples for the assessment of H. pylori. Reflux symptoms were considered present when a reflux syndrome score was > or =2 according to the Gastrointestinal Symptom Rating Scale (GSRS). RESULTS: The response rate was 44.2%, and 44.7% of the respondents were male. Age-adjusted prevalences were: for overweight, 35.6% (95% CI (32.4%; 38.8%)); for obesity, 10.0% (8.4%; 11.6%); for H. pylori: 21.2% (19.1%; 23.9%) and for reflux symptoms: 21.7% (19.5%; 23.9%). In the logistic regression analyses, H. pylori and smoking were not risk factors for reflux symptoms, whereas male gender (OR 4.78 (95%CI (1.88; 12.1)), age (1.01 (1.00; 1.03)) and overweight (1.51 (1.14; 2.00)) were. When stratified by gender, overweight and age were independent risk factors for reflux symptoms in females only, whereas H. pylori infection was protective against such symptoms in men. Models including these parameters could only explain 3% of the variations in reflux symptoms. CONCLUSIONS: BMI is an independent risk factor for gastro-oesophageal reflux symptoms among healthy female adults, but contributes only to a minor part of the variation in these symptoms. H. pylori is protective against reflux symptoms in men.

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.

Impact of observer variability on the usefulness of endoscopic images for the documentation of upper gastrointestinal endoscopy.

OBJECTIVE: Endoscopy is an observer-dependent diagnostic method, which, until recently, has lacked precise guidelines for written reports. There is an increasing demand for improvement in endoscopy records, which may necessitate the supplementation of image documentation. The aim of this study was to estimate interobserver as well as intra-observer variability in the assessment of images from gastroscopy. MATERIAL AND METHODS: We designed an Internet interface presenting endoscopy images, accompanied by a multiple-choice questionnaire for assessing pathology in the images. Ten images from the distal oesophagus and 10 images from the pyloric antrum were chosen. In order to study interobserver variability, physicians with varying endoscopy experience were invited to complete the questionnaire. The physicians were re-invited 5 months later to assess the same images again, this time in order to assess intra-observer variability. Kappa statistics were used for analysis of agreement. RESULTS: Initially, 13 of 20 invited physicians responded. Interobserver agreement varied between poor (kappa<0.2) and moderate (0.4