Treatment of acute myocardial infarction in the sub-arctic region of Norway. Do we offer an equal quality of care?

Patients, relatives, healthcare workers and administrators are concerned about the quality of care offered. We aimed to explore the treatment of acute myocatrdial infarction (AMI) in Northern Norway, compare it with the national figures, and document whether there is an equal quality of care or not. The retrospective study included data on patients' treatment for AMI. The following sources were employed. The Norwegian Patient Registry, National Quality of Care Database, Norwegian Myocardial Infarction Registry and data from the National Air Ambulance Services of Norway. The period 2012-2014/15 was studied and the variables were: incidence of AMI, gender and age adjusted rates of AMI and revascularization (PCI, CABG) based on patient's place of living (according to hospital catchment area) and 30-day survival rate. The annual incidence of AMI was 9% higher in the northern region. Significant incidence variations (2.7–5.9 AMI/1000 inhabitants) between the hospitals' catchment areas were revealed. The 30-day survival rate varied between 85.1–92.1% between hospitals. The variation in revascularization/AMI rate was 0.72–1.54. Air amublance services' availability varied through the day. In conclusion, significant variations in the AMI rate and an unequal service within the region was revealed.

[Drugs, narcotics--knowledge and habits in schools]

During the school session 1988/1989, the school doctors in the County of Roskilde carried out a questionnaire investigation among 4,004 pupils in the seventh and ninth classes about their knowledge, habits and attitudes to euphorising drugs. The questionnaire investigation was voluntary and anonymous and this probably contributed to the serious replies. Ten municipalities participated and the results showed that more than 50% of the pupils had employed analgesic medicine within the past three months. The consumption of medicine requiring prescription was about 2% during the same period. Medicine was obtained mainly from the parents. Approximately 6% of the pupils in the ninth grade had been offered speed while less than 1% had consumed speed. 1-4% of the pupils had attempted sniffing while only very few had tried cocaine, heroin and morphine. The need for a multidisciplinary health educational campaign concerning euphorising drugs is emphasized.

[Tobacco, hashish--knowledge and habits in schools]

A questionnaire investigation was carried out among pupils in the seventh and ninth grades of schools in the County of Roskilde in 1988-1989 to eluciate their knowledge and habits where tobacco and hash were concerned. A total of 4,044 pupils replied to the questionnaire. The investigation was anonymous. 5.7% of the pupils in the seventh grade and 9.7% of the pupils in the ninth grade stated that they smoked daily. At parties, 15.6% of the 13-year-olds and 35% of the 15 year-olds smoke. 0.5% of the 13 year-olds and 35% of the 15 year-olds smoke. 0.5% of the 13 year-olds and 44% of the 15 year-olds smoke more than ten cigarettes daily. 2.4% of the pupils in the seventh grade and 12.8% of those in the ninth grade had tried smoking hash. Differences were found between various municipalities and various schools. A total of 1.3% of the 15 year-olds are considered to be regular users of hash. The number of young tobacco smokers is still high and is probably influenced by the attitudes of parents, siblings and peers. Attempts to reduce the numbers of young smokers and to involve the parents in the problem are important. The number of hash smokers is alarming as these adolescents may obtain stronger drugs through the same channels as they obtain hash. It is important that all persons involved in youth welfare should combine their activities in combating these dangers.

[Knowledge about alcohol and alcohol drinking habits in the 7th and 9th grades. A questionnaire study in the county of Roskilde]

A total of 4,044 pupils in the seventh and ninth grades in the County of Roskilde participated in a questionnaire investigation. Approximately 1/10 of the pupils in the seventh grade and approximately 1/3 in the ninth grade drank alcohol once a week or oftener. The majority misapprehension that their peers drank much more often than was indeed the case was striking: in the seventh grade a factor 4 and in the ninth grade a factor 2. In the ninth grade, 0.5% drank alcohol daily and 11.5% a couple of times a week. 3.3% in the ninth grade and 0.5% in the seventh grade took more than ten drinks a week. 34.5% in the ninth grade and 4.9% in the seventh grade drank three or more drinks per week. The number who felt excluded from the community if they did not drink varied from 0 to 20% from school to school. Teaching about alcohol is important. It is, however, also important that, despite stringent economy, efforts are made to capture young peoples interests in a healthy manner in their everyday life.

Biochemical studies in a patient with defects in the metabolism of acyl-CoA and sarcosine: another possible case of glutaric aciduria type II

The clinical and biochemical abnormalities in a neonate, who died in coma accompanied by severe hypoglycaemia at the age of 3 days, are described. The study of the urinary metabolic profiles of organic acids and amino acids revealed that the excretion rates of glutaric acid, isovaleric acid, isovalerylglycine, 3-hydroxyisovaleric acid and isobutyric acid were very high. Increased excretion rates were also found for 2-methylbutyric acid, adipic acid, caproylglycine, 5-hydroxycaproic acid, caproic acid and butyric acid. The amino acid, sarcosine, was excreted in enhanced amounts and the patient had lactic aciduria, whereas the excretion of 3-hydroxybutyric acid was only moderately increased. This abnormal excretion pattern is consistent with a defect in the metabolism of acyl-CoAs and sarcosine. Normal activity of glutaryl-CoA dehydrogenase was found, excluding glutaryl-CoA dehydrogenase deficiency (glutaric aciduria type I).

Necrotising enterocolitis of the newborn--is it gas-gangrene of the bowel?

Necrotising enterocolitis (N.E.C.) of the newborn is thought to be caused by ischaemia of the bowel. This would favour the conversion of clostridial spores, which can occur very early in the intestinal tract of newborns, to toxin-producing, invading bacilli. The histology of resected gut specimens from 6 of 7 N.E.C. patients who had undergone operation was similar to that in cases of gas-gangrene of the bowel and that in experimentally provoked pneumatosis cystoides intestinalis. In one case Clostridium perfringens type A was cultured in great number by anaerobic technique. The clostridia in these cases may have played an important role in the development of N.E.C.