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Despite the introduction of clinical screening and early treatment of congenital dislocation of the hip (CDH), the prevalence of subluxated/luxated hips in later infancy is still reported to be as high as 1-3 per 1,000 infants. Using ultrasound, it is possible to evaluate both hip morphology and hip stability. Hip morphology is best evaluated using Graf's coronal section through the deepest part of the acetabulum. Classification of the hips into different categories can then be based on measuring the angle of inclination of the acetabulum (alpha-angle) or femoral had coverage. Hip stability can be assessed by a Barlow-equivalent provocation test during the ultrasound examination. In the Norwegian newborn population approximately 85% of the infants have morphologically normal hips (based on the alpha-angle) while 12% have immature and 3% dysplastic hips. About 80-90% of infants with dysplastic acetabula show only minor changes, and many of the hips may normalize without treatment. Several studies indicate that universal ultrasound screening might reduce the occurrence of late diagnosed congenital dislocation of the hip.

Studies suggest that maternal diabetes can cause both placental insufficiency and exaggerated foetal growth. Pregnant mothers with diabetes have suffered high risk of losing their child. Data from the Medical Birth Registry of Norway show a decrease in the still birth rate from 16th week of gestation from 115.7 per 1,000 in 1967-75 to 12.8 in 1986-92 in the diabetes groups. The relative risks were 7.8 and 1.4 respectively for the two time periods. The early neonatal mortality rate decreased correspondingly. The proportion of Caesarean sections in mothers with diabetes, and the proportion of children with low birth weight or born prematurely also increased in the diabetes group. However, children in the diabetes group were on average still as big at gestational age in the most recent period as in the first period. Our data suggest that the improved metabolic control of maternal diabetes has reduced the occurrence and degree of placental insufficiency, with inherent decreases in mortality and risk of complications, but without reducing the foetal growth-stimulating effect of maternal diabetes.

The occurrence of anencephalus as reported to the Norwegian Medical Birth Registry has fallen from 4.9 per 10,000 births in 1967-71 to 2.7 in 1987-90. The decrease is particularly noticeable for births with a gestational length of 28 weeks or more. On the other hand, there has been a significant increase in the number of cases of anencephalus with a gestational age less than 28 weeks. The occurrence of meningomyelocele has remained relatively stable throughout the same period. Ascertainment error could explain these contrasting trends, since cases of anencephalus detected on ultrasound screening may lead to early termination of pregnancy without notification to the Medical Birth Registry. Better routines for notification of malformations are needed to improve the basis for surveillance in Norway.

The authors present the state of Oregon's recent proposal for prioritizing the health services. We suggest that the proposal involves certain problems, and suggest alternative methods of making priorities. It is also pointed out, however, that there may be certain lessons to be learned from this proposal in terms of the method used to obtain a prioritized list of health care services.

The outcome of pregnancies in six countries in Norway has been studied during 12 months prior and subsequent to the Chernobyl accident. The accident took place in a period with an annual increase of births of approximately 3%. However, the year after the accident a decrease of 0.7% was observed with particularly low numbers during February--April 1987. Concomitantly, the miscarriage fraction of all pregnancies increased by 16.3% and particularly during November 1986--January 1987. The same pattern was found when observations from Haukeland Hospital were analyzed separately. When the time of conception was taken into consideration we found that conceptions during the period May--July 1986 ended more often as miscarriages. We have no explanation of the observations. The external radiation exposure seems too small to have produced these effects. The internal radiation from food may have played a role. People may also have changed their food intake, using less vegetables, due to fear of these being polluted by radioactive fallout.