Several studies have reported an increased incidence of candidaemia and a redistribution of species, with a decrease in the number of Candida albicans isolates. In Norway, a prospective, national surveillance study of candidaemia has been ongoing since 1991. Data from the period 1991-2003 have been published previously. The aim of this study was to follow up the incidence, species distribution and antifungal susceptibility of Candida species isolates from blood cultures in the period 2004-2012, and compare them with the corresponding findings from the period 1991-2003. Blood culture isolates of Candida species from all medical microbiological laboratories in Norway were identified and susceptibility tested at the Norwegian Mycological Reference Laboratory. A total of 1724 isolates were recovered from 1653 patients in the period 2004-2012. Comparison of the two periods showed that the average incidence of candidaemia episodes per 100 000 inhabitants increased from 2.4 (1991-2003) to 3.9 (2004-2012). The increase in incidence in the latter period was significantly higher in patients aged >40 years (p 0.001), and a marked increase was observed in patients aged >60 years (p < 0.001). In conclusion, the average incidence in Norway over a period of 22 years modestly increased from 2.4 to 3.9 per 100,000 inhabitants, this being mainly accounted for by candidaemia in the elderly. The species distribution was stable, and the rate of acquired resistance was low.

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Regional differences in mean birthweight in rural Papua New Guinea (PNG) and the importance of differences in family diet and maternal education and socio-economic status on such patterns were explored using birthweight data collected by the 1982/83 PNG National Nutrition Survey. A total of 6137 birthweight measurements from 85 PNG districts were available, representing 22% of all children included in the survey. The nature of possible selection biases are assessed and their implications discussed. Hierarchical Bayesian spatial models based on conditional autoregressive (CAR) priors were used to model spatial patterns in birthweights and their relation to different sets of covariates. Birthweights were found to exhibit striking geographical differences. Children from the central PNG highlands and from affluent lowland areas had the highest birthweights, while they were lowest in the (largely lowland) Sepik, Western, Madang and Milne Bay Provinces and in remote highland fringe areas. Maternal education, socio-economic status and diet were all important predictors, but only differences in family diet were correlated with the observed spatial patterns. The results of the present study highlight the importance of nutrition and socio-economic status in explaining differences in birthweights in PNG. Besides improving maternal health, interventions for improving birthweights in PNG should therefore aim at strengthening the economic base of rural populations and promote the cultivation and consumption of high quality foods.

The effects of cash cropping on nutrition in Papua New Guinea are reviewed. The interpretation of the available evidence is complicated by the introduction of cash cropping simultaneously with services such as health and education of the rural population. However, there is indication that the growth of children improved over the period in which cash cropping increased, particularly in the highlands, where, as a result of the later introduction of cash crops, more baseline data are available. There is no reason to believe that the same effect did not occur in the lowlands, where the infant mortality rate fell progressively over the same period. There is also evidence of an increase in the height and weight of adults, as well as an increase in the prevalence of degenerative diseases. Programmes need to be developed that retain the important benefits of child health and at the same time arrest the increasing prevalence of degenerative diseases in adults.

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