Steinar Hunskaar, Professor, Section for General Practice

Section for General Practice
Department of Public Health and Primary Health Care
University of Bergen
Norway

Tel. 47-55 58 61 26
E-mail: Steinar.Hunskar@isf.uib.no

• 1972-1975 Førde Gymnas (High school)
• 1975-1976 University of Bergen; Mathematics
• 1976-1982 University of Bergen; Medical school
• 1984-1992 Bachelor of Administration

• Approved specialist in general practice since 1993

• July 1982 - July 1983, Internship, medical and surgical departments, Odda Hospital.
• July 1983 - January 1984, Internship, general practice, Austrheim.
• January 1984 - November 1986, Research fellow, Department of Physiology (Neurophysiological Unit), University of Bergen.
• November 1986 - February 1990, General practitioner (part time, 50%), Bergen.
• November 1986 - 1992, Associate professor, Institute of General Practice, University of Bergen (Part time from Nov. 1986 - February 1990, full time from March 1990).
• June 1992 - August 1993, Medical Department, The Deaconess Hospital, Bergen
• November 1992 - February 1993, Department of Oncology, Haukeland University Hospital, Bergen
• August 1992 - Full time professor of General Practice (part time leave of absence August 1992-1993).
• August 1993 --> Part time general practitioner (20%) in Lindås community (group practice)
• December 2002 --> Project leader/professor, Research track and curriculum, Medical School, University of Bergen
• January 2005 --> Research director (20%), National Centre for Emergency Primary Health Care, University of Bergen

• Non-narcotic antinociceptive drugs. Studies with special emphasis on appropriate behavioral tests in mice. University of Bergen, October 1987.

• The Meltzer Prize 1989 (Best research by a scholar below 35 years of age, independent of Faculty, University of Bergen).
• University of Bergen 1992: Essay-prize. Best essay on "Medical education in year 2000".
• Curriculum development prize 1997. Medical Faculty, University of Bergen, 1997.
• Teacher of the year. Medical faculty, University of Bergen, 1999.
• Nordic Research Award 2001. Magda og Svend Aage Friederichs mindelegat, Denmark
• Best research publication 2003, Department of Public Health and Primary Health Care
• Best research publication 2003, Faculty of Medicine, University of Bergen
• Nidarosprisen 2005. Norwegian prize for sterling contributions to general practice field and organisations

• Norwegian Medical Association.
• Norwegian College of General Practitioners.
• International Continence Society
• WONCA
• EURACT

• Journal of the Norwegian Medical Association (member of board)
• International Urogynecology Journal (member of board)
• Neurourology and Urodynamics (Section editor)
• British Journal of General Practice
• Scandinavian Journal of Primary Health Care

• Referee for several international journals in general practice, urology and gynecology

• Head of Institute for General Practice, 1989-1990.
• Head of Department of Public Health and Primary Health Care, 1991-1993. Vice head 1999-2005
• Member of Faculty Board 1980-1982, 1986-1991, 1999-2001
• Member of Faculty Research Board 2003-2005
• Head, Department of Public Health and Primary Health Care 2005
• Director, Research track and curriculum, Medical School, University of Bergen 2002-
• Research director National Centre for Emergency Primary Health Care, University of Bergen, 2005-

• 1994: Visiting professor University of Western Ontario, London, Canada
• 1994-1999: Co-investigator, Canadian Study of Health and Aging
• 1995-2000: Editor, Cochrane Collaboration, Review group on urinary incontinence
• 1998: Chairman, Committee on Epidemiology, 1st International Consultation on Incontinence, WHO/ICUD/ICS, Monaco
• 2001: Chairman, Committee on Epidemiology, 2nd International Consultation on Incontinence, WHO/ICUD/ICS, Paris
• 2001-: Expert committee, NIH-NIDDK, USA: Epidemiology of urinary incontinence
• 2004-: Chairman, Committee on Epidemiology, 3nd International Consultation on Incontinence, WHO/ICUD/ICS, Monaco
• 2006: State-of-the-art lecturer at International Continence Society 36th Annual meeting, Christchurch, New Zealand

Urology and urinary incontinence
The Research Group on Urology and Urinary Incontinence based in Section for General Practice started in 1987 at a time when there was no tradition in the department for group based research or extensive long-time penetrating research. The group now (2007) consists of 5 senior scientists, 3 research fellows (PhD students) and several physicians and medical students enganged in a variety of UI projects. Since 1995 10 PhD theses have been defended with S Hunskaar as supervisor, 8 on the topic of incontinence. A research assistant and coordinator is part time employed. In addition, we have collaboration with specialists in survey statistics, urology, epidemiology, psychology and gynaecology.

Hunskaar's complete list of publications per 2007 includes more than 290 numbers. UI publications are now over 100, with approximately 60 original articles in English in referee assessed international journals. In addition we have published review articles, book chapters and educational articles for GPs and nurses. More than 40 of the articles have authors outside department, many also with authors from outside Norway. The impact factor has been steadily increasing, and some of our papers have been published in the best journals for this kind of research, including general journals as BMJ (3 publications) and New England Journal of Medicine.

Our research results and papers are well known and recognized in the incontinence research community. Especially the epidemiological studies represent major achievements, with higher quality and more advanced analyses than traditionally found in this field. During the last years Hunskaar has been invited to present results in Washington, San Fransisco, Ann Arbor, Paris, Heidelberg, Prague, Stockholm, Wroclaw, Copenhagen, Trondheim, and Oslo. Persons from the group regularly attend the major research congresses, most often with abstracts. Hunskaar has been elected as Chairman, Committee on Epidemiology for three International Consultations on Incontinence sponsored by WHO/ICUD/ICS (Monaco 1998, Paris 2001, and Monaco 2004), all resulting in extensive reviews and a book of almost 1000 pages. He was now invited as State-of-the-art-lecturer at the 2006 World Congress of International Continence Society in New Zealand, on of the first Scandinavians given this honour. He has also been acting as chairman for scientific sessions at international congresses the last 4 years.

The research group has made several major investments in order to access new data in the future:

• The Norwegian EPINCONT Study is a substudy of the Nord-Trøndelag Health Survey 2 (HUNT 2), a large survey performed in one county in Norway during the years 1995-97. We have a population of 6876 women with UI and 21060 controls. This makes the EPINCONT study an extraordinary resource for further studies. We are now engaged in HUNT-3, planned to be launched in 2006/2007, again with an extensive variable set and with the possibilities of follow up analyses and prospective perspectives

• The Hordaland women's cohort is part of the Hordaland Health Study '97-'99 (HUSK) conducted during 1997-99 as a collaboration between the National Health Screening Service, the University of Bergen and local health services. The study population included all individuals in Hordaland county born 1953-57 (29.400). A total of 8.598 men and 9. 983 women participated, yielding a participation rate of 57 % for men and 70 % for women. Every one in five women was randomly asked to be included in the a women's cohort. We were able to create a cohort of 2 230 women born in 1953-1957.

  The inclusion rate was more than 95% and the annual retraction rate has been close to 1% so far. The cohort have had follow-ups by questionnaires every 18-24 months. The follow-ups have showed very good response rates:

  • 1998/2000: 91%
  • 2000: 92%
  • 2002: 92%
  • 2003/2004: 89%
  • 2005/2006: 89%

  One of the strengths with this study is the consequent use of well known and validated questions and indices, from our first studies, then the EPINCONT study, and also the Cohort. The questions are adapted to the current ICS definitions. The 2nd International Consultation on Incontinence recommended development of standardized instruments for epidemiological research, including a screening question, frequency measure, quantity of urine loss, duration, type, and severity. Our study comply with all these recommendations.

• The Norwegian Mother and Child Study conducted by the Norwegian Institute of Public Health, a large survey with cohort design collecting data from 100.000 pregnant women. Here we have a major project involving a PhD student and also collaboration with The Norwegian University of Sport and Physical Education, Oslo, Norway.

This department is unusual in that they are very strong both in population surveys and register-based epidemiology and in the use of qualitative methods in clinical practice. They have publications in the most prestigious journals and much original work is being undertaken. There are some less developed areas, but the department appears to function well as a group. Overall rating: The substantial part of the research is excellent, although there is work of relatively weak quality being undertaken in some areas.

• Indrekvam S, Fosse OAK, Hunskaar S. A Norwegian national cohort of 3198 women treated with home-managed electrical stimulation for urinary incontinence. Demography and medical history. Scandinavian Journal of Urology and Nephrology 2001; 35: 26-31.
• Indrekvam S, Sandvik H, Hunskaar S. A Norwegian national cohort of 3198 women treated with home-managed electrical stimulation for urinary incontinence. Effectiveness and treatment results. Scandinavian Journal of Urology and Nephology 2001: 35; 32-9.
• Vinsnes AG, Harkless GE, Haltbakk J, Hunskaar S. Health Care Personell's Attitudes towards Patients with Urinary Incontinence. Journal of Clinical Nursing 2001; 10: 455-62.
• Backe B, Hunskaar S. Increased acceptance of HRT and improved level of information: a change in Norwegian women's opinion from 1990 to 1997. Acta Obstet Gynecol Scand 2001; 80: 623-627.
• Lyngset E, Hunskår S. Hudsvulstar i ein allmennpraksis. Tidsskr nor lægeforen 2001; 121: 2281-3.
• Steen K, Hunskaar S. Violence:A prospective study of police and health care recordings in an urban community in Norway. Medicine, science, and the law 2001; 41: 337-341.
• Rortveit G, Hannestad YS, Daltveit AK, Hunskaar S. Age- and type-dependent effects of parity on urinary incontinence: The Norwegian EPINCONT study. Obstet Gynecol 2001; 98: 1004-10.
• Eskeland B, Baerheim A, Ulvik R, Hunskaar S. Influence of mild infections on iron status parameters in women of reproductive age. Scandinavian Journal of Primary Health Care 2002; 20: 50-6.
• Hunskaar S, Burgio K, Diokno AC, Herzog AR, Hjälmås K, Lapitan MC. Epidemiology and natural history of urinary incontinence (UI). In: Abrams P, . Cardozo L, Khoury S, Wein A (ed.): Incontinence. 2nd International Consultation on Incontinence. 2nd edition. Plymouth: Health Publication Ltd, 2002. Pp 165-201.
• Steen K, Hunskaar S. Medical consequences of violence: A two-year prospective study from a primary care accident and emergency department. Scand J Prim Health Care 2002; 20: 108-12.
• Hannestad YS, Rortveit G, Hunskaar S. Help-seeking and associated factors in female urinary incontinence. Scandinavian Journal of Primary Health Care 2002; 20: 102-7.
• Indrekvam S, Hunskaar S. Side effects, feasibility and adherence to treatment during home-managed electrical stimulation for urinary incontinence. A Norwegian national cohort of 3198 women. Neurourology and Urodynamics 2002; 21: 546-552.
• Malterud K, Hunskaar S (red). Chronic myofascial pain. A patient-centered approach. Oxford: Radcliffe Medical Press, 2002.
• Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S. Urinary incontinence after vaginal delivery or Cesarian section. New England Journal of Medicine 2003; 348: 900-7.
• Hannestad YS, Rortveit G, Daltveit AK, Hunskaar S. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT study. British Journal of Obstetrics and Gynaecology 2003; 110: 247-54.
• Haltbakk J, Hanestad BR, Hunskaar S. Use and misuse of the concept of quality of life in evaluating surgical treatments for lower urinary tract symptoms. BJU International 2003; 91: 380-8.
• Brown JS, Nyberg LM, Kusek JW, Burgio KL, Diokno AC, Foldspang A, Fultz NH, Herzog AR, Hunskaar S, Milsom I, Nygaard I, Subak LL, Thom DH, for the NIDDK International Research Working Group on Bladder Dysfunction. Proceedings of the National Institute of Diabetes and Digestive and Kidney Diseases International Symposium on Epidemiologic Issues in Urinary Incontinence in Women. Am J Obstet Gynecol 2003;188:S77-S88.
• Hunskaar S, Burgio K, Diokno AC, Herzog AR, Hjälmås K, Lapitan MC. Epidemiology and natural history of urinary incontinence in women. Urology 2003; 62 (Suppl 4A): 16-23.
• Indrekvam S, Hunskaar S. Home electrical stimulation for urinary incontinence: A study of the diffusion of a new technology. Urology 2003; 62 (Suppl 4A): 24-30. Østbye T, Hunskaar S, Sykes L. Predictors and incidence of urinary incontinence in elderly Canadians with and without dementia - A 5 year follow up: The Canadian Study of Health and Aging. Can J Aging 2002; 21: 95-101.
• Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S. Vaginal delivery parameters and urinary incontinence: The Norwegian EPINCONT study. Am J Obstet Gynecol 2003; 189: 1268-74.
• Steen K, Hunskår S. Fastlegeordningen og legevakt. Tidsskr Nor Lægeforen 2004; 124: 365-6.
• Steen, K, Hunskaar S. Violence in an urban community from the perspective of an accident and emergency department: a two year prospective study. Med Sci Monit 2004; 10: CR75-9.
• Hunskaar S, Lose G, Sykes D, Voss S. The prevalence of urinary incontinence in women in four European countries. BJU Int 2004; 93: 324-30.
• Hetlevik Ø, Hunskår S. Listelengde, arbeidstid, ventetid og jobbtilfredshet blant fastleger i Bergen. Tidsskr Nor Lægeforen 2004; 124: 813-5.
• Steen K, Hunskaar S. Gender and physical violence. Social Science & Medicine 2004; 59: 567-71.
• Hannestad YS, Lie RT, Rortveit G, Hunskaar S. Familial risk of urinary incontinence in women: population based cross sectional study. BMJ 2004; 329: 889-91.
• Østbye T, Seim A, Krause K, Feightner J, Hachinski V, Sykes L, Hunskaar S. A 10-year follow-up of urinary and fecal incontinence among the oldest old in the community: The Canadian Study of Health and Aging. Canadian Journal of Aging 2004; 23: 319-331.
• Sandvik H, Hunskår S. Telefontilgjengelighet hos fastlegen. Tidsskr nor lægeforen 2005; 125: 182-5.
• Hunskaar S. Epidemiology of urinary incontinence. In: Becker H-D, Stenzl A,Wallwiener D, Zittel T (eds). Urinary and faecal incontinence. Berlin Heidelberg: Springer, 2005. 1-11.
• Hunskaar S, Burgio K, Clark A, Lapitan MC, Nelson R, Sillén U, Thom D. Epidemiology of Urinary (UI) and Faecal (FI) Incontinence and Pelvic Organ Prolapse (POP). In: Abrams P, Cardozo L, Khoury S, Wein A (ed). Incontinence, Vol.I. Plymouth, Health Publication Ltd, 2005: pp 255-312.
• van Geelen JM, Hunskaar S. The epidemiology of female urinary incontinence. European Clinics in Obstetrics and Gynaecology 2005; 1: 3-11.
• Haltbakk J, Hanestad BR, Hunskaar S. Relevance and variability of the severity of incontinence, and increased daytime and night-time voiding frequency, associated with quality of life in men with lower urinary tract symptoms. BJU International 2005; 96: 83-7.
• Haltbakk J, Hanestad BR, Hunskaar S. How important are mens lower urinary tract symptoms (LUTS) and their impact on the quality of life (QOL)? Quality of Life Research 2005; 14: 1733-41.
• Hunskaar S. Epidemiology of nocturia. BJU International 2005; 96 (Suppl 1): 4-7.
• Vassbø, B, Hagen HR, Hunskår S. Habilitetsproblem i fastlegepraksis. Tidsskrift for Den Norske Lægeforening 2005; 125: 2207-9.
• Papanicolaou S, Hunskaar S, Lose G, Sykes D. Assessment of bothersomeness and impact on quality of life of urinary incontinence in women in France, germany, Spain and the UK. BJU International 2005; 96: 831-8.
• O'Donnell M, Lose G, Sykes D, Voss S, Hunskaar S. Help-Seeking Behaviour and Associated Factors among Women with Urinary Incontinence in France, Germany, Spain and the United Kingdom. European Urology 2005; 47: 385-92.
• Baerheim A, Øren JN, Bjorvatn B, Hunskaar S. Tx-discs - no effect against subjective health complaints. A randomised controlled study. Complement Ther Med 2005; 13: 239-43.
• Bratland SZ, Hunskår S. Medisinsk-faglige vurderinger i tilsynssaker mot allmennleger. Tidsskrift for Den norske lægeforening 2006; 126: 166-9.
• Sykes D, Castro R, Pons ME, Hampel C, Hunskaar S, Papanicolaou S, Quail D, Samsioe G, Voss S, Wagg A, Monz BU. Characteristics of female outpatients with urinary incontinence participating in a 6-month observational study in 14 European countries. Maturitas. 2005; 52 Suppl 2:S13-23.
• Monz B, Pons ME, Hampel C, Hunskaar S, Quail D, Samsioe G, Sykes D, Wagg A, Papanicolaou S. Patient-reported impact of urinary incontinence--results from treatment seeking women in 14 European countries. Maturitas. 2005; 52 Suppl 2:S24-34.
• Brekke M, Hunskaar S, Straand J. Self-reported drug utilization, health, and lifestyle factors among 70-74 year old community dwelling individuals in Western Norway. The Hordaland Health Study (HUSK). BMC Public Health 2006; 6: 121. doi:10.1186/1471-2458-6-121.
• Sandvik H, Espuna M, Hunskaar S. Validity of the incontinence severity index: comparison with pad-weighing tests. Int Urogynecol J 2006 17: 520-4.
• Rortveit H, Hunskaar S. Urinary incontinence and age at the first and last delivery: The Norwegian HUNT/EPINCONT study. Am J Obstet Gynecol 2006; 195: 433-8.
• Hunskår S. Urininkontinens. I: Bondevik M, Nygaard HA. Tverrfaglig geriatri. Bergen: Fagbokforlaget; 2006: 243-51.
• Larsen OM, Eikeland O-J, Hunskår S. Yrke og medisinbruk - resultat fra Helseundersøkelsen i Hordaland. Tidsskr Nor Lægeforen 2006; 126: 2090-3.
• Brekke M, Hunskar S, Straand J. Antihypertensive and lipid lowering treatment in 70-74 year old individuals - predictors for treatment and blood-pressure control: a population based survey. The Hordaland Health Study (HUSK). BMC Geriatrics 2006, 6:16. doi:10.1186/1471-2318-6-16
• Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, Coyne K, Kelleher C, Hampel C, Artibani W, Abrams P. Population-Based Survey of Urinary Incontinence, Overactive Bladder, and Other Lower Urinary Tract Symptoms in Five Countries: Results of the EPIC Study. European Urology 2006; 50: 1306- 15.