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Tingleff T, Vikanes Å, Räisänen S, Sandvik L, Murzakanova G, Laine K. Risk of preterm birth in relation to history of preterm birth: a population-based registry study of 213 335 women in Norway. BJOG 2021; 129:900-907. [PMID: 34775676 DOI: 10.1111/1471-0528.17013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the association between preterm first birth and preterm second birth according to gestational age and to determine the role of placental disorder in recurrent preterm birth. DESIGN Population-based registry study. SETTING Medical Birth Registry of Norway and Statistics Norway. POPULATION Women (n = 213 335) who gave birth to their first and second singleton child during 1999-2014 (total n = 426 670 births). METHODS Multivariate logistic regression analyses, adjusted for placental disorders, maternal, obstetric and socio-economic factors. MAIN OUTCOME MEASURES Extremely preterm (<28+0 weeks), very preterm (28+0 -33+6 weeks) and late preterm (34+0 -36+6 weeks) second birth. RESULTS Preterm birth (<37 weeks) rates were 5.6% for first births and 3.7% for second births. Extremely preterm second births (0.2%) occurred most frequently among women with an extremely preterm first birth (aOR 12.90, 95% CI 7.47-22.29). Very preterm second births (0.7%) occurred most frequently after an extremely preterm birth (aOR 12.98, 95% CI 9.59-17.58). Late preterm second births (2.8%) occurred most frequently after a previous very preterm birth (aOR 6.86, 95% CI 6.11-7.70). Placental disorders contributed 30-40% of recurrent extremely and very preterm births and 10-20% of recurrent late preterm birth. CONCLUSION A previous preterm first birth was a major risk factor for a preterm second birth. The contribution of placental disorders was more pronounced for recurrent extremely and very preterm birth than for recurrent late preterm birth. Among women with any category of preterm first birth, more than one in six also had a preterm second birth (17.4%). TWEETABLE ABSTRACT Preterm first birth is a major risk factor for subsequent preterm birth, regardless of maternal, obstetric or fetal risk factors.
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Affiliation(s)
- T Tingleff
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
| | | | - S Räisänen
- Tampere University of Applied Sciences, Tampere, Finland
| | - L Sandvik
- Department of Obstetrics, Oslo University Hospital, Oslo, Norway
| | - G Murzakanova
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Obstetrics, Oslo University Hospital, Oslo, Norway
| | - K Laine
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
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Taylor I, Bing-Jonsson PC, Finnbakk E, Wangensteen S, Sandvik L, Fagerström L. Development of clinical competence - a longitudinal survey of nurse practitioner students. BMC Nurs 2021; 20:130. [PMID: 34271923 PMCID: PMC8283382 DOI: 10.1186/s12912-021-00627-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/31/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In order to achieve a sustainable standard of advanced clinical competence for nurse practitioners leading to a credible role, it is important to investigate the development of clinical competence among nurse practitioner students. AIM The aim of the present study is to analyse the development of nurse practitioner students' self-assessed clinical competence from the beginning of their education to after completion of their clinical studies. DESIGN The study involved the application of a longitudinal survey design adhering to STROBE guidelines. METHODS The participants consisted of 36 registered nurses from a nurse practitioner programme at a Norwegian university. The Professional Nurse Self-Assessment Scale II was used for data collection during the period August 2015 to May 2020. RESULTS The students developed their clinical competence the most for direct clinical practice. Our findings are inconclusive in terms of whether the students developed clinical competence regarding consultation, coaching and guidance, and collaboration. However, they do indicate a lack of development in some aspects of clinical leadership. The students with the lowest level of clinical competence developed their clinical competence regarding direct clinical practice significantly more than the students with the highest level of clinical competence. The differences between students with high and low levels of clinical competence were levelled out during their education. Thus, the students as a whole became a more homogenous group after completion of their clinical studies. Previous work experience in primary healthcare was a statistically significant, yet minor, predictor of the development of clinical competence. CONCLUSION Our findings indicate that the students developed their clinical competence for direct clinical practice in accordance with the intended learning outcomes of the university's Master's programme and international standards for nurse practitioners. It is imperative that the clinical field supports nurse practitioners by facilitating extended work-task fits that are appropriate to their newly developed clinical competence. We refrain from concluding with a recommendation that prior clinical work experience should be an entry requirement for nurse practitioner programmes. However, we recommend an evaluation of the nurse practitioner education programme with the aim of investigating whether the curriculum meets the academic standards of clinical leadership expected in advanced level of nursing.
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Affiliation(s)
- I Taylor
- Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), P. O. Box 235, 3603, Kongsberg, Norway.
| | - P C Bing-Jonsson
- Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), P. O. Box 235, 3603, Kongsberg, Norway
| | - E Finnbakk
- Lovisenberg Diaconal University College, Oslo, Norway
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
| | - S Wangensteen
- Faculty of Medicine and Health Science in Gjøvik, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - L Sandvik
- Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), P. O. Box 235, 3603, Kongsberg, Norway
| | - L Fagerström
- Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), P. O. Box 235, 3603, Kongsberg, Norway
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
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Tollisen KH, Hadley CL, Bjerva M, Dahl GT, Högvall LM, Sandvik L, Andersen GØ, Heyerdahl F, Jacobsen D. Clinical impact of chronic substance abuse in a Norwegian ICU-population. Acta Anaesthesiol Scand 2021; 65:515-524. [PMID: 33340102 DOI: 10.1111/aas.13766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/18/2020] [Accepted: 12/05/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The clinical impact of chronic substance abuse of alcohol and drugs-referred to as substance use disorders (SUD)-is often overlooked in the intensive care (ICU) setting. The aims of the present study were to identify patients with SUD-regardless of cause of admission-in a mixed Norwegian ICU-population, and to compare patients with and without SUD with regard to clinical characteristics and mortality. METHODS Cross-sectional prospective study of a mixed medical and surgical ICU-population aged ≥18 years in Oslo, Norway. Data were collected consecutively, using a questionnaire including the AUDIT-C test, medical records and toxicology results. Patients classified with SUD were divided into the subgroups alcohol use disorders (AUD) and drug use disorders (DUD). RESULTS Overall, 222 (26%) of the 861 patients included were classified with SUD; 137 (16%) with AUD and 85 (10%) with DUD. 130/222 (59%) of the SUD-patients had substance abuse-related cause of ICU-admission. Compared to non-SUD patients, DUD-patients were younger (median age 42 vs 65 years) and had lower SAPS II scores (41 vs 46), while AUD-patients had higher SOFA scores (8.0 vs 7.3). Overall, age-adjusted logistic regression analysis showed similar hospital mortality for SUD-patients and non-SUD patients, but AUD was associated with increased mortality among medical patients and in patients with sepsis (OR 1.7 (95% CI 1.0-2.8), and OR 2.6 (95% CI 1.1-6.2)). CONCLUSION One in four ICU-patients had SUD regardless of cause of admission. Alcohol use disorder was associated with increased mortality in medical patients and in patients with sepsis.
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Affiliation(s)
- K H Tollisen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - C L Hadley
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - M Bjerva
- Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
| | - G T Dahl
- Department of Anesthesiology, Diakonhjemmet Hospital, Oslo, Norway
| | - L M Högvall
- Department of Postoperative and Intensive care, Oslo University Hospital, Oslo, Norway
| | - L Sandvik
- Department of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - G Ø Andersen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - F Heyerdahl
- Division of Prehospital Services, Oslo University Hospital, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - D Jacobsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
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4
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Lundborg M, Holm JOH, Sandvik L, Lossius AH, Rehbinder EM, Sitek JC, Berents TL. Multidisciplinary educational programme for caregivers of children with atopic dermatitis- in South East Norway - an observational study. BMC Dermatol 2020; 20:20. [PMID: 33298043 PMCID: PMC7727126 DOI: 10.1186/s12895-020-00119-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/30/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Educational programmes for caregivers of children with atopic dermatitis (AD) are reported to reduce the severity of AD and improve quality of life (QOL). Oslo University Hospital (OUH) in Norway offers a multidisciplinary educational programme for caregivers of children with AD. We aimed to evaluate the AD educational programme by assessing QOL of the family, the severity of the disease and caregiver's fear of topical corticosteroid (TCS) before and after attending the programme. METHODS This was a small observational prospective cohort study including 41 caregiver-child pairs. The children (mean age 3.4 years) had doctors' diagnosed AD with a difficult to treat eczema. The children's caregivers were referred from physicians to attend the AD educational programme at our hospital. At inclusion and at a 3 months follow-up QOL was assessed by Dermatitis Family Impact (DFI), the eczema severity by Patient-Orientated - SCORing Atopic Dermatitis (PO-SCORAD) and caregivers fear of TCS was recorded by asking a dichotomous "yes" or "no" question: "Are you worried about using TCS on your child?" RESULTS Three months after caregivers attending the educational programme there was an improvement in QOL by reduced mean DFI from 9.6 (SD 6.3) to 6.8 (SD 5.4), the mean PO-SCORAD was reduced from 38.5 (SD 15.1) to 24.6 (SD13.6), the number of caregivers reporting fear of TCS use was reduced from 33/46 (72%) to 12/41 (29%). All results p < 0.001. CONCLUSION Our study suggests beneficial effects by improving QOL of the family, the severity of the eczema and in reducing the fear of TCS when caregivers of children with difficult to treat AD attend an AD multidisciplinary educational programme. Lack of control group makes it difficult to draw definite conclusions.
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Affiliation(s)
- M Lundborg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J-O H Holm
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - L Sandvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - A H Lossius
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - E M Rehbinder
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - J C Sitek
- Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - T L Berents
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway. .,Department of Dermatology, Oslo University Hospital, Oslo, Norway.
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Goderstad JM, Fosse E, Sandvik L, Lieng M. Development and validation of a curriculum for laparoscopic supracervical hysterectomy. Facts Views Vis Obgyn 2020; 12:83-90. [PMID: 32832922 PMCID: PMC7431195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
STUDY OBJECTIVE To develop and validate a three-step curriculum for laparoscopic supracervical hysterectomy (LSH) designed for a busy clinical setting. NETHODS Single-centre, prospective, cohort study. Twelve eligible gynaecological trainees were included (group 1). The theoretical part (step 1) was a validated multiple-choice test. The practical part (step 2) consisted of five tasks on a virtual reality simulator. The participants had to reach a pre-defined proficiency level before advancing to performing a LSH (step 3). The validation of the curriculum was based on the surgical performance. The surgical procedure was recorded and assessed by two experts using Global Operative Assessment of Laparoscopic Skills (GOALS) and Competence Assessment Tool - Laparoscopic Supracervical Hysterectomy (CAT-LSH). The scores were compared with scores from gynaecological trainees who performed their first LSH without virtual reality simulator training (group 2). RESULTS Ten trainees completed the curriculum and performed a LSH that was recorded and evaluated. Mean duration of the training period (step 1 and 2) was 57 days (SD 26.0), and mean training time spent on the simulator to reach the pre-set proficiency level was 173 min (SD 49). The mean GOALS score was 18.5 (SD 5.8) in group 1 and 13.6 (SD 3.3) in group 2, p=0.027. The mean CAT-LSH score of the performance of the hysterectomy was 42.1 (SD 6.9) in group 1 and 34.8 (SD 4.3) in group 2, p= 0.009. CONCLUSIONS Trainees who completed the curriculum appeared to have a higher performance score compared with trainees who did not perform structured training.
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Affiliation(s)
- JM Goderstad
- Department of Surgery, Sørlandet Hospital, Sykehusveien 1, 4838 Arendal, Norway
| | - E Fosse
- The Intervention Centre, Oslo University Hospital, 0424 Oslo, Norway;,Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
| | - L Sandvik
- Center for biostatistics and epidemiology, Oslo University Hospital, 0373 Oslo, Norway
| | - M Lieng
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway;,Division of Obstetrics and Gynecology, Oslo University Hospital, 0424 Oslo, Norway
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Goderstad JM, Sandvik L, Fosse E, Lieng M. Development and validation of a general and easy assessable scoring system for laparoscopic skills using a virtual reality simulator. Eur J Obstet Gynecol Reprod Biol X 2019; 4:100092. [PMID: 31673693 PMCID: PMC6817681 DOI: 10.1016/j.eurox.2019.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 07/03/2019] [Accepted: 08/04/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives To develop and validate a scoring system for laparoscopic skills for five specific tasks on a virtual reality simulator. Study design A longitudinal, experimental, non-randomised study including 30 gynecologists and gynecological trainees at three hospitals. The participants were categorized as inexperienced (Group 1), moderately experienced (Group 2), and experienced (Group 3). The study participants performed ten repetitions of three basic skill tasks, a salpingectomy and a laparoscopic supracervical hysterectomy on a virtual reality simulator. Assessment of skills was based on time, error parameters and economy of movements measured by the simulator. We used the results (mean and SD for each parameter in all tasks) of the four last repetitions performed by the experienced gynecologists as the basic for the scoring system. Performance equal to, and higher than, this mean score gave 2 points. A decrease of 1 SD from the mean gave 1 point. Every score below gave 0 points. The mean score for the inexperienced, moderately experienced and experienced study participants was compared. Results The mean scores in Task 1 were 3.4 (SD 0.6) in Group 1, 3.4 (SD 0.6) in Group 2 and 5.1 (SD 1.1) in Group 3, respectively. There was a statistically significant difference in score between Group 1 and 3 (p = 0.01), and group 2 and 3 (p = 0.01). In Task 2 no statistical significant differences were found. In Task 3, the total mean scores were 1.7 (SD 0.7) in Group 1, 1.9 (SD 0.9) in Group 2 and 2.8 (SD 0.5) in Group 3, respectively. The difference in score between study groups was statistically significant when comparing Group 1 and Group 3 (p < 0.01) and Group 2 and Group 3 (p = 0.02). In Task 4, the difference in used time between group 1 and 3 was statistically significant (p = 0.03). In task 5 there was a significant difference in performance score between group 1 and 3 (p = 0.01). Conclusions There was significant difference in scores between the experienced and the inexperienced gynecologist in four out of five tasks. The scoring system is easy assessable and can be used for summative and formative feedback in proficiency-based assessment.
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Affiliation(s)
- J M Goderstad
- Department of Surgery, Sørlandet Hospital, Sykehusveien, 4838, Arendal, Norway
| | - L Sandvik
- Oslo Center for biostatistics and epidemiology, Oslo University Hospital, Norway
| | - E Fosse
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Lieng
- Department of Gynecology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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7
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Nuru A, Weltzien JAH, Sandvik L, Tønnessen T, Bjørnstad JL. Short- and long-term survival after isolated coronary artery bypass grafting, the impact of gender and age. SCAND CARDIOVASC J 2019; 53:342-347. [PMID: 31321989 DOI: 10.1080/14017431.2019.1646430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives. Assess the short- and long-term survival for patients who underwent isolated coronary artery bypass grafting (CABG) and evaluate the impact of gender and age. Furthermore to assess the long-term survival in the CABG group compared to the general population. Design. This study included 4044 consecutive patients who underwent isolated CABG at Oslo University Hospital, Ullevål, in Oslo, Norway in the time period from 01 January 2003 to 31 December 2015. Patient data was collected retrospectively from the quality register at the department. Information on survival status was obtained from the Norwegian National Registry. Life expectancy data for the general population was gained from Statistics Norway. Results. Female patients were significantly older than male patients at the time of surgery (mean age 67.0 and 63.9 years, respectively, p < .001), and had significantly lower 30-day survival (mortality was 1.4% and 0.6%, respectively, p = .017). Male gender was independently associated with lower long-term survival (p = .0037) in a multivariate analysis. Male patients aged less than 60 years also showed significantly lower long-term survival (SMR = 1.84, 95% CI = 1.49-2.25) compared to the age-matched general population. Among patients older than 60 years, survival was similar to survival in the age-matched general population. Conclusions. Survival was excellent for patients undergoing surgery. Despite increased age and operative mortality, female patients had better adjusted long-time survival than male patients. There was lower long-term survival among male patients aged less than 60 compared to the general population. Our findings may help clinicians in selecting appropriate patients for surgery.
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Affiliation(s)
- A Nuru
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J A H Weltzien
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - L Sandvik
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - T Tønnessen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - J L Bjørnstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
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Rehbinder E, Winger A, Landrø L, Asarnoj A, Berents T, Carlsen K, Hedlin G, Jonassen C, Nordlund B, Sandvik L, Skjerven H, Söderhäll C, Vettukattil R, Carlsen K. Dry skin and skin barrier in early infancy. Br J Dermatol 2019; 181:218-219. [DOI: 10.1111/bjd.17626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- E.M. Rehbinder
- Oslo University Hospital and University of Oslo Oslo Norway
| | - A.J. Winger
- Oslo University Hospital and University of Oslo Oslo Norway
| | - L. Landrø
- Oslo University Hospital and University of Oslo Oslo Norway
| | - A. Asarnoj
- Karolinska University Hospital and Karolinska Institutet Stockholm Sweden
| | - T.L. Berents
- Oslo University Hospital and University of Oslo Oslo Norway
| | - K.H. Carlsen
- Oslo University Hospital and University of Oslo Oslo Norway
| | - G. Hedlin
- Karolinska University Hospital and Karolinska Institutet Stockholm Sweden
| | | | - B. Nordlund
- Karolinska University Hospital and Karolinska Institutet Stockholm Sweden
| | - L. Sandvik
- Oslo University Hospital and University of Oslo Oslo Norway
| | - H.O. Skjerven
- Oslo University Hospital and University of Oslo Oslo Norway
| | - C. Söderhäll
- Karolinska University Hospital and Karolinska Institutet Stockholm Sweden
| | - R. Vettukattil
- Oslo University Hospital and University of Oslo Oslo Norway
| | - K.C.L. Carlsen
- Oslo University Hospital and University of Oslo Oslo Norway
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Østefjells T, Lystad JU, Berg AO, Hagen R, Loewy R, Sandvik L, Melle I, Røssberg JI. Metacognitive beliefs mediate the effect of emotional abuse on depressive and psychotic symptoms in severe mental disorders. Psychol Med 2017; 47:2323-2333. [PMID: 28397634 DOI: 10.1017/s0033291717000848] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Early trauma is linked to higher symptom levels in bipolar and psychotic disorders, but the translating mechanisms are not well understood. This study examines whether the relationship between early emotional abuse and depressive symptoms is mediated by metacognitive beliefs about thoughts being uncontrollable/dangerous, and whether this pathway extends to influence positive symptoms. METHOD Patients (N = 261) with psychotic or bipolar disorders were assessed for early trauma experiences, metacognitive beliefs, and current depression/anxiety and positive symptoms. Mediation path analyses using ordinary least-squares regressions tested if the effect of early emotional abuse on depression/anxiety was mediated by metacognitive beliefs, and if the effect of early emotional abuse on positive symptoms was mediated by metacognitive beliefs and depression/anxiety. RESULTS Metacognitive beliefs about thoughts being uncontrollable/dangerous significantly mediated the relationship between early emotional abuse and depression/anxiety. Metacognitive beliefs and depression/anxiety significantly mediated the relationship between early emotional abuse and positive symptoms. The models explained a moderate amount of the variance in symptoms (R 2 = 0.21-0.29). CONCLUSION Our results indicate that early emotional abuse is relevant to depression/anxiety and positive symptoms in bipolar and psychotic disorders, and suggest that metacognitive beliefs could play a role in an affective pathway to psychosis. Metacognitive beliefs could be relevant treatment targets with regards to depression/anxiety and positive symptoms in bipolar and psychotic disorders.
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Affiliation(s)
- T Østefjells
- NORMENT,KG Jebsen Centre for Psychosis Research,Oslo University Hospital and Institute of Clinical Medicine,University of Oslo,Oslo,Norway
| | - J U Lystad
- NORMENT,KG Jebsen Centre for Psychosis Research,Oslo University Hospital and Institute of Clinical Medicine,University of Oslo,Oslo,Norway
| | - A O Berg
- NORMENT,KG Jebsen Centre for Psychosis Research,Oslo University Hospital and Institute of Clinical Medicine,University of Oslo,Oslo,Norway
| | - R Hagen
- Department of Psychology,Norwegian University of Science and Technology,Trondheim,Norway
| | - R Loewy
- Department of Psychiatry,University of California San Francisco,San Francisco,CA,USA
| | - L Sandvik
- Oslo Centre for Biostatistics and Epidemiology,Research Support Services,Oslo University Hospital,Oslo,Norway
| | - I Melle
- NORMENT,KG Jebsen Centre for Psychosis Research,Oslo University Hospital and Institute of Clinical Medicine,University of Oslo,Oslo,Norway
| | - J I Røssberg
- NORMENT,KG Jebsen Centre for Psychosis Research,Oslo University Hospital and Institute of Clinical Medicine,University of Oslo,Oslo,Norway
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10
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Gravensteen IK, Jacobsen EM, Sandset PM, Helgadottir LB, Rådestad I, Sandvik L, Ekeberg Ø. Healthcare utilisation, induced labour and caesarean section in the pregnancy after stillbirth: a prospective study. BJOG 2017; 125:202-210. [PMID: 28516500 DOI: 10.1111/1471-0528.14750] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate healthcare utilisation, induced labour and caesarean section (CS) in the pregnancy after stillbirth and assess anxiety and dread of childbirth as mediators for these outcomes. DESIGN Population-based pregnancy cohort study. SETTING The Norwegian Mother and Child Cohort Study. SAMPLE A total of 901 pregnant women; 174 pregnant after stillbirth, 362 pregnant after live birth and 365 previously nulliparous. METHODS Data from questionnaires answered in the second and third trimesters of pregnancy and information from the Medical Birth Registry of Norway. MAIN OUTCOME MEASURES Self-reported assessment of antenatal care, register-based assessment of onset and mode of delivery. RESULTS Women with a previous stillbirth had more frequent antenatal visits (mean 10.0; 95% CI 9.4-10.7) compared with women with a previous live birth (mean 6.0; 95% CI 5.8-6.2) and previously nulliparous women (mean 6.3; 95% CI 6.1-6.6). Induced labour and CS, elective and emergency, were also more prevalent in the stillbirth group. The adjusted odds ratio for elective CS was 2.5 (95% CI 1.3-5.0) compared with women with previous live birth and 3.7 (1.8-7.6) compared with previously nulliparous women. Anxiety was a minor mediator for the association between stillbirth and frequency of antenatal visits, whereas dread of childbirth was not a significant mediator for elective CS. CONCLUSIONS Women pregnant after stillbirth were more ample users of healthcare services and more often had induced labour and CS. The higher frequency of antenatal visits and elective CS could not be accounted for by anxiety or dread of childbirth. TWEETABLE ABSTRACT Women pregnant after stillbirth are ample users of healthcare services and interventions during childbirth.
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Affiliation(s)
- I K Gravensteen
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Haematology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - E-M Jacobsen
- Department of Haematology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - P M Sandset
- Department of Haematology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - L B Helgadottir
- Department of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - I Rådestad
- Sophiahemmet University, Stockholm, Sweden
| | - L Sandvik
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Ø Ekeberg
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Bakke V, Sporsem H, Von der Lippe E, Nordøy I, Lao Y, Nyrerød HC, Sandvik L, Hårvig KR, Bugge JF, Helset E. Vancomycin levels are frequently subtherapeutic in critically ill patients: a prospective observational study. Acta Anaesthesiol Scand 2017; 61:627-635. [PMID: 28444760 PMCID: PMC5485054 DOI: 10.1111/aas.12897] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/23/2017] [Accepted: 03/27/2017] [Indexed: 12/15/2022]
Abstract
Background Appropriate utilization of vancomycin is important to attain therapeutic targets while avoiding clinical failure and the development of antimicrobial resistance. Our aim was to observe the use of vancomycin in an intensive care population, with the main focus on achievement of therapeutic serum concentrations (15–20 mg/l) and to evaluate how this was influenced by dose regimens, use of guidelines and therapeutic drug monitoring. Methods A prospective observational study was carried out in the intensive care units at two tertiary hospitals in Norway. Data were collected from 83 patients who received vancomycin therapy, half of these received continuous renal replacement therapy. Patients were followed for 72 h after initiation of therapy. Blood samples were drawn for analysis of trough serum concentrations. Urine was collected for calculations of creatinine clearance. Information was gathered from medical records and electronic health records. Results Less than 40% of the patients attained therapeutic trough serum concentrations during the first 3 days of therapy. Patients with augmented renal clearance had lower serum trough concentrations despite receiving higher maintenance doses and more loading doses. When trough serum concentrations were outside of therapeutic range, dose adjustments in accordance to therapeutic drug monitoring were made to less than half. Conclusion The present study reveals significant challenges in the utilization of vancomycin in critically ill patients. There is a need for clearer guidelines regarding dosing and therapeutic drug monitoring of vancomycin for patient subgroups.
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Affiliation(s)
- V. Bakke
- Faculty of Medicine; University of Oslo; Oslo Norway
| | | | - E. Von der Lippe
- Department of Infectious Diseases; Oslo University Hospital - Ullevaal; Oslo Norway
| | - I. Nordøy
- Section for Clinical Immunology and Infectious Diseases; Oslo University Hospital - Rikshospitalet; Oslo Norway
- Research Institute for Internal Medicine; Oslo University Hospital - Rikshospitalet; Oslo Norway
| | - Y. Lao
- Oslo Hospital Pharmacy; Oslo Norway
| | - H. C. Nyrerød
- Department of Anesthesiology; Oslo University Hospital - Rikshospitalet; Oslo Norway
| | - L. Sandvik
- Oslo Center for Biostatistics and Epidemiology; Research support services; Oslo Norway
| | - K. R. Hårvig
- Department of Anesthesiology; Oslo University Hospital - Rikshospitalet; Oslo Norway
| | - J. F. Bugge
- Department of Anesthesiology; Oslo University Hospital - Rikshospitalet; Oslo Norway
| | - E. Helset
- Department of Anesthesiology; Oslo University Hospital - Ullevaal; Oslo Norway
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12
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Falk RS, Tretli S, Paulsen JE, Sandvik L, Erikssen J, Heir T. Response to Intravenous Glucose-Tolerance Test and Risk of Cancer: A Long-Term Prospective Cohort Study. EBioMedicine 2017; 21:117-122. [PMID: 28687499 PMCID: PMC5514427 DOI: 10.1016/j.ebiom.2017.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 11/18/2022] Open
Abstract
Background Impaired glucose regulation, measured with an oral glucose-tolerance test, has been associated with the risk of cancer. Here, we explored whether the response to an intravenous glucose-tolerance test (IVGTT) is associated with the risk of cancer. Methods A cohort of 945 healthy men, aged 40–59 years in 1972–75, was followed for 40 years. An IVGTT was performed at baseline. Blood samples for glucose determinations were drawn immediately before glucose injection and thereafter every 10 min for 1 h. Associations were assessed with incidence rate ratios (IRR) and Cox models. Findings Cancer incidence was higher among men with 10-min glucose levels below the median than in men with levels above the median (IRR: 1.5, 95% CI: 1.2–1.9). This association remained significant after adjusting for relevant confounders (HR: 1.6, 95% CI: 1.3–2.1) and when excluding the first 10 years of follow-up to minimize the possibility of reverse causality (HR: 1.5, 95% CI: 1.2–2.0). Interpretation Healthy middle-aged males that responded to an intravenous glucose injection with rapid glucose elimination during the first phase had an elevated risk of cancer during 40 years of follow-up. First phase response to a glucose load might be related to cancer development. Rapid elimination of plasma glucose during the first phase response was associated with a 60% elevated risk of cancer Plasma glucose uptake during the first-phase may depend on the effectiveness of the molecular glucose-sensing apparatus Polymorphisms critical for glucose transport into normal cells may also be crucial for transporting glucose into cancer cells
In this study low levels of plasma glucose in the early phase of an intravenous glucose-tolerance test were associated with a 60% elevated risk of cancer. The glucose level in the early phase may depend on the effectiveness of the molecular glucose-sensing apparatus. The transport of glucose into cancer cells, that normally requires a constant supply of high glucose, may be rate limited by polymorphisms that are critical for plasma glucose-sensing in general. Previous research has shown that some key proteins, e.g. GLUT 1 and GLUT 2, are involved as glucose transporters into cancer cells.
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Affiliation(s)
- R S Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - S Tretli
- Department of Research, Cancer Registry of Norway, Oslo, Norway; Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - J E Paulsen
- Department of Food Safety and Infection Biology, Norwegian University of Life Sciences, Oslo, Norway
| | - L Sandvik
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - J Erikssen
- Oslo Ischemia study, Oslo University Hospital, Oslo, Norway
| | - T Heir
- Oslo Ischemia study, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
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13
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Gagnum V, Stene LC, Jenssen TG, Berteussen LM, Sandvik L, Joner G, Njølstad PR, Skrivarhaug T. Causes of death in childhood-onset Type 1 diabetes: long-term follow-up. Diabet Med 2017; 34:56-63. [PMID: 26996105 DOI: 10.1111/dme.13114] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 12/20/2022]
Abstract
AIMS To assess the causes of death and cause-specific standardized mortality ratios in two nationwide, population-based cohorts diagnosed with Type 1 diabetes during the periods 1973-1982 and 1989-2012, and to evaluate changes in causes of death during the follow-up period. METHODS People with Type 1 diabetes who were aged < 15 years at diagnosis were identified in the Norwegian Childhood Diabetes Registry and followed from diagnosis until death, emigration or September 2013 (n = 7871). We assessed causes of death by linking data to the nationwide Cause of Death Registry and through a review committee that evaluated medical records, autopsy reports and death certificates. RESULTS During a mean (range) follow-up of 16.8 (0-40.7) years, 241 individuals (3.1%) died, representing 132 143 person-years. The leading cause of death before the age of 30 years was acute complications (41/119, 34.5%). After the age of 30 years cardiovascular disease was predominant (41/122, 33.6%), although death attributable to acute complications was still important in this age group (22/122, 18.0%). A total of 5% of deaths were caused by 'dead-in-bed' syndrome. The standardized mortality ratio was elevated for cardiovascular disease [11.9 (95% CI 8.6-16.4)] and violent death [1.7 (95% CI 1.3-2.1)] in both sexes combined, but was elevated for suicide only in women [2.5 (95% CI 1.2-5.3)]. The risk of death from acute complications was approximately half in women compared with men [hazard ratio 0.43 (95% CI 0.25-0.76)], and did not change with more recent year of diagnosis [hazard ratio 1.02 (0.98-1.05)]. CONCLUSIONS There was no change in mortality attributable to acute complications during the study period. To reduce premature mortality in people with childhood-onset diabetes focus should be on prevention of acute complications. Male gender implied increased risk.
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Affiliation(s)
- V Gagnum
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway
- Oslo Diabetes Research Centre, Oslo, Norway
| | - L C Stene
- Oslo Diabetes Research Centre, Oslo, Norway
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - T G Jenssen
- Oslo Diabetes Research Centre, Oslo, Norway
- Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway
- Metabolic and Renal Research Group, Arctic University of Norway, Tromsø, Norway
| | - L M Berteussen
- Department of Forensic Pathology and Clinical Forensic Medicine, Norwegian Institute of Public Health, Oslo, Norway
| | - L Sandvik
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - G Joner
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway
- Oslo Diabetes Research Centre, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - P R Njølstad
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
| | - T Skrivarhaug
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway
- Oslo Diabetes Research Centre, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Childhood Diabetes Registry, Department of Paediatrics, Oslo University Hospital, Oslo, Norway
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14
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Torfoss D, Fladhagen T, Holte H, Brinch L, Schjesvold FH, Fløisand Y, Nyquist E, Dalgaard J, Meyer P, Lehmann AK, Hammerstrøm J, Skjelbakken T, Høiby EA, Sandvik L, Kvaløy S. Benzylpenicillin plus an aminoglycoside versus meropenem in neutropenic lymphoma and leukaemia patients with a suspected bacterial infection: a randomized, controlled trial. Clin Microbiol Infect 2016; 23:179-187. [PMID: 27793737 DOI: 10.1016/j.cmi.2016.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 10/12/2016] [Accepted: 10/15/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES In Norway, initial treatment of febrile neutropenia (FN) has traditionally been benzylpenicillin plus an aminoglycoside. Internationally, FN is often treated with a broad-spectrum β-lactam antibiotic. We aimed to compare these two regimens in a prospective, randomized, trial in patients with lymphoma or leukaemia with an expected period of neutropenia ≥7 days, and a suspected bacterial infection. METHODS Adult neutropenic patients with lymphoma or leukaemia, and a suspected bacterial infection, were randomized for treatment with benzylpenicillin plus an aminoglycoside or meropenem. The primary endpoint was clinical success, defined as no modification of antibiotics and clinical stability 72 h after randomization. RESULTS Among 322 randomized patients, 297 proved evaluable for analyses. Fifty-nine per cent (95% CI 51%-66%), (87/148) of the patients given benzylpenicillin plus an aminoglycoside were clinically stable, and had no antibiotic modifications 72 h after randomization, compared with 82% (95% CI 75%-87%), (122/149) of the patients given meropenem (p <0.001). When the antibiotic therapy was stopped, 24% (95% CI 18%-32%), (36/148) of the patients given benzylpenicillin plus an aminoglycoside, compared with 52% (95% CI 44%-60%), (78/149) of the patients given meropenem, had no modifications of their regimens (p <0.001). In the benzylpenicillin plus an aminoglycoside arm, the all-cause fatality within 30 days of randomization was 3.4% (95% CI 1.2%-7.9%), (5/148) of the patients, compared with 0% (95% CI 0.0%-3.0%), (0/149) of the patients in the meropenem arm (p 0.03). CONCLUSION Clinical success was more common in FN patients randomized to meropenem compared with the patients randomized to benzylpenicillin plus an aminoglycoside. The all-cause fatality was higher among the patients given benzylpenicillin plus an aminoglycoside.
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Affiliation(s)
- D Torfoss
- Department of Oncology, Division of Cancer Medicine, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
| | - T Fladhagen
- Department of Oncology, Division of Cancer Medicine, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - H Holte
- Department of Oncology, Division of Cancer Medicine, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - L Brinch
- Department of Haematology, Division of Cancer Medicine, The National Hospital, Oslo University Hospital, Oslo, Norway
| | - F H Schjesvold
- Department of Haematology, Division of Cancer Medicine, The National Hospital, Oslo University Hospital, Oslo, Norway
| | - Y Fløisand
- Department of Haematology, Division of Cancer Medicine, The National Hospital, Oslo University Hospital, Oslo, Norway
| | - E Nyquist
- Department of Haematology, Division of Cancer Medicine, Ullevål University Hospital, Oslo University Hospital, Oslo, Norway
| | - J Dalgaard
- Medical Clinic, Vestre Viken Hospital, Drammen, Norway
| | - P Meyer
- Department of Haematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - A K Lehmann
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - J Hammerstrøm
- Department of Haematology, St Olav University Hospital, Trondheim, Norway
| | - T Skjelbakken
- Department of Haematology, University Hospital of North Norway, Tromsø, Norway
| | - E A Høiby
- National Institute of Public Health, Oslo, Norway
| | - L Sandvik
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - S Kvaløy
- Department of Oncology, Division of Cancer Medicine, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
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15
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Khan A, Utheim T, Reppe S, Sandvik L, Lyberg T, Roald B, Eidet J. Optimization of storage of differentiated retinal pigment epithelial cells. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Dahl J, Ormstad H, Aass HCD, Sandvik L, Malt UF, Andreassen OA. Recovery from major depressive disorder episode after non-pharmacological treatment is associated with normalized cytokine levels. Acta Psychiatr Scand 2016; 134:40-7. [PMID: 27028967 DOI: 10.1111/acps.12576] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Several lines of evidence show that the immune system is implicated in the pathophysiology of major depressive disorder (MDD) and that treatment with antidepressants affects cytokine and C-reactive protein (CRP) levels. Few studies have investigated immune markers during non-pharmacological treatment. In this follow-up study, we investigated whether CRP and elevated plasma cytokine levels observed before treatment of an acute episode of MDD are normalized during non-pharmacological treatment. METHODS We obtained clinical assessments and blood for CRP and cytokine analysis from 50 unmedicated MDD patients, and cytokine levels from healthy controls. The patients received 'therapy as usual' for 12 weeks, and the assessments were then repeated. Of the 43 completers, 29 patients did not receive medication. RESULTS In the patients receiving treatment without antidepressants, the depressive symptoms and the plasma levels of eight cytokines (interleukin (IL)-1Ra, IL-5,-6,-8,-10, G-CSF, IFN-γ, and TNF-α) were significantly reduced (P = 0.002-0.048). The cytokine levels were no longer different from the controls. The plasma CRP level did not change. CONCLUSION Cytokine plasma levels normalized during recovery from an acute depressive episode in MDD without antidepressant treatment. These findings may have implications for the understanding of the role of the immune system in depression and recovery from depression.
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Affiliation(s)
- J Dahl
- Ringerike Psychiatric Center, Vestre Viken Hospital Trust, Hoenefoss, Norway
| | - H Ormstad
- Faculty of Health Sciences, Buskerud University College, Drammen, Norway
| | - H C D Aass
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - L Sandvik
- Center for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - U F Malt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Research Network on Mood Disorders (Normood), Oslo, Norway.,Department of Research and Education, Division of Surgery and Neuroscience, Oslo University Hospital, Oslo, Norway
| | - O A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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17
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Vilming ST, Kloster R, Sandvik L. When Should an Epidural Blood Patch be Performed in Postlumbar Puncture Headache? A Theoretical Approach Based on a Cohort of 79 Patients. Cephalalgia 2016; 25:523-7. [PMID: 15955039 DOI: 10.1111/j.1468-2982.2005.00911.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of the present study was to decide on which day in the course of postlumbar puncture headache (PPH) an epidural blood patch (EBP) should be performed to minimize suffering. A cohort of 79 patients (64 female, 15 male) was followed prospectively for 14 days and the consequences of performing an EBP on different days were studied. If no EBP was performed, the patients would accumulate 141 days with PPH5 (bedridden most of the day), 216 days with PPH4-5 (bedridden more than half the day), and 293 days with PPH3-5 (bedridden half the day or more). If these patients were patched on day 2, 3 or 4 after an initial observation of the PPH grade on day 1, the expected suffering was substantially reduced, and the more the earlier in the course the EBP was performed. If the strategy was to treat only patients with PPH5 with an expected 90% success rate, the reduction compared with no treatment was 50% if treated on day 2, 37% if treated on day 3, and 29% if treated on day 4. The corresponding figures for treating patients with PPH4-5 was a 51, 44 and 29% reduction, and for PPH3-5 the reduction was 62, 49 and 35%, respectively. Irrespective of strategy, the expected reduction of suffering in the cohort was greatest when the EBP was performed early in the course of PPH. It is suggested that the decision to perform an EBP should be made at an early stage and offered to patients who have to lie in bed for more than half a day despite conservative treatment.
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Affiliation(s)
- S T Vilming
- Department of Neurology, Ullevaal University Hospital, University of Oslo, Oslo, Norway.
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18
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Berents T, Lødrup Carlsen K, Mowinckel P, Sandvik L, Skjerven H, Rolfsjord L, Kvenshagen B, Hunderi J, Bradley M, Lieden A, Carlsen K, Thorsby P, Gjersvik P. Vitamin D levels and atopic eczema in infancy and early childhood in Norway: a cohort study. Br J Dermatol 2016; 175:95-101. [DOI: 10.1111/bjd.14537] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 12/19/2022]
Affiliation(s)
- T.L. Berents
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Dermatology Oslo University Hospital Oslo Norway
| | - K.C. Lødrup Carlsen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Pediatrics Oslo University Hospital Oslo Norway
| | - P. Mowinckel
- Department of Pediatrics Oslo University Hospital Oslo Norway
| | - L. Sandvik
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Biostatistics and Epidemiology Oslo University Hospital Oslo Norway
- University of Oslo Oslo Norway
| | - H.O. Skjerven
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Pediatrics Oslo University Hospital Oslo Norway
| | - L.B. Rolfsjord
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Pediatrics Elverum Hospital Elverum Norway
| | - B. Kvenshagen
- Department of Pediatrics Østfold Hospital Fredrikstad Norway
| | - J.O.G. Hunderi
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Pediatrics Oslo University Hospital Oslo Norway
- Department of Pediatrics Østfold Hospital Fredrikstad Norway
| | - M. Bradley
- Department of Molecular Medicine Karolinska Institute at Karolinska Hospital Stockholm Sweden
| | - A. Lieden
- Department of Molecular Medicine Karolinska Institute at Karolinska Hospital Stockholm Sweden
| | - K.‐H. Carlsen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Pediatrics Oslo University Hospital Oslo Norway
| | - P.M. Thorsby
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Hormone Laboratory Department of Medical Biochemistry Oslo University Hospital Oslo Norway
| | - P. Gjersvik
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Dermatology Oslo University Hospital Oslo Norway
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Johannessen HH, Wibe A, Stordahl A, Sandvik L, Mørkved S. Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial. BJOG 2016; 124:686-694. [PMID: 27272501 DOI: 10.1111/1471-0528.14145] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the effect of pelvic floor muscle exercises (PFME) for postpartum anal incontinence (AI). DESIGN A parallel two-armed randomised controlled trial stratified on obstetrical anal sphincter injury with primary sphincter repair and hospital affinity. SETTING Ano-rectal specialist out-patient clinics at two hospitals in Norway. POPULATION One hundred and nine postpartum women with AI at baseline. METHODS The intervention group received 6 months of individual physiotherapy-led PFME and the control group written information on PFME. Changes in St. Mark's scores and predictors of post-intervention AI were assessed by independent samples t-tests and multiple linear regression analyses, respectively. The study was not blind. MAIN OUTCOME MEASURES The primary outcome measure was change in AI symptoms on the St. Mark's score from baseline to post-intervention. Secondary outcome measures were manometry measures of anal sphincter length and strength, endoanal ultrasound (EAUS) defect score and voluntary pelvic floor muscle contraction. RESULTS There was a significant difference in the reduction of St. Mark's scores from baseline to post-intervention in favour of the PFME group (-2.1 versus -0.8 points, P = 0.040). No differences in secondary outcome measures were found between groups. Baseline St. Mark's, PFME group affinity and EAUS defect score predicted post-intervention St. Mark's score in the imputed intention-to-treat analyses. The analysis on un-imputed data showed that women performing weekly PFME improved their AI scores more than women in the control group did. CONCLUSIONS Our results indicate that individually adapted PFME reduces postpartum AI symptoms. TWEETABLE ABSTRACT Performing regular pelvic floor muscle exercises may be an effective treatment for postpartum anal incontinence.
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Affiliation(s)
- H H Johannessen
- Department of Physiotherapy, Østfold Hospital Trust, Grålum, Norway
| | - A Wibe
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - A Stordahl
- Department of Surgery, Østfold Hospital Trust, Grålum, Norway
| | - L Sandvik
- Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - S Mørkved
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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20
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Grimholt TK, Jacobsen D, Haavet OR, Sandvik L, Jorgensen T, Norheim AB, Ekeberg O. Structured follow-up by general practitioners after deliberate self-poisoning: a randomised controlled trial. BMC Psychiatry 2015; 15:245. [PMID: 26467530 PMCID: PMC4604741 DOI: 10.1186/s12888-015-0635-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/05/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND General Practitioners (GPs) play an important role in the follow-up of patients after deliberate self-poisoning (DSP). The aim was to examine whether structured follow-up by GPs increased the content of, adherence to, and satisfaction with treatment after discharge from emergency departments. METHODS This was a multicentre, randomised trial with blinded assignment. Five emergency departments and general practices in the catchment area participated. 202 patients discharged from emergency departments after DSP were assigned. The intervention was structured follow-up by the GP over a 6-month period with a minimum of five consultations, accompanied by written guidelines for the GPs with suggestions for motivating patients to follow treatment, assessing personal problems and suicidal ideation, and availability in the case of suicidal crisis. Outcome measures were data retrieved from the Register for the control and payment of reimbursements to health service providers (KUHR) and by questionnaires mailed to patients and GPs. After 3 and 6 months, the frequency and content of GP contact, and adherence to GP consultations and treatment in general were registered. Satisfaction with general treatment received and with the GP was measured by the EUROPEP scale. RESULTS Patients in the intervention group received significantly more consultations than the control group (mean 6.7 vs. 4.5 (p = 0.004)). The intervention group was significantly more satisfied with the time their GP took to listen to their personal problems (93.1% vs. 59.4% (p = 0.002)) and with the fact that the GP included them in medical decisions (87.5% vs. 54. 8% (p = 0.009)). The intervention group was significantly more satisfied with the treatment in general than the control group (79% vs. 51% (p = 0.026)). CONCLUSIONS Guidelines and structured, enhanced follow-up by the GP after the discharge of the DSP patient increased the number of consultations and satisfaction with aftercare in general practice. Consistently with previous research, there is still a need for interventional studies. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01342809. Registered 18 April 2011.
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Affiliation(s)
- TK Grimholt
- Department of Acute Medicine, Oslo University Hospital, Pb. 4950 Nydalen, 0424 Oslo, Norway ,Regional Centre of Violence, Traumatic Stress and Suicide Prevention, Eastern Norway, Norway
| | - D. Jacobsen
- Department of Acute Medicine, Oslo University Hospital, Pb. 4950 Nydalen, 0424 Oslo, Norway
| | - OR Haavet
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - L. Sandvik
- Department of Biostatistics Oslo University Hospital, Oslo, Norway
| | - T. Jorgensen
- Psychiatric Consultation Team, Akershus University Hospital, Akershus, Norway
| | - AB Norheim
- Regional Centre of Violence, Traumatic Stress and Suicide Prevention, Eastern Norway, Norway ,Diakonhjemmet Hospital, Oslo, Norway
| | - O. Ekeberg
- Department of Acute Medicine, Oslo University Hospital, Pb. 4950 Nydalen, 0424 Oslo, Norway ,Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences. Faculty of Medicine, University of Oslo, Oslo, Norway
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21
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Hetmann F, Kongsgaard UE, Sandvik L, Schou-Bredal I. Prevalence and predictors of persistent post-surgical pain 12 months after thoracotomy. Acta Anaesthesiol Scand 2015; 59:740-8. [PMID: 25907109 DOI: 10.1111/aas.12532] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/09/2015] [Accepted: 03/12/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Persistent post-surgical pain is recognised as a major problem. Prevalence after different surgical procedures has been reported to range from 5% up to 85%. Limb amputation and thoracotomy have the highest reported prevalence. Prediction of persistent post-surgical pain has over the last decade caught attention. Several factors have been investigated, but in-depth knowledge is still scarce. The purpose of this study was to investigate the prevalence of persistent post-surgical pain, and predictive factors for persistent post-surgical pain 12 months after thoracotomy. METHODS A prospective longitudinal study was conducted. One-hundred and seventy patients were recruited before scheduled thoracotomy, and asked to answer a questionnaire. One-hundred and six patients completed the same questionnaire at 12-month follow-up. Regression analysis was performed to explore variables assumed predictive of persistent post-surgical pain. RESULTS One-hundred and six patients (62%) filled out the questionnaire at both time points. Preoperative, 34% reported muscle-skeletal related chronic pain. At 12-month follow-up, 50% of the patients reported persistent post-surgical pain. Of the variables explored in the logistic regression model, only preoperative pain (P < 0.001) and dispositional optimism (P = 0.04) were statistically significant. In this study, preoperative pain was a predominant predictor for persistent postoperative pain (OR 6.97, CI 2.40-20.21), while dispositional optimism (OR 0.36, CI 0.14-0.96) seem to have protective properties. CONCLUSION Our results show that preoperative pain is a predominant predictor of future pain. This implies that patients presenting with a chronic pain condition prior to surgery should be assessed thoroughly preoperatively and have an individually tailored analgesic regimen.
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Affiliation(s)
- F. Hetmann
- Department of Nursing; Oslo and Akershus University College of Applied Sciences; Oslo, Norway and University of Oslo, Oslo Norway
| | - U. E. Kongsgaard
- Department of Anaesthesiology; Oslo University Hospital, Oslo, Norway and University of Oslo; Oslo Norway
| | - L. Sandvik
- Department of Biostatistics and Epidemiology; Oslo University Hospital; Oslo, Norway and University of Oslo, Oslo Norway
| | - I. Schou-Bredal
- Department of Breast and Endocrine Surgery; Oslo University Hospital, Oslo, Norway and University of Oslo; Oslo Norway
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Kvalheim S, Sandvik L, Winsvold B, Hagen K, Zwart JA. Early menarche and chronic widespread musculoskeletal complaints--Results from the HUNT study. Eur J Pain 2015; 20:458-64. [PMID: 26132558 DOI: 10.1002/ejp.747] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a predominance of chronic widespread musculoskeletal complaints (WMSC) among women. Previous studies suggest an association between hormonal factors and pain. However, it is not known whether earlier age at menarche is associated with higher prevalence of chronic WMSC. The aim of this study was to investigate the association between age at menarche and chronic WMSC. METHODS Data from a cross-sectional study of inhabitants ≥20 years in Nord-Trøndelag County (Helseundersøkelsen i Nord-Trøndelag -HUNT), conducted in 1995-1997 (HUNT 2) were used. The study population comprised 32,673 women with valid information of age at menarche (exposure) and chronic WMSC (outcome data). RESULTS In total, 8986 (27.5%) women reported WMSC. The overall prevalence of WMSC was 29.7% among those with menarche ≤12 years and 26.7% among those with menarche >12 years. The prevalence of chronic WMSC was consistently higher for those with early age at menarche in all age groups. The crude odds ratio for chronic WMSC, when comparing women with age at menarche ≤12 years to women with age at menarche >12 years, was 1.16 (95% CI: 1.10-1.22). The corresponding odds ratio was 1.26 (95% CI: 1.19-1.34) when adjusted for age, education, body mass index (BMI), smoking, alcohol consumption, depression, systolic blood pressure (SBP) and parity. CONCLUSION In this cross-sectional study, there was an association between early age at menarche and chronic WMSC later in life, but the difference in absolute risk was low (3%).
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Affiliation(s)
- S Kvalheim
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology and FORMI, Oslo University Hospital, Oslo, Norway
| | - L Sandvik
- Department of Biostatistics, Oslo University Hospital, Oslo, Norway
| | - B Winsvold
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology and FORMI, Oslo University Hospital, Oslo, Norway
| | - K Hagen
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Norwegian National Headache Centre, Section of Neurology, St. Olavs Hospital, Trondheim, Norway
| | - J-A Zwart
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology and FORMI, Oslo University Hospital, Oslo, Norway
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Randjelovic A, Frønæs SG, Munsami M, Kvalsvig JD, Zulu SG, Gagai S, Maphumulo A, Sandvik L, Gundersen SG, Kjetland EF, Taylor M. A study of hurdles in mass treatment of schistosomiasis in KwaZulu-Natal, South Africa. S Afr Fam Pract (2004) 2015. [DOI: 10.1080/20786190.2014.978121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Gustavsen MW, Celius EG, Moen SM, Bjølgerud A, Berg-Hansen P, Nygaard GO, Sandvik L, Lie BA, Harbo HF. No association between multiple sclerosis and periodontitis after adjusting for smoking habits. Eur J Neurol 2014; 22:588-90. [PMID: 25041906 DOI: 10.1111/ene.12520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 05/26/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Periodontitis has been reported to be associated with several systemic disorders, and recently a possible relationship with multiple sclerosis (MS) was suggested. The aim of the present study was to investigate the association between periodontitis and MS in a Norwegian cohort. METHODS A case-control study in 756 MS patients and 1090 controls was conducted, and logistic regression analysis, adjusting for age, gender, place of residence, mononucleosis and smoking, was performed to investigate the association between MS and periodontitis. RESULTS In the unadjusted analysis a higher prevalence of periodontitis was seen in MS patients, but this difference was not statistically significant after adjusting for the covariates. CONCLUSIONS The previously suggested association between MS and periodontitis is not supported in this study. Our results underline the importance of adjusting for relevant covariates in epidemiological research.
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Affiliation(s)
- M W Gustavsen
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Abstract
BACKGROUND Sleep-disordered breathing (SDB) is common in heart failure patients. Many of them still remain undiagnosed. The aim of this study was to detect clinical predictors of sleep apnoea which may help to identify patients with SDB at a heart failure clinic. METHODS We performed an in-home sleep study on 115 consecutive patients from our heart failure clinic. Clinical characteristics, blood samples, daytime sleepiness and quality of life were registered. RESULTS Among 115 patients, 52% had moderate to severe SDB. Body Mass Index (BMI) ≥ 30 kg/m² was the only independent predictor of moderate to severe SDB [Odds ratio (OR) = 3.62, 95% Confidence interval (CI) 1.40-9.36, p = 0.008]. Quality of life and level of sleepiness were not significantly associated with SDB. Patients with mild to moderate chronic obstructive pulmonary disease (COPD) were unlikely to have SDB compared with patients without COPD (OR = 0.10, 95% CI 0.02-0.43, p = 0.002). Hypertension was a predictor of having obstructive sleep apnoea (OR = 2.78, 95% CI 1.15-6.75, p = 0.02), while haemoglobin ≥ 15 g/dl was associated with central sleep apnoea (OR = 6.71, 95% CI 1.96-22.99, p = 0.002). CONCLUSION BMI ≥ 30 kg/m(2) is associated with moderate to severe SDB, both obstructive and central sleep apnoea. Thus, BMI may be used as one of the selection criteria for referral of heart failure patients to a sleep specialist.
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Affiliation(s)
- T E Herrscher
- Department of Cardiology, Lovisenberg Diakonale Hospital, Oslo, Norway
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Schistad E, Espeland A, Pedersen L, Sandvik L, Gjerstad J, Røe C. Association between baseline IL-6 and 1-year recovery in lumbar radicular pain. Eur J Pain 2014; 18:1394-401. [DOI: 10.1002/j.1532-2149.2014.502.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 11/12/2022]
Affiliation(s)
- E.I. Schistad
- Department of Physical Medicine and Rehabilitation; Oslo University Hospital; Ulleval Norway
- Faculty of Medicine; University of Oslo; Norway
| | - A. Espeland
- Department of Radiology; Haukeland University Hospital; Norway
- Department of Surgical Sciences; University of Bergen; Norway
| | - L.M. Pedersen
- National Institute of Occupational Health; Oslo Norway
- Communication and Research Unit for Musculoskeletal Disorders (FORMI); Oslo University Hospital; Ulleval Norway
| | - L. Sandvik
- Unit of Biostatistics and Epidemiology; Oslo University Hospital; Norway
| | - J. Gjerstad
- National Institute of Occupational Health; Oslo Norway
- Department of Molecular Biosciences; University of Oslo Norway
| | - C. Røe
- Department of Physical Medicine and Rehabilitation; Oslo University Hospital; Ulleval Norway
- Faculty of Medicine; University of Oslo; Norway
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Johannessen HH, Mørkved S, Stordahl A, Sandvik L, Wibe A. Anal incontinence and Quality of Life in late pregnancy: a cross-sectional study. BJOG 2014; 121:978-87. [PMID: 24589074 DOI: 10.1111/1471-0528.12643] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2013] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate the association between different types of anal incontinence (AI) and Quality of Life (QoL) in late pregnancy. DESIGN Cross-sectional study. SETTING Two maternity units in Norway 2009-2010. POPULATION Primiparae aged 18 or over. METHODS Participants answered questions about AI during the last 4 weeks of pregnancy on the St. Mark's score and impact of QoL in the Fecal Incontinence QoL score. Socioeconomic data were obtained from hospital records. MAIN OUTCOME MEASURES Self-reported AI and impact on QoL. RESULTS 1571 primiparae responded; 573 (37%) had experienced AI during the last 4 weeks of pregnancy. One third of the incontinent women reported reduced QoL in the domain 'Coping'. 'Women experiencing urgency alone reported markedly better QoL compared to any other AI symptoms. AI appeared to have the strongest impact on the domains 'Coping' and 'Embarrassment'. Depression was only associated with experiencing the combination of all three symptoms [odds ratio (OR) 13; 95%confidence interval (CI) 3.2-51]. Experiencing flatus alone weekly or more was associated with the highest impact on 'Embarrassment' (OR 20; 95%CI 6.4-61) compared with all other symptoms or combination of AI symptoms, except the combination of all three AI symptoms. CONCLUSIONS Between 3 and 10% of the primiparae in this material experienced AI to such a extent that it affected QoL. The greatest impact was seen in the QoL domain 'Coping'. These findings highlight the importance of an increased awareness of AI in late pregnancy among health professionals and the need to implement routine discussions about AI with expectant and new mothers.
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Affiliation(s)
- H H Johannessen
- Department of Physiotherapy, Østfold Hospital Trust, Fredrikstad, Norway; Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
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Johannessen HH, Wibe A, Stordahl A, Sandvik L, Backe B, Mørkved S. Prevalence and predictors of anal incontinence during pregnancy and 1 year after delivery: a prospective cohort study. BJOG 2013; 121:269-79. [PMID: 24021090 DOI: 10.1111/1471-0528.12438] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2013] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the prevalence and predictors of anal incontinence (AI) in late pregnancy and 1 year after delivery. DESIGN Prospective population-based cohort study. SETTING Two maternity units in Norway 2009-2010. POPULATION Primiparae aged 18 years or over. METHODS Primiparae answered questions on the St. Mark's score about AI during the last 4 weeks of pregnancy. One year later, the same questionnaires were distributed by postal mail. Socio-economic and delivery-related data were obtained from hospital records. MAIN OUTCOME MEASURES Self-reported AI. RESULTS Answers on AI in late pregnancy were obtained from 1571 women, and 1030 responded 1 year later. Twenty-four per cent experienced one and 4.7% experienced three or more AI symptoms in late pregnancy. One year later, this was reduced to 19% and 2.2%, respectively. Multivariate logistic regression analyses were applied. Formed and loose stool incontinence were strongly associated at both time points. The main predictor of AI 1 year after delivery was AI in late pregnancy. Obstetric anal sphincter injury increased the risk of incontinence of stool and flatus (odds ratio [OR], 4.1; 95% confidence interval [CI], 1.7-9.6) after delivery. Urgency was associated with greater age (OR, 1.8; 95% CI, 1.0-3.3) and operative delivery (OR, 2.0; 95% CI, 1.3-2.9). CONCLUSION One in four primiparae experienced AI in late pregnancy. One year later, still one in five suffered from incontinence. Sphincter injury predicted incontinence of stool and flatus, whereas greater age and operative delivery predicted urgency. The identification and adequate follow-up of pregnant women with AI may reduce AI after delivery.
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Affiliation(s)
- H H Johannessen
- Department of Physiotherapy, Østfold Hospital Trust, Fredrikstad, Norway; Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
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Berg-Hansen P, Smestad C, Sandvik L, Harbo HF, Celius EG. Increased disease severity in non-Western immigrants with multiple sclerosis in Oslo, Norway. Eur J Neurol 2013; 20:1546-52. [DOI: 10.1111/ene.12227] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 06/05/2013] [Indexed: 01/24/2023]
Affiliation(s)
- P. Berg-Hansen
- Department of Neurology; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - C. Smestad
- Division of Mental Health and Addiction; Oslo University Hospital; Oslo Norway
| | - L. Sandvik
- Section of Epidemiology and Biostatistics; Oslo University Hospital; Oslo Norway
| | - H. F. Harbo
- Department of Neurology; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - E. G. Celius
- Department of Neurology; Oslo University Hospital; Oslo Norway
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Gursli S, Sandvik L, Skrede B, Stuge B. 214 Individual efficacy of Cough Technique versus Forced Expiration Technique in cystic fibrosis. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60355-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wik H, Jacobsen A, Fagerland M, Sandvik L, Sandset P. OC-17 Long-term mortality and incidence of cancer after pregnancy-related venous thrombosis (VT): Results of a population-based, prospective cohort study. Thromb Res 2013. [DOI: 10.1016/s0049-3848(13)70043-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bergrem A, Dahm A, Jacobsen A, Sandvik L, Sandset P. OC-16 Differential risk factors for pregnancy-related deep vein thrombosis and pulmonary embolism – Results from a population-based case-control study. Thromb Res 2013. [DOI: 10.1016/s0049-3848(13)70042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wik HS, Jacobsen AF, Sandvik L, Sandset PM. Long-term impact of pregnancy-related venous thrombosis on quality-of-life, general health and functioning: results of a cross-sectional, case-control study. BMJ Open 2012; 2:e002048. [PMID: 23144263 PMCID: PMC3533094 DOI: 10.1136/bmjopen-2012-002048] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 10/02/2012] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To evaluate the long-term consequences of pregnancy-related venous thrombosis (VT) by the assessment of generic quality-of-life (QOL), well-being, general health and daily-life functioning. We also wanted to evaluate the impact of the frequently occurring complication post-thrombotic syndrome (PTS) after that of deep vein thrombosis (DVT). DESIGN Population-based cross-sectional, case-control study. SETTING 18 Norwegian hospitals during 1990-2003. PARTICIPANTS The study population comprised 559 cases with a validated first-ever, pregnancy-related VT and 1229 controls naïve for VT at the time of index pregnancy. Cases were identified using the Norwegian Patient Register and the Medical Birth Registry of Norway and the latter was used to select as controls women who gave birth at the same time as a case. After exclusion of two cases with missing location of VT, the final study population comprised 311 cases and 353 controls. METHODS Self-completion of a comprehensive questionnaire in 2006. MAIN OUTCOME MEASURES Generic QOL and well-being assessed by the Ferrans and Powers QOL Index (QLI) and the General Health Questionnaire (GHQ-20). RESULTS QOL assessed by QLI did not differ between cases and controls; mean score 23.1 (95% CI 22.7 to 23.5) vs 23.7 (23.3 to 24.0), neither did well being assessed by GHQ-20; 18.7 (18.0 to 19.4) vs 17.9 (17.3 to 18.4). However, cases reported pain other than in the lower limbs and muscle-skeletal problems more often and were more often physically worn out after work compared with controls. Cases which developed PTS reported poorer health, had pain more often, developed skin and psychiatric problems, used analgesic drugs more frequently and were more often on sick leave as compared to those without PTS. CONCLUSIONS Long-term generic QOL and subjective well-being 3-16 years after a pregnancy-related VT were not different from a reference population, but women with PTS after DVT seemed to have poorer QOL and an impaired general health.
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Affiliation(s)
- Hilde Skuterud Wik
- Department of Haematology and Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
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Wik HS, Jacobsen AF, Sandvik L, Sandset PM. Prevalence and predictors for post-thrombotic syndrome 3 to 16 years after pregnancy-related venous thrombosis: a population-based, cross-sectional, case-control study. J Thromb Haemost 2012; 10:840-7. [PMID: 22452811 DOI: 10.1111/j.1538-7836.2012.04690.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The long-term outcome of pregnancy-related venous thrombosis (VT) is not known. OBJECTIVES To assess predictors and long-term frequency of post-thrombotic syndrome (PTS) after pregnancy-related VT. PATIENTS/METHODS In 2006, 313 women with pregnancy-related VT during 1990-2003 and 353 controls answered a comprehensive questionnaire that included self-reported Villalta score as a measure of PTS. Cases were identified from 18 Norwegian hospitals using the Norwegian Patient Registry and the Medical Birth Registry of Norway. The latter was used to select as possible controls women who gave birth at the same time as a case. Thirty-nine patients and four controls were excluded because of VT outside the lower limbs/lungs or missing Villalta scores. Two hundred and four patients had DVT in the lower limb and 70 had pulmonary embolism (PE). The control group comprised 349 women naive for VT at the time of the index pregnancy. RESULTS Forty-two per cent of cases with DVT in the lower limb, compared with 24% of cases with PE and 10% of controls, reported a Villalta score of ≥ 5. Severe PTS (Villalta score of ≥ 15) was reported among 7%, 4% and 1%. Proximal postnatal, but not antenatal, thrombosis was a strong predictor of PTS with an adjusted odds ratio of 6.3 (95% confidence interval, 2.0-19.8; P = 0.002). Daily smoking before the index pregnancy and age above 33 years at event were independent predictors for post-thrombotic syndrome. CONCLUSIONS PTS is a common long-term complication after pregnancy-related DVT. Proximal postnatal thrombosis, smoking and higher age were independent predictors of the development of PTS.
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Affiliation(s)
- H S Wik
- Department of Haematology, Clinical Research, Oslo University Hospital, and Institute of Clinical Medicine, Oslo, Norway
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Lund A, Michelet M, Sandvik L, Wyller T, Sveen U. A lifestyle intervention as supplement to a physical activity programme in rehabilitation after stroke: a randomized controlled trial. Clin Rehabil 2011; 26:502-12. [PMID: 22169830 DOI: 10.1177/0269215511429473] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of lifestyle group intervention on well-being, occupation and social participation. DESIGN A randomized controlled trial. SETTING Senior centres in the community. SUBJECTS Of 204 stroke survivors screened, 99 (49%) were randomized three months after stroke whereby 86 (87%) participants (mean (SD) age 77.0 (7.1) years) completed all assessments (39 in the intervention group and 47 in the control group). INTERVENTION A lifestyle course in combination with physical activity (intervention group) compared with physical activity alone (control group). Both programmes were held once a week for nine months. MAIN OUTCOME MEASURE The Short Form Questionnaire (SF-36), addressing well-being and social participation. Assessments were performed at baseline and at nine months follow-up. RESULTS We found no statistically significant differences between the groups at the nine months follow-up in the SF-36. Adjusted mean differences in change scores in the eight subscales of SF-36 were; 'mental health' (+1.8, 95% confidence interval (CI) -4.0, +7.6), 'vitality' (-3.0, 95% CI -9.6, +3.6), 'bodily pain' (+3.3, 95% CI -7.8, +14.4), 'general health' (-1.6, 95% CI -8.4, +5.1), 'social functioning' (-2.5, 95% CI -12.8, +7.8), 'physical functioning' (+1.0, 95% CI -6.7, +8.6), 'role physical' (-7.1, 95% CI -22.7, +8.4), 'role emotional' (+11.8, 95% CI -4.4, +28.0). CONCLUSIONS Improvements were seen in both groups, but no statistically significant differences were found in the intervention group compared to controls. An intervention comprising regular group-based activity with peers may be sufficient in the long-term rehabilitation after stroke.
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Affiliation(s)
- A Lund
- Oslo University Hospital, Geriatric Medicine, Oslo, Norway.
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Dormagen J, Meyerdierks O, Gaarder C, Naess P, Sandvik L, Klow NE. Contrast-enhanced ultrasound of the injured spleen after embolization--comparison with computed tomography. Ultraschall Med 2011; 32:485-491. [PMID: 21294071 DOI: 10.1055/s-0029-1246003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE The aim of this study was to compare the diagnostic performance of contrast-enhanced ultrasound (CEUS) to computed tomography (CT) in trauma patients after splenic embolization. MATERIALS AND METHODS 22 patients (17 male and 5 female) with a mean age of 32 (15 - 57 years) were studied with ultrasound (US), CEUS and CT in 23 early follow-up examinations 5 days (range: 0 - 12 days) after intervention and 17 late follow-up examinations 69 days (range: 52 - 189 days) after intervention. Perisplenic fluid, hematoma, laceration, infarction, scars and injury grade were evaluated. US and CEUS readings were performed independently by two radiologist, blinded to the CT results. RESULTS The sensitivity and specificity for CEUS at early follow-up were 85 % and 70 % for perisplenic fluid, 80 % and 94 % for subcapsular hematomas, 83 % and 73 % or lacerations and 75 % and 87 % for infarctions, respectively. The sensitivity and specificity at late follow-up were 60 % and 100 % for subcapsular hematomas, 91 % and 67 % for intrasplenic hematomas, 100 % and 93 % for lacerations and 89 % and 100 % for scars, respectively. The overall sensitivity and specificity for all lesions were 87 % and 88 % at early follow-up (n = 138) and 85 % and 95 % at late follow-up (n = 102), respectively. Compared to CT, CEUS underestimated the injury grade in 2 / 40 cases and overestimated the injury grade in 3/40 cases. CONCLUSION CEUS is a useful tool for the detection of post-traumatic lesions. It is comparable to CT in follow-up after splenic embolization and may replace CT in follow-up studies.
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Moen SM, Celius EG, Sandvik L, Nordsletten L, Eriksen EF, Holmøy T. Low bone mass in newly diagnosed multiple sclerosis and clinically isolated syndrome. Neurology 2011; 77:151-7. [PMID: 21747073 DOI: 10.1212/wnl.0b013e3182242d34] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Osteoporosis is common in patients with multiple sclerosis (MS) with long-standing disease. Hypovitaminosis D is a candidate risk factor for MS, and vitamin D also mediates bone mineralization. If vitamin D exerts a major effect on MS risk, skeletal consequences of hypovitaminosis D could be apparent shortly after the onset of MS. In order to test this hypothesis, we assessed bone mineral density (BMD) at early stages of disease in patients with no or minor disability. METHODS A population-based case-control study was conducted on 99 consecutive and newly diagnosed patients with clinically isolated syndrome or MS, and on 159 age-, sex-, and ethnicity-matched controls. BMD was measured by dual-energy x-ray absorptiometry of the femoral neck, total hip, anterior-posterior lumbar spine, total body, and nondominant ultradistal radius. RESULTS A total of 50.5% of the patients exhibited either osteopenia (-2.5 < T score < -1.0) or osteoporosis (T score ≤-2.5) in at least one skeletal site, compared to 37.1% of controls (p = 0.034). After adjusting for possible confounders, left femoral total hip T score and lumbar spine BMD and T score were significantly lower in patients than in controls (p = 0.023, 0.039, and 0.026, respectively). CONCLUSIONS Low bone mass appears to occur early in MS. This is compatible with shared etiologic or pathogenic factors in MS and osteoporosis, and calls for an active approach to optimize bone health in early stages of MS.
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Affiliation(s)
- S M Moen
- Department of Neurology, Oslo University Hospital Ulleval, 0407 Oslo, Norway.
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Gammelsrud KW, Sandven P, Høiby EA, Sandvik L, Brandtzaeg P, Gaustad P. Colonization by Candida in children with cancer, children with cystic fibrosis, and healthy controls. Clin Microbiol Infect 2011; 17:1875-81. [PMID: 21745258 DOI: 10.1111/j.1469-0691.2011.03528.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A longitudinal, prospective study was conducted intermittently in Norway, from 1999 to 2008, to investigate the Candida colonization rates and species distributions in the tonsillopharyngeal and faecal flora in: (i) children with cancer; (ii) children with cystic fibrosis (CF); and (iii) healthy children. The effect of antibiotic treatment on Candida colonization was also studied, and we looked for changes in antifungal susceptibility over time within each child and between the different groups of children. In total, 566 tonsillopharyngeal swabs and 545 faecal samples were collected from 45 children with cancer, 37 children with CF, and 71 healthy, age-matched controls. The overall colonization rate with Candida was not significantly higher in the two groups of children undergoing extensive treatment with broad-spectrum antibiotics than in healthy controls. Approximately one-third of the cancer patients had a total lack of Candida colonization or had only one Candida-positive sample, despite multiple samples being taken, treatment with broad-spectrum antibiotics, long hospital stays, and periods with neutropenia. Children with CF had the highest prevalence of Candida albicans. Amoxycillin, azithromycin, third-generation cephalosporins and oral vancomycin resulted in a significantly increased Candida colonization rate. Phenoxymethylpenicillin, second-generation cephalosporins, metronidazole, trimethoprim-sulphamethoxazole, ciprofloxacin, penicillinase-resistant penicillins and inhaled tobramycin or colistin showed minimal effects on the Candida colonization rate. We found no evidence of development of antifungal resistance over time.
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Affiliation(s)
- K W Gammelsrud
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway.
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Heir T, Erikssen J, Sandvik L. Overweight as predictor of long-term mortality among healthy, middle-aged men: a prospective cohort study. Prev Med 2011; 52:223-6. [PMID: 21277889 DOI: 10.1016/j.ypmed.2011.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 01/17/2011] [Accepted: 01/19/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Large epidemiological studies of non-smokers have demonstrated an association between overweight during midlife and increased mortality. However, little is known about whether this association may be explained by physical fitness. Thus, we aimed to examine this association in a long-term follow-up, with adjustment for fitness. METHODS We prospectively studied mortality in relation to overweight in 2014 healthy Norwegian men 40-59 years of age at enrollment in 1972-1975, and recorded cardiovascular and non-cardiovascular mortality during 25-27 years follow-up. Physical fitness was measured in a maximal exercise tolerance bicycle test. RESULTS At baseline 717 men had overweight (body mass index 25.0-29.9) and 1221 had normal weight (body mass index<25.0). During follow-up 746 men died, 377 from cardiovascular causes. Among non-smokers with overweight/normal weight, cardiovascular death rates were 19.4%/11.3%, and non-cardiovascular death rates were 13.2%/14.4%. Overweight was related to cardiovascular mortality, even after adjustment for age, physical fitness, blood pressure and cholesterol level (RR: 1.52, p=0.010), but not to non-cardiovascular mortality (RR: 0.84, p=0.32). Among smokers overweight was not associated with cardiovascular or non-cardiovascular mortality. The difference in cardiovascular mortality between non-smokers with overweight and normal weight first appeared after 15 years of follow-up. CONCLUSION Overweight appears to be an independent long-term predictor of cardiovascular mortality in middle-aged healthy non-smoking men, even after adjustment for physical fitness.
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Affiliation(s)
- T Heir
- Oslo University Hospital, Kirkeveien 166, N-0407 Oslo, Norway.
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Bergrem A, Dahm A, Jacobsen A, Mowinckel M, Sandvik L, Sandset P. 0.08b Reduced sensitivity to activated protein C in the absence of the factor V Leiden polymorphism is a risk factor for pregnancy related venous thrombosis. Thromb Res 2011. [DOI: 10.1016/s0049-3848(11)70049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wik H, Jacobsen A, Sandvik L, Sandset P. 0.08a Prevalence and predictors for post-thrombotic syndrome (PTS) three to 16 years after first-time pregnancy related venous thrombosis – a population-based case-control study. Thromb Res 2011. [DOI: 10.1016/s0049-3848(11)70048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fernandes L, Storheim K, Sandvik L, Nordsletten L, Risberg MA. Efficacy of patient education and supervised exercise vs patient education alone in patients with hip osteoarthritis: a single blind randomized clinical trial. Osteoarthritis Cartilage 2010; 18:1237-43. [PMID: 20633669 DOI: 10.1016/j.joca.2010.05.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 05/21/2010] [Accepted: 05/29/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the efficacy of patient education and supervised exercise with that of patient education alone for the management of pain in patients with hip osteoarthritis (OA). DESIGN Single blind randomized clinical trial. SETTING Recruitment of patients from hospitals, primary health care and advertisement, Oslo, Norway. PARTICIPANTS 109 patients with radiographic and symptomatic hip OA with mild to moderate symptoms. INTERVENTIONS Patient education (PE). Patient education and supervised exercise (PE+SE). PRIMARY OUTCOME MEASURE The pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC pain). RESULTS No significant between group differences were found for WOMAC pain over the 16-month follow-up. Significant improvements were found for the secondary outcome WOMAC physical function (P=0.011) in the group receiving PE+SE compared to the group receiving PE only. No significant differences were found for WOMAC stiffness, the SF-36 subscales or the activity scale. The effect sizes (95% confidence interval) for WOMAC pain were -0.26 (0.11, -0.64), -0.35 (0.07, -0.77), and -0.30 (0.15, -0.75), and for WOMAC physical function -0.29 (0.09, -0.67), -0.48 (-0.06, -0.91), and -0.47 (-0.02, -0.93) at 4, 10 and 16 months, respectively, in favor of the group receiving both PE and SE. All patients attended the three-session PE program, and 75% performed ≥16 sessions of the 12-week SE program. CONCLUSION The study could not demonstrate a significant difference in pain reduction over time between PE+SE vs PE alone. Adding SE to PE may improve physical function, but the magnitude of possible benefit is unknown as the 95% confidence intervals around the mean difference were wide. TRIAL REGISTRATION Clinical Trials NCT00319423.
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Affiliation(s)
- L Fernandes
- Norwegian Research Center for Active Rehabilitation (NAR), Department of Orthopedics, Oslo University Hospital, Oslo, Norway.
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Andersen BM, Tollefsen T, Seljordslia B, Hochlin K, Syversen G, Jonassen TØ, Rasch M, Sandvik L. Rapid MRSA test in exposed persons: costs and savings in hospitals. J Infect 2010; 60:293-9. [PMID: 20122959 DOI: 10.1016/j.jinf.2010.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 01/21/2010] [Accepted: 01/23/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To study a rapid Xpert polymerase chain reaction (PCR) method in detecting methicillin-resistant Staphylococcus aureus (MRSA) in patients and healthcare workers (HCW) exposed to MRSA, and to estimate savings associated to isolation or work restriction. METHODS A test set of four double (one for the growth and one for the rapid test) pre-wet swabs from the nose, throat, hands/wrists and perineum was studied by a growth method and by the Xpert MRSA test. RESULTS The total correspondence between the growth and the rapid test was 92.8%. The overall sensitivity, specificity, positive and negative predictive values were for the Xpert MRSA test: 87%, 99.6%, 68.5% and 99.9%, and for the growth test: 76%, 100%, 100%, and 99.8%, assuming a prevalence of MRSA of 0.01%. Among the MRSA positive persons, the Xpert and growth tests detected MRSA in 44.6% and 40% of nose samples, respectively, 38.2% and 45.5% throat samples, 30.8% and 11.5% hands/wrists samples, 44% and 38% perineum samples, and in 81.8% and 77.3% wound samples, respectively. By combining four anatomical sites, the detection rate increased to 87.5% by both methods. The cost for each Xpert and growth test was euro50 and euro6.25, respectively. The rapid test would save at least euro925 per exposed HCW and euro550 per patient that were MRSA negative. CONCLUSION The MRSA Xpert test is easy to perform, has a high negative predictive value, and may be used to control healthcare workers and patients exposed to MRSA. Sampling from multiple anatomical locations is recommended. Still, more then 10% of MRSA positive cases may not be found.
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Affiliation(s)
- B M Andersen
- Department of Hospital Infections, Oslo University Hospital - Ullevål, Oslo, Norway.
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Lieng M, Istre O, Sandvik L, Engh V, Qvigstad E. Clinical Effectiveness of Transcervical Polyp Resection in Women with Endometrial Polyps: A Randomised Controlled Trial. J Minim Invasive Gynecol 2009. [DOI: 10.1016/j.jmig.2009.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
There are few studies of long-term, cause-specific mortality in multiple sclerosis (MS) relating to population mortality. Our objective was to study survival, excess mortality and causes of death in a cohort of patients with a long history of MS. Patients living in Oslo with definite MS and onset during 1940—80 were included in 2006. Causes of death and mortality in the general population were obtained from the Cause of Death Registry of Statistics Norway. Of the 386 patients included in the study, 263 (68%) had died at inclusion. Median survival from onset was 35 years (Kaplan—Meier: 95% confidence interval 33—37). Primary progressive MS was associated with shorter survival, but mean age at death was similar for relapsing-remitting and primary progressive MS patients. The most frequent underlying cause of death was MS (50%), and infection was often registered as a contributory cause (56%). The all-cause standardized mortality ratio was 2.47. Excess mortality was most marked during the second decade after onset of MS. We conclude that infections are probably the main cause of death in patients with MS, but the frequency is underestimated due to misleading information on death certificates. Excess mortality in patients with MS first appeared during the second decade of the disease. Survival seems to be age-dependent rather than related to disease course.
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Affiliation(s)
- C. Smestad
- Department of Neurology, Oslo University Hospital, Ullevål, N-0407 Oslo, Norway,
| | - L. Sandvik
- Center for Clinical Research, Oslo University Hospital, Ullevål, N-0407 Oslo, Norway
| | - EG Celius
- Department of Neurology, Oslo University Hospital, Ullevål, N-0407 Oslo, Norway
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Enden T, Kløw NE, Sandvik L, Slagsvold CE, Ghanima W, Hafsahl G, Holme PA, Holmen LO, Njaastad AM, Sandbaek G, Sandset PM. Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: results of an open randomized, controlled trial reporting on short-term patency. J Thromb Haemost 2009; 7:1268-75. [PMID: 19422443 DOI: 10.1111/j.1538-7836.2009.03464.x] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Approximately one in four patients with acute proximal deep vein thrombosis (DVT) given anticoagulation and compression therapy develop post-thrombotic syndrome (PTS). Accelerated removal of thrombus by thrombolytic agents may increase patency and prevent PTS. OBJECTIVES To assess short-term efficacy of additional catheter-directed thrombolysis (CDT) compared with standard treatment alone. PATIENTS AND METHODS Open, multicenter, randomized, controlled trial. Patients (18-75 years) with iliofemoral DVT and symptoms < 21 days were randomized to receive additional CDT or standard treatment alone. After 6 months, iliofemoral patency was investigated using duplex ultrasound and air-plethysmography assessed by an investigator blinded to previous treatment. RESULTS One hundred and three patients (64 men, mean age 52 years) were allocated additional CDT (n = 50) or standard treatment alone (n = 53). After CDT, grade III (complete) lysis was achieved in 24 and grade II (50%-90%) lysis in 20 patients. One patient suffered major bleeding and two had clinically relevant bleeding related to the CDT procedure. After 6 months, iliofemoral patency was found in 32 (64.0%) in the CDT group vs. 19 (35.8%) controls, corresponding to an absolute risk reduction (RR) of 28.2% (95% CI: 9.7%-46.7%; P = 0.004). Venous obstruction was found in 10 (20.0%) in the CDT group vs. 26 (49.1%) controls; absolute RR 29.1% (95% CI: 20.0%-38.0%; P = 0.004). Femoral venous insufficiency did not differ between the two groups. CONCLUSIONS After 6 months, additional CDT increased iliofemoral patency from 36% to 64%. The ongoing long-term follow-up of this study will document whether patency is related to improved functional outcome.
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Affiliation(s)
- T Enden
- Department of Hematology, Oslo University Hospital, Ullevål, Norway.
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Hjerkinn EM, Seljeflot I, Sandvik L, Hjermann I, Arnesen H. Markers of endothelial cell activation in elderly men at high risk for coronary heart disease. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 65:201-9. [PMID: 16095049 DOI: 10.1080/00365510510013613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Circulating cell adhesion molecules (CAMS) are regarded as inflammatory markers related to the process of atherosclerosis and cardiovascular disease (CVD). In the haemostatic system, elevated levels of thrombomodulin (TM), von Willebrand factor (vWF) and tissue-type plasminogen activator antigen (tPAag) have likewise been associated with atherothrombotic cardiovascular disease states. MATERIAL AND METHODS Levels of these circulating markers were investigated in a cross-sectional study including 563 men aged 70 (64-76) years characterized as hypercholesterolaemic in 1972, as related to the following clinical entities: cardiovascular morbidity (28%), diabetes (15%), hypertension (70%) and smoking habits (34%) after 24 years. RESULTS In patients presenting with CVD, significantly higher levels of tPAag were encountered (12.9 versus 12.0 ng/ml, p = 0.02). In smokers, levels of sICAM-1 were significantly higher (331 versus 298 ng/ml, p < 0.001), whereas levels of sVCAM-1 and sTM were lower compared with those in non-smokers (543 versus 582 ng/ml, p = 0.01, 40.6 versus 44.5 ng/ml, p < 0.01, respectively). In diabetics, levels of sE-selectin and tPAag were significantly higher than those in non-diabetics (55.9 versus 45.7 ng/ml, p < 0.001, 13.6 versus 12.0, p = 0.001, respectively). In subjects with hypertension, levels of TM were elevated (44.0 versus 40.8 ng/ml, p = 0.03). In multivariate regression analyses, tPAag remained significantly associated with the presence of CVD (p = 0.03), sE-selectin with diabetes (p=0.004), sTM with hypertension (p = 0.02) and sVCAM-1, sICAM-1 and sTM with smoking, (p = 0.01, p < 0.001, p < 0.001, respectively). CONCLUSIONS The present results may contribute to the understanding of the multitude of factors influencing these endothelial markers and their evaluation in various disease entities.
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Affiliation(s)
- E M Hjerkinn
- Centre for Clinical Research, Ullevaal University Hospital, Oslo, Norway.
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Sagen Å, Kåresen R, Sandvik L, Risberg M. Changes in arm morbidities and health-related quality of life after breast cancer surgery: A five-year follow-up study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20602 Background: Many breast cancer survivors (BCS) suffer from longterm upper limb morbidities after axillary node dissection. The purpose of this five-year follow-up study was to describe changes in long-term upper limb morbidities, physical activity level, and Health-Related Quality of Life (HRQoL) and to find factors that predict HRQoL five years after surgery. Methods: This study included 204 women aged 55 ± 9 years who had primary breast cancer surgery with axillary node dissection. The subjects were examined for arm volumes and arm lymphedema, arm pain, sensation of heaviness, shoulder function, physical activity level, and HRQoL, prior to surgery, and six months and five years after surgery. The statistical analyses used included ANOVA for repeated measures and multivariate linear regression. Results: ALE (12%), pain (36%), and sensation of heaviness (32%) in the upper limbs were still present five years after surgery. ALE was the only morbidity that continued to increase over time. The HRQoL temporarily declined after surgery, but improved in the period from six months to five years after surgery. The significant predictive factors of HRQoL five years after surgery included HRQoL prior to surgery, physical activity level at leisure time (both prior to and at six months after surgery), and duration of sick leave after surgery (in weeks). Conclusions: The HRQoL improved from six months to five years, despite the chronic arm pain and increase in ALE. Three independent predictive factors of HRQoL were identified. No significant financial relationships to disclose.
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Affiliation(s)
- Å. Sagen
- Ulleval University Hospital, Oslo, Norway
| | - R. Kåresen
- Ulleval University Hospital, Oslo, Norway
| | - L. Sandvik
- Ulleval University Hospital, Oslo, Norway
| | - M. Risberg
- Ulleval University Hospital, Oslo, Norway
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Erichsen A, Server A, Landrø N, Sandvik L, Tallaksen C. Proton magnetic resonance spectroscopy and cognition in patients with spastin mutations. J Neurol Sci 2009; 277:124-9. [DOI: 10.1016/j.jns.2008.10.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 09/26/2008] [Accepted: 10/31/2008] [Indexed: 11/16/2022]
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