1
|
Wensaas KA, Simonsen KA, Welle-Nilsen LK, Litleskare S. Extended access to general practice services during weekends in the first wave of the COVID-19 pandemic. Scand J Public Health 2024; 52:247-252. [PMID: 38073156 DOI: 10.1177/14034948231213466] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
OBJECTIVE The incidence, symptoms, and trajectories of COVID-19 in the community were unknown in the early phase of the pandemic. Consequently, organizing a primary health care response was challenging. The aim of this study was to investigate whether reorganizing general practice services with extended weekend access for patients was feasible, and to assess the extent to which patients used this service. DESIGN Observational study with registration after a simple intervention. SETTING General practice services in the second half of March 2020 when the first wave of the COVID-19 pandemic hit Bergen, the second largest city in Norway. SUBJECTS All general practices in Bergen were asked to be available during weekends for their patients with respiratory tract infections (RTIs), by telephone, video-, or e-consultation. MAIN OUTCOME MEASURES Number of practices participating, patients connected to these practices, and consultations for RTIs and suspected COVID-19. RESULTS During the first weekend, 33 of 71 practices (45%) covering 51% of the population participated. The following weekend this increased to 39 practices (53%) covering 64% of the population. The first weekend 25 practices reported a total of 336 consultations for RTIs, eight of which were for confirmed and 113 were for suspected COVID-19. The corresponding numbers reported from 23 practices the second weekend were 158 RTI consultations, four for confirmed and 41 for suspected COVID-19. CONCLUSIONS On short notice about half the practices in Bergen were made accessible during weekends for their patients with RTIs. The number of consultations per practice was small, but combined this amounted to a substantial improvement in the emergency services.
Collapse
Affiliation(s)
- Knut-Arne Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre, Norway
| | | | | | - Sverre Litleskare
- Research Unit for General Practice, NORCE Norwegian Research Centre, Norway
| |
Collapse
|
2
|
Bjorvatn B, Waage S, Emberland KE, Litleskare S, Rebnord IK, Forthun I, Rortveit G. The associations between different types of infections and circadian preference and shift work. Chronobiol Int 2024; 41:259-266. [PMID: 38221779 DOI: 10.1080/07420528.2024.2303986] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/05/2024] [Indexed: 01/16/2024]
Abstract
Disturbed sleep and circadian disruption are reported to increase the risk of infections. People with an evening circadian preference and night workers typically report insufficient sleep, and the aims of the present study were to investigate possible associations between various types of infections and circadian preference and shift work status. Data were collected from an online cross-sectional survey of 1023 participants recruited from the Norwegian practice-based research network in general practice - PraksisNett. The participants completed questions about circadian preference (morning type, intermediate type, evening type), work schedule (day work, shift work without nights, shift work with night shifts), and whether they had experienced infections during the last three months (common cold, throat infection, ear infection, sinusitis, pneumonia/bronchitis, COVID-19, influenza-like illness, skin infection, gastrointestinal infection, urinary infection, venereal disease, eye infection). Data were analyzed with chi-square tests and logistic regression analyses with adjustment for relevant confounders (gender, age, marital status, country of birth, children living at home, and educational level). Results showed that evening types more often reported venereal disease compared to morning types (OR = 4.01, confidence interval (CI) = 1.08-14.84). None of the other infections were significantly associated with circadian preference. Shift work including nights was associated with higher odds of influenza-like illness (OR = 1.97, CI = 1.10-3.55), but none of the other infections. In conclusion, neither circadian preference nor shift work seemed to be strongly associated with risk of infections, except for venereal disease (more common in evening types) and influenza-like illness (more common in night workers). Longitudinal studies are needed for causal inferences.
Collapse
Affiliation(s)
- Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Siri Waage
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Knut Erik Emberland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sverre Litleskare
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Ingrid K Rebnord
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ingeborg Forthun
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Guri Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| |
Collapse
|
3
|
Hunskar GS, Rortveit G, Litleskare S, Eide GE, Hanevik K, Langeland N, Wensaas KA. Prevalence of fibromyalgia 10 years after infection with Giardia lamblia: a controlled prospective cohort study. Scand J Pain 2022; 22:348-355. [PMID: 34679267 DOI: 10.1515/sjpain-2021-0122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate whether acute infection with Giardia lamblia is associated with fibromyalgia 10 years after infection and whether fibromyalgia is associated with irritable bowel syndrome (IBS) and chronic fatigue (CF) in this setting. METHODS A cohort study was established after an outbreak of G. lamblia in Bergen, Norway, 2004. Laboratory-confirmed cases and a matched control group were followed for 10 years. The main outcome was fibromyalgia 10 years after giardiasis, defined by the 2016 revisions of the fibromyalgia diagnostic criteria using the Fibromyalgia Survey Questionnaire (FSQ). RESULTS The prevalence of fibromyalgia was 8.6% (49/572) among Giardia exposed compared to 3.1% (21/673) in controls (p<0.001). Unadjusted odds for having fibromyalgia was higher for Giardia exposed compared to controls (odds ratio (OR): 2.91, 95% confidence interval (CI): 1.72, 4.91), but adjusted for IBS and CF it was not (OR: 1.05, 95% CI: 0.57, 1.95). Among participants without CF the odds for fibromyalgia was 6.27 times higher for participants with IBS than those without (95% CI: 3.31, 11.91) regardless of exposure. Among participants without IBS the odds for fibromyalgia was 4.80 times higher for those with CF than those without (95% CI: 2.75, 8.37). CONCLUSIONS We found a higher prevalence of fibromyalgia among Giardia exposed compared to controls 10 years after the acute infection. Fibromyalgia was strongly associated with IBS and CF, and the difference between the exposed and controls can be attributed to the high prevalence of IBS and CF among the Giardia exposed. Notably, this study was not designed to establish causality between Giardia exposure and the outcomes.
Collapse
Affiliation(s)
- Gunnhild S Hunskar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Dermatology, Haukeland University Hospital, Bergen, Norway
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Guri Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Sverre Litleskare
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Geir Egil Eide
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Kurt Hanevik
- Norwegian National Advisory Unit for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Nina Langeland
- Norwegian National Advisory Unit for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Knut-Arne Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| |
Collapse
|
4
|
Emberland KE, Wensaas KA, Litleskare S, Iversen A, Hanevik K, Langeland N, Rortveit G. Correction to: Clinical features of gastroenteritis during a large waterborne Campylobacter outbreak in Askøy, Norway. Infection 2022; 50:355-357. [PMID: 35060102 PMCID: PMC8942931 DOI: 10.1007/s15010-021-01746-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Knut Erik Emberland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway.
| | - K-A Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - S Litleskare
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - A Iversen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Community Medicine, Askøy municipality, Norway
| | - K Hanevik
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Norwegian National Advisory Unit On Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - N Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - G Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| |
Collapse
|
5
|
Emberland KE, Wensaas KA, Litleskare S, Larsen L, Morch K, Ruths S, Rortveit G. Antibiotics for gastroenteritis in general practice and out-of-hour services in Norway 2006-15. Fam Pract 2022; 39:19-25. [PMID: 34263906 PMCID: PMC8769278 DOI: 10.1093/fampra/cmab080] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND When patients with gastroenteritis (GE) seek health care, they are generally managed in primary care. Little is known about the use of antibiotic treatment in these cases. OBJECTIVE The aim of this study was to investigate time trends and patient characteristics associated with antibiotic treatment for GE in Norwegian primary care in a 10-year period. METHODS We linked data from two nationwide registries, reimbursement claims data from Norwegian primary care (the KUHR database) and The Norwegian Prescription Database, for the period 2006-15. GE consultations were extracted, and courses of systemic antibiotics dispensed within 1 day were included for further analyses. RESULTS Antibiotic treatment was linked to 1.8% (n = 23 663) of the 1 279 867 consultations for GE in Norwegian primary care in the period 2006-15. The proportion of GE consultations with antibiotic treatment increased from 1.4% in 2006 to 2.2% in 2012 and then decreased to 1.8% in 2015. Fluoroquinolones (28.9%) and metronidazole (26.8%) were most frequently used. Whereas the number of fluoroquinolones courses decreased after 2012, the number of metronidazole courses continued to increase until year 2015. The antibiotic treatment proportion of GE consultations was lowest in young children and increased with increasing age. CONCLUSION Antibiotic treatment is infrequently used in GE consultations in Norwegian primary care. Although there was an overall increase in use during the study period, we observed a reduction in overall use after year 2012. Young children were treated with antibiotics in GE consultations less frequent than older patients.
Collapse
Affiliation(s)
- Knut Erik Emberland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Knut-Arne Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Sverre Litleskare
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Leo Larsen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kristine Morch
- Norwegian National Advisory Unit on Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Sabine Ruths
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Guri Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| |
Collapse
|
6
|
Bjorvatn B, Wensaas KA, Emberland KE, Fadnes LT, Litleskare S, Diaz E, Ruths S, Rørtveit G, Waage S. Restless legs syndrome - a study from general practice. Tidsskr Nor Laegeforen 2021; 141:21-0333. [PMID: 34758599 DOI: 10.4045/tidsskr.21.0333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The prevalence of restless legs syndrome (RLS) among adults in the general population is around 5-10 %. Few studies have been conducted on the prevalence among patients who consult their general practitioner. There are also few studies on associations between RLS and other common complaints such as irritable bowel syndrome (IBS), chronic fatigue (CF) and chronic muscle and back pain (CMBP). MATERIAL AND METHOD The study was conducted as a questionnaire survey at medical offices in Southern and Western Norway in the autumn of 2017 and spring of 2018, when patients waiting to see their general practitioner (GP) were invited to participate. A total of 2 634 people took part (62.2 % women, average age 49.6 years). The response rate was 86.8 %. Restless legs syndrome (RLS) was defined on the basis of international criteria. Associations between RLS and IBS, CF and CMBP were analysed by means of chi-squared tests and logistic regression. RESULTS AND INTERPRETATION The proportion of patients with RLS was 14.3 %. Of the patients with RLS, 44.8 % reported that their symptoms were moderately to very distressing, and 85.8 % that they did not use medication for it. The proportion of patients with RLS was significantly higher among patients with IBS (21.8 % versus 13.6 %, p = 0.009), CF (18.2 % versus 13.1 %, p = 0.003) and CMBP (23.2 % versus 12.2 %, p < 0.0005). GPs should be aware that many patients have RLS and that the condition is associated with other common complaints.
Collapse
|
7
|
Mortensen N, Jonasson SA, Lavesson IV, Emberland KE, Litleskare S, Wensaas KA, Rortveit G, Langeland N, Hanevik K. Correction: Characteristics of hospitalized patients during a large waterborne outbreak of Campylobacter jejuni in Norway. PLoS One 2021; 16:e0259407. [PMID: 34705871 PMCID: PMC8550597 DOI: 10.1371/journal.pone.0259407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
8
|
Emberland KE, Wensaas KA, Litleskare S, Iversen A, Hanevik K, Langeland N, Rortveit G. Clinical features of gastroenteritis during a large waterborne Campylobacter outbreak in Askøy, Norway. Infection 2021; 50:343-354. [PMID: 34215942 PMCID: PMC8942940 DOI: 10.1007/s15010-021-01652-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/23/2021] [Indexed: 11/30/2022]
Abstract
Purpose Outbreaks of Campylobacter infection are common, but studies exploring the clinical features of acute illness in the outbreak setting are scarce in existing literature. The main purpose of the present study was to investigate the clinical features of self-reported acute illness in gastroenteritis cases during a large waterborne Campylobacter outbreak in Askøy municipality, Norway, in 2019. Methods A web-based self-administered questionnaire, and invitation to participate was sent by the municipality of Askøy as text message to mobile phones using the municipality’s warning system to the inhabitants during the ongoing outbreak. Results Out of 3624 participants, 749 (20.7%) were defined as cases, of which 177 (23.6%) reported severe gastroenteritis. The most common symptoms were loose stools (90.7%), abdominal pain (89.3%) and diarrhea (88.9%), whereas 63.8% reported fever, 50.2% joint pain and 14.2% bloody stools. Tiredness, a symptom non-specific to gastroenteritis, was the overall most common symptom (91.2%). Conclusion About one in four of the cases reported symptoms consistent with severe gastroenteritis. We found more joint pain and less bloody stools than reported in published studies of laboratory confirmed campylobacteriosis cases. Tiredness was common in the current study, although rarely described in previous literature of acute illness in the outbreak setting. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01652-3.
Collapse
Affiliation(s)
- Knut Erik Emberland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. .,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway.
| | - K-A Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - S Litleskare
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - A Iversen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Community Medicine, Askøy municipality, Norway
| | - K Hanevik
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit On Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - N Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - G Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| |
Collapse
|
9
|
Mortensen N, Jonasson SA, Lavesson IV, Emberland KE, Litleskare S, Wensaas KA, Rortveit G, Langeland N, Hanevik K. Characteristics of hospitalized patients during a large waterborne outbreak of Campylobacter jejuni in Norway. PLoS One 2021; 16:e0248464. [PMID: 33755697 PMCID: PMC7987138 DOI: 10.1371/journal.pone.0248464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/27/2021] [Indexed: 11/18/2022] Open
Abstract
Very few reports describe all hospitalized patients with campylobacteriosis in the setting of a single waterborne outbreak. This study describes the demographics, comorbidities, clinical features, microbiology, treatment and complications of 67 hospitalized children and adults during a large waterborne outbreak of Campylobacter jejuni in Askoy, Norway in 2019, where more than 2000 people in a community became ill. We investigated factors that contributed to hospitalization and treatment choices. Data were collected from electronic patient records during and after the outbreak. Fifty adults and seventeen children were included with a biphasic age distribution peaking in toddlers and middle-aged adults. Most children, 14 out of 17, were below 4 years of age. Diarrhea was the most commonly reported symptom (99%), whereas few patients (9%) reported bloody stools. Comorbidities were frequent in adults (63%) and included cardiovascular disease, pre-existing gastrointestinal disease or chronic renal failure. Comorbidities in children (47%) were dominated by pulmonary and gastrointestinal diseases. Adult patients appeared more severely ill than children with longer duration of stay, higher levels of serum creatinine and CRP and rehydration therapy. Ninety-two percent of adult patients were treated with intravenous fluid as compared with 12% of children. Almost half of the admitted children received antibiotics. Two patients died, including a toddler. Both had significant complicating factors. The demographic and clinical findings presented may be useful for health care planning and patient management in Campylobacter outbreaks both in primary health care and in hospitals.
Collapse
Affiliation(s)
- Nicolay Mortensen
- Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | | | | | - Knut Erik Emberland
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sverre Litleskare
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Knut-Arne Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Guri Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Nina Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kurt Hanevik
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
- * E-mail:
| |
Collapse
|
10
|
Abstract
BACKGROUND Most of the patients with gastroenteritis seeking health care services are managed in primary care; yet, little is known about these consultations. Syndromic-based surveillance of gastrointestinal infections is used in several countries, including Norway. AIM To investigate the extent of, and explore characteristics associated with, consultations for gastroenteritis in primary care and to compare consultations in daytime general practice and out-of-hours (OOH) services in Norway. DESIGN AND SETTING Registry-based study using reimbursement claims data from all consultations in general practice and OOH services in Norway over the 10-year period, 2006-15. METHODS The main outcome variable was whether the consultation took place in general practice or OOH services. Possible associations with patient age and sex, time and use of point-of-care C-reactive protein (CRP) testing and sickness certificate issuing were investigated. RESULTS Gastroenteritis consultations (n = 1 281 048) represented 0.9% of all consultations in primary care (n = 140 199 637), of which 84.4% were conducted in general practice and 15.6% in OOH services. Young children and young adults dominated among the patients. Point-of-care CRP testing was used in 36.1% of the consultations. Sickness certificates were issued in 43.6% of consultations with patients in working age. Age-specific time variations in consultation frequencies peaking in winter months were observed. CONCLUSIONS The proportion of gastroenteritis consultations was higher in the OOH services when compared with daytime general practice. Young children and young adults dominated among the patients. The seasonal variation in consultation frequency is similar to that shown for gastroenteritis caused by norovirus.
Collapse
Affiliation(s)
- Knut Erik Emberland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Knut-Arne Wensaas
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Sverre Litleskare
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Guri Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| |
Collapse
|
11
|
Gjerde PB, Litleskare S, Lura NG, Tangen T, Helland CA, Wester K. Anxiety and Depression in Patients with Intracranial Arachnoid Cysts-A Prospective Study. World Neurosurg 2019; 132:e645-e653. [PMID: 31442638 DOI: 10.1016/j.wneu.2019.08.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Arachnoid cysts yield cognitive deficits that are normalized after surgical cyst decompression. OBJECTIVE The present study aimed to investigate whether arachnoid cysts also affect symptoms of anxiety and depression, and if surgical cyst decompression leads to reduction of these symptoms. METHODS Twenty-two adult patients (13 men and 9 women) with symptomatic temporal or frontal cysts were included in this questionnaire (Hospital Anxiety and Depression Scale [HADS])-based prospective study. The mean time between answering the preoperative questionnaire and surgery was 37 days. The patients answered the same HADS questionnaire 3-6 months postoperatively. RESULTS Preoperatively, both patients with frontal (N = 4) and patients with temporal (N = 18) cyst had higher mean HADS anxiety scores than those found in the general population. For patients with temporal cyst, there was a significant or near-significant difference in anxiety and depression scores and the combined scores between those with right-sided cysts and those with left-sided cysts. Postoperatively, the HADS scores normalized and were no longer different from those of the general population. The difference in scores between patients with right and left temporal cyst also disappeared. CONCLUSIONS Patients with arachnoid cyst have higher levels of anxiety and depression than do the general population and these scores were normalized after decompressive cyst surgery. We further found a hemispheric asymmetry: patients with a right temporal cyst showed higher anxiety, depression, and combined scores than did patients with a left temporal cyst. Also, this disparity normalized after cyst decompression. Thus, arachnoid cysts seem to affect not only cognition but also the level of affective symptoms.
Collapse
Affiliation(s)
- Priyanthi B Gjerde
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; The Norwegian Centre for Mental Disorders Research (NORMENT) and the K.G. Jebsen Centre for Psychosis Research, Department of Clinical Medicine K2, University of Bergen, Bergen, Norway
| | - Sverre Litleskare
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Research Unit for General Practice, Uni Research Health, Bergen, Norway
| | - Njål Gjærde Lura
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Tone Tangen
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Section of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Christian A Helland
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Department Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Knut Wester
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Department Neurosurgery, Haukeland University Hospital, Bergen, Norway.
| |
Collapse
|
12
|
Litleskare S, Rortveit G, Eide GE, Emberland KE, Hanevik K, Langeland N, Wensaas K. Quality of life and its association with irritable bowel syndrome and fatigue ten years after giardiasis. Neurogastroenterol Motil 2019; 31:e13559. [PMID: 30767352 PMCID: PMC6849782 DOI: 10.1111/nmo.13559] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/21/2018] [Accepted: 01/06/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Gastroenteritis has been associated with complications such as irritable bowel syndrome (IBS) and chronic fatigue (CF). Little is known about the implications for quality of life (QoL) in this setting. The aims of this study were to evaluate the association between exposure to Giardia infection and QoL ten years after the infection, and how this related to IBS and CF. METHODS We followed 1252 patients with laboratory-verified Giardia lamblia infection and a matched control group for 10 years after an epidemic in Bergen, Norway, in 2004. The main outcome was QoL after ten years as defined by the Short-form 12 version 2 with a physical component summary (PCS) and a mental component summary (MCS), both with range 0-100 (T-score). Regression analyses were performed using mixed modeling. KEY RESULTS Mean PCS T-score in the exposed group (51.4; 95% CI: 50.6-52.1) was 2.8 T-score points (95% CI: -3.8 to -1.9, P < 0.001) lower than that in the control group (54.2; 95% CI: 53.7-54.8). The mean MCS T-score was also 2.8 T-score points (95% CI: -3.8 to -1.9, P < 0.001) lower among the exposed (48.9; 95% CI: 48.2-49.6) than the controls (51.7; 95% CI: 51.1-52.4). Further analyses found that the effect of Giardia exposure on QoL was mediated by IBS and CF. CONCLUSIONS & INFERENCES Exposure to Giardia infection was associated with a lower QoL ten years later as compared to a control group, an effect that was mediated by IBS and CF.
Collapse
Affiliation(s)
- Sverre Litleskare
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway,Research Unit for General PracticeNORCE Norwegian Research CentreBergenNorway
| | - Guri Rortveit
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway,Research Unit for General PracticeNORCE Norwegian Research CentreBergenNorway
| | - Geir Egil Eide
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway,Centre for Clinical ResearchHaukeland University HospitalBergenNorway
| | - Knut Erik Emberland
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway,Research Unit for General PracticeNORCE Norwegian Research CentreBergenNorway
| | - Kurt Hanevik
- National Centre for Tropical Infectious DiseasesHaukeland University HospitalBergenNorway,Department of Clinical ScienceUniversity of BergenBergenNorway
| | - Nina Langeland
- National Centre for Tropical Infectious DiseasesHaukeland University HospitalBergenNorway,Department of Clinical ScienceUniversity of BergenBergenNorway,Haraldsplass Deaconess HospitalBergenNorway
| | - Knut‐Arne Wensaas
- Research Unit for General PracticeNORCE Norwegian Research CentreBergenNorway
| |
Collapse
|
13
|
Litleskare S, Rortveit G, Eide GE, Hanevik K, Langeland N, Wensaas KA. Prevalence of Irritable Bowel Syndrome and Chronic Fatigue 10 Years After Giardia Infection. Clin Gastroenterol Hepatol 2018; 16:1064-1072.e4. [PMID: 29378314 DOI: 10.1016/j.cgh.2018.01.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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] [Received: 09/29/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Irritable bowel syndrome (IBS) is a complication that can follow gastrointestinal infection, but it is not clear if patients also develop chronic fatigue. We investigated the prevalence and odds ratio of IBS and chronic fatigue 10 years after an outbreak of Giardia lamblia, compared with a control cohort, and changes in prevalence over time. METHODS We performed a prospective follow-up study of 1252 laboratory-confirmed cases of giardiasis (exposed), which developed in Bergen, Norway in 2004. Statistics Norway provided us with information from 2504 unexposed individuals from Bergen, matched by age and sex (controls). Questionnaires were mailed to participants 3, 6, and 10 years after the outbreak. Results from the 3- and 6-year follow-up analyses have been published previously. We report the 10-year data and changes in prevalence among time points, determined by logistic regression using generalized estimating equations. RESULTS The prevalence of IBS 10 years after the outbreak was 43% (n = 248) among 576 exposed individuals and 14% (n = 94) among 685 controls (adjusted odds ratio for development of IBS in exposed individuals, 4.74; 95% CI, 3.61-6.23). At this time point, the prevalence of chronic fatigue was 26% (n = 153) among 587 exposed individuals and 11% (n = 73) among 692 controls (adjusted odds ratio, 3.01; 95% CI, 2.22-4.08). The prevalence of IBS among exposed persons did not change significantly from 6 years after infection (40%) to 10 years after infection (43%; adjusted odds ratio for the change 1.03; 95% CI, 0.87-1.22). However, the prevalence of chronic fatigue decreased from 31% at 6 years after infection to 26% at 10 years after infection (adjusted odds ratio for the change 0.74; 95% CI, 0.61-0.90). CONCLUSION The prevalence of IBS did not change significantly from 6 years after an outbreak of Giardia lamblia infection in Norway to 10 years after. However, the prevalence of chronic fatigue decreased significantly from 6 to 10 years afterward. IBS and chronic fatigue were still associated with giardiasis 10 years after the outbreak.
Collapse
Affiliation(s)
- Sverre Litleskare
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Research Unit for General Practice, Uni Research Health, Bergen, Norway.
| | - Guri Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Research Unit for General Practice, Uni Research Health, Bergen, Norway
| | - Geir Egil Eide
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Kurt Hanevik
- National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Nina Langeland
- National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Knut-Arne Wensaas
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Research Unit for General Practice, Uni Research Health, Bergen, Norway
| |
Collapse
|
14
|
Litleskare S, Wensaas KA, Eide GE, Hanevik K, Kahrs GE, Langeland N, Rortveit G. Perceived food intolerance and irritable bowel syndrome in a population 3 years after a giardiasis-outbreak: a historical cohort study. BMC Gastroenterol 2015; 15:164. [PMID: 26585714 PMCID: PMC4653841 DOI: 10.1186/s12876-015-0393-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/10/2015] [Indexed: 02/08/2023] Open
Abstract
Background Studies have shown an increased prevalence of irritable bowel syndrome (IBS) after acute gastroenteritis. Food as a precipitating and perpetuating factor in IBS has gained recent interest, but food intolerance following gastroenteritis is less investigated. The aims of this study were firstly, to compare perceived food intolerance in a group previously exposed to Giardia lamblia with a control group; secondly, to explore the relation with IBS status; and thirdly, to investigate associations with content of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) in foods reported. Methods This is a historical cohort study with mailed questionnaire to 1252 Giardia exposed and a control cohort matched by gender and age. Differences between groups were investigated using bivariate and multivariate analyses. Results The questionnaire response rate in the exposed group was 65.3 % (817/1252) and in the control group 31.4 % (1128/3598). The adjusted odds ratio (OR) for perceived food intolerance for the exposed group was 2.00 with 95 % confidence interval (CI): 1.65 to 2.42, as compared with the control group. Perceived intolerance for dairy products was the most frequently reported intolerance, with an adjusted OR for the exposed of 1.95 (95 % CI: 1.51 to 2.51). Perceived intolerance for fatty foods, vegetables, fruit, cereals and alcohol was also significantly higher in the exposed group. The groups did not differ in perceived intolerance to spicy foods, coffee or soda. The association between exposure to Giardia infection and perceived food intolerance differed between the IBS group and the no-IBS group, but IBS was not a significant effect modifier for the association. Perceived intolerance for high FODMAP foods (adjusted OR 1.91) and low FODMAP foods (adjusted OR 1.55) was significantly associated with exposure status. Conclusion Exposure to Giardia infection was associated with perceived food intolerance 3 years after giardiasis. IBS status did not alter the association between exposure status and perceived food intolerance. Perceived intolerance to high FODMAP foods and low FODMAP foods were both statistically significantly associated with exposure to Giardia infection. Electronic supplementary material The online version of this article (doi:10.1186/s12876-015-0393-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sverre Litleskare
- Research Unit for General Practice, Uni Research Health, Kalfarveien 31, N-5018, Bergen, Norway.
| | - Knut-Arne Wensaas
- Research Unit for General Practice, Uni Research Health, Kalfarveien 31, N-5018, Bergen, Norway.
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Kurt Hanevik
- National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway. .,Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Gudrun Elise Kahrs
- Department of Clinical Nutrition, Haukeland University Hospital, Bergen, Norway.
| | - Nina Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Guri Rortveit
- Research Unit for General Practice, Uni Research Health, Kalfarveien 31, N-5018, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| |
Collapse
|