Search

Background: A broncho-esophageal fistula (BEF) is a medical and surgical disaster. Treatment of BEF is often limited to palliative stent treatment that may migrate or cause erosions and tissue necrosis. Surgical repair of BEF is the only established definite treatment., Case Presentation: BEF presented in a 40-year-old female patient 8 years after curative treatment with pneumonectomy and radio-chemotherapy for advanced lung cancer. She had autoimmune comorbidity, a single lung, vocal cord paralysis and an extremely hostile thorax. Multi-disciplinary collaboration, close patient involvement and evaluation by the hospital medical ethics committee were key elements in the following treatment course. After temporary stent treatment, a carefully staged surgical marathon was performed: Veno-venous ECMO was established to secure oxygenation, and bilateral thoracotomy and laparotomy performed to access structures in the frozen mediastinum. After extensive thoracoplasty and high-risk dissection, esophagectomy was performed and the 20 × 35 mm bronchial defect repaired by bronchoplasty with a latissimus muscle flap. It was complicated by thrombotic occlusion of the upper venous system, repeated postoperative bleedings and critical illness neuropathy. The patient recovered and was discharged 150 days after surgery. Within 1-2 years bronchoscopy showed a smooth undiscernible bronchoplasty with a stable open left main bronchus. At 5 years the patient lives an independent life at home with her family., Conclusions: Surgical treatment of BEF in an extremely complex patient may turn out successfully. It demands careful ethical considerations, comprehensive surgical strategy, multi-disciplinary teamwork, and shared decision making with the patient. The patient presented in this case report is closely followed up with good life quality after 5 years., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: The patient has provided written informed consent for inclusion and publication of this case report. Competing interests: The authors declare no competing interests. Guarantor statement: RH is the guarantor of the content of the manuscript and takes responsibility for the integrity of the information and data presented., (© 2025. The Author(s).)

Research focusing on the scope of practice by nurse anesthetists (NAs) is limited. The purpose of this study was to examine NAs' scope of practice in Norway, and to explore whether and how this has changed during the period from 1979 to 2018. The study had a repeated crosssectional design. All members of the Norwegian Association of Nurse Anesthetists at the four time-points (1979, 1989, 1999 and 2018) were invited to participate in a questionnaire study. Inclusion criteria were education and work as an NA and currently working in Norway. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Findings indicate that the scope of NAs' practice in Norway has been increasingly restricted from 1979 to 2018 (N = 2171, P < .001). Additionally, the presence of an anesthesiologist when performing anesthesia had significantly increased during that time (39% in 1979 vs 90% in 2018). However, NAs' independent practice significantly increased in some areas, such as handling of acute situations, (i.e., handling of laryngospasm/bronchospasm [41% in 1979 versus 54% in 2018]). International and national standards underline the independent role of NAs. The development shown in our results should be addressed to avoid further restrictions of NAs' scope of practice., Competing Interests: Name: Ann-Chatrin Linqvist Leonardsen, MSc, PhD, NA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. This author is the corresponding author of this article. Disclosures: This study was funded by the Norwegian Association of Nurse Anesthetists. The funding body did not take part in planning or conduction of the study, or in analysis of data or writing of the manuscript. Name: Sigrunn Drageset, MSc, PhD, NA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: This study was funded by the Norwegian Association of Nurse Anesthetists. The funding body did not take part in planning or conduction of the study, or in analysis of data or writing of the manuscript. Name: Sidsel Ellingsen, MSc, PhD, NA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: This study was funded by the Norwegian Association of Nurse Anesthetists. The funding body did not take part in planning or conduction of the study, or in analysis of data or writing of the manuscript. Name: Therese Jenssen Finjarn, MSc, NA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: This study was funded by the Norwegian Association of Nurse Anesthetists. The funding body did not take part in planning or conduction of the study, or in analysis of data or writing of the manuscript. Name: Leiv Sandvik, PhD Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: This study was funded by the Norwegian Association of Nurse Anesthetists. The funding body did not take part in planning or conduction of the study, or in analysis of data or writing of the manuscript. Name: Marit Vassbotten Olsen, MSc, NA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: This study was funded by the Norwegian Association of Nurse Anesthetists. The funding body did not take part in planning or conduction of the study, or in analysis of data or writing of the manuscript, (Copyright © by the American Association of Nurse Anesthetists.)

Objective: To explore the contribution of pregnancy-related complications on the prevalence of extremely, very and late preterm births in singleton and twin pregnancies. To study the risk of spontaneous preterm birth in twin pregnancies compared with singleton pregnancies., Design: Population-based registry study., Setting: Medical birth registry of Norway and Statistics Norway., Population: Nulliparous women with singleton (n = 472 449) or twin (n = 8727) births during 1999-2018., Methods: Prevalence rates of pregnancy-related complications for extremely, very and late preterm birth in twin and singleton pregnancies were calculated with 95% confidence intervals. Multivariable logistic regression was applied to assess odds ratios for preterm birth, adjusted for obstetric and socio-economic factors., Main Outcome Measures: Extremely preterm (<28 +0  weeks of gestation), very preterm (28 +0 -33 +6  weeks of gestation) and late preterm (34 +0 -36 +6  weeks of geatation) birth., Results: Preterm birth was significantly more prevalent in twin pregnancies than in singleton pregnancies in all categories: all preterm (54.7% vs 6.1%), extremely preterm (3.6% vs 0.4%), very preterm (18.2% vs 1.4%) and late preterm (33.0% vs 4.3%) births. Stillbirth, congenital malformation and pre-eclampsia were more prevalent in twin pregnancies than in singleton pregnancies, but the prevalence of complications differed in the three categories of preterm birth. Pre-eclampsia was more prevalent in singleton than in twin pregnancies ending in extremely and very preterm birth. The adjusted odds of spontaneous preterm live birth were between 19- and 54-fold greater in twin pregnancies than in singleton pregnancies., Conclusions: Singleton and twin pregnancies seem to have different pathways leading to extremely, very and late preterm birth., (© 2022 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Ethnopharmacological Relevance: Gentiana purpurea was one of the most important medicinal plants in Norway during the 18th and 19th centuries, and the roots were used against different types of gastrointestinal and airway diseases., Aim of the Study: To explore the content of bioactive compounds in a water extract from the roots, a preparation commonly used in traditional medicine in Norway, to assess the anti-inflammatory potential, and furthermore to quantify the major bitter compounds in both roots and leaves., Materials and Methods: G. purpurea roots were boiled in water, the water extract applied on a Diaion HP20 column and further fractionated with Sephadex LH20, reverse phase C18 and normal phase silica gel to obtain the low molecular compounds. 1D NMR, 2D NMR, and ESI-MS were used for structure elucidation. HPLC-DAD analysis was used for quantification. The inhibition of TNF-α secretion in ConA stimulated peripheral blood mononuclear cells (PBMCs) was investigated., Results: Eleven compounds were isolated and identified from the hot water extract of G. purpurea roots. Gentiopicrin, amarogentin, erythrocentaurin and gentiogenal showed dose-dependent inhibition of TNF-α secretion. Gentiopicrin is the major secondary metabolite in the roots, while sweroside dominates in the leaves., Conclusions: The present work gives a comprehensive overview of the major low-molecular weight compounds in the water extracts of G. purpurea, including metabolites produced during the decoction process, and show new anti-inflammatory activities for the native bitter compounds as well as the metabolites produced during preparation of the crude drug., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

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., (© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Background: Left vocal cord paralysis (LVCP) is a known complication of patent ductus arteriosus (PDA) surgery in extremely preterm (EP) born neonates; however, consequences of LVCP beyond the first year of life are insufficiently described. Both voice problems and breathing difficulties during physical activity could be expected with an impaired laryngeal inlet. More knowledge may improve the follow-up of EP-born subjects who underwent PDA surgery and prevent confusion between LVCP and other diagnoses. Objectives: Examine the prevalence of LVCP in a nationwide cohort of adults born EP with a history of PDA surgery, and compare symptoms, lung function, and exercise capacity between groups with and without LVCP, and vs. controls born EP and at term. Methods: Adults born EP (<28 weeks' gestation or birth weight <1,000 g) in Norway during 1999-2000 who underwent neonatal PDA surgery and controls born EP and at term were invited to complete questionnaires mapping voice-and respiratory symptoms, and to perform spirometry and maximal treadmill exercise testing. In the PDA-surgery group, exercise tests were performed with a laryngoscope positioned to evaluate laryngeal function. Results: Thirty out of 48 (63%) eligible PDA-surgery subjects were examined at mean (standard deviation) age 19.4 (0.8) years, sixteen (53%) had LVCP. LVCP was associated with self-reported voice symptoms and laryngeal obstruction during exercise, not with lung function or peak oxygen consumption (VO 2 peak). In the PDA-surgery group, forced expiratory volume in 1 second z-score (z-FEV 1 ) was reduced compared to EP-born controls ( n = 30) and term-born controls ( n = 36); mean (95% confidence interval) z-FEV 1 was -1.8 (-2.3, -1.2), -0.7 (-1.1, -0.3) and -0.3 (-0.5, -0.0), respectively. For VO 2 peak, corresponding figures were 37.5 (34.9, 40.2), 38.1 (35.1, 41.1), and 43.6 (41.0, 46.5) ml/kg/min, respectively. Conclusions: LVCP was common in EP-born young adults who had undergone neonatal PDA surgery. Within the PDA-surgery group, LVCP was associated with self-reported voice symptoms and laryngeal obstruction during exercise, however we did not find an association with lung function or exercise capacity. Overall, the PDA-surgery group had reduced lung function compared to EP-born and term-born controls, whereas exercise capacity was similarly reduced for both the PDA-surgery and EP-born control groups when compared to term-born controls., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Engan, Engeset, Sandvik, Gamlemshaug, Engesæter, Øymar, Vollsæter, Røksund, Hufthammer, Halvorsen and Clemm.)

Aims: The aim of this study was to analyse associations between maternal country of birth and preterm birth among women giving birth in Norway. Methods: A population-based register study was conducted employing official national databases in Norway. All singleton births, with neonates without major anomalies, between 1999 and 2014 were included ( N =910,752). We estimated odds ratios (ORs) for extremely preterm birth (<28 weeks gestation), very preterm birth (28-33 weeks gestation) and late preterm birth (34-36 weeks gestation) by maternal country of birth. We conducted multivariable regression analyses, adjusting for maternal, obstetric and socio-economic confounders. Results: For extremely preterm births (0.4% of the study population), women with an unknown country of birth (adjusted OR (aOR)=3.09; 95% confidence interval (CI) 2.26-4.22) and women born in sub-Saharan Africa (aOR=1.66; CI 1.40-1.96) had the highest ORs compared to Norwegian-born women. For very preterm births (1.2% of the study population), women with an unknown country of birth (aOR=1.72; CI 1.36-2.18) and women born in South Asia (aOR=1.48; CI 1.31-1.66) had the highest ORs. For late preterm births (3.8% of the study population), women born in East Asia Pacific/Oceania (aOR=1.33; CI 1.25-1.41) and South Asia (aOR=1.30; CI 1.21-1.39) had the highest ORs. Conclusions: After adjusting for maternal, obstetric and socio-economic risk factors, maternal country of birth remained significantly associated with preterm birth. Women with an unknown country of birth and women born in sub-Saharan Africa were found to be at increased risk of extremely preterm birth.

Purpose: The Oslo Ischaemia Study was designed to investigate the prevalence and predictors of silent coronary disease in Norwegian middle-aged men, specifically validating exercise electrocardiography (ECG) findings compared with angiography. The study has been important in investigating long-term predictors of cardiovascular morbidity and mortality, as well as investigating a broad spectrum of epidemiological and public health perspectives., Participants: In 1972-1975, 2014 healthy men, 40-59 years old, were enrolled in the study. Comprehensive clinical examination included an ECG-monitored exercise test at baseline and follow-ups. The cohort has been re-examined four times during 20 years. Linkage to health records and national health registries has ensured complete endpoint registration of morbidity until the end of 2006, and cancer and mortality until the end of 2017., Findings to Date: The early study results provided new evidence, as many participants with a positive exercise ECG, but no chest pain ('silent ischaemia'), did not have significant coronary artery stenosis after all. Still, they were over-represented with coronary disease after years of follow-up. Furthermore, participants with the highest physical fitness had lower risk of cardiovascular disease, and the magnitude of blood pressure responses to moderate exercise was shown to influence the risk of cardiovascular disease and mortality. With time, follow-up data allowed the scope of research to expand into other fields of medicine, with the aim of investigating predictors and the importance of lifestyle and risk factors., Future Plans: Recently, the Oslo Ischaemia Study has been found worthy, as the first scientific study, to be preserved by The National Archives of Norway. All the study material will be digitised, free to use and accessible for all. In 2030, the Oslo Ischaemia Study will be linked to the Norwegian Cause of Death Registry to obtain complete follow-up to death. Thus, a broad spectrum of additional opportunities opens., Competing Interests: Competing interests: JB is an epidemiologist employed by AstraZeneca. SEK has within the past 3 years received ad hoc lecture honoraria from Getz, Intas, Merck KGaA and Sanofi., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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., (© 2021. The Author(s).)

Women with female genital schistosomiasis (FGS) have been found to have genital symptoms and a three-fold higher risk of HIV infection. Despite WHO recommendations, regular antischistosomal mass drug administration (MDA) has not yet been implemented in South Africa possibly because of the lack of updated epidemiological data. To provide data for future prevention efforts against FGS and HIV, this study explored Schistosoma haematobium prevalence in girls and young women and the effects of antischistosomal MDA, respectively. Urinary schistosomiasis and genital symptoms were investigated in 70 randomly selected secondary schools in three districts within KwaZulu-Natal and 18 primary schools. All study participants were treated for schistosomiasis, and schools with the highest urinary prevalence were followed up after 1 and 4 years of MDA. At baseline, urine analysis data showed that most schools were within the moderate-risk prevalence category where biennial antischistosomal MDA is recommended, as per WHO guidelines. Young women had high prevalence of genital symptoms (36%) after correcting for sexually transmitted infections. These symptoms may be caused by infection with schistosomes. However, FGS cannot be diagnosed by urine analysis alone. In KwaZulu-Natal rural schools, this study suggests that antischistosomal MDA with praziquantel could prevent genital symptoms in more than 200,000 young women. Furthermore, it is feasible that more than 5,000 HIV infections could be prevented in adolescent girls and young women by treatment and prevention of FGS.

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., (© 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: Open-angle glaucoma (OAG) is a collective term for various subgroups of glaucoma of which primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEG) are the most common. There is increasing evidence that both conditions have systemic ramifications. We wanted to examine to what extent lifespan and cause of death are influenced by POAG, pseudoexfoliation syndrome (PES), and PEG., Materials and Methods: Of 1864 people who underwent an eye examination in 1985-86, the presence of PES and/or glaucoma, along with date and cause of death were recorded. Based on information from the National Death Registry, the individuals were classified into the following groups of systemic diseases regarded as causing death: Cardiovascular disease (with two subgroups), cerebrovascular disease and neoplasms., Results: All 1864 persons were followed to death, up to 30 years after examination. No difference in lifespan was observed when comparing OAG (i.e. POAG and PEG together) with the rest of the population. When adjusting for gender and age at inclusion, patients with POAG showed a reduced lifespan in the cardiovascular death group (2.44 years, p = 0.043). When comparing lifespan in the neoplastic group in the glaucoma patients, POAG and PEG, directly against each other, a mean age difference of 6.87 years (p = 0.017) was found., Conclusions: POAG patients showed reduced lifespan due to neoplasia and cardiovascular disease. Persons with PES and PEG did not show these lifespan reductions. Our main conclusion is that POAG and PEG, the two main OAG subgroups, are very different disease entities both from an ocular and a systemic point of view., Competing Interests: The authors declare no conflict of interest., (© 2021 The Authors.)

Objective: Early detection of frailty is essential to prevent or delay disability. The most appropriate screening tool for frailty among home-dwelling older adults is under debate. The present study estimates the prevalence of frailty among older adults, first-time applicants of public home care service in Norway, and investigates the appropriateness of gait speed and Short Physical Performance Battery as screening-tools for frailty., Design and Setting: We conducted a cross-sectional study of 116 older adults >65 years applying for public home care service for the first time. Frailty was assessed by an adapted version of the Fried Frailty Phenotype. The test accuracies of gait speed and Short Physical Performance Battery to detect frailty were calculated for a general population >70 years in Norway., Results: 62.1% of the participants were frail, 29.3% were prefrail, and 8.6% were robust. Mean gait speed and Short Physical Performance Battery-scores were significantly lower in frail compared to prefrail individuals, and significantly lower in prefrail compared to robust individuals. The sensitivity and specificity of gait speed at a cut point of 0.8 m/s to detect physical frailty phenotype was 99% and 68%, respectively., Conclusions: The high prevalence of frailty in the present study indicates that screening for frailty should be considered at an earlier time point than when older adults apply for public home care service for the first time. Gait speed may be an appropriate screening tool for frailty in a general population >70 years in Norway.KEY POINTSThe prevalence of frailty among older adults, first-time applicants of public home care services in Norway is major.Screening for frailty should be considered before older adults apply for public home care service for the first time.Gait speed at a cut point at 0.8 m/s may be an appropriate screening tool for frailty in a general population >70 years in Norway.

Purpose: To describe prevalence, life-time prevalence and incidence of glaucoma in Norway over a 15-year period., Materials and Methods: Data from The Norwegian Prescription Database was used to identify all prescriptions for glaucoma medication during the period 2004 to 2018. Population figures and lifespan data were obtained from The National Bureau of Statistics., Results: Of a population of 5.3 million, a total of 75733 patients using glaucoma eye drops were identified in 2018. The national prevalence was thus 1.4%, whilst in those over 70 years of age, 8.0%. When divided into counties, the prevalence varied between 1.1 and 1.9%. Overall, the prevalence was stable in the period 2004-2018. Life time prevalence was found to be 9.4% for men and 10.2% for women. National one-year incidence proportion per 10000 was 17.0 for the total population and a peak incidence of 93.8/10000 in the 80-89 year age group was identified., Conclusions: Glaucoma prevalence remained stable during the period 2004-2018, while incidence decreased slightly in the elderly population., Competing Interests: The authors have declared that no competing interests exist.

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.

Introduction: Simulation-based learning is a well-established technique in nursing education. However, there is a need for reliable and validated evaluation tools across both national boundaries and cultural conditions. Such evaluation tools may contribute in identifying areas for improvement in simulation-based learning from the nursing students' perspective., Objectives: The aim of this study was to test three widely used American questionnaires - the Simulation Design Scale, the Educational Practices Questionnaire, and the Student Satisfaction and Self-Confidence in Learning Scale, for psychometric properties among Norwegian undergraduate nursing students., Methods: A descriptive cross-sectional study was conducted at a university simulation center in southern part of Norway. A total of 105 undergraduate nursing students participated, giving a response rate of 77%. An exploratory factor analysis was used to examine construct validity. Cronbach's alpha was applied in order to establish the questionnaires' internal consistency., Results: The exploratory factor analyses displayed the same number of extracted factors as the number of subscales in each of the original American questionnaires. However, the item-factor structure differed from the original item-subscales. The Cronbach's alpha was > 0.7 for all three questionnaires, indicating acceptable internal consistency., Conclusion: Psychometric testing of the Norwegian versions of the three questionnaires, the Simulation Design Scale, the Educational Practices Questionnaire, and the Student Satisfaction and Self-Confidence in Learning Scale , could be used as valid instruments for nursing students to evaluate important aspects of simulation-based learning. This also makes it easier to compare evaluation results of SBL across languages and cultural boundaries. However, to confirm the construct validity of the factors extracted in this study, further multi-site studies are needed to perform a confirmatory factor analysis in a new, large sample., Competing Interests: None., (© 2020 The Authors.)

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., Competing Interests: Funding information: Oslo University Hospital funded the study (salary for first author)., (Copyright © 2020 Facts, Views & Vision.)

Background: Alcohol and drug abuse are potentially modifiable risk factors for critical illness. The aims of this study were to describe patients with substance abuse-related admissions (abbreviated SARA) in a mixed intensive care (ICU) population in Oslo, and to compare these patients with patients with non-SARA., Methods: Cross-sectional prospective study of a mixed medical and surgical ICU-population in Oslo, Norway. Data were collected consecutively using a questionnaire, medical records, and toxicology results. SARA included admissions due to acute or chronic complications of alcohol or drug abuse, as well as substance abuse-related injuries., Results: Of the 852 patients included, 168 (20%) had SARA; 102 (12%) alcohol-related and 66 (8%) drug-related. Male patients aged 18-39 had the highest proportion of SARA (47/97, 49%). Among the trauma patients, 69/182 (38%) were influenced by alcohol and drugs at the time of injury. Patients with SARA were significantly younger (median age 48 vs 66), had lower Charlson comorbidity index (mean 1.4 vs 2.5) and shorter length of stay (median days 2.4 vs 4.9), than non-SARA patients. Hospital mortality was similar when adjusting for age (OR 0.8, P = .27, non-SARA as reference)., Conclusion: Overall, one in five ICU admissions was associated with substance abuse. For male patients aged 18-39 this ratio was nearly half. More than one third of the trauma patients were influenced by alcohol or drugs at time of injury., (© 2019 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

Background: Although many people experience loneliness in old age, there is little knowledge of predisposing personality factors. The aim of the present study was to explore to what extent personality traits are associated with the risk of becoming lonely, in women and men aged 60-79 years at baseline., Methods: The panel data are from The Norwegian study on Life course, Ageing and Generations (NorLAG). Our sample consisted of 516 men and 419 women aged 60-79 years, who were surveyed in both 2002-2003 (baseline) and 2007-2008 (follow-up), and who reported not being lonely at baseline. Personality traits were measured by the Big Five scale. Multivariable logistic regression analyses were used to investigate the association between a personality trait and the risk of becoming lonely, with adjustment for age, mental health and living with a partner., Results: At follow-up 59 women and 54 men reported loneliness (14.1% vs. 10.5%, p = 0.092). Among women, high agreeableness at baseline was significantly associated with a higher risk of becoming lonely. Among men, low agreeableness, low conscientiousness and high neuroticism at baseline were significantly associated with a higher risk of becoming lonely., Conclusions: Personality traits related differently to loneliness depending on gender. These findings may be useful when developing strategies for preventing loneliness in old age.

Background: Dry skin is associated with increased transepidermal water loss (TEWL), which has been found to precede atopic dermatitis (AD) in childhood., Objective: We aimed to identify parental, prenatal, and perinatal predictive factors of dry skin, high TEWL, and AD at 3 months of age, and to determine if dry skin or high TEWL at 3 months can predict AD at 6 months., Methods: From the Preventing Atopic Dermatitis and Allergies in children prospective birth cohort study, we included 1150 mother-child pairs. Dry skin, TEWL, and eczema were assessed at 3- and 6-month investigations. Eczema, used as a proxy for AD, was defined as the presence of eczematous lesions, excluding differential diagnoses to AD. High TEWL was defined as TEWL >90th percentile, equaling 11.3 g/m 2 /h. Potential predictive factors were recorded from electronic questionnaires at 18- and 34-week pregnancy and obstetric charts., Results: Significant predictive factors (P < .05) for dry skin at 3 months were delivery >38 gestational weeks and paternal age >37 years; for high TEWL, male sex, birth during winter season, and maternal allergic disease; and for eczema, elective caesarean section, multiparity, and maternal allergic diseases. Dry skin without eczema at 3 months was predictive for eczema at 6 months (adjusted odds ratio: 1.92, 95% confidence interval: 1.21-3.05; P = .005), whereas high TEWL at 3 months was not., Conclusion: In early infancy, distinct parental- and pregnancy-related factors were predictive for dry skin, high TEWL, and AD. Dry skin at 3 months of age was predictive for AD 3 months later., (Copyright © 2019 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Aims and Objectives: (a) To describe and analyse advanced practice nursing students' self-assessment of their clinical competence and need for further training and (b) to analyse the possible predictive variables in their self-assessment., Background: The self-assessment of clinical competence in nursing education is important for identifying professional development and educational needs to improve patient care., Design: A cross-sectional survey following STROBE guidelines was used., Methods: Ninety-nine students from three universities/university colleges in Norway participated in the study, and data were collected using a revised version of the Professional Nurse Self-Assessment Scale II. Descriptive, correlation and regression analyses were performed., Results: The students gave the highest self-assessment ratings for their clinical competence in taking full responsibility and for their need for further training in medication effects and interactions. Although the students gave themselves low ratings for the use of electronic devices, they assessed their need for further training in this area as average. Clinical work experience as a registered nurse and previous higher education level were not significant predictors of clinical competence nor the need for further training., Conclusion: The findings indicate that self-assessment is appropriate for students in advanced practice nursing programmes. This study implies that programmes in advanced practice nursing need to familiarise students with the possibilities of information technology. It questions the entry requirement that stipulates that prospective students must have several years of clinical work experience as registered nurses before entering advanced practice nursing programmes. These programmes need to communicate that competencies other than direct clinical practice are also needed for students' future roles., Relevance to Clinical Practice: The study contributes to the exploration of how students self-assess own clinical competence and need for further training in advanced practice nursing programmes. Further research should evaluate the development of clinical competence., (© 2019 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.)

Background: Thirty-day all-cause readmissions are high after aortic valve replacement (AVR). We aimed to assess the effectiveness of a structured telephone follow-up (TFU) and a 24/7 hotline on reducing 30-day all-cause readmission (30-DACR) after AVR, on reducing symptoms of anxiety and depression and on improving perceived health state., Methods: A prospective randomized controlled trial was conducted. Patients (n = 288) were randomly allocated to either post-discharge usual care or to care that provided TFU and access to a 24/7 hotline after AVR. Ancillary endpoints were time-to-event (readmission), proportion of avoidable versus unavoidable readmissions after AVR, and predictors of 30-DACR after AVR., Results: 30-DACR was 22.3%. The structured TFU and 24/7 hotline intervention failed to reduce 30-DACR rates after AVR (P = 0.274). Symptoms of anxiety were significantly reduced 30 days after surgery (P = 0.031), an effect that did not persist one year after surgery (P = 0.108). Most readmissions occurred before 15 days post-discharge, and 75% of them were deemed to be unavoidable. Pleural drainage before hospital discharge (P = 0.027) and symptoms of anxiety before surgery (P = 0.003) were predictors of 30-DACR after AVR., Conclusion: The TFU and 24/7 hotline had no effect on reducing 30-DACR after AVR. However, we did measure reduced symptoms of anxiety the first month after AVR. Anxiety reduction appeared to be an important target for intervention, because we found it to be a risk factor for readmission. Future research should focus on the effectiveness of interventions to prevent avoidable unplanned readmissions., Trial Registration: ClinicalTrial.gov, NCT02522663., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: To examine whether serum levels of potassium and sodium were associated with long-term cancer risk in initially healthy men., Patients and Methods: A cohort of 1994 initially healthy men with no use of medication, aged 40-59 years, was followed for cancer during 40 years of follow-up. Associations between fasting electrolyte levels and cancer risk were assessed with incidence rates and Cox proportional hazards models., Results: Potassium, but not sodium, was linearly associated with cancer risk. This association remained significant after adjustment of several potential confounding factors, and also after excluding the first 10 years of follow-up. The age-adjusted risk of all-site cancer increased with 16% for each SD increase in potassium level. Men with hyperkalemia showed an incidence rate that was 40% higher than for men with normal potassium levels., Conclusion: Fasting serum potassium level in healthy men was positively associated with long-term cancer risk. Potassium or potassium ion channels may have a role in cell proliferation or differentiation. These findings might imply future cancer strategies for targeting individuals with high serum potassium levels., Competing Interests: The authors report no conflicts of interest in this work., (© 2020 Falk et al.)

Objectives: Patients with voice-related disorders are ideally treated by a multidisciplinary team. Acoustic voice analysis and patient-reported outcome measures are recommended parts of the clinical assessment. The present paper aims at further documenting the importance of acoustic voice analyses, maximum phonation time (MPT) and Voice Handicap Index (VHI) into clinical investigations., Study Design: The participants (N = 80 larynx cancer, N = 32 recurrent palsy, N = 23 dysfunctional, N = 75 degenerative/inflammation (N = 19 various excluded)) were included consecutively at the outpatient laryngology clinic at Haukeland University Hospital. In addition, a control group of 98 healthy subjects were included., Method: Voice samples, MPT, and the VHI scores in addition to standard clinical information were obtained. Acoustic analyses were performed from these samples determining level of jitter, shimmer and Noise-to-Harmonic ratio (NHR) as well as analyzing frequency of a prolonged vowel., Results: Jitter, shimmer, and NHR scores correlated strongly (r ≈ 0.8; P < 0.001) to each other. By Analysis of Variance analyses, we have determined significant dependence on diagnostic group analyzing all the obtained acoustic scores (all P < 0.001). All patient groups but the dysfunctional group scored to some extent worse than the control group (mostly at P < 0.001). In addition, jitter scores from dysfunction group were lower than recurrent palsy group (P < 0.05) and shimmer scores were lower among dysfunctional than the cancer group (P < 0.05). Regarding NHR the cancer patients scored higher than the degenerative/inflammatory group (P < 0.05). The cancer group scored with longer MPT than the degenerative/inflammatory (P < 0.001) and recurrent palsy groups (P < 0.05)., Conclusion: Among larynx disease patients acoustic and MPT analyses segregated with all determined analyses between patients and control conditions except the dysfunctional group, but also to some extent between various patient groups. VHI scores correlated to jitter, shimmer and NHR scores among cancer and degenerative/inflammatory disease patients. Acoustic analyses potentially add information useful to laryngological patient studies., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: To identify predictors of disease among a few factors commonly associated with endometriosis and if successful, to combine these to develop a prediction model to aid primary care physicians in early identification of women at high risk of developing endometriosis., Design: Cross-sectional anonymous postal questionnaire study., Setting: Women aged 18-45 years recruited from the Norwegian Endometriosis Association and a random sample of women residing in Oslo, Norway., Participants: 157 women with and 156 women without endometriosis., Main Outcome Measures: Logistic and least absolute shrinkage and selection operator (LASSO) regression analyses were performed with endometriosis as dependent variable. Predictors were identified and combined to develop a prediction model. The predictive ability of the model was evaluated by calculating the area under the receiver operating characteristic curve (AUC) and positive predictive values (PPVs) and negative predictive values (NPVs). To take into account the likelihood of skewed representativeness of the patient sample towards high symptom burden, we considered the hypothetical prevalences of endometriosis in the general population 0.1%, 0.5%, 1% and 2%., Results: The predictors absenteeism from school due to dysmenorrhea and family history of endometriosis demonstrated the strongest association with disease. The model based on logistic regression (AUC 0.83) included these two predictors only, while the model based on LASSO regression (AUC 0.85) included two more: severe dysmenorrhea in adolescence and use of painkillers due to dysmenorrhea in adolescence . For the prevalences 0.1%, 0.5%, 1% and 2%, both models ascertained endometriosis with PPV equal to 2.0%, 9.4%, 17.2% and 29.6%, respectively. NPV was at least 98% for all values considered., Conclusions: External validation is needed before model implementation. Meanwhile, endometriosis should be considered a differential diagnosis in women with frequent absenteeism from school or work due to painful menstruations and positive family history of endometriosis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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.

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., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2019 The Authors.)

Cancer prevention efforts include modification of unhealthy lifestyle, such as smoking cessation and resisting gain in body weight. Although physical activity is inversely related to risk of several cancers, it is poorly studied whether changes in physical activity or fitness influence future cancer risk. Thus, we aimed to investigate whether changes in midlife cardiorespiratory fitness (CRF), body mass index (BMI), and smoking habits influence cancer incidence and mortality. The study cohort includes 1689 initially healthy men, aged 40-59 years. Measurements of CRF, BMI and information on smoking habits were collected in two repeated waves, 7 years apart. Cox regression models estimated associations as hazard rates (HR) with 95% confidence intervals (CI), between midlife changes in the modifiable lifestyle factors and cancer incidence and mortality. The men were followed prospectively for more than 30 years. Compared to CRF loss (>5%), improved CRF (>5%) was associated with lower cancer incidence (HR 0.81, 95% CI 0.67-0.98) and mortality (HR 0.70, 95% CI 0.54-0.92), and maintaining the CRF stable yielded lower cancer incidence (HR 0.76, 95% CI 0.61-0.95). No association was seen for BMI gain, but maintaining the BMI stable was related to lower cancer incidence (HR 0.77, 95% CI 0.60-0.98), compared to BMI loss. Continue smoking was associated with higher cancer incidence and mortality, compared to men who stopped smoking. In particular, this study adds new knowledge about the potential preventive role of CRF in cancer development and emphasizes lifestyle modification as a highly important effort in cancer prevention., (© 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Introduction: Exercise induced laryngeal obstruction (EILO) is relatively common in adolescents, with symptoms often confused with exercise induced asthma. EILO often starts with medial or inward rotation of supraglottic structures of the larynx, whereas glottic adduction appears as a secondary phenomenon in a majority. Therefore, surgical treatment (supraglottoplasty) is used in thoroughly selected and highly motivated patients with pronounced symptoms and severe supraglottic collapse. Aim: To investigate efficacy and safety of laser supraglottoplasty as treatment for severe supraglottic EILO by retrospective chart reviews. Methods: The EILO register at Haukeland University Hospital, Bergen, Norway was used to identify patients who had undergone laser supraglottoplasty for severe supraglottic EILO, verified by continuous laryngoscopy exercise (CLE) test, during 2013-2015. Laser incision in both aryepiglottic folds anterior to the cuneiform tubercles and removal of the mucosa around the top was performed in general anesthesia. Outcomes were questionnaire based self-reported symptoms, and laryngeal obstruction scored according to a defined scheme during a CLE-test performed before and after surgery. Results: Forty-five of 65 eligible patients, mean age 15.9 years, were included. Post-operatively, 38/45 (84%) patients reported less symptoms, whereas CLE-test scores had improved in all, of whom 16/45 (36%) had no signs of obstruction. Most improvements were at the supraglottic level, but 21/45 (47%) also improved at the glottic level. Two of 65 patients had complications; self-limiting vocal fold paresis and scarring/shortening of plica ary-epiglottica. Conclusion: Supraglottoplasty improves symptoms and decreases laryngeal obstruction in patients with severe supraglottic EILO, and appears safe in highly selected cases.

Background and aims Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is challenging to live with, often accompanied by pervasive fatigue and pain, accompanied by decreased quality of life (QoL) as well as anxiety and/or depression. Associations between higher pain, lower QoL and higher anxiety and depression have been shown in patients with various chronic pain disorders. Few studies have however examined such associations in a sample of patients with ME/CFS. The aims of the current study were to examine the impact of pain levels and compare levels of pain, health related QoL, anxiety and depression between patients with ME/CFS and healthy controls. In addition, the study aimed and to examine these relationships within the patient group only. Methods This is a cross-sectional questionnaire based study comparing 87 well-diagnosed patients with ME/CFS with 94 healthy controls. The De Paul Symptom Questionnaire (DSQ), the Medical Outcomes Study Short-Form Surveys (SF-36) and the Hospital Anxiety and Depression Scale (HADS) were used to examine and compare pain, physical function, QoL, anxiety and depression in patients and healthy controls. Further the pain variables were divided into pain total, pain intensity and a pain frequency score for analyses of the above mentioned variables within the patient group only. Results Significantly higher levels of pain, anxiety and depression, and lower levels of QoL were found in the patient group compared with healthy controls. For the patient group alone, pain was significantly associated with lower QoL in terms of physical functioning, bodily pain, general health functioning, vitality and social functioning capacity. In this patient sample, only frequency of joint pain showed significant difference in psychological variables such as depression and anxiety - depression combined. Conclusions ME/CFS patients differ significantly from healthy controls in pain, health related QoL, anxiety and depression. Pain is significantly associated with reduced QoL and overall a lower level of functioning. The relation between pain and anxiety and depression appears less clear. Implications Pain is for many ME/CFS patients associated with reduced physical functioning and reduced QoL. A thorough pain assessment can therefore be essential for clinicians, and subsequent medical pain treatment combined with good pain coping skills may increase functioning level and QoL for these patients. The link between joint pain and psychological factors should also be focused in clinical practice in terms of mapping and counseling. Pain should be further examined to understand the importance it may have for functioning level as reduced function is a main criteria when diagnosing the patients.

Background: Recognizing patients with encephalitis may be challenging. The cardinal symptom, encephalopathy, has a wide array of differential diagnoses. In this prospective study we aimed to explore the etiology of encephalitis and to assess the diagnostic accuracy of symptoms and clinical findings in patients with encephalitis in an encephalopathic population., Methods: Patients with acute onset of encephalopathy (n = 136) were prospectively enrolled from January 2014-December 2015 at Oslo University Hospital, Ullevaal. Clinical and biochemical characteristics of patients who met the case definition of encephalitis were compared to patients with encephalopathy of other causes., Results: Among 136 patients with encephalopathy, 19 (14%) met the case-definition of encephalitis. For 117 patients other causes of encephalopathy were found, infection outside the CNS was the most common differential diagnosis. Etiology of encephalitis was confirmed in 53% (4 bacterial, 4 viral, 1 parasitic, and 1 autoimmune). Personality change, nausea, fever, focal neurology, recent travel history, and low inflammation markers were significantly more abundant in patients with encephalitis, but the diagnostic accuracy for individual parameters were low (area under the curve (AUC) < 0.7). The combination of fever (OR = 6.6, 95% CI, 1.6-28), nausea (OR = 8.9, 95% CI, 1.7-46) and a normal level of ESR (erythrocyte sedimentation rate < 17 mm/hr, OR = 6.9, 95% CI, 1.5-33) was significant in multivariate analysis with an AUC (area under the curve) of 0.85 (95% CI, 0.76-0.94). Moderately increased pleocytosis in CSF (5-100 × 10 6 /L) further increased the diagnostic accuracy of this combination, AUC 0.90 (95% CI, 0.81-0.98)., Conclusions: There is a wide diversity in differential diagnoses in patients with encephalopathy, and no single symptom or finding can be used to predict encephalitis with high accuracy in this group. The combination of fever, nausea and a low ESR in an encephalopathic population, increased the diagnostic accuracy of encephalitis compared to solitary parameters. The triad could be a useful clinical tool for early diagnosis of encephalitis, and these patients should be considered for further diagnostics such as lumbar puncture (LP).

Approximately 50% of uveal melanoma patients develop metastases. We want to evaluate the effect of stricter criteria on our data from our previous study correlating survival and bone marrow (BM) micrometastasis results using our immunomagnetic separation (IMS) method. Mononuclear cell fractions (MNC) isolated from BM were examined for tumour cells and the patients were classified as BM positive (BM+) or BM negative (BM-). The study originally included 328 consecutive patients with uveal melanoma from 1997 to 2006. The cohort was limited to 217 patients when we introduced cyto- or histopathological verification of melanoma cells in the patient as a main new criterion for inclusion. Tumour cells were found in BM-samples in 38.7% (95% CI, 32-45) at enrolment. Until the latest work-up 43.8% (95% CI, 38-50) of patients had developed melanoma metastases. After a minimum follow-up time of 8.5 years, 60.4% (95% CI, 54-66) of patients had died. The causes were: melanoma metastases 69.5%, another type of cancer 5.4% and non-cancerous causes 19.5%. Overall median survival was shorter for the BM- patients (11.3 years) (95% CI, 10-12) compared to the BM+ (16.5 years) (95% CI, 12-14), p = 0.04, log rank test. All-cause mortality and specific melanoma mortality estimated after 12 year follow-up showed a highly significant difference comparing BM- and BM+, p = 0.010 and p = 0,017, respectively. IMS yields a high fraction of BM+ samples due to micrometastasis at diagnosis and these cells appear to have a positive prognostic impact strengthening our previous report. The late recurrences support the concept of tumour dormancy.

Background and Purpose: Exercise interventions are effective at preventing falls in community-dwelling older adults, especially before disability is present. Gait speed below 1.0 m/s is a strong predictor for falls in the elderly. However, evidence is sparse for gait speed alone being sufficient to identify individuals at a high risk of falling. This study aimed to describe the prevalence of fall risk factors among community-dwelling older adults in their late 70s and to investigate the associations between these risk factors and low gait speed in this population., Methods: This cross-sectional cohort study comprised 108 elderly living in a small Norwegian municipality, born between 1936 and 1938. Exclusion criteria were living in residential care, inability to walk 4 m, and severe cognitive impairment. Measurements included gait speed, depressive symptoms, executive functions, fear of falling, vision function, fall history, body mass index, medications, and comorbidity. Gait speed was dichotomized using a cut-off of 1 m/s, and associations between different risk factors and low gait speed was explored using logistic regression analysis., Results: Mean gait speed was 1.0 ± 0.3 m/s. In 44.4% of the participants, gait speed was below 1.0 m/s, indicating increased fall risk. Low gait speed was significantly associated with a history of multiple falls (odds ratio [OR] = 3.70, 95% CI [1.18, 11.65]), low educational level (OR = 3.58, 95% CI [1.10, 11.66]), higher number of medications (OR = 4.28, 95% CI [1.63, 11.2]), and higher number of depressive symptoms (OR = 1.31, 95% CI [1.09, 1.58]). We found no significant associations between gait speed and comorbidity, sex, vision, executive functions, or fear of falling., Conclusion: Our results indicate that gait speed with cut-off 1.0 m/s could represent a useful tool for identifying individuals who are vulnerable but not yet disabled and could benefit from fall-preventive exercise. However, extended assessment is probably needed to personalize interventions., (Copyright © 2018 John Wiley & Sons, Ltd.)

Introduction: Women with endometriosis have reduced health-related quality of life (HRQoL). However, comparisons to the general population and other patient groups are lacking., Material and Methods: The present cross-sectional questionnaire study included 157 women with endometriosis, 156 women from the general population, and 837 women with rheumatoid arthritis (RA). During a period from 2012 to 2013, women aged 18-45 years were recruited from the Norwegian Endometriosis Association and from a random sample of women residing in Oslo, Norway. HRQoL data from women with RA were included from a survey conducted in 2009 among patients of the Oslo Rheumatoid Arthritis Register. The Short Form-36 (SF-36) questionnaire was used to measure HRQoL., Results: Compared with the control group, the endometriosis group had significantly reduced mean scores for all SF-36 scales. The difference was largest for the scale bodily pain with a mean score of 47.6 in the endometriosis group vs 81.5 in the control group. Compared with the RA group, the endometriosis group had significantly reduced mean scores for the three SF-36 scales vitality, social functioning, and mental health. The mean scores of these scales in the endometriosis group were 33.4, 62.7, and 66.3, respectively, vs 42.7, 68.8, and 72.6 in the RA group., Conclusions: Women with moderate to severe endometriosis seem to have overall impaired HRQoL compared with women from the general population, and poorer mental HRQoL compared with women with RA., (© 2018 Nordic Federation of Societies of Obstetrics and Gynecology.)

Background: Pseudoexfoliation syndrome (PES) is a common eye condition, indicating a risk of various eye diseases. Whether or not PES has extra-ocular physiological or even pathophysiological implications has been a matter of controversy for years., Methods: In total 1888 persons were examined for PES in 1985-86. Of these, 1864 (98·7%) had died and were therefore available for analysis by 01.01.2016. Age and cause(s) of death were recorded. 9 diagnostic groups (cardiovascular disease, cerebrovascular disease, neoplasms, systemic hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), Parkinson's disease, aortic aneurysm (AA), and amyloidosis) based on ICD-coding were analyzed for both a possible association between PES and lifespan, as well as PES and specific systemic diseases., Findings: In the cardiovascular group, PES was not associated with an alteration in longevity. The subgroups acute myocardial infarction and other cardiovascular diseases revealed significantly reduced and increased lifespan, respectively, compared to the rest of the population. These deviations were independent of PES. The impact of PES on the neoplasm group showed that PES-positive persons lived 1·81 years (p < 0·001) longer than PES-negative persons. No significant differences in the PES prevalence were found in any of the cause of death diagnostic groups., Interpretations: The present study suggests that lifespan reduction due to neoplasia is nullified by PES, and that this phenomenon is not restricted to one specific neoplasm type. Thus, the paradoxical conclusion emerges that PES provides a lifespan benefit to the patient with a neoplasm. For the remaining diagnostic groups, PES was neither associated with an altered lifespan, nor with any cause of death diagnoses.

Background: Psoriasis vulgaris is a chronic, inflammatory skin disease characterized by a dysregulated immune response and it is associated with substantial systemic comorbidities. Biological drugs such as tumour necrosis factor (TNF)-α inhibitors can ameliorate the disease but are expensive. Biosimilar drugs have the same amino-acid sequence as the originator, but differences in manufacturing can affect biological activity, efficacy and tolerability., Objectives: To explore potential differences in intracellular phosphorylation of signalling molecules in peripheral blood cells from patients with psoriasis treated with the TNF-α inhibitor infliximab compared with healthy controls, and to investigate if the phosphorylation pattern was influenced by switching from the originator infliximab to the biosimilar CT-P13., Methods: By flow cytometry, we measured phosphorylation of nuclear factor kappa B, extracellular signal-regulated kinase 1/2, p38 mitogen-activated protein kinase and signal transducer and activator of transcription 3, before and after TNF-α stimulation in monocytes and T, B, natural killer and CD3 +  CD56 + cells from 25 patients with psoriasis treated with infliximab and 19 healthy controls., Results: At inclusion, phosphorylation levels of peripheral blood mononuclear cells (PBMCs) were increased in patients with psoriasis compared with healthy controls, even though clinical remission had already been achieved. Phosphorylation levels declined in patients on both originator infliximab and biosimilar during continued treatment. No significant differences were detected between the two medications after 12 months., Conclusions: Patients with psoriasis on infliximab have higher activation levels of PBMCs than do healthy controls, possibly reflecting systemic inflammation. Switching from the originator infliximab to biosimilar CT-P13 did not affect phosphorylation levels or clinical parameters, suggesting that CT-P13 is a noninferior treatment alternative to the originator infliximab., (© 2017 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)

Introduction: The Endometriosis Health Profile-30 is a disease-specific patient-reported outcome measure of health-related quality of life. Cross-cultural validation of the Endometriosis Health Profile-30 has been performed for several translated versions. The aim of this study was to evaluate the measurement properties of a Norwegian version Endometriosis Health Profile-30., Methods: This study was designed as a cross-sectional anonymous postal questionnaire study. A total of 157 women with endometriosis were included during a period from 2012 to 2013. Women aged 18-45 years were recruited from the Norwegian Endometriosis Association. Principal components analysis with varimax rotation was used to assess construct validity. Short Form-36 was used to determine convergent validity. Cronbach's alpha was used to measure internal consistency. Intraclass correlation coefficients and paired t-tests were used to evaluate test-retest reliability. Floor and ceiling effects were estimated., Results: Factor analysis resulted in a three and five-factor model for the core and modular questionnaire, respectively. Factor analysis could not support construct validity of the scales self-image and treatment. The Norwegian version Endometriosis Health Profile-30 demonstrated acceptable internal consistency and test-retest reliability, except for the scale relationship with children. Floor effects were observed for the scales self-image (20.1%), work life (33.9%), relationship with children (34.2%), and medical profession (20.5%)., Conclusion: The construct self-image does not seem to be measured appropriately by the Norwegian version Endometriosis Health Profile-30, suggesting a lack of cross-cultural validity of the Endometriosis Health Profile-30. With multinational studies increasing, adequate translation, cross-cultural adaptation, and cross-cultural validation of instruments are essential to ensure equivalence in languages and cultures other than the original., Competing Interests: Declaration of conflicting interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Persons with chronic disabilities face a wide variety of problems with functioning that affect their level of physical activity and participation. We have limited knowledge about the effect of adapted physical activity (APA)-based rehabilitation on perceived mental and physical functioning., Aim: The main aim of this study was to evaluate the effect of APA‑based rehabilitation compared to waiting‑list on perceived mental and physical functioning. Secondly, we wanted to assess whether improvement in self‑efficacy, motivation, pain and fatigue during rehabilitation was related to the effect of the intervention., Design: Randomized controlled trial., Setting: In‑patient rehabilitation Center., Population: All subjects above 17 years who were referred by their physician to BHC between July 1, 2010 and August 1, 2012 without major cognitive or language problems were eligible for the study (N.=321)., Methods: Persons above 17 years (men and women) with chronic disabilities who applied for a rehabilitation stay, were randomized to an adapted physical activity‑based rehabilitation intervention (N.=304) or waiting‑list with delayed rehabilitation. A total of 246 consented and were allocated to four week intervention or a waiting‑list control group. The main outcome was physical and mental functioning evaluated four weeks after rehabilitation using the Medical Outcomes Study 12-Item Short‑Form Health Survey (SF-12)., Results: Compared to waiting‑list the adapted physical activity‑based intervention improved physical and mental functioning. Improvement in physical functioning during rehabilitation was related to reduced pain, improved motivation and self‑efficacy., Conclusions: The results indicate that an adapted physical activity‑based rehabilitation program improves functioning. Improved efficacy for managing disability may mediate the improvement in mental functioning., Clinical Rehabilitation Impact: Adapted physical activity‑based rehabilitation should be considered during the development of rehabilitation strategies for people with chronic disabilities. Motivational and self‑efficacy aspects must be addressed when organizing and evaluating rehabilitation programs.

Background: Radial Extracorporeal Shock Wave Therapy (rESWT) is increasingly used to treat patients with subacromial pain syndrome despite conflicting evidence of its effectiveness. Better knowledge regarding prognostic factors may contribute to the improvement in treatment and prognosis for the patients., Aim: The first aim of this study was to evaluate the effect of rESWT in addition to supervised exercises in patients with subacromial pain syndrome after one year. The second aim was to identify predictors of pain and disability and work status after one year in this patient group., Design: A randomized, double-blind, sham-controlled trial., Setting: An outpatient shoulder clinic of a University hospital., Methods: Patients aged 25 to 70 years, with subacromial pain syndrome lasting at least three months were included and randomly assigned to receive either rESWT and supervised exercises or sham rESWT and supervised exercises. The Shoulder Pain and Disability Index (SPADI) and work status were assessed after one year., Results: We screened 265 patients and enrolled 143; 74 were allocated to receive sham rESWT and exercises, and 69 were allocated to receive rESWT and exercises. After one year, no differences were found for the SPADI Score (mean difference -1.6, 95% confidence interval (CI) -10.2 to 7.0, P=0.71). Subgroup analysis of patients with calcification in the rotator cuff demonstrated no significant additional effect of rESWT to supervised exercises (mean difference -6.3, 95% CI -22.4 to 9.8, P=0.44). Marital status (single), frequent use of pain medication, not working at baseline, negative outcome expectations, low self-reported general health status and few supervised exercise sessions predicted a poor outcome on SPADI after one year., Conclusions: Radial ESWT was not superior to sham rESWT in addition to supervised exercises in the long term for patients with subacromial pain syndrome. The identified predictors for pain, disability and work should be assessed in future studies and addressed by clinicians in order to improve the effectiveness of supervised exercises., Clinical Rehabilitation Impact: Radial ESWT should not be recommended for patients with subacromial pain syndrome. Clinicians should assess patient`s outcome expectations, and if possible reduce the use of pain medication and sick leave in this patient group.

Objective: A 2-month randomized clinical trial (RCT) study comparing electric and manual toothbrushes used by residents in nursing homes showed significant reduction in plaque score for both groups. The aim of this follow up study was to study if the effect sustained in a longer perspective when toothbrushes were used according to resident's own preference., Materials and Methods: One year after baseline of the RCT-study, 100 participants were re-examined. The simplified oral hygiene index (OHI-S) was used as outcome measure on dental plaque., Results: The mean age was 86.6, 78.1% had three or more medical diagnoses and 52.2% had moderate to severe cognitive impairment. The mean number of natural teeth was 18.8. After 1 year, mean plaque scores was significantly reduced within the population, from 1.2 to 0.7 (p < .001). A total of 46 participants preferred to use an electric toothbrush and 54 preferred manual. No significant difference in plaque score was found between electric and manual toothbrushes., Conclusion: After 1 year, the improvement in dental hygiene from the RCT study sustained for users of both electric and manual toothbrush. Focus upon tooth brushing seems to be efficient and both manual and electric toothbrushes should be available in nursing homes.

Background: Prader-Willi syndrome (PWS) is the most common genetic human obesity syndrome and is characterized by hypotonia, endocrine disturbances, hyperphagia, obesity and mild mental retardation. Oral abnormalities, such as decreased salivary flow rates and extreme tooth wear, have also been described. Studies have shown a significant increase in reflux symptoms in individuals with obstuctive sleep apnoea syndrome and increased BMI, both of which are typical findings in PWS. Gastro-oesophageal reflux disease (GORD) has been identified in some individuals with PWS and is a significant intrinsic factor in dental tooth wear. The aim of this study was therefore to estimate the prevalence of GORD in adults and children and to evaluate a possible correlation between GORD and tooth wear in adults with PWS. They were all registered at the TAKO-centre., Results: Twenty-nine individuals, 17 adults with a mean age of 32.6 years (range 18-48) and 12 children with a mean age of 8.8 years (range 3-17), agreed to undergo 24-hour oesophageal pH monitoring, and 90% of those enrolled managed to complete the examination. Four children and eleven adults were diagnosed with pathological gastro-oesophageal reflux, which is defined as acid exposure (pH less than 4) more than 3.6 or 4.3 percent of the time, respectively. Manometry performed in the adult group showed a pathologically high lower oesophageal sphincter pressure in four of the five individuals who had normal oesophageal pH values (pH under 4 less than 4.3% of the time). The two groups (reflux and non-reflux) were well balanced according to BMI, genotype, tooth grinding and hyposalivation. However, twice as many individuals in the reflux group as in the non-reflux group reported high consumption of acidic foods and drinks. Increased tooth wear was significantly correlated with GORD in the two groups (reflux n=6 and non-reflux n=6)., Conclusions: The prevalence of gastro-oesophageal reflux is high in individuals with PWS. Tooth wear was strongly associated with GORD and acidic drinks, and both may be important aetiological factors underlying the extreme tooth wear in this group. Our data suggest a need for routine screening for GORD and dental wear in young individuals with Prader-Willi syndrome.

The advancement of human retinal pigment epithelial cell (hRPE) replacement therapy is partly dependent on optimization of cell culture, cell preservation, and storage medium. This study was undertaken to search for a suitable storage temperature and storage medium for hRPE. hRPE monolayer sheets were cultured under standard conditions at 37°C and then randomized for storage at six temperatures (4, 16, 20, 24, 28, and 37°C) for 7 days. After revealing a suitable storage temperature, hRPE sheets were subsequently stored with and without the silk protein sericin added to the storage medium. Live/dead assay, light microscopy, pH, and phenotypic expression of various proteins were used to assess cell cultures stored at different temperatures. After 7 days of storage, hRPE morphology was best preserved at 4°C. Addition of sericin to the storage medium maintained the characteristic morphology of the preserved cells, and improved pigmentation and levels of pigmentation-related proteins in the cultured hRPE sheets following a 7-day storage period at 4°C.

Introduction: High maternal body mass index (BMI) is associated with complications during pregnancy and delivery such as gestational diabetes, hypertensive disorders, perineal injuries and macrosomia. The aim of this study was to assess the association between maternal BMI and delivery method in non-breech, singleton deliveries, after 36 weeks of gestation, in women with no more than one previous cesarean section, in Oslo University Hospital, Ullevål., Material and Methods: This retrospective register study used data from the hospital obstetrical database in 2011-2012, forming a cohort of 8821 women. Women were categorized into five different BMI classes and stratified into subgroups according to parity and previous cesarean delivery. Mode of delivery was categorized to spontaneous delivery, instrumental vaginal delivery, planned cesarean section and emergency cesarean section., Results: Incidence of emergency cesarean delivery increased with increasing maternal BMI. Among primiparous women with overweight or obesity, the caesarean delivery rate was doubled (23.2 and 29.1%, respectively), compared with women with underweight or normal weight (12.5 and 13.7%). Also among parous women, maternal BMI ≥30 doubled the risk for cesarean delivery. The strongest risk factor for planned or emergency cesarean delivery was previous cesarean section [adjusted odds ratio 16.41 (confidence interval 12.19-22.08) and 8.72 (6.33-12.02), respectively]. Maternal BMI ≥30 increased the risk of planned cesarean delivery by 77%, and doubled the risk of emergency cesarean delivery., Conclusions: Prepregnancy BMI ≥30 was an independent risk factor for delivery by emergency cesarean section for both primiparous and parous women., (© 2017 Nordic Federation of Societies of Obstetrics and Gynecology.)

Background: Experiencing a stillbirth can be a potent stressor for psychological distress in the subsequent pregnancy and possibly after the subsequent birth. The impact on women's relationship with her partner in the subsequent pregnancy and postpartum remains uncertain. The objectives of the study were 1) To investigate the prevalence of anxiety and depression in the pregnancy following stillbirth and assess gestational age at stillbirth and inter-pregnancy interval as individual risk factors. 2) To assess the course of anxiety, depression and satisfaction with partner relationship up to 3 years after the birth of a live-born baby following stillbirth., Methods: This study is based on data from the Norwegian Mother and Child Cohort Study, a population-based pregnancy cohort. The sample included 901 pregnant women: 174 pregnant after a stillbirth, 362 pregnant after a live birth and 365 previously nulliparous. Anxiety and depression were assessed by short-form subscales of the Hopkins Symptoms Checklist, and relationship satisfaction was assessed by the Relationship Satisfaction Scale. These outcomes were measured in the third trimester of pregnancy and 6, 18 and 36 months postpartum. Logistic regression models were applied to study the impact of previous stillbirth on depression and anxiety in the third trimester of the subsequent pregnancy and to investigate gestational age and inter-pregnancy interval as potential risk factors., Results: Women pregnant after stillbirth had a higher prevalence of anxiety (22.5%) and depression (19.7%) compared with women with a previous live birth (adjusted odds ratio (aOR) 5.47, 95% confidence interval (CI) 2.90-10.32 and aOR 1.91, 95% CI 1.11-3.27) and previously nulliparous women (aOR 4.97, 95% CI 2.68-9.24 and aOR 1.91, 95% CI 1.08-3.36). Gestational age at stillbirth (> 30 weeks) and inter-pregnancy interval <  12 months were not associated with depression and/or anxiety. Anxiety and depression decreased six to 18 months after the birth of a live-born baby, but increased again 36 months postpartum. Relationship satisfaction did not differ between groups., Conclusion: Women who have experienced stillbirth face a significantly greater risk of anxiety and depression in the subsequent pregnancy compared with women with a previous live birth and previously nulliparous women.

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., (© 2017 Royal College of Obstetricians and Gynaecologists.)

The predictive value of coronary artery calcium (CAC) in heart transplant (HTX) patients is not established. We explored if the absence of CAC on computed tomography (CT) could exclude moderate and severe cardiac allograft vasculopathy [CAV 2-3 ; the International Society for Heart and Lung Transplantation (ISHLT) recommended nomenclature] and significant coronary artery stenosis (diameter reduction ≥50%) and predict long-term clinical outcomes. HTX recipients (n = 133) were prospectively included and underwent CT for CAC scoring and invasive coronary angiography (ICA) 7.8 ± 5.0 years after HTX. CAC was detected in 73 (55%) patients. The absence of CAC on CT had a negative predictive value of 97% for ISHLT CAV 2-3 and 88% for significant stenosis on ICA. During 7.5 ± 2.6 years of follow-up after CAC CT (n = 127), there were 57 (45%) nonfatal major adverse cardiac events and 23 (18%) deaths or graft losses registered as first events. Patients with CAC had significantly more events (P = 0.011). In an adjusted Cox regression analysis, the presence of CAC was significantly associated with a negative outcome (HR 1.8, 95% CI 1.1-3.0; P = 0.023). The absence of CAC predicted low prevalences of ISHLT CAV 2-3 and significant coronary artery stenosis in HTX patients. The presence of CACS was significantly associated with a worse long-term outcome., (© 2017 Steunstichting ESOT.)

Aim: To compare short- and long-term survival in patients admitted to hospital after acute myocardial infarction (AMI) with and without out-of-hospital cardiac arrest (OHCA)., Methods: Prospective cohort study of all AMI patients admitted to Oslo University Hospital Ulleval from September 1, 2005 to December 31, 2011. All-cause mortality was obtained from the Norwegian Cause of Death Registry with censoring date December 31, 2013. Cumulative survival was assessed with the Kaplan-Meier and the Life-table method. Logistic- and Cox regression were used for risk comparisons., Results: We identified 404 AMI patients with OHCA and 9425 AMI patients without. AMI patients without OHCA were categorized as ST-elevation myocardial infarction (STEMI, n=4522) or non-STEMI (NSTEMI, n=4903). Mean age was 63.6±standard deviation (SD) 12.5, 63.8±13.1 and 69.7±13.6 years in OHCA, STEMI and NSTEMI, respectively. Coronary angiography with subsequent percutaneous coronary intervention if indicated, was performed in 87% of OHCA, 97% of STEMI and 80% of NSTEMI patients. Thirty-day survival was 63%, 94% and 94%, and 8-year survival was 49%, 74%, and 57%, respectively. Among patients surviving the first 30days, no significant difference in risk during long-term follow-up was found (adjusted Hazard Ratio (aHR) OHCAvsSTEMI 1.15 [95% CI 0.82-1.60], aHR OHCAvsNSTEMI 0.89 [95% CI 0.64-1.24])., Conclusions: Long-term survival after OHCA due to AMI was good, with 49% of admitted patients being alive after eight years. Although short-term mortality remained high, OHCA patients alive after 30days had similar long-term risk as AMI patients without OHCA., (Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction and Hypothesis: The aims of this study were to evaluate the prevalence of levator ani muscle (LAM) avulsions in a selected cohort of patients with primary anterior compartment pelvic organ prolapse (POP) and to assess whether LAM avulsions, as an independent factor, affect the degree of POP symptoms and sexual dysfunction. Additionally, clinical and demographic variables of women with and those without avulsions were compared., Methods: We carried out a cross-sectional analysis of a prospective cohort study including 197 women scheduled for anterior compartment POP surgery. LAM avulsions were diagnosed on transperineal 4D ultrasound. Preoperative symptom severity and sexual dysfunction were evaluated using validated questionnaires (Pelvic Floor Disability Index [PFDI-20] and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-Short Form 12 [PISQ-12]). Linear regression was performed with avulsion as the main independent variable against total PFDI-20 and domain scores, bulge symptoms, and PISQ-12 score. Clinical and demographic variables for women with and without avulsions were compared using independent samples t test, Mann-Whitney U test or Chi-squared test., Results: The prevalence of LAM avulsions was 50.3%. Avulsions were not associated with symptom severity or sexual dysfunction. "Chronic disease causing pain, fatigue or increased intra-abdominal pressure" was the only independent factor associated with all domains of the PFDI-20. Women with avulsions were younger at presentation, older at their first delivery, had lower BMI, and more often had a history of forceps delivery (p < 0.01)., Conclusions: LAM avulsions were highly prevalent in this preoperative POP cohort. Avulsions were not associated with the severity of POP symptoms or sexual dysfunction. Women with avulsions seem to require fewer additional cofactors for developing POP.

Background and purpose - There are many techniques for placing the femoral component in correct rotational alignment in total knee arthroplasty (TKA), but only a few have been tested against the supposed gold standard, rotation determined by postoperative computed tomography (CT). We evaluated the accuracy and variability of a new method, the clinical rotational axis (CRA) method, and assessed the association between the CRA and knee function. Patients and methods - The CRA is a line derived from clinical judgement of information from the surgical transepicondylar axis, the anteroposterior axis, and the posterior condylar line. The CRA was used to guide the rotational positioning of the femoral component in 80 knees (46 female). At 3 years follow-up, the rotation of the femoral component was compared with the CT-derived surgical transepicondylar axis (CTsTEA) by 3 observers. Functional outcome was assessed with the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS) and patient satisfaction (VAS). Results - The mean (95% CI) rotational deviation of the femoral component from the CTsTEA was 0.2° (-0.15°-0.55°). The standard deviation (95% CI) was 1.58° (1.36°-1.85°) and the range was from 3.7° internal rotation to 3.7° external rotation. No statistically significant association was found between femoral component rotation and KOOS, OKS, or VAS. Interpretation - The CRA method was found to be accurate with a low grade of variability.