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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. ispartof: INTERNATIONAL JOURNAL OF CARDIOLOGY vol:300 pages:66-72 ispartof: location:Netherlands status: published

PurposeThe 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.ParticipantsIn 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 dateThe 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 plansRecently, 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.

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

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.

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.

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 (

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 (

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. Editorial comment In this retrospective clinical study, researchers from Oslo found that as many as 25% of patients admitted to their ICU reported having a substance use disorder. Among medical admissions, there was some association between reported alcohol abuse and a sepsis diagnosis.

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.

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/m2/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.

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.

ObjectivesTo 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.DesignCross-sectional anonymous postal questionnaire study.SettingWomen aged 18–45 years recruited from the Norwegian Endometriosis Association and a random sample of women residing in Oslo, Norway.Participants157 women with and 156 women without endometriosis.Main outcome measuresLogistic 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%.ResultsThe 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.ConclusionsExternal 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.

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.

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, Ulleval. 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.

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.

Background Previous studies on shoulder patients have suggested that the prevalence of rotator cuff or bursa abnormalities are weakly related to symptoms and that similar findings are often found in asymptomatic persons. In addition, it is largely unknown whether structural changes identified by magnetic resonance imaging (MRI) affect outcome after treatment for shoulder pain. The purpose of this study was therefore to evaluate the presence of structural changes on MRI in patients with subacromial pain syndrome and to determine to what extent these changes are associated with symptoms and predict outcome after treatment (evaluated by the Shoulder Pain and Disability Index (SPADI)). Methods A prospective, observational assessment of a subset of shoulder patients who were included in a randomized study was performed. All participants had an MRI of the shoulder. An MRI total score for findings at the AC joint, subacromial bursa and rotator cuff was calculated. Multiple linear regression analysis was applied to examine the relationship between the MRI total score and the outcome measure at baseline and to examine to what extent the MRI total score was associated with the change in the SPADI score from baseline to the one year follow-up. Results There was a weak, inverse association between the SPADI score at baseline and the MRI total score (β = −3.1, with 95% CI −5.9 to −0.34; p = 0.03), i.e. the SPADI score was higher for patients with a lower MRI total score. There was an association between the change in the SPADI score from baseline to the one year follow-up and the MRI total score (β = 8.1, 95% CI -12.3 to −3.8; p

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 [CAV2-3 ; 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 CAV2-3 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 CAV2-3 and significant coronary artery stenosis in HTX patients. The presence of CACS was significantly associated with a worse long-term outcome.

Background Impaired glucose regulation, measured with an oral glucose-tolerance test, has been associated with the risk of cancer. Here, we explored whether the response to an intravenous glucose-tolerance test (IVGTT) is associated with the risk of cancer. Methods A cohort of 945 healthy men, aged 40–59 years in 1972–75, was followed for 40 years. An IVGTT was performed at baseline. Blood samples for glucose determinations were drawn immediately before glucose injection and thereafter every 10 min for 1 h. Associations were assessed with incidence rate ratios (IRR) and Cox models. Findings Cancer incidence was higher among men with 10-min glucose levels below the median than in men with levels above the median (IRR: 1.5, 95% CI: 1.2–1.9). This association remained significant after adjusting for relevant confounders (HR: 1.6, 95% CI: 1.3–2.1) and when excluding the first 10 years of follow-up to minimize the possibility of reverse causality (HR: 1.5, 95% CI: 1.2–2.0). Interpretation Healthy middle-aged males that responded to an intravenous glucose injection with rapid glucose elimination during the first phase had an elevated risk of cancer during 40 years of follow-up. First phase response to a glucose load might be related to cancer development., Highlights • Rapid elimination of plasma glucose during the first phase response was associated with a 60% elevated risk of cancer • Plasma glucose uptake during the first-phase may depend on the effectiveness of the molecular glucose-sensing apparatus • Polymorphisms critical for glucose transport into normal cells may also be crucial for transporting glucose into cancer cells In this study low levels of plasma glucose in the early phase of an intravenous glucose-tolerance test were associated with a 60% elevated risk of cancer. The glucose level in the early phase may depend on the effectiveness of the molecular glucose-sensing apparatus. The transport of glucose into cancer cells, that normally requires a constant supply of high glucose, may be rate limited by polymorphisms that are critical for plasma glucose-sensing in general. Previous research has shown that some key proteins, e.g. GLUT 1 and GLUT 2, are involved as glucose transporters into cancer cells.

Background: Subacromial shoulder pain is a common complaint, and radial extracorporeal shock wave therapy (rESWT) is increasingly used to treat this condition. Although many therapists use rESWT in combination with supervised exercises, no studies have evaluated the additional effect of rESWT with supervised exercises for subacromial shoulder pain. Purpose: To assess whether rESWT is more effective than sham rESWT when combined with supervised exercises for improving pain and function in patients with subacromial shoulder pain. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients between 25 and 70 years of age with subacromial shoulder pain with and without calcification in the rotator cuff lasting at least 3 months were assessed for eligibility; 143 patients were recruited. Participants were allocated (1:1) by computer-generated randomization in blocks of 20 to receive either rESWT or sham rESWT in addition to supervised exercises. The rESWT and sham rESWT were performed once a week with additional supervised exercises once a week for the first 4 weeks. The following 8 weeks, the patients received supervised exercises twice a week. The primary outcome was change in the Shoulder Pain and Disability Index (SPADI) after 24 weeks. Patients and outcome assessors were masked to group assignment. Results: At 24 weeks, participants in both the sham group and the rESWT group had improved ( P < .001) in SPADI score compared with baseline (−23.9 points [SD, 23.8 points] and −23.3 points [SD, 25.0 points], respectively), but there were no differences between the groups (mean difference 0.7; 95% CI, −6.9 to 8.3; P = .76). Prespecified subgroup analysis of patients with calcification in rotator cuff showed that the rESWT group had a greater improvement in SPADI score after 24 weeks (mean difference −12.8; 95% CI, −24.8 to −0.8; P = .018). Conclusion: Radial ESWT offered no additional benefit to supervised exercises in the treatment of subacromial shoulder pain after 24 weeks, except in the subgroup of patients with calcification in the rotator cuff. Registration: NCT01441830 ( ClinicalTrials.gov identifier).

BackgroundEarly trauma is linked to higher symptom levels in bipolar and psychotic disorders, but the translating mechanisms are not well understood. This study examines whether the relationship between early emotional abuse and depressive symptoms is mediated by metacognitive beliefs about thoughts being uncontrollable/dangerous, and whether this pathway extends to influence positive symptoms.MethodPatients (N= 261) with psychotic or bipolar disorders were assessed for early trauma experiences, metacognitive beliefs, and current depression/anxiety and positive symptoms. Mediation path analyses using ordinary least-squares regressions tested if the effect of early emotional abuse on depression/anxiety was mediated by metacognitive beliefs, and if the effect of early emotional abuse on positive symptoms was mediated by metacognitive beliefs and depression/anxiety.ResultsMetacognitive beliefs about thoughts being uncontrollable/dangerous significantly mediated the relationship between early emotional abuse and depression/anxiety. Metacognitive beliefs and depression/anxiety significantly mediated the relationship between early emotional abuse and positive symptoms. The models explained a moderate amount of the variance in symptoms (R2= 0.21–0.29).ConclusionOur results indicate that early emotional abuse is relevant to depression/anxiety and positive symptoms in bipolar and psychotic disorders, and suggest that metacognitive beliefs could play a role in an affective pathway to psychosis. Metacognitive beliefs could be relevant treatment targets with regards to depression/anxiety and positive symptoms in bipolar and psychotic disorders.

We studied if patients surviving hospitalization for invasive pneumococcal disease (IPD) have an increased long-term mortality.In this population-based case-control study, we assessed adults discharged from Aker University Hospital in Oslo, Norway, from 1993 to 2008 after surviving IPD. Mortality among the study population was compared to the general Norwegian population using standardized mortality ratios (SMR). Median follow-up time was 7.2 years (range 5 days to 21.1 years). Associated factors were also investigated.We assessed 372 patients of whom 184 patients died during the observation period. Mortality was increased for 10 years after surviving hospitalization for IPD. Patients aged 18-64 years had a one-year SMR of 18.8 (95% CI: 10.0-32.1) and a 10-year SMR of 6·0 (95% CI: 4.4-8.0). SMR for the first five years among patients with and without underlying conditions were 10.7 (95% CI: 7.0-15.5) and 2.8 (95% CI: 0.9-6.4), respectively. Patients older than 65 years had a one-year SMR of 1·8 (95% CI: 1.2-2.7) and a 10-year SMR of 1.6 (95% CI: 1.4-1.9).Patients surviving IPD had an increased long-term mortality compared to the general population. This was particularly pronounced in patients with known underlying conditions. These findings suggest that IPD is a negative prognostic marker, and that a closer follow-up of patients who have suffered IPD is warranted.

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., Primary open-angle glaucoma, pseudoexfoliation glaucoma, pseudoexfoliation syndrome, lifespan, systemic diseases

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

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.

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)

Background The need for intensive care beds is high and expected to increase. Descriptive studies of the intensive care population may reveal differences in predisposing factors and outcome within subgroups and help identify areas in need of increased prevention efforts. Objective To describe preadmission and clinical characteristics of an intensive care population in Oslo, and to compare the characteristics and outcomes of selected subgroups of this ICU-population. Method Prospective observational cohort study of intensive care patients aged ≥ 18, admitted to two hospitals in Oslo during a one-year period. Acute illness characteristics, comorbidity, limitations of life-sustaining treatment and hospital mortality were studied for the overall population and stratified for a) Gender and b) Medical and surgical patients within the age groups 18-59 years and 60 and above. Results We included 861 patients, 567 (66%) males; median age 63 years (range 18-95); 537 (62%) medical admissions and 324 (38%) surgical admissions. 632 (73%) received mechanical ventilation. Trauma (n = 191, 21%) and cardiovascular disease (n = 180, 20%) were the most common causes of admission. In patients aged 18-59, poisoning caused 56/217 (26%) of the medical admissions and medical patients had a higher prevalence of pre-existing chronic disease (157/217, 72% vs. 69/160, 43%) and Charlson comorbidity index (mean 2.0 vs. 0.7, p < 0.001) than surgical patients. In patients aged 60 and above, comorbidity was similar, but medical patients had a higher hospital mortality (143/320, 45% vs. 58/164, 34%, p < 0.05). 205 (24%) died in the ICU, and limitations of life-sustaining treatment were made in 183 (89%) cases 279(32%) died during the hospital stay. Of the 582 surviving patients 455 (78%) were discharged to home or rehabilitation, 88 (15%) to nursing homes and 39 (7%) to other institutions. Conclusion In patients younger than 60 years, trauma and poisoning were the most common causes of admission. Within this age group, medical patients had much higher prevalence of preexisting chronic disease than surgical patients, suggesting differences in predisposing factors. The majority of the surviving patients were discharged to home or to rehabilitation, indicating a low prevalence of futile intensive care.

Objective: To evaluate the effectiveness of a group-based self-management program for people with chronic fatigue syndrome. Design: A randomized controlled trial. Setting: Four mid-sized towns in southern Norway and two suburbs of Oslo. Subjects: A total of 137 adults with chronic fatigue syndrome. Intervention: A self-management program including eight biweekly meetings of 2.5 hours duration. The control group received usual care. Main measures: Primary outcome measure: Medical Outcomes Study-Short Form-36 physical functioning subscale. Secondary outcome measures: Fatigue severity scale, self-efficacy scale, physical and mental component summary of the Short Form-36, and the illness cognition questionnaire (acceptance subscale). Assessments were performed at baseline, and at six-month and one-year follow-ups. Results: At the six-month follow-up, a significant difference between the two groups was found concerning fatigue severity ( p = 0.039) in favor of the control group, and concerning self-efficacy in favor of the intervention group ( p = 0.039). These significant differences were not sustained at the one-year follow-up. No significant differences were found between the groups concerning physical functioning, acceptance, and health status at any of the measure points. The drop-out rate was 13.9% and the median number of sessions attended was seven (out of eight). Conclusions: The evaluated self-management program did not have any sustained effect, as compared with receiving usual care.

To develop a procedure-specific rating scale for laparoscopic supracervical hysterectomy (LSH), and to compare the construct validity and reliability with a general rating scale in laparoscopic surgery, global operative assessment of laparoscopic skills (GOALS).Prospective interobserver study. In collaboration with an expert group, we developed the procedure-specific rating scale, competence assessment tool for laparoscopic supracervical hysterectomy (CAT-LSH). LSH was performed by gynecologists with different levels of surgical competence levels (13 procedures were performed by inexperienced trainees, 13 by intermediate experienced, and 15 by laparoscopic experts). All procedures were video-recorded. Surgical performance was evaluated in all procedures using both CAT-LSH and GOALS by the surgical assistant, as well as by 2 blinded observers evaluating the video recordings.University teaching hospital.Laparoscopic experts, consultants and gynecological registrars from the Department of Gynecology.There were significant differences between the 3 proficiency groups in both the rating scales. Mean GOALS score evaluated by the operating assistant and the 2 observers were for inexperienced surgeons 16.4 vs. 13.6 (p0.01), for surgeons with intermediate experienced 22.6 vs. 19.5 (p0.05) and for expert surgeons 26.1 vs. 22.4 (p0.01), respectively. Corresponding results for the CAT-LSH scores were 41.0/34.6 (p0.01), 49.2/43.1 (p0.01), and 58.7/51.1 (p0.01), respectively. The interrater reliability measured by the interclass correlation coefficient between the surgical assistant and the 2 blinded observers for GOALS and CAT-LSH were 0.71 and 0.75, respectively.The GOALS and CAT-LSH appear to have construct validity and high interrater reliability. Assessment of surgical competence during LSH is feasible in daily practice with objective rating scales like CAT-LSH and GOALS.

Objective To evaluate the effect of pelvic floor muscle exercises (PFME) for postpartum anal incontinence (AI). Design A parallel two-armed randomised controlled trial stratified on obstetrical anal sphincter injury with primary sphincter repair and hospital affinity. Setting Ano-rectal specialist out-patient clinics at two hospitals in Norway. Population One hundred and nine postpartum women with AI at baseline. Methods The intervention group received 6 months of individual physiotherapy-led PFME and the control group written information on PFME. Changes in St. Mark's scores and predictors of post-intervention AI were assessed by independent samples t-tests and multiple linear regression analyses, respectively. The study was not blind. Main outcome measures The primary outcome measure was change in AI symptoms on the St. Mark's score from baseline to post-intervention. Secondary outcome measures were manometry measures of anal sphincter length and strength, endoanal ultrasound (EAUS) defect score and voluntary pelvic floor muscle contraction. Results There was a significant difference in the reduction of St. Mark's scores from baseline to post-intervention in favour of the PFME group (−2.1 versus −0.8 points, P = 0.040). No differences in secondary outcome measures were found between groups. Baseline St. Mark's, PFME group affinity and EAUS defect score predicted post-intervention St. Mark's score in the imputed intention-to-treat analyses. The analysis on un-imputed data showed that women performing weekly PFME improved their AI scores more than women in the control group did. Conclusions Our results indicate that individually adapted PFME reduces postpartum AI symptoms. Tweetable abstract Performing regular pelvic floor muscle exercises may be an effective treatment for postpartum anal incontinence.

Physical activity is inversely associated with risk of some cancers. The relation with cancer‐specific death remains uncertain. Mainly, studies on relationships between physical activity and cancer are based on self‐reported physical activity (SPA). Hereby, we examined whether measured cardiorespiratory fitness (CRF) is associated with cancer risk, mortality, and case fatality. We also describe relationships between SPA and these outcomes, and between CRF and SPA. A cohort of 1997 healthy Norwegian men, aged 40–59 years at inclusion in 1972–75, was followed throughout 2012. At baseline, CRF was objectively measured. SPA (leisure time and occupational) was obtained through a questionnaire. Relationships between CRF or SPA, and the outcomes were estimated using Cox regression, adjusted for age, body mass index (BMI), and smoking. Pearson correlation coefficients evaluated agreements between CRF and SPA. During follow‐up, 758 men were diagnosed with cancer and 433 cancer deaths occurred. Analyses revealed lower cancer risk (Hazard ratio [HR] 0.85, 95% confidence intervals [CI]: 0.68–1.00), mortality (HR 0.68, 95% CI: 0.53–0.88), and case fatality (HR 0.74, 95% CI: 0.57–0.96), in men with high CRF compared to low CRF. Light leisure time SPA was associated with lower cancer risk (HR 0.70, 95% CI: 0.56–0.86) and mortality (HR 0.64 95% CI: 0.49–0.83), whereas strenuous occupational SPA was associated with higher risks (HR 1.42, 95% CI: 1.13–1.78 and HR 1.45, 95% CI: 1.09–1.93). Correlations between CRF and SPA were 0.351 (P

Objective Postoperative fatigue is a common problem after otherwise uncomplicated surgery. It may defer patients from resuming their daily activities and is often reported to be among their most severe symptoms. There are few validated instruments for assessing postoperative fatigue. Our aim was to translate into Norwegian and explore a Short Form of the Identity-Consequences Fatigue Scale; a fatigue questionnaire specifically developed to assess postoperative fatigue. Methods The fatigue scale was translated to Norwegian through a forward-backward process, and subsequently validated in a large, mixed surgical population. We performed Principal Component Analyses on the complete 31-item scale and on the 10-item Short Form. The analyses were performed separately on pre- and postoperative data (n = 422 and n = 315, respectively). Results The factor analyses confirmed that the translation was valid and revealed three defined dimensions in the 10-item scale. There was no statistically significant difference between means of reported fatigue when measured with the 31- or 10-item scale. Ninety-eight% of change in fatigue from pre- to postoperative status was retained when using the 10-item scale as compared to the 31-item scale. Conclusion The abridged, 10-item Short Form performed equal to the 31-item scale and may replace the complete 31-item ICSF scale in exploring the incidence of pre- and post-operative fatigue.

Post-thrombotic syndrome is a common complication after acute proximal deep vein thrombosis (DVT) and is associated with reduced quality of life and a substantial cost burden. In the 2-year results of the CaVenT study, additional catheter-directed thrombolysis reduced the risk of post-thrombotic syndrome by 14% compared with conventional therapy, but did not affect quality of life. In this study we report results at the 5-year follow-up, aiming to assess whether findings for post-thrombotic syndrome and quality of life have persisted.Between Jan 3, 2006, and Dec 22, 2009, we recruited patients aged 18-75 years with a first-time high proximal leg DVT from 20 hospitals in the Norwegian southeastern health region. With sealed envelopes, participants were randomly assigned (1:1) to standard treatment with compression stockings and anticoagulants (control group) or to standard treatment plus catheter-directed thrombolysis with alteplase within 21 days from symptom onset. Pre-specified outcomes in this analysis were post-thrombotic syndrome at 5 years as assessed with the Villalta score and scores for quality of life at 5 years with EQ-5D and the disease-specific VEINES-QOL/Sym. Analyses were by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00251771.At 5 year follow-up (last date Oct 14, 2014), data were available for 176 patients (84% of the 209 patients originally randomised)--87 originally assigned to catheter-directed thrombolysis and 89 originally assigned to the control group. 37 patients (43%; 95% CI 33-53) allocated to catheter-directed thrombolysis developed post-thrombotic syndrome, compared with 63 (71%; 95% CI 61-79) allocated to the control group (p0·0001), corresponding to an absolute risk reduction of 28% (95% CI 14-42) and a number needed to treat of 4 (95% CI 2-7). Four (5%) patients assigned to catheter-directed thrombolysis and one (1%) to standard treatment had severe post-thrombotic syndrome (Villalta score ≥ 15 or presence of an ulcer). Quality-of-life scores with either assessment scale did not differ between the treatment groups.Additional catheter-directed thrombolysis resulted in a persistent and increased clinical benefit during follow-up for up to 5 years, supporting the use of additional catheter-directed thrombolysis in patients with extensive proximal DVT. However, allocation to this therapy did not lead to better quality of life. The optimal endovascular thrombolytic approach needs further investigation.Southeastern Norway Regional Health Authority, the Research Council of Norway, University of Oslo, Oslo University Hospital.

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.

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.

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

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 and purpose — Recent research on outcomes after total knee arthroplasty (TKA) has raised the question of the ability of traditional outcome measures to distinguish between treatments. We compared functional outcomes in patients undergoing TKA with and without patellar resurfacing, using the knee injury and osteoarthritis outcome score (KOOS) as the primary outcome and 3 traditional outcome measures as secondary outcomes. Patients and methods — 129 knees in 115 patients (mean age 70 (42–82) years; 67 female) were evaluated in this single-center, randomized, double-blind study. Data were recorded preoperatively, at 1 year, and at 3 years, and were assessed using repeated-measures mixed models. Results — The mean subscores for the KOOS after surgery were statistically significantly in favor of patellar resurfacing: sport/recreation, knee-related quality of life, pain, and symptoms. No statistically significant differences between the groups were observed with the Knee Society clinical rating system, with the Oxford knee score, and with visual analog scale (VAS) for patient satisfaction. Interpretation — In the present study, the KOOS—but no other outcome measure used—indicated that patellar resurfacing may be beneficial in TKA.

Objectives To investigate the effect of a standardised acupuncture on nausea and vomiting in children after tonsillectomy with or without adenoidectomy when possible placebo effects were precluded. Methods A pragmatic, multicentre, double-blinded, randomised controlled trial. The study was conducted over 10 months in 2012–2013 at three ambulatory clinics. Two hundred and eighty-two children, age 1–11 years, American Society of Anesthesiologists grade ≤II, were included. To equalise expectancy effects, all parents were told that their child would receive acupuncture. However, children were randomly allocated to perioperative bilateral needling acupuncture at PC6, depth 7 mm, mean time 17 min (SD 5–45) during anaesthesia plus usual care, or to usual care only. The regional ethics committee approved this approach. Primary endpoints were nausea and vomiting 24 h postoperatively. Results This study did not demonstrate any effect of acupuncture (95% CI) compared with standard care. The overall vomiting in the acupuncture and usual-care groups was 44.2% and 47.9%, respectively. Nausea was experienced by 31.7% in the acupuncture group and by 32.6% in the usual-care group. The test power was acceptable for comparisons of vomiting. Conclusions The findings suggest that when controlling for possible placebo effects standardised PC6 acupuncture needling during anaesthesia without further stimulation of PC6 is not effective in reducing nausea and vomiting in children after tonsillectomy with or without adenoidectomy. Future studies should investigate acupuncture treatment which balances adequate dose and technique and a feasible, child-friendly acupuncture treatment. Trial Registration Number ClinicalTrials.gov NCT01729052.

Background: Persistent post-surgical pain is recognised as a major problem. Prevalence after different surgical procedures has been reported to range from 5% up to 85%. Limb amputation and thoracotomy have the highest reported prevalence. Prediction of persistent post-surgical pain has over the last decade caught atten- tion. Several factors have been investigated, but in-depth knowl- edge is still scarce. The purpose of this study was to investigate the prevalence of persistent post-surgical pain, and predictive fac- tors for persistent post-surgical pain 12 months after thoracotomy. Methods: A prospective longitudinal study was conducted. One- hundred and seventy patients were recruited before scheduled thoracotomy, and asked to answer a questionnaire. One-hundred and six patients completed the same questionnaire at 12-month follow-up. Regression analysis was performed to explore vari- ables assumed predictive of persistent post-surgical pain. Results: One-hundred and six patients (62%) filled out the questionnaire at both time points. Preoperative, 34% reported muscle-skeletal related chronic pain. At 12-month follow-up, 50% of the patients reported persistent post-surgical pain. Of the vari- ables explored in the logistic regression model, only preoperative pain ( P < 0.001) and dispositional optimism ( P = 0.04) were sta- tistically significant. In this study, preoperative pain was a pre- dominant predictor for persistent postoperative pain (OR 6.97, CI 2.40 – 20.21), while dispositional optimism (OR 0.36, CI 0.14 – 0.96) seem to have protective properties. Conclusion: Our results show that preoperative pain is a pre- dominant predictor of future pain. This implies that patients pre- senting with a chronic pain condition prior to surgery should be assessed thoroughly preoperatively and have an individually tailored analgesic regimen.

Background: Emergency room nurses were trained to provide a short-term psychological intervention in physically injured patients with Impact of Event Scale (IES) scores > 20. The aims were to study the effects of the psychological intervention relative to usual care (UC). Methods: In a randomized controlled trial, psychological distress, daily functioning and the personality traits optimism/pessimism were compared with patients who received the UC. The interventions were provided 1 - 3 months after discharge. Results: The IES scores were significantly reduced in both groups at 3 months (intervention: 41.1 - 28.6, P < 0.001 vs. UC: 35.4 - 26.2, P < 0.001), but not significantly different between groups. Baseline IES score was a significant predictor of IES scores at 3 (β = 0.4, P < 0.05) and 12 months (β = 0.3, P < 0.05), whereas overall daily functioning at 3 months predicted IES scores at 12 months (β = -0.5, P < 0.001). Patients receiving intervention became significantly more optimistic during the year, and had an increase in overall daily functioning from 3 to 12 months (P < 0.001). Patients declining intervention were more pessimistic and had lower daily functioning. Patients who talked with nurses with more training in psychological processing had a larger reduction in IES symptoms at 3 months (β = -0.3, P = 0.081). Conclusion: The nurse-led intervention had a significant effect on optimism and overall daily functioning. Nurses may become a low-cost option to perform short-term psychological interventions with physically injured hospitalized patients. J Clin Med Res. 2015;7(5):339-347 doi: http://dx.doi.org/10.14740/jocmr2082w

Background: It has been estimated that 700 million people worldwide and 5.2 million people in South Africa are in need of annual treatment for schistosomiasis. In accordance with the current policy the Department of Health (DoH) in KwaZulu-Natal province, South Africa, aimed to reach 75% treatment coverage in a mass treatment campaign (MTC) of schools in a schistosomiasis-endemic area.Methods: A cross-sectional study was designed to explore the implementation, coverage, challenges and limitations of a DoH MTC in a middle-income country. The study was conducted by exploring nurses’ and research team records, school enrolment lists and parental consent forms.Results: Slightly more than 10 000 learners in 43 primary and high schools were treated, achieving treatment coverage of 44.3%. A median of two schools per day were visited over the course of 39 days. We found that older learners, being male and attending a large school were independent significant predictors for low treatment coverage.Conclusion: Our r...

Background: Placebo effects emerging from expectancies of relatives, also known as placebo by proxy, is a rather unexplored field. In this study, we assume a correlation between parental anxiety/expectancy and postoperative morbidities in children. Accordingly, a reduction of parental anxiety is expected to enhance the effect of treatment. Methods: From October 2012 to June 2013, parents of 282 children completed a self-report closed-ended questionnaire embedded in a main RCT at three ambulatory care centers. Results: There were no significant associations between parental expectancy or anxiety and children experiencing vomiting and pain. Conclusion: The present study is the first to investigate placebo by proxy in acupuncture treatment for children. The findings were not able to demonstrate any placebo effect by proxy. Unknown confounders and limitations of methods may have contributed to the negative findings. Thus, the findings must be read with precaution, as the possibility of a type II error cannot be excluded. Trial Registration: ClinicalTrials.gov NCT01729052.

Purpose To compare the efficacy and safety of bevacizumab versus ranibizumab when administered according to a treat-and-extend protocol for the treatment of neovascular age-related macular degeneration (AMD). Design Multicenter, randomized, noninferiority trial with a noninferiority limit of 5 letters. Participants Patients aged ≥50 years with previously untreated neovascular AMD in 1 eye and best-corrected visual acuity (BCVA) between 20/25 and 20/320. Methods Patients were randomly assigned to receive ranibizumab 0.5 mg or bevacizumab 1.25 mg intravitreal injections. Monthly injections were given until inactive disease was achieved. The patients were then followed with a gradual extension of treatment interval by 2 weeks at a time up to a maximum of 12 weeks. If signs of recurrent disease appeared, the treatment interval was shortened by 2 weeks at a time. Main Outcome Measures Change in visual acuity at 1 year. Results Between March 2009 and July 2012, 441 patients were randomized at 10 ophthalmological centers in Norway. The 1-year visit was completed by 371 patients. In the per protocol analysis at 1 year, bevacizumab was equivalent to ranibizumab, with 7.9 and 8.2 mean letters gained, respectively (95% confidence interval [CI] of mean difference, −2.4 to 2.9; P = 0.845). The intention-to-treat analysis was concordant. There was no significant difference in measured central retinal thickness (CRT), with a mean decrease of −112 μm for bevacizumab and −120 μm for ranibizumab (95% CI of mean difference, −13 to 28; P = 0.460). There was a statistically significant difference ( P = 0.001) between the drugs regarding the number of treatments: 8.9 for bevacizumab and 8.0 for ranibizumab. There were fewer arteriothrombotic events in the bevacizumab group (1.4%) than in the ranibizumab group (4.5%) ( P = 0.050) and significantly more cardiac events in the ranibizumab group ( P = 0.036). However, patients treated with ranibizumab more often had a history of myocardial infarction ( P = 0.021). Conclusions Bevacizumab and ranibizumab had equivalent effects on visual acuity at 1 year when administered according to a treat-and-extend protocol. The visual acuity results at 1 year were comparable to those of other clinical trials with monthly treatment. The numbers of serious adverse events were small.

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 30 days, 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], aHROHCAvsNSTEMI 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 30 days had similar long-term risk as AMI patients without OHCA.

Bacterial antibiotic resistance is a steadily growing global problem, which today is compared with issues such as global warming, ozone depletion, and extinction of species. Consequently, calls come from global, Pan-European, and national authorities to gain insight into, limit, and stringently qualify the use of antibiotics in human and veterinary medicine, as well as in food production. Dentists are not considered to be frequent prescribers of antibiotics. However, few studies have identified how much, and in which situations, dentists prescribe such drugs. The aims of the present study were to survey Norwegian dentists' antibiotic-prescribing habits in 2015 and to compare the findings with previous studies (1990 and 2004) and with the actual numbers of dispensed prescriptions obtained from the 'Norwegian National Prescription Register'. The results from 1990 to 2004 show that there was a general increase in antibiotic prescriptions by Norwegian dentists, followed by a reduction or flattening of the prescription volume curve from 2004 to 2015. Despite this, possibilities for further improvements have been identified and recommendations given for targeted campaigns to reduce the prescription volume in dentistry by a further 30%, which has been ordered by the Norwegian National Assembly.

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.

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.

Background Patients undergoing surgical aortic valve replacement (sAVR) have high rates of 30-day readmissions. They also report a low health-related quality of life (HRQOL) and elevated anxiety and depression. The aim of the AVRre study is to determine the efficacy and cost of a 24/7 phone-support intervention in reducing post-discharge readmissions after sAVR. The nature of the support is to help patients better understand and self-manage non-urgent symptoms at home. Methods/design AVRre is a prospective, randomised controlled study comprising 30 days of continuous phone-support intervention and then intermittent follow-up for the first 12 months. Phone call data from and to patients are evaluated qualitatively; thus, the study has a mixed-method design. Two hundred and eighty-six patients, aged >18 years, scheduled for a sAVR — singly or in combination with another procedure — are recruited from locations in southeast Norway. Patients are randomly assigned to the intervention group, who are purposively phone-called individually 2 and 9 days after discharge and offered on-demand 24/7 (around-the-clock) telephone support for 30 days post-discharge. The primary outcome variable is the number of 30-day hospital readmissions. Secondary outcomes are anxiety and depression symptoms, as measured by the Hospital Anxiety and Depression Scale, HRQOL and quality-adjusted life years, measured by the EuroQol (EQ-5D). Intervention and hospital readmission (diagnosis-related groups (DRGs)/length of stay) for the first year after initial discharge from hospital are used for a cost-utility analysis. Standard parametric and non-parametric tests are used for evaluations over time. Analysis of covariance is used to control for possible differences at baseline. Narratives from phone calls are transcribed verbatim and analysed using systematic text condensation. Discussion A complex ‘around-the-clock’ intervention within a university hospital-based setting could be an effective strategy to reduce the high readmission rates to hospital after sAVR. Furthermore, the AVRre 24/7 phone-support manual can be adapted to other high-risk surgery populations with high readmission rates. Trial registration ClinicalTrials.gov, NCT02522663. Registered on 11 August 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1971-y) contains supplementary material, which is available to authorized users.

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. This is a post-peer-review, pre-copyedit version of an article published in International Urogynecology Journal. The final authenticated version is available online at: http://dx.doi.org/10.1007/s00192-017-3390-8