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Mortality in nursing home residents: A longitudinal study over three years
Get PDFOBJECTIVE:
Nursing home (NH) stay is the highest level of formal care. With the expected demographic changes ahead, the need for NH placement will put an increasing socioeconomic strain on the society. Survival in NHs and factors predicting survival are important knowledge in order to evaluate NH admission policies and plan future NH capacity.
METHODS:
We followed 690 NH residents included at admission to NH over a period of three years. Participants were examined at baseline (BL) and every six months. Demographic and clinical data were collected, including comorbidity, severity of cognitive impairment, dependency in activities of daily living (ADL) and neuropsychiatric symptoms. Median survival was calculated by the Kaplan-Meier analysis, and factors associated with mortality were identified by Cox models with baseline and time-dependent covariates.
RESULTS:
Median survival in NH was 2.2 years (95% confidence interval [CI]: 1.9-2.4). Yearly mortality rate throughout the three-year observation period was 31.8%. Mortality was associated with higher age and comorbidity at BL, and more severe dementia, higher ADL-dependency, less severe psychotic symptoms, and a lower BMI throughout the study period. Of the organizational variables, living on a ward with more residents resulted in a higher risk of mortality.
CONCLUSION:
In conclusion, the NH mortality rate remained stable throughout the three-year study period with about one third of the residents deceasing each year. Individual resident characteristics appeared to be more important than organizational variables for predicting mortality risk. The finding of an association between ward size and mortality risk deserves further investigation in future studies.The project Resource Use and Disease Course in Dementia - Nursing Home (REDIC-NH) was performed according to a request from and with funding by the Norwegian Directorate of Health. The Directorate of Health played no role in the design, execution, analysis and interpretation of data, or the writing of the study.publishedVersio
Differential expression of Vitamin D associated genes in the aorta of coronary artery disease patients with and without rheumatoid arthritis
No full textBACKGROUND:
Vitamin D has an important role in the immune system, and has been linked to rheumatoid arthritis (RA) and coronary artery disease (CAD). The exact mechanisms by which vitamin D is involved in these processes are still unclear. Therefore, we wanted to search for differences in expression of genes involved in the vitamin D receptor (VDR) activation pathway and genes that are known to alter upon vitamin D stimulation, in the aortic adventitia of CAD patients with and without RA.
METHODS:
Affymetrix microarray was used to determine gene expression profile in surgical specimens from the adventitia of the ascending aorta of CAD patients with RA (n = 8) and without RA (n = 8) from the Feiring Heart Biopsy Study.
RESULTS:
We identified three vitamin D associated genes that were differentially expressed between RA and non-RA patients: Growth arrest and DNA-damage-inducible protein 45 alpha (GADD45A) (FC = 1.47; p = 0.006), Nuclear Receptor Co-repressor 1 (NCOR1) (FC = 1,21; p = 0.005) and paraoxonases 2 (PON2) (FC = -1.37; p = 0.01). High expression of GADD45A in RA tissues was confirmed by real-time qRT-PCR. GADD45A expression correlated with plasma levels of 1,25(OH)2D3 (rs = 0.69; p = 0.003).
CONCLUSIONS:
Microarray analyses revealed higher expression of GADD45A and NCOR1; and lower expression of PON2 in the aortic adventitia of RA than non-RA patients. Further studies are needed to elucidate if and how GADD45A, NCOR1 and PON2 are involved in the development of accelerated atherosclerosis in RA. In theory, some of these factors might have proatherogenic effects whereas others might reflect an underlying vascular pathology promoting atherogenesis (such as vascular stress).This study was supported by the Innlandet Hospital Trust, South-Eastern Norway Regional Health Authority, the Norwegian Women’s Public Health Association, the Norwegian Rheumatism Association, and the Norwegian Association for People with Heart and Lung Diseases.publishedVersio
Short-term outcomes after elective colon cancer surgery: an observational study from the Norwegian registry for gastrointestinal and HPB surgery, NoRGast
Get PDFBackground: To describe the real burden of major complications after elective surgery for colon cancer in Norway, and to assess which predictors that are significantly associated with the short-term outcome.
Methods: An observational, multi-centre analysis of prospectively registered colon resections registered into the Norwegian Registry for Gastrointestinal Surgery, NoRGast, between January 2014 and December 2016. A propensity score-adjusted subgroup analysis for surgical access groups was attempted, with laparoscopic resections grouped as intention-to-treat.
Results: Out of 1812 resections, 14.0% of patients experienced a major complication within 30 days following surgery. The over-all reoperation rate was 8.7%, and rate of reoperation for anastomotic leak was 3.8%. Twenty patients (1.1%) died within 30 days after surgery. Higher age was not a significant predictor of major complications, including 30-day mortality. After correction for all co-variables, open access surgery was associated with higher rates of major complications (OR 1.67 (CI 1.22-2.29), p = 0.002), higher 30-day mortality (OR 4.39 (CI 1.19-16.13) p = 0.026) and longer length-of-stay (HR 0.58 (CI 0.52-0.65) p < 0.001).
Conclusions: Our results indicate a low complication burden and high rate of uneventful patient journeys after elective surgery for colon cancer in Norway. Age was not associated with higher morbidity or mortality rates. Open access surgery was associated with an inferior short-term outcome.submittedVersio
Role of the immune system in autism spectrum disorders (ASD)
Get PDFBackground: The evidence based supports that multifactorial and complex immune interactions play a role in autism spectrum disorders (ASD), but contradictory findings are also reported.
Objective: The aim of this selective review was to identify trends in the research literature on this topic, focusing on immunology and other aberrations with respect to the different ASD subtypes.
Methods: This selective review is based on original and review articles written in English and identified in literature searches of PubMed.
Results: Several studies have found that the risk of ASD is greater among children whose mothers suffered from autoimmune diseases while pregnant. Moreover, individuals with ASD show increased levels of antibodies that are specific for several specific proteins. Studies also show that mothers of children with ASD have antibodies against fetal brain proteins. There are also reports on the associations between increased levels of proinflammatory cytokines and ASD. Finally, infections in mothers during pregnancy are linked to an increased risk of ASD.
Conclusion: We propose that the large inconsistencies in findings among studies in the field are due to differences in subdiagnoses among the included children with ASD. Well-phenotyped ASD samples are needed to understand the biological and immunological mechanisms underpinning ASD and its subdiagnoses. Future research should apply new strategies to scrutinize the link between ASD and changes in immune responsivity. Important new research avenues are to investigate the associations (a) between different ASD phenotypes and aberrations in (auto)immune pathways and (b) between reduced natural regulatory autoimmune responses during pregnancy, which are in turn associated with increased oxidative and nitrosative stress in maternal blood and putative detrimental effects in the offspring.acceptedVersio
The course of neuropsychiatric symptoms in nursing home residents from admission to 30-month follow-up
Get PDFAim
The aim of this study was to describe the prevalence and persistence of clinically significant
neuropsychiatric symptoms (NPS) in nursing home residents with dementia, and to study
the association between severity of dementia and specific neuropsychiatric sub-syndromes
over time.
Methods
In total, 583 residents with dementia were included at admission to a nursing home and followed with biannual assessments until death, or to 30-month follow-up. At the end of the 30-
month follow-up, 305 participants had died and 57 had left the study for other reasons, leaving 221 residents in the study. We collected data on demographics, cognition, severity of
dementia, NPS, personal activities of daily living (P-ADL), physical health, medication and
type of nursing home unit. NPS was assessed using the Neuropsychiatric Inventory (NPI),
the Nursing Home version.
Results
The prevalence and persistence at two consecutive time-points of clinically significant NPS
was high during the study period. The mean NPI agitation sub-syndrome score increased
during the study period, while the NPI affective and psychosis sub-syndrome scores
remained unchanged. More severe dementia was associated with higher NPI agitation, psychosis and affective sub-syndrome scores. The association remained unchanged over time
for agitation and psychosis. For the NPI affective sub-syndrome, the association was stronger at the beginning, and declined towards the end of the study period.
Conclusion
The findings of high prevalence and persistence at two consecutive time points of clinically
significant NPS over time, and the associations between severity of dementia and NPI subsyndromes shed light on the burden and care needs of nursing home residents with dementia
after admission to nursing home care. This information is of interest to health care planners
and providers to enable them to increase the quality of care for nursing home residents.publishedVersio
Screening for frailty among older patients with cancer using blood biomarkers of inflammation
Get PDFIntroduction: As frailty is associated with inflammation, biomarkers of inflammation may represent objective measures that could facilitate the identification of frailty. Glasgow prognostic score (GPS), combines C-reactive protein (CRP) and albumin, and is scored from 0 to 2 points. Higher score indicates a higher degree of inflammation.
Objectives: To investigate whether (1) GPS is associated with frailty, (2) GPS could be used to screen for frailty, (3) IL-6 and TNF-α add to the accuracy of GPS as a screening tool, and (4) GPS adds prognostic information in frail older patients with cancer.
Methods: Prospective, observational study of 255 patients ≥70 years with solid malignant tumours referred for medical cancer treatment. At baseline, frail patients were identified by a modified Geriatric Assessment (mGA), and blood samples were collected.
Results: Mean age was 76.7 years, 49.8% were frail, and 56.1% had distant metastases. The proportion of frail patients increased with higher GPS (GPS zero: 43.2%, GPS one: 52.7%, GPS two: 94.7%). GPS two was significantly associated with frailty (OR 18.5), independent of cancer type, stage, BMI and the use of anti-inflammatory drugs. The specificity of GPS was high (99%), but the sensitivity was low (14%). Frail patients with GPS two had poorer survival than patients with GPS zero-one. TNF-α and IL-6 did not improve the accuracy of GPS when screening for frailty.
Conclusion: Frailty and GPS two are strongly associated, and GPS two is a significant prognostic factor in frail, older patients with cancer. The inflammatory biomarkers investigated are not suitable screening tools for frailty.This study was funded by Innlandet Hospital Trust (0303 150337).acceptedVersio
Visual-Constructional Ability in Individuals with Severe Obesity: Rey Complex Figure Test Accuracy and the Q-Score
Get PDFThe aims of this study were to investigate visual-construction and organizational strategy among individuals with severe obesity, as measured by the Rey Complex Figure Test (RCFT), and to examine the validity of the Q-score as a measure for the quality of performance on the RCFT. Ninety-six non-demented morbidly obese (MO) patients and 100 healthy controls (HC) completed the RCFT. Their performance was calculated by applying the standard scoring criteria. The quality of the copying process was evaluated per the directions of the Q-score scoring system. Results revealed that the MO did not perform significantly lower than the HC on Copy accuracy (mean difference −0.302, CI −1.374 to 0.769, p = 0.579). In contrast, the groups did statistically differ from each other, with MO performing poorer than the HC on the Q-score (mean −1.784, CI −3.237 to −0.331, p = 0.016) and the Unit points (mean −1.409, CI −2.291 to −0.528, p = 0.002), but not on the Order points score (mean −0.351, CI −0.994 to 0.293, p = 0.284). Differences on the Unit score and the Q-score were slightly reduced when adjusting for gender, age, and education. This study presents evidence supporting the presence of inefficiency in visuospatial constructional ability among MO patients. We believe we have found an indication that the Q-score captures a wider range of cognitive processes that are not described by traditional scoring methods. Rather than considering accuracy and placement of the different elements only, the Q-score focuses more on how the subject has approached the task.The authors had no conflict of interest when conducting this research. Innlandet Hospital Trust provided the funding for this study.publishedVersio
Experiences of Professional Helping Relations by Persons with Co-occurring Mental Health and Substance Use Disorders
Get PDFRecovery in co-occurring mental health and substance use disorders often involves relationships with professional helpers, yet little is known about how these are experienced by service users. The aim of this study was to explore and describe behaviour and attributes of professional helpers that support recovery, as experienced by persons with co-occurring disorders. Within a collaborative approach, in-depth individual interviews with eight persons with lived experience of co-occurring disorders were analysed using systematic text condensation. The analysis yielded four categories of recovery-supporting behaviour and attributes of professional helpers and the ability to build trust cuts across all of them: Building trust through (a) hopefulness and loving concern, (b) commitment, (c) direct honesty and expectation and (d) action and courage. Services should allow for flexibility and continuity, and training should recognise the importance of establishing trust in order to reach out to this group.publishedVersio
Muscle mass and association to quality of life in non-small cell lung cancer patients
Get PDFBackground Cancer wasting is characterized by muscle loss and may contribute to fatigue and poor quality of life (QoL). Our
aim was to investigate associations between skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD) and selected
QoL outcomes in advanced non-small cell lung cancer (NSCLC) at diagnosis.
Methods Baseline data from patients with stage IIIB/IV NSCLC and performance status 0–2 enrolled in three randomized
trials of first-line chemotherapy (n = 1305) were analysed. Associations between SMI (cm2/m2) and SMD (Hounsfield units)
based on computed tomography-images at the third lumbar level and self-reported physical function (PF), role function
(RF), global QoL, fatigue, and dyspnoea were investigated by linear regression using flexible non-linear modelling.
Results Complete data were available for 734 patients, mean age 65 years. Mean SMI was 47.7 cm2/m2 in men (n = 420) and
39.6 cm2/m2 in women (n = 314). Low SMI values were non-linearly associated with low PF and RF (men P = 0.016/0.020,
women P = 0.004/0.012) and with low global QoL (P = 0.001) in men. Low SMI was significantly associated with high fatigue
(P = 0.002) and more pain (P = 0.015), in both genders, but not with dyspnoea. All regression analyses showed poorer physical
outcomes below an SMI breakpoint of about 42–45 cm2/m2 for men and 37–40 cm2/m2 for women. In both genders, poor PF
and more dyspnoea were significantly associated with low SMD.
Conclusions Low muscle mass in NSCLC negatively affects the patients’ PF, RF, and global QoL, possibly more so in men than
in women. However, muscle mass must be below a threshold value before this effect can be detected.
Keywords Non-small cell lung cancer; Quality of life; Body composition; Muscle massThe study was funded by South-Eastern Norway Regional Health Authority. The collection of CT scans was supported by unrestricted grants from Pierre Fabre, Norway. The Canadian participation in the body composition analyses was supported by the Canadian Institute of Health Research and Alberta Cancer FoundationpublishedVersio
Den digitale bioteknologien i Norge - Muligheter for verdiskaping, kompetansebehov og utfordringer i næringsutvikling
Get PDFRapportFormålet med denne rapporten er å beskrive mulighetene
for digital bioteknologi i Norge. Møtet mellom bioteknologi
og moderne digitale verktøy kan gi store bioøkonomiske
muligheter innen helse, havbruk, landbruk og industri
i Norge. Rapporten presenterer en kartleggingsanalyse
av et bredt utvalg virksomheter innenfor dette
relativt nye området. Det er ikke tidligere gjort en helhetlig
analyse av digital bioteknologi i Norge. Undersøkelsen
avdekker status og behov innenfor marked og innovasjon,
kompetanse, samarbeid og nettverk, samt områder hvor
Senter for Digitalt Liv Norge kan bistå for å fremme
bioteknologisk forskning og innovasjon i Norge.
Bioøkonomi er et vidt begrep som i tillegg til det økonomiske
perspektivet også omfatter andre viktige aspekter som
ansvarlig og rettferdig fordeling, og anvendelse av biologiske
ressurser. Denne undersøkelsen fokuserer i hovedsak på det
næringsmessige perspektivet av bioøkonomien. Samfunnsperspektivet
omkring digital bioteknologi er imidlertid kommentert
i et selvstendig kapittel i rapporten.
I arbeidet med analysen har en referansegruppe gitt innspill
underveis i prosjektet. Gruppen representerer ulike virksomheter,
bionæringer og landsdeler. Deltakerne i gruppen er:
• Anne Cathrin Østebø, Validé AS, Stavanger
• Eirik Lundblad, Arctic biodiscovery, Tromsø
• Håvard Sletta, SINTEF, Trondheim
• Ingrid Lea Karlskås, NCE aquaculture, Bodø
• Ketil Widerberg, Oslo Cancer Cluster, Oslo
• Marius Øgaard, Oslotech/The lifescience cluster, Oslo
• Odd Arild Lehne, Pubgene AS, Oslo
• Olav Arne Bævre, Nibio, Ås
• Ole Kristian Hjelstuen, Inven2 AS, Oslo
• Randi Taxt, BTO AS, Bergen
Arbeidet er initiert og gjennomført av Digitalt Liv Norges
arbeidspakke for innovasjon og industri involvering ved
Kjetil Taskén og Tove Julie Evjen, UiO. De øvrige personene
i prosjektgruppen fra Digitalt Liv Norge har vært Gunnar Dick
og Kjetill Jakobsen, UiO. I tillegg har Menon Economics ved
Erland Skogli og Kaja Høiseth-Gilje vært viktige partnere.
Ved besvarelse av spørreundersøkelsen og dybdeintervjuer
har et stort antall virksomheter og enkeltpersoner bidratt
betydelig. Vi vil få takke alle som har bidratt i dette nybrottsarbeidet!
Senter for Digitalt Liv Norge er et nasjonalt senter for
bioteknologisk forskning og innovasjon. Senteret er et
resultat av Forskningsrådets strategiske satsing:
«Digitalt liv – konvergens for innovasjon».
Oslo, 3 mars 2017
Prosjektansvarlig Tove Julie Evjen
Senter for digitalt liv NorgepublishedVersio