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Assessment of dietary intake of nicotinic acid and nicotinamide in relation to tolerable upper intake levels. Opinion of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy of the Norwegian Scientific Committee for Food Safety. VKM report 2017:27
Get PDFThe Norwegian Scientific Committee for Food Safety (Vitenskapskomiteen for mattrygghet, VKM) has,at the request of the Norwegian Food Safety Authority (Mattilsynet; NFSA), assessed the intake of niacin in the Norwegian population. NFSA has also requested that VKM conduct scenario calculations to illustrate the consequences of establishing separate maximum limits for nicotinic acid(1, 4, 8 or 10 mg/day)and nicotinamide (100, 500, 700 or 900mg/day)in food supplements, by assessing these scenarios against existing tolerable upper intake levels (ULs).The current maximum limit for niacin added to food supplements is 32mg/day, including nicotinic acid, nicotinamide and inositol hexanicotinate.publishedVersio
The effect of referral templates on out-patient quality of care in a hospital setting: A cluster randomized controlled trial
Get PDFBackground The assessment of quality of care is an integral part of modern medicine. The referral represents the handing over of care from the general practitioner to the specialist. This study aimed to assess whether an improved referral could lead to improved quality of care. Methods A cluster randomized trial with the general practitioner surgery as the clustering unit was performed. Fourteen surgeries in the area surrounding the University Hospital of North Norway Harstad were randomized stratified by town versus countryside location. The intervention consisted of implementing referral templates for new referrals in four clinical areas: dyspepsia; suspected colorectal cancer; chest pain; and confirmed or suspected chronic obstructive pulmonary disease. The control group followed standard referral practice. Quality of treatment pathway as assessed by newly developed quality indicators was used as main outcome. Secondary outcomes included subjective quality assessment, positive predictive value of referral and adequacy of prioritization. Assessment of outcomes was done at the individual level. The patients, hospital doctors and outcome assessors were blinded to the intervention status. Results A total of 500 patients were included, with 281 in the intervention and 219 in the control arm. From the multilevel regression model the effect of the intervention on the quality indicator score was insignificant at 1.80% (95% CI, −1.46 to 5.06, p = 0.280). No significant differences between the intervention and the control groups were seen in the secondary outcomes. Active use of the referral intervention was low, estimated at approximately 50%. There was also wide variation in outcome scoring between the different assessors. Conclusions In this study no measurable effect on quality of care or prioritization was revealed after implementation of referral templates at the general practitioner/hospital interface. The results were hindered by a limited uptake of the intervention at GP surgeries and inconsistencies in outcome assessment.Funding This work was funded by a research grant from the Northern Norway Regional Health Authority (Helse Nord RHF) with grant number HST1026-11. The funding body had no role in the design of the study, collection and analysis of the data or writing of the manuscript.publishedVersio
Distinct Patterns of Everyday Executive Function Problems Distinguish Children With Tourette Syndrome From Children With ADHD or Autism Spectrum Disorders
No full textObjective: The aim is to investigate the everyday executive function (EF) in children with Tourette syndrome (TS), Inattentive or Combined presentations of ADHD (ADHD-I/ADHD-C), autism spectrum disorders (ASD), and typically developing children (TDC). Method: Nineteen TS, 33 ADHD-C, 43 ADHD-I, 34 ASD, and 50 TDC participated (8-17 years). Parents completed the Behavior Rating Inventory of Executive Function (BRIEF). Results: TS, ADHD-C, ADHD-I, or ASD were rated with significantly more regulation problems on all scales compared with TDC. Considerable overlap of symptoms between clinical groups made differentiation difficult on individual scales. Scale configurations showed children with TS to have more problems with emotional control (EC) than cognitive flexibility in relation to children with ASD, more problems with EC than inhibitory control in relation to ADHD-C, and more problems with EC than planning/organizing in relation to ADHD-I. Conclusion: Paired BRIEF scales dissociated EF problems in children with TS from children with ADHD-C, ADHD-I, or ASD. Clinical relevance is discussed.The project has received financial support from Innlandet Hospital Trust, Norway (grant number 150207) and the Regional Resource Center for Autism, ADHD, Tourette’s syndrome and Narcolepsy, Oslo University Hospital, Norway (grant number 150182).acceptedVersio
The relationships between mental health symptoms and gambling behavior in the transition from adolescence to emerging adulthood.
Get PDFResearch articleThere is a paucity of longitudinal investigations of gambling behavior in the transition from adolescence to emerging adulthood. We conducted a longitudinal investigation of the associations and patterns of change between mental health symptoms and gambling behavior. A representative sample of Norwegians completed questionnaires containing demographic, mental health, and gambling measures at age 17 (N = 2055), and at ages 18 (N = 1334) and 19 (N = 1277). Using latent class analysis, three classes of gambling behavior were identified: consistent non-gambling (71.1%), consistent non-risk gambling (23.8%), and risky-and-problem gambling (5.1%). Being male, showing higher physical and verbal aggression and having more symptoms of depression were associated with greater odds of belonging to the risky-and-problem gambling class at age 17. Overall, the risky-and-problem gambling class had the highest physical and verbal aggression, anxiety, and depression at 19 years. Our findings elucidate the reciprocal relationship between mental health and gambling behavior in the transition from adolescence to emerging adulthood, and the importance of recognizing these factors in designing targeted interventions.This work was supported by the Research Council of Norway (project number: 213757). The funding source had no influence on the study design, data collection and analysis, interpretation of the data, writing of the paper, and the decision to submit the paper for publication.publishedVersio
Resource Use and Disease Course in dementia - Nursing Home (REDIC-NH), a longitudinal cohort study; design and patient characteristics at admission to Norwegian nursing homes
Get PDFBackground Earlier studies of nursing home patients show a high prevalence of dementia, neuropsychiatric symptoms (NPS), pain, and dependency in activities of daily living. The REDIC-NH cohort was set up to study the disease course and the resources used in patients with dementia in Norway. The aim of this paper was to describe the methods and the data collection, and to present selected data about patients at admission to a nursing home. Methods We included 696 patients at admission to a nursing home and followed them with biannual assessments until death. Baseline data were collected between March 2012 and November 2014. In October 2016, patients had either completed an 18-month follow-up (n = 349), passed 18 months without assessments (n = 22), or left the study (n = 324). Data on demographics, cognition, NPS, activities of daily living (ADL) functioning, physical health, medication, Quality of Life (QoL), resource use, and caregiver burden, in addition to DNA samples were collected. Results Mean age of the participants at inclusion was 84.5 years (SD 7.5, range 50 – 105), 63.9% were women. According to data collected in the study, 83.8% had dementia, but only 55.9% of them had a diagnosis of dementia registered in their records. The most frequent dementia diagnosis was Alzheimer’s disease, which was present in 71% of those with dementia. Patients with dementia more often experienced delusions, hallucinations, agitation, anxiety, disinhibition, irritability, and aberrant motor behaviour compared to patients without dementia. Depression and anxiety were the most common NPS symptoms. Conclusions Dementia and NPS were highly prevalent among persons admitted to nursing homes. Only 55.9% of the patients with dementia had a diagnosis of dementia registered in their records.Resource Use and Disease Course in dementia - Nursing Home (REDIC-NH), a longitudinal cohort study; design and patient characteristics at admission to Norwegian nursing homesThe REDIC-NH study was administrated by the Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, and was initiated by the Norwegian Health Directorate, which also provided funding for the data collection. The Research Council of Norway funded the first author’s Ph.D. study.publishedVersio
Risk assessment of "other substances" – L-aspartic acid. Opinion of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy of the Norwegian Scientific Committee for Food Safety
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At the request of the Norwegian Food Safety Authority, the Norwegian Scientific Committee for Food Safety (VKM) has characterised the risk of specified doses of L-aspartic acid in food supplements. VKM concludes that:
In adults (≥18 years), adolescents (14 to < 18 years) and children (10 to < 14 years), the specified doses 3000, 3500, 4000, 4500, 5000 and 5700 mg/day L-aspartic acid in food supplements may represent a risk of adverse health effects.publishedVersio
Functional Bowel Disorders Are Associated with a Central Immune Activation
Get PDFBackground. Subjects with depression and unexplained neurological symptoms have a high prevalence of gastrointestinal comorbidity probably related to the brain-gut communication. This study explored associations between functional gastrointestinal disorders (FGID) and inflammatory markers in subjects with these disorders. Methods. The FGID, including irritable bowel syndrome (IBS), were classified according to the Rome III criteria, and degree of symptoms was assessed with IBS symptom severity score (IBS-SSS). A range of interleukins (IL), chemokines and growth factors, tryptophan, and kynurenine were analysed in serum and the cerebrospinal fluid (CSF), and short-chain fatty acids (SCFA) were analysed in the faeces. The results are reported as partial correlation (pc) and values. Results. Sixty-six subjects were included. IBS was associated with high levels of tryptophan () and kynurenine () and low level of IL-10 () in the CSF. IBS-SSS was associated with high tumor necrosis factor and low IL-10 in the CSF; and and and , respectively. Propionic minus butyric acid in faeces was negatively associated with IL-10 in the CSF (, ). Conclusions. FGID were associated with a proinflammatory immune activation in the central nervous system and a disturbed tryptophan metabolism that could have been mediated by the faecal microbiotapublishedVersio
Development of Hot and Cold Executive Function in Boys and Girls With ADHD: A 2-Year Longitudinal Study
Get PDFObjective: To investigate the development of executive function with pronounced emotional salience (hot EF) and less pronounced emotional salience (cold EF) in boys and girls with ADHD relative to typically developing (TD) children. Method: Seventy-five children with ADHD and 47 TD children were assessed with hot and cold EF tests at baseline and after 2 years. Results: Despite considerable maturation, the ADHD group remained impaired on all cold EF tests relative to TD children after 2 years. There was no effect of gender on cold EF test results. Females with ADHD outperformed TD counterparts on hot EF at baseline. Females with ADHD showed deteriorating hot EF performance, while TD counterparts showed improved hot EF performance across time. Conclusion: Enduring cold EF impairments after 2 years may reflect stable phenotypic traits in children with ADHD. Results indicate divergent developmental trajectories of hot EF in girls with ADHD relative to TD counterparts.The project has received financial support from Innlandet Hospital Trust (grant number 150186) and the Regional Resource Center for Autism, ADHD, Tourette syndrome and Narcolepsy, Oslo University Hospital (grant number 150182).acceptedVersio
Assessment of zinc intake in relation to tolerable upper intake Levels. Opinion of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy of the Norwegian Scientific Committee for Food Safety
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Alcohol and prescribed psychotropic drug use among patients admitted to a department of old age psychiatry in Norway
Get PDFBackground: Although alcohol and prescribed psychotropic drug use has increased among older people, the usefulness of information provided about these substances in patients’ referrals to departments of old-age psychiatry (OAPsy) is unknown. Aims: To examine whether patients’ self-reported elevated use of alcohol and prescribed psychotropic drugs corresponds with information provided in the referrals to OAPsy departments and to explore the factors associated with elevated self-reported use of these substances. Methods: We recorded the information provided in referrals about the elevated use of alcohol and psychotropic drugs in a sample of 206 patients (69 men) from 12 OAPsy departments. The Alcohol Use Disorders Identification Test (AUDIT) and Drug Use Disorders Identification Test (DUDIT) helped to assess self-reported use. We also collected demographic data, as well as information about cognitive functioning and symptoms of anxiety and depression. Results: Seventy-three patients (35%) scored above the cut-off for alcohol use for women/men (AUDIT ≥ 3/4) or psychotropic drugs (DUDIT ≥ 6/8), if not both. Twenty patients (10%) reported an elevated use of both alcohol and psychotropic drugs, and the referrals for eight (40%) and ten (50%) of them, respectively, included information about this use. There was a significant association between self-reported use of alcohol above the cut-off and information about elevated use in the referrals. However, no such association was found between information in the referrals and self-reported use of prescribed psychotropic drugs. Elevated alcohol use was associated with more years of education, while elevated use of psychotropic drugs was associated with younger age and severe symptoms of anxiety and depression. Conclusion: The information reported in referrals about the elevated use of alcohol and psychotropic drugs demonstrated a trend in associations with self-reported use. However, the risk factors for elevated use of alcohol and psychotropic drugs in the elderly need to be examined further.publishedVersio