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Diet in subjects with irritable bowel syndrome: A cross-sectional study in the general population
Get PDFAbstract
BACKGROUND:
Patients with irritable bowel syndrome (IBS) often relate symptoms to the intake of certain foods. This study assesses differences in diet in subjects with and without IBS.
METHODS:
The cross-sectional, population-based study was conducted in Norway in 2001. Out of 11078 invited subjects, 4621 completed a survey about abdominal complaints and intake of common food items. IBS and IBS subgroups were classified according to Rome II criteria.
RESULTS:
IBS was diagnosed in 388 subjects (8.4%) and, of these, 26.5% had constipation-predominant IBS (C-IBS), 44.8% alternating IBS (A-IBS), and 28.6% diarrhoea-predominant IBS (D-IBS). Low intake of dairy products (portions/day) (Odds Ratio 0.85 [CI 0.78 to 0.93], p = 0.001) and high intake of water (100 ml/day) (1.08 [1.02 to 1.15], p = 0.002), tea (1.05 [1.01 to 1.10], p = 0.019) and carbonated beverages (1.07 [1.01 to 1.14], p = 0.023) were associated with IBS. A lower intake of dairy products and a higher intake of alcohol and carbonated beverages were associated with D-IBS and a higher intake of water and tea was associated with A-IBS. In subjects with IBS the severity of symptoms was associated with a higher intake of vegetables and potatoes in subjects with C-IBS, with a higher intake of vegetables in subjects with A-IBS, and with a higher intake of fruits and berries, carbonated beverages and alcohol in subjects with D-IBS.
CONCLUSIONS:
In this study, the diet differed in subjects with and without IBS and between IBS subgroups and was associated with the severity of symptoms.This study was funded by Norwegian Foundation for Health and Rehabilitation through the Norwegian Asthma and Allergy Association, Norway. We thank the Norwegian Institute of Public Health for pleasant cooperation. Additionally, we thank Innlandet Hospital Trust for an unrestricted grant.publishedVersio
Disseminated tumor cells as selection marker and monitoring tool for secondary adjuvant treatment in early breast cancer. Descriptive results from an intervention study
Get PDFBackground: Presence of disseminated tumor cells (DTCs) in bone marrow (BM) after completion of systemic adjuvant treatment predicts reduced survival in breast cancer. The present study explores the use of DTCs to identify adjuvant insufficiently treated patients to be offered secondary adjuvant treatment intervention, and as a surrogate marker for therapy response.
Methods: A total of 1121 patients with pN1-3 or pT1c/T2G2-3pN0-status were enrolled. All had completed primary surgery and received 6 cycles of anthracycline-containing chemotherapy. BM-aspiration was performed 8-12 weeks after chemotherapy (BM1), followed by a second BM-aspiration 6 months later (BM2). DTC-status was determined by morphological evaluation of immunocytochemically detected cytokeratin-positive cells. If DTCs were present at BM2, docetaxel (100 mg/m², 3qw, 6 courses) was administered, followed by DTC-analysis 1 month (BM3) and 13 months (BM4) after the last docetaxel infusion.
Results: Clinical follow-up (FU) is still ongoing. Here, the descriptive data from the study are presented. Of 1085 patients with a reported DTC result at both BM1 and BM2, 94 patients (8.7%) were BM1 positive and 83 (7.6%) were BM2 positive. The concordance between BM1 and BM2 was 86.5%. Both at BM1 and BM2 DTC-status was significantly associated with lobular carcinomas (p = 0.02 and p = 0.03, respectively; chi-square). In addition, DTC-status at BM2 was also associated with pN-status (p = 0.009) and pT-status (p = 0.03). At BM1 28.8% and 12.8% of the DTC-positive patients had ≥2 DTCs and ≥3 DTCs, respectively. At BM2, the corresponding frequencies were 47.0% and 25.3%. Of 72 docetaxel-treated patients analyzed at BM3 and/or BM4, only 15 (20.8%) had persistent DTCs. Of 17 patients with ≥3 DTCs before docetaxel treatment, 12 patients turned negative after treatment (70.6%). The change to DTC-negativity was associated with the presence of ductal carcinoma (p = 0.009).
Conclusions: After docetaxel treatment, the majority of patients experienced disappearance of DTCs. As this is not a randomized trial, the results can be due to effects of adjuvant (docetaxel/endocrine/trastuzumab) treatment and/or limitations of the methodology. The clinical significance of these results awaits mature FU data, but indicates a possibility for clinical use of DTC-status as a residual disease-monitoring tool and as a surrogate marker of treatment response.
Trial registration: Clin Trials Gov NCT00248703.The study was supported by The Research Council of Norway, South-Eastern Norway
Regional Health Authority, The Norwegian Cancer Society, K. G. Jebsen
Centre for Breast Cancer Research and SanofipublishedVersio
Does death of a family member moderate the relationship between religious attendance and depressive symptoms? The HUNT study, Norway
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BACKGROUND:
The death of a family member is a stressful life event and can result in an increased level of depressive symptoms. Previous American research has shown inverse relationships between religious involvement and depression. European investigations are few and findings inconsistent; different contexts may have an important influence on findings. We therefore investigated the relationship between attendance at church/prayer house and depressive symptoms, and whether this relationship was moderated by the death of a close family member, in Norway.
METHODS:
A population-based sample from the Nord-Trøndelag Health Study, Norway (HUNT 3, N = 37,981), was the population examined. Multiple regression and interaction tests were utilised.
RESULTS:
Religious attendees had lower scores on depressive symptoms than non-attendees; death of a close family member moderated this relationship. The inverse relationships between attendance at church/prayer house and depressive symptoms were greater among those experiencing the death of an immediate family member in the last twelve months compared to those without such an experience, with men's decrease of depressive symptoms more pronounced than women's.
CONCLUSION:
In a population-based study in Norway, attendance at church/prayer house was associated with lower depressive symptoms, and the death of a close relative and gender moderated this relationship.This work was supported by MF Norwegian School of Theology (by employment) and Innlandet Hospital Trust, Norway (Grant no. 150149). The authors thank Tore Wentzel Larsen for statistical support. The Nord-Trøndelag Health Study (The HUNT Study) is a collaboration between HUNT Research Center (Faculty of Medicine, Norwegian University of Science and Technology NTNU), Nord-Trøndelag County Council, and The Norwegian Institute of Public Health.publishedVersio
Effectiveness of laxatives in elderly - a cross sectional study in nursing homes
Get PDFBACKGROUND:
Laxatives are efficient drugs, but the effectiveness has been questioned. In nursing homes, the prevalence of constipation is high and laxatives are commonly used drugs. The aims of the study were to assess the effectiveness of laxative therapy in an everyday setting in Norwegian nursing homes, study differences between treatment regimens and factors associated with normal bowel function.
METHODS:
A cross-sectional study. After giving informed consent, residents above 60 years of age using laxatives for functional constipation were included, and their characteristics, medical history, use of drugs and bowel functions were recorded. Normal bowel function was defined as bowel movements from 3 times/week to 3 times/day and stool consistency 3-5 on Bristol Stool Form Scale.
RESULTS:
Out of 647 residents in the nursing homes, 197 were included and 116 (59%) had normal bowel function. The treatment effect did not differ significantly between the laxatives, treatment regimens or expected efficacy of the regimens. The treatment was unsatisfactorily adapted to individual needs. In subjects with normal bowel function, 113 (97%) had persistent complaints; 68 (59.5%), 10 (8.0%), 34 (28.6%) and 26 (22.5%) reported straining, manual manoeuvre to facilitate bowel movements, feeling of incomplete bowel movements, and feeling of anorectal obstruction respectively. Good nutritional status, previous or present cancer disease and anxiety/depression were predictors of normal bowel function.
CONCLUSIONS:
Treatment of constipation in nursing homes was unsatisfactory. Nearly all patients with normal stool frequency and consistence had some persistent complaints. Improved nutrition and individualization of the treatment could improve the outcome.publishedVersio
The lateral trauma position: What do we know about it and how do we use it? A cross-sectional survey of all Norwegian emergency medical services
Get PDFBackground: Trauma patients are customarily transported in the supine position to protect the spine. The Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) principles clearly give priority to airways. In Norway, the lateral trauma position (LTP) was introduced in 2005. We investigated the implementation and current use of LTP in Norwegian Emergency Medical Services (EMS).
Methods: All ground and air EMS bases in Norway were included. Interviews were performed with ground and air EMS supervisors. Questionnaires were distributed to ground EMS personnel.
Results: Of 206 ground EMS supervisors, 201 answered; 75% reported that LTP is used. In services using LTP, written protocols were present in 67% and 73% had provided training in LTP use. Questionnaires were distributed to 3,025 ground EMS personnel. We received 1,395 (46%) valid questionnaires. LTP was known to 89% of respondents, but only 59% stated that they use it. Of the respondents using LTP, 77% reported access to written protocols. Flexing of the top knee was reported by 78%, 20% flexed the bottom knee, 81% used under head padding. Of 24 air EMS supervisors, 23 participated. LTP is used by 52% of the services, one of these has a written protocol and three arrange training.
Conclusions: LTP is implemented and used in the majority of Norwegian EMS, despite little evidence as to its possible benefits and harms. How the patient is positioned in the LTP differs. More research on LTP is needed to confirm that its use is based on evidence that it is safe and effective.publishedVersio
Calibrating and adjusting expectations in life: A grounded theory on how elderly persons with somatic health problems maintain control and balance in life and optimize well-being
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AIM:
This study aims at exploring the main concern for elderly individuals with somatic health problems and what they do to manage this.
METHOD:
In total, 14 individuals (mean=74.2 years; range=68-86 years) of both gender including hospitalized and outpatient persons participated in the study. Open interviews were conducted and analyzed according to grounded theory, an inductive theory-generating method.
RESULTS:
The main concern for the elderly individuals with somatic health problems was identified as their striving to maintain control and balance in life. The analysis ended up in a substantive theory explaining how elderly individuals with somatic disease were calibrating and adjusting their expectations in life in order to adapt to their reduced energy level, health problems, and aging. By adjusting the expectations to their actual abilities, the elderly can maintain a sense of that they still have the control over their lives and create stability. The ongoing adjustment process is facilitated by different strategies and result despite lower expectations in subjective well-being. The facilitating strategies are utilizing the network of important others, enjoying cultural heritage, being occupied with interests, having a mission to fulfill, improving the situation by limiting boundaries and, finally, creating meaning in everyday life.
CONCLUSION:
The main concern of the elderly with somatic health problems was to maintain control and balance in life. The emerging theory explains how elderly people with somatic health problems calibrate their expectations of life in order to adjust to reduced energy, health problems, and aging. This process is facilitated by different strategies and result despite lower expectation in subjective well-being.publishedVersio
Depression has a strong relationship to alterations in the immune, endocrine ad neural system
Get PDFEpidemiological findings indicate a connection between depressive symptoms and changes in status of the immune
system in depressed patients. This raises the possibility of causative connections. Theories on mechanisms for interactions
between immune and affective systems – directly and via endocrine system – are evolving. Such hypothesized
causative connections are supported by several findings. First, in depressed patients changes in the status of the immune
system in vivo and ex vivo are seen. Also, depressive symptoms are seen in patients with altered immune status (physiologically,
pathologically or chemically induced). Knowledge in this field may have implications regarding psychiatric follow
up of physically ill people suffering from diseases caused by an altered immune system (long lasting infections, autoimmune
diseases, hypersensitivity disorders) as well as disorders for which treatment and prognoses depends on the immune
system (infections, cancer). Similarly, medical treatment of depressed patients may be adjusted by more specific
knowledge about the interaction between neuroimmunology and depression. Important findings and the present knowledge
and theories are reviewed.acceptedVersio
Dual diagnoses – Severe Mental Illness and Substance Use Disorder. Part 2 – Effect of psychosocial interventions
No full textProblemstilling: Rapporten oppsummerer effekten av ti psykososiale behandlingstiltak for personer med dobbeldiagnose (samtidig alvorlig psykisk lidelse og ruslidelse). De til behandlingstiltakene er integrert behandling, case management, aktivt oppsøkende behandling, kognitiv atferdsterapi, motiverende intervju, familieterapi, sosial ferdighetstrening, selvhjelpsgrupper, boligtiltak og sysselsettingstiltak. Rapporten oppsummerer hvordan behandlingstiltakene virker sammenlignet med andre psykososiale tiltak eller behandling som vanlig og rapporterer følgende utfallsmål: bruk av stoff, medikamenter og alkohol, psykisk symptombelastning, funksjonsnivå og livskvalitet. Metode: Vi søkte etter systematiske oversikter over randomiserte kontrollerte studier på personer over 15 år med alvorlig psykisk lidelse og ruslidelse. De systematiske oversiktene ble inkludert i henhold til våre inklusjonskriterier og kvalitetsvurderinger. Vi oppsummerte resultatene som var rapportert i de systematiske oversiktene og brukte GRADE for å vurdere dokumentasjonsstyrken for resultatene. Resultat: To systematiske oversikter utgjorde kunnskapsgrunnlaget i rapporten. Oversiktene rapporterte resultater fra studier på syv av behandlingstiltakene. Enkelte resultater var statistisk signifikante: Motiverende intervju hadde positiv effekt på alkoholkonsum sammenlignet med psykoedukasjon. Kognitiv atferdsterapi kombinert med motiverende intervju hadde positiv effekt på henholdsvis funksjonsnivå og livstilfredshet sammenlignet med bl.a. psykoedukasjon og gruppesamtaler. Studier på de andre tiltakene hadde enten meget lav dokumentasjonsstyrke eller viste ingen statistisk signifikante resultater. Resultatene var imidlertid basert på enkeltstående studier, ofte med få deltakere og metodiske svakheter. De fleste resultatene fikk derfor en dokumentasjonsstyrke på middels, lav eller meget lav og gjorde det vanskelig å trekke klare konklusjoner. Vi fant ingen studier på effekten av boligtiltak, sysselsettingstiltak eller familietiltak. Konklusjon: De to systematiske oversiktene ga lite støtte for at de inkluderte psykososiale tiltakene har bedre eller dårligere effekt enn andre tiltak. Oversiktene indikerte mulige positive effekter for motiverende intervju alene eller i kombinasjon med kognitiv atferdsterapi. Det er behov for ytterlige forskning på dette området.Dual diagnoses – Severe Mental Illness and Substance Use Disorder. Part 2 – Effect of psychosocial interventionspublishedVersio
Dobbeldiagnose – alvorlig psykisk lidelse og ruslidelse: del 1 Screening og diagnoseinstrumenter
Get PDFPersoner med ruslidelser og personer med psykiske lidelser har tradisjonelt fått behandling i parallelle tiltak. Imidlertid har personer som er til behandling ved tverrfaglige, spesialiserte rustjenester, ofte psykiske lidelser, og personer som er til behandling i psykisk helsevern, har ofte en ruslidelse (komorbiditet). Befolkningsstudier fra Europa og USA viser at psykiske lidelser og ruslidelser ofte opptrer sammen. Jo mer alvorlig ruslidelsen er, desto høyere er forekomsten av psykiske lidelser. Denne rapporten oppsummerer forskning om nøyaktighet av screening- og diagnoseverktøy for ruslidelser og psykiske lidelser. Rapporten inkluderer studier som tilfredsstiller kravene om bruk av referansestandard, og forskningsmetoder som tillater beregning av verktøyets egenskaper. Dette gir rimelig god sikkerhet i funnene som presenteres i denne rapporten. Det kan imidlertid finnes verktøy som er klinisk relevante, men der det mangler metodisk god forskning.publishedVersio