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Laparoscopic nephropexy exposes a possible underlying pathogenic mechanism and allows successful treatment with tissue gluing of the kidney and fixation of the colon to the lateral abdominal wall.
No full textOBJECTIVES: Surgical treatment of "Ren Mobilis" has historically been associated with poor results and fairly high morbidity. We have used a transperitoneal laparoscopic approach in order to minimize morbidity. The goal of this study was to evaluate the success rate and to discuss the possible pathogenic mechanism, which has implications for the surgical strategy. MATERIALS AND METHODS: Seven women with a right mobile kidney were examined by intravenous pyelogram and CT scans. Symptoms were judged to emanate from the mobile kidney. Transperitoneal laparoscopic nephropexy was performed. The surgical treatment consisted of fixing the kidney to the dorsal abdominal wall using tissue glue (Tisseel) after diathermy coagulation of the surfaces to induce fibrosis. The right colon was fixed with clips to the lateral abdominal wall, trapping the kidney in place. RESULTS: In 6 of the cases, there was an incomplete rotation of the ascending colon to the right side, allowing the kidney to move freely. In one case, the kidney moved into a retroperitoneal pocket of the mesocolon. The 6 cases with a lateral passage for the kidney were symptom-free at follow-up (30-80 months), but in the 7th case the patient's kidney quickly loosened and she underwent an open reoperation, after which she was symptom-free. CONCLUSION: Our series demonstrates that good results can be achieved with a transperitoneal laparoscopic approach, but also indicates that there is a common pathogenic mechanism with incomplete rotation of the ascending colon that can be corrected during surgery, which might contribute to the good results
Alkoholpolitikken og opinionen. Endringer i befolkningens holdninger til alkoholpolitikken og oppfatninger om effekten av ulike virkemidler i perioden 2005-2009
No full textNORSK SAMMENDRAG: SIRUS har laget rapporten på oppdrag av Helsedirektoratet. Den bygger på data fra seks befolkningsundersøkelser av personer over 20 år som Synovate har utført for direktoratet fra 2005 til 2009. Studien tyder på at oppslutningen om en restriktiv alkoholpolitikk har økt de siste årene. Tidligere studier har vist samme tendens siden tusenårsskiftet.\ud
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Endrete holdninger\ud
Det er færre som ønsker en mer liberal alkoholpolitikk i 2009 enn i 2005, selv om det fortsatt er et flertall som mener at vin bør selges i butikk (61 % mot 71 % i 2005) og at alkohol er for dyrt (59 % mot 75 % i 2005).\ud
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På den annen side er det ikke lenger et flertall som mener at det er greit å smugle til eget forbruk (46 % mot 57 % i 2005). Bare 1 av 5 mener at det er for vanskelig å få kjøpt alkohol. Det er svært få som er enig at aldersgrensene er for høye (4 %) eller at dagens promillegrenser er for strenge (14 %).\ud
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Oppfatninger om effekt\ud
Fra 2005 til 2009 har det vært en økning i andelen som tror at høye priser (fra 25 til 33 %), vinmonopolordningen (fra 31 til 40 %) og begrenset tilgjengelighet på utesteder (fra 35 til 46 %) i stor grad kan bidra til å begrense skadevirkningene av alkohol. Men det har vært en nedgang i andelen som tror at aldergrenser og promillegrenser er effektivt i så måte. Andelen som tror at foreldres grensesetting og informasjons- og holdningsskapende tiltak har slik effekt har vært stabil høyt.\ud
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Gap mellom forskning og folks oppfatninger\ud
Det er fortsatt et stort gap mellom forskningen og folks oppfatninger om hva som har mest effekt for å begrense konsumet og skadevirkninger av alkohol. Forskning viser at høy pris og begrenset tilgjengelighet inkludert aldersgrenser og monopolordningen har god effekt, mens det er lite som tyder på at informasjons- og holdningsskapende arbeid har det.\ud
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Kvinner og eldre mest restriktive\ud
Oppslutningen om en restriktiv alkoholpolitikk er størst blant kvinner, eldre, de med høyest utdanning og de som aldri eller sjelden drikker alkohol. De samme gruppene har også størst tro på at de alkoholpolitiske virkemidlene de ble spurt om, er effektive for å begrense skadevirkningene.\ud
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Politikken allerede liberalisert\ud
Rapporten peker på noen mulige forklaringer på at færre ønsker en mer liberal alkoholpolitikk. De siste tiårene har politikken allerede blitt liberalisert med langt flere vinmonopol og utesteder og utvidete salgs- og skjenketider. Økt kjøpekraft har gjort at alkohol relativt sett er billigere enn tidligere, og det kan ha redusert motstanden mot prisreguleringer.\ud
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Alkoholforbruket har også økt betydelig de siste femten årene, og flere har kanskje opplevd alkoholens skyggesider. Det er også mulig at Helsedirektoratets alkoholkampanjer siden 2004 har bidratt til økt oppslutning om restriktive alkoholpolitiske virkemidler de siste årene
Serving of free school lunch to secondary-school pupils - a pilot study with health implications.
No full textOBJECTIVE: To study whether service of a free school lunch has an impact on weight development and food intake among pupils at a lower secondary school, and to assess the association between self-perceived school behaviour and food intake. DESIGN: A controlled intervention study involving service of a free healthy school lunch to 9th grade pupils took place over 4 months, from January to May 2007. Weight and height were measured before and after the intervention. The pupils also completed a short FFQ and a questionnaire concerning self-perceived school behaviour and the classroom environment before and after the intervention. A healthy food score was calculated using the FFQ data. SETTING: All 9th graders at three different lower secondary schools in southern Norway were invited to participate. One school was randomly selected as the intervention school. SUBJECTS: Fifty-eight pupils (91 %) from the intervention school and ninety-two pupils (77 %) from the control schools participated. RESULTS: BMI did not increase among the girls at the intervention school, but increased significantly among the boys at the intervention school and among the control school groups. The healthy food score correlated positively with the trait 'satisfied with schoolwork' (P < 0.001). Fifteen per cent of the variance in food score could be explained by gender and the trait 'satisfied with schoolwork'. CONCLUSIONS: Serving of a healthy free school lunch to secondary-school pupils may result in restricted weight gain. Further studies are needed to clarify the impact of school meals on overweight and academic performance
How children with cancer communicate and think about symptoms.
No full textBACKGROUND: For clinicians to effectively help children with their illness and symptoms, it is important to communicate with them in a language they can understand. METHODS: This study investigates how well children with cancer and healthy children understood 44 symptom terms; their thoughts about these symptoms in terms of causes, consequences, and cures; and what other terms the children use to express these symptoms. It also explores if there are differences in understanding and thoughts about symptoms between children who have the experience of cancer and those who do not. In all, 6 children with cancer and 8 healthy children participated in semistructured interviews. RESULTS: Children demonstrated a good understanding of symptom terms, yet were not always able to explain the symptoms. They had a rich vocabulary to talk about symptoms but did not use childish terms. Children with cancer had a more varied vocabulary for symptoms, but they did not use more medical terms. This study contributes to knowledge about children's understanding of symptoms that can be helpful to clinicians when communicating with children about their illness
Comparison of zopiclone concentrations in oral fluid sampled with intercept(®) oral specimen collection device and statsure saliva sampler™ and concentrations in blood.
No full textA clinical study of zopiclone was performed using doses of 5 and 10 mg. Samples of oral fluid were collected using the Statsure and Intercept devices, and blood samples were collected simultaneously. Concentrations of zopiclone in samples of oral fluid and blood were determined with liquid chromatography-mass spectrometry, and concentrations in undiluted oral fluid were calculated. The concentrations of zopiclone in oral fluid were generally higher when using the Intercept compared to the Statsure device; the median oral fluid/whole blood concentration ratios were 3.8 (range 1.5-15.9) and 1.9 (range 1.2-4.6), respectively (n = 21). The correlation between zopiclone concentrations in oral fluid collected with the two devices was fairly poor, r(2) = 0.35. The results indicate that the type of sampling device may significantly affect the analytical result for zopiclone in sampled oral fluid
Factors promoting and hindering the practice of female genital mutilation/cutting (FGM/C)
No full textBackground: In November 2008, the Norwegian Knowledge Centre for Violence and Traumatic Stress Studies (NKVTS) commissioned the Norwegian Knowledge Centre for the Health Services (NOKC) to conduct a systematic review about the factors promoting and hindering female genital mutilation/cutting (FGM/C), from the viewpoints of stakeholders residing in Western countries. The review would answer the question: What are the factors promoting and hindering the practice of FGM/C, as expressed by stakeholders residing in Western countries?\ud
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Methods: We searched systematically for relevant literature in international scientific databases, in databases of international organisations that are engaged in aspects related to FGM/C, and in reference lists of relevant reviews and included studies. Additionally, we communicated with professionals working with FGM/C related issues. We selected studies according to pre-specified criteria, appraised the methodological quality using checklists, and summarized the study level results in tables before performing an integrative evidence synthesis. Our conclusions were summed in a conceptual model.\ud
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Results: We included and summarized results from 25 studies, of which 16 were qualitative investigations, eight were quantitative studies, and one was a mixed-methods study. There were three stakeholders groups: exiled members from communities where FGM/C is practiced, health workers, and government officials. The results of these stakeholders' perceptions showed that the continuance of FGM/C is largely attributable to six factors: cultural tradition, the interconnected factors sexual morals and marriageability, religion, health benefits, and male sexual enjoyment. Factors perceived as hindering its continuance included health consequences, that it is not a religious requirement, that it is illegal, and that host society discourses reject FGM/C.\ud
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Conclusion: Our results show that an intricate web of cultural, social, religious, and medical pretexts for FGM/C exists. However, more research is needed to understand the totality and interconnectedness of factors promoting and hindering FGM/C among exiled members of practicing communities.*********************************************NORSK Bakgrunn:\ud
Kjønnslemlestelse innebærer at hele eller deler av de eksterne kvinnelige kjønnsorganene fjernes eller skades av ikke-terapeutiske grunner. Kjønnslemlestelse praktiseres i mer enn 28 land i Afrika og i noen land i Midtøsten og Asia. Det ser ut til at kjønnslemlestelse noen ganger forekommer i immigrantsamfunn i vestlige land, som Norge, Storbritannia, Sveits og Sverige. Kjønnslemlestelse fører ofte til helseplager som alvorlige smerter, blødninger, sjokk, infeksjoner og vanskeligheter ved urinering og avføring. Kjønnslemleste er anerkjent som en praksis som krenker menneskerettigheter.\ud
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Oppdrag\ud
Nasjonalt kunnskapssenter for helsetjenesten har gått systematisk gjennom forskning om faktorer som fremmer og forhindrer kjønnslemlestelse, i følge interessegrupper bosatt i vestlige land. Interessegruppene var immigranter som opprinnelig kom fra et land hvor kjønnslemlestelse praktiseres, helsepersonell og ansatte i offentlig virksomhet.\ud
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Hovedfunn\ud
Resultater av interessegruppenes synspunkter viste at det hovedsakelig var seks faktorer som fremmet og fire faktorer som forhindret kjønnslemlestelse:\ud
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Faktorer som fremmet kjønnslemlestelse var kulturell tradisjon, seksuell moral, gifteverdi, religion, helsegevinst og seksuell nytelse for menn\ud
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Faktorer som forhindret kjønnslemlestelse var helsefarer, at kjønnslemlestelse ikke er et religiøst krav, at det er lovstridig og at diskusjonen om kjønnslemlestelse i vestlige land er negativ overfor denne praksisen\ud
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Det er behov for ytterligere forskning for å forstå helheten og hvordan faktorer som underbygger hverandre er innbyrdes forbunde
The Intercultural Challenges of General Practitioners in Norway with Migrant Patients
No full textMigrants to Norway disproportionately use emergency medical services while under-using primary care, obviating the medical and cost advantages of the Regular General Practitioner (RGP) scheme. Little is known about migrants' use of the RGP scheme and the obstacles that affect ability and motivation to obtain or comply with treatment. The authors questioned 12 GPs around Oslo who serve migrants, using a semi-structured interview guide. GPs defined migrants in terms of socio-cultural difference rather than legal status, these differences often obstructing doctor-patient communication and understanding. GPs reported that migrants often seem helpless in dealing with the public health service owing to language difficulties, differences in expectations and a systemic failure to co-ordinate care. The findings suggest the importance of providing information about health services in a migrant's mother tongue upon arrival in Norway, of GPs taking detailed patient histories from the beginning to identify obstacles to communication and treatment, and of co-ordinating emergency services with other care
Utvikling av nasjonalt kvalitetssystem for primærhelsetjenesten – fastlegevirksomhet og øvrige allmennlegetjenester
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Intravenøs trombolytisk behandling av hjerneinfarkt i akuttfasen og sekundær blodproppforebyggende behandling (platehemmende behandling og antikoagulasjonsbehandling) etter hjerneslag
No full textNORSK: Bakgrunn \ud
Hjerneslag er den tredje hyppigste dødsårsaken og den vanligste årsaken til alvorlig nevrologisk funksjonshemning i Norge. Hjerneslag har store helsemessige og økonomiske konsekvenser både for pasienter, pårørende, helsevesenet og samfunnet forøvrig. Hvilket legemiddel som bør velges ved behandling av hjerneslag er avhengig av flere faktorer, som blant annet effektivitet og pris. \ud
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Kunnskapssenteret ble bedt om å gjøre en helseøkonomisk evaluering av alternative behandlingsmetoder ved hjerneslag.\ud
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Hovedfunn\ud
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Intravenøs trombolytisk behandling gitt innen tre timer etter akutt hjerneslag gir både høyere helsegevinst og lavere kostnader sammenlignet med ingen trombolytisk behandling.\ud
Trombolytisk behandling gitt mellom tre og fem timer etter hjerneslag er kostnadseffektivt i Kunnskapssenterets analyser, men bør vurderes nøye i et etisk perspektiv fordi slik behandling ser ut til å medføre både kortere forventet levetid og lavere livskvalitet sammenlignet med ingen trombolytisk behandling.\ud
Som sekundærforebygging etter hjerneslag, gir kombinasjonsbehandling med acetylsalisylsyre og dipyridamol større helsegevinst og reduserte livstidskostnader sammenlignet med acetylsalisylsyre alene. Sammenlignet med klopidogrel gir kombinasjonsbehandling med acetylsalisylsyre og dipyridamol også noe helsegevinst og reduserte livstidskostnader.\ud
For pasienter med hjerneslag som også har atrieflimmer, var antikoagu-lasjonsbehandling med warfarin dominant strategi (lavere kostnader og mer effektivt) som sekundærprofylakse sammenlignet med acetylsalisylsyre.ENGLISH: 1-page key messages\ud
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Background\ud
Stroke is the third most common cause of death, a major cause of severe disability and accounts for considerable consumption of healthcare resources. Which medication should be chosen for the treatment of stroke depends on several factors, including efficiency and price.\ud
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Task requirement\ud
The Norwegian Directorate of Health’s development groups for the preparation of national clinical guideline for stroke have commissioned the Norwegian Knowledge Centre for the Health Services to conduct economic evaluations of some central recommendations in the stroke guideline. We evaluated the clinical efficacy and conducted health economic evaluation of:\ud
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1. Intravenous thrombolytic treatment of patients with acute stroke (within 3 hours and between 3 to 5 hours after symptom onset) in addition to standard treatment compared to treatment without thrombolysis\ud
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2. Pharmacological secondary prevention of stroke\ud
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Antiplatelet therapy: acetylsalicylic acid (ASA) combined with slow-release dipyridamole compared with ASA monotherapy\ud
Antiplatelet therapy: ASA combined with slow-release dipyridamole compared with clopidogrel monotherapy\ud
Anticoagulation therapy with warfarin compared with ASA for prophylaxis of stroke in patients with atrial fibrillation\ud
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Main Results\ud
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Thrombolytic treatment within 3 hours after stoke reduces lifetime costs and adds quality-adjusted life years (QALYs) compared with standard treatment without thrombolysis for selected stroke patients.\ud
Thrombolysis given between 3 and 5 hours after stroke is cost-effective compared to no thrombolytic treatment. However, the choice of thrombolysis in this time interval should also be carefully considered from an ethical perspective, because it leads to shorter life expectancy relative to no thrombolytic treatment.\ud
The combination of ASA and extended-release dipyridamole increases QALYs and reduces lifetime costs compared with ASA monotherapy in secondary pre-vention of stroke.\ud
The use of ASA combined with slow-release dipyridamole for patients of 70 years reduces lifetime costs and adds QALYs compared to clopidogrel for sec-ondary prevention of stroke.\ud
Anticoagulation therapy with warfarin has lower expected costs and higher expected QALYs compared with ASA therapy for stroke patients with atrial fibrillation