Helsebibliotekets Research Archive
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An overview of research on the effects of results-based financing
No full textBackground: Norway is the lead promoter of results-based financing (RBF) as\ud
one of five actions being taken as part of the Global Campaign for the Health\ud
Millennium Development Goals and plans to support the use of RBF through\ud
the World Bank and in bilateral agreements with selected countries focusing\ud
on achieving the Millennium Development Goals (MDGs) of reducing child and\ud
maternal mortality (MDG 4 and 5).RBF-schemes can be targeted at different\ud
levels: recipients of healthcare, individual providers of healthcare, healthcare\ud
facilities, private sector organisations, public sector organisations, sub-national\ud
governments, and national governments. • Method: This report consists of an\ud
overview of systematic reviews and a critical appraisal of four evaluations of\ud
RBF schemes in the health sector in low and middle-income countries (LMIC).\ud
Results: • Ten systematic reviews that met the inclusion criteria for this report\ud
were summarised. In addition, four evaluations of RBF schemes in LMIC were\ud
critically appraised, including fi nancial incentives targeted at patients, individual\ud
providers, organisations, and governments.\ud
There are few rigorous studies of RBF and overall the evidence of its effects is\ud
weak. • Financial incentives targeting recipients of healthcare and individual\ud
healthcare professionals appear to be effective in the short run for simple and\ud
distinct, well-defi ned behavioural goals. There is less evidence that fi nancial incentives\ud
can sustain long-term changes. • The use of RBF in LMIC has commonly\ud
been as part of a package that may include increased funding, technical support,\ud
training, changes in management, and new information systems. It is not\ud
possible to disentangle the effects of RBF and there is very limited quantitative\ud
evidence of RBF per se having an effect, other than in the context of conditional\ud
cash transfers to poor and disadvantaged groups in Latin America to motivate\ud
preventive care
Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews.
No full textThis is the second in a Series of eight papers about Alma-AtaStrengthening health systems is a key challenge to improving the delivery of cost-effective interventions in primary health care and achieving the vision of the Alma-Ata Declaration. Effective governance, financial and delivery arrangements within health systems, and effective implementation strategies are needed urgently in low-income and middle-income countries. This overview summarises the evidence from systematic reviews of health systems arrangements and implementation strategies, with a particular focus on evidence relevant to primary health care in such settings. Although evidence is sparse, there are several promising health systems arrangements and implementation strategies for strengthening primary health care. However, their introduction must be accompanied by rigorous evaluations. The evidence base needs urgently to be strengthened, synthesised, and taken into account in policy and practice, particularly for the benefit of those who have been excluded from the health care advances of recent decades
Vitamin D-mangel, sekundær hyperparatyreoidisme og\ud bentetthet hos pakistanere og nordmenn bosatt i Oslo
No full textWe studied the prevalence of vitamin D deficiency and bone mineral density in Norwegian born and Pakistani\ud
born men and women living in Oslo. We measured 25-hydroxyvitamin D, iPTH and ionized calcium in serum\ud
and bone mineral density (BMD) at the forearm with single energy X-ray absorptiometry. 1386 persons born in\ud
Norway and 177 persons born in Pakistan participated. Among the Pakistani born 9% of the men and 21% of\ud
women were seriously vitamin D deficient (25(OH)D < 12.5 nmol/l). None of the Norwegian born had such\ud
low levels of vitamin D. While 86% of the Norwegians were vitamin D sufficient (25(OH)D ! 50 nmol/l), only\ud
8% of Pakistani men and 10% of Pakistani women had a sufficient vitamin D status. The prevalence of secondary\ud
hyperparathyroidism was four times higher in Pakistani women and five times higher in Pakistani men\ud
compared to their Norwegian counterparts. Unadjusted bone mineral density was not different between the two\ud
ethnic groups, but in the multivariate analysis BMD was 0.020 g/cm2 (95% CI: 0.007–0.033) higher in Pakistani\ud
men than in Norwegian men. We also found 5-8% higher bone mineral density in Pakistani men and women\ud
when we controlled for different skeletal size. While BMD was lower in Norwegian women with, compared to\ud
Norwegian women without, secondary hyperparathyroidsm (–0.027 g/cm2, p = 0.019), there was no difference\ud
in BMD between Pakistani women with and without secondary hyperparathyroidsm
Hydrodilatation, corticosteroids and adhesive capsulitis: a randomized controlled trial.
No full textBACKGROUND: Hydrodilatation of the glenohumeral joint is by several authors reported to improve shoulder pain and range of motion for patients with adhesive capsulitis. Procedures described often involve the injection of corticosteroids, to which the reported treatment effects may be attributed. Any important contribution arising from the hydrodilatation procedure itself remains to be demonstrated. METHODS: In this randomized trial, a hydrodilatation procedure including corticosteroids was compared with the injection of corticosteroids without dilatation. Patients were given three injections with two-week intervals, and all injections were given under fluoroscopic guidance. Outcome measures were the Shoulder Pain and Disability Index (SPADI) and measures of active and passive range of motion. Seventy-six patients were included and groups were compared six weeks after treatment. The study was designed as an open trial. RESULTS: The groups showed a rather similar degree of improvement from baseline. According to a multiple regression analysis, the effect of dilatation was a mean improvement of 3 points (confidence interval: -5 to 11) on the SPADI 0-100 scale. T-tests did not demonstrate any significant between-group differences in range of motion. CONCLUSION: This study did not identify any important treatment effects resulting from three hydrodilatations that included steroid compared with three steroid injections alone. TRIAL REGISTRATION: The study is registered in Current Controlled Trials with the registration number ISRCTN90567697
Factor structure of the Shoulder Pain and Disability Index in patients with adhesive capsulitis.
No full textBACKGROUND: The Shoulder Pain and Disability Index (SPADI) is a self-administered questionnaire that aims to measure pain and disability associated with shoulder disease. It consists of a pain section and a disability section with 13 items being responded to on visual analogue scales. Few researchers have investigated SPADI validity in specified diagnostic groups, although the selection of an evaluative instrument should be based on evidence of validity in the target patient group. The aim of the present study was to investigate factor structure of the SPADI in a study population of patients with adhesive capsulitis. METHODS: The questionnaire was administered to 191 patients with adhesive capsulitis. Descriptive statistics for items and a comparison of scores for the two subscales were produced. Internal consistency was analyzed by use of the Cronbach alpha and a principal components analysis with varimax rotation was conducted. Study design was cross-sectional. RESULTS: Two factors were extracted, but the factor structure failed to support the original division of items into separate pain and disability sections. CONCLUSION: We found minimal evidence to justify the use of separate subscales for pain and disability. It is our impression that the SPADI should be viewed as essentially unidimensional in patients with adhesive capsulitis
Gentester for brystkreft og eggstokkreft.
No full textSUMMARY IN ENGLISH IN THE REPORT.\ud
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Brystkreft og eggstokkreft er blant de hyppigste kreftformene som rammer kvinner i Norge. Man regner med at 5−10 % av disse krefttilfellene skyldes arv. Rapporten tar for seg tester for å påvise feil i BRCA-genene som forårsaker brystkreft og eggstokkreft. \ud
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Analytisk og klinisk validitet av BRCA-gentester:\ud
Det er ikke mulig å trekke klare konklusjoner om hva som er den mest analytisk gyldige testen for å påvise genfeil i BRCA1- og BRCA2-genene. Full mutasjons-undersøkelse vil være den sikreste måten å fange opp en genfeil på, og det gjøres ved en kombinasjon av flere teknikker. I Norge finnes det egne prediktive tester med høy sensitivitet og spesifisitet, disse testene vil fange opp kjente norske mutasjoner. De vil identifisere mange, men ikke alle familier med mutasjoner i BRCA1/2-genene.\ud
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Forebyggende tiltak for bærere av BRCA1/2-mutasjoner:\ud
Genetisk testing vil kunne identifisere bærere av BRCA-1/2-genfeil. Tett oppfølging med hyppige mammografiundersøkelser og/eller MRI er et aktuelt tiltak for bærere av BRCA1- og BRCA2-mutasjoner. MRI er mer sensitiv enn mammografi, særlig hos yngre kvinner. Forebyggende fjerning av friske organer reduserer kreftrisikoen vesentlig, men fjerner den ikke helt. Forebyggende fjerning av eggstokker (profylaktisk ooforektomi) kan redusere risikoen for eggstokkreft med 85 til 100 % og brystkreft med 53 til 68 %. Forebyggende fjerning av bryst (profylaktisk mastektomi) kan redusere risikoen for brystkreft med 85 til 100 %.\ud
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Etiske betraktninger\ud
Genetisk testing har konsekvenser også for andre enn den personen som testes, og reiser derfor mange etiske spørsmål. Det bør derfor stilles betydelige krav til informasjon og genetisk veiledning før genetisk testing skjer.\ud
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Konklusjon\ud
Mutasjoner i BRCA1/2-genene er assosiert med økt risiko for bryst- og eggstokkreft. Det foreligger tester for de vanligste mutasjonene i den norske befolkningen. Testene vil kunne gi verdifull informasjon til medlemmer av familier med kjent mutasjon. Flere genetiske testinger trengs for å utelukke en genmutasjon. Det er fortsatt et behov for flere studier om ulike strategier for oppfølging og forebygging av kreftutvikling hos BRCA1/2-mutasjonsbærere
Hypermethylated MAL gene - a silent marker of early colon tumorigenesis.
No full textBACKGROUND: Tumor-derived aberrantly methylated DNA might serve as diagnostic biomarkers for cancer, but so far, few such markers have been identified. The aim of the present study was to investigate the potential of the MAL (T-cell differentiation protein) gene as an early epigenetic diagnostic marker for colorectal tumors. METHODS: Using methylation-specific polymerase chain reaction (MSP) the promoter methylation status of MAL was analyzed in 218 samples, including normal mucosa (n = 44), colorectal adenomas (n = 63), carcinomas (n = 65), and various cancer cell lines (n = 46). Direct bisulphite sequencing was performed to confirm the MSP results. MAL gene expression was investigated with real time quantitative analyses before and after epigenetic drug treatment. Immunohistochemical analysis of MAL was done using normal colon mucosa samples (n = 5) and a tissue microarray with 292 colorectal tumors. RESULTS: Bisulphite sequencing revealed that the methylation was unequally distributed within the MAL promoter and by MSP analysis a region close to the transcription start point was shown to be hypermethylated in the majority of colorectal carcinomas (49/61, 80%) as well as in adenomas (45/63, 71%). In contrast, only a minority of the normal mucosa samples displayed hypermethylation (1/23, 4%). The hypermethylation of MAL was significantly associated with reduced or lost gene expression in in vitro models. Furthermore, removal of the methylation re-induced gene expression in colon cancer cell lines. Finally, MAL protein was expressed in epithelial cells of normal colon mucosa, but not in the malignant cells of the same type. CONCLUSION: Promoter hypermethylation of MAL was present in the vast majority of benign and malignant colorectal tumors, and only rarely in normal mucosa, which makes it suitable as a diagnostic marker for early colorectal tumorigenesis
Strålevernets overvåking av radioaktivitet i luft - beskrivelse og resultater for 2000-2004
No full textRapporten omfatter en beskrivelse av Strålevernets\ud
luftfilterstasjoner og resultater fra luftovervåkingen i perioden\ud
2000 - 2004.The report summarizes the data from NRPA’s high volume\ud
airfilter stations in the period 2000 - 2004. A short description of\ud
the system is also presented