Helsebibliotekets Research Archive
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Nordic society for radiation protection-NSFS. Proceedings of the NSFS XV conference in Ålesund Norway, 26–30 of May 2008
No full textRapporten inneholder skriftlig versjon av innlegg på Nordisk selskap\ud
for stråleverns konferanse i Ålesund 26–30 mai 2008. Rapporten inneholder fulltekstversjon, eventuelt sammendrag, fra samtlige\ud
sesjoner, dvs: opening, medical, effect studies, natural radiation and\ud
radiation in nature, emergency preparedness, radioactive waste og\ud
nuclear safety and security.\ud
inneholder fulltekstversjon, eventuelt sammendrag, fra samtlige\ud
sesjoner, dvs: opening, medical, effect studies, natural radiation and\ud
radiation in nature, emergency preparedness, radioactive waste og\ud
nuclear safety and security.The report contains written versions of the presentations at the\ud
conference in Ålesund, arranged by The Nordic society for radiation\ud
protection 26–30 of May 2008. Included are full text versions, or\ud
abstracts, from all sessions, i.e: opening, medical, effect studies,\ud
natural radiation and radiation in nature, emergency preparedness,\ud
radioactive waste and nuclear safety and security
Evidence-informed health policy 4 - Case descriptions of organizations that support the use of research evidence.
No full textABSTRACT: BACKGROUND: Previous efforts to produce case descriptions have typically not focused on the organizations that produce research evidence and support its use. External evaluations of such organizations have typically not been analyzed as a group to identify the lessons that have emerged across multiple evaluations. Case descriptions offer the potential for capturing the views and experiences of many individuals who are familiar with an organization, including staff, advocates, and critics. METHODS: We purposively sampled a subgroup of organizations from among those that participated in the second (interview) phase of the study and (once) from among other organizations with which we were familiar. We developed and pilot-tested a case description data collection protocol, and conducted site visits that included both interviews and documentary analyses. Themes were identified from among responses to semi-structured questions using a constant comparative method of analysis. We produced both a brief (one to two pages) written description and a video documentary for each case. RESULTS: We conducted 51 interviews as part of the eight site visits. Two organizational strengths were repeatedly cited by individuals participating in the site visits: use of an evidence-based approach (which was identified as being very time-consuming) and existence of a strong relationship between researchers and policymakers (which can be challenged by conflicts of interest). Two organizational weaknesses - a lack of resources and the presence of conflicts of interest - were repeatedly cited by individuals participating in the site visits. Participants offered two main suggestions for the World Health Organization (and other international organizations and networks): 1) mobilize one or more of government support, financial resources, and the participation of both policymakers and researchers; and 2) create knowledge-related global public goods. CONCLUSION: The findings from our case descriptions, the first of their kind, intersect in interesting ways with the messages arising from two systematic reviews of the factors that increase the prospects for research use in policymaking. Strong relationships between researchers and policymakers bodes well given such interactions appear to increase the prospects for research use. The time-consuming nature of an evidence-based approach, on the other hand, suggests the need for more efficient production processes that are 'quick and clean enough.' Our case descriptions and accompanying video documentaries provide a rich description of organizations supporting the use of research evidence, which can be drawn upon by those establishing or leading similar organizations, particularly in low- and middle-income countries
TNFα-hemmere ved inflammatorisk tarmsykdom
No full textBACKGROUND\ud
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Patients with the inflammatory bowel diseases ulcerative colitis and Crohn’s disease need lifelong treatment and care. Effect of traditional treatments is varied and may cause serious adverse events. Biological drugs aimed at blocking specific molecular steps in the inflammatory process have been developed. Tumor necrosis factor (TNF)α is a proinflammatory cytokine with a role in the inflammatory process associated with inflammatory bowel disease. Hence, a drug blocking this cytokine might be useful for patients with ulcerative colitis and Crohn’s disease. This report includes knowledge of the TNFα-inhibitors infliximab (Remicade®), adalimumab (Humira®), etanercept (Enbrel®) and certolizumab pegol (Cimzia®).\ud
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METHOD\ud
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We systematically reviewed and critically appraised available documentation on effect and safety of TNFα-inhibitors. In addition, we have reviewed health economic studies. We identified documentation by a systematic search in Cochrane Library, Medline, Embase, PubMed and NHS Economics Evaluation Database. Our evaluation on efficacy and safety was based on systematic reviews. However, to make sure that all available data was included, we searched for randomized controlled trials published afer the literature seach in the systematic reviews was performed.\ud
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RESULTS\ud
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In patients with ulcerative colitis, infliximab was more effective than placebo in achieving improvement of the disease. Data on response and remission are available up to 54 weeks. Infliximab gives a higer proportion of patients with endoscopic remission compared to placebo. None of the other TNFα-inhibitors were tested in patients with ulcerative colitis.\ud
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In patients with Crohn’s disease, infliximab, adalimumab and certolizumab were more effective than placebo in achieving response after induction treatment (1-3 administrations of drug or placebo). Based on patients responding to induction treatment, it has been shown that maintenance treatment with infliximab, adalimumab and certolizumab is more effective than placebo in maintaining the initial response. Infliximab have been showed to be more effective than placebo in achieving fistula closure. Data on etanercerpt in treatment of Crohn’s disease is limited. There is no basis to claim that etanercerpt has effect in treatment of Crohn’s disease.\ud
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We identified four economic evalutations in a systematic literature search. All studies were from contries outside Norway and delt with infliximabtreatment of patients with Crohn’s disease.\ud
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CONCLUSION\ud
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Infliximab is effective in treatment of ulcerative colitis and Crohn’s disease. Adalimumab and certolizumab have documented effect in treatment of Crohn’s disease, while studies on patients with ulcerative colitis are lacking. There is too limited data available to conclude regarding safety of long-term treatment with TNFα-inhibitors for both ulcerative colitis and Crohn’s disease.\ud
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Based on results from countries outside Norway, infliximab does not seem to be cost-effective as continuous treatment for patients with Crohn’s disease. There might be an exception in the case of patients exhibiting good and long-lasting response. No relevant economic studies were found for ulcerative colitis or for the other TNFα- inhibitors
Colorectal cancer screening – effect on mortality and incidence rate of colorectal cancer. Overview of documentation and international recommendations
No full textExpressions of EphA2 and EphrinA-1 in early squamous cell cervical carcinomas and their relation to prognosis.
No full textBy using immunohistochemistry we investigated the expression of EphA2 and EphrinA-1 in 217 early squamous cell cervical carcinomas and examine their prognostic relevance. For EphA2 expression, 21 tumors (10%) showed negative, 108 (50%) weak positive, 69 (32%) moderate positive and 19 (9%) strong positive, whereas for EphrinA-1 expression, 33 tumors (15%) showed negative, 91 (42%) weak positive, 67 (31%) moderate positive and 26 (12%) strong positive. In univariate analysis high expression (strong staining) of EphrinA-1 was associated with poor disease-free (P = 0.033) and disease-specific (P = 0.039) survival. However, in the multivariate analyses neither EphrinA-1 nor EphA2 was significantly associated to survival. The increased levels of EphA2 and EphrinA-1 in a relative high number of early stage squamous cell carcinomas suggested that these two proteins may play an important role in the development of a subset of early cervical cancers. However, EphA2 and EphrinA-1 were not independently associated with clinical outcome
Measuring physiotherapy performance in patients with osteoarthritis of the knee: a prospective study.
No full textABSTRACT: BACKGROUND: Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality of care. The purpose of this study is to measure physiotherapy performance in patient with knee OA by comparing clinical practice to evidence from systematic reviews. . METHODS: We developed a data collection form and invited all private practitioners in Norway [n=2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA. RESULTS: A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is high-quality evidence that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation which has moderate-quality evidence for reducing pain. Patient education, which has moderate-quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient, and offered many treatment modalities with low-quality evidence or no evidence from systematic reviews, e.g., traction and mobilisation, massage, stretching and different types of advice. CONCLUSIONS: Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into physiotherapy practice should be identified and evaluated
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.
No full textRusmiddelbruk blant personer med innvandrerbakgrunn. Oversikter fra befolkningsundersøkelser
No full textNORSK SAMMENDRAG: Personer med innvandrerbakgrunn fra Asia eller Afrika ser ut til å holde fast ved lavere rusmiddelbruk enn etnisk norske og vestlige innvandrere. Bruk av alkohol, hasj og snus er lavere både blant voksne og ungdom med bakgrunn fra Asia og Afrika enn blant etnisk norske, og spesielt lavt blant kvinner med slik bakgrunn. Det ser imidlertid ut til at unge kvinner med innvandrerbakgrunn fra Asia og Afrika i noen grad plukker opp norske røyke(u)vaner.\ud
Tord Finne Vedøy har sammen med forsker Ellen Amundsen gått gjennom syv ulike undersøkelser for å se hva de viser om rusmiddelbruk blant personer med innvandrerbakgrunn. Undersøkelsene dekker både ungdom og voksne og er utført av eller i samarbeid med SIRUS i perioden 2000-2007.\ud
Voksne personer født i Norge hadde hyppigst drukket og vært beruset. Andelen voksne personer født i Asia som hadde drukket alkohol og/eller vært beruset var vesentlig lavere. Likeledes var andelen som hadde drukket og/eller vært beruset blant muslimer vesentlig lavere enn blant kristne (statskirken) og personer uten religiøs tilhørighet.\ud
Røyking blant voksne varierte mindre enn alkoholbruk mellom grupper med ulik landbakgrunn. For alle grupper i alle undersøkelser var andelen som røykte daglig mindre eller lik 30 %. Røyking var minst utbredt blant de unge voksne i aldersgruppen 21 til 30 år på tvers av landbakgrunn. Religiøs tilhørighet ser ikke ut til å påvirke røyking i særlig grad.\ud
Bruk av snus var lite utbredt blant personer med innvandrerbakgrunn. Selv blant personer født i Norge var andelen personer som brukte snus daglig lav og varierte mellom 4 og 10 %.\ud
I likhet med snus var bruk av hasj lite utbredt i den voksne befolkningen. Imidlertid fant vi at personer født i Europa eller Norge oftere hadde prøvd hasj enn personer født i Asia eller Afrika.\ud
Det ser ut til at menn i større grad enn kvinner har prøvd alle de aktuelle rusmidlene. Det ser også ut til at personer som oppga religiøs tilknytning hadde lavere bruk av rusmidler enn personer uten religiøs tilhørighet. Kvinner med asiatisk eller afrikansk bakgrunn hadde en meget begrenset bruk av alkohol, tobakk og hasj.\ud
Det er store forskjeller i bruk av alkohol blant ungdom med forskjellig landbakgrunn i alle undersøkelser. Ungdom med asiatisk eller afrikansk bakgrunn hadde i mindre grad drukket noen gang eller vært beruset enn øvrig ungdom med innvandrerbakgrunn. Som for voksne fant vi at muslimsk ungdom i mindre grad enn kristen eller ikke-religiøs ungdom hadde drukket noen gang eller vært beruset.\ud
Røyking blant unge varierte mindre etter landbakgrunn enn bruk av alkohol. Imidlertid hadde ungdom med asiatisk bakgrunn i mindre grad enn ungdom med norsk eller europeisk bakgrunn røykt noen gang eller røykte daglig. Hva angår religion ser vi at en større andel av ungdommer som oppga at de ikke hadde noen religiøs tilhørighet hadde røykt noen gang eller røykte daglig enn muslimsk eller kristen ungdom.\ud
Bruk av snus blant ungdom med innvandrerbakgrunn var liten, spesielt for ungdom med asiatisk eller afrikansk bakgrunn.\ud
På spørsmål om man hadde brukt hasj noen gang var forskjellene mindre tydelige enn for alkohol og tobakk. Flertallet av undersøkelsene blant ungdom viser at ungdom med asiatisk bakgrunn var restriktive i bruken av hasj. Ungdom med europeisk bakgrunn svarte oftest at de hadde brukt hasj.ENGLISH SUMMARY: Data from seven surveys is used to describe the use of alcohol, cigarettes, snuff and hash among young people and adults in Oslo and Norway with dissimilar countries of origin. Based on Statistics Norway's definition of immigrants, numbers were used to designate continents. For the surveys conducted among adults, the continent was that of their own native country. Among young people, the continent stated was that of their father's country of birth.\ud
There were no alarming findings with regard to substance use among persons with an immigrant background in this summary of results from various population surveys. The use of alcohol, hashish and snuff was less common among both grown ups and youth with background from Asia and Africa, and especially low among women. It may be that young women from Asia have started to smoke to a larger extent than more grown up women from this continent.\ud
Adults born in Norway were those who had most frequently drunk alcohol and been intoxicated: About 96 to 98 per cent stated that they had drunk alcohol at some time and 42 to 85 per cent replied that they had been intoxicated. The survey figures vary. The corresponding figures for adults born in Asia varied from 51 to 70 per cent for drinking at some time and from 27 to 44 per cent for having been intoxicated. The percentages who had drunk at some time among Muslims, Christians (established church) and individuals without religious affiliation were 43, 99 and 98 per cent, respectively. .\ud
Smoking among adults varied less between groups with dissimilar countries of origin. For all groups in all surveys, the proportion who smoked daily was 30 per cent or lower. Smoking was least prevalent among young adults ages 21 to 30, regardless of country of origin. Religious affiliation does not appear to reduce smoking to any great extent.\ud
The use of snuff was not prevalent among individuals from immigrant backgrounds. Even among individuals born in Norway, the percentage who used snuff daily was low, varying from 4 to 10 per cent.\ud
As with snuff, the use of hash was not prevalent in the adult population. Meanwhile, we found that individuals born in Europe or Norway had tried hash more frequently than individuals born in Asia or Africa had.\ud
It appears that men were more likely than women to have tried all the stimulants in question. It also appears that individuals who stated a religious affiliation had a lower consumption of intoxicants than individuals without any religious affiliation. Women from Asiatic or African backgrounds had very limited use of alcohol, tobacco and hash.\ud
Among young people, we found differences in alcohol consumption among young people with different countries of origin in all the surveys. Among young people with two Norwegian-born parents, the proportion which had drunk alcohol was from 62 to 88 per cent. Between 48 and 73 per cent had been intoxicated. Among young people with two parents born abroad, the corresponding figures were 40 to 59 per cent for having drunk at some time and 31 to 53 per cent for intoxication. Young people from Asiatic or African backgrounds were less likely to have drunk at some time or been intoxicated than young people from other immigrant backgrounds. As for adults, we found that Muslim young people were less likely than Christian or non-religious young people to have drunk ever or been inebriated.\ud
Smoking among young people varied less by country of origin than the use of alcohol did. Young people from Asiatic backgrounds were less likely than young people from Norwegian or European backgrounds to have smoked ever or to smoke daily. As regards philosophy of life, we see that a larger percentage of adolescents who stated that they had no religious affiliation have smoked ever or smoke daily than Muslim or Christian young people.\ud
There was little use of snuff among young people from immigrant backgrounds, especially among young people from Asiatic or African backgrounds. Between 7 and 13 per cent of the young people with an Asiatic background had tried snuff ever and between 0 and 4 per cent used snuff daily. The corresponding figure for young people with two parents born in Norway was from 13 to 42 per cent who had used snuff ever and 2 to 10 per cent who used snuff daily.\ud
To the question of whether they had used hash ever, the differences were less clear than for alcohol and tobacco. The majority of the surveys among young people indicate that young people from Asiatic backgrounds are restrictive in their use of hash. Young people from European backgrounds usually responded that they had used hash.\ud
Girls from ethnic Norwegian backgrounds had tried both alcohol and cigarettes more often than boys from a comparable background, while the boys had more frequently tried snuff and hash. Among young people from Asiatic or African backgrounds, the main impression was that the girls used the various intoxicants to a very small extent, both compared with boys from Asiatic or African backgrounds and compared with ethnic Norwegian girls
Care of vision and ocular health in diabetic members of a national diabetes organization: a cross-sectional study.
No full textBACKGROUND: Regular examination and early treatment of diabetic retinopathy can prevent visual loss. The aim of the study was to describe the care of vision and ocular health in people with diabetes in Norway. METHODS: A cross-sectional questionnaire survey of a random sample (n = 1,887) of the Norwegian Diabetic Associations' (NDA) members was carried out in 2005. Questions were asked about care of vision and ocular health, history of ocular disease and visual symptoms, general medical history and diabetes management. The study was approved by the Regional Committee for Medical Research Ethics. RESULTS: The response rate was 74%. Forty-four questionnaires with incomplete data regarding gender, age or type of diabetes were excluded, leaving 1352 cases (52% females) for analysis. 451 (33%) had type 1 and 901 (67%) had type 2 diabetes, the mean duration of diabetes was respectively, 22 (sd +/- 14) and 10 (sd +/- 9) years. In all 1,052 (78%) had their eyes examined according to guidelines and 1,169 (87%) confirmed to have received information about regular eye examinations. One in two recalled to have received such information from their general practitioner. To have received information about the importance of eye examinations (PR 3.1, 95% CI 2.4 to 4.0), and diabetes duration > 10 years (PR 1.2, 95% CI 1.2 to 1.3), were independently associated with reporting regular eye examinations. A history of diabetic retinopathy was reported by 178 (13%) responders, of which 101 (57%) reported a history of laser treatment. Responders who had regular eye examinations reported more frequently a history of diabetic retinopathy (19% vs. 5%, p < 0.001). The frequency of retinopathy was significantly higher in responders with reported HbA1c values above treatment target (23% vs. 13%, p = 0.001). However, in responders who were not regularly examined, there was no difference in reported frequency of retinopathy with regard to HbA1c level. CONCLUSION: Eight out of ten diabetic members of the NDA had their eyes examined according to current guidelines and the majority was well informed about the risk of vision loss due to diabetes. The results indicate that the reported history of diabetic retinopathy likely underestimates the prevalence of retinopathy
User experiences of evidence-based online resources for health professionals: user testing of The Cochrane Library.
No full textBACKGROUND: Evidence-based decision making relies on easy access to trustworthy research results. The Cochrane Library is a key source of evidence about the effect of interventions and aims to "promote the accessibility of systematic reviews to anyone wanting to make a decision about health care". We explored how health professionals found, used and experienced The Library, looking at facets of user experience including findability, usability, usefulness, credibility, desirability and value. METHODS: We carried out 32 one-hour usability tests on participants from Norway and the UK. Participants both browsed freely and attempted to perform individually tailored tasks while "thinking aloud". Sessions were recorded and viewed in real time by researchers. Transcriptions and videos were reviewed by one researcher and one designer. Findings reported here reflect issues receiving a high degree of saturation and that we judge to be critical to the user experience of evidence-based web sites, based on principles for usability heuristics, web guidelines and evidence-based practice. RESULTS: Participants had much difficulty locating both the site and its contents. Non-native English speakers were at an extra disadvantage when retrieving relevant documents despite high levels of English-language skills. Many participants displayed feelings of ineptitude, alienation and frustration. Some made serious mistakes in correctly distinguishing between different information types, for instance reviews, review protocols, and individual studies. Although most expressed a high regard for the site's credibility, some later displayed a mistrust of the independence of the information. Others were overconfident, thinking everything on The Cochrane Library site shared the same level of quality approval. CONCLUSION: Paradoxically, The Cochrane Library, established to support easy access to research evidence, has its own problems of accessibility. Health professionals' experiences of this and other evidence-based online resources can be improved by applying existing principles for web usability, prioritizing the development of simple search functionality, emitting "researcher" jargon, consistent marking of site ownership, and clear signposting of different document types and different content quality