Helsebibliotekets Research Archive
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Radioactivity in the Marine Environment 2005. Results from the Norwegian Marine Monitoring Programme (RAME)
No full textThis report presents results of monitoring of radioactivity in seawater and biota collected along\ud
the Norwegian coast, the Barents Sea, the North Sea and the Skagerrak in 2005. An overview of\ud
discharges from Norwegian sources and data concerning the long-range transport of\ud
radionuclides from European nuclear facilities is included
Personaldoser ved intervensjonsradiologi. Kartlegging av effektiv dose og øyedose ved koronar intervensjonsradiologi
No full textIn the present study doses to interventional cardiologists have been recorded. The results show\ud
that the effective dose and the dose to the lens of the eye may be estimated on basis of the\ud
personnel dosimeter reading
Doctors learning habits: CME activities among Norwegian physicians over the last decade.
No full textABSTRACT: Background Coping with the increasing body of medical knowledge is a main challenge to all doctors. The aim of this study was to investigate self reported reading and learning habits among Norwegian doctors and their subjective ability to keep professionally updated. Methods A cross sectional survey among a randomised sample of Norwegian doctors was undertaken in 2004 (n = 1005, response rate 71 %). A similar study with many identical questions was done in 1993 (n = 1041, response rate 71 %) and a comparison of the results was made. Results Attending courses/congresses and reading medical literature were reported to be the most important sources of professional information in 2004, just like in 1993. Less time was spent on courses/congresses in 2004 than in 1993, and more time was spent on medical reading. The internet was regarded as useful for their professional life for three out of five, mostly among the younger and least among GPs. Two out of three doctors felt that they could obtain sufficient information for keeping updated in 2004, the same proportion as in 1993. A correlation was found between subjective coping with the information and a high level of continuing medical education (CME)-activities. The information copers had a higher level of job satisfaction than non-copers. Conclusions Over the last decade Norwegian doctors spend less time on attending courses/congresses and more time on medical reading, while the level of self perceived coping with information has been unchanged. The changing pattern of professional updating may reflect a more general individualistic trend in society. The consistent finding of a correlation between reading and attending courses, subjective coping and job satisfaction gives good reasons for recommending a high level of CME-activities among doctors
Rettssikkerhet for utviklingshemmede, II. Oppsummering av landsomfattende tilsyn i 2006 med rettssikkerhet knyttet til bruk av tvang og makt overfor personer med psykisk utviklingshemning
No full textNORSK SAMMENDRAG: Fylkesmennene gjennomførte i 2006 tilsyn med 59 kommuner som ledd i landsomfattende tilsyn med rettssikkerhet knyttet til bruk av tvang og makt overfor personer med psykisk utviklingshemning. Undersøkelsen gjaldt om kommunene sikrer at brukernes behov for tjenester etter lov om sosiale tjenester etter § 4-2, a-d endres i samsvar med endring i behov, og at forholdene legges til rette for tjenesteyting med minst mulig bruk av tvang og makt. \ud
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Statens helsetilsyn har over flere år vært opptatt av at kommunene sikrer personer med psykisk utviklingshemning forsvarlige sosialtjenester. I 2005 gjennomførte fylkesmennene et landsomfattende tilsyn rettet mot kommuner som hadde fattet vedtak om bruk av tvang og makt og/eller sendt meldinger om skadeavvergende tiltak i nødssituasjon. Tilsynet i 2005 innebar også at fylkesmennene etterså gjennomføring av enkeltvedtak om bruk av tvang og makt. I 2006 var oppmerksomhet rettet mot kommuner som ikke hadde fattet slike vedtak eller sendt meldinger om skadeavvergende tiltak i nødssituasjon. Fylkesmennene var i tilsynet i 2006 primært i kommuner de ikke hadde fått tilsendt vedtak eller meldinger fra.\ud
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Gjennom tilsynet i 2006 er det avdekket svikt i 32 av de 59 undersøkte kommunene når det gjelder kommunens sikring av at tjenestetilbudet til utviklingshemmede endres i samsvar med endring i behov. Det er særlig i tildelingsprosessen det avdekkes svikt. Blant annet mangler dokumentasjon på individuelle vurderinger, vedtak og begrunnelser, tjenestene evalueres ikke og ansatte kjenner ikke til vedtak. Fylkesmennene konstaterer også mangler knyttet til dokumentasjon av medvirkning fra bruker i tildelingsprosessen og av individuelle kartlegginger og vurderinger som grunnlag for tildeling av tjenester. \ud
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Kapittel 4A i lov om sosiale tjenester åpner for at tvang og makt kan brukes i særlige situasjoner. Når det gjelder kommunenes bruk av tvang og makt overfor utviklingshemmede, konstaterer fylkesmennene svikt i 44 av de 59 kommunene. Funn og erfaringer fra dette landsomfattende tilsynet når det gjelder bruk av tvang og makt overfor utviklingshemmede samsvarer i stor grad med tidligere tilsynserfaringer (jf. Rapport fra Helsetilsynet 6/2005 og 2/2006). Fylkesmennene konstaterer at tvang og makt brukes uten at det foreligger vedtak, og at kommunene mangler egenkontroll med oppfølging av meldinger når skadeavvergende tiltak i nødssituasjon brukes.SUMMARY IN ENGLISH: In 2006, the Offices of the County Governors carried out countrywide supervision in 59 municipalities to investigate legal safeguards associated with use of coercion and restraint for people with mental disabilities. It was investigated whether municipalities ensure that the services offered to clients in accordance with the Social Services Act, Section 4-2, a-d are adapted in relation to changing needs, and that services are organized in such a way that coercion and restraint are used as little as possible. \ud
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For several years, the Norwegian Board of Health Supervision has been concerned that municipalities ensure that people with mental disabilities receive social services that are in accordance with sound professional standards. In 2005 the offices of the county governors carried out countrywide supervision of municipalities that had made decisions about use of coercion and restraint and/or reported measures taken to prevent injury in critical situations. As part of supervision carried out in 2005, the Offices of the County Governors also investigated implementation of individual decisions regarding use of coercion and restraint. I 2006, supervision focused on municipalities that had not made such decisions or reported measures taken to prevent injury in critical situations. In 2006, the Offices of the County Governors primarily carried out supervision in municipalities that had not sent reports about decisions or special measures.\ud
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As a result of the supervision that was carried out in 2006, deficiencies were detected in 32 of the 59 municipalities that were investigated. These deficiencies were that the municipalities did not ensure that services offered to people with mental disabilities are adapted to the clients’ changing needs. Deficiencies were particularly associated with allocation of services. For example, documentation was often lacking about individual assessments, decisions made, and the justification for decisions. Services were not evaluated and the staff did not know about the decisions that had been made. The Offices of the County Governors also detected deficiencies related to documentation of client participation in the process of allocating services, and documentation of individual assessments and evaluation as the basis for allocation of services.\ud
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The Social Services Act, Chapter 4A allows the use of coercion and restraint in special situations. The Offices of the County Governors detected deficiencies in 44 of 59 municipalities related to use of coercion and restraint for people with mental disabilities. The findings and experience gained from this countrywide supervision are generally in line with earlier findings and experience (see previous reports: Reports from the Norwegian Board of Health 6/2005 and 2/2006). The Offices of the County Governors have ascertained that coercion and restraint are used when decisions about their use have not been made, and that control is lacking, since measures taken to prevent injury in critical situations are not followed up
Antimicrobial resistance predicts death in Tanzanian children with bloodstream infections: a prospective cohort study.
No full textBACKGROUND: Bloodstream infection is a common cause of hospitalization, morbidity and death in children. The impact of antimicrobial resistance and HIV infection on outcome is not firmly established. METHODS: We assessed the incidence of bloodstream infection and risk factors for fatal outcome in a prospective cohort study of 1828 consecutive admissions of children aged zero to seven years with signs of systemic infection. Blood was obtained for culture, malaria microscopy, HIV antibody test and, when necessary, HIV PCR. We recorded data on clinical features, underlying diseases, antimicrobial drug use and patients' outcome. RESULTS: The incidence of laboratory-confirmed bloodstream infection was 13.9% (255/1828) of admissions, despite two thirds of the study population having received antimicrobial therapy prior to blood culture. The most frequent isolates were klebsiella, salmonellae, Escherichia coli, enterococci and Staphylococcus aureus. Furthermore, 21.6% had malaria and 16.8% HIV infection. One third (34.9%) of the children with laboratory-confirmed bloodstream infection died. The mortality rate from Gram-negative bloodstream infection (43.5%) was more than double that of malaria (20.2%) and Gram-positive bloodstream infection (16.7%). Significant risk factors for death by logistic regression modeling were inappropriate treatment due to antimicrobial resistance, HIV infection, other underlying infectious diseases, malnutrition and bloodstream infection caused by Enterobacteriaceae, other Gram-negatives and candida. CONCLUSION: Bloodstream infection was less common than malaria, but caused more deaths. The frequent use of antimicrobials prior to blood culture may have hampered the detection of organisms susceptible to commonly used antimicrobials, including pneumococci, and thus the study probably underestimates the incidence of bloodstream infection. The finding that antimicrobial resistance, HIV-infection and malnutrition predict fatal outcome calls for renewed efforts to curb the further emergence of resistance, improve HIV care and nutrition for children
Measuring cognitive insight in schizophrenia and bipolar disorder: a comparative study.
No full textBACKGROUND: Beck Cognitive Insight Scale (BCIS) has been designed for assessment of self-reflection on patients' anomalous experiences and interpretations of own beliefs. The scale has been developed and validated for patients with schizophrenia. We wanted to study the utility of the scale for patients with bipolar disorder. The relationship between the BCIS as a measure of cognitive insight and established methods for assessment of insight of illness was explored in both diagnostic groups. METHODS: The BCIS self-report inventory was administered to patients with schizophrenia (n = 143), bipolar disorder (n = 92) and controls (n = 64). The 15 items of the inventory form two subscales, self-reflectiveness and self-certainty. RESULTS: The internal consistency of the subscales was good for the patient groups and the controls. The mean subscale scores were not significantly different for the three groups. Four items in subscale self-reflectiveness referring to psychotic experiences gave, however, different results in the control subjects. Self-certainty and scores on insight item PANSS correlated significantly in the schizophrenia, but not in the bipolar group. CONCLUSION: BCIS with its two subscales seems applicable for patients with bipolar disorder as well as for patients with schizophrenia. The self-report inventory can also be applied to control subjects if the items referring to psychotic experiences are omitted. In schizophrenia high scores on self-certainty is possibly associated with poor insight of illness. For the bipolar group the subscales are largely independent of traditional insight measures
Overskjenking i Bergen. En oppfølgingsevaluering av Ansvarlig vertskap i Bergen
No full textNORSK SAMMENDRAG: Rapporten er en studie av omfanget av overskjenking på utesteder i Bergen sentrum. Den søker å svare på når og hvor overskjenking foregår, og gir noen mulige forklaringer på funnene. Undersøkelsen er gjort på oppdrag av Sosial- og helsedirektoratet, og fokuserer også på effekter av Ansvarlig Vertskap i Bergen.\ud
Rapporten bygger på testkjøp på 55 skjenkesteder i Bergen sentrum i november 2006. Ved bruk av skuespillere som spilte svært beruset ble det testet om fulle gjester får servering og hva som skjer når gjestene bestiller.\ud
Antall overskjenkinger i Bergen har økt fra 63 prosent i 2003 til 84 prosent i 2006.\ud
I denne perioden har opplæring i Ansvarlig Vertskap blitt obligatorisk for alle ansatte på steder som har åpent til kl tre på natta i Bergen.\ud
I rapporten presenteres mulige forklaringer på overskjenkingen. Resultatene viser at det er lettere for svært berusede å få servering når det er høy musikk, mange gjester i lokalet og beruselsesnivået generelt er høyt. Mannlige skuespillere ble nektet servering noe oftere enn kvinner, og kvinnelige bartendere nektet å servere noe oftere enn mannlige.\ud
Den kulturelle konteksten blir framhevet som en viktig faktor. Den uformelle aksepten av beruselse er sterk i Norge, ikke minst blant de unge gjestene og ansatte på utestedene. Denne allmenne aksepten kan være mer avgjørende for om fulle gjester får servering enn lovens bestemmelser.\ud
Forskerne konkluderer med at det fortsatt er behov for mer og bedre opplæring om overskjenking og dens konsekvenser for ansatte i skjenkenæringen. Men kursingen må følges av mer og bedre kontroller, og alkoholloven må faktisk håndheves.ENGLISH SUMMARY: Under the provisions of the Alcohol Act, it is forbidden to serve alcoholic beverages to customers of bars and restaurants that are ”obviously under the influence of alcohol or drugs” (”åpenbart påvirket av rusmidler”). Despite this, overserving is known to be a highly prevalent occurrence. But we also know that other countries, not least Sweden, have had marked success in their efforts to reduce overserving by running staff training programmes. This report sets out the results of the first Norwegian study of overserving in bars and restaurants after most of the staff had completed a responsible alcohol serving programme. In addition to exploring the prevalence of overserving, we seek to explain why over¬serving takes place.\ud
Since 2000, more than 1,200 serving staff in the hospitality trade in Bergen have attended a Responsible host programme. In 2003 the programme became compulsory for workers in bars and restaurants with extended opening hours. In the same period, from 2000 to the end of 2006, more than 7,000 on-site inspections were carried out to monitor overserving. Only eight violations were reported, however, indicating either broad compliance with the Alcohol Act in Bergen, or a failure of the inspectors to report infringements.\ud
Over one weekend in November 2006, test purchases were made at 55 bars and restaurants in the centre of Bergen. By using actors to play inebriated customers, we were able to see whether they were served and to record aspects of the interaction and setting. The study also involved participant observation, qualitative interviews and document analysis.\ud
Our findings indicate that overserving is very widespread indeed, despite the fact that most of the staff involved in these situations had gone through the responsible serving programme. In 84 per cent of all test situations, the ”inebriated” customer received what s/he’d ordered, a rise of 21 per centage point since the previous evaluation, done in 2003.\ud
Although all serving staff at on-licensed premises with opening hours extending after midnight had attended the responsible serving programme, we did not observe a single case of our ”drunk customer” not being served in the last hour before closing, between 2 and 3 am. Since customers have probably consumed alcohol the whole evening, this is when most customers are likely to be drunk. Staff at a third of the 46 bars/restaurants did express misgivings about the customer’s state, but went on to serve him/her all the same. What the staff did in effect was to refrain from taking responsibility and “pass the buck” on to the customer saying something like ”you can have a beer, but nothing stronger!”, to the customer’s sober companion, ”You’ll just have to look after him!”, or to the bouncer, ”Since the bouncer let you in, then...!”.\ud
To understand the underlying causes of overserving we looked at the physical context, the people involved and Norwegian drinking culture. And what we found was that our “drunk” actor would be more likely to be served if the place was crowded, the music was loud, and other customers had already drunk to excess. We also discovered that our male actors were more likely to be turned down than the female actors. Regarding the bar staff, female servers were more likely to refuse to serve “drunk” customers than male servers, and older than younger servers.\ud
In most cases, the explanation for overserving is complex and a mix of several factors. One of the most influential factors however, is probably the drinking culture. Pubs and restaurants satisfy several social needs, and represent a setting where, for many customers, getting drunk plays an important role. Indeed, drinking to excess – within certain limits – is both expected and accepted behaviour, especially among younger age-groups. This is the age-group that consumes most alcohol and has the highest incidence of drunkenness. Daily life in the hospitality trade is often hectic. Customers want to enjoy themselves and drink in quantity. And it seems that behavioural norms that apply elsewhere in society are replaced by others, resulting in a collective acceptance of drunkenness. Refusing to serve a customer may therefore be felt as transgressing informal social norms. Whether a drunken customer is served or not, clearly other mechanisms are at play than the Alcohol Act.\ud
Our study shows a need for improved training programmes, heightened awareness about overserving and its consequences. The Responsible host programme trains the staff in conflict avoidance methods and prevention of drink-related violence. Information on overserving is however only a small part of the short programme, which in its present configuration at least is clearly not having much of an effect on the prevalence of overserving. It is also a well known fact the increased knowledge does not necessarily result in modified behaviour. Training also needs following up with practical steps to enforce the law; inspections should be held more frequently and control measures improved. If businesses break the law, sanctions should be used. Given its mission to “to curb to the greatest possible extent the harm to society and the individual that may result from the consumption of alcoholic beverages”, the Alcohol Act has, together with local licensing byelaws, a large, but possibly unused potential as a preventive mechanism
Degradation of the LDL receptors by PCSK9 is not mediated by a secreted protein acted upon by PCSK9 extracellularly.
No full textBACKGROUND: Proprotein convertase subtilisin/kexin type 9 (PCSK9) post-transcriptionally degrades the low density lipoprotein receptors (LDLR). However, it is unknown whether PCSK9 acts directly on the LDLR or if PCSK9 activates another protein that in turn causes degradation of the LDLR. RESULTS: We have transiently transfected HepG2 cells with wild-type and mutant D374Y-PCSK9 plasmids to study the effect of the conditioned medium on the LDLR of untransfected HepG2 cells. The ability of the conditioned medium to reduce the internalization of LDL was abolished by removal of recombinant PCSK9 from the conditioned medium by affinity chromatography. Thus, PCSK9 is the only factor in the conditioned medium able to mediate degradation of the LDLR. Moreover, fractionation of the conditioned medium by gel filtration showed that the ability of the fractions to reduce the internalization of LDL, closely paralleled the amount of D374Y-PCSK9 in the fractions. Incubation of a secreted, truncated LDLR without cytoplasmic and transmembrane domains, as well as membrane fractions from HepG2 cells, with conditioned medium containing PCSK9, did not reduce the amount of LDLR as determined by western blot analysis. Thus, the LDLR is not degraded by PCSK9 on the cell surface. The LDLR of HepG2 cells incubated with conditioned medium was protected from PCSK9-mediated degradation by the addition of nocodazole or ammonium chloride, but was not protected when the conditioned medium was made hypertonic. These findings indicate that the intracellular degradation of the LDLR involves intracellular transport along microtubules, an acidic intracellular compartment and that it occurs even when endocytosis through clathrin-coated pits has been blocked. CONCLUSION: Degradation of the LDLR by PCSK9 is not mediated by a secreted protein acted upon by PCSK9 extracellularly. Also the PCSK9-mediated degradation of the LDLR does not take place on the cell surface. Rather, the PCSK9-mediated degradation of the LDLR appears to take place intracellularly and occurs even when endocytosis through clathrin-coated pits is blocked by hypertonic medium
A magnetic resonance imaging study of patients with Parkinson's disease with mild cognitive impairment and dementia using voxel-based morphometry.
No full textBACKGROUND: Dementia is common in Parkinson's disease, but the underlying brain pathology is not yet fully understood. AIM: To examine the changes in the brain of patients with Parkinson's disease with mild cognitive impairment (MCI) and dementia, using structural magnetic resonance imaging. METHODS: Using voxel-based morphometry, the grey matter atrophy on brain images of patients with Parkinson's disease and dementia (PDD; n = 16) and Parkinson's disease without dementia (PDND; n = 20), and healthy elderly subjects (n = 20) was studied. In the PDND group, 12 subjects had normal cognitive status and 8 had MCI. Standardised rating scales for motor, cognitive and psychiatric symptoms were used. RESULTS: Widespread areas of cortical atrophy were found in patients with PDD compared with normal controls (in both temporal and frontal lobes and in the left parietal lobe). Grey matter reductions were found in frontal, parietal, limbic and temporal lobes in patients with PDD compared with those with PDND. In patients with PDND with MCI, areas of reduced grey matter in the left frontal and both temporal lobes were found. CONCLUSION: These findings show that dementia in Parkinson's disease is associated with structural neocortical changes in the brain, and that cognitive impairment in patients with PDND may be associated with structural changes in the brain. Further studies with larger groups of patients are needed to confirm these findings
