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Årsrapport fra persondosimetritjenesten ved Statens strålevern 2006
No full textÅrsrapport fra persondosimetritjenesten ved Statens strålevern for\ud
2006. Rapporten inneholder dosestatistikk for arbeidstakere som\ud
gjennom sitt arbeid blir eksponert for ioniserende stråling.Annual report from the dosimetry service at the Norwegian\ud
Radiation Protection Authority. The report contains dose statistics\ud
for occupational exposure from ionizing radiation
Calprotectin (a major leucocyte protein) is strongly and independently correlated with joint inflammation and damage in rheumatoid arthritis.
No full textOBJECTIVE: Calprotectin is a major leucocyte protein, shown to correlate well with laboratory and clinical assessments in several inflammatory rheumatic diseases, and large concentrations of calprotectin have been found in synovial fluid from patients with rheumatoid arthritis (RA). The objective of the present study was to examine correlations between calprotectin and joint damage. METHODS: 145 patients with RA were analysed cross sectionally with laboratory (calprotectin, C reactive protein (CRP), and erythrocyte sedimentation rate (ESR)), clinical (28 joint counts (tender, swollen), physician global VAS, DAS28 and RA Articular Damage score (RAAD)), and radiographic (plain hand radiographs; modified Sharp's method) measurements, on the same day. RESULTS: Calprotectin showed a highly significant correlation with measures of joint damage; modified Sharp score r = 0.43 (p<0.001) and RAAD r = 0.40 (p<0.001). The association with modified Sharp score and RAAD score was maintained after adjustment for CRP, ESR, rheumatoid factor, DAS28, sex, and age in a multiple regression analysis (p = 0.018 and p = 0.04, respectively), while neither CRP nor ESR showed any independent associations. Highly significant correlations (p<0.001) were also found between calprotectin and both laboratory and clinical markers of inflammation. CONCLUSION: Calprotectin was found to significantly and independently explain the variation in the radiological and clinical assessments of joint damage. Longitudinal studies are required to examine whether calprotectin may predict the progression of joint damage in RA
Pasienters erfaringer med døgnenheter ved somatiske sykehus - Resultater fra en nasjonal undersøkelse i 2006.
No full textNORSK SAMMENDRAG: Høsten 2006 gjennomførte Nasjonalt kunnskapssenter for helsetjenesten en spørreundersøkelse blant pasienter utskrevet etter somatiske døgnopphold ved sykehus i Norge. Totalt har 10912 pasienter svart på en rekke spørsmål om sine erfaringer med sykehusoppholdet. Undersøkelsen har en svarprosent på 45,9 og representativiteten er tilfredsstillende. Det er utarbeidet tre rapporter fra undersøkelsen: Hovedresultater, metodedokumentasjon og institusjonsresultater.\ud
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Pasientene rapporterer i stor grad positive erfaringer med sykehusene. Resultatene er oppsummert i seks hovedområder som handler om pleietjenesten, legetjenesten, informasjon om prøver og undersøkelser, sykehusenes standard, organisering av sykehusenes arbeid og sykehusenes behandling av pårørende. De nasjonale resultatene på disse områdene varierer fra 63 (organisering av sykehusenes arbeid) til 78 (pleietjenesten) på en skala fra null til 100 der 100 er best mulige resultat.\ud
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Informasjon om prøver og undersøkelser får en skåre på 67. Pasientene er imidlertid svært tilfreds med legetjenestene (75) og har særlig stor tillit til legenes faglige dyktighet. De opplever også i stor grad at pårørende ivaretas på en positiv måte av sykehusene (74).\ud
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Med unntak av området standard, er resultatene like på tvers av helseregionene. På institusjonsnivå er forskjellene noe større selv om resultatene for de fleste sykehusene peker i samme retning. Pasientenes vurdering av sykehusenes standard er området med størst forskjeller mellom sykehusene.\ud
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Enkelte spørsmål i spørreskjemaet er ikke med i undersøkelsens hovedområder, men disse er også viktige erfaringsområder. Dette gjelder for eksempel smertebehandling, uforutsett venting og opplevd feilbehandling. Det viser seg at pasienter som er misfornøyd med disse områdene også er misfornøyd med de fleste andre aspekter knyttet til sykehusoppholdet sitt. Resultatene rundt dette presenteres nærmere i kapittel fire.\ud
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Analysene viser også at svarers kjønn, alder, utdanningsnivå, diagnose, innleggelsesmåte (akutt eller elektivt) samt egenvurdert helsetilstand har betydning for vurderingene av sykehuset. Disse faktorene har vi derfor justert for når vi sammenligner institusjonene.ENGLISH SUMMARY: The Norwegian Knowledge Centre for the Health Services conducted a national survey of adults who had received inpatient somatic care at Norwegian hospitals during the autumn of 2006. A total of 10912 patients responded to a number of questions about their experiences with the hospital encounters. The response rate was 45,9 per cent. The methods, overall results and results for individual hospitals are presented in three different reports.\ud
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The patients largely report positive experiences with the hospitals. The results are presented as six main dimensions of patient experiences: nursing services, doctor services, information about tests and examinations, hospital standards, organisation of hospital work and hospital treatment of next of kins. The national results vary from 63 (hospital organisation) to 78 (nursing services) on a 0-100 scale where 100 represents the best possible experiences. The score for the dimension of information relating to tests and examinations was 67. The score of 75 for the doctor services dimension show that patients are generally have good experiences and in particular have a large amount of trust in the doctors’ medical skills. The score of 74 for the dimension of next of kins shows that patients feel that they were dealt with in a good manner by the hospitals. With the exception of hospital standards, the results are similar across different health regions. At hospital level the differences are larger although most of the hospitals’ results show similar patterns.\ud
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Additional items not included within the six dimensions relate to pain treatment, unforeseen waiting and malpractice. Patients who have poor scores for these items also tend to have poorer scores across the six dimensions. Our analysis shows that the respondents’ gender, age, level of education, diagnosis, admission type (acute or elective) and self-rated health are associated with the dimensio
An adapted version of the long International Physical Activity Questionnaire (IPAQ-L): construct validity in a low-income, multiethnic population study from Oslo, Norway.
No full textBACKGROUND: The aim was to assess the construct validity characteristics of an adapted version of the long International Physical Activity Questionnaire (IPAQ-L) and report seasonal variations in physical activity (PA). METHODS: In two multiethnic suburbs of Oslo, Norway, all men and women aged 31-67 years (N = 6140) were invited to a survey in 2000, and participants (N = 2950) were re-invited in 2003. Complete IPAQ-L forms were delivered by 2274 baseline participants. We used the first IPAQ-L version, which asks for PA in a usual week with separate answering alternatives for summer and winter. Baseline energy expenditure calculated from IPAQ-L was compared with anthropometrical and biological measurements including maximal aerobic power in a subgroup, and individual changes in PA were compared with changes in these measurements. RESULTS: Vigorous PA within all domains, leisure-time PA (LPA), total PA, and in men occupational PA correlated with waist-to-hip ratio (rho around -0.1, p < 0.05). For vigorous PA and LPA similar correlations were found with triglycerides and high-density lipoprotein-cholesterol (rho 0.1, p < 0.05). LPA was correlated with maximal aerobic power in both sexes with rho 0.2 for total LPA and 0.4 for vigorous LPA (p < 0.01). In men, similar correlations were found for changes in total vigorous PA.The overall energy expenditure reported was 18% higher in summer than in winter. The amount of total and commuting PA in the two seasons were highly correlated with rho values of 0.9 and 0.7, respectively (p < 0.01). CONCLUSION: Weak, but consistent correlations with baseline biological and anthropometrical measurements were found in both sexes, but for changes in PA such a pattern was seen in men only. The total energy expenditure in summer and winter were highly correlated although the absolute volume was higher in summer than in winter
Oppsummering av landsomfattende tilsyn i 2006 med tverrfaglige spesialiserte tjenester til rusmiddelmisbrukere
No full textNORSK SAMMENDRAG: Tverrfaglige spesialiserte tjenester til rusmiddelmisbrukere ble valgt som tema for landsomfattende tilsyn i 2006 fordi det nå er over to år siden tjenestene ble omorganisert og gjort til en del av spesialisthelsetjenesten. De nye ansvarlige eierne har derfor hatt tid til å sikre at denne til dels sårbare gruppen brukere får forsvarlige tverrfaglige tjenester og at kravene til pasientrettigheter etterleves.\ud
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Fire faser i behandling av rusmiddelmisbrukere ble undersøkt i tilsynet: henvisning og vurdering, utredning, behandling og avslutning av behandling. Det ble undersøkt om tjenestene i alle disse fasene er faglig forsvarlige og på hvordan det sikres at 30-dagersfristen når det gjelder rett til vurdering ble innfridd. Videre undersøkte vi samhandling med andre tjenester, brukeres medvirkning, ansattes kompetanse og sikring av dokumentasjon av individuelle forløp (journalføring).\ud
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Funnene bekreftet at det er nødvendig for de som tilbyr tverrfaglige spesialiserte tjenester å gjennomgå sine virksomheter for å identifisere områder som må forbedres:\ud
Flere virksomheter gir ikke forsvarlige tjenester ved at de ikke har den nødvendige kompetanse for å foreta forsvarlig vurdering, utredning og behandling. Det ble avdekket flere tilfeller med mangelfull nedtegnelse av pasientopplysninger i journal samt uforsvarlig oppbevaring av journalopplysninger. \ud
Flere virksomheter sikrer ikke at henvisninger til tverrfaglig spesialisert behandling blir vurdert i tverrfaglige vurderingsteam innen fristen på 30 virkedager. \ud
Det er påvist manglende mulighet for å tilby pasientene sammenhengende tiltaksskjeder fordi samarbeidet med andre spesialisthelsetjenester og med kommunenes helse- og sosialtjenester ikke er tilfredsstillende. \ud
Det ble påvist forhold som viser at virksomhetene ikke styrer systematisk slik at forsvarlig tjenesteyting sikres. Det er blant annet tilfeller med svikt i systematikken knyttet til om en virksomhet registrerer feil og uplanlagte hendelser og bruker disse aktivt i sin interne læring og kontinuerlige forbedring.SUMMARY IN ENGLISH: Multidisciplinary specialized services for people with alcohol and drug problems were chosen as a theme for countrywide supervision in 2006 because it is now more than two years since the services were reorganized and became part of specialized health services. The new owners with responsibility for these services have now had time to ensure that this vulnerable group of clients receives multidisciplinary services that are in accordance with sound professional standards and with the requirements laid down in the Patients’ Rights Act.\ud
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Supervision activities focused on four different phases of treatment for people with alcohol and drug problems: referral and assessment, clinical investigation, treatment and completion of treatment. We investigated whether services in all these phases are provided in accordance with sound professional standards. We also investigated how it is ensured that the deadline of 30 working days for the right to be assessed is met. Other areas that were investigated were team work with other services, client participation, whether there were enough employees with the necessary skills, and patient record-keeping.\ud
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The findings confirmed that it is necessary for providers of multidisciplinary specialized services to identify areas that need to be improved:\ud
Several institutions provide services that are not in accordance with sound professional standards, since they do not have the necessary professional expertise needed to make adequate assessments, to carry out investigations and to provide treatment. Several cases of inadequate patient record-keeping were detected, and patient records were not stored in such a way as to ensure necessary limitation of access. \ud
Several institutions did not ensure that clients who are referred to specialized treatment services are assessed by a multidisciplinary team within the deadline of 30 working days. \ud
The possibilities for clients to be offered coordinated services are inadequate, because cooperation between different sectors, and between multidisciplinary specialized services and municipal health and social services, is not satisfactory. \ud
Conditions were detected that show that management of the services is not systematic, so that provision of services in accordance with sound professional standards is not ensured. For example, there were deficiencies in the system associated with registration of adverse events, and active use of experience gained from these events in staff training and work with quality improvement
Somatic sequence alterations in twenty-one genes selected by expression profile analysis of breast carcinomas.
No full textINTRODUCTION: Genomic alterations have been observed in breast carcinomas that affect the capacity of cells to regulate proliferation, signaling, and metastasis. Re-sequence studies have investigated candidate genes based on prior genetic observations (changes in copy number or regions of genetic instability) or other laboratory observations and have defined critical somatic mutations in genes such as TP53 and PIK3CA. METHODS: We have extended the paradigm and analyzed 21 genes primarily identified by expression profiling studies, which are useful for breast cancer subtyping and prognosis. This study conducted a bidirectional re-sequence analysis of all exons and 5', 3', and evolutionarily conserved regions (spanning more than 16 megabases) in 91 breast tumor samples. RESULTS: Eighty-seven unique somatic alterations were identified in 16 genes. Seventy-eight were single base pair alterations, of which 23 were missense mutations; 55 were distributed across conserved intronic regions or the 5' and 3' regions. There were nine insertion/deletions. Because there is no a priori way to predict whether any one of the identified synonymous and noncoding somatic alterations disrupt function, analysis unique to each gene will be required to establish whether it is a tumor suppressor gene or whether there is no effect. In five genes, no somatic alterations were observed. CONCLUSION: The study confirms the value of re-sequence analysis in cancer gene discovery and underscores the importance of characterizing somatic alterations across genes that are related not only by function, or functional pathways, but also based upon expression patterns
Transparent development of the WHO rapid advice guidelines.
No full textEmerging health problems require rapid advice. We describe the development and pilot testing of a systematic, transparent approach used by the World Health Organization (WHO) to develop rapid advice guidelines in response to requests from member states confronted with uncertainty about the pharmacological management of avian influenza A (H5N1) virus infection. We first searched for systematic reviews of randomized trials of treatment and prevention of seasonal influenza and for non-trial evidence on H5N1 infection, including case reports and animal and in vitro studies. A panel of clinical experts, clinicians with experience in treating patients with H5N1, influenza researchers, and methodologists was convened for a two-day meeting. Panel members reviewed the evidence prior to the meeting and agreed on the process. It took one month to put together a team to prepare the evidence profiles (i.e., summaries of the evidence on important clinical and policy questions), and it took the team only five weeks to prepare and revise the evidence profiles and to prepare draft guidelines prior to the panel meeting. A draft manuscript for publication was prepared within 10 days following the panel meeting. Strengths of the process include its transparency and the short amount of time used to prepare these WHO guidelines. The process could be improved by shortening the time required to commission evidence profiles. Further development is needed to facilitate stakeholder involvement, and evaluate and ensure the guideline's usefulness
Pseudomonas aeruginosa contamination of mouth swabs during production causing a major outbreak.
No full textBACKGROUND: In 2002 we investigated an outbreak comprising 231 patients in Norway, caused by Pseudomonas aeruginosa and linked to the use of contaminated mouth swabs called Dent-O-Sept. Here we describe the extent of contamination of the swabs, and identify critical points in the production process that made the contamination possible, in order to prevent future outbreaks. METHODS: Environmental investigation with microbiological examination of production, ingredients and product, molecular typing of bacteria and a system audit of production. RESULTS: Of the 1565 swabs examined from 149 different production batches the outbreak strain of P. aeruginosa was detected in 76 swabs from 12 batches produced in 2001 and 2002. In total more than 250 swabs were contaminated with one or more microbial species. P. aeruginosa was detected from different spots along the production line. The audit revealed serious breeches of production regulations. Health care institutions reported non-proper use of the swabs and weaknesses in their purchasing systems. CONCLUSION: Biofilm formation in the wet part of the production is the most plausible explanation for the continuous contamination of the swabs with P. aeruginosa over a period of at least 30 weeks. When not abiding to production regulations fatal consequences for the users may ensue. For the most vulnerable patient groups only documented quality-controlled, high-level disinfected products and items should be used in the oropharynx
Immigration, social integration and mental health in Norway, with focus on gender differences.
No full textABSTRACT: BACKGROUND: Studies have shown that social integration may have a positive as well as a negative effect on the mental health of immigrants, depending on the social circumstances. AIMS OF THE STUDY: To investigate the relationship between social integration and psychological distress in immigrants in Oslo, Norway, with focus on gender differences. METHODS: The study was based on data from a community survey in Oslo (N = 15899), and included 1448 immigrants from non-Western and 1059 immigrants from Western countries. Psychological distress was measured by a 10 items version of Hopkins Symptom Check List (HSCL-10), and social integration was measured by an index based on four items: Knowledge of the Norwegian language, reading Norwegian newspapers, visits by Norwegians and receiving help from Norwegians. Information on paid employment, household income, marital status, social support and conflicts in intimate relationships was also included in the study. RESULTS: The non-western immigrants showed a higher level of psychological distress than the immigrants from western countries. In men this could be explained by the combination of less social integration, less employment, lower income, less social support and more conflicts in intimate relationships among non-western compared to western immigrants. In women the difference in level of psychological stress could not be explained by these variables, even if it was reduced. A reason for this seemed to be that social integration in non-western immigrants had a different effect on mental health in men and women. In men, social integration showed a positive effect through employment and income, as well as a positive effect in other areas. Also in non-western women social integration showed a positive effect through greater access to employment and income, but this effect was levelled out by integration causing problems in other areas. CONCLUSION: Unexpectedly, social integration in non-western immigrants was associated with good mental health in men, but not in women. A possible explanation for this might be that the traditional female role in these countries is more challenged by social integration into a Western country than the male role, resulting in conflicting norms, threat to the self and/or loss of identity
TP53 mutation status and gene expression profiles are powerful prognostic markers of breast cancer.
No full textINTRODUCTION: Gene expression profiling of breast carcinomas has increased our understanding of the heterogeneous biology of this disease and promises to impact clinical care. The aim of this study was to evaluate the prognostic value of gene expression-based classification along with established prognostic markers and mutation status of the TP53 gene (tumour protein p53) in a group of breast cancer patients with long-term (12 to 16 years) follow-up. METHODS: The clinical and histopathological parameters of 200 breast cancer patients were studied for their effects on clinical outcome using univariate/multivariate Cox regression. The prognostic impact of mutations in the TP53 gene, identified using temporal temperature gradient gel electrophoresis and sequencing, was also evaluated. Eighty of the samples were analyzed for gene expression using 42 K cDNA microarrays and the patients were assigned to five previously defined molecular expression groups. The strength of the gene expression based classification versus standard markers was evaluated by adding this variable to the Cox regression model used to analyze all samples. RESULTS: Both univariate and multivariate analysis showed that TP53 mutation status, tumor size and lymph node status were the strongest predictors of breast cancer survival for the whole group of patients. Analyses of the patients with gene expression data showed that TP53 mutation status, gene expression based classification, tumor size and lymph node status were significant predictors of survival. Breast cancer cases in the 'basal-like' and 'ERBB2+' gene expression subgroups had a very high mortality the first two years, while the 'highly proliferating luminal' cases developed the disease more slowly, showing highest mortality after 5 to 8 years. The TP53 mutation status showed strong association with the 'basal-like' and 'ERBB2+' subgroups, and tumors with mutation had a characteristic gene expression pattern. CONCLUSION: TP53 mutation status and gene-expression based groups are important survival markers of breast cancer, and these molecular markers may provide prognostic information that complements clinical variables. The study adds experience and knowledge to an ongoing characterization and classification of the disease