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Akutte rusmiddelforgiftninger ved legevakten i Oslo. Hvilke faktorer ved akutt rusmiddelforgiftning har sammenheng med sykehusinnleggelse?
No full textAndrogenreseptor og gonadotropinfrigjørende hormonreseptor i klinisk stumme gonadotrope hypofyseadenomer
No full textBakgrunn Stumme hypofyseadenomer er relativt vanlige neoplasier som ofte krever kirurgisk behandling og en multidisiplinær oppfølging. Det finnes ikke markører som kan predikere et aggressivt klinisk forløp. Formål Hensikten med studien var å bestemme det relative genuttrykket av androgenreseptor (AR) og gonadotropinfrigjørende hormonreseptor (GnRHR) i stumme gonadotrope hypofyseadenomer og sammenligne dette med kliniske aggressivitetsmarkører og genuttrykket av østrogenreseptor a (ERa) og follikkelstimulerende hormon b (FSHb). Metode Totalt 66 retrospektivt innsamlede tumorprøver ble inkludert i studien. Messenger ribonukleinsyre (mRNA) ble ekstrahert og revers transkriptase polymerasekjedereaksjon (RT-PCR) ble utført for å danne komplementære deoksyribonukleinsyrer (cDNA). Relative genuttrykk ble bestemt ved kvantitativ PCR (qPCR). Resultater Det var ingen forskjell mellom kvinner og menn i genuttrykket av AR (median 0,13, interkvartilbredde (IKB) (0,07-0,20) og median 0,14, IKB (0,07-0,19), P=0,77, henholdsvis) eller GnRHR (median 0,11, IKB (0,03-0,38) og median 0,10, IKB (0,04-0,29), P=0,88, henholdsvis). De to reseptorene viste ingen korrelasjon til hverandre (Spearmans korrelasjon (rs)=0,08, P=0,51). Det var ingen assosiasjon mellom genuttrykkene og de kliniske aggressivitetsmarkørene. AR var negativt korrelert med ERa (rs=-0,33, P=0,008). GnRHR var positivt korrelert med ERa og FSHb hos menn (rs=0,38, P=0,01 og rs=0,77, P=mindre enn 0,001, henholdsvis). Konklusjon Funnene tyder på at genuttrykket av AR og GnRHR ikke er assosiert med aggressivitet i klinisk stumme gonadotrope hypofyseadenomer. Imidlertid kan det se ut til at reguleringen av FSH via GnRHR er bevart hos menn. Materialet i studien er retrospektivt innsamlet og resultatene bør derfor valideres i systematiske prospektive studier
Reduksjon i bruk av lav-verdi-radiologi og relatert reduksjon i kostnad.
No full textRecent development in radiology is impressive and provides diagnostic opportunities that we once thought of as impossible. At the same time, it generates large costs. The technology is advanced, expensive to use, and demands trained staff for both capturing and interpretation. The assessment of allowed expenditure is a demanding, but important, process. This leads to questions concerning the core of low-value vs. high-value healthcare. This project thesis is a limited systematic review of available literature related to reduced costs when the use of low-value radiology is reduced. 34 studies were included, with 4 concerning CT, 5 concerning ultrasonography, 9 concerning MR, 10 concerning x-ray and 6 studies that described a combination of modalities. A wide variety of diagnoses were described. The result points towards a considerable cost-reduction when reducing use of low-value imaging. The extend of the cost-reduction varies. Other, non-economic costs are also prominent. The data supports that a reduction in low-value radiology will give reduction in costs and enable more use of high-value-services. An economic perspective is important in an evaluation of prioritization ethics, where cost and utility are central scopes. Research in this field is important to shed light on and prioritize this challenge that are highly relevant in today’s healthcare
Tidstrend og effekt av karotiskirurgi ved hjerneslag
No full textBackground: Around 11 000 people are diagnosed with a new ischemic stroke annually, and around 20 % of these are caused by an embolus from the carotid artery. Carotid endarterectomy is recommended for patients who have a 70-99 % carotid stenosis. The national guidelines recommend surgical treatment of symptomatic carotid stenosis within 14 days. The aim of this study was to investigate the time trends of carotid surgery for symptomatic stenosis at Akershus University Hospital (Ahus), and to see if they follow the national guidelines. Methods: Medical journals were retrospectively evaluated of patients receiving carotid endarterectomy due to a symptomatic carotid stenosis at Ahus. I compared data from the two time periods 2010-2013 and 2017-2019. Time from symptom onset to surgery, type of symptom, degree of stenosis, complications and medications were evaluated. Age, gender and other illnesses were also compared. Results: A total of 100 patients were registered. Median days from symptom debut to surgery went down from 10 days in 2010-2013 to 5,5 days in 2017-2019. The patients had a stenosis with a median value of 81,5 %. Around 1 % experienced a peroperative stroke. There was an increase in the use of the platelet inhibitor clopidogrel, and a decrease in the use of acetylsalicylic acid monotherapy and the combination medicine acetylsalicylic acid plus dipyridamole. Conclusion: 84,7 % of the patients in total were treated within the guidelines regarding the number of days from symptom debut to surgery, and there was a significant improvement from 2010 to 2019. The use of medications also improved in line with the guidelines, and the number of severe complications were low
Behandling av pasienter med sekveler av facialisparese ved Avdeling for plastikk- og rekonstruktiv kirurgi OUS
No full textAssociation of calcineurin inhibitors nephrotoxicity and acute kidney injury after lung transplantation
No full textChanges in the use of antiseizure medications in children and adolescents in Norway, 2009–2018
No full textBackground: The use of antiseizure medications (ASMs) in the pediatric population is poorly studied. The purpose of this study was to investigate changes in the use of ASMs in children and adolescents compared to adults, and to elucidate safety considerations of certain drugs.
Method: In this population-based pharmacoepidemiological study we used the Norwegian Prescription Database (NorPD), 2009–2018. The use of ASMs is presented as 1-year prevalence per 1000: number of ASM users in a year * 1000 / number of inhabitants that year. Variables included predetermined 5-year age groups, gender, ASMs, diagnosis-specific reimbursement codes, user, and population numbers. Selected ASMs used for specific indications or subgroups included ethosuximide, sulthiame, rufinamide, stiripentol, and clobazam. Gender differences in the use of valproate was examined due to safety considerations in girls/women.
Results: The total number of ASM users (all indications) for the age groups 0–19 and 20–59 years was 5807 and 47,481 respectively in 2009, and 5906 and 61,447 respectively in 2018. The 1-year prevalence for children/ adolescents (0–19 years) using ASMs in epilepsy remained stable from 2008 to 2018, 4.3–4.2/1000 inhabitants, as compared to 8.2–7.6/1000 in adults (20–59 years). Valproate, lamotrigine, and levetiracetam were the three most used ASMs in epilepsy in children/adolescents, similar to adults. The selected ASMs were mainly used in children/ adolescents, accounting for 0.74/1000 in 2018 versus 0.17/1000 in adults. A significant increase was seen for sulthiame (8-fold), ethosuximide (4-fold), clobazam (3-fold), and stiripentol (2-fold). The use of ASMs in non-epilepsy indications was limited and stable (17% in 2018); mainly lamotrigine in psychiatry in adolescents (15–19 years). This finding was in contrast to extensive non-epilepsy use in adults (71% in 2018).
Conclusion: Changes in the use of ASMs in children/adolescents differ as compared to adults, most notably extensive and increasing use of selected ASMs and limited non-epilepsy. This is an important part of pharmacovigilance and patient safety evaluations
Injury and Illness in Elite Athletics: A Prospective Cohort Study Over Three Seasons
No full textBackground: Athletics (also known as track and field) is one of the most popular sports in the world and is the centrepiece of the Summer Olympic Games. Participation in athletics training and competition involves a risk of illness and injury. Purpose: To describe injury and illness in British Olympic track and field athletes over three full training and competition seasons. Study Design: Descriptive Epidemiology Study Methods: A total of 111 athletes on the British national program were followed prospectively for three consecutive seasons between 2015-2018. Team medical personnel recorded all injuries and illnesses during this time, following current consensus-based methods. All data pertaining to these records were reviewed and analyzed for sports injury and illness epidemiological descriptive statistics. Results: The average age of the athletes was 24 years for both males and females (24 years, +/- 4). Total exposure for the three seasons was 79 205 athlete days (217 athlete years). Overuse injuries (56.4%) were more frequent than acute injuries (43.6%). The thigh was the most common injury location (0.6 per athlete year), followed by the lower leg (0.4 per athlete year) and foot (0.3 per athlete year). Muscle and tendon were the most commonly injured tissues, while strains and tears were the most common pathology type. Hamstring muscle strain was the most common diagnosis causing time loss, followed by Achilles tendinopathy and soleus muscle strain. Respiratory illness was the most common illness type (0.3 per athlete year). Conclusion: Hamstring strains, Achilles tendinopathy, and soleus strains are the most common injuries in athletics and have highest burden. Respiratory illness is the most common illness and has the highest burden. Knowledge of this injury and illness profile within athletics could be utilised for the development of targeted prevention measures within the sport at the elite level
The association between persistent low parental income during preschool age and mental disorder in adolescence and early adulthood: a Norwegian register-based study of migrants and non-migrants
No full textBackground: Low socioeconomic status during childhood is associated with increased risk of mental disorders later in life. Yet, there is limited research on whether this association varies by migrant background, despite an overrepresentation of migrants among the economically disadvantaged. Methods: Using national register data on a study population of 577,072 individuals, we investigated the association between persistent low parental income during preschool, measured at age 3–5 years and mental disorder during adolescence and early adulthood, measured between ages 16–25. Outpatient mental healthcare (OPMH) service use was a proxy for mental disorder and was measured between 2006 and 2015. We applied discrete‑time logistic regression analyses with interaction terms to study differences in the relationship between persistent low parental income and OPMH service use by migrant background and gender. Results: Persistent low parental income during preschool age was associated with increased odds of OPMH service use in adolescence and early adulthood (aOR = 1.99, 95% CI 1.90–2.08), even after adjusting for gender, migrant background, parental education and persistent lower income at later ages (aOR = 1.33, 95% CI 1.27–1.40). Statistically significant interactions between migrant background and persistent low parental income were recalculated and presented as marginal yearly probabilities. These results showed that the association was in the opposite direction for migrants; those in the higher income group had higher probability of OPMH service use, although the differences were non‑significant for some groups. The relationship did not vary by gender. Conclusions: Social inequalities in mental health, as measured by OPMH service use, may have an onset already in childhood. Interventions to reduce inequalities should therefore start early in the life course. Since the association differed for migrants, future research should aim to investigate the mechanisms behind these disparities