Drammen, Norway
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Bjornara K.A.,Drammen Hospital | Dietrichs E.,University of Oslo | Toft M.,University of Oslo
Parkinsonism and Related Disorders | Year: 2013

Background: REM sleep behavior disorder (RBD) is common in Parkinson's disease (PD). While previous studies of idiopathic RBD have reported a striking male preponderance, little information exists about potential gender differences of RBD in PD. Methods: We performed a cross sectional study of 107 PD patients. Probable RBD (pRBD) was diagnosed using the RBD Screening Questionnaire. Results: Men had more fights (96% versus 54%, p < 0.001), violent behavior (71% versus 39%, p = 0.04) and awakening by own movements (89% versus 62%, p = 0.04). More women experienced disturbed sleep (85% versus 32%, p = 0.02). The frequency of pRBD was 31% in women and 43% in men (p = 0.2), total frequency 38%. Conclusions: We found no clear differences in the frequency of pRBD among men and women with PD, but demonstrated significant gender differences in its clinical expression. Female PD patients reported significantly less fights and aggressive behavior during dreams, but had more disturbed sleep. © 2012 Elsevier Ltd.


Ramstad K.,University of Oslo | Jahnsen R.,University of Oslo | Skjeldal O.H.,Drammen Hospital | Diseth T.H.,University of Oslo
Developmental Medicine and Child Neurology | Year: 2011

Aim The aim of this study was to explore the prevalence, predictors, severity, and impact of recurrent musculoskeletal pain in children and adolescents with cerebral palsy (CP). Method One hundred and fifty-three participants (81males, 72females) aged 8 to 18years were assessed by clinical examination, interview, and questionnaires. CP type distribution was 38% unilateral spastic, 55% bilateral spastic, 6% dyskinetic, and 1% ataxic. Gross Motor Function Classification System (GMFCS) levels were as follows: level I, 54; level II, 56; level III, 20; level IV, 8; and level V, 15. Sixty-four children and 89 parents recorded pain on the Child Health Questionnaire, 56 children and 85 parents indicated impact of pain on 0 to 10 numeric rating scales, and 72 children indicated pain intensity on the Faces Pain Scale-Revised. Results Ninety-five (62%) children across all GMFCS levels experienced recurrent musculoskeletal pain. Age above 14years was the only significant predictor (OR 2.90, 95% CI 1.22-7.80, p=0.02, adjusted for sex, CP type, gross motor function and mother's education). Children reported recurrent musculoskeletal pain to be moderate. Parents reported pain to be more severe and with higher impact on sleep than their children did. Children and parents reported similar impact of pain on general activity and walking. Interpretation Recurrent musculoskeletal pain is the dominating pain problem in children and adolescents with CP. Monitoring of musculoskeletal pain should be part of the medical follow-up across the whole range of motor impairment. © The Authors. Developmental Medicine & Child Neurology © 2011 Mac Keith Press.


Westberg M.,University of Oslo | Snorrason F.,Drammen Hospital | Frihagen F.,University of Oslo
Acta Orthopaedica | Year: 2013

Background and purpose Prosthetic joint infection (PJI) remains a devastating complication of arthroplasty. Today, most displaced femoral neck fractures in the elderly are treated with arthroplasty. We estimated the incidence of and risk factors for PJI in primary arthroplasty after femoral neck fracture. Patients and methods Patients admitted for a femoral neck fracture in 2008 and 2009 were registered prospectively. We studied clinical, operative, and infection data in 184 consecutive patients. Results 9% of the patients developed a PJI. Coagulase-negative staphylococci and Staphylococcus aureus were the most frequently isolated organisms. We found that preoperative waiting time was associated with PJI and also with urinary tract infection. The median preoperative waiting time was 37 (11-136) h in the infection group as opposed to 26 (4-133) h in the group with no infection (p = 0.04). The difference remained statistically significant after adjusted analysis. The success of treatment with debridement and retention of the prosthesis was limited, and 5 of the 17 patients with PJI ended up with a resection arthroplasty. The 1-year mortality rate was 21% in the patients with no infection, and it was 47% in the infection group (p = 0.03). Interpretation We found a high incidence of PJI in this elderly population treated with arthroplasty after hip fracture, with possibly devastating outcome. The length of stay preoperatively increased the risk of developing PJI.


Westberg M.,University of Oslo | Grogaard B.,University of Oslo | Snorrason F.,Drammen Hospital
Acta Orthopaedica | Year: 2012

Background and purpose: Debridement and retention of the prosthesis is often attempted to treat early prosthetic joint infection (PJI). However, previous studies have found inconsistent results, with success rates ranging from 21% to 100%, and little has been written in the literature about hip function. We have therefore analyzed the clinical and functional outcome of early PJIs treated with this procedure. Patients and methods: 38 patients with early PJI after primary hip arthroplasty who were treated with debridement and retention of the implant between 1998 and 2005 were studied prospectively, with a median follow-up time of 4 (0.8-10) years. Early infection was defined as that which occurred within 4 weeks of index arthroplasty. The primary outcome measure was infection control. Functional outcome was assessed with the Harris hip score. Results: 27 of 38 patients were successfully treated, with no signs of infection or continued antibiotic treatment at the latest follow-up. Median Harris hip score was 86 (47-100) points. In 9 of the 11 patients for whom treatment failed, infection was successfully treated with 1-stage or 2-stage reimplantation or resection. Intraoperative cultures were positive in 36 hips, and the most frequently isolated organisms were Staphylococcus aureus and coagulase-negative staphylococci (CoNS). 15 infections were polymicrobial, and only 8 of them were successfully treated with debridement and retention of the implant. Interpretation: Our data suggest that debridement and retention of the prosthesis is a reasonable treatment option in early PJI after primary hip arthroplasty, with satisfactory functional results. Copyright © 2012 Nordic Orthopaedic Federation.


Tegn N.,University of Oslo | Abdelnoor M.,University of Oslo | Aaberge L.,University of Oslo | Endresen K.,University of Oslo | And 8 more authors.
The Lancet | Year: 2016

Background Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris are frequent causes of hospital admission in the elderly. However, clinical trials targeting this population are scarce, and these patients are less likely to receive treatment according to guidelines. We aimed to investigate whether this population would benefit from an early invasive strategy versus a conservative strategy. Methods In this open-label randomised controlled multicentre trial, patients aged 80 years or older with NSTEMI or unstable angina admitted to 16 hospitals in the South-East Health Region of Norway were randomly assigned to an invasive strategy (including early coronary angiography with immediate assessment for percutaneous coronary intervention, coronary artery bypass graft, and optimum medical treatment) or to a conservative strategy (optimum medical treatment alone). A permuted block randomisation was generated by the Centre for Biostatistics and Epidemiology with stratification on the inclusion hospitals in opaque concealed envelopes, and sealed envelopes with consecutive inclusion numbers were made. The primary outcome was a composite of myocardial infarction, need for urgent revascularisation, stroke, and death and was assessed between Dec 10, 2010, and Nov 18, 2014. An intention-to-treat analysis was used. This study is registered with ClinicalTrials.gov, number NCT01255540. Findings During a median follow-up of 1·53 years of participants recruited between Dec 10, 2010, and Feb 21, 2014, the primary outcome occurred in 93 (40·6%) of 229 patients assigned to the invasive group and 140 (61·4%) of 228 patients assigned to the conservative group (hazard ratio [HR] 0·53 [95% CI 0·41-0·69], p=0·0001). Five patients dropped out of the invasive group and one from the conservative group. HRs for the four components of the primary composite endpoint were 0·52 (0·35-0·76; p=0·0010) for myocardial infarction, 0·19 (0·07-0·52; p=0·0010) for the need for urgent revascularisation, 0·60 (0·25-1·46; p=0·2650) for stroke, and 0·89 (0·62-1·28; p=0·5340) for death from any cause. The invasive group had four (1·7%) major and 23 (10·0%) minor bleeding complications whereas the conservative group had four (1·8%) major and 16 (7·0%) minor bleeding complications. Interpretation In patients aged 80 years or more with NSTEMI or unstable angina, an invasive strategy is superior to a conservative strategy in the reduction of composite events. Efficacy of the invasive strategy was diluted with increasing age (after adjustment for creatinine and effect modification). The two strategies did not differ in terms of bleeding complications. Funding Norwegian Health Association (ExtraStiftelsen) and Inger and John Fredriksen Heart Foundation. © 2016 Elsevier Ltd.


Hay-Hansson A.W.,Drammen Hospital | Eldevik S.,University of Oslo
Research in Autism Spectrum Disorders | Year: 2013

This study investigated the effect of videoconferencing in training staff to implement discrete trial teaching in real life settings with children with autism. Fourteen participants were randomly assigned to two groups. One group received training on-site and the other group received training via videoconference. The participants in both groups received 3× 15 min of training on three different teaching programs: matching, receptive and expressive labeling. The results showed no significant differences between the groups in the post-test whilst both groups improved significantly following training. Although preliminary, these results suggest that videoconferencing can be a cost-saving way to train staff in how to implement discrete trial teaching. © 2013 The Authors. Published by Elsevier Ltd. All rights reserved.


Ramstad K.,University of Oslo | Jahnsen R.,University of Oslo | Skjeldal O.H.,Drammen Hospital | Diseth T.H.,University of Oslo
Developmental Medicine and Child Neurology | Year: 2012

Aim The aim of the study was to explore the contribution of recurrent musculoskeletal pain and mental health to aspects of participation in children with cerebral palsy (CP). Method A total of 105 participants (54 males, 51 females); mean age 14y (SD 3) were assessed by clinical examination, interview, and parental questionnaires. CP type distribution was as follows: spastic unilateral, 37%; spastic bilateral, 56%; and dyskinetic, 7%. Motor function assessed using the Gross Motor Function Classification System was level I, 33%; level II, 40%; level III, 15%; and level IV/V, 11%. Parents reported child participation using the Assessment of Life Habits, child mental health problems using the Strengths and Difficulties Questionnaire, their own mental health using the General Health Questionnaire, and their socioeconomic status. Results Recurrent musculoskeletal pain was associated with reduced accomplishment of daily activities (B=-1.22, p=0.02) and social roles (B=-1.17, p=0.03), and with reduced parental satisfaction with the accomplishment of daily activities (B=-1.14, p=0.03) and social roles (B=-1.48, p<0.01). Increasing levels of child mental health problems was associated with reduced accomplishment of daily activities (B=-0.10, p=0.02) and social roles (B=-0.11, p<0.01), and with reduced parental satisfaction with the accomplishment of social roles (B=-0.21, p<0.01). Interpretation Pain and child mental health should be considered in most participation models in CP. Regarding participation as an objective outcome measure is questionable. This article is commented on by Vargus-Adams on page 777 of this issue. © The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.


News Article | February 15, 2017
Site: www.eurekalert.org

Sophia Antipolis, Feb. 15, 2017: Statin side effects are the strongest predictor of failure to meet low-density lipoprotein (LDL) cholesterol targets, according to research published today in the European Journal of Preventive Cardiology.1 Other predictors were statin non-adherence and use of weaker statins. "The beneficial effect of reducing LDL cholesterol on slowing the progression of coronary heart disease is overwhelmingly documented today in epidemiologic and randomised controlled studies," said lead author Dr John Munkhaugen, a cardiology trainee and post-doctoral researcher at Drammen Hospital, Norway. "European guidelines2 recommend a blood LDL cholesterol goal of less than 1.8 mmol/l but just one in five cardiac patients taking lipid-lowering drugs achieve this,"3 he added. The NORwegian COR (NOR-COR) prevention project originates from the Department of Medicine at Drammen Hospital and is a collaboration between Drammen and Vestfold hospitals, and the Department of Behavioural Sciences in Medicine and Institute of Clinical Medicine, University of Oslo. It is investigating why patients fail to control risk factors including lipids and blood pressure after they have a cardiovascular event. This analysis examined the reasons why cardiac patients do not achieve the LDL cholesterol target. The study included 1,095 patients hospitalised with a first or recurrent coronary event or treatment (heart attack, coronary artery bypass graft, or coronary stent) who were identified from medical records at two Norwegian hospitals (Drammen and Vestfold). Sociodemographic, medical and psychosocial information was collected from medical records, an interdisciplinary self-report questionnaire, clinical examinations, and blood samples while patients were in hospital and at follow-up after two to 36 months. The impact of potential barriers on achieving the LDL cholesterol target was calculated with LDL as a dichotomous (above or below 1.8 mmol/l) and continuous variable. The researchers found that 57% of patients were not meeting the LDL target of 1.8 mmol/l at follow-up. Statin specific side effects (mainly muscle complaints), low statin adherence, and moderate- or low-intensity statin therapy were the main reasons for failing to meet the target. Patients with side effects were more than three times more likely to miss the cholesterol target than those without side effects. Those who did not take their statins were three times more likely to miss the target than patients who did take them. Patients prescribed moderate- or low-intensity statins were 62% more likely to miss the target than those prescribed high-intensity statins. "We found the same three reasons for not meeting the target when LDL was analysed as a dichotomous or continous variable which confirms the strength of the associations," said Dr Munkhaugen. "Surprisingly, low socioeconomic status and psychosocial factors did not predict failure to control LDL cholesterol." "The findings show that the focus for interventions to improve LDL cholesterol control are statin side effects, and adherence to and prescription of sufficiently potent statins," he continued. Dr Munkhaugen said more research was needed on why side effects of statins had such a big effect on meeting cholesterol goals. "Patients who experience side effects are probably more likely to reduce or terminate statin use, or their doctor may prescribe a weaker drug or take them off statins altogether," he said. "Individual variations in how the body reacts to and uses the drug may also play a role." The links between non-adherence and intensity of statin therapy on LDL cholesterol are likely explained by the pharmacological effects of the drug. "Not taking the prescribed amount of statins or being prescribed a weaker statin means there is less drug in the body to act and lower LDL," said Dr Munkhaugen. "The reasons for statin non-adherence are a complex interaction between factors related to the patient and the healthcare system," he added. "Interventions aiming to improve statin adherence have been a priority in recent years, but the success has been modest and short-lived." The study found that the use of high-intensity statins was significantly more frequent in patients who achieved the cholesterol target. But Dr Munkhaugen said: "The relationship with adherence and side effects needs to be clarified before advice can be given about the potency of statins that should be prescribed. Our findings point to the need for more research on ways to ensure adherence and prescription of sufficiently potent statins, while at the same time addressing side effects."


Fagerli K.M.,Diakonhjemmet Hospital | Lie E.,Diakonhjemmet Hospital | Van Der Heijde D.,Diakonhjemmet Hospital | Van Der Heijde D.,Leiden University | And 6 more authors.
Annals of the Rheumatic Diseases | Year: 2014

Background The role of co-medication with tumour necrosis factor inhibitors (TNFi) is well established in rheumatoid arthritis and ankylosing spondylitis. In psoriatic arthritis (PsA) there is little evidence available on this issue. Material and methods The analyses were based on data from the Norwegian longitudinal observational study on disease-modifying antirheumatic drugs (NORDMARD). Patients with PsA starting their first TNFi, either as monotherapy or with concomitant methotrexate (MTX), were selected. Baseline characteristics, responses after 3, 6 and 12 months, and drug survival were compared between those with and without MTX co-medication. A secondary analysis was performed on patients who had confirmed swollen joints at baseline. Cox regression was used to identify predictors of discontinuation. Results We included 440 patients, 170 receiving TNFi as monotherapy and 270 receiving concomitant MTX. The groups had similar baseline characteristics, except for number of swollen joints, which was higher in the concomitant MTX group. Responses were similar in the two groups in both analyses. Drug survival analyses revealed a borderline significant difference in favour of patients receiving co-medication ( p=0.07), and this was most prominent for patients receiving infliximab (IFX) ( p=0.01). In the Cox regression analysis lack of concomitant MTX and current smoking were independent predictors of discontinuation of TNFi. Conclusions We found similar responses to TNFi in patients with and without concomitant MTX, but drug survival was superior in patients receiving co-medication. The effect of MTX on drug survival was most prominent in patients receiving IFX. Smoking at baseline and use of TNFi as monotherapy were identified as independent predictors of drug discontinuation.


Tesson C.,French Institute of Health and Medical Research | Koht J.,Drammen Hospital | Stevanin G.,French Institute of Health and Medical Research
Human Genetics | Year: 2015

Hereditary spastic paraplegias (HSP) are rare neurodegenerative diseases sharing the degeneration of the corticospinal tracts as the main pathological characteristic. They are considered one of the most heterogeneous neurological disorders. All modes of inheritance have been described for the 84 different loci and 67 known causative genes implicated up to now. Recent advances in molecular genetics have revealed clinico-genetic heterogeneity of these disorders including their clinical and genetic overlap with other diseases of the nervous system. The systematic analysis of a large set of genes, including exome sequencing, is unmasking unusual phenotypes or inheritance modes associated with mutations in HSP genes and related genes involved in various neurological diseases. A new nosology may emerge after integration and understanding of these new data to replace the current classification. Collectively, functions of the known genes implicate the disturbance of intracellular membrane dynamics and trafficking as the consequence of alterations of cytoskeletal dynamics, lipid metabolism and organelle structures, which represent in fact a relatively small number of cellular processes that could help to find common curative approaches, which are still lacking. © 2015, The Author(s).

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