Welle-Strand G.K.,University of Oslo |
Welle-Strand G.K.,Norwegian Directorate of Health |
Skurtveit S.,University of Oslo |
Skurtveit S.,Norwegian Institute of Public Health |
And 4 more authors.
Acta Paediatrica, International Journal of Paediatrics | Year: 2013
Aim To examine the rate and duration of breastfeeding in a cohort of women in opioid maintenance treatment (OMT) in Norway, as well as the effect of breastfeeding on the incidence and duration of neonatal abstinence syndrome (NAS). Methods A national cohort of 124 women treated with either methadone or buprenorphine during pregnancy, and their neonates born between 1999 and 2009, was evaluated in three study parts. A standardized questionnaire was administered, and medical information from the hospitals and municipalities were collected to confirm self-reported data. Results There were high initiation rates of breastfeeding (77%) for women in OMT, but also high rates of early cessation of breastfeeding. Breastfed neonates exposed to methadone prenatally had significantly lower incidence of NAS requiring pharmacotherapy (53% vs. 80%), and both the whole group of infants and the methadone-exposed neonates needed shorter pharmacological treatment of NAS (p < 0.05) than neonates who were not breastfed. Conclusion Breastfed neonates exposed to OMT medication prenatally, and methadone-exposed newborns in particular, have lower incidence of NAS and require shorter pharmacotherapy for NAS than infants who are not breastfed. The results add to the evidence regarding the benefits of breastfeeding for neonates prenatally exposed to OMT medications. ©2013 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd.
Welle-Strand G.K.,University of Oslo |
Welle-Strand G.K.,Norwegian Directorate of Health |
Skurtveit S.,University of Oslo |
Skurtveit S.,Norwegian Institute of Public Health |
And 5 more authors.
Drug and Alcohol Dependence | Year: 2013
Background: In Norway, most opioid-dependent women are in opioid maintenance treatment (OMT) with either methadone or buprenorphine throughout pregnancy. The inclusion criteria for both medications are the same and both medications are provided by the same health professionals in any part of the country. International studies comparing methadone and buprenorphine in pregnancy have shown differing neonatal outcomes for the two medications. Method: This study compared the neonatal outcomes following prenatal exposure to either methadone or buprenorphine in a national clinical cohort of 139 women/neonates from 1996 to 2009. Results: After adjusting for relevant covariates, buprenorphine-exposed newborns had larger head circumferences and tended to be heavier and longer than methadone-exposed newborns. The incidence of neonatal abstinence syndrome (NAS) and length of treatment of NAS did not differ between methadone- and buprenorphine-exposed newborns. There was little use of illegal drugs and benzodiazepines during the pregnancies. However, the use of any drugs or benzodiazepines during pregnancy was associated with longer lasting NAS-treatment of the neonates. Conclusions: The clinical relevance of these findings is that both methadone and buprenorphine are acceptable medications for the use in pregnancy, in line with previous studies. If starting OMT in pregnancy, buprenorphine should be considered as the drug of choice, due to more favorable neonatal growth parameters. Early confirmation of the pregnancy and systematic follow-up throughout the pregnancy are of importance to encourage the women in OMT to abstain from the use of tobacco, alcohol, illegal drugs or misuse of prescribed drugs. © 2012 Elsevier Ireland Ltd.
Haffeld J.B.,University of Oslo |
Siem H.,Norwegian Directorate of Health |
Rottingen J.-A.,University of Oslo
Journal of Law, Medicine and Ethics | Year: 2010
The article comprises a conceptual framework to analyze the strengths and weaknesses of a global health convention. The analyses are inspired by Lawrence Gostin's suggested Framework Convention on Global Health. The analytical model takes a starting-point in events tentatively following a logic sequence: Input (global health funding), Processes (coordination, cooperation, accountability, allocation of aid), Output (definition of basic survival needs), Outcome (access to health services), and Impact (health for all). It then examines to what degree binding international regulations can create order in such a sequence of events. We conclude that a global health convention could be an appropriate instrument to deal with some of the problems of global health. We also show that some of the tasks preceding a convention approach might be to muster international support for supra-national health regulations, negotiate compromises between existing stakeholders in the global health arena, and to utilize WHO as a platform for further discussions on a global health convention. © 2010 American Society of Law, Medicine & Ethics, Inc.
Bjorkhem-Bergman L.,Karolinska University Hospital |
Andersen-Karlsson E.,Karolinska Institutet |
Diogene E.,Catalan Institute of Health |
Melien O.,Norwegian Directorate of Health |
And 6 more authors.
European Journal of Clinical Pharmacology | Year: 2013
Purpose: In September 2012 an interactive course on the "Interface Management of Pharmacotherapy" was organized by the Stockholm Drug and Therapeutics Committee in cooperation with Department of Clinical Pharmacology at Karolinska Institutet and at Karolinska University Hospital in Stockholm, Sweden, in collaboration with the WHO. The basis for the course was the "Stockholm model" for the rational use of medicines but also contained presentations about successful models in interface management of pharmacotherapy in other European countries. Methods: The "Stockholm model " consists of 8 components: 1) Independent Drug and Therapeutics Committee with key role for respected drug experts with policy for "interest of conflicts", 2) The "Wise List", recommendations of medicines jointly for primary and hospital care, 3) Communication strategy with continuous medical education, 4) Systematic introduction of new expensive medicines, 5) E-pharmacological support at "point of care", 6) Methods and tools for follow-up of medicines use, 7) Medicines policy strategy and 8) Operative resources. Results: The course highlighted the importance of efficient and targeted communication of drug recommendations building on trust among prescribers and patients for the guidelines to achieve high adherence. Trust is achieved by independent Drug and Therapeutics Committees with a key role for respected experts and a strict policy for "conflicts of interest". Representations of GPs are also crucial for successful implementation, being the link between evidence based medicine and practice. Conclusion: The successful models in Scotland and in Stockholm as well as the ongoing work in Catalonia were considered as examples of multifaceted approaches to improve the quality of medicine use across primary and hospital care. © Springer-Verlag 2013.
Ogden T.,University of Oslo |
Ulvestad Karkl F.,Norwegian Directorate of Health |
Stegenborg Teigen K.,Norwegian Directorate for Education AndTraining
Evidence and Policy | Year: 2010
In Norway, links between research, policy and practice are in a process of development, with initiatives to both strengthen the knowledge base for evidence-based policy and practice and increase the demand for research-based interventions. Examples of these initiatives from the fields of mental health, education and child welfare are provided, including institutions for research and development and the implementation of evidence-based programmes.The initiatives are set in the context of some basic facts about Norway and its research system. The implications of'importing' evaluated intervention programmes from other countries are discussed, and the relative merits of a 'what works' or broader approach to evidence-based policy and practice are assessed. evidence-based policy; evidence-based practices; transportability of EBP © The Policy Press.
Heggestad T.,University of Bergen |
Lilleeng S.E.,Sintef |
Lilleeng S.E.,Norwegian Directorate of Health |
Ruud T.,Akershus University Hospital |
Ruud T.,University of Oslo
Social Psychiatry and Psychiatric Epidemiology | Year: 2011
Objectives: Explore if a multi-dimensional analytic approach to routinely registered data provides a comprehensive way to characterise utilisation patterns, and to test if the patients' functional status is a predictor for the use of services. Method: We linked register contact data during a two-year period, including all types of specialised mental health services, in the population of a Norwegian county. Cox regression was applied in the models for prediction of admission and readmission. Results: Great variability and complexity in patterns of utilisation were found, including multiple transitions between in-patient and out-patient statuses. The distribution of services was characterised by a small group of patients receiving a disproportionally large amount of resources. A majority of 77% appeared as out-patients only. Severity of symptoms as well as of dysfunction, as assessed by the split GAF-score, differentiated amongst utilisation groups. Both dimensions were significant predictors for admission. In contrast, only the severity of dysfunction predicted readmission. Conclusion: Multi-dimensional data architecture and analytical perspectives can be applied to routine data, and should be used to analyse the diverse patterns of utilisation. Risk populations could be predicted by routinely registered information on functional status. © 2010 Springer-Verlag.
PubMed | Norwegian Directorate of Health, Norwegian University of Life Sciences, Fred Hutchinson Cancer Research Center, Norwegian University of Science and Technology and University of Oslo
Type: | Journal: Lipids in health and disease | Year: 2016
High-Density Lipoprotein (HDL)-cholesterol, has been associated with breast cancer development, but the association is under debate, and whether lipoprotein subfractions is associated with breast tumor characteristics remains unclear.Among 56 women with newly diagnosed invasive breast cancer stage I/II, aged 35-75 years, pre-surgery overnight fasting serum concentrations of lipids were assessed, and body mass index (BMI) was measured. All breast tumors were immunohistochemically examined in the surgical specimen. Serum metabolomics of lipoprotein subfractions and their contents of cholesterol, free cholesterol, phospholipids, apolipoprotein-A1 and apolipoprotein-A2, were assessed using nuclear magnetic resonance. Principal component analysis, partial least square analysis, and uni- and multivariable linear regression models were used to study whether lipoprotein subfractions were associated with breast cancer tumor characteristics.The breast cancer patients had following means: age at diagnosis: 55.1 years; BMI: 25.1 kg/m(2); total-Cholesterol: 5.74 mmol/L; HDL-Cholesterol: 1.78 mmol/L; Low-Density Lipoprotein (LDL)-Cholesterol: 3.45 mmol/L; triglycerides: 1.18 mmol/L. The mean tumor size was 16.4 mm, and the mean Ki67 hotspot index was 26.5%. Most (93%) of the patients had estrogen receptor (ER) positive tumors ( 1% ER+), and 82% had progesterone receptor (PgR) positive tumors ( 10% PgR+). Several HDL subfraction contents were strongly associated with PgR expression: Apolipoprotein-A1 ( 0.46, CI 0.22-0.69, p < 0.001), HDL cholesterol ( 0.95, CI 0.51-1.39, p < 0.001), HDL free cholesterol ( 2.88, CI 1.28-4.48, p = 0.001), HDL phospholipids ( 0.70, CI 0.36-1.04, p < 0.001). Similar results were observed for the subfractions of HDL1-3. We observed inverse associations between HDL phospholipids and Ki67 ( -0.25, p = 0.008), and in particular between HDL1s contents of cholesterol, phospholipids, apolipoprotein-A1, apolipoprotein-A2 and Ki67. No association was observed between lipoproteins and ER expression.Our findings hypothesize associations between different lipoprotein subfractions, and PgR expression, and Ki 67 % in breast tumors. These findings may have clinical implications, but require confirmation in larger studies.
Nes B.M.,Norwegian University of Science and Technology |
Janszky I.,Norwegian University of Science and Technology |
Janszky I.,Karolinska Institutet |
Aspenes S.T.,Norwegian University of Science and Technology |
And 4 more authors.
Medicine and Science in Sports and Exercise | Year: 2012
PURPOSE: The objective of this study is to examine how different approaches of the current exercise recommendations for adults associate with V̇O2peak in a large healthy population. We further examined how a lower duration than recommended, if performed at very vigorous intensity, was related to V̇O2peak. METHODS: A total of 4631 healthy adults age 19-89 yr (2263 men and 2368 women) were tested for V̇O2peak (mean = 44.3 and 35.9 mL•kg•min for men and women, respectively). Information on exercise habits was collected through a questionnaire, including questions on frequency, duration, and relative intensity (Borg scale 6-20). A general linear model was applied to assess the associations between physical activity and V̇O2peak. RESULTS: V̇O2peak did not differ considerably between people who reported to exercise ≥150 min•wk (average = 216 min•wk, V̇O2peak = 45.2 and 36.5 mL•kg•min for men and women, respectively) with moderate intensity and people who reported 75-149 min•wk (average = 112.5 min•wk, V̇O2peak = 47.5 and 37.3 mL•kg•min for men and women) with vigorous intensity, but it was higher than that in people who reported inactivity (V̇O2peak = 40.1 and 32.3 mL•kg•min for men and women) or low-intensity exercise (V̇O2peak = 41.2 and 40.1 mL•kg•min for men and women). Reporting exercise at very vigorous intensity but with a duration of less than 75 min•wk (average = 49 min•wk) was associated with a V̇O2peak that was similarly high (47.6 and 36.7 mL•kg•min for men and women). CONCLUSION: Our findings support current recommendations by showing that exercise of both "moderate intensity-long duration" and "vigorous intensity-short duration" was associated with similarly high V̇O2peak. Our results also suggest that exercising at very vigorous intensity may be beneficial for V̇O2peak even with considerably lower total exercise time than expressed in today's recommendations. Copyright © 2012 by the American College of Sports Medicine.
Prestmo A.,Norwegian University of Science and Technology |
Hagen G.,Norwegian University of Science and Technology |
Sletvold O.,Norwegian University of Science and Technology |
Helbostad J.L.,Norwegian University of Science and Technology |
And 9 more authors.
The Lancet | Year: 2015
Background: Most patients with hip fractures are characterised by older age (>70 years), frailty, and functional deterioration, and their long-term outcomes are poor with increased costs. We compared the effectiveness and cost-effectiveness of giving these patients comprehensive geriatric care in a dedicated geriatric ward versus the usual orthopaedic care. Methods: We did a prospective, single-centre, randomised, parallel-group, controlled trial. Between April 18, 2008, and Dec 30, 2010, we randomly assigned home-dwelling patients with hip-fractures aged 70 years or older who were able to walk 10 m before their fracture, to either comprehensive geriatric care or orthopaedic care in the emergency department, to achieve the required sample of 400 patients. Randomisation was achieved via a web-based, computer-generated, block method with unknown block sizes. The primary outcome, analysed by intention to treat, was mobility measured with the Short Physical Performance Battery (SPPB) 4 months after surgery for the fracture. The type of treatment was not concealed from the patients or staffdelivering the care, and assessors were only partly masked to the treatment during follow-up. This trial is registered with ClinicalTrials.gov, number NCT00667914. Findings: We assessed 1077 patients for eligibility, and excluded 680, mainly for not meeting the inclusion criteria such as living in a nursing home or being aged less than 70 years. Of the remaining patients, we randomly assigned 198 to comprehensive geriatric care and 199 to orthopaedic care. At 4 months, 174 patients remained in the comprehensive geriatric care group and 170 in the orthopaedic care group; the main reason for dropout was death. Mean SPPB scores at 4 months were 5.12 (SE 0.20) for comprehensive geriatric care and 4.38 (SE 0.20) for orthopaedic care (between-group difference 0.74, 95% CI 0.18-1.30, p=0.010). Interpretation: Immediate admission of patients aged 70 years or more with a hip fracture to comprehensive geriatric care in a dedicated ward improved mobility at 4 months, compared with the usual orthopaedic care. The results suggest that the treatment of older patients with hip fractures should be organised as orthogeriatric care.
Aas K.K.,Norwegian Institute of Public Health |
Tambs K.,Norwegian Institute of Public Health |
Kise M.S.,Norwegian Directorate of Health |
Magnus P.,Norwegian Institute of Public Health |
Ronningen K.S.,Norwegian Institute of Public Health
BMC Medical Genetics | Year: 2010
Background: Concerns about the general psychological impact of genetic testing have been raised. In the Environmental Triggers of Type 1 Diabetes (MIDIA) study, genetic testing was performed for HLA-conferred type 1 diabetes susceptibility among Norwegian newborns. The present study assessed whether mothers of children who test positively suffer from poorer mental health and well-being after receiving genetic risk information about their children.Methods: The study was based on questionnaire data from the Norwegian Mother and Child Cohort (MoBa) study conducted by the Norwegian Institute of Public Health. Many of the mothers in the MoBa study also took part in the MIDIA study, in which their newborn children were tested for HLA-conferred genetic susceptibility for type 1 diabetes. We used MoBa questionnaire data from the 30thweek of pregnancy (baseline) and 6 months post-partum (3-3.5 months after disclosure of test results). We measured maternal symptoms of anxiety and depression (SCL-8), maternal self-esteem (RSES), and satisfaction with life (SWLS). The mothers also reported whether they were seriously worried about their child 6 months post-partum. We compared questionnaire data from mothers who had received information about having a newborn with high genetic risk for type 1 diabetes (N = 166) with data from mothers who were informed that their baby did not have a high-risk genotype (N = 7224). The association between genetic risk information and maternal mental health was analysed using multiple linear regression analysis, controlling for baseline mental health scores.Results: Information on genetic risk in newborns was found to have no significant impact on maternal symptoms of anxiety and depression (p = 0.9), self-esteem (p = 0.2), satisfaction with life (p = 0.2), or serious worry about their child (OR = 0.98, 95% CI 0.64-1.48). Mental health before birth was strongly associated with mental health after birth. In addition, an increased risk of maternal worry was found if the mother herself had type 1 diabetes (OR = 2.39, 95% CI 1.2-4.78).Conclusions: This study did not find evidence supporting the notion that genetic risk information about newborns has a negative impact on the mental health of Norwegian mothers. © 2010 Aas et al; licensee BioMed Central Ltd.