Fredrikstad, Norway
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Eriksen E.K.,Norwegian University of Life Sciences | Holm H.,University of Oslo | Jensen E.,University of Tromsø | Aaboe R.,Norwegian University of Life Sciences | And 4 more authors.
British Journal of Nutrition | Year: 2010

The objective of the present study was twofold: first to compare the degradation patterns of caprine whey proteins digested with either human digestive juices (gastric or duodenal) or commercial porcine enzymes (pepsin or pancreatic enzymes) and second to observe the effect of gastric pH on digestion. An in vitro two-step assay was performed at 37C to simulate digestion in the stomach (pH 2, 4 or 6) and the duodenum (pH 8). The whey proteins were degraded more efficiently by porcine pepsin than by human gastric juice at all pH values. Irrespective of the enzyme source, gastric digestion at pH 2 followed by duodenal digestion resulted in the most efficient degradation. Lactoferrin, serum albumin and the Ig heavy chains were highly degraded with less than 6% remaining after digestion. About 15, 56 and 50% Ig light chains, -lactoglobulin (-LG) and -lactalbumin remained intact, respectively, when digested with porcine enzymes compared with 25, 74 and 81% with human digestive juices. For comparison, purified bovine -LG was digested and the peptide profiles obtained were compared with those of the caprine -LG in the digested whey. The bovine -LG seemed to be more extensively cleaved than the caprine -LG in the whey. Commercial enzymes appear to digest whey proteins more efficiently compared with human digestive juices when used at similar enzyme activities. This could lead to conflicting results when comparing human in vivo protein digestion with digestion using purified enzymes of non-human species. Consequently the use of human digestive juices might be preferred. © 2010 The Authors.


Debes A.J.,Oestfold Hospital Trust | Aggarwal R.,Imperial College London | Balasundaram I.,Imperial College London | Jacobsen M.B.,Oestfold Hospital Trust | Jacobsen M.B.,University of Oslo
American Journal of Surgery | Year: 2010

Background: This study aimed to assess the transferability of basic laparoscopic skills between a virtual reality simulator (MIST-VR) and a video trainer box (D-Box). Methods: Forty-six medical students were randomized into 2 groups, training on MIST-VR or D-Box. After training with one modality, a crossover assessment on the other was performed. Results: When tested on MIST-VR, the MIST-VR group showed significantly shorter time (90.3 seconds vs 188.6 seconds, P <.001), better economy of movements (4.40 vs 7.50, P <.001), and lower score (224.7 vs 527.0, P <.001). However, when assessed on the D-Box, there was no difference between the groups for time (402.0 seconds vs 325.6 seconds, P = .152), total hand movements (THC) (289 vs 262, P = .792), or total path length (TPL) (34.9 m vs 34.6 m, P = .388). Conclusion: Both simulators provide significant improvement in performance. Our results indicate that skills learned on the MIST-VR are transferable to the D-Box, but the opposite cannot be demonstrated. © 2010 Elsevier Inc. All rights reserved.


Debes A.J.,Oestfold Hospital Trust | Aggarwal R.,Imperial College London | Balasundaram I.,Imperial College London | Jacobsen M.B.J.,Oestfold Hospital Trust | Jacobsen M.B.J.,University of Oslo
American Journal of Surgery | Year: 2012

Background: Surgical training programs are now including simulators as training tools for teaching laparoscopic surgery. The aim of this study was to develop a standardized, graduated, and evidence-based curriculum for the newly developed D-box (D-box Medical, Lier, Norway) for training basic laparoscopic skills. Methods: Eighteen interns with no laparoscopic experience completed a training program on the D-box consisting of 8 sessions of 5 tasks with assessment on a sixth task. Performance was measured by the use of 3-dimensional electromagnetic tracking of hand movements, path length, and time taken. Ten experienced surgeons (>100 laparoscopic surgeries, median 250) were recruited for establishing benchmark criteria. Results: Significant learning curves were obtained for all construct valid parameters for tasks 4 (P <.005) and 5 (P <.005) and reached plateau levels between the fifth and sixth session. Within the 8 sessions of this study, between 50% and 89% of the interns reached benchmark criteria on tasks 4 and 5. Conclusions: Benchmark criteria and an evidence-based curriculum have been developed for the D-box. The curriculum is aimed at training and assessing surgical novices in basic laparoscopic skills. © 2012 Elsevier Inc. All rights reserved.


Aarak K.E.,Norwegian University of Life Sciences | Aarak K.E.,Norwegian Institute of Food | Kirkhus B.,Norwegian Institute of Food | Holm H.,University of Oslo | And 3 more authors.
British Journal of Nutrition | Year: 2013

In the present study, we hypothesised whether in vitro digestion of salmon oil would release different amounts of PUFA depending on the origin of the lipolytic enzymes used. For this purpose, in vitro digestion of salmon oil (SO) was performed using human duodenal juice (HDJ) or a commercial enzyme preparation consisting of porcine pancreatin and bile (PB). The lipolytic effect was determined by measuring the release of fatty acids (FA) using solid-phase extraction and GC-flame ionisation detection, withdrawing samples every 20 min during digestion. The amount of FA released indicated that a plateau was reached after 80 min with approximately similar amounts of FA detected using both HDJ and PB (379 (SD 18) and 352 (SD 23) mg/g SO, respectively). However, the release of 18 : 2, EPA (20 : 5) and DHA (22 : 6) was significantly different during in vitro digestion. At 80 min, HDJ and PB released 43 and 33% of 18 : 2, 14 and 9% of EPA and 11 and 9% of DHA, respectively. Both enzyme preparations released approximately the same amounts of the other FA analysed. The effect of the addition of bile salts (BS) was significantly different in the two enzyme systems, where porcine pancreatin highly responded to the increase in BS concentration, in contrast to HDJ. © The Authors 2013.


Trope A.,Akershus University Hospital | Jonassen C.M.,Akershus University Hospital | Sjoborg K.D.,Oestfold Hospital Trust | Nygard M.,Cancer Registry of Norway | And 3 more authors.
Gynecologic Oncology | Year: 2011

Objective: To evaluate testing for high-risk human papillomavirus (HR HPV) E6/E7 mRNA transcripts 6 months after conisation for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) to determine the risk of residual CIN2 +. Methods: We prospectively followed 344 women treated for CIN2+ by conisation. HR HPV mRNA testing (PreTect HPV-Proofer, NorChip®), HR HPV DNA testing (AMPLICOR HPV Test, Roche Diagnostics®) and cytology was performed at 6 and 12 months after conisation. Biopsies were taken within 18 months of conisation if indicated by abnormal cytology, abnormal colposcopy, or positive HPV test. The LINEAR ARRAY HPV Genotyping Test (Roche Diagnostics®) was used to genotype cases with histologically confirmed residual disease diagnosed within 18 months after conisation. Results: 6.4% (22/344) of study women had detected residual CIN2+. They were significantly older than those without residual CIN2+ (43.2 and 37.2 years respectively, p < 0.001). Among women with detected residual CIN2+, 54.5% (12/22) had positive resection margins, 63.6% (14/22) had abnormal cytology, and 95.5% (21/22) had a positive HR HPV DNA test at 6 months. Sensitivity of HR HPV mRNA testing was 45.5% (95% confidence interval: 26.8-65.5%) at 6 months to predict detected residual CIN2+. Eight of 12 women who were HR HPV mRNA-negative at 6 months were HR HPV DNA-positive for one of the HPV types included in the mRNA test. Conclusion: Detection of E6/E7 mRNA transcripts by PreTect HPV Proofer does not seem suitable for short-term follow-up to detect residual CIN2+ after conisation. © 2011 Elsevier Inc. All rights reserved.


Buyon J.P.,NYU Langone Medical Center | Kim M.Y.,Yeshiva University | Guerra M.M.,Hospital for Special Surgery | Laskin C.A.,Life Quest Center for Reproductive Medicine | And 11 more authors.
Annals of Internal Medicine | Year: 2015

Background: Because systemic lupus erythematosus (SLE) affects women of reproductive age, pregnancy is a major concern. Objective: To identify predictors of adverse pregnancy outcomes (APOs) in patients with inactive or stable active SLE. Design: Prospective cohort. Setting: Multicenter. Patients: 385 patients (49% non-Hispanic white; 31% with prior nephritis) with SLE in the PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study. Exclusion criteria were urinary protein-creatinine ratio greater than 1000 mg/g, creatinine level greater than 1.2 mg/dL, prednisone use greater than 20 mg/d, and multifetal pregnancy. Measurements: APOs included fetal or neonatal death; birth before 36 weeks due to placental insufficiency, hypertension, or preeclampsia; and small-for-gestational-age (SGA) neonate (birthweight below the fifth percentile). Disease activity was assessed with the Systemic Lupus Erythematosus Pregnancy Disease Activity Index and the Physician's Global Assessment (PGA). Results: APOs occurred in 19.0% (95% CI, 15.2% to 23.2%) of pregnancies; fetal death occurred in 4%, neonatal death occurred in 1%, preterm delivery occurred in 9%, and SGA neonate occurred in 10%. Severe flares in the second and third trimesters occurred in 2.5% and 3.0%, respectively. Baseline predictors of APOs included presence of lupus anticoagulant (LAC) (odds ratio [OR], 8.32 [CI, 3.59 to 19.26]), antihypertensive use (OR, 7.05 [CI, 3.05 to 16.31]), PGA score greater than 1 (OR, 4.02 [CI, 1.84 to 8.82]), and low platelet count (OR, 1.33 [CI, 1.09 to 1.63] per decrease of 50 × 109 cells/L). Non-Hispanic white race was protective (OR, 0.45 [CI, 0.24 to 0.84]). Maternal flares, higher disease activity, and smaller increases in C3 level later in pregnancy also predicted APOs. Among women without baseline risk factors, the APO rate was 7.8%. For those who either were LACpositive or were LAC-negative but nonwhite or Hispanic and using antihypertensives, the APO rate was 58.0% and fetal or neonatal mortality was 22.0%. Limitation: Patients with high disease activity were excluded. Conclusion: In pregnant patients with inactive or stable mild/ moderate SLE, severe flares are infrequent and, absent specific risk factors, outcomes are favorable. © 2015 American College of Physicians.


Dalbye R.,Oestfold Hospital Trust | Dalbye R.,Gothenburg University | Calais E.,Gothenburg University | Calais E.,Uppsala University Hospital | Berg M.,Gothenburg University
Sexual and Reproductive Healthcare | Year: 2011

Objectives: Previous reports have shown that skin-to-skin contact immediately after birth is the optimal form of care for a full-term, healthy infant and its mother. As this is rarely researched the aim of this study was to explore experiences of skin-to-skin care in healthy mothers of healthy, full-term infants in the first days after birth. Study design: Using a lifeworld phenomenological approach, 20 women who had childbirth in hospital and were practising skin-to-skin care were interviewed 1-2. weeks after birth. Analysis of all interview texts was directed towards discovering qualitative meanings through a process of identifying meaning units. These were then clustered and analysed with the aim of describing themes of meaning and the essence of the phenomenon. Findings: The mothers wanted to give their newborn child the best possible care and the skin-to-skin care started a positive spiral. A mutual interaction developed which acted as a generator releasing energy to the mother who wanted to continue the practice which in terms increased mother-infant affinity. Happiness, peace and satisfaction were expressed by the newborns; also a child who was crying or troublesome exhibited a positive response to skin-to-skin care. Conclusion: The study provides insight and knowledge which should guide attitudes and promote practices of this simple healthcare intervention; skin-to-skin contact care to healthy infants born at term. Healthcare professionals should support affinity between a mother and her newborn through facilitation and the provision of information about its benefits. © 2011 Elsevier B.V.


Kvenshagen B.K.,Oestfold Hospital Trust | Jacobsen M.,Oestfold Hospital Trust
Current Opinion in Allergy and Clinical Immunology | Year: 2013

PURPOSE OF REVIEW: The incidence of food allergy is increasing. Correct diagnosis is dependent on food challenges, which are not always performed, but more often based on history, skin prick test and specific IgE, leading to possible misdiagnoses. Mucosal provocation tests have been proposed as possible new diagnostic tools during recent decades. RECENT FINDINGS: The databases EMBASE, PUBMED and Cochraine Review were used. Seven full text articles fulfilled criteria for mucosal challenge and food allergy, only one from the last 12 months. Conjunctival, nasal, buccal, gastric and coecal/rectal mucosa have been challenged. All authors find mucosal changes after challenge, but the lack of validation against double-blind placebo-controlled challenges makes evaluation difficult, with the exception of the conjunctival provocation test. SUMMARY: As most mucosal surfaces are easily available, and small amounts of allergen are needed for an obvious reaction, this tool for diagnosing food allergy is promising. Further studies are however needed. © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins.


Trope A.,Akershus University Hospital | Sjoborg K.D.,Oestfold Hospital Trust | Nygard M.,Cancer Registry of Norway | Roysland K.,Cancer Registry of Norway | And 3 more authors.
Journal of Clinical Microbiology | Year: 2012

We carried out a prospective study comparing the performance of human papillomavirus (HPV) E6/E7 mRNA (PreTect HPVProofer; NorChip, Klokkarstua, Norway) and DNA (Amplicor HPV test; Roche Diagnostics, Basel, Switzerland) triage testing of women 6 to 12 months after atypical-squamous-cells-of- undetermined-significance (ASCUS) or low-grade-squamous-intraepithelial-lesion (LSIL) cytology in organized screening to predict high-grade cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) between screening rounds. Between January 2005 and April 2008, 692 study women with screening-detected ASCUS/LSIL cytology 6 to 12 months earlier returned for HPV mRNA and DNA testing and repeat cytology. The median follow-up time was 3 years, using existing health care facilities. Follow-up test results were available for 625 women. Of the 145 CIN2+ cases detected during the study period, 95 (65.5%) were HPV mRNA positive 6 to 12 months after screening-detected ASCUS/LSIL, 44 (30.4%) were HPV mRNA negative, and 6 (4.1%) were invalid. The corresponding HPV DNA results were 139 (95.9%), 5 (3.4%), and 1 (0.7%), respectively. The cumulative incidences of CIN2+ 3 years after a negative HPV mRNA and DNA test were 10.3% (95% confidence interval [CI], 7.2 to 13.3%) and 1.8% (95% CI, 0.0 to 3.6%), respectively. The cumulative incidences of CIN2+ 3 years after positive HPV mRNA and DNA tests were 52.8% (95% CI, 40.1 to 60.1%) and 41.3% (95% CI, 35.5 to 46.6%), respectively. In conclusion, both positive HPV mRNA and DNA test results have a high enough long-term prediction of CIN2+ risk to consider referral to colposcopy as good practice when performed in delayed triage of women with ASCUS/LSIL cytology. In addition, the low CIN2+ risk among women with a negative Amplicor HPV test in our study confirms its safe use in a clinical setting. Copyright © 2012, American Society for Microbiology. All Rights Reserved.


Simonsen B.O.,Innlandet Hospital Trust | Simonsen B.O.,Norwegian University of Science and Technology | Johansson I.,Gjoevik University College | Johansson I.,Karlstad University | And 4 more authors.
BMC Health Services Research | Year: 2011

Background: Medication errors are often involved in reported adverse events. Drug therapy, prescribed by physicians, is mostly carried out by nurses, who are expected to master all aspects of medication. Research has revealed the need for improved knowledge in drug dose calculation, and medication knowledge as a whole is poorly investigated. The purpose of this survey was to study registered nurses' medication knowledge, certainty and estimated risk of errors, and to explore factors associated with good results. Methods. Nurses from hospitals and primary health care establishments were invited to carry out a multiple-choice test in pharmacology, drug management and drug dose calculations (score range 0-14). Self-estimated certainty in each answer was recorded, graded from 0 = very uncertain to 3 = very certain. Background characteristics and sense of coping were recorded. Risk of error was estimated by combining knowledge and certainty scores. The results are presented as mean (SD). Results: Two-hundred and three registered nurses participated (including 16 males), aged 42.0 (9.3) years with a working experience of 12.4 (9.2) years. Knowledge scores in pharmacology, drug management and drug dose calculations were 10.3 (1.6), 7.5 (1.6), and 11.2 (2.0), respectively, and certainty scores were 1.8 (0.4), 1.9 (0.5), and 2.0 (0.6), respectively. Fifteen percent of the total answers showed a high risk of error, with 25% in drug management. Independent factors associated with high medication knowledge were working in hospitals (p < 0.001), postgraduate specialization (p = 0.01) and completion of courses in drug management (p < 0.01). Conclusions: Medication knowledge was found to be unsatisfactory among practicing nurses, with a significant risk for medication errors. The study revealed a need to improve the nurses' basic knowledge, especially when referring to drug management. © 2011 Simonsen et al; licensee BioMed Central Ltd.

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