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Saugstad O.D.,University of Oslo | Saugstad O.D.,Oslo Universitetssykehus
Neonatology | Year: 2011

Background: The global neonatal mortality of 28/1,000 live births is unacceptably high. Furthermore, the huge difference in mortality between high- and low-income countries and regions is presently one of the most burning human rights issues. The decline in neonatal mortality has been slow and is a main reason the Millennium Development Goal 4 does not seem to have been reached. Objectives: Several countries have shown it is possible to reduce neonatal mortality quickly and dramatically without much cost. Methods: It is important to learn from the successful countries and focus on the 3-4 major causes of neonatal death: asphyxia, infection, low birth weight/prematurity and congenital malformations. Results: A reasonable short-term goal is to reduce global neonatal mortality to 15/1,000 which can be achieved without introduction of high technology medicine. A further reduction of mortality to 5/1,000 should be the next global goal. Reaching this would reduce the present 3.8 million annual deaths by 3 million. In order to do this, regionalization of health care should be implemented. Maternal health should be the focus, with free antenatal care and centralized deliveries with health personnel attending the birth. Education of girls is perhaps the best way to prevent perinatal and neonatal deaths. Ten simple recommendations are given to reduce neonatal mortality. One of these is that each newborn baby in the world should have free access to essential drugs. Conclusions: It is possible to reduce newborn mortality in all countries and regions. Most important to achieve these goals is, however, political will. Copyright © 2010 S. Karger AG, Basel.


Nesvold I.-L.,University of Oslo | Nesvold I.-L.,Oslo Universitetssykehus | Reinertsen K.V.,University of Oslo | Fossa S.D.,University of Oslo | Dahl A.A.,University of Oslo
Journal of Cancer Survivorship | Year: 2011

Background: This cross-sectional and longitudinal study of breast cancer survivors (BCSs) examines the associations between arm/shoulder problems (ASPs), which consist of pain, restricted mobility and lymphedema, and different aspects of quality of life (QoL). Methods: BCSs who had breast surgery, axillary lymph node dissection and radiotherapy (n=255) were examined in 2004 (mean 4.1 years post-surgery) and a sub-sample (n=187) was re-examined in 2007. ASPs was rated clinically in 2004 and by self-report (EORTC BR23) in 2004 and 2007. QoL was self-reported with The Short Form-36 (SF-36) and The Impact of Cancer scale (IOC). Results: In 2004 BCSs with ASPs showed significantly poorer mean scores in most SF-36 domains compared to those without. No group differences were observed for positive IOC domains, while BCSs with ASPs showed significantly poorer mean scores in the negative ones. BCSs with clinically defined movement restriction showed significantly poorer SF-36 and negative IOC mean scores than those with clinically defined lymphedema. The longitudinal sub-study of self-rated pain, restricted mobility and lymphedema showed significant changes over time only for negative IOC domains in the pain group. Self-rated restricted mobility and lymphedema were significantly associated with most SF-36 domains both in 2004 and 2007, while few were associated with pain. Self-rated pain and restricted mobility showed significant associations with negative IOC domains. Implications for cancer survivors: Not only lymphedema, but pain and restricted mobility in the arm/shoulder are significantly associated with poor QoL in BCSs at long-term. These problems should be diagnosed and treated in order to improve QoL. © 2010 The Author(s).


Tjonnfjord G.E.,Oslo universitetssykehus
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række | Year: 2012

The clinical courses of chronic lymphocytic leukaemia (CLL) are very heterogeneous. Biological markers that provide good prognostic information at the time of diagnosis are available. The aim of the study was to determine the prevalence of these markers in a population-based material. Biological markers were examined using standard laboratory methods after obtaining an informed consent statement from patients diagnosed with chronic lymphocytic leukaemia in the period 1.10.2007-31.12.2009. There were 388 new cases of chronic lymphocytic leukaemia during the study period, and 236 patients (61%) were included in the study. Of 222 patients, 178 (80%) were in Binet's stage A, 26 (12%) in stage B and 18 (8%) in stage C. The V(H) gene was mutated in 69% and unmutated in 31% of cases. Cytogenetic aberrations were found in 68%: del(13q14) in 48%, trisomy 12 in 13%, del(11q22) in 10% and del(17p13) in 7%. CD38-positive disease was found in 28% of the patients. The V(H) gene was mutated in 67% of the patients in Binet's stage A, and in the majority of these a mutated V(H) gene was associated with non-expression of CD38 and del(13q14). At the time of diagnosis, most patients are asymptomatic and do not need treatment. The biological markers that indicate a favourable prognosis occur most frequently in this group. Markers that indicate a poor prognosis occur more frequently in the group that has symptoms at the time of diagnosis.


Raabe N.K.,CC Vest legesenter | Normann M.,Kreftsenteret | Lilleby W.,Oslo universitetssykehus
Tidsskrift for den Norske Laegeforening | Year: 2015

BACKGROUND: Prostate cancer is a radiosensitive type of cancer for which radiotherapy is used for both curative and palliative purposes. Low-dose-rate brachytherapy is an internal radiotherapy technique which allows high doses of radiation to be delivered to a tumour at short range and with a high degree of precision. We have conducted a systematic review of the evidence base for this treatment. The method is not established in Norway. METHOD: This review is based on systematic review articles and publications on treatment, outcomes, adverse effects and health economics considerations found by searching the databases Cochrane Library, Current Controlled Trials, Medline, Embase and NICE (National Institute of Clinical Excellence). RESULTS: Subsequent to long-term observations of the efficacy, adverse effects and costs presented in 43 selected studies, including one randomised, controlled trial, there is still uncertainty as to which of the three methods low-dose brachytherapy, external radiotherapy and radical prostatectomy is optimal. The reason for this is the methodological differences in patient selection and in endpoints such as biochemical disease-free interval and cause-specific survival. The evidence base appears to suggest that low-dose-rate brachytherapy causes more frequent grade 2 and 3 doctor-reported urogenital adverse effects than prostatectomy, but better patient-reported sexual functions and fewer patients with urinary incontinence than after surgery. Low-dose-rate brachytherapy appears to be socioeconomically cost-effective. INTERPRETATION: The evidence base with respect to therapeutic effect and toxicity in men with low-risk prostate cancer treated with low-dose brachytherapy is regarded as solidly documented. However, there are no good prospective randomised multi-centre trials with overall survival as an endpoint.


Tangen J.M.,Oslo universitetssykehus
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række | Year: 2010

BACKGROUND: The Norwegian treatment protocol for acute lymphoblastic leukaemia in adults was introduced in 1982 and has undergone minor changes thereafter. Earlier studies from The South Eastern Norway Regional Health Authority have reported 50 % five-year overall survival in patients treated according to this protocol. This article presents survival data for Norwegian adults with acute lymphoblastic leukaemia on a national basis. MATERIAL AND METHODS: Data for all patients between 15 and 65 years, who were diagnosed with acute lymphoblastic leukaemia in the period 2000-2007 according to The Norwegian Registry for Acute Leukaemia and Lymphoblastic Lymphoma, and were treated with chemotherapy with a curative intent were analysed for survival. RESULTS: 128 patients were diagnosed with acute lymphoblastic leukaemia in the study period. The overall remission rate was 85.9 %. Five-year survival was 49.2 % overall, 31.4 % for patients 40 years or older and 62.6 % for those younger than 40 years. INTERPRETATION: These results are in line with previous Norwegian studies and show a five- year overall survival which is more than 10 % higher than that reported in international multicenter studies. One explanation can be that the Norwegian treatment program is more intensive than most treatment protocols used in other countries.


Mohl B.,Psychiatric Center Copenhagen | Skandsen A.,Oslo Universitetssykehus
Personality and Mental Health | Year: 2012

The purpose of this paper is to provide an estimate of the prevalence and distribution of non-suicidal self-injury among Danish high school students. In a questionnaire study in seven high schools in the Copenhagen area (n=2864), we find a lifetime prevalence of 21.5% with a little preponderance of women, but it seems that men are involved in a more persistent and intense form of self-injurious behaviour. More men (14.7%) than women (6.2%) have injured themselves more than 20 times in the last year. Fewer men than women did not harm themselves in the last year. We conclude that it is important to be aware of self-harm both among women and men in high schools to avoid escalation. © 2011 John Wiley & Sons, Ltd.


Agewall S.,Oslo universitetssykehus
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række | Year: 2011

It is important to measure troponin levels when acute myocardial infarct is suspected. Many other factors that affect the heart can cause an increase in troponin levels, for example extreme physical exertion. Recent studies have shown that more normal physical activity can also lead to increase in troponin levels in healthy individuals.


Braekhus A.,Oslo universitetssykehus
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række | Year: 2011

The patients who are assessed at Oslo University Hospital's Memory Clinic are young--half of them are under 65 years of age. Most are suffering from mild cognitive impairment or dementia at a very early phase while others come to get a second opinion. The assessment takes 2 - 3 hours and is conducted by a doctor and a nurse. It includes a clinical investigation, cognitive testing, an MRI scan with measurement of the medial temporal lobes, a lumbar puncture and single-photon-emission tomography (SPECT of the brain).


Kristjansson S.R.,Oslo universitetssykehus
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række | Year: 2010

Polypharmacy is common among the elderly and consequences may be adverse drug reactions, interactions and toxicity. At the same time it is well documented that elderly patients are suboptimally treated for conditions such as atrial fibrillation and osteoporosis. When assessing medical treatment one must take into account the remaining life expectancy, time to effect, complication risk related to not treating, risks related to adverse drug effects and interactions, patient preferences and treatment goals.


Bjugn R.,Oslo universitetssykehus
Tidsskrift for den Norske Laegeforening | Year: 2015

BACKGROUND Medical and health research may yield findings that are of direct clinical significance for project participants. The Council of Europe has stated that information on such findings shall be offered to participants, and that applications to research ethics committees shall include plans for managing such findings. The purpose of the study was to investigate how the management of such findings had been described in research projects that had been granted prior approval by a regional committee for medical and health research ethics (REK). MATERIAL AND METHOD Research projects that were associated with Oslo University Hospital and had a start-up date in 2011 were identified in the database of the regional ethics committee. Copies of the application form submitted to the committee, project protocols, participant information/consent forms and letters of approval were reviewed with regard to information on the management of findings with possible clinical implications. RESULTS Of the 87 projects found in the database, 70 were included in the study. Of these, 57 studies involved direct interaction with humans, whereof 45 with intended use of biological material. In 21 studies, the management of findings with possible clinical implications was described in one or more documents. In all of these projects, the applicant him-/herself had referred to this topic in the initial application. INTERPRETATION The absence of written information on the management of research findings with possible clinical implications is not in conformity with the recommendations issued by the Council of Europe. By introducing a separate item for this in the form to be submitted to the regional ethics committee for application of prior approval, this issue could be made subject to better assessment.

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