Goeke J.M.,Regional University of the North
Psychiatric Annals | Year: 2017
It has been estimated that between 10% and 50% of people suffering a mild traumatic brain injury (mTBI) do not recover as expected. They often exhibit physical, cognitive, and psychological sequelae that seem out of proportion to the severity of the initial injury, and symptoms may persist for 1 year or more postinjury. People exhibiting this symptom pattern after mTBI often meet criteria for a diagnosis of postconcussion syndrome (PCS). Management of patients with PCS poses many potential challenges for the clinician. There is no clearly established treatment algorithm for PCS, and symptoms are highly variable in individual patients. In many cases, confounding social issues such as litigation or workers’ compensation involvement are present. These issues further cloud the clinical picture and may have an impact on patient treatment response. Neuropsychological approaches to the evaluation and management of this complex patient population are commonly used conjointly with medical modalities. This article reviews common issues and controversies in PCS from the perspective of the assessment and management of cognitive and psychological symptoms. © SLACK Incorporated.
Smith S.T.,Regional University of the North
Psychiatric Annals | Year: 2017
Postconcussion syndrome (PCS) remains one of the most challenging neuropsychiatric illnesses to evaluate and address clinically. Despite the fact that mild traumatic brain injury (or concussion) accounts for 75% of all head injuries, and that approximately 20% of patients will report a variety of symptoms lasting for months to years (sometimes indefinitely), our understanding of PCS is still evolving and there are few evidence-based treatment options for this condition. PCS involves a cluster of symptoms that are highly variable, not only in populations of patients with PCS, but also with regard to a person’s presentation over time. Common symptoms include headache, dizziness, tinnitus, light and noise sensitivity, memory deficits, movement disorders, sleep disturbances, and cognitive impairment, as well as depression, anxiety, and other neuropsychiatric symptoms. This article reviews the latest understanding of the epidemiology, pathophysiology, and risk factors associated with PCS. Possible symptoms, potential short- and long-term comorbidities, PCS diagnostic criteria, and the evaluation of athletes suspected of concussive injury are also reviewed. © SLACK Incorporated.
Raknes G.,University of Bergen |
Raknes G.,Regional University of the North |
Hunskaar S.,University of Bergen
BMC Emergency Medicine | Year: 2017
Background: Frequencies of reasons for encounter (RFEs) in emergency primary care out-of-hours (OOH) services are relevant for planning of capacities as well as to target the training of staff at casualty clinics. We aimed to present frequencies of RFEs in the different organ systems, and to identify the most frequent RFEs at different urgency levels. Methods: We analyzed data on RFEs in Norwegian OOH services. International Classification of Primary Care (ICPC-2) RFE codes were recorded in all contacts to eight representative OOH casualty clinics in 2014 and 2015 covering 20 municipalities with a total population of 260 196. Frequencies of each ICPC-2 chapters and groups of ICPC-2 codes were calculated at different urgency levels. Results: Musculoskeletal, respiratory, skin, digestive and general and unspecified issues were the most frequent RFE groups. Fever was the most frequent single ICPC-2 RFE code, but was less common among the most urgent cases. Abdominal pain was the most common RFE in patients with yellow urgency level (urgent), and chest pain dominated the potentially red (potentially life threatening) cases. There was less variation in the use of ICPC-2 with increasing urgency level. Conclusions: This study identifies important differences in RFEs between urgency levels in the Norwegian OOH services. The findings provide new insight into the function of the primary health care emergency services in the Norwegian health care system, and should have implications for staffing, training and equipment in the OOH services. © 2017 The Author(s).
Wu Y.,Zhejiang University |
Peng Y.,Hong Kong Polytechnic University |
Zhang X.,Hong Kong Polytechnic University |
Skitmore M.,Queensland University of Technology |
Song Y.,Regional University of the North
Habitat International | Year: 2012
China has experienced an extraordinary level of economic development since the 1990s, following excessive competition between different regions. This has resulted in many resource and environmental problems. Land resources, for example, are either abused or wasted in many regions. The strategy of development priority zoning (DPZ), proposed by the Chinese National 11th Five-Year Plan, provides an opportunity to solve these problems by coordinating regional development and protection. In line with the rational utilization of land, it is proposed that the DPZ strategy should be integrated with regional land use policy.As there has been little research to date on this issue, this paper introduces a system dynamic (SD) model for assessing land use change in China led by the DPZ strategy. Land use is characterized by the prioritisation of land development, land utilization, land harness and land protection (D-U-H-P). By using the Delphi method, a corresponding suitable prioritisation of D-U-H-P for the four types of development priority zones, including optimized development zones (ODZ), key development zones (KDZ), restricted development zones (RDZ), and forbidden development zones (FDZ) are identified. Suichang County is used as a case study in which to conduct the simulation of land use change under the RDZ strategy.The findings enable a conceptualization of DPZ-led land use change and the identification of further implications for land use planning generally. The SD model also provides a potential tool for local government to combine DPZ strategy at the national level with land use planning at the local level. © 2011 Elsevier Ltd.
Wu Y.,Zhejiang University |
Zhang X.,City University of Hong Kong |
Skitmore M.,Queensland University of Technology |
Song Y.,Regional University of the North |
Hui E.C.M.,Hong Kong Polytechnic University
Land Use Policy | Year: 2014
China is experiencing rapid progress in industrialization, with its own rationale toward industrial land development based on a deliberate change from an extensive to intensive form of urban land use. One result has been concerted attempts by local government to attract foreign investment by a low industrial land price strategy, which has resulted in a disproportionally large amount of industrial land within the total urban land use structure at the expense of the urban sprawl of many cities. This paper first examines "Comparable Benchmark Price as Residential land use" (CBPR) as the theoretical basis of the low industrial land price phenomenon. Empirical findings are presented from a case study based on data from Jinyun County, China. These data are analyzed to reveal the rationale of industrial land price from 2000 to 2010 concerning the CBPR model. We then explore the causes of low industrial land prices in the form of a "Centipede Game Model", involving two neighborhood regions as "major players" to make a set of moves (or strategies). When one of the players unilaterally reduces the land price to attract investment with the aim to maximize profits arising from the revenues generated from foreign investment and land premiums, a two-player price war begins in the form of a dynamic game, the effect of which is to produce a downward spiral of prices. In this context, the paradox of maximizing profits for each of the two players are not accomplished due to the inter-regional competition of attracted investment leading to a lose-lose situation for both sides' in competing for land premium revenues. A short-term solution to the problem is offered involving the establishment of inter-regional cooperative partnerships. For the longer term, however, a comprehensive reform of the local financial system, more adroit regional planning and an improved means of evaluating government performance is needed to ensure the government's role in securing pubic goods is not abandoned in favor of one solely concerned with revenue generation. © 2013 Elsevier Ltd.
Antypas K.,University of Tromsø |
Wangberg S.C.,Regional University of the North |
Wangberg S.C.,University of Tromsø
BMC Cardiovascular Disorders | Year: 2012
Background: Cardiac rehabilitation is very important for the recovery and the secondary prevention of cardiovascular disease, and one of its main strategies is to increase the level of physical activity. Internet and mobile phone based interventions have been successfully used to help people to achieve this. One of the components that are related to the efficacy of these interventions is tailoring of content to the individual. This trial is studying the effect of a longitudinally tailored Internet and mobile phone based intervention that is based on models of health behaviour, on the level of physical activity and the adherence to the intervention, as an extension of a face-to-face cardiac rehabilitation stay.Methods/Design: A parallel group, cluster randomized controlled trial. The study population is adult participants of a cardiac rehabilitation programme in Norway with home Internet access and mobile phone, who in monthly clusters are randomized to the control or the intervention condition. Participants have access to a website with information regarding cardiac rehabilitation, an online discussion forum and an online activity calendar. Those randomized to the intervention condition, receive in addition tailored content based on models of health behaviour, through the website and mobile text messages. The objective is to assess the effect of the intervention on maintenance of self-management behaviours after the rehabilitation stay. Main outcome is the level of physical activity one month, three months and one year after the end of the cardiac rehabilitation programme. The randomization of clusters is based on a true random number online service, and participants, investigators and outcome assessor are blinded to the condition of the clusters.Discussion: The study suggests a theory-based intervention that combines models of health behaviour in an innovative way, in order to tailor the delivered content. The users have been actively involved in its design, and because of the use of Open-Source software, the intervention can easily and at low-cost be reproduced and expanded by others. Challenges are the recruitment in the elderly population and the possible underrepresentation of women in the study sample. Funding by Northern Norway Regional Health Authority.Trial registration: Trial registry http://www.clinicaltrials.gov: NCT01223170. © 2012 Antypas and Wangberg; licensee BioMed Central Ltd.
Antypas K.,University of Tromsø |
Wangberg S.C.,Narvik University College |
Wangberg S.C.,Regional University of the North
Journal of Medical Internet Research | Year: 2014
Background: An increase in physical activity for secondary prevention of cardiovascular disease and cardiac rehabilitation has multiple therapeutic benefits, including decreased mortality. Internet- and mobile-based interventions for physical activity have shown promising results in helping users increase or maintain their level of physical activity in general and specifically in secondary prevention of cardiovascular diseases and cardiac rehabilitation. One component related to the efficacy of these interventions is tailoring of the content to the individual. Objective: Our trial assessed the effect of a longitudinally tailored Internet- and mobile-based intervention for physical activity as an extension of a face-to-face cardiac rehabilitation stay. We hypothesized that users of the tailored intervention would maintain their physical activity level better than users of the nontailored version. Methods: The study population included adult participants of a cardiac rehabilitation program in Norway with home Internet access and a mobile phone. The participants were randomized in monthly clusters to a tailored or nontailored (control) intervention group. All participants had access to a website with information regarding cardiac rehabilitation, an online discussion forum, and an online activity calendar. Those using the tailored intervention received tailored content based on models of health behavior via the website and mobile fully automated text messages. The main outcome was self-reported level of physical activity, which was obtained using an online international physical activity questionnaire at baseline, at discharge, and at 1 month and 3 months after discharge from the cardiac rehabilitation program. Results: Included in the study were 69 participants. One month after discharge, the tailored intervention group (n=10) had a higher median level of overall physical activity (median 2737.5, IQR 4200.2) than the control group (n=14, median 1650.0, IQR 2443.5), but the difference was not significant (Kolmogorov-Smirnov Z=0.823, P=.38, r=.17). At 3 months after discharge, the tailored intervention group (n=7) had a significantly higher median level of overall physical activity (median 5613.0, IQR 2828.0) than the control group (n=12, median 1356.0, IQR 2937.0; Kolmogorov-Smirnov Z=1.397, P=.02, r=.33). The median adherence was 45.0 (95% CI 0.0-169.8) days for the tailored group and 111.0 (95% CI 45.1-176.9) days for the control group; however, the difference was not significant (P=.39). There were no statistically significant differences between the 2 groups in stage of change, self-efficacy, social support, perceived tailoring, anxiety, or depression. Conclusions: Because of the small sample size and the high attrition rate at the follow-up visits, we cannot make conclusions regarding the efficacy of our approach, but the results indicate that the tailored version of the intervention may have contributed to the long-term higher physical activity maintained after cardiac rehabilitation by participants receiving the tailored intervention compared with those receiving the nontailored intervention. © Holly O Witteman.
Hoye A.,Regional University of the North |
Jacobsen B.K.,University of Tromsø |
Hansen V.,University of Tromsø
Schizophrenia Research | Year: 2011
A study of mortality for all patients with schizophrenia admitted to the University Hospital of North Norway during 1980-2006 was performed, with a special focus on gender differences and changes in mortality during a period of transition from hospital-based to community-based care. A total of 1111 patients with schizophrenia were included, and the cohort was linked to the Causes of Death Register of Norway. Males and females had 3.5 and 2.6 times, respectively, higher mortality than the general population. The standardized mortality ratios were higher during the last nine years than the first nine years, and for women admitted after 1992, we found evidence for an increasing difference in mortality compared to the general female population as well as an increase in absolute mortality. In the subgroup of patients who had always been admitted voluntarily, women tended to have higher mortality, and a particularly high standardized mortality rate (SMR) was found in this group of female schizophrenic patients. Our results confirmed a persisting mortality gap between patients with schizophrenia and the general population over a period of 27. years, with a tendency of increasing standardized mortality ratios over time. The SMR for total mortality of women with schizophrenia is rising and becoming just as high as for men, both for unnatural and natural causes of death. © 2011 Elsevier B.V.
Garcia B.H.,Hospital Pharmacy of North Norway Trust |
Smabrekke L.,University of Tromsoe |
Trovik T.,University Hospital of Tromsoe |
Giverhaug T.,Regional University of the North
European Journal of Clinical Pharmacology | Year: 2013
Purpose: Numerous studies have documented suboptimal adherence to guideline recommendations in secondary prevention of coronary heart disease (CHD SP). Clinical practice guidelines (CPGs) are continuously developed to define appropriate patient care, aiming to reduce risk of morbidity and death. The Medication Assessment Tool for CHDSP (MAT-CHD SP) was developed to assess adherence to CPGs concerning medication therapy and follow-up of patients with CHDSP. The aim of this study was to explore whether the MAT-CHDSP could be applied retrospectively to assess guideline adherence and therapy goal achievement in secondary prevention of CHD. Methods: We collected data from electronic medical records of all patients who underwent percutaneous coronary intervention with stent implantation from January to March 2008 (n = 300) and applied the MAT-CHD SP. We measured time for data collection and MAT application and tested reproducibility by calculating Cohen's kappa (κ) value for inter and intraobserver agreement. Results: A total of 247 MAT applications were analyzed, showing overall applicability of 66 % of the 4,446 MAT-CHD SP criteria and a high reproducibility of MAT-CHDSP application (κ values 0.93 and 0.95 for intra- and interobserver agreement, respectively). Mean time for data collection and MAT-CHDSP application was 11 min. Adherence to criteria concerning prescription was high (>75 %), but achievement of therapy goals for cholesterol and blood pressure was low (<50 %). Documentation of lifestyle advice achieved intermediate (50-75 %) or low adherence, as did therapy amendments in patients in whom therapy goals were unachieved at hospital admission. Conclusions: The MAT-CHDSP offers a means to identify both adherence and nonadherence to CPGs concerning CHDSP is applicable in retrospective assessment of CHDSP, and identifies potentials for improved patient care. © 2012 Springer-Verlag.
Egorov E.G.,Regional University of the North
Gornyi Zhurnal | Year: 2015
Modernization and innovative development of mineral mining and processing industry in the Northeastern Russia has regional-specific features. The operating diamond, gold, lead, coal and natural gas mines regularly upgrade production on a basis of introduction of state-of-the-art mining and processing equipment, including import. The problems of underground mining of diamonds and gold ore are partly being resolved by application of innovative technologies. Further innovative development of the diamond production industry in the Republic of Sakha (Yakutia) involves introduction of highly efficient and safe technologies for open, underground and combination mining of kimberlite pipes, finding of soft technologies for kimberlite weakening, elaboration of processing technologies for highly mineralized brines and concentration waste toward recovery of valuable elements and chemical compounds. The gold and lead extraction industry branches require high-performance and ecology-friendly technologies for mining and processing of natural ore bodies and mining waste, and for pushing the limits of application range for new heap leaching methods. New branches of mineral mining and processing and fuel-and-energy industries, including production of oil, gas, iron ore, complex ore, rare earth metals and other minerals, will spring up and turn out competitive products predominantly based upon innovative technologies. Currently, there are many prepared innovation-investment projects in the Northeastern Russia region. It is suggested to implement the projects by means of formation of territorial mining clusters. The article is prepared in the framework of R&D "Scientific-Technical and Organization-Economical Foundations for Advanced Innovative Development of Regional Economy in the Northeastern Russia" under the governmental assignment no. 1201460076.