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Tønsberg, Norway

Lee A.,University of Oslo | Nestaas E.,Vestfold Hospital Trust | Liestol K.,University of Oslo | Brunvand L.,University of Oslo | Fugelseth D.,University of Oslo
Archives of Disease in Childhood: Fetal and Neonatal Edition | Year: 2014

Background: Very preterm newborn infants often need cardiovascular support. More knowledge about myocardial function and factors that influence the immature myocardium may be helpful for optimising cardiovascular support in these infants. Objective: Serial assessment of global myocardial function by means of colour tissue Doppler imaging (cTDI) in very and extremely preterm infants during the first 24 h of life. Study design: One-centre, prospective, observational longitudinal cohort study in a third level Neonatal Intensive Care Unit. Sixty-five infants with median (range) gestational age (GA) 27 (24-31) weeks and birth weight (BW) 1049 (484-1620) g underwent echocardiographic examinations including cTDI at 5, 12 and 24 h after birth. Main outcome measures: Peak systolic and peak diastolic annular velocity and peak annular displacement of the left and right ventricle. Results: There was a significant reduction in systolic and diastolic velocities and displacement of both ventricles from 5 to 12 h age. From 12 to 24 h, there was a non-significant increase in myocardial velocities and displacement. At 5 h, babies with haemodynamically significant patent ductus arteriosus (PDA) had significantly higher systolic and diastolic velocities in both ventricles than those with non-significant PDA. Conclusions: Myocardial tissue velocities decrease significantly from 5 to 12 h after birth in very preterm infants. Further studies are needed to con firm these results and to determine their clinical implications.

Ringen P.A.,University of Oslo | Engh J.A.,Vestfold Hospital Trust | Birkenaes A.B.,Private Practice | Dieset I.,University of Oslo | Andreassen O.A.,University of Oslo
Frontiers in Psychiatry | Year: 2014

Background: Schizophrenia is among the major causes of disability worldwide and the mortality from cardiovascular disease (CVD) is significantly elevated. There is a growing concern that this health challenge is not fully understood and efficiently addressed. Methods: Non-systematic review using searches in PubMed on relevant topics as well as selection of references based on the authors experience from clinical work and research in the field. Results: In most countries, the standardized mortality rate (SMR) in schizophrenia is about 2.5, leading to a reduction in life expectancy between 15 and 20 years. A major contributor of the increased mortality is due to CVD, with CVD mortality ranging from 40-50% in most studies. Important causal factors are related to lifestyle, including poor diet, lack of physical activity, smoking and substance abuse. Recent findings suggest that there are overlapping pathophysiology and genetics between schizophrenia and CVD risk factors, further increasing the liability to CVD in schizophrenia. Many pharmacological agents used for treating psychotic disorders have side effects augmenting CVD risk. Although several CVD risk factors can be effectively prevented and treated, the provision of somatic health services to people with schizophrenia seems inadequate. Further, there is a sparseness of studies investigating the effects of life-style interventions in schizophrenia, and there is little knowledge about effective programs targeting physical health in this population. Discussion: The risk for CVD and CVD-related deaths in people with schizophrenia is increased, but the underlying mechanisms are not fully known. Coordinated interventions in different health care settings could probably reduce the risk. There is an urgent need to develop and implement effective programs to increase life expectancy in schizophrenia, and we argue that mental health workers should be more involved in this important task.

Notthellen J.,University of Oslo | Konst B.,Vestfold Hospital Trust | Abildgaard A.,University of Oslo
Physics in Medicine and Biology | Year: 2014

Purpose: to present a new and simplified method for pixel-wise determination of the signal-to-noise ratio improvement factor KSNR of an antiscatter grid, when used with a digital imaging system. The method was based on approximations of published formulas. The simplified estimate of K 2 SNR may be used as a decision tool for whether or not to use an antiscatter grid. Methods: the primary transmission of the grid T p was determined with and without a phantom present using a pattern of beam stops. The Bucky factor B was measured with and without a phantom present. Hence K2 SNR maps were created based on T p and B. A formula was developed to calculate K2 SNR from the measured Bs without using the measured Tp. The formula was applied on two exposures of anthropomorphic phantoms, adult legs and baby chest, and on two homogeneous poly[methyl methacrylate] (PMMA) phantoms, 5 cm and 10 cm thick. The results from anthropomorphic phantoms were compared to those based on the beam stop method. The results for the PMMA-phantoms were compared to a study that used a contrast-detail phantom. Results: 2D maps of K2 SNR over the entire adult legs and baby chest phantoms were created. The maps indicate that it is advantageous to use the antiscatter grid for imaging of the adult legs. For baby chest imaging the antiscatter grid is not recommended if only the lung regions are of interest. The K2 SNR maps based on the new method correspond to those from the beam stop method, and the K2 SNR from the homogenous phantoms arising from two different approaches also agreed well with each other. Conclusion: a method to measure 2D K2 SNR associated with grid use in digital radiography system was developed and validated. The proposed method requires four exposures and use of a simple formula. It is fast and provides adequate estimates for K2 SNR. © 2014 Institute of Physics and Engineering in Medicine.

Skjerven H.O.,University of Oslo | Hunderi J.O.G.,University of Oslo | Brugmann-Pieper S.K.,Vestre Viken Hospital Trust | Brun A.C.,Vestfold Hospital Trust | And 10 more authors.
New England Journal of Medicine | Year: 2013

BACKGROUND: Acute bronchiolitis in infants frequently results in hospitalization, but there is no established consensus on inhalation therapy - either the type of medication or the frequency of administration - that may be of value. We aimed to assess the effectiveness of inhaled racemic adrenaline as compared with inhaled saline and the strategy for frequency of inhalation (on demand vs. fixed schedule) in infants hospitalized with acute bronchiolitis. METHODS: In this eight-center, randomized, double-blind trial with a 2-by-2 factorial design, we compared inhaled racemic adrenaline with inhaled saline and on-demand inhalation with fixed-schedule inhalation (up to every 2 hours) in infants (<12 months of age) with moderate-to-severe acute bronchiolitis. An overall clinical score of 4 or higher (on a scale of 0 to 10, with higher scores indicating more severe illness) was required for study inclusion. Any use of oxygen therapy, nasogastric-tube feeding, or ventilatory support was recorded. The primary outcome was the length of the hospital stay, with analyses conducted according to the intention-to-treat principle. RESULTS: The mean age of the 404 infants included in the study was 4.2 months, and 59.4% were boys. Length of stay, use of oxygen supplementation, nasogastric-tube feeding, ventilatory support, and relative improvement in the clinical score from baseline (preinhalation) were similar in the infants treated with inhaled racemic adrenaline and those treated with inhaled saline (P>0.1 for all comparisons). On-demand inhalation, as compared with fixed-schedule inhalation, was associated with a significantly shorter estimated mean length of stay - 47.6 hours (95% confidence interval [CI], 30.6 to 64.6) versus 61.3 hours (95% CI, 45.4 to 77.2; P = 0.01) - as well as less use of oxygen supplementation (in 38.3% of infants vs. 48.7%, P = 0.04), less use of ventilatory support (in 4.0% vs. 10.8%, P = 0.01), and fewer inhalation treatments (12.0 vs. 17.0, P<0.001). CONCLUSIONS: In the treatment of acute bronchiolitis in infants, inhaled racemic adrenaline is not more effective than inhaled saline. However, the strategy of inhalation on demand appears to be superior to that of inhalation on a fixed schedule. (Funded by Medicines for Children; ClinicalTrials.gov number, NCT00817466; EudraCT number, 2009-012667-34.) Copyright © 2013 Massachusetts Medical Society.

Egeland J.,Vestfold Hospital Trust | Egeland J.,University of Oslo | Aarlien A.K.,Vestfold Hospital Trust | Saunes B.-K.,Telemark Hospital Trust
PLoS ONE | Year: 2013

Objective:Studies have shown that children with ADHD profit from working memory training, although few studies have investigated transfer effects comprehensively. The current Randomized Controlled Trial analyzes transfer to other neuropsychological (NP) domains, academic performance and everyday functioning at home and school.Method:Sixty-seven children with ADHD were randomized into a control group or a training group. The training group underwent Cogmed's RoboMemo program. All participants were assessed pre-training, immediately after and eight months later with a battery of NP tests, measures of mathematical and reading skills, as well as rating scales filled out by parents and teachers.Results:There was a significant training effect in psychomotor speed, but not to any other NP measures. Reading and mathematics were improved. There were no training induced changes in symptom rating scales either at home or at school. The increased reading scores remained significant eight months later.Conclusion:The study is the most comprehensive study of transfer effects to date, and with mixed results compared to previous research. More research is needed regarding how to improve the training program and the conditions and thresholds for successful training.Trial Registration: Controlled-Trials.com ISRCTN19133620. © 2013 Egeland et al.

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