http://hdl.handle.net/10143/76442 Search the Channel search http://hera.helsebiblioteket.no/hera/simple-search http://hdl.handle.net/10143/91914 Title: Self-Monitoring of Blood Glucose in Type 1 Diabetes Patients with Insufficient Metabolic Control: Focused Self-Monitoring of Blood Glucose Intervention Can Lower Glycated Hemoglobin A1C.<br/><br/>Authors: Skeie, Svein; Kristensen, Gunn B B; Carlsen, Siri; Sandberg, Sverre<br/><br/>Abstract: OBJECTIVE: Little attention has been given and few studies have been published focusing on how to optimize self-monitoring of blood glucose (SMBG) use to monitor daily therapy for persons with type 1 diabetes mellitus. This study was designed to evaluate the effect on glycated hemoglobin (A1C) of a structured intervention focused on SMBG in type 1 diabetes patients with insufficient metabolic control (A1C >/= 8%) using a randomized clinical trial design. METHOD: One hundred fifty-nine outpatients with type 1 diabetes on multiple injection therapy with insulin and A1C >/=8% were recruited and randomized to one group receiving a focused, structured 9-month SMBG intervention (n = 59) and another group receiving regular care based on guidelines (n = 64). RESULTS: Glycated hemoglobin values (mean % +/- standard deviation) at study start was similar: 8.65 +/- 0.10 in the intervention group and 8.61 +/- 0.09 in the control group. The two groups were comparable (age, gender, body mass index, complication rate, and treatment modality) at study start and had mean diabetes duration and SMBG experience of 19 and 20 years, respectively. At study end, there was decrease in A1C in the intervention group (p < .05), and the A1C was 0.6% lower compared with the control group (p < .05). No increase in the number of minor or major hypoglycemia episodes was observed in the intervention group during the study period. CONCLUSIONS: A simple, structured, focused SMBG intervention improved metabolic control in patients with longstanding diabetes type 1 and A1C >/= 8%. The intervention was based on general recommendations, realistic in format, and can be applied in a regular outpatient setting. Mon, 29 Dec 2008 22:58:59 GMT http://hdl.handle.net/10143/86633 Title: High Prevalence of Orthostatic Hypotension in Mild Dementia.<br/><br/>Authors: Sonnesyn, Hogne; Nilsen, Dennis W; Rongve, Arvid; Nore, Sabine; Ballard, Clive; Tysnes, Ole B; Aarsland, Dag<br/><br/>Abstract: Background/Aims: Orthostatic hypotension (OH) and QTc prolongation have potentially important prognostic and therapeutic consequences but have rarely been studied in patients with mild dementia. Methods: Patients with mild dementia were diagnosed according to consensus criteria after comprehensive standardized assessment. OH and QTc were assessed using standardized criteria. Results: OH was significantly more common in the dementia than in the control group, and systolic drop was higher in those with dementia with Lewy bodies. There were no significant differences in QTc values between dementia and control subjects. Conclusion: OH occurs even in patients with mild dementia, in particular in dementia with Lewy bodies. QTc was not prolonged in patients with mild dementia compared with normal controls. Wed, 29 Oct 2008 22:58:59 GMT http://hdl.handle.net/10143/86400 Title: Health state values during the first year of drug treatment in early-stage Parkinson's disease: a prospective, population-based, cohort study.<br/><br/>Authors: Vossius, Corinna; Nilsen, Odd Bjarte; Larsen, Jan Petter<br/><br/>Abstract: BACKGROUND: Parkinson's disease (PD) is a common neurodegenerative disorder in the elderly that may lead to both motor and non-motor symptoms with consequent severe impairment of quality of life. PD also represents a substantial economic burden on society because of the patient's decreased ability to work, increased need for care and need for costly treatment. Evaluation of quality-adjusted life-years (QALYs) is an important tool in cost-effectiveness analyses. To date, however, few data have become available about the utility gains or losses associated with the disease and its management. OBJECTIVES: To evaluate the changes in health state values in patients with newly diagnosed PD during their first year of drug treatment, and to calculate the gain in QALYs and the incremental cost-effectiveness ratio (ICER) for this patient group. METHODS: In this prospective, population-based, cohort study, 199 patients with incident PD and 172 controls were followed over 1 year. Clinical data, drug use and utility scores obtained from the Short Form 6D (SF-6D) health state questionnaire were documented. RESULTS: Patients with PD had lower SF-6D utility scores than controls at baseline. Patients started on antiparkinsonian drugs had an improvement in mean utility scores of 0.039 from 0.667 to 0.706 (p < 0.05). The ICER was euros 45,259 (2007 values) per QALY, of which two-thirds consisted of the costs of drugs and one-third represented the costs of clinical consultations. CONCLUSION: Drug treatment in patients with early-stage PD increases health state values, but the ICER is high. Further investigations will be necessary to capture the full consequences of treatment of PD and to evaluate the efficacy of disease management in this setting. Wed, 29 Oct 2008 22:58:59 GMT http://hdl.handle.net/10143/86113 Title: Occurrence and risk factors for apathy in Parkinson disease: a 4-year prospective longitudinal study.<br/><br/>Authors: Pedersen, Kenn Freddy; Alves, Guido; Aarsland, Dag; Larsen, Jan Petter<br/><br/>Abstract: BACKGROUND: Apathy is a common but under-recognised behavioural disorder associated with depression and cognitive impairment in patients with Parkinson disease (PD). However, the longitudinal course of apathy in PD has not been studied. OBJECTIVE: To examine the occurrence of and risk factors for apathy over time in a representative sample of patients with PD. METHODS: A sample of 139 patients was drawn from a population-based prevalence study of PD in Rogaland County, Western Norway. Apathy was measured with the Neuropsychiatric Inventory, using a composite score >or=4 to indicate clinically significant apathy. Additional measurements included standardised rating scales for parkinsonism, depression and cognitive impairment. A follow-up evaluation was carried out in 79 patients (78.2% of the survivors) 4 years later. RESULTS: Of the 79 patients included in this study, 29 patients (36.7%) had never had apathy, 11 (13.9%) had persistent apathy, and a further 39 (49.4%) developed apathy during follow-up. At follow-up, patients with apathy were more frequently depressed and demented than never-apathetic patients. Dementia at baseline and a more rapid decline in speech and axial impairment during follow-up were independent risk factors for incident apathy. CONCLUSIONS: Apathy is a persistent behavioural feature in PD with a high incidence and prevalence over time. Progression of motor signs predominantly mediated by non-dopaminergic systems may be a useful preclinical marker for incident apathy in PD. Thu, 29 Oct 2009 22:58:59 GMT http://hdl.handle.net/10143/83597 Title: Doubling of the capacity of child psychiatric services in a region of southwestern Norway--how did it affect the composition of the clinical population?<br/><br/>Authors: Kriz, Silvia; Thomsen, Per Hove<br/><br/>Abstract: This study analyzes changes in reasons for referral, diagnoses, age at referral and waiting times when the capacity of child and adolescent mental health services in an area was doubled over an 8-year period. In the region studied, there is a population of 60,000 children in the age-range 0-13 years. The treatment capacity rose from treating 0.9% of the population per year to 1.8%. There were only slight changes in the distribution of reasons for referral. Among diagnoses, there was a significant increase in the proportion of hyperkinetic disorder, at the expense of stress-related disorders, conduct disorders and emotional disorders with onset in childhood. Furthermore, the study found that the wait duration and age at referral remained almost unchanged. The results of the study support that the capacity of the services in 2004 is still not sufficient to meet fully the population needs, and that awareness should be directed towards early intervention and children with emotional disorders. Wed, 29 Oct 2008 22:58:59 GMT http://hdl.handle.net/10143/82958 Title: LOH at 1p31 (ARHI) and proliferation in lymph node-negative breast cancer.<br/><br/>Authors: Janssen, Emiel A M; Øvestad, Irene T; Skaland, Ivar; Søiland, Håvard; Gudlaugsson, Einar; Kjellevold, Kjell H; Nysted, Arne; Søreide, Jon-Arne; Baak, Jan P A<br/><br/>Abstract: BACKGROUND: The mitotic activity index (MAI) is a strong prognosticator in node-negative invasive breast cancer patients. Recently, a correlation between the MAI and specific chromosomal aberrations at chromosome 1p was described. METHODS: Analysis of MAI, immunohistochemical staining patterns for proliferation-associated phosphohistone H3 (PPH3), phosphorylated ERK1/2, p21, cyclin E, Ki67 and cyclin D1 proteins; and prognosis in 158 adjuvant chemotherapy-treated T1-2N0M0 invasive breast cancer patients, analysis of LOH at 1p31 (including ARHI) using the dinucleotide repeats D1S207, D1S430 and D1S464 in 76 patients. Single and multivariate survival analysis was used to evaluate the importance of the various markers tested. RESULTS: LOH at 1p31 did not correlate with MAI nor provide prognostic information. Phosphohistone H3 was the best prognosticator for patients in all age groups with 20 year distant metastasis free survival of distant metastases 93% vs. 72% respectively (p=0.004, HR=4.5). In multivariate analysis, phosphohistone H3<13 vs. > or =13 exceeded the prognostic value of the mitotic activity index. CONCLUSIONS: LOH at 1p31 is common in breast cancer, and correlates with loss of proliferation-associated proteins, but not with MAI, PPH3 or prognosis. PPH3 is the best prognosticator in this study group of adjuvant chemotherapy-treated lymph node-negative breast cancer patients. Wed, 29 Oct 2008 22:58:59 GMT http://hdl.handle.net/10143/82333 Title: Clinical characteristics of childhood Lyme neuroborreliosis in an endemic area of northern Europe.<br/><br/>Authors: Øymar, Knut; Tveitnes, Dag<br/><br/>Abstract: Neuroborreliosis may be caused by different species of Borrelia burgdorferi (BB) and the clinical presentation of neuroborreliosis in children may differ between geographical areas due to occurrence of different BB genospecies. The aim of this study was to evaluate the clinical characteristics in children with neuroborreliosis in an endemic area of Scandinavia. During 1996-2006, children with suspected neuroborreliosis referred to Stavanger University Hospital were investigated by a standard procedure including a lumbar puncture. A total of 143 children were diagnosed with neuroborreliosis, and all cases were diagnosed from April to December. The most common clinical presentations were symptoms of mild meningitis (75%) and/or facial nerve palsy (69%). Radicular pain was present in only 10 children. In all but 5 children, laboratory signs of meningitis were present. Erythema migrans preceded the neurological symptoms in only 27% of the children. In conclusion, we have found that in an endemic area of northern Europe, meningitis is present in the majority of children with neuroborreliosis, and that symptoms of a mild meningitis or facial nerve palsy are the most common presentations. Wed, 29 Oct 2008 22:58:59 GMT http://hdl.handle.net/10143/82034 Title: A small subgroup of operable breast cancer patients with poor prognosis identified by quantitative real-time RT-PCR detection of mammaglobin A and trefoil factor 1 mRNA expression in bone marrow.<br/><br/>Authors: Tjensvoll, Kjersti; Gilje, Bjørnar; Oltedal, Satu; Shammas, Victor F; Kvaløy, Jan Terje; Heikkilä, Reino; Nordgård, Oddmund<br/><br/>Abstract: PURPOSE: The utility of three different epithelial mRNA markers to detect clinically significant, disseminated tumour cells in bone marrow (BM) was explored. METHODS: Mammaglobin A (hMAM), trefoil factor 1 (TFF-1) and prostate derived Ets factor (PDEF) mRNA were quantitated by real-time RT-PCR in BM samples from 192 breast cancer patients undergoing surgery (control group: 26 healthy women). RESULTS: During a median follow-up of 72 months, four of the five hMAM BM-positive and three of the seven TFF-1 BM-positive patients experienced a systemic relapse. Kaplan-Meier survival analyses demonstrated significantly shorter recurrence-free-, breast-cancer-specific- and overall survival for both hMAM and TFF-1 BM-positive patients. In contrast, PDEF mRNA quantitation did not reveal any significant differences in the survival analyses. Multivariate Cox regression demonstrated hMAM mRNA BM expression to be an independent predictor of both overall- (hazard ratio = 5.896), breast-cancer-specific- (hazard ratio = 10.208) and systemic-recurrence-free survival (hazard ratio = 14.304). TFF-1 status was related to hMAM status (P < 0.001). CONCLUSION: Breast cancer patients with pre-operative elevated BM levels of hMAM and/or TFF-1 mRNA seem to constitute a small group of patients with a very poor prognosis. Sun, 28 Jun 2009 22:58:59 GMT http://hdl.handle.net/10143/82013 Title: Experiences of guilt as a mother in the context of eating difficulties.<br/><br/>Authors: Rørtveit, Kristine; Aström, Sture; Severinsson, Elisabeth<br/><br/>Abstract: The aim of this study was to explore motherhood in the context of eating difficulties. The research question was: What are mothers' daily life experiences when suffering from ED? An explorative design was used. In-depth interviews (n = 8) focused on experiences of motherhood and eating difficulties. Data were interpreted by hermeneutic analysis. The main theme, "experiencing guilt as a mother in the context of eating difficulties," comprised two themes: (1) having a guilty conscience in relation to being a good enough mother and (2) being preoccupied about not involving the children in the eating difficulties. The study illuminates the importance of identifying mothers with eating difficulties and offering them treatment and support. Mon, 28 Sep 2009 22:58:59 GMT http://hdl.handle.net/10143/81996 Title: Prediction of driving ability after inconclusive neuropsychological investigation.<br/><br/>Authors: Alexandersen, Alice; Dalen, Knut; Brønnick, Kolbjørn<br/><br/>Abstract: OBJECTIVE: The aim of the present study was to investigate the predictive value of neuropsychological tests for on-road evaluation outcome after inconclusive assessment. METHODS AND PROCEDURES: Thirty-five patients were assessed neurologically, neuropsychologically by traditional clinical tests and by on-road evaluation. Simple univariate tests, logistic regression and ROC-curve analysis were used to investigate the predictive power of different neuropsychological tests. MAIN OUTCOMES AND RESULTS: Six measures from the California Computerized Assessment Package (CalCAP) and the Digit-Symbol test from Wechsler Adult Intelligence Scale predicted the outcome of the on-road evaluation. A logistic regression analysis showed that a model with two variables from CalCAP and the Digit Symbol test predicted the results of the on-road driving evaluation with an overall accuracy of 84.8%. CONCLUSIONS: The findings indicate that the outcome of on-road assessment is most related to cognitive skills such as attention and processing speed in combination with cognitive flexibility. Sun, 29 Mar 2009 22:58:59 GMT