Bærum Sykehus

Lavt inntak av frukt og grønt (FG) er et viktig satsningsområde, både for å bygge helse og forebygge sykdom. Nye kostråd anbefaler nå et økt inntak fra 5 til 8 FG daglig. Flere studier har undersøkt hvordan små designendringer i miljøet kan påvirke matvalg. I denne studien har vi sett på om bruk av symboler påvirker volumsalget av FG i en nettbutikk. Nøkkelhullet og lignende symboler refereres til som «Front of Pack» (FOP)-symboler og kan betraktes som nudges. Nøkkelhull eller grått ikon ble plassert ved siden av matkategorien FG i Meny nettbutikk. Hensikten med studien var å måle eventuelle deskriptive endringer i salg av FG ved bruk av Nøkkelhullet. Et utvidet A/B-design ble brukt og kunder ble tilfeldig tildelt tre nettsidevarianter. Unike kjøp av FG økte med 4,4 % for Nøkkelhullvariant sammenlignet med originalversjonen. Totalt volumsalg av FG økte med 5,7 % for Nøkkelhullvariant. Inntekter fra FG økte med 5,5 % for Nøkkelhullvariant. Vi er ikke kjent med tidligere studier som viser at FOP-merking av FG med Nøkkelhullet kan bidra til økning i både unike kjøp og totalt volumsalg i en norsk nettbutikk. Denne piloten gir viktig innsikt i det videre arbeidet med å øke konsumet av FG i befolkningen.

Splenic trauma is a rare but potentially fatal complication of colonoscopy. A 74-year-old woman presented at the emergency department with abdominal pain. She had undergone a colonoscopy three days prior that had revealed a tumour in the transverse colon. After arriving at the hospital, her haemoglobin level gradually decreased and she eventually developed symptoms of hypovolaemia. A CT scan of the abdomen and pelvis with intravenous contrast showed a splenic haematoma and hemoperitoneum. The patient underwent a splenectomy and hemicolectomy due to the tumour in the transverse colon. Splenic injury is a rare but potentially fatal complication of colonoscopy, which it is important to be aware of given the increasing use of colonoscopy. Patients presenting with abdominal pain and hemodynamic instability following colonoscopy should raise strong suspicion of splenic injury.

Abstract Background Recent studies have suggested different time trends in incidence rates of stroke in younger compared to older age groups (1). However, updated nationwide data from Norway are lacking. Purpose This study aimed to examine time trends in the incidence of total stroke and stroke subtypes across different age groups in Norway the last 20 years. Methods We conducted a nationwide registry-based cohort study, identifying incident stroke cases from hospitalizations with stroke (ischemic stroke, intracerebral hemorrhage and unspecified stroke), TIA, or out-of-hospital deaths due to stroke. Included individuals were ≥ 15 years with no prior hospitalization for stroke during the past seven years. Incidence rates were age-standardized to the European standard population 2013 and analyzed by year, sex and age group. Average annual percentage change in incidence rates were estimated using weighted log-linear regression. Results Between 2001 and 2021, we identified 229,857 incident stroke cases (49.2% women) among 5,691,495 individuals during 82,820,703 person-years. Among these, 74.4% were ischemic stroke, 13.9% intracerebral hemorrhage and 11.6% unspecified stroke. In the same period, we identified 76,533 incident TIA cases (51.0% women). Age-standardized incidence rates of total stroke decreased by an average of 2.4% annually (95% confidence interval (CI): 2.2-2.6). Incidence rates decreased for all stroke subtypes in both men and women overall (figure 1). However, incidence rate of ischemic stroke increased by 1.6% (95% CI: 0.3-2.8) annually among men 15-35 years (figure 2). For TIA, both sexes experienced a sharp rise in incidence rate the latter part of the first decade, followed by a substantial decrease the last decade. Conclusion From 2001 to 2021, stroke incidence rates declined overall in the Norwegian adult population. However, less favourable time trends were observed among younger age groups, particularly an increase in ischemic stroke among young men. These trends are concerning and warrant further investigation to inform preventive strategies.Stroke and subtypes overallStroke and subtypes age groups

In Norway, treatment with COVID-19 convalescent plasma has been given through the NORPLASMA project. The treatment was initially offered to critically ill patients after an individual assessment, but from December 2020, the indication was limited to critically ill, immunocompromised patients. In this article we describe clinical characteristics, comorbidity and mortality in patients who received convalescent plasma in these two periods. From 22April 2020 to 30March 2022, a total of 79 patients were included in the observational studies NORPLASMA MONITOR and the Norwegian SARS-CoV-2 study. The patients had received a total of 193 units of convalescent plasma at 15 Norwegian hospitals/nursing homes; 62 in South-Eastern Norway Regional Health Authority, 8 in Western Norway Regional Health Authority and 9 in Central Norway Regional Health Authority. Information on immune status, comorbidity and course of infection was retrieved from the patient records after informed written consent was obtained. Of 79 patients with a median age of 65 years (interquartile range 51-⁠73) who were treated with convalescent plasma, 31 (39%) died during hospitalisation. A total of 59 patients were immunocompromised, and of these, 20 died in hospital compared to 11 of 20 who were assumed to be immunocompetent. Median number of comorbidities was 2 (interquartile range 1-4). The patients received a median of two plasma units (min.-max. 1-21). Two of the patients developed mild allergic skin reactions. Convalescent plasma was well tolerated by patients with COVID-19. Immunocompromised patients may have benefitted from the treatment, with lower mortality than for those assumed to be immunocompetent.

Background: Prolonged endurance exercise is associated with an increased risk of atrial fibrillation (AF) in men. Left atrial (LA) dilation is a marker of pathological atrial remodeling and associated with AF in the general population. In athletes, however, atrial dilation is part of a physiological response to exercise, and functional parameters may help separate physiological from pathological atrial remodeling in this group. LA mechanical dispersion (LA MD) is a novel marker of LA mechanical dyssynchrony associated with AF in the general population. The associations between prolonged endurance exercise, LA MD and AF are yet to be investigated. Purpose: To investigate LA MD in male veteran athletes who had regularly participated in an annual 54-kilometer cross-country (XC) ski race in Norway with and without paroxysmal AF and to investigate the ability of LA MD to identify veteran athletes with paroxysmal AF. Methods: Two hundred and ninety-three men from four groups, veteran XC skiers with (n=57) and without (n=87) AF, and men from a non-athletic population with (n=61) and without AF (n=88) underwent an echocardiographic exam while in sinus rhythm. Using speckle-tracking echocardiography, LA strain was measured in each of the six atrial segments in an atrial-focused apical four-chamber view. We defined LA MD as the standard deviation of time-to-peak strain (SD-TPS) and report the average from three consecutive loops. Results: XC-skiers (mean age 70.9 ± 5.7 years) reported an average of 40-50 years of regular endurance exercise and an average of 16 completed annual Birkebeiner XC ski races. LA volumes were associated with both AF and athletic status (p<0.001). SD-TPS was associated with AF (p<0.001), but not with athletic status (p=0.173). We found no significant trend between years of endurance exercise and SD-TPS in individuals without AF (p=0.846). SD-TPS did not add incremental value in identifying athletes with AF in addition to clinical markers, QRS width, LA volume, and LA reservoir strain (p=0.056). Conclusion: LA MD was associated with paroxysmal AF regardless of athletic status. However, it was not associated with years of performing endurance exercise, suggesting LA MD could be a promising marker of pathological atrial remodeling in endurance athletes, less affected by physiological exercise-induced atrial remodeling than absolute volumetric measurements. We found no incremental value of LA MD in identifying veteran athletes with paroxysmal AF when LA reservoir strain was included in the model.

The effectiveness of colorectal cancer screening programs depends on the participation rate. This study examined the association between type and severity of mental illness and colorectal cancer screening participation. Between 2012 and 2017, a total of 46,919 individuals were invited to sigmoidoscopy screening in Norway, and 70,019 were invited to fecal immunochemical testing. In 2022, logistic regression was used to evaluate the association between the use of antipsychotics, anxiolytics, hypnotics, and antidepressants in the year preceding the screening invitation and screening participation, adjusted for demographic and socioeconomic factors. Defined daily doses of individual drugs were used to assess dose‒response relationships. Overall, 19.2% (24.8% of women, 13.4% of men) of all invitees used at least 1 psychotropic medication. Nonparticipation in the 2 arms combined was associated with the use of anxiolytics (60.7% in users vs 43.2% in nonusers; OR=1.53; 95% CI=1.45, 1.62) and antipsychotics (64.3% vs 43.8%; OR=1.41; 95% CI=1.30, 1.53) and increased with higher doses for both drugs. Hypnotics and antidepressants were only weakly associated with nonparticipation in higher doses. Participation rates were 57.3%, 52.3%, 42.9%, and 35.4% in those prescribed 0, 1, 2, and 3-4 classes of psychotropic medications, respectively. The associations between the use of psychotropic medications and nonparticipation were similar for the 2 screening tests. These findings show significant disparities in colorectal cancer screening participation for individuals with mental illness, independent of the screening method. Moreover, screening participation varied depending on the type and severity of mental illness. Targeted interventions are warranted to ensure that people with mental illness are supported to access the benefits of colorectal cancer screening.

Cognitive behavioural therapy (CBT) is currently the treatment of choice for most anxiety disorders. Yet, with recovery rates of approximately 50%, many patients fail to achieve complete remission. This has led to increased efforts to enhance treatment efficacy. Physical exercise (PE) has in recent years been advocated as means to augment the effects of CBT for anxiety disorders. PE appears to reduce anxiety through other mechanisms than CBT, some of which might also have the potential to augment the effects of psychological treatment. The current review aimed to summarize and discuss the current research status on CBT augmented with PE for anxiety. A systematic literature search was conducted in the databases PsychInfo, Medline and Web of Science to evaluate the potential augmentative effect of combining PE with CBT for anxiety disorders. These effects were intended to be evaluated in a meta-analysis, but findings from the few and diverse studies were better summarized in a systematic review. Eight articles were included in this review, of which two had no control group, while six had from two to four experimental arms. Six of the studies concluded in favour of benefits of add-on PE, while two studies found no added benefits of the combined interventions. The combination of PE and CBT appears feasible. Add-on PE seems to be more beneficial for clinical populations, when administered regularly several times per week, across several weeks. Future studies should investigate further how and for whom to best combine PE and CBT.

Norwegian anaesthesiologists use a pulse oximeter for each and every case in the operating theatre. However, we suspected that most rely on the visual scale and alarm only (routinely set at 90% at our institution), and that the variable pitch sound of the pulse oximeter is not routinely audible during anaesthesia. In order to verify this, a short survey (3 questions) was emailed to all registered anaesthesiologists (specialists and trainees) in Norway during September 2020. The sample was based on the Norwegian Society of Anaesthesiology membership register, which includes both clinically active and non-active members.