Betanien Hospital

BackgroundCentral retinal artery occlusion can result in permanent vision loss. Effective treatment is lacking.MethodsWe conducted a phase 3, double-blind, double-dummy, randomized, controlled trial involving adults with acute, nonarteritic central retinal artery occlusion who had symptom onset within 4.5 hours before treatment. Patients were assigned, in a 1:1 ratio, to receive intravenous tenecteplase (at a dose of 0.25 mg per kilogram of body weight) and oral placebo or intravenous placebo and oral aspirin (at a dose of 300 mg). The primary end point was vision recovery, defined as a best corrected visual acuity (BCVA) in the affected eye at 30 days of up to 0.7 logMAR (logarithm of the minimum angle of resolution; equivalent to ≥20/100). Key secondary visual end points were a BCVA of up to 0.5 logMAR (equivalent to ≥20/63), mean improvement in BCVA, and perimetry score at 30 days. Key safety end points included symptomatic intracranial hemorrhage, major bleeding, and death.ResultsA total of 78 patients at 16 sites in six countries underwent randomization, with 40 assigned to receive tenecteplase and 38 to receive aspirin. At 30 days, 8 patients (20%) in the tenecteplase group and 9 patients (24%) in the aspirin group had vision recovery (risk difference, −3.7 percentage points; 95% confidence interval, −22.0 to 14.7; P=0.69). The outcomes with regard to the secondary visual end points did not differ substantially between the groups. There was a greater incidence of adverse events in the tenecteplase group, including one fatal intracranial hemorrhage.ConclusionsIntravenous tenecteplase administered within 4.5 hours after onset of central retinal artery occlusion did not result in significantly greater vision recovery at 30 days than oral aspirin but was associated with serious safety concerns. (Funded by Oslo University Hospital and others; TenCRAOS ClinicalTrials.gov number, NCT04526951; EU Clinical Trials number, 2024-517606-29-00.)

Abstract Background Several studies have reported associations between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD). However, sex-differences in ADHD and SUD, especially when associated with other psychiatric comorbidities, are less studied. Objective To compare the prevalence of SUD among individuals with and without ADHD to describe groups, defined by sex and psychiatric comorbidity, who may benefit from targeted follow-up. Methods Data from the Medical Birth Registry of Norway, the Norwegian Prescription Database and the Norwegian Patient Registry were linked. Individuals born 1988–2001 were identified and followed until 2019 (ages 18–31 years in 2019). Log binomial regression was used to calculate age-adjusted prevalence differences (PD) of SUD with 95% confidence intervals in males (N = 31,146) and females (N = 18,669) with ADHD, overall and with/without other psychiatric comorbidities, relative to those without ADHD (males N = 381,568; females N = 368,804). Results ADHD was associated with SUD across all substances among both males and females (“Any SUD”: PDfemales 10.9% (10.4; 11.4); PDmales 11.4% (11.0; 11.8). Compared to individuals without ADHD, PDs were larger in males with ADHD than females for disorders related to cannabis, sedatives, stimulants, other substances and multiple psychoactive substances. ADHD with psychiatric comorbidities was associated with even larger differences in SUD prevalence among both males and females, the largest for ADHD with psychosis/schizophrenia [PDmales 49.0% (45.6; 52.4); PDfemales 40.6% (36.1; 45.1)] and ADHD with personality disorders [PDmales 37.6% (35.2; 40.0); PDfemales 33.0% (31.0; 35.0)], compared to males and females without psychiatric disorders. For psychiatric comorbidities typically diagnosed in adulthood, PDs were larger in males than females with ADHD, whereas for comorbid childhood disorders, PDs were larger in females. Conclusion The high prevalence of SUD associated with ADHD, with higher PDs in males than females for most specific SUDs, indicates a need for targeted prevention. The substantially higher prevalence of SUD in individuals with ADHD and comorbid psychiatric disorders emphasizes the need for close follow-up of individuals with ADHD both regarding SUD and other psychiatric disorders. Further studies are needed to evaluate potential causal relations between ADHD, other psychiatric comorbidities, and SUD, and to understand the sex-differences in SUD prevalence across psychiatric comorbidities in ADHD.

Colorectal cancer (CRC) is not only the third most common cancer worldwide, with 1.1 million new cases per year; it is also the second leading cause of cancer death. However, mortality has decreased since 2012 due to early detection programs and better therapeutic approaches. While many patients are diagnosed at an early stage, there is up to 50% relapse after optimal initial treatment. Therefore, it is crucial to explore the mechanism underlying the development of recurrences and metastasis. It is known that tumors release dormant cells that escape chemotherapy and nest in a target organ without proliferating. Under certain circumstances that are not yet entirely clear, they can be activated and metastasize. Therefore, the objective of this work is to explore the detailed mechanisms of dormancy, including early detection of recurrence and therapeutic approaches for the treatment of CRC. The specific objectives are to determine biomarkers that may be useful in identifying dormant cells to detect minimal residual disease (MRD) after surgery and predicting disease progression, as well as evaluating biomarkers that are susceptible to therapeutic intervention.

AimTwo types of national registers surveil infections after primary total hip arthroplasty (THA) in Norway: The National surveillance system for surgical site infections (NOIS) that surveil all primary THAs 30 days postoperatively for surgical site infections (SSI), and the Norwegian Arthroplasty Register (NAR) that follow all THAs until any surgical reoperation/revision or the death of the patient. Since these registers report on the same THAs we assessed correspondence between and time trends for the two registers in period 2013 to 2022. All reported THAs were included.MethodThe THAs were matched on a group level according to sex, age and ASA-class. In addition to descriptive statistics, adjusted Cox regression analyses were performed with adjustment for sex, age group (<45, 45-54, 55-64, 65-74, 75-84, >85 years) and ASA-class (1, 2, 3, 4 and missing). Changes in annual incidence and adjusted hazard rate (aHR) was calculated. Endpoints in the NOIS were 30-Days SSI and 30-Days reoperation for SSI. Endpoints in the NAR were 30-Days and 1-Year reoperation for periprosthetic joint infection (PJI).ResultsThe NOIS had registered 87,923 THAs with 1,393 (1.58%) SSIs and 765 (0.87%) reoperations for SSI within 30 postoperatively. The NAR had registered 91,194 THAs with 725 (0.80%) reoperations for infection after 30 days, and 1,019 (1.21%) reoperations for infections after one year. The distribution of sex, age and ASA-class was near identical in the two registers. There was a mean annual reduction in risk of both SSI (aHR 0.92 (95% CI 0.90-0.93)) and reoperation for SSI (0.95(0.92-0.97)) and PJI (30-Days: 0.96 (0.94-0.99), 1-Year: 0.95-0.99)) over the period 2013-2022.ConclusionsThe NOIS and the NAR have excellent completeness and the registrations in both registers may be considered representative for the Norwegian population. Not all SSI are reoperated. The incidence and risk of SSI (NOIS) and reoperation for PJI (NAR) is declining and may reflect a true reduction in incidence of PJI after primary THA.

BackgroundPartially driven by public concerns about modern food production practices, organic food has gained popularity among consumers. However, the impact of organic food consumption during pregnancy on offspring health is scarcely studied. We aimed to investigate the association between maternal intake of organic food during pregnancy and symptoms of attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in offspring at 8 years of age.MethodsThis study was based on the Norwegian Mother, Father and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway (MBRN). The total study sample included 40,707 mother–child pairs (children born 2002–2009). Organic food consumption during pregnancy was assessed by six questions from a food frequency questionnaire in mid-pregnancy (sum score 0–18). Symptoms of ADHD and ASD in the offspring aged 8 years were measured by ADHD (0–54) and ASD (0–39) symptom scores based on the Parent/Teacher Rating Scale for Disruptive Behaviour disorders and the Social Communication Questionnaire. Associations between maternal intake of organic food during pregnancy and symptoms of ADHD and ASD in the offspring were analyzed using regression models with adjustment for covariates such as maternal anxiety and depression, including sibling analysis.ResultsMean ADHD and ASD symptom scores in the offspring differed only slightly by maternal intake of organic food. The covariate-adjusted unstandardized regression coefficient (adjusted(Adj)beta) with 95% confidence interval for the ADHD symptom score with one unit increase in organic food sum score was 0.03 (0.01, 0.05). Similarly, Adjbeta for autism symptom score was 0.07 (0.04, 0.10). For ADHD, the adjusted estimates weakened when adjusting for maternal symptoms of ADHD. The sibling analyses showed no significant results with Adjbeta − 0.07 (− 0.15, 0.01) and − 0.001 (− 0.12, 0.12) for ADHD and ASD outcomes, respectively.ConclusionsWe observed weak positive associations between frequent maternal organic food consumption during pregnancy and offspring ADHD and ASD symptom levels at 8 years of age. This trend weakened or disappeared after adjusting for maternal symptoms of ADHD, and in sibling analyses, suggesting that the associations mainly reflect genetic confounding. Our study indicates that consumption of organic food during pregnancy should neither be considered a risk factor nor protective against symptoms of ADHD and ASD in offspring.

Digital data processing has revolutionized medical documentation and enabled the aggregation of patient data across hospitals. Initiatives such as those from the AO Foundation about fracture treatment (AO Sammelstudie, 1986), the Major Trauma Outcome Study (MTOS) about survival, and the Trauma Audit and Research Network (TARN) pioneered multi-hospital data collection. Large trauma registries, like the German Trauma Registry (TR-DGU) helped improve evidence levels but were still constrained by predefined data sets and limited physiological parameters. The improvement in the understanding of pathophysiological reactions substantiated that decision making about fracture care led to development of patient’s tailored dynamic approaches like the Safe Definitive Surgery algorithm. In the future, artificial intelligence (AI) may provide further steps by potentially transforming fracture recognition and/or outcome prediction. The evolution towards flexible decision making and AI-driven innovations may be of further help. The current manuscript summarizes the development of big data from local databases and subsequent trauma registries to AI-based algorithms, such as Parkland Trauma Mortality Index and the IBM Watson Pathway Explorer.

Assessing minors with harmful sexual behavior (HSB) is a complex and sensitive task. The AIM3 Assessment Model was developed to assist practitioners with information collection and HSB evaluations. In this study, we explore the interrater reliability and the practitioners' experience with the AIM3. The multidisciplinary sample (n = 56) was recruited in Norway. The participants' mean age is 43.2 years (SD 9.5). The sample is 79% female and 21% male. Mean years of experience is 17.6 years (SD 9.5). The participants used the Norwegian version of the AIM3 to score three case vignettes. A survey containing questions about competence and experience was filled out. We used the intraclass correlation coefficient (ICC) to estimate interrater reliability as well as descriptive statistics to show experience. The estimated ICC for overall AIM3 factors is 0.547 (95% CI = 0.471, 0.634); for domain scores, the estimated ICC is 0.697 (95% CI = 0.548, 0.852). Both are in the moderate range. The majority of the participants reported that they will probably use the AIM3 in the future and that their experience with the AIM3 was highly useful with, for example, empirically informed decision-making and for intervention and safety planning. The moderate ICC results and the sample's generally positive experience with the AIM3 may indicate further usefulness in a Norwegian multidisciplinary setting. We provide recommendations on how the AIM3 and similar HSB assessments can be further evaluated and developed.

PurposeNorway is one of the few countries worldwide where societal factors facilitate complete population-based cohorts on rare diseases. Due to the organization of the specialist health services all patients with systemic lupus erythematosus (SLE) are likely to be captured at public hospitals. In addition, national identity numbers prevent lost to follow-upThe aim of this study was to estimate the annual incidence of SLE in South-East Norway (population 2.9 million) in the years 1999–2017 and look for trends over time by gender.This study has a large population over a long timespan making it possible to investigate age and gender differences over time.MethodsThrough research of the databases of the 12 public hospitals in the area, we identified patients coded by ICD-10 as M32. We reviewed all patients charts and recorded demographic and clinical parameters. Only individuals with clinical SLE meeting the 1997 American College of Rheumatology (ACR) classification criteria for SLE were included. Adult-onset SLE was defined as disease-onset ≥ 16 years. We looked for secular trends by dividing the cohort into two decades and stratified by age and gender. Incidence rate was estimated per 100 000. To investigate whether the incidence of SLE had changed over the years 1999–2017 chi-squared test for linear trend was used.ResultsOut of 3490 individuals coded as M32 1558 still had this diagnosis in their medical record. The 1997 ACR criteria for SLE were met by 1300 patients, and 673 patients were diagnosed between 1999–2017. The peak incidence rate was pointed at 4,3 for females aged 20–29 years, and more flattened at 0,6 for men aged 40–69 years.The average incidence rate for adult-onset SLE in the time-period 1999–2017 was 1,4; in females 2,4 and in males 0,5.The incidence rate for adult-onset SLE for 1999–2007 and 2008–2017 was respectively 2,6 and 2,2 for females and 0,5 and 0,4 for males, see Figure 1a. for incidence by age.We found that females age 50–59 years had a significant reduction of yearly incidence rate from the first to the second decade from 3,0–1,3 (p<0,001).Females 50–59 years of age also showed a significant decline in annual incidence over the years 1999–2017 (p=0,003) (Figure 1b).The overall time-trend for incidence rate from 1999–2017 showed a significant decline from 1999–2017 (p=0,004) for both females (p=0,003) and males (p=0.033). S09.2 Figure 1Age and gender specific incidence-rates1a. Incidence-rates from two time specific decades.lb. Decreasing incidence for females age 50–59 (1999–2017).ConclusionWe find decreasing incidence rate of SLE from 1999–2017, most pronounced in females 50–59 years of age. This might be due to the reduction of Hormone Replacement Therapy in the same time-period.1ReferenceHofvind et al. Int. J. Cancer 2012;130:2930–2938.

Purpose We explored the content and attainment of rehabilitation goals the first year after rehabilitation among patients with rheumatic and musculoskeletal diseases. Methods Participants (n = 523) recorded goals in the Patient Specific Functional Scale at admission and reported goal attainment at admission, discharge, and 12 months after rehabilitation on an 11-point numeric rating scale. Goal content was linked to the ICF coding system and summarized as high, maintained, or no attainment. Changes in absolute scores were investigated using paired samples t-tests. Results Goals had high attainment with a significant positive change (–1.83 [95% CI −2.0, −1.65], p > 0.001) during rehabilitation, whereas goals had no attainment with a significant negative change (0.36 [0.14, 0.57], p > 0.001) between discharge and 12 months after rehabilitation. Goals focusing on everyday routines, physical health, pain management, and social or work participation were highly attained during rehabilitation. Goals that were difficult to enhance or maintain after rehabilitation addressed everyday routines, physical health, and work participation. Conclusion The positive changes in goal attainment largely occurred during rehabilitation, but they appeared more difficult to maintain at home. Therefore, rehabilitation goals should be reflected in the follow-up care planned at discharge. Implications for rehabilitation The contents of rehabilitation goals reflect the complexity and wide range of challenges patients with rheumatic and musculoskeletal diseases experience. Positive changes in goal attainment largely occur during rehabilitation and appear to be more difficult to enhance or maintain at home. Rehabilitation interventions and follow-up care should be tailored to support patients in maintaining their attained goals for healthy self-management. Rehabilitation goals should be reflected in the follow-up care planned at discharge.

To examine the gender distribution in ASD in adults compared with children and the impact of comorbid intellectual disability (ID) and attention-deficit/hyperactivity disorder (ADHD) on the male to female ratio (MFR). We estimated the MFR and the male prevalence ratio (PR) for ASD in adults and children using the Medical Birth Registry of Norway, including all individuals born during 1967-2011. We examined variation with age, comorbid ID and ADHD as defined by diagnoses in the Norwegian Patient Registry during 2008-2015 and/or a dispensed prescription for ADHD medication. The sample included 1,701,206 adults and 804,146 children, including 8,995 (0.5%) adults and 8,056 (1.0%) children with ASD, 53,822 (3.2%) adults and 26,967 (3.4%) children with ADHD and 9,178 (0.5%) adults and 5,038 (0.6%) children with ID. The MFR for ASD was 3.67 in children and 2.57 in adults, corresponding to a male PR in ASD of 1.54 (95% CI 1.53-1.56) and 1.41 (1.39-1.24), respectively. Comorbid ID decreased the MFR and the male PR in both adults and children, whereas comorbid ADHD significantly increased the male PR in children. The MFR and the population prevalence of ASD, ADHD and ID decreased from children to younger adults and yet further to older adults. We found a lower MFR and male PR in adults than in children. Findings suggest the strong male predominance seen in childhood/clinical studies of ASD diminishes in adult samples, possibly reflecting the influence of non-aetiological factors such as later diagnosis in females, diagnostic biases and diagnostic trends.