SpesialistSenteret Pilestredet Park

SummarySubsequent fracture rates and associated mortality were compared before and after the introduction of fracture liaison service (FLS). In 100,198 women and men, FLS was associated with 13% and 10% lower risk of subsequent fragility fractures and 18% and 15% lower mortality. The study suggests that FLS may prevent fractures.PurposeEfficient fracture prevention strategies are warranted to control the global fracture burden. We investigated the effect of a standardized fracture liaison service (FLS) intervention on subsequent fracture risk and mortality.MethodsThe NoFRACT study was designed as a multicenter, pragmatic, register-supported, stepped-wedge cluster-randomized trial. The FLS intervention was introduced in three clusters with 4-month intervals starting May 2015 through December 2018 and included evaluation of osteoporosis and treatment in patients over 50 years with a low-energy fracture. Based on data from the Norwegian Patient Registry, patients with index fractures were assigned to the control period (2011–2015) or intervention period (2015–2018) depending on the time of fracture. Rates of subsequent fragility fractures (distal forearm, proximal humerus, or hip) and all-cause mortality were calculated.ResultsA total of 100,198 patients (mean age 69.6 years) suffered an index fracture of any type. During a maximum follow-up of 4.7 years, 11% (6948) of the women and 6% (2014) of the men experienced a subsequent fragility fracture, and 20% (14,324) of the women and 22% (8,326) of the men died. FLS was associated with 13% lower subsequent fragility fracture risk in women (hazard ratio (HR) 0.87, 95% confidence intervals (CI) 0.83–0.92) and 10% in men (HR 0.90, 95% CI 0.81–0.99) and 18% lower mortality in women (HR 0.82, 95% CI 0.79–0.86) and 15% in men (HR 0.85, 95% CI 0.81–0.89).ConclusionA standardized FLS intervention was associated with a lower risk of subsequent fragility fractures and mortality and may contribute to reduce the global fracture burden.

The Russian invasion of Ukraine in February 2022 led to Europe’s largest displacement of people since World War II, with significant substantial numbers of Ukrainian refugees seeking shelter in neighbouring countries. International research attests to the crucial roles public libraries can play in the reception and integration of refugees. However, diverse professional and geographical contexts and sociopolitical landscapes in which libraries work to support refugee reception and integration processes, necessitate ongoing and renewed focus on the topic. Therefore, this study examines how public libraries in Hungary and Poland responded to the influx of Ukrainian refugees, investigating their roles, programmes and partnerships. Using mixed methods, the study analyses previously unexamined 2018 questionnaire results and conducts 12 subsequent interviews with library staff. Findings reveal that libraries addressed a spectrum of user needs falling into three broad phases. Initially, they focussed on primary needs during the first phase, transitioning to settlement-related needs in the second phase. Variances between Poland and Hungary emerged during this phase, with Hungary primarily serving transient refugees and those with Hungarian backgrounds, while Poland saw a higher number of refugees of Ukrainian background settling. In the final phase, libraries emphasized literacy, integration and cultural support, aligning with reading and collection-oriented services. Service provision was characterized by nontraditional services in the first phase, non-collection-oriented services in the second phase and collection-oriented services in the third phase, with information provision central to all three phases. The study underscores public libraries’ role in addressing community needs, rooted in their core values of inclusivity and community engagement. However, their effectiveness hinges on inclusion in community-level efforts, awareness among new groups and securing economic and political support. Further research is warranted to explore library services to refugees globally amid increasing global migration and to understand the experiences of refugees using library services.

Abstract Previous studies have demonstrated that the administration of zoledronic acid (ZOL) once yearly for 3 years or once over 3 years, yields similar antifracture efficacy. Bone turnover markers can predict the antifracture efficacy of antiresorptive agents, with procollagen type 1 N-terminal propeptide (P1NP) being the most useful marker. In this retrospective cohort study, we explored the effects of intravenous dosing of ZOL guided by serum (S)-P1NP assessment on bone mineral density (BMD) and fractures. Consenting patients (N = 202, mean age 68.2 years) with osteoporosis were treated with ZOL for an average of 4.4 (range 2-8) years. S-P1NP and BMD were measured at baseline and every 1-2 years. We assessed the number of subsequent vertebral and nonvertebral fractures in the 2-year time periods. The number of patients assessed was 202, 147, 69, and 29 at years 1-2, 3-4, 5-6, and 7-8, respectively. A new ZOL infusion was given if S-P1NP exhibited values above 35 μg/L. BMD increased by 6.2% (SD 4.0) over the first 2 years and stabilized in years 2-8 (P <.05). Median S-P1NP exhibited an initial reduction from 58.0 to 31.3 μg/L at year 2 and then increased to 39.0 μg/L at years 7-8. Compared with fractures observed in the last 2 years before baseline, fracture rates exhibited consistent reductions, for vertebral fractures odds ratio (OR) [95% confidence interval] = 0.61 [0.47, 0.80], P <.001 and for nonvertebral fractures OR = 0.23 [0.18, 0.31], P <.001. In conclusion, intermittent dosing of intravenous ZOL based on the assessment of S-P1NP with cut-off at 35 μg/L resulted in an initial increase followed by a stable BMD, suppression of S-P1NP, and stable reduction of fractures for 8 years. Only 39% of patients needed more than one infusion. This approach reduces healthcare costs and might also reduce the risk of rare side effects such as osteonecrosis of the jaw and atypical femoral fracture.

Background Levels of thyroid-stimulating hormone (TSH) are believed to reflect degree of disease in patients with hypothyroidism, and normalization of levels is the treatment goal. However, despite adequate levels of TSH after starting levothyroxine (LT4) therapy, 5–10% of hypothyroid patients complain of persisting symptoms with a significant negative impact on quality of life. This indicates that TSH is not an optimal indicator of intracellular thyroid hormone effects in all patients. Our aim was to investigate different effects of LT3 and LT4 monotherapy on other biomarkers of the thyroid signaling pathway, in addition to adverse effects, in patients with residual hypothyroid symptoms. Methods Fifty-nine female hypothyroid patients, with residual symptoms on LT4 monotherapy or LT4/liothyronine (LT3) combination therapy, were randomly assigned in a non-blinded crossover study and received LT4 or LT3 monotherapy for 12 weeks each. Measurements, including serum analysis of a number of biochemical and hormonal parameters, were obtained at the baseline visit and after both treatment periods. Results Free thyroxine (FT4) was higher in the LT4 group, while free triiodothyronine (FT3) was higher in the LT3 group. The levels of reverse triiodothyronine (rT3) decreased after LT3 treatment compared with LT4 treatment. Both low-density lipoprotein (LDL) and total cholesterol levels were reduced, while sex hormone-binding globulin (SHBG) increased after LT3 treatment compared with LT4 treatment. The median TSH levels for both treatment groups were within the reference range, however, lower in the LT4 group than in the LT3 group. We did not find any differences in pro-B-type natriuretic peptide (NT pro-BNP), handgrip strength, bone turnover markers, or adverse events between the two treatment groups. Conclusion We have demonstrated that FT4, FT3, rT3, cholesterol, and SHBG show significantly different values on LT4 treatment compared with LT3 treatment in women with hypothyroidism and residual symptoms despite normal TSH levels. No differences in general or bone-specific adverse effects were demonstrated. This trial is registered with NCT03627611 in May 2018.

BackgroundThyroid hormones are essential for the full thermogenic response of brown adipose tissue (BAT) and have been implicated in dermal temperature regulation. Nevertheless, persistent cold-intolerance exists among a substantial proportion of hypothyroid patients on adequate levothyroxine (LT4) substitution.Materials and MethodsTo assess if skin temperature and activation of BAT during treatment with liothyronine (LT3) differs from that of LT4 treatment, fifty-nine female hypothyroid patients with residual symptoms on LT4 or LT4/LT3 combination therapy were randomly assigned in a non-blinded crossover study to receive monotherapy with LT4 or LT3 for 12 weeks each. Change in supraclavicular (SCV) skin temperature overlying BAT, and sternal skin temperature not overlying BAT, during rest and cold stimulation were assessed by infrared thermography (IRT). In addition, abundance of exosomal miR-92a, a biomarker of BAT activation, was estimated as a secondary outcome.ResultsCold stimulated skin temperatures decreased less with LT3 vs. LT4 in both SCV (mean 0.009°C/min [95% CI: 0.004, 0.014]; P<0.001) and sternal areas (mean 0.014°C/min [95% CI: 0.008, 0.020]; P<0.001). No difference in serum exosomal miR-92a abundance was observed between the two treatment groupsConclusionLT3 may reduce dermal heat loss. Thermography data suggested increased BAT activation in hypothyroid patients with cold-intolerance. However, this finding was not corroborated by assessment of the microRNA biomarker of BAT activation.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT03627611

Bakgrunn Anestesisykepleiere jobber daglig tett på andre yrkesgrupper i et høyteknologisk miljø og under tidvis krevende omstendigheter. Godt teamarbeid er essensielt for å gjennomføre arbeidet inne på en operasjonsstue. En arbeidssituasjon som i utgangspunktet oppleves som stressende, vil kunne få negative konsekvenser. Arbeidsmiljø, arbeidsglede, kommunikasjon og samarbeid blir markant redusert av uhøflig oppførsel.&#x0D; Hensikt Hensikten med denne studien var å få kunnskap om hvilke erfaringer og opplevelser anestesisykepleiere har vedrørende uhøflighet og samarbeidsklima på operasjonsstuene.&#x0D; Metode I studien er det benyttet kvalitativ metode med et deskriptivt, utforskende design. Data er samlet inn via to fokusgruppeintervjuer med totalt 8 anestesisykepleiere. Datamaterialet ble analysert ved hjelp av kvalitativ innholdsanalyse.&#x0D; Resultater Fire temaer ble identifisert: ‘varierende høflighet blant medarbeidere’, ‘uhøflighet ødelegger arbeidsgleden’, ‘uhøflig kommunikasjon skaper konflikter’ og ‘mestringsstrategier ved uhøflighet’. Samtlige informanter hadde rike beskrivelser av egne erfaringer med uhøflighet. Når de ble stående i slike situasjoner, følte de ubehag og reagerte med sjokk, apati, sinne og et ønske om å komme seg videre med arbeidet. Flere mente at slike situasjoner ble hengende igjen i en tid etterpå. Informantene beskrev det som et sjokk å være nyutdannet eller student da de som ferske i faget oftere opplevde uhøflig oppførsel på jobb.&#x0D; Konklusjon Resultatene tyder på at anestesisykepleiere er velkjent med temaet uhøflighet på operasjonsstua. Det er indikasjoner for at det er et røft arbeidsmiljø, men informantene mener kulturen er i endring. Uhøflighet oppleves som ubehagelig og anestesisykepleiere stiller spørsmålstegn ved hvorfor det må være slik på jobb. Informantene var samstemte i at dette er noe de blir vant til etterhvert, men at dette likevel er problematisk.

The last 25 years have seen the development of a plethora of new, effective agents for the treatment of osteoporosis. These agents reduce the risk of spine fractures by up to 70%, hip fractures by 40-50% and non-vertebral fractures by up to 50-80%. Amino-bisphosphonates, taken orally or intravenously, remain the dominant treatment modalities for osteoporosis. These so-called anti-resorptive or anti-catabolic agents stabilize the skeleton and reduce fracture risk in osteoporotic as well as osteopenic individuals. A monoclonal antibody against receptor activator of nuclear factor κB ligand, Denosumab, constitutes a new anti-resorptive agent recently approved worldwide. In younger postmenopausal women, low-dose estrogen or estrogen/progestin still has a place for short-term (up to 5 years) preservation of bone mass, especially in women with menopausal symptoms. Likewise, selective estrogen receptor modulators should be considered in younger postmenopausal women, especially those at increased risk of breast cancer. Anabolic (bone forming) regimens, of which parathyroid hormone is the only agent currently available, aid in the build up of new bone, increase bone mass and improve bone architecture. In cancellous bone, 30-60% increases of bone mass have been documented, but cortical bone thickness also increases. These improvements lead to profound reduction in fracture rates in both the axial and appendicular skeleton. Owing to cost and the need for parenteral administration, in most countries these agents are reserved for severe osteoporosis with multiple fractures.

Objective. To investigate the impact of reduction in total fat mass (FM) and regional FMs on indices of insulin resistance and dyslipidaemia in obese women (BMI > 30 kg/m2) after a 1-year weight loss (WL) program; and, secondly, to investigate the potential predictive effect of baseline insulin resistance on reduction in total and regional FMs. Material and methods. In 35 women with > 4kg weight loss, body composition by DXA (dual X-ray absorptiometry), fasting insulin, C-Peptide, insulin resistance (HOMA-IR), insulin sensitivity (QUICKI), metabolic clearance rate (MCRestOGTT) and serum lipids were assessed. Results. Mean WL was 9.6%; trunk and leg FM were reduced proportionally (14.9–14.7%). Improvement in HOMA-IR was 34.7%, insulin 30.7%, QUICKI 8.6% and MCRest OGTT 74%. The reduction in total, trunk and leg FM were similarly correlated with improvement in indices of insulin resistance (p < 0.001–0.05) and also with initial HOMA-IR (p = 0.000–0.02). In linear regressions improvement in HOMA-IR was similarly related with these FMs (p = 0.008), and initial HOMA predicted loss of trunk FM (p = 0.01). In multivariate analysis improvement in HOMA-IR was explained by loss of total FM (R2 = 0.20, p = 0.004); improvement of QUICKI by loss of leg FM (R2 = 0.33, p < 0.001). Conclusion. Loss of leg FM and trunk FM had similar importance for the improvement in insulin resistance. Baseline HOMA-IR predicted the potential for reduction in trunk FM.

Objectives To investigate the influence of age, menopausal stage and selected hormonal factors on insulin resistance and dyslipidaemia in obese (BMI>30 kg/m2) pre‐ and postmenopausal women. Material and methods: Thirty‐ eight pre‐ and postmenopausal women were matched one by one for leg/trunk fat mass (FM) ratio. Body composition and regional FM by dual X‐ ray absorptiometry (DXA), fasting glucose, insulin and C‐ peptide, insulin resistance by homeostasis model assessment (HOMA‐ IR), insulin sensitivity by quantitative insulin sensitivity check index (QUICKI) and metabolic clearance rate (MCRestOGTT), insulin secretion (HOMAsecr), serum lipids, oestradiol, SHBG, testosterone and testosterone index (total testosterone/SHBG), free thyroxine, free triiodothyronine, cortisol and IGF‐ 1 were assessed. Results: HDL‐ cholesterol was higher (p=0.025) and total cholesterol/HDL‐ cholesterol ratio lower (p=0.026) in post‐ than in premenopausal women. No differences in parameters of insulin resistance or hormonal factors except oestradiol were found. In forward stepwise multiple regression analysis, cholesterol/HDL‐ cholesterol ratio was negatively predicted by age (R2=0.25, p=0.02) and HDL‐ cholesterol negatively (R2=0.16, p=0.013) predicted by belonging to the premenopausal group. MCRestOGTT was unfavourably predicted by IGF‐ 1 (R2=0.28, p=0.005) and testosterone (R2=0.36, p=0.048). Because of the relatively small number of subjects studied, interpretation of the results may to some extent have limited general validity. Conclusion: FM distribution is the major determinant of insulin resistance and dyslipidaemia, with only minor roles for menopausal status, age as such and age‐ related changes in hormonal factors in the regulation of glucose and lipid metabolism.