Central Norway Research Articles

Transfusion practice in Central Norway – a regional cohort study in patients suffering from major haemorrhage

BackgroundIn patients with major hemorrhage, balanced transfusions and limited crystalloid use is recommended in both civilian and military guidelines. This transfusion strategy is often applied in the non-trauma patient despite lack of supporting data. The aim of this study was to describe the current transfusion practice in patients with major hemorrhage of both traumatic and non-traumatic etiology in Central Norway, and discuss if transfusions are in accordance with appropriate massive transfusion protocols.MethodsIn this retrospective observational cohort study, data from four hospitals in Central Norway was collected from 01.01.2017 to 31.12.2018. All adults (≥18 years) receiving massive transfusion (MT) and alive on admission were included. MT was defined as transfusion of ≥10 units of packed red blood cells (PRBC) within 24 hours, or ≥ 5 units of PRBC during the first 3 hours after admission to hospital. Clinical data was collected from the hospital blood bank registry (ProSang) and electronic patient charts (CareSuite PICIS). Patients undergoing cardiothoracic surgery or extracorporeal membrane oxygenation treatment were excluded.ResultsA total of 174 patients were included in the study, of which 85.1% were non-trauma patients. Seventy-six per cent of all patients received plasma:PRBC in a ratio ≥ 1:2 (high ratio) and 59.2% of patients received platelets:PRBC in a ratio ≥ 1:2 (high ratio). 32.2% received a plasma:PRBC-ratio ≥ 1:1, and 23.6% platelet:PRBC-ratio ≥ 1:1. Median fluid infusion of crystalloids in all patients was 5750 mL. Thirty-seven per cent of all patients received tranexamic acid, 53.4% received calcium and fibrinogen concentrate was administered in 9.2%.ConclusionsMost patients had a non-traumatic etiology. The majority was transfused with high ratios of plasma:PRBC and platelet:PRBC, but not in accordance with the aim of the local protocol (1:1:1). Crystalloids were administered liberally for both trauma and non-trauma patients. There was a lower use of hemostatic adjuvants than recommended in the local transfusion protocol. Awareness to local protocol should be increased.

Ritual Practice at Late Iron-Age and Viking-Age Cemeteries in Norway: The Mortuary Houses From Skeiet, Vinjeøra

THREE PROPOSED LATE IRON- AND VIKING-AGE MORTUARY HOUSES were recently excavated in Central Norway. Excavations and geoarchaeological investigations imply underground wooden buildings resembling domestic houses with doors. Radiocarbon dating indicates three succeeding buildings dating c AD 500–950. The finds included animal and food sacrifices. With their funerary context, the buildings provided an opportunity to frequently visit and interact with mortuary remains, as part of the rituals practised at cemeteries. They provided a ritualised space between the living and their dead relations.

Chronotherapy for patients with a depressive episode treated in a public outpatient mental healthcare clinic in Norway: protocol for a randomised controlled trial

IntroductionDepression is highly prevalent in outpatients receiving treatment for mental disorders. Treatment as usual (TAU) usually consists of either psychotherapy and/or antidepressant medication and often takes several weeks before clinical...

Deglaciation of the highest mountains in Scandinavia at the Younger Dryas–Holocene transition: evidence from surface exposure‐age dating of ice‐marginal moraines

Surface exposure–age dating was applied to rock surfaces associated with ice‐marginal moraines at elevations of ~1520–1780 m a.s.l. on the slopes of Galdhøpiggen and Glittertinden, the two highest mountains in Scandinavia located in the Jotunheimen mountains of central southern Norway. This is important for understanding the pattern and timing of wastage of the Scandinavian Ice Sheet at the Younger Dryas–Holocene transition. Cosmogenic exposure dating (here 10Be dating) of boulders from the moraine ridges yielded overall mean ages (corrected for glacio‐isostatic uplift, surface erosion and snow shielding) of ~11.6 ka from Galdhøpiggen and ~11.2 ka from Glittertinden. Similar 10Be ages were also obtained from additionally collected proximal and distal erratic boulders and bedrock samples. These enabled age calibration of Schmidt‐hammer R‐values and independent Schmidt‐hammer exposure‐age dating (SHD) of the moraine ridges, which yielded comparable mean SHD ages of ~10.8 and ~10.6 ka from the Galdhøpiggen and Glittertinden sites, respectively. Taking account of the age resolution and other limitations of both dating techniques, the results suggest that the two sets of moraines have approximately the same age but that neither technique can distinguish unambiguously between moraine formation in the late Younger Dryas or Early Holocene. Together with features of moraine‐ridge morphology and estimates of equilibrium‐line altitude depression of ~360–575 m (corrected for land uplift), the results imply moraine formation during short‐lived re‐advances of active glaciers, at least the lower reaches of which were warm‐based. It is concluded that the local glaciers remained active and advanced during deglaciation either very late in the Younger Dryas or very early in the Holocene, possibly in response to the Preboreal Oscillation at ~11.4 ka. The study supports the concept of a thin Younger Dryas ice sheet and places time constraints on the timing of final deglaciation in southern Norway.

Steep declines in radioactive caesium after 30 years of monitoring alpine plants in mountain areas of central Norway

The Chernobyl accident exposed large areas of northern Europe to radiocaesium (137Cs). We investigated temporal and spatial variation in concentrations of radiocaesium among five functional groups of alpine plants at two mountain areas in central Norway over a 31-year period from 1991 to 2022. Average concentrations of radiocaesium were initially high in lichens and bryophytes at around 4600–6400 Bq/kg dry weight during 1991–1994 but then decreased dramatically over three decades to current concentrations of <200 Bq/kg for all plant groups in 2019–2022. The effective half-life of radiocaesium was estimated to be 4–6 years in lichens and mosses, 7–13 years in herbaceous plants, and 22–30 years in woody plants, which were less than the physical half-life of 30.2 years. Concentrations of radiocaesium were greater at the nutrient-poor site than at the nutrient-rich site, probably due to greater deposition levels at higher elevations and the geographical pattern of the deposition. Functional groups of plants differed with higher concentrations among non-vascular than vascular plants. Common heather Calluna vulgaris was unusual among woody plants with high concentration of radiocaesium, especially in the new shoots. Our new estimates of concentrations and dynamics of radiocaesium for alpine plants in natural environments will be useful for modelling herbivore exposure and evaluating potential impacts on wildlife and human health.

Quantification of climate change impact on rainfall-induced shallow landslide susceptibility: a case study in central Norway

ABSTRACT Climate change impact on rainfall-induced landslide susceptibility of a certain region is often implied based on expected changes in rainfall patterns and rarely explicitly quantified. This study aims to address this gap by implementing coupled landslide and climate modelling chains to explicitly assess the effects of changing rainfall patterns on rainfall-induced landslide susceptibility. The effects of climate change are integrated into the landslide modelling chain via Intensity-Duration-Frequency (IDF) curves for the present and future climate conditions for a landslide-prone study area located in central Norway. The effects of climate change on landslide susceptibility are examined by using a physical-based landslide prediction model with rainfall events of varying duration and intensity that are simulated based on the climate-dependent IDF curves. The novelty of this study is the proposition of a novel probabilistic framework to assess the climate change impact on landslide susceptibility for rainfall events with a given duration. The proposed framework accounts for both the uncertainties of rainfall events through probabilistic interpretation of IDF curves and the uncertainties in the landslide model with the Monte Carlo method. Compared to results based on only intense rainfall events, the proposed framework leads to a lower increase in the probability of landslide initiation and landslide-susceptible extents due to climate change.

Dental professionals’ views on motivational interviewing for the prevention of dental caries with adolescents in central Norway

BackgroundEstablishing positive oral health behaviours during adolescence should be a key priority to improve lifelong oral health. However, changing adolescent behaviours is known to be a challenge. Motivational interviewing (MI) is a method of working with patients to activate their motivation for change and has shown promising results within the dental setting. Yet, little is known about the actual experiences and perspectives of Norwegian dental health professionals in delivering motivational interviewing as part of routine care to their young patients. The overall aim of the present study was to explore the implementation of motivational interviewing by dentists and dental hygienists, employed by the Norwegian Public Dental Service, for their adolescent patients.MethodsAs part of the larger #Care4YoungTeeth <3 project, a Norwegian Research Council funded four-year Collaborative Project to Meet Societal and Industry-related Challenges, an online survey was developed and administered to dental personnel (n = 168) in one region of Central Norway. Data were analysed by descriptive statistics and two-sample tests of proportions at the 95% confidence level.ResultsA total of 98 dental personnel responded to the survey (response rate 58.3%), of which 37 were dental hygienists (response rate 72.5%) and 61 were dentists (response rate 52.1%). A greater proportion of hygienists reported implementing this intervention compared to dentists (78.4% versus 50.8%; p = 0.007). Similarly, a greater proportion of hygienists (83.8%) stated that they had received training in MI compared to dentists (65.6%; p = 0.051). About 80% of dentists and 90% of dental hygienists felt that they understood the principles of MI. However, only about 45% and 60%, respectively, felt confident in its use. Dental hygienists found MI more usable in their work (p = 0.052), to a greater extent want to use MI (p = 0.002) and found that using MI works well (p < 0.001), as compared to dentists.ConclusionsA high proportion of dental professionals working within a Norwegian public dental service have received training in MI. However, barriers to implementation for adolescent patients and differences in practice between dentists and hygienists warrant further enquiry.

Measuring patient satisfaction with four items: validity of the client satisfaction questionnaire 4 in an outpatient population

IntroductionPatient satisfaction with mental health services has for several decades been considered an important component when evaluating service quality. It is often assessed in the context of monitoring quality of care, developing or evaluating newly implemented interventions or changes in practice. Because of this, patient satisfaction questionnaires are often added to longer questionnaire batteries, and shorter questionnaires are preferred to prevent respondent fatigue and non-compliance and to secure easy implementation. However, most studies use unvalidated patient satisfaction measures, making comparisons between studies difficult. Validation studies of short patient satisfaction measures are therefore warranted.MethodsThe primary aim was to examine the construct validity and internal reliability of the Client Satisfaction Questionnaire-4 (CSQ-4) in a Norwegian outpatient mental health setting. A total of 467 patients were recruited from an outpatient psychiatric care clinic in Central Norway. The secondary aim was to examine an earlier proposed cutoff for classifying dissatisfied patients in this new population. A principal component analysis was conducted to evaluate factor structure, correlation analyses were conducted to test for predicted relationships, and Cronbach’s alpha was calculated to examine internal reliability.ResultsThe CSQ-4 showed a clear unidimensional structure with one factor explaining 80% of its variance. Its internal reliability was very high, with a Cronbach’s alpha of 0.92. As hypothesised this study found no statistically significant sex differences in satisfaction and no statistically significant association between age and satisfaction. Positive changes in symptoms during treatment and higher post-treatment functional impairment were associated with higher patient-reported treatment satisfaction scores, which indicates good construct validity.ConclusionThis is the first study to evaluate the CSQ-4 in a psychiatric population. The CSQ-4 demonstrated good structural validity and internal reliability and was correlated with outcome variables in terms of symptom change and post-treatment functioning. In sum, this indicates that the CSQ-4 is a good short alternative for evaluating patient satisfaction in routine outpatient mental health care.

Gastric remnant cancer and long-term survival in Central Norway 2001 to 2016 – A population-based study

IntroductionGastric remnant cancer (GRC) has been defined as a distinct clinical entity and is reported to account for 1–8% of all gastric cancers. We aimed to characterize GRC patients and assess survival in a Western population. MethodsRetrospective population-based cohort study including 1217 patients diagnosed with gastric adenocarcinoma in Central Norway 2001–2016. GRCs (n = 78) defined as adenocarcinomas arising in the residual stomach after distal gastrectomy were compared to non-GRC (n = 1139) and to proximal non-GRC (n = 595). Results78 (6.4 %) gastric cancers were GRC. The annual number and proportion of GRC declined during the study period (p = 0.003). Median latency from distal gastrectomy to GRC diagnosis was 37.6 years (15.7–68.0) and previous Billroth II reconstruction was most common (87.7%). Compared to controls, GRC patients were more frequently males (83.3%), diagnosed in earlier TNM stages and were older at diagnosis. A smaller proportion of GRC patients received perioperative or palliative chemotherapy, but the R0/R1resection rate of 41.0% was no different from non-GRC patients. Overall median survival for GRC patients irrespective of treatment was 7.0 months, which did not differ from non-GRCs or proximal non-GRC. In multivariate analyses TNM stage and age were independently associated with mortality, whereas GRC per se was not. ConclusionsNumbers of GRCs declined during the study period, but the latency between distal gastrectomy and GRC diagnosis was long. GRC patients were more frequently male and older than other gastric cancer patients. GRC was not independently associated with survival after adjusting for TNM stage and tumor location.

Jurassic heritance of the geomorphology in Mid Norway

The age and formation of the Scandinavian mountains and the Norwegian strandflat have long been the subject of dispute. Some researchers argue that the present-day mountains are remains of the Caledonian orogen while others claim that the Caledonian nappes after erosion were buried by Mesozoic sediments and subsequently exhumed. In order to clarify these issues, we have studied remains of chemically weathered rocks (saprolites) from the coast to the interior of central Norway. The multidisciplinary study includes digital topography, electrical resistivity tomography (ERT), XRD, XRF, palynological analyses and K–Ar dating of samples from outcrops, trenches and core drilling. The coastal areas are dominated by an outer strandflat and an inner joint-valley landscape, while the interior is characterised by smoother landscapes referred to as palaeo-surfaces. Remnants of pre–Tertiary weathering occur in the joint valley landscape as well as on the palaeo-surfaces. The saprolites are found within fault- and fracture-zones and at depths exceeding 50 m in drillholes. It is suggested that the old saprolites were strongly eroded along the coast and in the fjords and valleys such as in Orkdalen and Sunndalen. K–Ar dating of mainland clay alteration most frequently yielded Jurassic ages along a profile extending from the coast to the Dovrefjell mountains (c. 1400 m a.s.l.). The formation age of the smectite- and kaolinite-containing saprolites seems to be almost contemporaneous along this profile implying that the entire area was subject to weathering in a warm and humid climate, such as prevailed during the Late Triassic and Jurassic. Palynological residues containing thermally altered Triassic and Jurassic pollen and spores in the clay-infected bedrock lend support to the saprolite interpretation. The Mesozoic landscape in central Norway was consequently shaped by uplift and deep weathering in the Jurassic. The entire Trøndelag county was most likely covered by Mesozoic sedimentary rocks until Cenozoic exhumation. The landscape was modified by Cenozoic tectonic uplift and erosion, and finally reworked by Pleistocene glacial erosion. We therefore conclude that both the observed saprolites and the shape of the present-day landscape in central Norway give a strong impression of the original Jurassic weathering surface.

Long-Term Results After Surgery for Degenerative Cervical Myelopathy.

Degenerative cervical myelopathy (DCM) is a frequent cause of spinal cord dysfunction, and surgical treatment is considered safe and effective. Long-term results after surgery are limited. This study investigated long-term clinical outcomes through data from the Norwegian registry for spine surgery. Patients operated at the university hospitals serving Central and Northern Norway were approached for long-term follow-up after 3 to 8 years. The primary outcome was change in the Neck Disability Index, and the secondary outcomes were changes in the European Myelopathy Scale score, quality of life (EuroQoL EQ-5D); numeric rating scales (NRS) for headache, neck pain, and arm pain; and perceived benefit of surgery assessed by the Global Perceived Effect scale from 1 year to long-term follow-up. We included 144 patients operated between January 2013 and June 2018. In total, 123 participants (85.4%) provided patient-reported outcome measures (PROMs) at long-term follow-up. There was no significant change in PROMs from 1 year to long-term follow-up, including Neck Disability Index (mean 1.0, 95% CI -2.1-4.1, P = .53), European Myelopathy Scale score (mean -0.3, 95% CI -0.7-0.1, P = .09), EQ-5D index score (mean -0.02, 95% CI -0.09-0.05, P = .51), NRS neck pain (mean 0.3 95% CI -0.2-0.9, P = .22), NRS arm pain (mean -0.1, 95% CI -0.8-0.5, P = .70), and NRS headache (mean 0.4, 95% CI -0.1-0.9, P = .11). According to Global Perceived Effect assessments, 106/121 patients (87.6%) reported to be stable or improved ("complete recovery," "much better," "slightly better," or "unchanged") at long-term follow-up compared with 88.1% at 1 year. Dichotomizing the outcome data based on severity of DCM did not demonstrate significant changes either. Long-term follow-up of patients undergoing surgery for DCM demonstrates persistence of statistically significant and clinically meaningful improvement across a wide range of PROMs.

Endoluminal treatment for Zenker’s diverticulum – a population-based observational study

Background Zenker’s diverticulum is a false diverticulum arising in the oesophago-pharyngeal junction. It may cause symptoms like dysphagia and regurgitation. In Central Norway, treatment is centralized to St. Olavs hospital, either as an endoscopic stapled oesophago-diverticulostomy procedure at the Department of Gastrointestinal Surgery or as laser diverticulostomy at the Department of Ear, Nose and Throat Surgery, depending on diverticulum size. Methods Retrospective, population-based, study from 2001–2020 on patients treated for Zenker’s diverticulum, at the time with a rigid endoscopic approach. Patients were identified through the in-hospital register for operations. The two treatment groups were compared on relevant pre-, intra-, and postoperative variables by review of the individual patient records. Results 78 consecutive patients, 36 at Dept. of Ear, Nose and Throat Surgery and 42 at Dept. of Gastrointestinal Surgery, were treated with a total of 104 interventions. Crude incidence for a surgery-demanding Zenker’s diverticulum was 0.57 per 100 000 per year. The Dept. of Ear, Nose and Throat Surgery administered significantly less often prophylactic antibiotics than the Dept. of Gastrointestinal Surgery (p < 0.001), administered more frequently intraoperative dexamethasone (p < 0.001), and had significantly more postoperative infections (19.6% vs 3.4%, p = 0.01). No procedure-related mortality was registered. Although no standardized follow-up took place, at a median of 119 months elapsed, observed clinical recurrence was 35% for the endostapler treatment and 51% for the laser treatment procedure. Conclusion Both rigid endoscopic stapled oesophago-diverticulostomy and laser diverticulostomy are safe treatments for Zenker’s diverticulum, however with a substantial risk of recurrence.

Vitamin and Mineral Deficiency 12 Years After Roux-en-Y Gastric Bypass a Cross-Sectional Multicenter Study

PurposeMicronutrient deficiencies are common after Roux-en-Y gastric bypass (RYGB). This study explores whether vitamin and mineral deficiency was associated with adherence to recommended supplementation 12 years after RYGB.Materials and MethodsThe cross-sectional Bariatric Surgery Observation Study (BAROBS) was conducted in 2018–2020 at three hospitals in Central Norway. We report data on 490 patients’ self-reported adherence to recommended supplements and vitamin and mineral levels in the blood. The patients, who had RYGB between 2003 and 2009, were recommended an over-the-counter multivitamin-mineral supplement, calcium/vitamin D (1000 mg/20 µg) and vitamin B12 injections (reimbursed), since bariatric supplements were not available then.ResultsMean (SD) age was 40.1 ± 9 years at RYGB, and time to follow-up 11.7 ± 1.6 years. Of 490 patients, 393 (80%) were women. Among 361 (74%) patients’ adherent to multivitamin-mineral supplements; folate, vitamin B2, and vitamin B6 deficiency were present in 39 (11%), 103 (29%), and 63 (17%) patients, respectively. The same deficiencies occurred in 44 (34%), 67 (52%), and 67 (52%) patients’ non-adherent to recommendations. Although 466 (95%) patients reported adherence to vitamin B12 supplements, sub-optimal levels were found in 73 (16%) patients.Though 336 (69%) patients adhered to calcium/vitamin D supplements (1000 mg/20 µg), sub-optimal vitamin D levels (< 75 nmol/l) were found in 174/336 (52%) adherent patients and 120/154 (78%) non-adherent patients.ConclusionTwelve years after RYGB, adherence to supplements, though in sub-optimal doses of new recommendations, decreases the probability of vitamin and mineral deficiency, especially for thiamine, vitamin B2, vitamin B6, folate, vitamin B12, and vitamin D, but does not eliminate it.Graphical

Early Holocene thinning and final demise of the Scandinavian Ice Sheet across the main drainage divide of southern Norway

The thinning and final decay of the Scandinavian Ice Sheet in the Gudbrandsdalen area in central southern Norway is described, based on (1) cosmogenic 10Be surface exposure dating of 25 glacially transported boulders, (2) radiocarbon dating of plant remains in the basal strata in four lakes and (3) mapping of large ice-dammed lakes that formed at different elevations and at different times during the last deglacation. We complement the new chronology with previously published 10Be-ages from the same region. The dated samples are spread from mountain summits 1800 m a.s.l. to the valley floor at 250 m a.s.l. Our results suggest that the ice sheet surface remained well above 1800 m a.s.l. in northern Gudbrandsdalen throughout the Younger Dryas. During the Early Holocene the ice sheet thinned rapidly, at rates estimated to 1.7–5.8 m yr−1. The final phase of deglaciation involved formation of large ice-dammed lakes, most notably the Store Dølasjø which was formed after 10.4 ka BP and finally drained around 10.0 ka BP. The ice-marginal landforms that characterize the mountain region of northern Gudbrandsdalen, i.e., moraine ridges, lateral meltwater channels, as well as deposits and shorelines from ice-dammed lakes, thus collectively originate from a period of rapid ice sheet downwasting over ca. 1600 years.

In-situ ice strength distribution of anchor ice dams

Ice runs and ice jams can cause significant damage to infrastructure and other human interests. Accurate modelling and prediction of these events rely on data and assumptions about river ice properties. This paper seeks to address the lack of data on ice strength distributions and associated properties in small, steep rivers and to obtain a better understanding of those. To this end, an ice data collection campaign was carried out in the Sokna river in central Norway during the 2020–2021 winter field season. The following types of data were collected for anchor ice dams and level ice sections: Borehole Jack (BHJ) in-situ ice strength, ice thickness, ice density, thin section imagery and associated depth measurements. A total of 27 ice cores and 68 thin sections were successfully collected and processed. Furthermore, a survey was carried out recording GPS coordinates of anchor ice dams in the river. Meteorological and hydrological data was also collated, and large boulder location data was obtained through the analysis of aerial photography. Ice strength distributions and trends on how ice strength varies in small, steep rivers were obtained from these data. A binomial generalized linear model for predicting ice dam locations was developed using field measurements and aerial photography data. This model describes how river width, slope and to a lesser degree large boulder density affect ice dam location. Sinuosity was shown to have no effect on ice dam location. This work highlights the significant variation in microstructure and large-scale structure of ice in small, steep rivers.

COVID-19 patients treated with convalescent plasma.

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.

Gestational age at birth and hospitalisations for infections among individuals aged 0–50 years in Norway: a longitudinal, register-based, cohort study

Preterm birth is associated with increased risk of childhood infections. Whether this risk persists into adulthood is unknown and limited information is available on risk patterns across the full range of gestational ages. In this longitudinal, register-based, cohort study, we linked individual-level data on all individuals born in Norway (January 01, 1967-December 31, 2016) to nationwide hospital data (January 01, 2008-December 31, 2017). Gestational age was categorised as 23-27, 28-31, 32-33, 34-36, 37-38, 39-41, and 42-44 completed weeks. The analyses were stratified by age at follow-up: 0-11 months and 1-5, 6-14, 15-29, and 30-50 years. The primary outcome was hospitalisation due to any infectious disease, with major infectious disease groups as secondary outcomes. Adjusted hospitalisation rate ratios (RRs) for any infection and infectious disease groups were estimated using negative binomial regression. Models were adjusted for year of birth, maternal age at birth, parity, and sex, and included an offset parameter adjusted for person-time at risk. Among 2,695,830 individuals with 313,940 hospitalisations for infections, we found a pattern of higher hospitalisation risk in lower gestational age groups, which was the strongest in childhood but still evident in adulthood. Comparing those born very preterm (28-31) and late preterm (34-36) to full-term (39-41 weeks), RRs (95% confidence interval) for hospitalisation for any infectious disease at ages 1-5 were 3.3 (3.0-3.7) and 1.7 (1.6-1.8), respectively. At 30-50 years, the corresponding estimates were 1.4 (1.2-1.7) and 1.2 (1.1-1.3). The patterns were similar for the infectious disease groups, including bacterial and viral infections, respiratory tract infections (RTIs), and infections not attributable to RTIs. Increasing risk of hospitalisations for infections in lower gestational age groups was most prominent in children but still evident in adolescents and adults. Possible mechanisms and groups that could benefit from vaccinations and other prevention strategies should be investigated. St. Olav's University Hospital and Norwegian University of Science and Technology, Norwegian Research Council, Liaison Committee for education, research and innovation in Central Norway, European Commission, Academy of Finland, Sigrid Jusélius Foundation, Foundation for Pediatric Research, and Signe and Ane Gyllenberg Foundation.

Retinal structure and visual pathway function at school age in children born extremely preterm: a population-based study

BackgroundChildren born extremely preterm (gestational age < 28 weeks) show reduced visual function even without any cerebral or ophthalmological neonatal diagnosis. In this study, we aimed to assess the retinal structure with optical coherence tomography (OCT) and visual function with pattern-reversal visual evoked potentials (PR-VEPs) in a geographically defined population-based cohort of school-aged children born extremely preterm. Moreover, we aimed to explore the association between measures of retinal structure and visual pathway function in this cohort.MethodsAll children born extremely preterm from 2006–2011 (n = 65) in Central Norway were invited to participate. Thirty-six children (55%) with a median age of 13 years (range = 10–16) were examined with OCT, OCT-angiography (OCT-A), and PR-VEPs. The foveal avascular zone (FAZ) and circularity, central macular vascular density, and flow were measured on OCT-A images. Central retinal thickness, circumpapillary retinal nerve fibre layer (RNFL) and inner plexiform ganglion cell layer (IPGCL) thickness were measured on OCT images. The N70-P100 peak-to-peak amplitude and N70 and P100 latencies were assessed from PR-VEPs.ResultsParticipants displayed abnormal retinal structure and P100 latencies (≥ 2 SD) compared to reference populations. Moreover, there was a negative correlation between P100 latency in large checks and RNFL (r = -.54, p = .003) and IPGCL (r = -.41, p = .003) thickness. The FAZ was smaller (p = .003), macular vascular density (p = .006) and flow were higher (p = .004), and RNFL (p = .006) and IPGCL (p = .014) were thinner in participants with ROP (n = 7).ConclusionChildren born extremely preterm without preterm brain injury sequelae have signs of persistent immaturity of retinal vasculature and neuroretinal layers. Thinner neuroretinal layers are associated with delayed P100 latency, prompting further exploration of the visual pathway development in preterms.

Configuring Secretarial Workflows in the Epic EHR Suite.

The primary goal of large-scale electronic health record (EHR) suites is to meet the needs of a broad range of users in healthcare institutions. EHR suites are extensively configurable, which makes it possible to tailor them to diverse professional practices and users. However, while users such as physicians and nurses may have clearly defined responsibilities, clerical personnel (i.e. secretaries) conduct "in-between" or invisible work that is not as easily defined. Therefore, it may be more difficult to tailor EHR suites to their needs. Moreover, because secretaries are quite low in the hospital hierarchy, it is difficult for them to obtain satisfactory solutions. In this paper, we explore the challenges of configuring the EHR suite for secretary workflows in the Health Platform program in central Norway.

Survival Trends in Patients with Small Intestinal Neuroendocrine Tumours—A Cohort Study in Central Norway

Improved surgical resection and oncological treatment, or an earlier diagnosis may increase survival in small intestinal neuroendocrine tumours (SI-NETs), but only few studies have examined survival trends. We aimed to examine the trend in overall survival and associated factors in SI-NET patients. All patients with SI-NETs at a regional hospital from June 2005 to December 2021 (n = 242) were identified, and the cohort was divided in half, constituting a first period (until November 2012) and a second period (from November 2012). Disease and treatment characteristics, including European Neuroendocrine Tumour Society (ENETS) stage, surgery, oncological treatment and survival, were recorded. The majority (n = 205 (84.7%)) were treated surgically and surgery was considered curative in 137 (66.8%) patients. Median survival was longer in the second period (9.0 years 95% CI 6.4–11.7 in the first period vs. median not reached in the second period, p = 0.014), with 5-year survival rates of 63.5% and 83.5%, respectively. ENETS stage and oncological treatment did not differ between the periods, but factors associated with surgical quality, such as lymph node harvest and resection of multiple SI-NETs, were significantly higher in the second period. Age, ENETS stage, time period and tumour resection were independently associated with survival in a multivariate analysis.