Northern Norway Regional Health Authority Research Articles

Regional differences in the use of proton pump inhibitors in children

Physiological gastroesophageal reflux in infancy is difficult to distinguish from reflux disease. International guidelines recommend restrictive use of acid suppression therapy for infants due to the lack of documented effect, but its use in infants and older children has increased in recent years. This study aims to describe change over time and geographic variation in the investigation and treatment of suspected gastroesophageal reflux disease. In aggregated data from the Norwegian Prescribed Drug Registry for the period 1.1.2007-31.12.2020, we examined regional differences in the number of proton pump inhibitors dispensed for children and adolescents. Data from the Norwegian Patient Registry were analysed to identify the use of 24-hour pH measurement and gastroscopy, which can support the suspicion of gastroesophageal reflux disease. The number of proton pump inhibitors dispensed in the first year of life increased and was highest in South-Eastern Norway Regional Health Authority, with 10.1 per 1000 children in 2007 and 54.7 per 1000 children in 2020 (relative risk 5.4, 95% confidence interval 4.6 to 6.4). The number dispensed in 2020 was 64% higher in South-Eastern Norway Regional Health Authority compared to Northern Norway Regional Health Authority and Central Norway Regional Health Authority. There was little change in the number of gastroscopies, but use of 24-hour pH measurement fell by 52% from 2016 to 2020. Use of proton pump inhibitors in infants has increased considerably despite the guidelines. Together with geographic variation, this may point towards overtreatment of physiological reflux in infants. Few investigations indicate that an increasing proportion are treated without supporting diagnostics.

Development of early life gut resistome and mobilome across gestational ages and microbiota-modifying treatments.

Gestational age (GA) and associated level of gastrointestinal tract maturation are major factors driving the initial gut microbiota composition in preterm infants. Besides, compared to term infants, premature infants often receive antibiotics to treat infections and probiotics to restore optimal gut microbiota. How GA, antibiotics, and probiotics modulate the microbiota's core characteristics, gut resistome and mobilome, remains nascent. We analysed metagenomic data from a longitudinal observational study in six Norwegian neonatal intensive care units to describe the bacterial microbiota of infants of varying GA and receiving different treatments. The cohort consisted of probiotic-supplemented and antibiotic-exposed extremely preterm infants (n=29), antibiotic-exposed very preterm (n=25), antibiotic-unexposed very preterm (n=8), and antibiotic-unexposed full-term (n=10) infants. The stool samples were collected on days of life 7, 28, 120, and 365, and DNA extraction was followed by shotgun metagenome sequencing and bioinformatical analysis. The top predictors of microbiota maturation were hospitalisation length and GA. Probiotic administration rendered the gut microbiota and resistome of extremely preterm infants more alike to term infants on day 7 and ameliorated GA-driven loss of microbiota interconnectivity and stability. GA, hospitalisation, and both microbiota-modifying treatments (antibiotics and probiotics) contributed to an elevated carriage of mobile genetic elements in preterm infants compared to term controls. Finally, Escherichia coli was associated with the highest number of antibiotic-resistance genes, followed by Klebsiella pneumoniae and Klebsiella aerogenes. Prolonged hospitalisation, antibiotics, and probiotic intervention contribute to dynamic alterations in resistome and mobilome, gut microbiota characteristics relevant to infection risk. Odd-Berg Group, Northern Norway Regional Health Authority.

Exercise and prevalence of cardiovascular disease in older female endurance athletes during 10 years follow-up

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): PhD student Kristoffer Johansen is funded by the Northern Norway Regional Health Authority (grant number HNF1568-21). The Birkebeiner Ageing Study has been funded by the Kavli research center for ageing and dementia and the Norwegian ExtraFoundation. Background Although research suggests that the health benefits of endurance sport practice is larger in female compared to male athletes, women are underrepresented in sports cardiology research. Furthermore, previous studies on endurance sport practice in women have mostly included younger to middle aged athletes. Thus, prospective studies addressing endurance sport practice and health among older female endurance athletes is lacking. Purpose The purpose of this study was to characterise how older recreational female cross-country skiers maintained exercise and cardiovascular health during 10-years follow up. Method Forty-six women aged ≥65 years that completed the 54-km Birkebeiner cross country ski race in Norway in 2009/2010 were included. The Birkebeiner race includes about 1000 uphill altitude meters and is considered one of the world's most challenging ski races. Participants answered a questionnaire addressing exercise habits and health issues at baseline in 2009/10 and at follow-up in 2014 and 2020. Thirty-five (76%) participants attended follow-up in 2014 and 36 (78%) participants attended follow-up in 2020. Descriptive statistics are given as mean ± SD for continuous variables and as percentages for categorical variables. Results Skiers (age 67.5 ± 2.2 years at baseline) reported a cumulative exposure to regular endurance exercise of 26 ± 15 years. The proportion reporting moderate- to vigorous exercise during the past year was 86% at baseline and 61% at follow-up in 2020. One woman died during follow up. During 10-years follow-up the cumulative prevalence of atrial fibrillation (AF) was 15.6%, more than twice as high as for other cardiac diseases (7.1%) and stroke (7.1%). Conclusion Most female athletes sustained a physically active and healthy lifestyle with advancing age. Notably, the prevalence of AF was twice as high as for other cardiac diseases and stroke. Thus, although previous literature indicates that the risk of AF in female athletes is reduced, our findings suggest that additional research is needed to draw more firm conclusions. Future studies aiming to further clarify the female athlete and AF association would greatly benefit from including older athletes that has accumulated several decades of endurance sport practice. In conclusion, further research aiming to close the knowledge gap between female and male athletes are highly warranted.

Machine-learning derived measures of vascular and brain age are independently associated with cognitive function

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UiT The Arctic University of Norway, Northern Norway Regional Health Authority. Background/Introduction Machine learning models have been applied to magnetic resonance images of the brain to estimate brain age gap as a biomarker of biological aging. Because of its association with cognitive performance and neurological disorders, brain age gap has become an indicator of general brain health. Among others, cardiovascular risk factors are associated with brain health. Recently a novel non-invasive biomarker of vascular ageing has been proposed based on the application of a deep-learning algorithm to digitised 12-lead electrocardiograms. The difference between electrocardiogram predicted age and chronological age is defined as vascular age gap and has been shown to be associated with an adverse cardiovascular profile. However, the association of vascular age gap with cognitive health and dementias has not yet been examined. Purpose We apply a causal mediation framework to vascular age gap, brain age gap and cognitive function data obtained in the same individuals who took part in a population-based study in Norway. We hypothesise that cardiovascular risk factors encapsulated in vascular age gap can indirectly affect cognitive function by increasing the brain age gap. Methods We applied a deep learning algorithm (1) to electrocardiograms (N=7779, age 40-85 years) collected from the population-based sample in Norway (mean age 63.8 years, 45.3% men) to obtain a vascular age gap. For a subsample (N=1693) magnetic resonance images of the brain were also available and another deep neural network algorithm (2) was applied to obtain a biomarker of brain age. For 1678 participants with both vascular age gap and brain age gap available we used mediation analysis to test whether brain age gap mediates the effects of vascular age gap on cognitive function (as measured by mini mental status test, word memory test, digit–symbol coding test, tapping test) by estimating total, direct and indirect effects. Results We found a weak correlation (Pearson’s r = 0.12) between vascular age gap and brain age gap. Both age gaps were associated with cognitive scores capturing psychomotor speed, attention and mental flexibility. For a 1 standard deviation (7.3 years) increase in vascular age gap digit-symbol coding test score decreased by 0.63 (95%CI: -0.89, -0.36; p<0.001) points, and tapping test decreased by 0.36 (95%CI: -0.56, -0.14; p=0.001). Only 13% of effect of vascular age gap on cognitive test results was mediated by brain age gap. Conclusion(s) Vascular age gap was weakly associated with poorer cognitive functioning, and only 13% of this association was mediated by brain age gap. This suggests that cognitive decline linked to accumulated damage of the vascular system is not fully captured by structural changes in the brain. Further investigations of novel measures of biological aging in relation to cognitive decline are warranted as these may hold promise for improved understanding of mechanisms and clinical prediction.

Trial-of-antibiotics to assist tuberculosis diagnosis in symptomatic adults in Malawi (ACT-TB study): a randomised controlled trial

Clinical practice and diagnostic algorithms often assume that tuberculosis can be ruled out in mycobacteriology-negative individuals whose symptoms improve with a trial-of-antibiotics. We aimed to investigate diagnostic performance, clinical benefit, and antimicrobial resistance using a randomised controlled trial. In this three-arm, individually randomised, open-label, controlled trial, we enrolled Malawian adults (aged ≥18 years) attending primary care who reported being unwell for at least 14 days (including cough) with no immediate indication for hospitalisation at Limbe and Ndirande Health Centres in Blantyre. Participants were randomly allocated (1:1:1) to azithromycin (500 mg taken once per day for 3 days), amoxicillin (1 g taken three times per day for 5 days), or standard of care with no immediate antibiotics, stratified by study site. Sputum at enrolment and day 8 was tested for tuberculosis (microscopy, Xpert MTB/RIF, and culture). The primary efficacy outcome was day 8 specificity (percentage with symptom improvement among mycobacteriology-negative participants), and day 29 clinical outcome (death, hospitalisation, or missed tuberculosis diagnosis) among all randomised participants. This study is registered with ClinicalTrials.gov, NCT03545373. Between Feb 25, 2019, and March 14, 2020, 5825 adults were screened and 1583 (mean age 36 years; 236 [14·9%] HIV positive) were randomly assigned to standard of care (530 participants), azithromycin (527 participants), or amoxicillin (526 participants) groups. Overall, 6·3% (100 of 1583 participants) had positive baseline sputum mycobacteriology. 310 (79·1%) of 392 patients receiving standard of care reported symptom improvement at day 8, compared with 340 (88·7%) of 383 patients receiving azithromycin (adjusted difference 8·6%, 95% CI 3·9-13·3%; p<0·0004) and 346 (89·4%) of 387 receiving amoxicillin (adjusted difference 8·8%, 4·0-13·6%; p=0·0003). The proportion of participants with day 29 composite clinical outcomes was similar between groups (standard of care 1% [7 of 530 participants], azithromycin 1% [6 of 527 participants], amoxicillin 2% [12 of 526 participants]). Routine outpatient trial-of-antibiotics during tuberculosis investigations modestly improved diagnostic specificity for mycobacteriologically confirmed tuberculosis but had no appreciable effect on death, hospitalisation, and missed tuberculosis diagnosis. These results confirm the limited benefit of trial-of-antibiotics, presenting an opportunity for discontinuation of trial-of-antibiotics and improved antimicrobial stewardship during tuberculosis screening, without affecting clinical outcomes. Northern Norway Regional Health Authority (Helse Nord RHF), Commonwealth Scholarship Commission in the UK, Wellcome Trust, UK Medical Research Council, and the UK Department for International Development.

Changes in health-related quality of life following percutaneous coronary intervention – a nationwide prospective cohort study

Abstract Background In addition to mortality and morbidity, improved health-related quality of life (HRQOL) is a goal of treatment in patients suffering of cardiovascular heart disease. There is a limited knowledge of changes in HRQOL following percutaneous coronary intervention (PCI). Aims The aims of this study were to determine total and gender specific changes in HRQOL at baseline and four-years following PCI. Methods This study use data from the Norwegian Coronary Stent Trial which included 9013 patients undergoing first time percutaneous coronary intervention in Norway during September 2008–February 2011. HRQOL was assessed using the Short-Form-12 (SF-12) at baseline and at four years of follow up in a representative subgroup (n=775). Results The mean age was 64 years (SD 9.2) and 75% were male. Eighty percent were living with a partner and 67% had a higher level of education. The majority of the patients had stable angina as indication for PCI (40%). There was a significant improvement in all domains of SF-12 from baseline to four years of follow up (p&amp;lt;0.001). The highest changes were in Role Physical (43.6 vs. 48.2), Bodily Pain (44.8 vs. 50.1) and Vitality (44.1 vs. 49.3). Analysing gender differences at four years follow-up, men had a higher improvement in the physical component summary score than women (4.8 vs 2.8, p=0.04), but not in the mental component summary score (2.8 vs 4.4, p=0.11). Conclusion In patients undergoing first time PCI, HRQOL improved significant from baseline to four years of follow up. Both at baseline and at five years of follow up males report a higher HRQOL compared to females. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Northern Norway Regional Health Authority

Cervical spine surgery in the Northern Norway Regional Health Authority area in 2014-18.

Knowledge about the variation in treatment rates is needed to assess whether the access to health services is equitable. The objective of this study was to investigate the rates of surgical treatment of degenerative cervical spine disease in Norway and the Northern Norway Regional Health Authority area and the local coverage in the Northern Norway Regional Health Authority area, and to assess the activity in the region. We included cervical spine procedures recorded in the Norwegian Patient Registry from the years 2014-18 and estimated age-standardised treatment rates for Norway, the health regions and health trusts in Northern Norway Regional Health Authority. We estimated the local coverage as the proportion of patients resident in the Northern Norway Regional Health Authority area who had undergone surgery at the University Hospital of North Norway in Tromsø. The treatment rate remained stable at an average of 29.6 surgical procedures per 100000 inhabitants (aged 18-105) per year. The rate for residents in the Northern Norway Regional Health Authority area was 23.0 procedures per 100000 inhabitants per year (78% of the national average). The rates in Finnmark and the areas of residence served by the University Hospital of North Norway were close to the national average. Residents in the Nordland and Helgeland areas had lower rates in each year of the study period, with an average of 16.6 and 18.1 procedures per 100000 inhabitants per year respectively. This corresponds to 56% and 61% of the national average. Local coverage in the Northern Norway Regional Health Authority area increased from 69% in 2014 to 91% in 2018. The treatment rate for degenerative cervical spine disease was lower in the Northern Norway Regional Health Authority area than in the rest of Norway. For this to be compensated and the local coverage to be increased to 100%, we have estimated that the activity needs to be increased by approximately 35 surgical procedures per year.

The chemotherapeutic drug methotrexate selects for antibiotic resistance.

BackgroundUnderstanding drivers of antibiotic resistance evolution is fundamental for designing optimal treatment strategies and interventions to reduce the spread of antibiotic resistance. Various cytotoxic drugs used in cancer chemotherapy have antibacterial properties, but how bacterial populations are affected by these selective pressures is unknown. Here we test the hypothesis that the widely used cytotoxic drug methotrexate affects the evolution and selection of antibiotic resistance.MethodsFirst, we determined methotrexate susceptibility (IC90) and selective abilities in a collection of Escherichia coli and Klebsiella pneumoniae strains with and without pre-existing trimethoprim resistance determinants. We constructed fluorescently labelled pairs of E. coli MG1655 differing only in trimethoprim resistance determinants and determined the minimum selective concentrations of methotrexate using flow-cytometry. We further used an experimental evolution approach to investigate the effects of methotrexate on de novo trimethoprim resistance evolution.FindingsWe show that methotrexate can select for acquired trimethoprim resistance determinants located on the chromosome or a plasmid. Additionally, methotrexate co-selects for genetically linked resistance determinants when present together with trimethoprim resistance on a multi-drug resistance plasmid. These selective effects occur at concentrations 40- to >320-fold below the methotrexate minimal inhibitory concentration.InterpretationOur results strongly suggest a selective role of methotrexate for virtually any antibiotic resistance determinant when present together with trimethoprim resistance on a multi-drug resistance plasmid. The presented results may have significant implications for patient groups strongly depending on effective antibiotic treatment.FundingPJJ was supported by 10.13039/100007465UiT The Arctic University of Norway and the Northern Norway Regional Health Authority (SFP1292–16/HNF1586–21) and JPI-EC-AMR (Project 271,176/H10). DIA was supported by the 10.13039/501100004359Swedish Research Council (grant 2017–01,527). The publication charges for this article have been funded by a grant from the publication fund of UiT The Arctic University of Norway.

Obesity prevalence and associations with socio-economic and behavioral factors in population-based studies in Russia and Norway, 2015–2017

Abstract Background Obesity is an epidemic of XXI century, as its prevalence doubled during the last forty years. As Russia and Norway are countries with different life expectancy there could be differences in obesity and its correlates. Purpose To investigate and compare prevalence and socio-economic and behavioral factors associated with obesity in Russia and Norway with data from population-based studies. Methods We used multivariable logistic regression to examine associations of obesity (body mass index&amp;gt;30 kg/m2) with socio-economic factors (age, education, marital status, and poor financial situation defined as difficulty to afford clothes) and behavioral characteristics (smoking, alcohol use) in participants aged 40–69 years from the Know Your Heart study (Russia, 2015–2017, N=4 106) and the seventh Study (Norway, 2015–16, N=17 604). All results for covariates are mutually adjusted. Between-study comparisons of the associations of obesity with the same covariates were performed through investigation of their interactions with the “study” variable. Results The age-standardized prevalence of obesity was higher in Russia among women (36.8 vs 22.0%, p&amp;lt;0.001) and did not differ among men (26.7 vs 25.7%, p=0.224). In Russian women, obesity was positively associated with age of 50–69 years relative to 40–49 years (OR=2.5, 95% CI 2.0–3.1), no university education (OR=1.5, 95% CI 1.2–1.8), and poor financial situation (OR=1.5, 95% CI 1.2–1.9). In Norwegian women, obesity was negatively associated with the age of 50–69 years (OR=0.8, 95% CI 0.8–1.0), current smoking (OR=0.8, 95% CI 0.7–1.0) and drinking alcohol ≥2 times per week (OR=0.6, 95% CI 0.5–0.6), and positively associated with no university education (OR=1.5, 95% CI 1.3–1.7), previous smoking (OR=1.3, 95% CI 1.1–1.4), and drinking ≥5 alcohol drinks per occasion (OR=1.7, 95% CI 1.3–2.2). In Russian men, obesity was positively associated with living with spouse/partner (OR=1.5, 95% CI 1.1–2.2), drinking alcohol ≥2 times per week (OR=1.4, 95% CI 1.1–1.8), and negatively associated with current smoking (OR=0.6, 95% CI 0.4–0.8). In Norwegian men, obesity was positively associated with no university education (OR=1.4, 95% CI 1.2–1.6), previous smoking (OR=1.3, 95% CI 1.2–1.5), and drinking ≥5 alcohol drinks per occasion (OR=1.7, 95% CI 1.5–1.9), and negatively associated with current smoking (OR=0.8, 95% CI 0.7–1.0) and drinking alcohol ≥2 times per week (OR=0.7, 95% CI 0.6–0.7). Interactions with the “study” variable in women were significant for age, financial situation, frequency of alcohol use; in men - for living with spouse/partner, frequency of alcohol use, number of alcohol drinks taken per occasion. Conclusion The prevalence of obesity was higher in Russian compared to Norwegian women, but there was no difference between Russian and Norwegian men. There were different between-country patterns of the associations of obesity with the socio-economic and behavioral characteristics. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): The Know Your Heart study was a component of International Project on Cardiovascular Disease in Russia and funded by Wellcome Trust Strategic Award [100217], UiT The Arctic University of Norway, Norwegian Institute of Public Health, and Norwegian Ministry of Health and Care Services. The Tromsø Study was funded by UiT The Arctic University of Norway, Northern Norway Regional Health Authority, Norwegian Ministry of Health and Care Services, Norwegian Research Council, and various public and charity research funds in Norway. PhD scholarship and operational funds of the first author were provided by Northern State Medical University, Arkhangelsk, Russia and by UiT The Arctic University of Norway

Employment status three years after percutaneous coronary intervention – a nationwide prospective cohort study

Abstract Background Return to work plays an important part in social readjustment after an acute coronary event, and has important implications for both the individual and the society. Updated knowledge is lacking regarding losng-term employment after percutaneous coronary intervention (PCI). Aims The aims of this study were to determine employment status three years after PCI and to assess predictors for return to work stratified by gender. Methods We included first-time PCI patients from the NorStent Trial, who were of working age (&amp;lt;60 years; n=2488) at a three-year follow-up. Employment status were assessed using self-report. Results Fifty-seven percent of females and 73% of males who were &amp;lt;60 years of age at the index event were employed at follow-up (p&amp;lt;0.001). Living with a partner, higher levels of education, and living in the western part of Norway were associated with a higher chance of being employed in males, while higher levels of education were associated with a higher chance of being employed in females. Prior cardiovascular morbidity and former smoking were associated with lower chance of being employed in males, while being older was associated with lower chance of being employed in females. Conclusion A significant number of working-age coronary heart disease patients are unemployed three years after coronary revascularization. Our findings indicate a need for revised and gender specific initiatives to promote vocational support. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): The Northern Norway Regional Health Authority

Cataract surgery in Norway 2010-19.

Cataract surgery is a very common intervention. The objective of this study was to investigate the trends in the number of cataract surgeries in Norway and the characteristics of patients who underwent cataract surgery in the period 2010-19. Data on cataract surgery were collected from the Norwegian Patient Registry. The number of cataract surgeries per million inhabitants was calculated on the basis of population data from Statistics Norway. The number of cataract surgeries in Norway increased from 36340in 2010to 48291in 2019.This corresponded to an increase of 21%, from 7480to 9063per million inhabitants respectively, in the same period. The average age was 74years, and more than 90% of the patients were above the age of 60.The proportion of cataract surgeries among patients older than 60years remained virtually unchanged through the study period. Women accounted for 60% of the cataract surgeries in 2010and 57% in 2019.The proportion of surgeries performed by contract specialists in the entire period varied from 32% in Central Norway Regional Health Authority to 62% in Northern Norway Regional Health Authority. The number of cataract surgeries increased throughout the period in pace with the population growth in the age group above 60years. With further population growth and an increasing number of older people, planning for a further increase in the number of cataract surgeries in future years is likely to be required.

Sex-specific temporal trends in the incidence of atrial fibrillation in a large Norwegian population-based study 1986–2014

Abstract Background Due to population aging, increasing prevalence of obesity and enhanced detection, the prevalence of atrial fibrillation (AF) worldwide is increasing steadily. Considerable sex differences in the epidemiology of AF such as lower prevalence and later onset in women compared to men have been reported. However, little is known about sex-specific temporal trends in AF incidence within the general population. Purpose To explore sex-specific age-adjusted secular trends in the incidence of AF in a general population from Norway between 1986 and 2014. Methods A total of 16,865 men and 15,413 women aged 20 years or older and without AF were enrolled in a longitudinal population study between 1986 and 2008 and followed up for incident AF to the end of 2014. Follow-up was from the date of attendance to the date of AF, emigration or death, whichever came first. All AF cases were validated by an independent endpoint committee using hospital and death records. AF incidence rates were calculated for each calendar year by dividing the number of AF cases per year by the corresponding person-time at risk. To allow for non-linear time trends, calendar year was fitted using fractional polynomials. Poisson regression was used to estimate calendar year-specific AF incidence rates adjusted for age. All analyses were stratified by sex. Results A total of 911 AF events in women and 1,139 AF events in men occurred over 324,090 person-years and 294,531 person-years of follow-up, respectively. During the study period AF incidence rates in men were at least double that in women (Figure). Age-adjusted AF incidence rates in women increased from 1986, peaked at 0.87 per 1000 person-years in 1998 and then decreased slightly towards 2014. In men AF incidence rates increased up to 2.18 per 1000 person-years in 2005 and then steeply decreased. Conclusion(s) AF incidence rates decreased in both women and men towards the end of the study period. The decrease was more profound in men compared to that in women. One possible explanation is more pronounced reduction in incidence and better treatment of myocardial infarction in men compared to women given that the aetiology of AF in men is mainly ischemic heart disease-related. However, further epidemiological analyses should be undertaken to identify explanatory factors. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): University Hospital of North Norway, Northern Norway Regional Health Authority

Incidence and risk factors for major bleeding among patients undergoing percutaneous coronary intervention: findings from the Norwegian coronary stent trial (NORSTENT)

Abstract Introduction Bleeding is a concern after percutaneous coronary intervention (PCI) and subsequent dual antiplatelet therapy (DAPT). Purpose We herein report the incidence and risk factors for major bleeding in the Norwegian Coronary Stent Trial (NORSTENT). Materials and methods NORSTENT was a randomized, double blind, pragmatic randomized trial among patients with acute coronary syndrome or stable coronary disease undergoing PCI during 2008–11. The patients (N=9,013) were randomized to receive either a drug eluting stent or a bare metal stent, and were treated with at least 9 months of DAPT. The patients were followed for a median of five years, with BARC 3–5 major bleeding as one of the safety endpoints. We estimated cumulative incidence by a competing risks model and risk factors through cause-specific Cox models. Results The 12-month cumulative incidence of major bleeding was 2.3%. Independent risk factors for major bleeding were chronic kidney disease (CKD), underweight (&amp;lt;60 kilograms), diabetes mellitus, and advanced age (&amp;gt;80 years). A myocardial infarction (MI) or PCI during follow-up increased the risk of major bleeding (HR = 1.7, 95% CI 1–3-2.2). Conclusions The 12-month cumulative incidence of major bleeding in NORSTENT was higher than reported in previous, explanatory trials. This analysis strengthens the role of CKD, advanced age, and underweight as risk factors for major bleeding among patients receiving DAPT after PCI. The presence of diabetes mellitus or recurrent MI among patients is furthermore a signal of increased bleeding risk. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Northern Norway Regional Health Authority (Helse Nord RHF)

Evaluering av den helse=faglige forsknings=satsingen i Helse Nord

The Northern Norway Regional Health Authority has specifically focused over time on enhancing health-related competence and research. This has resulted in a greater number of researchers and research fellows, and an increase in the number of published articles.

Evaluation of research investment in nurses and allied health professionals in the Northern Norway Regional Health Authority area

Evaluation of research investment in nurses and allied health professionals in the Northern Norway Regional Health Authority area

Data work: A condition for integrations in health care

Integration and interoperability between different information and communication technology (ICT) systems are crucial for efficient treatment and care in hospitals. In this article, we are particularly interested in the daily local work conducted by health-care personnel to maintain integrations. A principal aim of our article is, therefore, to contribute to a sociotechnical understanding of the "data work" that is embedded in the integration of health-care systems. Theoretically, we draw on the concepts of "information infrastructures" and "articulation work," and we discuss how social status may influence the invisible articulation work. Furthermore, we show how historical decisions and existing systems both nationally and regionally have impacts on the daily work of local actors. Empirically, we have studied the formative stages of a large-scale electronic medication management system project in the Northern Norway Regional Health Authority.

Norwegian trends in numbers of lower extremity revascularisations and amputations including regional trends in endovascular treatments for peripheral arterial disease: a retrospective cross-sectional registry study from 2001 to 2014

ObjectiveThe numbers of lower extremity revascularisations and amputations are insufficiently reported in Norway. To support future policy decisions regarding the provision of vascular treatment, knowledge of such trends is important.MethodsThis...

Effectiveness Of Identifying A Cancer Patient In The Hospital Sector In Northern-Norway - Analyses Based On Updated Regional Performance Database

Implementing a Danish model, Norway introduced 28 standardized diagnostic pathways (SDPs) in 2015 for patients suspected to have a malignancy. Authors evaluate the development of main indicators of SPDs and present the effectiveness of identifying a cancer patient by using SPDs in a secondary health care environment. The Northern-Norway Regional Health Authority Trust established a database collecting relevant information from electronic patient journals in all hospitals of the region according to SPDs (procedures, time stamps, medical decisions). All data recorded in the database has been anonymized. Data for patients who entered the secondary healthcare in 2015 and in 2016 were selected and analyzed. SAS software tools (Enterprise Guide 7.1, Visual Analytics 7.3) and MS Excel 2013 were used for data processing, analyses and visualization. A total number of 10232 (100%) diagnostic cancer pathway cases were initiated in 2015 and in 2016. 78,38% of all identified cancer cases in 2015 and 2016 (5781) were diagnosed by pathway activities. 68,94% of all fulfilled pathways (9781, 95,6%) were completed within national standard time intervals. Drop-out rate was 2,77%, in 50,85% cases the suspect of cancer was not confirmed, and 46,38% were identified as proven cancer patients. Effectiveness of pathways were estimated by the ratio of confirmed/unconfirmed cases in all pathways. This ratio varies from 9% (SDP-sarcomas, N=33) til 95% (cancer of the uterus N=122). Introduction of special and prioritized SPDs provide a good tool for monitoring and improving the quality of diagnostic processes. Two years after introduction of SPDs – not surprisingly – there is still wide range of variations in effectiveness. The evaluation of process indicators (pathways completed within national standard time; hit score) can be used to identify bottlenecks, identify variations in processes in order to increase effectiveness, subsequently avoiding unnecessary activities, risks and costs.

The Use of eHealth and Provider-Based Health Services by Patients with Diabetes Mellitus: Protocol for a Cross-Sectional Study.

BackgroundThe prevalence of diabetes and the use of electronic health (eHealth) resources are increasing. People with diabetes need frequent monitoring and follow-up of health parameters, and eHealth services can be of great significance in this regard. However, little is known about the extent to which different kinds of eHealth tools are used, and how the use of eHealth is associated with the use of provider-based health care services among people with diabetes.ObjectiveThe primary objective of this study is to investigate the use of eHealth and its association with the use of provider-based health care services. The secondary objectives include investigating which eHealth services are used (apps, search engines, video services, social media), the relationship between socioeconomic status and the use of different eHealth tools, whether the use of eHealth is discussed in the clinical encounter, and whether such tools might lead to (or prevent) doctor visits and referrals.MethodsWe will conduct cross-sectional studies based on self-reported questionnaire data from the population-based seventh Tromsø Study. Participants will be diabetic patients aged 40 years and older. According to our estimates, approximately 1050 participants will be eligible for inclusion. Data will be analyzed using descriptive statistics, chi-square tests, and univariable and multivariable logistic regressions.ResultsThe grant proposal for this study was approved by the Northern Norway Regional Health Authority on November 23, 2015 (HST 1306-16). Recruitment of participants for the Tromsø Study started in 2015 and will continue throughout 2016. This particular project started on July 1, 2016.ConclusionsThis project may yield benefits for patients, health care providers, hospitals, and society as a whole. Benefits are related to improved prevention services, health, experience of care services, self-management tools and services, organizational structures, efficiency of specialist care use, allocation of resources, and understanding of how to meet the challenges from the increasing prevalence of diabetes. This project has potential for generalization to other groups with chronic disease.

Trends in Abdominal Aortic and Iliac Aneurysm Repairs in Norway from 2001 to 2013

The objective was to examine trends in abdominal aortic and iliac aneurysm repairs in Norway from 2001 to 2013, and study regional variations and organizational developments in this type of vascular surgery. This was a retrospective study on aortic and iliac aneurysm repairs using data from the Norwegian Patient Register. The vascular centers were categorized by yearly volume of repairs into small (<18), medium (18-49) and large (≥50). Incidence rates were assessed per 100,000 ≥ 60 years. The percentage of endovascular aneurysm repairs (EVAR) was calculated among the conducted repairs at the three categories of centers and the South-Eastern, Western, Central, and Northern Norway Regional Health Authority (NRHA). The national incidence rates of intact repairs per 100,000 ≥ 60 years increased from 57.4 to 65.7 (p < .01). Ruptured repairs decreased from 19.7 to 9.2 (p < .01). The rate of EVAR increased from 6.0 to 29.9 (p < .01) in intact and from 0.4 to 2.5 (p < .01) in ruptured repairs. The vascular centers were reduced from 25 to 16. The rate of EVAR was 27.1% (p < .01) higher at large centers and 7.9% (p < .03) higher at medium centers compared with small centers, and from 11.1% to 15.7% higher (p < .01) at the Central, Western, and Northern NRHA compared with the South-Eastern NRHA, which had the most centers (also in the large category). The national increase in intact EVAR from 10.6% to 43.3% was less compared with many other Western countries. During the study period the rates of intact repairs increased while the ruptured repairs decreased. EVAR was associated with centers performing high volumes of abdominal aortic and iliac aneurysm repairs and regional authorities organized with few centers.