Trondheim University Hospital Research Articles

Neurodevelopmental outcome at two years of age and predictive value of General Movement Assessment in infants exposed to alcohol and/or drugs during pregnancy: a prospective cohort study

BackgroundExposure to alcohol and/or other addictive drugs in pregnancy is a documented risk factor for neurological impairment. We aimed to assess neurodevelopmental outcome at two years of age in infants exposed to prenatal alcohol and/or other addictive drugs and to examine the predictive value of early motor assessment.MethodsThis was a follow-up at two years of age in the prospective cohort study Children Exposed to Alcohol and/or Drugs in Intrauterine Life (CEADIL). The exposed group comprised 73 infants recruited from primary health care and included in a hospital follow-up programme at St. Olavs Hospital, Trondheim University Hospital, Norway. The control group comprised 93 healthy, unexposed infants recruited from the maternity ward at the same hospital. All children had been assessed by physiotherapists using the General Movement Assessment (GMA) at three months of age. Presence of fidgety movements, movement character and the Motor Optimality Score – Revised (MOS-R) were used. At two years of age, the children were assessed by trained examiners using the Bayley Scales of Infant and Toddler Development – Third Edition (BSID-III), Ages & Stages Questionnaires: Social-Emotional (ASQ:SE) and the Hollingshead Two-Factor Index of Social Position (SES).ResultsThe cognitive, language and motor composite scores of BSID-III were considerably lower in the exposed group than in the control group. Mean differences adjusted for age and parental SES ranged from − 13.3 (95% confidence interval, CI: -18.6 to -8.0) to -17.7 (95% CI: -23.3 to -12.2). Suboptimal fidgety movements and monotonous movement character had high sensitivity (0.94 to 0.74), but low specificity (0.10 to 0.32), while sensitivity and specificity of the MOS-R was around 50 and 60%, respectively.ConclusionsNeurodevelopmental outcome at two years of age was poorer in a group of children exposed to alcohol and/or drugs in pregnancy compared with a control group of healthy, unexposed children. Sensitivity of suboptimal fidgety movements and monotonous movement character at three months of age for later neurodevelopmental outcome was high to acceptable, but the MOS-R had limited sensitivity.

Leveraging machine learning to identify subgroups of misclassified patients in the emergency department: a multi-center proof-of-concept study.

Hospitals use triage systems to prioritize the needs of patients within available resources. Misclassification of a patient can lead to either adverse outcomes in a patient who did not receive appropriate care in the case of undertriage or waste of hospital resources in the case of overtriage. Recent advances in machine learning algorithms allow for the quantification of variables important to under- and overtriage. The aim of this study was to identify clinical features most strongly associated with triage misclassification using a machine learning classification model to capture non-linear relationships. Multicenter retrospective cohort data from two big regional hospitals in Norway was extracted. The South African Triage system is used at Bergen University Hospital and the Rapid Emergency Triage and Treatment System is used at Trondheim University Hospital. Variables included triage score, age, gendersex, arrival time, subject area affiliation, reason for emergency department contact, discharge location, level of care, and time of death were retrieved. Random forest classification models were used to identify features with the strongest association with overtriage and undertriage in clinical practice in Bergen and Trondheim. We reported variable importance as SHAP-values (SHapley Additive exPlanations). We collected data on 205,488 patient records from Bergen University Hospital and 304,997 patient records from Trondheim University Hospital. Overall, overtriage was very uncommon at both hospitals (all <0.1%), with undertriage differing between both locationlocations with 0.8% at Bergen and 0.2% at Trondheim University Hospital. Demographics were similar for both hospitals, however the percentage given a high priority triage score (red or orange) was higher in Bergen (24%) compared to 9% in Trondheim. Clinical referral department was found to be the variable with the strongest association with undertriage (mean SHAP +0.62 and +0.37 for Bergen and Trondheim, respectively). We identified subgroups of patients consistently undertriaged using two common triage systems. While the importance of clinical characteristics to triage misclassification varies by triage system and location, but we found consistent evidence between the two locations that clinical referral department is the most important variable associated with triage misclassification. Replication of this approach at other centers could help to further improve triage scoring systems and improve patient care worldwide.

Patient influx to emergency departments at two Norwegian university hospitals from 2012-21.

The increase in patient visits to emergency departments is a global challenge. We wished to survey patient inflow and patient composition over time at two Norwegian university hospitals. A retrospective, descriptive study of patient contacts (patients ≥16 years of age) in the emergency departments of Haukeland University Hospital, Bergen, and St Olav's Hospital, Trondheim University Hospital in the period 2012-21. Data were retrieved from patient records and the patient administration system. A total of 585780 patient contacts were included. The number of patient contacts in the emergency departments was 30696 in 2012 and 40396 in 2021 at Haukeland University Hospital, and 18967 in 2012 and 28822 in 2021 at St Olav's Hospital. The largest increase during the study period appeared to be in the age group 67-79 years, with an increase of 57% (from 6190 to 9691) at Haukeland University Hospital, and 77% (from 3849 to 6817) at St Olav's Hospital. The proportion of patient contacts that ended in hospitalisation was 82% in 2012 and 74% in 2021 at Haukeland University Hospital, and 87% in 2012 and 61% in 2021 at St Olav's Hospital. Of the patients that were admitted, the median age was 65 years, while the median age of those who were discharged from the emergency department was 48 years at Haukeland University Hospital and 52 years at St Olav's Hospital. The study showed an increase in patient contacts in the emergency departments at Haukeland University Hospital and St Olav's Hospital over a period of ten years. The number of older adults in the population will continue to increase in the years ahead, and the need for urgent care assessments will correspondingly increase. It is important that the health services are aware of changes in patient influx and patient composition in order to ensure patient safety and the working environment of emergency departments in the future.

Pelvic floor disorders and impact on sexual function: a cross-sectional study among non-sexually active and sexually active women.

Pelvic floor disorders are common and associated with impaired sexual function in women. To assess women with pelvic floor disorders and describe factors associated with not being sexually active and those associated with sexual function in sexually active women. A cross-sectional study was conducted that included nonpregnant women with symptoms of pelvic floor disorders who were referred to the urogynecologic and surgical outpatient clinic at 2 Norwegian university hospitals: St Olavs Hospital, Trondheim University Hospital, and the University Hospital of Northern Norway, Tromsø. Women answered a questionnaire anonymously. Pelvic Organ Prolapse Incontinence Sexual Questionnaire-IUGA Revised. Of 157 respondents, 111 (71%) reported being sexually active (with or without a partner), and 46 (29%) reported not being sexually active. As compared with sexually active women, not sexually active women were older (mean ± SD, 60.2 ± 13.3 vs 51 ± 12.1 years; P < .001), more were menopausal (78% vs 47%, P = .001), and more had symptom debut <1year (31% vs 9%, P < .001). They reported more distress related to pelvic floor disorders, especially pelvic organ prolapse. In a multivariate logistic regression analysis, menopausal women and women with symptom debut <1year were 4 times more likely to be not sexually active than premenopausal women (odds ratio, 4.0; 95% CI, 1.7-9.2) and women with symptom debut ≥1year (odds ratio, 4.0; 95% CI, 1.5-10.7). In sexually active women, colorectal-anal distress was negatively associated with 5 of 6 domains of sexual function: arousal/orgasm (ß = -0.36; 95% CI, -0.02 to -0.005), partner related (ß = -0.28; 95% CI, -0.01 to -0.002), condition specific (ß = -0.39; 95% CI, -0.002 to -0.009), global quality (ß = -0.23; 95% CI, -0.02 to -0.002), and condition impact (ß = -0.34; 95% CI, -0.02 to -0.006). Health care professionals should discuss sexual function in patients with pelvic floor disorders, especially menopausal women and women with colorectal-anal symptoms. The study used condition-specific measures and recruited women from 2 university hospitals with wide range of age. Limitations include the small sample size and wide confidence intervals. The number of women who considered themselves not sexually active was low, and item nonresponse levels among these women where somewhat high. Of 625 eligible women, 200 (32%) answered the questionnaire. Sexual health and sexual function are still surrounded with taboo, and some women were probably not comfortable answering the questions. Menopausal women and women with recent onset of symptoms of pelvic floor disorders are more likely to be sexually inactive, and colorectal-anal symptoms have the most negative impact on sexual function in sexually active women.

Sexual functioning, sexual enjoyment, and body image in Norwegian breast cancer survivors: a 12-year longitudinal follow-up study and comparison with the general female population

Background Given the scarcity of evidence concerning the long-term sexual health of breast cancer (BC) survivors (BC-Pop), we aimed to assess how BC treatments affect short- and long-term sexual functioning, sexual enjoyment, and body image, and compare with aged-matched women in the Norwegian general population (F-GenPop). Material and Methods The 349 patients in BC-Pop treated at Trondheim University Hospital in 2007–2014, were assessed in clinical controls at the hospital; before starting radiotherapy (T1, baseline), immediately after ending radiotherapy (T2), and after 3, 6, and 12 months (T3–T5), and at a long-term follow-up 7–12 years after baseline (T6). Meanwhile, F-GenPop included 2254 age-matched women in the Norwegian general population. The impact of BC treatment on sexual functioning was examined using a Linear Mixed Model. Sexual functioning, sexual enjoyment, and body image were assessed with the EORTC′s QLQ-BR23 scales and compared between the populations in the four age groups (30–49, 50–59, 60–69, and 70+ years) using means with 95% confidence intervals and Student t-test. Linear regression, adjusted for age and comorbidity was applied to estimate individual scores. Result BC survivors treated with mastectomy had overall lower sexual functioning than patients who had received breast-conserving surgery (p = 0.017). Although BC survivors treated with chemotherapy had lower sexual functioning than those treated without chemotherapy at T1–T5 (p = 0.044), both groups showed the same level of functioning at T6. BC-Pop exhibited significantly poorer sexual functioning (p < 0.001), lower sexual enjoyment (p < 0.05), and better body image (p < 0.001) than F-GenPop in all age groups. Conclusion The impact of specific BC treatments on sexual functioning was modest; only mastectomy had a persistent negative influence. Nevertheless, all age groups in BC-Pop displayed significantly poorer sexual functioning than F-GenPop at both 12 months and up to 12 years after treatment.

Pelvic dimensions and hypotheses on duration of active second stage of labour

BJOG: An International Journal of Obstetrics & GynaecologyEarly View LETTER TO THE EDITOR Pelvic dimensions and hypotheses on duration of active second stage of labour Tilde Broch Østborg, Corresponding Author Tilde Broch Østborg [email protected] orcid.org/0000-0003-3600-0283 Stavanger University Hospital, Stavanger, Norway Correspondence Email: [email protected]Search for more papers by this authorT. M. Eggebo, T. M. Eggebo orcid.org/0000-0002-3162-9595 St. Olavs Hospital, Trondheim University Hospital, Trondheim, NorwaySearch for more papers by this author Tilde Broch Østborg, Corresponding Author Tilde Broch Østborg [email protected] orcid.org/0000-0003-3600-0283 Stavanger University Hospital, Stavanger, Norway Correspondence Email: [email protected]Search for more papers by this authorT. M. Eggebo, T. M. Eggebo orcid.org/0000-0002-3162-9595 St. Olavs Hospital, Trondheim University Hospital, Trondheim, NorwaySearch for more papers by this author First published: 03 April 2023 https://doi.org/10.1111/1471-0528.17467Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Interpersonal violence and recurrent headache among adolescents with a history of psychiatric problems

BackgroundInterpersonal violence (IPV) is found to be associated with mental health problems and pain disorders such as headache among children and adolescents. It is well-known that adolescents in need of mental health services have experienced IPV more often than adolescents in the general population. However, there has not been much focus on pain conditions in child and adolescent psychiatric populations.MethodsData from the current study are based on a 3-year follow-up of the CAP-survey, which is a study of adolescents in the child and adolescent psychiatric unit population of St. Olavs Hospital (Trondheim University Hospital). The baseline study was conducted between 2009 and 2011, with 717 participants between 13 and 18 years. All participants were enrolled, or newly referred to the child and adolescent psychiatric clinic. At follow-up, 570 participants completed questionnaire, and 550 completed a diagnostic interview. The participants were aged 16–21 years (mean age 18.6 years).ResultsA third of the adolescents reported frequent headaches (weekly or daily). Adolescents with more severe mental problems were more likely to experience frequent headaches. Adolescents exposed to unpleasant sexual acts or bullying, reported more frequent headaches than non-exposed participants. Participants exposed to three or more types of IPV seemed to be at particularly high risk of experiencing frequent headache.ConclusionsBoth experiences of interpersonal violence and headache are common in this clinical psychiatric population. Clinicians should assess for headache disorders in addition to psychiatric and trauma assessment and provide need-based treatment to enhance chance of recovery among adolescents in mental health services.

P05.02.A 18F-FACBC PET/MRI in diagnostic assessment of gliomas

Abstract Background and Theory MRI and histopathological tissue sampling are routinely done as part of the diagnostic work-up of patients with glioma. MRI provides anatomical images with high resolution and excellent soft-tissue contrast. But this modality has limitations in identifying tumor grade, true tumor extension and differentiate viable tumor tissue from treatment induced changes. PET can provide quantitative information of cellular activity and metabolism, and may therefore have additional value compared to MRI alone. Objective The aim of this study was to find the sensitivity of [18F]FACBC PET in gliomas, and evaluate if PET imaging with this tracer can improve differentiation between low-and high-grade gliomas. Methods Patients with suspicion of primary (n=19) or recurrent gliomas (n=8) were recruited to this study from St. Olavs hospital, Trondheim University Hospital, Trondheim, and from the University Hospital of North Norway, Tromsø. PET acquisitions (30-45 min post injection) using the amino acid radiotracer [18F]FACBC (3 MBq/kg) were performed simultaneously to MRI acquisitions (T1 with and without contrast, FLAIR, and UTE for attenuation correction. The sensitivity of [18F]FACBC PET in glioma detection was assessed using histopathology as reference. Tumor-to-background ratios (TBRs) were compared to tumor subtype and grade to assess the diagnostic value of this tracer for glioma diagnostics. Results Histopathology revealed 2 WHO grade 1 gliomas (pilocytic astrocytoma n=1, pilocytic astrocytoma/ganglioglioma n=1), 7 WHO grade 2 gliomas(astrocytoma n=4, oligodendroglioma n=3), 7 WHO grade 3 gliomas(astrocytoma n=5, oligodendroglioma n=2) and 12 WHO grade 4 tumors(astrocytoma n=1, glioblastoma n=11). [18F]FACBC PET provided a sensitivity of 74.1% in the detection of gliomas. PET uptake was observed in all grade 4 tumors, 5/7 grade 3 tumors, 2/7 grade 2 tumors, and all grade 1 tumors. TBRpeak was high with a median value of 9.4 (range: 2.1-34.9) in PET positive tumors. Only tumors with a TBRpeak &amp;gt; 2.0 were detected with [18F]FACBC PET. TBRpeak was highest for grade 1 gliomas with a median value of 20.6, and increased significantly from grade 2 to grade 4 tumors with median values of 1.7 (grade 2), 6.2 (grade 3) and 12.4 (grade 4) (Kruskal-Wallis, p=0.001). Conclusion [18F]FACBC PET demonstrated high uptake in the majority of gliomas, and there was a clear tendency to higher uptake in the higher grade tumors. [18F]FACBC PET may be useful in the differentiation between glioms grades and subtypes. A future study using the same patient data will be performed to evaluate the assessment of [18F]FACBC PET in neurosurgical treatment planning. Image-localized biopsies from different regions of each tumor will be correlated to fused PET/MRI images to evaluate if [18F]FACBC PET can be used to guide surgical resection and to improve accuracy in histopathological tissue sampling.

Body mass index and physical activity in seven-year-old children whose mothers exercised during pregnancy: follow-up of a multicentre randomised controlled trial

BackgroundThere are limited data on long-term outcomes of children whose mothers have followed exercise interventions during pregnancy. The aim of this paper was to investigate whether regular moderate intensity exercise during pregnancy affected the children’s body mass index (BMI) and physical activity (PA) at 7 years of age, and determine the relationship between children’s and mothers’ BMI and PA.MethodsThis was a follow-up of a multicentre randomised controlled trial, carried out at St. Olavs Hospital, Trondheim University Hospital, and Stavanger University Hospital, Norway (2007–2009 and 2014–2016). Women were randomised to follow a 12-week structured exercise protocol or standard antenatal care during pregnancy. At the 7-year follow-up, parents reported their child’s height, weight, and PA. The mothers also reported their own weight and PA. Main outcome variables were BMI, frequency and duration of moderate to vigorous PA (MVPA), and intensity of PA.ResultsA total of 855 women were randomised to exercise (n = 429) or standard antenatal care (n = 426) during pregnancy. At follow-up, 164 (38.2%) children and mothers in the intervention group and 117 (27.5%) in the control group participated. We found no group differences in the children’s iso-BMI or PA. Findings were similar when we performed stratified analyses by sex, except boys in the control group spent more time on electrical devices than boys in the intervention group. Subgroup analyses of children of mothers who adhered to the exercise protocol and sensitivity analyses excluding children born preterm, children admitted to the neonatal intensive care unit, and children with diseases or health problems at the 7-year follow-up, did not change the results. Children’s BMI, weekly leisure time MVPA and intensity of PA correlated with mothers’ BMI, daily exercise, and intensity of exercise.ConclusionsRegular moderate intensity exercise during pregnancy did not affect BMI or PA of the children at 7 years. Good maternal health should be encouraged as it may influence the health of the next generation.Trial registrationThe initial RCT study was registered in ClinicalTrials.govNCT00476567.

Meningioma Segmentation in T1-Weighted MRI Leveraging Global Context and Attention Mechanisms.

Purpose: Meningiomas are the most common type of primary brain tumor, accounting for ~30% of all brain tumors. A substantial number of these tumors are never surgically removed but rather monitored over time. Automatic and precise meningioma segmentation is, therefore, beneficial to enable reliable growth estimation and patient-specific treatment planning. Methods: In this study, we propose the inclusion of attention mechanisms on top of a U-Net architecture used as backbone: (i) Attention-gated U-Net (AGUNet) and (ii) Dual Attention U-Net (DAUNet), using a three-dimensional (3D) magnetic resonance imaging (MRI) volume as input. Attention has the potential to leverage the global context and identify features' relationships across the entire volume. To limit spatial resolution degradation and loss of detail inherent to encoder-decoder architectures, we studied the impact of multi-scale input and deep supervision components. The proposed architectures are trainable end-to-end and each concept can be seamlessly disabled for ablation studies. Results: The validation studies were performed using a five-fold cross-validation over 600 T1-weighted MRI volumes from St. Olavs Hospital, Trondheim University Hospital, Norway. Models were evaluated based on segmentation, detection, and speed performances, and results are reported patient-wise after averaging across all folds. For the best-performing architecture, an average Dice score of 81.6% was reached for an F1-score of 95.6%. With an almost perfect precision of 98%, meningiomas smaller than 3 ml were occasionally missed hence reaching an overall recall of 93%. Conclusion: Leveraging global context from a 3D MRI volume provided the best performances, even if the native volume resolution could not be processed directly due to current GPU memory limitations. Overall, near-perfect detection was achieved for meningiomas larger than 3 ml, which is relevant for clinical use. In the future, the use of multi-scale designs and refinement networks should be further investigated. A larger number of cases with meningiomas below 3 ml might also be needed to improve the performance for the smallest tumors.

Semi-cyclic rostering of ranked surgeons — A real-life case with stability and flexibility measures

We consider the rostering problem for surgeons in residency at the Clinic of Surgery at St. Olav’s Hospital, Trondheim University Hospital, in Trondheim, Norway. Each surgeon in residency has a rank depending on experience. An exact number of surgeons of each rank must work emergency shifts in a cyclic structure. Each surgeon is affiliated to a section, which has a minimum staffing level. Section shifts can be planned in an acyclic structure, thus establishing a semi-cyclic structure in the full roster. The addition of more typical rostering constraints establishes the novel Semi-Cyclic Ranked Physician Rostering Problem. In manually created rosters, the staffing at sections varies greatly, leading to frequent understaffing. With the addition of absence among staff when rosters are executed, this is problematic for the Clinic of Surgery. We present a two-step matheuristic based on mixed integer linear programming to solve the problem for five real-life instances. Comparing our results with a manually created roster demonstrates superior results in terms of staff availability at sections, greatly improving roster resilience to absence. We also introduce shadow shifts designed to increase the flexibility of rosters to cover for absence at emergency night shifts.

Induction of labor in breech presentations - a retrospective cohort study.

There is limited evidence on the safety and outcome of induction of breech labor. In this study, we aimed to compare the outcomes of spontaneous and induced breech deliveries and to describe variations in induction rates. This was a retrospective cohort study comprising 1054 singleton live fetuses in breech presentation at Trondheim University Hospital from 2012 to 2019. The main outcome was intrapartum cesarean section, and secondary outcomes were postpartum hemorrhage, anal sphincter ruptures, Apgar scores, pH in the umbilical artery, and metabolic acidosis. All data were obtained from the hospital birth journal. Induction of labor was performed in 127/606 (21.0%) women with planned vaginal birth. The frequency of intrapartum cesarean section was 48.0% for induced labor vs 45.7% for spontaneous labor (P=.64). We found no differences in the frequency of postpartum hemorrhage or anal sphincter ruptures between induced and spontaneous births. The median pH in the umbilical artery was significantly lower in neonates with induced labor compared with neonates with spontaneous labor (7.22 vs 7.25; P=.02). The frequency of pH <7.05 was 7.0% for induced labor vs 2.9% (P=.05) for spontaneous labor, but the frequency of pH <7.0 was not significantly different: 2.6% vs 0.8% (P=.14), respectively. Three neonates with planned vaginal birth had metabolic acidosis: two with spontaneous labors and one with induced labor. Three fetuses with planned vaginal birth died during labor: two with spontaneous onset of labor and one with induced labor. All three were extremely preterm: two were delivered in week 23 and one in week 25. We did not observe any significant trend in induction rates in either parous or nulliparous women. The induction rates were stable during the study period. We did not observe any significant difference in intrapartum cesarean section rates, in the frequency of pH <7.0 in the umbilical artery, or in the frequency of metabolic acidosis when comparing induced and spontaneous breech deliveries.

A validity study of the rapid emergency Triage and treatment system for children

BackgroundThe Scandinavian Rapid Emergency Triage and Treatment System-pediatric (RETTS-p) is a reliable triage system that includes both assessment of vital parameters and a systematic approach to history and symptoms. In Scandinavia, the system is used in most pediatric emergency departments (PED). We aimed to study the validity of RETTS-p.MethodsWe conducted a study based on triage priority ratings from all children assessed in 2013 and 2014 to the PED at St. Olavs University Hospital Trondheim, Norway. Patients were assigned one of four priority ratings, based on the RETTS-p systematic evaluation of individual disease manifestations and vital parameter measurements. In the absence of a gold-standard for true disease severity, we assessed whether priority ratings were associated with 3 proxy variables: 1) hospitalization to the wards (yes vs. no), 2) length of hospital stay (≤ mean vs. > mean, and 3) referral to pediatric intensive care (yes vs. no). We further compared priority ratings with selected diagnoses and procedure codes at discharge.ResultsSix thousand three hundred sixty-eight children were included in the study. All analyses were performed in the entire population and separately in pediatric sub-disciplines, medicine (n = 4741) and surgery (general and neurosurgery) (n = 1306). In the entire population and the sub-disciplines, a high priority rate was significantly associated with hospitalization to wards, a longer hospital stay and referral to the pediatric intensive care unit compared to patients with low priority. We observed a dose-response relationship between increased triage code level and indicators of more severe disease (p-trend < 0.001). For the same three proxy variables, the sensitivity was 54, 61 and 83%, respectively, and the specificity 66, 62 and 57%, respectively. Subgroup analyzes within the most common complaints, demonstrated that more severe conditions were higher prioritized than less severe conditions for both medical and surgical patients. Overall, children with surgical diagnoses attained lower priority ratings than children with medical diagnoses.ConclusionsRETTS-p priority ratings varies among a broad spectrum of pediatric conditions and mirror medical urgency in both medical and surgical disciplines. RETTS-p is a valid triage system for children as used in a university hospital setting.

Trisomy 21 - incidence, diagnostics and pregnancy terminations 1999-2018.

We hypothesised that the examinations offered to pregnant women at fetal medicine centres differ from those offered to other pregnant women in Norway. We therefore wanted to investigate the incidence, prenatal diagnostics and pregnancy terminations in cases of trisomy 21. We also wanted to compare the figures from the National Center for Fetal Medicine, St Olav's Hospital, Trondheim University Hospital, with national figures for Norway. We analysed figures for the period 1999-2018retrospectively. National data were compared with an unselected population whose local hospital is St Olav's Hospital. National figures were retrieved from the Medical Birth Registry of Norway and local figures were from the quality registry at the National Center for Fetal Medicine. The national incidence of trisomy 21 was 0.20%, varying from 0.14% to 0.23%, and showed a significant increase over time (p < 0.01). The increasing incidence showed an association with increasing age in the women (p < 0.01). The incidence of live births was stable, even though the proportion of pregnancy terminations increased. In the local population, the incidence of trisomy 21 was 0.19%. A total of 68.2% of the local population were diagnosed prenatally, and 87.7% of these pregnant women terminated the pregnancy. There was a significantly higher proportion of pregnancy terminations in the local population than in the remainder of the national population (p < 0.01). The difference in the proportion of pregnancy terminations may be associated with variation in access to prenatal diagnostics.

Peripheral Blood Flow Intensity in Maternal Kidneys and Correlation with Blood Pressure

Abstract Objective: This article aimed to compare the peripheral blood flow intensity (BFI) in the maternal right and left kidney in uncomplicated third trimester pregnancies and to study possible associations between parenchymal BFI in the kidneys and maternal, labor and new-born characteristics. Methods: We conducted a prospective cohort study in third trimester pregnancies at Trondheim University Hospital, Norway, from January to April 2018. The BFI in the maternal kidneys was examined with color Doppler ultrasound and the peripheral BFI was calculated using the Pixel Flux-method which is a method based on pixel wise calculation of color in an image. Velocity was coded by the color bar in the ultrasound device. The peripheral BFI was calculated as the product of velocity and area encoded by all colored pixels divided by all pixels within the cortical layer by a software examining the color in each pixel of a standardized region of interest of the renal parenchyma in video-clips through a complete heart cycle. BFI (cm/s) was thus calculated as follows: JOURNAL/mfme/04.03/02123147-202007000-00003/display-formula1/v/2023-09-29T061627Z/r/image-tiff The primary outcome measure was peripheral BFI in the renal cortex. We also examined associations between BFI in the entire cortex with maternal age, body mass index, blood pressure, pH in the umbilical artery, Apgar score after 5 minutes and birthweight. Results: In all, 51 pregnant women were included in the study, but 17 were excluded, mainly due to movement artifacts from the pulsating aorta, leaving 34 women in the final study population. We found significantly lower BFI in the cortex of the left kidney compared with the right kidney, 0.37 cm/s versus 0.69 cm/s, respectively (P = 0.04). Dividing into regions, the BFI was significantly lower in the proximal 25% of the left renal cortex compared to the corresponding right side (P = 0.01), and in the proximal 50% cortex (P = 0.02), but the differences were not significantly different in the distal 25% (P = 0.06) or in the distal 50% (P = 0.20) of the renal cortex. We observed a significant negative correlation between peripheral BFI in the left kidney and both systolic blood pressure (r = −0.38; P = 0.03) and diastolic blood pressure (r = −0.36; P = 0.04), and no significant correlations between BFI with maternal age, body mass index, blood pressure, pH in the umbilical artery, Apgar score after 5 minutes and birthweight in the left kidney (P &gt; 0.05). We did not observe any significant correlations between BFI in the right kidney and maternal or new-born characteristics (P &gt; 0.05). Conclusion: The BFI in the left renal cortex was lower compared with the right renal cortex, and BFI in the left renal cortex was negatively correlated with blood pressure, but not significantly correlated with maternal age, body mass index or newborn characteristics. We did not observe any significant correlations between BFI in the right kidney and maternal or new-born characteristics.

Jarl A. Kahn (09 May 1943-16 May 2020).

If you ask people what it takes to be a pioneer, some will say it takes courage. Indeed, a certain amount of bravery is required if you are about to make a country’s first baby in a petri dish. Another key feature of pioneering is responsibility. When you are leading the team behind the first child born in the Nordics from a frozen-thawed embryo, the responsibility for that child’s health, and that of others born through similar procedures later, is inescapable. However, first and foremost, pioneers like Dr. Kahn see and seize opportunity. So when Professor Molne at Trondheim University Hospital, Dr. Kahn’s employer at the time, asked him to initiate the hospital’s first ever IVF-service, he accepted. Mona Susanne was born in 1984 after treatment carried out by Dr. Kahn’s team. She was the first Norwegian IVF-baby, born the same year as the first Norwegian heart-transplant. Both were considered major medical breakthroughs, although in terms of controversies the fiddling with eggs and sperm was in a league of its own. Dr. Kahn never shied away from the disputes his work created, but stood firmly alongside his infertile patients in their battle for appropriate treatment in the Norwegian healthcare system. As the IVF-unit at Trondheim University Hospital grew, Dr. Kahn published several papers on central themes within the field of fertility-treatment, gaining his PhD degree there in 1993. After a period abroad in Copenhagen and Brussels, he returned to Norway to establish his second IVF-unit at Telemark Hospital in 2002. Again, his courage and sense of responsibility towards his patients were instrumental in the success of what was to become his workplace until retirement. Ever the clinician, Dr. Kahn had a way with his infertile patients that made each individual feel unique. No small feat, considering the number of patients he saw throughout his professional life. Towards the end of his career, Dr. Kahn was appointed Knight 1st class of the Royal Norwegian Order of Saint Olav for his work. Dr. Jarl A. Kahn died on May 16, 2020 after a short period of illness. Our thoughts go out to his closest family in this difficult time.

Use of pocket-sized ultrasound device in vascular surgery.

Ultrasound is widely used in vascular surgery. Pocket-sized ultrasound devices have limited functionality compared to conventional ultrasound scanners, but are cheaper and highly portable. The aim of this study was to investigate whether vascular surgeons could benefit from using a pocket ultrasound device in everyday clinical practice. Pocket-sized ultrasound devices were made available in the Department of Vascular Surgery at St. Olavs Hospital, Trondheim University Hospital, for a 10-month period. Eleven doctors participated and were free to choose between a conventional ultrasound scanner and a pocket ultrasound device. After each use of a pocket ultrasound device, participants completed a form describing the indication for use, whether the clinical question was answered, the image quality experienced and the need for supplementary diagnostic imaging. At the end of the study period, each user completed a questionnaire. Pocket ultrasound devices were mainly used preoperatively. The clinical question was answered in 51 (85%) of 60 registered examinations with a pocket ultrasound device. Image quality was subjectively rated as good in 32 (53%) examinations, moderate in 21 (35%) and poor in 7 (12%), with the clinical question answered in 94%, 90% and 29% of cases, respectively. Doctors with less than five years of experience with ultrasound chose pocket ultrasound more frequently than more experienced users. For the examinations selected, the images supplied by the pocket ultrasound device were generally of sufficient quality and often answered the clinical question. Pocket ultrasound devices can be a useful supplementary tool in vascular surgery, especially for venous examinations.

Neurodevelopmental outcome in 7-year-old children is not affected by exercise during pregnancy: follow up of a multicentre randomised controlled trial.

To investigate whether regular moderate intensity exercise during pregnancy had adverse effect on neurodevelopment of offspring at 7years of age. Follow up of a multicentre randomised controlled trial. St Olavs Hospital, Trondheim University Hospital and Stavanger University Hospital, Norway (2007-09). Women randomised to follow a 12-week structured exercise protocol or standard antenatal care during pregnancy. At 7years of age, neurodevelopmental outcome was assessed by the parent questionnaire Five-To-Fifteen (FTF), including motor skills, executive functions, perception, memory, language, social skills and possible emotional/behavioural problems. Continuous and dichotomised (cut-off 90th centile) FTF scores. A total of 855 women were randomised to exercise (n=429) or standard antenatal care (n=426) during pregnancy. At follow up, 164 (38.2%) children born to mothers in the intervention group and 115 (27.0%) children born to mothers in the control group participated. We found no group differences in FTF scores or in the proportion of children with scores ≥90th centile. Stratified analyses by sex, subgroup analyses of women who adhered to the exercise protocol or sensitivity analyses excluding preterm children and/or children who had been admitted to the neonatal intensive care unit did not change the results. In the present randomised controlled trial follow-up study, regular moderate intensity exercise during pregnancy did not have adverse effect on neurodevelopment of offspring at 7years of age. Moderate intensity exercise during pregnancy had no adverse effect on neurodevelopment of offspring at 7years of age.

CN87 - Agreement between breast cancer patients and oncologists on the severity of patients’ symptoms and functions during a one-year follow-up after treatment

BackgroundDiscrepancies in perception of adverse events between patients and physicians may influence the follow up services of cancer patients. With patient ratings as the gold standard, physicians more often underrate the symptom severities. In breast cancer (BC) populations, studies of interrater agreement are deficient. We evaluated the agreement between BC patients and their oncologists on the rating of symptoms and functioning in a clinical follow-up study at Trondheim University Hospital. MethodsAt five clinical controls during the first year after primary treatment BC patients (n=250) and their oncologist (n=14) reported symptoms and functions by completing the EORTC QLQ-C30/QLQ-BR23 and CTCAE questionnaires, respectively. Fatigue, hot flushes, breast pain, arm pain, emotional and physical functioning were comparable and scored on a four point Likert scale: not at all, mild, moderate and severe. The degree of agreement was evaluated by the Kappa(κ) coefficient. The McNemar-Bowker Test was used to test for association between raters and rating outcome. ResultsFour symptoms and two functions were assessed five times. Of 35 assessments, poor agreement (κ<0.20) was identified on 24 assessments, fair agreement (0.21< κ>0.40) on 10 assessments and moderate agreement (κ=0.41) on one assessment (physical function). Overall, the oncologists rated the severity of all symptoms and the functions significantly lower than the patients (p<0.01). The agreement decreased with increasing symptom severity and function impairment. ConclusionsDiscrepancies in reporting symptom severity between patients and oncologists might be due to high subjectiveness of symptoms and different understanding of the construct being measured. Personal characteristics of both raters, the context of the clinical controls and the nature of the relationship between patients and physicians may also contribute to discrepancies. Our results emphasize the importance of collecting patient reported data during follow up after BC treatment as it may improve diagnosis and treatment of adverse effects. Legal entity responsible for the studyNTNU, Department of Circulation and Medical Imaging, the authors. FundingNorwegian University of Science and Technology. DisclosureAll authors have declared no conflicts of interest.

Incidence of Mild Traumatic Brain Injury: A Prospective Hospital, Emergency Room and General Practitioner-Based Study.

Background: There are no recent estimates of incidence rates of mild traumatic brain injury (MTBI) from Norway. Moreover, reported incidence rates rarely comprise cases of MTBI evaluated in the primary care setting. In this study, we utilized existing data collected as part of the recruitment to a large, follow-up study of patients with MTBI. We estimated the incidence rate of MTBI, including patients who visited outpatient clinics, in the age group 16–59 years in a Norwegian region.Methods: During 81 weeks in 2014 and 2015, all persons aged 16–59 years, presenting with possible MTBI to the emergency department (ED) at St. Olavs Hospital, Trondheim University Hospital or to the general practitioner (GP)-run Trondheim municipal outpatient ED, were evaluated for a diagnosis of MTBI. Patients were identified by computerized tomography (CT) referrals and patient lists. Patients referred to acute CT from their primary GP with suspicion of MTBI were also recorded. This approach identified 732 patients with MTBI. Age- and sex-specific incidence rates of MTBI were calculated using population figures from the regional catchment area.Results: Overall incidence of MTBI in people between 16 and 59 years was 302 per 100,000 person-years (95% confidence interval 281–324). The incidence rate was highest in the age group 16–20 years, where rates were 835 per 100,000 person-years in males and 726 in females.Conclusion: The overall incidence rate of MTBI was lower than expected from existing estimates. Like other reports, the incidence was highest in the late teens.