Epidemiology of traumatic spinal cord injury in Norway in 2012-2016: a registry-based cross-sectional study.

STUDY DESIGN: A registry-based cross-sectional study. OBJECTIVES: To analyse the epidemiological and demographic characteristics of persons with traumatic spinal cord injury (TSCI) in Norway. SETTING: TSCI patients admitted for primary rehabilitation to one of the three specialised spinal cord injury (SCI) departments (located in Bergen, Trondheim, and Oslo) and consented to the Norwegian Spinal Cord Injury Registry (NorSCIR). METHODS: Analysis of data from NorSCIR during a 5-year period (2012-2016) was performed. Data were collected by using the International SCI Core Data Set as recommended by the International Spinal Cord Society (ISCoS). RESULTS: The lowest incidence of TSCI was 11.4/million (2012), and the highest incidence was 15.9/million (2014). In the study period, 349 individuals were registered with TSCI. In total, 76% were male, and the mean age was 47 (SD ± 19) years. We observed dominance in the 60-74 years age group. The distribution between tetraplegia and paraplegia was 48%/42%. For those initially classified as American Spinal Cord Injury Association Impairment Scale (AIS) grade A (complete injury), 77% remained grade A at discharge. Considerable changes during primary rehabilitation after incomplete lesions were observed. Most patients (68%) were discharged home after primary rehabilitation. Falls were the main cause of TSCI (47%) and occurred more often during the weekend. CONCLUSION: Through a National Medical Quality Registry based on internationally provided data sets, we are able to present systematic and updated data from Norway.

Non-traumatic spinal cord injury in Norway 2012-2016: analysis from a national registry and comparison with traumatic spinal cord injury.

STUDY DESIGN: Registry-based cross-sectional study. OBJECTIVES: To describe and analyze epidemiological and demographic characteristics of non-traumatic spinal cord injury (NTSCI) and to compare persons with NTSCI and traumatic spinal cord injury (TSCI). SETTING: A total of 225 non-traumatic and 349 traumatic SCI patients were admitted for primary rehabilitation at one of the three specialized SCI departments in Norway (located in Bergen, Trondheim, and Oslo) from 2012 to 2016. Patients who consented to registration in the Norwegian Spinal Cord Injury Registry (NorSCIR) were included. METHODS: Data were collected using the International SCI Core Data Set, as recommended by the International Spinal Cord Society (ISCoS). Demographics and injury characteristics were analyzed descriptively. The NTSCI and TSCI groups were compared using a Mann-Whitney U test and chi-square test. RESULTS: The mean age of the NTSCI patients was 55 years, and 59% were male. The incidence of NTSCI was 7.7-10.4 per million person-years, which is lower than the incidence of TSCI. NTSCI individuals were older, less severely injured, and their length of stay at the hospital was shorter than the TSCI individuals. The results may be influenced by the inclusion criterion in the registry. This makes the analyzed sample for NTSCI less complete. However, the majority of patients with nonprogressive NTSCI are included in the NorSCIR. CONCLUSION: For the first time, we are able to provide the national epidemiological status on NTSCI based on available data from the national registry. Further studies are required to improve the capture of NTSCI for future incidence studies.

Extended life-span conferred by cotransporter gene mutations in Drosophila.

Aging is genetically determined and environmentally modulated. In a study of longevity in the adult fruit fly, Drosophila melanogaster, we found that five independent P-element insertional mutations in a single gene resulted in a near doubling of the average adult life-span without a decline in fertility or physical activity. Sequence analysis revealed that the product of this gene, named Indy (for I'm not dead yet), is most closely related to a mammalian sodium dicarboxylate cotransporter-a membrane protein that transports Krebs cycle intermediates. Indy was most abundantly expressed in the fat body, midgut, and oenocytes: the principal sites of intermediary metabolism in the fly. Excision of the P element resulted in a reversion to normal life-span. These mutations may create a metabolic state that mimics caloric restriction, which has been shown to extend life-span.

Correlative memory deficits, Abeta elevation, and amyloid plaques in transgenic mice.

Transgenic mice overexpressing the 695-amino acid isoform of human Alzheimer beta-amyloid (Abeta) precursor protein containing a Lys670 --> Asn, Met671 --> Leu mutation had normal learning and memory in spatial reference and alternation tasks at 3 months of age but showed impairment by 9 to 10 months of age. A fivefold increase in Abeta(1-40) and a 14-fold increase in Abeta(1-42/43) accompanied the appearance of these behavioral deficits. Numerous Abeta plaques that stained with Congo red dye were present in cortical and limbic structures of mice with elevated amounts of Abeta. The correlative appearance of behavioral, biochemical, and pathological abnormalities reminiscent of Alzheimer's disease in these transgenic mice suggests new opportunities for exploring the pathophysiology and neurobiology of this disease.

Who bears the cost of forest conservation?

BACKGROUND: While the importance of conserving ecosystems for sustainable development is widely recognized, it is increasingly evident that despite delivering global benefits, conservation often comes at local cost. Protected areas funded by multilateral lenders have explicit commitments to ensure that those negatively affected are adequately compensated. We make the first comparison of the magnitude and distribution of the local costs of a protected area with the magnitude and distribution of the compensation provided under the World Bank social safeguard policies (Performance Standard 5). METHODS: In the Ankeniheny-Zahamena Corridor (a new protected area and REDD+ pilot project in eastern Madagascar), we used choice experiments to estimate local opportunity costs (n = 453) which we annualized using a range of conservative assumptions concerning discount rates. Detailed surveys covering farm inputs and outputs as well as off-farm income (n = 102) allowed us to explore these opportunity costs as a proportion of local incomes. Intensive review of publically available documents provided estimates of the number of households that received safeguard compensation and the amount spent per household. We carried out a contingent valuation exercise with beneficiaries of this compensation two years after the micro-development projects were implemented (n = 62) to estimate their value as perceived by beneficiaries. RESULTS: Conservation restrictions result in very significant costs to forest communities. The median net present value of the opportunity cost across households in all sites was US$2,375. When annualized, these costs represent 27-84% of total annual income for median-income households; significantly higher proportionally for poorer households. Although some households have received compensation, we conservatively estimate that more than 50% of eligible households (3,020 households) have not. Given the magnitude of compensation (based both on amount spent and valuation by recipients two years after the compensation was distributed) relative to costs, we argue that no one was fully compensated. Achieving full compensation will require an order of magnitude more than was spent but we suggest that this should be affordable given the global value of forest conservation. DISCUSSION: By analyzing in unprecedented depth both the local costs of conservation, and the compensation distributed under donor policies, we demonstrate that despite well-intentioned policies, some of the poorest people on the planet are still bearing the cost of forest conservation. Unless significant extra funding is provided by the global beneficiaries of conservation, donors' social safeguarding requirements will not be met, and forest conservation in developing countries will jeopardize, rather than contribute to, sustainable development goals.

Missed and brief seizures during ECT: differential response between unilateral and bilateral electrode placement.

The number of electroconvulsive therapy (ECT) stimulations over a course of treatment that resulted in brief or no seizure activity was evaluated for depressed patients (N = 58, treated for DSM-III diagnosed major depressive disorder) who had been randomly assigned to either bilateral or unilateral nondominant ECT in a double-blind study. Comparable treatment efficacy between both groups was found. Although there were no group differences in brief seizures, unilateral nondominant ECT resulted in more missed seizures (p less than 0.01) and required more restimulations than bilateral ECT. Of 27 unilateral ECT patients, 63% had at least one missed seizure over the course of treatment, compared to 29% of 31 bilateral ECT patients (p less than 0.02). Although more missed seizures occurred early in treatment, brief seizures occurred later in treatment. As missed seizures are not always detected clinically, it is possible that without seizure monitoring, patients with unilateral nondominant ECT will not improve at the same rate as patients with bilateral ECT. Lack of seizure monitoring in the clinic is one likely explanation for the discrepancy between a number of research studies reporting equivalent efficacy for bilateral and unilateral ECT and the clinical impression that bilateral ECT is more effective.

Purification of a pituitary polypeptide that stimulates the replication of adipocyte precursors in culture.

A bovine anterior pituitary polypeptide that stimulates the replication of rat and human adipocyte precursors has been purified. Its Mr is 44 000-53 000 and its isoelectric point is 9.8-10.3. While pituitary basic fibroblast growth factor is equally mitogenic on adipocyte precursors and skin fibroblasts, the polypeptide described here is selectively more active on the precursors. We postulate that this adipocyte growth factor plays a physiological role by modulating the number of adipocyte precursors.

Hemoperfusion for chronic schizophrenia: preliminary psychiatric results.

Six patients with chronic schizophrenia unresponsive to accepted therapy were assigned randomly to receive as adjunctive therapy either (A) weekly coated-charcoal hemoperfusion (CCHP) or (B) sham hemoperfusion (Sham HP) in a double-blind study using two independent psychiatric raters. Four weeks of treatment suggested that (1) CCHP was associated with significant improvement in some psychiatric measures, (2) improvement was early in the treatment course, and (3) neither CCHP nor Sham-HP was associated with deterioration in any of the psychiatric measures. When one patient from each group was "crossed-over" to receive the opposite treatment these conclusions were supported. Further studies appear to be warranted.

Umbilical cord plasma interleukin-6 and fetal growth restriction in preeclampsia: a prospective study in Norway.

OBJECTIVE: To study the association between umbilical plasma levels of interleukin-6 (IL-6) in relation to fetal growth in subgroups of preeclampsia, and in control pregnancies. METHODS: Umbilical cord plasma was collected from 12,804 consecutive births. A total of 271 singleton cases of preeclampsia were identified, and classified as mild or severe, and as disease with early or late onset. As controls, 611 singleton pregnancies without preeclampsia were selected, and the ratio between observed and expected birth weight was used as a measure of fetal growth. In the analysis, we also included maternal smoking during pregnancy. Umbilical cord plasma IL-6 concentration was measured with an IL-6 bioassay. Comparing controls with subgroups of preeclampsia (severe and early onset), this study had a statistical power of 90% to detect a difference in cord IL-6 of 10 pg/mL. RESULTS: In severe preeclampsia, cord plasma IL-6 concentration was lower than among controls (P <.001), and there was a sharp decrease in cord plasma IL-6 with decreasing birth weight ratio (P trend <.001). By further dividing the preeclampsia group into early or late onset, the strong association between low IL-6 levels and low birth weight ratio appeared to be present mainly in early-onset disease. These results were not confounded by maternal smoking. CONCLUSION: Restricted fetal growth related to preeclampsia is associated with reduced umbilical cord plasma IL-6 concentration in cases with early-onset disease. In these cases, fetal growth restriction could be mediated by impaired trophoblast function.

Preeclampsia and fetal growth.

OBJECTIVE: To determine if the influence of preeclampsia on birth size varies with clinical manifestations of the disease, and to evaluate whether maternal factors, such as smoking, modify the effect of preeclampsia on fetal growth. METHODS: Among 12,804 deliveries in a population of approximately 239,000 over a 3-year period, 307 live singleton infants were born after preeclamptic pregnancies. We compared those with a sample of 619 control infants. Preeclampsia was defined as increased diastolic blood pressure (BP) (increase of at least 25 mmHg to at least 90 mmHg) and proteinuria after 20 weeks' gestation. Clinical manifestations were classified according to BP and proteinuria into subgroups of mild, moderate, or severe (including cases with eclampsia and hemolysis, elevated liver enzymes, low platelets [HELLP] syndrome) preeclampsia, and according to gestational age at onset, as early or late preeclampsia. Birth size was expressed as the ratio between observed and expected birth weights, and infants smaller than two standard deviations from expected birth weights were classified as small for gestational age (SGA). RESULTS: Preeclampsia was associated with a 5% (95% confidence interval [CI] 3%, 6%) reduction in birth weight. In severe preeclampsia, the reduction was 12% (9%, 15%), and in early-onset disease, birth weight was 23% (18%, 29%) lower than expected. The risk of SGA was four times higher (relative risk [RR] = 4.2; 95% CI 2.2, 8.0) in infants born after preeclampsia than in control pregnancies. Among nulliparas, preeclampsia was associated with a nearly threefold higher risk of SGA (RR = 2.8; 1.2, 5.9), and among paras, the risk of SGA was particularly high after recurrent preeclampsia (RR = 12.3; 3.9, 39.2). In relation to preeclampsia and maternal smoking, the results indicated that each factor might contribute to reduced growth in an additive manner. CONCLUSION: Severe and early-onset preeclampsia were associated with significant fetal growth restriction. The risk of having an SGA infant was dramatically higher in women with recurrent preeclampsia. Birth weight reduction related to maternal smoking appeared to be added to that caused by preeclampsia, suggesting that there is no synergy between smoking and preeclampsia on growth restriction.

Knowledge, attitudes and management strategies in Scandinavia concerning hormone replacement therapy: a comparison between gynecologists in Denmark, Norway and Sweden.

OBJECTIVES: To describe and compare attitudes, knowledge and management strategies concerning the prescription of hormone replacement therapy (HRT) between gynecologists from three Scandinavian countries. DESIGN AND METHODS: In a cross-sectional study gynecologists in Denmark (n=386), Norway (n=475) and Sweden (n=1323) were invited by letter to complete and return an enclosed questionnaire. Then 1653 of the 2184 (76%) contacted gynecologists completed and returned the questionnaire. RESULTS: of the 1653 Scandinavian gynecologists, 42% offered HRT to all women provided there was no contraindication, while 58% recommended HRT to selected women after considering the advantages and disadvantages of HRT. In Norway and Sweden, the proportion of gynecologists routinely prescribing HRT for women without contraindications increased with age and in the oldest age group of gynecologists (>55 years) 49 and 56%, respectively, recommended HRT to all women. The gynecologists were unanimous in their choice of the type of HRT for perimenopausal women as 94% preferred cyclical or sequential combined (estrogen/progestogen) treatment or estrogen monotherapy (orally or transdermally) for hysterectomized women (95%). For postmenopausal women, 75% of the gynecologists offered continuous combined HRT while cyclical combined therapy was chosen by 15% of the gynecologists. No significant differences were found between physicians in the three countries regarding indications and contraindications to HRT. CONCLUSIONS: Scandinavian gynecologists are generally well informed concerning HRT and liberally recommend HRT for women without contraindications.

Photoinhibition of Photosynthesis in Lemna gibba: The Effect of O(2), CO(2) and the Selective Inhibition of Photosystem II.

This study demonstrates that photoinhibition of Lemna gibba can be induced by exposing the plants in a N(2) atmosphere to a light intensity which exceeds that used for cultivation. The lack of O(2) and CO(2) appeared to be more important than the sudden increase in photon-flux rate for the induction of photoinhibition. Photoinhibition had no effect on the O(2) inhibition of photosynthesis. Moreover, Lemna exhibited a rather fast recovery to photoinhibition, which suggests that Lemna has some mechanism of protection that may be related to the presence of high CO(2) stored in their air sacs. Studies using selected monochromatic light during photoinhibitory treatment show that in vivo photoinhibition maybe due to reactions connected to the excitation of PS II.

Effect of ozone on net photosynthesis in oat (Avena sativa) and duckweed (Lemna gibba).

Short exposure to ozone depressed photosynthesis in both oat and duckweed at concentrations above 140 microg m(-3) and 300 microg m(-3), respectively. The effect on exposed oat flag leaves was age-dependent, with maximum susceptibility to ozone 10-20 days after emergence of the panicle. In duckweed, photosynthesis was more sensitive to differences in ozone concentration than to differences in duration of exposure.

Reduction of net photosynthesis in oats after treatment with low concentrations of ozone.

Oats (Avena sativa L. cv Titus) were exposed to low concentrations of O3 in an assimilation chamber system. Net photosynthesis (net CO2 uptake), measured before and after O3 fumigation, showed significantly different responses for leaves of different age. The oldest active leaf was the most sensitive to O3. Net photosynthesis was depressed after 2 h with 0.075 ppm (150 microg m(-3)) O3. For leaves exposed to 0.150 ppm (300 microg m(-3)) O3 for 2 h, net photosynthesis was reduced significantly for 4 h, after which recovery occurred, nearly reaching the preexposure level 19 h after the exposure. Dark respiration was initially more than doubled after exposure to 0.130 ppm (260 microg m(-3)) O3. There was no visible injury after any of the experiments. The results indicate that O3 may cause crop losses through effects on photosynthesis even in Scandinavia, where a typical O3 episode lasts 1 to 2 h, and the concentration seldom exceeds 0.150 ppm.

CPR knowledge and attitude to performing bystander CPR among secondary school students in Norway.

BACKGROUND: Early bystander cardiopulmonary resuscitation (CPR) is essential for survival from out-of-hospital cardiac arrest (OHCA). Young people are potentially important bystander CPR providers, as basic life support (BLS) training can be distributed widely as part of the school curriculum. METHODS: Questionnaires were distributed to nine secondary schools in North Norway, and 376 respondents (age 16-19 years) were included. The completed questionnaires were statistically analysed to assess CPR knowledge and attitude to performing bystander CPR. RESULTS: Theoretical knowledge of handling an apparently unresponsive adult person was high, and 90% knew the national medical emergency telephone number (113). The majority (83%) was willing to perform bystander CPR in a given situation with cardiac arrest. However, when presented with realistic hypothetical cardiac arrest scenarios, the option to provide full BLS was less frequently chosen, to e.g. a family member (74%), a child (67%) or an intravenous drug user (18%). Students with BLS training in school and self-reported confidence in their own BLS skills reported stronger willingness to perform BLS. 8% had personally witnessed a cardiac arrest, and among these 16% had performed full BLS. Most students (86%) supported mandatory BLS training in school, and three out of four wanted to receive additional training. CONCLUSION: Young Norwegians are motivated to perform bystander CPR, but barriers are still seen when more detailed cardiac arrest scenarios are presented. By providing students with good quality BLS training in school, the upcoming generation in Norway may strengthen the first part of the chain of survival in OHCA.

Pubertal anthropometry in sons and daughters of women with preeclamptic or normotensive pregnancies.

OBJECTIVE: To compare body mass index (BMI) and waist and hip circumference in early puberty (10.8 years in girls and 11.8 years in boys) among offspring of preeclamptic and normotensive pregnancies. DESIGN: Population based follow-up study. METHODS: Anthropometry measured in early puberty in 91 girls and 92 boys of preeclamptic pregnancies, and in 194 girls and 166 boys of normotensive pregnancies, with similar anthropometric measures among mothers, performed at the beginning of the index pregnancy, and at follow-up, when their offspring were in early puberty. RESULTS: Among girls, the preeclampsia group had higher body mass (BMI 18.3 kg/m(2) vs 17.5 kg/m(2), p = 0.01) and larger waist circumference (63.7 cm vs 61.6 cm, p = 0.05) compared to the normotensive group, but the differences were restricted to the offspring of mothers with a high body mass (BMI >30 kg/m(2)). Among boys, we observed no differences in anthropometric measurements between groups. CONCLUSIONS: The higher BMI and larger waist of daughters of women with preeclampsia was only present if their mothers were obese. These results suggest that preeclampsia in obese women may lead to a distinct disadvantage in body size for their daughters in early puberty.

[Quality assurance of medical leadership]. / Kvalitetssikring av medisinsk ledelse.

Quality assurance is a managerial responsibility, but the medical management itself must also be quality assured. Today quality assurance of medical management is usually performed when the organization is not functioning properly, but quality assurance should be a continuous process. Regular feedback to the management is essential from all levels of the organization. Standards must be established for good medical management. The medical profession must start this work now. There are many others who want to take it over.

Boys born by forceps and vacuum extraction examined at 18 years of age.

An 18-year follow-up study was made of 62 males delivered by forceps and 38 by vacuum extraction in 1962-63. The obstetrical data are compared with the medical and psychological military draft board examinations. The mortality and morbidity rates were not significantly different from those of the total cohort of Norwegian conscripts, either in the forceps or in the vacuum group. Rotation of the fetal head with Kielland's forceps in midcavity extractions did not adversely affect the late results. A significantly elevated mean intelligence score was found in the forceps group, while the vacuum group did not differ from the national average.