Reduced arterial elasticity after anabolic-androgenic steroid use in young adult males and mice.

High-doses of anabolic-androgenic steroids (AAS) is efficient for building muscle mass, but pose a risk of cardiovascular side effects. Little is known of the effect of AAS on vasculature, but previous findings suggest unfavorable alterations in vessel walls and vasoreactivity. Here, long-term effect of AAS on vascular function and morphology were examined in male weightlifters, and in a mimicking animal model. Arterial elasticity and morphology were tested with ultrasound, pulse wave velocity (PWV) and carotid intima media thickness (cIMT) in 56 current male AAS users, and 67 non-exposed weightlifting controls (WLC). Female mice were treated with testosterone for 14 days and echocardiography were applied to evaluate vascular function and morphology. Male AAS users had higher PWV (p = 0.044), reduced carotid artery compliance (p = 0.0005), and increased cIMT (p = 0.041) compared to WLC. Similar functional changes were found in the ascending aorta of mice after 7- (p = 0.043) and 14 days (p = 0.001) of testosterone treatment. This animal model can be used to map molecular mechanisms responsible for complications related to AAS misuse. Considering the age-independent stiffening of major arteries and the predictive power of an increase in PWV and cIMT, the long-term users of AAS are at increased risk of severe cardiovascular events.

Lyme neuroborreliosis: a treatable cause of acute ocular motor disturbances in children.

BACKGROUND: Lyme neuroborreliosis (LNB) designates central nervous system involvement caused by the tick-borne spirochaete Borrelia burgdorferi (Bb). The present study describes a spectrum of acquired ocular motor disorders in children with LNB. METHODS: Six paediatric patients (age 3-15 years) with ocular motor symptoms as first manifestations of LNB evaluated by a paediatrician and ophthalmologist are presented. Diagnosis was based on new onset ocular motor disturbances and detection of cerebrospinal fluid (CSF) pleocytosis and intrathecal synthesis of Bb IgM and/or IgG antibodies by lumbar puncture. The children were evaluated before and after antibiotic treatment with a follow-up time of 1-7 months. Videos were obtained both pre and post treatment in four patients. RESULTS: Two children presented with acquired nystagmus, one with combined nystagmus and partial sixth nerve palsy, one with partial sixth nerve palsy, one with ptosis and one with Adie's pupil. Five of the patients presented with severe fatigue, malaise, nausea, headache and fever. Four had recognised a tick bite recently, and two developed erythema migrans. Intrathecal synthesis of IgM and/or IgG antibodies specific for Bb was positive in all children, and five showed CSF pleocytosis. Cerebral MRI or CT of the brain were normal. Treatment with intravenous or oral antibiotics produced rapid clinical improvement in five of the six children. CONCLUSIONS: LNB can present as acute ocular motor disorders in conjunction with fatigue and other clinical manifestations. In endemic areas, children with unexplained, acquired ocular motor abnormalities should be evaluated for LNB, a treatable medical condition.

[Terminal care of cancer patients]. / Terminalomsorg til kreftpasienter.

BACKGROUND: Palliative medicine is increasingly important in the health services. MATERIAL AND METHODS: The records of 52 patients who died in the department of oncology of Ullevaal University Hospital, July to December 1999 were examined. Major symptoms at the time of admission, information, communication, and the quality of the patient records were registered. RESULTS: 50 out of 52 patients had severe pain at admission. Only five patients were in contact with the community care system at the time of admission. There was insufficient documentation in the patients' records of whether the patients themselves or their next of kin were sufficiently informed about their situation. INTERPRETATION: The treatment of cancer-related pain in a home-care setting could be improved. Cooperation between the hospital and home-based care is at present suboptimal. Documentation relating to terminal care in the patient records should be improved.

[Surgical injuries registered in the Norwegian system for patient injuries. Possibilities of the use of the material for quality improvement in Norwegian hospitals]. / Kirurgiske skader registrert i Norsk Pasientskadeerstatning. Muligheter for bruk av skadematerialet i kvalitetsutvikling i norske sykehus.

328 surgical "errors" reported to the Norwegian System of Compensation for Injuries to Patients were analysed in order to find out how the errors can be exploited for the purpose of quality improvement. In 8% of the cases the patients had been treated as emergency cases. 7% of the patients had been treated as out-patients. 30% of the patients had become more than 15% permanently disabled as a consequence of the "error". The Norwegian System of Compensation for Injuries to Patients operates with five different categories of errors defined by medical specialty, of which surgery is one. We found that among "surgical errors" 16% of the patients had been treated by an anaesthetist or by a specialist in internal medicine, and 13% had been treated by a gynaecologist. There were several recurring "errors" such as nerve injuries and complications related to general atherosclerosis. A system for categorising errors with a view to quality improvement should be different from other systems of categorisation. We suggest a system based on not only five but all medical specialties. Data from such a system could be used to prepare "pedagogic reports" that can be sent to the managers of services and education in each medical specialty. Thus, by turning surgical errors into "medical treasures", the errors can be exploited to promote quality improvement.

[Use of alternative medicine among Norwegian hospitalized cancer patients]. / Bruk av alternativ medisin blant norske hospitaliserte kreftpasienter.

A national multi-centre study was performed to investigate the prevalent use of alternative medicine, or non-proven therapies, among Norwegian cancer patients. Of 911 patients invited to take part in the study 642 were included in the final analysis. Among the 630 assessable patients, 20% had been or were current users of non-proven therapies. In the northern most and western parts of Norway the most preferred alternative methods are healing by hand and faith healing, while herbs, vitamins, diets and Iscador are popular in the central and southern parts. Use of nonproven therapies is common in the northern part of the country. Prevalent users are middle-aged patients with long-standing symptomatic disease and former users of non-proven therapies for nonmalignant disease. About 40% of the patients would like non-proven therapies to be an option in hospital. Most of the users of non-proven therapies (80%) had consulted practitioners of scientific medicine first; 15% had started treatment with non-proven therapies simultaneously. The users of non-proven therapies report having received less hope of cure (30%) from their physicians than the non-users (50%) had. Most of the users had learned about non-proven therapies from friends or relatives. Most users believe that non-proven therapies might make them stronger and relieve their symptoms. Very few patients believe in a cure (10%). Nearly 40% felt that non-proven therapies had no definite effect on them. Four patients reported adverse effects. 15 patients had been treated abroad, usually in Denmark.

Why are cancer patients using non-proven complementary therapies? A cross-sectional multicentre study in Norway.

This study addressed the use of alternative medicine, here called non-proven therapies (NPTs), among hospitalized Norwegian cancer patients. A total of 126 (20%) of the assessable 630 patients were users of NPTs. Approximately 43% of all patients and more than 60% of the users of NPTs stated that they would like NPTs to be an option in hospitals belonging to the National Health Service. Most users of NPTs (82%) consulted traditional medicine first, while 15% started treatment with NPTs simultaneously. Users of NPTs reported to have received less hope of a cure (30%) from their physicians than non-users (50%). Users mostly learned about NPTs from friends and relatives. Most users believed that NPTs might give them strength and relieve their symptoms. Very few patients believed in a cure (10%). Nearly 40% were uncertain of any effect of the NPTs or felt there had been no effect. 4 patients reported adverse effects. 15 patients had been treated abroad, most of them in Denmark. Expenses incurred through use of NPTs were mostly moderate, but some patients used large sums of money. Patients' opinions on whether or not the treatment had been expensive were closely linked to their anticipation of the effect of the treatment.

[Physicians' view on drug therapy for hypertension. A questionnaire in the county of Hordaland]. / Legers mening om medikamentell blodtrykksbehandling. En spørreundersøkelse i Hordaland fylke.

A questionnaire survey was conducted in Hordaland county to discover opinions on drug therapy for uncomplicated hypertensives with no other risk factors. The response rate was 66%; 179 general practitioners and 31 hospital doctors. The doctors were well informed about the documentation of the clinical benefit of various drugs. As regards the minimum blood pressure that was considered as warranting drug treatment, the majority of the doctors followed the recently issued national guidelines. For young patients the first choice drugs were beta-blockers (27%), ACE-inhibitors (25%) or calcium-blockers (20%). For older patients 65% of the doctors preferred diuretics or beta-blockers. The majority (80%) based their choice of drug primarily on documentation of clinical value or absence of side effects. The doctors underestimated the cost of the newer antihypertensive drugs.

[The relation between patient volume and quality of care. Results of a survey]. / Forholdet mellom pasientvolum og behandlingskvalitet. Resultat av høring.

A report on the relation between patient volume and quality of treatment has been evaluated by health administrators. The majority supports that adequate patient volume is important for quality of treatment and for quality assurance. The implementation of these concepts in the organizing of health services is advocated. There is a relation between every single administrator's attitude towards the volume-quality concept and the number of beds in their own hospital. Clinical audit by means of registers and more national control of the hospital service is supported.

[Use of psychiatrists in security matters]. / Bruk av psykiater i trygdesaker.

90 clients with uncertain symptoms and diagnosis, especially clients with pain in the musculoskeletal system or with minor neurotic symptoms, were examined by a psychiatrist ordered by Skedsmo Social Security Office. The number of clients with the diagnosis fibromyalgia was strongly reduced. The number of clients with somatic diagnosis increased from three to nine, and three cases of psychosis, not earlier diagnosed as such, were recorded. The number of clients on sick leave was reduced considerably. Rehabilitation for employment was proposed to many clients. The evaluation had little impact on clients applying for a disability pension. For 28 clients the examination resulted in necessary and important treatment. As a whole the examination produced the best results among clients under the age of forty.

[The requirement to use the cheapest synonymous preparation--does it work as intended?]. / Ordningen med billigste synonympreparat--virker den etter hensikten?

A retrospective analysis of all prescriptions for hypersensitive drugs was undertaken at a pharmacy serving 20 general practitioners and 17 temporarily employed doctors. The analysis was carried out in 1992 over two three-month periods separated by an interval of five months. The Governmental regulations aimed at promoting use of the "cheapest synonymous drug" apparently had little impact on the doctors' prescriptions. During the 11 months concerned, the prescribed antihypersensitive drugs contained an increasing share of expensive alternatives with no documented ability to reduce cardiovascular morbidity or mortality.

[Cooperation between regional and central hospitals--how to achieve the best results?]. / Samarbeidet mellom region-og sentralsykehus--hvordan kan det bli best mulig?

The authors reviews a recent governmental analysis of cooperation between third-line university clinics and local and central hospitals. The hospitals are owned by the government (mainly by the counties), and the various Acts and regulation permit the central authorities to make decisions on all aspects of highly specialized medicine. The analysis concludes that a limited number of problems should be solved by decision of the central government, but only those where national concerns are involved. The counties within a health region should cooperate within a Regional Health Policy Board, to create plans for flow of patients through the health care system, specified for each field of medicine. When such plans have been approved by the Regional Health Policy Board, each county should be willing to accept them. In the event of local disagreement, the central government should decide.

[Highly specialized medicine. How to assign the tasks?]. / Høyspesialisert medisin. Hvordan bør oppgavene fordeles?

Norway has four million inhabitants and five university hospitals, each serving one health region. The authors describe the work of a governmental medical committee, whose mandate is to advise on where to locate the various highly specialized medical services. Important questions have been the relationship between experience and quality, and the desire of each university clinic to be able to provide treatment within its own region for most health problems. Their reasons are concern about research and specialist training, and the preference of patients for treatment near to home. A list of proposed national and over-regional centers for certain treatments has been prepared on the basis of the experts' report and comments from all university clinics. These recommendations have provided a medical basis for later economic and political analyses prior to final decision by the Government. Norwegian legislation permits strong governmental regulation of the highly specialized health services.

[Complaints of patients on medical treatment]. / Klage på pasientbehandling.

Complaints handled by the Directorate of Health about medical treatment have been registered and analysed for the years 1980, 1985 and 1990. The analysis shows that the number of complaints against government hospitals increased fourfold from 1985 to 1990. Compensation awarded in cases where medical negligence was proved rose sevenfold from NOK 3 million in 1985 to NOK 20 million in 1990. We have reason to believe that there has been a similar increase in the number of claims for compensation, and in the amount of compensation awarded in cases of proven negligence, also in cases not involving the Directorate of Health. It is important to note that our study demonstrates an increase in serious events leading to permanent functional impairment or death. A post hoc analysis suggests that some 80% of the failures might have been avoided if an adequate system of quality assurance had been established.

[Sick-listing II--an evaluation of rehabilitation assistance]. / Sykmelding II--evaluering av bedriftsintern attføring.

Patients certified as sick for more than eight weeks qualify for sickness benefit scheme No. 2. 38 patients in this group who suffered from various indefinite diseases were called in to consultation with an advisory doctor. Patients with a high degree of motivation were later examined by a doctor specialized in occupational diseases. Information on all patients was obtained from the company medical service, personnel managers, and the doctors who had prescribed sick leave for the patients. The survey unveiled a low degree of cooperation and communication between the various personnel responsible for the patients. Furthermore, little was known about rehabilitation programmes at the different places of work. Only half of the employers knew about such opportunities. This lack of cooperation clearly indicates a need of greater involvement on the part of all parties concerned with these patients and for schemes of follow-up. The creation of such schemes might be the first step towards new and better relationships between the different kinds of personnel concerned.