The Effectiveness of Smartphone Apps for Lifestyle Improvement in Noncommunicable Diseases: Systematic Review and Meta-Analyses.

BACKGROUND: Noncommunicable diseases (NCDs) account for 70% of all deaths in a year globally. The four main NCDs are cardiovascular diseases, cancers, chronic pulmonary diseases, and diabetes mellitus. Fifty percent of persons with NCD do not adhere to prescribed treatment; in fact, adherence to lifestyle interventions is especially considered as a major challenge. Smartphone apps permit structured monitoring of health parameters, as well as the opportunity to receive feedback. OBJECTIVE: The aim of this study was to review and assess the effectiveness of app-based interventions, lasting at least 3 months, to promote lifestyle changes in patients with NCDs. METHODS: In February 2017, a literature search in five databases (EMBASE, MEDLINE, CINAHL, Academic Research Premier, and Cochrane Reviews and Trials) was conducted. Inclusion criteria was quantitative study designs including randomized and nonrandomized controlled trials that included patients aged 18 years and older diagnosed with any of the four main NCDs. Lifestyle outcomes were physical activity, physical fitness, modification of dietary habits, and quality of life. All included studies were assessed for risk of bias using the Cochrane Collaboration`s risk of bias tool. Meta-analyses were conducted for one of the outcomes (glycated hemoglobin, HbA1c) by using the estimate of effect of mean post treatment with SD or CI. Heterogeneity was tested using the I2 test. All studies included in the meta-analyses were graded. RESULTS: Of the 1588 records examined, 9 met the predefined criteria. Seven studies included diabetes patients only, one study included heart patients only, and another study included both diabetes and heart patients. Statistical significant effect was shown in HbA1c in 5 of 8 studies, as well in body weight in one of 5 studies and in waist circumference in one of 3 studies evaluating these outcomes. Seven of the included studies were included in the meta-analyses and demonstrated significantly overall effect on HbA1c on a short term (3-6 months; P=.02) with low heterogeneity (I2=41%). In the long term (10-12 months), the overall effect on HbA1c was statistical significant (P=.009) and without heterogeneity (I2=0%). The quality of evidence according to Grading of Recommendations Assessment, Development and Evaluation was low for short term and moderate for long term. CONCLUSIONS: Our review demonstrated limited research of the use of smartphone apps for NCDs other than diabetes with a follow-up of at least 3 months. For diabetes, the use of apps seems to improve lifestyle factors, especially to decrease HbA1c. More research with long-term follow-up should be performed to assess the effect of smartphone apps for NCDs other than diabetes.

Association of excessive daytime sleepiness with migraine and headache frequency in the general population.

BACKGROUND: Some previous studies have postulated an association between migraine and excessive daytime sleepiness (EDS). This study evaluated the association of EDS with migraine and headache frequency in a general population, after adjusting for potential confounding variables. METHODS: The study was a postal survey of a random age and gender-stratified sample of 40,000 persons aged 20 to 80 years old drawn by the National Population Register in Norway. The questionnaire included questions about migraine, headache, the Epworth sleepiness scale (ESS) and various comorbidities. EDS was defined as ESS > 10. The association of EDS and migraine/headache were analysed by bivariate and multivariable logistic regression analyses. RESULTS: A total of 21,177 persons responded to the ESS and were included in the analyses. The odds ratio (OR) for EDS was increased for migraineurs (1.42 (95% CI 1.31─1.54), p < 0.001) compared to non-migraineurs; however, this finding was not significant after adjustment for a number of possible confounders. EDS increased with increasing headache frequency, with an OR of 2.74 (95% CI 2.05─3.65), p < 0.001) for those with headache on >179 days per year compared to those without headache in multivariable analysis. CONCLUSIONS: In a general population, the odds for EDS increased significantly with the headache frequency, irrespective of migraine status. EDS was not associated with reported migraine in multivariable analysis.

Improved Clinical Efficacy with Wound Support Network Between Hospital and Home Care Service.

OBJECTIVE: The aim of this study was to test the efficacy of a wound support network model between the primary home care service and the hospital. The impact on wound healing rate, cost benefit, and transfer of knowledge was investigated. INTERVENTION: The intervention group was exposed to a wound support network (n = 32), and the control group continued standard organization of treatment (n = 21). DESIGN: Nonrandomized controlled study; observations were made before (baseline) and after the implementation of the intervention (12 weeks). PATIENTS: Patients with chronic wounds (lasting >6 weeks and with wound area >1 cm) in Oslo, Norway. MAIN OUTCOME MEASURES: Closure of the observation wound; wound size; total number of wounds; presence of eczema, edema, and pain; number of dressings per week; time spent per dressing; and number of control appointments at the hospital. The economic impact is calculated for the hospital and for the community of Oslo, Norway. MAIN RESULTS: The number of control appointments (t = 3.80, P < .001) was significantly decreased, and the number of completed treatments (P = .02) was significantly increased after 12 weeks in the intervention group compared with the control group. A significant improvement was evident in the intervention group in terms of eczema (P = .02), edema (P = .03), and closing of the observational wound (46.7% cases in the intervention group versus 25.0% in the control group). CONCLUSIONS: A wound support network between the primary home care service and the hospital is cost-effective, improves clinical efficacy of the home care services' work, and reduces the need for consultations at the hospital.

The effect of employment support integrated in substance use treatment: A health economic cost-effectiveness simulation of three different interventions.

Background: Unemployment rates for individuals in treatment for substance use disorder (SUD) are high, with Norwegian estimates in the range of 81%-89%. Although Individual Placement and Support (IPS) represents a promising method to improved vocational outcome, cross-disciplinary investigations are needed to document implementation benefits and address reimbursements needs. The aim of this study was to model the potential socioeconomic value of employment support integrated in SUD treatment. Methods: Based on scientific publications, an ongoing randomised controlled trial (RCT) on employment support integrated in SUD treatment, and publicly available economy data, we made qualified assumptions about costs and socioeconomic gain for the different interventions targeting employment for patients with SUD: (1) treatment as usual (TAU); (2) TAU and a self-help guide and a workshop; and (3) TAU and IPS. For each intervention, we simulated three different outcome scenarios based on 100 patients. Results: Assuming a 40% employment rate and full-time employment (100%) for 10 years following IPS, we found a 10-year socioeconomic effect of €18,732,146. The corresponding effect for the more conservative TAU + IPS simulation assuming 40% part-time positions (25%) for five years, was €2,519,906. Compared to the two alternative interventions, IPS was cost-effective and more beneficial after six months to two years. Discussion: This concept evaluation study suggests that integrating employment support in the health services is socioeconomically beneficial. Our finding is relevant for decision makers within politics and health. Once employment rates from our ongoing RCT is available, real-life data will be applied to adjust model assumptions and socioeconomic value assumptions.

Sleep apnoea headache in the general population.

BACKGROUND: The objective was to investigate the prevalence and clinical characteristics of sleep apnoea headache. METHODS: A postal questionnaire was received by 40,000 Norwegians from the general population. A total of 376 and 157 persons with high and low risk of sleep apnoea according to the Berlin Questionnaire had a polysomnography, and a clinical interview and examination by physicians. RESULTS: Sleep apnoea headache was diagnosed in 11.8% of the participants with obstructive sleep apnoea (OSA), while morning headache with similar symptomatology was diagnosed in 4.6% of the participants without OSA (p = 0.002). After adjusting for potential confounders the odds ratio for OSA remained significantly increased among participants with morning headache with an adjusted odds ratio of 2.92 (1.31-6.51). When using a cut-off of moderate (apnoea hypopnea index, AHI ≥ 15) and severe (AHI ≥ 30) OSA, the prevalence of sleep apnoea headache was 11.6% and 13.3%, respectively. Average oxygen desaturation and lowest oxygen saturation was not significantly different in participants with OSA with and without morning headache. CONCLUSION: Morning headaches were significantly more frequent among participants with OSA than those without OSA. Sleep apnoea headache is less common in the general population than has previously been reported in clinic populations. The relation of hypoxia and morning headache is questioned.

Tension-type headache and sleep apnea in the general population.

The main objective of this study is to investigate the relationship between tension-type headache and obstructive sleep apnea in the general population. The method involves a cross-sectional population-based study. A random age and gender stratified sample of 40,000 persons aged 20-80 years residing in Akershus, Hedmark or Oppland County, Norway were drawn by the National Population Register. A postal questionnaire containing the Berlin Questionnaire was used to classify respondents to be of either high or low risk of obstructive sleep apnea. Included in this study were 297 persons with high risk and 134 persons with low risk of sleep apnea, aged 30-65 years. They underwent an extensive clinical interview, a physical and a neurological examination by physicians, and in-hospital polysomnography. Those with apnea hypopnoea index (AHI) ≥5 were classified with obstructive sleep apnea. Tension-type headache was diagnosed according to the International Classification of Headache Disorders. Results showed the prevalence of frequent and chronic tension-type headache was 18.7 and 2.1% in the participants with obstructive sleep apnea. The logistic regression analyses showed no significant relationship between tension-type headache and obstructive sleep apnea, with adjusted odds ratios for frequent tension-type headache of 0.95 (0.55-1.62) and chronic tension-type headache of 1.91 (0.37-9.85). The results did not change when using cut-off of moderate (AHI ≥15) and severe (AHI ≥30) obstructive sleep apnea. Thus, we did not find any significant relationship between tension-type headache and the AHI. The presence and severity of sleep apneas seem not to influence presence and attack-frequency of tension-type headache in the general population.

Migraine and sleep apnea in the general population.

Objective is to investigate the relationship between migraine and obstructive sleep apnea in the general population. A cross-sectional population-based study. A random age and gender stratified sample of 40,000 persons aged 20-80 years residing in Akershus, Hedmark or Oppland County, Norway, were drawn by the National Population Register. A postal questionnaire containing the Berlin Questionnaire was used to classify respondents to be of either high or low risk of obstructive sleep apnea. 376 persons with high risk and 157 persons with low risk of sleep apnea aged 30-65 years were included for further investigations. They underwent an extensive clinical interview, a physical and a neurological examination by physicians, and in-hospital polysomnography. Those with apnea hypopnoea index (AHI) ≥5 were classified with obstructive sleep apnea. Migraine without aura (MO) and migraine with aura (MA) was diagnosed according to the International Classification of Headache Disorders. MO and MA occurred in 12.5 and 6.8% of the participants with obstructive sleep apnea. The logistic regression analyses showed no relationship between the two types of migraine and obstructive sleep apnea, with adjusted odds ratios for MO 1.15 (0.65-2.06) and MA 1.15 (0.95-2.39). Further, estimates using cutoff of moderate (AHI ≥ 15) and severe (AHI ≥ 30) obstructive sleep apnea, did not reveal any significant relationship between migraine and the AHI. Migraine and obstructive sleep apnea are unrelated in the general population.

Enabling Guidelines for the Adoption of eHealth Solutions: Scoping Review.

BACKGROUND: Globally, public health care is under increasing pressure, an economic burden currently amplified by the COVID-19 outbreak. With the recognition that universal health coverage improves the health of a population and reduces health inequalities, universal health coverage has been acknowledged as a priority goal. To meet the global needs in a population with increased chronic illness and longer life expectancy, the health care system is in dire need of new, emerging technologies. eHealth solutions as a method of delivery may have an impact on quality of care and health care costs. As such, it is important to study methods previously used to avoid suboptimal implementation and promote general guidelines to further develop eHealth solutions. OBJECTIVE: This study aims to explore and thematically categorize a selected representation of early phase studies on eHealth technologies, focusing on papers that are under development or undergoing testing. Further, we want to assess enablers and barriers in terms of usability, scaling, and data management of eHealth implementation. The aim of this study to explore early development phase and feasibility studies was an intentional effort to provide applicable guidelines for evaluation at different stages of implementation. METHODS: A structured search was performed in PubMed, MEDLINE, and Cochrane to identify and provide insight in current eHealth technology and methodology under development and gain insight in the future potential of eHealth technologies. RESULTS: In total, 27 articles were included in this review. The clinical studies were categorized thematically by illness comparing 4 technology types deemed relevant: apps/web-based technology, sensor technology, virtual reality, and television. All eHealth assessment and implementation studies were categorized by their focus point: usability, scaling, or data management. Studies assessing the effect of eHealth were divided into feasibility studies, qualitative studies, and heuristic assessments. Studies focusing on usability (16/27) mainly addressed user involvement and learning curve in the adoption of eHealth, while the majority of scaling studies (6/27) focused on strategic and organizational aspects of upscaling eHealth solutions. Studies focusing on data management (5/27) addressed data processing and data sensitivity in adoption and diffusion of eHealth. Efficient processing of data in a secure manner, as well as user involvement and feedback, both throughout small studies and during upscaling, were the important enablers considered for successful implementation of eHealth. CONCLUSIONS: eHealth interventions have considerable potential to improve lifestyle changes and adherence to treatment recommendations. To promote efficient implementation and scaling, user involvement to promote user-friendliness, secure and adaptable data management, and strategical considerations needs to be addressed early in the development process. eHealth should be assessed during its development into health services. The wide variation in interventions and methodology makes comparison of the results challenging and calls for standardization of methods.

Lessons learned: no increase despite clinical suspicion of acute mastoiditis.

Based on clinical information from one Norwegian hospital in 2005, an increase in childhood acute mastoiditis was postulated, but later nationally disproved. Our purpose was to explore the discrepancy between the clinically raised suspicion and Norwegian treatment data. Complete Norwegian data on children aged 0-16 hospitalized for acute mastoiditis in the period 1999-2005 was analyzed to study national variation in incidence by hospital, treatment region and age of hospitalization. In children below age 16 hospitalization rates for acute mastoiditis ranged from 4.9 to 6.3 from 1999 to 2005 and did not did not show an increase. The proportion of children below age two was stable throughout the study period. Although the number of children at Rikshospitalet (the National Hospital) varied from 6 to 21 during the study period, the pattern of childhood hospitalizations for acute mastoiditis in the region showed no variation in the same period of time. In conclusion, our study did not find evidence for an increase in acute mastoiditis hospitalizations. The postulated increase is likely a result of the reduction of otolaryngologic university departments from two to one in Oslo in 2004 and corresponding work-load increase at the remaining hospital, Rikshospitalet. In our opinion, health information presented as popular science may contribute to confusion rather than increasing understanding of complicated health issues.

Acceptability, usability and utility of a personalised application in promoting behavioural change in patients with osteoarthritis: a feasibility study in Norway.

OBJECTIVE: The dynamic and interactive mobile application Vett was designed to help change behaviour and is based on cognitive, motivational and visual techniques. Our aim is to investigate the acceptability, usability and utility of Vett as a personalised application for goal achievement. SETTING: The trial took place at the rheumatology clinic at Diakonhjemmet Hospital, Oslo, Norway from January to June 2015. PARTICIPANTS: Twelve participants with osteoarthritis were recruited from a 3.5-hour multidisciplinary group-based educational programme (osteoarthritis school). INTERVENTIONS: With the help of a physician, each participant followed a customised 12-week mixed-mode goal achievement plan with digital support based on preset goals, self-monitoring and individual feedback. Acceptability was measured as the perceived degree of goal achievement using a validated habit questionnaire scaled from 0 to 100. Utility and usability were assessed via 10 weekly questions and adherence by fulfilment of predetermined tasks. RESULTS: Mean goal achievement was 73 (95% CI 68 to 78), an increase of 22 (95% Cl 17 to 26, p<0.01), which equals 48% improvement (95% CI 32% to 59%). Mean user satisfaction was 81 (95% CI 76 to 85), and technical usability was 80 (95% CI 75 to 84), which both increased during the study period. CONCLUSION: The high levels of acceptability, usability and utility support the feasibility of the personalised application Vett as a viable goal achievement tool.

Trends in otitis media surgery: a decrease in adenoidectomy.

OBJECTIVE: Large variability in adenoidectomies and tympanostomy tube insertions between Norway and Finland has been suggested, but not yet confirmed. Objective is to compare trends in paediatric adenoidectomies and tympanostomy tube insertions for Norway and Finland from 1999 to 2005. METHODS: National Finnish and Norwegian databases (STAKES and NPR) provided information on children between 0 and 7 years operated in the years 1999-2005. Surgical rates were viewed in the light of child density, age and gender, and compared bi-nationally. RESULTS: Adenoidectomies were more common in Finland throughout the study period. Adenoidectomies in both countries decreased markedly from 1999 to 2005. The Finnish adenoidectomy rates were reduced from 212 to 133 per 10,000 children, equivalent Norwegian figures were 84 and 44 per 10,000 children. Tympanostomy tube insertions increased from 97 to 147 per 10,000 children in Finland in the same study period. In Norway the rates were more stable, 119 and 123 per 10,000 in 1999 and 2005, respectively. Peak-age for otitis media surgery was the second year of life in Finland, sixth in Norway. Boys were more frequently operated on in both countries. CONCLUSION: Our study confirmed differences in the approach to otitis media surgery and revealed a decreasing trend in adenoidectomies in both countries. Similar data from other countries is needed to confirm the latter.

Acute mastoiditis in Norway: no evidence for an increase.

OBJECTIVE: In a large Norwegian newspaper in November 2005, an otolaryngologist at Rikshospitalet claimed that the increasing number of children hospitalized for acute mastoiditis was worrying and questioned the restrictive use of antibiotics in Norway. Based on latter he recommended that all children below age 2 with symptoms of uncomplicated acute otitis media should receive antibiotics. Our purpose was to incidence variation and characteristics of acute mastoiditis in children. METHODS: Registry based study with complete data on hospitalization for acute mastoiditis and cortical mastoidectomy in Norway during 1999-2005. RESULTS: Three hundred and ninety-nine Norwegian children aged 0-16 years were included. The incidence of acute mastoiditis in children below 2 ranged from 13.5 to 16.8 per 100,000 during the study period. Corresponding numbers for children 2-16 years were 4.3-7.1 per 100,000 children. No incidence increase was found during the study period. Age-specific incidence revealed a peak during the second and third year of life, and acute mastoiditis was most common in boys. Cortical mastoidectomy was equally common in the young and older age group, 22% received surgery. For children aged 2 and above, significantly fewer children were hospitalized for acute mastoiditis media during the period July, August and September. CONCLUSION: Despite the introduction of restrictive Norwegian guidelines for antibiotic treatment of acute otitis media in children aged 1 year and above, our data did not give evidence for an increase in acute mastoiditis. Except for the high incidence of acute mastoiditis in young children, hospitalization characteristics were remarkably similar in children below and above 2 years.

Otitis media surgery: large variability between Finland and Norway.

OBJECTIVE: Bi-national comparison of surgical treatment for paediatric otitis media. METHODS: Registry based cross-sectional study with complete data on surgery for otitis media in 2002; 21,811 Finnish and Norwegian children aged 0-16 years. RESULTS: Total rates for otitis media surgery were 82.5 and 146.5 per 10,000 children in Norway and Finland, respectively. Adenoidectomies were four times more frequently performed in Finland and rates for tympanostomy tube insertions differed 2-3-fold, Finland having the higher rate. The contrast in surgery rates was most striking in the age group 0-2 years. Further, the more sparsely populated regions had significantly higher overall surgery rates. CONCLUSION: The large variability in the incidence of otitis media surgery between two similar countries questions whether present guidelines ensure equal treatment in similarly affected children and pinpoints the difficulty in giving advice on age, time and type of surgery.

Paediatric otitis media surgery in Norway.

CONCLUSIONS: In Norway there are large, regional differences in the incidence of surgery and combinations of surgery for otitis media. OBJECTIVES: A descriptive study of complete national administrative data on frequency of surgery for otitis media in 2002. MATERIALS AND METHODS: This study analysed anonymous patient data from the Norwegian patient registry for 2002 and measured rates of tympanostomy tube insertions, myringotomy and the combinations of adenoidectomies and tympanostomy tubes and myringotomy, respectively. Surgical rates were assessed by region and variations within the country were evaluated. RESULTS: The peak age for surgical treatment of otitis media was 5 years. Tympanostomy tubes were inserted in more than half of the children treated and the analysis showed considerable regional variation in the rates and in choice of surgical treatment.

Finnish adenoidectomy and tympanostomy rates in children; national variation.

OBJECTIVES: To assess upper respiratory surgery rates in Finnish children and compare the rates of adenoidectomy and tympanostomy tubes in 2002 with the 1987 cohort. METHODS: Descriptive study of national upper respiratory surgery in Finland in 1987 and 2002; adenoidectomies, tympanostomy tubes and combination of these two. Surgical rates were viewed in the light of child density and number of primary care physicians and otorhinolaryngologists. RESULTS: Rates of adenoidectomy and tympanostomy tubes were highest in Western Finland and lowest in Eastern Finland (p<0.00001). Peak-age for adenoidectomy and tympanostomy tubes was in the second year of life. Surgery was most common in boys (p<0.00001). Both the numbers of otorhinolaryngologists and operations increased from 1987 to 2002; the largest surgery increase, 7.3%, was found in Western Finland. CONCLUSION: Large national differences in rates of paediatric adenoidectomy and tympanostomy tubes in Finland propose that national guidelines have not had an impact on the selection of children for surgery.

The reliability of self-reported childhood otitis media by adults.

OBJECTIVE: To estimate reliability of retrospective questionnaire data on childhood recurrent otitis media, and to identify factors influencing inconsistency in self-report. METHODS: Retrospective questionnaire data from a population-based sample of 4430 Norwegian twins who participated in two questionnaire surveys, 6 years apart, containing identical questions on otitis media. Main outcome measure was individual consistency in reporting of otitis media. The tetrachoric correlation and Cohen's Kappa were used to measure reliability. Inconsistent and consistent responders were compared on medical history and mental distress. The use of twin data made it possible to test whether inconsistent responders represent a group with intermediate levels of otitis media severity. RESULTS: The test-retest tetrachoric correlation was 0.82 and Kappa was 0.53. Inconsistency in response was not associated with mental distress, but related to reported number of otitis media episodes per year, use of medical services and history of ear surgery. CONCLUSION: Retrospective self-reported otitis media is a relatively reliable measure. The study suggests that reporting inconsistency is likely to be associated with less severe disease. The finding that reporting pattern is related to disease severity is in accordance with the proposed need for a uniform agreement on the definition of the term "recurrent otitis media" for research purposes.

Recurrent otitis media and tonsillitis: common disease predisposition.

OBJECTIVE: To estimate the relative contribution of genetic and environmental effects to the association between recurrent otitis media and recurrent tonsillitis. METHODS: Self-report questionnaire data from a population-based cohort of 9479 Norwegian twins born from 1967 to 1979. Recurrent otitis media and recurrent tonsillitis were main outcome measures. Structural equation modelling was used to fit alternative biometric models to the twin data and to estimate the relative contribution of genetic and environmental effects to the association between otitis media and tonsillitis. RESULTS: The lifetime prevalence was 11.7% (95% CI: 11.0-12.3) for recurrent tonsillitis and 11.2% (95% CI 10.5-11.9) for recurrent otitis media. Tetrachoric correlations were greater in monozygotic than in dizygotic twins in both males and females. A model specifying additive genetic effects and individual environmental effects for otitis media and tonsillitis and non-additive genetic effects for tonsillitis yielded the best fit. There was no evidence for sex differences in the genetic source or magnitude of the genetic effects. There was a substantial overlap in genetic factors influencing variation in liability to otitis media and tonsillitis. CONCLUSION: Common genetic factors contribute substantially to comorbidity between recurrent otitis media and recurrent tonsillitis.

Heritability of recurrent tonsillitis.

OBJECTIVE: To estimate the relative contribution of genetic and environmental effects on the variance in the liability of recurrent tonsillitis. DESIGN: Retrospective questionnaire data from a population-based cohort. SETTING: Population-based data from Norway. PARTICIPANTS: A total of 9479 Norwegian twins born between January 1, 1967, and December 31, 1979, identified through the Medical Birth Registry of Norway. Main Outcome Measure Recurrent tonsillitis. RESULTS: The lifetime prevalence of recurrent tonsillitis was 11.7% (95% confidence interval, 11.0%-12.3%), with a significant predominance of female cases. The tetrachoric correlations for monozygotic twins were 0.71 for males and 0.60 for females. For dizygotic twins, the correlations were 0.12 for males, 0.14 for females, and 0.24 for dizygotic pairs of opposite sex. Structural equation modeling indicated that genetic effects explained 62% of the variation in the liability of recurrent tonsillitis. The remaining variance was attributed to individual environmental effects. There was no evidence of sex-specific genetic effects on the liability of recurrent tonsillitis. CONCLUSION: There is evidence for a substantial genetic predisposition for recurrent tonsillitis.

Obstructive sleep apnea in younger school children with Down syndrome.

OBJECTIVE: We aimed to assess the prevalence of obstructive sleep apnea (OSA) in 8 year old school children with Down syndrome (DS). While the prevalence in otherwise healthy children is below 5%, the prevalence estimates in children with DS are uncertain (30-80%). OSA directly affects cognitive development and school performance. STUDY DESIGN: Population based cross sectional study in a limited geographical area. METHODS: Polysomnography (PSG) with video and audio recordings was performed in 8-year-old children with DS in a pediatric sleep unit according to the guidelines of American Academy of Sleep Medicine. Twenty-nine of all 32 children with DS within a restricted area comprising >50% of the Norwegian population and 54% of the children with DS born in Norway in 2002 were enrolled. RESULTS: This study reports an apnea hypopnea index AHI>1.5 in 28 of 29 children and an obstructive apnea index (OAI)>1 in 24 of 29 children. 19 children (66%) had an AHI>5 and 17 children (59%) had an OAI>5 which indicated moderate to severe OSA. No correlation was found between OSA and obesity or gender. CONCLUSION: The high prevalence of disease found in these previously undiagnosed 8-year-old children underlines the importance of performing OSA diagnostics in children with DS throughout childhood. These findings suggest that the prevalence of OSA remains high up to early school years. In contrast to earlier publications, this current study has the advantage of being population based, the study is performed on children of a narrow age band to estimate prevalence of disease and the diagnostic gold standard of PSG is applied.

Hospitalization for acute otitis media as a useful marker for disease severity.

BACKGROUND: An increase in severe complications to otitis media is a potential threat to antibiotic restrictions and is difficult to measure due to its low-prevalent nature. Easily accessible indicators sensitive to illness change are needed to benchmark the judicious use of antibiotics. OBJECTIVE: To investigate whether there has been a constant increase of hospital admissions for acute otitis media after the year 2000. METHODS: Registry-based study with complete data on hospitalization for acute otitis media and acute mastoiditis in Norway during 1999 to 2006. RESULTS: Mean incidence rate for acute otitis media hospitalization was 22.4 per 10,000 children and peak incidence in the second year of life 52.2 per 10,000 children. Corresponding mean incidence rate and peak incidence for acute mastoiditis were 1.5 and 3.5 per 10,000 children in the second year of life, respectively. There was a gradient increase of the incidence rates of acute otitis media hospitalization from the year 2000 to 2006 considering the Poisson regression model with a significant test of linear trend. CONCLUSIONS: Hospital admission for acute otitis media is prevalent enough to be a useful marker for otitis media severity and its distribution proportionate to that of acute mastoiditis.