Det helsevitenskapelige fakultet

Age-related macular degeneration: Prevalence and risk factors - a cross-sectional study : The Tromsø Study 2007/2008

Thu, 30 May 2013 00:00:00 GMT

Erke, Maja Gran
Age-related macular degeneration (AMD) is an important cause of visual impairment and blindness worldwide. The number of people affected by the disease is expected to rise due to increasing longevity. Development of adequate eye care for these patients should be based on knowledge about the prevalence of AMD. Further, preventive measures are the best strategy for any disease. The aims of this thesis were to estimate the prevalence of AMD and examine risk factors associated with AMD. We described prevalence rates of AMD among Caucasian elderly participants from the Tromsø Eye Study, a population-based study in Norway. The overall prevalence of late AMD was 3.5 % among the participants aged 65-87 years old. Neovascular AMD outnumbered geographic atrophy. Symmetry between eyes was relatively low. Prevalence increased strongly with age. No significant sex differences in prevalence rates of AMD were observed. Refractive error was lower in eyes with late AMD than in eyes without late AMD. We then analysed relationships between traditional cardiovascular risk factors and AMD. Daily smoking was a strong predictor for the presence of late AMD. We found a significant interaction between age and sex for late AMD, suggesting that age may be a stronger risk factor for late AMD in women than in men. Higher systolic blood pressure, higher pulse pressure, infrequent physical exercise and overweight or obesity were in adjusted analyses associated with late AMD in females, but this was not observed in men. Based on our observation of sex and AMD, we studied associations between female hormone related factors and AMD. We found a significant inverse relationship between duration of lactation and late AMD. No significant relationships were found between late AMD and exogenous oestrogen exposure in the form of contraceptives or hormone therapy. Nor did we find an association between late AMD and onset, end or length of fertile years, bilateral oophorectomy or parity as surrogate measures.
The papers of this thesis are not available in Munin:
1. Bertelsen G, Erke MG, von Hanno T, Mathiesen EB, Peto T, Sjølie AK and Njølstad I.: 'The Tromsø Eye Study: study design, methodology and results on visual acuity and refractive errors', Acta Ophthalmologica (2012), Online before print. Available at http://dx.doi.org/10.1111/j.1755-3768.2012.02511.x
2. Erke MG, Bertelsen G, Peto T, Sjølie AK, Lindekleiv H and Njølstad I.: 'Prevalence of Age-Related Macular Degeneration in Elderly Caucasians: The Tromsø Eye Study', Ophthalmology (2012), vol.119(9):1737–1743. Available at http://dx.doi.org/10.1016/j.ophtha.2012.03.016
3. Erke MG, Bertelsen G, Peto T, Sjølie AK, Lindekleiv H and Njølstad I.: 'Cardiovascular risk factors associated with agerelated macular degeneration: The Tromsø Study' (manuscript)
4. Erke MG, Bertelsen G, Peto T, Sjølie AK, Lindekleiv H and Njølstad I.: 'Lactation, female hormones and age-related macular degeneration: The Tromsø Study' (manuscript)

Effects of anodal transcranial direct current stimulation on experimentally induced heat pain in healthy volunteers

Wed, 02 May 2012 00:00:00 GMT

Vasylenko, Olena
Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulatory technique that can reduce pain. Its side effects are milder than those of pharmacological treatments, and its analgesic effect on chronic pain has been demonstrated. In this study we investigated 1) the effects of anodal tDCS on pain intensity and threshold, 2) the placebo component of tDCS analgesic effect, and 3) whether stress and negative affect moderate the analgesic effect of tDCS. Sixty-four participants (32 females) received three blocks of heat stimuli, 43° C, 45° C, and 47° C in each block. The treatment group received anodal tDCS of 2 mA intensity for 7 minutes, the placebo group received sham stimulation for 30 seconds, and the natural history group received painful stimuli only. Participants rated pain intensity with CoVAS. Threshold was measured before the first and after the last block. Subjective stress was measured by two SACL items, and negative affect was measured by FPQ, PANAS, and BFI questionnaires. Compared to no treatment, tDCS reduced pain by 28%, for 47° C stimuli only. Compared to sham stimulation, tDCS reduced pain by 11%, but this reduction was only marginally significant. There was no placebo response, and no effect of tDCS on pain threshold. Fear of medical pain predicted pain reduction by tDCS, higher fear of medical pain was associated with larger pain reduction. Our findings confirm and extend those of earlier experimental and clinical studies.

Seksuelle script i norske swingers-miljøer. En kvalitativ intervjustudie.

Fri, 27 Apr 2012 00:00:00 GMT

Bentzen, Anne Sofie
Formålet med denne studien var fra en fenomenologisk tilnærming å utforske swinging i en norsk kontekst, med fokus på hvilke seksuelle script som gjelder i swinging på ulike sosiale arenaer. Kvalitative intervjuer med seks menn og seks kvinner ble gjennomført. Av informantene var det fem par, en gift mann og en singel kvinne, rekruttert fra internettgrupper for swingere. En semi-strukturert intervjuguide ble brukt. Informantens opplevelse av fenomenet swinging ble vektlagt, med en bakenforliggende forståelse i tråd med Schutz teori om multiple virkeligheter. Sjalusi ble ikke rapportert som et vanlig problem. Mulighet til å utforske egen seksualitet, se sin partner ha sex med andre, samt styrket selvbilde, ble rapportert som positive følger. Negative holdninger til mannlig biseksualitet, frykt for seksuelt overførbare infeksjoner og nødvendighet av hemmelighold, ble rapportert som problematiske følger av livsstilen. Det valide seksuelle scriptet i swingerskulturen var tydelig beskrevet innenfor rammene av swingers-klubbene, og fysiske tilnærmelser hadde hovedrollen i de interpersonlige script. På private arenaer lånte swingers-scriptet elementer fra tilgjengelige script utenfor denne subkulturen, som venne- og kjærestescript i varierende grad. Informantene opplevde at deres fantasier og etablerte intrapsykiske script fikk utløp i atferd på swingers-arenaen. De mente at swinging hadde positiv effekt både for dem personlig, og for deres parforhold. De negative effektene som ble rapportert hadde liten effekt på opplevd livskvalitet.; The aim of the study was from a phenomenological approach to explore swinging in a Norwegian context, focusing on sexual scripts in various social arenas. Qualitative interviews with six men and six women, was conducted. The informants included five heterosexual couples, one married man and one single woman. They were recruited from internet groups for swingers. A semi structured interview guide was used. The participant's experience of the phenomenon of swinging was emphasized, with an underlying understanding in line with Schutz's theory of multiple realities. Jealousy was not reported as a common problem. The opportunity to explore their own sexuality, see their partner have sex with others as well as enhanced self-esteem, were reported as positive consequences. Negative attitudes of male bisexuality, fear of sexually transmitted infections and the necessity of secrecy, was reported as problematic consequences of the lifestyle. The valid sexual script in the swinging culture was clearly described in the framework of swingers clubs. Physical approach was most commonly used in interpersonal scripts. On private arenas the swingers script used elements from available scripts from outside the subculture, like friend and dating scripts, to different degrees. The participant's felt that the swinging arena gave them the possibility to try out fantasies, and had room for expressing preestablished intrapsychic scripts. They felt that swinging had positive effects for them personally, as well as for their relationship. The negative effects that were reported had little effect on perceived quality of life.

Partial characterization of predicted ABCC5 inhibitors by the aid of human erythrocyte inside-out vesicles

Fri, 24 Jun 2011 00:00:00 GMT

Ørvoll, Elin
ABCC5 is a member of the superfamily of ABC-transporters, and it has been identified as an efflux transporter of cGMP. This transporter is also involved in export of antibiotic and cytostatic drugs from target cells, and as such represents a challenge in treatment of cancer and infectious diseases. In order to find inhibitors to ABCC5 mediated drug efflux, compounds predicted as potent inhibitors by virtual ligand screening (VLS) were chosen for in-vitro studies by the use of human erythrocyte inside-out vesicles (IOV). The procedure for IOV preparation was improved, and transport assays were performed where the inhibiting effects of the various compounds on transport of cGMP into inside-out vesicles were measured. Several of these compounds showed a potent inhibiting effect on cGMP transport, and the few that were chosen for further characterization showed more potent inhibition of ABCC5 than the known ABCC5 and PDE5 inhibitor sildenafil.

HPV mRNA testing in triage of women with ASC-US cytology may reduce the time for CIN2+ diagnosis compared with repeat cytology.

Tue, 01 Jan 2013 00:00:00 GMT

Sørbye, Sveinung Wergeland; Fismen, Silje; Gutteberg, Tore Jarl; Mortensen, Elin Synnøve; Skjeldestad, Finn Egil
Background: In delayed HPV triage women with atypical squamous cells of uncertain significance (ASC-US) cytology are retested after 6-12 months in order to decide whether they should be referred for colposcopy, further follow-up cytology or routine screening in three years. Triage using a specific HPV E6/E7 mRNA test may reduce referrals for colposcopy of women with ASC-US cytology compared to HPV DNA testing. We explored whether HPV mRNA triaging could reduce the time from ASC-US index cytology to biopsy compared with repeat cytology, and whether the positive predictive value (PPV) of the HPV mRNA test for high grade cervical intraepithelial neoplasia (CIN2+) was comparable with the PPV of repeat cytology. Material and methods: We used repeat cytology and the HPV mRNA test PreTect HPV-Proofer, which detects E6/E7 mRNA from HPV subtypes 16, 18, 31, 33 and 45, in the triage of women with ASC-US. We included all women from the two northernmost counties of Norway with a first ASC-US cytology during the period 2004-2008. Two triage methods were evaluated 1) only repeat cytology (n=964) and 2) both HPV mRNA testing and cytology (n=542). Histologically confirmed CIN2+ was the study endpoint. Results: Among 1506 women with an ASC-US index cytology, 59 women (3.9%) had biopsy taken, of whom 49 women had CIN2+ (PPV 83.1%). The mean time from index ASC-US cytology until the case was resolved (biopsy or return to screening) was 10.6 months in the repeat cytology group and 7.3 months in the HPV group (P<0.001). Of the 964 women in the group with repeat cytology only, 35 women (3.6%) had biopsy and 30 had CIN2+ (PPV 85.7%). Of the 542 women in the group with both HPV test and cytology, 24 women (4.4%) had biopsy and 19 had CIN2+ (PPV 79.2%). Conclusion: In triage of women with ASC-US, the HPV mRNA test significantly reduced the time from the first abnormal cytology until biopsy and had predictive values comparable with those of repeat cytology.

Vitamin D, Depression and Headache - Results from the Tromsø Study and an intervention study with vitamin D

Fri, 19 Apr 2013 00:00:00 GMT

Kjærgaard, Marie
Vitamin D is well known for the effect in bone metabolism and calcium regulation. In the past decade increasing evidence that vitamin D might be important in other areas has emerged. Especially glucose metabolism, cardiovascular disease and infectious diseases have been investigated. In addition, several population studies have shown that an association between vitamin D and depression might be of importance. Furthermore, increasing headache prevalence with higher latitudes has led to theories about a relation between headache and vitamin D. Our analyses from the Tromsø Study confirm that low levels of vitamin D are associated with higher depression scores independent of lifestyle factors that might influence vitamin D. However, whether vitamin D has any effect in treatment of depression cannot be answered from this type of study. We further investigated this by treating 243 healthy persons with either vitamin D or placebo for six months and monitoring depression by use of questionnaires and interviews. We found no superior effect of vitamin D compared with placebo in our study, but other studies suggest vitamin D might be beneficial in persons with more severe depressive symptoms. Furthermore, we did analyses of the depression questionnaires used (BDI-II, HADS, MADRS), and found that they are solid instruments, which can also be used in a healthy population. The analyses of the data from the Tromsø Study in addition showed that Tension-Type Headache are associated with low vitamin D levels, but even though adjustment were made for lifestyle factors, it is possible that this association is caused by an unhealthy lifestyle in persons with headache. We did not find any association between vitamin D and migraine. Further studies are needed to confirm these findings.
The papers of this thesis are not available in Munin:
1. Paper I. Kjærgaard, M., R. Joakimsen, and R. Jorde: 'Low serum 25-hydroxyvitamin D levels are associated with depression in an adult Norwegian population', Psychiatry Research (2011), vol. 190(2-3):221-225. Available at http://dx.doi.org/10.1016/j.psychres.2011.06.024
2. Kjærgaard, M., K. Waterloo, C.E. Wang, B. Almås, Y. Figenschau, M.S. Hutchinson, J. Svartberg, and R. Jorde: 'Effect of vitamin D supplement on depression scores in people with low levels of serum 25-hydroxyvitamin D: nested case-control study and randomised clinical trial', British Journal of Psychiatry (2012), vol. 201(5):360-368. Available at http://dx.doi.org/10.1192/bjp.bp.111.104349
3. Kjærgaard M, C.E.A. Wang, K. Waterloo, and R. Jorde: 'A study of the psychometric properties of the Beck Depression Inventory-II, the Montgomery and Åsberg Depression Rating Scale and the Hospital Anxiety and Depression Scale in a healthy population' (manuscript)
4. Kjærgaard M, A.E. Eggen, E.B. Mathiesen, and R. Jorde: 'Association Between Headache and Serum 25-Hydroxyvitamin D; the Tromsø Study: Tromsø 6', Headache (2012), vol.52(10):1499-1505. Available at http://dx.doi.org/10.1111/j.1526-4610.2012.02250.x

Symptoms of respiratory tract infection and associated care-seeking in subjects with and without obstructive lung disease; The Tromso Study: Tromso 6.

Sun, 01 Jan 2012 00:00:00 GMT

Melbye, Hasse; Joensen, Lisa; Risør, Mette Bech; Halvorsen, Peder Andreas
Respiratory tract infections (RTIs) may be more severe in those with asthma or COPD and these patients are more frequently in need of health care. The aim of the study was to describe the frequency of RTI symptoms in a general adult population and how care-seeking is associated with the presence of obstructive lung disease. Cross-sectional data including spirometry and self-reported chronic diseases were collected among middle-aged and elderly subjects in the Tromso population survey (Tromso 6). Self- reported RTI symptoms, consultations and antibiotic use were the main outcome variables. Possible predictors of RTI symptoms were evaluated by multivariable logistic regression. Of the 6414 subjects included, 798 (12.4 %) reported RTI symptoms in the previous week. RTI symptoms were reported less frequently by subjects aged 75 years or above, than by those younger than 55 years (OR 0.5). Winter season (OR 1.28), current smoking (OR 1.60), low self-rated health (OR 1.26) and moderate to severe bronchial obstruction (OR 1.51), were also statistically significant independent predictors of RTI symptoms, but these variables did not predict RTI symptoms that had started within the previous seven days. Among subjects with RTI symptoms, 5.1 % also reported a consultation with a doctor. In those with bronchial obstruction by spirometry, who did not report asthma or COPD, this frequency was 2.4 %. Antibiotic treatment was reported by 7.4 % of the participants, among whom one third had consulted a doctor. Antibiotics were taken more frequently when asthma or COPD was reported (13.7 %), but not in subjects with bronchial obstruction who did not report these diseases (7.2 %). RTI symptoms seldom led to consultation with a doctor and not even in subjects with obstructive lung disease. This was in particular the case in subject who did not know about their obstructive lung disease. Strategies for early diagnosis of COPD and providing health care to subjects with such disease cannot rely on their doctor visits due to respiratory symptoms.

Co-constructing standards in nursing

Fri, 05 Apr 2013 00:00:00 GMT

Meum, Torbjørg
Avhandlingen presenterer en kvalitativ studie av innføring og bruk av standarder i sykepleie og bygger på empiriske studier fra ulike sykehusmiljø. Standardisering er ofte ansett som en viktig forutsetning for å oppnå sømløs integrasjon ved bruk av informasjons – og kommunikasjonsteknologi (IKT) i helsesektoren. Terminologier og retningslinjer blir ofte utviklet av internasjonale organisasjoner som involverer omfattende prosesser for å ivareta faglige og helsepolitiske krav. Når standarder blir tatt i bruk blir de en del av en lokal arbeidspraksis som er preget av et dynamiske miljø som transformeres i takt med utvikling av ny kunnskap, teknologi og samarbeidsstrukturer. Fokuset for avhandlingen er i dette spenningsfeltet og gir først og fremst økt teoretisk og empirisk innsikt i de gjensidige tilpasningene mellom universelle standarder og lokal praksis (ko-konstruksjon). Videre gir studien innsikt i de koordinerende egenskaper ved bruk av standarder som en integrert del av arbeidspraksis og kan også ha betydning for design og utvikling av prosesstøttende EPR systemer.
The papers of this thesis are not available in Munin:
1. Meum, T. and G. Ellingsen: '‘Sound of silence’ – changing from an oral to a computer-mediated handover', Behaviour & Information Technology (2011), vol. 30(4):479-488. Available at http://dx.doi.org/10.1080/0144929X.2010.547221
2. Torbjørg Meum, Gro Wangensteen, Harald Igesund, Gunnar Ellingsen and Eric Monteiro: 'Standardization – the iron cage of nurses' work', in Studies in Health Technology and Informatics (2010), Volume 157: Information Technology in Health Care: Socio-Technical Approaches. Available at http://dx.doi.org/10.3233/978-1-60750-569-3-85
3. Torbjørg Meum, Eric Monteiro and Gunnar Ellingsen: 'The Pendulum of Standardization', ECSCW 2011: Proceedings of the 12th European Conference on Computer Supported Cooperative Work, 24-28 September 2011. Available at http://dx.doi.org/10.1007/978-0-85729-913-0_6
4. Meum, Torbjørg and Ellingsen, Gunnar: 'Standardization in nursing practice: Cross-contextual information sharing', ECIS 2011 Proceedings. Paper 139. Available at http://aisel.aisnet.org/ecis2011/139
5. Meum, T.: '“Lost in Translation”: The Challenges of Seamless Integration in Nursing Practices' (manuscript).
6. Torbjørg Meum: 'Electronic medication management: a socio - technical change process in clinical practice', CSCW '12 Proceedings of the ACM 2012 conference on Computer Supported Cooperative Work (2012), Pages 877-886. Available at http://dx.doi.org/10.1145/2145204.2145335

Hva gjør sykepleierne for å ivareta den gamle pasienten som har delirium, og som er innlagt på sykehus ved en medisinsk avdeling

Wed, 16 Jan 2013 00:00:00 GMT

Sjøvoll, Monica
Denne masteroppgaven handler om sykepleiere sine erfaringer , vurderinger og handlinger fra sin sykepleiepraksis i møte med den gamle pasienten med delirium. Bakgrunn for denne studien er at jeg er opptatt av den gamle pasienten og har lang erfaring med å møte den gamle pasienten som sykepleier. Jeg er kjent med at delirium er en ganske vanlig tilstand som den gamle opplever på sykehus, og noen ganger begrunnelsen til at pasienten blir innlagt på sykehus. Forskning viser også at denne tilstanden er en utfordring på sykehus, og kan i noen tilfeller være vanskelig å identifisere og gi riktig behandling. Forskning viser også at forebygging av tilstanden fører til færre tilfeller av delirium. Forekomst kan forebygges dersom kunnskap, verktøy og rutiner er på plass. I den forbindelsen hadde jeg et ønske om å spørre sykepleierne om deres erfaring i møte med den gamle pasienten med delirium. Empirien i oppgaven er intervju med fem sykepleiere som arbeider ved en generell akuttmedisinsk avdeling på sykehus. Det er brukt intervju som metode for å få frem sykepleiernes erfaring fra praksisfeltet. Tema under intervjuene var: kunnskap om delirium, identifisering av delirium, tiltak og handlinger i sykepleiepraksis. Funn i studien er kort oppsummert: liten tid til pasienter med delirium, det hyperaktive delirium blir identifisert, det hypoaktive delirium er ikke kjent og blir ikke diagnostisert men kan bli oppfattet som demenssykdom eller depresjon .Ønske om mer kunnskap fra sykepleierne, og bedre arbeidsforhold i form av tilrettelegging av omgivelser for å kunne gi optimal sykepleie til pasienter med delirium. Konklusjon er at vi vet mye om delirium og verktøy som kan brukes for å forbygge denne tilstanden. Det er allikevel slik at det ikke er implementert anbefalte rutiner og bruk av verktøy for å avdekke og forebygge delirium. Nøkkelord: sykepleierfaringer, den gamle pasienten, delirium og sykehus

"Bloggen er jo et redskap mot sykdommen". Narrativ analyse av fortellinger fra bloggen til en ungdom med alvorlig kreftsykdom

Tue, 15 Jan 2013 00:00:00 GMT

Østvik, Eva
Hensikten med denne studien er å dokumentere og lære av erfaringene til ungdom som blir ramma av kreft i en sårbar fase av livet. Ved å studere fortellinger fra blogg til ungdom ved hjelp av narrativ metode kan vi få et innblikk i hvordan det oppleves og erfares å være livstruende syk når man er ung og står på “terskelen til livet”. Målet er å gjøre ungdom mer synlig i vårt helsevesen, og bidra til at deres møter med helsevesenet blir så optimalt som mulig. Andre ungdommer i lignende situasjon kan muligens kjenne seg igjen og på den måten få støtte og bekreftelse på sine opplevelser. Narrativ metode kan karakteriseres som en del av kvalitativ metode, der fortellingene blir sett på som en avgjørende kilde for å undersøke menneskers erfaringer, handlinger og forståelse. I denne studien gjøres narrativ analyse av fortellingene i bloggen til en gutt. Jeg definerer fortellingene som identitetsskapende og sosiale handlinger. Mennesket har alltid presentert verden og seg selv gjennom fortellinger i sosialt samspill med andre. Bloggen består av fortellinger om kroppen, fortellinger om relasjoner og fortellinger om slutten. Kunnskapen som formidles gjennom fortellingene bidrar til å forstå hva som skjer med kroppen ved alvorlig kreftsykdom og behandling. Å fortelle bidrar til mestring. Å fortelle kan oppleves meningsfullt gjennom at fortellingen bidrar til å fastholde det som betyr noe, eller at fortellingen kan hjelpe andre. Fortellingene er identitetsskapende gjennom at man fremstiller seg slik man ønsker å bli oppfattet. Fortellingene er sosiale handlinger gjennom at de utvikles på bakgrunn av relasjonen til den som leser. I tillegg bidrar de til å holde kontakt med omverden.