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Browsing Doktorgradsavhandlinger (Helsefak) by Author
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Abelsen, Birgit (Doctoral thesis; Doktorgradsavhandling, 04-Dec-2009)[+][-]
Abstract: The organisation and financing of the Norwegian oral health care differ compared to general health care. The public responsibility for general health care includes the whole population, and the scope is universal coverage involving public finance, and historically public provision as well. Concerning oral health care, there seems to be less emphasis on providing the same level of service to all citizens. The limited public responsibility for providing oral health care leaves Norwegian dentistry dominated by private providers, and most adults faced with paying all costs themselves when they seek dental services. These aspects have potential distributional consequences, which are only explored to some extent in the research literature. On a general level, the research problems focused in this thesis concern different issues on provision and access to dental services in Norway. The present thesis is a collection of four separate papers. The introduction outlines theoretical and empirical aspects concerning the financing, government, need for, and the regulations of Norwegian oral health care, reflecting the different aspects of the four papers. The introduction also includes general methodological issues that are relevant for the empirical analyses. My scientific approach draws from multi disciplinary perspectives and theoretical frameworks. My basic perspective, however, is health economics, although I also focus on perspectives from sociology, political science, and critical theory. The thesis documents large geographical differences in dental attendance and self rated oral health among Norwegian adults. It also inquires as to health policy reasoning to explain why free pricing and free establishment rights for private dentists remain characteristic features of Norwegian dentistry. Description: Papers number 2 and 3 of the thesis are not available in Munin due to publishers' restrictions. Paper 4 is a manuscript and not available in Munin:
2. Birgit Abelsen and Jan A. Olsen: «Task division between dentists and dental hygienists in Norway», Community Dentistry and Oral Epidemiology (2008), Volume 36 Issue 6, Pages 558-566 (Wiley). Available at http://dx.doi.org/10.1111/j.1600-0528.2008.00426.x
3. Birgit Abelsen: «What a difference a place makes: Dental attendance and self-rated oral health among adults in three counties in Norway», Health & Place, Volume 14, Issue 4, December 2008, Pages 829-840 (Elsevier). Available at http://dx.doi.org/10.1016/j.healthplace.2008.01.003
4. Birgit Abelsen: 'On the absence of regulations of adult dental services in Norway: A critical discourse analysis' (manuscript)URI: http://hdl.handle.net/10037/2360 File(s) in this item: 2
paper_1.pdf (407.9Kb)thesis.pdf (693.3Kb) -
Agledahl, Kari Milch (Doctoral thesis; Doktorgradsavhandling, 22-Sep-2011)[+][-]
Abstract: All of clinical work also has a moral dimension since the purpose of health care is to help patients. The aim of this project is to understand how doctors deal with these moral dimensions of clinical work. The field of bioethics has largely emerged as a philosophically founded discipline, without taking into account how doctors already handle moral values as a tacit or implicit part of their clinical work. This has caused a gap between medical ethics and medical practice. This research contains data from two qualitative studies: observations and interviews with 17 general practitioners and hospital doctors, and observations of 101 video recorded patient consultations in hospital. The doctors focused exclusively on medical issues in the encounters, even if their patient’s worries could be related to more personal and existential parts of the patient’s life. Patients’ personal worries were systematically ignored by the doctors. In order to help their patients by the use of their biomedical knowledge of anatomy and bodily processes, the doctors often handled their patients as objects. However, for patients it is morally offensive to be rejected and treated as medical objects, and it might feel very unpleasant. The doctors, who often kept a good tone in the consultations, did not appear to recognise their concurrent moral offence. Our research suggests that these moral infringements might be unavoidable in medical work, but that doctors, nonetheless, ought to be aware of the distress they cause and how they can reduce it. URI: http://hdl.handle.net/10037/3616 File(s) in this item: 5
paper_1.pdf (140.8Kb)paper_2.pdf (91.91Kb)paper_3.pdf (176.1Kb)thesis_entire.pdf (6.288Mb)(more files) -
Ahlen, Maria Therese (Doctoral thesis; Doktorgradsavhandling, 31-Mar-2011)[+][-]
Abstract: The immune system is efficiently protecting us against infections by recognizing foreign structures; however it can occasionally cause complications during pregnancy by eliciting immune responses against foetal blood cells. Blood platelets have surface proteins that exist in different variants in the population. Those that are known to be a target for alloimmune responses are referred to as human platelet antigens (HPA). In cases where the foetus has inherited an HPA-determinant from its father that differs from the mother’s own, there is a risk of immunisation. Maternal antibodies are transferred over the placenta to the foetus during pregnancy, where platelet-reactive antibodies can cause depletion of foetal platelets and increase the risk of bleeding – a condition defined as neonatal alloimmune thrombocytopenia (NAIT). There is currently no treatment that can prevent immunisation. The vast majority of NAIT cases are due to incompatibility in the HPA-1 system, defined by a single amino acid difference (Leu33/Pro33) in β3-integrin on platelets. The knowledge of the underlying cellular mechanisms that result in production of maternal platelet-reactive antibodies has been limited. This thesis sheds light on cellular mechanisms, by characterizing HPA-1a-specific T cells isolated from HPA-1a-immunised women who have given birth to a child affected by NAIT. Formal evidence for these cells is important, as antigen-specific T cells are generally orchestrating any given antigen-specific immune response. Furthermore, the characteristics of these HPA-1a-specific T cells were studied; both regarding specific recognition and HLA-restriction. The MHC class II allele HLA-DRB3*01:01 is known to be associated with alloimmunisation with HPA-1a. However, the HLA class II genes are located in close proximity on the chromosome, and are therefore inherited in confined entities defined as haplotypes. The DRB3*01:01 allele seen in HPA-1a immunised women are associated with only a few DR-DQ haplotypes. The results indicate that other properties of the DR3-DQ2, additional to the HLA-DRB3*01:01, can influence immunisation. The understanding of the cellular reactions that results in production of anti-HPA-1a antibodies and subsequent NAIT, are important for potential treatment strategies to prevent immunisation. Description: The papers in this thesis are not available in Munin:
1. Ahlen MT, Husebekk A, Killie MK, Skogen B and Stuge TB: 'T cell responses associated with neonatal alloimmune thrombocytopenia: Isolation of HPA-1a-specific, HLA-DRB3*01:01-restricted CD4+ T cells', Blood 2009;113(16):3838-44 (publishers restriction). Available at http://dx.doi.org/10.1182/blood-2008-09-178475
2. Ahlen MT, Husebekk A, Killie IL, Haney D, Betts MR, Skogen B and Stuge TB: 'T cell responses associated with neonatal alloimmune thrombocytopenia: HPA-1aspecific T cell clones recognize a “self”-epitope that does not include the allogeneic Leu33 residue' (manuscript)
3. Ahlen MT, Heide G, Husebekk A, Skogen B, Kjeldsen-Kragh J and Stuge TB: 'HLA-DR-DQ haplotypes in HPA-1a-immunised women: DR3-association is stronger than expected by random distribution' (manuscript)URI: http://hdl.handle.net/10037/3100 File(s) in this item: 1
thesis.pdf (853.6Kb) -
Aljabri, Mohammad Belal (Doctoral thesis; Doktorgradsavhandling, 26-May-2011)[+][-]
Abstract: In this thesis different factors that promote or inhibit heart remodelling induced by angiotensin II were studied. The following conclusions can be drawn: 1. The presence of elevated levels of Ang II in the perfusion buffer did not increase myocardial injury during ischemia-reperfusion. However, the ability to protect the heart by ischemic postconditioning was lost. This seemed to be due to blockade of ERK1/2 signalling and GSK3-β inhibition induced by postconditioning. Elevated levels of Ang II, which is seen in untreated cardiovascular disease and in kidney disease, could therefore contribute to limit the outcome of the potential clinical use of postconditioning. 2. Non-compensatory (non-hypertrophic) heart remodelling was triggered by high-dose Ang II. This leads to changes in the contractile apparatus and reduced tolerance to ischemia in the absence of cellular hypertrophy. Increased expression of key genes involved in fibrosis was followed by an increase in interstitial fibrosis in heart tissue, which partly explains the post ischemic diastolic dysfunction. 3. Pregnancy did protect against the detrimental effects of Ang II since cardiac remodelling, fibrosis and reduced vessel density were less prominent in pregnant rats. 4. Iso treatment induced heart hypertrophy in both genders, but increased fibrosis was found only in males. Unlike the situation with exposure to high concentrations of Ang II, female gender did protect against the increase in fibrosis after Iso treatment. In summary, we can conclude that female gender and the unique female physiological status of pregnancy protect the heart, and provide a better handling of various stress stimuli after moderate Ang II and β-adrenergic influence. When the angiotensin II exposure reaches sub-toxic levels the protection afforded by female gender is lost. Description: Papers number 1, 3 and 4 of this thesis are not available in Munin:
1. M. B. Aljabri , T. Lund, T. V. Andreasen and K. Ytrehus: 'Angiotensin II abates the beneficial effects of postconditioning in ERK and GSK- 3β dependent manner' (submitted paper)
3. M. B. Aljabri, N. T. Songstad, T. Lund, M. C. Serrano, T. V. Andreasen, S. Al-Saad, S. Lindal, V. Sitras, G. Acharya, K. Ytrehus: 'Pregnancy protects against antiangiogenic and fibrogenic effects of angiotensin II in rat hearts', Acta Physiologica (Oxf) (2011) Apr;201(4):445-56. Available at http://dx.doi.org/10.1111/j.1748-1716.2010.02234.x
4. M. B. Aljabri , T. Lund, S. Al-Saad, J. Benjaminsen, T. V. Andreasen and K. Ytrehus: 'Chronic isoproterenol treatment enhances extracellular fibrosis and postischemic diastolic dysfunction in male but not female rat heart' (manuscript)URI: http://hdl.handle.net/10037/3555 File(s) in this item: 2
paper_2.pdf (397.9Kb)thesis.pdf (1.198Mb) -
Altintzoglou, Themistoklis (Doctoral thesis; Doktorgradsavhandling, 24-Sep-2010)[+][-]
Abstract: Young adults do not eat seafood frequently enough because they lack knowledge about the preparation of a quick and easy meal with seafood. One of the ways to improve this situation is to offer young adults a product which is based on their needs and helps them to eat seafood more frequently. The first survey study showed a positive association between health involvement, attitudes towards seafood consumption and total seafood consumption. In the second, young adults’ impressions of seafood were discussed in focus groups and resulted in nine values important for product development: successful preparation, healthiness, satiation, freedom of choice, convenience, visibility and trust, availability, image improvement and price. Finally, based on these nine values seafood product concepts were developed and evaluated in two web-based experiments. The result was a seafood concept consisting of cod and salmon portions with wild berries in a visible packaging which was ranked highly by young consumers. This concept is a starting point for further seafood product development which will increase seafood consumption by young adults. Description: URI: http://hdl.handle.net/10037/2821 File(s) in this item: 6
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Al-Saad, Samer (Doctoral thesis; Doktorgradsavhandling, 29-Apr-2010)[+][-]
Abstract: Lungekreft er krefttypen med den høyeste dødelighet av alle andre krefttyper. Hvert år får ca. 1,3 millioner mennesker av begge kjønn denne sykdommen på verdensbasis og mer enn 1,1 millioner mennesker dør av den. Det er en sterk sammenheng mellom røyking og lungekreft. Man kan få et bilde av en befolknings røykevaner ved å undersøke hyppigheten av lungekreft. For mer enn 10 år siden begynte man i Norge å observere en høyere dødelighet av lungekreft blant kvinner mellom 30-50 år, i forhold til menn, noe som gjenspeiler en økt røykingsrate hos unge kvinner. Man har satt i gang en rekke tiltak for å motivere folk til å kutte røyken, bl.a ved innføring av røykeloven i 2004, hevet tobakksprisene og merket tobakk med advarsel mot tobakkens skadevirkninger. Det er også blitt lettere for folk å få tak i nikotinholdige legemidler som alternativ til tobakk. Disse tiltakene har ført til en nedgang i antall røykere, også blant unge folk.
For de som allerede er rammet av denne sykdommen er det viktig å finne mer effektive legemidler som kan stoppe tumorveksten, eller i beste fall få tumoren til å skrumpe. De fleste pasienter som får behandling i en tidlig sykdomsfase kan hjelpes med operasjon, der man prøver å fjerne hele svulsten. De som allerede har fått spredning av svulsten utenfor lungene og til naboorganer har liten hjelp av kirurgisk behandling. Disse pasientene får tilbud om cellegiftbehandling og i noen tilfeller strålebehandling.
Det er per dags dato noen få legemidler som brukes ved lungekreft, men dessverre har mange pasienter kun liten effekt av denne behandlingen. Vi har i dette prosjektet tatt biter av svulster fra 335 lungekreft pasienter og har sett - ved hjelp av immunhistokjemi - hvorvidt kreftcellene uttrykker spesielle proteiner. Vi har gransket proteiner som man vet forekommer i celler med høy veksthastighet og som dermed har tendens til å spre seg i vevet. Selv om disse proteinene er blitt observert i kreftceller, har de hittil ikke vært tilstrekklig undersøkt i lungekreftsvulster, og deres betydning for overlevelse har ikke vært tilstrekklig dokumentert. I vår studie har vi undersøkt 15 slike proteiner og studert overlevelse og andre data om pasienten. Minst 8 av våre undersøkte proteiner kan med en viss nøyaktighet skille de farligste lungekrefttypene og si noe om en forventet overlevelse hos disse pasientene.
De proteinene som er knyttet til overlevelse, kan være sentrale ved planlegging av nye behandlingsstrategier for nye legemidler mot lungekreft. I tillegg håper man at noen av disse markørene i fremtiden kan være med på å bedre skreddersy behandlingen slik at man med større sannsynlighet vet hvem som vil ha effekt av denne.Description: The papers of the thesis are not available in Munin:
1.: Al-Saad S, Al-Shibli K, Donnem T, Persson M, Bremnes RM and Busund L-T: «The prognostic impact of NF-κB p105, vimentin, E-cadherin and Par6 expression in epithelial and stromal compartment in non-small-cell lung cancer», British Journal of Cancer (2008) 99, 1476-1483 (publisher's restriction - Nature Publishibng Group). Available at http://dx.doi.org/10.1038/sj.bjc.6604713
2. Al-Saad S, Donnem T, Al-Shibli K, Persson M, Bremnes RM and Busund L-T: «Diverse prognostic roles of Akt isoforms, PTEN and PI3K in Tumor epithelial cells and stromal compartment in non-small-cell lung cancer», Anticancer Research 2009 Oct;29(10):4175-83 (publisher's restriction - International Institute of Anticancer Research). Available at http://ar.iiarjournals.org/content/29/10/4175.full
3. Al-Saad S, Al-Shibli K, Donnem T, Sigve Andersen, Bremnes RM and Busund L-T: «High HER2 gene copy number evaluated by silver in situ hybridization (SISH) is associated with worse outcomes in females with non-smallcell lung cancer» (manuscript). Published with altered title in Journal of Thoracic Oncology, Volume 5, Number 10, October 2010, and available at http://dx.doi.org/10.1097/JTO.0b013e3181ea510aURI: http://hdl.handle.net/10037/2453 File(s) in this item: 1
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Al-Shibli, Khalid (Doctoral thesis; Doktorgradsavhandling, 27-May-2010)[+][-]
Abstract: Lungekreft er knyttet til røyking og har den høyeste dødelighet av alle andre krefttyper. Hvert år får ca. 1,3 millioner mennesker av begge kjønn denne sykdommen på verdensbasis og mer enn 1,1 millioner mennesker dør av den. En britisk analyse publisert i forskningsmagasinet Nature, bekreftet at det forskes lite på lungekreft i forhold til andre kreftformer. I analysen sto lungekreft bak 22 prosent av alle kreftrelaterte dødsfall, men bare tre prosent av de samlede kreftforskningsmidler går til forskning på dette området. Brystkreft stod til sammenlikning bak åtte prosent av kreftdødsfallene, men mottok 18 prosent av forskningsmidlene.
For de som allerede er rammet av denne sykdommen er det viktig å finne mer effektive legemidler som kan stoppe tumorveksten, eller i beste fall få tumoren til å skrumpe. Det er per dags dato noen få legemidler som brukes ved lungekreft, men dessverre har mange pasienter kun liten effekt av denne behandlingen. Målrettet behandling som kortfattet går ut på å tilføre antistoffer mot de markører som er vist å være relatert til dårlig prognose (for eksempel immunterapi eller hemmer blodkardannelse i lungekreftsvulster), kan være av stor hjelp. I tillegg er det viktig å finne markører som kan fortelle om hvilken pasient har mer aggressiv sykdom (prognose).
Prosjektet omfatter en gruppe av lungekreftpasienter, som er operert for såkalt ”ikkesmåcellet” lungekreft som representerer 80% av lunge kreft. Forskningsmaterialet inkluderer vevsprøver fra operasjonspreparater tilhørende 335 personer som ble operert for denne typen kreft i Nord-Norge (ved Nordlandssykehuset og ved Universitetssykehuset i Nord-Norge) i perioden 1990-2004. Vi har undersøkt hvilken betydning ulike typer celler i immunforsvaret har for overlevelsen ved operabel ikke-småcellet lungekreft. Det er påvist stor variasjon i overlevelse blant de som ble operert i Nord-Norge i disse årene. For eksempel har pasienter med høyt antall av to spesielle typer av disse forsvarscellene en overlevelse på ca. 75 % etter fem år, mot bare ca. 40 % hos dem med lave verdier.Description: The papers of the thesis are not available in Munin due to publishers' restrictions:
1. Al-Shibli KI, Donnem T, Al-Saad S, Persson M, Bremnes RM and Busund LT: «Prognostic Impact of Epithelial and Stromal Lymphocyte Infiltration in Non-Small Cell Lung Cancer», Clin Cancer Res., 2008 Aug 15;14(16):5220-7 (American Association for Cancer Research). Available at http://dx.doi.org/10.1158/1078-0432.CCR-08-0133
2. Al-Shibli K, Al-Saad S, Donnem T, Persson M, Bremnes RM and Busund LT: «The Prognostic Value of Intraepithelial and Stromal Innate Immune System Cells in Non-Small Cell Lung Carcinoma», Histopathology, 2009 Sep;55(3):301-12 (Wiley). Available at http://dx.doi.org/10.1111/j.1365-2559.2009.03379.x
3. Al-Shibli K, Al-Saad S, Andersen S., Donnem T, Bremnes RM and Busund LT: «The Prognostic Value of Intraepithelial and Stromal T cells and Plasma cells in Non-Small Cell Lung Carcinoma», APMIS 2010; 118: 371–82 (Wiley). Available at http://dx.doi.org/10.1111/j.1600-0463.2010.02609.xURI: http://hdl.handle.net/10037/2645 File(s) in this item: 1
thesis.pdf (7.999Mb) -
Anda, Erik Eik (Doctoral thesis; Doktorgradsavhandling, 04-Sep-2009)[+][-]
Abstract: The Murmansk County Birth Registry (MCBR) was initiated on January 1. 2006. Currently (April 2009) the MCBR has registered over 26 000 births. The registry covers a geographical area known as the Kola Peninsula in Northwest Russia, which is almost entirely located above the Arctic Circle. Murmansk County is about half the size of Norway and had 857 000 inhabitants in 2008. All the 15 delivery departments in the county are involved and their locations stretch from Nikel in the Northwest to Kandalaksha in the south. The Registry Office is located in the city of Murmansk with a trusted staff of four.
The MCBR annually registers over 99% of all deliveries in the region. Based on several measures such as quality control exercises and regional workshops, the registry seems to exhibit adequate validity. The registration of births in the MCBR is obligatory and embedded in regional legislation. It is a cooperative effort between the University of Tromsø and the Murmansk County Health Department. Together they have defined four major guidelines, or tasks for the registry:
• Monitor the health condition of mothers and their newborn;
• Monitor the availability of maternal and perinatal health care;
• Develop standards and guidelines for maternal and perinatal health care;
• Spawn new hypotheses and provide knowledge related to causal relationships for reproductive health risk factors.
Comparisons of selected pregnancy outcomes from Murmansk County with the northern regions of other Nordic countries (Norway, Sweden and Finland) revealed several interesting differences. First of all, there was the divergence of the demographic composition of the respective delivering populations. The pregnant women were much younger in Murmansk County (about 3.5 years), and the percentage of teenage mothers was about twice that of Northern Norway and 5 times higher than in Northern Sweden. Further each woman tended to have fewer children in Murmansk County, the babies were lighter on average (about 200 g), and the proportion of children with a birth weight over 4500 g was 4.5 times higher in Northern Norway.
A study comparing the birth weights, perinatal mortality and gestational ages between Northern Norway and Murmansk County disclosed valuable information. Based on WHO-guideline-calculations, the perinatal mortality among the women with a known gestational age was 11.0/1000 in Murmansk County (2006-2007) and 5.4/1000 in Northern Norway (2004-2006). The risk of perinatal mortality was higher at all gestational ages and at all birth weight increments in Murmansk County. There were large disparities between the two regions in the optimal perinatal-survival weights and the small-for-gestationalage 10 percent cut-off weight for term deliveries.
Two further studies aimed to map out challenges related to the collection of human tissue samples in the Russian Arctic for the analyses of environmental contaminants. After all, a relevant and effective protocol is the core of any viable epidemiological study. It was concluded that relative to cord blood and breast milk, maternal plasma/blood is the most fundamental biomonitoring medium for organochlorines and toxic metals. Also, complicated statistical analyses will require a detection frequency of the individual contaminant levels in each sample to exceed 80%. And finally, the correlations between concentrations of different organochlorines in the body fluids (with a few exceptions) were sufficiently high so that measuring the levels of a few with high detection frequencies would give a suitable picture of the combined body burden of these contaminants.
In conclusion, the MCBR constitutes an invaluable tool for reproductive health studies in the future such as the studies of adverse effects of environmental contaminants.Description: The papers of the thesis are not available in Munin:
1. Anda EE, Nieboer E, Voitov AV, Kovalenko AA, Lapina YM, Voitova EA, Kovalenko LF, Odland JØ: «Implementation, quality control and selected pregnancy outcomes of the Murmansk County Birth Registry (Russia)», Int J Circumpolar Health. 2008; 67(4):318- 34 (publisher's restrictions). Available at http://www.ijch.fi/show_abstract.php?abstract_id=30
2. Anda EE, Nieboer E, Wilsgaard T, Kovalenko AA, and Odland JØ: «Perinatal mortality in relation to birthweight and gestational age: A registry-based comparison for Northern Norway and Murmansk County, Russia» (manuscript)
3. Anda EE, Nieboer E, Dudarev AA, Sandanger TM and Odland JØ: «Intra- and intercompartmental associations between levels of organochlorines in maternal plasma, cord plasma and breast milk, and lead and cadmium in whole blood, for indigenous peoples of Chukotka, Russia», Journal of Environmental Monitoring 2007; 9: 884–93 (Royal Society of Chemistry - publisher's restrictions). Available at http://dx.doi.org/10.1039/b706717h
4. Sandanger TM, Anda EE, Dudarev AA, Nieboer E, Konoplev AV, Vlasov SV, Weber JP Odland JØ and Chashchin VP: «Case study of combining persistent organic pollutants (POPs) datasets in the context of a circumpolar environment-and-health study» (manuscript). Later published with altered title in Science of The Total Environment, Volume 407, Issue 19, 15 September 2009, Pages 5216-5222, available at http://dx.doi.org/10.1016/j.scitotenv.2009.06.020URI: http://hdl.handle.net/10037/2700 File(s) in this item: 1
thesis.pdf (2.548Mb) -
Andersen, Fred (Doctoral thesis; Doktorgradsavhandling, 21-Oct-2011)[+][-]
Abstract: Ni kommuner deltok i studien. I fem av kommunene fikk deltakerne med Alzheimers sykdom (AS) systematisk stimulering (n=103), i de resterende fire vanlig pleie og omsorg (n=84). Alle inkluderte ble randomisert dobbelt blindt til donepezil eller placebo, og fulgt med tre kognitive tester (MMSE, Klokketest og ADAS-Cog) hver fjerde måned i ett år. To testteknikere testet deltakerne på deres hjemsteder. Resultatene viser at deltakere behandlet med systematisk stimulering bevarte sine kognitive prestasjoner gjennom ett år. Det samme gjorde også de deltakerne som fikk vanlig pleie og omsorg. Ingen signifikant forskjeller i testresultat ble påvist i oppfølgingsperioden, verken mellom hoved- eller subgrupper. Også deltakere med alvorligere grad av Alzheimers sykdom ved inklusjon bevarte kognitivt funksjonsnivå i ett år. Donepezil hadde ingen tilleggseffekt, unntatt flere bivirkninger enn placebo. Deltakere med AS rekruttert ved screening var yngre, oftere menn og gjorde det bedre på kognitive tester enn deltakere rekruttert gjennom klinisk praksis. Deltakere med AS brukte flere medikamenter enn deltakere uten AS, uten signifikante forskjeller i sykelighet. Description: Paper 3 of this thesis is not available in Munin:
3. Fred Andersen, Dag S. Halvorsen, Bjørn Straume, Matti Viitanen, Tom Wilsgaard and Torgeir A Engstad: 'The effect of stimulation therapy and donepezil on cognitive function in Alzheimer’s disease. A community based RCT with a two-by-two factorial design' (submitted to Journal of the American Geriatrics Society)URI: http://hdl.handle.net/10037/3669 File(s) in this item: 3
paper_1.pdf (512.8Kb)paper_2.pdf (224.6Kb)thesis.pdf (2.140Mb) -
Andersen, Sigve (Doctoral thesis; Doktorgradsavhandling, 30-Nov-2011)[+][-]
Abstract: Lungekreft er uten sammenligning den kreftsykdommen som tar flest liv i Norge og 6 personer dør i gjennomsnitt hver dag av sykdommen. De som blir oppdaget i et tidlig stadium kan opereres med mål om å bli kurert. Likevel dør nesten halvparten av de som blir operert av lungekreft og behovet for nye behandlingsalternativer er stort. Andersens funn viser at markører for lave surstoff nivåer og karnydannelse kan være med på å identifisere pasienter med bedre og dårligere sjanser for dø av lungekreft etter en slik operasjon. Slik informasjon kan sammen med eksisterende faktorer brukes til å identifisere pasienter som trenger tilleggsbehandling samt at markørene som betyr noe for overlevelsen er mulige mål for framtidig behandling av lungekreft. Sammen med andre studier bidrar denne studien til at vi nærmer oss målet om individualisert kreftbehandling. Kandidaten har kunnet vise dette etter å ha studert overlevelse og uttrykket av slike markører i lungekreftsvulstene i 335 pasienter som ble operert for lungekreft ved Universitetssykehuset i Tromsø (UNN) og Nordlandssykehuset Bodø i perioden 1990-2004. Description: Paper 1 of this thesis is not available in Munin due to publishers' restrictions:
1. Andersen S, Eilertsen M, Donnem T, Al-Shibli K, Al-Saad S, Busund LT and Bremnes RM: 'Diverging prognostic impacts of hypoxic markers according to NSCLC histology', Lung Cancer (2011) 72(3):294-302. Available at http://dx.doi.org/10.1016/j.lungcan.2010.10.006URI: http://hdl.handle.net/10037/3682 File(s) in this item: 3
paper_2.pdf (2.084Mb)paper_3.pdf (271.1Kb)thesis.pdf (924.3Kb) -
Andersgaard, Alice Beathe (Doctoral thesis; Doktorgradsavhandling, 10-Nov-2011)[+][-]
Abstract: Det er viktig å kartlegge og gjennomgå alvorlige hendelser i forbindelse med svangerskap og fødsel. I dette arbeidet er det satt fokus på to dramatiske komplikasjoner; kvinner som har svangerskapsforgiftning (preeklampsi) og får kramer (eklampsi) og kvinner som dør i forbindelse med svangerskap og fødsel. I samarbeid med kolleger i Norge, Danmark og Sverige gjennomførte vi en registrering av eklampsi tilfellene i Skandinavia i en to års periode (1998-2000), og fant en forekomst på 1/2000 fødsel. En gjennomgang av pasient journalene viste at 87% hadde symptomer som sterk panne hodepine og kvalme i forkant av anfallet. En del av kvinnene ble intervjuet om langtidseffekter og 51% rapporterte fortsatt plager 11 måneder etter anfallet. Flere studier har vist en sammenheng mellom høyt blodtrykk i svangerskapet eller preeklampsi og økt risiko for å utvikling av hjerte- og karlidelser senere i livet. Med utgangspunkt i Tromsøs kvinnelige befolkning i Tromsø-undersøkelsen (Tromsø IV) ønsket vi å undersøke dette. Studien viste at kvinnene som hadde hatt høyt blodtrykk i svangerskapet eller preeklampsi, oftere hadde en familiær belastning av hjerte- og karlidelser og flere utviklet hypertensjon enn kvinner uten disse komplikasjonene i svangerskapet. Kvinner som hadde hatt preeklampsi hadde også oftere forandringer i halskarene (plaque og fortykket intima-media i arteria carotis) som også er et utrykk for økt risiko for fremtidig slag og hjerte-og karsykdom. Det er fortsatt usikkerhet knyttet til antall mødredødsfall i Norge. I perioden 1976-1995 døde 1 kvinne / 20.000 levende fødte barn i Norge av komplikasjoner direkte relatert til svangerskapet eller fødselen. En gjennomgang av forløpet forut for disse dødsfallene og de bakenforliggende årsaker og komplikasjoner i svangerskapet viste at hele 43% ikke ble behandlet etter anerkjente behandlingsmetoder og retningslinjer. Mange av kvinnene som fødte var forløst med keisersnitt (71%). Description: The papers of this thesis are not available in Munin:
1. Andersgaard AB, Herbst A, Johansen M, Ivarsson A, Ingemarsson I, Langhoff-Roos J, Henriksen T, Straume B and Øian P.: 'Eclampsia in Scandinavia: incidence, substandard care, and potentially preventable cases', Acta Obstetricia et Gynecologica Scandinavica (2006) 85:929-36. Available at http://dx.doi.org/10.1080/00016340600607149
2. Andersgaard AB, Herbst A, Johansen M, Borgström A, Bille AG and Øian P.: 'Follow-Up Interviews after Eclampsia', Gynecologic and Obstetric Investigation (2009) 67:49-52. Available at http://dx.doi.org/10.1159/000161569
3. Andersgaard AB, Acharya G, Ellisiv Mathiesen, Stein Harald Johnsen, Straume B and Øian P.: 'Recurrence and long-term maternal health risks of hypertensive disorders of pregnancy: a population based study' (submitted paper)
4. Andersgaard AB, Langhoff-Roos J and Øian P.: 'Direct maternal deaths in Norway 1976-1995', Acta Obstetricia et Gynecologica Scandinavica (2008) 87:856-61. Available at http://dx.doi.org/10.1080/00016340802237067URI: http://hdl.handle.net/10037/3685 File(s) in this item: 1
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Arntzen, Kjell Arne (Doctoral thesis; Doktorgradsavhandling, 19-Jun-2012)[+][-]
Abstract: The prevalence of dementia and cognitive impairment is rising worldwide as the number of elderly people increases in most countries. Vascular risk factors and carotid artery atherosclerosis have in some epidemiological studies been associated with increased risk of cognitive decline. The carotid artery is essential for blood supply to the brain, but is also vulnerable to atherosclerosis. The degree of atherosclerosis in the carotid artery can easily be measured by ultrasonography. The population-based Tromsø study, with repeated screening surveys of the Tromsø population, has made it possible to follow participants prospectively. Repeated carotid ultrasound scanning and cognitive test assessments have provided a unique opportunity for assessing change in atherosclerosis and change in cognitive test scores. In this study we assessed the impact of different vascular risk factors on scores in three cognitive tests after 7 years of follow-up, and studied if carotid atherosclerosis and progression of atherosclerosis were independent risk factors for lower cognitive test scores and cognitive decline in a middle–aged stroke-free population. We found that diabetes, smoking and systolic blood pressure were consistent and independent risk factors for lower cognitive test results after 7 years follow-up in both genders. Physical inactivity was associated with lower scores in women. Carotid atherosclerosis measured as total plaque area and number of plaques predicted lower scores on the verbal memory test 7 years later, whereas the average of plaque scores, measured at baseline and at follow-up, was associated with lower scores on all the cognitive tests in this study. Progression of carotid plaques over 7 years was associated with lower scores on the digit symbol coding test and the tapping test. We found no association between plaque scores and cognitive decline from 7 to 13 years of follow-up. Description: The papers of this thesis are not available in Munin:
1. Arntzen KA, Schirmer H, Wilsgaard T, Mathiesen EB.: 'Impact of cardiovascular risk factors on cognitive function : the Tromsø Study', European Journal of Neurology (2011), 18(5):737–743. Available at http://dx.doi.org/10.1111/j.1468-1331.2010.03263.x
2. Arntzen KA, Schirmer H, Johnsen SH, Wilsgaard T, Mathiesen EB.: 'Carotid atherosclerosis predicts lower cognitive test results : a 7 years follow-up study in 4371 stroke-free subjects. The Tromsø Study', Cerebrovascular Diseases (2012), 33(2):159-165. Available at http://dx.doi.org/10.1159/000334182
3. Arntzen KA, Schirmer H, Johnsen SH, Wilsgaard T, Mathiesen EB.: 'Carotid artery plaque progression and cognitive decline. The Tromsø Study 1994- 2008', (forthcomming paper in European Journal of Neurology)URI: http://hdl.handle.net/10037/4279 File(s) in this item: 1
thesis.pdf (6.381Mb) -
Asfeldt, Anne Mette (Doctoral thesis; Doktorgradsavhandling, 24-Apr-2009)[+][-]
Abstract: Dyspepsia is a highly prevalent condition, involving substantial health-care resources. Ever since Marshall and Warren in 1984 discovered that Helicobacter pylori could cause peptic ulcer, it has been discussed to what extend Helicobacter pylori play a role in dyspepsia in general. In 2004 a population based survey was carried out in the municipality of Sørreisa, comprising a questionnaire survey on gastrointestinal disorders and upper endoscopy of a subgroup of the population. The results from this survey were compared with a similar survey in Sørreisa from 1987.
Main Results
A diagnostic test, the “Amplified IDEIA Hp StAR®” (DakoCytomation, Denmark) was validated and found to be very accurate, also in patients using proton pump inhibitors. The observer variability in upper endoscopy was studied and found to be considerable. A systematic image documentation of the endoscopy findings, regardless of suspicion of pathology, would improve the quality of the procedure. The prevalence of H. pylori has decreased considerably since 1987, whereas the prevalence of dyspepsia has remained constant, thus questioning any relationship between the two. Helicobacter pylori is only a moderate risk factor for peptic ulcer, whereas other risk factors as smoking seems to be just as important. Helicobacter pylori causes inflammation of the gastric mucosa, but plays a minor role in more chronic changes of the gastric mucosa such as atrophy and intestinal metaplasia. Elimination of Helicobacter pylori infection causes regression of inflammation, but not regression of intestinal metaplasia once it has developed.
The thesis emanate from the Department of Community and the department of Clinical Medicine, University of Tromsø, NorwayDescription: Paper number 3 of the thesis is not available in Munin due to publisher's restrictions:
3. Anne Mette Asfeldt, Bjørn Straume, Sonja Eriksson Steigen, Maja-Lisa Løchen, Jon Florholmen, Bjørn Bernersen, Roar Johnsen, Eyvind J. Paulssen: 'Changes in the prevalence of dyspepsia and Helicobacter pylori infection after 17 years: The Sørreisa gastrointestinal disorder study' European journal of epidemiology (2008) 23:625–633 (Springer). Available at http://dx.doi.org/10.1007/s10654-008-9275-xURI: http://hdl.handle.net/10037/2331 File(s) in this item: 4
paper_1.pdf (121.6Kb)paper_2.pdf (288.3Kb)paper_4.pdf (182.5Kb)thesis.pdf (9.478Mb) -
Augestad, Knut Magne (Doctoral thesis; Doktorgradsavhandling, 10-May-2013)[+][-]
Description: Papers 1,2 and 3 of this thesis are not available in Munin:
1. Augestad KM, Lindsetmo RO, Stulberg JJ, Reynolds H, Senagore AJ, Champagne B, Heriot AG, Leblanc F and Delaney CP.: 'International preoperative rectal cancer management: staging, neoadjuvant treatment, and impact of multidisciplinary teams', World Journal of Surgery (2010), vol. 34:2689-2700. Available at http://dx.doi.org/10.1007/s00268-010-0738-3
2. Augestad KM, Lindsetmo RO, Stulberg JJ, Reynolds H, Senagore AJ, Champagne B, Heriot AG, Leblanc F and Delaney CP.: 'International trends in surgical treatment of rectal cancer', American Journal of Surgery (2011), vol. 201:353–358. Available at http://dx.doi.org/10.1016/j.amjsurg.2010.08.030
3. Augestad KM, Lindsetmo RO, Stulberg J, Reynolds H, Champagne B, Senagore AJ and Delaney CP.: 'System-based factors influencing intraoperative decision-making in rectal cancer by surgeons. An international assessment', Colorectal Disease (2012), vol. 14(10):e679-88. Available at http://dx.doi.org/10.1111/j.1463-1318.2012.03093.xURI: http://hdl.handle.net/10037/5167 File(s) in this item: 3
paper_4.pdf (177.5Kb)paper_5.pdf (1.636Mb)thesis.pdf (1.832Mb) -
Austgard, Kitt Irene Berg (Doctoral thesis; Doktorgradsavhandling, 12-Oct-2012)[+][-]
Abstract: Avhandlingen er en fortolkning av den sykepleiefaglige omsorgserfaringen i lys av Kari Martinsens og Ulrikke E. Nissens forfatterskap. Fortolkningen viser at omsorg var integrert i Nissens sykepleietenkning, forankret i den kristne kjærlighet og tro, i fenomener som nestekjærlighet, barmhjertighet, tillit, sannhet og verdighet. I Martinsens tekster trer omsorg og kjærlighet frem som ontologiske grunnvilkår for den felles menneskelige eksistens. Omsorgserfaringens substans relateres til de suverene livsytringene i Løgstrups fenomenologi, slik som tillit, talens åpenhet, medfølelse, håp og barmhjertighet. Holdningen, karakteregenskaper og dannelse ved den profesjonelle som person beskrives som viktige forutsetninger for omsorgserfaringen både hos Martinsen og Nissen. En omsorgserfaring betinger at sykepleier stiller seg og sin faglige kyndighet tilgjengelig for inntrykket i møte med pasienten samt tilegner seg en helhetlig forståelse av pasientens behov. Begge forfattere inkluderer teoretiske fagkunnskaper, men vektlegger den forskjellig. Austgard argumenterer for at den faglige omsorgserfaringen bør forankres i et meningsbærende innhold, noe som kan bidra til selvinnsikt i egen erfaringsprosess og åpenhet i møte mennesker i sårbare situasjoner. URI: http://hdl.handle.net/10037/4560 File(s) in this item: 1
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Bakland, Gunnstein (Doctoral thesis; Doktorgradsavhandling, 29-May-2012)[+][-]
Description: The papers of this thesis are not available in Munin:
1. Gunnstein Bakland1, Hans C. Nossent and Jan T. Gran: 'Incidence and prevalence of Ankylosing Spondylitis in Northern Norway', Arthritis & Rheumatism (2005), vol. 15;53(6):850-5. Available at http://dx.doi.org/10.1002/art.21577
2. Gunnstein Bakland, Jan T. Gran, Andrea Becker-Merok, Bjørn Y. Nordvåg and Johannes C. Nossent: 'Work Disability in patients with Ankylosing Spondylitis in Norway', The Journal of Rheumatology (2011), vol.38 no.3:479-484. Available at http://dx.doi.org/10.3899/jrheum.100686
3. Gunnstein Bakland, Jan Tore Gran and Johannes C Nossent: 'Increased mortality in ankylosing spondylitis is related to disease activity', Annals of the rheumatic diseases (2011), 70(11):1921-5. Available at http://dx.doi.org/10.1136/ard.2011.151191URI: http://hdl.handle.net/10037/4245 File(s) in this item: 1
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Bals, Margrethe (Doctoral thesis; Doktorgradsavhandling, 14-Jan-2011)[+][-]
Abstract: This thesis examined common and culture-specific risk and protective factors for internalizing (anxiety and depression) symptoms in Sami and non-Sami adolescents. This is a cross-sectional study, and the data are from The Norwegian Arctic Adolescent Health Study which was conducted among 10th graders in junior high schools in Arctic Norway in 2003-2005. The sample consisted of 4,449 adolescents, of whom 450 (10 %) were indigenous Sami and 3,999 (90 %) were non-Sami. The findings from this thesis were: (1) There were no differences between Sami and non-Sami adolescents in internalizing symptoms; (2) Strong ethnic identity, ethnic discrimination and loss of native language were cultural risk factors associated with increasing internalizing symptoms; (3) In the family socialization context, there were mostly similarities, but also some cultural differences in the impact of family factors on internalizing symptoms; (4) Engaging in cultural activities and ethnic pride were identified as cultural protective factors associated with decreasing symptom level; (5) Gender differences appeared in both ethnic groups in symptom level and in risk and protective factors associated with symptoms; (6) General protective factors, like self-efficacy, may strengthen the impact of the cultural protective factors. Findings from this study indicate both similarities and differences between Sami and non-Sami youth, and point out that the unique experience of indigenous Sami youth is related to symptoms of anxiety and depression. The integration of cultural protective factors with the well-known general protective factors is important when focusing on mental health problems and development in adolescents. Description: papers number 1 and 2 of the thesis are not available in Munin due to publishers' restrictions:
1. Bals, M., Turi, A. L., Skre, I., & Kvernmo, S.: 'Internalization symptoms, perceived discrimination and ethnic identity in indigenous Sami and non-Sami youth in Arctic Norway', Ethnicity and Health, 15(2), 2010, p. 165-179 (Taylor & Francis). Available at http://dx.doi.org/10.1080/13557851003615545.
2. Bals, M., Turi, A. L., Vittersø, J., Skre, I., & Kvernmo, S.: 'Self-reported internalization symptoms and family factors in indigenous Sami and non-Sami adolescents in North Norway', Journal of Adolescence (in press) (Elsevier). Available at http://dx.doi.org/10.1016/j.adolescence.2010.08.005URI: http://hdl.handle.net/10037/2934 File(s) in this item: 2
paper_3.pdf (155.0Kb)thesis.pdf (1.864Mb) -
Berge, Gerd (Doctoral thesis; Doktorgradsavhandling, 09-Dec-2009)[+][-]
Abstract: Cationic antimicrobial peptides (CAPs) are found in many diverse species playing a part in the innate immune system. CAPs are important as antimicrobial agents in most organisms, being able to kill a wide range of bacteria as well as fungi, enveloped viruses and protozoa. Certain CAPs also exhibit direct cytotoxic activity against many different types of human cancer cells. Bovine lactoferricin (LfcinB) derived from the protein bovine lactoferrin found in cow milk has been the starting point for this thesis. LfcinB is a CAP which exhibits antimicrobial and antitumor activities. In the present work the main focus has been to explore the anticancer activity of LfcinB and the de novo designed peptide, LTX-302, which is a 9-mer cytolytic peptide optimalized from parental LfcinB.
We found that LfcinB kill cancer cells by necrosis due to a dual mechanism of the peptide on both the mitochondrial membranes and the plasma membranes. In vivo studies of the more active peptide, LTX-302, demonstrated a vaccinating effect against the murine A20 B-cell lymphoma in immunocompetent mice. Subcutaneously established tumors were treated with LTX-302 by intratumoral injection of the peptide and a majority of the tumors obtained complete regression upon LTX-302 treatment. The cured mice were found to be protected against a rechallenge with A20 cells, but not against Meth A sarcoma cells, indicating a specific immune response. The complete regression was T-cell dependent, and both CD4 and CD8 T-cells were required for the protection. These studies show that local treatment of cancer by a CAP can induce active immunization against the cancer, conferring a novel strategy for therapeutic vaccination against cancer.Description: The papers of the thesis are not available in Munin:
1. L.T. Eliassen, G. Berge, B. Sveinbjørnsson, L. Vorland, J.S. Svendsen, Ø. Rekdal: 'Evidence for direct antitumor mechanism of action by bovine lactoferricin', Anticancer Research (2002), 22:2703-2710 (International Institute of Anticancer Research - publisher's restriction). Check availablility
2. Liv Tone Eliassen, Gerd Berge, Arild Leknessund, Mari Wikman, Inger Lindin, Cecilie Løkke, Frida Ponthan, John Inge Johnsen, Baldur Sveinbjørnsson, Per Kogner, Trond Flægstad and Øystein Rekdal: 'The antimicrobial peptide, Lactoferricin B, is cytotoxic to neuroblastoma cells in vitro and inhibits xenograft growth in vivo', International Journal of Cancer, Volume 119, Issue 3 (p 493-500) (Wiley - publisher's restriction). Available at http://dx.doi.org/10.1002/ijc.21886
3. Berge, G., Eliassen, L. T., Sveinbjørnsson, Bartnes, K. Ø. Rekdal: 'Therapeutic vaccination against a murine lymphoma by intratumoral injection of a cationic anticancer peptide' (Manuscript)URI: http://hdl.handle.net/10037/2373 File(s) in this item: 1
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Bergvik, Svein (Doctoral thesis; Doktorgradsavhandling, 05-Jun-2009)[+][-]
Abstract: The thesis comprises four studies of psychosocial factors associated with the recovery of patients following Coronary Artery Bypass Graft (CABG) surgery and Percutaneous Coronary Intervention (PCI) treatment in Northern Norway. Paper I describes an interview study of nine patients following CABG surgery. The patients reported extensive use of avoidant (e.g. neglecting symptoms, avoiding thoughts about illness) and approach coping strategies (e.g. persistently searching for a diagnosis, mentally preparing for surgery). In paper II, a Norwegian translation of the Type D personality measure (DS14) was tested in a survey of 432 CABG and PCI patients. The instrument showed acceptable psychometric properties. The prevalence of Type D personality was relatively low (18%) compared to other European and US studies. Based on the same survey, paper III describes a study of psychosocial and treatment factors associated with Return To Work (RTW) in 185 CABG and PCI patients that were working prior to hospitalization. Six independent and significant factors were associated with RTW, including age below 67 years, higher education and Internal Locus of Control (LoC) as positive predictors. CABG, smoking and Powerful Others LoC were negative predictors. Paper IV describes the development, training and implementation of a patientcentred information procedure provided by nurses to CABG patients. Using a qualitative method, a set of case descriptions was developed, illustrating difficult nurse-patient interactions and how the patient-centered approach could be applied in these situations. The nurses found the patient-centered approach useful in a range of communicatively challenging situations, including when patients asked a very high number of questions, when patients seemed to have difficulties expressing their worries, when patients had many complaints, and when spouses of patients expressed their own worries. Description: Papers number 1 and 3 of the thesis are submitted versions, and not available in Munin. Paper 4 is not available due to publisher's restriction:
1. Bergvik, S., Sørlie, T., & Wynn, R.: 'Approach and avoidance coping and Regulatory Focus in patients having Coronary Artery Bypass Graft surgery.'
3. Bergvik, S., Sørlie, T., Wynn, R., & Sexton, H.: 'Psychosocial factors associated with return to work following CABG and PCI treatment in coronary patients in Northern Norway.'
4. Bergvik, S., Wynn, R., & Sørlie, T. (2008): 'Nurse training of a patient-centered information procedure for CABG patients.' Patient Education and Counseling, 70, 227-233 (Elsevier). Available at http://dx.doi.org/10.1016/j.pec.2007.10.013URI: http://hdl.handle.net/10037/2104 File(s) in this item: 2
paper_2.pdf (119.9Kb)thesis.pdf (830.4Kb) -
Bernitz, Stine (Doctoral thesis; Doktorgradsavhandling, 08-Mar-2013)[+][-]
Description: The papers of this thesis are not available in Munin:
1. Stine Bernitz, Rune Rolland, Ellen Blix, Morten Jacobsen, Katrine Sjøborg and Pål Øian: 'Is the operative delivery rate dependent on the level of birth care? A randomised controlled trial', BJOG An International Journal of Obstetrics and Gynaecology (2011), vol. 118:1357-1364. Available at http://dx.doi.org/10.1111/j.1471-0528.2011.03043.x
2. Stine Bernitz, Eline Aas and Pål Øian: 'Economic evaluation of birth care in low-risk women. A comparison between a midwifeled birth unit and a standard obstetric unit within the same hospital in Norway. A randomised controlled trial', Midwifery (2012), Vol. 28 (5):591–599. Avilable at http://dx.doi.org/10.1016/j.midw.2012.06.001
3. Stine Bernitz, Pål Øian, Rune Rolland, Leiv Sandvik and Ellen Blix: 'Dystocia and augmentation with oxytocin as risk factors for adverse birth outcomes in lowrisk nulliparous women' (manuscript)URI: http://hdl.handle.net/10037/5060 File(s) in this item: 1
thesis.pdf (1.621Mb)
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