Munin: Browsing Doktorgradsavhandlinger (Helsefak) by Title

Damsgård, Elin (Doctoral thesis; Doktorgradsavhandling, 26-Feb-2010)

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Abstract:

Chronic musculoskeletal pain is a common health problem and a major cause for disability pension in Norway. Increased pain and fear related to general activity and exercise may be a barrier to rehabilitation of patients with chronic muscular-skeletal disorders.
The aim of the present research was to investigate the occurrence of activity related pain, and to explore its association with fear, psychological distress, self efficacy and pain (duration and distribution). The second aim was to explore how these psychological aspects and activity related pain associates with individuals’ readiness to adopt a self-management approach to pain, and how patients described and explained such pain experiences.
Data were collected by questionnaires and qualitative interviews with out-patients at a Physical Medicine clinic at the University Hospital of Northern Norway. Results showed that a majority of the participants experienced increased pain during activity. Pain related fear of movement/(re)injury was a unidimensional construct, which was statistically significantly associated with increased pain during activity, also among individuals without psychological distress. Participants with high levels of fear of movement/(re)injury and psychological distress and weak sense of (pain) self efficacy were more likely to report pain during activity. They were also less ready to take a self-management approach to pain. Activity related pain was described and explained as a complex experience with diverse meanings. Initial fear of pain was re-interpreted under the influence of time, learning and own experience. Participating in social life situations was an important incentive to stay active despite pain.

URI:

http://hdl.handle.net/10037/2500

File(s) in this item: 6

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Acute heart failure syndromes : treatment, outcomes and pathophysiological aspects of inflammation and vascular function

Hermansen, Stig Eggen (Doctoral thesis; Doktorgradsavhandling, 01-Nov-2012)

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Abstract:	Akutt hjertesvikt, spesielt ved sirkulatorisk kollaps, er en dramatisk tilstand med høy dødelighet. Forekomsten av akutt hjertesvikt er økende og tilgjengelig kunnskap om sykdomsmekanismene samt medisinsk behandling er begrenset.De siste tiår har det vært en revolusjonerende utvikling i behandlingen av og overlevelsen ved iskemisk hjertesykdom og akutt hjerteinfarkt. Tilsvarende utvikling har det dessverre ikke vært i behandlingen av akutt hjertesvikt som er et økende problem assosiert med høy dødelighet. Formålet med dette prosjektet har vært å kartlegge epidemiologi, behandling og prognose ved forskjellige typer akutt hjertesvikt. For å øke den patofysiologiske forståelsen av sirkulasjonsregulering ved de mest alvorlige former for akutt hjertesvikt (kardiogent sjokk) har vi gjennomført observajonsstudier av biokjemiske responser og perifer karfunksjon i sykdomsforløpet. Prosjektet har vært todelt. Vi har først har sett på forekomsten av forskjellige typer akutt hjertesvikt og behandlingen som ble gitt ved medisinsk og kirurgisk intensiv avdeling ved UNN over en 2 års periode. Tross moderne behandling med bla tidlig revaskularisering døde ca 1/4 av pasientene under sykehusoppholdet. Dårligst prognose hadde de med kardiogent sjokk der nesten halvparten døde. De med lettere former for akutt hjertesvikt hadde meget dårlige leveutsikter i perioden etter utskrivelse og kun 50 % var i live etter to år. Mer utstrakt og tidlig bruk av mekanisk sirkulasjonsstøtte (hjertepumper) kan potensielt bedre overlevelsen hos de med mest alvorlig og behandlingsrefraktær hjertesvikt. Hos pasienter med kardiogent sjokk og alvorlig hjertesvikt etter hjertekirurgi er dårlig respons på konvensjonelle blodtrykksøkende medikamenter forbundet med spesielt dårlig prognose. For å kartlegge de underliggende mekanismene ved sirkulasjonssvikt spesielt mtp perifer sirkulasjonsregulering har vi målt perifer karfunksjon (endotelfunksjon), markører på systemisk inflammasjon og sirkulerende NO-blokkere (ADMA) under sykdomsforløpet. Tilstanden var karakterisert av en betydelig systemisk inflammasjon samt redusert perifer karfunksjon. Høye nivå av ADMA var assosiert med organsvikt og graden av hypoperfusjon.
Description:	The papers and the appendix of this thesis are not available in Munin: 1. Hermansen SE, Hansen M, Roaldsen M, Muller S, How OJ & Myrmel T.: 'Utilization and outcome of coronary revascularization and valve procedures in acute heart failure : an evaluation based on the classification from the European Society of Cardiology', Interactive CardioVascular and Thoracic Surgery (2008) vol.7, no.5:833-838. Available at http://dx.doi.org/10.1510/icvts.2008.175067 2. Hermansen SE, Hansen M, Roaldsen M, Muller S, How OJ & Myrmel T.: 'How many acute heart failure patients need a ventricular assist device?', Scandinavian Cardiovascular Journal (2008) vol.42, no.2:118-124. Available at http://dx.doi.org/10.1080/14017430701819113 3. Hermansen SE, Hansen M, Muller S, How OJ & Myrmel T.: 'Endothelial function during open heart surgery' (manuscript) 4. Hermansen SE, Kalstad T, How OJ & Myrmel T.: 'Inflammation and reduced endothelial function in the course of severe acute heart failure', Translational Research (2011) vol.157, no.3:117–127. Available at http://dx.doi.org/10.1016/j.trsl.2010.12.002 5. Hermansen SE, Lund T, Kalstad T, Ytrehus K & Myrmel T.: 'Adrenomedullin augments the angiogenic potential of late outgrowth endothelial progenitor cells', American Journal of Physiology Cell Physiology (2011) vol.300 no.4, C783-C791. Available at http://dx.doi.org/10.1152/ajpcell.00044.2010 Appendix: Hermansen SE, Naesheim T, How OJ & Myrmel T.: 'Circulatory assistance in acute heart failure : where do we go from here?', Scandinavian Cardiovascular Journal (2009) vol. 43, no.4:211-216. Available at http://dx.doi.org/10.1080/14017430802715962
URI:	http://hdl.handle.net/10037/4622

File(s) in this item: 1

thesis.pdf (1.140Mb)

Advanced Non-small Cell Lung Cancer Effects of Chemotherapy and Impact on Health Related Quality of Life

Helbekkmo, Nina (Doctoral thesis; Doktorgradsavhandling, 13-Mar-2009)

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Abstract:	Avhandlingen presenterer behandlingseffekt, bivirkninger og livskvalitet hos lungekreftpasienter som får moderne cellegiftbehandling. Pasientene med performance status (PS) 2 er etterpå vurdert separat. Avhandlingens tittel er ”Advanced non-small cell Lung Cancer – Effects of Chemotherapy and Impact on Health Related Quality of Life”. Den ble forsvart for graden PhD 13.03.2009. På verdensbasis er lungekreft den vanligste kreftsykdommen og den som forårsaker flest kreftrelaterte dødsfall. I Norge dør rundt 2000 mennesker av lungekreft hvert år. De fleste pasientene har langtkommet sykdom og kan ikke kureres. Målet med behandling er forlengelse av livet og best mulig livskvalitet. Avhandlingen tar utgangspunkt i VING-studien som ble gjennomført for å undersøke om det var ulik overlevelse, bivirkningsprofil og livskvalitet forbundet med to ulike cellegiftkombinasjoner. Ca 40 % av pasientene med langtkommet lungekreft er i dårlig allmenntilstand ved diagnosetidspunktet. I avhandlingen vurderes nytte og effekt av behandlingen for pasienter med PS 2. VING-studien var en nasjonal multisenter fase III studie utgått fra Norsk Lungekreftgruppe. Fra september 2003 til desember 2004 inkluderte 33 sykehus over hele landet 432 pasienter i studien. Pasientene fikk tre cellegiftkurer med tre ukers mellomrom, enten vinorelbin/carboplatin, eller gemcitabin/carboplatin. De fylte ut livskvalitetsskjema ved studiens start, før hver kur og deretter regelmessig ved kontroller. Sammenligning av de to behandlingsalternativene viste at overlevelse og livskvalitet var den samme, men at behandling med vinorelbin gir mindre tiltakskrevende bivirkninger. Som en konsekvens av dette, ble cellegiftkombinasjonen vinorelbin/carboplatin standardbehandling ved langtkommet lungekreft i Norge. Undersøkelser av hvordan PS 2 pasientene tålte behandlingen, viste at disse hadde gevinst av behandlingen. De oppnådde bedring i generell livskvalitet og pusteproblemer, samt mindre smerter, utmattelse, søvn- og appetittproblemer. Man frykter at cellegiftbehandling er en for stor påkjenning for de sykeste, men disse resultatene tyder på at man i større grad enn tidligere bør tilby behandling til pasienter som ønsker det.
Description:	Papers number 1 and 2 of the thesis are not available in Munin, due to publishers' restrictions: 1. Helbekkmo N, Sundstrom SH, Aasebo U, Brunsvig PF, von Plessen C, Hjelde HH, Garpestad OK, Bailey A, Bremnes RM; for the Norwegian Lung Cancer Study Group: 'Vinorelbine/carboplatin vs gemcitabine/carboplatin in advanced NSCLC shows similar efficacy, but different impact of toxicity.' British Journal of Cancer (2007) 97, 283-289 (Nature Publishing Group). Available at http://dx.doi.org/10.1038/sj.bjc.6603869 2. Helbekkmo N, Aasebø U, Sundstrøm SH, von Plessen C, Brunsvig PF, Bremnes RM; for the Norwegian Lung Cancer Study Group: 'Treatment outcome in performance status 2 advanced NSCLC patients administered platinum-based combination chemotherapy.' Lung Cancer (2008) 62, 253-260 (Elsevier). Available at http://dx.doi.org/10.1016/j.lungcan.2008.03.003
URI:	http://hdl.handle.net/10037/1823

File(s) in this item: 2

paper_3.pdf (106.7Kb)

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Erke, Maja Gran (Doctoral thesis; Doktorgradsavhandling, 30-May-2013)

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Abstract:	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.
Description:	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)
URI:	http://hdl.handle.net/10037/5155

File(s) in this item: 1

thesis.pdf (942.4Kb)

Androgen receptor CAG and GGN polymorphisms in vivo and in vitro

Skjærpe, Paal André (Doctoral thesis; Doktorgradsavhandling, 21-Sep-2012)

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Abstract:	Mannens testosteronnivå påvirkes av genetiske variasjoner i androgenreseptorens lengde selv om sammenhangen er beskjeden. Studier på celler har også vist at den vanligste androgenreseptoren lengden er den mest effektive. I studien Androgen receptor CAG og GGN polymorfier in vivo og in vitro har vi studert sammenhengen mellom genetiske variasjoner i androgenreseptorens lengde og testosteronnivåer samt risikofaktorer for hjerte- karsykdom (Metabolsk syndrom). Vi har også på cellenivå studert hvilken betydning variasjoner i androgenreseptorlengden har på reseptorens effektivitet og evne til å skape det androgene uttrykk. Vi har i våre studier vist at testosteronnivået hos eldre menn er assosiert med en økende lengde på androgenreseptoren. Assosiasjonen var dog beskjeden sammenlignet med for eksempel betydningen av overvekt som er kraftig assosiert med lave testosteron nivåer. Man behøver derfor ikke å ta hensyn til reseptorens lengde ved undersøkelse av lavt testosteronnivå hos eldre menn. Videre fant vi at menn med kortere variasjon av reseptoren hadde flere risikofaktorer for hjerte- karsykdom. Hva gjelder reseptorens grad av effektivitet, så ble dette studert på cellenivå. Vi fant at det var den vanligste, middels lange reseptoren, som var den mest effektive varianten. Dette ble senere bekreftet blant eldre og yngre menn med kjent reseptorlengde, ved å måle mengden prostata spesifikk antigen (PSA), som en markør for androgenreseptor aktivitet. De med middels lang reseptor viste seg å ha den største mengden PSA i blodet. Dette skulle kunne ha betydning ved PSA screening for prostata kreft.
Description:	The papers of this thesis are not available in Munin: 1. Skjærpe PA, Lundberg Giwercman Y, Giwercman A and Svartberg J.: 'Androgen receptor gene polymorphism and sex hormones in elderly men: the Tromsø study', Asian Journal of Andrology (2009) 11:222-228. Available at http://dx.doi.org/10.1038/aja.2008.7 2. Skjærpe PA, Lundberg Giwercman Y, Giwercman A and Svartberg J.: 'Androgen receptor gene polymorphism and the metabolic syndrome in 60-80 years old Norwegian men', International Journal of Andrology (2010) 33:500–506. Available at http://dx.doi.org/10.1111/j.1365-2605.2008.00942.x 3. Nenonen H, Björk C, Skjærpe PA, Giwercman A, Rylander L, Svartberg J and Lundberg Giwercman Y.: 'CAG repeat number is not inversely associated with androgen receptor activity in vitro', Molecular Human Reproduction (2010) 16:153-157. Available at http://dx.doi.org/10.1093/molehr/gap097 4. Nenonen H, Skjærpe PA, Lippolis G, Sajid A, Bjartell A, Svartberg J, Giwercman A, Sävblom C and Lundberg Giwercman Y.: 'Androgen receptor CAG length dependent amount of prostate specific antigen in serum and in tissue' (manuscript)
URI:	http://hdl.handle.net/10037/4564

File(s) in this item: 1

thesis.pdf (1.266Mb)

Angiotensin II and heart remodelling : role of ischemia, gender and pregnancy

Aljabri, Mohammad Belal (Doctoral thesis; Doktorgradsavhandling, 26-May-2011)

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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)

Anticancer activity of bovine lactoferricin and a cytolytic 9-mer peptide : from milk to cancer vaccine?

Berge, Gerd (Doctoral thesis; Doktorgradsavhandling, 09-Dec-2009)

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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

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thesis.pdf (695.2Kb)

Antimicrobial resistance and bacterial diversity in Arctic environments

Glad, Trine (Doctoral thesis; Doktorgradsavhandling, 01-Jun-2011)

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Abstract:	Ampicillin er et antibiotikum som har vært brukt i flere tiår, og det er mange bakterier på sykehus og andre helseinstitusjoner som har utviklet resistens mot dette legemiddelet. Bakteriene blir resistente ved selv å utvikle eller ta opp resistensgener. Vi vet lite om bakteriene utenfor sykehusmiljøene har resistensgener mot ampicillin. Kunnskap om resistensgener i miljø hvor det er lite menneskelig påvirkning kan si oss noe om hvorvidt antibiotikaresistens oppstår i disse miljøene og så spres til klinikken eller motsatt. Glad ville videre finne ut hvilke typer bakterier som finnes i tarmsystemet til arktiske dyr. Hun har også studert samspillet mellom bakterier i reinens vom og det naturlige antibiotikumet usninsyre som finnes i laven reinen spiser. For å undersøke forekomsten av ampicillinresistens ble det tatt avføringsprøver fra isbjørn på Svalbard og fra sel i Vestisen. I tillegg ble forekomsten av resistensgener i jord og sedimenter på Svalbard og i Troms undersøkt. Glad var mest interessert i et spesielt gen, blaTEM-genet, som gjør bakteriene i stand til å ødelegge ampicillin, og brukte molekylære teknikker for å lete etter dette genet. Studiene viste at det var svært lite av dette genet i disse miljøene. Isbjørnene hadde en lite variert bakterieflora. Den var hovedsakelig dominert av stavformede bakterier kalt klostridier som også dominerer blant menneskets tarmbakterier. Dette bekrefter tidligere resultater som viser at kjøttetende dyr har færre bakterier og et mindre mangfold av bakterier i fordøyelsessystemet. Kjøttetende dyr fordøyer proteiner og fett raskt sammenlignet med fiberfordøyelsen hos planteetende dyr. Dette forklarer den lave diversiteten av bakterier i isbjørnens tarm. Hos selene derimot var flesteparten av bakterien ukjente og har aldri tidligere vært beskrevet. Hun fant også bakterier i reinens vom som var resistente mot usninsyren som finnes i lav. Disse bakteriene kan være involvert i nedbryting av usninsyre sånn at reinen kan spise og fordøye lav som er giftig for de fleste andre dyr og mennesker.
Description:	Papers number 1, 3 and 4 of the thesis are not available in Munin: 1. Brusetti, L., T. Glad, S. Borin, P. Myren, A. Rizzi, P. J. Johnsen, P. Carter, D. Daffonchio and K. M. Nielsen:'Low prevalence of blaTEM genes in Arctic environments and agricultural soil and rhizosphere', Microbial Ecology in Health and Disease (2008), 20: 27-36. (Publisher's restriction) Available at http://dx.doi.org/10.1080/08910600701838244 3. Glad T., V. F. Kristiansen, K. M. Nielsen, L. Brusetti, A.-D. Wright and M. A. Sundset:'Ecological characterisation of the colonic microbiota in Arctic and sub-Arctic seals', Microbial Ecology (2010), 60: 320-30. (Publisher's restrictions). Available at http://dx.doi.org/10.1007/s00248-010-9690-x 4. Glad, T., P. Barboza, A. Kohn, R. I. Mackie, A.-D. Wright, L. Brusetti, S. D. Mathiesen and M. A. Sundset:'Effect of usnic acid, a natural antibiotic in lichens, on rumen microbial ecology and resistance in reindeer' (manuscript)
URI:	http://hdl.handle.net/10037/3369

File(s) in this item: 2

paper_2.pdf (621.3Kb)

thesis.pdf (1.046Mb)

Aspects of experimental cooling and rewarming with special reference to accidental hypothermia

Filseth, Ole Magnus (Doctoral thesis; Doktorgradsavhandling, 17-Aug-2012)

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Abstract:	Methods and aims We performed open, randomized, placebo-controlled experimental studies in intact, anesthetized pigs with the following main aims: Paper 1 To describe in detail the hemodynamic function with emphasis on left ventricular contractility during surface cooling, steady state severe hypothermia at 25°C, surface rewarming and in the post-hypothermic period of 2 h. Paper 2 1) To investigate the pharmacokinetic properties of DA in normothermia and hypothermia. 2) To carry out a detailed analysis of the cardiovascular response to incrementing dosages of dopamine (DA) at core body temperatures at normothermia, at steady state hypothermia at 25°C, and during rewarming in the temperature span of 30 - 34°C. Paper 3 To compare differences between immersion cooling and cooling by cardiopulmonary bypass (CPB) in cardiovascular function and global delivery and consumption of oxygen i) during cooling until deep hypothermic circulatory arrest; ii) during rewarming by CPB; and iii) during the 2 h post-hypothermic period following weaning from CPB. Main results and conclusions Surface cooling, followed by surface rewarming, resulted in a mild post-hypothermic systolic cardiac failure that was well compensated for. Diastolic function was unaffected (Paper 1). Pharmacokinetics of DA was seriously altered at 25°C and DA did not increase cardiac output, but had the adverse effects of increased systemic vascular resistance (Paper 2). Immersion cooling to hypothermic circulatory arrest, followed by rewarming taking place on CPB, resulted in severe and uncompensated cardiovascular failure not encountered in CPB-cooled animals (Paper 3).
Description:	Paper 2 and 3 of this thesis are not available in Munin: 2. Filseth OM, How O-J, Kondratiev T, Gamst TM, Sager G, Tveita T.: 'Changes in cardiovascular effects of dopamine in response to graded hypothermia in vivo', Critical Care Medicine (2012), 40(1):178-86. Available at http://dx.doi.org/10.1097/CCM.0b013e31822d78de 3. Filseth OM, Hermansen SE, Kondratiev T, Tveita T.: 'Cooling to hypothermic circulatory arrest by immersion vs. cardiopulmonary bypass : worse outcome after rewarming in immersion cooled pigs' (manuscript)
URI:	http://hdl.handle.net/10037/4366

File(s) in this item: 2

paper_1.pdf (502.5Kb)

thesis.pdf (1.298Mb)

Assignment of mental health diagnoses and severity : effectiveness and reliability of online standardized assessment instruments

Brøndbo, Per Håkan (Doctoral thesis; Doktorgradsavhandling, 26-Sep-2012)

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Abstract:	During the last decade, child psychiatry has been a focus of the Norwegian government's plan to improve mental health care. Psychiatric assessment of children and adolescents is more complex than that of adults, and rating scales and diagnostic instruments have become increasingly important tools in both research and clinical practice. This dissertation investigates standardized assessment instruments used in routine clinical practice to assign diagnoses and severity of mental health problems. Both the reliability and the validity of some instruments were examined, and a main focus was the clinical usefulness of these instruments and their potential for more effective use of limited clinical resources. In paper 1 the agreement between diagnoses and severity ratings assigned by clinical specialists who were trained Child and Adolescent Mental Health Service (CAMHS) researchers examined. Information on 100 youths was obtained from multiple informants through a webbased Development and Well-Being Assessment (DAWBA). Based on this information, four experienced clinicians independently diagnosed (according to the International Classification of Diseases Revision 10) and rated the severity of mental health problems according to the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) and the Children’s Global Assessment Scale (C-GAS). Agreement for diagnosis was - =0.69-0.82. Intra-class correlation for single measures was 0.78 for HoNOSCA and 0.74 for C-GAS, and 0.93 and 0.92, respectively for average measures. Information obtained with the online DAWBA may be a sound basis on which to establish reliable clinical diagnoses and severity ratings for common mental health disorders in a clinical setting. A clinical practice that includes systematic, multiple independent assignments of diagnosis and severity, is preferable due to the resulting improved reliability of the severity ratings. In paper 2 the application of specific scoring algorithms for the Strengths and Difficulties Questionnaire (SDQ) was examined. Could available online norms be useful in screening for mental health disorders among children and adolescents in the CAMHS North Study? A total of 286 outpatients, aged 5 to 18 years, were assigned diagnoses based on the DAWBA. The main diagnostic groups (emotional, hyperactivity, conduct and other disorders) were then compared to the SDQ scoring algorithms using two dichotomisation levels: ‘possible’ and ‘probable’ levels. Sensitivity for the diagnostic categories included was 0.47-0.85 (‘probable’ dichotomisation level) and 0.81-1.00 (‘possible’ dichotomisation level). Specificity was 0.52-0.87 (‘probable’ level) and 0.24-0.58 (‘possible’ level). The discriminative ability, as measured by ORD, was in the interval for potentially useful tests for hyperactivity disorders and conduct disorders when dichotomised on the ‘possible’ level, but outside the interval for potentially useful tests for all diagnostic categories when dichotomised on the most common used ‘probable’ level. In conclusion, the ability of the SDQ to detect mental health disorders among patients referred to CAMHS is not sufficient for clinical purposes. When used as a screening instrument to determine whether further evaluation is warranted in a clinical CAMHS sample, the SDQ seems best suited to identify children and adolescents who do not require further psychiatric evaluation, although this also is problematic from a clinical point of view. In paper 3 the agreement between diagnoses and severity assigned by clinical specialists trained as CAMHS researchers, based only on DAWBA information collected online, and the routine clinical assignments by CAMHS clinicians was examined. Routine clinical assignment of diagnoses was compared to online clinical assignment of diagnoses for 286 patients from the CAMHS North study. Chi square analysis, kappa statistics and multinomial logistic regression analyses were performed. Raw agreement for diagnostic categories varied between 74% and 90%, resulting in kappa values of 0.41-0.49. The final multinomial regression models were significant. Agreement on mental health diagnoses can be fair when online clinical assignments and routine clinical assignments of mental health diagnoses are compared. This may be sufficient to replace the routine clinical assignment of diagnoses with an online clinical assignment in order to save time and resources. We also examined factors contributing to agreement or disagreement on the diagnoses. Age, gender and number of informants significantly contributed to the explanation of agreement and disagreement for ‘emotional diagnosis’ and ‘hyperkinetic/conduct diagnosis’. However, the changes in odds were small in magnitude and the factors probably do not consistently contribute to the understanding of agreement or disagreement in any clinically meaningful way. Lastly, implications for further research on reliable and effective assessment methods are discussed.
Description:	Paper 3 of this thesis is not available in Munin: 3. Brondbo PH, Mathiassen B, Martinussen M, Handegard BH and Kvernmo S.: 'Agreement on diagnoses and severity of mental health problems between a research and a naturalistic clinical setting' (manuscript).
URI:	http://hdl.handle.net/10037/4521

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A doctor close at hand : a qualitative analysis of GPs' work in cancer care

Johansen, May-Lill (Doctoral thesis; Doktorgradsavhandling, 31-Aug-2012)

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Abstract:	Summary of thesis The core of medicine, even specialized and high-tech medicine, is a meeting, a consultation, between a human being asking for advice and another human being, whose knowledge and experience is expected to be helpful. This thesis explores how the suspicion of cancer can arise in such a consultation, how general practitioners (GPs) can contribute to cancer care and how GPs might accompany people with cancer towards the end of life. 25 qualitative interviews with Norwegian GPs about diagnosing and attending people with cancer through the course of illness were analyzed. Besides clinical assessments and paperwork, the GPs often acted as intermediaries between the patient and the hospital. They pushed for quick hospital appointments, interpreted and translated discharge letters and were asked for second opinions. In rural areas some GPs offered cytostatic treatments. Knowing the patient and preferably also the family was seen as a premise for being a good GP. In the researcher’s interpretation, the GPs were well acquainted both with the patients’ world and with the clinical world. They could act as guides for their patients, but their personal knowledge of patients could, even if it was clinically relevant, be given less weight when confronted with hospital routines and criteria. This could lead to conflicting loyalties for the GPs. During end-of-life care in the patients’ homes, existential conversations were seen as demanding but rewarding. Palliation of pain was an easy task compared to being a fellow human being, listening and attempting to comfort a person who is afraid to die.
Description:	The papers of this thesis are not available in Munin: Johansen, M.-L., Holtedahl, K. A., & Rudebeck, C. E.: 'A doctor close at hand : how GPs view their role in cancer care', Scandinavian Journal of Primary Health Care (2010) vol. 28(4): 249-255. Available at http://dx.doi.org/10.3109/02813432.2010.526792 2. Johansen, M.-L., Holtedahl, K.A., Davidsen, A.S & Rudebeck, C.E.: 'I deal with the small things : the doctor-patient relationship and professional identity in GPs’ stories of cancer care', Health (2012). Online before print March 7. Available at http://dx.doi.org/10.1177/1363459312438565 3. Johansen, M.-L., Holtedahl, K.A., & Rudebeck, C.E.: 'How does the thought of cancer arise during a consultation in general practice?' (manuscript accepted in Scandinavian Journal of Primary Health Care)
URI:	http://hdl.handle.net/10037/4381

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A five-year prospective follow-up of longstanding eating disorders : influence from personality disorders and child sexual abuse

Vrabel, KariAnne R. (Doctoral thesis; Doktorgradsavhandling, 05-May-2010)

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Abstract:	Follow-up studies have shown that 20-30% of patients with eating disorders develop longstanding symptoms seriously impairing their daily life. There are very few studies on the course of these patients. This dissertation consists of three papers on patients admitted to a specialized inpatient treatment program at the Modum Bad psychiatric hospital. The participants were assessed upon admission, discharge and at one-, two-, and five-year follow-up. Paper I reports on the course and outcome at five years after completing treatment and identifies subgroups of patients with different course and outcome. The key findings were first that among the 77 patients (90%) who participated, 46 patients (61%) had improved, and 30 (39%) did not meet diagnostic criteria for an eating disorder. Second, a cluster analysis identified a group of 21 patients (27%) with no improvement over time. Paper II reports on the change in proportions of personality disorders over time. The results showed that during inpatient treatment, 58 patients (78%) had one or more personality disorders and this was reduced to 32 patients (43%) at the five-year follow-up. Dimensional indices and a mean personality index changed significantly over time in anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified, but no significant changes between diagnoses emerged. Recovered patients had lower frequency of personality disorder (p < .01). Paper III reports on prognostic factors for the poor outcome of eating disorder symptoms and how the predictors interact. Multi-level mixed model was used to examine the predictors. In these prospective longitudinal analyses, avoidant personality disorder and child sexual abuse interacted in predicting high levels of eating disorder during a long-term course. In sum, this dissertation addressed several important topics in the eating disorder field. The main findings are: There was statistically significant reduction in eating disorder symptoms at the five-year follow-up. Cluster analysis identified a group of patients with no improvement over time. Patients had higher probability of recovery from personality disorders than from eating disorders. Avoidant personality disorder and child sexual abuse interacted in predicting high levels of eating disorder symptoms during the long-term course.
Description:	Papers number 1 and 2 of the thesis are not available in Munin due to publisher's restrictions: 1. Vrabel, K. R., Ro, O., Martinsen, E. W., Hoffart, A., & Rosenvinge, J. H.: «The course of illness following inpatient treatment of adults with longstanding eating disorders: A 5-year follow-up», International Journal of Eating Disorders, 41(2008), 224-232 (Wiley). Available at http://dx.doi.org/10.1002/eat.20485 2. Vrabel, K. R., Ro, O., Martinsen, E. W., Hoffart, A., & Rosenvinge, J. H.: «Five-year prospective study of personality disorders in adults with longstanding eating disorders», International Journal of Eating Disorders, 43(2009), 22-28 (Wiley). Available at http://dx.doi.org/10.1002/eat.20662
URI:	http://hdl.handle.net/10037/2699

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A genetic spectrum approach to affective and schizophrenic disorders : a twin- and family study

Edvardsen, Jack A. (Doctoral thesis; Doktorgradsavhandling, 15-Sep-2009)

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Abstract:	Over 300 eneggete- og toeggete tvillingpar rekruttert fra sykehusarkiv, og deres 1.grads slektninger (foreldre og søsken), ble intervjuet personlig og diagnostisert i henhold til moderne diagnostiske systemer (DSM-III-R) både med hensyn til symptomforstyrrelser (Akse I), og personlighetsforstyrrelser (Akse II). De ble også intervjuet angående forhold knyttet til tvillingenes fødsel og oppvekst. Materialet ble analysert ved hjep av konkordansanalyser, variansanalyse og korrelasjonsanalyser, og arvelighet (heritabilitet, h2) ble estimert vha. moderne biometrisk modelltilpasning (Structural Equation Modelling, SEM). Resultatene viste at bipolare spektrum tilstander bestående av bipolar I, bipolar II og cyclothymi har høy arvelighet. Høyest var arveligheten for bipolar I og bipolar II betraktet som en tilstand. Ingen effekt av felles oppvekstmiljø ble påvist. Arveligheten er av additiv natur; ingen signifikant effekt av dominant arv ble påvist. Variansen ble forklart utelukkende av additiv genetisk arv og individspesifikke erfaringer. Resultatene kan tyde på at tilstandene innen det bipolare spektrum er ulike utrykk for den samme genetiske disposisjon eller overlappende genetiske disposisjoner. Videre viste resultatene at det unipolare depressive spektrum bestående av alvorlig depresjon, atypisk depresjon, dystymi og depressiv tilpasningsforstyrrelse er moderat arvelig. Høyest var arveligheten for alvorlig depresjon og atypisk depresjon betraktet som en tilstand. Ingen effekt av felles oppvekstmiljø ble påvist. Resultatene kan tyde på at tilstandene innen det unipolare depressive spektrum er, i hvert fall delvis, uttrykk for den samme bakenforliggende genetiske disposisjon. Førstegrads slektninger (tvillinger og andre) av personer med schizofreni skåret høyere enn de andre sammenligningsgrupper på inadekvat rapport/kontakt og merkelig kommunikasjon. Eneggete tvillingsøsken av personer med schizofreni skåret høyt på inadekvat rapport/kontakt, merkelig kommunikasjon, sosial isolasjon og vrangforestillinger/hallusinasjoner. Eneggede tvillingsøsken av personer med schizotyp personlighetsforstyrrelse skåret høyt på tendens til illusjoner, depersonalisering, derealisering og magisk tenkning. Basert på dette studiet synes altså såkalte negative schizotype trekk å være innen det schizofrene spektrum, mens de såkalt positive borderline-aktige trekk synes å han et annet genetisk grunnlag.
Description:	The papers of the thesis are not available in Munin due to publisher's restrictions: 1. Edvardsen J, Torgersen S, Røysamb E, Lygren S, Skre I, Onstad S, Øien PA: 'Heritability of bipolar spectrum disorders. Unity or heterogeneity?' Journal of Affective Disorders 2008 Mar;106(3):229-40 (Elsevier). Available at http://dx.doi.org/10.1016/j.jad.2007.07.001 2. Edvardsen J, Torgersen S, Røysamb E, Lygren S, Skre I, Onstad S, Øien PA: 'Unipolar depressive disorders have a common genotype.' Journal of Affective Disorders 2009 Sep;117(1-2):30-41 (Elsevier). Available at http://dx.doi.org/10.1016/j.jad.2008.12.004 3. Torgersen S, Edvardsen J, Øien PA, Onstad S, Skre I, Lygren S, Kringlen E: 'Schizotypal personality disorder inside and outside the schizophrenic spectrum.' Schizophrenia Research 2002 Mar 1; 54(1-2):33-8 (Elsevier). Available at http://dx.doi.org/10.1016/S0920-9964(01)00349-8
URI:	http://hdl.handle.net/10037/2132

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A genome-wide study of gene expression regulation in the Gram-negative fish pathogen Aliivibrio salmonicida

Hansen, Geir Åsmund (Doctoral thesis; Doktorgradsavhandling, 04-Oct-2011)

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Abstract:	Regulation of gene expression is essential for all bacteria to function and survive. The expression of genes into proteins is dependent on a number of steps, each of which can be subjected to regulation. In the literature much emphasis has typically been placed on transcriptional regulation, but during recent years gene regulation at the post-transcriptional level has also gained much attention. One contributing factor to this shift in knowledge is the accumulating amount of genomic data that has become available, and computational methods now play important roles in mapping expression regulation (such as genomic features). In this present work the Gram-negative fish pathogen Aliivibrio salmonicida has been used as a model for computational genome-wide predictions of transcription factor binding sites (TFBSs) and prediction of small regulatory RNAs (sRNAs). In Paper 1, a bioinformatical search for Ferric uptake regulator (Fur) TFBSs resulted in the identification of several genes previously not known to be regulated by Fur. The prediction and validation of genes that encode sRNAs in Paper 2 increased the knowledge of the non-coding RNA pool in our model system. Paper 3 and Paper 4 provide in-depth studies on two of the identified sRNAs from Paper 2, the Spot42 homolog and the novel VSsrna24. Overall, the results from these studies have increased our general understanding on gene regulation in A. salmonicida. In addition, the work has generated a number of good starting points for future experiments.
Description:	Papers number 1, 2 and 4 of this thesis are not available in Munin: 1. Rafi Ahmad, Erik Hjerde, Geir Åsmund Hansen, Peik Haugen and Nils-Peder Willassen: 'Prediction and Experimental Testing of Ferric Uptake Regulator Regulons in Vibrios', Journal of molecular microbiology and biotechnology (2008) 16:159-68. Available at http://dx.doi.org/10.1159/000128322 2. Rafi Ahmad, Geir Åsmund Hansen, Hilde Hansen, Erik Hjerde, May Liss Julianne Nyrud, Nils-Peder Willassen and Peik Haugen: 'Prediction, microarray, and Northern blot analyses identify new intergenic small RNAs in Aliivibrio salmonicida', (submitted paper to PLoS ONE) 4. Geir Åsmund Hansen, Rafi Ahmad, Erik Hjerde, Christopher G. Fenton, Nils-Peder Willassen and Peik Haugen: 'Aliivibrio salmonicida encodes a small RNA immediately downstream of spf : Microarray analysis and potential roles in carbohydrate transport and metabolism', (manuscript for submission to PLoS ONE)
URI:	http://hdl.handle.net/10037/3675

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Abstract:	Systemic lupus erythematosus (SLE) is a chronic, systemic autoimmune disease that predominantly affects young women. Knowledge of the processes underlying the development of autoimmunity as well as end-organ disease manifestations is limited. One of the major contributors to morbidity and mortality in SLE patients is the development of nephritis. Using a murine model of SLE we have characterized changes occuring within the kidney during the development of lupus nephritis. The results demonstrate qualitative and quantitative alterations in the collagen IV matrix within the glomerular extracellular membranes, associated with increased proteolytic activity and the activation of the Wnt signaling pathway. Co-inciding with these events there is a downregulation of renal Dnase1 expression, which is associated with the development of severe nephritis. These data identify major biochemical alterations within the glomerulus during development of lupus nephritis, offering new insight into the development and progression of the disease.
Description:	Papers number 1, 2 and 4 of the thesis are not available in Munin due to publishers' restrictions: 1. Tveita A, Rekvig OP, Zykova SN.: 'Increased glomerular matrix metalloproteinase activity in murine lupus nephritis', Kidney International 2008 Nov;74(9):1150-8 (Nature Publishing Group). Available at http://dx.doi.org/10.1038/ki.2008.308 2. Tveita A, Rekvig OP, Ninomiya Y, Sado Y, Zykova SN.: 'Lupus nephritis is associated with a glomerular collagen IV isoform switch', Lupus 2009 Apr;18(4):355-60 (Sage). Available at http://dx.doi.org/10.1177/0961203308100842 4. Tveita A, Rekvig OP.: 'Alterations in Wnt pathway activity in serum and kidneys during lupus development', Arthritis & Rheumatism 2011 vol. 63 Issue 2, February 2011, Pages: 513–522 (Wiley-Blackwell publisher's restrictions), available at http://dx.doi.org/10.1002/art.30116
URI:	http://hdl.handle.net/10037/2898

Abstract:	Helsepolitikk for samer har bygd på antakelser om at språk- og kulturforskjeller mellom helsepersonell og pasienter fører til et underforbruk av helsetjenester og en dårligere helsetjeneste. Første studie i denne avhandlingen analyserer forbruket av sykehus, og avviser at det er et underforbruk av helsetjenester blant samer generelt, men finner at de eldste innbyggerne i samiske kommuner er noe sjeldnere på sykehus enn eldre ellers i landet. Siden 1963 har man forsøkt å forbedre helsetjenesten i samiske kommuner gjennom samisk kvote på helsefagutdanninger. Samisk kvote på medisin skulle resultere i flere samiske leger i samiske kommuner. En sporingsstudie i denne avhandlingen stiller spørsmål ved kvoter som egnet virkemiddel til dette i dag. En sammenlignende studie fra USA, Canada, Australia og New Zealand peker på at effekter av slike kvoteordninger sjelden undersøkes.
Description:	Paper 3 of this thesis is not available in Munin: 3. Margrete Gaski: 'A comparative study of strategies for recruiting young Indigenous People to become physicians : nearly fifty years of preferential admission and support (accepted manuscript in Human Resources for Health)
URI:	http://hdl.handle.net/10037/4142

Abstract:	Avhandlingens tittel er ”Aspects of the primary assessment and management of anal incontinence - The introduction of a new treatment”. Disputas for graden Ph.D. finner sted 05.04.2013. Ufrivillig lekkasje av luft og avføring er en relativt vanlig og belastende tilstand, og kan gi redusert livskvalitet. Det er utviklet en ny metode for å behandle denne lidelsen, som består i å injisere et rom-oppfyllende stoff i endetarmskanalen. Det sentrale målet i prosjektet har vært å vurdere om denne nye behandlingen er bedre enn eksisterende metoder. I tillegg har prosjektgruppen ønsket å utvikle metoder til å vurdere anal inkontinens bedre.
Description:	The papers of this thesis are not available in Munin: 1. Norderval S, Dehli T, Vonen B.: 'Three-dimensional endoanal ultrasonography: intraobserver and interobserver agreement using scoring systems for classification of anal sphincter defects', Ultrasound in Obstetrics and Gynecology (2009), vol. 33 (3): 337-43. Available at http://dx.doi.org/10.1002/uog.6295 2. Dehli T, Martinussen M, Mevik K, Stordahl A, Sahlin Y, Lindsetmo RO, Vonen B.: 'Translation and validation of the Norwegian version of the fecal incontinence quality-of-life scale', Scandinavian Journal of Surgery (2011), vol. 100 (3): 190-5. Available at http://www.fimnet.fi/sjs/articles/SJS32011-190.pdf 3. Dehli T, Stordahl A, Vatten LJ, Romundstad PR, Sahlin Y, Lindsetmo RO, Vonen B.: 'Sphincter training or anal injections of dextranomer for treatment of anal incontinence: a randomized trial', Scandinavian Journal of Gastroenterology (2013) Vol. 48, No. 3. Available at http://dx.doi.org/10.3109/00365521.2012.758770
URI:	http://hdl.handle.net/10037/5047

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