Should stroke victims routinely receive supplemental oxygen? A quasi-randomized controlled trial.
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BACKGROUND AND PURPOSE: We sought to test the hypothesis that breathing 100% oxygen for the first 24 hours after an acute stroke would not reduce mortality, impairment, or disability. METHODS: Subjects admitted to the Central Hospital of Akershus, Norway, with stroke onset <24 hours before admittance were allocated to 2 groups by a quasi-randomized design using birth numbers. All patients with acute stroke admitted to hospital within 24 hours after a stroke were included and enrolled. Patients were allocated to a group that received supplemental oxygen treatment (100% atmospheres, 3 L/min) for 24 hours (n=292) or to the control group, which did not receive additional oxygen. Main outcome measures were 1-year survival, neurological impairment (Scandinavian Stroke Scale), and disability (Barthel Index) 7 months after stroke. RESULTS: One-year survival was 69% in the oxygen group and 73% in the control group (OR 0.82; 95% CI 0.57 to 1.19; P=0.30). Impairment scores and disability scores were comparable 7 months after stroke. Among patients with Scandinavian Stroke Scale (SSS) scores of >/=40, 82% in the oxygen group and 91% in the control group survived (OR 0. 45; 95% CI 0.23 to 0.90; P=0.023). For patients with SSS scores of <40, 53% in the oxygen group and 48% in the control group survived (OR 1.26; 95% CI 0.76 to 2.09; P=0.54). CONCLUSIONS: Supplemental oxygen should not routinely be given to nonhypoxic stroke victims with minor or moderate strokes. Further research is needed to give conclusive advice concerning oxygen supplementation for patients with severe strokes. (+info)
Distribution and skewness of occupational exposure sets of measurements in the Norwegian industry.
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Aggregated occupational sets of exposure measurements from the Norwegian industry registered in the exposure database EXPO at The National Institute of Occupational Health, Oslo were examined with respect to distributions and skewness. Data for lead in blood show a truncated almost normal distribution because of regulations for workers with high lead in blood concentrations. The styrene, dichloromethane and acetone measurements show quasi log-normal distributions possibly because of over-representation of worst-case measurements. The other personal and stationary measurements are relatively good fitted to a log-normal model. The stationary measurements indicate generally lower mean levels than the corresponding personal measurements. The statistical parameter skewness is valuable in connection with an exposure database as a distribution test for raw data and log-transformed data. (+info)
Population based study on serum ionised calcium, serum parathyroid hormone, and blood pressure. The Tromso study.
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OBJECTIVE: To study associations between serum ionised calcium, serum parathyroid hormone (PTH) and blood pressure. DESIGN: A population based, cross-sectional study was used. METHODS: Blood pressure, body mass index, serum ionised calcium and serum PTH were measured in 460 males and 486 females in the Tromso study in 1994/1995. None were on medication for hypertension. The data were analysed with a multiple linear regression model. RESULTS: When looking at subjects with serum ionised calcium<1.39mmol/l, there was a significant negative association (P<0.01) between serum ionised calcium and PTH. There was no association between blood pressure and serum ionised calcium. In both sexes there was a significant positive association between age and serum PTH (P<0.01). For women, but not for men, there was a significant positive association between serum PTH and systolic and diastolic blood pressure (P<0.01). Within each age group there was a difference in both systolic and diastolic blood pressure of 3-10mmHg between the upper and lower serum PTH halves of the female population. Females with hypertension had significantly higher serum PTH levels than the normotensive females (P<0.01). CONCLUSION: Serum PTH is strongly and positively associated with blood pressure in women. (+info)
Low levels of serum calcidiol in an African population compared to a North European population.
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OBJECTIVE: To compare vitamin D status in an African population living at 10 degrees N with a Norwegian population living at 60 degrees N. DESIGN: Serum samples from 30 healthy young Ethiopians and 31 full term pregnant women from Addis Ababa were collected in September, and from 24 healthy Norwegians in March and 23 pregnant women from Oslo in February to June. METHODS: Serum (s) levels of calcidiol and intact parathyroid hormone (iPTH) were measured. RESULTS: The median values for s-calcidiol were significantly lower in Ethiopians compared with Norwegians (young Ethiopians 23.5nmol/l vs young Norwegians 81nmol/l, P<0.001; pregnant Ethiopians 25nmol/l vs pregnant Norwegians 36nmol/l, P<0.05) while those for s-iPTH were significantly higher (young Ethiopians 5.7pmol/l vs young Norwegians 2.4pmol/l, P<0.001; pregnant Ethiopians 4.8pmol/l vs pregnant Norwegians 2.8pmol/l, P<0.02). CONCLUSION: In spite of abundant availability of ultraviolet radiation, the population from Addis Ababa had a high rate of biochemical vitamin D deficiency compared with the Norwegian group. (+info)
Rapid changes in the prevalence of obesity and known diabetes in an adult Norwegian population. The Nord-Trondelag Health Surveys: 1984-1986 and 1995-1997.
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OBJECTIVE: To determine whether changes in mean BMI and the prevalence of obesity in a total adult population during a short (11-year) period were associated with changes in the prevalence of diabetes. RESEARCH DESIGN AND METHODS: This study involved cross-sectional surveys of all inhabitants aged > or = 20 years of the county of Nord-Trondelag from 1984 to 1986 (n = 85,100) and from 1995 to 1997 (n = 92,434). Attendance rates were 88.1 and 71.3%, respectively, and 90.0% in an additional survey of people aged 13-19 years from 1995 to 1997 (n = 9,593). Main outcome measures were age-specific mean BMI for the diabetic and nondiabetic subgroups and the prevalence of obesity and diabetes. For comparison, mean BMIs from 18 of 19 Norwegian counties for the group aged 40-42 years were examined. RESULTS: Mean BMI increased from 27.2 to 29.0 kg/m2 in the diabetic population and from 25.1 to 26.3 kg/m2 in the nondiabetic population. The BMI distribution curve shifted to the right, but homogeneity was also reduced. A comparison with other Norwegian counties indicated that this increase occurred during the last 6 years between the surveys. The prevalence of obesity (BMI > or = 30 kg/m2) increased from 7.5 to 14% in nondiabetic men and from 13 to 18% in nondiabetic women. The increase was particularly great in men aged < 60 years and in women aged < 50 years. The overall prevalence of known diabetes increased between the two surveys (from 2.9 to 3.2%) but only in men. The largest increase was observed in the corresponding younger sex and age-groups. CONCLUSIONS: A substantial increase in mean BMI and the prevalence of obesity occurred in the younger age-groups at the same time as an increase in the prevalence of diabetes. A greater increase in diabetes prevalence in this ethnically stable Western European population may follow if effective primary preventive strategies are not undertaken. (+info)
Distribution patterns of marine bird digenean larvae in periwinkles along the southern coast of the Barents Sea.
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An important component of the parasite fauna of seabirds in arctic regions are the flukes (Digena). Different species of digeneans have life cycles which may consist of 1 intermediate host and no free-living larval stages, 2 intermediate hosts and 1 free-living stage, or 2 intermediate hosts and 2 free-living larval stages. This study examined the distribution of such parasites in the intertidal zones of the southern coast of the Barents Sea (northwestern Russia and northern Norway) by investigating 2 species of periwinkles (Littorina saxatilis and L. obtusata) which are intermediate hosts of many species of digeneans. A total of 26,020 snails from 134 sampling stations were collected. The study area was divided into 5 regions, and the number of species, frequency of occurrence and prevalence of different digenean species and groups of species (depending on life cycle complexity) were compared among these regions, statistically controlling for environmental exposure. We found 14 species of digeneans, of which 13 have marine birds as final hosts. The number of species per sampling station increased westwards, and was higher on the Norwegian coast than on the Russian coast. The frequency of occurrence of digeneans with more than 1 intermediate host increased westwards, making up a larger proportion of the digeneans among infected snails. This was significant in L. saxatilis. The prevalence of different species showed the same pattern, and significantly more snails of both species were infected with digeneans with complicated life cycles in the western regions. In L. saxatilis, environmental exposure had a statistically significant effect on the distribution of the most common digenean species. This was less obvious in L. obtusata. The causes of changing species composition between regions are probably (1) the harsh climate in the eastern part of the study area reducing the probability of successful transmission of digeneans with complicated life cycles, and (2) the distribution of different final hosts. (+info)
Clinical significance of apoptosis-related factors p53, Mdm2, and Bcl-2 in advanced ovarian cancer.
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PURPOSE: To investigate the prognostic and predictive relevance of p53, Mdm2, and Bcl-2 protein expression in advanced ovarian cancer. PATIENTS AND METHODS: Tumor biopsy specimens from 185 consecutive and homogeneously treated patients with stage III ovarian cancer were examined immunohistochemically for expression of p53, Mdm2, and Bcl-2 proteins. Both uni- and multivariate analyses of prognostic factors were performed, and correlations with classical clinicopathologic parameters and response to chemotherapy were examined. RESULTS: Forty-nine percent and 39% of cases were considered positive for expression of p53 and Bcl-2, respectively. p53 expression was correlated with loss of histologic differentiation and Bcl-2 expression with smaller residual disease after primary surgery. The absence of p53 expression and the presence of Bcl-2 expression were associated with improved survival but not with overall response to chemotherapy, although a positive correlation was found between Bcl-2 expression and the possibility of obtaining a completely negative second-look laparotomy. Expression of Mdm2 was found in 17% of cases. Although correlations were found with known favorable clinicopathologic factors, no prognostic significance was demonstrated for Mdm2 in this patient group. In multivariate analyses, histologic type, degree of differentiation, residual disease, and p53 alone or combined with Bcl-2 expression were found to be independently associated with overall survival. CONCLUSION: p53, and especially the combination of p53 and Bcl-2 expression data, represents an independent prognostic predictor in stage III ovarian cancer. Despite their role in the apoptotic process, p53 and Bcl-2 do not seem to be clinically useful predictors of response to combination chemotherapy in these patients. (+info)
Flexible sigmoidoscopy or colonoscopy as a screening modality for colorectal adenomas in older age groups? Findings in a cohort of the normal population aged 63-72 years.
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BACKGROUND: Most cases of colorectal cancer originate from adenomas. Removing adenomas has been shown to reduce the incidence of colorectal cancer. The design of cost effective endoscopic screening programmes requires a knowledge of the distribution of adenomas in different age groups. AIM: To investigate the distribution of colorectal adenomas in older age groups in the normal population. METHOD: A total of 356 men and women selected randomly from the population register were offered a colonoscopic screening examination to detect and remove polyps. RESULTS: In all, 241(68%) subjects, mean age 67.4 years (range 62-73), attended. The caecum was intubated in 193 (80%), and in this group 32 (38%) women and 51 (47%) men had adenomas. One hundred and ten (54%) of the adenomas and 11 (39%) of the "high risk adenomas" (adenomas larger than 10 mm in diameter, adenomas containing villous components, and adenomas with severe dysplasia) were found proximal to the sigmoid colon. In 36 (43%) of the subjects with adenomas, the adenomas were only found proximal to the sigmoid colon. Twenty two (11%) subjects had more than two adenomas. Of 203 adenomas discovered, 189 (93%) were less than 10 mm in diameter. CONCLUSION: More than half of the adenomas were localised proximal to the sigmoid colon, and, in nearly half of the adenoma bearing subjects examined, the adenoma was proximal to the descending colon. This indicates that a sigmoidoscopic screening examination in this age group would miss a substantial number of adenomas, but this may be acceptable as the vast majority of proximal adenomas do not progress to clinical cancer within the life expectancy of this age group. (+info)