Submitted manuscript version. Published version available in European Journal of Cancer (2017), 87, p. 92-100. ; Background: Early-onset prostate cancer is often more aggressive and may have a different etiology than later-onset prostate cancer, but has been relatively little studied to date. We evaluated occupation in relation to early-onset and later-onset prostate cancer in a large pooled study. Methods: We used occupational information from census data in five Nordic countries from 1960-1990. We identified prostate cancer cases diagnosed from 1961-2005 by linkage of census information to national cancer registries and calculated standardized incidence ratios (SIRs) separately for men aged 30-49 and those aged 50 or older. We also conducted separate analyses by period of follow-up, 1961-1985 and 1986-2005, corresponding to pre- and post-prostatespecific antigen (PSA) screening. Results: For early-onset prostate cancer (n=1,521), we observed the highest SIRs for public safety workers (e.g., firefighters) [SIR=1.71, 95% confidence interval (CI): 1.23-2.31] and military personnel (SIR=1.97, 95% CI: 1.31-2.85). These SIRs were significantly higher than the SIRs for later-onset disease (for public safety workers, SIR=1.10, 95% CI: 1.07-1.14, and for military personnel, SIR=1.09, 95% CI: 1.05- 1.13; pheterogeneity=0.005 and 0.002, respectively). Administrators and technical workers also demonstrated significantly increased risk for early-onset prostate cancer, but the SIRs did not differ from those for later-onset disease (pheterogeneity>0.05). While our early-onset finding for public safety workers was restricted to the post-PSA period, that for military personnel was restricted to the pre-PSA period. Conclusion: Our results suggest that occupational exposures, particularly for military personnel, may be associated with early-onset prostate cancer. Further evaluation is needed to explain these findings.
Source at https://doi.org/10.1371/journal.pmed.1002651 . ; Background - Helping consumers make healthier food choices is a key issue for the prevention of cancer and other diseases. In many countries, political authorities are considering the implementation of a simplified labelling system to reflect the nutritional quality of food products. The Nutri-Score, a five-colour nutrition label, is derived from the Nutrient Profiling System of the British Food Standards Agency (modified version) (FSAm-NPS). How the consumption of foods with high/low FSAm-NPS relates to cancer risk has been studied in national/regional cohorts but has not been characterized in diverse European populations. Methods and findings - This prospective analysis included 471,495 adults from the European Prospective Investigation into Cancer and Nutrition (EPIC, 1992–2014, median follow-up: 15.3 y), among whom there were 49,794 incident cancer cases (main locations: breast, n = 12,063; prostate, n = 6,745; colon-rectum, n = 5,806). Usual food intakes were assessed with standardized country-specific diet assessment methods. The FSAm-NPS was calculated for each food/beverage using their 100-g content in energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits/vegetables/legumes/nuts. The FSAm-NPS scores of all food items usually consumed by a participant were averaged to obtain the individual FSAm-NPS Dietary Index (DI) scores. Multi-adjusted Cox proportional hazards models were computed. A higher FSAm-NPS DI score, reflecting a lower nutritional quality of the food consumed, was associated with a higher risk of total cancer (HR Q5 versus Q1 = 1.07; 95% CI 1.03–1.10, P -trend < 0.001). Absolute cancer rates in those with high and low (quintiles 5 and 1) FSAm-NPS DI scores were 81.4 and 69.5 cases/10,000 person-years, respectively. Higher FSAm-NPS DI scores were specifically associated with higher risks of cancers of the colon-rectum, upper aerodigestive tract and stomach, lung for men, and liver and postmenopausal breast for women (all P < 0.05). The main study limitation is that it was based on an observational cohort using self-reported dietary data obtained through a single baseline food frequency questionnaire; thus, exposure misclassification and residual confounding cannot be ruled out. Conclusions - In this large multinational European cohort, the consumption of food products with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher risk of cancer. This supports the relevance of the FSAm-NPS as underlying nutrient profiling system for front-of-pack nutrition labels, as well as for other public health nutritional measures.
Source: doi:10.3945/ajcn.115.120873 ; Background: Vitamin D deficiency has been described as being pandemic, but serum 25-hydroxyvitamin D [25(OH)D] distribution data for the European Union are of very variable quality. The NIH-led international Vitamin D Standardization Program (VDSP) has developed protocols for standardizing existing 25(OH)D values from national health/nutrition surveys. Objective: This study applied VDSP protocols to serum 25(OH)D data from representative childhood/teenage and adult/older adult European populations, representing a sizable geographical footprint, to better quantify the prevalence of vitamin D deficiency in Europe. Design: The VDSP protocols were applied in 14 population studies [reanalysis of subsets of serum 25(OH)D in 11 studies and complete analysis of all samples from 3 studies that had not previously measured it] by using certified liquid chromatography–tandem mass spectrometry on biobanked sera. These data were combined with standardized serum 25(OH)D data from 4 previously standardized studies (for a total n = 55,844). Prevalence estimates of vitamin D deficiency [using various serum 25(OH)D thresholds] were generated on the basis of standardized 25(OH)D data. Results: An overall pooled estimate, irrespective of age group, ethnic mix, and latitude of study populations, showed that 13.0% of the 55,844 European individuals had serum 25(OH)D concentrations <30 nmol/L on average in the year, with 17.7% and 8.3% in those sampled during the extended winter (October–March) and summer (April–November) periods, respectively. According to an alternate suggested definition of vitamin D deficiency (<50 nmol/L), the prevalence was 40.4%. Dark-skinned ethnic subgroups had much higher (3- to 71-fold) prevalence of serum 25(OH)D <30 nmol/L than did white populations. Conclusions: Vitamin D deficiency is evident throughout the European population at prevalence rates that are concerning and that require action from a public health perspective. What direction these strategies take will depend on European policy but should aim to ensure vitamin D intakes that are protective against vitamin D deficiency in the majority of the European population.
Background and purpose — In Norway all compensation claims based on healthcare services are handled by a government agency (NPE, Norsk Pasientskade Erstatning). We provide an epidemiological overview of claims within pediatric orthopedics in Norway, and identify the most common reasons for claims and compensations. Patients and methods — All compensation claims handled by NPE from 2012 to 2018 within pediatric orthopedics (age 0 to 17 years) were reviewed. Data were analyzed with regard to patient demographics, diagnoses, type of injury, type of treatment, reasons for granted compensation, and total payouts. Results — 487 compensation claims (259 girls, 228 boys) within orthopedic surgery in patients younger than 18 years at time of treatment were identified. Mean age was 12 years (0–17). 150 out of 487 claims (31%) resulted in compensation, including 79 compensations for inadequate treatment, 58 for inadequate diagnostics, 12 for infections, and 1 based on the exceptional rule. Total payouts were US$8.45 million. The most common primary diagnoses were: upper extremity injuries (26%), lower extremity injuries (24%), congenital malformations and deformities (12%), spine deformities (11%), disorders affecting peripheral joints (9%), chondropathies (6%), and others (12%). Interpretation — Most claims were submitted and granted for mismanagement of fractures in the upper and lower extremity, and mismanagement of congenital malformations and disorders of peripheral joints. Knowledge of the details of malpractice claims should be implemented in educational programs and assist pediatric orthopedic surgeons to develop guidelines in order to improve patient safety and quality of care. ; publishedVersion
Background: Mobile phone has been one of the most technologically ubiquitous influences over the past decade. Mobile phone use has changed from a perceived item of luxury to an everyday necessity for many people. Given the widespread availability of mobile technology, there is increasing interest in the potential of interventions utilising these technologies to enhance medical treatment. Smartphones are therefore changing many industries, including the medical industry. Africa as a whole lags far behind compared to the richer regions of the world. Africa often have challenges in medical information, access to healthcare, treatment excellence and affordability. However, the speedy spread of mobile phones in so many of its countries is an extraordinary phenomenon, exclusively in the framework of their enormous economic and social challenges. Mobile technology is an example of such technologies that are readily available, accessible and affordable worldwide that can help African countries to solve their healthcare delivery challenges. This study explored and addressed the possible use of smartphones in providing basic health services in Ghana using health professionals at the 37 Military Hospital as a reference group. Method: A cross-sectional survey was conducted involving 101 healthcare professionals at the 37 Military Hospital. The study used primary data, however, secondary data were also employed where necessary. Data was gathered by administering structured closed-ended questionnaires to respondents who were sampled using convenience sampling technique. Findings: It was found that all the participants owned and used their smartphones for health purposes. It was particularly found that majority of the participants used their smartphones to communicate with patients. Specifically, applications (like whatsapp, imo, viber) was the most used medium of communication by the nurses, SMS was the most used medium the doctors and pharmacist use to communicate with patients according to the result. The radiologist/laboratory technicians preferred communicating with patients through two or more of the listed options as provided in the questionnaire. The data also revealed that it is only the doctors who admitted that their smartphones helped them in the diagnosis of diseases although majority said otherwise. The study also revealed that majority of the health professionals searched for health information using search engines like google, medline and pubmed. Moreso, internet access problems was the major challenge health professionals at the 37 Military Hospital faced in using their smartphones for health purposes. Conclusion: The use of smartphones by health care professionals is rising in popularity especially in less financially advanced countries). The use of mobile technologies to support the achievement of health objectives (mHealth) has the potential to transform the face of health service delivery. The Government and health policy makers in Ghana can make use of the potentials of this technology in the health care delivery of Ghana.
The Internet, given its availability and affordability, is increasingly being used for different purposes, including health-related purposes. In this context, the Internet serves as a medium for people to interact frequently with the health care professionals, access health information online, and form and participate in online support groups. Yet, the extant literature has focused mostly on the use of the Internet for health purposes in developed countries. To bridge this gap and to ascertain the utility of the Internet for health purposes in developing countries, a cross-sectional survey was conducted involving 363 students at the University of Ghana, using self-reported methodology. The study revealed that all the participants reported to use the Internet for health purposes. Particularly, the study found evidence that the participants use the Internet to seek for information online, interact with health professionals, engage in social support and group communication via popular social networks-Facebook and WhatsApp. Interestingly, the study also found that the majority of the participants own two or more electronic devices, used to access the Internet. More so, the availability of the Internet on campus, and easy access, motivated participants to use it. While the majority of the participants had indicated that they acquired knowledge and changed their lifestyle after accessing health information online, few had stated otherwise. The general implication of the study is that the use of the Internet for health purposes is not limited to developed countries. Government and policy makers in Ghana can make use of the Internet to provide relevant health information and services. The extent of the Internet usage raises the optimism that geographical and physical barriers to seeking health care information can be overcome. The findings are briefly discussed and also, the implications of the findings for promoting access to health information discussed.
This work is a synthesis of experiences gained during ten years of helping healthcare providers improve their service to victims of injury and acute disease. This work is based on my participation in two programs: The Trauma Care Foundation's Mine Injury Management Program in Kurdistan, northern Iraq, and the BEST Foundation: Better & Systematic Trauma Care's trauma team training program in Norwegian hospitals. My experience with both programs took place from 1996 to 2006-7. The purpose of the thesis was to: 1. Describe and assess the effects of trauma team training in Norway, and summarize health personnel's experience from implementation, and 2. Describe and assess the adaptation and maturation of a pre-hospital trauma care system in northern Iraq, and determine the impact of this system on villagers in mine-affected areas. I have summarized these experiences in order to enable health workers with a need for training and system improvement to draw upon our experiences. The thesis consists of five papers. In the first paper, the team training method from Norway is described as a solution to the team members' perceived lack of team skills (communication, leadership, and cooperation). In the second paper, the effects of team training are described in terms of perceived quality of care during multi-trauma resuscitation and individual knowledge and confidence. The feasibility of team training was also assessed. The third study is a follow-up of a program that trained paramedics and first responders in Kurdistan in northern Iraq, with an evaluation of the adaptation and maturation of the trauma system. The fourth study examined the impact of the development of chains of paramedics and first responders on Kurdish villages. Finally, the fifth paper examined how Norwegian healthcare personnel manage to maintain team training in their institutions. In these projects, we found that short-term educational activities are effective if they are targeted carefully, which indicates that they should be planned and adapted with cooperation between the local healthcare workers and the external teachers. We found that it is possible to transfer knowledge that continues to live and grow in some organizations, but that this is dependent on support to enthusiasts in the organizations in question. In both locations, the healthcare providers adapted their new knowledge and skills to different patient groups and different medical situations. Treatment quality seemed to remain at a high level. System maturation in northern Iraq resulted in a reduced time interval between injury and the first medical response, and improved physiological function after transportation. In areas where demanding medical challenges, such as severe trauma, occur infrequently, it seems useful to share experiences among health workers. In both settings, we found that health workers take responsibility for further development of their services, and that they are able and willing to apply their experience to other areas of patient care. Healthcare providers will act responsibly and employ what they believe are useful training methods provided they receive some sort of support. Responsible health personnel can be a powerful force of change. The training methods described here have great potential for application in similar areas. Medical training in low-income countries is a political act that has implications for the trainees and the societies in which they live that reach beyond the medical arena. In Norway, the decision on where to devote ones energy is also a political matter. However, trauma does not occur indiscriminately, neither should trauma training. ; Avhandlingen er basert på deltakelse i to programmer: Trauma Care Foundations mineskadeprogram i Kurdistan, Nord-Irak, og Stiftelsen BEST: Bedre & systematisk traumebehandlings treningsprogram for traumeteam på norske sykehus, begge i perioden 1996 til 2006-7. I begge programmene var formålet å gi helsepersonell praktisk og teoretisk opplæring for å forbedre behandlingen av pasienter med skader og akutt sykdom. Formålet med avhandlingen var å: 1. Beskrive og evaluere effekten av traumeteamtrening i Norge, og oppsummere helsepersonellets erfaringer fra implementeringen. 2. Beskrive og evaluere hvordan det prehospitale traumesystem i Nord-Irak modnet og tilpasset seg, og betydningen av systemet for landsbyboerne i mineområdene. Avhandlingen består av fem artikler. I den første beskrives treningsprogrammet for traumeteam som en løsning på teammedlemmenes opplevde mangel på teamferdigheter (kommunikasjon, ledelse og samarbeid). I den andre artikkelen evalueres effekten av treningen på opplevd behandlingskvalitet under resuscitering av multitraumatiserte, individuell viten og fortrolighet. Vi evaluerte også muligheten for å gjennomføre teamtrening. Det tredje studien er en oppfølging av mineskadebehandlere og førstehjelpere i Nord-Irak med vekt på hvordan det prehospitale system modnet og tilpasset seg endrede behov. Betydningen traumesystemet hadde for landsbyboerne i mineområdene ble undersøkt i artikkel fire. Den femte artikkelen undersøkte hva som avgjør om norsk helsepersonell lykkes med implementering av teamtrening på sine sykehus. Vi fant at korte treningskurser er effektive hvis de er målrettet og planlegges nøye etter deltakernes behov. Vi fant også at kunnskapen fortsetter å gro i organisasjonene og kan videreføres, men dette avhenger av at det finnes entusiaster som driver implementeringen, og i hvilken grad de får støtte. I begge områder tok helsepersonellet selv ansvar for å tilpasse viten og kunnskaper til nye pasientgrupper. Behandlingskvaliteten ser ut til å holde seg når kunnskapene blir brukt på nye grupper. I Nord-Irak førte modningen av traumesystemet til at tidsintervallet fra skade til første medisinske hjelp ble redusert og at den fysiologiske effekten av behandlingen økte gjennom studieperioden. I områder med sjeldne, krevende traumepasienter ser det ut til å være nyttig å dele erfaringer mellom helsepersonell ved nettverksmøter eller månedlige møter. Vi fant at helsepersonell tar ansvar for å forbedre sine tjenester, og at de er i stand til å overføre sine er faringer til andre områder i pasientbehandling. Studiene viser at helsepersonellet er ansvarlige, og bruker hva de opplever som nyttige læringsmetoder dersom de får en viss støtte. Denne typen helsepersonell har en sterk endrings- og utviklingskraft. De beskrevne treningsmetodene ser ut til å ha stort potensial for spredning til beslektede områder. Medisinsk opplæring i fattige land er en politisk handling. Opplæringen har ikke bare konsekvenser for de skadde, mineskadebehandlere, og førstehjelpere, men også for samfunnet, og betydningen rekker utover det medisinske. Også i Norge er beslutningen om hvor man som utdannet med spesialkompetanse skal bruke sin energi et politisk spørsmål. Personskade rammer ikke tilfeldig. Det bør treningen ikke heller.
Background and purpose — In Norway all compensation claims based on healthcare services are handled by a government agency (NPE, Norsk Pasientskade Erstatning). We provide an epidemiological overview of claims within pediatric orthopedics in Norway, and identify the most common reasons for claims and compensations. Patients and methods — All compensation claims handled by NPE from 2012 to 2018 within pediatric orthopedics (age 0 to 17 years) were reviewed. Data were analyzed with regard to patient demographics, diagnoses, type of injury, type of treatment, reasons for granted compensation, and total payouts. Results — 487 compensation claims (259 girls, 228 boys) within orthopedic surgery in patients younger than 18 years at time of treatment were identified. Mean age was 12 years (0–17). 150 out of 487 claims (31%) resulted in compensation, including 79 compensations for inadequate treatment, 58 for inadequate diagnostics, 12 for infections, and 1 based on the exceptional rule. Total payouts were US$8.45 million. The most common primary diagnoses were: upper extremity injuries (26%), lower extremity injuries (24%), congenital malformations and deformities (12%), spine deformities (11%), disorders affecting peripheral joints (9%), chondropathies (6%), and others (12%). Interpretation — Most claims were submitted and granted for mismanagement of fractures in the upper and lower extremity, and mismanagement of congenital malformations and disorders of peripheral joints. Knowledge of the details of malpractice claims should be implemented in educational programs and assist pediatric orthopedic surgeons to develop guidelines in order to improve patient safety and quality of care. ; publishedVersion
Little is known about medical consequences of losing arm(s) or leg(s) in military attacks. Many Palestinians in Gaza have suffered loss of one or more limbs during recurrent Israeli military incursions. Such serious physical trauma pose grave health problems not only for the amputee, but also for their families and for the society at large. The problem is increasing. Hanne Heszlein-Lossius, MD, from UiT The Arctic University of Tromsø has together with her supervisor professor Mads Gilbert (UiT) and Palestinian research colleagues in Gaza conducted a study of 254 patients with war-related traumatic extremity amputations in Gaza. The patients attended Gaza's main rehabilitation center, The Artificial Limb and Polio Centre (ALPC) in Gaza City for prosthesis and rehabilitation. The studies, published in The Lancet, BMJ and BMC found that the majority of the amputated Palestinians were young, well-educated men with large financial responsibilities, and often the family's sole breadwinner. Most traumatic amputations were major and will cause life-long disability. To lose the ability to work and thus loose income and the ability to care for one's family and put food on the table seemed to be an important trauma adding to the pain and loss of arms or legs. A variety of military weapons had caused the loss of limb(s) among the studied patients. Unarmed military airplanes carrying explosive weapons (drones) were the most common. Those who had been hit during drone-attacks suffered the most severe extremity amputations. The patients needed more surgical operations after drone strikes than amputations caused by other weapons.
The papers of this thesis are not available in Munin. Paper 1. Silsand, L., Ellingsen, G. (2014). Generification by Translation: Designing Generic Systems in Context of the Local. Available in: Journal of Association for Information Systems, vol. 15(4): 3. Paper 2. Christensen, B., Silsand, L., Wynn, R. and Ellingsen, G. (2014). The biography of participation. In Proceedings of the 13th Participatory Design Conference, 6-10 Oct. Windhoek, Namibia. ACM Digital Library. Paper 3. Silsand, L. and Ellingsen, G. (2016). Complex Decision-Making in Clinical Practice. In: Proceedings of the 19th ACM Conference on Computer-Supported Cooperative Work & Social Computing (CSCW '16). ACM Digital Library. ISBN: 978-1-4503-3592-8. Paper 4: Silsand, L., Ellingsen, G. (2017). Governance of openEHR-based information Infrastructures. (Manuscript). Paper 5. Silsand, L. (2017). The 'Holy Grail' of Interoperability of Health Information Systems: Challenges and Implications. Available in: Stigberg S., Karlsen J., Holone H., Linnes C. (eds) Nordic Contributions in IS Research. SCIS 2017. Lecture Notes in Business Information Processing, vol 294. Springer, Cham. ; This thesis provides empirical insights about socio-technical interdependencies affecting the making and scaling of an Information Infrastructure (II) for healthcare based on the development of large-scale Electronic Patient Records. The Ph.D. study is an interpretive case study, where the empirical data has been collected from 2012 to 2017. In most developed countries, the pressures from politicians and public in general for better IT solutions have grown enormously, not least within Electronic Patient Record (EPR) systems. Considerable attention has been given to the proposition that the exchange of health information is a critical component to reach the triple aim of (1) better patient experiences through quality and satisfaction; (2) better health outcomes of populations; and (3) reduction of per capita cost of health care. A promising strategy for dealing with the challenges of accessibility, efficiency, and effective sharing of clinical information to support the triple aim is an open health-computing platform approach, exemplified by the openEHR approach in the empirical case. An open platform approach for computing EPR systems addresses some vital differences from the traditional proprietary systems. Accordingly, the study has payed attention to the vital difference, and analyze the technology and open platform approach to understand the challenges and implications faced by the empirical process. There are two main messages coming out of this Ph.D. study. First, when choosing an open platform approach to establish a regional or national information infrastructure for healthcare, it is important to define it as a process, not a project. Because limiting the realization of a large-scale open platform based infrastructure to the strict timeline of a project may hamper infrastructure growth. Second, realizing an open platform based information infrastructure requires large structural and organizational changes, addressing the need for integrating policy design with infrastructure design.
Master's thesis in Global Development and Planning (UT505) ; The main objective of the study was to elucidate why thereis a gap between medical research conducted on the neglected tropical disease Female Genital Schistosomiasis (FGS) and work-related knowledge about the disease amongst professional nurses in the Ugu District, South Africa. The study is based on qualitative field work in three local governmental clinics in this area, and the purpose is to explore why there is such a gap and why the development of knowledge concerning FGS seems to stagnate despite a relatively high level of awareness related to its "twin disease", Urological Schistosomiasis which is commonly referred to as Bilharzia or Isichenene in Zulu.
Source at https://doi.org/10.1016/S2542-5196(18)30265-1. ; Background - Little data exist to describe the use and medical consequences of drone strikes on civilian populations in war and conflict zones. Gaza is a landstrip within the Palestinian territories and the home of 2 million people. The median age in Gaza is 17·2 years and almost half of the population is below the age of 14 years. We studied the prevalence and severity of extremity amputation injuries caused by drone strikes compared with those caused by other explosive weapons among patients with amputations attending the main physical prosthesis and rehabilitation centre in Gaza. Methods - In this retrospective cross-sectional study, we recruited patients from the Artificial Limb and Polio Centre (ALPC) in Gaza city in the Gaza strip with conflict-related traumatic extremity amputations. Patients were eligible if they had one or more amputations sustained during a military incursion in Gaza during 2006–16 and had an available patient record. Each patient completed a self-reporting questionnaire of the time and mechanism of injury, subsequent surgeries, comorbidities, and their socioeconomic status, and we collected each patient's medical history, recorded the anatomical location of their amputation or amputations, and interviewed each patient to obtain a detailed description of the incursion or incursions that led to their amputation injury. We classified the severity of amputations and number of subsequent surgeries on ordinal scales and then we determined the associations between these outcomes and the mechanism of explosive weapon delivery (drone strike vs other) using ordinal logistical regression. Findings - We collected data on 254 patients from APLC who had sustained an amputation injury. Of these patients, 234 (92%) were male and 43 (17%) were aged 18 years or younger at the time of injury. The age of participants was representative of the Gaza population, with a median age at inclusion was 28 years (IQR 23–33), and the median age at the time of injury was 23 years (IQR 20–29). 136 (54%) amputation injuries were caused by explosive weapons delivered by drone strikes, with explosives delivered by tanks being the next most common source of amputation injury (28 [11%]). Adjusted for age and sex, drone-delivered weapons caused significantly more severe injuries than explosives delivered by other mechanisms (eg, military jet airplanes, helicopters, tank shelling, and naval artillery; odds ratio [OR] 2·50, 95% CI 1·52–4·11; p=0·0003). Compared with all other types of weapons, the patients whose injuries were caused by drone strikes needed significantly more subsequent surgical operations to treat their amputation injuries than those injured by other weapons (OR 1·93, 1·19–3·14; p=0·008). Interpretation - Drone strikes were the most commonly reported cause of amputation injury in our study population and were associated with more severe injuries and more additional surgeries than injuries caused by other explosive weapons. Limitations of our study include the self-reported nature of the mechanism of injury and number of subsequent surgeries and selection bias from not incorporating amputation injuries from individuals who died immediately or due to complications. The increasing use of drones needs to be addressed, rather than passively accepted, by the international community. This study fills a gap in our knowledge of the civilian consequences of modern warfare and we believe it is also relevant to the growing populations that are being exposed to drone warfare and for health-care personnel treating these people.
An alert regarding an outbreak of carbapenem-resistant Klebsiella pneumoniae carrying bla NDM-1 and bla OXA-48 carbapenemase-encoding genes was sent by Germany to European Union (EU)/European Economic Area (EEA) countries in October 2019. Since only limited whole genome sequencing (WGS) data on bla NDM-1- and bla OXA-48 -positive K. pneumoniae were available in the public domain, national public health reference or equivalent expert laboratories from EU/EEA countries were invited to share WGS data from their national collections with the European Centre for Disease Prevention and Control (ECDC) to investigate the international dissemination of this epidemic strain. The analysis identified a Finnish case with an isolate closely related to the German outbreak strain and with an epidemiological link to St. Petersburg, Russia. In addition, several other clusters of genetically related bla NDM-1- and bla OXA-48 -positive K. pneumoniae unrelated to the German outbreak strain but affecting numerous EU/EEA countries were identified. The aim of this follow-up investigation was to characterise these clusters based on the integrated analysis of the WGS dataset on bla NDM-1 - and bla OXA-48 -positive K. pneumoniae submitted from 13 EU/EEA countries and additional epidemiological data.
Introduction: COVID-19 lockdown measures have been sources of both potential stress and possible psychological and addiction complications. A lack of activity and isolation during lockdown are among the factors thought to be behind the growth in the use of psychoactive substances and worsening addictive behaviors. Previous studies on the pandemic have attested to an increase in alcohol consumption during lockdowns. Likewise, data suggest there has also been a rise in the use of cannabis, although it is unclear how this is affected by external factors. Our study used quantitative data collected from an international population to evaluate changes in cannabis consumption during the lockdown period between March and October, 2020. We also compared users and non-users of the drug in relation to: (1) socio-demographic differences, (2) emotional experiences, and (3) the information available and the degree of approval of lockdown measures. Methods: An online self-report questionnaire concerning the lockdown was widely disseminated around the globe. Data was collected on sociodemographics and how the rules imposed had influenced the use of cannabis and concerns about health, the economic impact of the measures and the approach taken by government(s). Results: One hundred eighty two respondents consumed cannabis before the lockdown vs. 199 thereafter. The mean cannabis consumption fell from 13 joints per week pre-lockdown to 9.75 after it (p < 0.001). Forty-nine respondents stopped using cannabis at all and 66 admitted to starting to do so. The cannabis users were: less satisfied with government measures; less worried about their health; more concerned about the impact of COVID-19 on the economy and their career; and more frightened of becoming infected in public areas. The risk factors for cannabis use were: age (OR = 0.96); concern for physical health (OR = 0.98); tobacco (OR = 1.1) and alcohol consumption during lockdown (OR = 1.1); the pre-lockdown anger level (OR = 1.01); and feelings of boredom during the restrictions (OR = 1.1). Conclusion: In a specific sub-population, the COVID-19 lockdown brought about either an end to the consumption of cannabis or new use of the drug. The main risk factors for cannabis use were: a lower age, co-addictions and high levels of emotions. ; publishedVersion
Background: Adolescents have the right to be involved in decisions affecting their healthcare. More knowledge is needed to provide quality healthcare services that is both suitable for adolescents and in line with policy. Shared decision-making has the potential to combine user participation and evidence-based treatment. Research and governmental policies emphasize shared decision-making as key for high quality mental healthcare services. Objective: To explore adolescents' experiences with user participation and shared decision-making in mental healthcare inpatient units. Method: We carried out ten in-depth interviews with adolescents (16-18 years old) in this qualitative study. The participants were admitted to four mental healthcare inpatient clinics in Norway. Transcribed interviews were subjected to qualitative content analysis. Results: Five themes were identified, representing the adolescents' view of gaining trust, getting help, being understood, being diagnosed and labeled, being pushed, and making a customized treatment plan. Psychoeducational information, mutual trust, and a therapeutic relationship between patients and therapists were considered prerequisites for shared decision-making. For adolescents to be labeled with a diagnosis or forced into a treatment regimen that they did not initiate or control tended to elicit strong resistance. User involvement at admission, participation in the treatment plan, individualized treatment, and collaboration among healthcare professionals were emphasized. Conclusions: Routines for participation and involvement of adolescents prior to inpatient admission is recommended. Shared decision-making has the potential to increase adolescents' engagement and reduce the incidence of involuntary treatment and re-admission to inpatient clinics. In this study, shared decision-making is linked to empowerment and less to standardized decision tools. To be labeled and dominated by healthcare professionals can be a barrier to adolescents' participation in treatment. We suggest placing less emphasis on diagnoses and more on individualized treatment. ; publishedVersion
