Bodies out of control: Relapse and worsening of eating disorders in pregnancy

Background: Being pregnant is a vulnerable period for women with a history of eating disorders. A central issue in eating disorders is searching control of one’s body and food preferences. Pregnancy implies being increasingly out of control of this. Treatment and targeted prevention start with the patient’s experience. Little is known about how women with a history of eating disorder experience being pregnant. Method: We interviewed 24 women with a history of eating disorder at the time of pregnancy, recruited from five public pregnancy controls at local family health centers in Norway. Interviews were analyzed by means of ideal type analysis, with a particular focus on how the participants experienced pregnancy and perceived triggers in possible experiences of relapse or worsening during pregnancy. All participants completed the Eating Disorder Examination Questionnaire (EDE-Q) and were diagnosed (DSM-5) by using the Eating Disorder Examination (EDE). Results: On becoming pregnant, 23 of the 24 participants experienced worsening or relapse of their disorder. This occurred both at first time and after several pregnancies, and either interviewed early or late in pregnancy. Ideal type analyses indicated seven different personal features associated with worsening or relapse: the “chaotic” “rigid” “perfect” “worried” “shameful” “motherhood fearing” and “the mother with lost identity” Perceived triggers of worsening or relapse were: “loss of control” “unpredictability” “competition” “change of appearance” “shame and nausea” and “loss of identity.” Conclusion: Pregnancy is a vulnerable period for women with a history of eating disorders. A great variation in personal psychological dynamics seems to interact with perceived triggers in worsening or relapse of eating disorder. Our findings have important implications in understanding mechanisms of relapse in pregnancy, preventing relapse and help tailoring adequate intervention.Bodies out of control: Relapse and worsening of eating disorders in pregnancypublishedVersio

IVF-induced pregnancy and early motherhood among women with a history of severe eating disorders

BackgroundThere is a higher prevalence of eating disorders among women seeking in vitro fertilization (IVF). Women with a history of eating disorders may be particularly vulnerable to eating disorder relapse during IVF, pregnancy, and early motherhood. The experience of these women during this process has hardly been studied scientifically, despite its high clinical relevance. The overall aim of this study is to describe how women with a history of eating disorders experience the process of becoming a mother through IVF, pregnancy, and the postpartum period.MethodsWe recruited women with a history of severe anorexia nervosa who had undergone IVF (n = 7) at public family health centers in Norway. Semi-openly, the participants were interviewed extensively first during pregnancy, and then 6 months after birth. The 14 narratives were analyzed using interpretative phenomenological analyses (IPA). All participants were required to complete the Eating Disorder Examination Questionnaire (EDE-Q) and were diagnosed (DSM-5) by using the Eating Disorder Examination (EDE), during both pregnancy and postpartum.ResultsAll participants experienced a relapse of an eating disorder during IVF. They perceived IVF, pregnancy, and early motherhood to be overwhelming, confusing, a source of severe loss of control, and a source of body alienation. There were four core phenomena that were reported that were strikingly similar across all participants: “anxiousness and fear,” “shame and guilt,” “sexual maladjustment,” and “non-disclosure of eating problems.” These phenomena persisted continuously throughout IVF, pregnancy, and motherhood.ConclusionWomen with a history of severe eating disorders are highly susceptible to relapse when undergoing IVF, pregnancy, and early motherhood. The process of IVF is experienced as extremely demanding and provoking. There is evidence that eating problems, purging, over-exercising, anxiousness and fear, shame and guilt, sexual maladjustment, and non-disclosure of eating problems continue throughout IVF, pregnancy, and the early years of motherhood. Therefore, it is necessary for healthcare workers providing services to women undergoing IVF to be attentive and intervene when they suspect a history of eating disorders

Loss of health certificates among offshore petroleum workers on the Norwegian Continental Shelf 2002-2010

Background: A health certificate is required to work on the offshore petroleum installations of the Norwegian Shelf. Loss of health certificate (“loss of licence”, LOL) may cause economic problems for the individual worker. A private compensation system (OSO) was established for Norwegian offshore workers in 2002, comprising 8000–11,000 individual members of workers organisations: approximately one third of the population offshore. This study aims at describing the reasons for compensation of offshore workers who have lost their certificates. Materials and methods: Of 595 workers who applied for compensation in the period 2002–2010, 38 declined to participate in the study. Of the remaining 557, 507 were granted and 50 were denied compensation. All medical records held by the scheme concerning the 507 compensated applicants were examined. Health data were systematically extracted, analysed, and compared with general population statistics. Results: Musculoskeletal conditions were the most frequent conditions causing LOL for both sexes (42.5%), followed by psychiatric, neurological, and malignant diseases for women, and cardiovascular (19%), neurological, and psychiatric conditions for men. Musculoskeletal disorders were more prevalent than in the general population, and the prevalence of knee problems was particularly high. Among malignant diseases we found a high proportion of brain tumours and renal cancer. The causes are unknown and warrant further investigation in this population. Among women granted compensation, 78% were catering workers, while 50% of the men were process workers, reflecting the gender distribution in these working groups. Conclusions: Musculoskeletal conditions were the most frequent cause of application for LOL compensation for both sexes, followed by psychiatric, neurological, and malignant diseases for women, and cardiovascular, neurological, and psychiatric conditions for men. The cause of the higher incidence of musculoskeletal diseases, brain tumours, and renal cancer found in this study compared to the general population warrants further investigation.publishedVersio

Loss of health certificates among offshore petroleum workers on the Norwegian Continental Shelf 2002–2010

Background. A health certificate is required to work on the offshore petroleum installations of the Norwegian Shelf. Loss of health certificate (loss of licence, LOL) may cause economic problems for the individual worker. A private compensation system (OSO) was established for Norwegian offshore workers in 2002, comprising 8000–11,000 individual members of workers organisations: approximately one third of the population offshore. This study aims at describing the reasons for compensation of offshore workers who have lost their certificates. Materials and methods. Of 595 workers who applied for compensation in the period 2002–2010, 38 declined to participate in the study. Of the remaining 557, 507 were granted and 50 were denied compensation. All medical records held by the scheme concerning the 507 compensated applicants were examined. Health data were systematically extracted, analysed, and compared with general population statistics. Results. Musculoskeletal conditions were the most frequent conditions causing LOL for both sexes (42.5%), followed by psychiatric, neurological, and malignant diseases for women, and cardiovascular (19%), neurological, and psychiatric conditions for men. Musculoskeletal disorders were more prevalent than in the general population, and the prevalence of knee problems was particularly high. Among malignant diseases we found a high proportion of brain tumours and renal cancer. The causes are unknown and warrant further investigation in this population. Among women granted compensation, 78% were catering workers, while 50% of the men were process workers, reflecting the gender distribution in these working groups. Conclusions. Musculoskeletal conditions were the most frequent cause of application for LOL compensation for both sexes, followed by psychiatric, neurological, and malignant diseases for women, and cardiovascular, neurological, and psychiatric conditions for men. The cause of the higher incidence of musculoskeletal diseases, brain tumours, and renal cancer found in this study compared to the general population warrants further investigation

Associations between language difficulties, peer victimization, and bully perpetration from 3 through 8 years of age : results From a population-based study

Background and Purpose: Schoolchildren with language difficulties experience more peer victimization compared to their typically developing (TD) peers. Whether these children also bully their peers (bully perpetration) more than TD children is unclear. Furthermore, little is known about peer victimization and bully perpetration among preschool children with language difficulties and how it may be related to different paths of language difficulties. This study aimed to investigate associations between language difficulties, peer victimization, and bully perpetration from preschool to school age as well as the risk of peer victimization and bully perpetration for children with different developmental paths of language difficulties and mild language difficulties compared to TD children. Method: The sample was drawn from the Norwegian Mother, Father and Child Cohort Study. Participants with completed questionnaires at 3, 5, and 8 years of age (n = 22,628) were included. Paths between latent variables of language skills at 3, 5, and 8 years of age, peer victimization at 5 and 8 years of age, and bully perpetration at 8 years of age were examined with structural equation modeling. Logistic regression was used to investigate peer victimization and bully perpetration for predefined paths of language difficulties. Results: Poor language skills at 3 and 5 years of age were associated with peer victimization at 5 years of age. Poor language skills at 5 and 8 years of age were associated with peer victimization and bully perpetration at 8 years of age. The association between poor language skills at 5 years of age and bully perpetration at 8 years of age was stronger for girls. Persistent paths of language difficulties at 3, 5, and 8 years of age showed the highest risk of peer victimization and bully perpetration. Conclusions: Language difficulties are associated with peer victimization and bully perpetration. The risk of peer victimization and bully perpetration differs according to different developmental paths of language difficulties from preschool to school age

Real-Time Echocardiography Guidance for Optimized Apical Standard Views

Measurements of cardiac function such as left ventricular ejection fraction and myocardial strain are typically based on 2-D ultrasound imaging. The reliability of these measurements depends on the correct pose of the transducer such that the 2-D imaging plane properly aligns with the heart for standard measurement views and is thus dependent on the operator's skills. We propose a deep learning tool that suggests transducer movements to help users navigate toward the required standard views while scanning. The tool can simplify echocardiography for less experienced users and improve image standardization for more experienced users. Training data were generated by slicing 3-D ultrasound volumes, which permits simulation of the movements of a 2-D transducer. Neural networks were further trained to calculate the transducer position in a regression fashion. The method was validated and tested on 2-D images from several data sets representative of a prospective clinical setting. The method proposed the adequate transducer movement 75% of the time when averaging over all degrees of freedom and 95% of the time when considering transducer rotation solely. Real-time application examples illustrate the direct relation between the transducer movements, the ultrasound image and the provided feedback.publishedVersio

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Livet med anoreksi Erfaringer fra mennesker med diagnosen

Dette heftet er for deg som har fått diagnosen anoreksi. Her kan du lese om hvordan andre i samme situasjon har opplevd å få og å leve med sykdommen. Heftet kan også være nyttig for helsepersonell og for dine nærmeste pårørende. I tillegg kan informasjonen i heftet brukes som grunnlag for samtaler med helsepersonell eller i samtalegrupper med andre med diagnosen. Å få en diagnose kan ha mange fordeler - du kan få bedre hjelp og informasjon. Men det å få en diagnose kan også by på vanskeligheter. Erfaringene du nå vil lese om er både positive og negative. Slike erfaringer er noe man kan oppleve, men det er ikke sikkert du vil ha liknende opplevelser. Det er viktig at du mottar behandling for sykdommen. Mange blir mye bedre eller helt friske med tiden

Livet med hypokondri. Erfaringer fra mennesker med diagnosen

Dette heftet er for deg som har fått diagnosen hypokondri. Her kan du lese om hvordan andre i samme situasjon har opplevd å få og å leve med sykdommen. Heftet kan også være nyttig for pårørende og for ansatte i helsevesenet. Informasjonen i heftet kan brukes som grunnlag for samtaler med helsepersonell eller i samtalegrupper med andre som har fått denne diagnose