Does implementation of the European guidelines based on the SCORE model double the number of Norwegian adults who need cardiovascular drugs for primary prevention? The Tromsø study 2001

This is a pre-copy-editing, author-produced PDF of an article accepted for publication in European Heart Journal following peer review. The definitive publisher-authenticated version Hartz, I., Njølstad, I. & Eggen, A.E. (2005). Does implementation of the European guidelines based on the SCORE model double the number of Norwegian adults who need cardiovascular drugs for primary prevention? The Tromsø study 2001. European heart journal. 26(24), 2673 is available online at: dx.doi.org/10.1093/eurheartj/ehi556Aims To study the implications of European guidelines on the use of antihypertensives and/or lipidlowering drugs (LLDs) for primary prevention in a Norwegian population. Methods and results The Tromsø study is a population-based study in the municipality Tromsø, Norway (from 1974 to till now). This analysis includes 45–79-year-old participants in 2001 (n ¼ 6362, attendance rate 86%). From the age of 60 years in men and 70 years in women, almost all participants were defined as high-risk individuals according to the European guidelines, with established cardiovascular disease, diabetes, or a 10-year risk score of 5%. In the primary prevention subgroup of the 45–64-year-olds, recommended antihypertensive and/or LLD use would be higher in men only, 42% compared with 12% on current medication. Among the 65–79-year-olds, .90% would be eligible for antihypertensives and/or LLDs in both sexes when compared with current treatment rates of ,30%. In total, 40% of all participants aged 45–79 would be candidates for primary prevention, compared with 15% on current medication. Conclusion The implementation of the European guidelines could imply a doubling of the numbers of Norwegian adults on cardiovascular medication for primary prevention. Contributors to the increase would be more frequent drug use in men and elderly people, particularly for LLD use

Whom are we treating with lipid-lowering drugs? Are we following the guidelines? Evidence from a population-based study: the Tromsø study 2001

The original publication is available at: http://dx.doi.org/10.1007/s00228-004-0827-zAbstract Objective: The beneficial effect of lipid-lowering drugs (LLDs) is well documented. Despite increasing sales of LLDs, little is known about what characterizes LLD users. Our objective was to describe LLD users in a general population according to socio-demographic factors, cardiovascular risk factors and coronary heart disease (CHD), and to study the achievement of cholesterol treatment goals according to national guidelines. Methods: The Tromsø study is a population-based study of chronic diseases, risk factors and drug use in the municipality Tromsø, in north Norway. The fifth survey was conducted in 2001 and included 7,973 men and women (attendance rate 78.1%). Self-reported use of LLDs and/or proprietary LLDs was included as LLD use in the analysis. Results: LLD use was reported in 9.6% of all women and 14.0% of all men, of whom 36.5% achieved the nationally recommended lipid goal. Among individuals with CHD, 49.9% of all women and 55.4% of all men were LLD users. The individuals with a risk condition (hypertension and/or diabetes) and total cholesterol level above the target of 5.0 mmol/l and the healthy individuals with total cholesterol level ‡8.0 mmol/l constituted 47.2% of the study population without CHD. In this group, which was eligible for primary prevention, 8.0% of the women and 7.4% of the men reported LLD use. Conclusions: Only half of all subjects with CHD were taking a LLD. The large discrepancy between national recommendations and actual LLD use in primary prevention should be addressed in future revisions of the guidelines

Why do sales of lipid-lowering drugs vary between counties in Norway? Evidence from the OPPHED Health Study 2000 /2001

The original publication is available at: http://dx.doi.org/10.1080/02813430500475365Objective. To study and compare plausible factors that might explain varying sales of lipid-lowering drugs (LLDs) in the two neighbouring counties of Hedmark and Oppland in Norway, with a similar age distribution, socioeconomic structure, and access to healthcare services. Design, setting, subjects. Cross-sectional population study comprising 10 598 attendants aged 40, 45, 60, and 75 years in the OPPHED Health Study, 2000 /2001 (attendance rate 61%). Main outcome measure. Treatment eligibility (cardiovascular morbidity and risk score), treatment frequency in treatment-eligible subgroups and treatment intensity in terms of achievement of total cholesterol (TC) goal. Results. Proportions eligible for LLD treatment in Hedmark and Oppland were similar. There was no difference in prevalence of LLD use among participants with cardiovascular disease or diabetes (secondary prevention subgroup). However, LLD use among men in the primary prevention subgroup was higher in Hedmark compared with Oppland, 6.3% and 4.1%, respectively (pB/0.05). The same tendency was seen among women. In both sexes, more LLD users in the primary prevention subgroup achieved the TC goal in Hedmark compared with Oppland (pB/0.05). Conclusion and implications. The proportion of the population eligible for LLD treatment in the two counties should imply similar treatment rates in both. Higher LLD treatment frequency and intensity in the primary prevention subgroup in Hedmark are probably both contributing factors that explain the higher sales of LLDs in Hedmark compared with Oppland. Feasible intervention thresholds for primary prevention with concurrent reimbursement rules should be defined in guidelines to avoid unintentional variation in LLD use in the future

Psychotropic drug use among 0-17 year olds during 2004-2014: a nationwide prescription database study

This is an Open Access article licensed under the Creative Commons Attribution License 3.0 (CC BY 3.0) and originally published in BMC Psychiatry. You can access the article by following this link: http://dx.doi.org/10.1186/s12876-016-0446-zDette er en vitenskapelig, fagfellevurdert artikkel som opprinnelig ble publisert i BMC Psychiatry. Artikkelen er publisert under lisensen Creative Commons Attribution License 3.0 (CC BY 3.0). Du kan også få tilgang til artikkelen ved å følge denne lenken: http://dx.doi.org/10.1186/s12876-016-0446-zBackground Time-trend studies on psychotropic drugs among children and adolescents are scarce, and most of them are outdated. The purpose of this study was to study prevalences of psychotropic drug use during 2004–2014 among Norwegians aged <18 years, overall and in psychotropic sub-groups. Methods Data were obtained from the Norwegian Prescription Database, which covers all dispensed prescription drugs in Norway from 2004 and onwards. Psychotropic drugs included: antipsychotics (ATC-group N05A), anxiolytics (N05B), hypnotic/sedatives (N05C), antidepressants (N06A), stimulants (N06BA), and alimemazine (R06AD01). Period (1-year) prevalence of use, overall and in subgroups of psychotropic drugs, was estimated by identifying individuals <18 years who had at least one psychotropic drug dispensed during each year. Results Psychotropic drug use increased in 0–17 year olds over an 11-year period, in which the main contributing drugs were stimulants (boys overall; 15.0 to 20.8/1000, girls overall; 3.8 to 8.5/1000), hypnotic/sedative drugs in adolescents (boys overall; 4.2 to 10.8/1000, girls overall; 2.6 to 8.8/1000) and to some extent antidepressants among adolescent girls (girls overall from 3.1 to 4.0/1000). Psychotropic drug use was, however, reduced by half in the youngest children, attributed to reduction of alimemazine only (1-year olds: boys; from 36.6 to 10.2/1000, girls; 26.9 to 7.2/1000). A higher level of psychotropic drug use was observed among younger boys, but there is a shift towards girls using more psychotropic drugs than boys during adolescence for all psychotropic drugs except for stimulants. Conclusion Different trends in psychotropic drug use exist in age and gender subgroups. Psychotropic drug use has decreased among the youngest children, attributed to alimemazine, and increased in older children and adolescents, attributed mainly to stimulants and hypnotics/sedatives

Carbon or cash: Evaluating the effectiveness of environmental and economic messages on attitudes about wind energy in the United States

Public support or opposition to the expansion of wind energy plays a key role in energy policy and the development of the industry. For more than 30 years, scholars have attempted to understand the nature of public opinion about wind energy. Unfortunately, the largely observational and correlational nature of the evidence limits the abilities of scholars to isolate the causal relationships that shape attitudes about wind energy. Recent summaries of the literature illustrate the need for experimental designs to improve our understanding of the public’s view on this growing technology. Using an original survey experiment with a national sample, we test the effectiveness of messages about the economic and environmental implications of the expansion of wind energy. Our results indicate that 1) the public is sensitive to messaging about both the environmental and economic effects of wind energy; 2) the messages have both a persuasive (changing the content of attitudes) and priming (changing the weight applied to existing attitudes) effect on the public; and 3) the environmental messages have a greater effect on public opinions of wind energy than economic messages. Those interested in promoting positive attitudes about alternative energy need to be aware of both the persuasive and priming influences in messages about wind energy

The Cold Peace: Russo-Western Relations as a Mimetic Cold War

In 1989–1991 the geo-ideological contestation between two blocs was swept away, together with the ideology of civil war and its concomitant Cold War played out on the larger stage. Paradoxically, while the domestic sources of Cold War confrontation have been transcended, its external manifestations remain in the form of a ‘legacy’ geopolitical contest between the dominant hegemonic power (the United States) and a number of potential rising great powers, of which Russia is one. The post-revolutionary era is thus one of a ‘cold peace’. A cold peace is a mimetic cold war. In other words, while a cold war accepts the logic of conflict in the international system and between certain protagonists in particular, a cold peace reproduces the behavioural patterns of a cold war but suppresses acceptance of the logic of behaviour. A cold peace is accompanied by a singular stress on notions of victimhood for some and undigested and bitter victory for others. The perceived victim status of one set of actors provides the seedbed for renewed conflict, while the ‘victory’ of the others cannot be consolidated in some sort of relatively unchallenged post-conflict order. The ‘universalism’ of the victors is now challenged by Russia's neo-revisionist policy, including not so much the defence of Westphalian notions of sovereignty but the espousal of an international system with room for multiple systems (the Schmittean pluriverse)

Dendritic/antigen presenting cell mediated provision of T-cell receptor gamma delta (TCRγδ) expressing cells contributes to improving antileukemic reactions ex vivo

T-cell receptor gamma delta (TCRγδ) expressing T-cells are known to mediate an MHC-independent immune response and could therefore qualify for immune therapies. We examined the influence of dendritic cells(DC)/antigen presenting cell (APC) generated from blast-containing whole blood (WB) samples from AML and MDS patients on the provision of (leukemia-specific) TCRγδ expressing T-cells after mixed lymphocyte culture (MLC). Kit-M (granulocyte-macrophage colony-stimulating factor (GM-CSF) + prostaglandin E1 (PGE1)) or Kit-I (GM-CSF + Picibanil) were used to generate leukemia derived APC/DC (DCleu)from WB, which were subsequently used to stimulate T-cell enriched MLC. Immune cell composition and functionality were analysed using degranulation- (DEG), intracellular cytokine- (INTCYT) and cytotoxicity fluorolysis- (CTX) assays. Flow cytometry was used for cell quantification. We found increased frequencies of APCs/DCs and their subtypes after Kit-treatment of healthy and patients´ WB compared to control, as well as an increased stimulation and activation of several types of immune reactive cells after MLC. Higher frequencies of TCRγδ expressing leukemia-specific degranulation and intracellularly cytokine producing T-cells were found. The effect of Kit-M-treatment on frequencies of TCRγδ expressing cells and their degranulation could be correlated with the Kit-M-mediated blast lysis compared to control. We also found higher frequencies of TCRγδ expressing T-cells in AML patients´ samples with an achieved remission (compared to blast persistence) after induction chemotherapy. This might point to APC/DC-mediated effects resulting in the provision of leukemia-specific TCRγδ expressing T-cells: Moreover a quantification of TCRγδ expressing T-cells might contribute to predict prognosis of AML/MDS patients

Why do General Practitioners Decline Training to Improve Management of Medically Unexplained Symptoms?

BACKGROUND: General practitioners’ (GPs) communication with patients presenting medically unexplained symptoms (MUS) has the potential to somatize patients’ problems and intensify dependence on medical care. Several reports indicate that GPs have negative attitudes about patients with MUS. If these attitudes deter participation in training or other methods to improve communication, practitioners who most need help will not receive it. OBJECTIVE: To identify how GPs’ attitudes to patients with MUS might inhibit their participation with training to improve management. DESIGN: Qualitative study. PARTICIPANTS: GPs (N = 33) who had declined or accepted training in reattribution techniques in the context of a research trial. APPROACH: GPs were interviewed and their accounts analysed qualitatively. RESULTS: Although attitudes that devalued patients with MUS were common in practitioners who had declined training, these coexisted, in the same practitioners, with evidence of intuitive and elaborate psychological work with these patients. However, these practitioners devalued their psychological skills. GPs who had accepted training also described working psychologically with MUS but devalued neither patients with MUS nor their own psychological skills. CONCLUSIONS: GPs’ attitudes that suggested disengagement from patients with MUS belied their pursuit of psychological objectives. We therefore suggest that, whereas negative attitudes to patients have previously been regarded as the main barrier to involvement in measures to improve patient management, GPs devaluing of their own psychological skills with these patients may be more important