Adapting Statistics Education to a Cognitively Heterogeneous Student Population

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Risk factors for pressure sores in adult patients with myelomeningocele – a questionnaire-based study

BACKGROUND: Myelomeningocele (MMC) is a part of a complex neural tube defect and a disorder of the cerebrospinal fluid system. Pressure sores are a frequent complication for patients with MMC. Little is known about the risk factors for pressure sores in adults with MMC. The aim of this study was to investigate an association between the presence of pressure sores and other patient characteristics, in order to develop an improved strategy for the management of sores. METHODS: A structured questionnaire regarding sores, medical condition, function and living factors was designed and sent to the 193 patients with MMC registered in the year 2003 at TRS, a National Centre for Rare Disorders in Norway. RESULTS: Out of 193 total, 87 patients participated and 71 patients (82%) reported sores; 26 (30%) at the time of the interview and 45 (52%) during the last 5 years. Sores were mostly localized on toes and feet and occurred exclusively in regions with reduced or missing sensibility. A significant association was found between sores and memory deficit (p = 0.02), Arnold Chiari malformation (p = 0.02) and a record of previous sores (p = 0.004). Sores were not significantly associated with hydrocephalus, syringomyelia, nutrition, body mass index, smoking, physical activity, employment or living together with other persons. Some patients (18, 21%) reported skin inspection by others and the remainder relied on self-inspection. CONCLUSION: Patients with sensory deficit, memory problems, and Arnold Chiari malformation had a higher risk of having pressure sores. This patient group needs improved skin inspection routines and sore treatment

Reliability of the Pediatric Evaluation of Disability Inventory

ABSTRACT. Pediatric Evaluation of Disability Inventory (PEDI) is an instrument for evaluating function in children with disabilities aged 6 months to 7.5 years. The PEDI measures both functional performance and capability in three domains: (1) self-care, (2) mobility, and (3) social function. The PEDI has recently been translated into Norwegian. The purpose of this study was to investigate the inter-rater, inter-respondent and intra-rater reliability of the Norwegian version of the PEDI. Reliability was investigated in a sample of 30 Norwegian children without disabilities between 1.0 and 5.0 years. Interviews with parents were conducted twice by the same occupational therapist, and once by a physioMarie Berg, MSc, OTR, is affiliated with the Department of Occupational Therapy, Sunnaas Rehabilitation Hospital, University of Oslo, Norway and the Department of Occupational Therapy, National Hospital, University of Oslo, Norway. Reidun Jahnsen, MA, PT, is affiliated with the Research Department, Sunnaas Rehabilitation Hospital, University of Oslo, Norway. Kathrine Frey Frøslie, MSc, and Aktahr Hussain, MD, PhD, are both affiliated with the Department of Clinical Epidemiology and Statistics, National Hospital, University of Oslo, Norway. Address correspondence to: Marie Berg, Research Unit, Sunnaas Rehabilitation Hospital, 1450 Nesoddtangen, Norway (E-mail: [email protected]). The authors gratefully acknowledge all the parents and kindergarten teachers who participated in the present study. The study was supported by grants from the Norwegian Occupational Therapist Association (NETF), the Occupational Therapy Department, National Hospital, and the Occupational Department, Sunnaas Rehabilitation Hospital. therapist. Kindergarten teachers were also interviewed by the occupational therapist. Using children without disabilities allows us to set up a standard for functional ability. Deviation from the point may indicate improvement or worsening of the state. The inter-rater and intra-rater part of the study showed excellent agreement of the observations, indicated both by small differences and high Intraclass Correlation Coefficients (ICC) (0.95-0.99). The discrepancy between the different interviews was highest between the reports from the parents and the kindergarten teachers (inter-respondent reliability), indicated by ICC from 0.64-0.74. Results of this study indicate that improved reliability is secured when the same interviewer interviews the same respondent, as well as when two trained interviewers interview the same respondent. The consistency of scores should be reviewed when different respondents are interviewed. Professionals administering the PEDI needs to be trained following a required procedure in order to secure consistency in their rating

Incomplete spinal cord injury, exercise and life satisfaction

STUDY DESIGN: Cross-sectional survey. OBJECTIVE: This study investigates the role of physical exercise, perceived exercise mastery and fitness on life satisfaction of a sample of individuals with incomplete spinal cord injury (SCI). SETTING: Sunnaas Rehabilitation Hospital and the Norwegian School of Sport Sciences, Norway. METHODS: A questionnaire measuring life satisfaction, self-rated physical exercise and self-perceptions were mailed to persons with incomplete SCI. RESULTS: In total, 100 questionnaires were sent out and 69 respondents were included in the study. Of those, 68% performed physical activity regularly once or more a week. Participants who were exercising regularly once a week or more scored significantly higher on the summed life satisfaction scale (P=0.002) and on perceived fitness (P=0.004), but significantly lower on perceived exercise mastery (P=0.012) than those who were non-exercisers. CONCLUSION: Participants in this study with incomplete SCI who exercised regularly experienced a significantly higher life satisfaction and perceived exercise fitness, but lower perceived exercise mastery than their inactive peers. Perceived exercise fitness was the psychological variable that contributed meaningfully to life satisfaction in this study

De-medicalization of birth by reducing the use of oxytocin for augmentation among first-time mothers - A prospective intervention study

Background: The use of synthetic oxytocin for augmentation of labor is rapidly increasing worldwide. Hyper-stimulation is the most significant side effect, which may cause fetal distress and operative delivery. We performed an intervention consisting of an educational program and modified guidelines to achieve a more appropriate use of oxytocin. Methods: This prospective intervention study included 431 first-time mothers at term with spontaneous onset of labor before (October 2012 to May 2013), and 664 after the intervention (April 2014 to April 2015). Our outcomes were prevalence and duration of oxytocin treatment, mode of delivery, indication for operative delivery, episiotomy, anal sphincter tears, bleeding, labor duration, pain relief and the effect of oxytocin on mode of delivery. Results: After the intervention, 52.9% were diagnosed with dystocia, compared with 68.9% before (p < 0.001). Oxytocin was not always used in accordance with the guidelines, but a significant reduction in oxytocin rates from 63.3% to 54.1% (p < 0.001) was obtained. More women without dystocia according to the existing guidelines were augmented after the intervention (18.9% vs 8.4%, p < 0.001). Assessing all labors, the median duration of oxytocin treatment was reduced by 72% (from 90 to 25 min) without increasing the median duration of labor (385 min in both groups). There was a moderate reduction in operative vaginal deliveries from 26.9 to 21.5% (p = 0.04), and dystocia as an indication for these deliveries increased (p = 0.01). There was a moderate increase in caesarean sections from 6.7 to 10.2% (p = 0.05), but no increase in dystocia as an indication for these deliveries. Women receiving oxytocin were more likely to have an operative vaginal birth, even after adjusting for birth weight, epidural analgesia and labor duration, OR: 2.1 (CI 1.1-4.0) before and OR 2.7 (CI 1.6-4.5) after the intervention. Conclusions: Our intervention led to a significant reduction in the use of oxytocin. However, more than half of the women remained diagnosed with dystocia. Operative vaginal births seem to be associated with oxytocin treatment. Therefore, augmentation with oxytocin should be used with caution and only when medically indicated. Even more modified guidelines for augmentation than the ones applied in this study might be appropriate

Birth complications, overweight, and physical inactivity

Objective. Maternal lifestyle factors are potential predictors of pregnancy complications. We examined relations between modifiable factors and delivery complications. Design. Prospective cohort. Setting. University hospital antenatal clinic, Oslo, Norway. Sample. A cohort of 553 women followed through pregnancy and delivery. Main outcome measures. Pre-specified birth complications: cesarean section (CS), operative vaginal deliveries (VDs), third and fourth degree of perineal lacerations and hemorrhage (]1,000 ml). Methods. Univariate and multiple logistic regression analyses were performed. Besides high birthweight (]4,200 g), modifiable predictors (high body mass index (BMI), fasting glucose and physical inactivity) and non-modifiable predictors (parity, maternal age, gestational age, and gender) were considered. Results. Significant predictors for induction of labor were parity (odds ratio (OR): 2.1; 95% CI 1.3 3.5), maternal age (OR: 2.0; 1.2 3.4), gestational age (OR: 1.9; 1.1 3.1), and BMI ]30 (OR: 4.2; 2.2 7.8, pB0.01). High birthweight and high BMI were overrepresented among CSs. Emergency CS was associated with birthweight (OR: 3.7; 1.7 8.1), parity (OR: 3.5; 1.7 7.2), maternal age (OR: 2.6; 1.3 5.3), and induction of labor (OR: 4.8; 2.6 9.1). After excluding CS, operative VD was associated with parity (OR: 8.7; 3.8 20) and gender (OR: 2.2; 1.2 14.1). Perineal laceration was associated with pregestational physical inactivity (OR: 6.1; 1.6 22.9) and operative VD (OR: 5.1; 1.5 17.6). Hemorrhage was associated with high birthweight (OR: 4.2; 1.2 4.7) and BMI ]30 (OR: 4.6; 1.2 17.7). Conclusions. Pre-gestational physical inactivity increased the risk of perineal lacerations and male infants were associated with higher risk of vaginal operative delivery