Measurement properties of the high-level mobility assessment tool for mild traumatic brain injury

Background. The High-Level Mobility Assessment Tool (HiMAT) was developed to quantify balance and mobility problems after traumatic brain injury (TBI). Measurement properties of the HiMAT have not been tested in the mild TBI (MTBI) population. Objective. The aim of this study was to examine the reliability, validity, and responsiveness of the HiMAT in a sample of the MTBI population. Design. A cohort, pretest-posttest, comparison study was conducted. Methods. Ninety-two patients (69% men, 31% women) with a mean age of 37.1 years (SD 13.8) and a mean Glasgow Coma Scale score of 14.7 (SD 0.7) were recruited from Oslo University Hospital. All patients were tested with the HiMAT (range of scores 0 [worst] to 54 [best]) at 3 months postinjury. Fifty-one patients were retested at 6 months. A subgroup of 25 patients was selected for the reliability testing. Balance function reported on the Rivermead Post Concussion Symptoms Questionnaire was chosen as a criterion and anchor. Criterion-related validity was studied with correlation analysis. Intraclass correlation coefficients (ICCs) were used for assessing interrater and intrarater reliability. Minimal detectable change (MDC) for the HiMAT was estimated. Responsiveness was assessed with receiver operating characteristic curve analyses. Results. The mean HiMAT sum score was 46.2 (95% confidence interval 44.4 to 48.1). The HiMAT had a ceiling effect of 22.8%. The correlation between HiMAT scores and self-reported balance problems was large (r .63, P .001). Interrater and intrarater reliability of the HiMAT sum score was high (interrater ICC .99, intrarater ICC .95). The MDC was 3 to 4 points. Responsiveness was good, and the HiMAT discriminated well between patients with self-perceived improved balance function versus unchanged balance function (area under the curve 0.86). Limitations. The small sample size, a ceiling effect, and lack of a gold standard were limitations of the study. Conclusions. The HiMAT demonstrated satisfactory measurement properties for patients with MTBI. The HiMAT can be used as an outcome measure of balance and mobility problems in patients with MTB

Oral health and mortality risk in the institutionalised elderly

Objective: Examining oral health and oral hygiene as predictors of subsequent one-year survival in the institutionalised elderly. Design: It was hypothesized that oral health would be related to mortality in an institutionalised geriatric population. A 12-month prospective study of 292 elderly residing in nine geriatric institutions in Granada, Spain, was thus carried out to evaluate the association between oral health and mortality. Independent samples, T-test, chi- square test and Cox regression analysis were used to analyse the data. Sixty-three participants died during the 12-month follow-up. Results: Mortality was increased in denture users (RR = 2.18, p= 0.007) and in people suffering severe cognitive impairment (RR = 2. 24, p= 0.003). One-year mortality was 50% in participants having both these characteristics. Conclusions: Oral hygiene was not significantly associated with mortality. Cognitive impairment and wearing dentures increased the risk of death. One-year mortality was 50% in cognitively impaired residents wearing dentures as opposed to 10% in patients without dentures and cognitive impairmen

Psychometric testing of the Norwegian version of the Simulation Design Scale, the Educational Practices Questionnaire and the Student Satisfaction and Self-confidence in Learning Scale in nursing education

Introduction Simulation-based learning is a well-established technique in nursing education. However, there is a need for reliable and validated evaluation tools across both national boundaries and cultural conditions. Such evaluation tools may contribute in identifying areas for improvement in simulation-based learning from the nursing students’ perspective. Objectives The aim of this study was to test three widely used American questionnaires – the Simulation Design Scale, the Educational Practices Questionnaire, and the Student Satisfaction and Self-Confidence in Learning Scale, for psychometric properties among Norwegian undergraduate nursing students. Methods A descriptive cross-sectional study was conducted at a university simulation center in southern part of Norway. A total of 105 undergraduate nursing students participated, giving a response rate of 77%. An exploratory factor analysis was used to examine construct validity. Cronbach's alpha was applied in order to establish the questionnaires’ internal consistency. Results The exploratory factor analyses displayed the same number of extracted factors as the number of subscales in each of the original American questionnaires. However, the item-factor structure differed from the original item-subscales. The Cronbach's alpha was > 0.7 for all three questionnaires, indicating acceptable internal consistency. Conclusion Psychometric testing of the Norwegian versions of the three questionnaires, the Simulation Design Scale, the Educational Practices Questionnaire, and the Student Satisfaction and Self-Confidence in Learning Scale, could be used as valid instruments for nursing students to evaluate important aspects of simulation-based learning. This also makes it easier to compare evaluation results of SBL across languages and cultural boundaries. However, to confirm the construct validity of the factors extracted in this study, further multi-site studies are needed to perform a confirmatory factor analysis in a new, large sample.publishedVersio

Five-year mortality after acute poisoning treated in ambulances, an Emergency outpatient clinic and hospitals in Oslo

BACKGROUND: The long-term mortality after prehospital treatment for acute poisoning has not been studied previously. Thus, we aimed to estimate the five-year mortality and examine the causes of death and predictors of death for all acutely poisoned patients treated in ambulances, the emergency outpatient clinic, and hospitals in Oslo during 2003–2004. METHODS: A prospective cohort study included all adults (≥16 years; n=2045, median age=35 years, male=58%) who were discharged after treatment for acute poisoning in ambulances, the emergency outpatient clinic, and the four hospitals in Oslo during one year. The patients were observed until the end of 2008. Standardized mortality rates (SMRs) were calculated and multivariate Cox regression analysis was applied. RESULTS: The study comprised 2045 patients; 686 treated in ambulances, 646 treated in the outpatient clinic, and 713 treated in hospitals. After five years, 285 (14%) patients had died (four within one week). The SMRs after ambulance, outpatient, and hospital treatment were 12 (CI 9–14), 10 (CI 8–12), and 6 (CI 5–7), respectively. The overall SMR was 9 (CI 8–10), while the SMR after opioid poisoning was 27 (CI 21–32). The most frequent cause of death was accidents (38%). In the regression analysis, opioids as the main toxic agents (HR 2.3, CI 1.6–3.0), older age (HR 1.6, CI 1.5–1.7), and male sex (HR 1.4, CI 1.1–1.9) predicted death, whereas the treatment level did not predict death. CONCLUSIONS: The patients had high mortality compared with the general population. Those treated in hospital had the lowest mortality. Opioids were the major predictor of death

Design of a randomized controlled trial of comprehensive rehabilitation in patients with myocardial infarction, stabilized acute coronary syndrome, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting: Akershus Comprehensive Cardiac Rehabilitation Trial (the CORE Study)

OBJECTIVES: 1. To assess the long-term effectiveness of a comprehensive cardiac rehabilitation programme on quality of life and survival in patients with a large spectrum of cardiovascular diseases (myocardial infarction, acute coronary syndrome, percutaneous transluminal coronary angioplasty and coronary artery bypass grafting). 2. To establish the degree of correlation between expected improvement of health-related quality of life and improvement in physical function attributable to rehabilitation in the intervention group, in comparison with similar changes in the conventional care group. DESIGN: Randomized, controlled, parallel-group design (intervention/conventional care). SETTING: Akershus County, southeast of Oslo City, Norway. PARTICIPANTS: 500 patients, men and women, aged 40-85 years, who have sustained at least one of the above-mentioned cardiovascular diseases. INTERVENTIONS: 8 weeks of supervised, structured physical training of three periods of 20 min per week, targeting a heart rate of 60-70% of the individual's maximum; home-based physical exercise training with the same basic schedule as in the supervised period; quantification of patients' compliance with the exercise programme by the use of wristwatches, information stored in the watch memory being retrieved once a month during the 3-year follow-up period; and life-style modification with an emphasis on the cessation of smoking and on healthy nutrition and weight control

Rectal Visceral Sensitivity in Women with Irritable Bowel Syndrome without Psychiatric Comorbidity Compared with Healthy Volunteers

Background. Psychiatric comorbidity and visceral hypersensitivity are common in patients with irritable bowel syndrome (IBS), but little is known about visceral sensitivity in IBS patients without psychiatric disorders. Aim. We wanted to examine rectal visceral sensitivity in IBS patients without comorbid psychiatric disorders, IBS patients with phobic anxiety and healthy volunteers. Methods. A total of thirty-eight female, non-constipated IBS patients without psychiatric disorders and eleven female IBS patients with phobic anxiety were compared to nine healthy women using a barostat double random staircase method. The non-psychiatric patients were divided into those with diarrhoea predominant symptoms and those with alternating stool habits. Results. The IBS patients without psychiatric disorders had normal visceral pressure thresholds. However, in the diarrhoea predominant subgroup, the volume discomfort threshold was reduced while it was unchanged in those with alternating stool habits. The phobic IBS patients had similar thresholds to the healthy volunteers. The rectal tone was increased in the non-psychiatric IBS patients with diarrhoea predominant symptoms and in the IBS patients with phobic anxiety. Conclusions. Non-constipated IBS patients without psychiatric disorders had increased visceral sensitivity regarding volume thresholds but normal pressure thresholds. Our study suggests that the lowered volume threshold was due to increased rectal tone

Change in pain, disability and influence of fear-avoidance in a work-focused intervention on neck and back pain: a randomized controlled trial

Background Neck and back pain are among the most common causes of prolonged disability, and development of interventions with effect on pain, disability and return to work is important. Reduction of fear avoidance might be one mechanism behind improvement after interventions. The aim of the present study was to evaluate changes in pain and disability at the 12-month follow-up of patients with neck and back pain treated with a work-focused intervention compared to patients treated with standard interventions, and the influence of improvement fear avoidance beliefs during the interventions on pain, disability and return to work at 12-month follow-up. Methods 413 employed patients with back or neck pain referred to secondary care, and sick-listed between 4 weeks and 12 months, were randomized to a work-focused rehabilitation or control interventions. Follow-up was conducted 4 and 12 months after inclusion. The groups were compared (independent sample t-test) regarding differences in disability scores (Oswestry disability index/neck disability index) and pain (numeric rating scale) from baseline to 12-month follow-up. Changes in fear avoidance beliefs (FABQ) from baseline to 4 month follow-up were calculated, and the association between this change and return to work, pain and disability at 12 months were tested in stepwise multiple logistic regression models. Results Pain and, disability scores decreased to in both the work-focused and control intervention to 12-month follow-up, and there were no significant differences between the groups. FABQ decreased similarly in both groups to 4 month follow-up. The logistic regression model revealed an association between a reduced FABQ work score at 4 months and return to work within one year (adjusted OR 3.60, 95% CI 1.19 to 10.88). Reduced FABQ physical activity score at 4 months was associated with decreased disability after 12 months (adjusted OR (3.65. 95% CI 1.43 to 9.28). Conclusions Short work-focused rehabilitation had the same effect on pain and disability as control interventions. Reduction in FABQ-W score after treatment seems to be an important predictor for return to work in both groups

Factors affecting older adults' hearing-aid use

Hearing impairment is one of the most common disabilities among Western populations and represents a considerable communication disorder. Increasing human longevity is expected to raise the number of elderly people suffering from hearing loss. A major challenge of audiological rehabilitation has been to encourage those who have fitted hearing aids to use them. The aim of the present study was to describe hearing-aid use among older adults and to identify motivational factors associated with hearing-aid use. A 17-item questionnaire was developed. Ninety participants (=65 years of age) were recruited from a waiting list for hearing-aid refitting. Twenty-two percent had used their previously fitted hearing aids for less than one hour per day. A factor analysis revealed four factors related to hearing-aid use (Cronbach's alpha): ‘accepted need’–defined as the acknowledgement of a need for hearing aids (0.869); ‘follow-up support’–defined as organized check-ups and accessibility to professionals (0.900); ‘social assessment’ (0.552); and ‘consciousness’ (0.505). The first two factors explained 25% and 24% of the variance, respectively. Logistic regression revealed that the use of hearing aids was significantly associated with ‘accepted need’ and ‘follow-up support’, suggesting that these factors are important and should be emphasized in rehabilitation programmes

Low level of MAp44, an inhibitor of the lectin complement pathway, and long-term graft and patient survival; a cohort study of 382 kidney recipients

© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Higher incidence of malignancy and infectious diseases in kidney transplant recipients is related to immunosuppressive treatment after transplantation and the recipient’s native immune system. The complement system is an essential component of the innate immunity. The aim of the present study was to investigate the association of effector molecules of the lectin complement pathway with graft and patient survival after kidney transplantation. Methods: Two mannan-binding lectin (MBL) associated proteases, MASP-2 and MASP-3 (activators of the lectin pathway) and two MBL-associated proteins, MAp44 and MAp19 (inhibitors of the lectin pathway) were measured at the time of transplantation in 382 patients (≥17 years old) transplanted in 2000–2001. The cohort was followed until December 31, 2014. Data on patient and graft survival were obtained from the Norwegian Renal Registry. Cox proportional hazard regression models were performed for survival analyses. Results: Low MAp44 level (1st versus 2–4 quartile) was significantly associated with overall mortality; HR 1.52, 95 % CI 1.08–2.14, p = 0.017. In the sub analyses in groups below and above median age (51.7 years), low MAp44 as a predictor of overall mortality was statistically significant only in recipients of ≤51.7 years; HR 2.57, 95 % CI 1.42–4.66, p = 0.002. Furthermore, low MAp44 was associated with mortality due to infectious diseases; HR 2.22, 95 % CI 1.11–4.41, p = 0.023. There was no association between MASP-2, MASP-3 or MAp19 levels and patient mortality. No association between any measured biomarkers and death censored graft loss was found. Conclusions: Low MAp44 level at the time of transplantation was associated with increased overall mortality in kidney recipients of median age of 51.7 years or below and with mortality due to infectious diseases in the whole patient cohort after nearly 14-years of follow up after transplantation. No associations between other effector molecules; MASP-2, MASP-3 or MAp19 and recipient mortality were found, as well as no association of any biomarker with death censored graft loss

Surgery with disc prosthesis versus rehabilitation in patients with low back pain and degenerative disc: two year follow-up of randomised study

Objective To compare the efficacy of surgery with disc prosthesis versus non-surgical treatment for patients with chronic low back pain