A reliability study of the rapid emergency triage and treatment system for children

Background To evaluate inter- and intrarater reliability of a new Scandinavian triage system for children, the Rapid Emergency Triage and Treatment System-pediatric (RETTS-p). Methods Two observational studies were conducted at the Pediatric Emergency Department (PED), St. Olav’s University Hospital, Trondheim, Norway. Using RETTS-p, nurses assign one of five triage priority levels to each patient on the basis of clinical signs and symptoms evaluations and vital parameter measurements. Study 1: Prior to the introduction of RETTS-p in 2012, all nurses in the PED completed a theoretical and practical training. Four months later, 19 nurses triaged 20 fictive but realistic pediatric cases two times 9 months apart (Waves A and B). Study 2: Nurse pairs consisting of a regular nurse and a research nurse simultaneously and independently triaged 200 pediatric patients who were referred with various common medical and surgical complaints. Results Study 1: Kendall’s W for Waves A and B were 0.822 and 0.844, respectively. Using a mixed linear model, we found no difference in triage priority levels between Waves A and B. Compared to a consensus level made by the research group, the nurses rated 85.1 % fictive cases correctly, and 99 % were rated correctly or within one adjacent priority score. Study 2: The interrater correlation coefficient in a linear mixed model was 0.762, confirming a high interrater reliability in real-life triaging. Discussion We found a very high degree of agreement between nurses who used RETTS-p to prioritize children, both in a theoretical case scenarios study, but also in real-life triaging. Conclusions RETTS-p may be a credible and robust triage system, but it has not been validated yet.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

Constipation and diarrhoea - common adverse drug reactions? A cross sectional study in the general population

BACKGROUND: Constipation and diarrhoea are common complaints and often reported as adverse drug reactions. This study aimed at finding associations between drugs and constipation and diarrhoea in a general population. METHODS: A selection of inhabitants in Oppland County, Norway participated in a cross-sectional survey. Information about demographics, diseases including gastrointestinal complaints classified according to the Rome II criteria and use of drugs were collected on questionnaires. Constipation was defined as functional constipation and constipation predominant Irritable Bowel Syndrome (IBS), and diarrhoea as functional diarrhoea and diarrhoea predominant IBS. Associations between drugs and constipation and diarrhoea were examined with multivariable logistic regression models. Based on the multivariable model, the changes in prevalence (risk difference) of the abdominal complaints for non-users and users of drugs were calculated. RESULTS: In total 11078 subjects were invited, 4622 completed the questionnaires, 640 (13.8%) had constipation and 407 (8.8%) had diarrhoea. To start using drugs increased the prevalence of constipation and diarrhoea with 2.5% and 2.3% respectively. Polypharmacy was an additional risk factor for diarrhoea. Use of furosemide, levothyroxine sodium and ibuprofen was associated with constipation, and lithium and carbamazepine with diarrhoea. The excess drug related prevalence varied from 5.3% for the association between ibuprofen and constipation to 27.5% for the association between lithium and diarrhoea. CONCLUSIONS: Use of drugs was associated with constipation and diarrhoea in the general population. The associations are most likely adverse drug reactions and show that drug-induced symptoms need to be considered in subjects with these complaints

Drugs and Constipation in Elderly in Nursing Homes: What Is the Relation?

Introduction. Constipation is a common adverse drug reaction. Objective. Study associations between drugs and constipation in nursing home residents. Design. Cross-sectional study. Material and Methods. Nursing home residents above 60 years of age were included. Demographics, diet, physical activity, activity of daily living, nutritional status, use of drugs, and diseases were recorded. Constipation was defined as functional constipation or constipation-predominant IBS according to the Rome III criteria and/or regular use of laxatives. Drugs were classified according to the Anatomical-Therapeutic-Chemical Classification System (ATC), and anticholinergic effect was noted. Results. In all, 79 men and 188 women with a mean age of 85.4 (SD 7.1) years were included. The prevalence of constipation was 71.5%. Use of drugs in general, including polypharmacy, was not associated with constipation. Reduced activity of daily living (OR = 0.71, 95% CI : 0.60–0.84, P < 0.001), other antidepressants (N06AX) (OR 3.08, 95% CI : 1.09–8.68, P = 0.03), and benzodiazepine derivatives (N05BA) (OR = 2.80, 95% CI : 1.12–7.04, P = 0.03) were significantly associated with constipation; drugs with markedly anticholinergic effect (OR = 3.7, 95% CI : 0.78–17.53, P = 0.10), natural opium alkaloid (N02AA) (OR = 5.01, 95% CI : 0.95–25.94, P = 0.06), and propionic acid derivatives (M01AE) (OR = 7.00, 95% CI : 0.75–65.08, P = 0.09) showed a trend. Conclusion. In elderly with constipation, focus should be on specific groups of drugs and nonpharmacological factors, not on drugs in general

Parental chronic illness, internalizing problems in young adulthood and the mediating role of adolescent attachment to parents: A prospective cohort study

Background: Parental chronic illness is associated with an elevated risk for developing social-emotional and behavioral problems in children, in particular internalizing symptoms. This study aimed to investigate the associations between parental chronic illness when participants were adolescents and subsequent internalizing symptoms in young adulthood and whether adolescent attachment to parents or peers mediates these associations. Methods: The study used longitudinal survey data from the Youth and Mental Health Study, a cohort study including a representative sample of youth in central Norway assessed in the period from 1999 to 2000 (mean age 14.9 years) and in 2012 (mean age 27.2 years) (N = 1,266). The data consist of youth self-reports at both time points. Parental chronic illness was reported by the adolescents, quality of attachment was measured using the Inventory of Parent and Peer Attachment (IPPA), and internalizing problems were assessed in young adulthood by using the Adult Self-Report (ASR). Data were analyzed using parallel mediation analyses, controlling for adolescent sex, parental socioeconomic status, and divorce. In addition, separate analyses were conducted for adolescent girls and boys. Results: The total longitudinal effect was significant for both maternal and paternal chronic illness on internalizing problems in young adulthood. The direct effect on internalizing problems was only significant for maternal chronic illness. Attachment to fathers partially mediated the relationship between maternal chronic illness in adolescence and internalizing symptoms in young adulthood, whereas attachment to both mothers and fathers fully mediated the relationship between paternal chronic illness in adolescence and internalizing symptoms in young adulthood. A separate analysis for girls and boys indicated that the results were only significant for girls. Parental chronic illness did not play a significant indirect effect via attachment to peers on internalizing problems. Conclusions: Identifying protective factors in the pathways between parental chronic illness and mental distress in children could guide measures that promote the well-being of the child and family. The study demonstrates the importance of targeting the entire family in chronic illness care.publishedVersio

Neuropsychological function in individuals with morbid obesity: A cross-sectional study

Background:Previous research has shown cognitive dysfunction to be present in a significant number ofindividuals with obesity. The objective of this study was to assess the neuropsychological profile of morbidlyobese patients referred to weight-loss treatment.Methods:An extensive battery of neuropsychological tests with well-known normative data covering variouscognitive domains was administered to 96 patients. The test results were transformed to z-scores for comparisonswith normative data. As a means of determining level of cognitive impairmentwithinthe group, deficit scores wereapplied. Group comparisons on the different cognitive domains were conducted between patients with depressivesymptoms and patients reporting no such symptoms.Results:As illustrated in mean z-scores, the patients demonstrated lower performance compared to normative dataon visual memory (mean -.26, CI -.43 to -.09,p= .003), speed of information processing (mean -.22, CI -.34 to -.09,p= .001), executive functions (mean -.28, CI -.40 to -.16,p< .001), and attention/vigilance (mean -.25, CI -.37 to -.13,p< .001). Their performance was good on verbal fluency (mean .24, CI .04 to .44,p= .016) and verbal memory(mean .55, CI .38 to .72,p< .001). No significant performance differences were observed in the cognitive domainsof visuospatial ability, motor function, and working memory. The deficit scores, however, revealed working memoryand motor function to be significantly impaired within the group as well. Patients with depressive symptoms differed from patients without such symptoms on visual memory (mean .43, CI .07 to .80,p= .021).Conclusions:Some characteristic cognitive weaknesses and strengths were evident at the group level, althoughpronounced variation was observed. Deficits in executive functions, information processing, and attention shouldbe taken into consideration in clinical practice.publishedVersio

The delirium screening tool 4AT in routine clinical practice: prediction of mortality, sensitivity and specificity

Purpose Delirium is common and associated with poor outcomes, partly due to underdetection. We investigated if the delirium screening tool 4 A’s test (4AT) score predicts 1 year mortality and explored the sensitivity and specifcity of the 4AT when applied as part of a clinical routine. Methods Secondary analyses of a prospective study of 228 patients acutely admitted to a Medical Geriatric Ward. Physicians without formal training conducted the index test (the 4AT); a predefned cut-of≥4 suggested delirium. Reference standard was delirium diagnosed by two geriatricians using the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). We calculated hazard ratios (HR) using Cox regression based on the groups 4AT=0, 1–3, 4–7 and≥8, frst unadjusted, then adjusted for the covariates age, comorbidity, and personal activities of daily living. We calculated sensitivity, specifcity, and the area under the receiver operating curve (AUC). Results Mean age of patients was 86.6 years, 139 (61.0%) were female, 78 (34.2%) had DSM-5 delirium; of these, 56 had 4ATdelirium. 1 year mortality was 27.6% (63 patients). Compared to 4AT score 0, the group 4AT≥8 had increased 1 year mortality (HR 2.86, 95% confdence interval 1.28–6.37, p=0.010). The efect was reduced in multiadjusted analyses (HR 1.69, 95% confidence interval 0.70–4.07, p=0.24). Sensitivity, specifcity, and AUC were 0.72, 0.84, and 0.88, respectively. Conclusions 4AT≥8 indicates increased mortality, but the efect was reduced in multiadjusted analyses. 4AT had acceptable sensitivity and specifcity when applied as a clinical routine.publishedVersio

Role of parents in adolescent self-rated health: Norwegian Nord-Trøndelag Health Study

Background: Self-rated health (SRH) is a known important predictor of later mortality, morbidity, and health service attendance. From adolescence onwards, this multifactorial composite seems to be relatively stable. Therefore, it is important to study how SRH is also shaped and influenced by parental factors. Methods: Analyses were based on data from the Nord-Trøndelag Health studies in Norway during 1995–1997 among adolescent children aged 13–19 years and their parents. Cross-table analyses were made for parental and adolescent SRH. Proportional odds logistic regression analyses with parental SRH and a broad spectrum of other parental covariates were conducted, with adolescent SRH as the dependent variable, both unadjusted and adjusted. Results: Lower level of education, living alone, smoking, low general well being, and low life satisfaction were the most important parental factors associated with lower SRH in adolescents. However, the associations between parental SRH and adolescent SRH were rather weak, and in adjusted multivariable analyses lost significance for both genders. The net effect of genetics and early vertical family influence on adolescents’ SRH thus seems to be moderate. Notably, the association between more specific health-related and lifestyle variables in parent and adolescent SRH was rather weak. Conclusion: SRH in adolescents seems to be shaped only partly by parental influence, and is less “deterministic” than might be expected from some genetic studies. SRH may therefore be modifiable by health-promoting efforts in early life.publishedVersio