Improved Pregnancy Outcome in Type 1 Diabetic Women With Microalbuminuria or Diabetic Nephropathy: Effect of intensified antihypertensive therapy?

OBJECTIVE—To describe pregnancy outcome in type 1 diabetic women with normoalbuminuria, microalbuminuria, or diabetic nephropathy after implementation of an intensified antihypertensive therapeutic strategy

Kontroll av arbeidstakers tilstedeværelse på hjemmekontor

Oppgaven handler om adgangen til å iverksette digitale kontrolltiltak for å avdekke arbeidstakers tilstedeværelse på hjemmekontor. Forskning viser at arbeidsgivere opplever det som utfordrende å følge opp arbeidstakere på hjemmekontor, og med ny teknologi er det lettere for arbeidsgiver å implementere kontrolltiltak overfor arbeidstakere. Oppgaven tar utgangspunkt i tre kontrolltiltak, herunder kontroll av tilgjengelighetsstatus i samhandlingsverktøy, logging av tastatur og pålegg om bruk av webkamera. Digitaliseringen åpner opp for nye former for kontroll og overvåkning, og tiltakene illustrerer at retten til privatliv og personvern stadig utfordres.MasteroppgaveJUS399MAJURMAJUR-

Design and rationale of a large, international, prospective cohort study to evaluate the occurrence of malformations and perinatal/neonatal death using insulin detemir in pregnant women with diabetes in comparison with other long-acting insulins

BACKGROUND: There are a lack of data regarding the effect of basal insulin analogues on rates of events like congenital malformation and perinatal mortality in diabetic pregnancy. METHODS: The present study is a prospective, non-interventional, multicentre cohort study conducted in seven countries, designed to assess the safety of insulin detemir during pregnancy, and to monitor the health status of resulting infants (exposed in utero) up to 1 year of age. The study population includes women with type 1 or type 2 diabetes, who are pregnant and being treated with insulin. Data will be collected in the context of routine practice. The primary endpoint is the proportion of pregnancies in women treated with insulin detemir, compared with other basal insulin regimens, which do not result in any of the following events: major congenital malformations, perinatal death or neonatal death. A sample size of 3075 pregnancies was calculated to provide an 80% power to detect a difference of 3.5% between groups in the primary endpoint at a 5% level. DISCUSSION: The study will also examine other important maternal endpoints (e.g., incidences of severe hypoglycaemia and pre-eclampsia) and perinatal outcomes such as overweight neonates, as well as infant outcomes at 1 year of age. It has a fixed recruitment period from 2013 to 2018, enrolling all eligible patients, and is expected to inform future prescribing with basal insulins in diabetic pregnancy. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01892319 (date registered: 27.06.2013). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-016-1177-4) contains supplementary material, which is available to authorized users

Trends in prevalence of ultrasound-assessed carotid atherosclerosis in a general population over time. The Tromsø Study 1994-2016

Background: During the past decades, there has been a shift in risk factor levels in many high-income countries, with decrease in smoking, blood pressure and cholesterol levels, while body mass index, obesity and diabetes increase. The diverging trends may have opposite effects on prevalence of atherosclerosis. We aimed to assess carotid plaque prevalence and the association with risk factor levels in a general population over a period of 22 years. Methods: Prevalence of plaque, number of plaques and total plaque area in the carotid arteries were assessed in three repeated cross-sectional surveys of the population-based Tromsø Study from 1994 through 2016. The number of participants from the first to the last survey was 6362, 7069 and 3021. All surveys included physical examinations, questionnaires, and blood samples. Multivariable logistic regression analysis models were fitted to assess the relationship between risk factors and carotid plaque. Results: We found no significant change in plaque burden over a period of 22 years, neither when measured as plaque presence, plaque number or total plaque area. Plaques were more frequent in men (70%) than in women (59.4%) and increased by age. Systolic blood pressure and smoking increased, while BMI and diabetes decreased over time both in participants with and without plaque. Most risk factors remained higher in participants with plaque than in plaque- free participants while cholesterol levels decreased and reached similar levels in both groups. Age, male sex, systolic blood pressure, smoking, diabetes and HDL cholesterol (inverse) were associated with plaque prevalence. Conclusions: Plaque prevalence remained stable in the observation period. Favorable reductions in systolic blood pressure, cholesterol and smoking may have been partly counteracted by increased diabetes prevalence. Risk factor levels remained higher in participants with plaque than in plaque-free participants, indicating a potential for further improvement in primary prevention of carotid atherosclerosis

Kultur i kraftformat

Det har vært spennende å få anledning til å pløye inn i et felt som er så tidsaktuelt, men likevel lite dokumentert og analysert, som festivaler. Festivalene preger mediebildet, det engasjerer mennesker til en dugnadsinnsats som vi knapt har sett siden Gerhardsens glansdager og til en publikumstilstrømning som gir håp til både lokal, velkjent kultur og til mer innovativ, eksperimentell og internasjonal kunst. Festivalene har i seg kraft til å bevege mennesker fysisk og mentalt. De har styrke til å endre steders selvforståelser og til å gi nytt innhold til gamle og ofte utdaterte myter. Med hele 94 festivaler på Sørlandet blir behovet for en ytterligere profesjonalisering av festivalene tydelig. Denne rapporten har fanget opp noen viktige innspill fra festivalene selv i forhold til deres livsløp, deres investeringsbehov og nødvendigheten av en klarere festivalpolitikk knyttet til videreutvikling av dem

Poor pregnancy outcome in women with type 1 diabetes is predicted by elevated HbA1c and spikes of high glucose values in the third trimester

OBJECTIVE: To analyse data from a randomised, controlled study of prandial insulin aspart versus human insulin, both with NPH insulin, in pregnant women with type 1 diabetes for potential factors predicting poor pregnancy outcomes. RESEARCH DESIGN/METHOD: Post hoc analysis including 91 subjects randomised prior to pregnancy with known outcome in early pregnancy and 259 subjects randomised prior to pregnancy/during pregnancy of <10 weeks’ gestation with known late-pregnancy outcomes. Poor early-pregnancy outcomes included fetal loss <22 gestational weeks and/or congenital malformation (n = 18). Poor late-pregnancy outcomes included: composite endpoint including pre-eclampsia, preterm delivery and perinatal death (n = 78); preterm delivery (n = 63); and excessive fetal growth (n = 88). RESULTS: 18 patients experienced a malformed/lost fetus in early pregnancy – none preceded by severe hypoglycaemia. Albuminuria in early pregnancy was a significant predictor of poor late-pregnancy outcome (composite endpoint; p = 0.012). In the third trimester, elevated HbA(1c), ≥ 1 plasma glucose (PG) measurement >11 mmol/L (198 mg/dL) and %PG values outside 3.9–7.0 mmol/L (70–126 mg/dL) were significant predictors of poor late-pregnancy outcomes (all p < 0.05). CONCLUSIONS: Elevated HbA(1c), high glucose spikes and out-of-range %PG in the third trimester, and albuminuria in early pregnancy, are associated with poor late-pregnancy outcomes

Serum osteoprotegerin and renal function in the general population: The Tromsø Study

The following article: Vik, A., Brodin, E.E., Mathiesen, E.B., Brox, J., Jørgensen, L., Njølstad, I., ... Hansen, J.-B. (2017). Serum osteoprotegerin and renal function in the general population: The Tromsø Study. Clinical Kidney Journal, 10(1), 38-44. https://doi.org/10.1093/ckj/sfw095, has been accepted for publication in Clinical Kidney Journal Published by Oxford University Press. Source at https://doi.org/10.1093/ckj/sfw095. Published manuscript version, licensed CC BY-NC-ND 4.0.Background: Serum osteoprotegerin (OPG) is elevated in patients with chronic kidney disease (CKD) and increases with decreasing renal function. However, there are limited data regarding the association between OPG and renal function in the general population. The aim of the present study was to explore the relation between serum OPG and renal function in subjects recruited from the general population. Methods: We conducted a cross-sectional study with 6689 participants recruited from the general population in Tromsø, Norway. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equations. OPG was modelled both as a continuous and categorical variable. General linear models and linear regression with adjustment for possible confounders were used to study the association between OPG and eGFR. Analyses were stratified by the median age, as serum OPG and age displayed a significant interaction on eGFR. Results: In participants ≤62.2 years with normal renal function (eGFR ≥90 mL/min/1.73 m2) eGFR increased by 0.35 mL/min/1.73 m2 (95% CI 0.13–0.56) per 1 standard deviation (SD) increase in serum OPG after multiple adjustment. In participants older than the median age with impaired renal function (eGFR 2), eGFR decreased by 1.54 (95% CI −2.06 to −1.01) per 1 SD increase in serum OPG. Conclusions: OPG was associated with an increased eGFR in younger subjects with normal renal function and with a decreased eGFR in older subjects with reduced renal function. Our findings imply that the association between OPG and eGFR varies with age and renal function