Legemiddelsalg og uttaks compliance ved astma og KOLS hos eldre : en detaljert kartlegging av salget av legemidler ved obstruktiv lungesykdom til eldre, samt en studie av eldre pasienters compliance med hensyn på uttak av legemiddel under en tiårsperiode

Problemstilling: Hensikten med dette arbeidet er å i detalj kartlegge salget av legemidler ved astma/KOLS hos eldre pasienter, og å undersøke eldre pasienters compliance med hensyn på uttak av legemiddel under en tiårsperiode. Metode: Volumet (angitt som DDD/TIND) av midler ved obstruktiv lungesykdom (RO3) som ble kjøpt av individer, 45 år og eldre under året 2003 i Sverige, ble hentet ut fra Apoteket AB sin database X-plain. Fra Jämtlandsstudien, en database med individers legemiddeluttak fra resept, ble data som omfattet alle uttak (n=5946) av legemidlene: kombinasjonspreparater (RO3AK), glukokortikoider (RO3BA) og antikolinergika (RO3BB), for individer som er 60 år og eldre ved det siste uttaket under tiårsperioden 1994 – 2003 analysert. Gjennom å studere uttaksintervall kunne det avgjøres om pasientene hadde legemiddel tilgjengelig, slik at de overhodet hadde mulighet til å være compliant. Analysen ble gjennomført med hensyn på både under- og overforbruk. Akseptabel uttaks compliance ble definert som at pasientene tar ut 80-120 % av ordinert mengde legemiddel. Resultat: Legemiddelsalget økte kraftig med økende alder. Salgsvolumet av de ulike legemidlene ved obstruktiv lungesykdom i aldersgruppen 70-80 år var 2-20 ganger høyere enn i aldersgruppen 45-49 år. Salget til kvinner dominerer i aldersgruppene 45-74 år, i de eldste aldersgruppene dominerer salget til menn. Av de studerte individene fra Jämtlandsstudien hadde 27 % en akseptabel uttaks compliance under perioden 1994-2003. Uttrykt som non-compliance var 58 % underuttakere og 15 % overuttakere. Diskusjon: Resultatene fra denne kartleggingen tyder på, ut fra salgstall, at legemidler ved astma/KOLS brukes mest av den eldre del av befolkningen. I de lavere aldersgruppene bør astma være hovedsykdommen, i de høyere aldersgruppene er antagelig andelen av KOLS større, særlig blant menn. Det er flere mulige årsaker til det store underuttaket, f. eks at astma er en kronisk sykdom hvor de fleste kun føler seg syke ved anfall, og derfor bare tar sine forskrevne legemidler i tilknytning til slike forverringer. I dette tilfellet er pasientene eldre, fra 60 år og oppover, og faktorer som er typiske for denne aldersgruppen vil også spille en rolle. Konklusjon: Salget av legemidler ved astma/KOLS øker kraftig med økende alder. Av de studerte individene over 60 år hadde 27 % en akseptabel uttaks compliance under perioden 1994-2003, 58 % var underuttakere og 15 % var overuttakere

Tilbakemeldinger til sykepleiestudenter i praksis : Prosjektrapport 2015-2016

Ortopedisk sengepost har gjennom flere år drevet kontinuerlig forbedringsarbeid for å heve kvalitet til studentveiledning i praksis og samarbeidet med Høgskolen i Innlandet. Det allerede veletablert samarbeidet førte til at ortopedisk sengepost våren 2014 søkte på samarbeidsprosjektmidler ved Høgskolen i Innlandet. De søkte om et fagutviklingsprosjekt for å kunne utarbeide et skriftlig tilbakemeldingsskjema til bruk for studenter ved ortopedisk sengepost. Det var en utfordring for både studenter og daglige veiledere med å bruke det eksisterende skjema fokus for uken og arbeidsplan. Bakgrunn for prosjektet var et ønske å kunne gi studenter mer individuell og tilpasset tilbakemeldinger samt et ønske om mer refleksjon og læring. Studentveiledning er et prioritert område fra avdelingens ledelse og fagutviklingssykepleier i gjennom flere år. Hovedveiledermodellen er veletablert og mange av sykepleierne har formell veilederutdanning. Gode rutiner i avdelingen er etablert med en praksismodell som organiserer studentteam for studenter i 6. semester praksis. Det vurderes også muligheter for etablering av studentteam med 3. semester studenter. Et kriterium for praksisprosjektets gjennomføring er at studentene i praksis skal være delaktige i prosjektet. Sykepleierstudentene i praksis har deltatt ved å dele sine erfaringer med skriftlig tilbakemeldinger gjennom refleksjonsnotater og fokusgruppeintervju. Sykepleierne på ortopedisk sengepost har delt sine erfaringer gjennom fokusgruppeintervju. Praksisprosjektet har sin formelle oppstart januar 2015 og ble avsluttet desember 2015

Behavioral reactions of brown bears to approaching humans in Fennoscandia

Human disturbance causes behavioral responses in wildlife, including large carnivores. Previous research in Scandinavia has documented that brown bears (Ursus arctos) show a variety of behavioral reactions to different human activities. We investigated how proximity to human settlements and roads, as proxies of human influence, affected brown bears' reactions to encountering humans. We analyzed experimental approaches to GPS collared bears, 18 males and 23 single females, in Sweden (n = 148 approaches) and Finland (n = 33), conducted between 2004 and 2012. The bears in Finland inhabited areas with higher human density compared to Sweden. However, the proportion of bears staying or moving when approached and the flight initiation distances were similar in both countries. In Sweden, the flight responses were not dependent on human densities or roads inside the bears' home ranges or the distances from the bears to roads and settlements. Brown bears in Fennoscandia live in areas with relatively low human population densities, but in many areas with high forestry road densities. Our results show that bears' flight reactions were consistent between areas, which is an important message for management, reinforcing previous studies that have documented human avoidance by bears at different spatial and temporal scales.Peer reviewe

Shift Work Disorder in Nurses – Assessment, Prevalence and Related Health Problems

BACKGROUND: This study investigates the prevalence of symptoms of shift work disorder in a sample of nurses, and its association to individual, health and work variables. METHODOLOGY/PRINCIPAL FINDINGS: We investigated three different shift work disorder assessment procedures all based on current diagnostic criteria and employing symptom based questions. Crude and adjusted logistic regression analyses were performed with symptoms of shift work disorder as the dependent variable. Participants (n = 1968) reported age, gender, work schedule, commuting time, weekly work hours, children in household, number of nights and number of shifts separated by less than 11 hours worked the last year, use of bright light therapy, melatonin and sleep medication, and completed the Bergen Insomnia Scale, Epworth Sleepiness Scale, Global Sleep Assessment Questionnaire, Diurnal Scale, Revised Circadian Type Inventory, Dispositional Resilience (Hardiness) Scale--Revised, Fatigue Questionnaire, questions about alcohol and caffeine consumption, as well as the Hospital Anxiety and Depression Scale. CONCLUSIONS/SIGNIFICANCE: Prevalence rates of symptoms of shift work disorder varied from 32.4-37.6% depending on the assessment method and from 4.8-44.3% depending on the work schedule. Associations were found between symptoms of shift work disorder and age, gender, circadian type, night work, number of shifts separated by less than 11 hours and number of nights worked the last year, insomnia and anxiety. The different assessment procedures yielded similar results (prevalence and logistic regression analyses). The prevalence of symptoms indicative of shift work disorder was high. We argue that three symptom-based questions used in the present study adequately assess shift work disorder in epidemiological studies

Multiple Medicine Use : Patients’ and general practitioners’ perceptions and patterns of use in relation to age and other patient characteristics

There are widespread concerns about the increasing use of multiple medicines. The aims of this thesis were to identify older patients' and general practitioners' (GPs) attitudes to and experiences of multiple medicine use, as well as to describe patterns of multiple medicine use in different age groups in association with patient-related factors. An additional aim was to contribute to scientific methodological development by providing an empirical example of the application of the Lehoux, Poland, & Daudelin template for the analysis of interaction in focus groups. Data were collected via qualitative focus group discussions and from a cross-sectional community-based population survey conducted during 2001-2005. The patients revealed co-existing accounts of both immediate gratitude that medicines exist and problems with using multiple medicines such as worrying whether multiple medicine use is 'good' for the body. The patient-doctor relationship coloured their attitudes towards their treatment and care. The GPs at times felt insecure, though surrounded by treatment guidelines. Lack of communication with hospital specialists was perceived to reduce treatment quality, while influence of patient pressure was thought to contribute to the development of multiple medicine use. An interaction analysis helped in appreciating and clarifying the contexts in which results from the content analysis were created. Further discussion is needed on how to best report these results. Different cut-offs are useful in defining multiple medicine use in different age groups. Vast majorities of users of multiple medicines were found to have unique medicine combinations. Multiple medicine use was found to be associated with morbidity and poor self-rated health across all age groups

Kjønnsforskjeller i ADHD; Hva kan være noe av årsaken til at færre jenter enn gutter blir diagnostisert?

Hovedoppgave psykologprogrammetPROPSY317PRPSY

Aerial photo interpretation for change detection of treeline ecotones in the Swedish mountains

It is expected that the ongoing climate change will have a strong influence on the Earth’s vegetation and cause the advancement of treelines towards the poles and up to higher elevations. In the Swedish mountains, changes in the positions of alpine treelines have already been reported, and major changes due to changing climate are predicted for the near future. Remote sensing techniques have considerable potential to improve the monitoring of spatially complex treeline ecotones, which are likely to show site dependent responses to changing climate. Aerial photos provide the longest temporal record of remote sensing data for studying the historical treeline changes. High spatial resolution and the possibility of interpreting photos in three-dimensions are the main strengths of aerial photos. The National Inventory of Landscapes in Sweden (NILS) is a nationwide environmental monitoring program, which provides sampling infrastructure for monitoring treelines over the Swedish mountains using high spatial resolution remote sensing data. The aim of this project was to study the feasibility of visual interpretation of aerial photos for monitoring changes in treeline ecotones (transition zones between closed forest and treeless alpine vegetation). More specifically, our aim was to compare possible methods for change detection using recent and historical aerial photos, and to demonstrate a method that is applicable to the Swedish mountains using the NILS sampling infrastructure. We also wanted to evaluate how the technical properties of the aerial photos, particularly the photo scale, affect the change detection. The results were used for evaluating the potential and costs for a more comprehensive change detection study including a greater number of NILS squares. We compared interpretation methods in three 5×5 km NILS squares and studied in total six 5×5 km NILS squares for changes. Colour infrared aerial photos from two points in time (1975–1980 and 2002–2004) were used. The evaluation of the technical properties of aerial photos is important as the recent photos have been taken from a height of 4600 m (photo scale approximately 1:30,000) and the historical photos from 9200 m (1:60,000). The difference in photo scale could introduce significant errors to the change detection. Therefore the effect of photo scale was studied in two experiments in a separate study site, which had been photographed within a few days from both flying heights. We assessed three visual interpretation methods: complete cover mapping (polygon interpretation), sample plot method and transect method. To avoid recording false changes and to minimize the effect of different photo scales, we interpreted the recent and historical photos at the same time using scanned photos and digital photogrammetric workstations. The first method, polygon interpretation, was tested by comparing the current NILS interpretations for the central 1×1 km square within the 5×5 km NILS squares with the historical photos, and updating polygon borders and attributes if changes were observed. In the second method the vegetation variables were interpreted for circular sample plots (20 m radius). We used digital land cover data and GIS techniques for defining a buffer zone between the forest and the treeless alpine areas in order to focus the interpretation efforts on the treeline ecotone. The distance between the systematically sampled plots was 250 m within the treeline buffer. In the third method the variables were interpreted along subjectively selected transects across the altitudinal treeline transitions. Transects were also used for interpreting individual trees within the treeline, of which some were measured in the field. Based on the analyses we can recommend the sample plot method for interpreting tree cover changes within 5×5 km NILS squares. The main advantage with the method is that it can be applied to any NILS square overlapping the treeline ecotone, and that the sampling can be done objectively. A treeline buffer zone based on digital land cover data provides one possible method for pre-stratification. Delineation of polygon borders is not needed and small sized sample plots are easier to interpret concerning vegetation changes than larger polygons. This is particularly the case when changes are small. The polygon interpretation using change control mapping can also be a cost-effective method for change detection within the 1×1 km squares. The greatest advantage is that in addition to tree cover changes, it can provide information on the spatial patterns (landscape structure). However, the small changes in the borders are subjective and difficult to interpret. The transect method can also provide characterization of treelines, particularly in relation to elevation, but the selection of transects within NILS squares can be difficult. Furthermore, the result cannot be generalised to larger areas similar to the method based on probability sampling. We conclude that only tree cover changes can be interpreted with sufficient accuracy, because of the relatively small scale historical photos. Larger scale photos and more extensive field control would be necessary to interpret changes in small trees and shrubs. The experiments with photo scale show that the greatest source of uncertainty is related to the different photo scale of the recent and historical photos. The comparison of two independent interpretations made at different scales would lead to detection of substantial false changes, particularly if interpretations would be made by different interpreters. However, we think that concurrent comparison of digital aerial photos from two points in time provides meaningful change detection for tree cover although some errors due to scale effects should be expected. The interpretation of six NILS squares by the sample plot method suggests that tree cover has increased within the treeline ecotone in three of the squares. The results demonstrate the potential of visual interpretation of aerial photos for treeline change detection. The information on tree cover changes could supplement field based monitoring of treeline elevations. Therefore, we consider that there is potential for a more comprehensive study to examine tree cover changes in a greater number of NILS squares in the Swedish mountains. Then, however, more emphasis should be given to the panchromatic black and white photos from the 1960s, which have been taken from approximately the same flying height (4600 m) as the most recent CIR photos. We estimate that a large scale study, involving the interpretation of approximately 50–60 NILS squares for three points in time would require a budget of about 1 million SEK. Airborne laser scanning and larger scale aerial photos are potential data sources for monitoring future changes in treeline ecotones

Validation of sleep stage classification using non-contact radar technology and machine learning (Somnofy®)

Objective: To validate automatic sleep stage classification using deep neural networks on sleep assessed by radar technology in the commercially available sleep assistant Somnofy® against polysomnography (PSG). Methods: Seventy-one nights of overnight sleep in healthy individuals were assessed by both PSG and Somnofy at two different institutions. The Somnofy unit was placed in two different locations per room (nightstand and wall). The sleep algorithm was validated against PSG using a 25-fold cross validation technique, and performance was compared to the inter-rater reliability between the PSG sleep scored by two independent sleep specialists. Results: Epoch-by-epoch analyses showed a sensitivity (accuracy to detect sleep) and specificity (accuracy to detect wake) for Somnofy of 0.97 and 0.72 respectively, compared to 0.99 and 0.85 for the PSG scorers. The sleep stage differentiation for Somnofy was 0.75 for N1/N2, 0.74 for N3 and 0.78 for R, whilst PSG scorers ranged between 0.83 and 0.96. The intraclass correlation coefficient revealed excellent and good reliability for total sleep time and sleep efficiency, while sleep onset and R latency had poor agreement. Somnofy underestimated total wake time by 5 min and N1/N2 by 3 min. N3 was overestimated by 4 min and R by 3 min. Results were independent of institution and sensor location. Conclusion: Somnofy showed a high accuracy staging sleep in healthy individuals and has potential to assess sleep quality and quantity in a sample of healthy, mostly young adults. More research is needed to examine performance in children, older individuals and those with sleep disorders

Tilbakemeldinger til sykepleiestudenter i praksis : Prosjektrapport 2015-2016

Ortopedisk sengepost har gjennom flere år drevet kontinuerlig forbedringsarbeid for å heve kvalitet til studentveiledning i praksis og samarbeidet med Høgskolen i Innlandet. Det allerede veletablert samarbeidet førte til at ortopedisk sengepost våren 2014 søkte på samarbeidsprosjektmidler ved Høgskolen i Innlandet. De søkte om et fagutviklingsprosjekt for å kunne utarbeide et skriftlig tilbakemeldingsskjema til bruk for studenter ved ortopedisk sengepost. Det var en utfordring for både studenter og daglige veiledere med å bruke det eksisterende skjema fokus for uken og arbeidsplan. Bakgrunn for prosjektet var et ønske å kunne gi studenter mer individuell og tilpasset tilbakemeldinger samt et ønske om mer refleksjon og læring. Studentveiledning er et prioritert område fra avdelingens ledelse og fagutviklingssykepleier i gjennom flere år. Hovedveiledermodellen er veletablert og mange av sykepleierne har formell veilederutdanning. Gode rutiner i avdelingen er etablert med en praksismodell som organiserer studentteam for studenter i 6. semester praksis. Det vurderes også muligheter for etablering av studentteam med 3. semester studenter. Et kriterium for praksisprosjektets gjennomføring er at studentene i praksis skal være delaktige i prosjektet. Sykepleierstudentene i praksis har deltatt ved å dele sine erfaringer med skriftlig tilbakemeldinger gjennom refleksjonsnotater og fokusgruppeintervju. Sykepleierne på ortopedisk sengepost har delt sine erfaringer gjennom fokusgruppeintervju. Praksisprosjektet har sin formelle oppstart januar 2015 og ble avsluttet desember 2015

Phylogeny and Functional Expression of Ribulose 1,5-Bisphosphate Carboxylase/Oxygenase from the Autotrophic Ammonia-Oxidizing Bacterium Nitrosospira sp.Isolate 40KI

The autotrophic ammonia-oxidizing bacteria (AOB), which play an important role in the global nitrogen cycle, assimilate CO(2) by using ribulose 1,5-bisphosphate carboxylase/oxygenase (RubisCO). Here we describe the first detailed study of RubisCO (cbb) genes and proteins from the AOB. The cbbLS genes from Nitrosospira sp. isolate 40KI were cloned and sequenced. Partial sequences of the RubisCO large subunit (CbbL) from 13 other AOB belonging to the β and γ subgroups of the class Proteobacteria are also presented. All except one of the β-subgroup AOB possessed a red-like type I RubisCO with high sequence similarity to the Ralstonia eutropha enzyme. All of these new red-like RubisCOs had a unique six-amino-acid insert in CbbL. Two of the AOB, Nitrosococcus halophilus Nc4 and Nitrosomonas europaea Nm50, had a green-like RubisCO. With one exception, the phylogeny of the AOB CbbL was very similar to that of the 16S rRNA gene. The presence of a green-like RubisCO in N. europaea was surprising, as all of the other β-subgroup AOB had red-like RubisCOs. The green-like enzyme of N. europaea Nm50 was probably acquired by horizontal gene transfer. Functional expression of Nitrosospira sp. isolate 40KI RubisCO in the chemoautotrophic host R. eutropha was demonstrated. Use of an expression vector harboring the R. eutropha cbb control region allowed regulated expression of Nitrosospira sp. isolate 40KI RubisCO in an R. eutropha cbb deletion strain. The Nitrosospira RubisCO supported autotrophic growth of R. eutropha with a doubling time of 4.6 h. This expression system may allow further functional analysis of AOB cbb genes