Long-term Risk Factors for Stroke in Healthy Men

Stroke is a major cause of death and disability. In order to prevent stroke, knowledge of risk factors is essential. This thesis aims to build on the expanding knowledge of stroke risk factors, by using data from the Oslo Ischemia Study. The candidate studied the impact of potential novel risk factors obtained from an exercise test. Further, he investigated the impact of change in fitness and body weight during adult life. Prestgaard found that blood pressure and heart rate measured during exercise added prognostic information, even when taking into account traditional risk factors. He also observed that becoming fit during middle-age halved the risk of stroke, compared to remaining unfit. The opposite was true for those becoming unfit, which saw their stroke risk double. Lastly, he examined weight changes during two different time periods of adult life and found that weight gain during early adult life was associated with increased stroke risk. This was not found for those gaining weight during mid-life. These findings can help physicians identify those at heightened risk of stroke, while also serve as a basis for public health management strategies

‘United in Diversity’ on presidential recognition and sanctions? : An analysis of coherence in the EU’s foreign policy towards Venezuela

Although the EU foreign policy is guided by the principle of coherence, previous research describes how cases of incoherence prevail. This thesis aims to contribute to the literature on under which conditions the EU acts coherently and not. It does so by studying the EU’s foreign policy making in Venezuela post the contested presidential elections in 2018 that left the country with two self-proclaimed presidents and a deteriorating democracy. What is puzzling about the EU’s response is that it imposed sanctions in a coherent manner but acted incoherently regarding the issue of presidential recognition. The outcomes hence varied within the same empirical context, which calls for further analysis of what caused this variation. The thesis utilizes a most similar systems design and qualitative content analysis of official EU-documents and news reporting of the empirical events to analyze if and how three variables - the level of institutionalization and socialization, and interests - were referred to by the actors involved in EU foreign policy making as reasons for its coherence and incoherence respectively. The findings indicate that all three variables were relevant for determining the in/coherence of the respective outcome, and that they reinforced each other to some extent

Sanktioner, Certifiering och CSR - En idéanalys av Världsbankens och UNECA:s syn på hanteringen av Kongos konfliktmineraler

The trade in conflict minerals in eastern Congo contributes to the duration of the intrastate conflict. This essay will analyze documents of two organizations, United Nations Economic Commission for Africa and the World Bank, in relative to the question regarding trade in conflict minerals. Views of accountability and ideas of how to deal with conflict minerals differ between the organizations. The questions asked are therefore how much they differ, and what their views on accountability are. The documents will be analyzed through a critical perspective with a method of qualitative analysis of ideas. The analysis will focus on three aspects; sanctions, certification and Corporate Social Responsibility and will be exemplified by trade in eastern Congo. The critical perspective will be drawn upon theories of Kuntala Lahiri Dutt (2006) and Roland Dannreuther (2013) and exemplified in practice of a report of the non-governmental organization Global Witness. The essay finds that the World Bank and UNECA differ from Global Witness and critical theory in their views of sanctions, certification, CSR, and accountability. Although UNECA manages to combine a problem-solving theory with elements of critical theory to a greater extent than the World Bank. Another dividing line can also be seen between the views on mandatory measures in both CSR, certification and sanctions. The willingness to compromise on fundamental values is also a clear watershed as UNECA and the World Bank are more pragmatic while Global Witness values its commitment to its core values

Time is brain : Hvordan forbedre door-to-needle time ved nevrologisk avdeling, Drammen sykehus?

Bakgrunn Hjerneslag er en alvorlig hendelse som kan føre til død og varig invaliditet. Det medfører også store økonomiske kostnader. Det tilbys i dag relativt effektiv behandling i akuttfasen - trombolyse. Effekten minsker imidlertid drastisk når tid til behandling øker. SITS (Safe Implementation of Treatments in Stroke) anbefaler en median DNT (door-to-needle time) på under 40 minutter. Til tross for dette er median DNT på Drammen sykehus på 75 minutter. Vårt kvalitetsforbedringsarbeid har som mål å innføre tiltak for å redusere DNT på Drammen sykehus. Kunnskapsgrunnlaget Det er klar evidens i store metaanalyser for at tid fra ictus til start av trombolysebehandling er avgjørende for både overlevelse og grad av invaliditet hos slagpasienter. Det er stor variasjon i median DNT på ulike sykehus. Det har blitt vist på flere sykehus at fokus på å redusere DNT ved å innføre ulike tiltak har vært effektivt. Vi har ikke funnet ett eller noen få tiltak som er spesielt effektive, men at det er summen av ulike tiltak samt bevissthet rundt temaet som er avgjørende for å redusere DNT. Tiltak og indikatorer Vi ønsker å innføre flere tiltak ved Drammen sykehus for å redusere DNT. Vi vil innføre teamvarsling hvor alle aktører som er involvert i akuttbehandling av slagpasienter varsles når pasienten meldes til sykehuset. I teamet vil det være en egen trombolysesykepleier med ansvar for å gi trombolyse. Vi vil også sørge for mer effektiv CT takning. For å øke bevissthet rundt DNT vil vi innføre stoppeklokke for å måle DNT og graf hvor tiden registreres fortløpende. Prosess og organisering Vi vil anbefale at en av overlegene ved slagenheten skal ha det overordnede ansvaret for å koordinere innføringen av de ulike tiltakene og den videre oppfølgingen. Han vil lede et slagteam og sørge for at involverte parter får tilstrekkelig opplæring og at jevnlige møter gjennomføres. For å se på effekt av de ulike tiltakene anbefaler vi bruk av PUKK sirkelen der tiltakene bør planlegges og utføres ved å holde møter med teamet. Grafen hvor DNT skal registreres vil være viktig i kontrollfasen for vurdering av DNT. Dersom tiltakene viser seg å være effektive bør de implementeres i daglig praksis ved sykehuset. Konklusjon Tiltakene vi foreslår gjennomført ved Drammen sykehus er relativt enkle og medfører ingen store kostnader. Basert på kunnskap fra andre sykehus er det god grunn til å tro at tiltakene vil redusere DNT ved Drammen sykehus og bedre slagpasientenes overlevelse og grad av invaliditet

Changes in midlife fitness, body mass index, and smoking influence cancer incidence and mortality: A prospective cohort study in men

Abstract Cancer prevention efforts include modification of unhealthy lifestyle, such as smoking cessation and resisting gain in body weight. Although physical activity is inversely related to risk of several cancers, it is poorly studied whether changes in physical activity or fitness influence future cancer risk. Thus, we aimed to investigate whether changes in midlife cardiorespiratory fitness (CRF), body mass index (BMI), and smoking habits influence cancer incidence and mortality. The study cohort includes 1689 initially healthy men, aged 40‐59 years. Measurements of CRF, BMI and information on smoking habits were collected in two repeated waves, 7 years apart. Cox regression models estimated associations as hazard rates (HR) with 95% confidence intervals (CI), between midlife changes in the modifiable lifestyle factors and cancer incidence and mortality. The men were followed prospectively for more than 30 years. Compared to CRF loss (>5%), improved CRF (>5%) was associated with lower cancer incidence (HR 0.81, 95% CI 0.67‐0.98) and mortality (HR 0.70, 95% CI 0.54‐0.92), and maintaining the CRF stable yielded lower cancer incidence (HR 0.76, 95% CI 0.61‐0.95). No association was seen for BMI gain, but maintaining the BMI stable was related to lower cancer incidence (HR 0.77, 95% CI 0.60‐0.98), compared to BMI loss. Continue smoking was associated with higher cancer incidence and mortality, compared to men who stopped smoking. In particular, this study adds new knowledge about the potential preventive role of CRF in cancer development and emphasizes lifestyle modification as a highly important effort in cancer prevention

Changes in midlife fitness, body mass index, and smoking influence cancer incidence and mortality: A prospective cohort study in men

Cancer prevention efforts include modification of unhealthy lifestyle, such as smoking cessation and resisting gain in body weight. Although physical activity is inversely related to risk of several cancers, it is poorly studied whether changes in physical activity or fitness influence future cancer risk. Thus, we aimed to investigate whether changes in midlife cardiorespiratory fitness (CRF), body mass index (BMI), and smoking habits influence cancer incidence and mortality. The study cohort includes 1689 initially healthy men, aged 40‐59 years. Measurements of CRF, BMI and information on smoking habits were collected in two repeated waves, 7 years apart. Cox regression models estimated associations as hazard rates (HR) with 95% confidence intervals (CI), between midlife changes in the modifiable lifestyle factors and cancer incidence and mortality. The men were followed prospectively for more than 30 years. Compared to CRF loss (>5%), improved CRF (>5%) was associated with lower cancer incidence (HR 0.81, 95% CI 0.67‐0.98) and mortality (HR 0.70, 95% CI 0.54‐0.92), and maintaining the CRF stable yielded lower cancer incidence (HR 0.76, 95% CI 0.61‐0.95). No association was seen for BMI gain, but maintaining the BMI stable was related to lower cancer incidence (HR 0.77, 95% CI 0.60‐0.98), compared to BMI loss. Continue smoking was associated with higher cancer incidence and mortality, compared to men who stopped smoking. In particular, this study adds new knowledge about the potential preventive role of CRF in cancer development and emphasizes lifestyle modification as a highly important effort in cancer prevention

Tiårsprediksjon av hjerte-og karsykdom hos friske norske menn basert på NORRISK-2

BAKGRUNN Norske retningslinjer for primærforebygging av hjerte- og karsykdom anbefaler bruk av risikoskårmodellen NORRISK-2, med noen tillegg. Vi ønsket å undersøke om NORRISK-2 kunne predikere hjerte- og karsykdom hos friske norske menn som deltok i kohortstudien Oslo Ischemia Study. MATERIALE NORRISK-2-skår ble beregnet for 2 014 menn i aldersgruppen 40–60 år som i 1972–75 ble inkludert i Oslo Ischemia Study. Cox-regresjonsanalyser ble benyttet for å kalkulere hasardratio for død og hjerte- og karsykdom innen ti år etter førstegangsundersøkelsen. RESULTATER Ingen gikk tapt fra oppfølgingen. Av de 2 014 mennene døde 125 i første tiår etter inklusjon, hvorav 61 av kardiovaskulær sykdom. De som døde, var eldre enn de overlevende, med større andel dagligrøykere, og de hadde høyere systolisk blodtrykk og hvilepuls, økt totalkolesterol og lavere fysisk yteevne. Majoriteten av de som døde av akutt hjerteinfarkt og hjerneslag innen ti år, ble i NORRISK-2 klassifisert i høyrisikogruppen. FORTOLKNING NORRISK-2 identifiserte høyrisikopersonene godt i denne kohorten av friske, middelaldrende norske menn. Det støtter bruk av de norske retningslinjene i beslutningen om eventuell primærforebygging av hjerte- og karsykdom

Exercise Systolic Blood Pressure at Moderate Workload Is Linearly Associated With Coronary Disease Risk in Healthy Men

There is no consensus on the definition of an exaggerated increase in systolic blood pressure (SBP) during exercise. The aim was to explore a potential threshold for exercise SBP associated with increased risk of coronary heart disease in healthy men using repeated exercise testing. Two thousand fourteen healthy white male employees were recruited into the Oslo Ischemia Study during early 1970s. At follow-up 7 years later, 1392 men were still considered healthy. A bicycle exercise test at 100 W workload was performed at both visits. Cox regression analyses were performed with increasing cutoff levels of peak exercise SBP at 100 W workload (SBP100W) from 160 mm Hg to 200 mm Hg, adjusted for cardiovascular risk factors and physical fitness. Participants with SBP100W below cutoff level at both baseline and first follow-up were compared with participants with SBP100W equal to or above cutoff level at both visits. Compared with participants with SBP100W below all cutoff levels between 165 and 195 mm Hg, coronary heart disease risk was increased among participants with SBP100W equal to or above cutoff at all levels. There was no evidence of a distinct threshold level for coronary heart disease risk, and the relation between SBP100W and coronary heart disease appears linear. When investigating exercise SBP at moderate workload measured at 2 exercise tests in healthy middle-aged white men, there is increasing risk of coronary heart disease with increasing exercise SBP independent of SBP at rest. The association is linear from the low range of exercise SBP, and there is no sign of a distinct threshold level for increased coronary disease risk