Antibiotic Use in a Cohort of Norwegian Children and Neonates Before, During and After Hospitalisation : Exploring focus areas for antibiotic stewardship

Bakgrunn: Rasjonell antibiotikabruk blant barn er essensielt for å unngå økende antibiotikaresistens samt forstyrrelser i deres normale bakterieflora. Formål: Hensikten med dette prosjektet var å tilegne oss en bedre forståelse av mønster i antibiotikabruk blant norske barn innlagt i sykehus, både under innleggelsen, samt før og etter innleggelsen. Vi ønsket gjennom dette finne fokusområder for framtidig antibiotikastyring for barnepopulasjonen. Metode: Vi gjennomførte registreringer av antibiotikabruk i 2017 ved et distriktssykehus og et universitetssykehus. Kohorten av barn fra distriktssykehuset ble koblet mot Reseptregisteret og vi registrerte utleverte antibiotikaresepter et år før og et år etter innleggelsen. Gjennom Folkeregisteret etablerte vi en matchet kontrollgruppe. Resultater: For barn etter nyfødtperioden (N=238) fant vi at etterlevelsen av retningslinjene for antibiotikabruk var 72%, og at 21% av behandlingene involverte bredspektret antibiotika, hvorav 68% ble gitt til barn med komorbid sykdom. Vi fant store forskjeller i dosering innad og mellom sykehusene, samt i andel behandlinger som ble gitt for lungebetennelse. For nyfødte (N=184) fant vi at 82% av 121 behandlinger mot mistenkt tidlig sepsis blant de med gestasjonsalder på minst 28 uker ble gitt mot ubekreftede infeksjoner med en gjennomsnittlig behandlingslengde på 3.1 dager. Hos barn eldre enn tre måneder fant vi en relativ risiko for antibiotika-eksponering på 2.9 (95% konfidensintervall 2.4-3.5) gjennom året før sykehus-innleggelsen og 2.8 (2.3-3.3) året etter sykehusinnleggelsen, sammenlignet med kontrollgruppen. Hos spedbarn yngre enn tre måneder fant vi en relativ risiko for antibiotikaeksponering på 1.7 (1.1-2.5) gjennom året etter sykehusinnleggelsen, sammenlignet med kontrollgruppen. Komorbiditets-justering førte til noe lavere relativ risiko i alle analysene. Konklusjon og fortolkning: Vi avdekket områder som krever videre oppmerksomhet slik som den høye andelen av ubekreftede infeksjoner blant nyfødte, bruk av bredspektret antibiotika blant barn med komorbid sykdom, behandling av lungebetennelse og dosering av antibiotika. Både barn og spedbarn som hadde fått antibiotika i sykehus hadde høyere risiko for å få resept utenfor sykehus.Background: Appropriate antibiotic use in children is crucial in preventing antimicrobial resistance and to avoid disturbances of the microbiome. Objectives: The aim was to develop an understanding of main aspects of antibiotic use pattern in Norwegian hospitalised children, both during hospitalisation, and before and after hospitalisation, and to identify focus areas for antibiotic stewardship. Methods: We conducted period registrations of antibiotic use in 2017 in a district hospital and in a university hospital. The cohort of children from the district hospital was linked to the Norwegian Prescription Registry; ambulatory antibiotic use in these children were collected one year before and one year after hospitalisation. Through the Norwegian Population Registry, we established a matched reference group. Results: For children after the neonatal period (N=238), we found that total adherence rate to the antibiotic guideline was 72%, and 21% of treatments involved broad-spectrum antibiotics, whereof 68% were given to children with comorbidities. We found wide differences in dosing within and between the hospitals, and in the proportion of treatments for pneumonia. For neonates (N=184), we found that 82% of 121 treatments for suspected early-onset sepsis in those with gestational age of at least 28 weeks were given for unconfirmed infections, with an average treatment length of 3.1 days. In children more than three months, the relative risk of antibiotic exposure before hospitalisation was 2.9 (95% confidence interval 2.4-3.5) during the year before hospitalisation and 2.8 (2.3-3.3) during the year after hospitalisation compared to the reference group. In infants less than three months, the relative risk of antibiotic exposure was 1.7 (1.1-2.5) during the year after hospitalisation compared to the reference group. Comorbidity adjustment led to a slightly lower relative risk. Conclusions and implications: We found areas requiring further attention, such as the high proportion of unconfirmed infections in neonates, use of broad-spectrum antibiotics in children with comorbidities, treatments for pneumonia and antibiotic dosing. Both children and infants who had received antibiotics in-hospital had higher risk of receiving antibiotics in ambulatory care, an aspect that should be considered when monitoring antibiotic use in the future.Doktorgradsavhandlin

Half of all hospitalised children treated with antibiotics for pneumonia did not fulfil radiological, microbiological or laboratory criteria

Aim Evaluating the management of paediatric pneumonia is important. We aimed to estimate the proportion of children receiving antibiotics for suspected community-acquired pneumonia (CAP) that were likely to have a bacterial infection. Furthermore, we described antibiotic use in relation to guidelines. Methods We conducted a prospective observational study from a paediatric department in Norway. During 2017, all admitted children aged 0–17 years receiving antibiotics for CAP were enrolled in the study. We collected relevant data and defined likely CAP as one or more of the following: radiologically confirmed pneumonia, c-reactive protein of at least 100 mg/L, positive bacterial culture from blood or pleura, detection of bacteria from the nasopharynx associated with atypical pneumonia. Results In total, 70 episodes of suspected CAP were included. Median age was 41.5 months, and 36 (51%) were girls. Of all treatments, 38 (54%) fulfilled our criteria for likely CAP. Median duration of treatment was 10 days. Of empirical treatments, 36 (57%) only involved penicillin. None of the children had neutropenia or complications, and only two needed intensive care. Conclusion Only half of children receiving antibiotics for suspected CAP were likely to have bacterial infection. Despite no obvious reason, antibiotic treatment was longer than currently recommended.publishedVersio

Det største kongelige taffel i 90 år: Christian 10.s 25-års regeringsjubilæum på Christiansborg Slot i 1937

Denne artikel beskriver den storslåede fest, der blev holdt i anledning af Christian 10.s regeringsjubilæum i 1937. Dengang det kongelige festkøkken på Christiansbrog stadig var i fuldt vigør

Lesbian and gay individuals' path into foster parenting in Norway—Barriers and facilitators at the person and system levels

Growing numbers of lesbian, gay, bisexual, transgender, questioning (LGBTQ) people are becoming foster parents in several western countries. The LGBTQ perspective on the child welfare system has received little attention in practice, research and policy. Despite their increased rights, LGBTQ foster parents continue to face challenges related to fostering. Knowledge is needed on LGBTQ individual perceptions of the process of becoming foster parents, including barriers and facilitating factors. This paper reports on the experiences of 13 gay or lesbian foster parents in Norway. The study shows a lack of knowledge about the possibility of becoming foster parents due to lack of information directed at them as a minority group. Participants felt vulnerable and experienced “minority stress” before encountering the child welfare system, while mainly experienced the encounter with the staff as good and respectful. Although several valued being treated “like everyone else” by the system, others questioned why LGBTQ-specific parenting issues were not raised and discussed. Apart from lack of information, the process towards foster parenting seemed mostly hampered by participants' own assumptions that sexual identity would be a barrier and to some extent biological parents' refusal. The study suggests that foster care and child welfare services would benefit from information in recruitment of foster parents, aiming at being more inclusive. Furthermore, we address gender and sexuality diversity related to foster care work and highlight the strengths and challenges it may offer.acceptedVersio

Grundtvig som stridsmand og polemiker

Denne artikel er baseret på ph.d.-afhandlingen Herrens Stridsmand. Retorisk kritikaf N.F.S. Grundtvigs teologiske polemik i perioden 1810-1825. Afhandlingen eren undersøgelse af Grundtvigs polemiske retorik i den såkaldt ‘bibelkristne’ periodeaf forfatterskabet, særligt årene 1810-1815. Undersøgelsen angår både denpolemik, der findes på tværs af genrer, og den egentlig polemiske genre stridsskriftet,som har været noget overset i forskningen. Jeg har valgt at udformeundersøgelsen som en retorisk analyse og kritik, fordi det moderne retorikfag haret stort og udviklet begrebsapparat, som er velegnet til at analysere de elementer,der er på spil i polemiske tekster: forfatterens selvfremstilling, publikumskonstruktion,argumentation og stil.

Dancing around the pole: holarctic phylogeography of the Arctic fairy shrimp Branchinecta paludosa (Anostraca, Branchiopoda)

The distributional patterns of Arctic species are commonly affected by the recurring Pleistocene glaciations, which contributed to transient or permanent genetic isolation. Here we explore the phylogeography of the climate-sensitive Arctic fairy shrimp Branchinecta paludosa, which has a circumpolar range of distribution, with certain southern alpine outreaches. We sequenced the mitochondrial cytochrome oxidase I subunit from samples collected at ten Nearctic and nine Palaearctic sites, including southern alpine populations. A handful of ambiguous bases in certain sequences strongly suggested heteroplasmy, possibly being reported for the first time in anostracans. Evolutionary analysis of the sequence variations showed a temporal divergence coinciding with the flooding of the Beringia land bridge. Sequence alignment with outgroup taxa for phylogenetic analysis showed three distinct major clades, reflecting geographical isolation. The most divergent clade, from isolated alpine ponds in the Rocky Mountains, probably represents a different and undescribed species. Two other major clades corresponded to the geographical areas of Nearctic and Palaearctic. Finally, the southern Palaearctic outstretch showed genetic separation, most likely representing a geographical and climatic isolated relict population.publishedVersio