The venous thrombosis registry in Østfold Hospital (TROLL registry) - design and cohort description

Purpose: The incidence of venous thromboembolism (VTE) is expected to increase over the next decades, further increasing its substantial impact on patients and health care resources. Registries have the benefit of reporting real-world data without excluding clinically important subgroups. Our aim was to describe a Norwegian VTE registry and to provide descriptive data on the population and management. Registry Population: The Venous Thrombosis Registry in Østfold Hospital (TROLL) is an ongoing registry of consecutive patients diagnosed with, treated, and/or followed up for VTE at Østfold Hospital, Norway, since 2005. Baseline and follow-up data, including demographics, clinical features, risk factors, diagnostic procedures, classification of VTE, and treatment were collected during hospitalization, and at scheduled outpatient visits. Findings to Date: From January 2005 to June 2021, 5037 patients were eligible for research in TROLL. Median age was 67 years (interquartile range, 55–77), and 2622 (52.1%) were male. Of these, 2736 (54.3%) had pulmonary embolism (PE), 2034 (40.4%) had deep vein thrombosis (DVT), and 265 (5.3%) had upper-extremity DVT or splanchnic or cerebral sinus vein thrombosis. In total, 2330 (46.3%) were classified as unprovoked VTE, and 1131 (22.5%) had cancer. Direct oral anticoagulants were the most frequent therapeutic agents (39.3%) followed by low-molecular-weight heparins (30.4%) and vitamin K antagonists (30.3%). Outpatient treatment for PE increased from 4% in 2005 to 23% in 2019. Future Plans: TROLL is a population-based ongoing registry that represents a valuable source of real-world data that will be used for future research on the management and outcomes of VTE

Bridging global health actors and agendas: the role of national public health institutes.

Global health crises require coordination and collaboration among actors and global health agendas including health security, health promotion, and universal health coverage. This study investigated whether national public health institutes (NPHIs) unify agendas and actors, how this can be achieved, and what factors contribute to success. We conducted semi-structured interviews with 24 public health leaders from 18 countries in six WHO regions between 2019 and 2020. Respondents described how NPHIs bridge agendas reporting five strategies that institutes employ: serving as a trusted scientific advisor; convening actors across and within sectors; prioritizing transdisciplinary approaches; integrating public health infrastructures, and training that builds public health capacity. Findings also revealed five enabling factors critical to success: a strong legal foundation; scientific independence; public trust and legitimacy; networks and partnerships at global, national, and local levels; and stable funding. The Covid-19 pandemic underscores the urgency of securing scientific independence and promoting national institutes' responsiveness to public health challenges

Financial crisis and income-related inequalities in the universal provision of a public service: the case of healthcare in Spain

Background The objective of this paper is to analyse whether the recent recession has altered health care utilisation patterns of different income groups in Spain. Methods Based on information concerning individuals ‘income and health care use, along with health need indicators and demographic characteristics (provided by the Spanish National Health Surveys from 2006/07 and 2011/12), econometric models are estimated in two parts (mixed logistic regressions and truncated negative binominal regressions) for each of the public health services studied (family doctor appointments, appointments with specialists, hospitalisations, emergencies and prescription drug use). Results The results show that the principle of universal access to public health provision does not in fact prevent a financial crisis from affecting certain income groups more than others in their utilisation of public health services. Conclusions Specifically, in relative terms the recession has been more detrimental to low-income groups in the cases of specialist appointments and hospitalisations, whereas it has worked to their advantage in the cases of emergency services and family doctor appointments

Underuse of medication for circulatory disorders among unmarried women and men in Norway?

BACKGROUND: It is well established that unmarried people have higher mortality from circulatory diseases and higher all-cause mortality than the married, and these marital status differences seem to be increasing. However, much remains to be known about the underlying mechanisms. Our objective was to examine marital status differences in the purchase of medication for circulatory diseases, and risk factors for them, which may indicate underuse of such medication by some marital status groups. METHODS: Using data from registers covering the entire Norwegian population, we analysed marital status differences in the purchase of medicine for eight circulatory disorders by people aged 50-79 in 2004-2008. These differences were compared with those in circulatory disease mortality during 2004-2007, considered as indicating probable differences in disease burden. RESULTS: The unmarried had 1.4-2.8 times higher mortality from the four types of circulatory diseases considered. However, the never-married in particular purchased less medicine for these diseases, or precursor risk factors of these diseases, primarily because of a low chance of making a first purchase. The picture was more mixed for the divorced and widowed. Both groups purchased less of some of these medicines than the married, but, especially in the case of the widowed, relatively more of other types of medicine. In contrast to the never-married, divorced and widowed people were as least as likely as the married to make a first purchase, but adherence rates thereafter, indicated by continuing purchases, were lower. CONCLUSION: The most plausible interpretation of the findings is that compared with married people, especially the never-married more often have circulatory disorders that are undiagnosed or for which they for other reasons underuse medication. Inadequate use of these potentially very efficient medicines in such a large population group is a serious public health challenge which needs further investigation. It is possible that marital status differences in use of medicines for circulatory disorders combined with an increasing importance of these medicines have contributed to the widening marital status gap in mortality observed in several countries. This also requires further investigation

Improving the diagnostic workup of deep vein thrombosis: Findings from the Ri-Schedule study

In the Rivaroxaban for Scheduled Workup of Deep Vein Thrombosis (the Ri-Schedule) study, we identified patients with suspected deep vein thrombosis (DVT) of the leg in whom diagnostic workup could be deferred while receiving empiric anticoagulation therapy with rivaroxaban. Our findings provide an alternative for anticoagulation therapy than the standard empiric treatment with low-molecular-weight heparin. They may also aid physicians in deciding in which patients diagnostic workup may safely be deferred. Furthermore, we found that a diagnostic management strategy incorporating negative stand-alone D-dimer and a single, whole-leg CUS could safely rule out DVT. The strategy may facilitate an easier and more streamlined diagnostic workup

Medelevrespons

Masteroppgåva handlar om medelevrespons som del av undervegsvurdering av elevtekst. I denne oppgåva skildrar og analyserer eg kva som skjer i ei gruppe som utfører medelevrespons. Oppgåva byggjer på eit sosiokulturelt syn på læring, og teoridelen omfattar også skriveteori og forsking omkring respons. Tidlegare forsking viser at formativ vurdering påverkar læring positivt og at elevmedverknad kan bidra til å auke skrivekompetansen til elevane (Sadler, Wiliam, Black, Hattie). Den overordna problemstillinga er: Bidreg medelevrespons til meir medvitne skrivarar? For å belyse dette har eg formulert følgjande to forskingsspørsmål: Korleis og på kva nivå i teksten gir elevane kvarandre respons? Kva seier elevane om ulike aspekt om respons? Metoden som er brukt er observasjon, kvalitative intervju og analyse av elevutsegner om ulike aspekt omkring respons. Ved å gjere videoopptak av ei responsøkt såg eg på kommentarane dei gav, i tillegg til å sjå på omgrep dei brukte og kva læringssituasjonar eg kunne sjå undervegs. Gjennom intervju med elevane fekk eg høyre korleis dei opplever ulike former av respons og kor nyttig dei opplever medelevrespons er. Responsgruppa denne gongen hadde ei overvekt av positive, generelle kommentarar som truleg ikkje gir mykje hjelp til å utvikle den gjeldande teksten. Refleksjonen som elevane kom med gir likevel grunnlag for å tru at elevrespons over tid kan vere med på å gjere elevane til meir medvitne skrivarar ved at dei internaliserer skrivegrep. I granskinga viste det seg vidare at kommentarar på overordna tekststruktur var merkbart fleire i tal og viste betre kvalitet enn kommentarar som gjaldt mikronivået i teksten. Elevane kunne sjølve forklare dette med at oppbygging av tekst var noko dei hadde gått gjennom mange gonger, og det indikerer at ein blir betre på det ein øver mest på. Generelt ser mange av elevane medelevrespons som ein metode dei har nytte av å bruke. Der er vidare ei eintydig oppfatning av at "scaffolding" i form av responsark er nyttig. Det viser seg at utforminga av responsarka har innverknad på prosessen

Bandwidth Reduction and Convergence Analysis of Extremum Seeking Control with Feedback Encoding

Frequently a physical plant of a control system has an optimum operating point such as the spark (or injection) time of an internal combustion engine that results in maximum torque. Extremum Seeking Control (ESC) is a method of adaptive control capable of locating and maintaining a plant at such an optimum operating point in real time. It is capable of doing so with minimal a priori knowledge of the plant and can also track slowly varying changes. Input perturbed ESC schemes that use periodic dither signals have the disadvantage of requiring a high bandwidth for sampling and correlating the plant output with the dither signal. If the feedback path were to be implemented over a packet switched communication network, the high bandwidth requirement could result in increased congestion and consequently packet delays and dropouts. As a solution encoding using sporadic (aperiodic) sampling techniques can be used in the feedback path of the ESC scheme to reduce the required bandwidth. However, in order to ensure convergence of the ESC scheme with encoding, the effect of the signal reconstruction error due to encoding on the critical correlation stage has to be investigated. The contribution of this paper is an investigation of the convergence requirements and bandwidth performance of two encoding schemes; Memory Based Event Triggering (MBET) and Event Triggered Adaptive Differential Modulation (ETADM). The results show that MBET can fail for objective functions with plateaus. ETADM fails when the number of ETADM steps used for reconstructing the plant output per perturbation cycle are too low to allow correlation. In terms of bandwidth reduction MBET performs better than ETADM (97% and 70% respectively). However, the use of MBET results in a longer convergence time

Protein Functional Site Prediction Using the Shortest-Path Graph Kernel Method

Over the past decade Structural Genomics projects have accumulated structural data for over 75,000 proteins, but the function of most of them are unknown due to limitation of laboratory approaches for discovering the functionality of proteins. Computational methods play key roles to minimize this gap. Graphs are often used to describe and analyze the geometry and physicochemical composition of bimolecular structures such as, chemical compounds and protein functional sites. In this study, we developed an innovative graph method to represent protein surface based on how amino acid residues contact with each other. Further, we implemented a shortest-path graph kernel method to calculate similarities between the graphs. The nearest-neighbor method was used to compare the similarity of kernel values and predict functional sites of protein structures. The proposed approach achieved accuracy as high as 77.1% and would provide a useful tool for functional site prediction

Social inequalities in patient experiences with general practice and in access to specialists: the population-based HUNT Study

Background: In countries with gatekeeping and equitable access to general practitioners (GPs), social inequalities in GP-patient interaction could be an important mechanism by which inequalities in access to medical specialists arise. The aim of this study was to investigate whether socioeconomic inequalities in experiences with general practice are associated with socioeconomic inequalities in access to specialist services. Methods: The study included 6,067 participants in the third survey of the Nord-Trøndelag Health Study (HUNT3, 2006–08) who were asked to evaluate their experiences with primary care and their regular general practitioner in Norway. Self-reported data on health status and number of visits to GP and specialist services in the last 12 months were included in the study. Socioeconomic status was measured by education and household income and rescaled to relative index of inequality (RII). Relative risks were calculated using Poisson regression. Results: We found that a majority of patients reported positive experiences with general practice. Low socioeconomic status (SES) and male gender were associated with negative experiences. Patient experiences both directly and indirectly related to referrals were associated with the probability and quantity of specialist utilization: perception of low subjective influence on decisions about choice of medical care was associated with lower probability and quantity of specialist utilization, whereas desire to change the regular GP or to use GPs other than the regular GP and critical evaluations of the GP were associated with higher specialist consultation frequency. However, the level of education-related inequity in access to specialists was not sensitive to adjustment by survey responses. Conclusion: Patient experiences with general practice were associated with the patients’ level of utilization of specialist services. There are socioeconomic inequalities in patient experiences with general practice, however the aspects measured in this study do not explain the observed socioeconomic inequity in access to specialists.<p>© 2013 Vikum et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p