Effect of ADHD Medication on Criminality and Injuries : Quasi-Experimental Evidence for Patients on the Margin of Treatment

Attention-deficit/hyperactivity disorder (ADHD) er den vanligste nevropsykiatriske lidelsen hos barn og unge. Store geografiske variasjoner i diagnostisering og medisinering av ADHD har bidratt til bekymringer om under- og overbehandling. Det er behov for mer kausal kunnskap om hvordan farmakologisk behandling av ADHD påvirker virkelige utfall for personer med mildere symptomer som behandles eller ikke behandles avhengig av behandlers preferanser. Denne avhandlingen estimerer effekter av farmakologisk behandling av ADHD på kriminalitet og ulykker, og undersøker geografisk variasjon i diagnoser og symptombelastning for ADHD basert på norske register- og surveydata. Variasjon i klinikeres behandlingspreferanse for pasienter i «gråsonen» (eller på marginen) for behandling anvendes som en kvasieksperimentell randomisering til ADHD medisin for ellers like pasienter i et instrumentvariabeldesign. Behandlingsestimatene gjelder pasienter hvor klinikeres behandlingsbeslutninger varierer, og inkluderer ikke pasienter med lav eller høy symptombelastning der det er klinisk konsensus. Jeg finner beskyttende effekter av farmakologisk behandling på vold- og orden- og integritetsrelatert kriminalitet, men ikke andre typer kriminalitet. Jeg finner ikke klar støtte for behandlingseffekter på ulykker. Videre er den geografiske variasjonen i ADHD-diagnoser betydelig større enn det som kan forklares av variasjon i symptombelastning. Avhandlingen bidrar til tre områder innen ADHD-forskningen: debatten om under- og overbehandling, kausal inferens, og langtidseffekter for kriminalitet og ulykker. Kliniske behandlingsbeslutninger er basert på en helhetlig vurdering. Avhandlingen viser at farmakologisk behandling reduserer noen typer kriminalitet, men ikke ulykker, for den understuderte pasientgruppen i «gråsonen» for behandling, og utvider dermed evidensgrunnlaget til klinikers beslutninger for to viktige utfall. Samtidig vises hvordan kvasieksperimentelle design og registerdata kan kombineres for å gi effektestimater som ikke kan oppnås med randomiserte eksperimenter grunnet etikk eller observasjonsstudier grunnet uobservert konfundering.Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and adolescents. Large geographical variations in diagnosis and medication for ADHD have raised concerns about under- and overtreatment. There is demand for more causal knowledge about how pharmacological treatment of ADHD impacts real-life outcomes among otherwise similar patients who receive treatment due to varying provider preference for treatment. This thesis estimates effects of pharmacological treatment of ADHD on crime and injuries and examines geographical variation in diagnoses and symptom load of ADHD based on Norwegian population-wide registry and survey data. Variation in providers’ (i.e., clinicians) treatment preference for patients on the margin of treatment is used as quasi-experimental randomization to pharmacological treatment in an instrumental variable design. The treatment effects concern patients where providers differ in treatment decisions, and do not include patients with a very low or high symptom burden where there is clinical consensus. I find protective effects of pharmacological treatment on violence- and public-orderrelated crimes, but not other types of crime. I do not find clear evidence for treatment effects on overall injuries. Furthermore, the geographical variation in diagnoses of ADHD is much larger than what can be explained by variation in symptom load. The thesis contributes to three areas in ADHD research: the debate on under- and overtreatment, causal inference, and long-term effects on crime and injuries. Clinical treatment decisions are based on a holistic assessment where many outcomes are considered. This thesis shows that pharmacological treatment reduces some types of crimes, but not overall injuries, for the understudied patient group on the margin of treatment, and this expands the evidence base for clinicians’ decisions for two important real-life outcomes among people with ADHD. The methodological approach illustrates how quasi-experimental designs and registry data can be combined to estimate treatment effects that cannot be obtained in randomized experiments due to ethics nor observational studies due to unobserved confounding.Doktorgradsavhandlin

Antibiotic Therapy for Neonatal Sepsis - Studies on epidemiology, gentamicin safety, and early adverse effects of antibiotics

Paper 1, 2, 3 & 4 are not available in Munin. Paper 1: Fjalstad, J.W., Stensvold, H.J., Bergseng, H., Simonsen, G.S., Salvesen, B., Rønnestad, A.E. & Klingenberg, C. (2016). Early-onset Sepsis and Antibiotic Exposure in Term Infants: A Nationwide Population-based Study in Norway. Available in The Pediatric Infectious Disease Journal, 35(1), 1-6. Paper 2: Fjalstad, J.W., Laukli, W., van den Anker, J.N. & Klingenberg, C.(2013). High-dose gentamicin in newborn infants: is it safe? Available in European journal of pediatrics (2014),173, 489-495. Paper 3: Esaiassen, E., Fjalstad, J.W., Juvet, L.K., van den Anker, J.N. & Klingenberg, C. (2017). Antibiotic exposure in neonates and early adverse outcomes: a systematic review and meta-analysis. Available in Journal of Antimicrobial Chemotherapy, 72(7), 1858-70. Paper 4: Fjalstad, J.W., Esaiassen, E., Juvet, L.K., van den Anker, J.N. & Klingenberg, C. (2017). Antibiotic therapy in neonates and impact on gut microbiota and antibiotic resistance development: a systematic review. Available in Journal of Antimicrobial Chemoterapy (2018), 73(3), 569-580. Objectives: The overall aim of this thesis was to investigate different aspects of antibiotic therapy for neonatal sepsis. Material and Methods: The epidemiology of early onset sepsis (EOS) and systemic antibiotic exposure in the first week of life was studied in a nationwide population-based study from the Norwegian Neonatal Network between 2009-2011. A high-dose extended-interval gentamicin regimen was studied in the neonatal unit in Tromsø from 2004-2012. Early adverse effects of antibiotic therapy were studied in a systematic review. We included observational studies and randomized controlled trials that provided data on different categories of antibiotic therapy and either the risk of necrotizing enterocolitis, invasive fungal infection, death, antibiotic resistance development, or changes in the gut microbiota. Results: There were 0.54 cases of culture-confirmed EOS per 1000 live-born term infants with a mortality rate of 1%. Intravenous antibiotics were administered to 2.3% of all live-born term infants in Norway, and half of them were not diagnosed with an infection. In the neonatal unit in Tromsø, gentamicin trough concentrations were above the threshold of 2 mg/L in 6% of cases. Only 1% of these infants suffered from permanent hearing loss. In our systematic reviews, prolonged antibiotic exposure was significantly associated with necrotizing enterocolitis and/or death in preterm infants and reduced gut microbial diversity in all infants. Broad-spectrum antibiotic treatment increased the risk of invasive fungal infection. All categories of antibiotic exposure were associated with an increased risk of antibiotic resistance development. Main Conclusions: The incidence of culture-confirmed EOS in Norway was in line with previous international reports, and the mortality was very low. A large proportion of infants were treated with antibiotics without an infection. The extended-interval high-dose gentamicin regimen studied in this thesis seems safe. Neonatal antibiotic treatment was associated with several adverse effects

Can attention explain the abnormal dynamics of the stock market?

MasteroppgaveECON391PROF-SØKMASV-SØ

A gentle introduction to instrumental variables

Instrumental variables (IV) is a central strategy for identifying causal effects in absence of randomized experiments. Clinicians and epidemiologists may find the intuition of IV easy to grasp by comparison to randomized experiments. Randomization is an ideal IV because treatment is assigned randomly, and hence unaffected by everything else. IV methods in nonexperimental settings mimic a randomized experiment by using a source of “as good as” random variation in treatment instead. The main challenge with IV designs is to find IVs that are as good as randomization. Discovering potential IVs require substantive knowledge and an understanding of design principles. Moreover, IV methods recover causal effects for a subset of the population who take treatment when induced by the IV. Sometimes these estimates are informative, other times their relevance is questionable. We provide an introduction to IV methods in clinical epidemiology. First, we introduce the main principles and assumptions. Second, we present practical examples based on Mendelian randomization and provider preference and refer to other common IVs in health. Third, practical steps in IV analysis are presented. Fourth, the promise and perils of IV methods are discussed. Finally, we suggest further readings.publishedVersio

Implementation of music therapy in somatic contexts in Norway: Creation, expansion and maintenance of music therapy services

Music therapy services and positions are quite rare in Norwegian healthcare settings, despite research showing great potential. This thesis investigates how music therapy services in somatic contexts in Norway are created, expanded and maintained; and thereby how music therapy positions in somatic contexts are increased. Data has been collected through semi structured, qualitative interviews with six informants from two healthcare settings: three music therapists, two administrators in leadership positions, and one chief physician. Through thematic analysis five main themes emerged: visibility and understanding, being supported and a part of a professional community, the social currents and zeitgeist of the time, leadership and power, and personal driving force/impetus. Furthermore, project and research positions can succeed over time if conditions are sufficient, particularly when internally anchored or internally financed. An ambivalence exists between the need for external financing and the sense of insecurity it creates. Through increased visibility, it is possible to counteract skepticism towards music therapy. Visibility and adaptability contribute to interdisciplinary collaboration. The findings suggest that music therapy service development is complex like a jigsaw: the themes and subthemes are interconnected, and no one theme/factor alone is sufficient when trying to create, expand or maintain music therapy services and positions.Masteroppgave i musikkterapiMUTP350MAHF-INMU

Om rebning

I de landsbyer, hvor der herskede såkaldte regelbundne landskifter, blev jorden i praksis fordelt ved såkaldt rebning. Artiklen sammenligner de oplysninger, der kan udledes af markbøgerne fra 1680'erne, med ældre oplysninger om en gennemført rebning i konkrete landsbyer. Der påvises gennemgående god overensstemmelse, som peger på, at den gennemførte rebning som hovedregel holdt sig. Dog er der nogle steder sket reguleringer i forbindelse med nyopdyrkning, deling af gårde og andet

Dristige damer i internasjonalt farvann

Women On Waves (WOW) is an international feminist network organization working to expand and protect womenâs reproductive rights. By using the Internet to fund and equip abortion ships sailing to international waters to give women from all countries legal and safe abortion services, they represent a new combination of feminist activism and vision. WOW organizes an abortion ship that visits local harbours in European countries like Ireland, Poland and Portugal where abortion is legally forbidden. WOW represents a new global health service that challenge the idea of abortion and reproductive rights as national issues. Local and global knowledge expert elites, sharing feminist visions and hopes to reduce womenâs suffering and to improve the quality of motherhood all over the world, work together and illustrate new ways of combing global and local solidarities

Gearing up for growth : the growth process of new ventures at the base of the pyramid

Author's accepted version (postprint).This is an Accepted Manuscript of an article published by Inderscience Publishers in International Journal of Entrepreneurial Venturing on 13/02/2020.Available online: http://www.inderscience.com/offer.php?id=105137acceptedVersio