Prevalence of unruptured intracranial aneurysms: impact of different definitions-the Tromsø Study

Background - Management of incidental unruptured intracranial aneurysms (UIAs) remains challenging and depends on their risk of rupture, estimated from the assumed prevalence of aneurysms and the incidence of aneurysmal subarachnoid haemorrhage. Reported prevalence varies, and consistent criteria for definition of UIAs are lacking. We aimed to study the prevalence of UIAs in a general population according to different definitions of aneurysm. Methods - Cross-sectional population-based study using 3-dimensional time-of-flight 3 Tesla MR angiography to identify size, type and location of UIAs in 1862 adults aged 40–84 years. Size was measured as the maximal distance between any two points in the aneurysm sac. Prevalence was estimated for different diameter cutoffs (≥1, 2 and 3 mm) with and without inclusion of extradural aneurysms. Results - The overall prevalence of intradural saccular aneurysms ≥2 mm was 6.6% (95% CI 5.4% to 7.6%), 7.5% (95% CI 5.9% to 9.2%) in women and 5.5% (95% CI 4.1% to 7.2%) in men. Depending on the definition of an aneurysm, the overall prevalence ranged from 3.8% (95% CI 3.0% to 4.8%) for intradural aneurysms ≥3 mm to 8.3% (95% CI 7.1% to 9.7%) when both intradural and extradural aneurysms ≥1 mm were included. Conclusion - Prevalence in this study was higher than previously observed in other Western populations and was substantially influenced by definitions according to size and extradural or intradural location. The high prevalence of UIAs sized <5 mm may suggest lower rupture risk than previously estimated. Consensus on more robust and consistent radiological definitions of UIAs is warranted

Extinguishing or Fueling the Fire: Resilience in Clinical and Counseling Psychology Graduate Students

Resilience in clinical and counseling graduate students was examined as a tripartite construct consisting of personality, coping, and psychological functioning in a structural equation model. Specifically, five personality traits were included as predictors of coping and psychological functioning, and coping served as a predictor of psychological functioning. Three hundred and nine graduate students in clinical and counseling psychology programs participated in an online questionnaire survey consisting of self-report instruments measuring the five-factor model of personality, coping, social support, depression, anxiety, wellbeing, and burnout. In the best fitting model, conscientiousness was a positive predictor of coping and a negative predictor psychological functioning, neuroticism negatively predicted coping, and openness to new experiences positively predicted coping. Extraversion and agreeableness were not significant predictors of coping or psychological functioning in the structural equation model. The goal of the study was to better understand the relationships between personality, coping, and psychological functioning as well as contribute to the empirical data on the functioning of graduate students in clinical and counseling psychology. The results suggest that there are certain characteristics that may be more important for graduate students and their mentors and supervisors to be aware of to increase the wellbeing of graduate students and protect against burnout and other stress related problems later in their careers. For example, conscientiousness positively predicted coping, yet negatively predicted psychological functioning, suggesting that high levels of conscientiousness could be problematic if the student is over-extended academically. Future work in this area might productively focus on examining more comprehensive and complex models of resilience, utilizing additional personality constructs and variables for a clearer idea of resilience in both psychology graduate students as well as other populations

Redusert jordarbeiding og glyfosat. En sammenstilling av norske og internasjonale forsknings- og overvåkingsresultater, samt en småskala feltstudie av avrenning av glyfosat ved ulik jordarbeiding.

Denne rapporten gir et innblikk i ulike aspekter knyttet til jordarbeiding, bruk av plantevernmiddelet glyfosat og risiko for tap av glyfosat ved overflateavrenning og utlekking gjennom jordprofilet. Vi har valgt å illustrere problemstillingen ved en gjennomgang av norske og internasjonale forskningsrapporter, en gjennomgang av faktiske funn av glyfosat i overvåkingsprogrammer i Norge og Sverige, samt gjennom feltforsøk hvor avrenning av glyfosat fra ruter med ulik jordarbeiding er undersøkt.publishedVersio

Redusert jordarbeiding og glyfosat. En sammenstilling av norske og internasjonale forsknings- og overvåkingsresultater, samt en småskala feltstudie av avrenning av glyfosat ved ulik jordarbeiding.

Denne rapporten gir et innblikk i ulike aspekter knyttet til jordarbeiding, bruk av plantevernmiddelet glyfosat og risiko for tap av glyfosat ved overflateavrenning og utlekking gjennom jordprofilet. Vi har valgt å illustrere problemstillingen ved en gjennomgang av norske og internasjonale forskningsrapporter, en gjennomgang av faktiske funn av glyfosat i overvåkingsprogrammer i Norge og Sverige, samt gjennom feltforsøk hvor avrenning av glyfosat fra ruter med ulik jordarbeiding er undersøkt.publishedVersio

Variations in the Circle of Willis in a large population sample using 3D TOF angiography: The Tromsø Study

The main arteries that supply blood to the brain originate from the Circle of Willis (CoW). The CoW exhibits considerable anatomical variations which may have clinical importance, but the variability is insufficiently characterised in the general population. We assessed the anatomical variability of CoW variants in a community-dwelling sample (N = 1,864, 874 men, mean age = 65.4, range 40–87 years), and independent and conditional frequencies of the CoW’s artery segments. CoW segments were classified as present or missing/hypoplastic (w/1mm diameter threshold) on 3T time-of-flight magnetic resonance angiography images. We also examined whether age and sex were associated with CoW variants. We identified 47 unique CoW variants, of which five variants constituted 68.5% of the sample. The complete variant was found in 11.9% of the subjects, and the most common variant (27.8%) was missing both posterior communicating arteries. Conditional frequencies showed patterns of interdependence across most missing segments in the CoW. CoW variants were associated with mean-split age (P = .0147), and there was a trend showing more missing segments with increasing age. We found no association with sex (P = .0526). Our population study demonstrated age as associated with CoW variants, suggesting reduced collateral capacity with older age

Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration

Study Design: Single blind randomized study. Objectives: To compare the effectiveness of lumbar instrumented fusion with cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Summary of Background Data: To the authors’ best knowledge, only one randomized study has evaluated the effectiveness of lumbar fusion. The Swedish Lumbar Spine Study reported that lumbar fusion was better than continuing physiotherapy and care by the family physician. Patients and Methods: Sixty-four patients aged 25–60 years with low back pain lasting longer than 1 year and evidence of disc degeneration at L4–L5 and/or L5–S1 at radiographic examination were randomized to either lumbar fusion with posterior transpedicular screws and postoperative physiotherapy, or cognitive intervention and exercises. The cognitive intervention consisted of a lecture to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The main outcome measure was the Oswestry Disability Index. Results: At the 1-year follow-up visit, 97% of the patients, including 6 patients who had either not attended treatment or changed groups, were examined. The Oswestry Disability Index was significantly reduced from 41 to 26 after surgery, compared with 42 to 30 after cognitive intervention and exercises. The mean difference between groups was 2.3 (-6.7 to 11.4) (P = 0.33). Improvements inback pain, use of analgesics, emotional distress, life satisfaction, and return to work were not different. Fearavoidance beliefs and fingertip-floor distance were reduced more after nonoperative treatment, and lower limbpain was reduced more after surgery. The success rateaccording to an independent observer was 70% after surgery and 76% after cognitive intervention and exercises. The early complication rate in the surgical group was 18%. Conclusion: The main outcome measure showed equal improvement in patients with chronic low back pain and disc degeneration randomized to cognitive intervention and exercises, or lumbar fusion