Et Agderperspektiv på utsatt ungdom

Denne undersøkelsen springer ut av hovedundersøkelsen "Levekår i Vest-Agder", finansiert av Sørlandets Kompetansefond. I hovedundersøkelsen fant vi en serie indikatorer på at fylket har en overrepresentasjon av unge marginaliserte, hvorav andelen yngre uførepensjonister, narkotikastraffede og barn og ungdom med grunn- og hjelpestønad er de viktigste. Med marginaliserte mener vi i praksis ungdom som står utenfor ordinært arbeids- og utdanningsliv. De er i en posisjon mellom det å være integrerte samfunnsmedlemmer og det å være ekskludert. For et samfunn som ønsker gode levekår for flest mulig, er det et betydelig problem når unge ”snubler i starten” på denne måten og står i fare for å ikke få brukt sine ressurser

Substantial changes in inflammatory and cardiovascular biomarkers in patients with autonomous cortisol secretion

Objective To map inflammatory biomarkers in patients with autonomous cortisol secretion (ACS) and overt Cushing syndrome (CS). Method Observational study including serum from prospectively included patients with ACS (n = 63), adrenal CS (n = 2), pituitary CS (n = 8), and healthy subjects (n = 120). Serum samples were analysed for 92 inflammatory biomarkers using proximity extension assay (OLINK). Results Combined, the ACS and CS patients displayed significant differences in levels of 49/92 inflammatory biomarkers (46 increased/3 decreased) compared with healthy controls. No differences in biomarker levels were found between ACS and overt CS, and none of the biomarkers correlated with the degree of hypercortisolism. Postoperative samples were available for 17 patients, median 24 months (range 6–40) after surgery and biochemical curation. There was no significant normalization of the biomarkers postoperatively. Conclusion There was a systemic rise in inflammatory biomarkers in patients with ACS and CS, not correlated to the degree of hypercortisolism. These biomarkers were not normalized following biochemical cure.publishedVersio

Systemic Activation of the Kynurenine Pathway in Graves Disease With and Without Ophthalmopathy

Context Graves disease (GD) is one of the most common autoimmune disorders. Recent literature has shown an immune response involving several different inflammatory related proteins in these patients. Objective This work aimed to characterize the kynurenine pathway, activated during interferon-γ (IFN-γ)–mediated inflammation and cellular (T-helper type 1 [Th1] type) immunity, in GD patients with and without thyroid eye disease (TED). Methods We analyzed 34 biomarkers by mass spectrometry in serum samples from 100 patients with GD (36 with TED) and 100 matched healthy controls. The analytes included 10 metabolites and 3 indices from the kynurenine pathway, 6 microbiota-derived metabolites, 10 B-vitamers, and 5 serum proteins reflecting inflammation and kidney function. Results GD patients showed significantly elevated levels of 7 biomarkers compared with healthy controls (omega squared [ω2] > 0.06; P < .01). Of these 7, the 6 biomarkers with the strongest effect size were all components of the kynurenine pathway. Factor analysis showed that biomarkers related to cellular immunity and the Th1 responses (3-hydroxykynurenine, kynurenine, and quinolinic acid with the highest loading) were most strongly associated with GD. Further, a factor mainly reflecting acute phase response (C-reactive protein and serum amyloid A) showed weaker association with GD by factor analysis. There were no differences in biomarker levels between GD patients with and without TED. Conclusion This study supports activation of IFN-γ inflammation and Th1 cellular immunity in GD, but also a contribution of acute-phase reactants. Our finding of no difference in systemic activation of the kynurenine pathway in GD patients with and without TED implies that the local Th1 immune response in the orbit is not reflected systemically.publishedVersio

Foreldres fordeling av omsorgsarbeid i barnets første leveår : en analyse av sammehengene mellom diskurs, omsorgsarrangement, praksis og kompetanseutvikling

Temaet i denne oppgaven er foreldres fordeling av omsorgsarbeid i barnets første leveår. Problemstillingen i oppgaven dreier seg om hvilke diskurser mor og far forholder seg til i de begrunnelsene de gir om fordeling av permisjonstid det første året og hvordan diskursene avleires i praksis gjennom hverdagslivets omsorgsarbeid. Det blir også undersøkt om beslutningsprosessene kan bære preg av ulike typer forhandlinger. Det gir oppgaven et kjønnsperspektiv. Både mors og fars stemmer får komme frem, og gjennom dette tas det høyde for at foreldrene kan være uenige. Søkelyset på forhandlinger kan også gi et grunnlag for å si noe om eventuelle maktforhold mellom mor og far når omsorgen blir organisert på forskjellige måter. Er det slik at mødrene kommer i en maktposisjon når hun er den som tilbringer mesteparten av tiden med barnet det første året, og på hvilken måte kommer det i så fall til uttrykk? Relasjonelle sider ved fordelig av barneomsorg vil på denne måten også være gjenstand for utforsking. I kapittel 2 diskuteres det teoretiske grunnlaget for oppgaven. Først og fremst er det diskursanalyse som teori og metode som vies plass, og det diskuteres hvordan en slik analytisk innfallsvinkel kan bidra til å identifisere de ”hverdagsdiskursene” som foreldre knytter seg til når omsorgen for små barn skal organiseres. Videre vil det også bli presentert to ulike forståelser av forhandlingsbegrepet som kan sette oss på sporet av en kjønns- og maktdimensjon, mens Bråtens modellmaktteori vil presenteres som et redskap til å forstå hvordan slik makt kan oppstå og hvordan den kan opphøre. Metodevalg og fremgangsmåte er tema i kapittel 3. Studien benytter en kvalitativ metodisk tilnærming hvor det teoretiske perspektivet tar utgangspunkt i det som i sosiologien kalles fortolkende metode. Det empiriske grunnlaget er dannet gjennom semistrukturerte intervjuer og utvalget er hentet fra en mellomstor bydel i Oslo. Oppgavens metodedel viser hvordan den metodiske tilnærmingen har bidradd til å skaffe informasjon og kunnskap om de problemstillingene som reises, og hvordan prosessene inkluderte utfordringer når det gjaldt praktisk gjennomføring av prosjektet og etiske dilemmaer med hensyn til bruk av metoder og forholdet til informantene. Det har blitt foretatt spesielle analytiske valg i oppgaven som dreier seg om kategorisering av materialet og hvordan de identifiserte diskursene skulle betegnes. I kapittel 4 redegjøres for disse valgene. Analysen presenteres i tre deler. I kapittel 5 er målet å identifisere de diskursene som brukes i begrunnelsene for valg av omsorgsarrangement i familier hvor mor tar ut hele den delbare permisjonen. I kapittel 6 vil jeg ha samme fokus, men da i forhold til de delingsorienterte familiene. I begge disse kapitlene rettes blikket mot i hvilken grad disse familien bedriver forhandlinger, og jeg forsøker å kartlegge hva slags forhandlinger det eventuelt kan dreie seg om. Temaene i kapittel 5 og kapittel 6 vil altså være en identifisering av typer av omsorgsarrangement, typer av diskurser og typer av forhandlinger og sammenhengen mellom disse. Kapittel 7 vil handle om omsorgspraksiser. Et hovedspørsmål vil være i hvilken grad det omsorgsarrangementet som er valgt har betydning for hvordan far yter omsorg i dagliglivet, og i hvilken grad diskursene som mor og far knytter seg til har betydning for denne praksisen. Det er i dette kapittelet analysen vil inkludere en maktdimensjon, og jeg vil studere kompetanseutvikling på omsorgsarbeid som grunnlag for makt. I kapittel 8 diskuteres resultatene fra analysen og det pekes på implikasjoner for videre forskning

Clinical Efficacy of Combined Surgical Patient Safety System and the World Health Organization’s Checklists in Surgery. A Nonrandomized Clinical Trial

Importance: Checklists have been shown to improve patient outcomes in surgery. The intraoperatively used World Health Organization surgical safety checklist (WHO SSC) is now mandatory in many countries. The only evidenced checklist to address preoperative and postoperative care is the Surgical Patient Safety System (SURPASS), which has been found to be effective in improving patient outcomes. To date, the WHO SSC and SURPASS have not been studied jointly within the perioperative pathway. Objective: To investigate the association of combined use of the preoperative and postoperative SURPASS and the WHO SSC in perioperative care with morbidity, mortality, and length of hospital stay. Design, Setting, and Participants: In a stepped-wedge cluster nonrandomized clinical trial, the preoperative and postoperative SURPASS checklists were implemented in 3 surgical departments (neurosurgery, orthopedics, and gynecology) in a Norwegian tertiary hospital, serving as their own controls. Three surgical units offered additional parallel controls. Data were collected from November 1, 2012, to March 31, 2015, including surgical procedures without any restrictions to patient age. Data were analyzed from September 25, 2018, to March 29, 2019. Interventions: Individualized preoperative and postoperative SURPASS checklists were added to the intraoperative WHO SSC. Main Outcomes and Measures: Primary outcomes were in-hospital complications, emergency reoperations, unplanned 30-day readmissions, and 30-day mortality. The secondary outcome was length of hospital stay (LOS). Results: In total, 9009 procedures (5601 women [62.2%]; mean [SD] patient age, 51.7 [22.2] years) were included, with 5117 intervention procedures (mean [SD] patient age, 51.8 [22.4] years; 2913 women [56.9%]) compared with 3892 controls (mean [SD] patient age, 51.5 [21.8] years; 2688 women [69.1%]). Parallel control units included 9678 procedures (mean [SD] patient age, 57.4 [22.2] years; 4124 women [42.6%]). In addition to the WHO SSC, adjusted analyses showed that adherence to the preoperative SURPASS checklists was associated with reduced complications (odds ratio [OR], 0.70; 95% CI, 0.50-0.98; P = .04) and reoperations (OR, 0.42; 95% CI, 0.23-0.76; P = .004). Adherence to the postoperative SURPASS checklists was associated with decreased readmissions (OR, 0.32; 95% CI, 0.16-0.64; P = .001). No changes were observed in mortality or LOS. In parallel control units, complications increased (OR, 1.09; 95% CI, 1.01-1.17; P = .04), whereas reoperations, readmissions, and mortality remained unchanged. Conclusions and Relevance: In this nonrandomized clinical trial, adding preoperative and postoperative SURPASS to the WHO SSC was associated with a reduction in the rate of complications, reoperations, and readmissions

Clinical Efficacy of Combined Surgical Patient Safety System and the World Health Organization’s Checklists in Surgery. A Nonrandomized Clinical Trial

Importance: Checklists have been shown to improve patient outcomes in surgery. The intraoperatively used World Health Organization surgical safety checklist (WHO SSC) is now mandatory in many countries. The only evidenced checklist to address preoperative and postoperative care is the Surgical Patient Safety System (SURPASS), which has been found to be effective in improving patient outcomes. To date, the WHO SSC and SURPASS have not been studied jointly within the perioperative pathway. Objective: To investigate the association of combined use of the preoperative and postoperative SURPASS and the WHO SSC in perioperative care with morbidity, mortality, and length of hospital stay. Design, Setting, and Participants: In a stepped-wedge cluster nonrandomized clinical trial, the preoperative and postoperative SURPASS checklists were implemented in 3 surgical departments (neurosurgery, orthopedics, and gynecology) in a Norwegian tertiary hospital, serving as their own controls. Three surgical units offered additional parallel controls. Data were collected from November 1, 2012, to March 31, 2015, including surgical procedures without any restrictions to patient age. Data were analyzed from September 25, 2018, to March 29, 2019. Interventions: Individualized preoperative and postoperative SURPASS checklists were added to the intraoperative WHO SSC. Main Outcomes and Measures: Primary outcomes were in-hospital complications, emergency reoperations, unplanned 30-day readmissions, and 30-day mortality. The secondary outcome was length of hospital stay (LOS). Results: In total, 9009 procedures (5601 women [62.2%]; mean [SD] patient age, 51.7 [22.2] years) were included, with 5117 intervention procedures (mean [SD] patient age, 51.8 [22.4] years; 2913 women [56.9%]) compared with 3892 controls (mean [SD] patient age, 51.5 [21.8] years; 2688 women [69.1%]). Parallel control units included 9678 procedures (mean [SD] patient age, 57.4 [22.2] years; 4124 women [42.6%]). In addition to the WHO SSC, adjusted analyses showed that adherence to the preoperative SURPASS checklists was associated with reduced complications (odds ratio [OR], 0.70; 95% CI, 0.50-0.98; P = .04) and reoperations (OR, 0.42; 95% CI, 0.23-0.76; P = .004). Adherence to the postoperative SURPASS checklists was associated with decreased readmissions (OR, 0.32; 95% CI, 0.16-0.64; P = .001). No changes were observed in mortality or LOS. In parallel control units, complications increased (OR, 1.09; 95% CI, 1.01-1.17; P = .04), whereas reoperations, readmissions, and mortality remained unchanged. Conclusions and Relevance: In this nonrandomized clinical trial, adding preoperative and postoperative SURPASS to the WHO SSC was associated with a reduction in the rate of complications, reoperations, and readmissions

Clinical Efficacy of Combined Surgical Patient Safety System and the World Health Organization's Checklists in Surgery: A Nonrandomized Clinical Trial

Importance Checklists have been shown to improve patient outcomes in surgery. The intraoperatively used World Health Organization surgical safety checklist (WHO SSC) is now mandatory in many countries. The only evidenced checklist to address preoperative and postoperative care is the Surgical Patient Safety System (SURPASS), which has been found to be effective in improving patient outcomes. To date, the WHO SSC and SURPASS have not been studied jointly within the perioperative pathway. Objective To investigate the association of combined use of the preoperative and postoperative SURPASS and the WHO SSC in perioperative care with morbidity, mortality, and length of hospital stay. Design, Setting, and Participants In a stepped-wedge cluster nonrandomized clinical trial, the preoperative and postoperative SURPASS checklists were implemented in 3 surgical departments (neurosurgery, orthopedics, and gynecology) in a Norwegian tertiary hospital, serving as their own controls. Three surgical units offered additional parallel controls. Data were collected from November 1, 2012, to March 31, 2015, including surgical procedures without any restrictions to patient age. Data were analyzed from September 25, 2018, to March 29, 2019. Interventions Individualized preoperative and postoperative SURPASS checklists were added to the intraoperative WHO SSC. Main Outcomes and Measures Primary outcomes were in-hospital complications, emergency reoperations, unplanned 30-day readmissions, and 30-day mortality. The secondary outcome was length of hospital stay (LOS). Results In total, 9009 procedures (5601 women [62.2%]; mean [SD] patient age, 51.7 [22.2] years) were included, with 5117 intervention procedures (mean [SD] patient age, 51.8 [22.4] years; 2913 women [56.9%]) compared with 3892 controls (mean [SD] patient age, 51.5 [21.8] years; 2688 women [69.1%]). Parallel control units included 9678 procedures (mean [SD] patient age, 57.4 [22.2] years; 4124 women [42.6%]). In addition to the WHO SSC, adjusted analyses showed that adherence to the preoperative SURPASS checklists was associated with reduced complications (odds ratio [OR], 0.70; 95% CI, 0.50-0.98; P = .04) and reoperations (OR, 0.42; 95% CI, 0.23-0.76; P = .004). Adherence to the postoperative SURPASS checklists was associated with decreased readmissions (OR, 0.32; 95% CI, 0.16-0.64; P = .001). No changes were observed in mortality or LOS. In parallel control units, complications increased (OR, 1.09; 95% CI, 1.01-1.17; P = .04), whereas reoperations, readmissions, and mortality remained unchanged. Conclusions and Relevance In this nonrandomized clinical trial, adding preoperative and postoperative SURPASS to the WHO SSC was associated with a reduction in the rate of complications, reoperations, and readmissions