Psychometric Properties of the Norwegian Version of the Fear of COVID-19 Scale.

To examine the psychometric properties of the Norwegian version of the Fear of COVID-19 Scale (FCV-19S), randomly selected individuals from a larger registry study were invited. We assessed the reliability and validity of the instrument in a sample of 1089 adults in Norway (response rate 73%). Internal consistency measured by Cronbach's alpha (0.88) was acceptable. Omega alphaHierarchical (ωt = 0.69) was lower indicating that the general factor is less reliable, explaining 69% of the total variance. Confirmatory factor analysis indicated that the FCV-19S is not strictly unidimensional. Exploratory graph analysis and confirmatory factor analysis supported a two-factor model (cognitive and somatic fear), which were highly correlated (r = 0.84). The Norwegian version of the FCV-19S showed an underlying two-factor structure. However, the high correlation means the two latent factors (cognitive and somatic fear) act as indicators for a second-order general factor and support use of the FCV-19S sum score. The FCV-19S appears to be a valid instrument to assess fear of COVID-19 with good psychometric properties. Supplementary Information: The online version contains supplementary material available at 10.1007/s11469-020-00454-2.

Dynamic modelling of aquatic exposure and pelagic food chain transfer of cyclic volatile methyl siloxanes in the Inner Oslofjord.

The marine fate and pelagic food chain transfer of three cyclic volatile methyl siloxanes (cVMS: D4, D5 and D6) was explored in the Inner Oslofjord, Norway, using two dynamic models (the Oslofjord POP Model and the aquatic component of ACC-HUMAN). Predicted concentrations of D4, D5, and D6 in the water column were all less than current analytical detection limits, as was the predicted concentration of D4 in sediment (in agreement with measured data). The concentrations predicted for D5 and D6 in sediment were also in broad agreement with measured concentrations from the Inner Oslofjord. Volatilisation was predicted to be the most important loss mechanism for D5 and D6, whereas hydrolysis was predicted to dominate for D4. Concentrations of all three compounds in sediment are controlled by burial below the active mixed sediment layer. The marine food web model in ACC-HUMAN predicted "trophic dilution" of lipid-normalised cVMS concentrations between zooplankton and herring (Culpea harengus) and between herring and cod (Gadus morhua), principally due to a combination of in-fish metabolism and reduced gut absorption efficiency (as a consequence of high KOW). Predicted D5 concentrations in herring and cod agree well with measured data from the inner fjord, particularly when measured concentrations in zooplankton were used to set the initial dissolved-phase aqueous concentrations. Predicted concentrations of D4 and D6 in fish were over- and under-estimated by the model - possibly due to extrapolation of the metabolism rate constant from D5.

Global distribution and budget of PCBs and HCB in background surface soils: implications for sources and environmental processes.

This paper presents data from a survey of polychlorinated biphenyls (PCBs) and hexachlorobenzene (HCB) concentrations in 191 global background surface (0-5 cm) soils. Differences of up to 4 orders of magnitude were found between sites for PCBs. The lowest and highest PCB concentrations (26 and 97,000 pg/g dw) were found in samples from Greenland and mainland Europe (France, Germany, Poland), respectively. Background soil PCB concentrations were strongly influenced by proximity to source region and soil organic matter (SOM) content Most (>80%) of the estimated soil PCB burden remains in the "global source region" of the Northern Hemisphere (NH) temperate latitudes (30-60 degrees N) or in the OM-rich soils just north of that %SOM correlated with PCB and HCB in the global data set, with the correlation coefficients being greater for HCB and the lighter PCBs than for heavier homologues. OM-rich soils in the NH consistently contained the highest burdens; such soils are a key global compartment for these compounds. Evidence for global fractionation of PCBs was found in the subset of soils from latitudes north of the global source region but was not discerned with the global data set The full data set was used to estimate the burden for individual congeners/homologues in surface background soils and a global soil total PCB burden of 21,000 t. The significance of the inventory is briefly discussed in relation to the latest estimates of global production and atmospheric emission.

Inter-current and nosocomial infections among visceral leishmaniasis patients in Ethiopia: an observational study.

From July 1989 up to September 1997, a total of 247 non-HIV associated visceral leishmaniasis (VL) patients were treated on outpatient basis in rural clinics (195 patients) and hospitalised in the Northern-Omo Regional Hospital (18 patients) and in Addis Ababa referral hospitals (34 patients). Patients treated in the rural clinics and in the Regional hospital originated from the same endemic area and had comparable baseline characteristics. Overall rates of complications (inter-current/concurrent infectious or non-infectious diseases or deaths) in the three categories were 10.7, 38.9 and 61.6%, while case fatality rates were 2.5, 5.6 and 11.7%, respectively. Nosocomial bacterial infections occurred in 16.6% of patients treated in the Regional hospital and 32.3% of patients treated in Addis Ababa referral hospitals, and these infections accounted for 42.8 and 52.4% of the complications seen in the respective categories. Among VL patients originating from the same endemic place and with comparable baseline clinical data, patients treated hospitalised had significantly higher rates of complications than patients treated on outpatient basis (P<0.001). Patients who had complications during the course of VL therapy had significantly lower pre-treatment haemoglobin levels. Considering the extra cost of hospitalisation and risk of nosocomial infections and petavalent antimonial therapy being fairly safe, we recommend that VL patients, unless with serious complications, should preferably be treated on ambulatory basis with follow-up to monitor response and inter-current infections if any.

Long-term follow-up of 1059 consecutive primary and recurrent inguinal hernias in a teaching hospital.

OBJECTIVE: To study the early and late outcome of various methods of inguinal hernia repair. DESIGN: Retrospective study. SETTING: Teaching hospital, Norway. SUBJECTS: 1059 repairs of inguinal hernias in men and women by 43 surgeons. INTERVENTIONS: Analysis of patients charts, results of questionnaires concerning 712 hernias (67%) and follow-up consultations when needed. MAIN OUTCOME MEASURES: Freedom from recurrence and postoperative groin symptoms after repairs of primary and recurrent hernias. RESULTS: After a median follow-up of 5.5 years, range 3-8, the recurrence rate was 8% for primary repairs and 29% after recurrent hernias. The incidence of permanent pain or discomfort was unexpectedly high, being 11% after primary repairs and 15% after recurrent hernia repairs. CONCLUSIONS: The number of recurrences at long-term follow-up after repairs of primary and recurrent inguinal hernias was unsatisfactory. The extent of postoperative pain was surprising as this was not given enough attention during the learning period. We have introduced a uniform treatment policy with a prospective surveillance programme with the aim of improving results in our teaching programme.

Use of alpha-, beta- and gamma-hexachlorocyclohexane in Europe, 1970-1996.

Data on current and historical usage of alpha, beta, and gamma-hexachlorocyclohexane (HCH) in Europe are presented. The data were collected and estimated as a part of a project studying the regional cycling of persistent organic pollutants (POPs) in the Baltic environment (Popcycling-Baltic). Better data on sources, environmental discharges and atmospheric emissions of HCH and other POPs are needed to study, and hopefully reduce, the impact of these pollutants on the environment. Substantial uncertainties are assigned to the estimated data for individual countries and years, but it seems likely that the general trend of usage in Europe is captured. The quality of the estimates is thought to improve in general throughout the period, thus, reflecting the availability of reliable data. The results suggest that 382,000 t of technical HCH and 81,000 t of lindane were used in Europe from 1970 to 1996. This is equivalent to an estimated cumulative usage of 259,000 t alpha-HCH, 235,000 t gamma-HCH and 20,000 t beta-HCH. The usage of technical HCH was the major source of gamma-HCH until the late 1970s, and thereafter lindane became the dominating source of this isomer. The use of gamma-HCH in 1996 was estimated to still be nearly one-third of the European usage in 1970. The pattern of decreasing concentrations in biota follows the pattern of reductions in usage for the studied period within the Baltic area.

An algorithm for automatic measurement of stimulation thresholds: clinical performance and preliminary results.

We have developed an algorithmic method for automatic determination of stimulation thresholds in both cardiac chambers in patients with intact atrioventricular (AV) conduction. The algorithm utilizes ventricular sensing, may be used with any type of pacing leads, and may be downloaded via telemetry links into already implanted dual-chamber Thera pacemakers. Thresholds are determined with 0.5 V amplitude and 0.06 ms pulse-width resolution in unipolar, bipolar, or both lead configurations, with a programmable sampling interval from 2 minutes to 48 hours. Measured values are stored in the pacemaker memory for later retrieval and do not influence permanent output settings. The algorithm was intended to gather information on continuous behavior of stimulation thresholds, which is important in the formation of strategies for programming pacemaker outputs. Clinical performance of the algorithm was evaluated in eight patients who received bipolar tined steroid-eluting leads and were observed for a mean of 5.1 months. Patient safety was not compromised by the algorithm, except for the possibility of pacing during the physiologic refractory period. Methods for discrimination of incorrect data points were developed and incorrect values were discarded. Fine resolution threshold measurements collected during this study indicated that: (1) there were great differences in magnitude of threshold peaking in different patients; (2) the initial intensive threshold peaking was usually followed by another less intensive but longer-lasting wave of threshold peaking; (3) the pattern of tissue reaction in the atrium appeared different from that in the ventricle; and (4) threshold peaking in the bipolar lead configuration was greater than in the unipolar configuration. The algorithm proved to be useful in studying ambulatory thresholds.

Clinical use of low output settings in 1.2-mm2 steroid eluting electrodes: three years of experience.

A new generation of tined steroid-eluting leads featuring 1.2-mm2 distal electrodes (CapSure Z, Medtronic Inc., Minneapolis MN, USA) has the potential to reduce battery current drain and enhance pulse generator longevity by means of high pacing impedance and low pacing threshold. Forty patients aged 50-87 years (mean 72.4 years) were implanted with 33 ventricular (models 4033 and 5034) and 30 atrial-J (models 4533 and 5534) leads with 1.2-mm2 electrodes. Low pacing outputs, mainly in the range from 1 V/0.20 ms to 1.6 V/0.36 ms with > or = 3:1 pulse width safety margins (PWSM) applied, were instituted at 3-6 months of implantation and adjusted at subsequent follow-up controls according to changes in thresholds. Cumulative follow-up period of low outputs was 1,512 months (24 months per lead, range 9-36 months), which involved 3.43 follow-up controls per lead (range 2-5). During follow-up, pulse width thresholds (PWTs) at the used amplitudes did not change in 55.5% of the leads; PWTs increased by < or = 100% in 36.5%, by 101%-200% in 1.6%, and by > 200% in 6.3% of the leads. Changes in PWT that would apparently exceed 3:1 PWSM over a 1-year period occurred in one atrial lead where even the nominal 3.5 V/0.4-ms output would not be effective and in one ventricular lead in the aftermath of an acute myocardial infarction (300% PWT rise at 1.6 V). Based on the present observations, pacemaker dependent patients require > or = 4:1 PWSM and other patients > or = 3:1 PWSM with output pulse widths < or = 0.60 ms and annual pacemaker clinic visits. Calculated battery current drain and anticipated longevity associated with a variety of pacing outputs and impedances are provided, compared, and discussed. Correlation between acute and chronic pacing impedances and pacing thresholds was weak, implying that a systematic intraoperative pacing site optimization cannot contribute significantly to the extension of average battery longevity.

Clinical performance of steroid-eluting pacing leads with 1.2-mm2 electrodes.

To raise pacing impedance and reduce battery current drain, new tined steroid-eluting leads were developed with 1.2-mm2 hemispherical electrodes, instead of conventional 5-8 mm2. Twenty-two unipolar J-shaped atrial leads and 25 unipolar ventricular leads (models 4533 and 4033, respectively) were implanted in 33 consecutive patients and followed for a mean of 25 months (range 18-29). Handling characteristics of atrial leads were found favorable. The leads slipped easily into the right atrial appendage and were easy to position. Handling characteristics of ventricular leads were satisfying, but more efforts had to be applied to cross the tricuspid valve. Special care was taken to avoid perforation of the myocardium due to the small lead tip. Following implantation, four ventricular and one atrial lead exhibited instability of pacing thresholds that resolved spontaneously within 1-3 days of implantation. Except for this, no lead malfunctioned. The reoperation rate was zero. The mean electrogram amplitudes of 15 mV (ventricle) and 4 mV (atrium), and the mean chronic pacing threshold of 0.085 ms at 1.6 V (app. 0.43 V at 0.5 ms) were comparable with the best values seen in the literature on passive fixation leads. The rest of the electrophysiological parameters were enhanced: mean pacing impedances were 984 omega (acute) and 900 Q (chronic), mean slew rates 3.26 V/s (ventricle) and 1.75 V/s (atrium), mean acute voltage threshold at 0.5 ms was 0.25 V, mean current and energy thresholds calculated at 0.5 ms were 260 microA and 32 nJ (acute) and 478 microA and 103 nJ (chronic). The electrical characteristics of these leads provide for increased pacemaker longevity in combination with substantial safety margins for pacing and sensing.

Clinical evaluation of a thin bipolar pacing lead.

The main disadvantages of bipolar pacing leads have traditionally been related to their relative thickness and stiffness compared to unipolar leads. In a new "drawn filled tube" plus "coated wire" technology, each conductor strand is composed of MP35N tubing filled with silver core and coated with a thin ETFE polymer insulation material. This and parallel winding of single anode and cathode conductors into a single bifilar coil resulted in a bipolar lead (ThinLine, Intermedics) with a body diameter and flexibility similar to unipolar leads. The lead is tined, polyurethane, with the cathode and the anode made of iridium-oxide-coated titanium (IROX). The slotted 8-mm2 cathode tip is coated with polyethylene glycol, a blood soluble material. We present the clinical evaluation results from four pacemaker clinics, where 47 leads (23 atrial-J model 432-04 and 24 ventricular model 430-10) were implanted in 25 patients and followed for up to 2 years. The lead handling characteristics were found to be very satisfactory. Electrical parameters of the leads were measured at implant and noninvasively on postoperative days 1, 2, 21, 42, and months 3, 6, 12, and 24. Mean chronic pulse width thresholds at 2.5 V were 0.14 +/- 0.05 ms in the atrium and 0.10 +/- 0.02 ms in the ventricle, pacing impedances 443 +/- 104 omega and 520 +/- 241 omega, while median electrogram amplitudes were > or = 3.5 mV and > or = 7 mV, respectively. Pacing impedances and thresholds were found to be slightly but statistically significantly higher in unipolar than in bipolar configuration--the findings are explainable by the lead construction. One of 47 leads failed 3 weeks after implant; the conductors were short circuited due to an error during the manufacturing process. We conclude that the new lead thus far has demonstrated appropriate mechanical and electrical characteristics.

New temporary atrial and ventricular pacing leads for patients after cardiac operations.

We have studied two new temporary pacing leads (Medtronic 6491 and 6492) intended for pacing after cardiac operations. The conductor has stainless steel strands coated with polyethylene connected to a 4' mm2 surface area, stainless steel, smooth, tapered electrode. A soft 4-0 coiled polypropylene fiber served as as fixation mechanism in the heart. The study included 15 children (aged 3 months to 7 years, body weight 4.4 to 20 kg) with a variety of congenital heart defects and 15 adults (aged 45 to 78 years) with coronary artery disease (n = 13) and aortic valve disease (n = 2). A pair of leads each was placed in a bipolar fashion in the right atrial wall and nonsystemic ventricle in the children (median implant duration 12 days) and in the right atrial wall only in the adults (median implant duration 9 days). The atrial current threshold values in children increased from 0.61 +/- 0.34 mA immediately after implant to 2.08 +/- 1.86 mA at explant (p < 0.002). In the adults the threshold values increased from 0.95 +/- 1.44 mA immediately after implant to 2.76 +/- 2.76 mA at explant (p < 0.002). In the ventricle the threshold values increased from 0.38 +/- 0.13 mA immediately after implant to 2.22 +/- 1.63 mA at explant (p < 0.002). Tissue resistance immediately after implant measured 809 +/- 182 omega at explant (children, p = not significant). Corresponding values in adults were 778 +/- 190 omega and 599 +/- 91 omega (p < 0.004). In the ventricle resistances changed from 1019 +/- 143 omega to 876 +/- 137 omega (p < 0.05). P wave amplitudes measured 1.8 +/- 1.5 mV immediately after implant and decreased to 1.6 +/- 1.2 mV at explant (p = not significant, children) and 2.0 +/- 1.3 mV to 1.8 mV (p = not significant, adults). R wave amplitude were 13.1 +/- 3.0 mV immediately after implant and fell to 8.7 +/- 4.5 mV at explant (p < 0.005). Thus, threshold values, tissue resistances, and electrogram and pliable amplitudes assured a safe pacemaker function. The small diameter and pliable texture of these leads provided a smooth surgical handling. They were found particularly suitable in children.

Mini-tip leads: stimulation impedance trends and daily variations

In a clinical study of a unipolar tined porous steroid-eluting lead with the cathode electrode surface area of only 1.2 mm2 (CapSure tm Z models 4533 and 4033, medtronic Inc), a total of 19 leads, ten atrial and nine ventricular, were implanted in 12 patients. Pulse generators capable of automatic measurement and recording of pacing impedance over a long-term period (Thera, Medtronic Inc) were used. The mean impedance during the first six months after implant, with all the leads included, was consientlly 900. Observed daily variations were also consistent, and the six-month average ranged rom 50 to 280 in different leads. The variations were not considered to indicate lead instability.

Dilation of the internal mammary artery by external and intraluminal papaverine application.

Three methods for prevention of perioperative spasm of the internal mammary artery were compared in 78 patients undergoing coronary artery bypass grafting. In group 1, internal mammary artery pedicles were divided distally, clamped, and placed under the upper sternum submerged in papaverine solution (1.5 mg/ml). In group 2, as in group 1 but before clamping, 2 ml of heparinized blood with 1.5 mg/ml papaverine added was injected into the vessel lumen. In group 3 treatment was as in group 2, but heparinized blood with papaverine was injected a second time just before extracorporeal bypass was begun. In a univariate analysis free flow from dilated internal mammary arteries was not significantly different among the groups (group 1, 58 ml/min; group 2, 82 ml/min; group 3, 68 ml/min; p < 0.1). When free flow from dilated internal mammary arteries was the dependent variable in a regression analysis, the use of intraluminal papaverine, high blood pressure during flow measurement, and high initial blood flow were predictors of high flow (all p < 0.01). Morphometric measurements on the resected distal portion of the dilated internal mammary arteries disclosed less folding of the internal elastic lamina and a larger luminal area in groups 2 and 3 compared with respective findings in group 1 (1.21 mm2 and 1.42 mm2 versus 0.77 mm2; p < 0.02). Mechanical vessel wall injury occurred in 8 of 52 internal mammary arteries treated with intraluminal papaverine. Intraluminal papaverine solution injected once or twice in addition to external papaverine exposure therefore provides a better blood flow rate and distal dilation than mere submersion in papaverine solution, but at a considerable risk of mechanical wall injury.

[Infantile hypertrophic pyloric stenosis]. / Infantil hypertrofisk pylorusstenose.

We present 40 patients operated consecutively for pyloric stenosis during an 8-year period (1981-88). The most common symptom was projectile vomiting, which occurred in 92.5% of the cases. On examination only three patients had a palpable hypertrophic pylorus. In 39 patients, a preoperative x-ray examination with contrast was necessary to confirm the diagnosis. A pyleromyotomy was performed in all patients. We discuss the diagnostic routines and the results of our treatment.

Mental and physical capacity and consumption of neuroleptic drugs in residents of homes for aged people.

The mental and physical capacity of all residents in homes for aged people were estimated, and their neuroleptic drug consumption and duration of stay were registered. One third was moderately to severely mentally impaired and 38% demanded more extensive nursing care. Physical dependence was significantly associated with mental decline, and less with age. One quarter of severely mentally impaired people had stayed for less than one year; 23% of the residents received neuroleptic drugs. Treatment was more common in physically incapacitated people together with wandering and aggressive ones. Lack of psychogeriatric services may enhance the use of neuroleptic drugs in homes for aged people.

Assessment of the work capacity and relationship between rate response and exercise tolerance associated with activity-sensing rate-responsive ventricular pacing.

The relationship between rate response and exercise tolerance was studied by measuring the symptom-limited maximum treadmill time (MTT)both during fixed rate VVI pacing and during VVI + activity mode pacing (RRP) in 15 patients (mean age, 73 years) who had received rate-responsive ventricular pacemakers. Their indications were atrioventricular block, sino-atrial block, and atrial fibrillation with slow ventricular response. Basic rate was programmed to 60 ppm in both pacing modes; rate response and activity threshold were programmed to 5 and medium, respectively. The order in which the two pacing modes were tested was randomly determined. The MTT was, on average, 29% longer in RRP than in VVI mode with a mean of 12 minutes in VVI and 14.8 minutes in RRP (p less than 0.001). For the subgroup of eight patients with paced-only rhythm the average increase in MTT was 38% with a mean of 9.5 minutes in VVI and 12.8 minutes in RRP (p less than 0.01). Seven patients who showed episodes of spontaneous rhythm, increased their average MTT by 17% (mean in VVI, 14.9 minutes; in RRP, 17.1 minutes; p less than 0.02). During RRP, a significant positive correlation existed between MTT and the increase in heart rate (N = 15; r = 0.83; p less than 0.001). In 12 patients with paced-only rhythm, the pacing rate remained at the programmed basic rate when the patients were lying, sitting, and standing and increased to 86 +/- 4 ppm during casual walking, and to 101 +/- 4 ppm during jumping up and down with the pacemaker programmed to the above-mentioned parameters. The maximum pacing rate during jumping corresponded with the maximum pacing rates measured from Holter recordings during normal daily activities.

Dementia and work load evaluation of the elderly.

Dementia and work load were estimated in 4736 elderly home-nursed or institutionalized persons. Mental status was estimated by means of the Clinical Dementia Rating scale (CDR), and work load by means of a traditional work load scale. Approximately one third of elderly over 85 years were living in an institution. 4.6% of the population over 65 years of age were moderately to severely and 1.8% mildly demented. Work load increased with increasing dementia. In homes for the aged 40% and in nursing homes 85% of the residents create a heavy work load. 14.5% of the estimated population are considered misplaced, the majority of whom should be transferred to a higher care level. Dementias cause a major problem on every care level. Services which are lacking for this group and necessary rehabilitation facilities should be provided.