Assessment of mental health trajectories before and after myocardial infarction, atrial fibrillation or stroke: analysis of a cohort study in Tromsø, Norway (Tromsø Study, 1994-2016).

OBJECTIVES: The increased survival rate of cardiovascular disease (CVD) implies a higher proportion of individuals who live with CVD. Using data from the Tromsø Study, we aimed to investigate mental health symptom trajectories before and after myocardial infarction, atrial fibrillation or stroke in a general population and to explore factors that contribute to the association. DESIGN: Cohort study. SETTING: Sample drawn from inhabitants of the municipality of Tromsø, Norway, who participated in the Tromsø Study (1994-2016). PARTICIPANTS: A total of 18 719 participants (52.3% women) were included, and of these 2098 (32.9% women) were diagnosed with myocardial infarction, 1896 (41.9% women) with atrial fibrillation and 1263 (42.9% women) with stroke. PRIMARY OUTCOME MEASURES: Mental health symptoms were assessed using the Hopkins Symptom Checklist-10 and the Conor Mental Health Index. RESULTS: The participants who were diagnosed with either myocardial infarction or stroke had a significant monotonous increase in mental health symptoms before myocardial infarction (p=0.029) and stroke (p=0.029) that intensified at the time of diagnosis. After the event, the study found a higher prevalence of mental health symptoms with a decline in symptom levels over time for myocardial infarction (p<0.001) and stroke (p=0.004), but not for atrial fibrillation (before: p=0.180, after: p=0.410). The risk of elevated mental health symptoms with myocardial infarction, atrial fibrillation and stroke was associated with sex (p<0.001), age (p<0.01), physical activity (p<0.001), diabetes (p<0.05) and other comorbidities (p<0.001). CONCLUSION: The study indicates that mental health problems among individuals with myocardial infarction, atrial fibrillation and stroke may have started to develop several years before the cardiovascular event and suggests that successful CVD rehabilitation may need to consider previous life factors. Future research is recommended to examine whether health promotion measures in a general population also create mental health resilience after a CVD event.

Prevalence of gestational diabetes and pregnancy outcomes in Nordland and Troms counties 2004­15. / Prevalens av diabetes blant gravide og svangerskapsutfall i Nordland og Troms 2004­15.

BACKGROUND: The aim was to investigate the prevalence of gestational diabetes and pregnancy outcomes in women with gestational diabetes in Nordland and Troms counties. MATERIAL AND METHOD: We included all 1 067 women with type 1 diabetes, type 2 diabetes and gestational diabetes among 34 915 births at four hospitals in Nordland and Troms counties from 2004 to 2015. Prevalence of diabetes was calculated based on ICD-10 codes in patient records for women with diabetes in Nordland and Troms counties, and compared with national prevalence figures from the Medical Birth Registry of Norway. Prevalence of pre-eclampsia, macrosomia (birth weight > 4 500 grams) and caesarian section was calculated for all women with diabetes and all those giving birth in the same region. RESULTS: Prevalence of type 1 diabetes and type 2 diabetes remained stable. Prevalence of gestational diabetes increased from 1.0 % to 4.0 % in Nordland and Troms counties and from 1.0 % to 3.8 % nationally. Prevalence of pre-eclampsia among all women with diabetes fell from 18.8 % in 2004-06 to 12.4 % in 2013-15. In women with diabetes, the prevalence of pre-eclampsia was 4.6 times higher, that of macrosomia was 3.5 times higher, and the proportion of caesarian sections was 2.3 times higher than in the background population. INTERPRETATION: Prevalence of gestational diabetes increased in Nordland and Troms counties, as it did nationally. Prevalence of pre-eclampsia among pregnant women with diabetes fell, but prevalence of pre-eclampsia, macrosomia and caesarean section was higher than in the background population.

[Is antibiotic prophylaxis in Cesarean section necessary?]. / Er antibiotikaprofylakse ved keisersnitt nødvendig?

BACKGROUND: A Cochrane Review from October 1998 recommends prophylactic antibiotics for all women undergoing elective and non-elective caesarean section. This is expected to reduce the frequency of postoperative endometritis by two thirds to three quarters. In this study we evaluate the infection rate after caesarean section in a hospital where prophylactic antibiotics are given only to high-risk groups. METHODS: Case records of 344 patient delivered by caesarean section were studied. 30 days after the operation, 83% answered a questionnaire about wound infection. RESULTS: In all, 39% received prophylactic antibiotics. 33 patients (9.6%) developed post-cesarean infections; only 17 were given antibiotic treatment. One patient had endometritis. There were no significant differences with regard to infections between the elective and the non-elective groups (p = 0.63), or between those receiving and those not receiving antibiotic prophylaxis (p = 0.84). CONCLUSION: The policy of selective use of prophylactic antibiotics for caesarean sections has been successful in our hospital. This study does not permit conclusions as to whether selective prophylactics is a better alternative than routine prophylactics, but the results question whether the recommendation in the Cochrane Review is the best choice for all delivery units.