Measurement Properties of the Nordic Questionnaire for Psychological and Social Factors at Work: A Rasch Analysis.

The main aim of this study was to evaluate the measurement properties of the Nordic Questionnaire for Psychological and Social Factors at Work (QPS Nordic) and the domains of demand, control and support. The Rasch analysis (RUMM 2030) was based on responses from 226 subjects with back pain who completed the QPS Nordic dimensions of demand, control, and social support (30 items) at one year follow up. The Rasch analysis revealed disordered thresholds in a total of 25 of the 30 items. The domains of demand, control and support fit the Rasch model when analyzed separately. The demand domain was well targeted, whereas patients with current neck and back pain had lower control and higher support than reflected by the questions. Two items revealed DIF by gender, otherwise invariance to age, gender, occupation and sick-leave was documented. The demand, control support domains of QPS Nordic comprised unidimensional constructs with adequate measurement properties.

Exchange students crossing language boundaries in clinical nursing practice.

AIM: This article examines challenges and learning outcomes for nursing students from a Central European university of applied sciences who completed 3 months of clinical practice in Norway. The clinical practice was supervised in English by Norwegian nurses and nursing teachers. English is not the primary language in any of the countries. BACKGROUND: Increases in global migration have contributed to the need for an international dimension in nursing education. Personal mobility is a crucial part of the European Union's goal of becoming a knowledge society. Clinically based experiences pose challenges that are additional to and often more complex than traditional course-based experiences. Students who come from a non-English-speaking country for clinical practice in Norway face challenges regarding language. Accepting incoming students is a way of achieving higher quality and more relevant education in nursing. FINDINGS: The study shows that clinical practice in a foreign country gives added value compared with clinical practice at home. Greater self-confidence and understanding of core concepts in nursing is described by the participants. Language differences are not regarded as a problem but as a way of developing personal and professional competence. The ability to compare healthcare systems in the two counties is important in developing competencies in nursing.

Similarities and mutual understanding: exchange experiences in Malawi for host and guest students.

BACKGROUND: A Malawian nursing college and a Norwegian university college have agreed to cooperate in facilitating clinical exchanges for nursing students at their respective institutions. This study describes the experiences of students in an innovative exchange. Norwegian and Malawian nursing students shared clinical placement in pairs of two in Malawi for 8 weeks. This study shows that both host and guest students benefit from the clinical placement as it enhances development of clinical competence. METHODS: The design of the study is phenomenological/hermeneutical. The theoretical foundation is based upon Campinha-Bacote's model for the development of cultural competence. All participating nursing students were interviewed. Their stories provided the rationale for the three main categories that are discussed. FINDINGS: Students experience both similarities and differences in practice, but similarities are regarded as the stronger impression. Learning relational skills is the primary learning outcome, but learning how to nurse patients is also an important outcome. During the exchange period all students developed cultural competence. This way of organizing shared placements for guest and host students from different countries is valuable for all students. It also met the curricular demands in both countries.

Hearing impairment among adults--extent of the problem and scientific evidence on the outcome of hearing aid rehabilitation.

Scientific surveys on current and estimated prevalence of hearing impairment (HI) in adult populations (> or = 18 years of age) in Denmark, Finland, Norway, Sweden and the United Kingdom, and scientific reports on the outcome of hearing aid (HA) rehabilitation worldwide were reviewed. Only a few of the studies meet strict scientific criteria, and many locally clinically relevant studies cannot be generalized to larger populations. Population-based studies indicate an increase in prevalence of HI with age, but because of differences in study populations and available national population statistics, the studies do not allow reliable comparisons between countries or estimation of future prevalence of HI. Studies on HA prescription or outcomes do not provide uniform data in favour of non-linear amplification, but they do show some subject preference for the newer technology. No conclusions can be drawn regarding the degree of HI and the effects of amplification. The literature review alone gives only limited information regarding the extent of the problem of HI in adult populations in the target countries. Similarly, only a few studies on HA outcome meet strict scientific criteria and even fewer studies correlate rehabilitation outcome with the degree of HI, disability or handicap.

Myocardial laser revascularization in the year 2000 as seen by a Norwegian specialist panel. The process of evaluating and implementing new methods in clinical practice.

OBJECTIVE: In Norway "Transmyocardial laser revascularization" as a routine method was prohibited by the Ministry of Health in 1995 due to lacking evidence of treatment effect and concerns about procedural morbidity and mortality. In 1999 Norwegian health authorities asked for a re-evaluation of the method based on a systematic review of literature. METHODS: Medline and Embase were searched and a total of 267 articles were identified. Publications were classified by an expert panel according to type of study and importance for the project. RESULTS: Based on the literature review the panel concluded that heart laser treatment does not have a life-saving effect, nor does it improve myocardial function. However, the method has a considerable short-term symptomatic effect, the mechanism of which is not understood. Neoangiogenesis, denervation and placebo may play a role. Based on the report the Norwegian health authorities recommended use of this method be restricted to scientific trials only. CONCLUSIONS: Based on a systematic literature review it was concluded that the only documented effect of heart laser treatment is symptom relief, the mechanism for which is unclear. It could partly or totally be a placebo effect. A conflict of interest may arise when new technologies are to be implemented in health care. The communication between professionals evaluating scientific results and decision makers is challenging. Quality assurance of this process may be obtained by use of expert panels working under the auspices of an official institution.

[Telemedicine and medical technology assessment]. / Telemedisin og medisinsk metodevurdering.

Telemedicine is a rapidly evolving technology. Health technology assessments of telemedicine applications are needed to assist decision-makers. A few health technology assessment reports and a Cochrane protocol on principles for evaluating telemedicine installations have been published. Studies providing evidence on the effectiveness of teleconsultations and teleradiology are summarised. Telemedicine shows great promise in some areas; however, the use of this technology should still be regarded as experimental. Therefore, it should be implemented in a way that facilitates ongoing evaluation.

[Principles for assessment and diagnosis of work-related pulmonary and pleural diseases]. / Prinsipper for utredning og diagnostikk ved yrkesrelaterte lunge- og pleurasykdommer.

Proposals for diagnostic methods and clinical evaluation of occupational lung and pleural diseases have been worked out by a Working Group appointed by the Norwegian Thoracic Society and the Norwegian Society of Occupational Medicine. The management of this group of diseases demands both an evaluation of occupational exposure and a specific pulmonary diagnosis. Recommendations were made especially for obstructive, interstitial, and malignant diseases.

[Expert statement and assessment of medical impairment in work-related pulmonary disease]. / Spesialisterklaeringen og fastsettelse av medisinsk invaliditet ved yrkesrelaterte lungesykdommer.

The Norwegian Societies of Thoracic Medicine and Occupational Medicine established a working group to standardise diagnostic procedures and evaluation of work-related respiratory disorders. In cases of suspected work-related diseases the physician may be asked by the National Insurance Administration or an insurance company to make a statement which will be one of the documents used to decide the patient's right to compensation benefit. We discuss the role of the physician as an independent expert. This is different from his role as clinician. The statement should include a balanced presentation of information from different sources, including health and occupational history, and the employer's information about the work environment (quantitative and qualitative exposure data). The statement must also include the results of a clinical examination and an assessment of functional status based on objective tests. The paper contains recommendations for evaluation of permanent impairment in light of the present Norwegian laws and regulations.

Physiological effects of altitude training on elite male cross-country skiers.

Seven elite male cross-country skiers trained for 3 weeks at an altitude of 1900 m. Haemoglobin concentration ([Hb]), haematocrit (Hct) (obtained from venous blood), maximal oxygen uptake (VO2 max) and energy expenditure during a standard submaximal workload were measured before and after training at altitude, and 1 year later while training at sea level (control). Both [Hb] and Hct increased significantly, and the skiers with the lowest initial [Hb] and Hct experienced the largest increases during training at altitude. The increase in blood lactate (BLa) concentration (using haemolysed capillary blood) during a standard submaximal exercise test was significantly lower after training at altitude than before it or 1 year later (control). A significant correlation was found between the magnitude of increase in [Hb] and Hct and the difference in the lactate response to the standard submaximal workload pre- and post-altitude training. Although VO2 max remained unchanged, lower BLa concentration during the submaximal test probably reflects an improved ability to exercise at higher submaximal workloads shortly after training at altitude compared with pre-altitude training. It is suggested that subjects with low initial [Hb] and Hct improve their aerobic performance capacity most during altitude training.

Increased plasma hypoxanthine values in humans during exposure to simulated altitude of 7,620 meters (25,000 feet).

In this study we have determined the effect of severe and moderate hypoxemia on plasma hypoxanthine and lactate values. Hypoxemia was induced in healthy humans in a low pressure chamber. The test subjects breathed atmospheric air at barometric pressures of 279 mm Hg and 385 mm Hg, representing a simulated altitude of about 7,620 and 5,334 m (25,000 and 17,500 ft), respectively. Exposure to 279 mm Hg represents a severe hypoxemia and all subjects exposed to this simulated altitude for 2 min showed symptoms related to hypoxia. After this exposure, plasma hypoxanthine increased by an average of 2.4 times compared to preexposure values. Exposure to 385 mm Hg represents a moderate hypoxemia and the persons tested at this simulated altitude for 45 min showed no or minor symptoms related to hypoxia and there was no change in plasma hypoxanthine values. In contrast to the unchanged plasma hypoxanthine values there was a 50% increase in plasma lactate values after 30 min exposure. We conclude that plasma hypoxanthine is a reliable marker for severe cellular hypoxia in humans and that enhanced plasma hypoxanthine levels are a rapid response to cellular hypoxia.

The effect on pulmonary function of tangential field technique in radiotherapy for carcinoma of the breast.

Twenty-five patients treated by lumpectomy and radiotherapy for Stage I breast cancer were enrolled in a prospective study to measure the effects of tangential field irradiation on pulmonary function. Fractional doses of 2 Gy to a total of 50 Gy were administered with the tangential technique. An additional 10 Gy (2 Gy x 5) was given as direct booster. Dynamic and static lung volumes, distribution of ventilation and gas transfer were measured before irradiation and at varying intervals up to 1 year after the completion of therapy. There was a small, but statistically significant decrease in the forced vital capacity (mean 63 ml) and the forced expiratory volume in 1 second (mean 79 ml) measured 3 months after irradiation (p less than 0.05). These changes were reversed within 1 year. The reduction in total lung capacity (mean 240 ml) after 3 months was nearly significant (p = 0.06). The remaining variables did not change to a significant degree. We conclude that a slight restrictive ventilatory impairment may occur when a combined tangential and direct booster technique is applied. The changes are, however, small and reversible, and imply no clinical importance.

Prolonged photostress macular recovery after reduced blood pressure.

In order to investigate an association between systemic blood pressure and restitution of normal visual function in dim illumination after photostress, macular recovery time and blood pressure were measured in two groups: 1) 90 young and healthy military pilots and applicants for military pilot training; and 2) 10 hypertensive patients before and after 12 weeks of antihypertensive treatment. Young normotensive subjects (20/20 vision) with low diastolic blood pressure performed less well (longer macular recovery time) than those with higher pressure (r = -0.42, p less than or equal to 0.05). Among the hypertensive patients three were given doxazosin, three, prazosin, and four, placebo. The treatment period produced significant fall in blood pressures, a small reduction in intraocular pressure (p less than or equal to 0.03) and a lengthening of initial monocular recovery period (p = 0.04) in addition to reduced monocular (p = 0.015) and binocular (p = 0.022) macular recovery in the remaining part of the 2-min test period. This observation may be important for antihypertensive treated patients whose occupation requires fast visual adjustment to changing stimuli in dim light.

Impairment of rat polymorphonuclear neutrophilic granulocyte phagocytosis following repeated hypobaric hypoxia.

Exposure of rats to repeated hypobaric hypoxia (17 h at 0.5 atm for 0-7 d) induced significant reduction of the phagocytic capacity of peripheral blood polymorphonuclear neutrophilic granulocytes (PMNL). In addition, the hypoxia induced a significant increase of the hematocrit, hemoglobin, thrombocyte, and total leukocyte concentrations. Differential counting of peripheral blood revealed significant granulocytosis. An increase of the concentration of corticosterone was demonstrated following 2 d of hypobaric hypoxia, whereas 5 d later the corticosterone concentrations were similar to that of the controls. The reduced PMNL phagocytic capacity observed following repeated hypobaric hypoxia may have consequences for host defence in situations of hypoxia exposure.

The form of selenium determines the response to supplementation in a selenium replete population.

In an ongoing study of selenium bioavailability, effects of supplementation with organic and inorganic forms of selenium were investigated in healthy, Norwegian women, aged 23-50 years. In phase I of the study, 58 women received 200 micrograms selenium per day either as selenite or selenium-rich pea flour for 3 months. The selenium tablets were taken together with placebo or ascorbic acid in a double blind design. Initial blood and serum selenium concentrations were 153 +/- 15 micrograms/l and 117 +/- 12 micrograms/l, respectively. These are average values for Norwegians. Indications of increased blood levels were seen in all groups, but the rise reached significance only for the subgroup receiving selenite and ascorbic acid, 14 micrograms/l, P less than 0.05. On the other hand, selenium analysis of 72-h urine samples confirmed that at an average 50 per cent of the selenium supplements had been absorbed. In phase II of the study, 28 of the participants continued for another 5 weeks, still on 200 micrograms Se per day, but this time consuming commercially available preparations. Of four preparations that were tested, two consisted of yeast Se. Only one of these produced a significant rise in blood and serum selenium levels, 60 and 55 micrograms/l respectively. Blood glutathione peroxidase values were not affected by any supplementation. The study demonstrates that different forms of organic selenium elicit widely different responses when administered to a relatively selenium-replete population, and that the explanation for this must be sought at the metabolic level.

The response of the light reflex of retinal vessels to reduced blood pressure in hypertensive patients.

The response of retinal arteries and veins to 3 months of antihypertensive medication was studied in 10 patients (39-56 years old) with essential hypertension. We used computerized microdensitometry on fundus photographs, a technique allowing for objective and simultaneous measures of the caliber of blood columns and the width and intensity of their central 'light reflex'. A moderate lowering of diastolic and systolic blood pressures (P less than 0.001) resulted in a significant reduction in the intensity of reflection from retinal arteries (38.6%; P less than 0.005). An increase in the width of the blood column (2.8%; n.s.) and the reflex (8.6%; n.s.) was indicated. Traditionally, changes in light reflectivity has been associated with arteriosclerosis of the vessel wall. The study shows, however, that the vascular reflex is most sensitive to changes in the systemic blood pressure. This signals a need for critical reviewal of interpretation and usefulness of classical grading systems of ophthalmoscopic signs of hypertensive retinopathy.

Vascular response of retinal arteries and veins to acute hypoxia of 8,000, 10,000, 12,500, and 15,000 feet of simulated altitude.

Computerized scanning microdensitometry of fundus photographs was used to study the effect of acute hypoxia on vessel diameters of 238 retinal arteries and 227 veins in 40 men aged 18-23 years. Fundus photography was performed at sea level and at simulated altitudes in a low-pressure chamber, randomly selecting 10 men to each of four altitudes--8,000, 10,000, 12,500, and 15,000 ft (2,400, 3,000, 3,800, and 4,500 m). After 15 min of hypoxic exposure, the caliber of small arteries (less than 75 microns) increased 4% (p less than 0.01) and that of large arteries (greater than or equal to 75 microns) 7% (p less than 0.05), already at 8,000 ft (2,400 m). The caliber of large veins did not change until an increase of 6% (p less than 0.01) was observed at 15,000 ft (4,500 m). Although large arteries increased 7% (p less than 0.05) and 8% (p less than 0.01) in diameter at 10,000 ft (3,000 m) and 15,000 ft and small veins 9% (p less than 0.05) and 12% (p less than 0.01) at the same altitudes, respectively, no change was observed at 12,500 ft (3,800 m). Thus, the dilating effect of hypobaric hypoxia was nonlinear from sea level to 15,000 ft of simulated altitude. As an overall response to the four simulated altitudes the vasodilation was negatively correlated to the vessel diameter at sea level (r = -0.20) in both arteries and veins (p less than 0.01). The variability of hypoxic vascular response was as great within different parts of individual retinas as between different retinas.

Hypoxia and deposition of iron in liver and spleen of mice given iron supplement.

Iron-related changes in peripheral blood and variations in liver and spleen iron concentrations during alternating periods of hypoxia and normoxia have been investigated in iron-supplemented mice by chemical and histological methods. During hypoxia, packed cell volume increased from 40 to 70%. The iron content of the liver increased during the first hypoxic and the following normoxic period, while an increase in spleen iron started after the first hypoxic period. Transferrin saturation fell from about 60 to about 20% during hypoxia and normalized during normoxia. Hypoxia together with iron supplementation led to increased erythropoiesis and parenchymal iron deposition in liver. The reduction in transferrin saturation may be attributed to the effective uptake of iron by hepatocytes simultaneously with the erythropoiesis. The spleen seemed to participate in the production of red cells during hypoxia. The increase in spleen iron during normoxia can be explained by the role of the spleen in the catabolism of excess erythrocytes.

[Iron and sports]. / Jern og idrett.

We review normal iron metabolism and iron deficiency in athletes with and without anemia, and possible causal relationships. Hard physical training, such as medium and long distance running, appears to promote negative iron balance, with and without fall in hemoglobin concentration. A normally varied diet is suggested as adequate to meet the iron requirements in male athletes. Iron supplementation is not recommended unless blood/serum concentration of hemoglobin, ferritin, iron and transferrin are measured and the results indicate a state of iron deficiency. However, female athletes should consider iron supplementation, since loss of iron is higher in women than in men.

The effect of hypoxia upon macular recovery time in normal humans.

Bright light illumination (photostress) of the macula produces a negative after-image in the form of a central scotoma. The time needed for restoring normal visual acuity function, "macular recovery time," may be measured using a nyctometer. We have measured the recovery in 30 normal men, aged 18 to 23 years, at sea level and at 8,000 ft (n = 10), 15,000 ft (n = 10), and 18,000 ft (n = 10) of simulated altitudes in a low pressure chamber. The degree of initial recovery (the first 30-40 s) was unaffected by hypoxia equivalent to 8,000, 15,000, and 18,000 ft. The recovery at 2 min was impaired by hypoxia at an altitude of 18,000 ft (p = 0.009) but not at 8,000 ft or 15,000 ft. The initial phase of recovery may represent the neural phase of macular function and appears to be more resistant to hypoxia than the recovery at 2 min, the latter probably being dominated by photochemical recovery. The study establishes a critical level of hypoxia where complete recovery of macular sensitivity is not achieved.