The association between childhood fractures and adolescence bone outcomes: a population-based study, the Tromsø Study, Fit Futures.

Childhood fracture may predict persistent skeletal fragility, but it may also reflect high physical activity which is beneficial to bone development. We observe a difference in the relationship between previous fracture and bone outcome across physical activity level and sex. Further elaboration on this variation is needed. PURPOSE: Childhood fracture may be an early marker of skeletal fragility, or increased levels of physical activity (PA), which are beneficial for bone mineral accrual. This study investigated the association between a previous history of childhood fracture and adolescent bone mineral outcomes by various PA levels. METHODS: We recruited 469 girls and 492 boys aged 15-18 years to this study. We assessed PA levels by questionnaire and measured areal bone mineral density (aBMD) and bone mineral content (BMC) using dual-energy X-ray absorptiometry (DXA) at arm, femoral neck (FN), total hip (TH), and total body (TB) and calculated bone mineral apparent density (BMAD, g/cm3). Fractures from birth to time of DXA measurements were retrospectively recorded. We analyzed differences among participants with and without fractures using independent sample t test. Multiple linear regression was used to examine the association between fractures and aBMD and BMC measurements according to adolescent PA. RESULTS: Girls with and without a previous history of fracture had similar BMC, aBMD, and BMAD at all sites. In multiple regression analyses stratified by physical activity intensity (PAi), there was a significant negative association between fracture and aBMD-TH and BMC-FN yet only in girls reporting low PAi. There was a significant negative association between forearm fractures, BMAD-FN, and BMAD-arm among vigorously active boys. CONCLUSION: Our findings indicate a negative association between childhood fractures and aBMD/BMC in adolescent girls reporting low PAi. In boys, such an association appears only in vigorously active participants with a history of forearm fractures.

Atomic layer deposition of sodium and potassium oxides: evaluation of precursors and deposition of thin films.

Thin films of sodium and potassium oxides have for the first time been deposited using atomic layer deposition. Sodium and potassium complexes of tert-butanol, trimethylsilanol and hexamethyldisilazide have been evaluated as precursors by characterising their thermal properties as well as tested in applications for thin film depositions. Out of these, sodium and potassium tert-butoxide and sodium trimethylsilanolate and hexamethyldisilazide were further tested as precursors together with the Al(CH3)3 + H2O/O3 process to form aluminates and together with ozone to form silicates. Sodium and potassium tert-butoxide and sodium trimethylsilanolate showed self-limiting growth and proved useable at deposition temperatures from 225 to 375 or 300 °C, respectively. The crystal structures of NaO(t)Bu and KO(t)Bu were determined by single crystal diffraction revealing hexamer- and tetramer structures, respectively. The current work demonstrates the suitability of the ALD technique to deposit thin films containing alkaline elements even at 8'' wafer scale.

Guidance of growth mode and structural character in organic-inorganic hybrid materials - a comparative study.

A main goal in the construction of thin films is to control film growth in all aspects. Accurate control of the building blocks and their reaction sites is one way to achieve that. This is a key feature of the atomic layer deposition (ALD) technique. The aim of this study is to achieve such growth control of organic-inorganic thin films. The organic building blocks consist of the linear carboxylic acids: glutaric, tricarballylic, and trans-aconitic acid and the amino acid l-glutamic acid. All of these are based on five carbon long backbones. The acids were linked by aluminium using trimethylaluminum (TMA). These precursors made it possible to study the effect of the functionality of the organic acid backbone on growth rate, reaction modes, and the material properties of the deposited materials. The growth dynamics were investigated by in situ characterization using a quartz crystal microbalance (QCM). QCM revealed that all systems are of a self-limiting ALD-type. Ideal ALD growth was found for the tricarballylic acid-TMA system. For the other systems, the growth rate decreased with increasing temperature. The growth rates ranged from 0.05 to 2 nm per cycle. Analysis by Fourier transform infrared spectroscopy (FTIR) verified the hybrid character of the films and the presence of two different growth modes. The films were X-ray amorphous as deposited, with the exception of the l-glutamic-TMA system. Surface roughness and topography of the films was investigated by atomic force microscopy (AFM). Optical and surface wetting properties of the films were investigated by UV-Vis spectroscopy and the goniometer method for sessile drops, respectively. All films were stable in contact with water and generally had very low surface roughness. The present work has shown that the ALD technique can offer controlled growth of functionalized hybrid materials. It is likely that specifically chosen functionalized precursors can be employed to obtain specific structural designs and properties. The first sign of this was found for the l-glutamic-TMA system. The diffraction features of the as-deposited films of this system indicate the presence of sheet-like ordering within the material. This is one of the first observations of this kind by ALD.

Phenotypic and genotypic properties of Neisseria gonorrhoeae isolates in Norway in 2009: antimicrobial resistance warrants an immediate change in national management guidelines.

Despite rapidly diminishing treatment options for Neisseria gonorrhoeae and high levels of ciprofloxacin resistance worldwide, Norwegian guidelines still recommend ciprofloxacin as empirical treatment for gonorrhea. The present study aimed to characterize phenotypical and genotypical properties of N. gonorrhoeae isolates in Norway in 2009. All viable N. gonorrhoeae isolates (n = 114) from six university hospitals in Norway (2009) were collected, representing 42% of all notified gonorrhea cases. Epidemiological data were collected from the Norwegian Surveillance System for Communicable Diseases and linked to phenotypical and genotypical characteristics for each N. gonorrhoeae isolate. Resistance levels to the antimicrobials examined were: ciprofloxacin 78%, azithromycin 11%, cefixime 3.5%, ceftriaxone 1.8%, and spectinomycin 0%. The minimum inhibitory concentrations of gentamicin varied from 1.5 to 8 mg/L. Forty-one (36%) of the isolates were ß-lactamase-producing, 17 displayed penA mosaic alleles, and 72 different N. gonorrhoeae multiantigen sequence types (ST; 37 novel) were identified. The most common ST was ST1407 (n = 11), containing penA mosaic allele. Four of these isolates displayed intermediate susceptibility/resistance to cefixime. The N. gonorrhoeae strains circulating in Norway were highly diverse. The level of ciprofloxacin resistance was high and the Norwegian management guidelines should promptly exclude ciprofloxacin as an empirical treatment option for gonorrhea.

Public health implications of an outbreak of rabies in arctic foxes and reindeer in the Svalbard archipelago, Norway, September 2011.

Between 16 September and 5 October 2011 rabies was diagnosed in two arctic foxes and eight reindeer in the Svalbard archipelago, in Norway. This outbreak occurs at the end of the reindeer hunting season and poses an increased risk to many people that were involved in the hunt. As of 28 September 2011, 280 people had received post-exposure prophylaxis. No human cases of rabies have occurred.

The effect of fluoride surface modification of ceramic TiO2 on the surface properties and biological response of osteoblastic cells in vitro.

This study investigates the effect of fluoride surface modification on the surface properties of polycrystalline ceramic TiO(2) and the biological response of murine osteoblast cells to fluoride-modified TiO(2) in vitro. Fluoride concentrations up to 9 at.% were detected and the fluoride was found to bind to the surface in a ligand exchange reaction between surface hydroxyl groups and the fluoride anions from the HF. No significant changes in the surface topography were detected. In vitro experiments were performed in order to evaluate the biological response of the MC3T3-E1 cells to the fluoride-modified ceramic TiO(2) surfaces. No difference in the lactate dehydrogenase (LDH) activity was seen in comparison to unmodified samples, apart from the highest fluoride concentration (∼9 at.%) which was found to be more toxic to the cells. Real-time PCR analysis showed no conclusive evidence for the fluoride-induced promotion of osteoblast differentiation as no significant increase in the collagen-1, osteocalcin, or BMP-2 mRNA levels was detected on the fluoride-modified ceramic TiO(2) surfaces apart from one group, which showed an elevated osteocalcin level and higher number of cells. Since the observed grain boundary corrosion is also anticipated to reduce the mechanical properties of ceramic TiO(2), this surface modification method may not be an ideal method for improving the osteogenic response of ceramic TiO(2) scaffolds.

Risk factors of post-operative urinary retention in hospitalised patients.

BACKGROUND: Post-operative urinary retention (POUR) is most accurately determined by using ultrasound to measure bladder volume. The aim of this study was to define the risk factors of POUR in the recovery room in hospitalised patients. METHODS: An ultrasound-determined bladder volume ≥400 ml at arrival in the recovery room was used to define POUR. Multivariate regression analysis was used to identify patient and system factors linked to POUR in 773 consecutive hospitalised patients who had undergone orthopaedic, abdominal, gynaecological or plastic surgery without an indwelling urinary catheter. RESULTS: We found the incidence of POUR to be 13%. The lack of pre-operative voiding, use of regional anaesthesia, anaesthesia time >2 h and emergency surgery were all independent risk factors for POUR. CONCLUSIONS: The detected incidence of POUR at arrival in the recovery room was rather high but had easily identifiable risk factors. We recommend pre-operative voiding whenever possible. Routine bladder scanning at arrival in the recovery room should be considered, especially after spinal anaesthesia, emergency surgery or when the anaesthesia time exceeds 2 h.

Parkinson's disease and hospital admissions: frequencies, diagnoses and costs.

OBJECTIVE: To evaluate the frequencies, causes and costs related to hospital admissions for patients with Parkinson's disease (PD) and controls. METHODS: In a prospective cohort study, 108 patients with PD from a population-based prevalence study and 854 age- and sex-matched controls were followed regarding admissions to the Stavanger University Hospital over a period of 12 years. RESULTS: There was no significant difference regarding the number of patients admitted, number of admissions or length of stay between the two cohorts. Based on 2005 prices, the costs per person year of survival were EUR 3288 for patients with PD and EUR 2466 for control individual with incremental costs of EUR 822. However, the difference in costs was not statistically significant. The two cohorts had a different distribution of diagnoses causing hospital admissions. Patients with PD were more often admitted for PD-related symptoms and falls, while vascular disorders and cancer were substantially more common in control individuals. CONCLUSION: Hospitalization in PD does not induce incremental costs. The diagnoses causing hospital admissions were different in patients with PD as compared with controls. Our results indicate that cancer and vascular diseases might be less common in patients with PD than in the general population.

Parkinson's disease and nursing home placement: the economic impact of the need for care.

BACKGROUND AND PURPOSE: To examine the relative risk (RR) for living in nursing homes for patients with Parkinson's disease (PD) compared with the general population and to ascertain society's costs related to nursing home placement for this patient group. METHODS: We evaluated the frequency of admission to nursing homes in a cross-sectional study and during a 12-year follow-up study of 108 patients with PD and 864 controls who were matched for age and sex. The RR for living in a nursing home was calculated at baseline and during follow-up. On the basis of 2007 prices, we estimated the costs per person year of survival for patients with PD and controls. RESULTS: The RR for living in a nursing home at baseline was 5.0 for patients with PD and 4.8 during follow-up. Patients with PD caused 4.8 times higher costs for nursing home placement with euro 18 875 versus euro 3978 per individual and year. The annual costs for institutional care of patients with PD in Norway were euro 132 million. CONCLUSION: Patients with PD have a substantially higher risk for living in nursing homes than the general population. This causes high costs to society. Therapeutic interventions to prevent or delay nursing home admissions are therefore important.

A local outbreak of quinolone-resistant gonorrhoea in Norway, January 2008.

Since 1994, the incidence of gonorrhoea in Østfold county, Norway, has remained within the range of 1-8 cases per year, with 40% of cases being imported from abroad. On 20 January 2008, a general practitioner in the county diagnosed two seemingly unrelated domestic cases of gonorrhoea in three days and started contact tracing. A case was defined as a person with clinical symptoms of gonorrhoea who was a part of the sexual network. Available isolates from the samples taken were tested for resistance. Among 13 contacts identified in the sexual network, eight were classified as cases on the basis of symptoms, four of whom had laboratory-confirmed gonorrhoea. The index case acquired the infection abroad. The three isolated strains were resistant to ciprofloxacin, but sensitive to ceftriaxone which was used for treatment. In the outbreak described, most cases were diagnosed only after contact tracing although they had had symptoms. A quinolone-resistant strain was imported from abroad and introduced into the population. The Norwegian national treatment guidelines, which still recommend quinolones for empirical treatment, should be updated.

Inhibition of P-glycoprotein in Caco-2 cells: effects of herbal remedies frequently used by cancer patients.

1. The herbal products Natto K2, Agaricus, mistletoe, noni juice, green tea and garlic were investigated for in vitro inhibitory potential on P-glycoprotein (P-gp)-mediated transport of digoxin (30 nM) in differentiated and polarized Caco-2 cells. 2. Satisfactory cell functionality was demonstrated through measurements of assay linearity, transepithelial electric resistance (TEER), cytotoxicity, mannitol permeability, and inclusion of the positive inhibition control verapamil. 3. The most potent inhibitors of the net digoxin flux (IC(50)) were mistletoe > Natto K2 > Agaricus > green tea (0.022, 0.62, 3.81, >4.5 mg ml(-1), respectively). Mistletoe also showed the lowest IC(25) value, close to that obtained by verapamil (1.0 and 0.5 microg ml(-1), respectively). The IC(50)/IC(25) ratio was found to be a good parameter for the determination of inhibition profiles. Garlic and noni juice were classified as non-inhibitors. 4. This study shows that mistletoe, Natto K2, Agaricus and green tea inhibit P-gp in vitro. Special attention should be paid to mistletoe due to very low IC(50) and IC(25) values and to Natto K2 due to a low IC(50) value and a low IC(50)/IC(25) ratio.

Impact of antenatal HIV screening to prevent HIV infection in children in Norway 1987-99.

OBJECTIVE: To assess the impact of the antenatal HIV screening programme in Norway in preventing HIV infection in children. SETTING: Norway, 1987-99. METHODS: In a simulated retrospective cohort design data were used from the mandatory HIV surveillance system to compare the observed number of children born infected with HIV in Norway 1987-99 to the expected number without the antenatal screening programme. The main measures were relative and absolute performance of the screening programme. Other measures were uptake and false positive rate of screening, and number and exposure category of screen positive women. RESULTS: 96% of 961 000 eligible pregnant women were tested. 0.1% had an indeterminate test result and 46 women (5.0/100 000) were confirmed screen positive. 27 were African or south east Asian women infected before immigration to Norway. Nine out of 739 000 live born children (1.2/100 000) were infected compared with the expected 18 with no screening. The absolute impact of the screening programme was 1.3 (95% confidence interval (95% CI) -0.1 to 2.7) prevented infections in 100 000 women screened. The relative preventive impact was 51% (-15% to 81%). CONCLUSIONS: The limited absolute impact is because of the very low prevalence of undetected HIV infection among pregnant women in Norway.

[HIV infection from Africa to Norway]. / HIV-infeksjon fra Afrika til Norge.

BACKGROUND: More than two thirds of the world's HIV infected persons live in Africa. Africans seek asylum in Norway and some Norwegians work for longer periods in Africa. We used the Norwegian surveillance system for communicable diseases (1983-99) to assess the connections between the Norwegian and African epidemics. MATERIAL AND METHODS: We estimated the incidence of HIV infection in persons from Norway who acquired HIV from Africans, and measured the annual number of Africans diagnosed in Norway. RESULTS: Out of the 2,016 cases of HIV infection ever diagnosed in Norway (population 4.4 million), 489 (24%) had connections to Africa. 80 persons from Norway have been infected in Africa, usually during work for aid agencies. 39 persons have been infected by Africans in Norway. For both groups the annual number of new cases was 0-2 in 1997-99. Cumulatively, 370 Africans have been diagnosed with HIV infection acquired before immigration. Median time from immigration to diagnosis is three months. INTERPRETATION: Currently, few Norwegians are infected by Africans in Norway or Africa. African immigrants constitute an increasing proportion of the HIV positive population in Norway. This is a challenge to the health services and to society at large.

Single- and multiple-dose pharmacokinetics, kidney tolerability and plasma protein binding of tenoxicam in renally impaired patients and healthy volunteers.

The 20 mg single-dose and 12 days repeated-dose pharmacokinetics of tenoxicam and the 5-OH-tenoxicam metabolite have been evaluated in healthy volunteers and two groups of patients with different degree of renal impairment, in total 20 persons. Concomitantly, the plasma protein binding of tenoxicam and the effects of treatment on renal function were evaluated. No differences were found between the investigated groups in the pharmacokinetics of total tenoxicam and the 5-OH metabolite did not interfere either with the pharmacokinetics or with the plasma protein binding of tenoxicam. A positive correlation was found between an increase in the free fraction (% F) of tenoxicam in plasma and a decrease in the plasma elimination half-life in the low creatinine clearance group (40-20 ml/min.) both after the single-dose and at steady-state. At steady-state, a non-linear correlation was demonstrated between a decrease in the urinary excretion of the 5-OH metabolite and a decrease in creatinine clearance from 130 to 20 ml/min. An increase in the plasma level of the 5-OH metabolite by three times was found in the low creatinine clearance group as compared to healthy subjects. 14C-Impurities of tenoxicam, as low as 1.2%, were shown to greatly influence the determination of the plasma protein binding (equilibrium dialysis) of the highly protein-bound tenoxicam due to a non-binding ability of the impurities to plasma proteins. No significant changes in renal parameters were found during the study. It can be concluded that the pharmacokinetics and plasma protein binding of tenoxicam and the pharmacokinetics of the 5-OH-tenoxicam metabolite are increasingly changed in subjects with a creatinine clearance below 40 ml/min. A decreased binding of tenoxicam to plasma proteins in low clearance patients is probably the reason for a faster elimination of tenoxicam in this group rather than a higher intrinsic hepatic metabolic activity. This study conducted in a low number of patients did not bring forward any new data indicating any adverse effects of tenoxicam on renal function.

Anonymous reporting of HIV infection: an evaluation of the HIV/AIDS surveillance system in Norway 1983-2000.

Several European countries are considering implementing surveillance systems for HIV infection, but questions remain regarding patient confidentiality. The population-based HIV/AIDS surveillance system in Norway integrates anonymous HIV case reports from laboratories and clinicians and named AIDS case reports. This evaluation includes a description of the system, evidence of system attributes, estimation of resources for system operations, and documentation of the system's usefulness. HIV case reports provide a far better picture of the epidemic than AIDS reports. The median delay between positive HIV test and reporting was 30 days (interquartile range 18-49 days). Completeness of demographic and epidemiologic information in the surveillance database ranges from 60 to 100%. Information on pre-AIDS mortality and emigration is incomplete. The system cost euro 25,200 in 1999. Results are published every week and used for planning of health care and prevention. We conclude that the Norwegian surveillance system with anonymous reporting of HIV cases is simple, inexpensive and flexible, and capable of providing a representative and timely overview that guides prevention. The system fulfils its objectives while respecting confidentiality and adhering to ethical principles. A similar system may be considered in other countries.

Back-calculation based on HIV and AIDS registers in Denmark, Norway and Sweden 1977-95 among homosexual men: estimation of absolute rates, incidence rates and prevalence of HIV.

BACKGROUND: The Scandinavian countries, Denmark, Norway and Sweden, have established both HIV and AIDS registers to monitor the HIV epidemic. Information in such registers can be used to estimate the number of new HIV infections over time, incidence rates and prevalence. Information from the HIV registers made it possible to study what kind of effects such information had in the estimation process, compared with using information about new AIDS cases only. METHODS: A Markov model back-calculation approach was used. One model incorporated data on cases of both HIV and AIDS. Another model incorporated data on cases of AIDS only. Death or emigration prior to the onset of AIDS and effects of treatment were included in both models. RESULTS: Estimates of absolute rates of HIV for men who have sex with men (MSM) showed a distinct development in each country. Significant differences in incidence rates and prevalence of HIV among MSM were found between Scandinavian countries when information on diagnosed HIV was incorporated. Precision was improved when using both HIV and AIDS diagnosed cases compared with using AIDS cases only. The epidemic in Denmark was more extensive than in the two other countries for the whole study period. DISCUSSION: The results were fairly robust against reasonable variation in the model parameters. The more extensive epidemic in Denmark may have been caused by the homosexual culture denying that HIV was a disease more relevant to them than to others, until the HIV test was publicly available in 1985.

Prediction of in vivo metabolic clearance of 25 different petroleum hydrocarbons by a rat liver head-space technique.

In vitro rates of metabolism and Michaelis-Menten constants were determined for 25 different C6 to C10 hydrocarbons using rat liver slices in a vial head-space equilibration system. The rates of metabolism were compared with steady-state levels obtained in vivo in the same strains of rats after inhalation. Aromates were metabolized at a higher rate than naphthenes n-alkanes, isoalkanes and 1-alkenes. The aromates showed, in contrast to the other hydrocarbons investigated, increased metabolism with increasing number of carbon atoms up to C8 (o-xylene, the most extensively metabolized compound). The in vivo steady-state concentrations of the aromates in blood were inversely related to the in vitro efficiency of their metabolism. This explains the pattern of blood levels observed for the C6 to C10 aromates in the rat after inhalation, with o-xylene demonstrating the lowest concentration. In general, the extent of tissue metabolism of the investigated hydrocarbons might be of greater importance for their body distribution than their lipophilicity, especially for the highly metabolized compounds. The high in vitro intrinsic liver clearances found for the aromates indicate a flow-dependent metabolism of these hydrocarbons in vivo. The head-space liver slice equilibration system seems to work adequately for metabolic studies of hydrocarbons with different volatility and water solubility.

[Attitude of pregnant women to routine voluntary antenatal HIV testing]. / Gravides holdninger til rutinemessig tilbud om HIV-testing.

INTRODUCTION: Since 1987, more than 95% of pregnant Norwegian women have accepted the offer of an antenatal HIV test. We investigated women's opinion regarding antenatal HIV testing. MATERIAL AND METHODS: In an anonymous questionnaire survey in 1997, we asked 500 randomly selected women who had recently given birth about their knowledge about HIV, perception of the information given, and their attitudes towards HIV testing. RESULTS: The response rate was 74%. Half the women knew that testing was voluntary. 30% were satisfied with the information. This was associated with having been told that the test was voluntary (odds ratio 13). 61% of those who were tested, were told so. 75% of the women would opt for HIV testing in a future pregnancy and most women wanted the offer of a test to be routine procedure. INTERPRETATION: Women do not receive information that meets their needs. The programme does not accord with its objectives and is hardly ethically justifiable. There is a need for more information, especially concerning the voluntary character of antenatal HIV testing.

[HIV infection, gonorrhea and syphilis from Thailand to Norway]. / HIV-infeksjon, gonoré og syfilis fra Thailand til Norge.

Thailand, a popular tourist destination for Norwegians, is experiencing an increasing epidemic of HIV infection. We used the Norwegian surveillance system for communicable diseases to assess the connections between the Norwegian and Thai epidemics. Before 1999, 1,869 cases of HIV-infection had been reported in Norway. From 1993 to 1998, 1,334 cases of gonorrhoea and 62 cases of syphilis were reported. We studied cases with a Thai patient or source partner and cases acquired in Thailand. 56 (3%) of HIV-infection cases, 64 (5%) of gonorrhoea cases and two (3%) of syphilis cases were connected to Thailand. All the Norwegians who acquired HIV in Thailand were males, with a median age of 39. Eight of them were diagnosed in 1998 as compared to 16 during the previous ten-year period. 21 Thai women and seven males were diagnosed with HIV infection in Norway, eight in 1998 and 20 in the previous ten-year period. The Norwegian HIV epidemic is influenced by the Thai epidemic. Norwegian men are infected in Thailand during holidays. Thai women come with their Norwegian partner to Norway and later discover their HIV status. We recommend raising the awareness of the Thai epidemic among Norwegian tourists. Immigrants to Norway from highly endemic countries should be offered HIV counselling and testing.