Det helsevitenskapelige fakultet

Applications of telemedicine in dentistry. Review of literature

Wed, 14 Aug 2013 00:00:00 GMT

Elmokadem, Mohamed Said Elsayed
The aim of this study was to review the different papers and articles that discuss applications of telemedicine in the dental field. This study is qualitative narrative review of literature Research of teledentistry literature was conducted in order to identify the relevant articles. The research focused on the electronic database of US National library of medicine .National institute of health (Pubmed.gov) and Journal of telemedicine and telecare. Specific keywords that were used in the research: “Teledentistry”, “Telemedicine and dentistry” and “Dental videoconferencing” and others corresponding words. 294 Papers have been identified. After applying the inclusion and exclusion criteria 53 articles have been found relevant to be selected for our study which represents small percent compared to the literature discussing telemedicine applications in general. The selected articles were categorized according to area of intervention in the different dental specialties in addition to category includes articles that discuss the use of telemedicine in general without focusing on specific dental specialty and another category that includes applying telemedicine in the field of dental education. Analysis and study of these articles revealed that more number of articles focused on incorporating teledentistry into specific dental specialties and aspects while incorporating teledentistry within some other dental specialties had been relatively neglected. The majority of articles included in the review discussed applying teleconsultation systems that allow communication between general dental practitioners and specialists. This can be attributed to the current availability and relatively low costs of the basic infrastructure required for such teleconsultation systems. However, more researches are required to study using teledentistry in the operative or surgical phase in dentistry. The shortage of this kind of researches can be attributed to the complicated, advanced and expensive technology required for such teledentistry systems for example the robotic surgery. Despite this small number of articles discussing using teledentistry in the different dental fields, results of the majority of the articles relevant to the review achieved positive outcome after implementation of the teledentistry systems. These positive outcomes in addition to the continuous advancement of information technology makes us expect increasing in the number of studies that investigate incorporating teledentistry in dentistry in the future and the expand of these applications into more dental specialties as well as the different aspects of dentistry.

Changes in bone mineral density over time in patients with self-reported chronic diseases: The Tromsø Study

Sun, 17 Aug 2014 00:00:00 GMT

Bhandari, Anita
Objective: To examine the total hip (TH) and femoral neck (FN) bone loss in women and men above 50 years of age with self-reported chronic diseases. Methods: Using data from ‘The Tromsø Study’, men and women aged 50-74 years were included in this study. Disease status was identified based on self-reports. Bone mineral density (BMD) of TH and FN were measured using DXA (Dual-energy X-ray Absorptiometry). The change in BMD was calculated as the difference between BMD in Tromsø 5 and Tromsø 6. Linear regression analysis was used to assess relationship between the predictor variables (diseases) and the outcome (change in total hip and femoral neck BMD). Results: Out of 2310 participants, 860 were men and 1450 were women. Men had significantly more cases of heart disease (p<0.0001) and stroke compared to women, (p=0.036) whereas, hypothyroidism was more frequent among women (p<0.0001). Significantly higher levels of baseline TH and FN BMD were measured in men than women (p<0.0001). A significant annual percentage change in TH BMD among women with CVD (-0.23%; p=0.019) and hypothyroidism (-0.1%; p=0.041) was observed in models adjusted with several common risk factors. The annual percentage change in FN BMD was significant among men with stroke (-0.46 %; p=0.012). Conclusion: The results of this study indicate that self-reported chronic diseases are associated with increased deterioration of BMD in elderly men and women. Bone loss was evident in women with CVD or hypothyroidism, and in men with stroke. This highlights the need of careful evaluation of elderly patients with chronic diseases with respect to BMD and thereby fractures risk.

Risk in homeopathy: Classification of adverse events and homeopathic aggravations – A cross sectional study among Norwegian homeopath patients

Wed, 10 Jun 2015 00:00:00 GMT

Stub, Trine; Kristoffersen, Agnete Egilsdatter; Alræk, Terje; Musial, Frauke; Steinsbekk, Aslak
The registration of adverse events is important to identify treatment that might impose risk to patients. Homeopathic aggravation, a concept unique for homeopathy may impose a particular risk, as it is tolerant towards a worsening of the patients’ symptoms. The aim of this study was to explore the classification of patient reported reactions as homeopathic aggravations or adverse events.
Design and setting In a cross sectional survey, patients were asked to register any reactions they had experienced 14 days after taking homeopathic remedies. Worsening of symptoms was classified as homeopathic aggravation if it was i) an increase of the patients’ existing symptoms ii) and/or a feeling of well-being that emerged 1-3 days after taking the remedy iii) and/or headache and/or fatigue accompanying these symptoms.
Results A total of 26% of the participants reported worsening of symptoms. One third was classified as adverse events. Half of these were graded as minor and the other half as moderate according to the Common Terminology Criteria for Adverse Events. Two thirds were classified as homeopathic aggravations. Of these, 73% were classified as minor and 27% as moderate, giving a tendency towards milder severity for those classified as homeopathic aggravations (p=0.065).
Conclusion Patients reported a substantial part of the short-term reactions after taking homeopathic remedy as a worsening of symptoms. These reactions were classified as mild and moderate. Hence, the risk connected to homeopathic treatment is minor. More studies are needed to confirm the existence of homeopathic aggravation and how to classify the concept in a clinically meaningful way.
This is the accepted manuscript version. Published version is available at http://dx.doi.org/10.1016/j.ctim.2015.06.004

Health Related Quality of life in Adolescents with Chronic Fatigue Syndrome: A Cross-sectional Study

Fri, 03 Jul 2015 00:00:00 GMT

Winger, Anette; Kvarstein, Gunnvald; Wyller, Vegard Bruun; Ekstedt, Mirjam; Sulheim, Dag; Fagermoen, Frode Even; Småstuen, Milada C; Helseth, Sølvi
Aim: To study health related quality of life (HRQOL) and depressive symptoms in adolescents with chronic fatigue syndrome (CFS) and to investigate in which domains their HRQOL and depressive symptoms differ from those of healthy adolescents.
Background and objective: Several symptoms such as disabling fatigue, pain and depressive symptoms affect different life domains of adolescents with CFS. Compared to adolescents with other chronic diseases, young people with CFS are reported to be severely impaired, both physiologically and mentally. Despite this, few have investigated the HRQOL in this group.
Method: This is a cross-sectional study on HRQOL including 120 adolescents with CFS and 39 healthy controls (HC), between 12 and 18 years. The Pediatric Quality of Life Inventory™, 4.0 (PedsQL) was used to assess HRQOL. The Mood and Feelings Questionnaire assessed depressive symptoms. Data were collected between March 2010 and October 2012 as part of the NorCAPITAL project (Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial). Linear and logistic regression models were used in analysis, and all tests were two-sided.
Results: Adolescents with CFS reported significantly lower overall HRQOL compared to HCs. When controlling for gender differences, CFS patients scored 44 points lower overall HRQOL on a scale from 0–100 compared to HCs. The domains with the largest differences were interference with physical health (B = −59, 95 % CI −54 to −65) and school functioning (B = −52, 95 % CI −45 to −58). Both depressive symptoms and being a patient were independently associated with lower levels of HRQOL
Conclusion: The difference in HRQOL between CFS patients and healthy adolescents was even larger than we expected. The large sample of adolescents with CFS in our study confirms previous findings from smaller studies, and emphasizes that CFS is a seriously disabling condition that has a strong impact on their HRQOL. Even though depressive symptoms were found in the group of patients, they could not statistically explain the poor HRQOL.

Air ambulance nurses as expert supplement to local emergency services

Wed, 25 Dec 2013 00:00:00 GMT

Wisborg, Torben; Bjerkan, Bjørn
Introduction: Flight nurses in the Norwegian National Air Ambulance Service are specialist nurse anesthetists or intensive care nursing specialists. For air ambulance bases far from hospitals, these nurses represent otherwise unavailable competencies. This study reports a 6-year experience with flight nurse participation in local emergencies beyond the transportation phase.
Methods: The fixed-wing air ambulance base in Alta, Northern Norway (20,000 inhabitants), with two aircraft and two on-call teams, is 150 km by road from the nearest hospital. We did a prospective registration of all emergency non-flight missions near the air ambulance base through January 1, 2005, to December 31, 2010.
Results: The 217 completed missions corresponded to three missions per month, half during daytime. Twentythree percent of patients were under age 18, injury rate was high (36%), and 63% had potentially or manifest life-threatening conditions while 11% died during treatment. One third of all missions (67 of 217) resulted in an air ambulance flight to the hospital.
Conclusion: Mission frequency did not significantly reduce flight availability, and precision in case selection for this special service was good. The use of flight nurses in the local community promotes equal access to advanced medical services for populations far from hospitals.
Accepted manuscript version. Published version is available at http://dx.doi.org/10.1016/j.amj.2013.08.004

Evaluation of training program for surgical trauma teams in Botswana

Fri, 21 Nov 2014 00:00:00 GMT

Hanche-Olsen, Terje Peder; Alemu, Lulseged; Viste, Asgaut; Wisborg, Torben; Hansen, Kari Schrøder
Background Trauma represents a challenge to healthcare systems worldwide, particularly in low-and middle-income countries. Positive effects can be achieved by improving trauma care at the scene of the accident and throughout hospitalization and rehabilitation. Therefore, we assessed the long-term effects of national implementation of a training program for multidisciplinary trauma teams in a southern African country. Methods From 2007 to 2009, an educational program for trauma, “Better and Systematic Team Training,” (BEST) was implemented at all government hospitals in Botswana. The effects were assessed through interviews, a structured questionnaire, and physical inspections using the World Health Organization’s “Guidelines for Essential Trauma Care.” Data on human and physical resources, infrastructure, trauma administrative functions, and quality-improvement activities before and at 2-year follow-up were compared for all 27 government hospitals. Results A majority of hospitals had formed local trauma organizations; half were performing multidisciplinary trauma simulations and some had organized multidisciplinary trauma teams with alarm criteria. A number of hospitals had developed local trauma guidelines and local trauma registries. More equipment for advanced airway management and stiff cervical collars were available after 2 years. There were also improvements in the skills necessary for airway and breathing management. The most changes were seen in the northern region of Botswana. Conclusions Implementation of BEST in Botswana hospitals was associated with several positive changes at 2-year follow-up, particularly for trauma administrative functions and quality-improvement activities. The effects on obtaining technical equipment and skills were moderate and related mostly to airway and breathing management.
Submitted manuscript version. Published version is available at http://dx.doi.org/10.1007/s00268-014-2873-8

Rollen til urokinase plasminogen aktivator reseptoren (uPAR) for uttrykk av molekyler involvert i celle adhesjon, migrasjon og invasjon

Thu, 20 May 2010 00:00:00 GMT

Haustreis, Stine-Mari
Urokinase-type-plasminogen activator reseptor (uPAR) er funnet overuttrykt i organer som har omfattende remodulering av vevet. uPAR har flere ligander, blant annet serine proteasen urokinase plasminogen aktivator uPA, ekstracellulær matrix proteine vitronectin og integriner. uPA aktiveres ved binding til uPAR. Aktiv uPA aktiverer ved binding til uPAR og kan deretter aktivere plasmin som kan degradere en rekke eCM molekyler direkte og direkte ved å binde ECM komponenter og indirekte ved å aktivere MMPer. uPAR fungerer ikke bare som en reseptor for proteaser. Ved å binde integriner påvirker den også cellers migrasjon, adhesjon, differensiering og proliferasjon gjennom intracellulær signalering. Fordi uPAR har disse egenskapene er den vist å være en viktig komponent ved invasiv kreft og metastasering i en rekke kreftformer. I denne oppgaven var målet å studere om overuttrykk av uPAR i oralekreftceller påvirket uttrykket i utvalgte gener og proteiner som er involvert i celle adhesjon, migrasjon og invasjon. Det ble først verifisert at klonene AT-84-EV1, AT84-EV3, AT-84-EV4, AT-84-uPARmedium og AT-84 uPARhøy har ulik mengde uPAR på proteinnivå ved Western blotting og på RNA nivå ved RT- qPCR. Deretter ble RT-qPCR brukt for å avdekke om overutrykk av uPAR i klonene hadde påvirket uttrykket av et utvalg av gener. I tillegg ble det gjort en screen ved bruk av en RT-qPCR basert metode kalt RT2-profiler der mRNA nivået til 84 gener knyttet til kreft ble analysert. Resultatet viser at overuttrykk av uPAR og E-cadherin resulterte i en nedregulering av MMP-9, mens nivåene av uPA, PAI-1,S100A4 og MMP-2 ikke så ut til å være endret. Nedreguleringen av E-cadherin ble også verifisert på proteinnivå ved Westernblot.

Establishing IMMULITE® 2000 cut-off values for serum allergen-specific immunoglobulin and exploring their relationship to exhaled nitric oxide

Mon, 31 Mar 2014 00:00:00 GMT

Evjenth, Bjørg; Hansen, Tonje Elisabeth; Brekke, Ole Lars; Holt, Jan
Aim: Paediatric cut-off values for serum allergen-specific IgE (sIgE) using the Siemens IMMULITE 2000 system to diagnose allergic rhinoconjunctivitis have not been established. We aimed to determine cut-off levels for sIgE for 10 common inhalant allergens and to study the relationship between sIgE, total IgE and fractional exhaled nitric oxide (FENO).
Methods: We enrolled 243 schoolchildren, including 164 with allergic rhinoconjunctivitis. Parental interviews, skin prick tests, sIgE, total IgE, FENO measurements, spirometry and exercise tests were performed.
Results: Cut-off values with the best combined sensitivity and specificity were above the detection limit of the assay for seven of the ten allergens (0.23–1.1 kU/L). The overall accuracy of the IMMULITE in detecting allergic rhinoconjunctivitis was good. sIgE was superior to total IgE and FENO in predicting allergic rhinoconjunctivitis to timothy, birch, mugwort, cat, dog and house dust mite. FENO was elevated in children with allergic rhinoconjunctivitis, irrespective of asthma.
Conclusion: Cut-off values for sIgE were dependent on the allergic phenotype and were above the IMMULITE detection limit for seven of ten inhalant allergens. Consequently, using the detection limit for sIgE as the decision point would result in over-diagnosing allergic rhinoconjunctivitis. When measuring elevated FENO in children, allergic rhinoconjunctivitis should be suspected.

Medical constructions of long-term exhaustion, past and present

Fri, 24 Apr 2015 00:00:00 GMT

Lian, Olaug S; Bondevik, Hilde
Culture and history affect the ways in which medical knowledge is shaped, sustained and changed. The less knowledge we have, the larger the space for the cultural imprint becomes. Based on these assumptions, we ask: how have medical constructions of long-term exhaustion changed over time, and how are changing constructions related to societal change? To discuss these questions we conducted a comparative study of medical texts from two historical periods: 1860–1930 and 1970–2013. Our data are limited to two diagnoses: neurasthenia and encephalomyelitis. After comparing the two periods by identifying diverging and converging aspects, we interpreted observed continuities and interruptions in relation to historical developments. We found that in the medical literature, longterm exhaustion became transformed from a somatic ailment bred by modern civilisation to a self-inflicted psychiatric ailment. At the same time, it changed from being a male-connoted high-status condition to a female-connoted low-status condition. We interpret these changes as contingent upon culturally available modes of interpretations. Medical knowledge thereby becomes infused with cultural norms and values which give them a distinct cultural bias. The historical controversies surrounding this medically contested condition neatly display the socially contingent factors that govern the social construction of medical knowledge.

Ny diagnostikk for Alzheimers i Nytt Senter

Thu, 23 Apr 2015 00:00:00 GMT

Fjellaksel, Richard; Hjelstuen, Ole Kristian; Sundset, Rune