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Biomedical subjects

I Aursnes

Publications and source records attributed to I Aursnes.

At least 19 recordsLinked to original sources
PubMed2003

Guidelines for iron supplementation in pregnancy: compliance among 431 parous Scandinavian women.

OBJECTIVE: The need for iron in pregnancy is rarely met by dietary food intake alone. Therefore, guidelines on iron supplementation have been developed to ensure optimal maternal and foetal iron provision. Today, the World Health Organization recommends iron supplementation during the second half of pregnancy. Our aim was to study compliance to these guidelines among 431 parous Scandinavian women. In addition, the association between maternal socio-demographic and lifestyle factors, maternal haemoglobin (Hb) values and non-compliance was assessed. METHODS: The women were interviewed about iron use at gestational weeks 25, 33 and 37 at the three Scandinavian study sites, Trondheim, Bergen and Uppsala. RESULTS: In all, 27% of the women used iron supplements continuously during the second half of pregnancy, hence complying with the guidelines. Further, 41% of the women reported periodical and 32% no use of iron supplementation during the second half of pregnancy. In the multivariable analyses, high Hb-concentration, living in Uppsala [OR: 3.1 (1.6-6.0)] or Bergen [OR: 4.7 (2.4-9.3)] as opposed to Trondheim, and smoking during pregnancy [OR: 2.0 (1.1-3.5)] were associated with non-compliance to guidelines. CONCLUSION: We conclude that maternal Hb values, demographic factors and smoking during pregnancy are among the factors associated with non-compliance to guidelines on iron supplementation during pregnancy.

Adult↗
PubMed2001

[Anti-ischemic and infarction-reducing effects of angiotensin-converting enzyme inhibitors].

BACKGROUND: Angiotensin-converting enzyme is probably involved in the pathogenesis and progression of atherosclerosis, both through an increase in vascular angiotensin II and by an effect on the degradation of bradykinin into inactive fragments. Moreover, angiotensin II has a prothrombotic effect and prevails in increased concentration in the blood of animals subjected to experimentally induced myocardial infarction. MATERIAL AND METHODS: We have evaluated the relevant literature (including animal experiments and human studies) describing the infarct-reducing and anti-ischaemic effects of angiotensin-converting enzyme inhibitors. We also refer to studies in which these drugs have reduced the progression of atherosclerosis. RESULTS: Angiotensin-converting enzyme inhibitors probably have favourable effects in various ways. There are indications that they counteract ischaemia, reduce heart failure and prevent reinfarction. Experimental observations in animals also indicate that angiotensin-converting enzyme inhibitors limit myocardial injury, presumably in part through the effects of bradykinin. This is supported by some few clinical studies, including a Norwegian epidemiological study. Angiotensin-converting enzyme inhibitors reduced the progression of intima-media thickness in the carotid arteries. INTERPRETATION: Angiotensin-converting enzyme inhibitors have favourable biochemical and haemodynamic properties that may explain their beneficial effects in patients with coronary heart failure.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2001

Drug use during early pregnancy. The impact of maternal illness, outcome of prior pregnancies and socio-demographic factors.

OBJECTIVE: Socio-demographic factors have been associated with drug use in pregnancy. However, information on maternal illness has rarely been included in previous studies. The aim of this study was therefore to estimate the impact of maternal illness and prior pregnancy outcome on the use of analgesics/antipyretics, anti-infectives and antihistamines in early pregnancy controlling for socio-demographic factors. METHODS: One thousand nine-hundred and forty-five parous pregnant women from Norway and Sweden were included in an interview study. Information on drug use, obstetric history, maternal illness and socio-demographic factors was collected by specially trained midwives at gestational week 17 and form the basis for the present analyses. RESULTS: After control for socio-demographic factors, reported illness was associated with the use of analgesics/antipyretics, anti-infectives and antihistamines during early pregnancy. The use of analgesic/antipyretic and anti-infective drugs differed between study sites. Sociodemographic factors such as age, parity, marital status, education, occupation and smoking habits did not influence drug use in the multivariate analysis. CONCLUSION: Maternal illness during pregnancy was associated with drug use in early pregnancy. When studying factors related to drug use during pregnancy, it is important to include information on maternal illness. Socio-demographic factors may be confounders and lead to erroneous conclusions about the factors related to drug use.

Adult↗
PubMed2000

More non-Q-wave myocardial infarctions but similar infarct sizes in patients with hypertension.

Of 350 consecutive patients without previous symptoms of coronary artery disease, admitted to hospital with an acute myocardial infarction, 109 of them (31%) reported a history of previous hypertension. Hypertensive patients were older than their normotensive counterparts, more of them were females, and thrombolytic treatment was administered to significantly fewer. Blood pressure values at admission to hospital were higher in hypertensive patients; this difference was significant in hypertensive males. Altogether 44 out of 49 female (90%) and 42 out of 60 male hypertensive patients (70%) reported using antihypertensive medication. A previous history of hypertension did not change infarct size as assessed by peak enzyme levels, neither in the bivariate nor in the multivariate analysis. In contrast to this, the adjusted odds ratio for developing a non-Q-wave infarct was 2.51 (p=0.003), i.e. the chance of developing a non-Q-wave infarct in hypertensives was increased by 151%. Thus, in spite of similar infarct size in normotensive and hypertensive patients, a relative smaller proportion of the probably hypertrophied left ventricular wall developed necrosis in the hypertensive population. The propensity towards non-Q-wave infarctions may contribute to the observed less use of fibrinolytic drug treatment in the presently observed patients with hypertension.

Aged↗
PubMed1999

Hospital mortality from acute myocardial infarction has been modestly reduced after introduction of thrombolytics and aspirin: results from a new analytical approach. European Secondary Prevention Study Group.

The objective of this study was to investigate how the introduction of thrombolytics and aspirin has affected hospital mortality (case fatality) among patients with acute myocardial infarction. The study design was the application of the therapeutic effects found in the clinical trials in a nonselected myocardial infarction population characterized in detail. The study took place in health region 1 in Norway, population 850,000, and subjects were all patients hospitalized and discharged, alive or dead, with a diagnosis of acute myocardial infarction in the 10 hospitals in the region over a period of 2 months. The main outcome measures were deaths in hospital and estimation of expected hospital mortality without thrombolytics or aspirin, weighing and evaluating the effects of delay of different lengths from onset of symptoms to admission, different ages, and different electrocardiogram changes. We found that 32% of the patients received thrombolytics, and 72% received aspirin. Hospital mortality was 18.1% compared with 20.6% had neither of the treatments been administered, implying that the two regimens had reduced mortality by 12%, aspirin contributing about four fifths and thrombolytics one fifth. We conclude that hospital mortality in a nonselected myocardial infarction population has been reduced to moderate extent since the introduction of thrombolytics and aspirin. The effects observed in clinical trials are not translated into epidemiologically documented reduction in mortality, as the optimal conditions are found only in a proportion of the patient groups constituting a nonselected myocardial infarction population.

Aged↗
PubMed1998

[Treatment of Helicobacter pylori infection].

The article presents information gained from a survey among Norwegian hospitals in March 1997 concerning their treatment of infections with Helicobacter pylori. Altogether 52 hospitals answered the questionnaire. A combination of proton pump inhibitors, metronidazole and clarithromycin was used by 59% as first choice and urea quick test (94%) and urea breath test (42%) as the primary diagnostic procedures, whereas serology was in little use (17%). Besides ordinary ulcer disease, indications for treatment were: ulcer induced by non-steroid anti-inflammatory drugs (79%), gastrooesophageal reflux (37%), non-ulcer dyspepsia (14%) and cancer prophylaxis (14%). The gastro group at the Department of Pharmacotherapeutics at the University of Oslo invited specialists from all health regions to discuss indications for treatment of H pylori, the diagnosis and the role of general practitioners. The extensive use of clarithromycin might be doubtful due to development of resistance. Indications for treatment of H pylori other than ulcer disease and mucosa associated lymphoid tissue lymphoma are still uncertain. Uncritical use of serological tests in primary care should be discouraged. At present there is no uniform strategy for the diagnosis and treatment of H pylori infection, and a coordinated strategy between general practitioners and specialists is needed.

Antacids↗
PubMed1998

Acute myocardial infarction mortality related to use of calcium antagonists before admission to hospital.

We investigated whether prior use of calcium antagonists in 80 (16.8%) out of 477 patients (64% males) admitted with acute myocardial infarction (MI) had any impact on in-hospital mortality. Patients using calcium antagonists were slightly older (74 years vs. 72 years, 2P = 0.039) than those not taking them and fewer were male patients. Previous MI, diabetes mellitus, and prior use of aspirin, beta-blockers, and long-acting nitrates were more frequent in patients on calcium antagonists. In contrast, fewer patients on calcium antagonists prior to symptoms received thrombolytic treatment (21.3% vs. 34.8%, 2P = 0.018). The study had an observational exposed/nonexposed design, and we looked for both crude and adjusted effects. Of the 83 patients (17.4%) who died during hospitalization, 18 patients were in the calcium antagonist group (22.5%). The odds ratio (OR) for these patients to die in the hospital was 1.48 and the 95% confidence interval (CI) 0.78-2.78; 2P = 0.19. When adjusting for confounders (gender, age, smoking habit, previous MI, and diabetes mellitus, as well as prior use of aspirin, beta-blockers, long-acting nitrates, and thrombolytic treatment at entry) OR was 1.08 and 95% CI 0.57-2.05; 2P = 0.85. Thus, we found no excess in-hospital mortality in patients with acute MI using calcium antagonists prior to the onset of symptoms.

Acute Disease↗
PubMed1997

[Use of alendronate in osteoporosis--is it cost-effective?].

The objective of the analysis was to establish the cost-effectiveness of five years intervention with alendronate in women aged 65 years with a bone mineral density (BMD) of the femoral neck 2.5 SD below peak bone mass. A cost-utility analysis based on a simulation model was used. The risk of future fractures was estimated on the basis of clinical and epidemiologic data. The costs of intervention and of fracture treatment were based on market prices (measurement of BMD), the Norwegian DRG price list (in-patient hospital care), the pay scale of the Norwegian Medical Association (out-patient care, doctor's visits, laboratory tests, radiographs), public accounts (nursing home care, rehabilitation) and customary charges (transport, physiotherapy etc.). The discounted cost per Quality Adjusted Life Year (QALY) was NOK 528,000, NOK 291,000 and NOK 147,000 when BMD was respectively 1.5, 2.5 and 3.5 SD below peak bone masa at onset of intervention. Sensitivity analyses indicate that the cost per QALY is relatively sensitive to future risk of fracture, cost of intervention, discount rate, and magnitude and duration of the effects of the intervention. The results indicate that the use of alendronate competes favourably with other commonly used preventive programmes when administered to women with high risk of fragility fractures.

Aged↗
PubMed1997

Interaction between enalapril and aspirin on mortality after acute myocardial infarction: subgroup analysis of the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II)

The use of angiotensin-converting enzyme (ACE) inhibitors early after an acute myocardial infarction to reduce mortality has been studied in several trials with inconsistent results. Aspirin (ASA) has become a well-documented therapeutic adjunct in patients with coronary heart disease. Attention has recently been focused on a possible interaction between ASA and ACE inhibitors. We therefore reanalyzed data from the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II) to find any evidence of differential effects of the ACE inhibitor enalapril in subgroups defined by use of ASA at baseline. Logistic regression tested the multiplicative interaction. We used Rothman synergy index S, which would be equal to unity under additivity, and less than unity when suggesting antagonism, to examine the postulated interaction with departure from an additive model. Logistic regression showed that the enalapril-ASA interaction term was a significant predictor of mortality at the end of the study (p = 0.047), and was a borderline significant predictor of mortality 30 days after randomization (p = 0.085). The Rothman synergy index S was 0.66 (95% confidence interval 0.46 to 0.94) for mortality at the end of the study, and 0.68 ( 0.44 to 1.04) for 30-day mortality, indicating antagonism between enalapril and ASA with departure from an additive model. Thus, we found evidence of enalapril-ASA interaction. The effect of enalapril was less favorable among patients taking ASA than among patients not taking ASA at baseline.

Aged↗
PubMed1996

Cost effectiveness of cholesterol-lowering drugs: a review of the evidence.

Four studies of the cost per life year saved through lipid lowering with lovastatin or simvastatin showed considerable variation in the results. For example, the cost per life year saved on administration of simvastatin 20 mg/day for primary prevention in men 42 years old at the start of therapy and with an initial cholesterol level of 8 mmol/L, was 19,000 1994-US dollars according to one study, and 55,000 according to another. Both when the differences were due to different cost estimates and when they were due to different estimates of the number of life years saved, plausible explanations for the discrepancies between the cost-effectiveness ratios were generally found. The cost per life year saved through primary prevention was about three times greater among women than men at age 40, twice greater at age 60, an 1.3 times greater at age 70. The accordance between the studies was not good regarding how cost per life year saved varies with age at the start of drug therapy. According to one study, the cost per life year saved for secondary prevention is generally low. We also compared the estimates for statins with estimates for several other life-extending health interventions. Given current guidelines for the prescription of cholesterol-lowering drugs, primary prevention with statins seems generally to be one of the less cost-effective life extending health interventions, especially for women. The cost effectiveness of statins is likely to become more favorable, though, when the patients on these drugs expire.

Adult↗
PubMed1995

Association between various drugs used for hypertension and risk of acute myocardial infarction.

We examined the relation between various drugs used for treating high blood pressure and the incidence of acute myocardial infarction with a case-control design. Four hospitals taking care of all patients in Oslo with acute myocardial infarction participated with a total of 95 hypertensive men and women under 75 years of age who had had an acute myocardial infarction. A total of 329 age and sex matched controls were hypertensive citizens in Oslo without myocardial infarction. Frequency of treatment with drugs and odds ratio of risks with these drugs were calculated. The risk (odds ratio) of myocardial infarction for drug treatment during the last five years versus non drug treatment was 0.70 (95% confidence interval 0.42-1.18). The risk for diuretics and beta-blockers tested against no treatment was 0.91 (0.52-1.61). The corresponding risk for vasodilating drugs was 0.43 (0.20-0.91). Four weeks of exposure to alpha-blockers, on the other hand, tested against other drug treatments, indicated an odds ratio of 4.62 (1.01-24.0) for individuals with a history of angina. These data confirm that treatment with diuretics and beta-blockers has only little effect on the incidence of myocardial infarction. As a whole, vasodilators are associated with a significant reduction in this incidence, but alpha-blockers enhance the risk in patients with angina.

Aged↗
PubMed1994

Bleeding times related to serum triglyceride levels in healthy young adults.

A diet rich in fish tends to increase the bleeding time both in patients and healthy controls. Another effect of such a diet is a reduction in serum triglyceride levels in the individuals. It is not known whether these two effects are interrelated. In order to rule out effects of selenium in the fish diet, half of a control group consumed bread enriched with selenium while the other half had a normal diet. This combined control group (n = 21) was compared with healthy volunteers (n = 11) eating 250 g of fish daily for six weeks. Blood tests were performed at the start of the study, after three weeks and at the end. Changes in bleeding time were then related to changes in hemostatic variables and serum lipids. An inverse correlation (r = -0.41, p = 0.001) was present in the controls between serum triglyceride levels and bleeding times, but neither of the two variables changed in the course of the study. A negative correlation was observed in the fish eating group, and a change in the variables mentioned occurred in an orderly manner in the course of the study: a prolongation of the bleeding time from the start of the study to the end was only seen in individuals with low triglyceride levels, i.e. less than 1 mmol/L. Selenium in the diet, on the other hand, did not affect any of the observed variables.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Lipid-lowering medication--indications and possible hazards. Report from a hearing].

Drug treatment of hyperlipidaemia should be founded on scientific evidence. A hearing was arranged to arrive at practical measures based on reported clinical trials. Several studies during recent years have shown regression of coronary atheromatosis, and some people would say the effect is striking. Studies using clinical endpoints, like morbidity and mortality, have not yielded equally convincing results, but it should be noted that the results of studies with more than 10% reduction in total serum cholesterol levels are not yet available. So far, the trials have been too small to judge effects on total mortality. It is uncertain whether the treatment actually has untoward effects on the incidence of violent deaths and neoplasms. An upper limit for drug treatment of about 8 mmol/l was proposed during the hearing. The limit can be lowered to 7 if established coronary disease is present. For women without coronary disease the limit should be higher than that for men. All in all, this implies an increase in the total number of individuals treated compared with present practice. It was agreed that at present, high risk individuals are undertreated. The new levels have been set partly on the basis of economic considerations.

Arteriosclerosis↗