Biomedical subjects

K Stavem

Publications and source records attributed to K Stavem.

At least 19 recordsLinked to original sources

PubMed2006

Breathlessness, phlegm and mortality: 26 years of follow-up in healthy middle-aged Norwegian men.

OBJECTIVES: It is well known that pulmonary function is associated with all-cause and cardiovascular (CV) death. Less is known about the association between respiratory symptoms and mortality and whether such an association is independent of physical fitness. In this study, we assessed the association of breathlessness and productive cough with CV and all-cause mortality over 26 years. DESIGN: Prospective occupational cohort study. SETTING AND SUBJECTS: In 1972-75, 1999 apparently healthy men aged 40-59 years were recruited to the study from five companies in Oslo, Norway. At study entry clinical, physiological and biochemical parameters including respiratory symptoms, spirometry, and an objective assessment of physical fitness were measured in all subjects, of whom 1,623 had acceptable spirometry. The data was analysed using Cox proportional hazards analysis, adjusting for age, lung function, physical fitness, and other possible confounders, with mortality until 2000. RESULTS: After 26 years (range 25-27), 615 men (38%) had died, of whom 308 (50%) from CV deaths. In multivariable proportional hazards models, 'having phlegm winter mornings' [hazard ratio (HR) 1.30, P = 0.01], 'breathlessness when hurrying/walking uphill' (HR 1.43, P = 0.005) and combinations of the two symptoms remained significant predictors of all-cause mortality. None of six respiratory symptoms were significant predictors of CV mortality in multivariable models. CONCLUSIONS: Phlegm, breathlessness and combinations of them were associated with all-cause mortality, even after adjusting for physical fitness, known CV and other risk factors such as smoking, and lung function. The finding of an association also after adjustment for physical fitness is new. In contrast, none of the six respiratory symptoms individually or in combination were associated with CV mortality in multivariable analysis.

Adult↗

PubMed2005

Comparison of traditional Chinese acupuncture, minimal acupuncture at non-acupoints and conventional treatment for chronic sinusitis.

OBJECTIVES: To compare traditional Chinese acupuncture, minimal acupuncture at non-acupoints and conventional treatment for chronic sinusitis. DESIGN: A three-armed single blind randomised controlled study. SETTING: In an outpatient specialist clinic, we recruited 65 patients with symptoms of sinusitis >3 months and signs of sinusitis on computed tomography (CT). INTERVENTIONS: We randomised patients to one of three study arms: (1) 2-4 weeks of medication with antibiotics, corticosteroids, 0.9% sodium chloride solution, and local decongestants (n=21), (2) 10 treatments with traditional Chinese acupuncture (n=25), or (3) 10 treatments with minimal acupuncture at non-acupoints (n=19). OUTCOME MEASURES: Change in sinus soft tissue swelling on CT, symptoms of sinusitis, and health-related quality of life (HRQoL), using the two component summary scales of the Short Form 36 and a rating scale. RESULTS: In the conventional treatment group, sinus soft tissue swelling was reduced over 4 weeks (p=0.04), and HRQoL improved over 12 weeks (p=0.01-0.05). Pairwise comparisons of changes in total symptom score between the groups showed signs of a difference between conventional medication and sham over 4 weeks (p=0.06). CONCLUSION: Sinus soft tissue swelling was reduced in the conventional treatment group over 4 weeks, and HRQoL improved over 12 weeks. Only a non-significant difference in symptom score change over 4 and 12 weeks was shown between conventional medication and traditional Chinese acupuncture.

Acupuncture↗

PubMed2005

Predictors of headache 22 years after hospitalization for head injury.

OBJECTIVES: To assess predictors of headache in patients who had sustained a head injury 22 years earlier. MATERIALS AND METHODS: A questionnaire about headache was sent to 361 subjects hospitalized for head injury in 1974-1975. RESULTS: A total of 249 patients (69%) responded to the questionnaire. The prevalence of headache >14 days a month last year was 11%. In multivariate logistic regression analysis female sex (OR = 3.4, 95% CI 1.2-9.6), severe headache 3 months after the head injury (OR = 10.6, 95% CI 2.6-43.5) and psychiatric disease (OR = 2.9, 95% CI 1.1-7.7) predicted chronic headache. There was no significant association between chronic headache and post-traumatic amnesia or other trauma-related variables. CONCLUSION: Female sex and headache 3 months after the head injury were the strongest predictors of long-term headache, while there was little association between long-term headache and trauma variables.

Adult↗

PubMed2005

Lung function, smoking and mortality in a 26-year follow-up of healthy middle-aged males.

Lung function has been associated with mortality after adjusting for other risk factors; however, few studies have adjusted for physical fitness and reported separate analyses according to smoking status. In 1972-1975, spirometry, clinical and physiological parameters were recorded in 1,623 apparently healthy males aged 40-59 yrs. After 26 yrs of follow-up, the current authors investigated the association between baseline lung function and mortality, adjusting for smoking, physical fitness and other potential factors. By 2000, 615 individuals (38%) had died, with 308 (50%) of these deaths from cardiovascular (CV) causes. Forced expiratory volume in one second was a predictor of all-cause mortality (risk ratio (RR) 1.10 per reduction of 10%) after adjusting for smoking, physical fitness, age, systolic blood pressure, body mass index and serum cholesterol. The corresponding multivariate RR was 1.07 for CV causes and 1.34 for respiratory death. In conclusion, in stratified analyses among current and former smokers, forced expiratory volume in one second % predicted was a strong independent predictor of all-cause mortality and respiratory death among current smokers. Forced expiratory volume in one second % predicted was not associated with mortality among never-smokers.

Adult↗

PubMed2004

Inter-observer agreement in audit of quality of radiology requests and reports.

AIMS: To assess the quality of the imaging procedure requests and radiologists' reports using an auditing tool, and to assess the agreement between different observers of the quality parameters. MATERIALS AND METHODS: In an audit using a standardized scoring system, three observers reviewed request forms for 296 consecutive radiological examinations, and two observers reviewed a random sample of 150 of the corresponding radiologists' reports. We present descriptive statistics from the audit and pairwise inter-observer agreement, using the proportion agreement and kappa statistics. RESULTS: The proportion of acceptable item scores (0 or +1) was above 70% for all items except the requesting physician's bleep or extension number, legibility of the physician's name, or details about previous investigations. For pairs of observers, the inter-observer agreement was generally high, however, the corresponding kappa values were consistently low with only 14 of 90 ratings >0.60 and 6 >0.80 on the requests/reports. For the quality of the clinical information, the appropriateness of the request, and the requested priority/timing of the investigation items, the mean percentage agreement ranged 67-76, and the corresponding kappa values ranged 0.08-0.24. CONCLUSION: The inter-observer reliability of scores on the different items showed a high degree of agreement, although the kappa values were low, which is a well-known paradox. Current routines for requesting radiology examinations appeared satisfactory, although several problem areas were identified.

Humans↗

PubMed2004

Predictors of seizure outcome after temporal lobectomy for intractable epilepsy.

OBJECTIVES: To assess predictors of outcome of temporal lobectomy for intractable epilepsy. MATERIAL AND METHODS: In 63 adult patients operated with anterior temporal lobectomy during 198892, we used logistic regression analysis to assess predictors of being seizure-free (Engel's class I) 2 years after surgery. As potential predictors, we included the following variables: gender, age at operation, age at onset of seizures, epilepsy duration, etiology, generalized vs not generalized seizures, seizure frequency, intelligence quotient, ictal electroencephalography, magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), side of resection, and extent of the resection. RESULTS: About 44% of the surgery patients were seizure-free (Engel's class I) 2 years after surgery. In multivariate analysis (n = 55), MRI pathology defined as atrophy in the temporal lobe, angioma, tumor or mesial temporal sclerosis (odds ratio, OR 7.4, 95%CI: 1.7-32.9) and extent of the hippocampal resection (increase of 1 cm) (OR 2.2, 95%CI: 1.1-4.6) predicted being seizure-free. CONCLUSION: Focal pathology in preoperative MRI and the extent of the hippocampal resection were the only significant predictors of being seizure-free after 2 years.

Adolescent↗

PubMed2003

A survey of therapeutic hemapheresis in Norway year 2000.

In a survey of therapeutic hemapheresis in Norway, we sent a questionnaire to all regional and central hospitals, asking about hemapheresis activities, patients, indications, and adverse events. All units responded to the questionnaire: 17 dialysis units, 7 blood units, and 2 specialized units for stem cell apheresis. In total, they performed 2141 procedures that is 5.0 stem cell collections and 42.5 therapeutic apheresis procedures per 100,000 inhabitants. The most frequent indications were Guillain-Barré syndrome, hypercholesterolemia, and myasthenia gravis. Adverse effects were frequent, but mild. Dialysis units performed a majority of the procedures, leading to an extensive use of filtration techniques.

Blood Component Removal↗

PubMed2002

Reliability and validity of the COOP/WONCA health status measure in patients with chronic obstructive pulmonary disease.

The objective of the study was to assess the reliability and validity of the Dartmouth Primary Care Cooperative Information Project/World Organization of National Colleges, Academies, and Academic Associations of General Practice/Family Physicians (COOP/WONCA) questionnaire in outpatients with chronic obstructive pulmonary disease (COPD). The test-retest reliability of individual items of the COOP/WONCA questionnaire was assessed using a weighted kappa-statistic, and construct validity was assessed by correlating items of the COOP/WONCA with the EQ-5D health status measure. Discriminant validity was assessed by comparing scores for known groups, at the same time comparing the results with those of a lung-specific health status questionnaire. The individual items of the COOP/WONCA had test-retest reliabilities of 0.67-0.78 (weighted kappa). Spearman's rank correlations between COOP/WONCA single-item scores and corresponding EQ-5D ranged 0.45-0.72, which were generally higher than associations between non-corresponding items. Four of the five COOP/WONCA items did not discriminate between patient groups divided according to forced expiratory flow in 1 sec (FEV1) in percent of predicted and 6-min walking distance, while four of five items of the lung-specific questionnaire discriminated well between these groups. The COOP/WONCA chart system was reliable and showed properties supporting the construct validity of the measure. The items, however, did not discriminate well between known groups, indicating that this questionnaire is not very sensitive in patients with COPD. The reliability of the COOP/WONCA items was acceptable for use at group level, but lower than current recommendations for use in individual patients.

Adult↗

PubMed2002

Survival of unselected stroke patients in a stroke unit compared with conventional care.

BACKGROUND: Recent meta-analyses have reported a beneficial effect of stroke units compared with traditional care, both on patient survival and on dependency after one year. AIM: To determine whether these results can be reproduced outside a clinical trial setting. SETTING: A medium-sized general hospital. METHODS: From 1993 to 1998, all patients aged >60 years with suspected acute stroke were allocated either to a stroke unit or general medical wards according to date of birth (day of the month). Patients were identified retrospectively, using a discharge diagnosis of ICD-9 codes 431, 434 and 436. We assessed 30-day and 1-year survival. RESULTS: In the stroke unit, 926/1128 patients survived at 30 days, vs. 905/1141 in the general medical wards (p=0.08). Beyond the first 30 days, there was no difference in survival (p=0.27). Under Cox regression analysis, there was a 20% reduction in mortality in the stroke unit after 30 days compared with the general medical wards (RR 0.80, p=0.02) after adjusting for age, gender, stroke type and season of the year. DISCUSSION: In this, the largest single-centre study to evaluate the survival benefit of a stroke unit, survival at 30 days was increased, although not significantly so. Survival at one year was unchanged.

Acute Disease↗

PubMed2002

Association of willingness to pay with severity of chronic obstructive pulmonary disease, health status and other preference measures.

SETTING: Willingness to pay (WTP) is a method frequently used to measure the benefits of health interventions in monetary terms. OBJECTIVE: To assess the construct validity of the WTP method in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Fifty-nine COPD patients (34 men, mean age 57 years) were asked about their maximum WTP for a theoretical cure for COPD. In addition, they reported utility scores using standard gamble, time trade-off, a multi-attribute utility instrument, and a rating scale. They also responded to the Short Form 36 (SF-36) questionnaire, dyspnea measures and had comprehensive pulmonary function tests. RESULTS: The participants reported a median WTP of Norwegian kroner 200 000 (US $24 096) for a theoretical cure for COPD without side-effects. The associations of WTP with utility scores, dimensions of health status, dyspnea measures and lung function tests were low. CONCLUSION: The findings of this study question the validity of the WTP method in patients with chronic obstructive pulmonary disease.

Adult↗

PubMed2001

Properties of the 15D and EQ-5D utility measures in a community sample of people with epilepsy.

To perform economic evaluation studies in epilepsy using utilities, such as cost-utility analyses, it is necessary to have reliable and valid instruments for eliciting people's preferences. The objective of this study was to assess the reliability and validity of two multiattribute utility measures in a community sample of 397 people with epilepsy. We assessed the test-retest reliability of individual questionnaire items and aggregate scores. Additionally, construct validity was assessed by correlating items of the EQ-5D with items of the 15D health status questionnaire, and discriminant validity was assessed by comparing scores for known groups. The test-retest reliabilities for the individual items of the 15D (weighted kappa 0.59-0.90, except mobility with only 0.28) and the EQ-5D (weighted kappa 0.49-0.86) were acceptable. For the composite utility scores the test-retest reliability was better (intraclass correlation coefficient 0.93 for both 15D and the EQ-5D). Spearman's rank correlations between EQ-5D single item scores and corresponding 15D single item scores were high (rho 0.34-0.79) and generally higher than the associations between non-corresponding items. Some EQ-5D and 15D items discriminated well between patients according to seizure status, psychiatric comorbidity and working status; less well after antiepileptic drug use and neurologic comorbidity. Both the EQ-5D and 15D were reliable instruments and showed properties supporting the construct validity of both measures.

Adult↗

PubMed2001

The benefit of an acute stroke unit in patients with intracranial haemorrhage: a controlled trial.

OBJECTIVES: Patients with stroke receiving organised inpatient (stroke unit) care after stroke are more likely to be alive and independent compared with patients offered conventional care. The objective was to determine the effect of an acute stroke unit on patients with primary intracranial haemorrhage. METHODS: In a prospective controlled study, the effect of an acute stroke unit was examined on 30 day and 1 year mortality in patients with primary intracranial haemorrhage. Patients treated in general medical wards served as controls. RESULTS: Of 121 patients included, 56 were allocated to an acute stroke unit and 65 to a general medical ward. The 30 day mortality rate was 39% in the acute stroke unit compared with 63% in the general medical wards, and the 1 year mortality rates were 52% and 69%, respectively. There was a difference between the 30 day and 1 year survival curves between the groups (p=0.007 and 0.013, respectively); however, there was no difference in survival between 30 and 365 days. There was no difference in risks of being discharged home or to long term care between the groups. CONCLUSIONS: In this study admission to an acute stroke unit reduced mortality 30 days and 1 year after primary intracranial haemorrhage, which could be attributed to a large difference in survival during the first 30 days.

Acute Disease↗

PubMed2001

Factors influencing physicians' assessment of urgency for inpatient surgery.

OBJECTIVES: To assess to what extent patient, disease and referral characteristics influenced physicians' assessment of urgency of inpatient surgery. METHODS: In total, 452 patients, mean age 50 years, were examined in surgical or gynaecological outpatient clinics in one hospital and referred for inpatient surgery. Data were collected by the examining physician, and the patients were either given a maximal waiting time or the waiting time was not specified. A stepwise logistic regression, with urgency for surgery within four weeks or less as the dependent variable, was used. The results are presented as adjusted odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Of 452 patients, 181 (40%) were deemed urgent (four weeks or less). In multivariate logistic regression analysis, suspected or verified malignant disease (OR 3.45, 95% CI 2.11 to 5.64), risk of serious deterioration (OR 4.53, 95% CI 2.17 to 9.46), being on sick leave from work (OR 3.97, 95% CI 1.82 to 8.64) and being assessed by a physician undergoing specialist training (OR 1.99, 95% CI 1.24 to 3.21) were significant predictors of being assessed as needing inpatient surgery urgently. CONCLUSIONS: Physicians' judgements, in an informal way, internalize many of the public's concerns for fairness, such as the severity of a condition, the potential for improvement and aversion to inequalities in health. More research is needed to understand the difference in urgency ratings between junior and more experienced physicians.

Acute Disease↗

PubMed2001

The self-perceived health status of Norwegian physicians compared with a reference population and foreign physicians.

AIMS: To compare the self-perceived health status of a representative sample of Norwegian physicians with a general reference population; and to investigate differences in health status among groups of physicians. METHODS: A cross-sectional postal survey was carried out of 1,126 Norwegian physicians and 1,742 subjects in a general reference population, using the widely used general health status questionnaire--Short Form 36 (SF-36). Scores were adjusted for differences in age, gender and education where applicable. RESULTS: The health status of Norwegian physicians was better than that of subjects with a lower level of education in the four dimensions of the SF-36 related to physical health. Male physicians scored better on the physical functioning scale and lower on vitality and social functioning than comparable university graduates. Older physicians scored better than younger in dimensions related to mental health and social functioning. Norwegian general practitioners reported better health status than colleagues in Sweden and the UK. CONCLUSIONS: The self-perceived health status of Norwegian physicians was as good or better than that of the general population. The cross-national differences could be caused by cultural differences, or be related to practice style or job strain.

Adult↗

PubMed2000

[Scenario analysis--a method for long-term planning].

Scenarios are known from the film industry, as detailed descriptions of films. This has given name to scenario analysis, a method for long term planning using descriptions of composite future pictures. This article is an introduction to the scenario method. Scenarios describe plausible, not necessarily probable, developments. They focus on problems and questions that decision makers must be aware of and prepare to deal with, and the consequences of alternative decisions. Scenarios are used in corporate and governmental planning, and they can be useful and complementary to traditional planning and extrapolation of past experience. The method is particularly useful in a rapidly changing world with shifting external conditions.

Decision Making, Organizational↗

PubMed2000

[13 years old scenarios for this year].

This article examines two scenarios, published in 1987, for the future development of Norwegian health care towards the year 2000. The scenarios emphasize different external forces and priorities. The 1987 scenarios are then assessed in the light of actual developments during the period. Scenario I describes a picture characterised by reduced economic growth 1987-2000 compared to previous decades, resulting in a year 2000 health care system with limited resources and hard priorities, focus on cost containment, increased efficiency, and search for alternative solutions. In Scenario II, the year 2000 health care system had more resources; however, the demand for services was as high or higher than in the 1980s. Instead of improvements in efficiency, alternative modes of financing health care and social security had evolved. Increasing knowledge among consumers, dissatisfaction and new technology had driven up costs, and health care professions tried to take advantage of the situation. This scenario is characterized by people wanting more, and getting more.

Decision Making, Organizational↗

PubMed2000

The health-related quality of life of patients with epilepsy compared with angina pectoris, rheumatoid arthritis, asthma and chronic obstructive pulmonary disease.

The objective of this study was to compare the health-related quality of life (HRQL) of patients with epilepsy with populations suffering from different chronic diseases, using the short form 36 (SF-36) health profile measure. The populations to be compared were adult patients drawn from hospital based registers, with confirmed epilepsy (n = 397), angina pectoris (n = 785), rheumatoid arthritis (n = 1,030), asthma (n = 117) and chronic obstructive pulmonary disease (COPD) (n = 221). Health-related quality of life scores were compared using analysis of covariance (ANCOVA) for predicting mean scores adjusted for age, gender, education and comorbidity. Patients with epilepsy on average scored highest on all scales, reflecting that in our sample the majority had well-controlled epilepsy. Our results indicate that the HRQL of a representative sample of patients with epilepsy is good, when compared with other chronic disorders, although reduced in several dimensions compared with a general reference population. Patients with rheumatoid arthritis (RA) and COPD scored lowest on the physical function scales, while rheumatoid arthritis patients reported most pain.

Adult↗

PubMed2000

Health-related quality of life is associated with arterial P(O2) in chronic obstructive pulmonary disease.

Insensitive lung-specific questionnaires may explain the poor association between arterial P(O2) and reported health-related quality of life. Conceivably, modern lung specific or generic quality of life measures might show a better association with arterial P(O2). Fifty-nine outpatients (34 men) with chronic obstructive pulmonary disease (COPD) who fulfilled the following criteria were studied: age 18-67 years, FEV1 < or = 70%, < or = 15% reversibility after beta2-agonist inhalation, and no other disabling disorders. All completed the Respiratory Quality of Life Questionnaire (RQLQ) and Short Form 36 (SF-36), and were tested with spirometry and arterial blood gases. In accordance with available COPD staging systems, patients were divided into those with an FEV1 of < 50% and 50-70% of predicted. Patients' characteristics were, [mean (SD)]: age: 57.0 years (9.0); FEV1: 1.46 (0.6). Spearman's rank correlations between arterial P(O2) and dimensions of the RQLQ ranged from 0.25-0.52, and were greater than for the SF-36 (0.14-0.36) in patients with moderate to severe COPD. The association between arterial P(O2) and quality of life scores in moderately to severely affected COPD patients was moderate, but higher than previously reported. The associations were higher with a lung-specific questionnaire than with a general health measure, indicating a higher sensitivity of the lung-specific measure in this patient group.

Adolescent↗