Cathrine Brunborg

Intravenous Drug Administration During Out-of-Hospital Cardiac Arrest: A Randomized Trial

CONTEXT Intravenous access and drug administration are included in advanced cardiac life support (ACLS) guidelines despite a lack of evidence for improved outcomes. Epinephrine was an independent predictor of poor outcome in a large epidemiological study, possibly due to toxicity of the drug or cardiopulmonary resuscitation (CPR) interruptions secondary to establishing an intravenous line and drug administration. OBJECTIVE To determine whether removing intravenous drug administration from an ACLS protocol would improve survival to hospital discharge after out-of-hospital cardiac arrest. DESIGN, SETTING, AND PATIENTS Prospective, randomized controlled trial of consecutive adult patients with out-of-hospital nontraumatic cardiac arrest treated within the emergency medical service system in Oslo, Norway, between May 1, 2003, and April 28, 2008. INTERVENTIONS Advanced cardiac life support with intravenous drug administration or ACLS without access to intravenous drug administration. MAIN OUTCOME MEASURES The primary outcome was survival to hospital discharge. The secondary outcomes were 1-year survival, survival with favorable neurological outcome, hospital admission with return of spontaneous circulation, and quality of CPR (chest compression rate, pauses, and ventilation rate). RESULTS Of 1183 patients for whom resuscitation was attempted, 851 were included; 418 patients were in the ACLS with intravenous drug administration group and 433 were in the ACLS with no access to intravenous drug administration group. The rate of survival to hospital discharge was 10.5% for the intravenous drug administration group and 9.2% for the no intravenous drug administration group (P = .61), 32% vs 21%, respectively, (P<.001) for hospital admission with return of spontaneous circulation, 9.8% vs 8.1% (P = .45) for survival with favorable neurological outcome, and 10% vs 8% (P = .53) for survival at 1 year. The quality of CPR was comparable and within guideline recommendations for both groups. After adjustment for ventricular fibrillation, response interval, witnessed arrest, or arrest in a public location, there was no significant difference in survival to hospital discharge for the intravenous group vs the no intravenous group (adjusted odds ratio, 1.15; 95% confidence interval, 0.69-1.91). CONCLUSION Compared with patients who received ACLS without intravenous drug administration following out-of-hospital cardiac arrest, patients with intravenous access and drug administration had higher rates of short-term survival with no statistically significant improvement in survival to hospital discharge, quality of CPR, or long-term survival. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00121524.

Risk Factors for Community-Acquired Urinary Tract Infections Caused by ESBL-Producing Enterobacteriaceae -A Case-Control Study in a Low Prevalence Country

Community-acquired urinary tract infection (CA-UTI) is the most common infection caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, but the clinical epidemiology of these infections in low prevalence countries is largely unknown. A population based case-control study was conducted to assess risk factors for CA-UTI caused by ESBL-producing E. coli or K. pneumoniae. The study was carried out in a source population in Eastern Norway, a country with a low prevalence of infections caused by ESBL-producing Enterobacteriaceae. The study population comprised 100 cases and 190 controls with CA-UTI caused by ESBL-producing and non-ESBL-producing E. coli or K. pneumoniae, respectively. The following independent risk factors of ESBL-positive UTIs were identified: Travel to Asia, The Middle East or Africa either during the past six weeks (Odds ratio (OR) = 21; 95% confidence interval (CI): 4.5–97) or during the past 6 weeks to 24 months (OR = 2.3; 95% CI: 1.1–4.4), recent use of fluoroquinolones (OR = 16; 95% CI: 3.2–80) and β-lactams (except mecillinam) (OR = 5.0; 95% CI: 2.1–12), diabetes mellitus (OR = 3.2; 95% CI: 1.0–11) and recreational freshwater swimming the past year (OR = 2.1; 95% CI: 1.0–4.0). Factors associated with decreased risk were increasing number of fish meals per week (OR = 0.68 per fish meal; 95% CI: 0.51–0.90) and age (OR = 0.89 per 5 year increase; 95% CI: 0.82–0.97). In conclusion, we have identified risk factors that elucidate mechanisms and routes for dissemination of ESBL-producing Enterobacteriaceae in a low prevalence country, which can be used to guide appropriate treatment of CA-UTI and targeted infection control measures.

Incidence of hospital-treated traumatic brain injury in the Oslo population.

Background: The aim of this prospective, population-based study is to present the incidence of hospital-treated traumatic brain injury (TBI) in Oslo, Norway, and to describe the severity of brain injuries and outcome of the patients’ acute medical care. Methods: Data were obtained from hospital admission registers and medical records from May 2005 to May 2006. The initial severity of TBI was measured by the Glasgow Coma Scale. The region is urban with a population of 534,129. Results: The 445 patients identified represent an annual incidence of 83.3/100,000. The median age was 29 years. The male:female ratio was 1.8:1.0. The highest incidence of TBI hospitalizations was found in the elderly males and the youngest children. The most common causes of TBI were falls (51%) and transport accidents (29.7%). Intracranial lesions were found more often in the elderly. The case fatality rate was 2.0/100 hospitalized patients and was highest in the elderly. Conclusions: The incidence of hospital-treated TBI in this study is considerably lower than that found in previous studies from Norway and Scandinavia. Despite the apparent decline in TBI hospitalization rates, our findings should also draw attention to the need for more effective preventive programmes related to falls. Studies that assess long-term consequences of TBI in elderly patients are also needed.

Reduction in BMI z-score and improvement in cardiometabolic risk factors in obese children and adolescents. The Oslo Adiposity Intervention Study - a hospital/public health nurse combined treatment

BackgroundWeight loss and increased physical fitness are established approaches to reduce cardiovascular risk factors. We studied the reduction in BMI z-score associated with improvement in cardiometabolic risk factors in overweight and obese children and adolescents treated with a combined hospital/public health nurse model. We also examined how aerobic fitness influenced the results.MethodsFrom 2004-2007, 307 overweight and obese children and adolescents aged 7-17 years were referred to an outpatient hospital pediatrics clinic and evaluated by a multidisciplinary team. Together with family members, they were counseled regarding diet and physical activity at biannual clinic visits. Visits with the public health nurse at local schools or at maternal and child health centres were scheduled between the hospital consultations. Fasting blood samples were taken at baseline and after one year, and aerobic fitness (VO2peak) was measured. In the analyses, 230 subjects completing one year of follow-up by December 2008 were divided into four groups according to changes in BMI z-score: Group 1: decrease in BMI z-score≥0.23, Group 2: decrease in BMI z-score≥0.1-< 0.23, Group 3: decrease in/stable BMI z-score≥0.0-< 0.1, Group 4: increase in BMI z-score (>0.00-0.55).Results230 participants were included in the analyses (75%). Mean (SD) BMI z-score was reduced from 2.18 (0.30) to 2.05 (0.39) (p < 0.001) in the group as a whole. After adjustment for BMI z-score, waist circumference and gender, the three groups with reduced BMI z-score had a significantly greater reduction in HOMA-IR, insulin, total cholesterol, LDL cholesterol and total/HDL cholesterol ratio than the group with increased BMI z-score. Adding change in aerobic fitness to the model had little influence on the results. Even a very small reduction in BMI z-score (group 3) was associated with significantly lower insulin, total cholesterol, LDL and total/HDL cholesterol ratio. The group with the largest reduction in BMI z-score had improvements in HOMA-IR and aerobic fitness as well. An increase in BMI z-score was associated with worsening of C-peptide and total/HDL cholesterol ratio.ConclusionsEven a modest reduction in BMI z-score after one year of combined hospital/and public health nurse intervention was associated with improvement in several cardiovascular risk factors.

The establishment of a new national network leads to quality improvement in childhood diabetes: Implementation of the ISPAD Guidelines

Margeirsdottir HD, Larsen JR, Kummernes SJ, Brunborg C, Dahl‐Jørgensen K on the behalf of the Norwegian Study Group for childhood diabetes. The establishment of a new national network leads to quality improvement in childhood diabetes: Implementation of the ISPAD Guidelines.

Ethnic differences in metabolic syndrome among overweight and obese children and adolescents: the Oslo Adiposity Intervention Study

Aim: Are there differences in the prevalence of metabolic syndrome between obese and overweight Norwegian and immigrant children and adolescents?

Predictive Value of Serial High‐Resolution Computed Tomography Analyses and Concurrent Lung Function Tests in Systemic Sclerosis

Systemic sclerosis (SSc) carries a high risk of progressive interstitial lung disease (ILD), but tools for stratifying individual risk are scarce. The purpose of this study was to assess detailed data from serial lung fibrosis measurements and paired pulmonary function tests (PFTs) as outcome prediction tools in a prospective cohort of SSc patients.

Body mass index and the risk of meningioma, glioma and schwannoma in a large prospective cohort study (The HUNT Study)

Background:Obesity increases the risk for a number of solid malignant tumours. However, it is not clear whether body mass index (BMI) and height are associated with the risk of primary tumours of the central nervous system (CNS).Methods:In a large population study (The Nord–Trøndelag Health Study (HUNT Study)) of 74 242 participants in Norway, weight and height were measured. During follow-up, incident CNS tumours were identified by individual linkage to the Norwegian Cancer Registry. Sex- and age-adjusted and multivariable Cox regression analyses were used to evaluate BMI and height in relation to the risk of meningioma, glioma and schwannoma.Results:A total of 138 meningiomas, 148 gliomas and 39 schwannomas occurred during 23.5 years (median, range 0–25) of follow-up. In obese women (BMI ⩾30 kg m−2), meningioma risk was 67% higher (hazard ratio (HR)=1.68, 95% confidence interval (CI): 0.97–2.92, P-trend=0.05) than in the reference group (BMI 20–24.9 kg m−2), whereas no association with obesity was observed in males. There was no association of BMI with glioma risk, but there was a negative association of overweight/obesity (BMI ⩾25 kg m−2) with the risk of schwannoma (HR=0.48, 95% CI: 0.23–0.99). However, the schwannoma analysis was based on small numbers. Height was not associated with the risk for any tumour subgroup.Conclusion:These results suggest that BMI is positively associated with meningioma risk in women, and possibly, inversely associated with schwannoma risk.

Elevated visfatin levels in overweight and obese children and adolescents with metabolic syndrome

Abstract Objective: Adipokines have been implicated in the pathogenesis of metabolic syndrome (MetS) and insulin resistance. We investigated the association between these conditions and serum levels of visfatin, adiponectin and leptin. Material and methods: 175 overweight and obese boys and girls aged 3–17 years. MetS was defined as presence of at least three of the following: triglycerides ≥ 1.24 mmol/L, high-density lipoprotein cholesterol ≤ 1.03 mmol/L, fasting glucose ≥ 6.1 mmol/L, elevated waist circumference and systolic or diastolic blood pressure ≥ 90th percentile. Results: After adjustment for age and gender visfatin levels were significantly higher (median 19.0 [25th, 75th percentiles 11.9 , 37.1] vs. 15.2 [11.6 , 21.1] ng/ml; padjusted = 0.02) in subjects with MetS (n = 41) compared to subjects without (n = 134). There were no significant differences in adiponectin or leptin levels between the two groups after adjustment for age and gender. Visfatin levels increased proportionally with number of MetS components (β = 0.16, 95%CI 0.04, 0.28; padjusted = 0.01), and adiponectin levels decreased proportionally with number of components (β = −0.11, 95%CI −0.18, −0.04; padjusted = 0.002). Leptin levels were not related to number of components of MetS. Unlike visfatin, both adiponectin (β = −0.24, 95%CI −0.33, −0.15; padjusted < 0.001) and leptin (β = 0.14, 95%CI 0.01, 0.28; padjusted = 0.03) were associated with insulin resistance. Conclusion: The elevation of visfatin observed in children and adolescents with MetS was proportionate to number of components of MetS but was not associated with insulin resistance. The increase in visfatin may contribute to low-grade systemic inflammation associated with MetS.

Sweets, snacking habits, and skipping meals in children and adolescents on intensive insulin treatment.

Aim:  To examine the association between skipping meals and snacking events and dietary and clinical characteristics in children and adolescents using modern insulin treatment.