Jonas Christoffer Lindstrøm

Effect of high-dose vitamin D3 supplementation on antibody responses against Epstein–Barr virus in relapsing-remitting multiple sclerosis:

Background: Elevated antibody levels against Epstein–Barr virus (EBV) and a poor vitamin D status are environmental factors that may interact in relapsing-remitting multiple sclerosis (RRMS) aetiology. Objectives: To examine effects of high-dose oral vitamin D3 supplementation on antibody levels against EBV nuclear antigen 1 (EBNA1) in RRMS. Methods: Serum 25-hydroxyvitamin D3 (25(OH)D) and immunoglobulin G antibody levels against EBNA1 (whole protein and amino acid 385–420 fragment), EBV viral capsid antigen (VCA), cytomegalovirus (CMV) and varicella zoster virus (VZV) were measured in 68 RRMS patients enrolled in a 96-week randomised double-blinded placebo-controlled clinical trial of oral vitamin D3 supplementation (20,000 IU/week) (NCT00785473). Results: The mean 25(OH)D level more than doubled in the vitamin D group and was significantly higher than in the placebo group at study conclusion (123.2 versus 61.8 nmol/L, p < 0.001). Compared to the placebo group, both anti-EBNA1 protein and fragment antibody levels decreased in the vitamin D group from baseline to week 48 (p = 0.038 and p = 0.004, respectively), but not from baseline to week 96. Vitamin D3 supplementation did not affect antibodies against VCA, CMV or VZV. Conclusion: The results indicate that high-dose oral vitamin D3 supplementation can affect humoral immune responses against the latent EBV antigen EBNA1 in RRMS.

Monitoring adverse events in Norwegian hospitals from 2010 to 2013

Objectives To describe how adverse event (AE) rates were monitored and estimated nationally across all Norwegian hospitals from 2010 to 2013, and how they developed during the monitoring period. Monitoring was based on medical record review with Global Trigger Tool (GTT). Setting All publicly and privately owned hospitals were mandated to review randomly selected medical records to monitor AE rates. The initiative was part of the Norwegian patient safety campaign, launched by the Norwegian Ministry of Health and Care Services. It started in January 2011 and lasted until December 2013. 2010 was the baseline for the review. One of the main aims of the campaign was to reduce patient harm. Method To standardise the medical record reviews in all hospitals, GTT was chosen as a standard method. GTT teams from all hospitals reviewed 40 851 medical records randomly selected from 2 249 957 discharges from 2010 to 2013. Data were plotted in time series for local measurement and national AE rates were estimated, plotted and monitored. Results AE rates were estimated and published nationally from 2010 to 2013. Estimated AE rates in severity categories E-I decreased significantly from 16.1% in 2011 to 13.0% in 2013 (−3.1% (95% CI −5.2% to −1.1%)). Conclusions Monitoring estimated AE rates emerges as a potential element in national systems for patient safety. Estimated AE rates in the category of least severity decreased significantly during the first 2 years of the monitoring.

Prevalence of Posttraumatic Stress Disorder in Persons with Chronic Pain: A Meta-analysis

Objective To summarize evidence for the prevalence of posttraumatic stress disorder (PTSD) among persons with chronic pain (CP). Methods We searched databases for studies published between January 1995 and December 2016, reporting the prevalence of PTSD in persons with CP. Two reviewers independently extracted data and assessed the risk of bias. We calculated the pooled prevalence using a random-effects model and performed subgroup analyses according to pain location, the population and assessment method. Results Twenty-one studies were included and the PTSD prevalence varied from 0–57%, with a pooled mean prevalence of 9.7%, 95% CI (5.2–17.1). In subgroup analysis, the PTSD prevalence was 20.5%, 95% CI (9.5–39.0) among persons with chronic widespread pain, 11.2%, 95% CI (5.7–22.8) among persons with headache, and 0.3%, 95% CI (0.0–2.4) among persons with back pain. The prevalence in clinical populations was 11.7%, 95% CI (6.0–21.5) and in non-clinical populations 5.1%, 95% CI (0.01–17.2). In studies of self-reported PTSD symptoms, PTSD prevalence was 20.4%, 95% CI (10.6–35.5), and in studies where structured clinical interviews had been used to assess PTSD its prevalence was 4.5%, 95% (CI 2.1–9.3). The risk of bias was medium for most studies and the heterogeneity was high (I2 = 98.6). Conclusion PTSD is overall more prevalent in clinical cohorts of persons with CP and particularly in those with widespread pain, but may not always be more prevalent in non-clinical samples of persons with CP, compared to the general population. There is a large heterogeneity in prevalence across studies. Future research should identify sources of heterogeneity and the mechanisms underlying the comorbidity of the two conditions.

Exploring similarities and differences in hospital adverse event rates between Norway and Sweden using Global Trigger Tool

Objectives In this paper, we explore similarities and differences in hospital adverse event (AE) rates between Norway and Sweden by reviewing medical records with the Global Trigger Tool (GTT). Design All acute care hospitals in both countries performed medical record reviews, except one in Norway. Records were randomly selected from all eligible admissions in 2013. Eligible admissions were patients 18 years of age or older, undergoing care with an in-hospital stay of at least 24 hours, excluding psychiatric and care and rehabilitation. Reviews were done according to GTT methodology. Setting Similar contexts for healthcare and similar socioeconomic and demographic characteristics have inspired the Nordic countries to exchange experiences from measuring and monitoring quality and patient safety in healthcare. The co-operation has promoted the use of GTT to monitor national and local rates of AEs in hospital care. Participants 10 986 medical records were reviewed in Norway and 19 141 medical records in Sweden. Results No significant difference between overall AE rates was found between the two countries. The rate was 13.0% (95% CI 11.7% to 14.3%) in Norway and 14.4% (95% CI 12.6% to 16.3%) in Sweden. There were significantly higher AE rates of surgical complications in Norwegian hospitals compared with Swedish hospitals. Swedish hospitals had significantly higher rates of pressure ulcers, falls and ‘other’ AEs. Among more severe AEs, Norwegian hospitals had significantly higher rates of surgical complications than Swedish hospitals. Swedish hospitals had significantly higher rates of postpartum AEs. Conclusions The level of patient safety in acute care hospitals, as assessed by GTT, was essentially the same in both countries. The differences between the countries in the rates of several types of AEs provide new incentives for Norwegian and Swedish governing bodies to address patient safety issues.

Are Users Satisfied with Assertive Community Treatment in Spite of Personal Restrictions

Abstract The purpose of this explorative study was to examine satisfaction among 70 users of 12 Norwegian Assertive Community Treatment teams. The study was carried out among a group of 70 service users, and reveals generally high levels of satisfaction with the service, with satisfaction also being high in comparison to other ACT satisfaction studies. Users under a Community Treatment Order were more satisfied, while users with an alcohol use disorder were less satisfied. Younger service users were less positive than older users. There was no difference in satisfaction between the genders. This study’s positive result may reflect the ACT model’s focus on user involvement, recovery and building relationships, and the fact that this service has a more holistic approach than previous services that users have experienced.

Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms: A Cluster Randomized Controlled Trial

OBJECTIVE To determine the effectiveness of the Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) for treatment of moderate to severe agitation in people with dementia. METHODS In a single-blinded, cluster randomized controlled trial in 33 nursing homes (clusters) from 20 municipalities in Norway, 229 patients (104 patients in 17 nursing homes and 125 patients in 16 nursing homes) were randomized to an intervention or control group, respectively. The intervention group received TIME, and the control group received a brief education-only intervention. TIME is an interdisciplinary multicomponent intervention and consists of a comprehensive assessment of the patient with the goal to create and put into action a tailored treatment plan. The primary outcome was the between-group difference in change at the agitation/aggression item of the Neuropsychiatric Inventory Nursing Home version between baseline and 8 weeks. Secondary outcomes were the between-group difference in change at the agitation/aggression between baseline and 12 weeks in other neuropsychiatric symptoms, quality of life, and use of psychotropic and analgesic medications between baseline and 8 and 12 weeks. RESULTS A significant between-group difference in reduction of agitation at both 8 weeks (1.1; 95% confidence interval: 0.1-2.1; p = 0.03) and 12 weeks (1.6; 95% confidence interval: 0.6-2.7; p = 0.002) in favor of the TIME intervention was found. CONCLUSION The implementation of TIME resulted in a significant reduction of agitation among nursing homes patients with dementia. These results should inform training programs for care staff in Norway and internationally.

High dose vitamin D supplementation does not affect biochemical bone markers in multiple sclerosis – a randomized controlled trial

BackgroundPeople with multiple sclerosis have high risk of osteoporosis and fractures. A poor vitamin D status is a risk factor for MS, and vitamin D supplementation has been recommended both to prevent MS progression and to maintain bone health.MethodsWe assessed the effect of 20,000 IU vitamin D3 weekly compared to placebo on biochemical markers of bone metabolism in 68 persons with relapsing remitting multiple sclerosis.ResultsSerum levels of 25-hydroxyvitamin D more than doubled in the vitamin D group, and parathyroid hormone decreased in the vitamin D group compared to the placebo group at week 48 and week 96. There was however no effect on bone formation as measured by procollagen type I N propeptide (PINP), or on bone resorption as measured by C-terminal cross-linking telopeptide of type I collagen (CTX1). Neither PINP nor CTX1 predicted bone loss from baseline to week 96.ConclusionsThese findings corroborate the previously reported lack of effect of weekly high dose vitamin D supplementation on bone mass density in the same patients, and suggest that such vitamin D supplementation does not prevent bone loss in persons with MS who are not vitamin D deficient.Trial registrationThe trial was registered at ClinicalTrials.gov on April 4 2008, registration number NCT00785473.

Psychometric properties of the Norwegian version of the Evidence-Based Practice Attitude Scale (EBPAS): to measure implementation readiness

BackgroundAttitudes can be a precursor to the decision of whether or not to try a new practice. In order to tailor the implementation of evidence-based practices (EBPs) in mental health settings, we must first consider practitioner attitudes towards EBP adoption. To assess these attitudes, the Evidence-Based Practice Attitude Scale (EBPAS) was developed. The purpose of this study was to investigate the psychometric properties of the Norwegian version of the EBPAS, and to examine differences in attitudes towards implementing EBPs among mental health practitioners.MethodsThe EBPAS was translated into Norwegian and administered to 294 practitioners from seven primary and 22 specialized mental care units within a defined geographical area of Norway.ResultsThe EBPAS showed good psychometric properties. The less clinical experience the practitioner had, the more positive their attitude toward EBPs. Primary care practitioners reported more positive attitudes towards implementing EBPs that were required of them than specialized care practitioners.ConclusionsThe Norwegian version of the EBPAS is a promising tool for measuring implementation readiness in mental health services, and can be used in clinical practice to tailor implementation efforts.Trial registrationThe study was approved by the regional committees for medical and health research ethics [REK 2013/2035] on 25th of May, 2014.

Psychometric properties of a Norwegian adaption of the Barratt Impulsiveness Scale-11 in a sample of Parkinson patients, headache patients, and controls.

To assess the psychometric properties of a Norwegian translation of the Barratt Impulsiveness Scale (BIS‐11) for use in populations of headache, Parkinsons disease (PD), and healthy controls.

Sex ratio in multiple sclerosis mortality over 65 years; an age-period-cohort analysis in Norway

Increasing female: male ratio in multiple sclerosis (MS) has been assigned to cohort effects, with females in more recent birth cohorts possibly being more exposed or vulnerable to environmental risk factors than males. We collected MS mortality data in Norway from 1951 to 2015 from The Norwegian Cause of Death registry. Age-Period-Cohort analysis was conducted using log-linear Poisson models, including sex interaction terms. MS was registered as the underlying, contributing or direct cause in 6060 deaths. MS associated mortality remained stable with a slight preponderance among males until after 1980, and have since increased preferentially among females. Throughout the study period the mean annual increase was 1.25% for females and 0.3% for males (p < 0.0001). Age-period-cohort analysis revealed limited evidence of cohort effects for the gender differences; the best fitting model only included gender-age and gender-period interaction terms. The period effect evened out for males in the last three decades but increased for females, especially among the oldest age-groups. In conclusion, the increased female: male mortality ratio in MS associated mortality is driven mainly by increased mortality among females in the three last decades, particularly in the older age groups. It is best explained by disproportional period effects, providing evidence of time-varying external factors including improved access to diagnosis among females.