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This scoping review will look into barriers and facilitators to referral, access, and participation in cancer rehabilitation for patients with head, neck, or lung cancer from a structural- and healthcare professionals’ perspectives.

Kollektivtrafikk er viktig for menneske over heile verda, og speler ei viktig rolle i å skape trygge og moderne byar. Offentleg eigde reiseselskap, finansiert med fellesskapet sine midlar, har ofte monopol på utforming av kollektivtilbodet. I denne masteroppgåva undersøkast forholdet mellom lokal samferdselspolitikk og retorikk med kritisk diskursanalyse som rammeverk. Eg tek for meg reiseselskapa Ruter i Noreg og Metro de Medellín i Colombia sine strategiar for å kommunisere med passasjerar når samfunna dei opererer i endrar seg. Oppgåva består av ein multimodal tekstanalyse av to kampanjar frå 2018 og 2019, samt ein kontekstanalyse i to lag. Ein toposanalyse kastar ljos over reiseselskapa si eigenforståing, og omgrep frå Fairclough og Halliday gjev ulike perspektiv på dei ulike laga i diskursen. Maurice Charland sin teori om korleis retorikk kan fungere konstitutivt forklarar kva rolle retorikken speler når samfunnet endrar seg. Oppgåva synar at reiseselskapa sine strategiar kan fungere konstituerande om vilkåra i samfunnet ligg til rette for det, slik det gjorde i Medellín på 80- og 90-talet, og at liknande strategiar har potensiale i Oslo. Det kjem også fram at reiseselskapa delar ei bransjeforståing av eigen verksemd og at marknadstenking dominerer i større grad drifta til Metro de Medellín enn Ruter. Funna i denne oppgåva synar at retorikken i kollektivtrafikken er avhengig av reell samfunnsendring for å vere effektiv, men at å etablere eit kollektivt subjekt kan endre korleis menneska i byar samhandlar med kvarandre i det offentlege rom.

Background Grip strength has consistently been found to predict all-cause mortality rates. However, few studies have examined cause-specific mortality or tested age differences in these associations. Methods In 1994, grip strength was measured in the population-based Tromsø Study, covering the ages 50–80 years (N=6850). Grip strength was categorised into fifths, and as z-scores. In this cohort study, models with all-cause mortality and deaths from specific causes as the outcome were performed, stratified by sex and age using Cox regression, adjusting for lifestyle-related and health-related factors. Results During 17 years of follow-up, 2338 participants died. A 1 SD reduction in grip strength was associated with HR=1.17 (95% CI 1.12 to 1.22) for all-cause mortality in a model adjusted for age, gender and body size. This association was similar across all age groups, in men and women, and robust to adjustment for a range of lifestyle-related and health-related factors. Results for deaths due to cardiovascular disease (CVD), respiratory diseases and external causes resembled those for all-cause mortality, while for cancer, the association was much weaker and not significant after adjustment for lifestyle-related and health-related factors. Conclusions Weaker grip strength was associated with increased all-cause mortality rates, with similar effects on deaths due to CVD, respiratory disease and external causes, while a much weaker association was observed for cancer-related deaths. These associations were similar in both genders and across age groups, which supports the hypothesis that grip strength might be a biomarker of ageing over the lifespan.

Source at https://doi.org/10.1093/gerona/gly234. Background: Evidence pertaining to whether more recent born generations of adults reaching old age have better physical capability than previous generations is scarce and inconclusive. We aimed to investigate birth cohort differences in grip strength. Methods: The study comprised 5,595 individuals from the Tromsø study waves in 1994/1995, 2007/2008, and 2015/2016. Grip strength (bar) was measured using a Martin vigorimeter, and compared across three birth cohorts of 66- to 84-year-olds (born in: 1910–1929, 1923–1942, 1931–1949), as well as within narrower age bands to ensure nonoverlapping cohorts. Linear regression was applied, adjusted for age, education, smoking, physical activity, height, and weight. Results: Grip strength increased across birth cohorts, and the increase was similar within narrower age bands and across genders. Overall, the increase in sex-adjusted mean grip strength when comparing the first and latest born cohorts, born 21 years apart, was 0.06 bar (95% CI 0.04, 0.07). Higher educational levels, and greater height and weight in the most recent born cohort explained 48% of this difference, while reduced smoking and physical inactivity in more recent born cohorts had little impact. Conclusions: Our findings suggest higher grip strength in more recent birth cohorts of older Norwegian adults, which can be partly attributed to higher education and greater height. This difference corresponded to a 5-year difference in grip strength; more recent born generations of 80-year-olds, therefore, have similar mean grip strength as 75-year-olds born one generation earlier.

Secular trends in sex-specific prevalence of LTPA 1979–2008. (PDF 28 kb)

Secular trends in sex-specific prevalence of WPA 1979–2008. (PDF 32 kb)

BACKGROUND: Absolute risk estimation is a preferred approach for assessing fracture risk and treatment decision making. This study aimed to evaluate and validate the predictive performance of the Garvan Fracture Risk Calculator in a Norwegian cohort. METHODS: The analysis included 1637 women and 1355 aged 60+ years from the Tromsø study. All incident fragility fractures between 2001 and 2009 were registered. The predicted probabilities of non-vertebral osteoporotic and hip fractures were determined using models with and without BMD. The discrimination and calibration of the models were assessed. Reclassification analysis was used to compare the models performance. RESULTS: The incidence of osteoporotic and hip fracture was 31.5 and 8.6 per 1000 population in women, respectively; in men the corresponding incidence was 12.2 and 5.1. The predicted 5-year and 10-year probability of fractures was consistently higher in the fracture group than the non-fracture group for all models. The 10-year predicted probabilities of hip fracture in those with fracture was 2.8 (women) to 3.1 times (men) higher than those without fracture. There was a close agreement between predicted and observed risk in both sexes and up to the fifth quintile. Among those in the highest quintile of risk, the models over-estimated the risk of fracture. Models with BMD performed better than models with body weight in correct classification of risk in individuals with and without fracture. The overall net decrease in reclassification of the model with weight compared to the model with BMD was 10.6% (p = 0.008) in women and 17.2% (p = 0.001) in men for osteoporotic fractures, and 13.3% (p = 0.07) in women and 17.5% (p = 0.09) in men for hip fracture. CONCLUSIONS: The Garvan Fracture Risk Calculator is valid and clinically useful in identifying individuals at high risk of fracture. The models with BMD performed better than those with body weight in fracture risk prediction.

This thesis highlights several clinically important questions related to bone loss the first year following stroke and with regard to bone mass at stroke onset: Lack of mobility and weight bearing early after stroke is an important factor for the greater bone loss in the proximal femur on the paretic side. Relearning to walk within the first two month after stroke, even with support of another person may, however, reduce the bone loss after immobilisation. The reduction in BMD in the femoral neck appears mainly to occur in the lower part of the neck and on the paretic side. It depends on when or if the patients start to walk after stroke, but also on the amount of body weight born through the paretic leg. Thus, measuring the lower part of the femoral neck may give a better estimate of the impact of gait and weight bearing than measuring the total femoral neck. During the first year after stroke bone mineral is lost in the proximal humerus of the paretic arm, but the loss depends on the initial degree of the paresis. However, stroke patients who regain almost normal arm function within one year, despite being severely impaired initially, loose less bone mineral than patients where a severe paresis persists. Female, but not male, stroke patients have lower femoral neck BMD than population controls. At present it is unclear if low BMD actually increases the risk of stroke in women or reflects a poor health with both high stroke risk and low BMD.