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Tanja Louise Ibsen,1 Siren Eriksen1,2 1Norwegian National Advisory Unit on Aging and Health (Aging and Health), Vestfold Hospital Trust, Tønsberg, Norway; 2Lovisenberg Diaconal University College, Oslo, NorwayCorrespondence: Tanja Louise Ibsen, Email tanja.ibsen@aldringoghelse.noAbstract: Authorities and research institutions emphasise and encourage interdisciplinary research to meet complex societal health challenges as dementia. However, studies that describe an interdisciplinary approach for dementia research are limited. What does it take for research to become interdisciplinary? Is it enough to include researchers from different disciplines? This paper reflects on an interdisciplinary approach to dementia research. Based on existing literature and theories, we elaborate the concept of interdisciplinarity, and how the perspective can contribute and improve dementia care.Keywords: interdisciplinary research, interdisciplinarity, dementia, dementia research

Siren Eriksen,1,2 Ingeborg Pedersen,3 Liv Bjerknes Taranrød,1 Lina Harvold Ellingsen-Dalskau,3 Bjørnar Finnanger Garshol,3 Tanja Louise Ibsen,1 Øyvind Kirkevold,1,4,5 Elin Strandli,1 Grete Grindal Patil31Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway; 2Faculty of Health Studies, Vid Specialized University, Oslo, Norway; 3Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway; 4Centre of Old Age Psychiatry Research, Innlandet Hospital Trust, Gjøvik, Norway; 5Norwegian University of Science and Technology (NTNU) Department of Health Sciences in Gjøvik, NorwayIntroduction: The increasing number of people with dementia will place a considerable challenge on the health care system and will necessitate innovation and new solutions. Day care services aim to provide meaningful activities and coping experiences for the target group. The aim of the present study is to explore the experience and potential health benefits for people with dementia attending farm-based day care services in Norway and their next of kin.Methods and design: The present study is a prospective study organized into several qualitative and quantitative sub-studies. Study period will last from 2016–2020. We use a multi-method approach and both an empirical and a constructivist view on knowledge to explore this multi-facetted phenomenon.Discussion: Several challenges are expected, for instance, the ability to include participants with dementia and keep them within the study for the whole study period. The functioning level of participants regarding language and understanding could challenge their ability to answer. Despite having several limitations, we believe that this study with its different approaches and methods will add important knowledge to the field. Knowledge from our study could be essential for creating day care services of good quality for people with dementia and such services could reduce the burden of care for their next of kin.Keywords: care farms, coping, farm-based activities, green care, meaningful activities, multi-method approach

Tanja Louise Ibsen,1 Siren Eriksen,1 Grete Grindal Patil2 1Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; 2Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway Background: Day care services provide meaningful activities and coping experiences in a safe environment for people with dementia, as well as improve quality of life. Such services vary in types and settings. Farm-based day care (FDC) services are described as services that have been adapted from the farm setting, using farm resources to promote health. There is limited knowledge on the service offered in both FDC and regular day care services for people with dementia. The present study aims to investigate FDC in Norway and describe the services and the participants’ care environment. Materials and methods: We mapped the existing farms offering day care in Norway by the spring 2017 (N=33) and collected information through two cross-sectional surveys (N=32) answered by the service providers at the farms. Results: The farms included in this survey provided day care services to 227 people with dementia, located in most regions of Norway. The services varied in terms of group size and half of the services had young people with dementia (≤65 years) and people with dementia at an early stage as their primary target group. About half of the staff had health care education (47.5%), and there were staff with agricultural competence available in most FDCs. All farms reported that the participants spent time outdoors every day, and all services, except two, had animals. The providers highlighted the opportunity to choose activities that were individually tailored for each participant, as the diversity of resources in the farm made it possible to organize different activities. Conclusion: FDC services have similarities in organization, daily structure, and number of health education personnel to other day care services, but differ in type of care environment with a wide range of activities and available resources like farm buildings, gardens, animals, and outdoor areas. Keywords: green care, care farms, farm context, day care service, person-centered care

Existem fortes evidências de menor incidência de doença cerebrovascular oclusiva, de aterosclerose coronariana e de outros vasos em indivíduos com consumo leve ou moderado de álcool. Este estudo procura analisar o efeito do etanol, em diferentes doses no comportamento da aterosclerose carotídea extracraniana. Através do ultrassom Doppler colorido, foram investigadas 328 artérias carótidas extracranianas, de homens e mulheres brancos, com mais de 35 anos de idade, normotensos, não tabagistas e sem as principais doenças que constituam fatores de risco para doenças cardiovasculares. Foram divididos de acordo com o consumo de álcool por semana (em mililitros) em abstêmios, etilistas leves (1 a 100), moderados (101 a 300) e pesados (301 ou mais). Houve menor incidência de placas de aterosclerose e de estenose naqueles que ingeriram moderada quantidade. CONCLUSÃO: O estudo sugere uma ação protetora do álcool etílico para aterosclerose carotídea, quando ingerido em moderada quantidade.There is less incidence of occlusive cerebrovascular disease, of coronarian atherosclerosis and of other arteries with a light to moderate consumption of alcohol, suggesting that the same may occur with respect with the extracranial carotid arteries. Using color Doppler ultrasonography, we studied 328 extracranial carotid arteries of white male and females over 35 year old, with normal blood pressure, non-smokers and free of the main diseases make up the risk factors for cardiovascular diseases. They were stratified, according to the level of weekly alcohol consumption in milliliters (ml), in abstainers, light drinkers (1 to 100), moderate drinkers (101 to 300) and heavy drinkers (over 301). There was a lower incidence of atherosclerotic plaque and stenosis in the moderate drinkers. CONCLUSION: The study suggests that ethyl alcohol when drunk with moderation exerts a protective action from carotid atherosclerosis.

OBJECTIVE: To evaluate the spontaneous evolution of extracranial carotid atherosclerosis in asymptomatic patients who did not present the main risk factors associated to the disease. METHOD:A prospective study including patients of both genders, age ranging from 40 to 70 years, not presenting any signs and symptoms of cerebrovascular disease and without the main atherosclerosis risk factors were included. Patients who were using or had used medication during the follow-up period that could potentially influence in the spontaneous course of atherosclerosis were excluded. The evaluation of the plaque and degree of stenosis were acquired using mode B, 7.5 MHz Doppler ultrasonography (USG). The follow-up was carried out for 36 months, with clinical, neurological, and USG exams repeated in a period of 6 to 8 months. Ninety-six individuals (48 women) completed the study with the presence of plaque, and 52 (26 women) with a degree of stenosis. RESULTS: As to the degree of stenosis, 25% of the patients had worsening, 69% remained stable and 6% improved. When only the presence or absence of plaque was considered, 20% showed worsening (plaque developed during follow-up), 7% improved (disappearance of plaque), and 73% remained stable. No differences were found between the male and female patients. CONCLUSION: These results confirm the dynamic characteristics of plaque. In asymptomatic individuals without specific treatment, spontaneous improvement may occur, however, rarely. These findings may contribute as an assessment criterion when a decision is to be made in high-risk patients.OBJETIVO: avaliar a evolução espontânea da aterosclerose carotídea. MÉTODO: estudo prospectivo com pessoas de ambos os sexos, idade de 40 a 70 anos, sem sinais e sintomas de doença cerebrovascular e sem os principais fatores de risco para aterosclerose. Foram excluídos os doentes que estavam em uso ou os que, durante o período de acompanhamento, usaram medicações que potencialmente pudessem influir no curso espontâneo da aterosclerose. As avaliações da placa e do grau de estenose foram obtidas por ultrassonografia com Doppler (USG). Investigou-se separadamente a presença de placa e o grau de estenose. O seguimento foi feito por 36 meses, com exame clínico, neurológico e novo USG repetidos com intervalo de 6 a 8 meses. Completaram o estudo 96 indivíduos (48 mulheres) quanto à presença da placa e 52 (26 mulheres) quanto ao grau de estenose. RESULTADOS: Quanto ao grau de estenose, 25% dos indivíduos pioraram, 69% permaneceram estáveis e 6% melhoraram. Quando se considerou apenas a presença ou ausência da placa, 20% pioraram (desenvolveram placa durante o seguimento), 7% melhoraram (desaparecimento da placa) e 73% permaneceram estáveis. Não houve diferença em relação ao sexo. CONCLUSÃO: Estes resultados confirmam as características dinâmicas da placa. Em indivíduos assintomáticos e sem tratamento específico, a melhora espontânea ocorre, porém é pequena. Estes dados podem contribuir para auxiliar na tomada de uma decisão, em doentes de alto risco.

INTRODUÇÃO: O acidente vascular cerebral (AVC) é atualmente a primeira causa de morte no Brasil. O risco de recorrência de AVC é de aproximadamente 30% em cinco anos. Agentes antiagregantes plaquetários são frequentemente prescritos para a prevenção de recorrência do AVC, porém sem um parâmetro laboratorial de ajuste terapêutico. OBJETIVO: Determinar a aplicabilidade da curva de agregação plaquetária, no controle do antiagregante, na prevenção secundária do acidente vascular cerebral isquêmico (AVCi). MÉTODO: Estudo retrospectivo de janeiro de 1990 a janeiro de 2001; foram analisados 189 pacientes com diagnóstico de AVCi acompanhados durante este período com curva de agregação plaquetária. Foram excluídos os portadores de doenças cardioembólicas. Consideraram-se hipoagregados os doentes com agregação plaquetária ativada pelo ADP e/ou pela adrenalina menor ou igual a 50%. Os doentes tiveram acompanhamento por 1 a 6 anos e a taxa de recorrência de AVCi foi comparada entre os normoagregados e os hipoagregados. RESULTADOS: Nove doentes apresentaram novo AVCi no período do seguimento. Entre os hipoagregados ocorreu 2,6% de recidiva e entre os normoagregados, 15,1% (0,03

Introduction: The purpose of this study was to observe the occurrence and character of firework injuries on the two days around New Year in Denmark over the last decade., Materials and Methods: Since 1995/1996 all Accident and Emergency Departments in Denmark have registered all contacts where fireworks were the cause of injury on 31st December and 1st January. Data comprised hospital, sex, age, type of firework, diagnosis and final treatment. Follow-up and reminder by phone secured a 100% response rate. The total number of injured patients was 4,447., Results: The number of firework injuries on the 31st of December and 1st of January was reduced by half over the 12-year period. Furthermore, the number of firework injuries caused by illegal fireworks in 2006/2007 was only 10% of the number in 1996/1997. Only 8% of injuries on last New Year's Eve were caused by illegal firewoks compared to almost 50% at the beginning of the period. A similar halving is seen in serious injuries. Roughly one quarter sustained injuries to the eyes, one quarter to the head/neck and 38% to hands., Conclusion: Firework injuries are now half of the level in 1996/1997. Injuries caused by illegal fireworks and serious injuries have shown a downward tendency throughout the period. The actual number of severe injuries from illegal fireworks is now only 10% of the level in the mid-1990s. This reduction can be attributed to preventive campaigns, greater knowledge of the risk of fireworks in general as well as legislation. Continued focus on preventive campaigns, control of fireworks for the general public and control of firework distribution to professionals is recommended.

Studies performed on airway smooth muscle in vitro have indicated that salmeterol is a partial agonist on the beta2-receptor in comparison to formoterol. In the present study we evaluated whether these pharmacological differences between salmeterol and formoterol also are applicable to asthmatic patients. The protective effects by increasing cumulative doses of formoterol (12, 60, 120 micrograms) and salmeterol (50, 250, 500 micrograms) on methacholine-induced bronchoconstriction were evaluated in a double-blind, crossover, placebo-controlled design. Patients were regularly treated with salbutamol 200 micrograms twice daily during the study period, to avoid variability in beta2-adrenoceptor tolerance. S-potassium, heart rate corrected Q-T interval (Q-Tc), and tremor score were followed as measures of systemic effects. Formoterol dose-dependently protected against methacholine responsiveness (4.6 doubling doses after 120 micrograms). Salmeterol, however, showed a flatter dose-response curve, and a significantly weaker maximal protective effect (2.8 doubling doses after 250 micrograms). Formoterol caused a significantly higher tremor score and a larger drop in S-potassium than salmeterol at the highest doses. These data show that salmeterol is a partial agonist on the beta2-receptor in relation to formoterol in human airways in vivo. Further studies are required to document the clinical consequences of this finding, for example in severe asthmatic patients.

Patients with chronic obstructive pulmonary disease (COPD) are often treated with high dose inhalations of beta 2-agonists. We compared domiciliary therapy with terbutaline administered by the Turbuhaler and by a jet nebulizer. Forty nebulizer users with severe COPD were included in the randomized, double-blind, cross-over study. Terbutaline was inhaled t.i.d. for 2 weeks as dry powder (5 doses = 2.5 mg) by Turbuhaler or as solution (2 ml = 5 mg) by jet nebulizer (Pari Inhalierboy). The mean age of the 25 completing patients was 66 years (range: 54-81), the mean FEV1 was 0.73 l or 29% of predicted (range: 11-55%). The period where the Turbuhaler delivered the active drug was preferred by 16 patients, the nebulizer period by seven (P = 0.09). The median score concerning feeling of control over the disease--according to the Chronic Respiratory Disease Questionnaire--was better after the Turbuhaler period (P = 0.01). Other scores concerning disease related quality of life, the daily peak expiratory flow rates, the additional use of a metered dose inhaler were not significantly different for the two types of treatment. It is concluded that high dose domiciliary terbutaline treatment by Turbuhaler can replace nebulizer treatment in most patients with severe COPD.

The bronchodilating effect of terbutaline dry powder inhaled via Turbuhaler was compared with terbutaline inhaled via a conventional, chlorofluorocarbon (CFC) inhaler and Nebuhaler (750 ml spacer) in 68 consecutive patients attending the emergency department with acute severe bronchial obstruction. The study was of an open, randomized, parallel group design with one study day. Patients were treated with 2.5 mg of terbutaline 15 min apart, either as dry powder via Turbuhaler or with a CFC inhaler in conjunction with Nebuhaler. Data from 62 patients were analyzed. The mean baseline FEV1 values were 0.81 L (SD, 0.64; range, 0.14 to 2.74 L) in the Turbuhaler group (n = 33), and 0.90 L (SD, 0.90; range, 0.27 to 2.60 L) in the Nebuhaler group (n = 29). The mean increases in FEV1 from baseline were 0.40 L (SD, 0.40; range, 0.06 to 2.36 L) and 0.21 L (SD, 0.25; range, -0.05 to 0.95 L) 10 min after the last inhalation via Turbuhaler and Nebuhaler, respectively. The difference between mean values of the increase in FEV1 after terbutaline treatment with Turbuhaler and the CFC inhaler and Nebuhaler was statistically significant (p = 0.0004, ANOVA). This study showed that inhalation of terbutaline via Turbuhaler produced a significantly greater increase in FEV1 compared with the same dose of terbutaline administered via the CFC inhaler and Nebuhaler in patients attending the emergency department with acute severe bronchial obstruction.

A cross sectional study of 1064 unselected school children aged 6-17 years obtained the following for 851 of them (80%): complete data from a questionnaire on current asthma diagnosed by a physician, information on previous recurrent wheezing and present exposure to tobacco smoking combined with measurement of peak expiratory flow rate (PEFR) before and after six minutes running. Seventy-five (8.8%) had had previous periods of recurrent wheezing, and 535 (62.7%) were exposed to tobacco smoking at home. A correlation was found between passive smoking and previous recurrent wheezing. Thirty-four (4.0%) suffered from current asthma. Thirty-one children (3.6%) without an earlier diagnosis of asthma showed a significant exercise-induced fall in PEFR) (at least 15%). Thirty of these 31 children were followed up, and at reinvestigation, 27 (95%) were confirmed to suffer from hyperreactive airways based on significant exercise-induced fall in PEFR and/or a significantly increased variability of PEFR of at least 15% as measured by home recordings of PEFR. In conclusion the point prevalence of asthma diagnosed by a physician was 4.0%. In addition at least 3.2% had reproducible significant bronchial hyperreactivity indicating a point prevalence of asthma/clinically significant bronchial hyperreactivity of at least 7.2%. Asthma seems to be underdiagnosed in school children. Furthermore, our results indicate an association between passive smoking and recurrent wheezing.

Bambuterol is the first long-acting oral beta 2-agonist with a 24 h effective duration. In order to investigate the possibility of replacing established treatment modalities with bambuterol once daily, we wanted to compare the bronchodilating and tremorogenic effects of bambuterol, 10 mg once daily, and terbutaline, 5 mg controlled-release (CR) tablets twice daily. The study was of a double-blind, double-dummy, randomized, cross-over design and involved two, two week treatment periods, separated by a one week wash-out period. Peak expiratory flow (PEF) recorded in patients' diaries was the primary efficacy variable. Seventy adult, asthmatic out-patients with mild to moderate asthma were included (forced expiratory volume in one second (FEV1) > or = 50% predicted). After treatment with bambuterol, mean morning and evening PEF (SD) were 347 (122) and 365 (121) l.min-1, respectively and 346 (121) and 365 (122) l.min-1, respectively, after treatment with terbutaline. FEV1 (SD) was 2.21 (0.91) l and 2.27 (0.93) l after bambuterol and terbutaline treatments, respectively. Tremor scores tended to be lower during treatment with bambuterol, although not significantly so. Tremor scores were low, in general. In conclusion, no difference in the bronchodilating effect was demonstrated between bambuterol, 10 mg once daily, and controlled release terbutaline, 5 mg twice daily. A tendency towards less tremor was seen with bambuterol.

A total of 140 patients with chronic obstructive pulmonary disease was included in this multicentre parallel group investigation with the object of assessing whether poor inhalation technique results in increased consumption of beta 2-agonist. On the basis of measurements of pulmonary function, the patients were stratified into two groups with good and poor inhalation techniques, respectively, and these were subdivided at random to inhalation of terbutaline via either a freon spray (aerosol) or Turbohaler (powder). During a period of four weeks the daily terbutaline consumption, the symptoms and pulmonary function were noted. Patients with poor inhalation technique did not have significantly increased terbutaline consumption. The consumption of terbutaline was independent of the method of administration. The Turbohaler was just as effective as the spray and the patients preferred this method, (p less than 0.05).

During recent years, in assessment of the therapeutic effect of medicinal treatment, measurement of the general condition of health or quality of life has been extensively employed. This holds true particularly in patients with chronic disease, including patients with chronic obstructive pulmonary disease. In this patient category, several controlled investigations have been carried out in which one or more questionnaires concerning general health have been employed. The questionnaires employed and reviewed are the Sickness impact profile (SIP), Mcmaster's chronic respiratory disease questionnaire (CRQ), Quality of well-being scale (QWB), General health questionnaire (GHQ), Minnesota multiphasic personality inventory (MMPI) and Profile of mood states (POMS). The questionnaires contain questions regarding many aspects of the existence of the patients and have been tested to varying extents for reproducibility, sensitivity and validity. No patent method exists for measurement of quality of life. It is therefore important for interpretation of investigations that the aspects of quality of life which have been measured are clearly defined and that the questionnaire method employed is quoted.

During the period 1976-83, 47 women were operated on for recurrent or persistent cancer of the uterine cervix following initial radiation therapy. The operations performed were Wertheim's operation combined with dissection of the pelvic nodes, or some type of pelvic exenteration. With a 5-year survival of 31% in our material, surgical treatment of centrally located recurrences is a realistic possibility. We recommend an exenterative procedure as the operation is technically easier and the complications require less radical surgical treatment. The operation should only be done on narrow indications in the hope of achieving a cure, and the selection of patients must thus be stringent.

A 71-year-old man developed severe hemorrhagic proctitis 1 year after pelvic irradiation for carcinoma of the urinary bladder. Conservative treatment as well as performance of a colostomy failed to control the rectal bleeding. After irrigation of the rectum with a formalin solution the bleeding stopped, and no recurrence has been observed for the next 14 months.