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Objectives: To study possible effects of aerosol exposure on lung function, fractional exhaled nitric oxide (FeNO) and inflammatory markers in blood from Norwegian cement production workers across one work shift (0 to 8 h) and again 32 h after the non-exposed baseline registration.Methods: 95 workers from two cement plants in Norway were included. Assessment of lung function included spirometry and gas diffusion pre- and post-shift (0 and 8 h). FeNO concentrations were measured and blood samples collected at 0, 8 and 32 h. Blood analysis included cell counts of leucocytes and mediators of inflammation.Results: The median respirable aerosol level was 0.3 mg/m(3) (range 0.02-6.2 mg/m(3)). FEV(1), FEF(25-75%) and DL(CO) decreased by 37 ml (p=0.04), 170 ml/s (p<0.001) and 0.17 mmol/min/kPa (p=0.02), respectively, across the shift. A 2 ppm reduction in FeNO between 0 and 32 h was detected (p=0.01). The number of leucocytes increased by 0.6×10(9) cells/l (p<0.001) across the shift, while fibrinogen levels increased by 0.02 g/l (p<0.001) from 0 to 32 h. TNF-α level increased and IL-10 decreased across the shift. Baseline levels of fibrinogen were associated with the highest level of respirable dust, and increased by 0.39 g/l (95% CI 0.06 to 0.72).Conclusions: We observed small cross-shift changes in lung function and inflammatory markers among cement production workers, indicating that inflammatory effects may occur at exposure levels well below 1 mg/m(3). However, because the associations between these acute changes and personal exposure measurements were weak and as the long-term consequences are unknown, these findings should be tested in a follow-up study. [ABSTRACT FROM AUTHOR]

Background: Occupational worker wellness and safety climate are key determinants of healthcare organizations' ability to reduce medical harm to patients while supporting their employees. We designed a longitudinal study to evaluate the association between work environment characteristics and the patient safety climate in hospital units., Methods: Primary data were collected from Norwegian hospital staff from 970 clinical units in all 21 hospitals of the South-Eastern Norway Health Region using the validated Norwegian Work Environment Survey and the Norwegian version of the Safety Attitudes Questionnaire. Responses from 91,225 surveys were collected over a three year period. We calculated the factor mean score and a binary outcome to measure study outcomes. The relationship between the hospital unit characteristics and the observed changes in the safety climate was analyzed by linear and logistic regression models., Results: A work environment conducive to safe incident reporting, innovation, and teamwork was found to be significant for positive changes in the safety climate. In addition, a work environment supportive of patient needs and staff commitment to their workplace was significant for maintaining a mature safety climate over time., Conclusions: A supportive work environment is essential for patient safety. The characteristics of the hospital units were significantly associated with the unit's safety climate scores, hence improvements in working conditions are needed for enhancing patient safety., Competing Interests: The authors have decleared that no competing interests exist.

This cross-sectional study of the general population of Telemark County, Norway, aimed to identify risk factors associated with poor asthma control as defined by the Asthma Control Test (ACT), and to determine the proportions of patients with poorly controlled asthma who had undergone spirometry, used asthma medication, or been examined by a pulmonary physician. In 2014-2015, the study recruited 326 subjects aged 16-50 years who had self-reported physician-diagnosed asthma and presence of respiratory symptoms during the previous 12 months. The clinical outcome measures were body mass index (BMI), forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), fractional exhaled nitric oxide (FeNO), immunoglobulin E (IgE) in serum and serum C-reactive protein (CRP). An ACT score ≤ 19 was defined as poorly controlled asthma. Overall, 113 subjects (35%) reported poor asthma control. The odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with poorly controlled asthma were: self-reported occupational exposure to vapor, gas, dust, or fumes during the previous 12 months (OR 2.0; 95% CI 1.1-3.6), body mass index ≥ 30 kg/m2 (OR 2.2; 95% CI 1.2-4.1), female sex (OR 2.6; 95% CI 1.5-4.7), current smoking (OR 2.8; 95% CI 1.5-5.3), and past smoking (OR 2.3; 95% CI 1.3-4.0). Poor asthma control was also associated with reduced FEV1 after bronchodilation (β -3.6; 95% CI -7.0 to -0.2). Moreover, 13% of the participants with poor asthma control reported no use of asthma medication, 51% had not been assessed by a pulmonary physician, and 20% had never undergone spirometry. Because these data are cross-sectional, further studies assessing possible risk factors in general and objectively measured occupational exposure in particular are needed. However, our results suggest that there is room for improvement with regards to use of spirometry and pulmonary physician referrals when a patient's asthma is inadequately controlled., Competing Interests: The authors have declared that no competing interests exist.

Objective: To investigate whether physician-diagnosed asthma modifies the associations between multiple lifestyle factors, sick leave and work ability in a general working population., Methods: A cross-sectional study was conducted in Telemark County, Norway, in 2013. A sample of 16 099 respondents completed a self-administered questionnaire. We obtained complete data on lifestyle, work ability and sick leave for 10 355 employed persons aged 18-50 years. We modelled sick leave and work ability using multiple logistic regression, and introduced interaction terms to investigate whether associations with lifestyle factors were modified by asthma status., Results: Several lifestyle risk factors and a multiple lifestyle risk index were associated with sick leave and reduced work ability score among persons both with and without physician-diagnosed asthma. A stronger association between lifestyle and sick leave among persons with asthma was confirmed by including interaction terms in the analysis: moderate lifestyle risk score * asthma OR = 1.4 (95% CI 1.02-2.1); high lifestyle risk score * asthma OR = 1.6 (95% CI 1.1-2.3); very high lifestyle risk score * asthma OR = 1.6 (95% CI 0.97-2.7); obesity * asthma OR = 1.5 (95% CI 1.02-2.1); past smoking * asthma OR = 1.4 (95% CI 1.01-1.9); and current smoking * asthma OR = 1.4 (95% CI 1.03-2.0). There was no significant difference in the association between lifestyle and work ability score among respondents with and without asthma., Conclusions: In the present study, we found that physician-diagnosed asthma modified the association between lifestyle risk factors and sick leave. Asthma status did not significantly modify these associations with reduced work ability score. The results indicate that lifestyle changes could be of particular importance for employees with asthma., Competing Interests: The authors have declared that no competing interests exist.

Objective: This study examines the association between profession-specific work environments and the 7-day mortality of patients admitted to these units with acute myocardial infarction (AMI), stroke and hip fracture., Design: A cross-sectional study combining patient mortality data extracted from the South-Eastern Norway Health Region, and the work environment scores at the hospital ward levels. A case-mix adjustment model was developed for the comparison between hospital wards., Setting: Fifty-six patient wards in 20 hospitals administered by the South-Eastern Norway Regional Health Authority., Participants: In total, 46 026 patients admitted to hospitals with AMI, stroke and hip fracture, and supported by 8800 survey responses from physicians, nurses and managers over a 3-year period (2010-2012)., Primary and Secondary Outcome Measures: The primary outcome measures were the associations between the relative mortality rate for patients admitted with AMI, stroke and hip fractures and the profession-specific (ie, nurses, physicians, middle managers) mean scores on the 19 organisational factors in a validated cross sectional, staff survey conducted annually in Norway. The secondary outcome measures were the mean scores with SD on the organisational factors in the staff survey reported by each profession., Results: The Nurse workload (beta 0.019 (95% CI0.009-0.028)) and middle manager engagement (beta 0.024 (95% CI0.010-0.037)) levels were associated with a case-mix adjusted 7-day patient mortality rates. There was no significant association between physician work environment scores and patient mortality rates., Conclusion: 7-day mortality rates in hospital wards were negatively correlated with the nurse workload and manager engagement levels. A deeper understanding of the relationships between patient outcomes, organisational structure and their underlying cultural barriers is needed because they may provide a better understanding of the harm and death risks for patients due to organisational characteristics., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Health effects of traffic-related air pollution (TRAP) concentrations in densely populated areas are previously described. However, there is still a lack of knowledge of the health effects of moderate TRAP levels. The aim of the current study, a population-based survey including 16 099 adults (response rate 33%), was to assess the relationship between TRAP estimates and respiratory symptoms in an area with modest levels of traffic; Telemark County, Norway. Respondents reported respiratory symptoms the past 12 months and two TRAP exposure estimates: amount of traffic outside their bedroom window and time spent by foot daily along a moderate to heavy traffic road. Females reported on average more symptoms than males. Significant relationships between traffic outside their bedroom window and number of symptoms were only found among females, with the strongest associations among female occasional smokers (incidence rate ratio [IRR], 1.75, 95% confidence interval (CI) [1.16-2.62] for moderate or heavy traffic compared to no traffic). Significant relationship between time spent daily by foot along a moderate to heavy traffic road and number of symptoms was found among male daily smokers (IRR 1.09, 95% CI [1.04-1.15] per hour increase). Associations between traffic outside bedroom window and each respiratory symptom were found. Significant associations were primarily detected among females, both among smokers and non-smokers. Significant associations between time spent by foot daily along a moderate to heavy traffic road (per hour) and nocturnal dyspnoea (odds ratio (OR) 1.20, 95% CI [1.05-1.38]), nocturnal chest tightness (OR 1.13 [1.00-1.28]) and wheezing (OR 1.14 [1.02-1.29]) were found among daily smokers, primarily men. Overall, we found significant associations between self-reported TRAP exposures and respiratory symptoms. Differences between genders and smoking status were identified. The findings indicate an association between TRAP and respiratory symptoms even in populations exposed to modest levels of TRAP., Competing Interests: The authors have declared that no competing interests exist.

Purpose: To examine gender-specific associations between multiple lifestyle-related risk factors, appearance satisfaction and depressive symptoms in a sample of Norwegian adolescents (13-16 years of age), and to study the role of appearance satisfaction as a possible confounder in the associations between lifestyle and depressive symptoms. Materials and methods: Data were obtained from Ungdata , a cross-sectional national survey of adolescents in Norway. In total 4379 subjects were included in the study. We constructed a lifestyle risk index and used multiple logistic regressions to examine the associations between lifestyle-related risk factors, appearance satisfaction, and depressive symptoms. Results: High screen time and use of alcohol were significantly associated with depressive symptoms among girls, while high screen time, tobacco and cannabis use were significantly associated with depressive symptoms among boys. An additive relationship was observed between the lifestyle risk index scores and the likelihood of depressive symptoms for both genders, the relationship being strongest among boys. Low appearance satisfaction was strongly associated with depressive symptoms, especially among boys, and identified as an important confounder in the associations between lifestyle and depressive symptoms, particularly among girls. Conclusions: High screen time was the most prevalent lifestyle risk behavior independently associated with depressive symptoms. Multiple lifestyle changes and improvement of appearance satisfaction should be included in measures targeting adolescents for the prevention and treatment of depressive symptoms. Future studies should elaborate on the gender differences in other adolescent age groups. Appearance satisfaction should be acknowledged as an important confounder in future studies of lifestyle and depressive symptoms.

Aims: A prolonged corrected QT interval (QTc) ≥500 ms is associated with high all-cause mortality in hospitalized patients. We aimed to explore any difference in short- and long-term mortality in patients with QTc ≥500 ms compared with patients with QTc <500 ms after adjustment for comorbidity and main diagnosis., Methods and Results: Patients with QTc ≥500 ms who were hospitalized at Telemark Hospital Trust, Norway between January 2007 and April 2014 were identified. Thirty-day and 3-year all-cause mortality in 980 patients with QTc ≥500 ms were compared with 980 patients with QTc <500 ms, matched for age and sex and adjusting for Charlson comorbidity index (CCI), previous admissions, and main diagnoses. QTc ≥500 ms was associated with increased 30-day all-cause mortality [hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.38-2.62; P < 0.001]. There was no significant difference in mortality between patients with QTc ≥500 ms and patients with QTc <500 ms who died between 30 days and 3 years; 32% vs. 29%, P = 0.20. Graded CCI was associated with increased 3-year all-cause mortality (CCI 1-2: HR 1.62, 95% CI 1.34-1.96; P < 0.001; CCI 3-4: HR 2.50, 95% CI 1.95-3.21; P < 0.001; CCI ≥5: HR 3.76, 95% CI 2.85-4.96; P < 0.001) but was not associated with 30-day all-cause mortality., Conclusion: QTc ≥500 ms is a powerful predictor of short-term mortality overruling comorbidities. QTc ≥500 ms also predicted long-term mortality, but this effect was mainly caused by the increased short-term mortality. For long-term mortality, comorbidity was more important., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Objectives: The aim of this study was to investigate the association between multiple lifestyle-related risk factors (unhealthy diet, low leisure-time physical activity, overweight/obesity and smoking) and self-rated work ability in a general working population., Setting: Population-based cross-sectional study, in Telemark County, Norway, 2013., Participants: A random sample of 50 000 subjects was invited to answer a self-administered questionnaire and 16 099 responded. Complete data on lifestyle and work ability were obtained for 10 355 participants aged 18-50 years all engaged in paid work during the preceding 12 months., Outcome Measure: Work ability was assessed using the Work Ability Score (WAS)-the first question in the Work Ability Index. To study the association between multiple lifestyle risk factors and work ability, a lifestyle risk index was constructed and relationships examined using multiple logistic regression analysis., Results: Low work ability was more likely among subjects with an unhealthy diet (OR adj 1.3, 95% CI 1.02 to 1.5), inactive persons (OR adj 1.4, 95% CI 1.2 to 1.6), obese respondents (OR adj 1.5, 95% CI 1.3 to 1.7) and former and current smokers (OR adj 1.2, 95% CI 1.1 to 1.4 and 1.3, 95% CI 1.2 to 1.5, respectively). An additive relationship was observed between the lifestyle risk index and the likelihood of decreased work ability (moderate-risk score: OR adj 1.3; 95% CI 1.1 to 1.6; high-risk score: OR adj 1.9; 95% CI 1.6 to 2.2; very high risk score: OR adj 2.4; 95% CI 1.9 to 3.0). The overall population attributable fraction (PAF) of low work ability based on the overall risk index was 38%, while the PAFs of physical activity, smoking, body mass index and diet were 16%, 11%, 11% and 6%, respectively., Conclusions: Lifestyle risk factors were associated with low work ability. An additive relationship was observed. The findings are considered relevant to occupational intervention programmes aimed at prevention and improvement of decreased work ability., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Asthma is defined by variable respiratory symptoms and lung function, and may influence work ability. Similarly, obesity may contribute to respiratory symptoms, affect lung function, and reduce work ability. Thus, assessment of the influence of obesity on work ability, respiratory symptoms, and lung function in adults with asthma is needed., Objectives: We hypothesized that patients with obesity and asthma have more respiratory symptoms and reduced work ability and lung function compared with normal-weight patients with asthma., Methods: We examined 626 participants with physician-diagnosed asthma, aged 18-52 years, recruited from a cross-sectional general population study using a comprehensive questionnaire including work ability score, the asthma control test (ACT), height and weight, and spirometry with reversibility testing., Results: Participants with a body mass index (BMI) ≥30 kg/m2 (i.e., obese) had a higher symptom score (OR 1.78, 95% CI 1.14-2.80), current use of asthma medication (1.60, 1.05-2.46), and incidence of ACT scores ≤19 (poor asthma control) (1.81, 1.03-3.18) than participants with BMI ≤24.9 kg/m2 (i.e., normal weight). Post-bronchodilator forced vital capacity (FVC) as a percentage of predicted (β coefficient -4.5) and pre-bronchodilator forced expiratory volume in 1 s as a percentage of predicted (FEV1) (β coefficient -4.6) were negatively associated with BMI ≥30 kg/m2. We found no statistically significant association of BMI >30 kg/m2 (compared to BMI <24.9 kg/m2) with sick leave (1.21, 0.75-1.70) or reduced work ability (1.23, 0.74-2.04)., Conclusions: There were indications that patients with obesity had a higher symptom burden, poorer asthma control, higher consumption of asthma medication, and reduced lung function, in particular for FVC, compared with normal-weight patients., (© 2019 S. Karger AG, Basel.)

Purpose: The present study investigated the associations between the aspects of sleep problems and mental health in Norwegian young adolescents., Materials and Methods: Adolescents (12-13 years) were recruited from the primary schools in Telemark County, Norway. Sleep related problems were assessed by asking parents three questions related to their childrens' sleep quality, sleep sufficiency, and daytime sleepiness. Parents reported data on mental health by the extended version of the Strengths and Difficulties Questionnaire (SDQ), and information on the child's physical activity, screen time, eating pattern, gender, and background variables. Height and weight were objectively measured. Complete data were obtained for 690 adolescents., Results: Multiple logistic regressions were used. Bivariate analyses indicated important associations between the sleep aspects and mental health. When adjusting the sleep variables for each other, lifestyle factors and background variables, sleep quality problems were associated with any psychiatric problem (OR adj : 4.0, CI: 2.0-8.2), emotional problems (OR adj : 15.1, CI: 3.4-66.8), and hyperactivity-inattention problems (OR adj : 5.1, CI: 2.2-12.1). Daytime sleepiness problems were associated with any psychiatric problem (OR adj : 2.3, CI: 1.2-4.4), and hyperactivity-inattention problems (OR adj : 2.5, CI: 1.1-5.5). Bivariate associations between problems with sufficient sleep and mental health problems lost the significance when adjusted for other sleep variables., Conclusions: The results indicate that different aspects of sleep problems may be important underlying factors for mental health problems in adolescents, independently of lifestyle factors, BMI-category, gender, and background variables. This highlights the importance of examining specific sleep problems when investigating associations between sleep and mental health.

Background: In Norway, data on the association between second-hand tobacco smoke (SHS) exposure at home and respiratory symptoms in adults are limited., Methods: We assessed the association between self-reported exposure to SHS and the prevalence of respiratory symptoms among never-smokers aged 16 to 50 years from the general population who were included in a cross-sectional population-based study in Telemark County, Norway. Logistic regression analysis was used to estimate the odds ratios of symptoms among 8850 never-smokers who provided an affirmative response to questions regarding SHS; 504 (5.7%) of these reported that they lived in a home with daily or occasional indoor smoking., Results: Productive cough and nocturnal dyspnoea were statistically associated with daily SHS exposure (ORs 1.5 [95% CI 1.04-2.0] and 1.8 [1.2-2.7], respectively). In analyses stratified by gender, nocturnal dyspnoea was associated with SHS among women (OR 1.8 [1.1-3.1]), but not among men (OR 0.93 [0.49-1.8]). Symptoms were not associated with occasional SHS exposure in the entire group, but infrequent exposure among men only was associated with increased prevalence of chronic cough; (OR 1.6; [1.04-2.6]) and was negatively associated with wheeze; (OR 0.44 [0.21-0.92)]., Conclusions: Daily SHS exposure in private homes was associated with productive cough and nocturnal dyspnoea. Our results suggest that preventive measures may be needed to reduce the respiratory effects of SHS at home., Trial Registration: ClinicalTrials.gov Identifier: NCT02073708 Registered February 27. 2014.

Objectives: The aim of this study was to estimate the prevalence of respiratory symptoms and physician-diagnosed asthma and assess the impact of current occupational exposure., Design: Cross-sectional analyses of the prevalence of self-reported respiratory health and association with current occupational exposure in a random sample of the general population in Telemark County, Norway., Settings: In 2013, a self-administered questionnaire was mailed to a random sample of the general population, aged 16-50, in Telemark, Norway. The overall response rate was 33%, comprising 16 099 responders., Outcome Measures: The prevalence for respiratory symptoms and asthma, and OR of respiratory symptoms and asthma for occupational groups and exposures were calculated. Occupational exposures were assessed using self-reported exposure and an asthma-specific job-exposure matrix (JEM)., Results: The prevalence of physician-diagnosed asthma was 11.5%. For the occupational groups, the category with agriculture/fishery workers and craft/related trade workers was associated with wheezing and asthma attack in the past 12 months, showing OR 1.3 (1.1 to 1.6) and 1.9 (1.2 to 2.8), respectively. The group including technicians and associated professionals was also associated with wheezing OR 1.2 (1.0 to 1.3) and asthma attack OR 1.4 (1.1 to 1.9). The JEM data show that exposure to flour was associated with wheezing OR 3.2 (1.4 to 7.3) and woken with dyspnoea OR 3.5 (1.3 to 9.5), whereas exposures to diisocyanates, welding/soldering fumes and exposure to vehicle/motor exhaust were associated with dyspnoea OR 2.9 (1.5 to 5.7), 3.2 (1.6 to 6.4) and 1.4 (1.0 to 1.8), respectively., Conclusions: The observed prevalence of physician-diagnosed asthma was 11.5%. The 'manual' occupations were associated with respiratory symptoms. Occupational exposure to flour, diisocyanates, welding/soldering fumes and vehicle/motor exhaust was associated with respiratory symptoms in the past 12 months and use of asthma medication. However, prospective data are needed to confirm the observed associations., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objective: To investigate BMI-specific associations between health-related behaviours in early adolescence and the likelihood of overweight in mid-adolescence in a sample of Norwegian adolescents., Design: Longitudinal study of 393 adolescents recruited from schools in Telemark County, Norway. Parents reported baseline data on children's behavioural variables and background data (at age 12-13 years). Dietary data were reported by means of a retrospective FFQ. Eating patterns were identified using principal component analysis. Height and weight were measured at baseline and 3-year follow-up. BMI-specific differences in health-related behaviours (eating patterns, physical activity and screen time) at baseline were analysed using cross-tabulation and Pearson's χ 2 test (Fisher's test). Associations between early health-related behaviours and the likelihood of later overweight were examined using multiple logistic regression., Setting: Primary and secondary schools, Telemark, Norway., Subjects: Children (n 393) in 7th grade (mean age 12·7 (sd 0·3) years), followed up in 10th grade, and parents., Results: A moderate to high intake of a varied Norwegian eating pattern combined with moderate-to-vigorous physical activity ≥1 h/d in the 7th grade were associated with a reduced likelihood of being overweight in the 10th grade, but only among already overweight adolescents (adjusted OR=0·2; 95 % CI 0·1, 1·0). Screen time of >3 h/d in the 7th grade was associated with an increased likelihood of subsequent overweight only among adolescents with an initial normal weight (adjusted OR=2·8; 95 % CI 1·1, 7·3)., Conclusions: BMI-specific associations were observed between health-related behaviours in early adolescence and the likelihood of being overweight in mid-adolescence.

Background and Aims: In Norway, data on the aetiology of community-acquired pneumonia (CAP) in hospitalized patients are limited. The aims of this study were to investigate the bacterial aetiology of CAP in hospitalized patients in Norway, risk factors for CAP and possible differences in risk factors between patients with Legionnaire's disease and pneumonia because of other causes., Methods: Adult patients with radiologically confirmed CAP admitted to hospital were eligible for the study. Routine aerobic and Legionella culture of sputum, blood culture, urinary antigen test for Legionella pneumophila and Streptococcus pneumoniae, polymerase chain reaction detection of Chlamydophila pneumoniae, Mycoplasma pneumoniae and Bordetella pertussis from throat specimens, and serology for L. pneumophila serogroup 1-6 were performed. A questionnaire, which included demographic and clinical data, risk factors and treatment, was completed., Results: We included 374 patients through a 20-month study period in 2007-2008. The aetiological agent was detected in 37% of cases. S. pneumoniae (20%) was the most prevalent agent, followed by Haemophilus influenzae (6%) and Legionella spp. (6%). Eight Legionella cases were diagnosed by urinary antigen test, of which four also had positive serology. In addition, 13 Legionella cases were diagnosed by serology. The degree of comorbidity was high. An increased risk of hospital-diagnosed Legionella pneumonia was found among patients with a diagnosis of chronic congestive heart failure., Conclusion: Our results indicate that S. pneumoniae is the most common bacterial cause of pneumonia in hospitalized patients, and the prevalence of Legionella pneumonia is probably higher in Norway than recognized previously., (© 2015 John Wiley & Sons Ltd.)

Objective: To examine gender-specific associations of weight perception and appearance satisfaction with slimming attempts and eating patterns among young Norwegian adolescents., Design: Cross-sectional study. Adolescent dietary data were reported by parents using a retrospective FFQ. Eating patterns were identified using principal component analysis. Adolescents' reported weight perception, appearance satisfaction and slimming attempts were analysed using cross-tabulation and Pearson's χ 2 test. Associations between perceived weight, appearance satisfaction and slimming attempts/eating patterns were examined using multiple logistic regression analysis., Setting: Primary schools, Telemark, Norway., Subjects: Children (n 469), mean age 12·7 (sd 0·3) years, and parents., Results: Gender differences were observed in self-perceived weight and appearance satisfaction. Girls were most satisfied with appearance when feeling thin, boys when feeling just the right weight. Perceived overweight was the main predictor of slimming attempts across genders (adjusted OR=15·3; 95 % CI 6·0, 39·1 for girls; adjusted OR=18·2; 95 % CI 5·8, 57·3 for boys). Low appearance satisfaction was associated with slimming attempts (adjusted OR=3·3; 95 % CI 1·0, 10·5) and a dieting eating pattern (adjusted OR=2·8; 95 % CI 1·5, 5·2) in girls. Perceived underweight was associated with a junk/convenience eating pattern in boys (adjusted OR=2·8; 95 % CI 1·2, 6·4)., Conclusions: Gender differences were observed in subjective body concerns. Perceived overweight was the main predictor of slimming attempts by both genders. Different aspects of body dissatisfaction were related to different food behaviours in boys and girls. Health professionals should be aware of these gender differences when planning health promotion programmes targeting young adolescents.

Objectives: Declining participation in epidemiological studies has been reported in recent decades and may lead to biased prevalence estimates and selection bias. The aim of the study was to identify possible causes and effects of non-response in a population-based study of respiratory health in Norway., Design: The Telemark study is a longitudinal study that began with a cross-sectional survey in 2013., Setting: In 2013, a random sample of 50,000 inhabitants aged 16-50 years, living in Telemark county, received a validated postal questionnaire. The response rate was 33%. In this study, a random sample of 700 non-responders was contacted first by telephone and then by mail., Outcome Measures: Response rates, prevalence and OR of asthma and respiratory symptoms based on exposure to vapours, gas, dust or fumes (VGDF) and smoking. Causes of non-response., Results: A total of 260 non-responders (37%) participated. Non-response was associated with younger age, male sex, living in a rural area and past smoking. The prevalence was similar for responders and non-responders for physician-diagnosed asthma and several respiratory symptoms. The prevalence of chronic cough and use of asthma medication was overestimated in the Telemark study, and adjusted prevalence estimates were 17.4% and 5%, respectively. Current smoking was identified as a risk factor for respiratory symptoms among responders and non-responders, while occupational VGDF exposure was a risk factor only among responders. The Breslow-Day test detected heterogeneity between productive cough and occupational VGDF exposure among responders., Conclusions: The Telemark study provided valid estimates for physician-diagnosed asthma and several respiratory symptoms, while it was necessary to adjust prevalence estimates for chronic cough and use of asthma medication. Reminder letters had little effect on risk factor associations. Selection bias should be considered in future investigations of the relationship between respiratory outcomes and exposures., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Overweight and mental health problems represent two major challenges related to child and adolescent health. More knowledge of a possible relationship between the two problems and the influence of peer problems on the mental health of overweight children is needed. It has previously been hypothesized that peer problems may be an underlying factor in the association between overweight and mental health problems. The purpose of the present study was to investigate the associations between overweight, peer problems, and indications of mental health problems in a sample of 12-13-year-old Norwegian schoolchildren. Children aged 12-13 years were recruited from the seventh grade of primary schools in Telemark County, Norway. Parents gave information about mental health and peer problems by completing the extended version of the Strength and Difficulties Questionnaire (SDQ). Height and weight were objectively measured. Complete data were obtained for 744 children. Fisher's exact probability test and multiple logistic regressions were used. Most children had normal good mental health. Multiple logistic regression analysis showed that overweight children were more likely to have indications of psychiatric disorders (adjusted OR: 1.8, CI: 1.0-3.2) and peer problems (adjusted OR: 2.6, CI: 1.6-4.2) than normal-weight children, when adjusted for relevant background variables. When adjusted for peer problems, the association between overweight and indications of any psychiatric disorder was no longer significant. The results support the hypothesis that peer problems may be an important underlying factor for mental health problems in overweight children.

Objective: To investigate meal pattern longitudinally and explore whether meal skipping was associated with overweight among Norwegian children and adolescents., Design: Longitudinal study. Children's meal frequencies were reported by their parents using a retrospective FFQ. Weight and height were measured by public health nurses. Descriptive data comparing 4th and 7th grade were analysed by paired-sample t tests for continuous variables and χ 2 tests for categorical variables. Odds ratio estimates, including confidence intervals, with BMI category (normal/overweight) as the dependent variable, were determined through logistic regression analyses., Setting: Primary schools, Telemark County, Norway., Subjects: A cohort of 428 Norwegian boys and girls; 4th graders in 2007, 7th graders in 2010., Results: The number of children eating four main meals per day (regular meal frequency) decreased from 4th grade (47 %) to 7th grade (38 %; P = 0·001). Those who ate regular meals in 4th grade but not in 7th grade had higher odds (OR = 3·1; 95 % CI 1·1, 9·0) of being overweight in 7th grade after adjusting for gender, maternal education and physical activity, but the odds ratio was not statistically significant after adjusting for overweight in 4th grade (OR = 2·8; 95 % CI 0·7, 11·6)., Conclusions: The present study showed significant increases in overall meal skipping among children between 4th and 7th grade. The results indicate an association between overweight and meal skipping, but additional prospective and longitudinal analyses and intervention trials are warranted to confirm this relationship.

Objective: To investigate the association between eating patterns and mental health problems in young Norwegian adolescents (12-13 years of age)., Design: Cross-sectional study. Dietary information was reported by parents using a retrospective FFQ. Eating patterns were identified using principal component analysis. The Strengths and Difficulties Questionnaire was used to measure mental health problems. The association between eating patterns and mental health problems was examined using multiple logistic regression analysis., Setting: Primary schools, Telemark County, Norway., Subjects: Children (n 1095) aged 12-13 years and their parents., Results: Children with high scores on a 'varied Norwegian' eating pattern were less likely to have indications of any psychiatric disorders (adjusted OR = 0·5; 95 % CI 0·3, 1·0) and hyperactivity-inattention disorders (adjusted OR = 0·4; 95 % CI 0·2, 0·8) than children with low scores on this pattern. Children with high scores on a 'junk/convenient' eating pattern were more likely to have indications of hyperactivity-inattention disorders (adjusted OR = 3·4; 95 % CI 1·3, 8·6) than children with low scores on this pattern. Children with high scores on a 'snacking' eating pattern were more likely to have indications of conduct/oppositional disorders (adjusted OR = 3·8; 95 % CI 1·2, 11·5) than those with low scores on this eating pattern., Conclusions: We identified a significant association between eating patterns and mental health problems in young adolescents, independently of physical activity, sedentary activity and background variables. A diverse diet rich in unrefined plant foods, fish and regular meals was associated with better mental health, while energy-dense, nutrient-poor diets and irregular meals were associated with poorer mental health.

Objective: To determine (i) the importance of parents’ motives for everyday family food choices; and (ii) the relationship between parental food choice motives and eating patterns of 12- to 13-year-old children., Design: Cross-sectional study. A modified version of the Food Choice Questionnaire was used to determine parental motives for food choices. The children’s food and drink intake was reported by their parents using a retrospective FFQ. Eating patterns were derived using principal component analysis. The association between food choice motives and eating patterns was examined using multiple linear regression analysis., Setting: Primary schools, Telemark County, Norway., Subjects: In total, 1095 children aged 12–13 years and their parents., Results: The parental motive ‘sensory appeal’ was the most important for food choice, followed by ‘health’, ‘convenience’, ‘natural content’ and ‘weight control’. The food choice motives were associated with the eating patterns of the children, independent of background variables. The motive ‘health’ was most strongly associated with a ‘varied Norwegian’ eating pattern, representing a diverse diet and regular meals, while the motive ‘convenience’ appeared to be the most important barrier to this eating pattern. ‘Weight control’ was not associated with the ‘varied Norwegian’ eating pattern., Conclusions: To encourage parents to make healthy food choices for their children, health promotion activities should focus on the health benefits of a diverse diet and regular meals, rather than weight control. Recommended food products should be made more convenient and easily available for families with children.

Background: The aim of this study was to describe eating patterns in early adolescence and to determine associations between eating patterns and overweight from middle childhood (4th grade, 9 to 10 years old) to early adolescence (7th grade, 12 to 13 years old)., Methods: Children were recruited from primary schools in Telemark County, Norway. Dietary data were obtained by parental report using a food frequency questionnaire. Height and weight were objectively measured, and overweight was defined using international standard cut-off points. Complete data were obtained for 924 4th grade and 691 7th children, and 427 children provided complete data at both time points. Principal component analysis was applied to identify eating patterns. We used multiple logistic regression to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for being overweight., Results: The same four distinct eating patterns were identified at both time points. Correlation coefficients for the factor scores of corresponding eating patterns at baseline and follow up ranged from 0.44 to 0.60. In the follow-up sample, 345 children (80%) were still of normal weight, while 41 (10%) remained overweight. Children with high "dieting" pattern scores and low "varied Norwegian" pattern scores in the 7th grade had an increased risk of being overweight. Children with stable or increased "varied Norwegian" pattern scores had a lower risk of remaining overweight over time than children with decreased scores for this pattern; adjusted OR: 0.4 (95% CI: 0.2, 0.8). This pattern included foods and meals close to current dietary guidelines, including vegetables, fruit and unrefined cereal products. We did not observe an increased risk of overweight in children with high "unhealthy" eating pattern scores, termed "snacking" or "junk/convenient" in either cross-sectional or longitudinal analyses., Conclusions: Slight to moderate stability of eating patterns was observed. Children adhering to a "varied Norwegian" eating pattern were less likely to remain overweight than children with declining adherence to this pattern. Overweight children should be encouraged to eat regular main meals and retain a diverse diet that includes unrefined plant foods, water and fish, rather than fat- and sugar-reduced foods and drinks.

We have studied the influence of genetic polymorphisms in the xenobiotic-metabolizing genes GSTM1, GSTP1, GSTT1, EPHX1, NAT1 and NAT2 and the folate-metabolizing genes MTR and MTHFR on the frequencies of cells with chromosomal aberrations (CAs) in peripheral lymphocytes of Norwegian men. Log-linear Poisson regression models were applied on 357 subjects of whom data on all the polymorphisms examined were available. Total CAs and chromosome-type aberrations (CSAs) were significantly increased by higher age alone, whereas chromatid-type aberrations (CTAs) were elevated by the GSTT1-null genotype and MTHFR codon 222 variant allele and chromatid gaps (CTGs) by EPHX1 high activity genotype and occupational exposure. Stratification by smoking and age (<40 and ≥40 years) showed that the effect of the GSTT1 null and EPHX1 high activity genotypes only concerned (older) smokers, in agreement with the roles of the respective enzymes in detoxification and metabolic activation. The MTHFR codon 222 variant allele was associated with high CTGs in smokers, the MTR codon 919 variant allele with high CTAs in older smokers and the NAT2 fast acetylator genotype with high CTGs in older subjects. Among younger nonsmokers, however, carriers of the MTHFR codon 222 and MTR codon 919 variant alleles showed a decrease in the level of CTGs and total CAs, respectively. In conclusion, polymorphisms of GSTT1, EPHX1, MTHFR, MTR and NAT2 differentially affect the frequency of CTAs, CSAs and CTGs, showing interaction with smoking and age. It appears that CA subtypes rather than total CAs should be considered in this type of studies.

Background/objectives: Increasing prevalence of overweight in children is a growing health problem. The aim of this study was to describe the eating patterns of 9- to 10-year-old schoolchildren, and to investigate the relationship between overweight and eating patterns., Subjects/methods: We recruited 1045 children for a cross-sectional study in Telemark County, Norway. The children's food, snacking and meal frequencies were reported by their parents using a retrospective food frequency questionnaire. Height and weight were measured by health professionals, and body mass index categories were calculated using international standard cutoff points (International Obesity Task Force values). Complete data were obtained for 924 children. Four distinct eating patterns were identified using principal component analysis. We used multiple logistic regression and calculated odds ratios (ORs) with 95% confidence intervals (CIs) for being overweight, and adjusted for parental characteristics and physical activity levels of the children (aORs)., Results: Parental characteristics and physical activity were associated with both obesity and eating patterns. Children adhering to a 'junk/convenient' eating pattern had a significantly lower likelihood of being overweight (aOR: 0.6; 95% CI: 0.4, 0.9), whereas children adhering to a 'varied Norwegian' or a 'dieting' eating pattern had a significantly higher likelihood of being overweight (respective values: aOR: 2.1; 95% CI: 1.3, 3.2; aOR: 2.2; 95% CI: 1.4, 3.4). No association with overweight was seen for a 'snacking pattern'., Conclusions: The main finding was that, although family characteristics influenced both the prevalence of overweight and overall dietary behaviour, independent associations were evident between eating patterns and overweight, indicating parental modification of the diets of overweight children.

Background and Study Aim: To reduce the costs of colonoscopy the feasibility of unsedated procedures has been explored. The aims of our study were to assess patient satisfaction with on-demand sedation and identify factors related to painful colonoscopy., Patients and Methods: The Norwegian Gastronet quality assurance documentation tools consist of endoscopy reports (completed on site) and a patient satisfaction questionnaire (completed by the patient on the day after colonoscopy). Data were collected from January 1 2004 to December 31 2006. Colonoscopies reported to be moderately or severely painful were defined as "painful colonoscopy.", Results: Nine endoscopy centers representing 86 endoscopists reported 14 915 examinations and 12 354 patient reports were returned (83 % response rate). Patient satisfaction with service and information given was greater than 95 % for all centers. Mean rate of painful colonoscopy was 34 % and mean sedation rate 34 %. Odds ratio (OR) for painful colonoscopy was 2.2 ( P < 0.001) when sedation was given. The ORs for painful colonoscopy were similar for all but one center (no. 4) with OR 1.6 ( P = 0.04), while the OR for giving sedation was higher for all but one center (no. 1) compared with the reference center (ORs 2.2 to 7.5, all P-values < 0.001)., Conclusion: A surprisingly high rate of painful colonoscopy was found. High sedation rates were not associated with low rates of painful colonoscopy. Recommending increased sedation rates as the only intervention to improve suboptimal performance might not lead to lower rates of painful colonoscopy., ((c) Georg Thieme Verlag KG Stuttgart . New York.)

Objective: Cement aerosol exposure is associated with increased morbidity of airway disease among exposed workers. Our aim was to compare levels of inflammatory cells and soluble inflammatory markers in induced sputum samples from cement production workers between exposed and unexposed periods, and to compare these variables between cement workers and references., Methods: 35 healthy, non-smoking aerosol-exposed cement production workers from Norway provided a blood sample and performed induced sputum and spirometry after 5 days without exposure and during a period of exposure. These values were compared with those from an internal low-exposed reference group of 15 office workers and an external reference group of 39 non-exposed workers. Differential cell counts and inflammatory markers were assessed., Results: Median thoracic aerosol concentration over one work shift (8 h) was 0.6 mg/m(3) (range 0.2-8.1) in maintenance workers and 1.75 mg/m(3) (0.2-15.5) in furnace department workers. The median percentage of airway neutrophils in both groups combined was 51% (32-66) in the exposed period, which was significantly higher than in both the unexposed period (38%; 23-55) (p=0.04) and the external reference group (30%; 19-44) (p=0.001). Median interleukin-1beta concentration was elevated compared with both office workers (p=0.05) and the external reference group (p=0.006)., Conclusions: A significantly higher percentage of neutrophils was observed in cement production workers during the exposed period compared with both the non-exposed period and the external reference group, and corresponded with elevated IL-1beta concentration. These data indicate that cement aerosol exposure in concentrations below the Norwegian occupational limits (respirable dust 5 mg/m(3); total dust 10 mg/m(3)) may cause airway inflammation.

Objective: An important challenge of any quality assurance (QA) programme is to maintain interest among participants to ensure high data quality over time. The primary aim of this study was to identify factors associated with endoscopist compliance with the Norwegian QA programme for colonoscopies (Gastronet)., Material and Methods: The Gastronet registration tools are an endoscopy report form to be filled in directly after the procedure by the endoscopist, and a satisfaction questionnaire to be filled in by the patient on the day after the examination. During the study period from 1 January 2004 to 31 December 2006, endoscopist compliance was measured by assessing patient report coverage, defined as the percentage of patient satisfaction questionnaires received by the Gastronet secretariat divided by the total number of colonoscopy reports registered by the individual endoscopists during the study period. Multivariate logistic regression models were applied to identify individual factors related to patient report coverage., Results: Eighty-eight endoscopists from 10 hospitals contributed a total of 16,149 colonoscopies. Overall patient report coverage decreased from 87% in 2004 to 80% in 2006. A low patient report coverage was associated with time since the registrations started [odds ratio (OR) 0.98, 95% confidence interval (CI) 0.97-0.98; P < 0.001], use of sedation (OR 0.7, 95% CI 0.61-0.76; P < 0.001), and incomplete colonoscopy (OR 0.6, 95% CI 0.54-0.76; P < 0.001)., Conclusions: Decreasing compliance with registration over time may compromise data quality and the validity of the results. Lower coverage of patient's reports (presumably for the most difficult examinations) may lead to erroneous conclusions regarding colonoscopy performance.

Background: No previous in vitro studies have tested radio frequency radiation for at least one full cell cycle in culture. The aim was to test if exposure used in mobile phones and wireless network technologies would induce DNA damage in cultured human lymphocytes with and without a known clastogen., Materials and Methods: Lymphocytes from six donors were exposed to 2.3 GHz, 10 W/m(2) continuous waves, or 2.3 GHz, 10 W/m(2) pulsed waves (200 Hz pulse frequency, 50% duty cycle). Mitomycin C was added to half of the cultures. DNA synthesis and repair were inhibited in one experiment., Results: No statistically significant differences were observed between control and exposed cultures. A weak trend for more chromosomal damage with the interaction of pulsed fields with mitomycin C compared to a constant field was observed., Conclusion: Exposure during the whole cell cycle in inhibited cultures did not resulted in significant differences in chromosomal aberrations as compared to controls.

Introduction: First aid measures can be life-saving. Starting first aid education early may strengthen interest, motivation and ability to provide first aid., Objective: To determine if a first aid teaching program including 5 lessons (45 min each) of theoretical and practical training for 6-7-year-old children can influence their performance in a first aid scenario., Methods: 228 primary school children at the age of 6-7 years were included in the study, 102 girls and 126 boys. One child was 5 years old. 117 children were taught basic first aid measures and 111 without training served as control group. In the test scenario the children had to provide first aid to an unconscious victim after a cycle accident. The course participants were retested after 6 months., Results: Statistically significant differences between course participants compared to those without training could be shown for all tested subjects, including correct assessment of consciousness (p<0.001), correct assessment of breathing (p<0.001), knowledge of the correct emergency telephone number (p<0.001), giving correct emergency call information (p<0.001), knowledge of correct recovery position (p<0.001), correct airway management (p<0.001). Retesting after 6 months showed statistically significant differences for 5 of 6 tested items., Conclusion: 6-7-Year-old children can give basic first aid to an unconscious patient. A course with 5 lessons leads to a significant increase in first aid knowledge and skills. Knowledge retention is good after 6 months. All primary school children should receive first aid training starting in first grade.

Background: Deciding whether an elderly patient with end-stage renal disease is a candidate for kidney transplantation can be difficult. We aimed to evaluate pre- and early posttransplant risk factors that could predict outcome in elderly kidney recipients., Methods: Data from all elderly (>or= 70 years, n=354), senior (60-69 years, n=577), and control (45-54 years, n=563) patients receiving their first kidney transplant at our center from 1990 to 2005 were retrieved. Patient and graft survival were analyzed in a Cox model addressing the common risk factors including Charlson comorbidity index (CCI), pretransplant dialysis time, and early acute rejection episodes., Results: Acute rejection in the first 90 days, Hazard ratio (HR) 1.74 (1.34-2.25); time on dialysis, HR 1.02 (1.01-1.03) per month; and donor age more than 60 years, HR 1.52 (1.14-2.01) predicted mortality in the elderly. CCI score did not predict mortality in the elderly, HR 1.05 (0.98-1.12); but did so both in senior, HR 1.17 (1.08-1.27) and control recipients, HR 1.33 (1.19-1.48). Delayed graft function, HR 3.69 (2.01-6.79); donor age more than 60 years, HR 2.42 (1.30-4.49); and presence of human leukocyte antigen antibodies, HR 3.96 (1.38-11.37) were independent predictors for death-censored graft loss in the elderly., Conclusion: Adequate immunosuppression with low frequency of rejection episodes improves the outcome for elderly kidney recipients as does a reduction of time on dialysis. CCI score at transplantation does not seem helpful in the selection of elderly patients for kidney transplantation but plays a significant role in patients under 70 years of age.

Background: Elderly patients are the fastest growing population requiring renal replacement therapy. With increasing scarcity of organs, old patients are likely to remain in dialysis. We have had an active transplant program with elderly patients (i.e. > or = 70 years) and present results from our experiences., Methods: From 1990 throughout 2005, we performed 301 first kidney transplantations in elderly patients. Data were compared with 513 senior patients aged 60-69 years and 512 control patients, aged 45-54 years, transplanted during the same time period. Time in dialysis prior to transplantation, number of patients receiving a living donor (LD) kidney, donor age, HLA mismatch, rejections, patient- and graft survival data were collected., Results: The 5-year actuarial patient survival was 56% in elderly patients, 72% in senior patients; P < 0.001 versus elderly and 91% in control patients; P < 0.001 versus elderly. Death censored graft survival was similar in the different groups, 89% in elderly, 88% in senior and 90% in control patients. LD was used in 35%; 17% in elderly patients, 34% in senior patients; P < 0.001 and 47% in control patients; P < 0.001. Pre-emptive transplantation was performed in 19% of the patients; 10% in elderly patients, 18% in senior patients; P = 0.003 and 25% in control patients; P < 0.001., Conclusions: Our data show no difference in death censored graft survival between the age groups. Given the poor prognosis during dialysis treatment, selected elderly patients may successfully be offered a kidney transplant.

Objectives: The aim of our study was to register the prevalence of nosocomial urinary tract infections (NAUTIs) in urology sections in Europe and Asia., Methods: A total of 6033 hospitalised patients in 194 different urology departments were screened in two Internet-based studies. Detailed reports on 727 patients with NAUTI were provided., Results: The prevalence of NAUTI was 10% in the Pan European Prevalence (PEP) study, 14% in the Pan EuroAsian Prevalence (PEAP) study, and 11% in the combined analysis. The largest group was asymptomatic bacteriuria (29%) followed by cystitis (26%), pyelonephritis (21%), and urosepsis (12%). There were significant differences between regions and types of hospitals., Conclusions: NAUTI is a large problem for urologic patients and causes huge extra costs for hospitals.

We have studied the effect of genetic polymorphisms in the DNA repair genes hOGG1, XRCC1, XRCC3, ERCC2 and the MTHFR gene in the folate metabolism on the frequencies of cells with chromosomal aberrations (CA), chromosome-type aberrations (CSA), chromatid-type aberrations (CTA), chromatid breaks (CTB) and chromatid gaps (CTG) scored in peripheral blood lymphocytes from 651 Norwegian subjects of Caucasian descendant. DNA was extracted from fixed cell suspensions. The log-linear Poisson regression model was used for the combined data which included age, smoking, occupational exposure and genotype for 449 subjects. Our results suggest that individuals carrying the hOGG1 326Cys or the XRCC1 399Gln allele have an increased risk of chromosomal damage, while individuals carrying the XRCC1 194Trp or the ERCC2 751Gln allele have a reduced risk regardless of smoking habits and age. Individuals carrying the XRCC1 280His allele had an increased risk of CSA which was only apparent in non-smokers. This was independent of age. A protective effect of the XRCC3 241Met allele was only found in the older age group in non-smokers for CA, CSA and CTA, and in smokers for CSA. In the youngest age group, the opposite effect was found, with an increased risk for CA, CTA and CTG in smokers. Carrying the MTHFR 222Val allele gave an increased risk for chromosome and chromatid-type aberrations for both non-smokers and smokers, especially for individuals in the older age group, and with variable results in the youngest age group. The variables included in the different regression models accounted, however, for only 4-10% of the variation. The frequency ratio for CTG was significantly higher than for CTA and CTB for only 7 of the 43 comparisons performed. Some of the gap frequencies diverge from the trend in the CA, CSA, CTA and CTB results.

Background: Successful change processes in hospitals require leaders with strong competence and personal suitability, who can develop resource efficient and creative solutions. We have investigated how division leaders handle change processes and solve problems that arise in cross-disciplinary meeting activities., Material and Methods: Eight division leaders at two hospitals in the same region of Norway have gone through in-depth interviews about change leadership., Results and Interpretations: Some of the division leaders were familiar with facilitating change processes and used a range of methods and tools, but the majority had limited insight into which methods would be most appropriate in the various phases of a change process. They signalised that the most difficult challenge was to handle interactions dominated by suspicion, negative interpretation, assumptions and hidden agendas. Such interplays were the most limiting factor in the development of a common understanding of demands, goals and commitment to change processes across departments and units.

Introduction: The EasyTube, which is constructed in a similar way to the Combitube, is a recently introduced alternative to tracheal intubation for airway management in emergency medicine., Objective: To determine if there is a difference in rate of, and time to, successful airway placement and ventilation using tracheal intubation, Combitube and EasyTube., Methods: Twenty-six paramedics, trained in tracheal intubation received additional training in the use of the Combitube and the EasyTube. Each participant performed all three methods twice in random order on a manikin. Time to successful ventilation (presented as mean and standard deviation) and success rate were recorded., Results: Mean time to successful ventilation was significantly longer for tracheal intubation (45.2 s (S.D.=15.8)) than for the Combitube (36.0 s (S.D. = 8.6)) p = 0.002 and the EasyTube (38.0 s (S.D.=15.3)) p = 0.023 with no difference between the latter (p = 1.000). Success rate for the Combitube and EasyTube combined (103/104) was significantly higher than for tracheal intubation (45/52) with odds ratio 16.0 (95% CI: 1.9-134); p = 0.002., Conclusion: For paramedics tested on manikins placement success rate was higher with less time required for the Combitube and Easytube than for tracheal intubation with no differences between the Combitube and EasyTube.

Data from two internet-based studies on NAUTI in hospitalized urological patients are presented together: the Pan European Prevalence (PEP) study, which was a 1-day prevalence study in November 2003; and the Pan Euro-Asian Prevalence (PEAP) study, which was carried out in November 2004. Overall, 93 and 101 hospitals from the two studies, respectively, completed the hospital questionnaires and provided patient information for the present study. NAUTI was diagnosed according to the Centres for Disease Control and Prevention (CDC) criteria in 727 of the 6033 patients hospitalized on study days in urological departments. The most commonly reported pathogen was Escherichia coli (31%), followed by species of Pseudomonas (13%), Enterococcus (10%), Klebsiella (10%), Enterobacter (6%) and Proteus (6%). Candida spp. and Pseudomonas spp. occurred significantly more frequently as causative agents in urosepsis than in other types of infections. The resistance of E. coli, Klebsiella and Proteus spp. was below 45% for the most commonly used antibiotics. Enterococcus spp. and Pseudomonas spp. however, had resistance rates above 70% to most antibiotics. A total of 56% of the hospitalized urological patients were receiving antimicrobial therapy on the study day; 46% for prophylaxis, 26% for microbiologically proven UTI, 21% for only clinically suspected UTI and 7% for other infections. The most commonly used antibiotics were fluoroquinolones (35%), cephalosporins (27%), penicillins (16%), aminoglycosides (15%), and co-trimoxazole (9%). Differences between countries and regions were highly significant. There is an urgent need for continuous surveillance of NAUTI and improvement of antibiotic policy to counteract the widespread increase of antimicrobial resistance.

In order to elucidate the relative contributions made by cytology and histology in the diagnosis of lung cancer, we studied the cytology and histology reports of all patients who received a microscopic diagnosis of lung cancer in our hospital during the 7 years 1996-2002. This gave a total of 407 patients. The most frequent diagnoses were squamous cell carcinoma (34.9%), adenocarcinoma (24.8%), and small cell carcinoma (17.8%). One hundred and fifteen patients (28.3%) received their microscopic diagnosis based only on cytology, which therefore proved to be of great diagnostic value. The most useful type of cytology specimen was taken by bronchial lavage or bronchial brushing. These types of specimens provided the diagnosis in 71 patients (17.4%). Cytology was especially capable of finding squamous cell carcinomas. Small cell carcinomas were underrepresented (9.6% versus 17.8%) and unspecified carcinomas greatly overrepresented (9.6% versus 2.9%) among the diagnoses obtained by cytology alone. We conclude that cytology is of considerable diagnostic value, although not as specific as histology for the subtyping of carcinomas. Clinicians should be more aware of the usefulness of cytology, especially in cases where it is difficult to obtain bronchoscopic biopsy samples for histological examination.