Search

ObjectivesTo investigate whether and to what extent, return to work (RTW) expectancy and workability mediate the effect of two vocational interventions on reducing sickness absence in workers on sick leave from a musculoskeletal condition.MethodsThis is a preplanned mediation analysis of a three-arm parallel randomised controlled trial which included 514 employed working adults with musculoskeletal conditions on sick leave for at least 50% of their contracted work hours for ≥7 weeks. Participants were randomly allocated (1:1:1) to one of three treatment arms; usual case management (UC) (n=174), UC plus motivational interviewing (MI) (n=170) and UC plus a stratified vocational advice intervention (SVAI) (n=170). The primary outcome was the number of sickness absence days over 6 months from randomisation. Hypothesised mediators included RTW expectancy and workability assessed 12 weeks after randomisation.ResultsThe mediated effect of the MI arm compared with UC on sickness absence days through RTW expectancy was −4.98 days (−8.89 to −1.04), and workability was −3.17 days (−8.55 to 2.32). The mediated effect of the SVAI arm compared with UC on sickness absence days through RTW expectancy was −4.39 days (−7.60 to −1.47), and workability was −3.21 days (−7.90 to 1.50). The mediated effects for workability were not statistically significant.ConclusionsOur study provides new evidence for the mechanisms of vocational interventions to reduce sickness absence related to sick leave due to musculoskeletal conditions. Changing an individual’s expectation that RTW is likely may result in meaningful reductions in sickness absence days.Trial registration numberNCT03871712.

Supplementary information describing the Nucleotyping method in more detail, including the training and validation results for the calculated Nucleotyping features.

Background: Most endometrial carcinoma patients are diagnosed at an early stage with a good prognosis. However, a relatively low fraction with lethal disease constitutes a substantial number of patients due to the high incidence rate. Preoperative identification of patients with high risk and low risk for poor outcome is necessary to tailor treatment. Nucleotyping refers to characterization of cell nuclei by image cytometry, including the assessment of chromatin structure by nuclear texture analysis. This method is a strong prognostic marker in many cancers but has not been evaluated in preoperative curettage specimens from endometrial carcinoma.Methods: The prognostic impact of changes in chromatin structure quantified with Nucleotyping was evaluated in preoperative curettage specimens from 791 endometrial carcinoma patients prospectively included in the MoMaTEC multicenter trial.Results: Nucleotyping was an independent prognostic marker of disease-specific survival in preoperative curettage specimens among patients with Federation Internationale des Gynaecologistes et Obstetristes (FIGO) stage I–II disease (HR=2.9; 95% CI, 1.2–6.5; P = 0.013) and significantly associated with age, FIGO stage, histologic type, histologic grade, myometrial infiltration, lymph node status, curettage histology type, and DNA ploidy.Conclusions: Nucleotyping in preoperative curettage specimens is an independent prognostic marker for disease-specific survival, with potential to supplement existing parameters for risk stratification to tailor treatment.Impact: This is the first study to evaluate the prognostic impact of Nucleotyping in curettage specimens from endometrial carcinoma and shows that this may be a clinically useful prognostic marker in endometrial cancer. External validation is warranted. Cancer Epidemiol Biomarkers Prev; 26(1); 61–67. ©2016 AACR.

Objectives: To evaluate if adding motivational interviewing (MI) or a stratified vocational advice intervention (SVAI) to usual case management (UC), reduced sickness absence over 6 months for workers on sick leave due to musculoskeletal disorders. Methods: We conducted a three-arm parallel pragmatic randomised controlled trial including 514 employed workers (57% women, median age 49 (range 24–66)), on sick leave for at least 50% of their contracted work hours for ≥7 weeks. All participants received UC. In addition, those randomised to UC+MI were offered two MI sessions from social insurance caseworkers and those randomised to UC+SVAI were offered vocational advice from physiotherapists (participants with low/medium-risk for long-term sickness absence were offered one to two sessions, and those with high-risk were offered three to four sessions). Results: Median sickness absence was 62 days, (95% CI 52 to 71) in the UC arm (n=171), 56 days (95% CI 43 to 70) in the UC+MI arm (n=169) and 49 days (95% CI 38 to 60) in the UC+SVAI arm (n=169). After adjusting for predefined potential confounding factors, the results showed seven fewer days in the UC+MI arm (95% CI −15 to 2) and the UC+SVAI arm (95% CI −16 to 1), compared with the UC arm. The adjusted differences were not statistically significant. Conclusions: The MI-NAV trial did not show effect on return to work of adding MI or SVAI to UC. The reduction in sickness absence over 6 months was smaller than anticipated, and uncertain due to wide CIs. Effectiveness of adding motivational interviewing or a stratified vocational advice intervention to usual case management on return to work for people with musculoskeletal disorders: The MI-NAV randomised controlled trial

To evaluate if adding motivational interviewing (MI) or a stratified vocational advice intervention (SVAI) to usual case management (UC), reduced sickness absence over 6 months for workers on sick leave due to musculoskeletal disorders.We conducted a three-arm parallel pragmatic randomised controlled trial including 514 employed workers (57% women, median age 49 (range 24-66)), on sick leave for at least 50% of their contracted work hours for ≥7 weeks. All participants received UC. In addition, those randomised to UC+MI were offered two MI sessions from social insurance caseworkers and those randomised to UC+SVAI were offered vocational advice from physiotherapists (participants with low/medium-risk for long-term sickness absence were offered one to two sessions, and those with high-risk were offered three to four sessions).Median sickness absence was 62 days, (95% CI 52 to 71) in the UC arm (n=171), 56 days (95% CI 43 to 70) in the UC+MI arm (n=169) and 49 days (95% CI 38 to 60) in the UC+SVAI arm (n=169). After adjusting for predefined potential confounding factors, the results showed seven fewer days in the UC+MI arm (95% CI -15 to 2) and the UC+SVAI arm (95% CI -16 to 1), compared with the UC arm. The adjusted differences were not statistically significant.The MI-NAV trial did not show effect on return to work of adding MI or SVAI to UC. The reduction in sickness absence over 6 months was smaller than anticipated, and uncertain due to wide CIs.NCT03871712.

Objectives Stratified care using prognostic models to estimate the risk profiles of patients has been increasing. A refined version of the popular STarT Back tool, the Keele STarT MSK tool, is a newly developed model for matched treatment across a wide range of musculoskeletal pain presentations. The aim of this study was to translate and culturally adapt the Keele STarT MSK tool into Norwegian, examine its construct validity and assess the representativeness of the included sample. Methods The Keele STarT MSK tool was formally translated into Norwegian following a multistep approach of forward and backward translation. A pre-final version was tested in 42 patients. Minor changes were implemented. To assess its construct validity, an online survey was conducted among workers aged 18–67 years who were on sick leave (>4 weeks) due to musculoskeletal disorders. Construct validity was evaluated in terms of convergent and discriminant validity using Pearson’s correlation coefficient, and known-group validity by comparing risk subgroups as suggested by the COSMIN checklist. The representativeness of the sample was assessed by comparing demographic and sick leave information of participants to eligible non-participants (n=168,137). Results A representative sample of 549 workers participated in the validity assessment; 74 participants (13.5%) were categorised as low risk, 314 (57.2%) as medium risk and 161 (29.3%) as high risk. The construct validity was found sufficient, with 90.9% and 75.0% of the pre-defined hypotheses confirmed for convergent and discriminant validity, and known-group validity, respectively. Floor or ceiling effects were not found. Conclusions The Keele STarT MSK tool was successfully translated into Norwegian. The construct validity of the tool was acceptable in a representative cohort of workers on sick leave as a result of musculoskeletal pain. However, the analyses raised concerns as to whether one of the questions captures the construct it is intended to measure.

Additional file 1: Appendix 1. Protocol. Appendix 2. Search strategy. Appendix 3. Excluded studies and reason. Appendix 4. Certainty of evidence for secondary outcomes.

This letter presents a novel design and evaluation procedure for capacity-enhancing multiple-input–multiple-output (MIMO) antenna systems for mobile communication. Based on channel simulations, optimized patterns are defined prior to an antenna design. A multiple-antenna system is proposed, which switches between patterns covering desired directions. This antenna system is then evaluated in an urban environment at 2.49 GHz based on 2 × 2 MIMO channel simulation and measurement results. An improvement of the channel capacity exceeding 1 b/s/Hz compared to an omnidirectional antenna system is confirmed by both simulation and measurement.

Introduction/Background* Lower limb lymphoedema (LLL) is the most disabling adverse effect of surgical staging of pelvic lymph nodes. In studies, LLL is often assessed by calculation of limb volumes based on five circumference measurements. However, the lack of standardisation of this method hinders direct comparison between the studies and makes LLL reporting unreliable. The aim of our study is to report outcomes from a prospective SENTIX trial that have implications for the standardisation of LLL assessment. Methodology In the prospective international multicentre trial SENTIX (ENGOT-cx2/CEEGOG CX-01), a group of 150 patients with stage IA1–IB2 cervical cancer treated by uterine surgery with bilateral SLN biopsy was prospectively evaluated by objective LLL assessment, based on limb volume change (LVC) using circumferrential limb measurements and subjective patient-reported swelling. The assessments were conducted in six-month periods over 24 months post-surgery. Result(s)* Patient LVC substantially fluctuated in both positive and negative directions (figure 1), which were comparable in frequency up to 14% +/- LVC increments. Thirty-eight patients experienced persistent LVC increase and >10% classified as LLL, for whom median time to onset was nine months (95% CI: 7.0-11.0). Some 34.2% of cases experienced onset later than one year after the surgery. Thirty-three patients (22%) experienced transient oedema characterised as LVC >10%, which resolved without intervention between two consequent follow-up visits (figure 2). No significant correlation between LVC >10% and a patient-reported swelling was observed. Conclusion* Our study showed that lower-limb volumes after surgical treatment of cervical cancer significantly fluctuate in positive and negative directions. A diagnostic threshold for LLL should be increased to >15% LVC. Transient oedema occurs frequently, and its distinction from persistent LLL requires repeated measurements. One-third of new LLL cases were diagnosed in the second year of follow-up, highlighting the importance of a sufficient follow-up period duration. Finally, patient-reported limb swelling correlated poorly with LVC and should only be used as an adjunct to objective LLL assessment.

Introduction/Background* The aim was to provide long-term outcome data in endometrial cancer patients undergoing robot-assisted laparoscopic surgery and sentinel lymph node (SLN) mapping. Methodology Retrospective cohort study of 108 patients with primary endometrial cancer who underwent robot-assisted laparoscopic surgery and sentinel lymph node mapping using theMemorial Sloan Kettering Cancer Center algorithm with near-infrared fluorescence detection of indocyanine green for endometrial cancer from November 20th 2012 to January 1st 2016 at St. Olavs hospital in Norway. The primary endpoint was recurrence-free survival. Secondary endpoints were overall survival and treatment complications. Result(s)* After a median follow up of 75 months (range 61-98), five (4.6%) patients had recurred and three patients had died from the disease. The 5-year recurrence-free survival was 95.4% (95% CI, 91.5 – 99.3). The 5-year disease specific survival was 97.2% (95% CI, 94.1 – 100.3). Four of the patients with recurrent disease had lymph node metastasis at diagnosis. The 5-year overall survival was 92.6% (95% CI, 87.7 – 97.5). Peripheral neuropathy after chemotherapy was the most common complication (9.3%), followed by lower limb edema (2%) and postoperative hernia (2%). Conclusion* The present study demonstrated excellent oncologic outcome and few treatment complications in patients treated according to the SLN algorithm more than five years after diagnosis.

BackgroundThe Musculoskeletal Health Questionnaire (MSK-HQ) is a recently developed generic questionnaire that consists of 14 items assessing health status in people with musculoskeletal disorders. The objective was to translate and cross-culturally adapt the MSK-HQ into Norwegian and to examine its construct validity and reliability in people on sick leave with musculoskeletal disorders.MethodsA prospective cohort study was carried out in Norway on people between 18 and 67 years of age and sick leave due to a musculoskeletal disorder. The participants were recruited through the Norwegian Labour and Welfare Administration during November 2018–January 2019 and responded to the MSK-HQ at inclusion and after four weeks. Internal consistency was assessed by Cronbach’s alpha, and structural validity with a factor analysis. Construct validity was assessed by eight “a priori” defined hypotheses regarding correlations between the MSK-HQ and other reference scales. Correlations were analyzed by Spearman’s- or Pearson’s correlation coefficient and interpreted as high with values ≥ 0.50, moderate between 0.30–0.49, and low ResultsA total of 549 patients, mean age (SD) 48.6 (10.7), 309 women (56.3%), were included. The mean (SD) MSK-HQ sum scores (min–max 3–56) were 27.7 (8.2). Internal consistency was 0.86 and a three-factor structure was determined by factor analysis. Construct validity was supported by the confirmation of all hypotheses; high correlation with HRQOL, psychosocial risk profile, and self-perceived health; moderate correlation with physical activity, self-perceived work ability, and work presenteeism; and low correlation with the number of sick days. The test–retest reliability was good with an intraclass correlation coefficient of 0.83 (95% CI, 0.74–0.89), SEM was 2.3 and SDC 6.5.ConclusionsThe Norwegian version of the MSK-HQ demonstrated high internal consistency, a three-factor structure,good construct validity and good test–retest reliability when used among people on sick leave due to musculoskeletal disorders.

Background: To prospectively assess LLL incidence among cervical cancer patients treated by uterine surgery complemented by SLN biopsy, without PLND. Methods: A prospective study in 150 patients with stage IA1–IB2 cervical cancer treated by uterine surgery with bilateral SLN biopsy. Objective LLL assessments, based on limb volume increase (LVI) between pre- and postoperative measurements, and subjective patient-perceived swelling were conducted in six-month periods over 24-months post-surgery. Results: The cumulative incidence of LLL at 24 months was 17.3% for mild LLL (LVI 10–19%), 9.2% for moderate LLL (LVI 20–39%), while only one patient (0.7%) developed severe LLL (LVI &gt, 40%). The median interval to LLL onset was nine months. Transient edema resolving without intervention within six months was reported in an additional 22% of patients. Subjective LLL was reported by 10.7% of patients, though only a weak and partial correlation between subjective-report and objective-LVI was found. No risk factor directly related to LLL development was identified. Conclusions: The replacement of standard PLND by bilateral SLN biopsy in the surgical treatment of cervical cancer does not eliminate the risk of mild to moderate LLL, which develops irrespective of the number of SLN removed.

Hovedbudskap: Folkehelseinstituttet har på oppdrag fra Arbeids- og velferdsdirektoratet (NAV) utført en systematisk oversikt om effekten av arbeidsrettede rehabiliteringstiltak på retur til arbeid for personer som er, eller står i fare for å bli, langtidssykmeldt. Vi utførte i mai 2020 et systematisk søk i samfunnsmedisinske forskningsdatabaser. Vi vurderte treffene, trakk ut data og analyserte studier som møtte inklusjonskriteriene. Vi inkluderte 20 randomiserte kontrollerte studier, samt 13 systematiske oversikter av høy metodisk kvalitet. Primærstudiene omhandlet åtte forskjellige tiltak. Rapportens hovedfunn er: Det er usikkert om det er noen forskjell mellom arbeidsrettede rehabiliteringstiltak og andre aktive tiltak eller vanlig praksis i retur til arbeid etter 12 måneder. Det er trolig ingen forskjell mellom tverrfaglig rehabilitering og andre aktive tiltak i retur til arbeid etter 24 måneder. Det er usikkert om det er noen forskjell mellom arbeidsrettede rehabiliteringstiltak og vanlig praksis i helserelaterte utfall. Det ser ikke ut til å være noen forskjell på arbeidsrettede rehabiliteringstiltak og andre aktive tiltak eller vanlig praksis i effekt på retur til arbeid for personer som er langtidssykmeldt. Vår konklusjon sammenfaller med tidligere systematiske oversikter. Fremtidige studier kan endre konklusjonen.

Dette oppdraget består av en oversikt over systematiske oversikter som har sett på effekten av lindrende behandling og omsorg i sykehjem og eget hjem. Vi utførte i oktober 2020 et litteratursøk i relevante databaser. Vi vurderte referansene, trakk ut data og analyserte resultatene i oversiktene som møtte inklusjonskriteriene. Vi vurderte tilliten til resultatene ved hjelp av verktøyet GRADE. Fem systematiske oversikter ble inkludert. Populasjonen var i hovedsak voksne pasienter med kreft, mens pårørende ble inkludert i to oversikter. Lindrende behandling og omsorg omfattet oppfølging fra palliativt team, bruk av sansehager, støtte til pårørende og ulike alternative tiltak. Relevante utfall var pasientenes og pårørendes livskvalitet, uønskede hendelser, dødssted, pasienttilfredshet, sykehusinnleggelse, funksjonsnedsettelse, depresjon og angst. Rapportens hovedfunn er: • Det er usikkert hvilken effekt hjemmebasert eller sykehjemsbasert lindrende behandling og omsorg har blant pasienter med ulike diagnoser og deres pårørende sammenliknet med vanlig omsorg. • Det er usikkert hvilken effekt lindrende behandling og omsorg i sansehager eller gjennom alternative tiltak har blant pasienter med ulike diagnoser sammenliknet med vanlig omsorg. • Det mangler informasjon om effekten av lindrende behandling og omsorg blant barn og unge. Vi har svært lav tillit til resultatene for samtlige utfall grunnet metodiske skjevheter, manglende presisjon, samt begrenset overførbarhet til norske forhold. The Norwegian Ministry of Health and Care Services commissioned the Norwegian Institute of Public Health to summarize evidence on the effects of palliative care interventions in nursing homes and in patients' homes. We conducted an overview of systematic reviews. In October 2020, we conducted an extensive literature search. Two researchers independently selected reviews for inclusion, extracted data, and assessed risk of bias and the quality of evidence for all outcomes using the GRADE approach. Five systematic reviews were included. The population was mainly older patients with cancer, while caregivers were included in two reviews. Two reviews studied home-based palliative care, one studied palliative care in nursing homes, whereas the two remaining reviews evaluated horticulture or alternative therapies, such as massage, reflexology, and aromatherapy. The reviews reported outcome data for patients’ and caregivers’ quality of life, adverse events, place of death, patient satisfaction, hospitalization, disability, depression, and anxiety. The results indicated that: • It is uncertain whether home-based or nursing home-based palliative care have an effect on patients with different diagnoses and their caregivers. • It is uncertain whether palliative care given in a horticultural setting or alternative therapies has an effect on patients with different diagnoses. • There is a lack of summarized evidence about the effects of palliative care for children and youth. We have very low confidence in the results, and the true effect is likely to be substantially different from those reported. Our certainty in the evidence was downgraded due to methodological biases, imprecision, and limited generalizability to the Norwegian context.

Subarray-based hybrid beamforming communication systems are a cost- and power-efficient architectural solution to realize massive multiple-input multiple-output (MIMO) systems. To estimate the required channel state information (CSI) current research focuses on beam training algorithms, which suffer from long estimation times and require precise system calibration. In order to overcome these problems, two channel estimation algorithms in combination with suitable beamforming algorithms are proposed. The presented algorithms are based on sparse array measurements, where only one antenna per subarray is active during the estimation process. This allows for the reconstruction of the complex MIMO channel matrix by performing multiple sparse array measurements. Channel estimation algorithms, which drastically reduce the channel estimation time are proposed in this letter. Their high performance is proven in small cell communication measurements around 28 GHz.

Massive multiple-input multiple-output (MIMO) systems operating in the centimeter-wave (cmWave) and millimeter-wave (mmWave) region offer huge spectral efficiencies, which enable to satisfy the urgent need for higher data rates in mobile communication networks. However, the proper design of those massive MIMO systems first requires a deep understanding of the underlying wireless propagation channel. Therefore, we present a fully-digital MIMO measurement system operating around 28 GHz. The system enables to take fast subsequent snapshots of the complex MIMO channel matrix. Based on this method we statistically analyze the time-dependent channel behavior, the achievable signal quality and spectral efficiency, as well as the channel eigenvalue profile. Furthermore, the presented calibration approach for the receiver enables an estimation of the dominant absolute angle of arrival (AoA) and allows us to draw conclusions about the line-of-sight (LOS) dominance of the scenario. In total, 159 uplink communication measurements over 20 seconds are conducted in three different small cell site scenarios to investigate the wireless propagation behavior. The measurements reveal the existence of several spatial propagation paths between the mobile transmitter and the base station. Furthermore, an insight into their likelihood in different propagation scenarios is also given.

Hybrid beamforming systems represent an efficientarchitectural solution to realize massive multiple-input multiple-output (MIMO) communication systems in the centimeter wave (cmW) and millimeter wave (mmW) region. These hybrid beamforming systems separate the beamforming process into a digital and analog beamforming network. The analog beamforming networks can be realized by different architectural solutions, which demand dedicated algorithms to determine the complex weighting factors in the digital and analog domain. To date, novel hybrid beamforming architectures and algorithms are solely compared in numerical simulations based on statistical channel models. These abstract channel models simplify the complicated electromagnetic propagation process, thereby not exactly reconstructing the wireless channel. Within this work, we present a measurement-based evaluation of hybrid beamforming algorithms and compare them with numerical results gained from a statistical path-based MIMO channel model. The results show that by adjustment of the channel model parameter the simulation achieves a good match with the measured maximum achievable spectral efficiencies.

ObjectiveTo evaluate the cost–utility of 100 days of antibiotics in patients with chronic low back pain (LBP) and type I or II Modic changes included in the Antibiotic treatment In patients with chronic low back pain and Modic changes (AIM) study.DesignA cost–utility analysis from a societal and healthcare perspective alongside a double-blinded, parallel group, placebo, multicentre trial.SettingHospital outpatient clinics at six hospitals in Norway. The main results from the AIM study showed a small effect in back-related disability in favour of the antibiotics group, and slightly larger in those with type I Modic changes, but this effect was below the pre-defined threshold for clinically relevant effect.Participants180 patients with chronic LBP, previous disc herniation and Modic changes type I (n=118) or type II (n=62) were randomised to antibiotic treatment (n=89) or placebo-control (n=91).InterventionsOral treatment with either 750 mg amoxicillin or placebo three times daily for 100 days.Main outcome measuresQuality-adjusted life years (QALYs) by EuroQoL-5D over 12 months and costs for healthcare and productivity loss measured in Euro (€1=NOK 10), in the intention-to-treat population. Cost–utility was expressed in incremental cost-effectiveness ratio (ICER).ResultsMean (SD) total cost was €21 046 (20 105) in the amoxicillin group and €19 076 (19 356) in the placebo group, mean difference €1970 (95% CI; −3835 to 7774). Cost per QALY gained was €24 625. In those with type I Modic changes, the amoxicillin group had higher healthcare consumption than the placebo group, resulting in €39 425 per QALY gained. Given these ICERs and a willingness-to-pay threshold of €27 500 (NOK 275 000), the probability of amoxicillin being cost-effective was 51%. Even when the willingness-to-pay threshold increased to €55 000, the probability of amoxicillin being cost-effective was never higher than 53%.ConclusionsAmoxicillin treatment showed no evidence of being cost-effective for people with chronic LBP and Modic changes during 1-year follow-up.Trial registration numberClinicalTrials.govNCT02323412.

Hovedbudskap Vi undersøkte hva forskning fra 2010-2019 sier om tiltak, metoder og strategier som skal legge til rette for god omsorg for barn og unge i barnevernsinstitusjoner. Vår systematiske kartleggingsoversikt identifiserte 16 primærstudier, med ca. 3400 barn og unge på ungdomsinstitusjon. Vi fant fire kvalitative studier om erfaringer og 12 studier om betydningen av ulike strategier institusjonsledelsen kan vurdere for å tilrettelegge for god omsorg. Det var syv tiltak gitt til ungdommene og to tiltak gitt til ansatte. Studienes resultater tyder på at det fins tiltak for både unge og ansatte på institusjon som i all hovedsak fremmer god omsorg. For at ungdomsinstitusjoner skal kunne gi barn og unge best mulig omsorg ser det ut til at viktige elementer er medvirkning, kontakt med familie og venner, plasseringsstabilitet, og at bostedet og dagliglivet oppleves som trygt, samt at institusjonene har tydelige rammer og tilstrekkelig bemanning med kompetanse til å bygge gode relasjoner der ansatte bryr seg, lytter til og anerkjenner den unges sinntilstander og erfaringer. Vi fant at omfanget av studier om strategier som skal legge til rette for god omsorg for barn og unge i ungdomsinstitusjoner er noe begrenset og variert. Det ser ikke ut til å foreligge slike studier fra Norge eller andre nordiske land. Vi fant få kvalitative studier og få studier som undersøkte ulike former for organisasjonsstruktur, ulike turnusordninger og sammensetning av ansatte. Det kan være at slike aspekter er viktige for å tilrettelegge for god omsorg for barn og unge i ungdomsinstitusjon.