Implementation of a computerized alcohol advice concept in routine emergency care

BackgroundThere is a growing body of evidence for computer-generated advice for many health behaviours. This study evaluated the implementation of a computerized concept to provide tailored advice on alcohol in a Swedish emergency department (ED).AimThe aim was to evaluate the usage of the concept over 12 months: participation rate among the ED population; representativeness of the participants; and participation development over time.MethodsThe target population was defined as all patients aged 18–69 years given a card from ED triage staff with a request to conduct a computerized test about their alcohol use. After completing the 5–10-min programme, the patient received a printout, containing personalised alcohol habit feedback, as calculated by the computer from the patient’s answers. Data for this study were primarily obtained from the computer programme and ED logs.ResultsForty-one percent of the target population completed the computerized test and received tailored alcohol advice. The number of patients who used the concept showed a slight decreasing trend during the first half of the year, leveling off for the second half of the year.ConclusionA computerized concept for provision of alcohol advice can be implemented in an ED without unrealistic demands on staff and with limited external support to attain sustainability.     

Anthropometric factors and Breslow thickness

Melanoma is the most rapidly increasing cancer form in Norway, and in 2016, 2114 men and women were diagnosed with the disease. This form of cancer is often diagnosed at an early stage, and if you follow changes in your skin you will be able to detect the cancer at an early stage. Melanoma with metastasis (spreading elsewhere in the body), however, is a serious disease that is difficult to treat, and more than 300 people die in Norway from melanoma each year. The thickness of the tumour (called Breslow thickness) is an important factor for survival after melanoma; those with a thin tumour at diagnosis live longer than those with a thick tumour. In a new Norwegian study, researchers explored associations between certain factors (called anthropometric factors ‐ such as body mass index (BMI), body surface area (BSA), height, weight and weight change) and Breslow thickness, overall and by anatomical site and histological subtype (type of melanoma). Nearly 300,000 Norwegian men and women who were enrolled into a study group called the Janus population‐based cohort 1972–2003 were followed for melanoma. By 2014, 2570 cases of melanoma with information on tumour thickness were identified. This large case‐series of incident melanomas, demonstrated positive associations between BMI, BSA, weight and Breslow thickness, and showed that Breslow thickness increased with increasing BMI, BSA and weight, before levelling off or declining at high values, suggesting that behavioural or other mechanisms apply at high values.     

Effect of climate therapy at Gran Canaria on vitamin D production, blood glucose and lipids in patients with psoriasis

Background Climate therapy (heliotherapy) of psoriasis is an effective and natural treatment. Ultraviolet radiation (UVB) from the sun improves psoriasis and induces vitamin D₃ synthesis. Objective The aim of the study was to investigate the effect of climate therapy on vitamin D₃ synthesis, blood glucose, lipids and vitamin B12 in psoriasis patients. Methods Twenty Caucasian patients (6 women and 14 men; mean age, 47.2 years; range, 24–65) with moderate to severe psoriasis [mean Psoriasis Area and Severity Index (PASI) score 9.8; range, 3.8–18.8] received climate therapy at the Gran Canarias for 3 weeks. Blood samples were drawn before and after 15 days of sun exposure. In addition, the patients’ individual skin UV doses based on UV measurements were estimated. Results Sun exposure for 15 days lead to a 72.8% (± 18.0 SD) reduction in the PASI score in psoriasis patients. Although no direct correlation was observed between PASI score improvement and UVB dose, the sun exposure improved the vitamin D, lipid and carbohydrate status of the patients. The serum concentrations of 25‐hydroxyvitamin D [25(OH)D] increased from 57.2 ± 14.9 nmol/L before therapy to 104.5 ± 15.8 nmol/L (P < 0.0001) after 15 days of sun exposure; the serum levels of 1,25‐dihydroxyvitamin D [1,25(OH)₂D] increased from 146.5 ± 42.0 to 182.7 ± 59.1 pmol/L (P = 0.01); the ratio of low‐density lipoprotein cholesterol and high‐density lipoprotein cholesterol decreased from 2.4 to 1.9 (P < 0.001); and the haemoglobin A₁c (HbA₁c) levels decreased from 5.6 ± 1.7% to 5.1 ± 0.3% (P < 0.0001). Conclusion Climate therapy with sun exposure had a positive effect on psoriasis, vitamin D production, lipid and carbohydrate status.     

Maternal smoking cessation in early pregnancy and offspring weight status at four years of age. A prospective birth cohort study

Background:

Maternal smoking during pregnancy is associated with fetal growth restriction, but also with increased risk for overweight in childhood. If the mother stops smoking in early pregnancy fetal growth is not restricted, but whether the risk for later overweight persists is unclear.

Aim:

To study if four year old children of mothers who stopped smoking in early pregnancy have higher mean body mass index (BMI) and/or increased odds of being overweight compared with children of non-smokers.

Study Design:

Prospective population based study on Norwegian mothers and children.

Subjects:

Among 711 children available for analysis, 540 were children of never smoking mothers, 114 of mothers who stopped smoking in early pregnancy, and 57 of mothers who continued to smoke throughout pregnancy.

Outcome Measures:

BMI and overweight defined by international criteria at age four.

Results:

Compared with children of never smoking mothers, children of smoking mothers had higher mean BMI (mean difference: 0.47; 95% CI: 0.10, 0.84 kg/m²), whereas mean BMI was not higher among children of mothers who stopped smoking (mean difference: 0.02; 95% CI: -- 0.24, 0.28 kg/m². Similarly, children of smoking mothers had increased odds for overweight (adjusted OR: 2.83; 95% CI: 1.13, 7.10), whereas children of mothers who stopped smoking did not have increased odds (adjusted OR: 1.29; 95% CI: 0.62, 2.68) compared with children of never smoking mothers.

Conclusions:

In this study, the association between smoking exposure and childhood overweight did not persist in children of mothers who stopped smoking early in pregnancy.     

Demographic and behavioural factors in Tanzanian and Norwegian patients with sexually transmitted infections

To evaluate whether differences in demographic or behavioural factors might explain differences in reported or diagnosed sexually transmitted infections (STI), we have compared data from 1097 Tanzanian and Norwegian STI patients. Most demographic data were similar, whereas some behavioural data differed. Norwegian patients reported significantly higher numbers of sexual partners than Tanzanian. Thirty-three percent of Tanzanian patients tested positive for HIV antibodies, females more often (43%) than males (26%). Approximately one-third and two-thirds of the female HIV-positive Tanzanian STI patients had already seroconverted at the age of 25 and 30 years, respectively. The national differences encountered probably reflect cultural differences, different panoramas of STI and a lower accessibility to optimal health services in Tanzania. Lack of expected statistical associations between some of the data in the Tanzanian STI group might question the validity of the retrospectively collected data in this group, or indicate that questions not included in the questionnaire might be of importance.     

Combined influence of early sexual maturation and central adiposity on subsequent stature

Introduction Shorter adult stature has been attributed to early sexual maturation, as well as early adiposity, but it is not clear if these factors are interrelated.Results and discussion A number of 1,605 Norwegian adolescents were followed from early (baseline) to late adolescence (follow-up). Maturational timing was assessed by self-reports of pubertal status (pubertal development scale, PDS) in boys and age at menarche (AAM) in girls. Height, weight and waist circumference were measured at baseline and at follow-up. Differences in height at follow-up and height gain related to the timing of sexual maturation and the level of central adiposity (i.e. high or low waist circumference) at baseline were estimated using general linear modelling. At follow-up, the median height was 180 cm in boys and 167 cm in girls. Early maturing boys and girls with relatively high central adiposity at baseline were, on average, 5.7 cm (P value<0.001) and 3.6 cm (P value<0.001) taller than early maturing boys and girls with low central adiposity. Differences in stature related to central adiposity were less pronounced for intermediate and late maturing boys and girls. The height was lowest in boys (176.6 cm) and girls (163.8 cm) who had matured early and had low central adiposity at baseline. Height gain during follow-up was independent of the level of central adiposity, but was closely related to the timing of sexual maturation. The association between the early timing of sexual maturation and subsequent height was modified by the level of central adiposity in early adolescence.Conclusion The results suggest that early maturity combined with adiposity yields higher stature than early maturity and leanness.     

Folic acid and multivitamin supplement use and risk of placental abruption: a population-based registry study

The authors investigated a possible association of supplemental folic acid and multivitamin use with placental abruption by using data on 280,127 singleton deliveries recorded in 1999-2004 in the population-based Medical Birth Registry of Norway. Odds ratios, adjusted for maternal age, marital status, parity, smoking, pregestational diabetes, and chronic hypertension, were estimated with generalized estimating equations for logistic regression models. Use of folic acid and/or multivitamin supplements before or any time during pregnancy was reported for 36.4% of the abruptions (0.38% of deliveries) and 44.4% of the nonabruptions. Compared with no use, any supplement use was associated with a 26% risk reduction of placental abruption (adjusted odds ratio = 0.74, 95% confidence interval: 0.65, 0.84). Women who had taken folic acid alone had an adjusted odds ratio of 0.81 (95% confidence interval: 0.68, 0.98) for abruption, whereas multivitamin users had an adjusted odds ratio of 0.72 (95% confidence interval: 0.57, 0.91), relative to supplement nonusers. The strongest risk reduction was found for those who had taken both folic acid and multivitamin supplements (adjusted odds ratio = 0.68, 95% confidence interval: 0.56, 0.83). These data suggest that folic acid and other vitamin supplementation during pregnancy may be associated with reduced risk of placental abruption.