Variations in labor supply between female and male hospital physicians: Results from a modern welfare state

In industrialized countries, female physicians have up to 10h lower labor supply a week than male physicians. At the same time, the number of female physicians is increasing. The question analyzed in this article is whether these differences in labor supply for female and male hospital physicians persist in a modern welfare society, such as Norway, where comprehensive welfare reforms aim to reduce gender inequality are implemented. Information on weekly working hours from all hospital physicians in Norway during the period 2001-2007 was merged with economic variables (wages, income from other sources, net personal dept), demographic variables (age, sex, marital status, children born in the year, number of children), managerial positions and variables describing the hospital, specialty and time (year). The estimation method employed both random and fixed-effects models. Labor supply for women was 10-11 percent or 4-4.5h per week lower than among men. The effects of children diverged strongly between the sexes. For instance, childbirth in a given year reduced the supply of working hours by women by approximately 80% but had no effects for men. After controlling for children and other factors, female physicians worked some 3-4% or 1-1.5 fewer hours than comparable male physicians. Although significant, variation in labor supply between female and male physicians is much lower in Norway then in other advanced industrialized countries.     

Comparing a novel automatic 3D method for LGE-CMR quantification of scar size with established methods

Current methods for the estimation of infarct size by late-enhanced cardiac magnetic imaging are based upon 2D analysis that first determines the size of the infarction in each slice, and thereafter adds the infarct sizes from each slice to generate a volume. We present a novel, automatic 3D method that estimates infarct size by a simultaneous analysis of all pixels from all slices. In a population of 54 patients with ischemic scars, the infarct size estimated by the automatic 3D method was compared with four established 2D methods. The new 3D method defined scar as the sum of all pixels with signal intensity (SI) ≥35 % of max SI from the complete myocardium, border zone: SI 35–50 % of max SI and core as SI ≥50 % of max SI. The 3D method yielded smaller infarct size (?2.8 ± 2.3 %) and core size (?3.0 ± 1.7 %) than the 2D method most similar to ours. There was no difference in the size of the border zone (0.2 ± 1.4 %). The 3D method demonstrated stronger correlations between scar size and left ventricular (LV) remodelling parameters (LV ejection fraction: r = ?0.71, p < 0.0005, LV end-diastolic index: r = 0.54, p < 0.0005, and LV end-systolic index: r = 0.59, p < 0.0005) compared with conventional 2D methods. Infarct size estimation by our novel 3D automatic method is without the need for manual demarcation of the scar; it is less time-consuming and has a stronger correlation with remodelling parameters compared with existing methods.     

Glucose-Insulin-Potassium Reduces Infarct Size When Administered During Reperfusion

Coronary reperfusion improves ventricular function and survival after infarction, but the metabolic conditions at this time may not be optimal to protect the heart. The objective of this study was to evaluate if metabolic support with glucose-insulin-potassium (GIK) administered at the time of coronary reperfusion could elicit the same cardioprotection as GIK infusion during the entire ischemia/reperfusion period. Three groups of anesthetized, open-chest rats were subjected to 30 minutes of regional ischemia and 180 minutes of reperfusion. Groups 1 (controls) and 2 (GIK_IR) received saline or GIK, respectively, throughout the whole experimental period, whereas a third group (GIK_R) received GIK from the onset of reperfusion only. Infarct size was significantly reduced in the GIK-treated groups, compared with controls (GIK_IR 44 ± 5% and GIK_R 45 ± 5% vs. control 66 ± 4%; P < 0.05). Postischemic recovery of cardiac function improved when GIK was only administered during the reperfusion phase. Furthermore, infusion of GIK resulted in reduced plasma concentrations of free fatty acids and increased plasma glucose (both P < 0.05) compared with controls. This study demonstrates that glucose-insulin-potassium administration at the onset of the postischemic reperfusion period is as cardioprotective as administration of GIK during the entire ischemia/reperfusion period.     

RAMP2 and RAMP3 mRNA levels are increased in failing rat cardiomyocytes and associated with increased responsiveness to adrenomedullin

Adrenomedullin (AM) is a potent vasorelaxing peptide with natriuretic and diuretic actions. Recent data indicate that AM may function as an endogenous regulator of cardiac function. We investigated to what extent AM, the AM receptor subtypes, and AM receptor-associated proteins were regulated in cardiomyocytes and non-cardiomyocytes of rats with congestive heart failure (CHF), and whether such regulation was paralleled by corresponding alterations of functional responses to AM. Cardiomyocytes and non-cardiomyocytes were isolated from myocardial tissue of rats 7 days after induction of myocardial infarction or sham operation. AM immunoreactivity was found in cardiomyocytes, endothelial cells, and fibroblasts. Robust increase of AM mRNA levels was observed both in the cardiomyocytes and in the non-cardiomyocytes of CHF rats compared to that of sham-operated rats (2.7-fold and 3.7-fold, respectively, P <0.05). Fairly high mRNA levels and immunoreactivity against the AM receptor chaperone receptor activity-modifying protein-2 (RAMP2) were also detected in the cardiomyocytes and non-cardiomyocytes. However, induction of RAMP2 mRNA expression was restricted to cardiomyocytes (1.8-fold increase in cardiomyocytes from CHF rats vs. sham rats; P <0.05). In contrast, very low levels of RAMP3 mRNA were observed. RAMP3 mRNA levels, however, were elevated in both cardiomyocytes and non-cardiomyocytes from CHF rats (6.5-fold and 2.4-fold increase vs. sham rats, respectively; P <0.05). Parallel increases of specific AM receptor binding sites and of AM-stimulated adenylyl cyclase activities were observed in failing cardiomyocytes compared to cardiomyocytes from sham rats (fivefold and sixfold increase, respectively; P <0.05). Thus, this study demonstrates that AM mRNA levels, AM receptor binding sites, and AM-stimulated adenylyl cyclase activities are increased in cardiomyocytes from failing rat hearts. Furthermore, our data suggest that induction of RAMP2 and RAMP3 contributes to the increased responsiveness to AM in failing cardiomyocytes.     

Varus Femoral Osteotomy Improves Sphericity of the Femoral Head in Older Children With Severe Form of Legg-Calvé-Perthes Disease

Background  

In the Norwegian prospective study on Legg-Calvé-Perthes disease (LCPD), we found varus femoral osteotomy gave better femoral head sphericity at a mean of 5 years postoperative than physiotherapy in children older than 6.0 years at diagnosis with femoral head necrosis of more than 50%. That study did not include separate analyses for hips with 100% necrosis and those with a percentage of necrosis between 50% and 100%.     

Epidemiology of perforated peptic ulcer:Age-and gender-adjusted analysis of incidence and mortality

AIM:To investigate the epidemiological trends in inci-dence and mortality of perforated peptic ulcer(PPU)in a well-defined Norwegian population. METHODS:A retrospective,population-based,single-center,consecutive cohort study of all patients diag-nosed with benign perforated peptic ulcer.Included were both gastric and duodenal ulcer patients admitted to Stavanger University Hospital between January 2001 and December 2010.Ulcers with a malignant neoplasia diagnosis,verified by histology after biopsy or resection,were excluded.Patients were identified from the hospitals administrative electronic database using pertinent ICD-9 and ICD-10 codes(K25.1,K25.2,K25.5, K25.6,K26.1,K26.2,K26.5,K26.6).Additional searches using appropriate codes for relevant laparoscopic and open surgical procedures(e.g.,JDA 60,JDA 61,JDH 70 and JDH 71)were performed to enable a complete identification of all patients.Patient demographics,presentation patterns and clinical data were retrieved from hospital records and surgical notes.Crude and adjusted incidence and mortality rates were estimated by using national population demographics data. RESULTS:In the study period,a total of 172 patients with PPU were identified.The adjusted incidence rate for the overall 10-year period was 6.5 per 100 000 per year(95%CI:5.6-7.6)and the adjusted mortality rate for the overall 10-year period was 1.1 per 100 000 per year(95%CI:0.7-1.6).A non-significant decline in ad-justed incidence rate from 9.7 to 5.6 occurred during the decade.The standardized mortality ratio for the whole study period was 5.7(95%CI:3.9-8.2),while the total 30-d mortality was 16.3%.No difference in in-cidence or mortality was found between genders.However,for patients≥60 years,the incidence increased over 10-fold,and mortality more than 50-fold,compared to younger ages.The admission rates outside office hours were high with almost two out of three(63%) admissions seen at evening/night time shifts and/or during weekends.The observed seasonal variations in admissions were not statisti     

Plate fixation of tibial fractures in the rabbit: Correlation of bone strength with duration of fixation

Bone healing after metal plate fixation of rabbit tibial osteotomies was studied in order to gain information as to the optimum time for plate removal. The fracture had regained almost normal biomechanical properties after 6 weeks. Significantly greater strength and stiffness of the healing tibiae were obtained at 12 weeks when the plate was removed after 4, 6 or 9 weeks and no further fixation was subsequently applied, compared to those plated for 12 weeks. The results indicate that a metal plate should be removed as soon as the fracture has regained normal biomechanical properties; i.e. before the stress-protecting effect has secondarily weakened the bone.

The findings suggest that metal plates should be removed at an earlier stage of the healing period than is usual in clinical practice.     

Low doses of methylphenidate (Ritalin) may alter the delay-of-reinforcement gradient

The present study investigated effects of methylphenidate on spatio-temporal distributions of responses generated by a fixed interval 60-s schedule of reinforcement. A response panel with 20 different response locations (holes) made it possible to distinguish effects of the drug on the procedurally-correct response (correct according to the contingencies) and effects on other topographically similar responses acting as functionally-adequate responses. Detailed flow charts show how the dynamics of responding changed with dose and segment of the fixed interval. The number of holes visited was increased after low and medium doses, but decreased after high doses. The spatial differences between responses in the initial and the final parts of the fixed interval gradually disappeared after 6 mg/kg or higher doses as the functionally-adequate responses moved to earlier segments of the fixed interval. Few results could, however, be described as response rate dependent. Distributions of responses around the correct hole illustrated differences between procedurally-correct and functionally-adequate classes. The number of holes included in the latter class changed by dose in an inverted U-shaped fashion. Perseverations and stereotyped responding increased with increasing dose. Most of the effects may be described as motor stimulatory. One way of explaining the stimulatory effect is in terms of a lengthened delay-of-reinforcement gradient. The rate-dependent effect of methylphenidate on the procedurally-correct class after some doses may have been due to the combined effects of a lengthened delay gradient increasing the response rates early in the interval and interference from perseverations having their most detrimental effects on the high rates late in the interval. Offprint request to: T. Sagvolden