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Search Results: 1 - 10 of 228 matches for " Einar Heldal "
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Resultat av tuberkulosebehandling i Norge 1995
Einar Heldal
Norsk Epidemiologi , 2009,
Abstract: SAMMENDRAG I tillegg til insidens og mortalitet, har andelen pasienter som fullf rer tuberkulosebehandlingen ( helbredelsesrate ) nylig blitt anbefalt av IUATLD og WHO som en indikator for vurdering av tuberkulosekontrollen. I denne studien ble resultatet av tuberkulosebehandlingen vurdert hos alle pasienter med dyrkningsbekreftet lungetuberkulose meldt til Det sentrale tuberkuloseregister i 1995. Av 101 pasienter fullf rte 77 behandlingen ( helbredelsesrate 76%), 9 forsvant, 14 d de og én fortsatte v re smittef rende. De fleste (7 av 9) som forsvant var f dt utenfor Norge, mens de fleste (13 av 14) som d de var f dt i Norge. Helbredelsesraten i Norge er langt d rligere enn WHOs anbefalinger (85% helbredelsesrate) og resultatene oppn dd i enkelte andre land som Nederland. Vurdering av behandlingsresultat er en viktig del av tuberkuloseoverv kningen. Tiltak b r iverksettes for redusere mortaliteten og andelen pasienter som forsvinner f r avsluttet behandling. Heldal E. Results of tuberculosis treatment in Norway 1995. Nor J Epidemiol 1997; 7 (2): 231-233. ENGLISH SUMMARY In addition to incidence and mortality the proportion of patients who complete tuberculosis treatment (cure rate) has recently been recommended by the IUATLD and WHO as an indicator in assessing tuber
Tuberculosis screening and follow-up of asylum seekers in Norway: a cohort study
Ingunn Harstad, Einar Heldal, Sigurd L Steinshamn, Helge Gar?sen, Geir W Jacobsen
BMC Public Health , 2009, DOI: 10.1186/1471-2458-9-141
Abstract: We assessed a national programme for screening, treatment and follow-up of tuberculosis infection and disease in a cohort of asylum seekers.Asylum seekers ≥ 18 years who arrived at the National Reception Centre from January 2005 to June 2006, were included as the total cohort. Those with a Mantoux test ≥ 6 mm or positive x-ray findings were included in a study group for follow-up.Data were collected from public health authorities in the municipality to where the asylum seekers had moved, and from hospital based internists in case they had been referred to specialist care.Individual subjects included in the study group were matched with the Norwegian National Tuberculosis Register which receive reports of everybody diagnosed with active tuberculosis, or who had started treatment for latent tuberculosis.The total cohort included 4643 adult asylum seekers and 97.5% had a valid Mantoux test. At least one inclusion criterion was fulfilled by 2237 persons. By end 2007 municipal public health authorities had assessed 758 (34%) of them. Altogether 328 persons had been seen by an internist. Of 314 individuals with positive x-rays, 194 (62%) had seen an internist, while 86 of 568 with Mantoux ≥ 15, but negative x-rays (16%) were also seen by an internist. By December 31st 2006, 23 patients were diagnosed with tuberculosis (prevalence 1028/100 000) and another 11 were treated for latent infection.The coverage of screening was satisfactory, but fewer subjects than could have been expected from the national guidelines were followed up in the community and referred to an internist. To improve follow-up of screening results, a simplification of organisation and guidelines, introduction of quality assurance systems, and better coordination between authorities and between different levels of health care are all required.As tuberculosis (TB) in native populations in Western countries decreases, the relative importance of cases among immigrants increases. Latent tuberculosis is preval
Treatment outcome of new culture positive pulmonary tuberculosis in Norway
Mohamed Farah, Aage Tverdal, Tore W Steen, Einar Heldal, Arne B Brantsaeter, Gunnar Bjune
BMC Public Health , 2005, DOI: 10.1186/1471-2458-5-14
Abstract: This was a register-based cohort study. Treatment outcome was assessed according to sex, birthplace, age group, isoniazid (INH) susceptibility, mode of detection and treatment periods (1996–1997, 1998–1999 and 2000–2002). Logistic regression was also used to estimate the odds ratio for treatment success vs. non-success with 95% confidence interval (CI), taking the above variables into account.Among the 655 patients included, the total treatment success rate was 83% (95% CI 80%–86%). The success rates for those born in Norway and abroad were 79% (95% CI 74%–84%) and 86% (95% CI 83%–89%) respectively. There was no difference in success rates by sex and treatment periods. Twenty-two patients (3%) defaulted treatment, 58 (9%) died and 26 (4%) transferred out. The default rate was higher among foreign-born and male patients, whereas almost all who died were born in Norway. The majority of the transferred out group left the country, but seven were expelled from the country. In the multivariate analysis, only high age and initial INH resistance remained as significant risk factors for non-successful treatment.Although the TB treatment success rate in Norway has increased compared to previous studies and although it has reached a reasonable target for treatment outcome in low-incidence countries, the total success rate for 1996–2002 was still slightly below the WHO target of success rate of 85%. Early diagnosis of TB in elderly patients to reduce the death rate, abstaining from expulsion of patients on treatment and further measures to prevent default could improve the success rate further.The key elements in tuberculosis (TB) control are to detect the disease as early as possible and to ensure that those diagnosed complete their treatment and get cured. The World Health Organization (WHO) target for treatment success is 85 percent of all detected smear-positive cases [1]. Even where free medication is available, many patients are not successfully treated [2,3]. Main reason
Patient and health care system delays in the start of tuberculosis treatment in Norway
Mohamed Farah, Jens Rygh, Tore W Steen, Randi Selmer, Einar Heldal, Gunnar Bjune
BMC Infectious Diseases , 2006, DOI: 10.1186/1471-2334-6-33
Abstract: This study was based on information from the National TB Registry, clinical case notes from hospitals and referral case notes from primary health care providers. Delays were divided into patient, health care system and total delays. The association with sex, birthplace, site of the disease and age group was analyzed by multiple linear regression.Among the 83 TB patients included in this study, 71 (86%) were born abroad. The median patient, health care system and total delays were 28, 33 and 63 days respectively, with a range of 1–434 days. In unadjusted analysis, patient delay and health care system delay did not vary significantly between men and women, according to birthplace or age group. Patients with extra-pulmonary TB had a significantly longer patient, health care system and total delay compared to patients with pulmonary TB. Median total delay was 81 and 56 days in the two groups of TB patients respectively. The health care system delay exceeded the patient delay for those born in Norway. The age group 60+ years had significantly shorter patient delay than the reference group aged 15–29 years when adjusted for multiple covariates. Also, in the multivariate analysis patients born in Norway had significantly longer health care system delay than patients born abroad.A high proportion of patients had total delays in start of TB treatment exceeding two months. This study emphasizes the need of awareness of TB in the general population and among health personnel. Extra-pulmonary TB should be considered as a differential diagnosis in unresolved cases, especially for immigrants from high TB prevalence countries.The tuberculosis (TB) epidemiology in Norway has changed in the last 30 years. TB is now more likely to occur among immigrants (median age 31 years) than among those born in Norway (median age 72 years) [1,2]. The proportion of immigrants in the total population in 2003 was 7.3% [3]. DNA fingerprinting of bacterial strains indicated a low degree of recent tra
Screening for tuberculosis infection among newly arrived asylum seekers: Comparison of QuantiFERON?TB Gold with tuberculin skin test
Brita Winje, Fredrik Oftung, Gro Korsvold, Turid Manns?ker, Anette Jeppesen, Ingunn Harstad, Berit Heier, Einar Heldal
BMC Infectious Diseases , 2008, DOI: 10.1186/1471-2334-8-65
Abstract: The 1000 asylum seekers (age ≥ 18 years) enrolled in the study were voluntarily recruited from 2813 consecutive asylum seekers arriving at the national reception centre from September 2005 to June 2006. Participation included a QFT test and a questionnaire in addition to the mandatory TST and chest X-ray.Among 912 asylum seekers with valid test results, 29% (264) had a positive QFT test whereas 50% (460) tested positive with TST (indurations ≥ 6 mm), indicating a high proportion of latent infection within this group. Among the TST positive participants 50% were QFT negative, whereas 7% of the TST negative participants were QFT positive. There was a significant association between increase in size of TST result and the likelihood of being QFT positive. Agreement between the tests was 71–79% depending on the chosen TST cut-off and it was higher for non-vaccinated individuals.By using QFT in routine screening, further follow-up could be avoided in 43% of the asylum seekers who would have been referred if based only on a positive TST (≥ 6 mm). The proportion of individuals referred will be the same whether QFT replaces TST or is used as a supplement to confirm a positive TST, but the number tested will vary greatly. All three screening approaches would identify the same proportion (88–89%) of asylum seekers with a positive QFT and/or a TST ≥ 15 mm, but different groups will be missed.The incidence of tuberculosis in Norway is generally low (6.3/100 000 population in 2006), but high among immigrants from countries where tuberculosis is endemic [1]. Most cases of tuberculosis are due to imported new strains rather than transmission within Norway [2,3]. WHO have estimated the global prevalence of latent tuberculosis infection in 1997 to be 35% for Africa, 44% for Southeast Asia and 15% for Europe [4]. The enormous pool of persons with latent tuberculosis challenges control of tuberculosis in low endemic countries. National guidelines for prevention and control of tuberculo
School based screening for tuberculosis infection in Norway: comparison of positive tuberculin skin test with interferon-gamma release assay
Brita Winje, Fredrik Oftung, Gro Korsvold, Turid Manns?ker, Ingvild Ly, Ingunn Harstad, Anne Dyrhol-Riise, Einar Heldal
BMC Infectious Diseases , 2008, DOI: 10.1186/1471-2334-8-140
Abstract: This cross-sectional multi-centre study was conducted during the school year 2005–6 and the TST positive children were recruited from seven public hospitals covering rural and urban areas in Norway. Participation included a QFT test and a questionnaire regarding demographic and clinical risk factors for latent infection. All positive QFT results were confirmed by re-analysis of the same plasma sample. If the confirmatory test was negative the result was reported as non-conclusive and the participant was offered a new test.Among 511 TST positive children only 9% (44) had a confirmed positive QFT result. QFT positivity was associated with larger TST induration, origin outside Western countries and known exposure to tuberculosis. Most children (79%) had TST reactions in the range of 6–14 mm; 5% of these were QFT positive. Discrepant results between the tests were common even for TST reactions above 15 mm, as only 22 % had a positive QFT.The results support the assumption that factors other than tuberculosis infection are widely contributing to positive TST results in this group and indicate the improved specificity of QFT for latent tuberculosis. Our study suggests a very low prevalence of latent tuberculosis infection among 9th grade school children in Norway. The result will inform the discussion in Norway of the usefulness of the current TST screening and BCG-policy.The incidence of tuberculosis in Norway is generally low (6.3/100 000 population in 2006), but high among immigrants from countries where tuberculosis is endemic [1]. Although the tuberculin skin test (TST) has low specificity, it is still the major tool for detecting tuberculosis infection. Screening for tuberculosis infection by TST has in Norway been offered to all children in the 9th grade of school (age 14–15) for several decades. Historically there have been three objectives of this screening: (1) to measure the transmission rate of tuberculosis infection in the population, (2) to identify cases wi
The role of entry screening in case finding of tuberculosis among asylum seekers in Norway
Ingunn Harstad, Geir W Jacobsen, Einar Heldal, Brita A Winje, Saeed Vahedi, Anne-Sofie Helvik, Sigurd L Steinshamn, Helge Gar?sen
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-670
Abstract: We aimed to assess the effectiveness of entry screening of a cohort of asylum seekers. Cases detected by screening were compared with cases detected later. Further we have characterized cases with active tuberculosis.All asylum seekers who arrived at the National Reception Centre between January 2005 - June 2006 with an abnormal chest X-ray or a Mantoux test ≥ 6 mm were included in the study and followed through the health care system. They were matched with the National Tuberculosis Register by the end of May 2008.Cases reported within two months after arrival were defined as being detected by screening.Of 4643 eligible asylum seekers, 2237 were included in the study. Altogether 2077 persons had a Mantoux ≥ 6 mm and 314 had an abnormal chest X-ray. Of 28 cases with tuberculosis, 15 were detected by screening, and 13 at 4-27 months after arrival. Abnormal X-rays on arrival were more prevalent among those detected by screening. Female gender and Somalian origin increased the risk for active TB.In spite of an imperfect follow-up of screening results, a reasonable number of TB cases was identified by the programme, with a predominance of pulmonary TB.In recent years most new tuberculosis (TB) cases in Norway have occurred among immigrants from high incidence countries. Rarely, new cases are due to transmission within the country [1].Low incidence countries have diverse policies on entry screening of immigrants from high incidence countries. These range from no screening at all, to pre-immigration screening or screening after arrival [2-4]. There is an ongoing discussion about the content and effectiveness of different screening programmes to control tuberculosis [5,6]. Studies of screening of tuberculosis among immigrants have given TB prevalences that range from 0.1-1.2% [7-10], that can be due to differences in the characteristics of the populations and the screening programmes.Previous studies have shown differences between cases detected by or outside the screening
Intensified Tuberculosis Case Finding among Malnourished Children in Nutritional Rehabilitation Centres of Karnataka, India: Missed Opportunities
Prashant G. Bhat, Ajay M. V. Kumar, Balaji Naik, Srinath Satyanarayana, Deepak KG, Sreenivas A. Nair, Suryakanth MD, Einar Heldal, Donald A. Enarson, Anthony J. Reid
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0084255
Abstract: Background Severe acute malnutrition (SAM) is the most serious form of malnutrition affecting children under-five and is associated with many infectious diseases including Tuberculosis (TB). In India, nutritional rehabilitation centres (NRCs) have been recently established for the management of SAM including TB. The National TB Programme (NTP) in India has introduced a revised algorithm for diagnosing paediatric TB. We aimed to examine whether NRCs adhered to these guidelines in diagnosing TB among SAM children. Methods A cross-sectional study involving review of records of all SAM children identified by health workers during 2012 in six tehsils (sub-districts) with NRCs (population: 1.8 million) of Karnataka, India. Results Of 1927 identified SAM children, 1632 (85%) reached NRCs. Of them, 1173 (72%) were evaluated for TB and 19(2%) were diagnosed as TB. Of 1173, diagnostic algorithm was followed in 460 (37%). Among remaining 763 not evaluated as per algorithm, tuberculin skin test alone was conducted in 307 (41%), chest radiography alone in 99 (13%) and no investigations in 337 (45%). The yield of TB was higher among children evaluated as per algorithm (4%) as compared to those who were not (0.3%) (OR: 15.3 [95%CI: 3.5-66.3]). Several operational challenges including non-availability of a full-time paediatrician, non-functioning X-ray machine due to frequent power cuts, use of tuberculin with suboptimal strength and difficulties in adhering to a complex diagnostic algorithm were observed. Conclusion This study showed that TB screening in NRCs was sub-optimal in Karnataka. Some children did not reach the NRC, while many of those who did were either not or sub-optimally evaluated for TB. This study pointed to a number of operational issues that need to be addressed if this collaborative strategy is to identify more TB cases amongst malnourished children in India.
Intuition, a Part of Bipolar Disorder? The Emotional Brain-Survival and Time  [PDF]
Einar Hellbom
Open Journal of Depression (OJD) , 2014, DOI: 10.4236/ojd.2014.32009
Abstract: Survival and reproduction are essential for all living forms. Can intuition increase the survival rate and be a part of the evolution? One of our survival functions is the automatic response to fear like our reaction to snakes mediated by the amygdala also called the emotional brain. But how fast can the amygdala react? Can it react and protect even before an event has occurred? Dreams and visions bringing warnings of future danger have been described by many people. The condition can be related to psychiatric disorders and have a genetic base. If we strictly follow Einstein’s general theory, time is a dimension containing our universe’s past and future at the same time. Then a “time mirage” can be like an optical mirage where you can see people in the desert but they cannot see you. Our methods of measuring this dimension are limiting our understanding of it; but if the brain has access to the dimension, we might be able to study and understand it better with new tests.
Scaling Up Programmatic Management of Drug-Resistant Tuberculosis: A Prioritized Research Agenda
Frank G. J Cobelens ,Einar Heldal,Michael E Kimerling,Carole D Mitnick,Laura J Podewils,Rajeswari Ramachandran,Hans L Rieder,Karin Weyer,Matteo Zignol,on behalf of the Working Group on MDR-TB of the Stop TB Partnership
PLOS Medicine , 2008, DOI: 10.1371/journal.pmed.0050150
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