> Continued need for well designed studies Menstrual irregularities are very common, and affect women's health, wellbeing, and daily life.[1][1] Before the covid-19 vaccination roll-out, menstrual changes after vaccination were rarely reported to spontaneous reporting systems, and no associations
Background The Scandinavian society of anaesthesiology and intensive care medicine task force on pre‐hospital airway management was asked to formulate recommendations following standards for trustworthy clinical practice guidelines. Methods The literature was systematically reviewed and the grading of recommendations assessment, development and evaluation ( GRADE ) system was applied to move from evidence to recommendations. Results We recommend that all emergency medical service ( EMS ) providers consider to: apply basic airway manoeuvres and airway adjuncts (good practice recommendation); turn unconscious non‐trauma patients into the recovery position when advanced airway management is unavailable (good practice recommendation); turn unconscious trauma patients to the lateral trauma position while maintaining spinal alignment when advanced airway management is unavailable [strong recommendation, low quality of evidence (QoE)]. We suggest that intermediately trained providers use a supraglottic airway device ( SAD ) or basic airway manoeuvres on patients in cardiac arrest (weak recommendation, low QoE). We recommend that advanced trained providers consider using an SAD in selected indications or as a rescue device after failed endotracheal intubation ( ETI ) (good practice recommendation). We recommend that ETI should only be performed by advanced trained providers (strong recommendation, low QoE). We suggest that videolaryngoscopy is considered for ETI when direct laryngoscopy fails or is expected to be difficult (weak recommendation, low QoE). We suggest that advanced trained providers apply cricothyroidotomy in ‘cannot intubate, cannot ventilate’ situations (weak recommendation, low QoE). Conclusion This guideline for pre‐hospital airway management includes a combination of techniques applied in a stepwise fashion appropriate to patient clinical status and provider training.
While prophylactic human papilloma virus (HPV) vaccination is considered effective in young girls, it is unclear whether a catch-up vaccination of older girls would be beneficial. We, therefore, aimed to examine the potential health impact of a HPV catch-up vaccination of girls who were too old at the time of vaccine introduction, hence aged 16 and older. We systematically searched the literature for randomized clinical trials (RCTs) that examined the effect of HPV vaccines on overall mortality, cancer mortality and incidence, high-grade cervical intraepithelial neoplasia grade 2 and higher (CIN2+), vulvar intraepithelial neoplasia (VIN) and vaginal intraepithelial neoplasia (VaIN) grade 2 and higher lesions (VIN2+ and VaIN2+, respectively) genital warts (condyloma). We considered all lesions and those associated with HPV type(s) included in the vaccines. RCTs reporting on serious adverse events were also eligible. Selected publications were assessed for potential risk of bias, and we ascertained the overall quality of the evidence for each outcome using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta-analyses were performed, assuming both random and fixed effects, to estimate risk ratios (RR) and corresponding 95% confidence intervals (CI), using intention-to-treat and per-protocol populations. We included 46 publications reporting on 13 RCTs. Most of the RCTs had a maximum follow-up period of four years. We identified no RCT reporting on the effect of HPV catch vaccination on overall and cancer related mortality, and on cervical cancer incidence. We found a borderline protective effect of a HPV catch-up vaccination on all CIN2+, with a pooled RR of 0.80 (95% CI: 0.62-1.02) for a follow-up period of 4 years. A HPV catch-up vaccination was associated with a reduction in VIN2+ and VaIN2+ lesions, and condyloma. No difference in risk of serious adverse events was seen in vaccinated participants versus unvaccinated women (pooled RR of 0.99 (0.91-1.08)). This systematic review indicates that a HPV catch-up vaccination could be beneficial, however the long-term effect of such a vaccination, and its effect on cervical cancer incidence and mortality is still unclear.
Hurtigoppsummering fra Nasjonalt kunnskapssenter for helsetjenesten i fht kunnskapsgrunnlaget for effekt av tiltak for a forhindre fall hos eldre pasienter i sykehus og sykehjem.
Many signals of menstrual disturbances as possible side effects of vaccination against COVID-19 have been reported. Our objective was to compare the risk of menstrual disturbances before and after vaccination among women aged 18-30 years in Oslo, Norway. We used electronic questionnaires to collect reports of menstrual disturbances from 3972 women aged 18-30 years, participating in the population-based Norwegian Young Adult Cohort. We examined the occurrence of menstrual disturbances (heavier bleeding than usual, prolonged bleeding, shorter interval between menstruations, longer interval between menstruations, spot bleedings, stronger pain during menstruation, period pain without bleeding) before and after the first and second dose of COVID-19 vaccine. Relative risks (RR) according to vaccination were estimated using a self-controlled case-series design. We performed additional analyses stratified by vaccine brand, contraception/hormone use, and presence of gynecological condition(s). The prevalence of any menstrual disturbance was 36.7% in the last menstrual cycle prior the first vaccine dose. The RR for heavier bleeding than usual was 1.90 (95% CI: 1.69-2.13) after the first vaccine dose and 1.84 (1.66-2.03) after the second dose. Increased risks of prolonged bleeding, shorter interval between menstruations, and stronger pain during menstruation were also observed after both doses. The RRs did not differ with vaccine brand, contraception/hormone use, or presence of gynecological condition(s) for any of the menstrual disturbances. Menstrual disturbances were common regardless of vaccination. We found increased risk of menstrual disturbances after vaccination, particularly for heavier bleeding than usual, prolonged bleeding, shorter interval between menstruations, and stronger period pain. In the future, menstrual characteristics should be included in vaccine trials.
To evaluate the cost-effectiveness of expanding the Norwegian HPV vaccination program to catch-up females and 12 years old boys. We systematically searched the literature for randomized clinical trials (RCTs) that examined the effect of HPV vaccines on cancer mortality and incidence, precancerous stages and serious adverse events. We assessed selected publications for potential risk of bias, and the overall quality of the evidence for each outcome using GRADE. We adapted a published economic model to the Norwegian setting with respect to incidence of HPV-related outcomes, costs and quality adjusted life years (QALYs) lost from HPV-related diseases. The cost utility analysis reported results in Euros/QALY gained in both a public health budget and a societal perspective. We included 46 publications reporting on 13 RCTs for young women, and 3 on 2 RCT for boys (maximum follow-up period: three-four years). We found a borderline protective effect of HPV catch-up vaccination on all CIN2+, with a pooled risk ratio (RR) of 0.80 (95% CI: 0.62-1.02) for a follow-up period of 4 years. HPV catch-up vaccination was associated with a reduction in VIN2+ and VaIN2+ lesions, and genital warts. No difference in risk of serious adverse events was seen in vaccinated participants versus unvaccinated women (pooled RR of 0.99 (0.91-1.08) ). We are currently reviewing the studies on boys. From a public health budget perspective, catch-up vaccination led to higher costs and health gains and an ICER=70371€. From a societal perspective, the incremental costs were lower, resulting in an ICER=67365€. This systematic review indicates that a HPV catch-up vaccination could be beneficial and cost-effective for young women. The long-term effect of such a vaccination, and its effect on cancer incidence and mortality is still unclear.
In Norway more than a third of all patients with cancer use some form of complementary or alternative therapy (CAM). In order to support The Norwegian Cancer Society’s work with information in this field we have identified and summarized 39 systematic reviews on the efficacy and safety of some main complementary and alternative therapies for patients with cancer.The Norwegians law from 2003 gives the following definition of alternative treatment; Alternative treatment means health-related treatment as practiced outside the health service and are not performed by licensed health care professional. Treatment that is exercised in the health service or by an authorized health care providers, however, covered by the term alternative treatment when used methods which are mainly used outside the health service. When patients use alternative therapies in addition to the treatment they receive at the hospital, it is also called complementary or integrated treatment.We searched for systematic reviews documenting efficacy and safety of complementary and/or alternative therapy (CAM) used among patients with cancer. We included systematic reviews of the following methods or therapies: Vitamins and minerals, food supplements, different types of herbs (also pharmacologically produced), acupuncture, reflexology, massage, aromatherapy, hypnosis, homeopathy, traditional Chinese medicine, and various body and mind techniques.The evidence from these 39 systematic reviews, with a few exceptions, was generally of low quality, and most results are uncertain.There is a lack of evidence for the efficacy and safety for most types of alternative methods for treatment and symptom relief for patients with cancer. For some of the alternative treatment methods there is evidence of adverse events. Further research is required. When it comes to safety, it should be considered whether it is justifiable to carry out major new studies with measures that have shown serious side effects.
