Background: Sick leave and return to work are common outcome variables in studies where the aim is to measure the effect of targeted interventions for individuals that are on sick leave benefits or other allowances. Use of official register data is often restricted, and research on sick leave and return to work are often based on the participants self-reports. However, there is insufficient documentation that there is agreement between self-reports and register data on sick leave benefits and allowances.Aims: The aim of this study was to analyse the individuals' knowledge about states of sick leave benefits or allowances compared with register data from The Labour and Welfare Administration (NAV) in Norway.Method: 153 individuals, sick-listed or on allowances, participated in a 4-week inpatient occupational rehabilitation program. 132 (86%) answered a questionnaire on assessments of work, sick leave, and allowances three months after completed rehabilitation. Self-reported data were compared with register data from NAV according to four categories: working, sick-listed, on medical/vocational rehabilitation allowance or disability pension. Agreement between self-reported and register data was evaluated in cross-tabulations and reported with kappa values. Stratified analyses were done for gender, age, education, medical diagnosis and length of sick leave/allowances at baseline.Results: Good agreement was found for medical/vocational rehabilitation allowance (kappa=.70) and disability pension (kappa=.65). Moderate agreement was found for working (kappa=.49) and fair agreement for sick-listed (kappa=.36). Stratified analyses showed significant better kappa values for individuals that had been sick-listed less than 12 months before entering the rehabilitation program.Conclusions: Agreements from good to fair were found between self-reported and official register data on sick leave. However, official register data is preferred in research because this will ensure complete data sets. Data on sick leave and other benefits are not absorbing states, and there are often multiple and recurrent episodes. These data may be hard to obtain from self-reports.
The present study examines the quantity, size, element signatures and distribution of titanium particles in normal oral mucosal tissue and in oral mucosa exposed to a titanium implant. Tissue samples from six healthy patients were obtained by a full thickness biopsy taken from the edge of the oral mucosa when inserting a titanium dental implant. At the abutment insertion 6 months later, a punch test biopsy of oral mucosa was taken over the implant site. Laser Ablation Inductively Coupled Plasma Mass Spectrometry (LA-ICP-MS) is a sensitive and specific multi-element microanalytical technique that demonstrated the presence of Ti particles in the tissue adjacent to implant cover-screws. The epithelial part of the control samples revealed more particles than the corresponding area of the test samples, consisting partly of newly formed scar tissue. High-Resolution Optical Darkfield Microscope (HR-ODM) confirmed the presence of particles in both the control and the test samples. The combination of LA-ICP-MS and HR-ODM appears to be a powerful combination for detection of particles in oral tissues; optical microscopy provides an overview with histological references, whereas LA-ICP-MS identifies the chemical composition.
Background
Tracheostomy alone, without mechanical ventilation, has been advocated to maintain a free airway in patients with traumatic brain injury in low-income settings with minimal critical care capacity. However, no reports exist on the outcomes of this strategy. We examine the results of this practice at a central hospital in Malawi.
Methods
This is a retrospective review of medical records and prospectively gathered trauma surveillance data of patients admitted to Kamuzu Central Hospital, with traumatic brain injury from January 2010 to December 2015. In-hospital mortality rates were examined according to registered traumatic brain injury severity and airway management.
Results
In our analysis, 1875 of 2051 registered traumatic brain injury patients were included; 83.3% were male, mean age 32.6 (SD 12.9) years. 14.2% (n=267) of the patients had invasive airway management (endotracheal tube or tracheostomy) with or without mechanical ventilation. Mortality in severe traumatic brain injury treated with tracheostomy without mechanical ventilation was 42% (10/24) compared to 21% (14/68) in patients treated without intubation or tracheostomy (p= 0.043). Tracheostomies had an overall complication rate of 11%.
Conclusion
Tracheostomy without mechanical ventilation in severe traumatic brain injury did not improve survival outcomes in our setting. Tracheostomy for severe traumatic brain injury cannot be recommended when mechanical ventilation is not available unless there are sufficient specialized human resources for follow up in the ward. Efforts to improve critical care facilities and human resource capacity to allow proper use of mechanical ventilation in severe traumatic brain injury should be a high priority in low-income countries where the burden of trauma is high.
The aim of this study was to examine the association between systemic lupus erythematosus (SLE) and periodontitis in Norway during a 10-year period from 2008 through 2017.In this population-based study, 1,990 patients were included in the SLE-cohort based on diagnostic codes registered in the Norwegian Patient Registry. The control group (n = 170,332) comprised patients registered with diagnostic codes for non-osteoporotic fractures or hip or knee replacement because of osteoarthritis. The outcome was periodontitis, defined by procedure codes registered in the Control and Payment of Health Refunds database. Logistic regression analyses were performed to estimate odds ratio for periodontitis in patients versus controls adjusted for potential covariates.Periodontitis was significantly more common in SLE patients compared to controls (OR 1.78, 95% CI 1.47-2.14) and the difference was highest in SLE-patients 20 to 30 years of age (OR 3.24, 95% CI 1.23 - 8.52). The periodontitis rate in SLE patients was in the same range as for patients with diabetes mellitus type 2.Patients with SLE had an almost doubled risk of periodontitis compared with the control population, and the difference was most accentuated in the young patients. These findings warrant an increased focus on dental health in SLE-patients.
Primary Sjögren's syndrome (pSS) is a systemic autoimmune disorder characterized by focal lymphocytic infiltration of the exocrine glands causing dry eyes and dry mouth. Immunological mechanisms in pSS have similarities with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), which have increased risk for periodontitis [1]. Patients with pSS already have inferior oral health and information regarding a possible connection between periodontitis and pSS is sparce. There is a need to explore this further in a large-scale study.
Objectives
To investigate the association between periodontitis and primary Sjögren's syndrome in a large national cohort.
Methods
We conducted a population-based study, where the cohorts were identified based on International Classification of Disease (ICD)-10-codes registered in the Norwegian Patient registry (NPR) during the period January 2011 – December 2017. The outcome was the manifestation of periodontitis defined by either at least one registration of periodontal surgery or 6 or more registrations of systematic treatment of periodontitis in the Norwegian Control and Payment of Health Reimbursement (KUHR). To be included in the pSS cohort (n=10 086) patients had to have 4 or more registrations with M35.0 as the main diagnosis in NPR. This limit was set to minimize the risk of miscoding. The comparative cohort (n=310 573) entailed patients treated for assumed non-osteoporotic fracture or having undergone hip- or knee replacement due to osteoarthritis during the study period. Only patients between 20 – 80 years of age were included, and patients with RA or SLE was excluded from the study population. Odds Ratio (OR) for periodontitis was calculated using logistic regression analyses adjusting for sex, age, diabetes mellitus (DM) 1 and 2, myocardial infarction (MI) and death. Lastly, similar regression analyses were performed for 6 age categories.
Results
A total of 760 (7.5%) patients in the pSS cohort had periodontitis, compared to 22 178 (7.1%) in the control cohort (p = 0.13), Table 1. When adjusting for age, sex, DM1 and DM2, the presence of pSS had no significant association to periodontitis (OR: 1.06, 95% CI: 0.98 – 1.14), Figure 1. In the age group 50 – 60 years the presence of pSS was statistically significantly associated periodontitis (OR: 1.22, 95% CI: 1.06 – 1.40). The same association could not be seen in any other age group. Furthermore, increasing age was associated with increased risk of periodontitis (OR: 1.025, 95% CI: 1.024 – 1.026.)
Conclusion
These results indicate that patients with pSS age 50-60 years have a significant increased risk of periodontitis compared to a control population. However, we observed no association between periodontitis and pSS in any of the other age groups in this large nationwide study.
Reference
[1]Bolstad et al., J Periodontol 2022
Acknowledgements:
NIL.
Disclosure of Interests
Odd-Olav Aga: None declared, Anne Bolstad: None declared, Stein Lie: None declared, Bjørg Tilde Svanes Fevang Speakers bureau: Part of discussion board at UCB conference on spondyloarthritis, Consultant of: Part of advisory board Lilly.
Operative treatment of acetabular fractures generally yields good results, but several authors report up to 15-20% of patients developing post-traumatic osteoarthritis (OA). Previous studies have shown that total hip arthroplasty (THA) following post-traumatic OA have inferior results compared to THA for primary OA. The aim of this study was to report on long-term outcome of THA following acetabular fracture, compared to primary OA.
Abstract Background To compare presence and levels of serum cytokines in smokers and non-smokers with periodontitis following periodontal therapy. Methods Thirty heavy smokers and 30 non-smokers with stage III or IV periodontitis were included in this prospective cohort study. Clinical data and blood serum were collected at baseline (T0), after step I-III (T1), and after 12 months step IV periodontal therapy (T2). Cytokine IL-1β, IL-6, IL-8, TNF-α, IL-10, and IP-10 levels were measured using multiplex kit Bio-Plex Human Pro™ Assay. Linear regression models with cluster robust variance estimates to adjust for repeated observations were used to test intra- and intergroup levels for each marker, IL-6 and IL-8 defined as primary outcomes. Results Clinical outcomes improved in both groups following therapy ( p < 0.05). IL-6 levels increased with 75.0% from T0-T2 among smokers ( p = 0.004). No significant intra- or intergroup differences were observed for IL-8. Higher levels of TNF-α (44.1%) and IL-10 (50.6%) were detected in smokers compared with non-smokers at T1 ( p = 0.007 and p = 0.037, respectively). From T1-T2, differences in mean change over time for levels of TNF-α and IL-10 were observed in smokers compared with non-smokers ( p = 0.005 and p = 0.008, respectively). Conclusion Upregulated levels of serum cytokines in smokers indicate a systemic effect of smoking following periodontal therapy. Differences in cytokine levels between smokers and non-smokers demonstrate a smoking induced modulation of specific systemic immunological responses in patients with severe periodontitis.
There is limited knowledge on the effect of acute exacerbations in chronic obstructive pulmonary disease (AECOPD) on lung cancer risk in COPD patients with and without a history of asthma. This study aims to examine whether AECOPD is associated with risk of lung cancer, and whether the effect depends on a history of asthma.In the GenKOLS study of 2003-2005, 852 subjects with COPD performed spirometry, and filled out questionnaires on smoking habits, symptoms and disease history. These data were linked to lung cancer data from the Cancer Registry of Norway through 2013. AECOPD, measured at baseline was the main predictor. To quantify differences in lung cancer risk, we performed Cox-proportional hazards regression. We adjusted for sex, age, smoking variables, body mass index, and lung function.During follow-up, 8.8% of the subjects with, and 5.9% of the subjects without exacerbations were diagnosed with lung cancer. Cox regression showed a significant increased risk of lung cancer with one or more exacerbations in COPD patients without a history of asthma, HRR = 2.77 (95% CI 1.39-5.52). We found a significant interaction between a history of asthma and AECOPD on lung cancer.AECOPD is associated with an increased risk of lung cancer in COPD patients without a history of asthma.
Return to work (RTW) after long-term sick leave can be a long-lasting process where the individual may shift between work and receiving different social security benefits, as well as between part-time and full-time work. This is a challenge in the assessment of RTW outcomes after rehabilitation interventions. The aim of this study was to analyse the probability for RTW, and the probabilities of transitions between different benefits during a 4-year follow-up, after participating in a work-related rehabilitation program. The sample consisted of 584 patients (66% females), mean age 44 years (sd = 9.3). Mean duration on various types of sick leave benefits at entry to the rehabilitation program was 9.3 months (sd = 3.4)]. The patients had mental (47%), musculoskeletal (46%), or other diagnoses (7%). Official national register data over a 4-year follow-up period was analysed. Extended statistical tools for multistate models were used to calculate transition probabilities between the following eight states; working, partial sick leave, full-time sick leave, medical rehabilitation, vocational rehabilitation, and disability pension; (partial, permanent and time-limited). During the follow-up there was an increased probability for working, a decreased probability for being on sick leave, and an increased probability for being on disability pension. The probability of RTW was not related to the work and benefit status at departure from the rehabilitation clinic. The patients had an average of 3.7 (range 0–18) transitions between work and the different benefits. The process of RTW or of receiving disability pension was complex, and may take several years, with multiple transitions between work and different benefits. Access to reliable register data and the use of a multistate RTW model, makes it possible to describe the developmental nature and the different levels of the recovery and disability process.
