AIM:To compare self-reported pain sensitivity and the use of pain medication in young adults born extremely preterm (EP) with matched term-born controls. METHODS:In this third follow-up of a population-based cohort study of individuals born EP (gestational age ≤28 weeks) in 1991-92, the Pain Sensitivity Questionnaire (PSQ) was administered together with health-related questions. Matched term-born controls served as a comparison group. RESULTS:At 27 years of age, 24 (69%) EP-born and 26 (74%) term-born controls consented to participate. There were no significant differences between groups in PSQ total, moderate, or minor scores, nor in the use of pain medication. No associations were found between the number of painful procedures in the neonatal period and pain sensitivity at 27 years. CONCLUSION:Self-reported pain sensitivity and use of pain medication at 27 years of age did not differ between adults born extremely preterm and their term-born peers.

Background/Objectives: Psychological distress, including symptoms of anxiety and depression, is common among individuals with inflammatory bowel disease (IBD) and may adversely affect well-being and disease management. However, routine assessment of mental health is not consistently integrated into clinical care. This study assessed the prevalence of anxiety and depression among patients newly diagnosed with IBD at diagnosis and after three months of treatment and explored associations between psychological symptoms, disease activity, and clinical characteristics. Methods: This prospective cohort study included 304 adults newly diagnosed with IBD and treated at Stavanger University Hospital between 2012 and 2019. Symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale at baseline and after three months. Disease activity was evaluated using the Harvey–Bradshaw Index and Partial Mayo Score. Clinical variables included C-reactive protein, faecal calprotectin, folate, cobalamin, and body mass index. Multivariable regression analyses were conducted to identify factors associated with psychological symptoms. Results: The prevalence of anxiety decreased from 29.8% at diagnosis to 21.6% after three months, while the prevalence of combined anxiety and depression declined from 22.2% to 16.3%. The prevalence of depression alone remained stable over time. Higher disease activity, particularly as measured by the Harvey–Bradshaw Index, showed the strongest association with anxiety and depressive symptoms. However, after adjustment for potential confounders, no significant improvement in psychological symptoms was observed, suggesting that the association between time and HADS scores may be explained by changes in one or more measured covariates. Conclusions: Psychological symptoms remained common during the first months following an IBD diagnosis and were closely associated with disease activity. Medical treatment alone was insufficient to achieve meaningful improvements in mental health outcomes. These findings highlight the importance of systematic psychological assessment, early identification of emotional distress, and integrated multidisciplinary care, including nursing-led screening and supportive interventions, for individuals newly diagnosed with IBD.

BACKGROUNDGiven the early discharge associated with ambulatory surgery, digital health interventions (DHIs) may be useful in out of hospital follow-up. However, there are no systematic reviews concerning the use of DHIs in this setting.OBJECTIVETo identify and evaluate the effects of DHIs on, patient safety, patient experience, and efficiency in post discharge ambulatory surgery.DESIGNSystematic review and meta-analysis. Cochrane Risk of Bias Tool and Grading of Recommendations, Assessment, Development, and Evaluation were used.DATA SOURCESMEDLINE, EMBASE, CINAHL, Cochrane Library, and Scopus were systematically searched from inception to 9 October 2024.ELIGIBILITY CRITERIARandomised controlled trials (RCTs); ambulatory surgical patients >= 18 years; post discharge digital health interventions, including but not limited to computer tablets, mobile applications, and smart phones. Control group interventions included post discharge follow-up by a general practitioner, office-based follow-up, telephone follow-up, or no intervention.RESULTSSix RCTs, with a total of 1397 patients were included. The meta-analyses showed no significant effects of DHIs compared with control group interventions on average pain intensity during postoperative days one to three, standardised mean difference = -0.15 (95% CI, -0.66 to 0.35), P = 0.556, or on unplanned healthcare encounters up to six months postoperatively, relative risk = 0.98 (95% CI, 0.92 to 1.05), P = 0.580. A review of individual articles showed that patients in the DHI groups reported significantly less impaired sleep, mood swings, stress, dizziness, headaches, sore mouth, constipation, and wound-related problems. Additionally, costs were lower, and patients reported improved functional status and well being compared with the control group. The risk of bias varied from low to moderate and the quality of evidence was low.CONCLUSIONSDigital health interventions may reduce some symptoms and costs following discharge from ambulatory surgery, while improving quality of life. However, uncertainty remains due to the limited number of studies, some inconsistent results, and the low certainty of evidence.

BACKGROUND:Given the early discharge associated with ambulatory surgery, digital health interventions (DHIs) may be useful in out of hospital follow-up. However, there are no systematic reviews concerning the use of DHIs in this setting. OBJECTIVE:To identify and evaluate the effects of DHIs on, patient safety, patient experience, and efficiency in post discharge ambulatory surgery. DESIGN:Systematic review and meta-analysis. Cochrane Risk of Bias Tool and Grading of Recommendations, Assessment, Development, and Evaluation were used. DATA SOURCES:MEDLINE, EMBASE, CINAHL, Cochrane Library, and Scopus were systematically searched from inception to 9 October 2024. ELIGIBILITY CRITERIA:Randomised controlled trials (RCTs); ambulatory surgical patients ≥18 years; post discharge digital health interventions, including but not limited to computer tablets, mobile applications, and smart phones. Control group interventions included post discharge follow-up by a general practitioner, office-based follow-up, telephone follow-up, or no intervention. RESULTS:Six RCTs, with a total of 1397 patients were included. The meta-analyses showed no significant effects of DHIs compared with control group interventions on average pain intensity during postoperative days one to three, standardised mean difference = -0.15 (95% CI, -0.66 to 0.35), P = 0.556, or on unplanned healthcare encounters up to six months postoperatively, relative risk = 0.98 (95% CI, 0.92 to 1.05), P  = 0.580. A review of individual articles showed that patients in the DHI groups reported significantly less impaired sleep, mood swings, stress, dizziness, headaches, sore mouth, constipation, and wound-related problems. Additionally, costs were lower, and patients reported improved functional status and well being compared with the control group. The risk of bias varied from low to moderate and the quality of evidence was low. CONCLUSIONS:Digital health interventions may reduce some symptoms and costs following discharge from ambulatory surgery, while improving quality of life. However, uncertainty remains due to the limited number of studies, some inconsistent results, and the low certainty of evidence.

AIMS:The study aims to examine whether self-reported mental health outcomes among adults born extremely preterm differ from those of adults born at term. METHODS:A population-based, cross-sectional study was conducted. The study included 48 eligible individuals born between 1982 and 1985 in western Norway with a gestational age ≤ 28 weeks or birth weight ≤ 1000 g, and 46 term-born controls. Mental health was assessed at age 34 years using the Adult Self-Report questionnaire. Data was analysed to compare outcomes between preterm and term-born controls. RESULTS:At age 34 years, 32 (67 %) extremely preterm born and 36 (78 %) term-born participated. The extremely preterm group reported significantly higher scores than the term-born group on the mental health scales for anxious/depressed, withdrawn, somatic complaints, aggressive behaviour, internalizing, and total problems. The extremely preterm group had lower levels of education and employment, and higher rates of disability or unemployment. CONCLUSIONS:The findings suggest an association between being born extremely preterm or with extremely low birth weight and poorer self-reported mental health in adulthood compared with term-born controls. Future research should investigate potential underlying causes of this relationship to improve understanding and develop preventive strategies.

Background Right-sided colon cancer (RCC) differs in mutation profile and risk of recurrence compared to distal colon cancer. Circulating tumour DNA (ctDNA) present after surgery can identify patients with residual disease after curative surgery and predict risk of early recurrence. Methods This is a prospective observational biomarker trial with exploration of ctDNA in 50 non-metastatic RCC patients for which oncological right-sided colectomy was performed. Blood samples were collected preoperatively, within 1 month post surgery, 3 months (not mandatory), 6 months and every 6 months thereafter. Plasma cell free DNA and/or tumour was investigated for cancer-related mutations by the next-generation sequencing (NGS) panel AVENIO surveillance specifically designed for ctDNA analysis. Detected mutations were quantified using digital droplet PCR (ddPCR) for follow-up. Recurrence-free survival was explored. Results 50 patients were recruited. Somatic cancer-related mutations were detected in 47/50 patients. ddPCR validated results from NGS for 27/34 (plasma) and 72/72 samples (tumour). Preoperative ctDNA was detected in 31/47 of the stage I/III patients and the majority of ctDNA positive patients showed reduction of ctDNA after surgery (27/31). ctDNA-positive patients at first postoperative sample had high recurrence risk compared to patients without measurable ctDNA (adjusted hazard ratio: 172.91; 95% c.i.: 8.70 to 3437.24; P: 0.001). Conclusion ctDNA was detectable in most patients with non-metastatic RCC before surgery. Positive postoperative ctDNA was strongly associated with early recurrence. Detectable postoperative ctDNA is a prognostic factor with high (100%) positive predictive value for recurrence in this cohort of non-metastatic RCC. Clinical Trial Registration ClinicalTrials.gov ID: NCT03776591

Objective: This study aimed to evaluate associations of intra-operative risk factors and the WHO Surgical Safety Checklist with the incidence of surgical site infections (SSIs) following abdominal surgery up to 30 days post-surgery. Background: SSIs pose a significant challenge in healthcare, particularly after major abdominal surgery. Implementing the Surgical Safety Checklist is considered a strategy to mitigate the risk of SSIs. Evidence on intra-operative risk factors contributing to post-discharge SSIs, especially in abdominal surgery patients, is limited. Method: A retrospective observational, cohort study was conducted over 5 years at a Norwegian university hospital, and included adult patients undergoing colon resection, cholecystectomy, and caesarean sections. Standardised anaesthetic techniques were applied, and core body temperatures were routinely recorded at the start and end of surgery. Data were collected from an administrative operation planning system and SSIs register. SSIs were monitored according to the Norwegian national surveillance system on Surgical Site Infections (NOIS) and The Healthcare-Associated Infections Surveillance Network (HAI-Net), with additional patient and physician-reported data on wound infections. The probability of SSIs was analysed using multiple logistic regression. Results: A total of 11.2% (463/4142) of patients developed SSIs, of which 4.6% (189/4142) developed SSIs after discharge from hospital. Age, gender, forced air warming blankets, fluid warmer, volume of intravenous fluids, and the Surgical Safety Checklist use were not associated with the total number of SSIs. Perioperative temperature, duration of surgery, open surgical access, type of surgery, regional anaesthesia, and higher comorbidity were observed as risk factors. A significant association was found between omitting use of the WHO SSC Time-Out component and post-discharge SSIs, with a fully adjusted odds ratio of 1.95. The incidence of SSIs after discharge was also associated with factors such as perioperative temperature. Conclusion: The WHO SSC may predominantly impact the incidence of SSIs after discharge. Moreover, intra-operative work processes such as shorter duration of surgery and maintaining perioperative normothermia may protect against SSIs. Clinical Trial Identifier:NCT03112317

AIM:To identify occurrence of harmful incidents related to patient positioning on operating table. DESIGN:Systematic review and meta-analysis. DATA SOURCES:Eight databases including Ovid, Medline, Embase, CINAHL, the Cochrane Library, Epistemonikos, Scopus, Web of Science and Google Scholar were systematically searched from the inception of the databases to August 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram depicting the flow information. REVIEW METHODS:The Cochrane Risk of Bias Tools were used to assess the risk of bias. Risk of harm with 95% confidence interval (CI) was estimated for each included study, and an overall risk was calculated using meta-analysis. RESULTS:Of the 22 included reports, two were randomized controlled trials (RCTs), five had a prospective cohort design, three had a cross-sectional design, and 12 were register-based studies. Intraoperative peripheral nerve injuries, perioperative pressure ulcers, musculoskeletal injuries, vascular injuries, postoperative pain and eye injuries were related to supine, lithotomy, Trendelenburg, prone and beach chair positioning. Overall risk of any harm was estimated as 0.2%. Studies with patients placed in prone positioning (8 study samples) had the highest risks of harm varying from 0.19 to 0.81, with an overall risk of 0.33. Meta-analysis of the two RCTs showed higher risk of chemosis with head-down positioning than with head in neutral position (overall relative risk = 1.64; 95% CI: [1.25, 2.14]). CONCLUSIONS:Harmful incidents related to patient positioning occur and consequences can be severe. The operating room teams should be aware of the harms and prevent and treat them seriously. IMPACT:This review underlines that research is sparse on patient positioning on operating table and harmful incidents. There is a need for high-quality, well-designed studies that focus on harmful incidents and prevention of harm related to patient positioning. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution, as this is a review of previous research.

Aim To evaluate placental pathology in term and post-term births, investigate differences in clinical characteristics, and assess the risk of adverse neonatal outcome. Methods This prospective observational study included 315 singleton births with gestational age (GA) > 36 weeks + 6 days meeting the local criteria for referral to placental histopathologic examination. We applied the Amsterdam criteria to classify the placentas. Births were categorized according to GA; early-term (37 weeks + 0 days to 38 weeks + 6 days), term (39 weeks + 0 days to 40 weeks + 6 days), late-term (41 weeks + 0 days to 41 weeks + 6 days), and post-term births (≥ 42 weeks + 0 days). The groups were compared regarding placental pathology findings and clinical characteristics. Adverse neonatal outcomes were defined as 5-minute Apgar score < 7, umbilical cord artery pH < 7.0, admission to the neonatal intensive care unit or intrauterine death. A composite adverse outcome included one or more adverse outcomes. The associations between placental pathology, adverse neonatal outcomes, maternal and pregnancy characteristics were evaluated by logistic regression analysis. Results Late-term and post-term births exhibited significantly higher rates of histologic chorioamnionitis (HCA), fetal inflammatory response, clinical chorioamnionitis (CCA) and transfer to neonatal intensive care unit (NICU) compared to early-term and term births. HCA and maternal smoking in pregnancy were associated with adverse outcomes in an adjusted analysis. Nulliparity, CCA, emergency section and increasing GA were all significantly associated with HCA. Conclusions HCA was more prevalent in late and post-term births and was the only factor, along with maternal smoking, that was associated with adverse neonatal outcomes. Since nulliparity, CCA and GA beyond term are associated with HCA, this should alert the clinician and elicit continuous intrapartum monitoring for timely intervention.

The aim of this study was to investigate psychometric properties, reliability and validity, of Astrid Lindgren and Lund Children's Hospitals Pain and Stress Assessment Scale for Preterm and Sick Newborn Infants (ALPS-Neo), as a measure for procedural pain. This observational, prospective study with a repeated measures design, explored inter-rater reliability by two raters assessing 21 neonates during non-pain and pain events. Construct validity was explored, that is, ability to discriminate between non-pain and pain, and criterion validity by correlating ALPS-Neo with Premature Infant Pain Profile-Revised (PIPP-R) and Skin Conductance Algesimeter (SCA) in 54 neonates without ventilator support and sedation undergoing routine heel-stick procedure in a tertiary neonatal intensive care unit. Mean gestational and assessment age of 54 infants was 33.8 weeks and 12.7 days respectively. Inter-rater reliability from baseline, skin wiping, heel-stick events for 21 infants demonstrated intraclass correlations with 95% confidence intervals (CI) of 0.49 (−0.27 to 0.79), 0.86 (0.65–0.94) and 0.73 (0.34–0.89) respectively. ALPS-Neo discriminated significantly between baseline, non-pain and heel-stick (mean differences from pain event −2.3 and −1.0 respectively) and correlated during heel-stick with PIPP-R ( r  = 0.56, 95% CI: 0.34–0.72), not with SCA. ALPS-Neo may be used as a measure for procedural pain.

Background:There is no consensus on the management of incidental meningiomas. The literature on long-term growth dynamics is sparse and the natural history of these tumors remains to be illuminated. Methods:We prospectively assessed long-term tumor growth dynamics and survival rates during active monitoring of 62 patients (45 female, mean age 63.9 years) harboring 68 tumors. Clinical and radiological data were obtained every 6 months for 2 years, annually until 5 years, then every second year. Results:The natural progression of incidental meningiomas during 12 years of monitoring was growth (P < .001). However, mean growth decelerated at 1.5 years and became insignificant after 8 years. Self-limiting growth patterns were seen in 43 (63.2%) tumors, non-decelerating in 20 (29.4%) and 5 (7.4%) were inconclusive due to ≤ 2 measurements. Decelerating growth persisted once established. Within 5 years, 38 (97.4%) of 39 interventions were initiated. None developed symptoms prior to intervention. Large tumors (P < .001) involving venous sinuses (P = .039) grew most aggressively. Since inclusion 19 (30.6%) patients have died of unrelated causes and 2 (3%) from grade 2 meningiomas. Conclusion:Active monitoring seems a safe and appropriate first-line management of incidental meningiomas. Intervention was avoided in > 40% with indolent tumors in this cohort. Treatment was not compromised by tumor growth. Clinical follow-up seems sufficient beyond 5 years if self-limiting growth is established. Steady or accelerating growth warrant monitoring until they reach a stable state or intervention is initiated.

Abstract Background A central lymphadenectomy in right-sided colon cancer involves dissection along the superior mesenteric axis, but the extent is debated due to a lack of consensus and the fear of major complications. This randomized controlled trial compared the rate of postoperative morbidity in patients undergoing laparoscopic versus open right-sided colectomy with central lymphadenectomy. Methods This open, prospective, randomized controlled trial compared patients operated on with open and laparoscopic right-sided colectomy (cStages I–III) with a central lymphadenectomy at two Norwegian institutions between October 2016 and December 2021. Dissections were conducted along the superior mesenteric vein in the laparoscopic group, and along the left anterior border of the superior mesenteric artery in the open group, both according to complete mesocolic excision principles. Surgery was standardized and performed by three experienced surgeons for each study group. The primary outcome of interest was to measure postoperative 30-day complications (Clavien–Dindo ≥ grade II). Results Of 273 eligible patients, 135 were randomized and 128 analysed (63 operated on with open and 65 using laparoscopic procedures). Postoperative complications occurred in 42.8 per cent of the patients treated with open and 38.4 per cent of the patients treated using laparoscopic surgery, P = 0.372. The incidence of Clavien–Dindo grade IIIb complications was 7.9 per cent in the open versus 4.6 per cent in the laparoscopic group, P = 0.341. There were no grade IV or V complications, and no re-operations due to anastomotic leakages. There was no significant difference in the mean(s.e.m.) number of removed lymph nodes (open versus laparoscopic respectively: 31.9(1.8) versus 29.3(1.3); P = 0.235). Conclusion There was no significant difference in complications between the two groups. Standardized oncologic right-sided colectomy with central lymphadenectomy along the mesenterial root was performed safely, both open and laparoscopic, with incidence of major complications ranging between 4.6 and 7.9 per cent and no re-operations for anastomotic leakage. Radicality in terms of lymphadenectomy was comparable between the two groups. Registration number: NCT03776591 (http://www.clinicaltrials.gov).

Objective: To investigate changes and predictors of change in physical and mental function over a 3-year period after rehabilitation. Design: Prospective cohort. Participants: Patients, across diseases, living in western Norway, accepted for somatic specialized interprofessional rehabilitation (n = 984). Methods: Physical and mental function were assessed at admittance (baseline), and after 1 and 3 years using the Medical Outcome Study Short Form 36 (SF-36). Associations between changes in SF-36 component summary scores and sense of coherence, pain, disease group (musculoskeletal, neoplasm, cardiovascular, neurological, other), exercise habits and demographic variables were analysed using linear mixed modelling. Results: In the total group, mean (standard deviation) physical component summary scores improved by 2.9 (8.4) and 3.4 (9.3) points at 1 and 3 years, respectively. Mental component summary scores improved by 2.1 (9.7) and 1.6 (10.8) points. Improvement in physical component summary was significantly greater for patients with higher sense of coherence (b = 0.09, p = 0.001) and for the neoplasm disease group (b = 2.13, p = 0.046). Improvement in mental component summary was significantly greater for patients with low sense of coherence (b = –0.13, p = < 0.001) and higher level of education (b = 3.02, p = 0.0302). Interaction with age (physical component summary: b = 0.22, p = 0.039/mental component summary b = 0.51, p = 0.006) indicated larger effect at 1 year than at 3 years. Conclusion: Physical and mental function improved in the total study group over the 3-year period. Sense of coherence at baseline was associated with improved physical and mental function, suggesting that coping resources are important in rehabilitation. LAY ABSTRACT Rehabilitation aims to improve function among people with disabilities. This study investigated how physical and mental function change in a 3-year period after rehabilitation, and the factors related to these changes. In a cohort of 984 rehabilitation patients, physical and mental function were measured before rehabilitation (baseline) and at 1 and 3 years after rehabilitation. Both physical and mental function improved over a period of 3 years, with the greatest improvement from baseline to 1 year. Improved function at 1 year remained relatively stable over time. Participants with higher coping resources at baseline, measured by sense of coherence, had the greatest improvement in physical function, and less improvement in mental function. Participants’ disease group influenced change in physical function. Participants with a higher level of education demonstrated greater improvement in mental function. These results imply that coping resources should be addressed as an important part of rehabilitation.

Aims: Patients with symptomatic aortic valve stenosis are efficiently treated by aortic valve replacement (AVR), using a biological or mechanical valve. For some patients with mechanical valves, the metallic clicking sound may be problematic. The aim of this study was to investigate the perceived disturbance from the sound of a mechanical valve and the association between noise perception and symptoms of anxiety and depression. Methods and results: The study had a cross-sectional design. In April 2013, all patients who had undergone AVR at one university hospital during the period 2000-12 were invited by post to participate. The primary variables were assessed using a valve-specific questionnaire and the Hospital Anxiety and Depression Scale. Of the 912 (77%) respondents, 245 had mechanical valves. Of these, 59 (24%) were women, the mean (standard deviation) age was 61 (11) years, and the mean time since surgery was 7 (3) years. The valve-specific questionnaire showed that 84% of the patients could sometimes or often hear the valve sound. A moderate positive correlation was found between valve prosthesis noise disturbance and anxiety, r = 0.35 (P = 0.001), and depression, r = 0.27 (P = 0.001). In a multiple linear regression analysis, valve noise perception was only significantly associated with anxiety among several other bio-psychosocial factors. Conclusion: This study shows an association between valve noise disturbance and symptoms of anxiety and highlights the importance of preparing all patients for the sound from the mechanical valves that arises after surgery. [GRAPHICS] .

BACKGROUND:Histologic chorioamnionitis (HCA) is most often caused by ascending bacterial infection originating from the cervicovaginal tract. OBJECTIVES:To investigate whether HCA with a fetal inflammatory response (FIR) has a worse clinical outcome than HCA alone. Further, if FIR or a positive maternal microbiologic culture obtained prior to birth were related to adverse neonatal outcomes in a cohort of extremely preterm (EP) neonates. METHODS:Prospective observational cohort study recruiting EP singleton pregnancies (gestational age at birth ≤28 weeks) with confirmed HCA. FIR was defined by fetal neutrophils in the chorionic vessels and/or umbilical vessels. Positive culture was defined as growth of potentially pathogenic bacteria in a sample from the cervicovaginal tract prior to birth, or if a cervicovaginal culture was lacking, a culture result from the placenta was used. Logistic regression was used to estimate odds ratios and 95% confidence intervals for the associations between FIR, a positive culture result and adverse outcomes, defined as bronchopulmonary dysplasia (BPD), brain pathology assessed by magnetic resonance imaging, retinopathy of prematurity, necrotizing enterocolitis, early-onset neonatal sepsis, and perinatal death. A composite outcome variable included one or more adverse outcomes. RESULTS:We included 71 cases with HCA, of which 51 (72%) had FIR. Maternal age, rate of clinical chorioamnionitis (CCA), preterm pre-labor rupture of membranes (PPROM), the number of women receiving antenatal steroids and antibiotics, and the rate of positive maternal cultures of potentially pathogenic bacteria were all significantly higher in the HCA with FIR. Neonates in the FIR group had significantly higher levels of blood leukocytes compared to those without. FIR was associated with a longer interval from PPROM to delivery (log-rank test: p = .022). Microbiological sampling had been performed in 63 (89%) cases, of which 60 (95%) were cervicovaginal samples. No associations were found between a positive culture and adverse neonatal outcomes, in contrast to FIR, that was significantly associated to BPD and brain pathology. CONCLUSIONS:In a cohort of EP pregnancies with confirmed HCA, the presence of FIR was associated with advanced maternal age, CCA, PPROM, antenatal steroids and antibiotics, and a positive maternal culture of potentially pathogenic bacteria. However, the presence of FIR, and not a positive culture, was associated with adverse neonatal outcomes.

The aim of this study was to investigate psychometric properties, reliability and validity, of Astrid Lindgren and Lund Children's Hospitals Pain and Stress Assessment Scale for Preterm and Sick Newborn Infants (ALPS‐Neo), as a measure for procedural pain.

Petechial hemorrhages are of interest to forensic pathologists because of their association with pressure on the neck. This study shows the associations between ethanol, opioids in blood and the risk of petechiae in conjunctivae and eye lids of 865 medico-legally examined victims from intoxication, 112 (12.9 %) with petechiae. Livor mortis on the front, face down body position, higher body weight, and younger age of the victims were independently associated with higher risk of petechiae. These variables were used for adjustment in the logistic regression analyzes. We found associations between ethanol, opioids, and the risk of petechiae when analyzed simultaneously. The association between ethanol and the risk of petechiae differed in opioid negative and positive victims (interaction, p = 0.028). In the opioid negative group, the association was J-formed, victims with low to medium level ethanol having lower risk (OR = 0.77) than those without ethanol or opioids, whereas high ethanol level gave a 4-fold higher risk (OR = 3.97). In the opioid positive group, the J-formed pattern was reversed. Victims with low to medium level ethanol had more than 4 times higher risk (OR = 4.65), whereas high level ethanol gave a slightly elevated risk (OR = 1.34) only compared to no ethanol or opioids. The results suggest that ethanol and opioids have a complex association with the risk of petechiae independent of livor mortis, initial body position, body weight, and age in victims from intoxication. Of practical value for the post-mortem examination is that the pathologist must consider both the ethanol level and the presence of opioids when judging the significance of petechiae in the eye regions.

Objectives: We studied the prevalence of vascular risk factors (RFs) among 385 ischaemic stroke patients ⩽60 years and 260 controls, and their association with atherosclerosis in seven vascular areas. Methods: History of cardiovascular events (CVE), hypertension, diabetes mellitus (DM), dyslipidaemia, pack-years of smoking (PYS), alcohol, and physical inactivity were noted. Blood pressure, body mass index (BMI), waist-hip ratio (WHR), lipid profile, epicardial adipose tissue (EAT), visceral abdominal adipose tissue (VAT), and subcutaneous abdominal adipose tissue were measured. Numeric staging of atherosclerosis was done by standardized examination of seven vascular areas by right and left carotid and femoral intima-media thickness, electrocardiogram, abdominal aorta plaques, and the ankle-arm index. All results were age and sex-adjusted. Poisson regression analysis was applied. Results: At age ⩽49 years at least one RF was present in 95.6% patients versus 90.0% controls. Compared to controls, male patients and middle-aged female patients showed no significant differences. Young female patients compared to young female controls had a higher burden of RFs (94.3% vs 88.6%, p = 0.049). Poisson regression analysis combined for patients and controls, adjusted for age and sex, showed numeric staging of atherosclerosis associated with age, prior CVE, hypertension, DM, dyslipidaemia, PYS, alcohol, BMI, WHR, EAT, VAT, and an increased number of risk factors. Adjusted for all risk factors, numeric staging of atherosclerosis was associated with increasing age, hypertension, DM, PYS, and BMI. Conclusion: Vascular risk factors are highly prevalent in young- and middle-aged patients and controls, and are predictors of established atherosclerosis at study inclusion. Focus on main modifiable vascular RFs in primary prevention, and early and aggressive secondary treatment of patients are necessary to reduce further progression of atherosclerosis.

We evaluated the role of placental pathology in predicting adverse outcomes for neonates born extremely preterm (EPT) before 28 weeks of gestation. This was a prospective observational study of 123 extremely preterm singletons born in a hospital in western Norway, and the placentas were classified according to the Amsterdam criteria. The associations between histologic chorioamnionitis (HCA), by the presence or the absence of a foetal inflammatory response (FIR+ or FIR−), maternal vascular malperfusion (MVM) as a whole and adverse neonatal outcomes were evaluated by logistic regression analyses. Adverse outcomes were defined as perinatal death, necrotising enterocolitis (NEC), bronchopulmonary dysplasia (BPD), brain pathology by magnetic resonance imaging at term-equivalent age, retinopathy of prematurity and early-onset neonatal sepsis. The results are reported as odds ratios (ORs) with 95% confidence intervals (CIs). HCA was associated with NEC (OR 12.2, 95% CI 1.1 to 137.1). HCA/FIR+ was associated with BPD (OR 14.9, 95% CI 1.8–122.3) and brain pathology (OR 9.8, 95% CI 1.4–71.6), but HCA/FIR− was not. The only neonatal outcome that MVM was associated with was low birthweight. Placental histology provided important information when assessing the risk of adverse neonatal outcomes following EPT birth.