IntroductionImpulse control disorders (ICDs) are frequent non-motor symptoms in Parkinson’s disease (PD), with potential negative effects on the quality of life and social functioning. ICDs are closely associated with dopaminergic therapy, and genetic polymorphisms in several neurotransmitter pathways may increase the risk of addictive behaviors in PD. However, clinical differentiation between patients at risk and patients without risk of ICDs is still troublesome. The aim of this study was to investigate if genetic polymorphisms across several neurotransmitter pathways were associated with ICD status in patients with PD.MethodsWhole-exome sequencing data were available for 119 eligible PD patients from the Norwegian ParkWest study. All participants underwent comprehensive neurological, neuropsychiatric, and neuropsychological assessments. ICDs were assessed using the self-report short form version of the Questionnaire for Impulsive-Compulsive Disorders in PD. Single-nucleotide polymorphisms (SNPs) from 17 genes were subjected to regression with elastic net penalization to identify candidate variants associated with ICDs. The area under the curve of receiver-operating characteristic curves was used to evaluate the level of ICD prediction.ResultsAmong the 119 patients with PD included in the analysis, 29% met the criteria for ICD and 63% were using dopamine agonists (DAs). Eleven SNPs were associated with ICDs, and the four SNPs with the most robust performance significantly increased ICD predictability (AUC = 0.81, 95% CI 0.73–0.90) compared to clinical data alone (DA use and age; AUC = 0.65, 95% CI 0.59–0.78). The strongest predictive factors were rs5326 in DRD1, which was associated with increased odds of ICDs, and rs702764 in OPRK1, which was associated with decreased odds of ICDs.ConclusionUsing an advanced statistical approach, we identified SNPs in nine genes, including a novel polymorphism in DRD1, with potential application for the identification of PD patients at risk for ICDs.

Purpose To review the incidence, aetiology and outcomes of endophthalmitis during a 20‐year period in a Norwegian university hospital. Methods Single‐centre retrospective review. Medical records of all patients admitted to Stavanger University Hospital with suspected endophthalmitis between January 1999 and December 2018 were reviewed. Results We identified 84 eyes of 81 patients. Postoperative endophthalmitis (PE) was seen in 64 eyes (76%), endogenous endophthalmitis in thirteen eyes (15%), trauma in four eyes (5%) and three eyes (4%) had keratitis‐associated endophthalmitis. Administration of intravitreal injections (IVI) was the most common cause (30%), followed by cataract surgery (CS) (21%). Of 40238 IVI, 23 PE cases were identified (incidence, 0.057%; 95% confidence interval [CI] 0.036–0.086%). Of 39697 CS, 12 PE cases were identified (incidence, 0.030%; 95%CI 0.016–0.053%). After introduction of intracameral cefuroxime PE incidence after CS decreased from 0.10% in 1999–2003 to 0.015% in 2004–2018 (p = 0.003). Eighty‐four per cent of organisms were Gram‐positive. Coagulase‐negative staphylococci accounted for 54% of culture‐proven cases, and 89% of post‐IVI culture‐proven cases. Thirty eyes (36%) either regained their previous vision or lost ≤1 Early Treatment Diabetic Retinopathy Study line. One third of endophthalmitis cases had a favourable visual outcome of logMAR 0.2 or better. Conclusion PE after IVI occurred in 1 in 1750 procedures, and was the most common cause of PE. The incidence of PE after CS has decreased >sixfold since 2003, to 1 in 6700 surgeries. A high proportion of low‐virulence bacterial species may have contributed to the favourable visual outcome.

Face mask ventilation of apnoeic neonates is an essential skill. However, many non-paediatric healthcare personnel (HCP) in high-resource childbirth facilities receive little hands-on real-life practice. Simulation training aims to bridge this gap by enabling skill acquisition and maintenance. Success may rely on how closely a simulator mimics the clinical conditions faced by HCPs during neonatal resuscitation. Using a novel, low-cost, high-fidelity simulator designed to train newborn ventilation skills, we compared objective measures of ventilation derived from the new manikin and from real newborns, both ventilated by the same group of experienced paediatricians. Simulated and clinical ventilation sequences were paired according to similar duration of ventilation required to achieve success. We found consistencies between manikin and neonatal positive pressure ventilation (PPV) in generated peak inflating pressure (PIP), mask leak and comparable expired tidal volume (eVT), but positive end-expiratory pressure (PEEP) was lower in manikin ventilation. Correlations between PIP, eVT and leak followed a consistent pattern for manikin and neonatal PPV, with a negative relationship between eVT and leak being the only significant correlation. Airway obstruction occurred with the same frequency in the manikin and newborns. These findings support the fidelity of the manikin in simulating clinical conditions encountered during real newborn ventilation. Two limitations of the simulator provide focus for further improvements.

Background Early to middle adolescence is a critical period of development for mental health issues. Illuminating sex/gender differences in mental health trajectories in this period is important for targeting screening and preventive interventions; however, evidence to date on the extent and nature of sex/gender differences in common mental health issue trajectories in this period has produced mixed findings. There is a particular gap in our knowledge of sex/gender differences in the joint trajectories of commonly co‐occurring mental health issues in adolescence, given the strong tendency for mental health issues to co‐occur. Method We applied sex/gender‐stratified latent class growth analysis to an age‐heterogeneous cohort (age 10–15) derived from the population‐representative UK Household Longitudinal Study. We explored sex/gender differences in attention deficit hyperactivity disorder (ADHD) symptoms, internalizing problems, and conduct problems individually and jointly. Results We found indications of sex/gender differences in a number of areas. There were fewer classes in the optimal model to describe the heterogeneity in internalizing problems and conduct problems trajectories in males and females respectively. Further, for ADHD, affected males were more likely to enter adolescence with already elevated symptoms whereas affected female trajectories were characterized by an escalation of symptoms during adolescence. Conclusions There are sex/gender differences in the levels and trajectories of specific mental health symptoms in early to middle adolescence; however, in both males and females there is a strong tendency for multiple issues to co‐occur.

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Aim To assess the factors associated with the knowledge and expectations among the general public about dispatcher assistance in out‐of‐hospital cardiac arrest incidents. Background In medical dispatch centres, emergency calls are frequently operated by specially trained nurses as dispatchers. In cardiac arrest incidents, efficient communication between the dispatcher and the caller is vital for prompt recognition and treatment of the cardiac arrest. Design A cross‐sectional observational survey containing six questions and seven demographic items. Method From January–June 2017 we conducted standardized interviews among 500 members of the general public in Norway. In addition to explorative statistical methods, we used multivariate logistic analysis. Results Most participants expected cardiopulmonary resuscitation instructions, while few expected “help in deciding what to do.” More than half regarded the bystanders present to be responsible for the decision to initiate cardiopulmonary resuscitation. Most participants were able to give the correct emergency medical telephone number. The majority knew that the emergency call would not be terminated until the ambulance arrived at the scene. However, only one‐third knew that the emergency telephone number operator was a trained nurse. Conclusion The public expect cardiopulmonary resuscitation instructions from the emergency medical dispatcher. However, the majority assume it is the responsibility of the bystanders to make the decision to initiate cardiopulmonary resuscitation or not. Based on these findings, cardiopulmonary resuscitation training initiatives and public campaigns should focus more on the role of the emergency medical dispatcher as the team leader of the first resuscitation team in cardiac arrest incidents.

Background: Many children who suffer from one mental health issue also suffer from at least one co-occurring disorder and a range of developmental psychopathology theories, including developmental cascade and network models, have been proposed to explain this widespread comorbidity. Autoregressive latent trajectory models with structured residuals (ALT-SR) and multilevel graphical vector autoregression (GVAR) are recently proposed complementary approaches that can help operationalise and test these theories and provide new insights into the reciprocal relationships between multiple mental health domains to advance the understanding of comorbidity development.Methods: This study uses ALT-SR and multilevel GVAR models to analyse the temporal, contemporaneous, and between-person relationships between key dimensions of child mental health: emotional problems, peer problems, conduct problems, hyperactivity/inattention and prosociality as measured by the parent-reported Strengths and Difficulties Questionnaire (SDQ) in 17,478 children from the UK Millennium Cohort Study at ages 3, 5, 7, 11, 14 and 17 years.Results: Children's strengths and difficulties in different domains of psychosocial functioning were dynamically associated with each other over-and within-time. The ALT-SR highlighted that hyperactivity/inattention plays a central role in affecting other domains over developmental time, while the GVAR model highlighted comparably strong bidirectional relationships between conduct problems and prosociality as well as between emotional problems and peer problems. Conclusion:This study confirms that mental health difficulties influence one another dynamically over time. The complementary techniques of ALT-SR and GVAR models offer different insights into comorbidity and hold promise for supporting the building of more comprehensive developmental psychopathological theories that acknowledge the interconnectedness of different domains of mental health.

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