Importance Colorectal cancer is a major health burden. Screening is recommended in many countries. Objective Estimate the effectiveness of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality in a population-based trial. Design Randomized controlled trial in individuals aged 50–64 years. Screening was performed in 1999–2000 (55–64 year age-group) and 2001 (50–54 year age-group). End of follow-up: Dec 31st 2011. Setting Population of Oslo city and Telemark County, Norway. Participants 100,210 individuals were identified in the screening areas. 1,415 individuals were excluded due to prior colorectal cancer, emigration, or death. Three individuals could not be traced in the population registry. Intervention Individuals randomized to the screening group were invited to screening. Within the screening group, individuals were randomized 1:1 to once-only flexible sigmoidoscopy or combination of once-only flexible sigmoidoscopy and fecal occult blood-testing (FOBT). Individuals with positive screening test (cancer, adenoma, polyp ≥10 mm, or positive FOBT) were offered colonoscopy. The control group received no intervention. Main outcome measures Colorectal cancer incidence and mortality. Results 98,792 individuals were included in the intention to screen analyses; 78,220 in the control group and 20,572 in the screening group (10,283 randomized to flexible sigmoidoscopy and 10,289 to flexible sigmoidoscopy and FOBT). Compliance with screening was 63%. After median 10.9 years, 71 individuals had died from colorectal cancer in the screening group, and 330 in the control group (31.4 vs. 43.1 deaths, absolute rate difference 11.7 (95% CI 3.0–20.4) per 100,000 person-years); hazard ratio [HR] 0.73 (95% confidence interval [CI] 0.56–0.94). Colorectal cancer was diagnosed in 253 individuals in the screening group, and 1,086 in the control group (112.6 vs. 141.0 cases, absolute rate difference: 28.4 (95% CI 12.1–44.7) per 100,000 person-years); HR 0.80 (95% CI 0.70–0.92). Colorectal cancer incidence was reduced in both the 50–54 year age-group (HR 0.68; 95% CI 0.49–0.94) and the 55–64 year age-group (HR 0.83; 95% CI 0.71–0.96). There was no difference between the flexible sigmoidoscopy only and the flexible sigmoidoscopy/FOBT screening groups. Conclusion and relevance In Norway, once-only flexible sigmoidoscopy screening or flexible sigmoidoscopy and FOBT reduced colorectal cancer incidence and mortality on a population level compared with no screening. Screening was effective both in the 50–54 and the 55–64 year age-group. Trial registration ClinicalTrials identifier NTC00119912, http://clinicaltrials.gov

In patients undergoing parenchyma-sparing liver resection for colorectal metastases, laparoscopic surgery was associated with significantly less postoperative complications compared to open surgery. Laparoscopic resection was cost-effective compared to open resection with a 67% probability. The rate of free resection margins was the same in both groups. Our results support the continued implementation of laparoscopic liver resection.

Norwegian government and Norwegian Cancer Society.

No abstract

C esarean section (CS) accounted for roughly 5% of all deliveries in the United States in 1970, and has increased to 32% of deliveries in 2007. A similar pattern of increase has been found in several European countries and this recent rise of CS is concerning to many obstetricians. From 4% to 18% of all CSs are performed at maternal request. The preference of CS versus vaginal delivery by mothers can be caused by a number of factors such as anxiety and fear of birth, previous cesarean delivery, previous negative birth experiences, maternal age, and socioeconomic dynamics. This study was conducted to provide a tool to predict which groups of women were more likely to prefer a CS.Data were collected from the Norwegian Mother and Child Cohort Study (MoBa), which consists of a database of >100,000 pregnancies which occurred between 1999 and 2008. Women were included if they responded to a question about their preference of delivery method; 58,881 women were included in the study (29,373 nulliparous and 29,508 multiparous). Socioeconomic information, obstetric and medical factors, emotional factors, and provider characteristics were all studied to identify their impact on delivery preference (outcome variable). Delivery preference was measured at 30 weeks gestation. First, the patients gave a response to the statement, "If I could choose, I would prefer to have a cesarean," on a 6-point response scale: agree completely, agree, agree somewhat, disagree somewhat, disagree, and disagree completely. Agree somewhat and disagree somewhat were excluded from the analysis (n = 7330) because preference of CS was unclear. Second, emotional variables were calculated on a 6-point scale based on the patients' responses to the statements, "I am really dreading giving birth," (fear of birth) "I worry all the time that the baby will not be healthy or normal," and "On the whole, I am satisfied with the way I have been followed by the health service." Previous delivery experiences were scored on a 5-point scale: very good, good, alright, bad, and very bad, and data on previous loss of a child were collected ("yes" or "no"). Background socioeconomic data including age ( < 35 y, Z35 y), marital status (married/cohabitant vs. no partner), education (secondary school, high school, higher education <4 y, higher education >4 y, other), work status (student, working, not working), smoking habits, income, and country of origin were gathered as well as data on preexisting maternal comorbidity: diabetes (preexisting or gestational), chronic diseases (ie, hypertension or epilepsy), and anxiety/depression. Obstetric risk factors included bleeding before week 28, in vitro fertilization and multiple pregnancy. The authors also took into account the type of antenatal care received: hospital clinic versus other (ie, midwife or general physician).A nulliparous and a multiparous "reference woman" were established. The nulliparous patient was defined as one without any of the risk factors commonly associated with a preference for a CS: <35 years, married ...

A 3-month motivational interviewing intervention following CHT had positive overall effects on disease severity, self-efficacy, psoriasis knowledge and health behaviour change. This approach has the potential to be an important complement to medical management, self-management and education in patients with psoriasis.

BackgroundReablement is a promising new rehabilitation model, which is being implemented in some Western countries to meet current and future needs for home-based services. There is a need for further investigation of the effects of reablement among community-dwelling adults in terms of clinical and economic outcomes. This study will investigate the effectiveness of reablement in home-dwelling adults compared with standard treatment in terms of daily activities, physical functioning, health-related quality of life, coping, mental health, use of health care services, and costs.Methods/DesignThe study is a multicenter controlled trial. In total, 44 Norwegian municipalities will participate, including eight municipalities as a control group. For three municipalities with two zones, one will be assigned to the control group and the other to the intervention group. The experimental group will be offered reablement and the control group standard treatment. The sample will comprise approximately 750 participants. People will be eligible if they are home-dwelling adults, understand Norwegian, and have functional decline. Participants will be assessed at baseline, and after 10 weeks, 6 months, and 12 months. The primary outcome will be activity and participation measured by the Canadian Occupational Performance Measure. Physical functioning will be measured by the Short Physical Performance Battery and health-related quality of life by the European Quality of Life Scale. Coping will be measured by the Sense of Coherence questionnaire and mental health by the Mental Health Continuum Short Form. Costs will be generated based on registered working hours in different professions. Data analyses will be performed according to intention to treat. Univariate analysis of covariance will be used to investigate differences between the groups at baseline and the end of intervention. The data will be organized into two levels using a multilevel structure, i.e., individuals and municipalities, which will be analyzed using linear mixed-effects models. The working hours data (panel data) will be analyzed with random mixed-effects regression models. The cost-effectiveness of reablement will be evaluated according to the incremental cost-effectiveness ratio and uncertainty will be explored via the bootstrap method.DiscussionThe findings will make an important contribution to knowledge of rehabilitation approaches for community-dwelling adults.Trial registrationThe trial was registered at ClinicalTrials.gov on October 24, 2014, identifier: NCT02273934.

OBJECTIVE: To study factors related to preference for cesarean delivery, among pregnant women without medical complications. METHODS: A cross-sectional study was carried out among 156 pregnant women, in a private clinic in the city of Osasco, State of São Paulo, from October 2000 to December 2001. The pregnant women were at 28 weeks of pregnancy or more, with no formal contraindication for vaginal delivery at the time of the interview. Sociodemographic data and past and present obstetric history were assessed by applying a questionnaire. The pregnant women were specifically asked what their current preference for delivery was. Pearson's Chi-square test and logistic regression for multivariate analysis were performed with a 5% significance level. RESULTS: Sixty-seven pregnant women (42.9%) said they had little motivation to undergo vaginal delivery. In the multivariate analysis, the following variables were statistically significant: previous vaginal birth (p=0.001; ORadj=0.04; 95% CI=0.01-0.12); husband's monthly income greater than 750 reais (p=0.006, ORadj=3.44; 95% CI=1.38-8.33). The women with a previous vaginal delivery presented 25-fold lower chance of choosing cesarean delivery. The opinion that the previous delivery experience was unsatisfactory was marginally associated with the main outcome (p=0.06; ORadj=0.42; 95% CI=0.16-1.05). CONCLUSIONS: Motivation for cesarean delivery is associated with influences such as the type and degree of satisfaction with previous delivery and income.