Turning up the NAD^(+)-mitophagy axis to treat Alzheimer's disease

The increase in the prevalence of individuals with Alzheimer's disease(AD)combined with the lack of a cure calls for the development of novel therapies against AD(Canter et al.,2016).The key disease-defining pathological features of AD are the accumulation of extracellular amyloid-beta(Aβ)plaques(accompanied by increasing intracellular Aβ_(1-42))and higher intracellular neu rofi brilla ry tangles,comprised mostly of hyperphosphorylated tau protein/pTau(Goedert,2015;Hardy,2017).It is evident that the elderly are more predisposed to develop AD,and thus aging is considered to be the primary risk factor for AD.By extra polation,strategies that delay aging may also slow down(if not stop)AD.

Long term recurrence,pain and patient satisfaction after ventral hernia mesh repair

AIM: To compare long term outcomes of laparoscopic and open ventral hernia mesh repair with respect to recurrence, pain and satisfaction.METHODS: We conducted a single-centre follow-up study of 194 consecutive patients after laparoscopic and open ventral hernia mesh repair between March 2000 and June 2010. Of these, 27 patients(13.9%) died and 12(6.2%) failed to attend their follow-up appointment. One hundred and fifty-three(78.9%) patients attended for follow-up and two patients(1.0%) were interviewed by telephone. Of those who attended the follow-up appointment, 82(52.9%) patients had received laparoscopic ventral hernia mesh repair(LVHR) while 73(47.1%) patients had undergone open ventral hernia mesh repair(OVHR), including 11 conversions. The follow-up study included analyses of medical records, clinical interviews, examination of hernia recurrence and assessment of pain using a 100 mm visual analogue scale(VAS) ruler anchored by word descriptors. Overall patient satisfaction was also determined. Patients with signs of recurrence were examined by magnetic resonance imaging or computed tomography scan.RESULTS: Median time from hernia mesh repair to follow-up was 48 and 52 mo after LVHR and OVHR respectively. Overall recurrence rates were 17.1% after LVHR and 23.3% after OVHR. Recurrence after LVHR was associated with higher body mass index. Smoking was associated with recurrence after OVHR. Chronic pain(VAS > 30 mm) was reported by 23.5% in the laparoscopic cohort and by 27.8% in the open surgery cohort. Recurrence and late complications were predictors of chronic pain after LVHR. Smoking was associated with chronic pain after OVHR. Sixty point five percent were satisfied with the outcome after LVHR and 49.3% after OVHR. Predictors for satisfaction were absence of chronic pain and recurrence. Old age and short time to follow-up also predicted satisfaction after LVHR.CONCLUSION: LVHR and OVHR give similar long term results for recurrence, pain and overall satisfaction. Chronic pain is frequent and is therefore important for explaining dissatisfaction.

Real-life chromoendoscopy for dysplasia surveillance in ulcerative colitis

AIM To evaluate the use of chromoendoscopy for surveillance of ulcerative colitis in a real-life community hospital setting.METHODS Patients with extensive ulcerative colitis, having disease duration of more than 8 years and who presented between the years of 1999 to 2013, were offered enrolment in this single cohort prospective study. All participants underwent standard bowel preparation with sodium phosphate and chromoendoscopy. Two expert endoscopists, novice to chromoendoscopy, evaluated each segment of the colon with standarddefinition colonoscopes after spray application of 0.4% indigo carmine. All observed lesions were recorded and evaluated before being removed and/or biopsied. In addition, nontargeted biopsies were taken from each segment of the colon. The dysplasia detection rate and dysplasia detection yield were ascertained. RESULTS A total of 21 neoplastic lesions(2 carcinomas, 4 of high-grade dysplasia and 15 of low-grade dysplasia) and 27 nondysplastic lesions were detected in 16 of the total 67 patients(70% male; median disease duration: 17 years; median age at diagnosis: 25 years; 92% aminosalicylate-treated). The dysplasia detection rate was 10.5%(7/67 patients). The dysplasia detection yield was 20.8%(10/48) for targeted biopsies and 3.5%(11/318) for nontargeted biopsies. The sensitivity and specificity for the macroscopic evaluation of neoplasia using chromoendoscopy were 48% [95% confidence interval(CI): 26%-70%] and 96%(95%CI: 93%-98%), respectively. The positive predictive and negative predictive values were 42%(95%CI: 27%-59%) and 97%(95%CI: 95%-98%), respectively. A total of 19/21 dysplastic lesions were detected in mucosa with histologic inflammation.CONCLUSION Chromoendoscopy seems to be of value for dysplasia surveillance of ulcerative colitis in a community hospital setting. The yield of non-targeted biopsies is negligible.

Prospective evaluation of the cause of acute pancreatitis,with special attention to medicines

AIM: To investigate the cause of acute pancreatitis(AP) by conducting a thorough investigation of drugs and their possible etiological role.METHODS: We investigated the cause of AP in a large retrospective cohort of 613 adult patients admitted with AP at the Akershus University Hospital, Norway, from 2000 until 2009, who were evaluated with standard ward investigations. This group was compared with a prospectively evaluated group(n = 57) admitted from January 2010 until September 2010 who investigated more extensively using medical history and radiological assessment.RESULTS: The groups were comparable with regards to gender, age, comorbidity and severity. The most common etiology was bile stones and alcohol, occurring in 60% in both groups. The prospective group was examined more thoroughly with regards to the use of alcohol and medicines. An increased number of radiological investigations during hospital stay and at follow-up were also performed. A more extensive use of radiological evaluation did not increase the detection frequency of bile stones. In the prospective group, more than half of the patients had two or more possible causes of pancreatitis, being mostly a combination of bile stones and drugs. No possible cause was found in only 3.5% of these patients, compared with 29.7% in the retrospective group.CONCLUSION: A detailed medical history and extensive radiological evaluation may determine a possible etiology in almost all cases of AP. Many patients have several possible risk factors, and uncertainty remains in establishing the definitive etiology.

Perforated midgut diverticulitis:Revisited

AIM:To study and provide data on the evolution of medical procedures and outcomes of patients suffering from perforated midgut diverticulitis. METHODS:Three data sources were used:the Medline and Google search engines were searched for case reports on one or more patients treated for perforated midgut diverticulitis (Meckel's diverticulitis excluded) that were published after 1995. The inclusion criterion was sufficient individual patient data in the article. Both indexed and non-indexed journals were used. Patients treated for perforated midgut diverticulitis at Vestfold Hospital were included in this group. Data on symptoms, laboratory and radiology results, treatment modalities, surgical access, procedures, complications and outcomes were collected. The Norwegian patient registry was searched to find patients operated upon for midgut diverticulitis from 1999 to 2007. The data collected were age, sex, mode of access, surgical procedure performed and number of patients per year. Historical controls were retrieved from an article published in 1995 containing pertinent individual patient data. Statistical analysis was done with SPSS software.RESULTS:GroupⅠ:106 patients (48 men) were found. Mean age was 72.2 ± 13.1 years (mean ± SD). Age or sex had no impact on outcomes (P = 0.057 and P = 0.771, respectively). Preoperative assessment was plain radiography in 53.3% or computed tomography (CT) in 76.1%. Correct diagnosis was made in 77.1% with CT, 5.6% without (P = 0.001). Duration of symptoms before hospitalization was 3.6 d (range:1-35 d), but longer duration was not associated with poor outcome (P = 0.748). Eighty-six point eight percent of patients underwent surgery, 92.4% of these through open access where 90.1% had bowel resection. Complications occurred in 19.2% of patients and 16.3% underwent reoperation. Distance from perforation to Treitz ligament was 41.7 ± 28.1 cm. At surgery, no peritonitis was found in 29.7% of patients, local peritonitis in 47.5%, and diffuse peritonitis in 22.8%. Peritonitis grade correlated with the reoperation rate (r = 0.43). Conservatively treated patients had similar hospital length of stay as operated patients (10.6 ± 8.3 d vs 10.7 ± 7.9 d, respectively). Age correlated with hospital stay (r = 0.46). No difference in outcomes for operated or nonoperated patients was found (P = 0.814). Group Ⅱ:113 patients (57 men). Mean age 67.6 ± 16.4 years (range: 21-96 years). Mean age for men was 61.3 ± 16.2 years, and 74.7 ± 12.5 years for women (P = 0.001). Number of procedures per year was 11.2 ± 0.9, and bowel resection was performed in 82.3% of patients. Group Ⅲ: 47 patients (21 men). Patient age was 65.4 ± 14.4 years. Mean age for men was 61.5 ± 17.3 years and 65.3 ± 14.4 years for women. Duration of symptoms before hospitalization was 6.9 d (range: 1-180 d). No patients had a preoperative diagnosis, 97.9% of patients underwent surgery, and 78.3% had multiple diverticula. Bowel resection was performed in 67.4% of patients, and suture closure in 32.6%. Mortality was 23.4%. There was no difference in length of history or its impact on survival between Groups Ⅰ and Ⅲ (P = 0.241 and P = 0.198, respectively). Resection was more often performed in Group Ⅰ (P = 0.01). Mortality was higher in Group Ⅲ (P = 0.002). CONCLUSION: In cases with contained perforation, conservative treatment gives satisfactory results, laparosco-py with lavage and drainage can be attempted and continued with a conservative course.

Development of otology specific outcome measure:Ear Outcome Survey-16 (EOS-16)

Purpose An important outcome measure of patient care is the impact on the patient’s health-related quality of life(HRQoL).Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different subdivisions such as symptoms,hearing problems,psychosocial impact,and the need for care.The optimal length of the recall period has not been studied.For these reasons,a new survey is needed that would cover most chronic ear diseases.Methods A preliminary 24-item survey(EOS-24)was created.Untreated adult patients(included n=186)with one of seven different chronic otologic conditions from all university hospitals in Finland were recruited to respond to EOS-24 and the 15D general HRQoL instrument.The recruiting otologists evaluated the severity of the disease and the disability caused by it.A control group was recruited.Based on the patients’responses in different diagnosis groups,the items were reduced according to pre-defined criteria.The resulting survey was validated using a thorough statistical analysis.Results The relevance and necessity of the original 24 items were thoroughly investigated,leading to the exclusion of 8 items and the modification of 1.The remaining 16 items were well-balanced between subdivisions and were useful in all seven diagnosis groups,thus constituting the final instrument,EOS-16.The most suitable recall period was three months.Conclusions EOS-16 has been created according to the HRQoL survey guidelines with a versatile nationwide patient population.The survey has been validated and can be used for a wide range of chronic ear diseases as a HRQoL instrument.

patients with inflammatory bowel disease:Mechanisms and possible clinical impact

BACKGROUND High-dose intravenous iron is an effective treatment option for iron deficiency(ID)or ID anaemia(IDA)in inflammatory bowel disease(IBD).However,treatment with ferric carboxymaltose(FCM)has been associated with the development of hypophosphatemia.AIM To investigate mechanisms behind the development of hypophosphatemia after intravenous iron treatment,and disclose symptoms and clinical manifestations related to hypophosphatemia short-term.METHODS A prospective observational study of adult IBD patients with ID or IDA was conducted between February 1,2017 and July 1,2018 at two separate university hospitals in the southeast region of Norway.Patients received one dose of 1000 mg of either FCM or ferric derisomaltose(FDI)and were followed for an observation period of at least 7 wk.Blood and urine samples were collected for relevant analyses at baseline,week 2 and at week 6.Clinical symptoms were assessed at the same timepoints using a respiratory function test,a visual analogue scale,and a health-related quality of life questionnaire.RESULTS A total of 106 patients was available for analysis in this study.The FCM treatment group consisted of 52 patients and hypophosphatemia was present in 72.5%of the patients at week 2,and in 21.6%at week 6.In comparison,the FDI treatment group consisted of 54 patients and 11.3%of the patients had hypophosphatemia at week 2,and 3.7%at week 6.The difference in incidence was highly significant at both week 2 and 6(P<0.001 and P<0.013,respectively).We observed a significantly higher mean concentration of intact fibroblast growth factor 23(P<0.001),a significant rise in mean urine fractional excretion of phosphate(P=0.004),a significant decrease of 1,25-dihydroxyvitamin D(P<0.001)and of ionised calcium levels(P<0.012)in the FCM-treated patients compared with patients who received FDI.No clinical symptoms could with certainty be related to hypophosphatemia,since neither the respiratory function test,SF-36(36-item short form health survey)or the visual analogue scale scores resulted in significant differences between patients who developed hypophosphatemia or not.CONCLUSION Fibroblast growth factor 23 has a key role in FCM induced hypophosphatemia,probably by inducing loss of phosphate in the urine.Short-term clinical impact of hypophosphatemia was not demonstrated.

Clinical Predictors for Reduced Long-Term Survival and Cause of Death after Curative Resection for Rectal Cancer

Purpose: To identify clinical predictors for reduced long-term survival and describe the cause of death after surgical treatment for rectal cancer. Methods: A retrospective follow-up study of 442 consecutive, unselected patients treated for rectal cancer at a tertiary centre from 1990 until 2000 and followed for 17 years or until death. Predictors for death were assessed by Cox regression analysis. The cause of death was obtained from the Norwegian Cause of Death Registry. Results: 254 men and 188 women with a median age of 71 years (21 - 95 years) were resected for rectal cancer with low anterior resection (n = 266), abdominoperineal resection (n = 125), Hartmann’s procedure (n = 19) or diverting stoma only (n = 32). Median follow-up was 5 years (0 - 17 years). The relative five-year survival rates for stages I, II, III and IV was 83.9%, 65.2%, 41.1% and 9.3%, respectively. The proportion of deaths due to recurrence from colorectal cancer in stages I, II, III and IV was 23.5%, 55.8%, 72.3% and 98.0%, respectively. Heart, lung and cerebrovascular disease and other malignancies were the cause of death in the other patients. Higher age, abdominoperineal resection compared to low anterior resection, lack of lymph node dissection compared to total mesorectal excision (TME), postoperative reoperations, TNM stages II and III compared to stage I and residual tumours after surgery were all significant independent predictors of reduced survival in the adjusted Cox regression model. Conclusions: Age, tumour stage, type of surgery, lymph node dissection, residual tumour after surgery and reoperations are predictors for survival after surgery for rectal cancer. In the patients who died, the cause of death was due to a condition other than colorectal cancer recurrence in 32.3% of the patients. The five-year relative survival rate was related to tumour stage.

Cause of Death and Clinical Predictors of Survival after Curative Resection for Colon Cancer

Background: Clinical predictors of death and survival in surgical treatment of colon cancer are easily confounded by the modern adjuvant and neo-adjuvant chemotherapy. This study focuses on lethality and survival during implementation of ultra-radical surgery for colonic cancer prior to multimodal therapy. Methods: Retrospective observational follow-up study of 824 consecutive, unselected patients resected for Stage I, II, III and IV colon cancer from 1990 until 2000 at one tertiary centre, with a median follow-up of 45 months (0 - 202 months). Predictors for death were assessed by Cox regression analyses and log-rank test. The cause of death was obtained from the Norwegian Cause of Death Registry. Results: The relative survival rates were 86.3%, 71.9%, 50.3% and 6.6% in Stage I, II, III and IV, respectively. In 28.7% of the patients, the cause of death was other than colorectal cancer recurrence. The adjusted Cox regression model showed that higher age (1.04 (95% CI: 1.03;1.05)), male gender (1.37 (1.14;1.66)), emergency surgery (1.52 (1.21;1.93)), left vs. right hemicolectomy (1.39 (1.03;1.87)), and perioperative blood transfusion (1.25 (1.01;1.55)) were predictors of reduced survival. Health without known comorbidity (0.71 (0.58;0.88)), D2 versus D1 lymph node dissection (0.66 (0.53;0.83)) and tumour Stage I, II, III versus Stage IV 0.10 (0.06;0.16), 0.14 (0.11;0.19), 0.23 (0.18;0.30) were associated with prolonged survival. Conclusions: In 28.7% of the patients, the cause of death was other than colorectal cancer recurrence. Age, sex, comorbidity, emergency resection, lack of lymph node dissection, tumour stage, and preoperative blood transfusions are all significant predictors for reduced survival after surgery for colon cancer.

The Link between Facets of Impulsivity and Aggression in Extremely Violent Prisoners

Evidence is growing that aggressive behavior and impulsivity have subgroups. The subscales of the Urgency, Premeditation, Perseverance and Sensation seeking (UPPS) impulsivity scale and the Bryant and Smith shortened and refined version of the Aggression Questionnaire were used to describe and compare impulsive and aggressive behavior in extremely violent and aggressive male inmates and non-violent healthy male controls. The Mann-Whitney test showed that there was a significant difference (p < 0. 006) in the total UPPS impulsivity scale scores between the aggressive inmates and the controls. The subscales revealed that this difference was based mainly on the urgency score (p < 0. 003). On the aggression subscales, the inmates scored significantly higher for physical aggression than the controls (p < 0.001), but no significant difference was seen between inmates and controls for verbal aggression, anger and hostility, although the exact p-value was very close to statistical significance at 0.054. Regression analysis revealed a strong relationship between urgency and the aggression subscales hostility (p = 0.0004) and anger (p = 0.003) and that urgency was also linked to symptoms of anxiety (p = 0.008). Finally, a statistically significant link was found between both hostility (p = 0.0003) and anger (p = 0.002) and symptoms of anxiety. The highly selected subgroup of extremely violent criminals in this study were more physically aggressive than non-violent controls, with urgency as the driving feature in their impulsive behavior, and hostility, anger and symptoms of anxiety as underlying traits.

DNA或RNA为基础的检测法在检测宫颈上皮瘤变处人乳头瘤病毒中的比较

Objective. To compare DNA- based and mRNA- based methods for detection of high-grade cervical neoplasia in Norway. Methods. HPV prevalence was analyzed in 383 women with positive index cytology, selected from gynecology clinics. All patients were investigated by a new PAP smear, histology, and two commercially available HPV tests: Hybrid Capture II (Digene, Gaithersburg, MD) and the Pre Tect HPV- Proofer (NorChip AS). Cases with positive DNA test and negative mRNA test and cases with high-grade histology and negative HPV tests were retested with PCR and sequencing. We regarded the infection as latent or transient if sequencing revealed an HPV type included in both assays. Results. High-risk HPV was detected in 99.7% of the histological confirmed high-grade lesions (CIN2+ ) (290/291). The DNA test was positive in 95% (275/291), and the mRNA test was positive in 77% (225/291)- of the histological confirmed high-grade lesions. All invasive carcinomas were mRNA positive. The DNA test was significantly more often positive in benign and low-grade lesions, some of which were found to be false positive due to crosscontamination with unrelated types. High-grade histology was detected in 83% of women with normal cytology and positive mRNA test. Latent or transient infections were detected in 11 low-grade and 12 high-grade preinvasive lesions. Sequencing revealed high-risk HPV types included only in the DNA test in 35 high-grade preinvasive lesions, HPV 52 and 58 were the most prevalent HPV types. Conclusions. These HPV tests have the potential to improve the detection rate of high-grade cervical neoplasia, with some limitations. The mRNA test seems to be more appropriate for risk-evaluation. Larger scale, population based studies are necessary to evaluate the predictive values of HPV testing in Norway.

血浆嗜铬粒蛋白A水平对有并发症心肌梗死患者的预后预测价值

背景:嗜铬粒蛋白A广泛分布于神经内分泌系统,因其在体内外的长半衰期而可能成为评估整体神经内分泌活性的强有力可选指标。新近发现。

Clinical Predictors for Recurrence after Curative Resection for Colorectal Cancer

Purpose: To identify clinical predictors of recurrence of colorectal cancer after curative surgical treatment. Methods: Retrospective follow-up-study of 925 consecutive patients treated with R0-resection for colorectal cancer Stage I, II and III from 1990 until 2000 with a mean follow-up of 60 ± 37 months. Predictors for cancer recurrence were identified in a pilot-sample of these patients, followed by analyses of the rest of the patients (test-sample), and finally with a concluding analyses of the entire patient group. Data were analyzed with Pearson Chi-square test (χ2), Cox regression analyses and log rank test. Results: Tumor stage (Stage I: HR 0.10 (0.05;0.19), Stage II: HR 0.31 (0.24;0.41)) and postoperative reoperations due to complications due to other causes than anastomotic leakage (HR 2.02 (1.21;3.36)) were significant predictors of cancer recurrence in the multivariate Cox regression model. The association between reoperations and recurrence was strongest for the patients with the best prognosis: Stage I and Stage II-cancers. Long duration of surgery, strongly associated with blood-loss and infusions of liquid and blood-products, reoperation due to anastomotic leakage as well as right colon/transversum localization were significant at a trend-level (10%). Conclusions: Tumor stage and reoperations due to postoperative complications other than anastomotic leakage are significant predictors for recurrence after curative surgery for colorectal cancer.

Improved Survival after Implementation of Multidisciplinary Team Meetings,Perioperative Chemotherapy,Extended Lymphnode Dissection and Laparoscopic Surgery in the Treatment of Advanced Gastric Cancer

Aims: The treatment of gastric cancer has changed in the western countries during the last decade. This includes multidisciplinary team (MDT) meetings, perioperative chemotherapy, extended lymph node dissection, and laparoscopic surgery, all of which were gradually implemented at our department from 2008. The aim of the present study was to determine the effect of these changes on morbidity and survival. Material and Methods: 185 patients with gastric cancer were operated with curative intent from 2000 until 2016 in this retrospective, observational, follow-up study;83 before implementation of modern principles in 2008 (period 1) and 102 were treated after 2008 (period 2). Results: The resection rate (94% vs 92.8%) and mortality rates (4.8% vs 2.9%) did not differ between the two periods. In period 2, 48 patients (47.1%), received neoadjuvant chemotherapy. In 36 patients (35.3%), laparoscopic surgery with D2 lymphadenectomy was performed. There was a significantly higher yield in the number of lymph nodes in period 2 compared to period 1 (14 vs 8, p pparent between laparoscopic and open surgery in the second period (32 vs 10, p The five-year survival rate was significantly improved after the change in treatment principles with an estimated improvement from 30% to 40% between the periods (p = 0.033). Conclusion: The combined effect of MDT meetings, neoadjuvant chemotherapy, extended lymphnode dissection and laparoscopy has improved the prognosis of gastric cancer patients.

Diagnostic procedures and classification of antisocial behavior in Norwegian inmates in preventive detention

In official Norwegian government reports’ prison statistics, it is claimed that the prevalence of Dissocial Personality Disorder (DPD) or Antisocial Personality Disorder (APD) among inmates in preventive detention is approximately 50%. Furthermore, previous findings have described a practice in which forensic examiners use the DSM SCID axis II for APD to confirm an ICD 10 diagnosis of DPD. Clinical investigation supported by the use of SCID Axis II for quality assurance was performed on almost half the population of inmates (46.4%) in preventive detention at a high security prison. The inmates had all committed severe violent acts including murder. All the information obtained by applying the DSM IV-TR criteria was tested against the ICD-10 Research Criteria (ICD-10-RC) for Dissocial Personality Disorder (ICD-10, DPD). It was found that all inmates met the ICD-10-RC for (DPD) and the DSM-IV-TR definition for Adult Antisocial Behavior (AAB). On the other hand, none met the DSM-IV-TR criteria for (APD). The SCID Axis II failed to identify inmates with APD because the DSM-IV-TR C-criteria, referring to symptoms of childhood Conduct Disorder (CD), were not met. These findings raise important questions since the choice of diagnostic system may influence whether a person’s clinically described antisocial behaviour should be classified as a personality disorder or not. For the inmates, a diagnosis of APD or DPD may compromise their legal rights and affect decisions on prolongation of the preventive detention. Studies have shown that combining the DSM and the ICD diagnostic systems may have consequences for the reliability of the diagnosis.

Work and activity in rehabilitation of persons with co-occurring severe mental health difficulties and substance use problems

Background: Participating in working life is important for most peoples’ economy, self-confidence, independence, social life, and feeling of belonging. Persons with co-occurring severe mental health difficulties and substance use problems have challenges in entering working life. Objective: The aim of the study was to explore the importance of work and activity for the recovery of persons with co-occurring severe mental health difficulties and substance use problems and to determine the significant elements that aid them in getting into work and/or meaningful activities. Methods: A professional development program was conducted to explore how following-up on these persons could lead to participation in working life. The data were collected through qualitative interviews with 24 participants, and with 25 of those carrying out the follow-up. Results: The participants described the benefit from the follow-up as well. They expressed enthusiasm for work and vocational training, although they all did not obtain work. Many had a better life, with more daily structure and less substance abuse. The personal encounter between the helper and the participant was ascribed crucial importance— being respected and valued, being relied on, and being able to be honest were considered significant. Conclusions: The participants valued work and regular activities, a more structured life, decreased drug abuse, and altogether a better life. The helpers’ respect, recognition and their ability to see dignity through wretchedness?and broken agreements were important. The participants emphasized the importance of getting help for different problems from different helpers at the same time, and the providers’ interdisciplinary collaboration in teams was essential. It seems that the supported employment philosophy on speedy job seeking ought to be adapted to this target group and that prior social training may be necessary.

The Norwegian 22 July 2011 Terror Acts and Mass Murder: Insanity, Evilness or Both?

This review presents unique information rarely seen in a description of a politically extreme right wing terrorist. During the trial following the terror acts in Norway on July 22nd 2011, the author, a forensic psychiatrist was at the time engaged by a national Norwegian newspaper to comment on the court proceedings. The author has later thoroughly gone through all available background material such as the terrorist’s childhood, relationship to his mother, childhood psychological evaluation, the interviews made by the forensic psychiatrists and information from the police documents. This information is shared in the review. The author also discusses how it was possible for two pairs of court appointed experienced forensic psychiatrists to arrive at completely different conclusions. One pair concluded with insanity due to Paranoid Schizophrenia and the second pair found no signs of psychotic disorder at all and concluded with Narcissistic Personality Disorder. The court found the terrorist capable to stand trial and sentenced him to 21 years in preventive detention with 10 years to be served before the possibility to apply for an appeal.

Aggression questionnaire scores in extremely violent male prisoners, male bodybuilders, and healthy non-violent men

Two aggression questionnaires, the Revised Swedish Version (AQ-RSV) of the Buss-Perry Aggression Questionnaire (AQ) and the shortened and refined version by Bryant and Smith (BS-AQ) were compared. Both questionnaires identified subscore levels of aggression and there were significant differences between the groups. On the AQ-RSV subscales, the violent inmates showed statistically significantly more aggression for Hostility (p = 0.000), Anger (p = 0.000), Physical Aggression (p = 0.000) and Verbal Aggression (p = 0.01) than the healthy (non-violent) men. The bodybuilders, all “on” performance-enhancing substances, scored significantly higher on the Physical Aggression subscale than the healthy men (p = 0.000). Compared to the bodybuilders, the violent inmates scored significantly higher on the Anger (p = 0.02) and Hostility (p = 0.002) subscales. For the BS-AQ, where general variance was higher than for the original AQ, some of the above mentioned relationships were different. The violent inmates still scored significantly higher than the healthy men for Hostility (p = 0.000), Anger (p = 0.006) and Physical Aggression (p = 0.000), but not for Verbal Aggression. The inmates scored significantly higher than the bodybuilders for Anger (p = 0.006) and Verbal Aggression (p = 0.006), and the bodybuilders scored higher than the healthy men on the Physical Aggression (p = 0.002) subscale only. These and other more complex relationships are discussed in the light of previous findings. Thus the BS-AQ resulted in more sharply defined relationships and, at the same time, showed some important differences between the groups studied. Verbal Aggression does not seem to distinguish violent inmates from healthy men. Angry bodybuilders tend to express their aggression through Physical Aggression.

Gender Differences in Hope and Its Relevance to Depression Symptoms among Norwegian Adolescents

Introduction: Several studies indicate that the number of individuals experiencing depression symptoms is growing. There is a prevailing consensus in the literature that while depression is represented among both genders, it is consistently reported that females are more exposed to depression compared to males both in frequency and severity. Studies suggest that as many as 15 - 20 percent of adolescents in Norway exhibit depression or depression like symptoms. Furthermore, several studies indicate that the number of individuals experiencing depression symptoms is growing. There is a prevailing consensus in the literature that while depression is represented among both genders, it is consistently reported that females are more exposed to depression compared to males both in frequency and severity. Methods: All data utilized in this study were extracted from the Norwegian Ungdata survey conducted in 2014 among adolescents in Norway. The sample consists of 46,374 observations. Conclusions: The finding of significant differences in prevalence of self-diagnosed depression symptoms among Norwegian adolescents, showed females are more exposed. Furthermore, as hypothesized, there is a strong and significant relation between hope and depression, where hope is proxied through expectations regarding the individuals’ future education, happiness and wealth. Based on these findings, we apply hope as an instrument for addressing depression symptoms. Results from this analysis indicate that males are significantly less optimistic for the future.

Gender Differences in Usage of Over-the-Counter Analgesics among Norwegian Adolescents

Introduction: Usage of over-the-counter (OTC) analgesic has increased among Norwegian adolescents since 2001. It has been noted that females tend to have a higher usage compared to males. In this paper we explore this gender difference. Data: Our dataset consists of 284,674 from Norwegian adolescents attending junior high school and high school between 2014 and 2017. Methods: The econometric approach consists of applying ordered logistic regressions with usage of OTC analgesics as the dependent variable and a dichotomous gender variable as the independent variable. Control variables include variables such as frequency of physical and mental health problems and other sociodemographic variables. Results: Gender, physical and mental health problems and various sociodemographic variables are found to have a significant effect on usage of OTC analgesics. Females are predicted to use significantly more analgesics. A large proportion of the gender difference evaporates when controlling for various other determinants. Conclusion: A considerable part of the observed gender difference in OTC analgesic usage can be traced back to differences in frequency and severity of physical and mental health problems. Part of the gender difference in usage, however remains unexplained.