Retinopathy with and without diabetes: Risk factors and visual impairment.

Størrelse: px
Begynne med side:

Download "Retinopathy with and without diabetes: Risk factors and visual impairment."

Transkript

1 FACULTY OF HEALTH SCIENCES DEPARTMENT OF COMMUNITY MEDICINE Retinopathy with and without diabetes: Risk fators and visual impairment. The Tromsø Eye Study and a Norwegian sreening study Geir Bertelsen A dissertation for the degree of Philosophiae Dotor January 2013

2

3 Retinopathy with and without diabetes: Risk fators and visual impairment. The Tromsø Eye Study and a Norwegian sreening study Geir Bertelsen Department of Ophthalmology and Neurosurgery, University Hospital of North Norway. Department of Community Mediine, Faulty of Health Sienes, University of Tromsø. 1

4 2

5 Table of Contents Figures and tables... 5 Aknowledgements... 6 Norsk populærvitenskapelig sammendrag... 8 Summary... 9 List of papers Abbreviations Introdution Diabetes Diagnosti riteria of diabetes Compliations of diabetes The eye Diabeti retinopathy Diabeti maular oedema Prevalene of diabeti retinopathy Risk fators for diabeti retinopathy Retinopathy without diabetes Prevalene of retinopathy without diabetes Risk fators for retinopathy without diabetes Aim of the thesis Methods paper I-III, Tromsø Eye Study The Tromsø Study and Tromsø Eye Study Study sample Data olletion and definitions Laboratory measurements Eye examinations Visual auity Retinal imaging and interview Grading of images Retinopathy Statistial analyses Methods paper IV Study sample Retinal imaging Retinopathy grading Visual auity Interview

6 The author ontribution Main results Paper I: The Tromsø Eye Study: Study design, methodology and results on visual auity and refrative errors Paper II: Tromsø Eye Study: Prevalene and risk fators of diabeti retinopathy Paper III: Sex differenes in risk fators for retinopathy in non-diabeti men and women. The Tromsø Eye Study Paper IV: Prevalene of diabeti retinopathy in Norway: report from a sreening study General disussion Methodology onsiderations paper I-III, Tromsø Eye Study Study design Internal validity Seletion bias Information bias and mislassifiation Confounding External validity Statistial onsiderations Methodologial onsiderations paper IV Conlusions Impliations for publi health Risk fators for retinopathy Sreening Further researh Referenes

7 Figures and tables Figure 1: The shemati eye Figure 2: The normal human retina. (Photo: Tromsø Eye Study ) Figure 3: Diabeti maular oedema. (Photo: Tromsø Eye Study ) Figure 4: Flow hart illustrating the study sample. Tromsø Study Figure 5: Age distribution of partiipants. Tromsø Eye Study Figure 6: Confounding illustrated by offee, smoking and lung aner Table 1: Age distribution in invitees and partiipants in the sixth Tromsø Study Table 2: The International Clinial Diabeti Retinopathy Severity Sales Table 3: The International Clinial Diabeti Maular Edema Severity Sales

8 Aknowledgements The studies inluded in this thesis were funded by the Norwegian Extra Foundation for Health and Rehabilitation through EXTRA funds, the Norwegian Diabetes Assoiation, the Researh Counil of Norway, University of Tromsø, the North Norway Regional Health Authority and Simon Fougner Hartmanns Familiefond. My interest in researh started as a medial student when I was given the opportunity to work part time at the Cardiovasular Researh Group, Department of Medial Biology, University of Tromsø. I would like to thank Rune Sundset, Laila Arvola, Knut Steinnes and all the other olleagues for giving me a positive and stimulating introdution to researh. By hoosing a linial areer in ophthalmology it beame diffiult to ontinue the ardiovasular researh. The researh at the Ophthalmology Department was limited without any possibilities for supervising a PhD-projet and we had to find other alternatives. At the same time the sixth survey of the Tromsø Study was under planning. Inger Njølstad at the Department of Community Mediine, University of Tromsø, agreed to supervise a PhDprojet in the Tromsø Study and has been important for all parts of the study from beginning until end. This thesis and the Tromsø Eye Study would not have happened without you. I sinerely thank Anne Katrin (Anka) Sjølie for o-supervising the study. Anka s long experiene in ophthalmologial researh has been invaluable, and I m very grateful for all the effort Anka has put in to the study. I greatly aknowledge Tunde Peto for reviewing and helping out on all the Tromsø Eye Study papers, the thesis and for introduing the Tromsø Eye Study to international onsortia. I owe you a bottle of Champagne. I am thankful for the work all the o-authors have done on ritial review of the papers, and all the members of the Tromsø Eye Study group for interesting disussions, espeially Maja who was the first to join in on the Tromsø Eye Study, sharing many frustrations and solving problems. 6

9 The tehnial and administrative staffs at the Tromsø Study have been important for the study, and espeially Ann-Kristin, Bente and Unni who worked hard on the eye examinations, and Elise, Kristin and Merete who made the Tromsø Study possible. I also appreiate the support from all the good olleagues at the Department of Ophthalmology and Neurosurgery, University Hospital of North Norway, and thanks to Oleg and Kjell Arne for making offee breaks interesting. Without the enthusiasm of the partiipants the Tromsø Study would not have happened. The inhabitants of Tromsø deserve my warmest thanks for partiipating in the Tromsø Study. I also thank those I have not mentioned and who deserve a thank you. Finally, I would like to thank the family, my wife Eirin and my two little prinesses Marie and Sofie for ontinuous support and most important of all; making life meaningful. 7

10 Norsk populærvitenskapelig sammendrag Diabetes retinopati er en av mange komplikasjoner knyttet til diabetes. I den vestlige verden er dette den viktigste årsak til nedsatt syn og blindhet i arbeidsfør alder. Vi gjennomførte øyeundersøkelser av deltagere i den sjette Tromsøundersøkelsen. Forekomsten av diabetes retinopati var 26,9% blant deltakere med diabetes, og varigheten av diabetes, blodsukker nivå, blodtrykk og mikroalbuminuri var risikofaktorer. Det var en lav andel med redusert syn. Vi undersøkte også forekomsten av diabetes retinopati blant diabetikere rekruttert fra allmennpraktikere i Tromsø, Tønsberg og Stavanger og fant en forekomst på 28,2%. Denne studien viste også at omtrent en tredjedel av deltagerne ikke hadde vært undersøkt av øyelege i løpet at de siste to år slik de nasjonale retningslinjer anbefaler. Videre undersøkte vi forekomsten av retinopati hos deltakere i Tromsøundersøkelsen uten diabetes og fant at det var forskjeller mellom menn og kvinner. Forekomsten hos menn var 15,9% og hos kvinner 14,0%. Risikofaktorer for kvinner var blodtrykk, alder og mikroalbuminuri og for menn blodtrykk og blodsukkernivå målt ved forsukret hemoglobin (HbA1). 8

11 Summary Diabeti retinopathy is a well-known ompliation of diabetes and a major ause of visual impairment and blindness in developed ountries. We explored visual impairment and diabeti retinopathy among partiipants with diabetes in the Tromsø Eye Study. The prevalene of visual impairment (orreted Snellen visual auity < 20/40) was 4.1% in the better-seeing eye. We found no legally blind partiipants. The prevalene of diabeti retinopathy was 26.9% and maular edema 3.9%. In a multivariable logisti regression model, retinopathy was assoiated with longer diabetes duration, insulin use, non-fasting gluose and urinary albumin exretion. We found a very low miroalbuminuria ut-off level for inreased risk of diabeti retinopathy (urinary albuminreatinine ratio > 1.16 mg/mmol). Visual impairment and diabeti retinopathy were also explored in diabetes patients reruited from general pratitioners in a multi-entre study onduted in Tromsø, Tønsberg and Stavanger. In this study the prevalene of visual impairment (orreted Snellen visual auity < 20/40) was 5.4% and one partiipant was legally blind. The prevalene of diabeti retinopathy was 28.2%. This study also showed that about one third of the diabetes patients did not attend at least biannual eye examination as reommended by the national guidelines. Retinopathy lesions, suh as miroaneurysms and retinal haemorrhages, are also ommon in subjets without diabetes. We explored retinopathy in subjets without diabetes in the Tromsø Eye Study, and the overall prevalene of retinopathy was 14.8%. Men had a higher prevalene of retinopathy ompared to women (15.9% vs. 14.0%, p=0.04). In men retinopathy was assoiated with hypertension and HbA1. In women retinopathy was assoiated with age, hypertension and urinary albumin exretion. In women, the miroalbuminuria ut-off level for inreased risk of retinopathy was very low (urinary albumin-reatinine ratio > 0.43 mg/mmol). 9

12 Visual impairment was also explored in a general population using data from both diabeti and non-diabeti partiipants in the Tromsø Eye Study and the overall prevalene of visual auity < 20/60 was 1.2%. 10

13 List of papers I. Bertelsen G, Erke MG, von Hanno T, Mathiesen EB, Peto T, Sjølie AK, Njølstad I. The Tromsø Eye Study: study design, methodology and results on visual auity and refrative errors. Ata Ophthalmol. 2012; [Epub ahead of print]. II. Bertelsen G, Peto T, Lindekleiv H, Shirmer H, Solbu MD, Toft I, Sjølie AK, Njølstad I. Tromsø Eye Study: prevalene and risk fators of diabeti retinopathy. Ata Ophthalmol. 2012; [Epub ahead of print]. III. Bertelsen G, Peto T, Lindekleiv H, Shirmer H, Solbu MD, Toft I, Sjølie AK, Njølstad I. Sex differenes in risk fators for retinopathy in non-diabeti men and women. The Tromsø Eye Study. [Submitted]. IV. Kilstad HN, Sjølie AK, Gøransson L, Hapnes R, Henshien HJ, Alsbirk KE, Fossen K, Bertelsen G, Holstad G, Bergrem H. Prevalene of diabeti retinopathy in Norway: report from a sreening study. Ata Ophthalmol 2012; 90:

14 Abbreviations ACR: Urinary Albumin/Creatinine Ratio AGE: Advaned Glyation End-produts BMI: Body Mass Index DCCT: Diabetes Control and Compliations Trial EDIC: Epidemiology of Diabetes Interventions and Compliations ETDRS: Early Treatment Diabeti Retinopathy Study egfr: Estimated Glomerular Filtration Rate GP: General Pratitioner HbA1: Glyosylated Haemoglobin HPLC: High Performane Liquid Chromatography ICPC-2: International Classifiation of Primary Care, Seond edition IRMA: Intra Retinal Mirovasular Abnormalities PKC: Protein Kinase C UKPDS: UK Prospetive Diabetes Study WESDR: Wisonsin Epidemiologi Study of Diabeti Retinopathy WHO: World Health Organization 12

15 Introdution Diabetes Diabetes Mellitus is a hroni metaboli disorder haraterized by hyperglyaemia and disturbanes in arbohydrate, fat and protein metabolism aused by defets in insulin seretion, ation or both [1]. The global prevalene among adults is inreasing and has been estimated to 6.4% in 2010 and 7.7% in 2030 [2]. The prevalene inreases with age and a Norwegian study using data from 9 population based studies onduted from 1996 to 2001 reported an overall prevalene of 3.4% in adults 30 years and older. In subjets aged 80 years and older the prevalene was 12.4% in women and 11.5% in men [3]. Type 1 diabetes is haraterised by an autoimmune destrution of insulin produing beta-ells usually leading to absolute insulin defiieny and aounts for 5-10% of the diabetes ases [4]. Type 2 diabetes is haraterised by insulin resistane and usually a relative insulin defiieny, and aounts for 90-95% of diabetes ases [4]. The aetiology is multifatorial and assoiated with both geneti and environmental fators as inativity and over-nutrition, ausing a slowly progressing hyperglyaemia and altered lipid metabolism [5]. The gradual onset of symptoms may result in several years of undiagnosed type 2 diabetes [3]. Diagnosti riteria of diabetes In 1965, the World Health Organization (WHO) published guidelines for diabetes, and sine then the diagnosti riteria have been revised several times. The urrent WHO riteria is based on the presene of diabeti retinopathy and uses fasting plasma gluose 7.0 mmol/l and two hour plasma gluose 11.1 mmol/l [6]. Reently a WHO report from 2011 reommended glyosylated haemoglobin (HbA1) 6.5% as an alternative diagnosti riterion for diabetes [7]. Compliations of diabetes Diabetes inreases the risk of many different ompliations that in general an be divided into maro- and mirovasular disease [8]. The marovasular ompliations inlude oronary heart disease and erebrovasular disease. The mirovasular ompliations inlude 13

16 neuropathy, nephropathy and diabeti retinopathy. Diabeti retinopathy is a major long-term ompliation of diabetes and the major ause of visual impairment and blindness below 75 years of age in developed ountries [9-12]. In addition, diabetes inreases the risk for atarat and glauoma [13]. Due to the risk of visual impairment and blindness aused by diabeti retinopathy, national guidelines reommend annual or biannual eye examination for diabetes patients without retinopathy. In ase of retinopathy more frequent examination is reommended [14]. Figure 1: The shemati eye The eye A shemati eye is illustrated in figure 1. The eye is often ompared to a amera. The ornea, lens and pupil orrespond to the amera lens and aperture to reate a foused image with adequate amount of light on the neurosensory retina lining the inside posterior 2/3 of the eye (Figure 2). In the retina, rods and ones onverts the photons into eletrial signals by photo transdution. This proess orresponds to the image sensor in a modern amera. 14

17 Figure 2: The normal human retina. (Photo: Tromsø Eye Study ) Diabeti retinopathy Diabeti retinopathy is a multifatorial disease of the retina, and the underlying pathologial mehanisms are omplex. Several biohemial pathways leading to the hyperglyaemia indued abnormalities seen in diabeti retinopathy have been identified and probably interat. Pathologial biohemial mehanisms inluding Advaned Glyation End-produts (AGEs), Protein Kinase C (PKC), the polyol pathway, the hexosamine pathway, angiogeni fator expression and oxidative stress probably ause damage to all major retinal ells leading to neuroglial and mirovasular damage [15]. The relative ontribution of the different biohemial abnormalities is unlear. The progressive neuroglial and mirovasular damage are also affeted by an interplay of fators suh as blood pressure, impaired retinal autoregulation and hormones to develop the linial manifestation of diabeti retinopathy where inflammation, leuostasis, ishemia and strutural alterations are important features [15-17]. Histopathology studies of diabeti retinopathy show thikening of the apillary basement membrane, loss of periytes, miroaneurysms, endothelial ell death and apillary loss [16]. 15

18 Retinopathy is linially haraterised by miroaneurysms, haemorrhages, venous beading, otton wool spots, intra retinal mirovasular abnormalities and new proliferative vessels. The retinal abnormalities range from hanges not visible on a retinal photo to severe proliferative retinopathy with pathologial angiogenesis resulting in fibrovasular proliferation on top of the retina or into the vitreous, and eventually vitreous haemorrhage and trational retinal detahment. Diabeti maular oedema The retina laks lymphati drainage, and fluid transportation aross the apillaries must be Figure 3: Diabeti maular oedema. (Photo: Tromsø Eye Study ) balaned by apillary reuptake and transportation aross the pigment epithelium separating the retina and underlying horoid. In diabeti maular oedema hyperglyaemia indued apillary dysfuntion and damage auses exess vasopermeability, hypoxia and retinal oedema resulting in dereased visual auity. Key omponents in the pathophysiology inlude altered hemodynamis, breakdown of blood retina barrier, angiogeni fator expression, inflammation and oxidative stress [18]. The entre of the maula is prone to oedema due to the high metaboli turnover and the foveal avasular zone limiting both the blood supply and apillary reuptake of extraellular fluid. In a retinal image, maular oedema is haraterised by hard exudates onsisting of lipid and protein deposits. Figure 3 illustrates maular oedema with hard exudates, miroaneurysms and haemorrhages. Prevalene of diabeti retinopathy There are inonsistenies between epidemiologial studies and differenes in study methods ontribute to onfliting reports on prevalene of diabeti retinopathy [12, 19]. A reent study used pooled data from 35 studies using similar methodology and estimated the world 16

19 prevalene (age-standardized) of any diabeti retinopathy to 34.6%, proliferative retinopathy to 7.0% and diabeti maular oedema to 6.8% in subjets aged years with diabetes [20]. Risk fators for diabeti retinopathy Diabetes duration The most important and onsistent risk fator for retinopathy in observational studies is diabetes duration [21-24]. Type 1 diabetes has a higher prevalene of retinopathy ompared to type 2 diabetes [20]. In the Wisonsin Epidemiologi Study of Diabeti Retinopathy (WESDR) the prevalene of diabeti retinopathy was 98% for diabetes duration > 14 years in type 1 diabetes. In type 2 diabetes the prevalene of diabeti retinopathy was 85% for insulin users and 58% for non-insulin users for diabetes duration > 14 years [25]. Hyperglyaemia Hyperglyaemia is an important risk fator for diabeti retinopathy. Clinial trials as the Diabetes Control and Compliations Trial (DCCT) and UK Prospetive Diabetes Study (UKPDS) have demonstrated the benefiial effet of tight glyaemi ontrol on development and progression of diabeti retinopathy [26, 27]. Longitudinal observational studies as WESDR, the Blue Mountains eye study and others have also doumented the relationship between elevated gluose and diabeti retinopathy [28-30]. Blood pressure In most studies, blood pressure is orrelated to retinopathy [31]. Clinial trials as the UKPDS, DCCT, Epidemiology of Diabetes Interventions and Compliations (EDIC) and EuroDIAB studies have demonstrated the importane of blood pressure, but the initial blood pressure was relatively high in some studies [32-34]. The ACCORD study failed to demonstrate any effet of intensive blood pressure ontrol in type 2 diabetes suggesting that there might be a lower limit for the benefiial effet of blood pressure ontrol [35]. In observational studies the results are less onsistent, but may be onfounded by blood pressure treatment [29, 30, 36-39]. 17

20 Hyperlipidaemia Observational studies have investigated the relationship between hyperlipidaemia and retinopathy reporting both positive, negative and no assoiations [36, 40-42]. The ACCORD Lipid study showed that intensive lipid lowering therapy with fenofibrate slowed the progression of retinopathy at four years ompared to plaebo, indiating an effet of hyperlipidaemia on retinopathy [35]. Renal disease Kidney disease is a well-known ompliation of diabetes, and about 50% of diabetes patients will develop miroalbuminuria, and 1/3 of the miroalbuminuria ases will progress to proteinuria eventually leading to end stage renal disease in many ases [8]. Miroalbuminuria and proteinuria are assoiated with retinopathy in several studies [39, 43, 44]. In addition diabeti retinopathy have been reported to be assoiated with pregnany, ardiovasular disease, stroke and ognitive funtion [45-49] Retinopathy without diabetes The knowledge about the pathogenesis leading to retinopathy without diabetes in a general population is limited and mostly derived from observational studies. The onept of retinopathy ourring in a presumably healthy individual makes it diffiult to explore the pathogenesis in detail. The retinal lesions found in a retinal image inlude the same as in diabeti retinopathy, although usually more disrete and limited to a few haemorrhages, miroaneurysms or otton wool spots. Although hypertension and diabetes are seemingly well defined linial entities, in reality they both probably represent parts of a ontinuum with progressive dysfuntion. Studies of diabeti retinopathy and hypertensive retinopathy may therefore provide important lues about the pathogenesis of retinopathy without diabetes whih probably is a mixture of several pathologial mehanisms when studied in a general population. 18

21 Prevalene of retinopathy without diabetes Retinopathy lesions are relatively ommon in subjets without diabetes. Several studies have reported the prevalene in non-diabeti populations ranging from % in different ethni populations, but the results are onfounded by differenes in age distribution, methodology and number of images used in the retinopathy grading [43, 50-54]. Risk fators for retinopathy without diabetes Studies have found assoiations between several risk fators and non-diabeti retinopathy inluding blood pressure, age, miroalbuminuria, body mass index, arotid artery intimamedia thikness, smoking, ardiovasular disease, stroke, ognitive impairment and impaired gluose metabolism below the urrent diagnosti threshold for diabetes [43, 50, 52-61]. Even though the results differ between the studies, hypertension seems to be the most onsistent risk fator in the non-diabeti population. In general the risk fators for retinopathy are similar in diabeti and non-diabeti populations although diabetes duration and severity are obviously not relevant in non-diabeti populations. The wide range of assoiations between retinopathy and vasular disease in various organ systems suggests that retinopathy is a result of systemi proesses. 19

22 Aim of the thesis To investigate the prevalene of visual impairment in diabetes Estimate prevalene of diabeti retinopathy Assess risk fators for diabeti retinopathy Estimate prevalene of retinopathy in a non-diabeti population Assess risk fators for retinopathy without diabetes Determine the proportion of diabetes patients following the national guidelines on regular eye examination 20

23 Methods paper I-III, Tromsø Eye Study The Tromsø Study and Tromsø Eye Study The Tromsø Eye Study is a substudy of the Tromsø Study. The Tromsø Study is a large omprehensive longitudinal population-based study started in The Tromsø Study and the ohort profile has been desribed elsewhere [62]. A total of 40,051 subjets have partiipated in at least one of the six surveys. A desription of the large amount of variables olleted is presented at: Serum samples from eah survey and DNA samples from the 4 th survey and onwards are stored in a biobank. The Tromsø Study holds several endpoint registers with registration of inident myoardial infartion, stroke, atrial fibrillation, diabetes and non-vertebral fratures from ase note reviews at the only loal hospital in the region. The 6 th Tromsø Study survey was onduted from Otober 2007 through Deember 2008 and onsisted of two separate visits [63]. All partiipants were invited to a 1 st visit where they answered a questionnaire (Appendix I) and underwent a physial examination omprising the measurement of blood pressure, height, weight, waist and hip irumferene. Blood sampling, bone mineral density and pain threshold tests were also performed. A large subgroup was invited to a 2 nd visit a few weeks later. The eye examinations of the Tromsø Eye Study were performed at the 2 nd visit. In addition, the 2nd visit omprised a seond questionnaire (Appendix II), blood samples, ognitive tests, ultrasound of the arotid artery, 12-lead eletroardiogram, ehoardiography, spirometry, and bone mineral densitometry. The Tromsø Study and Tromsø Eye Study followed the tenets of the Delaration of Helsinki for researh involving humans and were approved by the Regional Committee for Medial and Health Researh Ethis. All partiipants gave an informed written onsent. Study sample The study sample was based upon the offiial population registry and all subjets were residents of the muniipality of Tromsø. The sampling strategy for the 6 th Tromsø Study survey was omplex and a balane between the need for inluding the partiipants from 21

24 previous visits for longitudinal analyses and the different needs in all substudies for new partiipants. Therefore the sample onsists of a mix of whole birth ohorts, random samples and previous partiipants. First visit A total of 19,762 subjets were invited to the 1 st visit. Subjets invited to the 1 st visit of the 6 th Tromsø Study survey were: 1. All Tromsø residents aged or years (n=12,578). 2. A 10% random sample of individuals aged years (n=1056). 3. A 40% random sample of individuals aged years (n= 5787). 4. Subjets who had attended the 2 nd visit of the 4 th survey, if not already inluded in the three groups above (n=341). A total of 12,984 subjets (65.7%) partiipated. Seond visit The 2 nd visit study sample was preseleted before the start of the survey, and inluded: 1. All subjets eligible for the 1 st visit aged years or aged years (n=7657). 2. A 20% random sample of subjets eligible for the 1 st visit aged years (n=942). 3. Subjets, if not already inluded in the two groups above, who had attended the 2 nd visit of the 4 th survey (n=2885). In addition, partiipation in the 1 st visit was a prerequisite to be reinvited to the 2 nd visit [62]. A total of 7958 were invited and 7307 (91.8%) attended the 2 nd visit. A total of 6540 attended retinal photography (82.2%). Figure 4, 5 and Table 1 illustrates the study sample and seletion proess. The partiipants in the 2 nd visit were mainly Cauasians with 91% reporting Norwegian ethniity and 1.5% reporting Sami ethniity. 22

25 Figure 4: Flow hart illustrating the study sample. Tromsø Study Invited 1 st visit n = 19,762 All aged and % random sample aged % random sample aged Previously attended seond visit of T4* Attended 1 st visit n = 12,984 Not attending 1 st visit n = 6778 Not invited 2 nd visit n = 5026 Invited 2 nd visit n = 7958 All aged and % random sample aged Previously attended seond visit of T4* Not attending 2 nd visit n = 651 Attended 2 nd visit n = 7307 Not attending retinal photographi examination n = 767 Tromsø Eye Study n = 6540 (Attended retinal photographi examination) *T4: The 2 nd visit of the 4 th Tromsø Study survey. 23

26 Table 1: Age distribution in invitees and partiipants in the sixth Tromsø Study First visit Seond visit Tromsø Eye Study* Age, years Invited (n) Attended n (%) Invited (n) Attended n (%) Attended n (%) (46.9) (91.3) 20 (87.0) (68.0) (95.3) 183 (85.1) (71.5) (93.6) 1927 (84.6) (76.9) (94.0) 2736 (85.3) (68.9) (89.6) 1344 (78.4) (40.1) (76.2) 330 (63.3) Total (65.7) (91.8) 6540 (82.2) * Partiipated in retinal photographi examination Figure 5: Age distribution of partiipants. Tromsø Eye Study Partiipants (n) Invited seond visit Attended seond visit Attended photographi examination Age, Years 24

27 Data olletion and definitions Anthropometri measurements, blood pressure, blood and urine samples were obtained by physial examination. Blood pressure was measured by trained tehniians, using an automated devie (Dinamap Vital Signs Monitor, Tampa, FL, USA). Three onseutive measurements were done with one minute intervals and the mean of the two last measurements were used in the analyses. Hypertension was defined as systoli blood pressure > 140 mmhg, diastoli blood pressure > 90mmHg, or use of antihypertensive treatment. Pulse pressure was defined as the differene between systoli and diastoli blood pressure and mean arterial pressure as: 2/3(diastoli blood pressure) + 1/3(systoli blood pressure). Body mass index (BMI) was alulated by dividing body weight (kilograms) with the square of height (meters). Diabetes was defined as self-reported diabetes, non-fasting blood gluose 11.1 mmol/l, Hb1A > 6.5% or a diabetes diagnosis in the Tromsø Study diabetes registry. Estimated glomerular filtration rate (egfr) was alulated using the CKD-EPI formula [64]. Smoking habits and medial history were obtained by questionnaires. Laboratory measurements All laboratory measurements were performed at the University Hospital of North Norway. Urinary albumin exretion was assessed as urinary Albumin/Creatinine Ratio (ACR). Three separate urine samples of morning spot urine from three onseutive days were olleted and analysed within 20 hours. Urine reatinine was measured using olorimetri methods (Jaffes reation) with an autoanalyzer (ABX PENTRA, Horiba ABX, Montpellier, Frane). Urine albumin onentration was measured with immunoturbidimetri method, on an ABX PENTRA autoanalyzer (Horiba ABX, Montpellier, Frane). ACR was alulated by dividing albumin onentration (mg/l) by reatinine (mmol/l). Mean of the three ACRs from three different days, was defined as ACR. In paper II miroalbuminuria was defined as: ACR > 3.4 mg/mmol. Paper III used two alternative miroalbuminuria ut-off levels defined as: ACR > 25

28 3.4 mg/mmol or ACR > 1.13 mg/mmol (aording to KDIGO) [65]. Due to the extremely skewed distribution of ACR, we also analysed log-transformed ACR in paper II and III. Serum reatinine was analysed on a Hitahi Modular model using an enzymati method that has been standardized against isotope dilution mass spetrosopy (CREA Plus, Rohe Diagnostis, GmbH, Mannheim, Germany). HbA1 was measured in EDTA whole blood by high performane liquid hromatography (HPLC) using an automated analyser (Variant II, Bio-Rad Laboratories In., Herules, CA, USA). Non-fasting serum holesterol, triglyerides and gluose were analysed using an automated linial hemistry analyser (Modular P, Rohe Diagnostis, Mannheim, Germany). Standard enzymati olorimetri assays were used for holesterol and triglyerides, and UV test (hexokinase) for gluose. Eye examinations The eye examination was divided in two parts and visual auity was measured in the first part. Visual auity Visual auity was measured by a Nidek AR 660A auto refrator (Nidek CO., LTD., Gamagori, Japan). Auto-Shot and Auto eye traking were enabled and visual auity reorded using the built in Snellen harts ranging from 20/200 20/20 after obtaining stable refration measurements. In ase of visual auity below 20/200, no attempt on further testing was performed. The visual auity results were ategorized and adapted to WHO riteria as visual impairment (< 20/60) or blindness (< 20/200). For omparison to other studies visual impairment defined as visual auity < 20/40 was also analysed. Spherial equivalent was alulated as spherial power plus half the ylindrial power in dioptres (D) and presented as the mean value of left and right eye. Visual auity results and refrative measures were printed on paper, stored and entered in the Tromsø Study database at a later date. 26

Passasjerer med psykiske lidelser Hvem kan fly? Grunnprinsipper ved behandling av flyfobi

Passasjerer med psykiske lidelser Hvem kan fly? Grunnprinsipper ved behandling av flyfobi Passasjerer med psykiske lidelser Hvem kan fly? Grunnprinsipper ved behandling av flyfobi Øivind Ekeberg 5.september 2008 Akuttmedisinsk avdeling, Ullevål universitetssykehus Avdeling for atferdsfag, Universitetet

Detaljer

Norwegian FAOS, version LK1.0

Norwegian FAOS, version LK1.0 Norwegian FAOS, version LK1.0 The KOOS form was translated from Swedish into Norwegian by the Norwegian Arthroplasty Register (NAR). The Norwegian National Knee Ligament Registry (NKLR) translated the

Detaljer

Blodsukker ved diabetes type 2 hvor lavt?

Blodsukker ved diabetes type 2 hvor lavt? Blodsukker ved diabetes type 2 hvor lavt? Budskap Blodsukkerkontroll er viktig intervensjon ved type 2 Men moderat forebyggende effekt på hjertekarsykdom Annen intervensjon desto viktigere Røykeslutt

Detaljer

Medisinsk statistikk, KLH3004 Dmf, NTNU 2009. Styrke- og utvalgsberegning

Medisinsk statistikk, KLH3004 Dmf, NTNU 2009. Styrke- og utvalgsberegning Styrke- og utvalgsberegning Geir Jacobsen, ISM Sample size and Power calculations The essential question in any trial/analysis: How many patients/persons/observations do I need? Sample size (an example)

Detaljer

Eiendomsverdi. The housing market Update September 2013

Eiendomsverdi. The housing market Update September 2013 Eiendomsverdi The housing market Update September 2013 Executive summary September is usually a weak month but this was the weakest since 2008. Prices fell by 1.4 percent Volumes were slightly lower than

Detaljer

The regulation requires that everyone at NTNU shall have fire drills and fire prevention courses.

The regulation requires that everyone at NTNU shall have fire drills and fire prevention courses. 1 The law The regulation requires that everyone at NTNU shall have fire drills and fire prevention courses. 2. 3 Make your self familiar with: Evacuation routes Manual fire alarms Location of fire extinguishers

Detaljer

Kritisk lesning og skriving To sider av samme sak? Geir Jacobsen. Institutt for samfunnsmedisin. Kritisk lesning. Med en glidende overgang vil denne

Kritisk lesning og skriving To sider av samme sak? Geir Jacobsen. Institutt for samfunnsmedisin. Kritisk lesning. Med en glidende overgang vil denne og skriving To sider av samme sak? Geir Jacobsen Institutt for samfunnsmedisin Med en glidende overgang vil denne presentasjonen først handle om av fagartikler I engelsk litteratur brukes også begrepene

Detaljer

Norwegian KOOS, version LK1.0

Norwegian KOOS, version LK1.0 Nasjonalt Register for Leddproteser The Norwegian Arthroplasty Register,c. Bergen 15 May 2007 Norwegian KOOS, version LK1.0 The KOOS form was translated into Norwegian in the following way. Translation

Detaljer

Vertebral fractures: Prevalence, risk factors, and health-related quality of life. A cross-sectional study. The Tromsø study 2007/2008

Vertebral fractures: Prevalence, risk factors, and health-related quality of life. A cross-sectional study. The Tromsø study 2007/2008 Vertebral fratures: Prevalene, risk fators, and health-related quality of life. A ross-setional study The Tromsø study 2007/2008 Svanhild Haugnes Waterloo Department of Community Mediine Faulty of Health

Detaljer

Administrasjon av postnummersystemet i Norge Post code administration in Norway. Frode Wold, Norway Post Nordic Address Forum, Iceland 5-6.

Administrasjon av postnummersystemet i Norge Post code administration in Norway. Frode Wold, Norway Post Nordic Address Forum, Iceland 5-6. Administrasjon av postnummersystemet i Norge Frode Wold, Norway Post Nordic Address Forum, Iceland 5-6. may 2015 Postnumrene i Norge ble opprettet 18.3.1968 The postal codes in Norway was established in

Detaljer

SFI-Norman presents Lean Product Development (LPD) adapted to Norwegian companies in a model consisting of six main components.

SFI-Norman presents Lean Product Development (LPD) adapted to Norwegian companies in a model consisting of six main components. Hovedoppgave Masteroppgave ved ved IMM Høsten 2013 Lean Product Development Stability Drivers. Identifying Environmental Factors that Affect Performance. SFI-Norman presents Lean Product Development (LPD)

Detaljer

04.11.2014. Ph.d-utdanningen. Harmonisering av krav i Norden

04.11.2014. Ph.d-utdanningen. Harmonisering av krav i Norden Ph.d-utdanningen Harmonisering av krav i Norden 2 1 Nasjonalt forskningsdekanmøte i Tromsø, oktober 2014 Nordic Medical Research Councils (NOS-M), november 2014 Prodekanmøte våren 2015 Dekanmøte våren

Detaljer

Psykososiale faktorer og livsstil som risikofaktorer for kronisk generalisert smerte: En HUNT studie

Psykososiale faktorer og livsstil som risikofaktorer for kronisk generalisert smerte: En HUNT studie Psykososiale faktorer og livsstil som risikofaktorer for kronisk generalisert smerte: En HUNT studie PhD student Ingunn Mundal Allmennmedisinsk forskningsenhet /ISM Institutt for nevromedisin, DMF, NTNU

Detaljer

VEIEN TIL ROM: HVORDAN JEG BLE KATOLIKK (NORWEGIAN EDITION)

VEIEN TIL ROM: HVORDAN JEG BLE KATOLIKK (NORWEGIAN EDITION) VEIEN TIL ROM: HVORDAN JEG BLE KATOLIKK (NORWEGIAN EDITION) (first published 1999) Synopsis: Download A Veien Til Rom: Hvordan Jeg Ble Katolikk (Norwegian Edition) PDF ebook by Kjell Arild Pollestad Veien

Detaljer

Oppgave 1a Definer følgende begreper: Nøkkel, supernøkkel og funksjonell avhengighet.

Oppgave 1a Definer følgende begreper: Nøkkel, supernøkkel og funksjonell avhengighet. TDT445 Øving 4 Oppgave a Definer følgende begreper: Nøkkel, supernøkkel og funksjonell avhengighet. Nøkkel: Supernøkkel: Funksjonell avhengighet: Data i en database som kan unikt identifisere (et sett

Detaljer

Newtons fargeskive. Regnbuens farger blir til hvitt. Sett skiva i rask rotasjon ved hjelp av sveiva.

Newtons fargeskive. Regnbuens farger blir til hvitt. Sett skiva i rask rotasjon ved hjelp av sveiva. Newtons fargeskive Regnbuens farger blir til hvitt. Sett skiva i rask rotasjon ved hjelp av sveiva. Se hva som skjer med fargene. Hvitt lys består av en blanding av alle farger. Når fargeskiva roterer

Detaljer

Kritisk lesning og skriving To sider av samme sak?

Kritisk lesning og skriving To sider av samme sak? og skriving To sider av samme sak? Geir Jacobsen Institutt for samfunnsmedisin Med en glidende overgang vil denne presentasjonen først handle om Kritisk lesning av fagartikler I engelsk litteratur brukes

Detaljer

PETROLEUM PRICE BOARD

PETROLEUM PRICE BOARD 1 PETROLEUM PRICE BOARD Our reference Date OED 15/712 21/09/2015 To the Licensees on the Norwegian Continental Shelf (Unofficial translation) NORM PRICE FOR CRUDE OIL PRODUCED ON THE NORWEGIAN CONTINENTAL

Detaljer

BEST in Akureyri, Island Hildigunnur Svavarsdóttir Director, Akureyri Hospital. BEST network meeting Bergen * Norway * 10.

BEST in Akureyri, Island Hildigunnur Svavarsdóttir Director, Akureyri Hospital. BEST network meeting Bergen * Norway * 10. BEST in Akureyri, Island Hildigunnur Svavarsdóttir Director, Akureyri Hospital BEST network meeting Bergen * Norway * 10. November 2014 Topics to be covered Our BEST activities in the last 2 years Results

Detaljer

Stipend fra Jubileumsfondet skoleåret 2002-2003

Stipend fra Jubileumsfondet skoleåret 2002-2003 Til skolen Rundskriv S 09-2002 Oslo, 15. februar 2002 Stipend fra Jubileumsfondet skoleåret 2002-2003 For nærmere omtale av H.M. Kong Olav V s Jubileumsfond viser vi til NKF-handboka kap. 12.3.4. Fondet

Detaljer

Salting of dry-cured ham

Salting of dry-cured ham Salting of dry-cured ham Controlled by CT scanning Torunn Thauland Håseth Skjervold-symposium 2005 Hamar, June 3rd. - en del av Matalliansen NLH - Matforsk - Akvaforsk To give you a different aspect of

Detaljer

UNIVERSITETET I OSLO ØKONOMISK INSTITUTT

UNIVERSITETET I OSLO ØKONOMISK INSTITUTT UNIVERSITETET I OSLO ØKONOMISK INSTITUTT Eksamen i: ECON1220 Velferd og økonomisk politikk Exam: ECON1220 Welfare and politics Eksamensdag: 29.11.2010 Sensur kunngjøres: 21.12.2010 Date of exam: 29.11.2010

Detaljer

Jørn Kristiansen MET Norway. jornk@met.no

Jørn Kristiansen MET Norway. jornk@met.no Dissemination of weather and climate information to various users of Yr : Experiences and strategy for data access, commercial use, attribution and data policy. Jørn Kristiansen MET Norway jornk@met.no

Detaljer

Forbruk & Finansiering

Forbruk & Finansiering Sida 1 Forbruk & Finansiering Analyser og kommentarer fra Forbrukerøkonom Randi Marjamaa basert på en undersøkelse gjennomført av TEMO/MMI for Nordea RESULTATER FRA NORGE OG NORDEN Nordea 2006-02-28 Sida

Detaljer

Brukerdokumentasjon Brukerdokumentasjon

Brukerdokumentasjon Brukerdokumentasjon Brukerdokumentasjon Brukerdokumentasjon 2 Brukerveiledning For en som skal ta en test: For den som skal ta en test er det mening at en bruksanvisning skal være unødvendig. De få informasjonene som en bruker

Detaljer

En praktisk anvendelse av ITIL rammeverket

En praktisk anvendelse av ITIL rammeverket NIRF 17. april 2012 En praktisk anvendelse av ITIL rammeverket Haakon Faanes, CIA,CISA, CISM Internrevisjonen NAV NAVs ITIL-tilnærming - SMILI NAV, 18.04.2012 Side 2 Styring av tjenestenivå Prosessen omfatter

Detaljer

Assessing second language skills - a challenge for teachers Case studies from three Norwegian primary schools

Assessing second language skills - a challenge for teachers Case studies from three Norwegian primary schools Assessing second language skills - a challenge for teachers Case studies from three Norwegian primary schools The Visions Conference 2011 UiO 18 20 May 2011 Kirsten Palm Oslo University College Else Ryen

Detaljer

Rapporterer norske selskaper integrert?

Rapporterer norske selskaper integrert? Advisory DnR Rapporterer norske selskaper integrert? Hvordan ligger norske selskaper an? Integrert rapportering er å synliggjøre bedre hvordan virksomheten skaper verdi 3 Norske selskaper har en lang vei

Detaljer

PIM ProsjektInformasjonsManual Tittel: REDUKSJON AV FLUORIDEKSPONERING I ALUMINIUMINDUSTRIEN INKLUDERT GRUNNLAG FOR KORTTIDSNORM FOR FLUORIDER

PIM ProsjektInformasjonsManual Tittel: REDUKSJON AV FLUORIDEKSPONERING I ALUMINIUMINDUSTRIEN INKLUDERT GRUNNLAG FOR KORTTIDSNORM FOR FLUORIDER SLUTTRAPPORT Innhold 1. Innledning 1.1 Deltakere 1.2 Bakgrunn 1.3 Mål 1.4 Organisasjon 2. Oppsummering 3. Summary in English 4. Referanser/References 1. INNLEDNING 1.1 Deltakere Alcan á Ísland Alcoa Fjarðaál

Detaljer

Dialogkveld 03. mars 2016. Mobbing i barnehagen

Dialogkveld 03. mars 2016. Mobbing i barnehagen Dialogkveld 03. mars 2016 Mobbing i barnehagen Discussion evening March 3rd 2016 Bullying at kindergarten Mobbing i barnehagen Kan vi si at det eksisterer mobbing i barnehagen? Er barnehagebarn i stand

Detaljer

Nærings-PhD i Aker Solutions

Nærings-PhD i Aker Solutions part of Aker Motivasjon og erfaringer Kristin M. Berntsen/Soffi Westin/Maung K. Sein 09.12.2011 2011 Aker Solutions Motivasjon for Aker Solutions Forutsetning Vilje fra bedrift og se nytteverdien av forskning.

Detaljer

Søker du ikke om nytt frikort, vil du bli trukket 15 prosent av din pensjonsutbetaling fra og med januar 2014.

Søker du ikke om nytt frikort, vil du bli trukket 15 prosent av din pensjonsutbetaling fra og med januar 2014. Skatteetaten Saksbehandler Deres dato Vår dato 31.10.2013 Telefon Deres referanse Vår referanse For information in English see page 3 Skattekort for 2014 Du fikk helt eller delvis skattefritak ved likningen

Detaljer

Grunnkurs D, Kongsberg 10.05.2016

Grunnkurs D, Kongsberg 10.05.2016 Grunnkurs D, Kongsberg 10.05.2016 Presentasjon av PhD prosjekt Sven Eirik Ruud Lege Allmennlegevakten i Oslo PhD stipendiat UIO Legevakten i Oslo 2 «Karriere»! 2006-2014 lege/skiftleder Allmenn LV 2009-2011

Detaljer

Norway. Museum Statistics for 2011. Statistical data from 134 museums that were open to the public and had at least one man year regular staff.

Norway. Museum Statistics for 2011. Statistical data from 134 museums that were open to the public and had at least one man year regular staff. Norway Museum Statistics for 2011. Statistical data from 134 museums that were open to the public and had at least one man year regular staff. Arts Council Norway Tel: +47 21 04 58 00 post@kulturrad.no

Detaljer

SAS FANS NYTT & NYTTIG FRA VERKTØYKASSA TIL SAS 4. MARS 2014, MIKKEL SØRHEIM

SAS FANS NYTT & NYTTIG FRA VERKTØYKASSA TIL SAS 4. MARS 2014, MIKKEL SØRHEIM SAS FANS NYTT & NYTTIG FRA VERKTØYKASSA TIL SAS 4. MARS 2014, MIKKEL SØRHEIM 2 TEMA 1 MULTIPROSESSERING MED DATASTEGET Multiprosessering har lenge vært et tema i SAS Stadig ny funksjonalitet er med på

Detaljer

Registrering av barnehoftesykdommene Nasjonalt Barnehofteregister

Registrering av barnehoftesykdommene Nasjonalt Barnehofteregister 1 Registrering av barnehoftesykdommene Nasjonalt Barnehofteregister Ola Wiig, Overlege PhD, Ortopedisk avdeling, Seksjon for barneortopedi og deformitetskirurgi, Oslo Universitetssykehus, Rikshospitalet

Detaljer

Sikkert Drillingnettverk på CAT-D Rig

Sikkert Drillingnettverk på CAT-D Rig Sikkert Drillingnettverk på CAT-D Rig Med fokus på IT sikkerhet i offshore bransjen Kristiansand, 21/10/2014, Asgeir Skretting, Dag Tang Sikkert Drillingnettverk på CAT-D Rig Agenda Hvorfor sikker offshore

Detaljer

KROPPEN LEDER STRØM. Sett en finger på hvert av kontaktpunktene på modellen. Da får du et lydsignal.

KROPPEN LEDER STRØM. Sett en finger på hvert av kontaktpunktene på modellen. Da får du et lydsignal. KROPPEN LEDER STRØM Sett en finger på hvert av kontaktpunktene på modellen. Da får du et lydsignal. Hva forteller dette signalet? Gå flere sammen. Ta hverandre i hendene, og la de to ytterste personene

Detaljer

// Translation // KLART SVAR «Free-Range Employees»

// Translation // KLART SVAR «Free-Range Employees» // Translation // KLART SVAR «Free-Range Employees» Klart Svar is a nationwide multiple telecom store, known as a supplier of mobile phones and wireless office solutions. The challenge was to make use

Detaljer

Bestille trykk av doktoravhandling Ordering printing of PhD Thesis

Bestille trykk av doktoravhandling Ordering printing of PhD Thesis Bestille trykk av doktoravhandling Ordering printing of PhD Thesis Brukermanual / User manual Skipnes Kommunikasjon ntnu.skipnes.no PhD Thesis NTNU LOG IN NOR: Gå inn på siden ntnu.skipnes-wtp.no, eller

Detaljer

The internet of Health

The internet of Health The internet of Health! Biler, helse og fremtiden!! Velkon 2014, 22. October 2014 Nard Schreurs, IKT-Norge Få ut begrepet «pasient» av tanker om helse. Aldring 1980-2010 Menn 72 år til 79 år Kvinner 79

Detaljer

6350 Månedstabell / Month table Klasse / Class 1 Tax deduction table (tax to be withheld) 2012

6350 Månedstabell / Month table Klasse / Class 1 Tax deduction table (tax to be withheld) 2012 6350 Månedstabell / Month table Klasse / Class 1 Tax deduction table (tax to be withheld) 2012 100 200 3000 0 0 0 13 38 63 88 113 138 163 4000 188 213 238 263 288 313 338 363 378 386 5000 394 402 410 417

Detaljer

DecisionMaker Frequent error codes (valid from version 7.x and up)

DecisionMaker Frequent error codes (valid from version 7.x and up) DecisionMaker Frequent error codes (valid from version 7.x and up) DM Frequent Error Codes Bisnode Credit IT 03.02.2014 1 (5) CONTENTS 1 Target... 3 2 About this document... 3 3 Error codes an messages...

Detaljer

STILLAS - STANDARD FORSLAG FRA SEF TIL NY STILLAS - STANDARD

STILLAS - STANDARD FORSLAG FRA SEF TIL NY STILLAS - STANDARD FORSLAG FRA SEF TIL NY STILLAS - STANDARD 1 Bakgrunnen for dette initiativet fra SEF, er ønsket om å gjøre arbeid i høyden tryggere / sikrere. Både for stillasmontører og brukere av stillaser. 2 Reviderte

Detaljer

Work on storage diseases on apple by Bioforsk. Jorunn Børve

Work on storage diseases on apple by Bioforsk. Jorunn Børve Work on storage diseases on apple by Bioforsk Jorunn Børve Apple storage in Norway Short time storage (until December 1 or February for juice) Ordinary cold storage MA and CA? Aroma main cultivar, new

Detaljer

OTC USE IN NORWAY FOR PARACETAMOL, ATC-CODE: N02BE01

OTC USE IN NORWAY FOR PARACETAMOL, ATC-CODE: N02BE01 OTC USE IN NORWAY FOR PARACETAMOL, ATC-CODE: N02BE01 To gain OTC prescription status for a medicinal product an application in accordance with A guideline on changing the classification for the supply

Detaljer

Interaction between GPs and hospitals: The effect of cooperation initiatives on GPs satisfaction

Interaction between GPs and hospitals: The effect of cooperation initiatives on GPs satisfaction Interaction between GPs and hospitals: The effect of cooperation initiatives on GPs satisfaction Ass Professor Lars Erik Kjekshus and Post doc Trond Tjerbo Department of Health Management and Health Economics

Detaljer

Overvekt og fedme- et økende problem i Innlandet og i Norge?

Overvekt og fedme- et økende problem i Innlandet og i Norge? Overvekt og fedme- et økende problem i Innlandet og i Norge? Haakon E. Meyer Professor Avdeling for samfunnsmedisin Universitetet i Oslo & Nasjonalt folkehelseinstitutt Andel (%) med fedme 40-42 år gamle

Detaljer

Kliniske og praktiske utfordringer i flymedisin. Erfaringer med piloter Oslo, 05.09.2013

Kliniske og praktiske utfordringer i flymedisin. Erfaringer med piloter Oslo, 05.09.2013 Kliniske og praktiske utfordringer i flymedisin Erfaringer med piloter Oslo, 05.09.2013 Cardiovascular system An accumulation of risk factors (smoking, family history, lipid abnormalities, hypertension,

Detaljer

Økologisk og kulturell dannelse i økonomiutdanningen

Økologisk og kulturell dannelse i økonomiutdanningen Økologisk og kulturell dannelse i økonomiutdanningen Dannelse på norsk fra ord til handling Professor Ove Jakobsen HHB/UiN Frihet med ansvar Om høyere utdanning og forskning i Norge NOU 2000:14 Det er

Detaljer

The building blocks of a biogas strategy

The building blocks of a biogas strategy The building blocks of a biogas strategy Presentation of the report «Background report for a biogas strategy» («Underlagsmateriale til tverrsektoriell biogass-strategi») Christine Maass, Norwegian Environment

Detaljer

Forebyggende behandling

Forebyggende behandling Forebyggende behandling Odd Mørkve Senter for internasjonal helse Universitetet i Bergen Landskonferanse om tuberkulose 24. mars 2011 Latent tuberkulose (LTBI) Hva er LTBI? Hva er gevinsten ved å behandle

Detaljer

EXAM TTM4128 SERVICE AND RESOURCE MANAGEMENT EKSAM I TTM4128 TJENESTE- OG RESSURSADMINISTRASJON

EXAM TTM4128 SERVICE AND RESOURCE MANAGEMENT EKSAM I TTM4128 TJENESTE- OG RESSURSADMINISTRASJON Side 1 av 5 NTNU Norges teknisk-naturvitenskapelige universitet Institutt for telematikk EXAM TTM4128 SERVICE AND RESOURCE MANAGEMENT EKSAM I TTM4128 TJENESTE- OG RESSURSADMINISTRASJON Contact person /

Detaljer

Kjersti Oterhals. Hjerteavdelingen, Haukeland Universitetssykehus, Bergen,

Kjersti Oterhals. Hjerteavdelingen, Haukeland Universitetssykehus, Bergen, Kjersti Oterhals Hjerteavdelingen, Haukeland Universitetssykehus, Bergen, UNITE Research Group; Christi Deaton, Sabina De Geest, Tiny Jaarsma, Mattie Lenzen, Philip Moons, Jan Mårtensson, Karen Smith,

Detaljer

Søker du ikke om nytt frikort/skattekort, vil du bli trukket 15 prosent av utbetalingen av pensjon eller uføreytelse fra og med januar 2016.

Søker du ikke om nytt frikort/skattekort, vil du bli trukket 15 prosent av utbetalingen av pensjon eller uføreytelse fra og med januar 2016. Skatteetaten Saksbehandler Deres dato Vår dato 26.10.2016 Telefon Deres Vår referanse For information in English see page 3 Skattekort for 2016 Du fikk helt eller delvis skattefritak ved likningen for

Detaljer

The Future of Academic Libraries the Road Ahead. Roy Gundersen

The Future of Academic Libraries the Road Ahead. Roy Gundersen The Future of Academic Libraries the Road Ahead Roy Gundersen Background Discussions on the modernization of BIBSYS Project spring 2007: Forprosjekt modernisering Process analysis Specification Market

Detaljer

Gode indikasjoner (appropriateness criteria) for operasjon av degenerativ spondylolistese

Gode indikasjoner (appropriateness criteria) for operasjon av degenerativ spondylolistese 1 Gode indikasjoner (appropriateness criteria) for operasjon av degenerativ spondylolistese Konsensus fra en tverrfaglig internasjonal studie basert på gjennomgang av 744 fiktive pasientkasuistikker Jens

Detaljer

INNKALLING TIL ORDINÆR GENERALFORSAMLING I TELIO HOLDING ASA NOTICE OF ANNUAL SHAREHOLDERS MEETING IN TELIO HOLDING ASA

INNKALLING TIL ORDINÆR GENERALFORSAMLING I TELIO HOLDING ASA NOTICE OF ANNUAL SHAREHOLDERS MEETING IN TELIO HOLDING ASA INNKALLING TIL ORDINÆR GENERALFORSAMLING I TELIO HOLDING ASA NOTICE OF ANNUAL SHAREHOLDERS MEETING IN TELIO HOLDING ASA Aksjonærene i Telio Holding ASA ( Selskapet ) innkalles med dette til ordinær generalforsamling

Detaljer

Social Media Insight

Social Media Insight Social Media Insight Do you know what they say about you and your company out there? Slik fikk Integrasco fra Grimstad Vodafone og Sony Ericsson som kunder. Innovasjon og internasjonalisering, Agdering

Detaljer

Innovasjonsvennlig anskaffelse

Innovasjonsvennlig anskaffelse UNIVERSITETET I BERGEN Universitetet i Bergen Innovasjonsvennlig anskaffelse Fredrikstad, 20 april 2016 Kjetil Skog 1 Universitetet i Bergen 2 Universitetet i Bergen Driftsinntekter på 4 milliarder kr

Detaljer

Profile handbook. for

Profile handbook. for Profile handbook for March 2007 Logo For the logo, we have chosen a shape in conformity with the general visual direction. The logo is inspired by the shape of the product, and the circle also creates

Detaljer

UNIVERSITY OF OSLO. Faculty of Mathematics and Natural Sciences

UNIVERSITY OF OSLO. Faculty of Mathematics and Natural Sciences Page 1 UNIVERSITY OF OSLO Faculty of Mathematics and Natural Sciences Exam in BIO4210/9210 Classification and Phylogeny Day of exam: 13. December 2011 Exam hours: 9.00-12.00 (3 hours) This examination

Detaljer

To slemme søsken : Diabetes og kronisk nyresykdom. Harald Bergrem Stavanger Universitetssjukehus

To slemme søsken : Diabetes og kronisk nyresykdom. Harald Bergrem Stavanger Universitetssjukehus To slemme søsken : Diabetes og kronisk nyresykdom Harald Bergrem Stavanger Universitetssjukehus Change in height, weight and body mass index: Longitudinal data from the HUNT Study in Norway. Drøyvold

Detaljer

Hvor finner vi flått på vårbeiter? - og betydning av gjengroing for flåttangrep på lam på vårbeite

Hvor finner vi flått på vårbeiter? - og betydning av gjengroing for flåttangrep på lam på vårbeite Hvor finner vi flått på vårbeiter? - og betydning av gjengroing for flåttangrep på lam på vårbeite Lucy Gilbert, Lise Grove, Unni Støbet Lande, Ingeborg Klingen, Kirstyn Brunker Gjenngroing På verdensbasis

Detaljer

of color printers at university); helps in learning GIS.

of color printers at university); helps in learning GIS. Making a Home Page Why a Web Page? Easier to submit labs electronically (lack of color printers at university); Easier to grade many labs; Provides additional computer experience that helps in learning

Detaljer

UNIVERSITETET I OSLO ØKONOMISK INSTITUTT

UNIVERSITETET I OSLO ØKONOMISK INSTITUTT UNIVERSITETET I OSLO ØKONOMISK INSTITUTT Utsatt eksamen i: ECON1410 - Internasjonal økonomi Exam: ECON1410 - International economics Eksamensdag: 18.06.2013 Date of exam: 18.06.2013 Tid for eksamen: kl.

Detaljer

EARLY CANCER DIAGNOSTIC IN NORWAY OLE ALEXANDER OPDALSHEI, THE NORWEGIAN CANCER SOCIETY

EARLY CANCER DIAGNOSTIC IN NORWAY OLE ALEXANDER OPDALSHEI, THE NORWEGIAN CANCER SOCIETY EARLY CANCER DIAGNOSTIC IN NORWAY OLE ALEXANDER OPDALSHEI, THE NORWEGIAN CANCER SOCIETY Norwegian Cancer Society in brief - The only national cancer society in Norway - Around 180 employees (different

Detaljer

Microsoft Dynamics C5 Version 2008 Oversigt over Microsoft Reporting Services rapporter

Microsoft Dynamics C5 Version 2008 Oversigt over Microsoft Reporting Services rapporter Reporting Services - oversigt Microsoft Dynamics C5 Version 2008 Oversigt over Microsoft Reporting Services rapporter Summary Efterfølgende vises en oversigt over de rapporter som er indeholdt i Microsoft

Detaljer

Utvikling av nyresvikt

Utvikling av nyresvikt Utvikling av nyresvikt Stein Hallan, MD PhD St. Olavs Hospital, Trondheim Definisjon Nyresvikt = Chronic renal failure = Chronic kidney failure = Chronic kidney disease stage 5 S-Creatinine >200 umol/l?

Detaljer

UNIT LOG (For local use)

UNIT LOG (For local use) (EUROpean Pain Audit In Neonates) European survey of sedation and analgesia practices for ventilated newborn infants UNIT LOG (For local use) MONITORING OF INCLUSIONS/ EXCLUSIONS Principal Investigators

Detaljer

EKSAMENSOPPGAVE I AK3005 Fiskens utviklingsbiologi

EKSAMENSOPPGAVE I AK3005 Fiskens utviklingsbiologi Norges teknisk-naturvitenskapelige universitet Institutt for biologi EKSAMENSOPPGAVE I AK3005 Fiskens utviklingsbiologi Faglig kontakt under eksamen: Elin Kjørsvik Tlf.: 918 97 578 - Eksamensdato: 18.05.2009

Detaljer

INSTRUKS FOR VALGKOMITEEN I AKASTOR ASA (Fastsatt på generalforsamling i Akastor ASA (tidligere Aker Solutions ASA) 6. mai 2011)

INSTRUKS FOR VALGKOMITEEN I AKASTOR ASA (Fastsatt på generalforsamling i Akastor ASA (tidligere Aker Solutions ASA) 6. mai 2011) INSTRUKS FOR VALGKOMITEEN I AKASTOR ASA (Fastsatt på generalforsamling i Akastor ASA (tidligere Aker Solutions ASA) 6. mai 2011) 1 Oppgaver Valgkomiteens oppgaver er å avgi innstilling til - generalforsamlingen

Detaljer

DISTRIKTSRØNTGEN. Høgskolen i Sørøst-Norge

DISTRIKTSRØNTGEN. Høgskolen i Sørøst-Norge DISTRIKTSRØNTGEN 216 kommuner i Norge er definert som distriktskommuner ( mer enn 50 km fra et sykehus) 47 kommuner tilbyr distrikts røntgen (12 sentre) ( Bønes, 2014) Ulike modeller for organisering:

Detaljer

Kundetilfredshetsundersøkelse FHI/SMAP

Kundetilfredshetsundersøkelse FHI/SMAP Kundetilfredshetsundersøkelse FHI/SMAP Sluttrapport pr. 20. April 2010 Alle 9 kunder av FHI s produksjonsavdeling for biofarmasøytiske produkter (SMAP) i perioden 2008-2009 mottok i januar 2010 vårt spørreskjema

Detaljer

Juridiske aspekter ved publisering i åpne institusjonelle arkiv

Juridiske aspekter ved publisering i åpne institusjonelle arkiv Juridiske aspekter ved publisering i åpne institusjonelle arkiv Professor dr juris Olav Torvund Publisering i åpne institusjonelle arkiv Førstegangspublisering Masteroppgaver Doktoravhandlinger (?) Grålitteratur

Detaljer

Contingent Liabilities in Norwegian Local Government Accounting. Redress Programs Relating to Institutional Child Abuse

Contingent Liabilities in Norwegian Local Government Accounting. Redress Programs Relating to Institutional Child Abuse Contingent Liabilities in Norwegian Local Government Accounting Redress Programs Relating to Institutional Child Abuse telemarksforsking.no Telemarksforsking What is Redress Programs Relating to Institutional

Detaljer

buildingsmart Norge seminar Gardermoen 2. september 2010 IFD sett i sammenheng med BIM og varedata

buildingsmart Norge seminar Gardermoen 2. september 2010 IFD sett i sammenheng med BIM og varedata buildingsmart Norge seminar Gardermoen 2. september 2010 IFD sett i sammenheng med BIM og varedata IFD International Framework for Dictionaries Hvordan bygges en BIM? Hva kan hentes ut av BIM? Hvordan

Detaljer

Welcome to one of the world s coolest golf courses!

Welcome to one of the world s coolest golf courses! All Photography kindly supplied by kevinmurraygolfphotography.com Velkommen til Verdens råeste golfbane! Lofoten Links er en spektakulær 18-hulls mesterskapsbane som ligger vakkert i naturen. Her kan sola

Detaljer

ATO program for Renewal of IR, Class or Type-rating

ATO program for Renewal of IR, Class or Type-rating May be used by the ATO in order to establish an individual training program for renewal of IR, Class or Type-rating in accordance with FCL.625 IR(c)(d) / AMC1 FCL.625(c) and FCL.740(b)(1)(2) / AMC1 FCL.740(b)(1)

Detaljer

Lavkarbo-effekterog - bivirkninger

Lavkarbo-effekterog - bivirkninger Lavkarbo-effekterog - bivirkninger Mange går pådiett -lavkarboer populært 17 % har gått (siste år) eller går pådiett 640 000 nordmenn 280 000 går eller har gått pålavkarbo, 100 000 følger myndighetenes

Detaljer

Assessment of Urban Forestry Research in the Nordic and Baltic countries. Project Description Form

Assessment of Urban Forestry Research in the Nordic and Baltic countries. Project Description Form Assessment of Urban Forestry Research in the Nordic and Baltic countries Project Description Form 1. Project name Project name in English 2. Project website Provide web address 3. Research organisation

Detaljer

Lovlig bruk av Cloud Computing. Helge Veum, avdelingsdirektør Difi, Oslo 17.03.2014

Lovlig bruk av Cloud Computing. Helge Veum, avdelingsdirektør Difi, Oslo 17.03.2014 Lovlig bruk av Cloud Computing Helge Veum, avdelingsdirektør Difi, Oslo 17.03.2014 Vårt utgangspunkt Det er Datatilsynets utgangspunkt at det er mulig å oppnå godt personvern også i nettskyen Dette er

Detaljer

NORM PRICE FOR CRUDE OIL PRODUCED ON THE NORWEGIAN CONTINENTAL SHELF 3rd QUARTER 2015

NORM PRICE FOR CRUDE OIL PRODUCED ON THE NORWEGIAN CONTINENTAL SHELF 3rd QUARTER 2015 1 PETROLEUMSPRISRÅDET Deres ref Vår ref Dato OED 15/712 07/12/2015 Til rettighetshaverne på norsk sokkel (Unofficial translation) NORM PRICE FOR CRUDE OIL PRODUCED ON THE NORWEGIAN CONTINENTAL SHELF 3rd

Detaljer

UNIVERSITETET I OSLO ØKONOMISK INSTITUTT

UNIVERSITETET I OSLO ØKONOMISK INSTITUTT UNIVERSITETET I OSLO ØKONOMISK INSTITUTT Bokmål Eksamen i: ECON1210 Forbruker, bedrift og marked Exam: ECON1210 Consumer Behaviour, Firm behaviour and Markets Eksamensdag: 12.12.2014 Sensur kunngjøres:

Detaljer

Eksamen PSY2012 Forskningsmetodologi III: Statistisk analyse, design og måling Våren 2011

Eksamen PSY2012 Forskningsmetodologi III: Statistisk analyse, design og måling Våren 2011 Psykologisk institutt Eksamen PSY2012 Forskningsmetodologi III: Statistisk analyse, design og måling Våren 2011 Skriftlig skoleeksamen, fredag 20. mai kl. 14:30 (4 timer). Dato for sensur: 10. juni. Ingen

Detaljer

COST-EFFECTIVENESS OF ASTHMA EDUCATION - A RANDOMISED CONTROLLED TRIAL

COST-EFFECTIVENESS OF ASTHMA EDUCATION - A RANDOMISED CONTROLLED TRIAL COST-EFFECTIVENESS OF ASTHMA EDUCATION - A RANDOMISED CONTROLLED TRIAL Frode Gallefoss Seksjonsoverlege Sørlandet Sykehus Kristiansand e-mail: frode.gallefoss@sshf.no Introduction: A PudMed Medline search

Detaljer

Petroleumsundersøkelsen om skiftarbeid, søvn og helse (PUSSH)

Petroleumsundersøkelsen om skiftarbeid, søvn og helse (PUSSH) Petroleumsundersøkelsen om skiftarbeid, søvn og helse (PUSSH) Pål Molander Direktør, Prof. Dr. www.pussh.org Agenda Litt om bakgrunnen og bakteppet for prosjektet Hvem er det som har besluttet at det foreligger

Detaljer

Skiskole side 2. Pr. pers. 3 dager/3 days 885 4 dager/4 days NY/NEW 995 5 dager/5 days NY/NEW 1090

Skiskole side 2. Pr. pers. 3 dager/3 days 885 4 dager/4 days NY/NEW 995 5 dager/5 days NY/NEW 1090 Skiskole Side 1 Priser Snowsports Skeikampen vinter 2013/2014. Individuelle gjester. Prices Snowsports Skeikampen winter 2013/2014. Individual guests. Gruppeundervisning, voksne, ungdom og Fjellbandidos

Detaljer

Fra tegnebrett til 2D/3D verktøy for plattform prosjektering.

Fra tegnebrett til 2D/3D verktøy for plattform prosjektering. Fra tegnebrett til 2D/3D verktøy for plattform prosjektering. Roger Kopperstad 22.05.2007 Tegningsorientert metode for design 3D-orientert metode for design 3D regelbasert metode for design og ekstraksjon

Detaljer

May legally defined terms be useful for improved interoperability in the public sector?

May legally defined terms be useful for improved interoperability in the public sector? May legally defined terms be useful for improved interoperability in the public sector? Prof. Dag Wiese Schartum, Norwegian Research Center for Computers and Law, University of Oslo How may terms be legally

Detaljer

Baltic Sea Region CCS Forum. Nordic energy cooperation perspectives

Baltic Sea Region CCS Forum. Nordic energy cooperation perspectives Norsk mal: Startside Baltic Sea Region CCS Forum. Nordic energy cooperation perspectives Johan Vetlesen. Senior Energy Committe of the Nordic Council of Ministers 22-23. april 2015 Nordic Council of Ministers.

Detaljer

Kan vi identifisere friske overvektige barn blant syke overvektige? Rønnaug Ødegård Barneklinikken/RSSO St Olavs Hospital LBK/NTNU

Kan vi identifisere friske overvektige barn blant syke overvektige? Rønnaug Ødegård Barneklinikken/RSSO St Olavs Hospital LBK/NTNU Kan vi identifisere friske overvektige barn blant syke overvektige? Rønnaug Ødegård Barneklinikken/RSSO St Olavs Hospital LBK/NTNU 1 The metabolically healthy but obese - 20 30% av fedmepopulasjonen? 2

Detaljer

Exploratory Analysis of a Large Collection of Time-Series Using Automatic Smoothing Techniques

Exploratory Analysis of a Large Collection of Time-Series Using Automatic Smoothing Techniques Exploratory Analysis of a Large Collection of Time-Series Using Automatic Smoothing Techniques Ravi Varadhan, Ganesh Subramaniam Johns Hopkins University AT&T Labs - Research 1 / 28 Introduction Goal:

Detaljer

The Norwegian Kidney Register/National Center in Nephropathology Department of Medicine/Department of Pathology Haukeland University Hospital

The Norwegian Kidney Register/National Center in Nephropathology Department of Medicine/Department of Pathology Haukeland University Hospital The Norwegian Kidney Register/National Center in Nephropathology Department of Medicine/Department of Pathology Haukeland University Hospital Head of the board: Bjarne M. Iversen, professor MD PhD Head

Detaljer

stjerneponcho for voksne star poncho for grown ups

stjerneponcho for voksne star poncho for grown ups stjerneponcho for voksne star poncho for grown ups www.pickles.no / shop.pickles.no NORSK Størrelser XS (S) M (L) Garn Pickles Pure Alpaca 300 (350) 400 (400) g hovedfarge 100 (100) 150 (150) g hver av

Detaljer

Kunnskapsesenterets nye PPT-mal

Kunnskapsesenterets nye PPT-mal Dagens Medisin Arena 6. Mars 2013 Om nye metoder for å beregne risiko og nytte og en ny generasjon faglige retningslinjer Kunnskapsesenterets nye PPT-mal Per Olav Vandvik Jeg har ingen finansielle interessekonflikter,

Detaljer

Climate change and adaptation: Linking. stakeholder engagement- a case study from

Climate change and adaptation: Linking. stakeholder engagement- a case study from Climate change and adaptation: Linking science and policy through active stakeholder engagement- a case study from two provinces in India 29 September, 2011 Seminar, Involvering ved miljøprosjekter Udaya

Detaljer

BOASNEGLEN (LIMAX MANMUS) OG IBERIASNEGLEN (ARION LUCITANZCUS) I NORGE; UTBREDELSE, SPREDNING OG SKADEVIRKNINGER

BOASNEGLEN (LIMAX MANMUS) OG IBERIASNEGLEN (ARION LUCITANZCUS) I NORGE; UTBREDELSE, SPREDNING OG SKADEVIRKNINGER Vitenskapsmuseet Rapport Zoologisk Serie 1997-4 BOASNEGLEN (LIMAX MANMUS) OG IBERIASNEGLEN (ARION LUCITANZCUS) I NORGE; UTBREDELSE, SPREDNING OG SKADEVIRKNINGER Dag Dolmen og Kirsten Winge Norges teknisk-naturvitenskapelige

Detaljer

Forberedelse til skolebesøk

Forberedelse til skolebesøk Engineering Challenge et læringsspill om ingeniøryrket Engineerium, Fornebu Slide 1 Innhold Verden trenger energi Hva er olje og gass Olje og gass i Norge Om olje- og gassbransjen Spennende muligheter

Detaljer