[Right to necessary health care--our priority law].
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Decision Making↗
Biomedical subjects
Knut Rasmussen
Publications and source records attributed to Knut Rasmussen.
Homocysteine lowering and cardiovascular events after acute myocardial infarction.
BACKGROUND: Homocysteine is a risk factor for cardiovascular disease. We evaluated the efficacy of homocysteine-lowering treatment with B vitamins for secondary prevention in patients who had had an acute myocardial infarction. METHODS: The trial included 3749 men and women who had had an acute myocardial infarction within seven days before randomization. Patients were randomly assigned, in a two-by-two factorial design, to receive one of the following four daily treatments: 0.8 mg of folic acid, 0.4 mg of vitamin B12, and 40 mg of vitamin B6; 0.8 mg of folic acid and 0.4 mg of vitamin B12; 40 mg of vitamin B6; or placebo. The primary end point during a median follow-up of 40 months was a composite of recurrent myocardial infarction, stroke, and sudden death attributed to coronary artery disease. RESULTS: The mean total homocysteine level was lowered by 27 percent among patients given folic acid plus vitamin B12, but such treatment had no significant effect on the primary end point (risk ratio, 1.08; 95 percent confidence interval, 0.93 to 1.25; P=0.31). Also, treatment with vitamin B6 was not associated with any significant benefit with regard to the primary end point (relative risk of the primary end point, 1.14; 95 percent confidence interval, 0.98 to 1.32; P=0.09). In the group given folic acid, vitamin B12, and vitamin B6, there was a trend toward an increased risk (relative risk, 1.22; 95 percent confidence interval, 1.00 to 1.50; P=0.05). CONCLUSIONS: Treatment with B vitamins did not lower the risk of recurrent cardiovascular disease after acute myocardial infarction. A harmful effect from combined B vitamin treatment was suggested. Such treatment should therefore not be recommended. (ClinicalTrials.gov number, NCT00266487.).
Adult↗
[National health resources for highly specialised medicine].
BACKGROUND: In order to monitor quality and efficiency in the use of health resources for highly specialised medicine, a National Professional Council has since 1990 advised the Norwegian health authorities on the establishing and localisation of such services. MATERIALS AND METHOD: A comprehensive review of both the quality, economy and the geographical distribution of patients in each specialised service has been carried out. RESULTS: 33 defined national programmes were centralised to one hospital only and distributed among seven university hospitals. Eight multiregional programmes were centralised to two hospitals only and included four university hospitals. In 2001, a total of 2711 new patients were treated in these programmes. The system seems to have secured a sufficient patient flow to each programme so as to maintain quality. However, a geographically skewed distribution of patients was noted, particularly in some of the national programmes. INTERPRETATION: In a small country like Norway, with 4.5 million inhabitants, a centralised monitoring of highly specialised medicine seems both rational and successful. By the same logic, however, international cooperation should probably be sought for the smallest patient groups.
Centralized Hospital Services↗
[Medical monopolies--a choice between quality and equality?].
BACKGROUND: The highly specialised medical services in Norway consist of 33 monopolies and 8 bipolies, involving both a duty of referral and a duty of admittance for defined patient groups. All the specialised services are located to large hospitals in southern Norway. MATERIAL: In conjunction with a thorough review of the specialised services, the geographical distribution of the 2711 patients treated in 2001 was analysed. RESULTS: The geographical distribution was highly skewed, with a decreasing coverage with increasing distances from the monopoly centres. The ratio between the county with the most and the one with the least use of the services was 2.3. Northern Norway had a significantly lower usage. INTERPRETATION: Monopolies seem to have an inherent tendency to give poor distribution of health care. Medical monopolies seem to have many of the negative effects associated with economic monopolies. A cautious attitude towards new and a rigid control of old monopolies is recommended. Equality of access to services should be maintained as a primary goal in public health care systems.
Centralized Hospital Services↗
Left ventricular dysfunction in subjects with mild secondary hyperparathyroidism detected with pulsed wave tissue Doppler echocardiography.
AIMS: To assess left ventricular function by conventional and pulsed wave tissue Doppler (PWTD) echocardiography in subjects with mild secondary hyperparathyroidism, and to evaluate whether PWTD would be more sensitive than conventional echocardiography in detecting subtle changes in LV systolic and diastolic function. METHODS: In the fifth Tromsø study (2001) serum PTH and calcium were measured in 7,954 subjects. One hundred subjects with secondary hyperparathyroidism (SHPT; serum PTH >6.40 pmol/l and serum calcium <2.40 mmol/l) and 106 control subjects with normal PTH and calcium levels and with no history of cardiovascular disease were examined at the follow-up 6-12 months later. RESULTS: Conventional transthoracic echocardiography and PWTD of mitral annulus were successfully performed in 83 cases and 88 controls. At follow-up mean serum PTH values were 6.0 +/- 2.2 versus 3.2 +/- 1.3 pmol/l (p < 0.05) and mean calcium 2.28 +/- 0.10 versus 2.33 +/- 0.08 mmol/l (p < 0.05) in cases and controls, respectively. Unpaired t test and multiple linear regression analyses were used. No significant differences in conventional echocardiographic parameters were found. However, PWTD showed reduced systolic velocity in septal, lateral and anterior mitral annulus (p < 0.05) and also reduced early diastolic velocity in septal and anterior mitral annulus (p < 0.05). CONCLUSION: Subjects with mild SHPT have impaired left ventricular long axis function as evaluated by PWTD compared to conventional echocardiography. PWTD seems to be a more sensitive tool in detecting minor changes in left ventricular function and the new modality should routinely be included in studies evaluating left ventricular function, especially the long axis function.
Aged↗
[Strange reaction to drug therapy].
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Advertising↗
[Chest pain and anxiety].
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Angina Pectoris↗