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Author (up) Askim, A.; Gustad, L.T.; Paulsen, J.; Reitan, S.K.; Mehl, A.; Mohus, R.M.; Dewan, A.; Damas, J.K.; Solligard, E.; Asvold, B.O. url  doi
  Title Anxiety and Depression Symptoms in a General Population and Future Risk of Bloodstream Infection: The HUNT Study Type Journal Article
  Year 2018 Publication Psychosomatic Medicine Abbreviated Journal Psychosom Med  
  Volume 80 Issue 7 Pages 673-679  
  Keywords  
  Abstract OBJECTIVE: We examined whether anxiety and depression symptoms constitute increased risk of bloodstream infection (BSI), as a proxy for sepsis. METHODS: A general population with self-reported anxiety and depression symptoms was followed prospectively for hospital-verified BSI. Using multivariable Cox regression analysis, we estimated hazard ratios (HR) with 95% confidence intervals (CI) of BSI and BSI mortality, with and without statistical adjustment for comorbidities, BMI, and life-style factors that may confound or mediate the associations. RESULTS: During 14.8 years median follow-up of 59,301 individuals, 1578 (2.7%) experienced BSI and 328 (0.55%) participants died within 30 days after a BSI. Severe depression symptoms were associated with a 38% increased risk of BSI, adjusted for age, sex, and education (HR = 1.38, 95% CI = 1.10-1.73). The HR was attenuated to 1.23 (0.96-1.59) after adjustment for comorbidities and to 1.15 (0.86-1.53) after additional adjustment for BMI and life-style factors. For severe anxiety symptoms, the corresponding HRs were 1.48 (1.20-1.83), 1.35 (1.07-1.70), and 1.28 (0.99-1.64). Moderate symptoms of depression and anxiety were not associated with increased BSI risk. The analysis of BSI mortality yielded imprecise results but suggested an increased risk of BSI mortality in participants with moderate depression symptoms. CONCLUSIONS: Severe depression and anxiety symptoms were associated with a moderately increased risk of BSI. The association may, at least in part, be confounded or mediated by comorbidities, BMI, and life-style. Future research should investigate whether interventions targeting improved BMI and life-style may reduce the risk of BSI and sepsis in people with depression and anxiety symptoms.  
  Address From the Department of Circulation and Medical Imaging (Askim, Gustad, Mohus, Solligard), NTNU, Norwegian University of Science and Technology; Clinic of Anesthesia and Intensive Care (Askim, Mohus, Solligard), St Olavs Hospital, Trondheim University Hospital; Mid-Norway Sepsis Research Group (Askim, Gustad, Paulsen, Mehl, Mohus, Damas, Solligard, Asvold), NTNU, Norwegian University of Science and Technology, Trondheim; Department of Medicine (Gustad, Mehl), Levanger Hospital, Nord-Trondelag Hospital Trust, Nord-Trondelag; Centre of Molecular Inflammation Research, Department of Cancer Research and Molecular Medicine, NTNU (Paulsen, Damas), Norwegian University of Science and Technology; Department of Mental Health, NTNU (Reitan), Norwegian University of Science and Technology; Department of Psychiatry (Reitan), St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Chronic Disease Epidemiology (Dewan), Yale University School of Public Health, New Haven, Connecticut; Department of Infectious Diseases (Damas), St Olavs Hospital, Trondheim University Hospital; Department of Public Health and Nursing, NTNU (Asvold), Norwegian University of Science and Technology; and Department of Endocrinologyn (Asvold), St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0033-3174 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:29923889 Approved no  
  Call Number HUNT @ maria.stuifbergen @ Serial 2070  
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Author (up) Askim, A.; Mehl, A.; Paulsen, J.; DeWan, A.T.; Vestrheim, D.F.; Asvold, B.O.; Damas, J.K.; Solligard, E.   
  Title Epidemiology and outcome of sepsis in adult patients with Streptococcus pneumoniae infection in a Norwegian county 1993-2011: an observational study Type Journal Article
  Year 2016 Publication BMC Infect Dis Abbreviated Journal BMC infectious diseases  
  Volume 16 Issue 1 Pages 223  
  Keywords  
  Abstract BACKGROUND: Invasive pneumococcal disease (IPD) is responsible for significant mortality and morbidity worldwide. There are however few longitudinal studies on the changes in case fatality rate of IPD in recent years. We carried out a prospective observational study of patients with IPD in Nord Trondelag county in Norway from 1993 to 2011 to study the clinical variables and disease outcome. The main outcome was all-cause mortality after 30 and 90 days. METHODS: Patients with positive blood cultures were registered prospectively by the microbiology laboratory and clinical variables were registered retrospectively from patients' hospital records. The severity of sepsis was assigned according to the 2001 International Sepsis Definition Conference criteria. The association between mortality and predictive factors was studied using a logistic regression model. RESULTS: The total number of patients was 414 with mean age of 67 years and 53 % were male. Comorbidity was assessed by the Charlson Comorbidity Index (CCI). A CCI-score of 0 was registered in 144 patients (34.8 %), whereas 190 had a score of 1-2 (45.9 %) and 80 (19.3 %) had a score >/=3. 68.8 % of the patients received appropriate antibiotics within the first 6 h. The 30-day mortality risk increased by age and was 3-fold higher for patients aged >/=80 years (24.9, 95 % CI 16.4-33.4 %) compared to patients aged  
  Address  
  Corporate Author Thesis  
  Publisher Place of Publication Clinic of Anaesthesia and Intensive Care, St Olav University Hospital, Trondheim, Norway. asa.askim@ Editor  
  Language Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN ISBN Medium  
  Area Expedition Conference  
  Notes Approved no  
  Call Number HUNT @ maria.stuifbergen @ Askim2016 Serial 1730  
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Author (up) Mohus, R.M.; Paulsen, J.; Gustad, L.; Askim, A.; Mehl, A.; DeWan, A.T.; Afset, J.E.; Asvold, B.O.; Solligard, E.; Damas, J.K. url  doi
  Title Association of iron status with the risk of bloodstream infections: results from the prospective population-based HUNT Study in Norway Type Journal Article
  Year 2018 Publication Intensive Care Medicine Abbreviated Journal Intensive Care Med  
  Volume 44 Issue 8 Pages 1276-1283  
  Keywords *Bacteraemia; *Epidemiology; *Iron; *Population based; *Sepsis  
  Abstract PURPOSE: As iron is essential for both immune function and microbial growth, alterations in iron status could influence the risk of infections. We assessed the associations of iron status with risk of bloodstream infections (BSIs) and BSI mortality. METHODS: We measured serum iron, transferrin saturation (Tsat) and total iron-binding capacity (TIBC) in 61,852 participants in the population-based HUNT2 study (1995-97). Incident BSIs (1995-2011) were identified through linkage with the Mid-Norway Sepsis Register, which includes prospectively registered information on BSI from local and regional hospitals. We assessed the risk of a first-time BSI and BSI mortality with the iron indices using Cox proportional hazards regression analysis. RESULTS: During a median follow-up of 14.8 years, 1738 individuals experienced at least one episode of BSI, and 370 died within 30 days after a BSI. In age- and sex-adjusted analyses, BSI risk was increased among participants with indices of iron deficiency, serum iron </= 2.5th percentile (HR 1.72, 95% CI 1.34-2.21), Tsat </= 2.5th percentile (HR 1.48, 95% CI 1.12-1.96) or TIBC >/= 97.5th percentile (HR 1.46, 95% CI 1.06-2.01). The associations remained similar after adjusting for comorbidities and exclusion of BSI related to cancer, rheumatic illnesses and inflammatory bowel disease. BSI mortality showed similar associations. CONCLUSION: Indices of severe iron deficiency are associated with an increased risk of a future BSI.  
  Address Department of Infectious Diseases, St. Olavs Hospital, 7006, Trondheim, Norway. jan.k.damas@ntnu.no  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0342-4642 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:30039264 Approved no  
  Call Number HUNT @ maria.stuifbergen @ Serial 2138  
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Author (up) Paulsen, J.; Askim, A.; Mohus, R.M.; Mehl, A.; Dewan, A.; Solligard, E.; Damas, J.K.; Asvold, B.O. url  doi
  Title Associations of obesity and lifestyle with the risk and mortality of bloodstream infection in a general population: a 15-year follow-up of 64 027 individuals in the HUNT Study Type Journal Article
  Year 2017 Publication International Journal of Epidemiology Abbreviated Journal Int J Epidemiol  
  Volume 46 Issue 5 Pages 1573-1581  
  Keywords Bacteraemia; alcohol drinking; exercise; obesity; sepsis; smoking  
  Abstract Background: Bloodstream infections (BSI) cause considerable morbidity and mortality, and primary prevention should be a priority. Lifestyle factors are of particular interest since they represent a modifiable target. Methods: We conducted a prospective cohort study among participants in the population-based Norwegian HUNT2 Survey, where 64 027 participants were followed from 1995-97 through 2011 by linkage to prospectively recorded information on BSI at local and regional hospitals. The exposures were: baseline body mass index (BMI) measurements; and self-reported smoking habits, leisure time physical activity and alcohol intake. The outcomes were hazard ratios (HR) of BSI and BSI mortality. Results: During 810 453 person-years and median follow-up of 14.8 years, 1844 (2.9%) participants experienced at least one BSI and 396 (0.62%) died from BSI. Compared with normal weight participants (BMI 18.5-24.9 kg/m2), the age- and sex-adjusted risk of a first-time BSI was 31% [95% confidence interval (CI) 14-51%] higher at BMI 30.0-34.9 kg/m2, 87% (95% CI 50-135%) higher at BMI 35.0-39.9 kg/m2 and 210% (95% CI 117-341%) higher at BMI >/= 40.0 kg/m2. The risk of BSI mortality was similarly increased. Compared with never-smokers, current smokers had 51% (95% CI 34-70%) and 75% (95% CI 34-129%) higher risks of BSI and BSI mortality, respectively. Physically inactive participants had 71% (95% CI 42-107%) and 108% (95% CI 37-216%) higher risks of BSI and BSI mortality, respectively, compared with the most physically active. Conclusions: Obesity, smoking and physical inactivity carry increased risk of BSI and BSI mortality.  
  Address Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0300-5771 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:28637260 Approved no  
  Call Number HUNT @ maria.stuifbergen @ Serial 1969  
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Author (up) Paulsen, J.; Mehl, A.; Askim, A.; Solligard, E.; Asvold, B.O.; Damas, J.K. url  doi
  Title Epidemiology and outcome of Staphylococcus aureus bloodstream infection and sepsis in a Norwegian county 1996-2011: an observational study Type Journal Article
  Year 2015 Publication BMC Infect Dis Abbreviated Journal BMC infectious diseases  
  Volume 15 Issue Pages 116  
  Keywords Aged; Female; Hospital Mortality; Humans; Incidence; Male; Middle Aged; Norway/epidemiology; Prospective Studies; Retrospective Studies; Sepsis/*epidemiology/mortality; Shock, Septic/microbiology; Staphylococcal Infections/*epidemiology/mortality; Staphylococcus aureus/*isolation & purification  
  Abstract BACKGROUND: Staphylococcus aureus is one of the most common and lethal causes of bloodstream infection and the incidence is increasing. We carried out a prospective observational study of patients with Staphylococcus aureus bloodstream infection and sepsis in Nord-Trondelag county in Norway from 1996-2011. The main outcome of interest was all-cause mortality within 30 and 90 days. METHODS: Positive blood cultures were registered prospectively by the microbiology laboratory and clinical variables were retrospectively registered from patients' hospital records. The severity of sepsis was assigned according to the 2001 International Sepsis Definition Conference criteria. The association between clinical characteristics and mortality was studied using logistic regression analysis, and adjusted 30- and 90-day mortality risks were estimated. RESULTS: Among 373 patients, the median age was 74 years and 60.3% were male. 0.8% of the patients were diagnosed with MRSA. 29.8% of the patients developed severe sepsis and 12.9% developed septic shock. The all-cause mortality was 14.5%, 27.3% and 36.2% at 7, 30 and 90 days, respectively. Compared to patients with sepsis without organ failure (Mortality risk 13.3%, 95% CI 7.5-16.3%), the 30-day mortality risk was 3-fold higher among those with severe sepsis (39.9%, 95% CI 29.5-48.5%) and more than 4-fold higher for those with septic shock (57.3%, 95% CI 42.5-72.2%). The 30-day all-cause mortality varied by focus of infection, with the highest 30-day mortality risk among those with a pulmonary focus (42.4%, 95% CI 26.0-58.5%) and unknown focus of infection (38.7%, 95% CI 27.5-48.2%). The mortality risk did not differ between the first and second halves of the study period with a 30-day mortality risk of 27.3%, (95% CI 18.1-33.1%) for 1996-2003 versus 27.4% (95% CI 19.4-31.4%) for 2004-2011. The same pattern was seen for 90-day mortality risk. CONCLUSION: Staphylococcus aureus bloodstream infection carries a high case fatality rate, especially among those with severe sepsis and septic shock and among those with a pulmonary or unknown focus of infection. There was no decrease in 30- or 90-day mortality risk during the study period. This underscores the importance of continuing surveillance and efforts to improve the outcome of this serious disease.  
  Address  
  Corporate Author Thesis  
  Publisher Place of Publication Centre of Molecular Inflammation Research, Department of Cancer Research and Molecular Medicine, Nor Editor  
  Language Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN ISBN Medium  
  Area Expedition Conference  
  Notes Paulsen, JulieMehl, ArneAskim, AsaSolligard, ErikAsvold, Bjorn OlavDamas, Jan KristianengMulticenter StudyResearch Support, Non-U.S. Gov'tEngland2015/04/19 06:00BMC Infect Dis. 2015 Mar 4;15:116. doi: 10.1186/s12879-015-0849-4. Approved no  
  Call Number HUNT @ maria.stuifbergen @ Paulsen2015 Serial 1852  
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