Arne Stray-Pedersen - Academia.edu (original) (raw)

Papers by Arne Stray-Pedersen

Research paper thumbnail of Injuries associated with mechanical chest compressions and active decompressions after out-of-hospital cardiac arrest: A subgroup analysis of non-survivors from a randomized study

Research paper thumbnail of Young adults in motor vehicle collisions in Norway: user safety errors observed in majority of cases with severe or fatal injuries

Forensic Science, Medicine and Pathology

Purpose We performed a multidisciplinary investigation of young adults involved in motor vehicle ... more Purpose We performed a multidisciplinary investigation of young adults involved in motor vehicle collisions (MVCs) to elucidate injury mechanisms and the role of passive safety equipment such as seat belts and airbags. Methods MVCs resulting in death or serious injuries to the driver or passengers aged 16–24 years in southeastern Norway during 2013–2016 were investigated upon informed consent. We assessed the crash scene, the motor vehicle (MV) interior and exterior, and analyzed data from medical records, forensic autopsies and reports from police and civil road authorities. Results This study included 229 young adult occupants involved in 212 MVCs. The Maximum Abbreviated Injury Scale (MAIS) score was ≥2 in 111 occupants, of which 22 were fatalities. In 59% (65/111) of the cases with MAIS score ≥2 injuries, safety errors and occupant protection inadequacies were considered to have contributed to the injury outcome. Common errors were seatbelt non-use and misuse, carrying insecure ...

Research paper thumbnail of 2. Cause of Death: SIDS

Rutgers University Press eBooks, Dec 31, 2019

Research paper thumbnail of Abstract 267: Injuries Associated With Mechanical Chest Compressions in Patients With Out-Of-Hospital Cardiac Arrest: A Comparison of LUCAS 2 and LUCAS 2 Active Decompression

Circulation, 2019

Background: Skeletal injuries (rib or sternum fractures) are common complications after cardiopul... more Background: Skeletal injuries (rib or sternum fractures) are common complications after cardiopulmonary resuscitation (CPR). Visceral injuries are also reported. During manual chest compressions, incidence of rib fractures is reported to be 13-97% and sternal fractures 1-43%. Studies on active compression decompression (AD) devices report incidence on rib fractures ranging from 4-87% and sternal fractures 0-93%. The aim of the present study is to describe and compare injury patterns caused by two mechanical, piston-based chest compression devices; LUCAS 2 and LUCAS 2AD in patients with out-of-hospital cardiac arrest. Method: In the randomized clinical trial comparing standard LUCAS 2 with LUCAS 2AD, patients who died were eligible for medical or forensic autopsy. The pathologists described injury pattern in each patient focusing on CPR-related injuries, but was blinded for the device used. We used Pearson X 2 test with an alpha level of 0.05 to evaluate our findings. Results: Of the...

Research paper thumbnail of A roadmap to the safe practice of forensic medicine in the COVID-19 pandemic

Journal of Forensic and Legal Medicine, 2020

The COVID-19 pandemic has forced forensic practitioners to consider how we perform our normal dut... more The COVID-19 pandemic has forced forensic practitioners to consider how we perform our normal duties, especially when those duties involve humans. The potential for contracting the virus from working in close contact with living sufferers is high, and we have yet to fully determine the risk of infection from the deceased. In an attempt to support the community, the Journal of Forensic & Legal Medicine has drawn together three articles which underline the importance of continued forensic medical practice during the pandemic and highlight some factors to consider in a Roadmap towards safe practice. Our Roadmap has intentionally taken an international perspective and supports other work we have published in the Journal on our collective response to the COVID-19 crisis.

Research paper thumbnail of Additional file 1: of Rubella sero-prevalence among children in Kilimanjaro region: a community based study prior to the introduction of rubella vaccine in Tanzania

Past and current Childhood immunization schedule in Tanzania. (DOCX 12 kb)

Research paper thumbnail of Re‐evaluation of abusive head trauma in Norway appears flawed

Acta Paediatrica, 2021

A review by Wester et al in Acta Paediatrica presented 17 adjudicated cases of Norwegian infants ... more A review by Wester et al in Acta Paediatrica presented 17 adjudicated cases of Norwegian infants with abusive head trauma (AHT).(1) Their interpretation of the medical findings identified alternative diagnoses for 16 of the 17 children and suggested that the injuries were not inflicted and may have been the result of spontaneously occurring events. The authors stated that eight children had clinical and radiological characteristics consistent with external hydrocephalus, complicated by chronic subdural haematoma, and that six had findings compatible with hypoxic-ischaemic insults. Fractures were attributed to prematurity and sequelae from birth trauma. If their interpretations are correct, this study calls for a thorough review of how the medical community, forensic experts and the courts manage AHT cases. However, there are several elements of concern in the Wester et al study that we believe need clarification before a conclusion can be reached.

Research paper thumbnail of Aquaporin-1 and aquaporin-9 gene variations in sudden infant death syndrome

International Journal of Legal Medicine, 2021

Several studies have indicated that a vulnerability in the development and regulation of brain fu... more Several studies have indicated that a vulnerability in the development and regulation of brain function is involved in sudden infant death syndrome (SIDS). The aim of this study was to investigate the genes encoding the brain aquaporins (AQPs) AQP1 and AQP9 in SIDS. The hypothesis was that specific variants of these genes are part of the genetic vulnerability predisposing infants to sudden unexpected death. The study included 168 SIDS cases with a median age of 15.5 (range 2–52) weeks and 372 adolescent/adult deceased controls with a median age of 44 (range 11–91) years. In the AQP1 gene, the rs17159702 CC/CT genotypes were found to be associated with SIDS (p = 0.02). In the AQP9 gene, the combination of a TT genotype of rs8042354, rs2292711 and rs13329178 was more frequent in SIDS cases than in controls (p = 0.03). In the SIDS group, an association was found between genetic variations in the AQP1 gene and maternal smoking and between the 3xTT combination in the AQP9 gene and being ...

Research paper thumbnail of Aquaporin 4 expression in the hippocampus in sudden infant death syndrome and sudden unexplained death in childhood

Journal of Chemical Neuroanatomy, 2021

Aquaporin 4 (AQP4) is the main membrane water channel in the brain involved in regulating water h... more Aquaporin 4 (AQP4) is the main membrane water channel in the brain involved in regulating water homeostasis. The water distribution in neural tissue is often dysregulated after hypoxic neural injury. Previous research has indicated that victims of sudden infant death syndrome (SIDS) and sudden unexplained death in childhood (SUDC) have an underlying brain dysfunction that impairs their critical arousal response to hypoxic stress during sleep. The aim of this study was to determine the expression levels of AQP4 in the hippocampus in SIDS/SUDC cases and controls, and compare the findings with AQP4 genotypes that previously have been shown to be associated with SIDS. Immunochemical staining and morphometry were used to evaluate the density of AQP4-positive astrocytes in 30 SIDS/SUDC cases and 26 controls. AQP4-positive cells were counted in grids covering three layers in the hippocampus, which revealed that their count in any of the layers did not differ significantly between cases and controls. A decline in AQP4 expression was observed for infants older than 12 weeks. The AQP4 expression was lower in infants and children with the rs2075575 CT/TT genotype than in those with the CC genotype. This study indicates that AQP4 expression may be influenced by both age and genotype in infants. The role of AQP4 in the pathogenesis of SIDS remains to be elucidated.

Research paper thumbnail of A Scandinavian Perspective

SIDS Sudden infant and early childhood death: The past, the present and the future, 2018

Research paper thumbnail of Samsoving og krybbedød

Tidsskrift for Den Norske Laegeforening, 2005

I første del av studien ble krybbedødsfall i en periode før kampanjen mot mageleie (1984-89) anal... more I første del av studien ble krybbedødsfall i en periode før kampanjen mot mageleie (1984-89) analysert i forhold til en tilsvarende periode (1998-2003) e er kampanjen. Dernest ble det gjort en pasient-kontroll-studie der variabler som samsoving, røyking og amming i den siste perioden ble studert opp mot 244 levende kontrollbarn.

Research paper thumbnail of Iterative reconstruction improves image quality and reduces radiation dose in trauma protocols; A human cadaver study

Acta Radiologica Open, 2021

Background Radiation-related cancer risk is an object of concern in CT of trauma patients, as the... more Background Radiation-related cancer risk is an object of concern in CT of trauma patients, as these represent a young population. Different radiation reducing methods, including iterative reconstruction (IR), and spilt bolus techniques have been introduced in the recent years in different large scale trauma centers. Purpose To compare image quality in human cadaver exposed to thoracoabdominal computed tomography using IR and standard filtered back-projection (FBP) at different dose levels. Material and methods Ten cadavers were scanned at full dose and a dose reduction in CTDIvol of 5 mGy (low dose 1) and 7.5 mGy (low dose 2) on a Siemens Definition Flash 128-slice computed tomography scanner. Low dose images were reconstructed with FBP and Sinogram affirmed iterative reconstruction (SAFIRE) level 2 and 4. Quantitative image quality was analyzed by comparison of contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). Qualitative image quality was evaluated by use of visual gr...

Research paper thumbnail of Autopsy findings in drivers and passengers from fatal motor vehicle collisions: limited differences in injury patterns and toxicological test results

Forensic Science, Medicine and Pathology, 2021

We performed a retrospective study of the injuries and characteristics of occupant fatalities in ... more We performed a retrospective study of the injuries and characteristics of occupant fatalities in motor vehicle collisions in southeast Norway. The goal was to provide updated knowledge of injuries sustained in modern vehicles and detect possible differences in injury pattern between drivers and passengers. Forensic autopsy reports, police, and collision investigation reports from 2000 to 2014 were studied, data extracted and analyzed.A total of 284 drivers, 80 front-seat passengers, and 37 rear-seat passengers were included, of which 67.3% died in front collisions, 13.7% in near-side impacts, 13.5% in rollovers and 5.5% in other/combined collisions. Overall, 80.5% died within one hour after the crash. The presence of fatal injuries to the head, neck, thorax and abdomen were observed in 63.6%, 10.7%, 61.6% and 27.4% respectively. All occupants with severe injuries to the head or neck had signs of direct impact with contact point injuries to the skin or skull. Injuries to the heart an...

Research paper thumbnail of Vaccine Induced Immune Thrombotic Thrombocytopenia Causing a Severe Form of Cerebral Venous Thrombosis With High Fatality Rate: A Case Series

Frontiers in Neurology, 2021

During a 2-week period, we have encountered five cases presenting with the combination of cerebra... more During a 2-week period, we have encountered five cases presenting with the combination of cerebral venous thrombosis (CVT), intracerebral hemorrhage and thrombocytopenia. A clinical hallmark was the rapid and severe progression of disease in spite of maximum treatment efforts, resulting in fatal outcome in for 4 out of 5 patients. All cases had received ChAdOx1 nCov-19 vaccine 1–2 weeks earlier and developed a characteristic syndrome thereafter. The rapid progressive clinical course and high fatality rate of CVT in combination with thrombocytopenia in such a cluster and in otherwise healthy adults is a recent phenomenon. Cerebral autopsy findings were those of venous hemorrhagic infarctions and thrombi in dural venous sinuses, including thrombus material apparently rich in thrombocytes, leukocytes and fibrin. Vessel walls were free of inflammation. Extra-cerebral manifestations included leech-like thrombi in large veins, fibrin clots in small venules and scattered hemorrhages on ski...

Research paper thumbnail of Amongst Norwegian paediatricians there is little agreement in management of cases of suspected child maltreatment

Acta Paediatrica, 2021

Child maltreatment is not unusual in our society but little is known about the medical management... more Child maltreatment is not unusual in our society but little is known about the medical management of cases in the Nordic countries. This study investigated physician knowledge and practice in cases of suspected physical and sexual abuse and neglect.

Research paper thumbnail of Violent Infant Surrogate Shaking: Continuous High-Magnitude Centripetal Force and Abrupt Shift in Tangential Acceleration May Explain High Risk of Subdural Hemorrhage

Neurotrauma Reports, 2021

Violent shaking is believed to be a common mechanism of injury in pediatric abusive head trauma. ... more Violent shaking is believed to be a common mechanism of injury in pediatric abusive head trauma. Typical intracranial injuries include subdural and retinal hemorrhages. Using a laboratory surrogate model we conducted experiments evaluating the head motion patterns that may occur in violent shaking. An anthropomorphic test device (ATD; Q0 dummy) matching an infant of 3.5 kg was assembled. The head interior was equipped with accelerometers enabling assessment of three-axial accelerations. Fifteen volunteers were asked to shake the surrogate vigorously holding a firm grip around the torso. We observed the volunteers performing manual shaking of the surrogate at a median duration of 15.5 sec (range 5-54 sec). Typical acceleration/deceleration patterns were produced after 2-3 shakes with a steady-state shaking motion at a pace of 4-6 cycles (back and forth) per second. Mean peak sagittal tangential accelerations at the vertex were 45.7g (range 14.2-105.1g). The acceleration component in the orthogonal direction, the radial acceleration, fluctuated around a negative mean of more than 4g showing that the surrogate head was continuously subjected to centripetal forces caused by rotations. This surrogate experiment showed that violent shaking may induce high peak tangential accelerations and concomitantly a continuous high-magnitude centripetal force. We hypothesize that the latter component may cause increased pressure in the subdural compartment in the cranial roof and may cause constant compression of the brain and possibly increased stretching or shearing of the bridging veins. This may contribute to the mechanism accountable for subdural hematoma in abusive head trauma.

Research paper thumbnail of Norwegian parents avoid placing infants in prone sleeping positions but frequently share beds in hazardous ways

Acta Paediatrica, 2021

The dramatic decline in the incidence of sudden infant death syndrome (SIDS) in the early 1990 s ... more The dramatic decline in the incidence of sudden infant death syndrome (SIDS) in the early 1990 s has primarily been attributed to back-to-sleep campaigns, which advised parents to avoid placing infants in the prone position. 1,2 In Norway, 142 infants died of SIDS in 1989, compared to an average of 7 deaths per year in the 10-year period between 2010 and 2020. 3 These numbers correspond to a drop in incidence from approximately 2.6 to 0.12 per 1000 live births. In addition to the prone position, a number of other factors in the child's sleeping environment have been shown to increase the risk of sudden death in infancy. Overly-soft mattresses, bumper pads and excessive bedding or clothing may lead to overheating. It may also lead to hypoxia, because the baby is rebreathing expired air, or entrapment, which mechanically restricts its airway passage. 4 Putting the baby to sleep in a defective or broken bed may cause

Research paper thumbnail of Serious motor vehicle collisions involving young drivers on Norwegian roads 2013–2016: Speeding and driver-related errors are the main challenge

Traffic Injury Prevention, 2020

Objective: Motor vehicle collisions (MVCs) are a leading cause of death and acute disability amon... more Objective: Motor vehicle collisions (MVCs) are a leading cause of death and acute disability among young adults worldwide. We performed a prospective study of young drivers involved in severe MVCs, investigating the critical events leading up to a collision with an emphasis on driver-related factors and collision culpability. Methods: A study was conducted in southeastern Norway of all drivers younger than 25 years who were involved in high-energy MVCs resulting in immediate hospitalization during 2013-2016. Collision investigators evaluated the exterior and interior of the motor vehicle (MV) within 24 h. Complementary information was obtained from interviews of collision victims, ambulance personnel and witnesses, from police reports, and medical records. Results: There were 145 young drivers included during a 3-year study period, representing an estimated incidence of 29 per 100,000 drivers with registered driving licenses. Ninety-two percent (133/145) were considered culpable of initiating the MVC, and only 2% of the critical factors preceding the collision were not related to the driver. There were 74% (108/145) males, the median MV age was 14 years, and 86% (125/145) of the MVs were passenger cars. The MVCs predominantly occurred on rural roads (90%, 130/145). Among the culpable drivers, speeding behavior was the main predisposing factor in 80% (106/133) of the collisions. Driving at excessive speed was associated with single-vehicle collisions (87%, 74/85) and the presence of passengers (89%, 56/63). Compared to nonculpable drivers, culpable drivers were more often younger than 21 years (66% vs 33%, p = 0.031), had obtained their license less than 2 years previously (68% vs 20%, p = 0.004), and were more likely to have been drinking or using drugs (27% vs 0%, p = 0.039). The overall rate of seatbelt use was 79% (114/145). Conclusion: The vast majority of injury-causing MVCs involving young drivers are initiated by those drivers. These incidents are characterized by male drivers with little driving experience who are operating old cars on rural roads at excessive speeds. Driving under the influence of alcohol or drugs is also not uncommon. These issues should be targeted in future preventive measures.

Research paper thumbnail of Socio-Demographic Determinants of Road Traffic Fatalities in Women of Reproductive Age in the Republic of Georgia: Evidence from the National Reproductive Age Mortality Study (2014)

International Journal of Women's Health, 2020

Purpose: Globally and in the European region, the road traffic injuries (RTI) have emerged as a m... more Purpose: Globally and in the European region, the road traffic injuries (RTI) have emerged as a major public health and development problem, killing the most productive adult members of a population, including women. This study aimed to identify the key sociodemographic determinants of premature and avoidable RTI mortality in reproductive-aged women (15-49 years) in Georgia. Materials and Methods: The study employed verbal autopsy data from the second national reproductive age mortality survey (RAMOS 2014). Univariate and multivariate logistic regression models were fitted using the Firth method to assess the crude and adjusted effects of each individual level socio-demographic factor on the odds of RTI-attributed death, with corresponding 95% confidence intervals (COR and AOR, 95% CI). Results: Of 843 women aged 15-49 years, 78 (9.3%) were the victims of fatal traffic crashes. After multivariate adjustment, the odds of dying from RTI were significantly higher in women aged 15-29 years (AOR=7.73, 95% CI= 4.20 to 14.20), those being employed (AOR=2.11, 95% CI= 1.22 to 3.64) and the wealthiest (AOR=2.88, 95% CI= 1.44 to 5.77) compared, respectively, to their oldest (40-49 years), unemployed and poorest counterparts. Conversely, there were no statistically significant ethnic, marital, rural/urban, and educational disparities in women's RTI fatalities. Overall, motorized four-wheeler occupants (78.2%), particularly passengers (71.8%), appeared to be the most common victims of fatal road injuries than pedestrians (20.5%). Alarmingly, the vast majority (85.9%) of any type of road users died instantly at the scene of collision, as compared to deaths en route to hospital (1.3%) or in hospital (11.5%). Conclusion: Age, employment, and wealth status appeared to be the strong independent predictors of young women's RTI mortality in Georgia. Future comprehensive research would be advantageous for further deciphering the differential impact of social determinants on traffic-induced fatalities, as a vital platform for evidence-based remedial actions on this predictable and preventable safety hazard.

Research paper thumbnail of Mother’s Knowledge on HIV, Syphilis, Rubella, and Associated Factors in Northern Tanzania: Implications for MTCT Elimination Strategies

International Journal of Pediatrics, 2020

Background. Infections transmitted from mother to child (MTCT) during pregnancy, childbirth, and ... more Background. Infections transmitted from mother to child (MTCT) during pregnancy, childbirth, and breastfeeding contribute significantly to the high infant and childhood morbidity and mortality in sub-Saharan African countries. The most significant and preventable of these include HIV, syphilis, and rubella. To achieve elimination, mothers need to be aware of and to understand effective preventive measures against these infections. Lack of comprehensive knowledge on transmission and prevention of MTCT infections is one of the factors hindering achievement of the elimination goals for these infections. The aim of this study was to assess the knowledge of HIV, syphilis, rubella, and associated factors among mothers in the Kilimanjaro region of Tanzania. Methods. We conducted a community-based cross-sectional study in three districts of the Kilimanjaro region from September to October 2016. The study involved mothers with children up to five years of age. Data collection involved the us...

Research paper thumbnail of Injuries associated with mechanical chest compressions and active decompressions after out-of-hospital cardiac arrest: A subgroup analysis of non-survivors from a randomized study

Research paper thumbnail of Young adults in motor vehicle collisions in Norway: user safety errors observed in majority of cases with severe or fatal injuries

Forensic Science, Medicine and Pathology

Purpose We performed a multidisciplinary investigation of young adults involved in motor vehicle ... more Purpose We performed a multidisciplinary investigation of young adults involved in motor vehicle collisions (MVCs) to elucidate injury mechanisms and the role of passive safety equipment such as seat belts and airbags. Methods MVCs resulting in death or serious injuries to the driver or passengers aged 16–24 years in southeastern Norway during 2013–2016 were investigated upon informed consent. We assessed the crash scene, the motor vehicle (MV) interior and exterior, and analyzed data from medical records, forensic autopsies and reports from police and civil road authorities. Results This study included 229 young adult occupants involved in 212 MVCs. The Maximum Abbreviated Injury Scale (MAIS) score was ≥2 in 111 occupants, of which 22 were fatalities. In 59% (65/111) of the cases with MAIS score ≥2 injuries, safety errors and occupant protection inadequacies were considered to have contributed to the injury outcome. Common errors were seatbelt non-use and misuse, carrying insecure ...

Research paper thumbnail of 2. Cause of Death: SIDS

Rutgers University Press eBooks, Dec 31, 2019

Research paper thumbnail of Abstract 267: Injuries Associated With Mechanical Chest Compressions in Patients With Out-Of-Hospital Cardiac Arrest: A Comparison of LUCAS 2 and LUCAS 2 Active Decompression

Circulation, 2019

Background: Skeletal injuries (rib or sternum fractures) are common complications after cardiopul... more Background: Skeletal injuries (rib or sternum fractures) are common complications after cardiopulmonary resuscitation (CPR). Visceral injuries are also reported. During manual chest compressions, incidence of rib fractures is reported to be 13-97% and sternal fractures 1-43%. Studies on active compression decompression (AD) devices report incidence on rib fractures ranging from 4-87% and sternal fractures 0-93%. The aim of the present study is to describe and compare injury patterns caused by two mechanical, piston-based chest compression devices; LUCAS 2 and LUCAS 2AD in patients with out-of-hospital cardiac arrest. Method: In the randomized clinical trial comparing standard LUCAS 2 with LUCAS 2AD, patients who died were eligible for medical or forensic autopsy. The pathologists described injury pattern in each patient focusing on CPR-related injuries, but was blinded for the device used. We used Pearson X 2 test with an alpha level of 0.05 to evaluate our findings. Results: Of the...

Research paper thumbnail of A roadmap to the safe practice of forensic medicine in the COVID-19 pandemic

Journal of Forensic and Legal Medicine, 2020

The COVID-19 pandemic has forced forensic practitioners to consider how we perform our normal dut... more The COVID-19 pandemic has forced forensic practitioners to consider how we perform our normal duties, especially when those duties involve humans. The potential for contracting the virus from working in close contact with living sufferers is high, and we have yet to fully determine the risk of infection from the deceased. In an attempt to support the community, the Journal of Forensic & Legal Medicine has drawn together three articles which underline the importance of continued forensic medical practice during the pandemic and highlight some factors to consider in a Roadmap towards safe practice. Our Roadmap has intentionally taken an international perspective and supports other work we have published in the Journal on our collective response to the COVID-19 crisis.

Research paper thumbnail of Additional file 1: of Rubella sero-prevalence among children in Kilimanjaro region: a community based study prior to the introduction of rubella vaccine in Tanzania

Past and current Childhood immunization schedule in Tanzania. (DOCX 12 kb)

Research paper thumbnail of Re‐evaluation of abusive head trauma in Norway appears flawed

Acta Paediatrica, 2021

A review by Wester et al in Acta Paediatrica presented 17 adjudicated cases of Norwegian infants ... more A review by Wester et al in Acta Paediatrica presented 17 adjudicated cases of Norwegian infants with abusive head trauma (AHT).(1) Their interpretation of the medical findings identified alternative diagnoses for 16 of the 17 children and suggested that the injuries were not inflicted and may have been the result of spontaneously occurring events. The authors stated that eight children had clinical and radiological characteristics consistent with external hydrocephalus, complicated by chronic subdural haematoma, and that six had findings compatible with hypoxic-ischaemic insults. Fractures were attributed to prematurity and sequelae from birth trauma. If their interpretations are correct, this study calls for a thorough review of how the medical community, forensic experts and the courts manage AHT cases. However, there are several elements of concern in the Wester et al study that we believe need clarification before a conclusion can be reached.

Research paper thumbnail of Aquaporin-1 and aquaporin-9 gene variations in sudden infant death syndrome

International Journal of Legal Medicine, 2021

Several studies have indicated that a vulnerability in the development and regulation of brain fu... more Several studies have indicated that a vulnerability in the development and regulation of brain function is involved in sudden infant death syndrome (SIDS). The aim of this study was to investigate the genes encoding the brain aquaporins (AQPs) AQP1 and AQP9 in SIDS. The hypothesis was that specific variants of these genes are part of the genetic vulnerability predisposing infants to sudden unexpected death. The study included 168 SIDS cases with a median age of 15.5 (range 2–52) weeks and 372 adolescent/adult deceased controls with a median age of 44 (range 11–91) years. In the AQP1 gene, the rs17159702 CC/CT genotypes were found to be associated with SIDS (p = 0.02). In the AQP9 gene, the combination of a TT genotype of rs8042354, rs2292711 and rs13329178 was more frequent in SIDS cases than in controls (p = 0.03). In the SIDS group, an association was found between genetic variations in the AQP1 gene and maternal smoking and between the 3xTT combination in the AQP9 gene and being ...

Research paper thumbnail of Aquaporin 4 expression in the hippocampus in sudden infant death syndrome and sudden unexplained death in childhood

Journal of Chemical Neuroanatomy, 2021

Aquaporin 4 (AQP4) is the main membrane water channel in the brain involved in regulating water h... more Aquaporin 4 (AQP4) is the main membrane water channel in the brain involved in regulating water homeostasis. The water distribution in neural tissue is often dysregulated after hypoxic neural injury. Previous research has indicated that victims of sudden infant death syndrome (SIDS) and sudden unexplained death in childhood (SUDC) have an underlying brain dysfunction that impairs their critical arousal response to hypoxic stress during sleep. The aim of this study was to determine the expression levels of AQP4 in the hippocampus in SIDS/SUDC cases and controls, and compare the findings with AQP4 genotypes that previously have been shown to be associated with SIDS. Immunochemical staining and morphometry were used to evaluate the density of AQP4-positive astrocytes in 30 SIDS/SUDC cases and 26 controls. AQP4-positive cells were counted in grids covering three layers in the hippocampus, which revealed that their count in any of the layers did not differ significantly between cases and controls. A decline in AQP4 expression was observed for infants older than 12 weeks. The AQP4 expression was lower in infants and children with the rs2075575 CT/TT genotype than in those with the CC genotype. This study indicates that AQP4 expression may be influenced by both age and genotype in infants. The role of AQP4 in the pathogenesis of SIDS remains to be elucidated.

Research paper thumbnail of A Scandinavian Perspective

SIDS Sudden infant and early childhood death: The past, the present and the future, 2018

Research paper thumbnail of Samsoving og krybbedød

Tidsskrift for Den Norske Laegeforening, 2005

I første del av studien ble krybbedødsfall i en periode før kampanjen mot mageleie (1984-89) anal... more I første del av studien ble krybbedødsfall i en periode før kampanjen mot mageleie (1984-89) analysert i forhold til en tilsvarende periode (1998-2003) e er kampanjen. Dernest ble det gjort en pasient-kontroll-studie der variabler som samsoving, røyking og amming i den siste perioden ble studert opp mot 244 levende kontrollbarn.

Research paper thumbnail of Iterative reconstruction improves image quality and reduces radiation dose in trauma protocols; A human cadaver study

Acta Radiologica Open, 2021

Background Radiation-related cancer risk is an object of concern in CT of trauma patients, as the... more Background Radiation-related cancer risk is an object of concern in CT of trauma patients, as these represent a young population. Different radiation reducing methods, including iterative reconstruction (IR), and spilt bolus techniques have been introduced in the recent years in different large scale trauma centers. Purpose To compare image quality in human cadaver exposed to thoracoabdominal computed tomography using IR and standard filtered back-projection (FBP) at different dose levels. Material and methods Ten cadavers were scanned at full dose and a dose reduction in CTDIvol of 5 mGy (low dose 1) and 7.5 mGy (low dose 2) on a Siemens Definition Flash 128-slice computed tomography scanner. Low dose images were reconstructed with FBP and Sinogram affirmed iterative reconstruction (SAFIRE) level 2 and 4. Quantitative image quality was analyzed by comparison of contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). Qualitative image quality was evaluated by use of visual gr...

Research paper thumbnail of Autopsy findings in drivers and passengers from fatal motor vehicle collisions: limited differences in injury patterns and toxicological test results

Forensic Science, Medicine and Pathology, 2021

We performed a retrospective study of the injuries and characteristics of occupant fatalities in ... more We performed a retrospective study of the injuries and characteristics of occupant fatalities in motor vehicle collisions in southeast Norway. The goal was to provide updated knowledge of injuries sustained in modern vehicles and detect possible differences in injury pattern between drivers and passengers. Forensic autopsy reports, police, and collision investigation reports from 2000 to 2014 were studied, data extracted and analyzed.A total of 284 drivers, 80 front-seat passengers, and 37 rear-seat passengers were included, of which 67.3% died in front collisions, 13.7% in near-side impacts, 13.5% in rollovers and 5.5% in other/combined collisions. Overall, 80.5% died within one hour after the crash. The presence of fatal injuries to the head, neck, thorax and abdomen were observed in 63.6%, 10.7%, 61.6% and 27.4% respectively. All occupants with severe injuries to the head or neck had signs of direct impact with contact point injuries to the skin or skull. Injuries to the heart an...

Research paper thumbnail of Vaccine Induced Immune Thrombotic Thrombocytopenia Causing a Severe Form of Cerebral Venous Thrombosis With High Fatality Rate: A Case Series

Frontiers in Neurology, 2021

During a 2-week period, we have encountered five cases presenting with the combination of cerebra... more During a 2-week period, we have encountered five cases presenting with the combination of cerebral venous thrombosis (CVT), intracerebral hemorrhage and thrombocytopenia. A clinical hallmark was the rapid and severe progression of disease in spite of maximum treatment efforts, resulting in fatal outcome in for 4 out of 5 patients. All cases had received ChAdOx1 nCov-19 vaccine 1–2 weeks earlier and developed a characteristic syndrome thereafter. The rapid progressive clinical course and high fatality rate of CVT in combination with thrombocytopenia in such a cluster and in otherwise healthy adults is a recent phenomenon. Cerebral autopsy findings were those of venous hemorrhagic infarctions and thrombi in dural venous sinuses, including thrombus material apparently rich in thrombocytes, leukocytes and fibrin. Vessel walls were free of inflammation. Extra-cerebral manifestations included leech-like thrombi in large veins, fibrin clots in small venules and scattered hemorrhages on ski...

Research paper thumbnail of Amongst Norwegian paediatricians there is little agreement in management of cases of suspected child maltreatment

Acta Paediatrica, 2021

Child maltreatment is not unusual in our society but little is known about the medical management... more Child maltreatment is not unusual in our society but little is known about the medical management of cases in the Nordic countries. This study investigated physician knowledge and practice in cases of suspected physical and sexual abuse and neglect.

Research paper thumbnail of Violent Infant Surrogate Shaking: Continuous High-Magnitude Centripetal Force and Abrupt Shift in Tangential Acceleration May Explain High Risk of Subdural Hemorrhage

Neurotrauma Reports, 2021

Violent shaking is believed to be a common mechanism of injury in pediatric abusive head trauma. ... more Violent shaking is believed to be a common mechanism of injury in pediatric abusive head trauma. Typical intracranial injuries include subdural and retinal hemorrhages. Using a laboratory surrogate model we conducted experiments evaluating the head motion patterns that may occur in violent shaking. An anthropomorphic test device (ATD; Q0 dummy) matching an infant of 3.5 kg was assembled. The head interior was equipped with accelerometers enabling assessment of three-axial accelerations. Fifteen volunteers were asked to shake the surrogate vigorously holding a firm grip around the torso. We observed the volunteers performing manual shaking of the surrogate at a median duration of 15.5 sec (range 5-54 sec). Typical acceleration/deceleration patterns were produced after 2-3 shakes with a steady-state shaking motion at a pace of 4-6 cycles (back and forth) per second. Mean peak sagittal tangential accelerations at the vertex were 45.7g (range 14.2-105.1g). The acceleration component in the orthogonal direction, the radial acceleration, fluctuated around a negative mean of more than 4g showing that the surrogate head was continuously subjected to centripetal forces caused by rotations. This surrogate experiment showed that violent shaking may induce high peak tangential accelerations and concomitantly a continuous high-magnitude centripetal force. We hypothesize that the latter component may cause increased pressure in the subdural compartment in the cranial roof and may cause constant compression of the brain and possibly increased stretching or shearing of the bridging veins. This may contribute to the mechanism accountable for subdural hematoma in abusive head trauma.

Research paper thumbnail of Norwegian parents avoid placing infants in prone sleeping positions but frequently share beds in hazardous ways

Acta Paediatrica, 2021

The dramatic decline in the incidence of sudden infant death syndrome (SIDS) in the early 1990 s ... more The dramatic decline in the incidence of sudden infant death syndrome (SIDS) in the early 1990 s has primarily been attributed to back-to-sleep campaigns, which advised parents to avoid placing infants in the prone position. 1,2 In Norway, 142 infants died of SIDS in 1989, compared to an average of 7 deaths per year in the 10-year period between 2010 and 2020. 3 These numbers correspond to a drop in incidence from approximately 2.6 to 0.12 per 1000 live births. In addition to the prone position, a number of other factors in the child's sleeping environment have been shown to increase the risk of sudden death in infancy. Overly-soft mattresses, bumper pads and excessive bedding or clothing may lead to overheating. It may also lead to hypoxia, because the baby is rebreathing expired air, or entrapment, which mechanically restricts its airway passage. 4 Putting the baby to sleep in a defective or broken bed may cause

Research paper thumbnail of Serious motor vehicle collisions involving young drivers on Norwegian roads 2013–2016: Speeding and driver-related errors are the main challenge

Traffic Injury Prevention, 2020

Objective: Motor vehicle collisions (MVCs) are a leading cause of death and acute disability amon... more Objective: Motor vehicle collisions (MVCs) are a leading cause of death and acute disability among young adults worldwide. We performed a prospective study of young drivers involved in severe MVCs, investigating the critical events leading up to a collision with an emphasis on driver-related factors and collision culpability. Methods: A study was conducted in southeastern Norway of all drivers younger than 25 years who were involved in high-energy MVCs resulting in immediate hospitalization during 2013-2016. Collision investigators evaluated the exterior and interior of the motor vehicle (MV) within 24 h. Complementary information was obtained from interviews of collision victims, ambulance personnel and witnesses, from police reports, and medical records. Results: There were 145 young drivers included during a 3-year study period, representing an estimated incidence of 29 per 100,000 drivers with registered driving licenses. Ninety-two percent (133/145) were considered culpable of initiating the MVC, and only 2% of the critical factors preceding the collision were not related to the driver. There were 74% (108/145) males, the median MV age was 14 years, and 86% (125/145) of the MVs were passenger cars. The MVCs predominantly occurred on rural roads (90%, 130/145). Among the culpable drivers, speeding behavior was the main predisposing factor in 80% (106/133) of the collisions. Driving at excessive speed was associated with single-vehicle collisions (87%, 74/85) and the presence of passengers (89%, 56/63). Compared to nonculpable drivers, culpable drivers were more often younger than 21 years (66% vs 33%, p = 0.031), had obtained their license less than 2 years previously (68% vs 20%, p = 0.004), and were more likely to have been drinking or using drugs (27% vs 0%, p = 0.039). The overall rate of seatbelt use was 79% (114/145). Conclusion: The vast majority of injury-causing MVCs involving young drivers are initiated by those drivers. These incidents are characterized by male drivers with little driving experience who are operating old cars on rural roads at excessive speeds. Driving under the influence of alcohol or drugs is also not uncommon. These issues should be targeted in future preventive measures.

Research paper thumbnail of Socio-Demographic Determinants of Road Traffic Fatalities in Women of Reproductive Age in the Republic of Georgia: Evidence from the National Reproductive Age Mortality Study (2014)

International Journal of Women's Health, 2020

Purpose: Globally and in the European region, the road traffic injuries (RTI) have emerged as a m... more Purpose: Globally and in the European region, the road traffic injuries (RTI) have emerged as a major public health and development problem, killing the most productive adult members of a population, including women. This study aimed to identify the key sociodemographic determinants of premature and avoidable RTI mortality in reproductive-aged women (15-49 years) in Georgia. Materials and Methods: The study employed verbal autopsy data from the second national reproductive age mortality survey (RAMOS 2014). Univariate and multivariate logistic regression models were fitted using the Firth method to assess the crude and adjusted effects of each individual level socio-demographic factor on the odds of RTI-attributed death, with corresponding 95% confidence intervals (COR and AOR, 95% CI). Results: Of 843 women aged 15-49 years, 78 (9.3%) were the victims of fatal traffic crashes. After multivariate adjustment, the odds of dying from RTI were significantly higher in women aged 15-29 years (AOR=7.73, 95% CI= 4.20 to 14.20), those being employed (AOR=2.11, 95% CI= 1.22 to 3.64) and the wealthiest (AOR=2.88, 95% CI= 1.44 to 5.77) compared, respectively, to their oldest (40-49 years), unemployed and poorest counterparts. Conversely, there were no statistically significant ethnic, marital, rural/urban, and educational disparities in women's RTI fatalities. Overall, motorized four-wheeler occupants (78.2%), particularly passengers (71.8%), appeared to be the most common victims of fatal road injuries than pedestrians (20.5%). Alarmingly, the vast majority (85.9%) of any type of road users died instantly at the scene of collision, as compared to deaths en route to hospital (1.3%) or in hospital (11.5%). Conclusion: Age, employment, and wealth status appeared to be the strong independent predictors of young women's RTI mortality in Georgia. Future comprehensive research would be advantageous for further deciphering the differential impact of social determinants on traffic-induced fatalities, as a vital platform for evidence-based remedial actions on this predictable and preventable safety hazard.

Research paper thumbnail of Mother’s Knowledge on HIV, Syphilis, Rubella, and Associated Factors in Northern Tanzania: Implications for MTCT Elimination Strategies

International Journal of Pediatrics, 2020

Background. Infections transmitted from mother to child (MTCT) during pregnancy, childbirth, and ... more Background. Infections transmitted from mother to child (MTCT) during pregnancy, childbirth, and breastfeeding contribute significantly to the high infant and childhood morbidity and mortality in sub-Saharan African countries. The most significant and preventable of these include HIV, syphilis, and rubella. To achieve elimination, mothers need to be aware of and to understand effective preventive measures against these infections. Lack of comprehensive knowledge on transmission and prevention of MTCT infections is one of the factors hindering achievement of the elimination goals for these infections. The aim of this study was to assess the knowledge of HIV, syphilis, rubella, and associated factors among mothers in the Kilimanjaro region of Tanzania. Methods. We conducted a community-based cross-sectional study in three districts of the Kilimanjaro region from September to October 2016. The study involved mothers with children up to five years of age. Data collection involved the us...