Ivar Aursnes's research while affiliated with University of Oslo and other places
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Publications (53)
Background:
In Norway, total sales of benzodiazepines and Z drugs (zopiclone and zolpidem) have increased since the mid-1990s. On the basis of data from the Norwegian Prescription Database, we have studied the choice of medications and patterns of use in various gender and age groups.
Material and method:
Numbers for redemptions of benzodiazepin...
The objective of the study was to examine the efficacy and the degree of adverse effects connected with atypical neuroleptic drugs and haloperidol by using a previously described Bayesian statistical method that includes both direct and indirect comparisons simultaneously.
The authors used the results of 30 double-blind, randomized studies includin...
It is unknown to which degree the effect of antidepressant drugs are related to baseline degree of depression, dose level, patient's age, or type of questionnaire used. We explored this for paroxetine.
We used placebo-controlled published and unpublished randomized, double-blind, clinical trials of paroxetine that included moderate to severely depr...
Purpose: Atypical neuroleptics, especially clozapine, are clinically more efficacious than the typical neuroleptic haloperidol. We examined the possibility of a further ranking in efficacy of the atypical drugs by using a previously described Bayesian statistical method that included both direct and indirect comparisons simultaneously.
Method: We...
Objective: Pioglitazone lowers triglycerides and is indifferent towards low-density lipoproteins (LDL), while rosiglitazone has no effect on triglycerides and increases LDL. Our purpose was to test the hypothesis that the risk of acute myocardial infarction (AMI) in thiazolidinediones differs. Methods: We followed a cohort from the Norwegian Prescr...
We wanted to determine to what extent adverse drug effects associated with a selective serotonin reuptake inhibitor (SSRI) were known but not assessed before application for registration of paroxetine.
With a special permit from the Norwegian Ministry of Health, we obtained reports from 82 clinical trials presented by the paroxetine license holder...
A recent meta-analysis of drug effects in patients with hypertension claims that all beta-adrenergic blockers are equally effective but less so than other antihypertensive drugs. Published comparisons of the beta-adrenergic blocker atenolol and non-atenolol beta-adrenergic blockers indicate different effects on death rates, arrhythmias, peripheral...
In Malawi essential drugs are provided free of charge to patients at all public health facilities in order to ensure equitable access to health care. The country thereby spends about 30% of the national health budget on drugs. In order to investigate the level of drug shortages and eventually find the reasons for the drugs shortages in Malawi, we s...
The aim of the study was to investigate women's attitudes towards hormone treatment (HT), their judgment of the various sources of information, and their knowledge of indications for HT.
We posted questionnaires to 1000 Norwegian women between 45 and 60 years of age, randomly selected from the National Register. We received replies from 386 women (...
Following our previous publication we have received critical comments to our conclusions as well as new data that are strengthening our findings.
With the new data, 11 suicide attempts among patients on paroxetine against 1 among patients on placebo, we found with a Bayesian technique that the posterior probability that medication with paroxetine i...
Inclusion of unpublished data on the effects of antidepressants on children has suggested unfavourable risk-benefit profiles for some of the drugs. Recent meta-analyses of studies on adults have indicated similar effects. We obtained unpublished data for paroxetine that have so far not been included in these analyses.
The documentation for drug reg...
Several clinical studies have documented that intake of fish may reduce mortality from coronary heart disease, and two epidemiological investigations have shown a 50% reduction in the incidence of sudden death and of "primary cardiac arrest" in subjects eating fish. However, in some studies no beneficial effects of fish intake on coronary heart dis...
To investigate to what extent and by what methods clinicians assess left ventricular (LV) function after an acute myocardial infarction (AMI) and how the results of the assessments relate to the use of angiotensin-converting enzyme (ACE) inhibitors; furthermore, to explore which main indications caused the clinicians to initiate ACE inhibitor thera...
According to published data, the ability to prevent various hypertension-related events differs between the various antihypertensive drug groups. Although absolute drug effects differ among studies, relative drug effects could be considered constant. We therefore explored the possibility of drawing statistically valid conclusions about the differen...
Several studies, which have compared the efficacy of conventional antihypertensive drugs (thiazide diuretics and beta-blockers) with the newer agents [calcium blockers and angiotensin-converting enzyme (ACE) inhibitors], have shown that they are almost equally efficacious with regard to effects on blood pressure, and in preventing cardiovascular mo...
To investigate the prescription pattern for cardiovascular drugs among patients discharged after an acute myocardial infarction (AMI) in hospitals that had participated in a corresponding study seven years earlier, and examine what the indications were for use of the different drugs.
From 16 hospitals we drew a sample of patients who were discharge...
Bayesian statistical analysis is a paradigm quite different from traditional statistical inference. We wanted to show the usefulness of this approach for some medical problems.
We started with Bayes equation as it is used for estimating the probability of illness based on a specific laboratory test. We also looked into a recent Cochrane report on m...
Angiotensin-converting enzyme is probably involved in the pathogenesis and progression of atherosclerosis, both through an increase in vascular angiotensin II and by an effect on the degradation of bradykinin into inactive fragments. Moreover, angiotensin II has a prothrombotic effect and prevails in increased concentration in the blood of animals...
Objective: To investigate whether patients who are using angiotensin converting enzyme (ACE) inhibitors at the onset of infarction develop smaller infarcts, as assessed by peak enzyme levels, and to what extent this is associated with more non-Q-wave infarcts.
Design and Setting: Observational study set in coronary care units in Norway.
Patients: 7...
Of 350 consecutive patients without previous symptoms of coronary artery disease, admitted to hospital with an acute myocardial infarction, 109 of them (31%) reported a history of previous hypertension. Hypertensive patients were older than their normotensive counterparts, more of them were females, and thrombolytic treatment was administered to si...
The objective of this study was to investigate how the introduction of thrombolytics and aspirin has affected hospital mortality (case fatality) among patients with acute myocardial infarction. The study design was the application of the therapeutic effects found in the clinical trials in a nonselected myocardial infarction population characterized...
The article presents information gained from a survey among Norwegian hospitals in March 1997 concerning their treatment of infections with Helicobacter pylori. Altogether 52 hospitals answered the questionnaire. A combination of proton pump inhibitors, metronidazole and clarithromycin was used by 59% as first choice and urea quick test (94%) and u...
We investigated whether prior use of calcium antagonists in 80 (16.8%) out of 477 patients (64% males) admitted with acute myocardial infarction (MI) had any impact on in-hospital mortality. Patients using calcium antagonists were slightly older (74 years vs. 72 years, 2P = 0.039) than those not taking them and fewer were male patients. Previous MI...
The objective of the analysis was to establish the cost-effectiveness of five years intervention with alendronate in women aged 65 years with a bone mineral density (BMD) of the femoral neck 2.5 SD below peak bone mass. A cost-utility analysis based on a simulation model was used. The risk of future fractures was estimated on the basis of clinical...
The use of angiotensin-converting enzyme (ACE) inhibitors early after an acute myocardial infarction to reduce mortality has been studied in several trials with inconsistent results. Aspirin (ASA) has become a well-documented therapeutic adjunct in patients with coronary heart disease. Attention has recently been focused on a possible interaction b...
In 1994 the calcium antagonists were the most widely used group of drugs for treating heart disease in Norway - amlodipine being the market leader. However, meta-analyses of clinical trials indicate that calcium antagonists do not prolong patient survival - with the possible exception of verapamil and diltiazem, both of which have a tendency to red...
Four studies of the cost per life year saved through lipid lowering with lovastatin or simvastatin showed considerable variation in the results. For example, the cost per life year saved on administration of simvastatin 20 mg/day for primary prevention in men 42 years old at the start of therapy and with an initial cholesterol level of 8 mmol/L, wa...
We examined the relation between various drugs used for treating high blood pressure and the incidence of acute myocardial infarction with a case-control design. Four hospitals taking care of all patients in Oslo with acute myocardial infarction participated with a total of 95 hypertensive men and women under 75 years of age who had had an acute my...
Several drugs have been investigated regarding their effect on mortality when given early after an acute myocardial infarction. The use of angiotensinconverting enzyme (ACE) inhibitors has been studied in several trials with inconsistent results. Aspirin (ASA) has become a well documented therapeutic adjunct in patients with coronary heart disease....
A diet rich in fish tends to increase the bleeding time both in patients and healthy controls. Another effect of such a diet is a reduction in serum triglyceride levels in the individuals. It is not known whether these two effects are interrelated. In order to rule out effects of selenium in the fish diet, half of a control group consumed bread enr...
The value of the exercise test has been challenged in connection with assessments of the effects of drugs on angina. Therefore, a series of test variables were correlated with clinical improvement in 30 patients with effort-related angina and coronary stenoses proved by angiography. The patients had two bicycle tests with an interval of 1 year. The...
Drug treatment of hyperlipidaemia should be founded on scientific evidence. A hearing was arranged to arrive at practical measures based on reported clinical trials. Several studies during recent years have shown regression of coronary atheromatosis, and some people would say the effect is striking. Studies using clinical endpoints, like morbidity...
The effect of intravenous infusion of adenosine diphosphate (ADP) on haemostatic and thrombotic mechanisms was studied in rats and rabbits. Infusion of ADP (0.2-1 microMol/kg/min) in rabbits prolonged the skin capillary bleeding time threefold after between 1/2 and 2 hours of infusion. Prolongation of the bleeding time was parallelled by reduced in...
Today it is considered a primary goal to reduce morbidity and mortality from stroke. It will probably also be possible to reduce other pressure-related illnesses, such as heart failure and renal failure. Coronary morbidity is influenced to some extent only, and involves risk of over-treatment. There is most probably a J-shaped relationship between...
In order to exemplify the use of effect measures and confidence intervals in epidemiology, it is assumed that a group of patients treated with antiflogistic drugs were compared by repeated gastroscopy with a control group. The effect measures "incidence rate difference" and "incidence rate ratio" are used to compare ulcer incidence in the two group...
The ability of exercise testing to predict the extent of coronary artery disease was examined in 268 male patients undergoing both coronary angiography and bicycle testing with electrocardiography before coronary artery bypass surgery. When maximal ST-depressions limited by symptoms increased from 0 to 4 mm or more, the percentage of patients with...
Acute coronary syndrome is defined as unstable angina or acute myocardial infarction. A discussion on drug treatment of these conditions was arranged by the Norwegian Society of Cardiology and the Department of Pharmacotherapeutics, University of Oslo, soon after preliminary results of the GISSI II study were available. Relatively simple rules were...
Platelet rich plasma was prepared with soybean trypsin inhibitor (SBTI) as anticoagulant, to preserve normal Ca++-concentration, and subsequently tested in an aggregometer. Shear stress alone, induced by stirring, resulted in platelet aggregation and disaggregation. Such platelets showed only minor aggregational response on the addition of ADP, ind...
Background We wanted to investigate whether unpublished, detailed data from before the time of the registration of the antidepressant drug citalopram would yield any additional information that should have been taken into consideration before licensing the drug. Methods Through an application to the Danish Ministry of Health and with help from the...
Citations
... The most frequently identified PIMs with both tools were hypnotics, and zopiclone in particular. Nearly 30% of our study population used zopiclone ≥3.75 mg after hospitalisation (Table 2), a result supported by other Norwegian studies [26]. Given the considerable evidence relating hypnotics to ADEs in older adults, the widespread use of zopiclone is alarming, and interventions are warranted [27]. ...
... [27][28][29] Other trials also reported a tendency toward reduced benefit from ACE inhibition among patients taking ASA, although the existing data are still controversial and inconclusive. [29][30][31] Nguyen et al 32 conducted a retrospective subgroup analysis of data from the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II) and showed that the enalapril-ASA interaction was a significant predictor of mortality at the end of the study, and thus concluded that the effect of enalapril therapy was less favorable among pa-tients taking ASA than among patients not taking ASA at baseline. At the same time, the authors did not find a significant interaction with regard to nonfatal major events. ...
... With regard to relapse, clozapine appears to be superior to FGAs long-term [79,125], but evidence from meta-analyses is inconsistent [64] (see Fig. 2H). With regard to response, clozapine appears to be superior to placebo with large effect sizes [57,66], superior to FGAs short-term with small effect sizes [48,99,106,125], but not superior to single SGAs (e.g. quetiapine, risperidone, olanzapine) [29,30,61,67,70,122] (see Fig. 2G). ...
... 13 86 88 Few reviews focus on primary care (ie, general/ family practice and outpatients). 67 68 71 72 83 89 While some reviews combine primary and secondary care inpatient studies, 23 use of data on file, which misses search strategies and misses references, preventing others from replicating the review 56 66 75 76 81 ; assessing and reporting on efficacy but not on adverse effects or dropout rates 18 20 56 59 61 64-67 69 74 76 78-81 83 ; and assessing response without reporting remission effects. However, even after considering the potential limitations of previous reviews, this systematic review of reviews and meta-narrative synthesis shows an overall consensus that SSRIs demonstrate a flat doseresponse effect for efficacy, and poorer acceptability and tolerability as SSRI doses are increased for the treatment of depression. ...
... Once in the blood stream, ADP can cause platelet activation. A reversible platelet aggregation has been shown upon ADP infusions in rats and rabbits [36,37]. There are studies in rats demonstrating administration of Hb associated with various molecules, leading to increased platelet aggregation and adhesion in vivo on prothrombotic surfaces such as an injured vessel wall. ...
... The best of three trials was selected for calculations. Exercise test was performed in a temperature-controlled exercise laboratory at 22°C using a bicycle ergometer (Monark, Ergomedic 818, Sweden) and the Bruce protocol [9]. The test began with no load (zero watts). ...
... Coagulation factors, specifically fibrinogen and factor VII, (serum prothrombin conversion accelerator) have been implicated as risk factors for atherosclerotic diseases (Wilhelmsen et al., 1984;Meade et al., 1986). Several cross-sectional studies also have suggested an association between factor VIII and von Willebrand factor (vWF) with atherosclerotic heart disease, but other studies have found no association with heart disease (Sugrue et al., 1985;Myreng et al., 1986). Thus, a reduction in the risk of CAD can be related to the prevention of clotting or thrombosis, especially because 90% of patients with fatal myocardial infarction have associated coronary thrombosis. ...
... Once platelets are activated by shear stress or ADP, they are less responsive to a subsequent stimulation. This phenomenon of desensitization has been proven for ADP and thrombin receptors on platelets [22,23]. In the present study, lower aggregation (AUC) in impedance aggregometry was observed after PTS transports independent of whether testing was conducted in the OR area by trained anesthesia personnel or the central laboratory by specialized laboratory personnel. ...
... Such statistical adjustment is these studies observed an increased CHD risk in patients treated with a calcium antagonist 38 and two likely to be incomplete due both to the error with which confounding factors (such as disease history did not. 39,40 Among those not reporting an increase in risk, one included about 200 cases and 800 con-or risk factor levels) were measured and to the limited number of potential confounding factors for trols 39 and the other included about 100 cases and 300 controls. 40 Both of these studies were too small which data were available (eg typically, little data were available about evidence of subclinical athero-to detect even a doubling in the risk of CHD with calcium antagonists. ...
... Total fat intake may theoretically influence haemostasis indirectly through effects on blood lipoproteins. Serum or plasma triacylglycerol concentration is positively associated with factor VII, (Miller, 1993), bleeding times (Mundal et al. 1994) and with tPA and PAI-1 concentrations (Is0 et al. 1993a). Factor VII, also correlates with apolipoprotein B levels (Vaisanen et al. 1995). ...