Norway has among the highest incidence rates of fractures in the world. Vertebral fracture assessment (VFA) and trabecular bone score (TBS) provide information about fracture risk, but their ...importance have not been studied in Norwegian patients with fragility fractures. The objectives of this study were to examine the clinical characteristics of a cohort of women and men with fragility fractures, their prevalence of vertebral fractures using VFA and prevalence of low TBS, and explore the differences between the sexes and patients with and without vertebral fractures.
This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative (NoFRACT) included 839 patients with fragility fractures. Of these, 804 patients had bone mineral density (BMD) of the total hip, femoral neck and/or spine assessed using dual energy x-ray absorptiometry, 679 underwent concomitant VFA, 771 had TBS calculated and 696 responded to a questionnaire.
Mean age was 65.8 (SD 8.8) years and 80.5% were women. VFA revealed vertebral fractures in 34.8% of the patients and 34.0% had low TBS (≤ 1.23), with no differences between the sexes. In all patients with valid measures of both VFA and TBS, 53.8% had either vertebral fractures, low TBS, or both. In the patients with osteopenia at the femoral neck, 53.6% had either vertebral fractures, low TBS, or both. Femoral neck BMD T-score ≤ −2.5 was found in 13.8% of all patients, whereas the corresponding figure was 27.4% using the skeletal site with lowest T-score. Women exhibited lower BMD at all sites and lower TBS than men (1.27 vs. 1.29), (all p < 0.05). Patients with prevalent vertebral fractures were older (69.4 vs. 64.0 years), exhibited lower BMD at all sites and lower TBS (1.25 vs.1.29) than those without vertebral fractures (all p < 0.05). Before assessment, 8.2% were taking anti-osteoporotic drugs (AOD), and after assessment, the prescription rate increased to 56.2%.
More than half of the patients with fragility fractures had vertebral fractures, low TBS or both. The prescription of AOD increased seven fold from before assessment to after assessment, emphasizing the importance of risk assessment after a fragility fracture.
•35% of patients with fragility fracture had prevalent vertebral fractures.•34% of patients with fragility fractures had low trabecular bone score (TBS).•54% of patients had either prevalent vertebral fractures, low TBS or both.•Prescription of anti-osteoporotic drugs increased from 8% before to 56% after assessment.
School teachers' sickness absence has been shown to affect student achievement in the short run. However, we know little about whether socioeconomic backgrounds may compensate for reductions in ...instructional quality and to what extent teacher absence effects persist over time. This paper examines the socioeconomic differences in the short- and long-term effects of teacher absence. We use population-wide Norwegian register data to study the effects of certified teacher absence during lower secondary school (grades 8-10) on non-completion of upper secondary education by age 21 (i.e. school dropout) as well as academic achievement in 10th grade. In a school fixed effects model, we find that an increase in teacher absence of 5 percentage points reduces students' examination grades by 2.3% of a standard deviation and increases the dropout probability by 0.6 percentage points. However, the teacher absence effects vary considerably by family background, with large effects for low-SES students driving the overall effects. Overall, our findings indicate that reductions in instructional quality increase social inequality in long-term educational outcomes. This result highlights that studying heterogeneous impacts of contextual exposures is needed to understand the role of schools in shaping inequality.
The aim of this study was to investigate the prognostic value of the PAM50 intrinsic subtypes and risk of recurrence (ROR) score in patients with early breast cancer and long-term follow-up. A ...special focus was placed on hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) pN0 patients not treated with chemotherapy.
Patients with early breast cancer (n = 653) enrolled in the observational Oslo1 study (1995-1998) were followed for distant recurrence and breast cancer death. Clinicopathological parameters were collected from hospital records. The primary tumors were analyzed using the Prosigna® PAM50 assay to determine the prognostic value of the intrinsic subtypes and ROR score in comparison with pathological characteristics. The primary endpoints were distant disease-free survival (DDFS) and breast cancer-specific survival (BCSS).
Of 653 tumors, 52.2% were classified as luminal A, 26.5% as luminal B, 10.6% as HER2-enriched, and 10.7% as basal-like. Among the HR+/HER2- patients (n = 476), 37.8% were categorized as low risk by ROR score, 22.7% as intermediate risk, and 39.5% as high risk. Median follow-up durations for BCSS and DDFS were 16.6 and 7.1 years, respectively. Multivariate analysis showed that intrinsic subtypes (all patients) and ROR risk classification (HR+/HER2- patients) yielded strong prognostic information. Among the HR+/HER2- pN0 patients with no adjuvant treatment (n = 231), 53.7% of patients had a low ROR, and their prognosis at 15 years was excellent (15-year BCSS 96.3%). Patients with intermediate risk had reduced survival compared with those with low risk (p = 0.005). In contrast, no difference in survival between the low- and intermediate-risk groups was seen for HR+/HER2- pN0 patients who received tamoxifen only. Ki-67 protein, grade, and ROR score were analyzed in the unselected, untreated pT1pN0 HR+/HER2- population (n = 171). In multivariate analysis, ROR score outperformed both Ki-67 and grade. Furthermore, 55% of patients who according to the PREDICT tool ( http://www.predict.nhs.uk/ ) would be considered chemotherapy candidates were ROR low risk (33%) or luminal A ROR intermediate risk (22%).
The PAM50 intrinsic subtype classification and ROR score improve classification of patients with breast cancer into prognostic groups, allowing for a more precise identification of future recurrence risk and providing an improved basis for adjuvant treatment decisions. Node-negative patients with low ROR scores had an excellent outcome at 15 years even in the absence of adjuvant therapy.
•This paper uses a subset of the models that have rendered mixed findings in the literature.•The goal is to investigate to what extent confounding biases the returns to college quality.•The returns ...to college quality are positive.•The returns increase over the course of students’ work careers.•The standard regression model provides a reasonable estimate of the returns to college quality.
This paper addresses the recent discussion on confounding in the returns to college quality literature using the Norwegian case. The main advantage of studying Norway is the quality of the data. Norwegian administrative data provide information on college applications, family relations and a rich set of control variables for all Norwegian citizens applying to college between 1997 and 2004 (N=141,319) and their succeeding wages between 2003 and 2010 (676,079 person-year observations). With these data, this paper uses a subset of the models that have rendered mixed findings in the literature in order to investigate to what extent confounding biases the returns to college quality. I compare estimates obtained using standard regression models to estimates obtained using the self-revelation model of Dale and Krueger (2002), a sibling fixed effects model and the instrumental variable model used by Long (2008). Using these methods, I consistently find increasing returns to college quality over the course of students’ work careers, with positive returns only later in students’ work careers. I conclude that the standard regression estimate provides a reasonable estimate of the returns to college quality.
•This paper investigates heterogeneous returns to college quality across the wage distribution.•Students from privileged backgrounds benefit the most from college quality.•They benefit the most ...especially at the top of the wage distribution.
This paper investigates the heterogeneous returns to college quality across the wage distribution, using Norwegian administrative data. An ongoing debate in the literature is whether students who are most likely to attend a high-quality college benefit the most from college quality (the positive selection hypothesis) or whether students who are least likely to attend a high-quality college benefit the most (the negative selection hypothesis). The findings in this paper support the predictions in the positive selection hypothesis, especially at the top of the wage distribution. But the findings suggest that this pattern of positive selection is not caused by students self-selecting into colleges based on expected gain. Instead, the findings suggest that a second filter on family background exists. Students from privileged background are not only more likely to attend a high-quality college (the first filter), but are also more likely to convert their high-quality college education into success at the labor market (the second filter).
Abstract
A child’s environment is thought to be composed of different levels that interact with their individual genetic propensities. However, studies have not tested this theory comprehensively ...across multiple environmental levels. Here, we quantify the contributions of child, parent, school, neighbourhood, district, and municipality factors to achievement, and investigate interactions between polygenic indices for educational attainment (EA-PGI) and environmental levels. We link population-wide administrative data on children’s standardised test results, schools and residential identifiers to the Norwegian Mother, Father, and Child Cohort Study (MoBa), which includes >23,000 genotyped parent-child trios. We test for gene-environment interactions using multilevel models with interactions between EA-PGI and random effects for school and residential environments (thus remaining agnostic to specific features of environments). We use parent EA-PGI to control for gene-environment correlation. We found an interaction between students’ EA-PGI and schools suggesting compensation: higher-performing schools can raise overall achievement without leaving children with lower EA-PGI behind. Differences between schools matter more for students with lower EA-PGI, explaining 4 versus 2% of the variance in achievement for students 2 SD below versus 2 SD above the mean EA-PGI. Neighbourhood, district, and municipality variation contribute little to achievement (<2% of the variance collectively), and do not interact with children’s individual EA-PGI. Policy to reduce social inequality in achievement in Norway should focus on tackling unequal support across schools for children with difficulties.
It has now been 50 years since Flanagan (1954) published his classic article on the
critical incident technique (CIT) - a qualitative research method that is still
widely used today. This article ...reviews the origin and evolution of the CIT during
the past 50 years, discusses CIT’s place within the qualitative research
tradition, examines the robustness of the method, and offers some recommendations
for using the CIT as we look forward to its next 50 years of use. The focus of this
article is primarily on the use of the CIT in counselling psychology, although other
disciplines are touched upon.
High dropout rates from upper secondary school are related to substantial societal costs, and are hence a major policy concern. The Norwegian folk high schools provide a non-academic education in an ...intimate and nurturing environment where interpersonal and social skills are emphasised, and where individuals grow in sense of self-esteem and sense of coping. The unique non-academic nature of folk high schools allows us to explore if non-academic investments in youth could be effective tools in the battle against dropout. We have obtained access to high-quality Norwegian administrative data and use both a covariate adjustment technique and an instrumental variable technique to investigate whether a folk high school education raises the probability of dropouts completing upper secondary school. We find that dropouts are significantly more likely to complete an academic course if they have attended a folk high school. However, a folk high school education makes dropouts less likely to complete a vocational course. The non-academic education has the surprising tendency of redirecting vocational students to academic paths.
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