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The association between household biomass fuel use and leukocyte telomere length among toddlers in Bhaktapur, Nepal
Get PDFBackground Biomass fuels are still in use for cooking by many households in resource poor countries such as Nepal and is a major source of household air pollution (HAP). Chronic exposure to HAP has been shown to be associated with shorter telomere length in adults. Objectives To measure the association between exposure related to household biomass fuel in infancy and leukocyte telomere length (LTL) at 18–23 months of age among 497 children from Bhaktapur, Nepal. Methods In a prospective cohort study design, we have collected information on household cooking fuel use and several clinical, anthropometric, demographic, and socioeconomic variables. We estimated the association between biomass fuel use and the relative LTL in multiple linear regression models. Results Most of the families (78%) reported liquified petroleum gas (LPG) as the primary cooking fuel, and 18.7% used biomass. The mean relative (SD) LTL was 1.03 (0.19). Children living in households using biomass fuel had on average 0.09 (95% CI: 0.05 to 0.13) units shorter LTL than children in households with no biomass fuel use. The observed association was unaltered after adjusting for relevant confounders. The association between LTL and biomass use was strongest among children from households with ≤2 rooms and without separate kitchen. Significance Exposure to biomass fuel use in early life might have consequences for longevity, and risk of chronic illnesses reflected in shortening of the telomeres. Our findings support the ongoing effort to reduce exposure to biomass fuel in low-resource settings. Impact statements Biomass for cooking is a leading source of household air pollution in low and middle-income countries, contributing to many chronic diseases and premature deaths. Chronic exposure to biomass fuel through oxidative stress and inflammation has been associated with a shortening of the telomeres, a “biological marker” of longevity. This prospective cohort study describes the association between household biomass fuel use and leukocyte telomere length among 497 toddlers. Leukocyte telomere length was significantly shorter among children living in households with biomass fuel than in children from homes where mainly LPG was used for cooking.This work was supported by Thrasher Research Fund (award # 11512), the GC Rieber
foundation, the University of Bergen (UiB), and the Innlandet Hospital Trust (grant 150403).publishedVersio
Chelation Combination - A Strategy to Mitigate the Neurotoxicity of Manganese, Iron, and Copper?
Get PDFThe chelating thiol dimercaptosuccinate (DMSA) and the traditional agent D-penicillamine (PSH) are effective in enhancing the urinary excretion of copper (Cu) and lead (Pb) in poisoned individuals. However, DMSA, PSH, EDTA (ethylenediamine tetraacetate), and deferoxamine (DFOA) are water-soluble agents with limited access to the central nervous system (CNS). Strategies for mobilization of metals such as manganese (Mn), iron (Fe), and Cu from brain deposits may require the combined use of two agents: one water-soluble agent to remove circulating metal into urine, in addition to an adjuvant shuttler to facilitate the brain-to-blood mobilization. The present review discusses the chemical basis of metal chelation and the ligand exchange of metal ions. To obtain increased excretion of Mn, Cu, and Fe, early experiences showed promising results for CaEDTA, PSH, and DFOA, respectively. Recent experiments have indicated that p-amino salicylate (PAS) plus CaEDTA may be a useful combination to remove Mn from binding sites in CNS, while the deferasirox-DFOA and the tetrathiomolybdate-DMSA combinations may be preferable to promote mobilization of Fe and Cu, respectively, from the CNS. Further research is requested to explore benefits of chelator combinations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).publishedVersio
Unrecognized depression among the elderly: a cross-sectional study from Norwegian general practice
No full textBackground: Depression is common in old age and is associated with disability, increased mortality,
and impairment from physical diseases.
Aim: To estimate the prevalence of depression among older patients in Norwegian general practice,
to evaluate the extent they talk about it during their consultation, whether it was previously known or
suspected by their GP, and how frequently patients with depression visit their GP.
Design & setting: Cross-sectional study among patients and GPs at 18 primary care clinics in the
south of Norway.
Method: Patients aged ≥65 years who visited their GP were asked to complete the Patient Health
Questionnaire-9 (PHQ-9). The GPs reported what kind of issues the patient presented at the
consultation, if a current depression was known, and the consultation frequency.
Results: Forty-four (11.4%) of 383 patients reported moderate or severe depressive symptoms (PHQ 9 ≥10). Among the cases with data from both patient and GP (n = 369), 38 patients (10.3%) reported
moderately depressive symptoms. Of these, only 12 (31.6%) mentioned psychological problems to
their GP during their consultation; 12 (31.6%) with previous depression were neither known to the
GP nor suspected of currently having depression; and 67.6% of them visited their GP ≥5 times a year.
Conclusion: Older patients tend to speak little of their depression to the GP. Almost one in three older
patients with moderate depressive symptoms were unrecognised by their GP. Older patients who
frequently visit the GP should be suspected of potentially having mental health problems.publishedVersio
In what ways do emerging adults with substance use problems experience their communities as influencing their personal recovery processes?
Get PDFApplying the multiple psychological sense of community concept (MPSOC), this study explored how emerging adults with substance use problems experience the influences of various senses of community and communities on their personal recovery processes. Semi-structured interviews with 21 emerging adults from different urban contexts in Norway were analysed using a collaborative, seven-step, deductive, and reflexive thematic approach. MPSOC is shown to be a key concept for achieving a broad, in-depth understanding of emerging adults' senses of community and personal experiences of community influences on recovery processes from substance use. Positive and negative senses of community in geographical, relational, substance use-related and ideal communities influence the potentials and challenges in emerging adults' recovery processes. Supportive and motivating community relationships, meaningful activities with peers, and distance from recovery-impeding communities were identified as important recovery components. To promote recovery and prevent substance use in emerging adults, community approaches and tools applied in substance use treatment have to take into account and utilise multidimensional and age group-specific aspects of belonging.publishedVersio
Music therapy for people with substance use disorders
Get PDFBackground Substance use disorder (SUD) is the continued use of one or more psychoactive substances, including alcohol, despite negative effects on health, functioning, and social relations. Problematic drug use has increased by 10% globally since 2013, and harmful use of alcohol is associated with 5.3% of all deaths. Direct effects of music therapy (MT) on problematic substance use are not known, but it may be helpful in alleviating associated psychological symptoms and decreasing substance craving. Objectives To compare the effect of music therapy (MT) in addition to standard care versus standard care alone, or to standard care plus an active control intervention, on psychological symptoms, substance craving, motivation for treatment, and motivation to stay clean/sober. Search methods We searched the following databases (from inception to 1 February 2021): the Cochrane Drugs and Alcohol Specialised Register; CENTRAL; MEDLINE (PubMed); eight other databases, and two trials registries. We handsearched reference lists of all retrieved studies and relevant systematic reviews. Selection criteria We included randomised controlled trials comparing MT plus standard care to standard care alone, or MT plus standard care to active intervention plus standard care for people with SUD. Data collection and analysis We used standard Cochrane methodology.Music therapy for people with substance use disorderspublishedVersio
Attention-deficit/hyperactivity disorder persistence from childhood into young adult age: a 10-year longitudinal study
Get PDFProblems with executive function (EF) are considered a hallmark of Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). However, little is known about the developmental pathway of everyday EF in these two groups, and whether the two groups follow a similar or different developmental course. In this longitudinal study, children and adolescents with ADHD (n = 84, Mage = 11.6, SD = 2.0), ASD (n = 38, Mage = 12.0, SD = 2.3), and typically developing children (TDC; n = 50, Mage = 11.6, SD = 2.0) were clinically diagnosed and assessed with parent-ratings of everyday EF at baseline and at two-year followup (97% retention). Results showed that both individuals with ADHD and individuals with ASD displayed elevated levels of everyday EF problems relative to the TDC at baseline (Hedges g = 1.99 to 2.99). Over the two-year period, everyday EF improved in individuals with ADHD relative to the TDC, whereas individuals with ASD displayed no improvement relative to the TDC. At two-year followup, individuals with ADHD and individuals with ASD continued to display elevated levels of everyday EF problems relative to the TDC (Hedges g = 1.61 to 3.19).submittedVersio
The association between biomass fuel use for cooking and linear growth in young children in Bhaktapur, Nepal
Get PDFBackground There are still many people in the world who prepare their meals on open fires or stoves using solid fuels from biomass, especially in low-and middle-income countries. Although biomass cooking fuels have been associated with adverse health impacts and diseases, the association with child linear growth remains unclear. Objectives In a cohort design, we aimed to describe the association between the use of biomass cooking fuels and linear growth in children aged 18–23 months living in the urban and peri-urban community of Bhaktapur, situated in the Kathmandu valley in Nepal. Methods Caretakers of 600 marginally stunted children aged 6–11 months were interviewed about their source of cooking fuel and other socio-demographic characteristics at enrolment into a randomized controlled trial. Children’s body length was measured when children were 18–23 months old. In linear regression models, we estimated the association between the use of biomass fuel and length-for-age Z-scores (LAZ), adjusted for relevant confounders. We repeated these analyses in pre-defined sub-groups and different percentiles of LAZ using quantile regression models. Results Among study participants, 101 (18%) used biomass as cooking fuel. The association between biomass fuel and LAZ was not statistically significant in the full sample (adjusted regression coefficient: –0.14, 95% CI: −0.28, 0.00). The association was stronger in some of the sub-groups and in the lower tail of the LAZ distribution (those who are stunted), but neither reached statistical significance. Discussion Children from households in poor, urban neighborhoods in Nepal which used biomass fuel for cooking were on average slightly shorter than other children, although the association only approached statistical significance. As this was an observational study, residual confounding cannot be excluded. Further studies are needed to confirm these associations, in particular those seen in certain sub-groups.publishedVersio
“It was an important part of my treatment”: a qualitative study of Norwegian breast Cancer patients’ experiences with mainstreamed genetic testing
Get PDFBackground: In South-Eastern Norway, genetic testing for BRCA1 and BRCA2 is offered to breast cancer patients by their treating surgeon or oncologist. Genetic counselling from a geneticist or a genetic counsellor is offered only to those who test positive for a pathogenic variant or have a family history of cancer. This practice is termed “mainstreamed genetic testing”. The aim of this study was to learn about patients’ experience of this healthcare service.
Methods: Qualitative in-depth interviews were conducted with 22 breast cancer patients who had been diagnosed during the first half of 2016 or 2017 at one regional and one university hospital and who had been offered testing by their treating physician. A six-phase thematic approach was used to analyse the data.
Results: The participants had varied experiences of how and when testing was offered. Three main themes emerged from the analysis: 1. informational and communicational needs and challenges during a chaotic time, 2. the value of genetic testing and 3. the importance of standardised routines for mainstreamed genetic testing.
Conclusions: Despite the shock of their diagnosis and the varying experiences they had in respect of how and when testing was offered, all of the participants emphasised that genetic testing had been an important part of their diagnosis and treatment. Our results indicate that there is a need for continuous collaboration between geneticists, surgeons, oncologists and laboratory specialists in order to establish simple and robust routines so as to ensure that all eligible breast cancer patients are offered testing at a point when the test result can have an impact on treatment.This study was funded by a grant from the Norwegian Cancer Society’s Pink
Ribbon Campaign (grant number 194790–2017).publishedVersio
Longitudinal determinants of insomnia among patients with alcohol use disorder
Get PDFInsomnia is common among patients with AUD and can impair quality of life and cognitive functioning, as well as cause psycho-social problems and increased risk of relapse. Nonetheless, determinants of insomnia in patients with AUD have scarcely been studied. We aimed to examine prevalence and development of self-perceived insomnia among inpatients in treatment for AUD, and to examine factors in this group known to be associated with sleep disturbance in the general population. We examined self-reported information about sleep from ninety-four AUD inpatients in long-term treatment (up to nine months) using a questionnaire identifying probable insomnia. Potential predictors identified in bivariate tests were used in binomial logistic regressions to examine the effect on sleep at baseline and at six-week follow-up. Longitudinal multilevel analyses were used to examine factors affecting development of sleep quality during the treatment stay. At baseline, 54% of the patients reported sleep problems indicating insomnia. This was reduced to 35% at six-week follow-up. In a cross-sectional analysis of sleep at baseline, we found that being male (OR 0.18, p=0.042) and engaging in physical activity (OR 0.09, p<0.001) were negatively associated with insomnia, while a high level of depressive symptoms (OR 1.10, p=0.010) was positively associated after adjustment for age, history of trauma and severity of dependence. Multilevel analyses of data over a six-month period showed time interactions with physical activity, such that sleep improvement was greater in patients who initially had a low level of physical activity. This longitudinal study corroborates findings of high prevalence of insomnia among AUD patients and identifies factors in this group associated with insomnia, such as sex, depression and physical activity. Future longitudinal studies are needed to examine the causal directions between sleep, depression, and physical activity and how these might be targeted in clinical settings. Keywords: Alcohol use disorder; depression; insomnia; physical activity; sleep.submittedVersio
The experience of relatives of nursing home residents with COVID-19 : a qualitative study
Get PDFBackground: The coronavirus disease 2019 (COVID-19) pandemic had significant consequences for relatives’ opportunities to communicate with and offer care to seriously ill and dying nursing home residents with COVID-19. Residents in nursing homes were urged to protect themselves through social distancing, and visits have been permanently regulated and limited. These restrictions have been challenging, and the limitations have raised many questions and led to difficult choices. The aim of this study was to explore the experiences of relatives of nursing home residents with COVID-19. We investigated the following two research questions: How did relatives of COVID-19 patients in Norwegian nursing homes experience the situation and how did the physical distancing and precepts of infection control affect the relationship between the long-term residents and the relatives?. Methods: The study has a qualitative explorative design with a phenomenological-hermeneutic approach, with individual in-depth interviews used for data collection. The study included ten relatives of nursing home residents with COVID-19. Results: Three main perspectives were identified from the participants’ experiences: (1) the difficult choices; (2) maintaining the relationship; and (3) experiencing support. The relatives experienced ethical dilemmas when weighing the risk of getting COVID-19 if they visited the patient versus the consequences of not visiting their loved one. In this situation, they needed good information and support from health care professionals. Conclusion: To enable relatives of COVID-19 patients to make choices in line with their goals and intrinsic motivations, it is important that staff members possess competence in infection control, updated knowledge about the residents’ situations, and the skills to facilitate a safe and confident dialogue. Trust in the care staff and a feeling of safety are essential for relatives in a stressful situation with difficult choices, while a lack of confidence, routines, and/or dialogue might increase relatives’ feelings of insecurity and stress and make their caring role difficult.The experience of relatives of nursing home residents with COVID-19 : a qualitative studyThe study was funded by the Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust; Lovisenberg Diaconal University College; the Faculty of Health Sciences and Social Care, Molde University College; and the Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust.publishedVersio