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Muscular performance decreases with increasing complexity of resistance exercises in subjects with chronic obstructive pulmonary disease
Get PDFChronic obstructive lung disease (COPD) is associated with impaired muscle functions in addition to the impaired cardiopulmonary capacity inherent to the disease. The purpose of this study was to compare muscular performance between COPD subjects (COPD, n = 11, GOLD grade II/III; FEV1 = 53 ± 14% predicted; 61 ± 7 years) and healthy controls (HC, n = 12, 66 ± 8 years) in three resistance exercises with different complexity: (a) one‐legged knee extension (1KE), and (b) one‐ and (c) two‐legged leg press (1LP and 2LP, respectively). For each exercise, muscular performance was defined as repetitions to exhaustion at 60% of one‐repetition maximum or overall exercise volume, calculated as the sum of three exercise sets. In HC, muscular performance increased progressively with increasing physiological complexity: 1KE 1LP), advocating utilization of one‐legged resistance protocols for rehabilitation purposes.publishedVersio
Quality of life, salivary cortisol and atopic diseases in young children
Get PDFAbstract BACKGROUND: Children with atopic disease may have reduced health-related quality of life (QoL) and morning cortisol. Possible links between QoL, morning cortisol and atopic disease are unclear. We aimed to determine if QoL was associated with morning salivary cortisol at two years of age, and if asthma, atopic dermatitis and/or allergic sensitisation influenced this association. Secondarily, we aimed to determine if QoL at one year of age was associated with salivary cortisol one year later. METHODS AND FINDINGS: The Bronchiolitis All SE-Norway study included infants during hospitalisation for acute bronchiolitis in infancy (bronchiolitis group) and population-based control infants (controls). The present study included all 358 subjects with available Infant Toddler Quality of Life Questionnaire (ITQOL) from parents, consisting of 13 domains and morning salivary cortisol at two years of age. Answers from the same 0-100 score questionnaire, with optimal score 100 nine months after enrolment, was also available for 289 of these children at about one year of age. Recurrent bronchial obstruction was used as an asthma proxy. Atopic dermatitis was defined by Hanifin and Rajka criteria and allergic sensitisation by a positive skin prick test. Due to different inclusion criteria, we tested possible interactions with affiliation groups. Associations between QoL and cortisol were analysed by multivariate analyses, stratified by bronchiolitis and control groups due to interaction from affiliation grouping on results. At two years of age, QoL decreased significantly with decreasing cortisol in 8/13 QoL domains in the bronchiolitis group, but only with General health in the controls. The associations in the bronchiolitis group showed 0.06-0.19 percentage points changes per nmol/L cortisol for each of the eight domains (p-values 0.0001-0.034). The associations remained significant but diminished by independently including recurrent bronchial obstruction and atopic dermatitis, but remained unchanged by allergic sensitisation. In the bronchiolitis group only, 7/13 age and gender adjusted QoL domains in one-year old children were lower with lower cortisol levels at two years of age (p = 0.0005-0.04). CONCLUSIONS: At two years, most QoL domains decreased with lower salivary cortisol among children who had been hospitalised for acute bronchiolitis in infancy, but for one domain only among controls. Recurrent bronchial obstruction and to a lesser extent atopic dermatitis, weakened these associations that nevertheless remained significant. After bronchiolitis, lower QoL in one-year old children was associated with lower salivary cortisol at two years.The project was supported by a grant to
the first author’s employer, Innlandet Hospital
Trust, (Project no. 150189 to LBR) from a research
fund foundation, Klosterstiftelsen. Klosterstiftelsen
does not have any specific URL, but further
information can be reached at https://www.
purehelp.no/m/company/details/klosterstiftelsen/
982953146. No commercial companies funded the
study or authors. The funders had no role in study
design, data collection and analysis, decision to
publish, or preparation of the manuscript. The
other authors did not receive any specific funding
for this work.publishedVersio
A review on coordination properties of thiol-containing chelating agents towards mercury, cadmium, and lead
Get PDFAbstract: The present article reviews the clinical use of thiol-based metal chelators in intoxications and overexposure with mercury (Hg), cadmium (Cd), and lead (Pb). Currently, very few commercially available pharmaceuticals can successfully reduce or prevent the toxicity of these metals. The metal chelator meso-2,3-dimercaptosuccinic acid (DMSA) is considerably less toxic than the classical agent British anti-Lewisite (BAL, 2,3-dimercaptopropanol) and is the recommended agent in poisonings with Pb and organic Hg. Its toxicity is also lower than that of DMPS (dimercaptopropane sulfonate), although DMPS is the recommended agent in acute poisonings with Hg salts. It is suggested that intracellular Cd deposits and cerebral deposits of inorganic Hg, to some extent, can be mobilized by a combination of antidotes, but clinical experience with such combinations are lacking. Alpha-lipoic acid (α-LA) has been suggested for toxic metal detoxification but is not considered a drug of choice in clinical practice. The molecular mechanisms and chemical equilibria of complex formation of the chelators with the metal ions Hg2+, Cd2+, and Pb2+ are reviewed since insight into these reactions can provide a basis for further development of therapeutics. Keywords: BAL; DMPS; DMSA; metal chelator; metal ionThis research was funded by Regione Autonoma della Sardegna, grant number “RASSR79857”, by
Ministero dell’Istruzione, dell’Università e della Ricerca, grant number (PON RI 2014-2020) and by Ministarstvo
Prosvete, Nauke i Tehnološkog Razvoja (Project III 46009.publishedVersio
Prognostic value and reproducibility of different microscopic characteristics in the WHO grading systems for pTa and pT1 urinary bladder urothelial carcinomas
Get PDFBACKGROUND:
European treatment guidelines for pTa and pT1 urinary bladder urothelial carcinoma depend highly on stage and WHO-grade. Both the WHO73 and the WHO04 grading systems show some intra- and interobserver variability. The current pilot study investigates which histopathological features are especially sensitive for this undesired lack of reproducibility and the influence on prognostic value.
METHODS:
Thirty-eight cases of primary non-muscle invasive urothelial carcinomas, including thirteen cases with stage progression, were reviewed by three pathologists. Thirteen microscopic features were extracted from pathology textbooks and evaluated separately. Reproducibility was measured using Gwet's agreement coefficients. Prognostic ability regarding progression was estimated by the area under curve (AUC) of the receiver operating characteristics (ROC) function.
RESULTS:
The best reproducible features (Gwet's agreement coefficient above 0.60) were papillary architecture, nuclear polarity, cellular maturation, nuclear enlargement and giant nuclei. Nucleoli was the strongest prognostic feature, and the only feature with an AUC above 0.70 for both grading systems, but reproducibility was not among the strongest. Nuclear polarity also had prognostic value with an AUC of 0.70 and 0.67 for the WHO73 and WHO04, respectively. The other features did not have significant prognostic value.
CONCLUSIONS:
The reproducibility of the histopathological features of the different WHO grading systems varied considerably. Of all the features evaluated, only nuclear polarity was both prognostic and significantly reproducible. Further validation studies are needed on these features to improve grading of urothelial carcinomas.publishedVersio
Change in Mental Health Stigma After a Brief Intervention Among Internally Displaced Persons in Central Sudan
No full textStigmatizing attitudes towards people with mental illness is a worldwide phenomenon, This Longitudinal study aimed to determine the level of stigma, among the internal displaced persons in central Sudan and explore possible changes in stigma associated with an intervention. 1549 persons were interviewed using standardized stigma attitude tools. The study reveled high level of stigma among our respondents and there was no significant difference in attitudes towards mental illness observed after the intervention. The intervention was not associated with change in stigma. However, the findings can inform policy to create sustainable national mental health strategies to address the stigma.The project was funded by Oslo University: Division of Mental Health and addiction, Quota scheme and Faculty of Medicine.acceptedVersio
Frailty identified by geriatric assessment is associated with poor functioning, high symptom burden and increased risk of physical decline in older cancer patients: Prospective observational study
Get PDFBackground:
Maintaining quality of life including physical functioning is highly prioritized among older cancer patients. Geriatric assessment is a recommended approach to identify patients with increased vulnerability to stressors (frailty). How frailty affects quality of life and physical functioning in older cancer patients has scarcely been investigated.
Aim:
Focusing on physical functioning and global quality of life, we investigated whether frailty identified by a geriatric assessment was associated with higher risk of quality-of-life deterioration during cancer treatment and follow-up.
Design:
Prospective, observational study. Patients were classified as frail or non-frail by a modified geriatric assessment. Quality of life was measured using the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire at inclusion, 2, 4, 6 and 12 months.
Setting:
Eight Norwegian outpatient cancer clinics.
Participants:
Patients ⩾70 years with solid tumours referred for palliative or curative systemic medical cancer treatment.
Results:
Among 288 patients included, 140 (49%) were frail and 148 (51%) non-frail. Frail patients consistently reported poorer scores on all functioning and symptom scales. Independent of age, gender and major cancer-related factors, frail patients had significantly poorer physical functioning and global quality of life during follow-up, and opposed to non-frail patients they had both a clinically and statistically significant decline in physical functioning from baseline until 12 months.
Conclusions:
Geriatric assessment identifies frail patients with increased risk of physical decline, poor functioning and high symptom burden during and following cancer treatment. Frail patients should therefore receive early supportive or palliative care.The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This study was publicly funded by Innlandet Hospital Trust.acceptedVersio
Modifiable factors affecting older patients' quality of life and physical function during cancer treatment
Get PDFBACKGROUND:
Maintaining physical function and quality of life (QoL) are prioritized outcomes among older adults. We aimed to identify potentially modifiable factors affecting older patients' physical function and QoL during cancer treatment.
METHODS:
Prospective, multicenter study of 307 patients with cancer ≥70 years, referred for systemic treatment. Pre-treatment, a modified geriatric assessment (mGA) was performed, including registration of comorbidities, medications, nutritional status, cognitive function, depressive symptoms (Geriatric Depression Scale-15 [GDS]), and mobility (Timed Up and Go [TUG]). Patient-reported physical function (PF)-, global QoL-, and symptom scores were assessed at baseline, two, four, and six months by the EORTC Quality of Life Core Questionnaire-C30. The impact of mGA components and symptoms on patients' PF and global QoL scores during six months was investigated by linear mixed models. To identify groups following distinct PF trajectories, a growth mixture model was estimated.
RESULTS:
288 patients were eligible, mean age was 76.9 years, 68% received palliative treatment. Higher GDS-scores and poorer TUG were independently associated with an overall level of poorer PF and global QoL throughout follow-up, as were more pain, dyspnea, and appetite loss, and sleep disturbance. Three groups with distinct PF trajectories were identified: a poor group exhibiting a non-linear statistically (p < .001) and clinically significant decline (≥10 points), an intermediate group with a statistically (p = .003), but not clinically significant linear decline, and a good group with a stable trajectory. Higher GDS-scores and poorer TUG, more pre-treatment pain and dyspnea were associated with higher odds of belonging to the poor compared to the good PF group.
CONCLUSION:
Depressive symptoms, reduced mobility, and more physical symptoms increased the risk of decrements in older patients' PF and global QoL scores during cancer treatment, and represent potential targets for interventions aiming at improving these outcomes.This study was funded by Innlandet Hospital Trust and registered at ClinicalTrials.gov (NCT01742442). We want to thank the cancer clinics at Innlandet Hospital Trust, Oslo University Hospital (OUH) and Akershus University Hospital (AHUS) for their participation in the study. A special thanks to the study nurses at all locations who participated in the inclusion and assessment of patients, and to the local principal investigators at OUH and AHUS:Morten Brændengen and Olav Yri.submittedVersionpublishedVersio
Intermittent auscultation fetal monitoring during labour: A systematic scoping review to identify methods, effects, and accuracy
Get PDFMETHODS:
We conducted a systematic scoping review following the Joanna Briggs methodology. Medline, EMBASE, Cinahl, Maternity & Infant Care, Cochrane Library, SveMed+, Web of Science, Scopus, Lilacs and African Journals Online were searched for publications up to January 2019. We did hand searches in relevant articles and databases. Studies from all countries, international guidelines and national guidelines from Denmark, United Kingdom, United States, New Zealand, Australia, The Netherlands, Sweden, Denmark, and Norway were included. We did quality assessment of the guidelines according to the AGREEMENT tool. We performed a meta-analysis assessing the effects of IA with a Doppler device vs. Pinard device using methods described in The Cochrane Handbook, and we performed an overall assessment of the summary of evidence using the GRADE approach.
RESULTS:
The searches generated 6408 hits of which 26 studies and 11 guidelines were included in the review. The studies described slightly different techniques for performing IA, and some did not provide detailed descriptions. Few of the studies provided details of normal and abnormal IA findings. All 11 guidelines recommended IA for low risk women, although they had slightly different recommendations on the frequency, timing, and duration for IA, and the FHR characteristics that should be observed. Four of the included studies, comprising 8436 women and their babies, were randomised controlled trials that evaluated the effect of IA with a Doppler device vs. a Pinard device. Abnormal FHRs were detected more often using the Doppler device than in those using the Pinard device (risk ratio 1.77; 95% confidence interval 1.29-2.43). There were no significant differences in any of the other maternal or neonatal outcomes. Four studies assessed the accuracy of IA findings. Normal FHR was easiest to identify correctly, whereas identifying periodic FHR patterns such as decelerations and saltatory patterns were more difficult.
CONCLUSION:
Although IA is the recommended method, no trials have been published that evaluate protocols on how to perform it. Nor has any study assessed interrater agreements regarding interpretations of IA findings, and few have assessed to what degree clinicians can describe FHR patterns detected by IA. We found no evidence to recommend Doppler device instead of the Pinard for IA, or vice versa.The authors received no specific funding for this work.publishedVersio
Parental height modifies the association between linear growth and neurodevelopment in infancy
Get PDFAbstract
AIM:
To estimate the extent to which maternal and paternal height modify the association between length-for-age Z-score (LAZ) and neurodevelopmental outcomes assessed by the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III).
METHODS:
Baseline data from a clinical trial in 600 Nepalese infants aged six to 11 months with LAZ less than -1 were utilised. The primary exposure was the LAZ score, interaction variables were maternal and paternal height, and the outcomes were Bayley-III cognitive, language and motor scaled scores. Linear regression and generalised additive model (GAM) were used to identify potential interactions.
RESULTS:
Linear regression analysis stratified by parental height categories showed that association between unit increase in LAZ and cognitive scaled score differed across maternal (normal height: ß 1.16, 95% CI; 0.75, 1.57 and short height: ß 0.67, 95% CI; 0.28, 1.05) and paternal (normal height: ß 1.32, 95% CI; 0.91, 1.72 and short height: ß 0.61, 95% CI; 0.03, 1.18) height categories. Maternal height also modified the association between LAZ and fine motor scaled score.
CONCLUSION:
The association between LAZ and neurodevelopmental outcomes was attenuated when maternal and paternal height was taken into account. Parental stature should be considered when using LAZ as a proxy for neurodevelopment among infants.Thrasher Research (award # 11512) fund, GC Rieber funds, and the Research Council of Norway (grant # 234495).submittedVersio
Partnering with persons in long-term recovery from substance use disorder: experiences from a collaborative research project
Get PDFBACKGROUND:
Traditional research about substance use disorder (SUD) treatment is considered, among an increasing number of service users, to be disempowering and poorly reflective of their priorities. Thus, this methodological article sought to examine the experiences of a peer research group (PRG), whose four members were in long-term SUD recovery, and a principal investigator (PI), when collaborating on a study of SUD recovery. This article has also aspired to discern the influence of peer researcher participation on the research process. The purpose of the qualitative research project that formed the basis of this methodological study was to examine the reasons provided and strategies employed for abstaining from problematic substance use among persons with SUDs.
METHODS:
The project took place from 2015 to 2018, during which time individual interviews were conducted with 18 persons in recovery from SUDs. The PRG contributed to all parts of the project and worked alongside the PI in preparing the study, during early stages of data analysis, and while writing up the findings. In total, ten group discussions were held over the course of 3 years.
RESULTS:
The study showed that the PRG offered important contributions with respect to developing the interview guide, preunderstanding among the PRG members, and discussing alternative forms of data collection. Key findings about how this collaborative research process was experienced relate to three matters: the group aspect of participation, the value of predictable routines and clear expectations, and the open sharing of private matters. The PI experienced the research process as having been enriched by alternative ways of asking questions and interpreting findings and as an interactive arena for reciprocal social and professional support.
CONCLUSIONS:
When establishing a PRG while studying recovery processes, it can be advantageous to include several peer researchers with diverse lived experiences concerning substance use, treatment, and recovery. If possible, at least one peer researcher with formal training or qualitative research experience might be included. The PI should be trained in collaborating with peer researchers or should be part of a research environment in which it is possible to discuss methodological challenges with other researchers.Innlandet Hospital Trust, NorwaypublishedVersio