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Neurocognitive Outcome and Compensating Possibilities in Children and Adolescents Treated for Acute Lymphoblastic Leukemia With Chemotherapy Only
Get PDFAim: To examine the neurocognitive outcomes in children and adolescents with acute lymphoblastic leukemia (ALL) in remission who were treated with systemic chemotherapy only (CTO). Methods: Neurocognitive performances in 36 children and adolescents, aged 8.4-15.3 years, in long-term remission from ALL 4.3-12.4 years post diagnosis, without relapse, and with no pre-diagnosis history of neurodevelopmental disorder were compared with 36 healthy controls matched for gender, age, and parents' socio-economic status. The former patients and the healthy controls completed an extensive battery of standardized neuropsychological tests. Results: Survivors who were treated by CTO obtained significantly lower scores than did healthy controls on the domains of Copy and drawing (p = 0.001; Cohen's d 0.85; after controlling for Type 1 errors q = 0.006), Arithmetic (p = 0.001; Cohen's d 0.80; after controlling for Type 1 errors, q = 0.006), and Tactile sensory functions (p = 0.008; Cohen's d 0.65; after controlling for Type 1 errors, q = 0.03). Fifty percent of the ALL group were more than 1 SD below the control groups mean on Copy and drawing. There was an interaction between age and group (ALL vs. Control, p = 0.042) on Copy and drawing, indicating that the youngest ALL patients exhibited the worst performance. The oldest ALL patients performed equal to or better than the controls. A tendency in the same direction was seen for Arithmetic and Tactile sensory functions. The ALL survivors exhibited a steeper rising learning slope on repeated tests, with lower scores on a tactile problem-solving task, tactile sensory tests, verbal memory, and visual attention, but they performed as well as the controls when stimuli were repeated. Conclusion: The results indicate that neurocognitive long-term sequelae in ALL survivors are limited to specific domains - particularly complex drawing, arithmetic, and tactile processing, and novelty processing. Cognitive deficits are shown among the youngest ALL patients. Intervention programs and school programs should account for difficulties with processing new information and taking advantage of repetitions as a strength, which may prevent survivors from falling behind their peers.This research was supported by the Department of Psychology in the Norwegian University of Science and Technology (NTNU), the Section of Clinical Neuropsychology, Departments of Paediatrics in the two University Hospitals – Oslo University Hospital, Oslo and the St. Olav’s Hospital, Trondheim, Norway and the Norwegian Support Group for Children with Cancer.publishedVersio
Levels of Lipoprotein (a) in patients with coronary artery disease with and without inflammatory rheumatic disease: A cross-sectional study
Get PDFOBJECTIVES:
Patients with various inflammatory rheumatic diseases (IRDs) have increased risk of atherothrombotic disease. Lipoprotein (a) (Lp(a)) is a risk factor for atherosclerosis but its role in IRD with accompanying coronary artery disease (CAD) is still unclear. We aimed to examine if serum Lp(a) levels differed between CAD patients with and without accompanying IRD.
DESIGN:
A cross-sectional observational, patient-based cohort study.
SETTING:
Referred centre for coronary artery bypass grafting in the South Eastern part of Norway.
PARTICIPANTS:
67 CAD patients with IRD (CAD/IRD) and 52 CAD patients without IRD (CAD/non-IRD). All patients were Caucasians, aged >18 years, without any clinically significant infection or malignancy.
METHODS:
Lp(a) levels in serum were analysed by particle enhanced immunoturbidimetric assay, and Lp(a) levels were related to clinical and biochemical characteristics of the patient population.
RESULTS:
We found no differences in serum levels of Lp(a) between CAD patients with and without IRD. In general, we found that Lp(a) correlated poorly with clinical and biochemical parameters including C reactive protein with the same pattern in the CAD/non-IRD and CAD/IRD groups.
CONCLUSIONS:
Our data do not support a link between inflammation and Lp(a) levels in CAD and in general Lp(a) levels were not correlated with other risk factors for cardiovascular disease.publishedVersio
Crystallized but not soluble uric acid elicits pro-inflammatory response in short-term whole blood cultures from healthy men
Get PDFSeveral epidemiological studies have pointed at serum uric acid (SUA) as an independent risk factor for mortality, diabetes, hypertension, cardiovascular and kidney disease; however, no clear pathogenic pathway is established. Uric acid (UA) crystals show pro-inflammatory properties and can thus create or contribute to the state of chronic low-grade inflammation, a widely accepted pathogenic mechanism in several of the above-mentioned pathologies. On the other hand, soluble uric acid possesses antioxidant properties that might attenuate inflammatory responses. We aimed to explore the net effects of experimentally rising SUA in human whole blood cultures on several mediators of inflammation. production of tNF-α, IL-1ß, IL-1RA, MCP-1 and IL-8 was assessed upon addition of 200 μM UA, 500 μM UA or monosodium urate (MSU) crystals in the presence or absence of 5 ng/ml lipopolysaccharide (LPS). RT-qPCR and multiplex bead based immunoassay were used to measure mRNA expression and cytokine release at 2 and 4 h of culture, respectively. 14C labeled UA was used to assess intracellular uptake of UA. We show that crystallized, but not soluble, UA induces production of pro-inflammatory mediators in human whole blood. Soluble UA is internalized in blood cells but does not potentiate or reduce LPS-induced release of cytokines.Crystallized but not soluble uric acid elicits pro-inflammatory response in short-term whole blood cultures from healthy menThe authors thank Gro Bolstad for technical assistance, Trine Kalstad for help with Bio-Plex multiplex analysis, Thomas Vennø Andreassen for advice and technical assistance, Knut Steinnes for technical assistance. The publication charges for this article have been funded by a grant from the publication fund of UiT - The Arctic University of Norway. The study has been funded by the UiT – The Arctic University of Norway and the Tromsø Research Foundation (grant nr 311333/A22349).publishedVersio
Tumor necrosis factor inhibitors are associated with reduced complement activation in spondylarthropathies: An observational study
Get PDFBackground The complement system is involved in pathogenesis of cardiovascular disease, and might play a role in accelerated atherogenesis in spondylarthropathies (SpA). Hence, we examined complement activation in SpA, and its relationship to antirheumatic treatment, inflammatory and cardiovascular markers. Methods From PSARA, a prospective observational study, we examined 51 SpA patients (31 psoriatic arthritis (PsA), and 20 ankylosing spondylitis (AS)), starting tumor necrosis factor (TNF) inhibitor alone (n = 25), combined with methotrexate (MTX) (n = 10), or MTX monotherapy (n = 16). Complement activation was determined by the soluble terminal complement complex (sC5b-9), inflammation by erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and endothelial function by finger plethysmography (Endopat) at baseline, after 6 weeks and 6 months of treatment. Results SpA patients had sC5b-9 levels at (PsA) or above (AS) the upper limit of the estimated reference range. Median sC5b-9 levels decreased significantly from baseline to 6 weeks, with no significant difference between the AS and PsA group. Notably, a significant reduction in sC5b-9 was observed after administration of TNF inhibitor ± MTX, whereas no significant changes were observed in patients treated with MTX alone. Between 6 weeks and 6 months, sC5b-9 remained stable across all subgroups. Reduction in sC5b-9 was independently related to decreased ESR and CRP, and to increased high density cholesterol and total cholesterol. Reduction in sC5b-9 from baseline to 6 weeks was associated with improved EF in age and gender adjusted analyses. Conclusion TNF-inhibition, but not MTX monotherapy, led to rapid and sustained reduction of complement activation in SpA. Thus, the observed decrease in cardiovascular morbidity in patients treated with TNF-inhibitors might be partly due to its beneficial effect on complement. Trial registration Clinical Trials (NCT00902005), retrospectively registered on the 14th of May 2009.Tumor necrosis factor inhibitors are associated with reduced complement activation in spondylarthropathies: An observational studyThe first author’s PhD scholarship is funded by The Norwegian Women’s Public Health Association, Grant 14902, URL: https://www. sanitetskvinnene.no/. Financial support to the complement analyses was kindly provided by The Norwegian Council on Cardiovascular Disease, The Odd Fellow Foundation and The Simon Fougner Hartmann Family Fund, URL: https:// nasjonalforeningen.no/, https://www.oddfellow.no/, and no webpage, respectively. The establishment of PSARA biobank was sponsored by Abbott Laboratories Norway - now Abbvie, URL: https:// www.abbvie.no/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscriptpublishedVersio
Postoperative treatment after partial nail ablation of ingrown toenails — does it matter what we recommend? A blinded randomised study
Get PDFTrial design: In this blinded randomized study we analyzed patient reported outcome of three different treatments after nail surgery. We compared daily footbath with either alkaline or acidic soap or just a simple bandage of gauze dressing. Method: After partial nail ablation surgery, patients were randomized into three postoperative treatment modalities. Outcome in terms of reduction in pain, improvement of function, reduction of signs of infection and postoperative soothing effect were reported after one and two weeks. A generalized linear mixed model was used to analyze possible statistical differences between the groups. Results: 97 patients, 57% women, mean age 31 years, were included. Men reported significantly less pain and better function than women. Despite a registered lower growth of invasive pathogenic microbes following the use of acidic soaps, this did not lead to less infections than in the groups using either alkaline soap baths or bandaging. On the contrary, patients keeping the bandage on had significantly lower signs of infection after one week. Two patients using soap baths had growth of MRSA. Two weeks postoperatively, all three treatment alternatives had similar patient reported outcome in all parameters, and nobody needed antibiotics. Conclusions: This prospective randomized study was unable to prove that footbath with either acidic or alkaline soap should be preferred to just leave the postoperative bandage on for a week after partial nail ablation. We recommend that postoperative advice should be given on an individual basis, especially since our study did not involve patients with high risk of infections. KEYWORDS: bandage; infection; ingrown toenail; pain; postoperative treatment; soapbathpublishedVersio
Microplastics; occurrence, levels and implications for environment and human health related to food. Scientific opinion of the Scientific Steering Committee of the Norwegian Scientific Committee for Food and Environment
Get PDFSummary
The steering committee of VKM has self-initiated a mandate for an opinion on microplastics based on recently published international and/or national reports complemented with literature from December 2016 to February 2019. The mandate requested a summary of the state of knowledge on the presence of microplastics in the environment and the implications for the ecosystem, terrestrial and aquatic organisms, food production and human health. An overview of main national and international ongoing initiatives was also requested, and highlighting of data gaps where specific Norwegian data was needed.
VKM appointed a working group consisting of two VKM members and eight external experts (two are former VKM-members), in addition to a project leader from the VKM secretariat to write the assessment.
Introduction
Microplastics are global contaminants and have been ubiquitously detected in water, atmosphere, sediments, soils, sewage sludge, biota, and foodstuff, primarily as a result of degradation and fragmentation of larger plastic debris (secondary microplastics). Fragmentation occurs as plastic debris turns brittle due to weathering, especially as a result of solar photodegradation. Due to a large variation in material composition and environmental conditions, the fragmentation kinetics and processes are poorly understood, so there are no reliable estimates of the time to embrittlement of different types of plastics. Nano- and microplastics originally manufactured to be that size (primary microplastics) contribute to a lesser extent. Plastics contain a mixture of chemicals added during manufacture and may also ab/adsorb and act as vectors for persistent, bioaccumulative and toxic contaminants (PBTs) and microorganisms from the environment.
Microplastics have been subject to several recent reviews and risk assessments from international authorities which address both potential environmental and human health effects. (EFSA Panel on Contaminants in the Food Chain (CONTAM) on the presence of nano- and microplastics in food, with particular focus on seafood in 2016 (Alexander et al., 2016), a technical paper on the status of knowledge on microplastics in fisheries and aquaculture from Food and Agriculture Organization of the United Nations (FAO) (Lusher et al., 2017b), and a scientific perspective on microplastics in nature and society (SAPEA, 2019)).publishedVersio
Factors associated with alcohol consumption and prescribed drugs with addiction potential among older women and men – the Nord-Trøndelag health study (HUNT2 and HUNT3), Norway, a population-based longitudinal study
Get PDFBACKGROUND:
Little is known about factors associated with alcohol consumption and use of drugs with addiction potential in older adults. The aim of this study was to explore the association between socio-demographic variables, physical and mental health and the later (11 years) use of frequent drinking, prescribed drugs with addiction potential and the possible combination of frequent drinking and being prescribed drugs with addiction potential in older adults (≥ 65 years).
METHODS:
In this longitudinal study, we used data from two surveys of the Nord-Trøndelag Health Study (HUNT2 1995-1997 and HUNT3 2006-2008), a population based study in Norway. We totally included 10,656 individuals (5683 women) aged 54 years and older when they participated in HUNT2. Frequent drinking was defined as drinking alcohol 4 days or more per week. Data on prescribed drugs with addiction potential were drawn from the Norwegian Prescription Database. Drugs with addiction potential were defined as at least one prescription of benzodiazepines, z-hypnotics or opioids during one year for a minimum of two consecutive years between 2005 and 2009.
RESULTS:
The typical frequent drinker in HUNT3 was younger, more educated, lived in urban areas, and reported smoking and drinking frequently in HUNT2 compared to the non-frequent drinker in HUNT3. The typical user of prescribed drugs with addiction potential in HUNT3 was an older woman who smoked and was in poor health, suffered from anxiety, had been hospitalized in the last 5 years and used anxiety or sleep medication every week or more often in HUNT2. The typical individual in HUNT3 with the possible combination of frequent drinking and being prescribed drugs with addiction potential had more education, smoked, drank frequently and used anxiety or sleep medication in HUNT2.
CONCLUSION:
Individuals who were identified as frequent drinkers in HUNT2 were more likely to be frequent drinkers in HUNT3, and to have the possible combination of frequent drinking and being prescribed drugs with addiction potential in HUNT3. Health care professionals need to be aware of use of alcohol among older adults using drugs with addiction potential.This project has been made possible by the Norwegian Extra Foundation for Health and Rehabilitation (https://www.extrastiftelsen.no/) through the Norwegian Council for Mental Health (http://www.psykiskhelse.no/) (2015/ FO5044). In addition, the project has been funded partly by the Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust (http:// www.aldringoghelse.no/). KT is a PhD fellow in this project and she received the funding. The funders had no role in the study design, data collection and analyses, decision to publish, or preparation of the manuscriptpublishedVersio
Exercise-induced laryngeal obstruction in athletes treated with inspiratory muscle training
Get PDFBackground:
Exercise-induced laryngeal obstruction (EILO) is common in athletes and presents with dyspnoea, chest tightness, inspiratory stridor and sometimes panic reactions. The evidence for conservative treatment is weak, but case reports suggest effects from inspiratory muscle training (IMT). We aimed to explore effects from IMT used in athletes with EILO.
Method:
Twenty-eight athletes, mean age 16.4 years, diagnosed with EILO at our clinic, participated in a 6-week treatment programme, using a resistive flow-dependent IMT device (Respifit S). Four athletes competed at international level, 13 at national and 11 at regional levels. Video-recorded continuous transnasal flexible laryngoscopy was performed from rest to peak exercise (continuous laryngoscopy exercise (CLE) test) and scored before and 2-4 weeks after the training period. Ergospirometric variables were obtained from this CLE set-up. Lung function was measured according to guidelines. Symptom scores and demographic variables were obtained from a questionnaire.
Results:
After the treatment period, symptoms had decreased in 22/28 (79%) participants. Mean overall CLE score had improved after treatment (p<0.001), with the scores becoming normal in five athletes but worse in two. Most of the improvement was explained by changes at the glottic laryngeal level (p=0.009). Ergospirometric variables revealed significantly higher peak minute ventilation explained by higher tidal volumes and were otherwise unchanged.
Conclusion:
This explorative study underlines the heterogeneous treatment response of EILO and suggests that IMT may become an efficient conservative treatment tool in subgroups, possibly contributing to better control of the vocal folds. The signals from this study should be tested in future controlled interventional studies.Funding Major funding institutions: Haukeland University Hospital and University of Bergen.publishedVersio
Evidence‐based practice integration in hospital wards—The complexities and challenges in achieving evidence‐based practice in clinical nursing
Get PDFAbstract: Aim: Exploring the processes involved in two different strategies to integrate evidence‐based practice into nursing practice. Design: Classical grounded theory methodology was used. Methods: Data were collected through 90 hr of observation and 4 focus groups among clinical nurses in two different hospital wards. Results: We identified a multidimensional evidence‐based practice integration framework that illuminates the complexities involved in the integration process. The dimensions were approaches to evidence‐based practice, positions of evidence‐based practice and levels of evidence‐based practice. The interactions between the dimensions gave five combinations; an explicit evidence‐based practice performed as a parallel to daily work at the systems level, an implicit evidence‐based practice integrated into daily work at the systems level, an explicit evidence‐based practice integrated into daily work at the individual level, an explicit evidence‐based practice integrated into daily work at the systems level and an implicit evidence‐based practice integrated into daily work at the individual level.Innlandet Hospital Trust, Norway funded the study.publishedVersio
Art of Learning – An Art-Based Intervention Aimed at Improving Children’s Executive Functions
Get PDFExecutive functions (EFs) can be conceptualized as a mean of behavioral self-regulation, and difficulties with EFs may adversely affect school success, social function, and cognitive and psychological development. Research about EFs and how they are affected by various educational and psychosocial factors is sparse. EFs are of great importance to understand how children can handle the challenges that they meet at various stages of development. There has been an increased focus on programs aimed at improving EFs, either as a primary outcome, or as a supplemental result of a specific activity. In this randomized controlled study, 66 children (31 girls, mean age 7:1 years) were given an arts and culture rich intervention (Art of Learning) aimed at improving EFs. EFs were assessed with the Behavior Rating Inventory of Executive Functioning-teacher version (BRIEF-teacher form) before, immediately after, and 6 months after intervention. Outcome in the intervention group was compared to children from two schools serving as controls (n = 37, 18 girls, mean age 7:3 years). In addition, teachers from intervention schools were also interviewed both individually and in focus groups. The results reveal that both groups improved their EFs, as measured with BRIEF, over time on the global executive composite (GEC) score, the metacognition index, and on behavioral regulation index (BRI). However, the intervention group displayed a significantly greater improvement than the control group on GEC and BRI. The teacher interviews reveal positive effects for the children when it comes to several aspects: collaboration, conflict management, inclusion, vocabulary, and confidence. These factors are regarded as important for EFs development and academic outcome. The results support the notion of best training transfer effects for tasks addressing global executive functioning and specifically behavioral regulation skills (BRI).The intervention was funded by Kulturtanken – Arts for Young Audiences in Norway and Oppland County Municipality.publishedVersio