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Prevention of progression in Parkinson’s disease
Get PDFEnvironmental influences affecting genetically susceptible individuals seem to contribute significantly to the development of Parkinson’s disease (PD). Xenobiotic exposure including transitional metal deposition into vulnerable CNS regions appears to interact with PD genes. Such exposure together with mitochondrial dysfunction evokes a destructive cascade of biochemical events, including oxidative stress and degeneration of the sensitive dopamine (DA) production system in the basal ganglia. Recent research indicates that the substantia nigra degeneration can be decelerated by treatment with iron binding compounds such as deferiprone. Interestingly compounds known to decrease PD risk including caffeine, niacin, nicotine and salbutamol also possess iron binding properties. Adequate function of antioxidative mechanisms in the vulnerable brain cells can be restored by acetylcysteine supplementation to normalize intracellular glutathione activity. Other preventive measures to reduce deterioration of dopaminergic neurons may involve life-style changes such as intake of natural antioxidants and physical exercise. Further research is recommended to identify therapeutic targets of the proposed interventions, in particular protection of the DA biosynthesis by oxygen radical scavengers and iron binding agents.Prevention of progression in Parkinson’s diseasepublishedVersio
Dermatologists across Europe underestimate depression and anxiety: results from 3635 dermatological consultations
Get PDFBackground: It was recently demonstrated that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. Studies have shown that physicians not trained as psychiatrists underdiagnose depression. This has not been explored among dermatologists.
Objectives: To estimate the concordance between clinical assessment of depression and anxiety by a dermatologist and assessment with the Hospital Anxiety and Depression Scale (HADS).
Methods: The study was an observational cross-sectional multicentre study of prevalent cases of skin diseases in 13 countries in Europe. Consecutive patients were recruited in outpatient clinics and filled in questionnaires prior to clinical examination by a dermatologist who reported any diagnosis of skin disease and signs of mood disorders.
Results: Analysis of the 3635 consultations showed that the agreement between dermatologist and HADS was poor to fair (lower than 0·4) for all diagnosis categories. The true-positive rate (represented by the percentage of dermatologists recognizing signs of depression or anxiety in patients with depression or anxiety as defined by a HADS value ≥ 11) was 44·0% for depression and 35·6% for anxiety. The true negative rate (represented by the percentage of dermatologists not detecting signs of depression or anxiety in non-depressed or non-anxious patients defined by HADS-value < 11) was 88.8% for depression and 85.7% for anxiety.
Conclusions: Dermatologists in Europe tend to underestimate mood disorders. The results suggest that further training for dermatologists to improve their skills in diagnosing depression and anxiety might be appropriate. When present, the psychological suffering of patients with dermatological conditions needs to be addressed.submittedVersio
Leisure-time physical activity among adolescents and subsequent use of antidepressant and hypnotic drugs: a prospective register linkage study
Get PDFIn this prospective study, the association between physical activity and subsequent use of antidepressant and hypnotic drug use in adolescents aged 15–16 years was examined. This study is based on information retrieved from the Norwegian Youth Health Surveys (2000–2003) and linked to prescription data from the Norwegian Prescription Database (2004–2013). In total, the study included 10711 participants with a participation rate of 87%. Adolescents were asked how many hours per week they spent on physical activity that made them sweat and/or be out of breath outside of school. Incident psychotropic drug use (outcome measure) was defined as ≥ 1 prescription of one of the following psychotropic drugs: hypnotics and antidepressants registered in the Norwegian Prescription Database. In the crude model for the time period 2004–2007, the odds of incident hypnotic use were lower for those who were physically active 1–2 h per week (OR 0.48–0.64), compared to those who were physically inactive (< 1 h per week). However, the association become non-significant 4-year post-baseline (2008–2010 and 2011–2013). In the crude model for the time periods 2004–2007, 2008–2010 and 2011–2013, the odds of incident antidepressant use were lower for physically active adolescents (2004–2007: OR 0.46–0.71, 2008–2010: OR 0.40–0.67 and 2011–2013: OR 0.37–0.58, compared to those who were physically inactive < 1 h. However, after adjustment for confounders, the association became non-significant in all time periods except in physical activity 5–7 and 8–10 h in the period 2008–2010. Physical activity does not indicate any association with later use of antidepressants, and the significant association with incident hypnotic drug use was for short-term follow-up only and disappeared on longer term follow-up periods. Given the scarcity of longitudinal studies examining the association between physical activity and mental health as well as psychotropic drug use among young people, the current study adds to previous research.Leisure-time physical activity among adolescents and subsequent use of antidepressant and hypnotic drugs: a prospective register linkage studypublishedVersio
A conservative weight loss intervention relieves bowel symptoms in morbidly obese subjects with irritable bowel syndrome: a prospective cohort study
Get PDFBackground:
Irritable bowel syndrome (IBS) is common in subjects with morbid obesity; the effect of weight loss programs on bowel symptoms is largely unknown.
Methods:
This prospective cohort study explored bowel symptoms, health scores, and biomarkers in subjects with morbid obesity during a six-month-long conservative weight loss intervention. Bowel symptoms were assessed with IBS-severity scoring system (IBS-SSS) and Gastrointestinal Symptom Rating Scale-IBS. Changes in all variables and associations between the changes in bowel symptoms and the other variables were analysed.
Results:
Eighty-eight subjects (81% females) were included. Body mass index was reduced from 42.0 (3.6) to 38.7 (3.5) (p < 0.001). IBS-SSS was reduced from 116 (104) to 81 (84) (p=0.001). In all, 19 out of 25 variables improved significantly. In subjects with and without IBS at inclusion, the improvement in IBS-SSS was 88 (95% CI 55 to 121) and 10 (95% CI -9 to 29), respectively. Improved bowel symptoms were associated with improved subjective well-being, sense of humour, and vitamin D and negatively associated with reduced body mass index.
Conclusion:
Body mass index and health scores improved during a conservative weight loss intervention. Subjects with IBS before the intervention had a clinically significant improvement in bowel symptomsThis project was funded by Innlandet Hospital Trust, Brumunddal, Norway.publishedVersio
Systemic exertion intolerance disease diagnostic criteria applied on an adolescent chronic fatigue syndrom cohort: evaluation of subgroup differences and prognostic utility
Get PDFObjective:
Existing case definitions for chronic fatigue syndrome (CFS) all have disputed validity. The present study investigates differences between adolescent patients with CFS who satisfy the systemic exertion intolerance disease (SEID) diagnostic criteria (SEID-positive) and those who do not satisfy the criteria (SEID-negative).
Methods:
120 adolescent patients with CFS with a mean age of 15.4 years (range 12-18 years) included in the NorCAPITAL project (ClinicalTrials ID: NCT01040429) were post-hoc subgrouped according to the SEID criteria based on a comprehensive questionnaire. The two subgroups were compared across baseline characteristics, as well as a wide range of cardiovascular, inflammatory, infectious, neuroendocrine and cognitive variables. Data from 30-week follow-up were used to investigate prognostic differences between SEID-positive and SEID-negative patients.
Results:
A total of 45 patients with CFS were SEID-positive, 69 were SEID-negative and 6 could not be classified. Despite the fact that clinically depressed patients were excluded in the NorCAPITAL project, the SEID-positive group had significantly higher score on symptoms suggesting a mood disorder (Mood and Feelings Questionnaire): 23.2 vs 13.4, difference 9.19 (95% CI 5.78 to 12.6). No other baseline characteristics showed any group differences. When accounting for multiple comparisons, there were no statistically significant differences between the groups regarding cardiovascular, inflammatory, infectious, neuroendocrine and cognitive variables. Steps per day and Chalder Fatigue Questionnaire at week 30 showed no differences between the groups.
Conclusion:
The findings question the discriminant and prognostic validity of the SEID diagnostic criteria in adolescent CFS, and suggest that the criteria tend to select patients with depressive symptoms.This study was funded by Health South-East Hospital Trust and the University of Oslo.publishedVersio
Parental severity assessment predicts supportive care in infant bronchiolitis
Get PDFAIM:
In infants with acute bronchiolitis, the precision of parental disease severity assessment is unclear. We aimed to determine if parental assessment at the time of hospitalisation predicted the use of supportive care, and subsequently determine the likelihood that the infant with acute bronchiolitis would receive supportive care.
METHODS:
From the Bronchiolitis ALL south-east Norway study, we included all 267, 0-12 month old, infants with acute bronchiolitis whose parents at the time of hospitalisation completed a three-item visual analogue scale (VAS) concerning Activity, Feeding and Illness. Respiratory rate, oxygen saturation (SpO2 ) and use of supportive care were recorded daily. By multivariate logistic regression analyses we included significant predictors available at hospital admission to predict the use of supportive care.
RESULTS:
The parental Activity, Feeding and Illness VAS scores significantly predicted supportive care with odds ratios of 1.23, 1.26 and 1.36, respectively. The prediction algorithm included parental Feeding and Illness scores, SpO2 , gender and age, with an area under the curve of 0.76 (95% CI 0.69, 0.81). A positive likelihood ratio of 2.1 gave the highest combined sensitivity of 81% and specificity of 61%.
CONCLUSION:
Parental assessment at hospital admission moderately predicted supportive care treatment in infants with acute bronchiolitis.
TRIAL REGISTRATION:
ClinicalTrials.gov NCT00817466.Funding source: The study received support in part by Medicines for Children, Pediatric department, Haukeland University hospital, Norway.acceptedVersio
Atraumatic (pencil-point) versus conventional needles for lumbar puncture: A clinical practice guideline
Get PDFIs the needle tip configuration important when
performing a lumbar puncture for any indication? A
systematic review published in the Lancet in December 2017 suggests that it is. The review found that
using atraumatic (pencil-point) lumbar puncture
needles instead of conventional lumbar puncture
needles reduced the risk of post-dural-puncture
headache and of return to hospital for additional
pain control.1
This guideline recommendation aims
to promptly and transparently translate this evidence
to a clinical recommendation, following standards
for GRADE methodology and trustworthy guidelines.2
The BMJ Rapid Recommendations panel makes a
strong recommendation for the use of atraumatic
needles for lumbar puncture in all patients regardless
of age (adults and children) or indication instead of
conventional needles.3 4 Box 1 shows the article and
evidence linked to this Rapid Recommendation. The
main infographic provides an overview of the absolute benefits and harms (although none were present
here) of atraumatic needles. Table 1 below shows any
evidence that has emerged since the publication of
this guideline.publishedVersio
Acceptability and Reliability of the Bayley Scales of Infant and Toddler Development-III Among Children in Bhaktapur, Nepal
Get PDFAbstract
Background: The Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) is the most widely used developmental assessment tool for infants and toddlers worldwide, but less is known about its psychometric properties and feasibility in low and middle-income countries. Aim: To assess the psychometric properties and feasibility of the Bayley-III when used in a large scale randomized controlled intervention trial in Nepal. Methods: The participating infants were part of a randomized, doubled blind, placebo-controlled trial to measure the efficacy of vitamin B12 supplementation on growth and neurodevelopment. A total of 600 children aged 6-11 months were enrolled and included for developmental assessment. The Bayley-III measures child development across five domains: cognition, receptive and expressive language, fine and gross motor skills. Some items were culturally adapted. To measure and ensure appropriate inter-observer agreement, standardization exercises were performed during the initial training, and double scoring of 7% of test sessions were conducted throughout the study by two examiners. Results: The inter-rater agreement was excellent for both the standardization exercises before the start of the study, and for the quality control throughout the study with intraclass correlation coefficient ranging from 0.95 to 0.99. The internal consistency measured by the Cronbach's alpha coefficient ranged between 0.57 and 0.87. The subtests raw scores as well as scaled scores were significantly correlated (p < 0.001). The means and SDs of the scaled scores compared with American norms were similar to the distribution in the American sample, with the exception of the receptive (Mean = 7.7, SD = 2.2) and expressive (Mean = 7.3, SD = 1.9) language subtests that were lower than the American norms. Conclusion: The inter-rater reliability between the scorers on the Bayley-III was excellent both during standardization and for the quality control. The distributions for the cognitive and motor subscales are comparable to the American norms, while caution is needed in the interpretation of the language scales. The results suggest that Bayley-III is a feasible tool for the assessment of neurodevelopmental status in nutritional studies in low resource settings such as Nepal. Cultural adaptations, training and standardization are prerequisites for a valid and reliable assessment using the Bayley-III.This work has been supported by the Thrasher Research fund (award 11512) and GC Rieber funds.publishedVersio
Raised serum levels of syndecan-1 (CD138), in a case of acute idiopathic systemic capillary leak syndrome (SCLS) (Clarkson's disease)
Get PDFBACKGROUND Systemic capillary leak syndrome (SCLS) (Clarkson's disease) is a rare disorder of unknown etiology, characterized by transient episodes of hypotension, and the microvascular leak of fluids into the peripheral tissues, resulting in edema. Between 80-90% of patients with SCLS have a concomitant monoclonal gammopathy. Although translational in vitro studies have implicated vascular endothelial barrier dysfunction in the etiology of SCLS, the etiology and disease associations in clinical cases remain unknown. CASE REPORT We report a case of SCLS in a 49-year-old woman who initially presented with an upper respiratory tract infection, which was complicated by edema and compartment syndromes in the extremities that required fasciotomies. Serum levels of the cell surface heparan sulfate proteoglycan, syndecan-1 (CD138), a measure of endothelial surface glycocalyx (ESG) damage, were measured by enzyme-linked immunoassay (ELISA), peaked at up to 500 ng/mL (reference range, 50-100 ng/mL) and normalized on disease remission. CONCLUSIONS This case report supports the view that damage to the microvascular endothelium, has a role in the pathogenesis of acute SCLS. This case also indicated that monitoring serum levels of syndecan-1 (CD138) might be used to monitor the progression and resolution of episodes of SCLS.publishedVersio
Consumption of energy drinks among adolescents in Norway: a cross-sectional study
Get PDFBackground Energy drink (ED) consumption is increasing all over the world. We sought to describe the consumption of EDs among adolescents in Norway, and to explore the determinants of daily and high consumption. Methods Population-based cross-sectional data were collected from a sample of 31,091 secondary school students in grade 8–13 aged 12–19 years. School grade, residency, socioeconomic status (SES), physical activity and leisure screen time were included in multiple regression analyses, in order to investigate their associations with daily and high (≥four times weekly) ED consumption. Results 52.3% of the respondents were ED consumers and 3.5% were high consumers. Boys consumed twice as much ED as girls (boys: 36.3 ml/day, girls: 18.5 ml/day, geometric means), and the proportion of male high consumers was 3.7-times higher than that of females. The adjusted odd ratio (OR) of upper secondary school (grades 11–13, ages 15–19) students being high ED consumers were higher than for lower secondary school (grades 8–10, ages 12–15) students (OR 1.1(confidence interval (CI):1.0–1.3)), as well as higher for rural than urban residents (OR 1.3 (CI: 1.1–1.5)). Gradients for the increased ORs of being a high ED consumer were found for decreased SES, decreased frequency of physical activity and increased daily leisure screen time. Conclusions More than half of the respondents reported that they were ED consumers. Daily and high consumption were independently associated with male gender, physical inactivity, high leisure screen time, low socioeconomic status and rural residency.Consumption of energy drinks among adolescents in Norway: a cross-sectional studyThe study was based on data from a survey conducted by Norwegian Social
Research (NOVA), in collaboration with the seven regional drug and alcohol
competence centres (KoRus), and was financed by the Norwegian
Directorate of Health, the Ministry of Children, Equality and Social Inclusion
and the Ministry of Justice. Naim Degirmenci and Ingrid Nesdal Fossum were
funded through research grants upon application to the Innlandet Hospital
Trust. None of the funding bodies were involved in the design of the study,
collection, analyses or interpretation of the data or in the writing of the
manuscript.publishedVersio