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Assessment of vitamin B6 status in never-pregnant, pregnant and postpartum women and their infants
Get PDFPurpose: Pyridoxal 5´-phosphate (PLP) is the main form of vitamin B6 in humans and functions a coenzyme for more than 160 different enzymatic reactions. The purpose of the study was to find plasma PLP concentrations, which ensure an optimal vitamin B6 status determined by a metabolic marker, in never-pregnant, pregnant and lactating women and their infants.
Methods: In an observational, prospective study, plasma PLP and the metabolic marker, HKr (hydroxykynurenine/(kynurenic acid + anthranilic acid + xanthurenic acid + hydroxyanthranilic acid) were assessed in women (n = 114) from pregnancy week 18 to 6 months postpartum and related to infant status. Never-pregnant women 18-40 years (n = 127) were included as controls.
Results: Compared to controls, plasma PLP decreased during pregnancy and increased postpartum, while HKr increased from week 18 to 6 weeks postpartum, indicating maternal vitamin B6 insufficiency during this period. In never-pregnant women, HKr increased gradually with plasma PLP < 100 nmol/L, and in pregnancy week 28 a sharp increase in HKr was seen at plasma PLP < 30 nmol/L. Despite correcting for maternal vitamin B6 status, infant median plasma PLP decreased with months of exclusive breastfeeding.
Conclusions: Plasma PLP and kynurenine concentrations differ substantially between never-pregnant, pregnant and postpartum women and infants. A plasma PLP concentration in the range of 50-100 nmol/L seems to ensure an optimal vitamin B6 status for never-pregnant women, whereas a plasma PLP > 30 nmol/L in pregnancy week 28 ensures an adequate vitamin B6 status during pregnancy and lactation. Infant vitamin B6 status at age 6 months is inversely correlated to number of months of exclusive breastfeeding.publishedVersio
Impact of the COVID-19 pandemic on daily life and worry among mothers in Bhaktapur, Nepal
Get PDFThe COVID-19 pandemic has affected many aspects of daily life worldwide, but the impact may be higher for impoverished populations. The main aim of this study is to describe the impact of the COVID-19 pandemic on different aspects of daily life in mothers in Nepal. We included 493 mothers of children aged 54–71 months participating in a randomized controlled trial on vitamin B12 supplementation. Mothers answered questions regarding the exposure and impact of the pandemic on their daily lives, and pandemic-related worries and sleep problems. We examined the extent to which worry, and sleep problems differed between mothers according to their exposure to COVID-19, socioeconomic status, and previous symptoms of depression. The mean age (SD) of the mothers was 32.3 (4.6) years and 54% had education below the secondary level. Of the mothers, 5.4% had either been exposed to someone who had tested positive or who had a family member with COVID-19. One-third of the participants responded that the pandemic had affected their economic situation, employment, and family life to a great deal. Both mothers and fathers with educational levels above 10 years or households with higher socioeconomic status had significantly higher average worry scores (maternal p = 0.020 and paternal p = 0.005). Mothers with a history of symptoms of depression had significantly more worry-related sleep problems during the pandemic (p = 0.020) than those without a history of depressive symptoms. Our study underlines the negative impact of the COVID-19 pandemic on diverse aspects of everyday life of mothers in Nepal.This study was funded by grants from the Innlandet Hospital Trust, the Thrasher Research Fund (award # 11512), and the South-Eastern Norway Regional Health Authority (grant # 2012090). TAS reports funding from the South-Eastern Norway Regional Health Authority (grant # 2012090), MU from Thrasher Research Fund (award # 11512), and CS from the Research Council of Norway through a grant to Centre for Intervention Science in Maternal and Child Health (CISMAC) for conducting this research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.publishedVersio
Incidental dural tears associated with worse clinical outcomes in patients operated for lumbar spinal stenosis
Get PDFoai:sihf.brage.unit.no:11250/3067283Study design: Retrospective cohort study.
Objective: Incidental dural (ID) tear is a common complication of spine surgery with a prevalence of 4-10%. The association between ID and clinical outcome is uncertain. Former studies found only minor differences in Oswestry Disability Index (ODI). We aimed to examine the association of ID with treatment failure after surgery for lumbar spinal stenosis (LSS).
Methods: Between 2007 and 2017, 11,873 LSS patients reported to the national Norwegian spine registry (NORspine), and 8,919 (75.1%) completed the 12-month follow-up. We used multivariate logistic regression to study the association between ID and failure after surgery, defined as no effect or any degrees of worsening; we also compared mean ODI between those who suffered a perioperative ID and those who did not.
Results: The mean (95% CI) age was 66.6 (66.4-66.9) years, and 52% were females. The mean (95% CI) preoperative ODI score (95% CI) was 39.8 (39.4-40.1); all patients were operated on with decompression, and 1125 (12.6%) had an additional fusion procedure. The prevalence of ID was 4.9% (439/8919), and the prevalence of failure was 20.6% (1829/8919). Unadjusted odds ratio (OR) (95% CI) for failure for ID was 1.51 (1.22-1.88); p < 0.001, adjusted OR (95% CI) was 1.44 (1.11-1.86); p = 0.002. Mean postoperative ODI 12 months after surgery was 27.9 for ID vs. 23.6 for no ID.
Conclusion: We demonstrated a significant association between ID and increased odds for patient-reported failure 12 months after surgery. However, the magnitude of the detrimental effect of ID on the clinical outcome was small.publishedVersio
A Retrospective Evaluation of the Predictive Value of Newborn Screening for Vitamin B12 Deficiency in Symptomatic Infants Below 1 Year of Age
Get PDFBackground: The sensitivity of newborn screening (NBS) in detecting infants that later develop symptomatic vitamin B12 deficiency is unknown. We evaluated the predictive value using NBS algorithms in detecting infants that later were clinically diagnosed with symptomatic B12 deficiency. Furthermore, we investigated whether being born in a hospital using nitrous oxide (N2O) as pain relief in labor may have had an impact on total homocysteine at NBS. Methods: We retrospectively retrieved NBS data and analyzed total homocysteine, methylmalonic acid and methyl citrate on stored NBS dried blood spots (DBS) of 70 infants diagnosed with symptomatic B12 deficiency and compared them to 646 matched and 434 unmatched DBS controls to evaluate the Austrian and Heidelberg B12 NBS algorithms. Results: The sensitivity of NBS in detecting infants later diagnosed with symptomatic B12 deficiency at median age 10.9 weeks was ≤10%. Total homocysteine was higher in DBS for the unmatched controls who were born in hospitals providing N2O compared to in hospitals not providing N2O, with median total homocysteine 4.0 µmol/L compared to 3.5 µmol/L (n = 434, 95% CI 0.04-0.87, p = 0.03). Conclusion: NBS algorithms were unable to identify most infants diagnosed with symptomatic B12 deficiency after the neonatal period. Being born in hospitals providing N2O may impact total homocysteine at NBS. Keywords: homocysteine; infant; newborn screening; nitrous oxide; second-tier; vitamin B12; vitamin B12 deficiency. © 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
The burden of somatic diseases among people with alcohol- and drug use disorders are influenced by mental illness and low socioeconomic status. A registry-based cohort study in Norway
Get PDFObjectives: Persons with alcohol use disorder (AUD) and drug use disorder (DUD) have a lower life expectancy than the general population. We examined the burden of somatic diseases among persons with AUD or DUD and investigated impact of socioeconomic status (SES) and mental health disorders on the co-occurrence of somatic diseases in these groups.
Methods: We performed a retrospective, register-based cohort study with a 6-year follow-up of persons (aged ≥18 y) with AUD (13,478) or DUD (16,659). Cox regression analyses were used to estimate hazard ratios (HRs) of somatic diseases.
Results: Patients with DUD were, on average, 10 years younger at the point of diagnosis than patients with AUD. Mental illnesses were prominent in both groups (AUD: 40.5%, and DUD: 46.9% vs 3.5% in controls). Adjusting for mental disorders, the risk of all somatic diseases among the AUD and DUD groups was reduced by 30%. Some of the elevated risk of somatic diseases among persons with AUD and DUD is explained by low SES, though less than that explained by the presence of mental disorders. The diseases with highest risk among AUD patients were metabolic disorders (16.9-fold) and hypertension (14.8-fold), and among AUD patients, viral hepatitis (23.3-fold), after adjusting for low SES and mental disorders.
Conclusions: Persons with AUD had a higher risk of most somatic diseases, while those with DUD had specific risks for infections and viral hepatitis. Mental health disorders and SES adjusted the associations regarding most somatic diseases. In general, improvement of socio-economic conditions, preferably in combination with professional support to self-manage mental health problems, will reduce the risk of somatic illness in both groups. For DUD patients, available sterile user equipment will reduce the risk of viral hepatis.publishedVersio
Beyond Wellness Monitoring: Continuous Multiparameter Remote Automated Monitoring of Patients
Get PDFThe pursuit of more efficient patient-friendly health systems and reductions in tertiary health services use has seen enormous growth in the application and study of remote patient monitoring systems for cardiovascular patient care. While there are many consumer-grade products available to monitor patient wellness, the regulation of these technologies varies considerably, with most products having little to no evaluation data. As the science and practice of virtual care continues to evolve, clinicians and researchers can benefit from an understanding of more comprehensive solutions capable of monitoring multiple biophysical parameters (eg, oxygen saturation, heart rate) continuously and simultaneously. These devices, herein referred to as continuous multiparameter remote automated monitoring (CM-RAM) devices, have the potential to revolutionise virtual patient care. Through seamless integration of multiple biophysical signals, CM-RAM technologies can allow for the acquisition of high-volume big data for the development of algorithms to facilitate early detection of negative changes in patient health status and timely clinician response. In this article, we review key principles, architecture, and components of CM-RAM technologies. Work to date in this field and related implications are also presented, including strategic priorities for advancing the science and practice of CM-RAM. Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.publishedVersio
The Role of Tryptophan Dysmetabolism and Quinolinic Acid in Depressive and Neurodegenerative Diseases
Get PDFEmerging evidence suggests that neuroinflammation is involved in both depression and
neurodegenerative diseases. The kynurenine pathway, generating metabolites which may play a role
in pathogenesis, is one of several competing pathways of tryptophan metabolism. The present article
is a narrative review of tryptophan metabolism, neuroinflammation, depression, and neurodegenera tion. A disturbed tryptophan metabolism with increased activity of the kynurenine pathway and
production of quinolinic acid may result in deficiencies in tryptophan and derived neurotransmit ters. Quinolinic acid is an N-methyl-D-aspartate receptor agonist, and raised levels in CSF, together
with increased levels of inflammatory cytokines, have been reported in mood disorders. Increased
quinolinic acid has also been observed in neurodegenerative diseases, including Parkinson’s disease,
Alzheimer’s disease, amyotrophic lateral sclerosis, and HIV-related cognitive decline. Oxidative
stress in connection with increased indole-dioxygenase (IDO) activity and kynurenine formation
may contribute to inflammatory responses and the production of cytokines. Increased formation of
quinolinic acid may occur at the expense of kynurenic acid and neuroprotective picolinic acid. While
awaiting ongoing research on potential pharmacological interventions on tryptophan metabolism, ad equate protein intake with appropriate amounts of tryptophan and antioxidants may offer protection
against oxidative stress and provide a balanced set of physiological receptor ligands.publishedVersio
A systematic review of social support for siblings of children with neurodevelopmental disorders
Get PDFBackground Social support is a protective factor for siblings of children with neurodevelopmental disorders. Aims We reviewed studies on social support received by siblings of children with neurodevelopmental disorders. Methods and procedures We conducted a pre-registered systematic review (CRD42020207686), searching PsycINFO, MEDLINE, Web of Science, and Scopus. Outcomes and results Fifteen articles were eligible for the review, 13 of which used cross-sectional designs. Two studies investigated sibling social support after an intervention. Multiple variables were negatively related to social support (e.g., sibling depression, loneliness, stress). Variables that were positively related to social support included prosocial behavior, competence (academic, social, and activity-related), problem-focused coping, and family quality of life. Potential moderators of the relationship between social support and psychosocial adjustment included the type of disorder of the affected sibling and the type of social support provider. We conclude with an overview of the reliability and validity of the seven social support measurements used across the studies. Conclusions and implications Lower levels of social support are associated with more negative psychosocial adjustment among siblings of children with neurodevelopmental disorders. We encourage future researchers to further investigate ways to increase social support for siblings to improve outcomes. Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.A systematic review of social support for siblings of children with neurodevelopmental disorderspublishedVersio
Direction- and Angle-Assisted Buttonhole Cannulation of Arteriovenous Fistula in Hemodialysis Patients: A Multicenter Randomized Controlled Trial
Get PDFRationale & objective: Arteriovenous fistula cannulation with the buttonhole technique is often preferred by patients but has been associated with an increased infection risk. Guidelines disagree on whether it should be abandoned, thus we assessed a technologically simple method to facilitate gentler arteriovenous fistula cannulation with potentially less discomfort and damage to the epithelial lining of the buttonhole tract. Study design: 8-week, prospective, open-label, randomized controlled trial. Setting & participants: Patients with buttonhole tracts receiving hemodialysis at 7 dialysis centers in Norway were randomized to the intervention group (43 patients, 658 cannulations) or control group (40 patients, 611 cannulations). Intervention: Direction and angle of the established buttonhole tract were marked on the forearm skin in the intervention group, whereas the control group had no structured cannulation information system. Outcomes: The primary outcome was successful cannulation, defined as correct placement of both blunt needles at the first attempt without needing to change needles, perform extra perforations, or reposition the needle. The secondary outcomes were patient-reported difficulty of cannulation (verbal rating scale: 1 = very easy, 6 = impossible) and intensity of pain (numeric rating scale: 0 = no pain, 10 = unbearable pain). Results: After a 2-week run-in period, successful cannulation was achieved in 73.9% and 74.8% of the patients in the intervention and control groups, respectively (relative risk [RR], 0.99; 95% CI, 0.87-1.12; P = 0.85). However, the probability of a difficult arterial cannulation (verbal rating scale, 3-6) was significantly lower in the intervention group (RR, 0.69; 95% CI, 0.55-0.85; P = 0.001). There were no improvements for venous cannulations. Furthermore, the probability of a painful cannulation (numeric rating scale, 3-10) was lower in the intervention group (RR, 0.72; 95% CI, 0.51-1.02; P = 0.06). Limitations: Unable to evaluate hard end points such as infections and thrombosis owing to the small sample size. Conclusions: Marking direction and angle of cannulation did not improve cannulation success rates; however, patients more often reported an unproblematic procedure and less pain. Funding: None. Trial registration: ClinicalTrials.gov (NCT01536548).publishedVersio
Vold, overgrep, utelatt helsehjelp, forsømmelser og aggresjon: Begrepsbruk i en norsk sykehjemskontekst
Get PDFVold, overgrep, utelatt helsehjelp, forsømmelser og aggresjon er begreper som beskriver uønskede hendelser i syke hjem. Samtidig er det ingen enhetlig oppfatning av hvordan disse begrepene forstås eller brukes. I denne artikkelen ser
vi nærmere på de mest brukte begrepene og hva som kan være en hensiktsmessig begrepsbruk som er gjenkjennbar
både i forskning og praksis. Begrepsavklaring er viktig fordi det former synet og holdningene til beboerne, de ansatte
og sykehjemmet. Beboere i norske sykehjem har sammensatte behov, og sykehjemmet er en svært kompleks organi sasjon. Kompleksitetsteorien og den kontekstuelle teorien om overgrep vektlegger at multifaktorielle og komplekse
fenomener må forstås gjennom kontekstuell kunnskap. Hver hendelse av overgrep, utelatt helsehjelp og aggresjon
krever en bred tilnærming og utredning utover individuelle egenskaper hos beboeren eller den ansatte. Vi foreslår en
begrepsbruk hvor vi skiller mellom begrepene, og beskriver det som faktisk skjer, for å unngå å bruke fellesbetegnelser
for mange ulike hendelser. Vi anbefaler også at begreper med stor negativ og normativ valør, som vold og forsømmel ser som sekkebetegnelser, bør unngås, spesielt der en antyder en individuell intensjon om å skade.publishedVersio