RESUMO
BACKGROUND: Gaming has become an integrated part of life for children and adults worldwide. Previous studies on the impact of gaming on biochemical parameters have primarily addressed the acute effects of gaming. The literature is limited, and the study designs are very diverse. The parameters that have been investigated most thoroughly are blood glucose and cortisol. OBJECTIVE: This exploratory study is the first to investigate the effects of long gaming sessions on the biochemical parameters of healthy male adults. The extensive testing allowed us to observe short-term changes (within 6 hours), long-term changes during the duration of the gaming sessions, and follow-up after 1 week to determine whether any changes were longer lasting. METHODS: In total, 9 experienced gamers completed 2 back-to-back 18-hour gaming sessions interspersed with a 6-hour rest period. All participants adhered to a structured sleep pattern due to daytime employment or attending university. Blood, saliva, and urine samples were collected from the participants every 6 hours. Linear mixed-effect models were used to analyze the repeated-measures data accumulated during the study. A total of 51 biochemical parameters were investigated. RESULTS: In total, 12 of the 51 biochemical parameters significantly changed during the study: alkaline phosphatase, aspartate aminotransferase, bilirubin, chloride, creatinine, glucose, hemoglobin, immature reticulocyte fraction, lactate, methemoglobin, sodium, and thrombocytes. All changes were within the normal range. The mean glucose level of the participants was 4.39 (SD 0.07) mmol/L at baseline, which increased significantly by 0.24 (SD 0.07) mmol/L per 6 hours during the first period and by 0.38 (SD 0.07) mmol/L per 6 hours in the second period (P<.001). The glucose levels during the second session increased even though the participants had little energy intake. Cortisol levels did not change significantly, although the cortisol pattern deviated from the typical circadian rhythm. During both gaming sessions, we observed increasing cortisol levels from 6 AM until noon. The participants were relatively dehydrated at the start of the study. The patients were asked to fast before the first blood sampling. Within the first 6 hours of the study, the participants rehydrated, followed by relative dehydration during the remainder of the study. This pattern was identified using the following parameters: albumin, creatinine, hemoglobin, erythrocytes, potassium, and platelets. CONCLUSIONS: This study is the first of its kind, and many of the analyses in the study yielded novel results. The study was designed to emulate the behavior of gamers during the weekend and other long gaming sessions. At this point, we are not able to determine the difference between the effects of gaming and behavior during gaming. Regardless, the results of this study suggest that healthy gamers can partake in long gaming sessions, with ample amounts of unhealthy foods and little rest, without acute impacts on health.
RESUMO
BACKGROUND: Recent studies have shown that anticholinergic medications are associated with cardiovascular disease. Little is known about how discontinuation of anticholinergic medication affects this association. We investigated how baseline anticholinergic load and change in anticholinergic load associates with major adverse cardiovascular events (MACE) on four different scales. METHODS: We included all geriatric outpatients aged 65 and older in Denmark between January 2011 and December 2018. Data were sourced from Danish national registries. Anticholinergic drug exposure was assessed at first contact to the outpatient clinic (baseline) and changes were assessed at 180 days after outpatient contact. Anticholinergic scales were the CRIDECO Anticholinergic Load Scale, Anticholinergic Drugs Scale, Anticholinergic Cognitive Burden and a scale by the Danish Institute of Rational Pharmacotherapy. Multivariate analyses were conducted to investigate the 1- and 5-year risk of MACE by baseline anticholinergic load and changes in anticholinergic load after 180 days. RESULTS: We included a total of 64 378 patients in the analysis of baseline anticholinergic load and 54 010 patients remained after 180 days for inclusion in the analysis of change in anticholinergic load. At baseline the mean age was 81.7 year (SD 7.5) and 68% were women. Higher level of anticholinergic load on any scale associated with greater risk of MACE in a dose response pattern. There were no association between reduction in anticholinergic load and risk of MACE. CONCLUSION: While anticholinergic load at baseline was associated with MACE, reducing anticholinergic load did not lower the risk of MACE indicating the association may not be causal.
Assuntos
Doenças Cardiovasculares , Antagonistas Colinérgicos , Sistema de Registros , Humanos , Antagonistas Colinérgicos/efeitos adversos , Feminino , Masculino , Idoso de 80 Anos ou mais , Dinamarca/epidemiologia , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/induzido quimicamente , Fatores de Risco de Doenças Cardíacas , Medição de Risco , Pacientes Ambulatoriais/estatística & dados numéricos , Avaliação Geriátrica/métodos , Estudos de CoortesRESUMO
INTRODUCTION: Older adults are susceptible to anticholinergic effects. Dysphagia and pneumonia are associated with anticholinergic usage, though a definitive causative relationship has not been established. There is no effective way to predict the prognosis of older adults with pneumonia; therefore, this study investigates the predictive value of anticholinergic burden. METHODS: Patients aged 65 years and above admitted for community-acquired pneumonia from 2011 to 2018 in Denmark were included through Danish registries. We calculated anticholinergic drug exposure using the CRIDECO Anticholinergic Load Scale (CALS). The primary outcome was in-hospital mortality, and other outcomes included intensive care unit admission, ventilator usage, length of stay, 30-day/90-day/1-year mortality, institutionalisation, home care utilisation and readmission. RESULTS: 186,735 patients were included in the in-hospital outcome analyses, 165,181 in the readmission analysis, 150,791 in the institutionalisation analysis, and 95,197 and 73,461 patients in the home care analysis at follow-up. Higher CALS score was associated with higher in-hospital mortality, with a mean risk increasing from 9.9% (CALS 0) to 16.4% (CALS >10), though the risk plateaued above a CALS score of 8. A higher CALS score was also associated with greater mortality after discharge, more home health care, more institutionalizations and higher readmission rates. CONCLUSIONS: High anticholinergic burden levels were associated with poor patient outcomes including short-/long-term mortality, dependence and readmission. It may be useful to calculate the CALS score on admission of older patients with pneumonia to predict their prognosis. This also highlights the importance of avoiding the use of drugs with a high anticholinergic burden in older patients.
Assuntos
Antagonistas Colinérgicos , Pneumonia , Humanos , Idoso , Antagonistas Colinérgicos/efeitos adversos , Hospitalização , Alta do Paciente , Pneumonia/diagnóstico , Dinamarca/epidemiologiaRESUMO
BACKGROUND: The Minimal Eating Observation Form - Version II (MEOF-II) is a brief and easy to use screening tool for eating difficulties, that is psychometrically robust. The aim of this study was to explore convergent (measuring similar constructs) and discriminant (measuring somewhat different constructs) validity of the MEOF-II to other validated dysphagia specific, activity and participation related instruments. METHODS: In this cross-sectional study, participants (n = 100, mean age 72, n = 42 women), diagnosed with either chronic pulmonary disease, Parkinson´s disease, Multiple Sclerosis, or stroke were recruited from rehabilitation centres. Patient-reported outcomes and clinical-rated assessments, capturing eating ability in general and swallowing in specific, included: The Dysphagia Handicap Index (DHI), the 4-question test (4QT), the Minimal Eating Observation Form - II, the Volume - Viscosity Swallow Test (V-VST), Flexible Endoscopic Evaluation of Swallowing (FEES) documented according to the Penetration-Aspiration Scale (PAS). Type of oral intake was documented using the Functional Oral Intake Scale (FOIS). Activities in daily living was assessed with Barthel index (BI). Spearman's correlation coefficient was used to analyze associations. The MEOF-II total score was hypothesised to have moderate correlations (r ≥ 0.3) with the other assessments, besides with PAS and FOIS (weak correlations, r < 0.3). RESULTS: In total 78 participants had any type of eating difficulties (MEOF-II), 69 reported dysphagia (4QT), 62 had dysphagia according to V-VST, 29 showed evidence of penetration/aspiration (PAS), and 31 participants had decreased oral intake ability (FOIS). The MEOF-II total score had moderate correlations with DHI, BI, 4QT, V-VST volume, and weak correlations with V-VST dysphagia and viscosity, PAS, and FOIS. Comparing a prior hypothesised correlation strengths against empirical findings showed that 83% of the hypothesised correlations were correct. CONCLUSIONS: The MEOF-II is a holistic and objective screening tool that can indicate the need for further assessment and corresponds well with the persons' subjective experiences. MEOF-II does not specifically assess the risk for penetration/aspiration.
Assuntos
Transtornos de Deglutição , Doença de Parkinson , Humanos , Feminino , Idoso , Estudos Transversais , Transtornos de Deglutição/diagnóstico , Deglutição , Medidas de Resultados Relatados pelo PacienteRESUMO
BACKGROUND: Food bolus obstruction (FBO) leading to hospital treatment is often associated with eosinophilic oesophagitis (EoE), stenosis, or oesophageal cancer (1). Danish national guidelines recommend that patients with FBO undergo a diagnostic upper endoscopy within two weeks of presentation to exclude possible malignancy, and histological evaluation of eight biopsies (2, 3). AIMS: The aims of this study were to (1) report the incidence and describe the causes and treatment of FBO in the North Denmark Region (NDR), (2) determine the proportion of patients who underwent upper endoscopy and biopsy according to regional and national guidelines, and (3) identify International Classification of Diseases 10th Revision (ICD-10) diagnosis and procedure codes applied to the hospital visits due to FBO in the NDR. METHODS: Among all acute hospital visits in the NDR in 2021, all visits with ICD-10 codes possibly reflecting FBO, as well as a random sample of 14,400 visits with unspecific ICD-10 codes (R and Z codes), were screened manually for possible FBO. Diagnosis, follow-up, and treatment of all patients with FBO were recorded. RESULTS: The median patient age was 66.0 (Q1-Q3: 49.8-81.0) years, and half of the patients had experienced FBO before. Two thirds of patients (66.0%) were never diagnosed with a cause of FBO, followed by 17.3% with EoE. 30% of patients did not undergo upper endoscopy within two weeks of the hospital visit, and 50.7% were never biopsied in the oesophagus. Of 1886 hospital visits with registry ICD-10 codes that possibly reflected FBO, 8.4% were due to FBO, while FBO was present in 0.028% of the random sample of unspecific ICD-10 codes. CONCLUSIONS: Most hospitalized FBO patients in the NDR in 2021 were never diagnosed with a cause. In these patients there is a high risk of overlooked EoE or upper gastrointestinal cancers. The area needs immediate focus and changed routines to improve treatment and prevent new FBO.
Assuntos
Esofagite Eosinofílica , Estenose Esofágica , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Esofagite Eosinofílica/complicações , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/epidemiologia , Estenose Esofágica/diagnóstico , Estenose Esofágica/epidemiologia , Estenose Esofágica/etiologia , Dinamarca/epidemiologiaRESUMO
OBJECTIVE: Interpreting thyroid function tests can be challenging due to inherent variation, and the need for tests rises with age. While age-related changes in thyrotropin (TSH) levels are known, the biological variation in older adults remains unclear. DESIGN: We recruited nineteen 65-99-year-old (older adults) without thyroid disease for monthly blood sampling for 1 year. PATIENTS AND MEASUREMENTS: Serum was stored at -20C°, and TSH, total thyroxine (TT4) and total triiodothyronine (TT3) were analysed in random order in a single batch for each participant. Results were compared to test results from 15 euthyroid men aged 24-53 years (younger adults) collected previously using a similar methodology. RESULTS: Interindividual coefficients of variation in older/younger adults were 46.7%/44.0% for TSH, 12.7%/19.5% for TT4 and 14.6%/22.4% for TT3. Intraindividual coefficients of variation (CVI ) were 19.0%/25.4% for TSH, 5.5%/10.8% for TT4 and 6.9%/13.2% for TT3. The index of individuality was below 0.6 for all hormones in all age groups. The number of samples required to determine the homoeostatic set-point at 10% precision in older adults was 14-21 for TSH and 2 for TT4 and TT3. TT4 in older adults was the only parameter in any group with comparable CVI between individuals (p = .22). CONCLUSIONS: CVI for TT4 and TT3 was halved in older compared to younger adults with two tests of TT4 needed to describe the individual set-point. Similar CVI between older adults caused TT4 to provide a reliable estimate of thyroid function, and the added value of measuring thyroxine could improve clinical practice.
Assuntos
Testes de Função Tireóidea , Tiroxina , Masculino , Humanos , Idoso , Tri-Iodotironina , TireotropinaRESUMO
BACKGROUND: Anaemia is common following hip fracture in ortho-geriatric patients and is associated with postoperative infections.. This study investigated whether intravenous iron supplements reduced the rate of postoperative infections within 30 days postoperatively in older adults after hip fracture surgery. METHODS: This observational study included 198 ortho-geriatric patients July 2018-May 2020. In May 2019 a local guideline was implemented and recommended II therapy on the 3rd postoperative day if haemoglobin concentration was < 6.5 mmol/L after hip fracture surgery. RESULTS: The patients were divided into four treatment groups: blood transfusion (n = 44), IV iron (n = 69), blood transfusion + IV iron (n = 35) and no treatment (n = 50). The number of patients who had an infection within 30 days was similar in the two time periods (38.8% before vs. 38.9% after systematic I.V. iron supplementation, P = 1.00) and no significant difference according to risk of infection was found between treatment groups. CONCLUSION: This study documents no effect of intravenous iron supplements on postoperative infections in older adults after hip fracture surgery. TRIAL REGISTRATION: The study was registered with the Danish Data Protection Authority (2008-58-0028) the 2th of September 2019.
Assuntos
Anemia , Fraturas do Quadril , Humanos , Idoso , Ferro , Anemia/tratamento farmacológico , Anemia/epidemiologia , Anemia/etiologia , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologiaRESUMO
PURPOSE: Thyroid deficiency may reduce mortality in older adults, but older adults prioritize independence over merely staying alive. We investigated the association between thyroid dysfunction and nursing home admission and all-cause mortality in community-dwelling older adults over 80. METHODS: We conducted a retrospective population-based open cohort study using data from laboratory registries covering 75% of Denmark supplemented by national registries. We included all community-dwelling older adults over 80 years with a first TSH measurement between 1996 and 2019. Participants with prior thyroid disorders or medication affecting the thyroid were excluded. Participants were followed from inclusion until nursing home admission, death or loss to follow-up due to emigration. RESULTS: We included 272,495 participants at baseline. Median follow-time was 3.71 years in analyses of nursing home admissions and 4.00 years for all-cause mortality. Hypothyroidism was associated with lower nursing home admission (TSH 5-10 mIU/l: HR 0.85, 95% CI: 0.80-0.91, P < 0.001); TSH >10 mIU/l HR 0.68, 95% CI: 0.54-0.85, P = 0.001) and with reduced all-cause mortality (TSH >10 mIU/l: HR 0.81, 95% CI: 0.70-0.93, P = 0.002). The association between hyperthyroidism and nursing home admission was of little clinical significance while hyperthyroidism was associated with increased all-cause mortality hazard both for low (HR 1.16, 95% CI 1.13-1.19, P < 0.001) and suppressed (HR 95% CI: 1.14 1.07-1.21, P < 0.001) TSH. CONCLUSION: Hypothyroidism is associated with a reduced nursing home admission hazard and to a lesser extent all-cause mortality in community-dwelling adults over 80 years, while hyperthyroidism is associated with increased all-cause mortality but not hazard of nursing home admission.
Assuntos
Hipertireoidismo , Hipotireoidismo , Humanos , Estudos de Coortes , Hipertireoidismo/complicações , Hipotireoidismo/complicações , Vida Independente , Casas de Saúde , Estudos Retrospectivos , Fatores de Risco , Tireotropina , Idoso de 80 Anos ou maisRESUMO
OBJECTIVE: To establish a generally accepted Danish definition of dysphagia to enhance collaboration across sectors and professions. METHODS: The study was initiated by a multi-professional group of experienced researchers and board members of the Danish Society for Dysphagia. We used a modified Delphi methodology to achieve consensus among experienced health care professionals from different professions and contexts. The initial stage consisted of a literature search leading to the draft of different definitions followed by two Delphi rounds between professionals and a stakeholder consultation round. RESULTS: We conducted two Delphi rounds until one definition was clearly preferred. A total of 194 participants responded in round one, and 279 in round two. Both rounds had a broad representation of sectors and geography and most participants had worked with dysphagia for more than four years. CONCLUSION: The preferred definition was 'Dysphagia is a functional impairment that either prevents or limits the intake of food and fluids, and which makes swallowing unsafe, inefficient, uncomfortable or affects quality of life'. The definition was widely accepted among different health professional groups, patients and across sectors.
Assuntos
Transtornos de Deglutição , Humanos , Transtornos de Deglutição/diagnóstico , Técnica Delphi , Qualidade de Vida , Pessoal de Saúde , DinamarcaRESUMO
Oropharyngeal dysphagia (OD) impacts the safety and efficacy of the swallowing function. The aim was to uncover the effect of chin tuck against resistance (CTAR) exercises compared to standard care in relation to the swallowing function in citizens with OD. Ninety-two citizens (46% male, median age 78 years (IQR 71, 84)) with OD confirmed by the Volume-Viscosity Swallow Test and/or Minimal Eating Observation Form version II were randomised to standard care with the addition of CTAR daily for six weeks or standard care only. The participants were included from seven Danish municipalities from March 2019 to October 2020. A nonsignificant effect on dysphagia of CTAR training combined with standard care versus standard care alone was documented. Both CTAR training combined with standard care and standard care alone had a significant effect on the swallowing function in citizens with OD, with the best effect in the group receiving CTAR training combined with standard care. A significant effect compared to baseline was observed in all participants (p = 0.03) after 12 weeks. Participants in both groups had a significant reduction in problems with manipulating food in the mouth (p = 0.005), swallowing (p = 0.005), and chewing (p = 0.03) but an increased appetite (p = 0.01). The reported quality of life scored with DHI-DK was significantly improved in both groups.
RESUMO
BACKGROUND: Minor alterations in thyroid function are frequent, and interpretation of thyroid function tests in the individual patient can be challenging. Furthermore, the choice of thyroid function test is debatable. To inform the debate, we performed a comparative evaluation of the variation in thyrotropin (TSH) and thyroxine (T4) in two different cohorts to illustrate the precision of TSH and T4 in the diagnosis and monitoring of thyroid dysfunction. METHODS: A comparative analysis of two separate longitudinal studies previously surveyed with monthly blood sampling for one year among 35 subjects. Participants were included based on T4 within the reference range and TSH either within (euthyroid; n = 15) or above (subclinical hypothyroidism; n = 20) the laboratory reference range on two independent blood samplings before inclusion. Exclusion criteria were known thyroid disease or use of thyroid interfering medication. TSH and T4 in individual samples were measured in a single batch to prevent between-batch variation. The distributions TSH and T4 were compared among euthyroid and subclinical hypothyroid individuals, and bootstrap estimates were used to calculate area under the curve (AUC). RESULTS: Collection of twelve, monthly blood samples in the 35 participants provided 420 samples, and data completeness was 100%. The mean TSH was 1.27/7.19 mIU/L and the mean total T4 was 106/85 nmol/L in euthyroid/subclinical hypothyroid participants. The subclinical hypothyroidism state deviated from the euthyroid by 20% for total T4 and by 466% for TSH. The overlap between the euthyroid and subclinical hypothyroid groups was 92.6% (389/420) for total T4 and 9.0% (38/420) of test results for TSH. The estimated AUC was 0.999 (95%-CI: 0.995; 1.00) for TSH and 0.853 (0.736; 0.935) for total T4. There was no confidence interval overlap between participant groups for TSH while there was a considerable overlap for total T4 (p < 0.001). CONCLUSION: The distributions of thyroid function tests illustrated how TSH outperforms T4 for detecting delicate differences in thyroid function in an individual. Thus, TSH was markedly better than T4 to discriminate between the subtle differences in thyroid function corroborating that TSH is the more sensitive and accurate index of thyroid function status in the individual patient.
RESUMO
BACKGROUND: Subcutaneous (SC) hydration is a valuable method for treating dehydration in the very old patients. Data are absent on the absorption rate, and the availability of SC infused fluid in the circulation in this group of patients where SC hydration is particularly relevant. METHODS: We performed an explorative study on ill very old (range 78-84 years old) geriatric patients with comorbidities who received an SC infusion of 235 ml isotonic saline containing a technetium-99m pertechnetate tracer. The activity over the infusion site was measured using a gamma detector to assess the absorption rate from the SC space. The activity was measured initially every 5 minutes, with intervals extended gradually to 15 minutes. Activity in blood samples and the thyroid gland was measured to determine the rate of availability in the circulation. RESULTS: Six patients were included. The mean age was 81 years (SD 2.1), the number of comorbidities was 4.6 (SD 1.3), and the Tilburg frailty indicator was 3.8 (SD 2.4). When the infusion was completed after 60 minutes, 53% (95% CI 50-56%) of the infused fluid was absorbed from the SC space, with 88% (95% CI 86-90%) absorbed one hour later. The absorption rate from the SC space right after the completion of the infusion was 127 ml/h (95% CI 90-164 ml/h). The appearance of the fluid into the blood and the thyroid gland verified the transfer from SC to circulation. CONCLUSION: This first explorative study of absorption of SC infused fluid in the very old found an acceptable amount of fluid absorbed from the SC space into the circulation one hour after infusion had ended. Results are uniform but should be interpreted cautiously due to the low sample size. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04536324.
Assuntos
Pertecnetato Tc 99m de Sódio , Tecnécio , Idoso , Idoso de 80 Anos ou mais , Humanos , Hipodermóclise , Infusões ParenteraisRESUMO
Dysphagia is a risk factor that impaires an individual's experience of mealtimes. Few studies contribute to the knowledge on the health-related quality of life (HRQoL) of citizens with oropharyngeal dysphagia (OD) living independently. The aim of this study involves evaluating the HRQoL in citizens living independently and suffering from OD. This cross-sectional study was performed in seven municipalities in Denmark between March 2019 and December 2020. The 90 citizens included (54% female, mean age 76.6 years (SD 0.8)) were ≥18 years, as well as diagnosed with OD using the volume-viscosity swallow test and Minimal Eating Observation Form version II. The Dysphagia Handicap Index-DK, Barthel 20, and European Quality of Life-5 Dimensions were fulfilled. Of the participating citizens, 66% of them needed additional time to eat, 64% coughed while eating, and 58% coughed while drinking. Additionally, 60% reported having a dry mouth, 62% needed to drink to succeed with swallowing foods, and 57% had to swallow multiple times. About one-third felt embarrassed when eating with others. They could not enjoy eating in the same manner as they had previously, and/or felt handicapped or limited. OD was shown to have had a high impact on the QoL in citizens with OD living independently. Focus is needed on xerostomia, as well as on the psychological aspects pertainings to mealtimes for citizens with OD.
RESUMO
INTRODUCTION: Lichen sclerosus (LS) can affect sexuality and quality of life (QoL). OBJECTIVE: The aim of the study was to evaluate the impact of psychosexual counseling in women with LS. MATERIALS AND METHODS: One hundred fifty-eight women 18 years or older, newly diagnosed with LS, and referred to North Denmark Regional Hospital from January 2018 to November 2019 were included. The women were randomized in a 1:1 ratio to usual care or an intervention group receiving usual care and up to 8 individual consultations with a specialist in sexual counseling. Spouses or partners were encouraged to participate. The women filled out the questionnaires Female Sexual Function Index (FSFI), Dermatology Life Quality Index, and the WHO-5 Well-Being Index at baseline and after 6 months. RESULTS: The controls presented a mean score of 14.8 ± 8.7 and the intervention group presented a mean score of 12.8 ± 8.9 at FSFI. At follow-up, the controls had an FSFI score of 15.2 ± 9.2 and the intervention group revealed an FSFI score of 18.3 ± 9.5. Both groups experienced improved sexual functioning and for the intervention group the increase was significant ( p < .001).At baseline, the Dermatology Life Quality Index mean score was 8.9 ± 5.6 for the control group and 9.3 ± 6.1 for the intervention group. At follow-up, the controls revealed a score of 8.6 ± 5.5 and the intervention group a score of 6.8 ± 5.8. The intervention group reached a significantly higher degree of QoL than the controls ( p = .008). CONCLUSIONS: Psychosexual counseling has a significant impact on sexual functioning and QoL in women with LS.
Assuntos
Líquen Escleroso e Atrófico , Aconselhamento , Feminino , Humanos , Qualidade de Vida/psicologia , Comportamento Sexual , Inquéritos e QuestionáriosRESUMO
Background: Patients with inflammatory bowel disease (IBD) and symptoms of irritable bowel syndrome (IBS) may be intolerant to fermentable carbohydrates (FODMAPs). The aim of this study was to test the feasibility of eliminating and subsequently reintroducing FODMAPs in patients with IBS symptoms as part of the IBD manifestation and to compare the severity of IBS symptoms and pain, bloating and quality of life (QoL). Methods: An eight-week randomised open-label FODMAP elimination with double-blinded, crossover provocations of FODMAP and placebo. Diet patients were on a low-FODMAP diet for eight weeks with blinded two-week provocations after two and six weeks. Questionnaires, blood and stool samples were collected. Results: Patient enrolment was challenging. Nineteen participants were included in the study. Eliminating low FODMAP for two weeks resulted in significant decreases in pain and bloating scores (p < 0.003), whereas there were no statistical differences in pain scores between diet patients and controls. Pain and bloating scores increased, returning to baseline levels after two weeks of double-blinded provocations with placebo, (p > 0.05). Conclusions: The results document the possibility of performing a randomised controlled study following the gold standard for testing food intolerance with blinding of the Low FODMAP diet. Recruitment of participants was challenging.
Assuntos
Colite Ulcerativa , Síndrome do Intestino Irritável , Dieta com Restrição de Carboidratos/métodos , Estudos de Viabilidade , Fermentação , Humanos , Qualidade de VidaRESUMO
OBJECTIVE: A transient rise in the occurrence of hyperthyroidism ensued the introduction of iodine fortification (IF) of salt in Denmark. Older adults are at risk of complications to hyperthyroidism that could prove fatal to vulnerable individuals. We evaluated the association between thyroid function and mortality in older adults before and after nationwide implementation of IF. DESIGN: Retrospective cohort study. PATIENTS: All 68-year-olds from the general population in the city of Randers were invited to participate in a clinical study in 1988 and followed until death, emigration or end of study (31 December 2017) using Danish registries. MEASUREMENTS: Baseline measures comprised of a questionnaire, physical examination and blood and urine samples. Kaplan-Meier survival curves and Cox regression were used to determine the association between thyroid function and death before and after IF. Time-stratification of results before and after IF was employed due to violation of proportional hazards assumptions in Cox regression. RESULTS: Median urinary iodine concentration was 42 µg/L at baseline consistent with moderate iodine deficiency. Hyperthyroidism (thyrotropin < 0.4 mIU/L) occurred in 37 (9.1%) participants. Kaplan-Meier survival curves showed an increase in mortality among participants with hyperthyroidism after IF. There was no significant association between hyperthyroidism and mortality before IF compared to euthyroid participants, but after IF hyperthyroid subjects had an increased mortality (adjusted hazard ratio: 2.22, 95% confidence interval: 1.44-3.44). CONCLUSIONS: IF was associated with raised mortality among older adults with a history of hyperthyroidism and moderate iodine deficiency. Our results highlight the need for cautious iodine supplementation and for monitoring of IF.
Assuntos
Hipertireoidismo , Iodo , Idoso , Humanos , Estudos Retrospectivos , Cloreto de Sódio na Dieta , TireotropinaRESUMO
Background: The ageing Arctic populations raise the need for work-up of cognitive function that reflects language and cultural understandings.Aim: To translate and evaluate tools for work-up of cognitive impairment in Greenland.Methods: Step A: An expert panel was established to select tools suitable for the work-up of cognitive impairment at three different settings in Greenland. Step B: Tools were translated in a multiple-step process of independent translations with back-translation and adaptations by two independent translators and two Greenlandic physicians. Step C: a testing and validation process of the tools at three locations: the national hospital in the capital city; regional hospital in a town; health care centre in a small town.Results: Tools selected were Mini-Cog and RUDAS. Participants for testing of tools were 43 of 61 invited, of which six had dementia. RUDAS and Mini-Cog scores were associated (p < 0.001). The smoothed AUC was 0.87 (95%-CI, 0.65-0.95) for Mini-Cog and 0.90 (95%-CI, 0.76-0.97) for RUDAS. The sensitivity of Mini-Cog with a cut-off at ≤3 was 83.3%, and specificity was 62.2%. For RUDAS with a cut-off at ≤23, these were 100% and 75.7%, respectively.Conclusion: Requested tools have been translated for assessing cognitive function in the native Arctic setting. Small town residents with a Mini-Cog score of 3 or lower should be referred to a regional hospital for RUDAS, and a score of 23 or less should cause referral to the national hospital for a full work-up of cognitive function.
Assuntos
Demência , Inuíte , Algoritmos , Cognição , Demência/diagnóstico , Groenlândia , Humanos , Testes Neuropsicológicos , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To systematically review and critically appraise prognostic models for falls in community-dwelling older adults. ELIGIBILITY CRITERIA: Prospective cohort studies with any follow-up period. Studies had to develop or validate multifactorial prognostic models for falls in community-dwelling older adults (60+ years). Models had to be applicable for screening in a general population setting. INFORMATION SOURCE: MEDLINE, EMBASE, CINAHL, The Cochrane Library, PsycINFO and Web of Science for studies published in English, Danish, Norwegian or Swedish until January 2020. Sources also included trial registries, clinical guidelines, reference lists of included papers, along with contacting clinical experts to locate published studies. DATA EXTRACTION AND RISK OF BIAS: Two authors performed all review stages independently. Data extraction followed the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist. Risk of bias assessments on participants, predictors, outcomes and analysis methods followed Prediction study Risk Of Bias Assessment Tool. RESULTS: After screening 11 789 studies, 30 were eligible for inclusion (n=86 369 participants). Median age of participants ranged from 67.5 to 83.0 years. Falls incidences varied from 5.9% to 59%. Included studies reported 69 developed and three validated prediction models. Most frequent falls predictors were prior falls, age, sex, measures of gait, balance and strength, along with vision and disability. The area under the curve was available for 40 (55.6%) models, ranging from 0.49 to 0.87. Validated models' The area under the curve ranged from 0.62 to 0.69. All models had a high risk of bias, mostly due to limitations in statistical methods, outcome assessments and restrictive eligibility criteria. CONCLUSIONS: An abundance of prognostic models on falls risk have been developed, but with a wide range in discriminatory performance. All models exhibited a high risk of bias rendering them unreliable for prediction in clinical practice. Future prognostic prediction models should comply with recent recommendations such as Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis. PROSPERO REGISTRATION NUMBER: CRD42019124021.
Assuntos
Vida Independente , Idoso , Idoso de 80 Anos ou mais , Viés , Humanos , Prognóstico , Estudos ProspectivosRESUMO
BACKGROUND: Anemia is common among ortho-geriatric hip fracture patients and is associated with prolonged recovery and increased postoperative mortality rate. Intravenous iron seems to increase hemoglobin recovery and reduce the mortality rate in patients undergoing orthopedic surgeries. This study investigated the association between short-term mortality risk and intravenous iron therapy in older patients undergoing hip fracture surgery. METHODS: This observational study included 210 patients undergoing hip fracture surgery from July 2018 to May 2020. These 210 patients were alive and had a hemoglobin ≤ 6.5 mmol/L on the 3rd postoperative day. In May 2019, a local intravenous iron therapy protocol was implemented and recommended intravenous iron (Monofer©) if hemoglobin on the 3rd postoperative day was ≤ 6.5 mmol/L. According to the treatment of postoperative anemia between the 1st and 3rd day post-surgery, the patients were divided into four groups: no treatment (n=52), blood transfusion (n=38), IV Monofer (n=80), and blood transfusion and IV Monofer (n=40). Primary outcome was 30-day mortality post-surgery. The secondary outcome was the impact on hemoglobin level 14-30 days postoperatively. Multivariable Cox regression was used to estimate the 30-day mortality standardized for covariates. RESULTS: Of 210 patients, 17 (8.1%) died within 30 days after surgery. There was a significantly lower mortality among the patients who received IV Monofer compared to those who received no treatment (HR 0.17, 95% CI [0.03-0.93], P = 0.041). Among the 86 patients with available hemoglobin measurements within 14 to 30 days post-surgery, there was no significant difference in hemoglobin level between the various treatment groups (mean 6.6 mmol/L, P = 0.1165). CONCLUSION: IV Monofer on the 3rd postoperative day in older hip fracture patients seemed to reduce 30-day mortality compared with no treatment. No significant differences in hemoglobin levels between 14 and 30 days post-surgery across treatment groups were found, although this was assessed in a subset of patients with available hemoglobin levels warranting further study.