Group-based, individualized, comprehensive core stability and balance intervention provides immediate and long-term improvements in walking in individuals with multiple sclerosis: A randomized controlled trial.

OBJECTIVES: Walking impairments are common in individuals with multiple sclerosis. Trunk control is a prerequisite for walking; however, knowledge regarding whether core stability and balance training influence walking is limited. This study aimed to investigate the immediate and long-term effects of a group-based, individualized, comprehensive core stability and balance intervention (GroupCoreDIST) compared with those of standard care on walking. METHODS: This assessor-blinded, prospective randomized controlled trial included 80 participants (Expanded Disability Status Scale scores 1-6.5) randomly allocated to GroupCoreDIST, conducted in groups of three for 60 min three times per week for 6 weeks (18 sessions) or standard care (n = 40/40). One participant attended no posttests, leaving 79 subjects for intention-to-treat analysis. The assessments were performed at baseline and at Weeks 7, 18, and 30. Outcomes included the 2-min walk test (2MWT), 10-m walk test-preferred/fast/slow speed (10MWT), Multiple Sclerosis Walking Scale-12 (MSWS-12), Patient Global Impression of Change-walking (PGIC-walking), Rivermead Visual Gait Assessment (RVGA), and ActiGraphsWgt3X-BT activity monitors (ActiGraph). The statistical analyses included repeated-measures mixed models performed in IBM SPSS Version 24. RESULTS: There were no significant between-group differences in the outcome measurements at baseline. The mean differences between groups were significant at all follow-up time points in favour of GroupCoreDIST for the 2MWT, 16.7 m at 7 weeks (95% CI [8.15, 25.25], 15.08 m at 18 weeks (95% CI [6.39, 23.77]) and 16.38 m at 30 weeks (95% CI [7.65, 25.12]; and the PGIC-walking, 0.89 points at 7 weeks (95% CI [1.34, 0.45]), 0.97 points at 18 weeks (95% CI [1.42, 0.52]), and 0.93 points at 30 weeks (95% CI [1.39, 0.48]; all p ≤ .001). The 10MWT-fast speed and the MSWS-12 showed significant between-group differences at 7 and 18 weeks and the RVGA at 7 weeks. No between-group differences were found regarding activity level (ActiGraph) or the 10MWT-preferred or slow speed. CONCLUSION: Compared with standard care, GroupCoreDIST significantly improved walking immediately after the intervention for up to 24 weeks of follow-up.

Injury coding in a national trauma registry: a one-year validation audit in a level 1 trauma centre.

BACKGROUND: Hospitals must improve patient safety and quality continuously. Clinical quality registries can drive such improvement. Trauma registries code injuries according to the Abbreviated Injury Scale (AIS) and benchmark outcomes based on the Injury Severity Score (ISS) and New ISS (NISS). The primary aim of this study was to validate the injury codes and severities registered in a national trauma registry. Secondarily, we aimed to examine causes for missing and discordant codes, to guide improvement of registry data quality. METHODS: We conducted an audit and established an expert coder group injury reference standard for patients met with trauma team activation in 2015 in a Level 1 trauma centre. Injuries were coded according to the AIS. The audit included review of all data in the electronic health records (EHR), and new interpretation of all images in the picture archiving system. Validated injury codes were compared with the codes registered in the registry. The expert coder group's interpretations of reasons for discrepancies were categorised and registered. Inter-rater agreement between registry data and the reference standard was tested with Bland-Altman analysis. RESULTS: We validated injury data from 144 patients (male sex 79.2%) with median age 31 (inter quartile range 19-49) years. The total number of registered AIS codes was 582 in the registry and 766 in the reference standard. All injuries were concordantly coded in 62 (43.1%) patients. Most non-registered codes (n = 166 in 71 (49.3%) patients) were AIS 1, and information in the EHR overlooked by registrars was the dominating cause. Discordant coding of head injuries and extremity fractures were the most common causes for 157 discordant AIS codes in 74 (51.4%) patients. Median ISS (9) and NISS (12) for the total population did not differ between the registry and the reference standard. CONCLUSIONS: Concordance between the codes registered in the trauma registry and the reference standard was moderate, influencing individual patients' injury codes validity and ISS/NISS reliability. Nevertheless, aggregated median group ISS/NISS reliability was acceptable.

Group-Based Individualized Comprehensive Core Stability Intervention Improves Balance in Persons With Multiple Sclerosis: A Randomized Controlled Trial.

BACKGROUND: Balance and trunk control are often impaired in individuals with multiple sclerosis (MS). Interventions addressing these issues are needed. OBJECTIVE: The objective of this study was to compare the immediate and long-term effects of a 6-week individualized, group-based, comprehensive core stability intervention (GroupCoreDIST) with standard care on balance and trunk control in individuals with MS. DESIGN: This study was a prospective, assessor-masked, randomized controlled trial. SETTING: The GroupCoreDIST intervention was conducted by 6 physical therapists in 6 municipalities in Norway. Standard care included the usual care for individuals with MS in the same municipalities. Assessments at all time points took place at a Norwegian hospital. PARTICIPANTS: Eighty people with Expanded Disability Status scores of 1 to 6.5 participated in this trial. INTERVENTION: Randomized, concealed allocation was used to assign the participants to the GroupCoreDIST intervention (n = 40) or to standard care (n = 40). The GroupCoreDIST intervention was conducted with groups of 3 participants (1 group had 4 participants), for 60 minutes 3 times per week. MEASUREMENTS: Assessments were undertaken at baseline and at weeks 7, 18, and 30. Outcomes were measured with the Trunk Impairment Scale-Norwegian Version, Mini Balance Evaluation Systems Test, and Patient Global Impression of Change-Balance. Repeated-measures mixed models were used for statistical analysis. RESULTS: One individual missed all postintervention tests, leaving 79 participants in the intention-to-treat analysis. GroupCoreDIST produced significant between-group effects on the mean difference in the following scores at 7, 18, and 30 weeks: for Trunk Impairment Scale-Norwegian Version, 2.63 points (95% confidence interval [CI] = 1.89-3.38), 1.57 points (95% CI = 0.81-2.33), and 0.95 point (95% CI = 0.19-1.71), respectively; for Mini Balance Evaluation Systems Test, 1.91 points (95% CI = 1.07-2.76), 1.28 points (95% CI = 0.42-2.15), and 0.91 points (95% CI = 0.04-1.77), respectively; and for Patient Global Impression of Change-Balance, 1.21 points (95% CI = 1.66-0.77), 1.02 points (95% CI = 1.48-0.57), and 0.91 points (95% CI = 1.36-0.46), respectively. LIMITATIONS: Groups were not matched for volume of physical therapy. CONCLUSIONS: Six weeks of GroupCoreDIST improved balance and trunk control in the short and long terms compared with standard care in individuals who were ambulant and had MS. The intervention is an effective contribution to physical therapy for this population.

Incidence and predictors of Uveitis in juvenile idiopathic arthritis in a Nordic long-term cohort study.

BACKGROUND: The incidence of uveitis associated with juvenile idiopathic arthritis (JIA) varies around the world. Our aim was to investigate the incidence and predictors of uveitis in a Nordic population-based cohort. METHODS: Consecutive JIA cases from defined geographical areas in Denmark, Finland, Sweden and Norway with disease onset between January 1997 to June 2000 were followed for median 98 months in this prospective longitudinal cohort study. Potential clinical and immunological predictors of uveitis were identified with logistic regression analysis. RESULTS: Uveitis occurred in 89 (20.5%) of the 435 children with regular ophtalmologic follow-up among the 500 included. Chronic asymptomatic uveitis developed in 80 and acute symptomatic uveitis in 9 children. Uveitis developed at a median interval of 0.8 (range - 4.7 to 9.4) years after onset of arthritis. Predictors of uveitis were age < 7 years at JIA onset (Odds ratio (OR) 2.1, 95% confidence interval (CI) 1.3 to 3.5), presence of antihistone antibodies (AHA) > 15 U/ml (OR 4.8 (1.8 to 13.4)) and antinuclear antibodies (ANA) (OR 2.4 (1.5 to 4.0)). Mean combined IgM/IgG AHA was significantly higher in the uveitis group (19.2 U/ml) than in the non-uveitis group (10.2 U/ml) (p = 0.002). Young age at JIA onset predicted uveitis in girls (p < 0.001), but not in boys (p = 0.390). CONCLUSION: Early-onset arthritis and presence of AHA in girls, as well as presence of ANA in both genders, were significant predictors of chronic uveitis. The high incidence of uveitis in this long-term Nordic JIA cohort may have severe implications in a lifelong perspective.

Blood donor Borrelia burgdorferi sensu lato seroprevalence and history of tick bites at a northern limit of the vector distribution.

In order to study the antibody seroprevalence of the causal agent of Lyme borreliosis, Borrelia burgdorferi sensu lato (s.l.), and the history of tick bites at a geographical distribution limit of Ixodes ricinus, we compared healthy blood donors in geographically extreme regions: the borreliosis-endemic Vestfold County (59°N) and the region of northern Norway. Blood samples were screened using IgG/VlsE ELISA, and positive/borderline samples were confirmed using C6 ELISA and immunoblot assays. Also, donors completed a questionnaire consisting of several items including the places they have lived, and whether they owned any pets. The seroprevalence was 0.48% (5/1048) in northern Norway and 9.25% (48/519) in Vestfold County. Seven donors (of 1048) had experienced a single tick bite in the southern part of Nordland County (65°N) in northern Norway. This first study on B. burgdorferi s.l. antibody seroprevalence and tick bites on humans and pets in northern Norway showed that the seroprevalence of B. burgdorferi s.l. infection and the risk of tick bite in northern Norway are insignificant; the fact that only five positive IgG samples were detected underscores the very low background seroprevalence. These results suggest that so far I. ricinus has not expanded north of the previously established geographical distribution limit.

Patients on outpatient commitment orders in Northern Norway.

BACKGROUND: In recent years, an increasing number of countries have introduced outpatient commitment orders (OC), which imply that patients can be subject to compulsory follow-up and treatment while living in the community. However, few studies on how OC is practised have been published. METHOD: Retrospective case register study based on medical files of all patients receiving an OC order in 2008-2012. We used a pre/post design, recording the use of inpatient services three years before and three years after for those patients who received their first ever OC order in 2008 and 2009. RESULTS: A total of 345 OC orders applying to 286 persons were identified in the study period 2008-2012. Incidence and prevalence rates were relatively stable, but decreased during the last years of the study period. For all the 54 patients receiving their first ever OC order in 2008 and 2009, need for treatment was the reason for imposing OC, and all received psychotropic medication. The number of inpatient admissions and inpatient days was greater, while the number of days for each admission was lower three years after the OC order than three years before. The first ever OC lasted under a year for 76% of the patients. Receiving depot medication and follow-up by psychiatrists predicted longer OC durations than such treatment and care by psychologists. Only nine patients were not hospitalized during the three-year follow-up after the first ever OC order. CONCLUSION: Patients on first ever OC orders in Northern Norway used inpatient services more after OC orders than before. Further studies are needed to explore whether increased use of inpatient services by OC patients is beneficial or a failure of OC.

Prediction of Relapse After Therapy Withdrawal in Women with Endometrial Hyperplasia: A Long-term Follow-up Study.

AIM: To investigate whether risk of relapse of endometrial hyperplasia persists many years after successful primary therapy and whether clinical or biological markers observed at primary diagnosis may predict relapse. MATERIALS AND METHODS: A series of 57 women with endometrial hyperplasia received levonorgestrel-impregnated intrauterine system or oral progestin for three months during 1998-2000. Index biopsies were classified according to WHO1994 and D-score systems, and immunohistochemical staining for estrogen receptor α (ERα), estrogen receptor ß (ERß), progesterone receptor A (PRA), progesterone receptor B (PRB), B-cell lymphoma 2/apoptosis regulator (BCL2), BCL2-associated X protein/apoptosis regulator (BAX), paired box 2 (PAX2), and phosphatase and tensin homolog (PTEN) reported as H-scores. RESULTS: Over a follow-up of 157.8 months, 23% (10/43) of patients experienced relapse. No correlation with age, body mass index, parity, WHO94 classification, or D-score was found. Only PRA (p=0.004) and PRB (p=0.038) showed certain correlation with relapse. CONCLUSION: Endometrial hyperplasia recurs many years after successful progestin therapy. Increased expression of PRB and reduced expression of PRA significantly correlated with relapse. Our results support the importance of continuous endometrial protection and the need for new clinical surveillance guidelines.

Multisite musculoskeletal pain in adolescence and later mental health disorders: a population-based registry study of Norwegian youth: the NAAHS cohort study.

OBJECTIVES: To examine the association between multisite musculoskeletal pain in adolescence and mental health disorders in young adulthood. DESIGN AND SETTING: Data were obtained from a linkage between the Norwegian Patient Registry (2008-2012) and the Norwegian Arctic Adolescent Health Study, a school-based survey conducted among 10th grade students in North Norway (2003-2005). PARTICIPANTS: In total, 3987 (68%) of all 5877 invited participants consented to the registry linkage. OUTCOME MEASURES: Mental healthcare use and disorders from age 18-20 to 23-25 years (5 years). METHODS: Musculoskeletal pain was measured by the number of musculoskeletal pain sites. Multivariable logistic regression was used to explore the association with later mental healthcare use and disorders. RESULTS: Multisite adolescent musculoskeletal pain was significantly associated with an increase in mental healthcare use and mental health disorders in young adulthood. The relationship was stronger for anxiety and mood disorders, in both genders. Overall, the association between musculoskeletal pain and later mental health problems was attenuated after controlling for adolescent psychosocial and mental health problems, not by physical or sedentary activity. This could be due to confounding or mediation. However, when examining different mental health disorders, we found musculoskeletal pain to be significantly associated with anxiety disorders, and showing a strong trend in mood disorders, when adjusted for the adolescent factors. CONCLUSIONS: Physicians should be aware that multisite adolescent pain is associated with mental health problems in adolescence, and that these adolescents are at increased risk of mental health disorders in young adulthood. As youth troubled by mental health problems commonly present physical symptoms it is important to examine for psychosocial problems in order to offer early interventions.

HE4 is a novel tissue marker for therapy response and progestin resistance in medium- and low-risk endometrial hyperplasia.

BACKGROUND: The aim of the present study was to investigate whether changes in the tissue expression of human epididymis-specific protein 4 (HE4) could predict therapy resistance and relapse after progestin hormone therapy for medium- and low-risk endometrial hyperplasia. METHODS: Endometrial biopsies were obtained from women participating in a multicentre RCT performed according to the CONSORT guidelines; the women were randomly assigned to either LNG-IUS; 10 mg of oral medroxyprogesterone acetate (MPA) administered for 10 days per cycle; or 10 mg of oral MPA administered daily for 6 months. Of the 153 women who completed therapy, 141 had adequate material for immunohistochemistry in pre- and post-treatment biopsies. An antibody to HE4 (clone 12A2 monoclonal IgG1 antibody, Fujirebio Diagnostics, Inc.) was used for the immunohistochemical staining of the pre- and post-treatment biopsies from each participant. The expression of HE4 staining was evaluated by the histological score (H-score) using light microscopy. RESULTS: Changes in the expression of HE4 (H-score) during therapy were related to the therapy group (P<0.001) and therapy response (P<0.001) of the individuals but could not predict relapse (P>0.05). Changes in the intracellular bodies were shown to predict both the therapy response (P=0.038) and relapse (P=0.014). CONCLUSIONS: Changes in the expression of HE4 during progestin therapy regimens can predict therapy response or indicate progestin resistance for medium- and low-risk endometrial hyperplasia.

The All-Age Prevalence of Helicobacter pylori Infection and Potential Transmission Routes. A Population-Based Study.

BACKGROUND AND AIMS: Previous research on H. pylori epidemiology has mostly focused on adult populations. We have aimed to study H. pylori prevalence in all age groups including children and adolescents and to identify potential routes of transmission. METHODS: Subjects from all age groups (children 0-11 years, adolescents 12-17 years and adults ≥18 years of age), recruited from both an urban and a rural community in Northern Norway, were invited to provide stool samples for the diagnosis of H. pylori antigen and to fill in a questionnaire (adult and adolescents only) on gastrointestinal symptoms, lifestyle factors and biometric data. RESULTS: A total of 1 624 (35.3%) of the invited subjects, including 173 (39.3%) of the children, 46 (19.2%) of the adolescents, and 1 416 (36.1%) of the adults, responded to the invitation. H. pylori infection was nearly undetectable (0.6%) among the children, whereas the prevalence increased from 20% in adolescents toward a peak of 45% in the highest age group. Univariate analyses of possible risk factors of H. pylori infection showed significant associations to private well water, the use of outhouse toilet, and having farm animals in childhood, but the associations waned in multivariate analyses. CONCLUSIONS: In our populations, with apparent high hygienic standards, the transmission of H. pylori infection may start not only in childhood, but also in adolescence, where potential transmission routes may be outdoor toilet use, private well water, and farm animals.

Expression of PAX2 and PTEN Correlates to Therapy Response in Endometrial Hyperplasia.

AIM: To investigate if a levonorgestrel-impregnated intrauterine system (LNG-IUS) was more efficient compared to oral progestin in the clearance of the paired box 2 gene (PAX2) - and phosphatase and tensin homolog (PTEN)-null endometrial glands and assess the significance of PAX2- and PTEN-null glands as markers for therapy response in endometrial hyperplasia. PATIENTS AND METHODS: Immunohistochemical staining using antibodies against PAX2 and PTEN was performed in 141 pre- and post-treatment endometrial biopsies comparing the effect of LNG-IUS, 10 mg medroxyprogesterone acetate (MPA) taken continuously, or 10 mg MPA taken 10 days per cycle for six months. PAX2- and PTEN-null glands were investigated by light microscopy in pre-and post-treatment biopsies. RESULTS: Clearance of PAX2- and PTEN-null glands was significantly more efficient by LNG-IUS compared to oral MPA (p<0.000 and p=0.008, respectively) and significantly related to therapy response (p<0.000 and p=0.002, respectively).

Respiratory symptoms, lung functions, and exhaled nitric oxide (FENO) in two types of fish processing workers: Russian trawler fishermen and Norwegian salmon industry workers.

OBJECTIVE: Respiratory outcomes and work-related factors were studied in two seafood worker populations representing different occupational environments. METHODS: Levels of fractional exhaled nitric oxide (FENO), spirometric values, prevalence of respiratory symptoms, and self-evaluated exposures were compared between 139 Norwegian salmon workers and 127 Russian trawler workers. RESULTS: Increased odds ratios (ORs) of shortness of breath with wheezing and prolonged cough as general respiratory symptoms were found in salmon workers, while increased ORs of work-related dry cough and running nose were found in trawler fishermen. Both worker groups ranked "cold work environment," "use of disinfectants," and "contaminated indoor air" as the first, second, and third most important causes of work-related respiratory symptoms, respectively. Fractional exhaled nitric oxide levels were higher in asthmatic trawler workers compared to asthmatic salmon workers. CONCLUSIONS: Respiratory symptoms commonly associated with obstructive airway diseases were more prevalent in salmon workers, while symptoms commonly associated with asthma and short-term effects of cold air exposure were more prevalent in trawler workers.

Respiratory effects of bioaerosols: exposure-response study among salmon-processing workers.

OBJECTIVES: The aim of the study was to determine exposure-response relationships in salmon-processing workers. METHODS: Cross-shift FEV1, acute respiratory symptoms, and exposure to total protein, parvalbumin and endotoxin were main variables measured during one workweek. Exposure-response relationships were analyzed by Generalized Estimation Equations of cross-week data and by multiple regressions of day-to-day data. RESULTS: Exposure levels were higher in those workers who reported use of water hose. GEE showed negative coefficients for interaction between TP exposure and time (days) on cross-week change of FEV1. Multiple regressions showed significant associations between TP levels and cross-shift change of FEV1 and symptoms (cough, chest tightness) only for Monday shifts. CONCLUSIONS: A tolerance effect during the course of a workweek is suggested. Use of water hose is a risk process with regard to the liberation of measured components of bioaerosols.

Outcomes of planned home births and planned hospital births in low-risk women in Norway between 1990 and 2007: a retrospective cohort study.

BACKGROUND: The safety of planned home births remains controversial in Western countries. The aim of the present study was to compare outcomes in women who planned, and were selected to, home birth at the onset of labor with women who planned for a hospital birth. METHODS: Data from 1631 planned home births between 1990 and 2007 were compared with a random sample of 16,310 low-risk women with planned hospital births. The primary outcomes were intrapartum intervention rates and complications. Secondary outcomes were perinatal and neonatal death rates. RESULTS: Primiparas who planned home births had reduced risks for assisted vaginal delivery (OR 0.32; 95% CI 0.20-0.48), epidural analgesia (OR 0.21; CI 0.14-0.33) and dystocia (OR 0.40; CI 0.27-0.59). Multiparas who planned home births had reduced risks for operative vaginal delivery (OR 0.26; CI 0.12-0.56), epidural analgesia (OR 0.08; CI 0.04-0.16), episiotomy (OR 0.48; CI 0.31-0.75), anal sphincter tears (OR 0.29; CI 0.12-0.70), dystocia (OR 0.10; CI 0.06-0.17) and postpartum hemorrhage (OR 0.27; CI 0.17-0.41). We found no differences in cesarean section rate. Perinatal mortality rate was 0.6/1000 (CI 0-3.4) and neonatal mortality rate 0.6/1000 (CI 0-3.4) in the home birth cohort. In the hospital birth cohort, the rates were 0.6/1000 (CI 0.3-1.1) and 0.9/1000 (CI 0.5-1.5) respectively. CONCLUSIONS: Planning for home births was associated with reduced risk of interventions and complications. The study is too small to make statistical comparisons of perinatal and neonatal mortality.

Prevalence, comorbidity, and risk factors for functional bowel symptoms: a population-based survey in Northern Norway.

OBJECTIVE: To assess the occurrence of functional bowel (FB) symptoms in Northern Norway, and to describe gender differences, comorbidity, and association to risk factors, including Helicobacter pylori infection. MATERIALS AND METHODS: Adult subjects (18-85 years) from the communities Bodø and Sørreisa were invited to complete a questionnaire on gastrointestinal symptoms, and to provide stool samples for assessment of H. pylori. RESULTS: Of 3927 invited subjects, 1731 (44.1%) responded to the questionnaire and 1416 (36.0%) provided stool samples. Functional bowel symptoms were found in 25%, somewhat more frequent in females (28.6%). Symptom pattern differed between genders only with regard to constipation. Presence of FB symptoms was significantly associated with gastroesophageal reflux symptoms, headache, dizziness, palpitations, sleep disturbances, and musculoskeletal symptoms. Psychometric traits were also more prevalent: feeling of low coping ability, feeling depressed, feeling of time pressure, and a low self-evaluation of health. In a multivariate regression model, factors that influenced the reporting FB symptoms were male gender (OR 0.71, 95% CI (0.52; 0.96)), age 50-69 years or ≥70 years (OR 0.49 (0.30; 0.80) and 0.40 (0.21; 0.79)), obesity (OR 1.61 (1.05; 2.47)), NSAID use (OR 2.50 (1.63; 3.83)), and previous abdominal surgery (OR 1.54 (1.05; 2.26)). The presence of H. pylori was not associated with FB symptoms. CONCLUSIONS: Functional bowel symptoms are prevalent, but our findings may be prone to self-selection bias. FB symptoms carry a significant burden of comorbidity. Female gender and low age are known risk factors for FB symptoms, whereas NSAID use as a risk factor deserves further clarification.

The effect of stimulation therapy and donepezil on cognitive function in Alzheimer's disease. A community based RCT with a two-by-two factorial design.

BACKGROUND: Progressive neurodegeneration in Alzheimer's disease (AD) induces cognitive deterioration, and there is controversy regarding the optimal treatment strategy in early AD. Stimulation therapy, including physical exercise and cholinesterase inhibitors are both reported to postpone cognitive deterioration in separate studies. We aimed to study the effect of stimulation therapy and the additional effect of donepezil on cognitive function in early AD. DESIGN: A two-by-two factorial trial comprising stimulation therapy for one year compared to standard care to which a randomized double-blinded placebo controlled trial with donepezil was added. SETTING: Nine rural municipalities in Northern Norway. PARTICIPANTS: 187 participants 65 years and older with a recent diagnosis of mild or moderate AD were included in the study of which 146 completed a one-year follow-up. INTERVENTIONS: In five municipalities the participants received stimulation therapy whereas participants in four received standard care. All participants were randomised double-blindly to donepezil or placebo and tested with three different cognitive tests four times during the one-year study period. MAIN OUTCOME: Changes in MMSE sum score.Secondary outcome: Changes in ADAS-Cog and Clock Drawing Test. RESULTS: MMSE scores remained unchanged amongst AD participants receiving stimulation therapy and those receiving standard care. The results were consistent for ADAS-Cog and Clock Drawing Test. No time trend differences were found during one-year follow-up between groups receiving stimulation therapy versus standard care or between donepezil versus placebo. CONCLUSION: In rural AD patients non-pharmacological and pharmacological therapy did not improve outcome compared with standard care but all groups retained cognitive function during one year follow-up. Other studies are needed to confirm these results. TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT00443014). EudraCT database (no 2004-002613-37).

Recurrence and long-term maternal health risks of hypertensive disorders of pregnancy: a population-based study.

OBJECTIVE: The purpose of this study was to investigate the recurrence risk of hypertensive disorders in subsequent pregnancies and to explore the associations among hypertensive disorders of pregnancy and maternal cardiovascular risk factor profile and the development of cardiovascular diseases later in life. STUDY DESIGN: We used population-based, cross-sectional data from the fourth survey of the Tromsø Study. RESULTS: Preeclampsia in the first pregnancy increased the risk of recurrence in later pregnancies (relative risk, 6.6; 95% confidence interval, 5.5-7.9) compared with a normotensive first pregnancy. Women with a history of preeclampsia or nonproteinuric hypertension had an unfavorable cardiovascular risk profile. Hypertension was prevalent in 25% and 28% of the women, respectively. The carotid artery intima-media thickness and total carotid plaque area were significantly larger in women with previous preeclampsia. CONCLUSION: A strong association between hypertensive disorders of pregnancy and an increased risk of atherosclerosis and cardiovascular diseases was demonstrated by the assessment of risk factors that can be potentially modified.

Co-morbidity and drug treatment in Alzheimer's disease. A cross sectional study of participants in the dementia study in northern Norway.

BACKGROUND: Inappropriate medical treatment of co-morbidities in Alzheimer's disease (AD) is an increasing concern in geriatric medicine. The objective of this study was to compare current drug use related to co-morbidity between individuals with a recent diagnosis of AD and a cognitively healthy control group in a population based clinical trial in Northern Norway. SETTING: Nine rural municipalities with 70,000 inhabitants in Northern Norway. PARTICIPANTS: PARTICIPANTS with and without AD recruited in general practice and by population based screening.187 participants with a recent diagnosis of AD were recruited among community dwellers. Of 791 respondents without cognitive symptoms, 500 were randomly selected and invited to further clinical and cognitive testing. The final control group consisted of 200 cognitively healthy individuals from the same municipalities. Demographic characteristics, data on medical history and current medication were included, and a physical and cognitive examination was performed. The statistical analyses were carried out by independent sample t-test, chi-square, ANCOVA and logistic regression. RESULTS: A co-morbidity score was significantly higher in AD participants compared to controls. The mean number of drugs was higher for AD participants compared to controls (5.1±3.6 and 2.9±2.4 respectively, p<0.001 age and gender adjusted), also when adjusted for co-morbidity. AD participants used significantly more anticholinergic, sedative and antidepressant drugs. For nursing home residents with AD the mean number of drugs was significantly higher compared to AD participants living at home (6.9±3.9 and 4.5±3.3, respectively, p<0.001). CONCLUSIONS: AD participants were treated with a significantly higher number of drugs as compared to cognitively healthy controls, even after adjustment for co-morbidity. An inappropriate use of anticholinergic and sedative drugs was identified, especially among nursing home residents with AD. The drug burden and the increased risk of adverse reactions among individuals suffering from AD need more attention from prescribing doctors.

An analysis of the respiratory health status among seafarers in the Russian trawler and merchant fleets.

OBJECTIVES: Trawler fishermen and merchant seafarers have tough working conditions. While workers in both occupations are exposed to a challenging environment, trawler fishermen are also engaged in onboard fish processing, which is considered to be additional exposure. The aim of the present study was to characterize respiratory health status in both groups of seamen. METHODS: In total 127 trawler fishermen and 118 merchant seafarers were enrolled during their regular medical health examinations. The study protocol comprised a standardized questionnaire, lung function test and measurements of fractional nitric oxide concentrations (FE(NO) ) in exhaled air. RESULTS: Doctor-diagnosed asthma was reported only by trawler fishermen (3.9%, P < 0.05, Pearson Chi-square test). Adjusted odds ratios (OR) of respiratory symptoms were more often elevated in trawler fishermen compared to merchant seafarers. Trawler fishermen had reduced spirometric parameters: FEV(1) % of predicted values (adjusted ß: -5.28, 95%CI: -9.28 to -1.27), FVC % of predicted values (adjusted ß: -5.21, 95%CI: -9.25 to -1.17). Increased OR of the work-related cough with phlegm (OR: 6.6, 95% CI: 1.8-21.9), running nose (OR: 3.0, 95%CI: 1.2-7.7), and frequent sneezing (OR: 3.4, 95%CI: 1.0-12.7) were found among those trawler workers whose work tasks included filleting of fish. FE(NO) levels were not significantly different between trawler and merchant seamen. CONCLUSIONS: The present study indicated that trawler fishermen exhibited impaired lung function and were more likely to have asthma. The environment of the onboard factories where fishermen fillet fish is suggested as a risk factor for work-related respiratory symptoms.