The interplay between the impact of household's and children's education on the risk of type 2 diabetes and death among older adults: a Danish register-based cohort study.

OBJECTIVES: This study aims to assess the association of household's and children's education on the risk of type 2 diabetes (T2D) and subsequent death. STUDY DESIGN: Danish register-based cohort study. METHODS: In total, 1,021,557 adults were included at their 65th birthday between 2000 and 2018. A multistate survival model was performed to estimate the association of household's and children's education on the transition between the three states: 1) 65th birthday; 2) diagnosis of T2D; and 3) all-cause death. RESULTS: The incidence rates per 1000 person-years were 9.1 for T2D, 18.4 for death without T2D, and 45.0 for death with T2D. Compared to long household's education and children's education, long household's education combined with either short-medium children's education or no children were associated with a 1.49- (95% confidence interval [CI]: 1.44; 1.54] and 1.69-times (95% CI: 1.61;1.78) higher hazard of T2D, respectively. Short-medium household's education combined with either long children's education or no children were associated with 0.64- (95% CI: 0.62; 0.66) and 0.77-times (95% CI: 0.74; 0.79) lower hazard of T2D, respectively. Compared to long household's education and children's education, any other combination of household's and children's education was associated with higher hazards of death both without and with T2D. CONCLUSION: Older adults living in households with long education with no children or children with short-medium education had higher hazards of T2D. Households with short-medium education and no children or children with long education were associated with lower hazards of T2D. Both household's and children's education were associated with higher hazard of death without and with T2D.

The effect of exercise on depressive symptoms in multiple sclerosis based on a meta-analysis and critical review of the literature.

BACKGROUND AND PURPOSE: The purpose of this study was to perform a systematic review of the literature on the effects of exercise on depressive symptoms in patients with multiple sclerosis (MS), as well as to apply meta-analytical procedures to the results. METHODS: A systematic search covering eight databases was conducted. The included studies were randomized controlled trials applied to people with definite MS who completed a structured exercise intervention which were compared to any comparator, including other forms of exercise. The outcomes included a primary measure of depression/depressive symptoms or an instrument with a clearly defined depression subscale. RESULTS: Fifteen randomized controlled trial studies were identified including a total of 331 exercising subjects and 260 controls. The average Physiotherapy Evidence Database (PEDro) score was 5.6 ± 1.3 points. Only one study applied depressive symptoms as the primary outcome. Four studies showed positive effects of exercise on depressive symptoms. An in-depth analysis of the studies revealed that the baseline level of depressive symptoms, patient disability level, choice of depression instrument and exercise intensity may influence the results. The meta-analysis included 12 studies reflecting a total of 476 subjects. The standardized mean difference across studies was g = -0.37, 95% confidence interval (-0.56; -0.17), and the null hypothesis of homogeneity within the sample could not be rejected (Q = 12.05, df = 11, P = 0.36). DISCUSSION: Exercise may be a potential treatment to prevent or reduce depressive symptoms in individuals with MS, but existing studies do not allow solid conclusions. Future well-designed studies evaluating the effects of exercise on depressive symptoms and major depression disorder in MS are highly warranted.

Effects of sprint interval training on VO2max and aerobic exercise performance: A systematic review and meta-analysis.

Recently, several studies have examined whether low-volume sprint interval training (SIT) may improve aerobic and metabolic function. The objective of this study was to systematically review the existing literature regarding the aerobic and metabolic effects of SIT in healthy sedentary or recreationally active adults. A systematic literature search was performed (Bibliotek.dk, SPORTDiscus, Embase, PEDro, SveMed+, and Pubmed). Meta-analytical procedures were applied evaluating effects on maximal oxygen consumption (VO2max). Nineteen unique studies [four randomized controlled trials (RCTs), nine matched-controlled trials and six noncontrolled studies] were identified, evaluating SIT interventions lasting 2-8 weeks. Strong evidence support improvements of aerobic exercise performance and VO2max following SIT. A meta-analysis across 13 studies evaluating effects of SIT on VO2max showed a weighted mean effects size of g = 0.63 95% CI (0.39; 0.87) and VO2max increases of 4.2-13.4%. Solid evidence support peripheral adaptations known to increase the oxidative potential of the muscle following SIT, whereas evidence regarding central adaptations was limited and equivocal. Some evidence indicated changes in substrate oxidation at rest and during exercise as well as improved glycemic control and insulin sensitivity following SIT. In conclusion, strong evidence support improvement of aerobic exercise performance and VO2max following SIT, which coincides with peripheral muscular adaptations. Future RCTs on long-term SIT and underlying mechanisms are warranted.

Technetium-99m-nanocolloid scintigraphy in orthopedic infections: a comparison with indium-111-labeled leukocytes.

Twenty-three patients with clinically suspected acute or chronic osteomyelitis and 21 patients with suspected joint prosthetic infection underwent scintigraphy using both 99mTc-nanocolloid and 111In-labeled leukocytes. The scintigrams of the two tracers were blindly interpreted by three independent observers. Their evaluations showed high correspondence. Patients were classified as having no infection, probable infection or proven infection according to specific criteria which included results of bacteriological cultures and histopathological examinations. For proven and probable infection taken together, the sensitivity with 99mTc-nanocolloid was 94%, the specificity 84% and the accuracy 87%, compared with 75%, 90% and 85% with 111In-labeled leukocytes. We conclude that 99mTc-nanocolloid scintigraphy is at least equivalent with 111In-leucocyte scintigraphy, and its additional advantages are shorter examination time, less complexity and better radiation dosimetry.

Radioisotope evaluation of the esophageal remnant and the gastric conduit after gastric pull-up esophagectomy.

BACKGROUND: The act of swallowing after gastric pull-up esophagectomy has not been thoroughly investigated. The aim of this study was to evaluate deglutition in the esophageal remnant and in the gastric conduit in patients who have undergone this operation. METHODS: The residual radionuclide activity was measured 15 seconds after a swallow in the esophageal remnant and at intervals up to a maximum of 120 minutes after a swallow in the gastric conduit. The scintigraphic rate of transit of a bolus in both areas was compared in patients who had anastomosis in the neck (n = 15) versus patients who had anastomosis in the chest (n = 19). Comparisons were also made between patients with and without symptoms of dysphagia. The scintigraphic measurements were also correlated with anastomotic diameters, measured with use of a volumetric balloon insufflation method, at 3, 6, and 12 months after operation. RESULTS: There were no significant differences in esophageal residual radionuclide activity at 15 seconds after a swallow in the groups with anastomosis in the neck versus anastomosis in the chest, with 30% residual activity up to 12 months after operation in both groups (P = .24). In the patients as a whole the 50% gastric conduit emptying time of 44 to 61 minutes did not change during the first postoperative year (P = .12). There was no association between anastomotic diameter and residual activity in the remaining esophagus (P < .126). Moderate and severe dysphagia was reported in only a few patients, and there was no correlation between dysphagic symptoms and retention in the residual esophagus or slower emptying in the gastric conduit. CONCLUSIONS: The amount of peristaltic activity in the remaining esophagus after esophagectomy with gastric replacement is unaffected by the level of the anastomosis. The gastric conduit empties slowly in all patients, and there is no correlation between the rate of emptying and either anastomotic diameter or symptoms of dysphagia.

One year follow-up of lung clearance of 99mTc-diethylene triamine penta-acetic acid and disease activity in sarcoidosis.

BACKGROUND AND AIM OF THE WORK: In interstitial lung disease lung clearance of 99mTc-diethylenetriaminepentaacetic acid (DTPA) reflects alterations in the alveolar capillary barrier. Our objective was to describe changes in lung clearance during one year in sarcoidosis, and to relate clearance to other data of lung function and disease activity. METHODS: Twenty-three newly diagnosed patients were studied with respect to lung DTPA clearance, spirometry, 67Ga scintigraphy and serum angiotensin converting enzyme (SACE). Lung mechanics and arterial PO2 at rest and exercise were studied in patients with radiological parenchymal changes. Six of these patients were prescribed peroral steroids. RESULTS: At inclusion lung DTPA clearance measured over 30 minutes was 53 +/- 16 minutes and at follow-up 59 +/- 20 minutes (p > 0.05). The number of pathological clearance curves at inclusion was 10 and at follow-up 6. In treated patients lung DTPA clearance improved as did lung 67Ga score and SACE. However, lung clearance did not correlate significantly with changes in lung function or other activity parameters. CONCLUSIONS: Lung DTPA clearance reflects lung function from an aspect different from that of other methods. It seems sensitive to pathology reversed by steroids and may, in some cases, help in the evaluation of disease activity.

Magnetic resonance imaging, scintigraphy, and arthroscopic evaluation of traumatic hemarthrosis of the knee.

Forty patients with traumatic knee hemarthrosis were examined within 1 week after injury and observations made with magnetic resonance imaging, scintigraphy, arthroscopic evaluation, radiography, and physical examination were compared. Thirty-four patients (85%) had anterior cruciate ligament injuries according to the arthroscopic findings and 28 (83%) of these had associated meniscal tears. Magnetic resonance imaging confirmed the arthroscopic findings, especially if only meniscal tears that required surgery were taken into account (sensitivity, 94% for the lateral and 83% for the medial meniscus). However, the specificity of magnetic resonance imaging was only 29% and 27% for the lateral and medial menisci, respectively, and the accuracy was 28% and 50%, respectively. Marrow edemas, or bone bruises, were seen on magnetic resonance imaging in 80% of the patients and were mainly seen in the lateral compartment. Bone scans correlated well with magnetic resonance imaging findings of marrow edemas. Plain radiographs were normal in all but one case. We show that magnetic resonance imaging does not add information on the status of the anterior cruciate ligament compared with the clinical examination, and that it may be as good as arthroscopic evaluation for the diagnosis of meniscal tears that require surgery.

Arterial desaturation in healthy children during and after minor surgery.

Pulse oximetry (PO) was applied to 79 otherwise healthy children during and after minor ENT surgery under general anaesthesia in private practice. The PO data were not available to the anaesthetist unless desaturation to less than or equal to 85% was present for greater than or equal to 30 s. This occurred in 12 and 9 cases during anaesthesia and recovery, respectively, only 8 and 5 cases, respectively, being diagnosed clinically. Desaturation during and after anaesthesia was more common in children undergoing adenoidectomy than during procedures for which endotracheal intubation was not performed. During recovery, desaturation was more likely to occur in the same patients again. Lower values of SaO2 were found in younger children and in children resisting or crying at induction. There was a (weak) negative correlation between SaO2 and HR. As clinically undiagnosed desaturation occurs even in healthy children undergoing minor surgical procedures, a more widespread use of PO during and after anaesthesia may be advisable.

Fine-Needle aspiration biopsy of bone lesions in the spine: diagnostic value.

Fine-needle aspiration biopsy was performed in 92 patients with back pain and a lesion confirmed via x-ray of the spine. In 31 patients in whom x-ray findings had suggested spondylitis, fine-needle aspiration biopsy showed the presence of a tumour in three patients. Of 61 patients with radiographic findings suggestive of malignancy, 26 had benign unspecific lesions, and 35 patients had neoplastic lesions. There were four false negative cytological reports and one false positive report. Additional ESR determination was of no clinical value. There were no complications. Fine-needle aspiration biopsy of bone lesions is recommended as an easy, safe and very often a valuable diagnostic complement.

Evaluation of anamnestic data in patients referred for oral cholecystography.

The knowledge about how patients are selected for elective gallbladder investigations is limited. In this study the anamnestic data of 817 patients referred for an elective cholecystography have been compared with those of 789 matched controls. Other diseases in the medical history were commonly seen, and different gastrointestinal symptoms occurred frequently in the patients. Only 207 (23%) patients presented with a gallstone disease, and no symptom was commoner in these patients than in the patients with normal cholecystograms. The low positive yield could be due to liberal and unclear indications for oral cholecystography. Many gallstones detected this way may in fact be asymptomatic, which should be borne in mind when a cholecystectomy is considered.

Are digital images good enough? A comparative study of conventional film-screen vs digital radiographs on printed images of total hip replacement.

The aim of this study was to evaluate the inter- and intra-observer variability and to find differences in diagnostic safety between digital and analog technique in diagnostic zones around hip prostheses. In 80 patients who had had a total hip replacement (THR) for more than 2 years, a conventional image and a digital image were taken. Gruen's model of seven distinct regions of interest was used for evaluations. Five experienced radiologists observed the seven regions and noted in a protocol the following distances: stem-cement; cement-bone; and stem-bone. All images were printed on hard copies and were read twice. Weighted kappa, kappa(w), analyses were used. The two most frequently loosening regions, stem-cement region 1 and cement-bone region 7, were closely analyzed. In region 1 the five observers had an agreement of 86.75-97.92% between analog and digital images in stem-cement, which is a varied kappa(w) 0.29-0.71. For cement-bone region 7 an agreement of 87.21-90.45% was found, which is a varied kappa(w) of 0.48-0.58. All the kappa values differ significantly from nil. The result shows that digital technique is as good as analog radiographs for diagnosing possible loosening of hip prostheses.

CT of the wrist in suspected scaphoid fracture.

Bone scan and sagittal projection CT of the scaphoid was performed in 10 patients with clinically suspected scaphoid fractures. The primary and follow-up plain radiographs were negative or equivocal for fracture. CT examination demonstrated scaphoid fracture in 7 patients and normal findings in 3. It is concluded that CT of the scaphoid can replace bone scan to diagnose or rule out fracture in institutions where nuclear medicine facilities are not available.

Fine needle aspiration biopsy of the thoracic cage including the pleura--clinical value.

In a series comprising 122 patients with a lesion localized to the thoracic cage or pleura the value of fine needle aspiration biopsy has been analyzed. In 53 patients the cytological reports were decisive for further clinical evaluation and management. Two false negative reports were recorded. No complications occurred. Fine needle aspiration biopsy is recommended as first diagnostic step since it is well tolerated by the patients, without complication and has a fair diagnostic safety.

Film-screen vs. digital radiography in rheumatoid arthritis of the hand. An ROC analysis.

In a prospective investigation the diagnostic accuracy of film-screen and digital radiography in rheumatoid arthritis of hands was compared. Seventy hands of 36 patients with established rheumatoid arthritis were included in the study. Each of 11 joints in every hand was evaluated regarding the following radiologic parameters: soft tissue swelling, joint space narrowing, erosions and periarticular osteopenia. The digital images were obtained with storage phosphor image plates and evaluated in 2 forms; as digital hard-copy on film and on a monitor of an interactive workstation. The digital images had a resolution of either 3.33 or 5.0 lp/mm. ROC curves were constructed and comparing the area under the curves no significant difference was found between the 3 different imaging forms in either resolution group for soft tissue swelling, joint space narrowing and erosions. The film-screen image evaluation of periarticular osteopenia was significantly better than the digital hard-copy one in the 3.33 lp/mm resolution group, but no significant difference was found in the 5.0 lp/mm group. These results support the view that currently available digital systems are capable of adequate diagnostic performance.

Spatial resolution requirements in digital radiography of scaphoid fractures. An ROC analysis.

PURPOSE: To investigate the spatial resolution requirements in digital radiography of scaphoid fractures. MATERIAL AND METHODS: Included in the study were 60 scaphoid radiographs with and 60 without fractures of the scaphoid bone. The film-screen images were digitized using pixel sizes of 115, 170, and 340 microns along with 170 microns with a 10:1 wavelet compression. The digital images were displayed on a 1280 x 1024 x 8 bits monitor, and 5 observers evaluated the images in 5 randomized sessions. The results for each pixel size were then compared to the film-screen images by ROC analysis. RESULTS: The mean area under the ROC curves was larger for the film-screen images than for the digital images at all resolutions. However, this difference was not significant when the areas under the ROC curves for the film-screen images were compared to the digital images of 115, 170, and 170 microns with 10:1 compression. There was a significant difference for the 340-microns pixel size in favour of the film-screen images. The mean ROC curves for the digital images were very similar for the 115 and 170 microns pixel sizes, although slightly better for 115 microns. At 170 microns, the compression seemed to have a relatively small negative effect on the diagnostic performance; the deterioration was greater when the pixel size was increased to 340 microns. There was no obvious correlation between diagnostic performance and the experience of the observers in using work-stations. CONCLUSIONS: The pixel size of 170 microns is adequate for the detection of subtle fractures, even after wavelet compression by a ratio of 10:1.