How do multimorbidity and lifestyle factors impact the perceived health of adults with intellectual disabilities?

BACKGROUND: Adults with intellectual disability (ID) have poorer physical and perceived health than the general population. Knowledge of perceived health predictors is both limited and important for guiding the development of preventive actions. The aims of this study were to investigate (1) the associations between perceived health and demographics, degree of ID, physical health conditions, and weight and physical activity level and (2) lifestyle factors and multimorbidity as predictors for perceived health adjusted for age, gender, and level of ID. METHOD: The North Health in Intellectual Disability study is a community based cross-sectional survey. The POMONA-15 health indicators were used. Univariate and multivariate logistic regression analyses with poor versus good health as the dependent variable were applied. RESULTS: The sample included 214 adults with a mean age 36.1 (SD 13.8) years; 56% were men, and 27% reported perceiving their health as poor. In univariate analyses, there were significant associations between poor health ratings and female gender, lower motor function, number of physical health conditions and several indicators of levels of physical activity. In the final adjusted model, female gender [odds ratio (OR) 2.4, P < 0.05], level of ID (OR 0.65, P < 0.05), numbers of physical health conditions (OR 1.6, P < 0.001) and lower motor function (OR 1.5 P < 0.05) were significant explanatory variables for poor perceived health, with a tendency to independently impact failure to achieve 30 min of physical activity daily (OR 2.0, P = 0.07). CONCLUSION: Adults with ID with female gender, reduced motor function and more physical health conditions are at increased risk of lower perceived health and should be given attention in health promoting interventions. A lack of physical activity tends to negatively influence perceived health.

"Do I exist in this world, really, or is it just her?" Youths' perspectives of living with a sibling with anorexia nervosa.

Little is known about how severe anorexia nervosa (AN) in youths affects siblings and siblings' experiences of family-based treatment for AN. Thirteen youths (M age = 15.5 years, SD = 3.0; 23% boys) who had been co-admitted with their sibling with AN and parents at an inpatient clinic for eating disorders 3 to 6 years earlier participated in qualitative interviews. Interviews were analyzed using systematic text condensation. Results showed AN is difficult to understand, particularly at onset, and is associated with confusion and lack of information for siblings. AN evokes difficult emotions, including fears of death, frustration about rigid behavior, and sadness about changed life situations. AN affects family dynamics and relations, including conflicts and disruptions at home, limited and divided family life, and less attention from parents and extended family. Siblings pay attention to other people eating habits, strive for a balanced view on eating, and experience family meals as conflictual. Siblings experience increased knowledge and personal development, and are ambivalent to family treatment. Ways of coping include creating distance, seeking social support, rationalizing, and keeping hope. In conclusion, siblings' experiences of severe AN are complex and ambiguous. Family-based treatment for AN in young people should address siblings' perspectives.

Altered Brain Structure in Infants with Turner Syndrome.

Turner syndrome (TS) is a genetic disorder affecting approximately 1:2000 live-born females. It results from partial or complete X monosomy and is associated with a range of clinical issues including a unique cognitive profile and increased risk for certain behavioral problems. Structural neuroimaging studies in adolescents, adults, and older children with TS have revealed altered neuroanatomy but are unable to identify when in development differences arise. In addition, older children and adults have often been exposed to years of growth hormone and/or exogenous estrogen therapy with potential implications for neurodevelopment. The study presented here is the first to test whether brain structure is altered in infants with TS. Twenty-six infants with TS received high-resolution structural MRI scans of the brain at 1 year of age and were compared to 47 typically developing female and 39 typically developing male infants. Results indicate that the typical neuroanatomical profile seen in older individuals with TS, characterized by decreased gray matter volumes in premotor, somatosensory, and parietal-occipital cortex, is already present at 1 year of age, suggesting a stable phenotype with origins in the prenatal or early postnatal period.

Intrathecal Use of Gadobutrol for Glymphatic MR Imaging: Prospective Safety Study of 100 Patients.

BACKGROUND AND PURPOSE: Intrathecal contrast-enhanced glymphatic MR imaging has shown promise in assessing glymphatic function in patients with dementia. The purpose of this study was to determine the safety profile and feasibility of this new MR imaging technique. MATERIALS AND METHODS: A prospective safety and feasibility study was performed in 100 consecutive patients (58 women and 42 men, 51 ± 19 years of age) undergoing glymphatic MR imaging from September 2015 to August 2018. Short- and long-term serious and nonserious adverse events were registered clinically and by interview after intrathecal administration of 0.5 mL of gadobutrol (1.0 mmol/mL) along with 3 mL of iodixanol (270 mg I/mL). Adverse events are presented as numbers and percentages. RESULTS: One serious adverse event (anaphylaxis) occurred in a patient with known allergy to iodine-containing contrast agents (1%). The main nonserious adverse events during the first 1-3 days after contrast injection included severe headache (28%) and severe nausea (34%), though the frequency depended heavily on the diagnosis. After 4 weeks, adverse events had resolved. CONCLUSIONS: Intrathecal administration of gadobutrol in conjunction with iodixanol for glymphatic MR imaging is safe and feasible. We cannot conclude whether short-duration symptoms such as headache and nausea were caused by gadobutrol, iodixanol, the lumbar puncture, or the diagnosis. The safety profile closely resembles that of iodixanol alone.

Exposure of fish to high-intensity sonar does not induce acute pathology.

This study investigated immediate effects of intense sound exposure associated with low-frequency (170-320 Hz) or with mid-frequency (2.8-3.8 kHz) sonars on caged rainbow trout Oncorhynchus mykiss, channel catfish Ictalurus punctatus and hybrid sunfish Lepomis sp. in Seneca Lake, New York, U.S.A. This study focused on potential effects on inner ear tissues using scanning electron microscopy and on non-auditory tissues using gross and histopathology. Fishes were exposed to low-frequency sounds for 324 or 628 s with a received peak signal level of 193 dB re 1 microPa (root mean square, rms) or to mid-frequency sounds for 15 s with a received peak signal level of 210 dB re 1 microPa (rms). Although a variety of clinical observations from various tissues and organ systems were described, no exposure-related pathologies were observed. This study represents the first investigation of the effects of high-intensity sonar on fish tissues in vivo. Data from this study indicate that exposure to low and midfrequency sonars, as described in this report, might not have acute effects on fish tissues.

The antennal system and cockroach evasive behavior. II. Stimulus identification and localization are separable antennal functions.

Cockroaches ( Periplaneta americana) orient their antennae toward moving objects based on visual cues. Presumably, this allows exploration of novel objects by the antennal flagellum. We used videographic and electrophysiological methods to determine if receptors on the flagellum are essential for triggering escape, or if they enable cockroaches to discriminate threatening from non-threatening objects that are encountered. When a flagellum was removed, and replaced with a plastic fiber, deflection of a "prosthetic flagellum" still activated the descending mechanosensory interneurons associated with escape and produced typical escape responses. However, escape was essentially eliminated by constraining the movement of the scape and pedicel at the antennal base. When cockroaches approached and briefly explored the surface of a spider or another cockroach with the flagellum, they produced escape significantly more often in response to subsequent controlled contact from a spider than from a cockroach. This discrimination did not depend on visual or wind-sensory input, but required flagellar palpation of the surface. The crucial sensory cues appear to involve texture rather than surface chemicals. These results indicate that cockroaches acquire basic information on stimulus identity during exploration of surfaces with flagellar receptors, but that basal receptors are triggers for escape behavior.

Adoption of new health care services in Norway (1993-1997): specialists' self-assessment according to national criteria for priority setting.

OBJECTIVES: To identify health care services adopted in Norway in the period 1993-1997, and examine them according to proposed national guidelines for priority setting. These guidelines define core services. DESIGN: Two-stage self-administered questionnaire. SETTING: The Norwegian public healthcare system. SUBJECTS: Presidents of all relevant specialist and sub-specialist associations in the Norwegian Medical Association (n=56). OUTCOME MEASURES: Number of adopted services satisfying the priority criteria of core services, according to physician's self-assessment. Number and type of interventions suited for the priority-setting criteria. RESULTS: Thirty-two percent of new technologies satisfied the definition of core services according to specialists' own assessment. Of the 88 responses analysed for the second stage of our survey, fifteen answers (17%) indicated lack of applicability of the priority setting criteria. Loss of applicability was related to diagnostic and procedure-related technologies. CONCLUSIONS: Less than one-half of the assessed technologies adopted in Norway in the period 1993-1997 satisfy proposed national criteria for priority setting. The guidelines are applicable for most interventions, but fail in most evaluations of diagnostic and procedure-related improvements. Independent and systematic evaluations of new technologies are needed within the context of priority setting.

Latency as a function of intensity in auditory neurons: influences of central processing.

The response latencies of sensory neurons typically shorten with increases in stimulus intensity. In the central auditory system this phenomenon should have a significant impact on a number of auditory functions that depend critically on an integration of precisely timed neural inputs. Evidence from previous studies suggests that the auditory system not only copes with the potential problems associated with intensity-dependent latency change, but that it also modifies latency change to shape the response properties of many cells for specific functions. This observation suggests that intensity-dependent latency change may undergo functional transformations along the auditory neuraxis. The goal of our study was to explore these transformations by making a direct, quantitative comparison of intensity-dependent latency change among a number of auditory centers from the lower brainstem to the thalamus. We found two main ways in which intensity-dependent latency change transformed along the neuraxis: (1) the range of latency change increased substantially and (2) one particular type of latency change, which has been suggested to be associated with sensitivity to temporally segregated stimulus components, occurred only at the highest centers tested, the midbrain and thalamus. Additional testing in the midbrain (inferior colliculus) indicated that inhibitory inputs are involved in shaping latency change. Our findings demonstrate that the central auditory system modifies intensity-dependent latency changes. We suggest that these changes may be functionally incorporated, actively enhanced, or modified to suit specific functions of the auditory system.

[Measures to promote healthy dietary habits among schoolchildren]. / Tiltak for å fremme sunne kostvaner blant skoleelever.

The Norwegian National Nutrition Council has, over the past years, implemented a number of measures designed specifically to promote well-organized school meals and increase the consumption of fruit and vegetables among school children. These measures include the development of national guidelines for organizing school meals, economic support for trying out new methods of operating a school cafeteria, national campaigns to promote the traditional Norwegian packed lunch, open community meetings with political and administrative leaders at municipality level, the introduction of a system whereby pupils can purchase fresh fruit and vegetables at school, and advocacy through mass media. Results of an ongoing evaluation seem to indicate that these measures have had a positive effect on the organization of school meals. More young children are attended to by an adult during mealtimes, more pupils are allowed at least 20 minutes for their lunch break, and a growing number of secondary schools are introducing school cafeterias. However, only half of the total number of schools seem to be aware of the new guidelines, and much more work is required in order to ensure all students are provided with a well-organized school meal. Health personnel play a critical role in ensuring that this work is given political priority, also at the local level.

[How shall we set priorities among experimental treatment methods?]. / Hva skal vi satse på av utprøvende behandling?

There is an increasing demand from patients to have access to new and promising treatment for severe diseases. Norway has recently started ordinary public funding of large-scale clinical investigation of treatment effect and safety for new treatment modalities. The government has thus established a new principle for funding a sub-category of clinical research: investigational medicine. How should we prioritize between promising clinical protocols when resources are scarce? The article examines criteria for priority setting in investigational medicine: quality of evidence; magnitude of expected benefit from treatment; balance between risks and benefits; quality of the research protocol; cost; and size of patient population. These criteria are applied on a controversial clinical examples, high-dose chemotherapy with hematopoietic stem cell support for metastatic breast cancer.

A double-blind, placebo-controlled evaluation of intranasal metoclopramide in the prevention of postoperative nausea and vomiting.

Nausea and vomiting are common complaints in the postoperative period and contribute to patient distress and delay of discharge for outpatient surgical procedures. Laparoscopic procedures are associated with a high incidence of postoperative nausea and vomiting (PONV) episodes. Parenteral use of metoclopramide prevents and treats PONV. The intranasal route provides rapid and complete absorption of metoclopramide without many of the adverse effects observed with parenteral administration of the drug. We performed a prospective, double-blinded, randomized, placebo-controlled study to evaluate the safety and efficacy of metoclopramide 20 mg administered intranasally for emetic prophylaxis in laparoscopic surgery patients. The results from 109 patients enrolled in the study showed that this intranasal dose of metoclopramide may be ineffective in preventing the occurrence of PONV. The poor performance of the intranasal metoclopramide formulation in this study cannot be attributed to patient-specific and perioperative factors. It may be due to an inadequate dose or slow absorption of the drug. The small sample size, however, may also have been a factor.

[Prioritizing in hospital departments]. / Prioritering på avdelingsnivå.

A framework for decision-making is introduced in which two out of five patients will be denied treatment. Certain resource constraints are accepted in this hypothetical example. The authors' own ranking of five patients from a department of internal medicine are presented. It was not difficult to select the highest prioritized patients. However, ranking of the remaining patients revealed considerable controversy. Emphasis is therefore laid on the reasons given for each ranking. An interesting finding is that variations in awarding priority to some cases are clearly based on disagreement about facts, not values. The article concludes by suggesting a classification of selection criteria for priority setting based on a distinction between necessary, controversial and unacceptable criteria. The article is presented in an attempt to stimulate a debate about priority setting in everyday hospital work.

Hemodialysis clearance of encainide and metabolites.

The disposition of encainide and metabolites O-desmethylencainide (ODE) and 3-methyl-ODE (MODE) was evaluated in a 31-year-old hemodialysis patient following a 25 mg oral dose during an interdialytic period and a second 25 mg oral dose 48 h later, 2 h before a hemodialysis procedure. The inter- and intradialytic elimination half-lives were not different for encainide and its metabolites ODE and MODE. The hemodialysis clearance of encainide, MODE, and ODE are all less than 10% of the creatinine clearance of the dialyzer. Thus, hemodialysis does not result in clinically significant removal of encainide or its metabolites.