Improving identification of idiopathic intracranial hypertension patients in Swedish patient register.

OBJECTIVE: Idiopathic intracranial hypertension (IIH) is often misdiagnosed. This can cause problems if conducting register-based studies. The study purpose was to produce algorithms that better identify patients with correct diagnosis of IIH in the Swedish National Patient Register (NPR). METHODS: Patients with ICD-10 code G93.2 for IIH registered in the NPR (2006-2013, Stockholm County) were included and diagnosis validated by medical record reviews. Patients were randomized into two groups: one used to produce the algorithm (n = 105) and one for validation (n = 102). We tested variables possible to extract from registries and used forward stepwise logistic regression which provided a predicted probability of correct diagnosis for each patient. RESULTS: We included 207 patients of which 135 had confirmed IIH. This gave a positive predictive value of 65.2% (CI: 58.4-71.4). The algorithm produced with variables extracted from registries, that is, age, number of times with diagnosis code G93.2 recorded (>2 times), and acetazolamide treatment, predicted the diagnosis correctly 88.2% (CI: 80.3-93.3) of the time. Excluding treatment data from the algorithm did not change the prediction notably, 86.3% (CI: 78.1-91.7). CONCLUSION: We produced two algorithms that with improved accuracy predict whether an IIH diagnosis in the NPR is correct. This can be a useful tool when performing register-based studies.

Population-based incidence and clinical characteristics of idiopathic intracranial hypertension.

OBJECTIVE: To validate the diagnosis of idiopathic intracranial hypertension (IIH) from the Swedish National Patient Register (NPR) and investigate the incidence of IIH, as well as co-morbidities and medication use in a large Swedish population-based sample. METHODS: We searched the NPR to find all patients ≥18 years old with the ICD-10 diagnosis code (G93.2) for IIH in Stockholm County from Jan 1, 2006, to Dec 31, 2013. All medical records were reviewed to validate the diagnosis and to collect additional information. RESULTS: We included 207 patients with an IIH diagnosis, of which 135 (65%) were correctly diagnosed when validated by charts review. Eighty-three patients had disease onset during the study period. This gave a yearly incidence of 0.65/100 000. Female-to-male ratio was 6.1:1. Females, mean age 31.0 (CI 28.8-33.1), were younger at time of diagnosis compared to males, mean age 42.9 (CI 36.4-49.5), P<.001. The most common co-morbidities were obesity (92%), hormonal conditions (21%) and recent infections preceding the diagnosis (21%). Prior treatment with tetracycline derivatives were seen in 9%. CONCLUSION: The incidence of IIH in Stockholm is in the lower range of previously reported rates, possibly due to a lower prevalence of obesity. A substantial proportion of patients (35%) did not fulfill diagnostic criteria. Disease onset occurs at younger age in females. Co-morbidities were mainly associated with diseases affecting hormonal balance or causing inflammatory activation. These findings raise new hypothetical theories regarding mechanisms involved in IIH pathogenesis.

Multiple sclerosis and risk of attempted and completed suicide - a cohort study.

BACKGROUND AND PURPOSE: Patients with multiple sclerosis (MS) are known to have an elevated suicide risk, but attempted suicide is incompletely investigated. The relation between education level and suicidality has not been investigated in MS patients. Our objective was to estimate attempted suicide and completed suicide risks amongst MS patients. METHODS: A total of 29 617 Swedish MS patients were identified through the Swedish Patient Register and matched with 296 164 people without MS from the general population. Cox regression analysis estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for the association of MS with attempted and completed suicide, with adjustment for age, sex, education and calendar period. RESULTS: The adjusted HR for attempted suicide amongst MS patients is 2.18 (95% CI 1.97-2.43) compared with the general population cohort. For completed suicide the HR is 1.87 (95% CI 1.53-2.30). In both groups women are at higher risk of attempting suicide, whilst men are at higher risk of completing suicide. Education level is inversely associated with completed suicide amongst the non-MS cohort (0.68, 0.51-0.91), but not amongst MS patients (1.10, 0.60-2.04). CONCLUSION: Multiple sclerosis patients are at higher risk of both attempted and completed suicide. No evidence was found of an inverse association between educational level and risk of completed suicide amongst MS patients.

Dietary fat reduction achieved by increasing consumption of a starchy food--an intervention study.

OBJECTIVE: To test t he hypothesis that increased consumption of foods in rich in starch, such as breakfast cereals, will enable a substantial reduction in the percentage dietary energy derived from fat. DESIGN: Parallel experimental design, with matched subjects allocated randomly to an intervention or a control group. SETTING: Free-living subjects (mean age 20 y), undergraduate students at a college for higher education. SUBJECTS: Sixty-two enrolled, 59 completed the study; 7 d weighed intakes at baseline, 4 weeks and 12 weeks. INTERVENTION: The intervention group were required to eat 60 g breakfast cereal daily with semi-skimmed milk. Pre-weighed portions of three types of cereal were distributed without charge at the beginning of each week of the study; subjects were reimbursed for the cost of milk used. No other dietary advice was given. RESULTS: At baseline, total energy intake and percentage energy from macronutrients was very similar in both the intervention and control group. After four weeks of intervention there was a significant reduction in % energy from fat (-5.4%) in the experimental group, maintained at the 12 weeks follow-up. There was a corresponding rise in energy from CHO: a significant increase of 5.5% after four weeks had reached 6.5% by 12 weeks. Total energy remained virtually unchanged, indicating a replacement of fat energy by carbohydrate energy. These changes were not found in the control group. CONCLUSIONS: A simple dietary intervention to increase consumption of breakfast cereal led to a 5% reduction in % dietary fat energy, with a beneficial effect on micronutrient intakes. The results support the case for positive advice to increase consumption of complex carbohydrate, as a strategy for dietary fat reduction in the wider population.