Introducing extended consultations for patients with severe mental illness in general practice: Results from the SOFIA feasibility study.

BACKGROUND: People with a severe mental illness (SMI) have shorter life expectancy and poorer quality of life compared to the general population. Most years lost are due to cardiovascular disease, respiratory disease, and various types of cancer. We co-designed an intervention to mitigate this health problem with key stakeholders in the area, which centred on an extended consultations for people with SMI in general practice. This study aimed to1) investigate general practitioners' (GPs) experience of the feasibility of introducing extended consultations for patients with SMI, 2) assess the clinical content of extended consultations and how these were experienced by patients, and 3) investigate the feasibility of identification, eligibility screening, and recruitment of patients with SMI. METHODS: The study was a one-armed feasibility study. We planned that seven general practices in northern Denmark would introduce extended consultations with their patients with SMI for 6 months. Patients with SMI were identified using practice medical records and screened for eligibility by the patients' GP. Data were collected using case report forms filled out by practice personnel and via qualitative methods, including observations of consultations, individual semi-structured interviews, a focus group with GPs, and informal conversations with patients and general practice staff. RESULTS: Five general practices employing seven GPs participated in the study, which was terminated 3 ½ month ahead of schedule due to the COVID-19 pandemic. General practices attempted to contact 57 patients with SMI. Of these, 38 patients (67%) attended an extended consultation, which led to changes in the somatic health care plan for 82% of patients. Conduct of the extended consultations varied between GPs and diverged from the intended conduct. Nonetheless, GPs found the extended consultations feasible and, in most cases, beneficial for the patient group. In interviews, most patients recounted the extended consultation as beneficial. DISCUSSION: Our findings suggest that it is feasible to introduce extended consultations for patients with SMI in general practice, which were also found to be well-suited for eliciting patients' values and preferences. Larger studies with a longer follow-up period could help to assess the long-term effects and the best implementation strategies of these consultations.

Lifespan data on postural balance in multiple standing positions.

BACKGROUND: Maintaining balance is important throughout life. The Nintendo Wii Balance Board (WBB) can give reliable quantitative measures of postural balance, but reference data are lacking. Furthermore, one-leg standing balance across the adult lifespan is not fully described. The aim of the study was (1) to provide reference data on postural balance in multiple standing positions using a WBB, (2) to determine an age cut-off for the ability to stand on one-leg in men and women. METHODS: This was a cross-sectional study and data was collected in two cities in Denmark (Aalborg and Odense) and Norway (Oslo and Ålesund) during spring and summer of 2016. Postural balance was assessed in individuals across the adult lifespan in three different bases of support positions (hip-wide and narrow two-legged stance, and one-legged stance) using a WBB. Reference data were analyzed and presented in 10-year intervals. RESULTS: A total of 354 individuals aged 20-99 years were recruited. Reference data were presented in percentiles stratified by gender for the following age categories: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, and 80+. Data showed that the difference between men and women's balance was larger at older age with men performing worst. The cut-off ability to stand on one-leg was 72.5 years without statistical evidence of gender difference. CONCLUSION: This study reports reference data for postural balance across the entire adult lifespan using a WBB. More than half of the individuals over 72.5 years of age were unable to stand balanced on one-leg.

Reference data on hand grip and lower limb strength using the Nintendo Wii balance board: a cross-sectional study of 354 subjects from 20 to 99 years of age.

BACKGROUND: Accurate assessment of isometric hand grip strength (HGS) and isometric lower limb strength (LS) are often limited to specialized clinics due to high costs and need for specialized equipment and personnel. A mobile and user-friendly device would facilitate a wider use of these measures in the clinical setting. The Nintendo Wii Balance Board (WBB) is a novel and pragmatic tool that has been validated for measuring muscle strength and other clinically relevant physiological variables. However, reference data for HGS and LS are lacking. The purpose of the current study is to establish reference data for HGS and LS in individuals ≥20 years of age using the WBB method, and to characterize the effects of age in these measurements. METHOD: Healthy participants were recruited at various locations and their HGS and LS were tested by six assessors using the WBB. Reference data were analysed and presented in age-groups, while the age-related change in HGS and LS was tested and characterized with linear regression models. RESULTS: Three hundred and fifty-four participants between 20 and 99 years of age were tested. Data are presented separately according to gender and the following age categories: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, and 80+, and presented in absolute values as well as percentiles. The main findings were; (1) Significantly higher HGS and LS among males compared to females and for the dominant limb compared to the non-dominant limb, (2) a significant decline in strength with increasing age, and (3) the rate of decline increased significantly (i.e. it was non-linear) with age for HGS, but not for LS. CONCLUSION: This study reported reference data with percentiles for a novel method for assessing HGS and LS. Data were consistent with previously known effects of age and gender on HGS and LS. The presented data may supplement future trials using the WBB in research or in the clinical setting.

Large Seebeck effect by charge-mobility engineering.

The Seebeck effect describes the generation of an electric potential in a conducting solid exposed to a temperature gradient. In most cases, it is dominated by an energy-dependent electronic density of states at the Fermi level, in line with the prevalent efforts towards superior thermoelectrics through the engineering of electronic structure. Here we demonstrate an alternative source for the Seebeck effect based on charge-carrier relaxation: a charge mobility that changes rapidly with temperature can result in a sizeable addition to the Seebeck coefficient. This new Seebeck source is demonstrated explicitly for Ni-doped CoSb3, where a marked mobility change occurs due to the crossover between two different charge-relaxation regimes. Our findings unveil the origin of pronounced features in the Seebeck coefficient of many other elusive materials characterized by a significant mobility mismatch. When utilized appropriately, this effect can also provide a novel route to the design of improved thermoelectric materials.

Low-cost monitoring of Campylobacter in poultry houses by air sampling and quantitative PCR.

The present study describes the evaluation of a method for the quantification of Campylobacter by air sampling in poultry houses. Sampling was carried out in conventional chicken houses in Poland, in addition to a preliminary sampling in Denmark. Each measurement consisted of three air samples, two standard boot swab fecal samples, and one airborne particle count. Sampling was conducted over an 8-week period in three flocks, assessing the presence and levels of Campylobacter in boot swabs and air samples using quantitative real-time PCR. The detection limit for air sampling was approximately 100 Campylobacter cell equivalents (CCE)/m3. Airborne particle counts were used to analyze the size distribution of airborne particles (0.3 to 10 µm) in the chicken houses in relation to the level of airborne Campylobacter. No correlation was found. Using air sampling, Campylobacter was detected in the flocks right away, while boot swab samples were positive after 2 weeks. All samples collected were positive for Campylobacter from week 2 through the rest of the rearing period for both sampling techniques, although levels 1- to 2-log CCE higher were found with air sampling. At week 8, the levels were approximately 10(4) and 10(5) CCE per sample for boot swabs and air, respectively. In conclusion, using air samples combined with quantitative real-time PCR, Campylobacter contamination could be detected earlier than by boot swabs and was found to be a more convenient technique for monitoring and/or to obtain enumeration data useful for quantitative risk assessment of Campylobacter.

Altered reward processing in the orbitofrontal cortex and hippocampus in healthy first-degree relatives of patients with depression.

BACKGROUND: Healthy first-degree relatives of patients with major depression (rMD+) show brain structure and functional response anomalies and have elevated risk for developing depression, a disorder linked to abnormal serotonergic neurotransmission and reward processing. METHOD: In a two-step functional magnetic resonance imaging (fMRI) investigation, we first evaluated whether positive and negative monetary outcomes were differentially processed by rMD+ individuals compared to healthy first-degree relatives of control probands (rMD-). Second, in a double-blinded placebo-controlled randomized trial we investigated whether a 4-week intervention with the selective serotonergic reuptake inhibitor (SSRI) escitalopram had a normalizing effect on behavior and brain responses of the rMD+ individuals. RESULTS: Negative outcomes increased the probability of risk-averse choices in the subsequent trial in rMD+ but not in rMD- individuals. The orbitofrontal cortex (OFC) displayed a stronger neural response when subjects missed a large reward after a low-risk choice in the rMD+ group compared to the rMD- group. The enhanced orbitofrontal response to negative outcomes was reversed following escitalopram intervention compared to placebo. Conversely, for positive outcomes, the left hippocampus showed attenuated response to high wins in the rMD+ compared to the rMD- group. The SSRI intervention reinforced the hippocampal response to large wins. A subsequent structural analysis revealed that the abnormal neural responses were not accounted for by changes in gray matter density in rMD+ individuals. CONCLUSIONS: Our study in first-degree relatives of depressive patients showed abnormal brain responses to aversive and rewarding outcomes in regions known to be dysfunctional in depression. We further confirmed the reversal of these aberrant activations with SSRI intervention.

Decreased levels of brain-derived neurotrophic factor in the remitted state of unipolar depressive disorder.

OBJECTIVE: Decreased levels of peripheral brain-derived neurotrophic factor (BDNF) have been associated with depression. It is uncertain whether abnormally low levels of BDNF in blood are present beyond the depressive state and whether levels of BDNF are associated with the course of clinical illness. METHOD: Whole-blood BDNF levels were measured in blood samples from patients with unipolar disorder in a sustained state of clinical remission and in a healthy control group. Participants were recruited via Danish registers, a method that benefits from the opportunity to obtain well-matched community-based samples as well as providing a high diagnostic validity of the patient sample. RESULTS: A total of 85 patients and 50 controls were included in the study. In multiple linear regression analyses, including the covariates age, gender, 17-item Hamilton Depression Rating Scale scores, body-mass index, education, smoking and physical exercise, patients with unipolar depressive disorder had decreased levels of BDNF compared to healthy control individuals [B = -7.4, 95% CI (-11.2, -3.7), = 0.21 P < 0.001]. No association between course of clinical illness and BDNF levels was present. CONCLUSION: Whole-blood BDNF levels seem to be decreased in patients remitted from unipolar depressive disorder, suggesting that neurotrophic changes may exist beyond the depressive state.

Dose response to adjunctive light therapy in citalopram-treated patients with post-stroke depression. A randomised, double-blind pilot study.

BACKGROUND: Post-stroke depression affects the outcome of stroke rehabilitation and is observed in approximately 30% of all stroke patients. We investigated whether the addition of light treatment to medical antidepressants influences the course of depression as measured by the Hamilton Depression Scale. METHODS: The effect of a combination of light therapy and citalopram in stroke victims receiving citalopram was examined by use of two different doses of light therapy under double-blind conditions. Altogether, 63 patients were included in the study. The mean age was 74.9 years. RESULTS: After 4 weeks of therapy, the 6-item subscale of the Hamilton Depression Scale showed a statistically significantly larger improvement in patients receiving high-intensity light treatment compared to those treated with medium-intensity light (p < 0.05). CONCLUSION: This pilot study demonstrates a dose response effect of light used as an adjunct therapy to antidepressants in post-stroke patients with major depression.

Measurement of biodegradable dissolved organic carbon (BDOC) in lake water with a bioreactor.

Once-through, plug-flow bioreactors were colonised and maintained with a microbial community from a mesotrophic lake and used to measure the concentration of biodegradable dissolved organic carbon (BDOC). A BDOC measurement can be done within 3-4h by this method. Glucose was used to test whether oxygen consumption (BOD) could substitute for measurements of dissolved organic carbon (DOC). All added glucose was utilised, however, without a concomitant increase in oxygen demand. Oxygen consumption should not be used in bioreactor measurements. The site-specificity was tested by comparing DOC utilisation in bioreactors with batch cultures inoculated with indigenous bacteria and incubated for 28 days. The bioreactors were not site-specific and required no acclimation to measure BDOC from three different systems. However, humic substances were adsorbed in the reactors and about two days were needed to equilibrate the reactors. The BDOC concentrations in two lakes varied 2-fold over diurnal cycles and 3-fold during the period February-June. No significant relations to the light, dark cycle, chlorophyll, and DOC were found. The absolute BDOC concentrations ranged from 20 to almost 200 microM and averaged 13% of the DOC in the lakes. It is concluded that BDOC in lakes and other fresh waters can be measured quickly and reliably with a bioreactor.

Beneficial effects of a soy-based dietary supplement on lipid levels and cardiovascular risk markers in type 2 diabetic subjects.

OBJECTIVE: Consumption of soy protein has recently been shown to improve the blood lipid levels in nondiabetic subjects. The purpose of this study was to evaluate if a dietary supplement of soy protein, isoflavones, and cotyledon fiber (Abalon) affects cardiovascular risk markers, blood glucose, and insulin levels in type 2 diabetic subjects. RESEARCH DESIGN AND METHODS: Twenty type 2 diabetic subjects participated in a crossover trial. They were randomized to double-blind supplementation for 6 weeks with Abalon (soy protein [50 g/day] with high levels of isoflavones [minimum 165 mg/day] and cotyledon fiber [20 g/day]) or placebo (casein [50 g/day] and cellulose [20 g/day]), separated by a 3-week wash-out period. RESULTS: The results are expressed as means +/- SD. The percentage mean treatment difference between Abalon and placebo demonstrated significantly lower mean values after Abalon for LDL cholesterol (10 +/- 15%, P < 0.05), LDL/UHDL ratio (12 +/- 18%, P < 0.05), apolipoprotein (apo) B100 (30 +/- 38%, P < 0.01), triglycerides (22 +/- 10%, P < 0.05), and homocysteine (14 +/- 21%, P < 0.01), whereas the total cholesterol value tended to be less significant but still lower (8 +/- 15%, P < 0.08). No change occurred in HDL cholesterol, apo B100/apo A1 ratio, plasminogen activator inhibitor 1, factor VIIc, von Willebrand factor, fibrinogen, lipoprotein(a), glucose, HbA1c, or 24-h blood pressure. CONCLUSIONS: These results indicate beneficial effects of dietary supplementation with Abalon on cardiovascular risk markers in type 2 diabetic subjects. This improvement is seen even in individuals with near-normal lipid values.

Design of expanded bed supports for the recovery of plasmid DNA by anion exchange adsorption.

In this study we detail the rational design of new chromatographic adsorbents tailored for the capture of plasmid DNA. Features present on current chromatographic supports that can significantly enhance plasmid binding capacity have been identified in packed bed chromatography experiments and blueprints for improved expanded bed adsorbents have been put forward. The characterisation and testing of small (20-40 microm) high density (>3.7 g cm(-3)) pellicular expanded bed materials functionalised with various anion exchange structures is presented. In studies with calf thymus DNA, dynamic binding capacities of 1.2 and 3.4 mg ml(-1) were recorded for prototype diethylaminoethyl-and polyethylene imine-linked adsorbents which were respectively 25 and 70 fold higher than those of equivalently derivatised commercial expanded bed materials. The prototype polyethylene imine-coupled material exhibited severe sensitivity to inter-particle bridging by nucleic acid polymers, gave low DNA recoveries (<37%) and proved difficult to regenerate. In contrast, few operational difficulties were experienced with the diethylaminoethyl-linked prototype adsorbent and successful high capacity (>0.8 mg ml(-1)) capture of plasmid DNA from crude neutralised E. coli lysate was demonstrated.

Retention and internal loading of phosphorus in shallow, eutrophic lakes.

This paper gives a general overview of the nature and important mechanisms behind internal loading of phosphorus (P), which is a phenomenon appearing frequently in shallow, eutrophic lakes upon a reduction of the external loading. Lake water quality is therefore not improved as expected. In particular summer concentrations rise and P retention may be negative during most of the summer. The P release originates from a pool accumulated in the sediment when the external loading was high. In most lake sediments, P bound to redox-sensitive iron compounds or P fixed in more or less labile organic forms constitute major fractions--forms that are potentially mobile and eventually may be released to the lake water. The duration of the recovery period following P loading reduction depends on the loading history, but it may last for decades in lakes with a high sediment P accumulation. During the phase of recovery, both the duration and net P release rates from the sediment seem to decline progressively. Internal P loading is highly influenced by the biological structure as illustrated by lakes shifting from the turbid to the clearwater state as a result of, for example, biomanipulation. In these lakes P concentrations may be reduced to 50% of the pre-biomanipulation level and the period with negative retention during summer can thus be reduced considerably. The duration of internal loading can be reduced significantly by different restoration methods such as dredging to remove accumulated P or addition of iron or alum to elevate the sorption capacity of sediments. However, an important prerequisite for achieving long-term benefits to water quality is a sufficient reduction of the external P loading.

Interactions between proteolytic and non-proteolytic Pseudomonas fluorescens affect protein degradation in a model community.

The metabolic interactions between proteinase-producing bacteria and other members of bacterial communities are poorly investigated, although they are important for the understanding of structure-function relationships in complex ecosystems. We constructed simple model communities consisting of proteolytic and non-proteolytic Pseudomonas fluorescens strains to identify relevant interactions and to assess their specific significance during the mobilization of protein for growth. The proteolytic or non-proteolytic model communities were established by co-inoculating proteolytic or proteinase-deficient Tn5-mutants of P. fluorescens strain ON2 with the non-proteolytic reporter strain DF57-N3 that expresses bioluminescence in response to nitrogen limitation. The growth medium was composed such that growth would be nitrogen limited in the absence of proteolytic activity. In the proteolytic communities data on growth and nitrogen availability showed that the protein hydrolysates were available to both the proteolytic and the non-proteolytic strain. Competition between these strains profoundly affected both growth and proteinase production. Hence, the mobilization of protein was closely coupled to the competitive success of the proteolytic strain. These findings provide new insight into the metabolic interactions that occur when protein is degraded in mixed bacterial communities.

Attached and free-living bacteria: Production and polymer hydrolysis during a diatom bloom.

Abundance, production and extracellular enzymatic activity of free-living and attached bacteria were measured during the development and collapse of a spring bloom in a eutrophic lake. Free-living bacteria accounted for most of the total bacterial production during the first part of the bloom. Their production had a significant positive correlation to chlorophyll (P < .01) and polysaccharide concentration (P < .02) and to potential ß-glucosidase and aminopeptidase activity (P < .05), suggesting that algal release of dissolved polymeric compounds provided an important carbon source for bacterial production. As the bloom collapsed, we observed a change in the activity and structure of the microbial community. The mean contribution of attached bacteria to total bacterial production increased from 12% during the first part of the bloom to 26% at the end. Also, the extracellular enzymatic activity of attached bacteria increased as the bloom collapsed and constituted up to 75% of the total hydrolytic activity. An estimated disparity between hydrolytic activity and the corresponding carbon demand of attached bacteria suggested a net release of dissolved organic compounds from organic particles via polymer hydrolysis by attached bacteria.

Bacterioplankton Growth Yield: Seasonal Variations and Coupling to Substrate Lability and beta-Glucosidase Activity.

The seasonal variation in the carbon growth yield of pelagic bacteria in the eutrophic lake Frederiksborg Slotssø was studied. The growth yield was determined in dilution culture experiments, in which a substrate of dissolved organic carbon (DOC) from the lake was incubated with a natural bacterioplankton assemblage. Bacterial growth efficiency varied annually from 8 to 60% with an average (and standard deviation) of 41 +/- 11% (n = 29). Simultaneous measurements of growth yield, substrate lability (DOC(L)), chlorophyll and bacterial production, abundance, and extracellular enzymatic activity revealed new aspects of the regulation of bacterial DOC utilization. Growth yield correlated positively to DOC(L) and negatively to beta-d-glucosidase activity. These results indicated a close coupling between the substrate conditions and the physiological response of the bacteria. The large variations in yield within a few days and the close coupling to substrate availability showed that one single global carbon yield factor cannot be expected to apply in pelagic systems.

Adolescents and contraceptive advice.

PIP: In the Scandinavian countries there is no age limit for adolescents' access to contraceptive advice. Denmark deems it important to avoid barriers which prevent young girls from seeking contraceptive advice. Offering easy access to counseling is preferable to adolescent girls having unwanted pregnancies. In Denmark there is no age limit for adolescent girls to see their general practitioner (GP) for instruction in the use contraceptive methods. Without parental consent all can receive such counseling. In addition, the GP is obliged to observe professional secrecy at counseling, hence parents cannot request any information from the GP. There must be exceptionally serious reasons for breaking this professional secrecy. Thus a young woman should not refrain from seeking advice out of fear that her parents will know about her intimate life, and that she protects herself against unwanted pregnancy. It is not desirable to fix any age limit for adolescents' right to seek this advice because it concerns the adolescents' actual sex life. After the introduction of free abortion, many quite young girls sought abortion. The objective is to bolster the development that all children receive the requisite sex education at school, as well as to ensure that there is easy access to information on contraceptive methods. The GP's counseling is provided free of charge. A number of contraceptive clinics are available all over the country to provide alternative contraceptive counseling in case a young woman does not want to consult her GP because perchance the GP is her family doctor. Denmark as well as the other Scandinavian countries characteristically give high priority to promoting and improving the access to information and counseling on contraceptive methods by avoiding all economical, geographical, ethical, or emotional barriers.^ieng

Iron stores in female blood donors evaluated by serum ferritin.

Iron stores were evaluated by serum ferritin determinations in 948 menstruating and 141 non-menstruating female blood donors. Blood donation was associated with a decrease in ferritin. First-time donors (n = 163) had a geometric mean ferritin of 24 micrograms/l and multiple-time donors a value of 19 micrograms/l (p less than 0.01). In the donating population 31.5% had ferritin values less than 15 micrograms/l (i.e. depleted iron stores). Menstruating donors had lower mean serum ferritin than non-menstruating donors (p less than 0.001), and a higher frequency of ferritin values less than 15 micrograms/l (p less than 0.05). There was no relationship between ferritin levels and the number of pregnancies. The frequency of donations was more predictive of ferritin levels than the number of donations. Mean ferritin displayed a moderate fall up to the 2nd donation, and was hereafter relatively constant, whereas an increase in donation frequency was accompanied by a significant decrease in ferritin. Female donors, especially when phlebotomised greater than or equal to 3 times per year, should have their iron status checked at appropriate intervals by measurement of serum ferritin and should be advised regular iron supplementation.