Prevalence of long-term opioid therapy in spine center outpatients the spinal pain opioid cohort (SPOC).

PURPOSE: No reference material exists on the scope of long-term problems in novel spinal pain opioid users. In this study, we evaluate the prevalence and long-term use of prescribed opioids in patients of the Spinal Pain Opioid Cohort. METHODS: The setting was an outpatient healthcare entity (Spine Center). Prospective variables include demographics, clinical data collected in SpineData, and The Danish National Prescription Registry. Patients with a new spinal pain episode lasting for more than two months, aged between 18 and 65 years, who had their first outpatient visit. Based on the prescription of opioids from 4 years before the first spine center visit to 5 years after, six or more opioid prescriptions in a single 1-year interval fulfilled the main outcome criteria Long-Term Opioid Therapy (LTOT). RESULTS: Overall, of 8356 patients included in the cohort, 4409 (53%) had one or more opioid prescriptions in the registered nine years period. Of opioid users, 2261 (27%) were NaiveStarters receiving their first opioid prescription after a new acute pain episode; 2148(26%) PreStarters had previously received opioids. The prevalence of LTOT in PreStarters/NaiveStarters was 17.2%/11.2% in their first outpatient year. Similar differences between groups were seen in all follow-up intervals. In the last follow-up year, LTOT prevalence in Prestarters/NaiveStarters was 12.5%/7.0%. CONCLUSIONS: Previous opioid treatment-i.e., before a new acute spinal pain episode and referral to a Spine Center-doubled the risk of LTOT 5 years later. The results underscore clinicians' obligation to carefully and individually weigh the benefits against the risks of prescribing opioid therapy. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Comparison of exhaustion symptoms in patients with stress-related and other psychiatric and somatic diagnoses.

BACKGROUND: Several rating scales assessing stress-related symptoms of exhaustion have emerged in recent years. However, more knowledge is needed about the performance of these rating scales in patients with stress-related disorders as well as in other patient groups. With the recently developed Karolinska Exhaustion Disorder Scale (KEDS), we compared symptoms of exhaustion in different patient groups that were sorted according to diagnosis. METHODS: Patients were sampled consecutively from departments of occupational medicine (DOM) at three Danish hospitals. The total study group comprised 698 care-seeking patients (487 women). Patients with stress-related diagnoses (n = 217; the International Classification of Diseases [ICD]-10 code F43: reaction to severe stress and adjustment disorder) were compared to a diverse group of patients with a range of somatic diagnoses (n = 338) and to patients with other psychiatric diagnoses (n = 143), including subgroups with major depression disorder (n = 34; F32 and F33) and problems related to employment and unemployment (n = 99; Z56). The data were analysed using linear mixed models with the SPSS statistical program. RESULTS: The mean KEDS sum score in patients with stress-related diagnoses (29.3; SD = 8.0) was significantly higher than in patients with other psychiatric diagnoses (25.9; SD = 9.5) and in patients with somatic diagnoses (17.6; SD = 10.8). The subgroup with a major depression disorder had high mean KEDS sum scores (31.4, SD = 8.1), similar to patients with stress-related diagnoses, while the mean KEDS sum score in patients with problems related to employment and unemployment (Z56) was 23.5 (SD = 9.0). Young and old patients scored similarly on KEDS, but in patients with somatic diagnoses, female patients scored significantly higher than male patients. CONCLUSION: The symptoms of exhaustion measured with KEDS were higher in patients with stress-related diagnoses and major depression disorder than in patients with somatic diagnoses. The intermediate level of the symptoms of exhaustion that were associated with problems related to employment and unemployment, (Z56) compared to the lower level of the symptoms with somatic diagnoses, suggests that KEDS might be useful in detecting mild, prodromal states of exhaustion. This needs further investigation.

Workplace violence and development of burnout symptoms: a prospective cohort study on 1823 social educators.

PURPOSE: Burnout and workplace violence (WPV) have been associated in cross-sectional studies, but longitudinal studies with solid methods and adequate sample sizes are lacking. This study investigates whether WPV increases burnout symptoms during a 12-month period. METHODS: Questionnaire data were collected on 1823 social educators at baseline and 12-month follow-up, coupled with additionally 12 monthly text-message surveys on exposure to WPV. Using general linear modelling for repeated measures, we estimated change over time in burnout symptoms in three WPV exposure groups (none, low, high). RESULTS: A time by exposure to WPV interaction existed for development of burnout; F(2) = 7.2, p = 0.001 η2 = 0.011. Burnout increased significantly within the group of low exposure; F(1) = 6.8, p = 0.01 and high exposure; F(1) = 6.7 p = 0.001, but not within the non-exposed F(1) = 2.1 p = 0.15. At follow-up, both the low exposed and high exposed had significantly higher levels of burnout compared to the non-exposed. CONCLUSION: Exposure to WPV increases level of burnout within a 12-month period. We propose that assessment of burnout in future studies should utilize instruments capable of detecting small changes. We further propose that prevention against employee burnout could be improved using monitoring targeted at employees exposed to WPV.

Prevalence of persons contacting general practice for psychological stress in Denmark.

OBJECTIVE: The prevalence of psychological stress has previously been estimated based on self-reported questionnaires. This study aimed to investigate the prevalence of persons who contact the general practitioner (GP) for psychological stress and to explore associations between psychological stress and characteristics relating to the patient, the GP, and area-specific socioeconomic factors. DESIGN: Cross-sectional computer assisted journal audit. SETTING: General practice in the Region of Southern Denmark. SUBJECTS: Patients aged 18-65 years with a consultation during a six-month period that was classified with a stress-related diagnosis code. MAIN OUTCOME MEASURES: Six months prevalence of GP-assessed psychological stress and characteristics relating to the patient, the GP, and area-specific socioeconomic factors. RESULTS: Fifty-six GPs (7% of the invited) identified 1066 patients considered to have psychological stress among 51,422 listed patients. Accordingly, a 2.1% six months prevalence of psychological stress was estimated; 69% of cases were women. High prevalence of psychological stress was associated with female sex, age 35-54 years, high education level and low population density in the municipality, but not with unemployment in the municipality or household income in the postal district. GP female sex and age <50 years, few GPs in the practice and few patients per GP were also associated with a higher prevalence of psychological stress. CONCLUSIONS: A total of 2% of the working-age population contacted the GP during a six-month period for psychological stress. The prevalence of psychological stress varies with age, sex and characteristics of both the regional area and the GP. Key points Psychological stress is a leading cause of days on sick leave, but its prevalence has been based on population surveys rather than on assessment by health care professionals. • This study found that during six months 2.1% of all working-age persons have at least one contact with the GP regarding psychological stress. • The six months prevalence of psychological stress was associated with patient age and sex, GP age and sex, practices' number of GPs and patients per GP, and area education and urbanization level.

Pesticide use, erythrocyte acetylcholinesterase level and self-reported acute intoxication symptoms among vegetable farmers in Nepal: a cross-sectional study.

BACKGROUND: As pesticide use is increasing and proper handling training is lacking, exposure to pesticides and intoxications are an important public health problems among farmers in developing countries. This study describes pesticide use among farmers and compares symptoms of possible acute intoxication and Erythrocyte Acetylcholinesterase(AChE) levels among vegetable farmers with a control group of blood donors in Nepal. METHODS: A cross-sectional study was carried out among 90 pesticide-exposed farmers and a control group of 90 blood donors. Participants were randomly selected and data were gathered through questionnaires, observation and blood test. Chi-square test, logistic regression and Student's t-test were used for data analysis to describe pesticide use and compare symptoms and AChE levels between the two groups. This study was approved by Nepal Health Research Council. RESULTS: The majority of pesticides used were WHO class II, classified as moderately hazardous. The mean numbers of personal protective equipment used by farmers were 2.22 (95% CI: 1.89; 2.54). Out of five hygienic practices asked, farmers followed 3.63 (95% CI: 3.40; 3.86) hygienic practices on the average. Farmers reported more symptoms of possible pesticide intoxication in the past month than did controls, mean 5.47 (95% CI: 4.70; 6.25) versus 2.02 (95% CI: 1.63; 2.40) (p < 0.05). The mean haemoglobin-adjusted AChE(Q) was significantly lower among farmers compared to controls, 28.92 (95% CI: 28.28; 29.56) U/g versus 30.05 (95% CI: 29.51; 30.60) U/g, (p = 0.01). The risk of a farmer having lower Q level was about 3 times (OR = 2.95; 95% CI: 1.16; 7.51) greater than controls. CONCLUSION: Nepalese farmers exposed to pesticides have significantly more symptoms of possible pesticide intoxication than a control group of healthy individuals. A lower mean haemoglobin- adjusted AChE level was seen among farmers compared to the controls. The use of highly toxic pesticides, inadequate use of personal protective equipment and poor hygienic practices might explain the reason for symptoms of pesticide intoxication and a lower AChE level among farmers. Education and information of farmers should be undertaken to remediate these problems.

Low quality of life in binge eating disorder compared to healthy controls.

INTRODUCTION: Patients with binge eating disorder (BED) tend to report a lower quality of life (QoL) than patients with other eating disorders. However, most research on QoL in eating disorders include generic rather than disease-specific measures. Depression and obesity are frequent comorbid conditions in patients with BED affecting QoL. In the present study, we aimed to assess disease-specific QoL in BED and to investigate the impact of obesity and depression. METHODS: Adult patients who met the DSM-5 criteria for BED (N = 98) were recruited from a newly established specialised online treatment programme for BED and completed the following questionnaires: the Eating Disorder Quality of Life Questionnaire (EDQLS), the Major Depression Inventory (MDI) and the newly introduced Binge Eating Disorder Questionnaire for measuring BED severity. Healthy, normal-weight individuals were recruited through online invitations on social media, n = 190. RESULTS: QoL in BED individuals was significantly lower than in healthy individuals. No relationship was found between BMI and EDQLS, whereas significant, negative correlations were found between depression and all subscales of the EDQLS. CONCLUSION: Disease-specific QoL in BED was associated with depression but not with BMI. FUNDING: none. CLINICALTRIALS: gov NCT05010798.

Does computer use affect the incidence of distal arm pain? A one-year prospective study using objective measures of computer use.

PURPOSE: To study how objectively recorded mouse and keyboard activity affects distal arm pain among computer workers. METHODS: Computer activities were recorded among 2,146 computer workers. For 52 weeks mouse and keyboard time, sustained activity, speed and micropauses were recorded with a software program installed on the participants' computers. Participants reported weekly pain scores via the software program for elbow, forearm and wrist/hand as well as in a questionnaire at baseline and 1-year follow up. Associations between pain development and computer work were examined for three pain outcomes: acute, prolonged and chronic pain. RESULTS: Mouse time, even at low levels, was associated with acute pain in a similar way for all the examined regions. There were no exposure-response threshold patterns. Keyboard time had no effect. Mouse and keyboard sustained activity, speed and micropauses were not risk factors for acute pain, nor did they modify the effects of mouse or keyboard time. Computer usage parameters were not associated with prolonged or chronic pain. A major limitation of the study was low keyboard times. CONCLUSION: Computer work was not related to the development of prolonged or chronic pain. Mouse time was associated with acute distal arm pain, but the impact was quite small.

Are You All right (AYA)? Association of cumulative traumatic events among Danish police officers with mental health, work environment and sickness absenteeism: protocol of a 3-year prospective cohort study.

INTRODUCTION: Police officers are frequently exposed to potentially traumatic events at work that increases risk of developing mental health problems, in particular post-traumatic stress disorder (PTSD). Individual and organisational factors may influence the detrimental effects of cumulative exposure to traumatic events. Occupational stress and lack of organisational support are associated with increased risk of PTSD among police officers. The Are You All right? (AYA) project is a prospective cohort study investigating the cumulative effect of traumatic events at work on mental health problems and absenteeism among police officers. The study also investigates whether potential risk and protective factors modify the association of traumatic events at work with mental health problems and absenteeism. METHOD AND ANALYSIS: The AYA-study includes the entire Danish police force. Prospective survey data are collected over a 3-year period beginning in the spring of 2021. Electronic surveys are sent out at baseline with 1-year, 2-year and 3-year follow-up. Further, short surveys are sent out every third month, covering exposure to traumatic events and current mental health status. The survey data are paired with workplace register data on sickness absence. Register data on sickness absence cover the period from 2020 to 2025. ETHICS AND DISSEMINATION: This study was presented for evaluation at the National Ethics Committee in Denmark (reference number: 20202000-216), but according to Danish legislation, survey studies do not require approval by official Danish scientific or ethical committees. Participation in the project is based on informed consent, and data are handled in accordance with the Danish data legislation (journal number: 20/41457). Results are published in scientific journals and disseminated at international conferences.

Physiological Offset Parameters of the Adult Shoulder Joint-A MRI Study of 800 Patients.

Background: Humeral offset (HO) and glenoidal offset (GO) are important morphological parameters in diagnostics and therapy for shoulder pathologies. However, physiological reference values have not yet been sufficiently determined. The aim of the present study was to establish physiological reference values for shoulder offset parameters (SOPs). Methods: MRI images of the shoulder joints of 800 patients (mean age: 50.13 years [±16.01]) were analysed retrospectively. HO, GO, lateral glenoidal humeral offset (LGHO), humeral shaft axis offset (HAO) and cortical offset (CO) were measured. SOPs were examined for associations with age, gender, side and osteoarthritis. Results: The mean HO was 26.19 (±2.70), the mean GO was 61.79 (±5.67), the mean LGHO was 54.49 (±4.69), the mean HAO was 28.17 (±2.82) and the mean CO was 16.70 (±3.08). For all SOPs, significantly higher values were measured in male shoulders. There was a significantly (p < 0.001) higher mean value for HO, GO and LGHO in right shoulders. There was a significant correlation between age and LGHO, and HAO and CO, but not between age and HO or GO. Shoulders with osteoarthritis and non-osteoarthritis did not differ in the mean value of HO, GO, LGHO and HAO, except for CO (p = 0.049). Conclusion: Reference values for SOPs in the adult shoulder joint were determined for the first time. Significant gender-specific differences were found for all measured SOPs. In addition, it was seen that for some SOPs, the joint side and the patient's age has to be taken into account in shoulder diagnostics and surgery.

Surface electromyography of forearm and shoulder muscles during violin playing.

The aims of this study were to explore muscle activity levels during different violin repertoires, quantify the general levels bilaterally in upper extremity muscles, and evaluate associations between muscle activity and anthropometrics characteristics. In 18 skilled violin players surface EMG was recorded bilaterally from trapezius (UT), flexor digitorum superficialis (FDS), extensor carpi ulnaris (ECU), extensor digitorum cummunis (EDC), and extensor carpi radialis (ECR) during A and E major scales played in three octaves and Mozart's Violin Concerto no. 5. To compare side differences the static, median and peak levels of muscle activity were calculated from an amplitude probability distribution function (APDF). This study demonstrated that scales played as standardized tasks can be used to estimate the average muscle activity during violin playing. Comparing results from scales and the music piece revealed a similar muscle activity across all muscles in the music piece and E major scales. The static, median and peak EMG levels were higher in left than in right forearm muscles with left ECU presenting the highest peak load of 30 %MVE. Females demonstrated a higher muscle activity than males, but this was in accordance with differences in anthropometric measures.

Can high workplace social capital buffer the negative effect of high workload on patient-initiated violence? Prospective cohort study.

BACKGROUND: High workload seems to increase the risk of patient-initiated workplace violence (patient-initiated violence). However, the temporal association between workload and violence remains uncertain. Understanding the interplay of factors in the psychosocial working environment and patient-initiated violence is important to future preventive initiatives. AIM: To assess whether a high workload increases the risk of patient-initiated violence, and whether intraorganizational relationships based on trust, reciprocity, justice and collaboration, known as workplace social capital, moderate this risk. METHOD: Baseline survey data on 1823 social educators was collected followed by 12 monthly surveys on patient-initiated violence exposure. Poisson regressions, in mixed models, were conducted to assess the risk of violence at four levels of workload. Further, moderation analyses were conducted to assess the moderating effects of three sub-types of workplace social capital. RESULTS: High and very high workload increased the risk of patient-initiated violence: RR = 1.5 [1.4-1.6], p < .001 and RR = 1.4 [1.3-1.4], p < .001. All three levels of workplace social capital had a moderating effect on the workload-violence association: Workload*Workplace social capital(co-worker): F (3, 16,712) = 3.4, p = .017, Workload*Workplace social capital(local management): F (3, 16,748) = 11.9, p < .001, Workload*Workplace social capital(general management): F (3, 16,556) = 5.5, p < .001. Only high Workplace social capital (co-workers) reduced the risk of violence at all levels of workload. Workplace social capital (general management) reduced the risk of violence at high, medium and low workload, and Workplace social capital (local management) reduced the risk of violence at medium and low workload. CONCLUSION: High workload clearly increases the risk of patient-initiated violence. A high workplace social capital appears to be a viable protective factor and should be investigated further in studies of patient-initiated violence prevention.

Long-Term Opioid Therapy in Spine Center Outpatients: Protocol for the Spinal Pain Opioid Cohort (SPOC) Study.

BACKGROUND: Spinal pain is the leading cause of patient-years lived with chronic pain and disability worldwide. Although opioids are well documented as an effective short-term pain-relieving medication, more than a few weeks of treatment may result in a diminishing clinical effect as well as the development of addictive behavior. Despite recognition of opioid addiction in pain patients as a major problem commonly experienced in the clinic, no reference material exists on the scope of long-term problems in novel opioid users and the link to clinical outcomes. OBJECTIVE: The main aims of this study are to describe baseline and follow-up characteristics of the Spinal Pain Opioid Cohort (SPOC), to evaluate the general use of opioids in spinal pain when an acute pain episode occurs, and to demonstrate the prevalence of long-term opioid therapy (LTOT). METHODS: Prospective clinical registry data were collected from an outpatient spine center setting during 2012-2013 including patients with a new spinal pain episode lasting for more than 2 months, aged between 18 and 65 years who had their first outpatient visit in the center. Variables include demographics, clinical data collected in SpineData, the Danish National Patient Register, and The Danish National Prescription Registry. The primary outcome parameter is long-term prescription opioid use registered from 4 years before the first spine center visit to 5 years after. RESULTS: This is an ongoing survey. It is estimated that more than 8000 patients fulfill the SPOC inclusion criteria. In 2019, we began the intellectual process of identifying the most relevant supplementary data available from the wide range of existing national registries available in Denmark. We have now begun merging SpineData with relevant opioid data from Danish national registers and will continue to extract data up to 2021-2022. We will also be looking at data regarding somatic or psychiatric hospitalization patterns, patient usage of health care resources, as well as their working status and disability pensions. CONCLUSIONS: To our knowledge, this survey will be the first to document the scope of long-term problems regarding LTOT and opioid addiction following new spinal pain episodes and comparing descriptive follow-up data between substance users and nonusers. TRIAL REGISTRATION: ISRCTN Registry ISRCTN69685117; http://www.isrctn.com/ISRCTN69685117. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/21380.

Occupational Violence and PTSD-Symptoms: A Prospective Study on the Indirect Effects of Violence Through Time Pressure and Nontraumatic Strains in the Occupational Context.

OBJECTIVE: The aim of this study was to assess whether frequency of occupational violence (OV) affects posttraumatic stress disorder (PTSD) symptoms through nontraumatic strains in the occupational context. METHODS: Twelve-month prospective survey data on 1763 Social educators were used. Path-analysis measured direct and indirect pathways of frequency of OV on PTSD through change in time pressure, change in burnout, change in sense of safety at work, and change in coping with regret in patient work. RESULTS: Forty-two pct. of the variance in PTSD symptoms was predicted; F (20, 1541) = 36.8, P < 0.001, R = 0.42. Frequency of OV indirectly affected level of PTSD through all the mediators; estimated indirect effects = 0.14, 95% confidence interval 0.07 to 0.22. CONCLUSION: PTSD resulting from OV is not only a result of the violent acts themselves but is also caused by nontraumatic strains. It is essential to include the broader context of work environment factors in prevention of work-related PTSD.

Are frequency and severity of workplace violence etiologic factors of posttraumatic stress disorder? A 1-year prospective study of 1,763 social educators.

Although cross-sectional studies have associated workplace violence (WPV) with posttraumatic stress disorder (PTSD), prospective studies are needed to ascertain the exposure leading to the development of PTSD. Using a 1-year prospective survey design, with monthly measures of violence, and 1,763 participants, we investigated whether frequency and/or severity of WPV could be considered etiological factors for PTSD. Binary logistic regression models were used, with subclinical and clinical PTSD as outcomes. The models were adjusted for demographic, lifestyle, and trauma-related factors, as well as strain in the work environment. Compared with the nonexposed group, frequency of WPV increased the risk of PTSD in an exposure-response pattern: low frequencyOR = 4.0, 95% confidence intervals [CI] [1.0, 16.3], medium frequency OR = 5.9, 95% CI [1.4, 24.3], and high frequency OR = 6.5, 95% CI [1.6, 25.6]. We also found that when threat was the most severe incident of WPV, the risk of PTSD increased, OR = 5.4, 95% CI [1.2, 24.2]. In addition, severe incidents of WPV increased the risk of PTSD, OR = 6.5, 95% CI [1.6, 26.0]. This prospective study consolidates existing cross-sectional studies, which have indicated that frequency of WPV is an etiological factor for PTSD. The study underlines the need for integrating an understanding of the pattern and characteristics of WPV in future research. Specifically, we propose the use of frequency of WPV as an additional factor in targeting employees at risk of developing PTSD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Consistent Use of Assistive Devices for Patient Transfer Is Associated With Less Patient-Initiated Violence: Cross-Sectional Study Among Health Care Workers at General Hospitals.

This study investigated whether factors related to bodily contact between health care workers and patients were associated with patient-initiated violence. This cross-sectional study surveyed 496 Danish health care workers measuring patient-initiated violence, use of assistive devices, body mass index, physical exertion, frequency of patient transfers, psychosocial work environment, gender, age, and seniority. Associations were modeled using logistic regression analyses using patient-initiated violence as the outcome. Twenty-five percent of the respondents had experienced physical or verbal violence during the past year. Infrequent use of assistive devices, high physical strain, and severe obesity all significantly increased the risk of physical violence (risk ratio [RR] = 1.18, RR = 1.18, and RR = 1.16, respectively), whereas only the lack of assistive device use significantly increased the risk of verbal violence (RR = 1.13 and RR = 1.08). Consistent use of assistive devices appears to reduce the risk of patient-initiated violence. Managers should require the use of assistive devices when designing work processes for patient transfers.

The Regret Coping Scale for Health-Care Professionals (RCS-HCP): A validation study with Danish social educators.

BACKGROUND: Coping with regret has a substantial impact on wellbeing and mental health, but has rarely been investigated in an occupational setting. OBJECTIVE: To translate the Regret Coping Scale for Health-Care Professionals (RCS-HCP) and explore internal consistency, construct-, criterion- and predictive validity. METHODS: The instrument was translated using forward- back method. The qualities were evaluated with a sample of 2758 social educators using exploratory and confirmatory factor analysis as well as Cronbach's alpha, Pearson correlation, and multivariable regression. RESULTS: The translated instrument showed a trend similar to the original instrument. A 10-item version resulted from the research being reported. The reduced RCS-HCP showed improved fit (Full model, 15 items); CFI = 0.91, TLI = 0.89, RMSEA = 0.66, PClose = 0.000 and BIC = 1392 vs. (Reduced instrument, 10 items); CFI = 0.97, TLI = 0.96, RMSEA = 0.05, PClose = 0.499 and BIC 307. This instrument had acceptable internal consistency for short scales (Cronbach's alpha = 0.65, 0.69 and 0.84 respectively). The subscales correlated as expected with measures of health and occupational factors, coefficient ranging from 0.182 to 0.399. Also, the RCS-HCP predicted stress three month later ΔF[3,2747] = 15.1, p < 0.001, but with very small effect ΔR2 = 0.01, p≤0.001. CONCLUSIONS: The 10-item Danish version of the RCS-HCP is a valid instrument for measuring coping with regret in health related work.

Neurobiological effects of work-related stress: protocol for a case-control neuroimaging study.

INTRODUCTION: Stress is one of the greatest burdens of our society and often implies impairments in cognitive and emotional functions. Here, we hypothesise that changes in the brain's dopamine (DA)-based mesocorticolimbic projec-tions in patients with work-related stress (adjustment disorder) will manifest themselves as altered glucose metabolism in relation to neural activity, and as altered DA radiotracer binding potentials at the relevant receptors. METHODS: Subjects and healthy controls undergo neuropsychiatric tests and PET/MRI with three tracers: 18F-fluorodeoxyglucose to measure glucose metabolism as a marker of neural activity, 11C-raclopride to explore binding potentials in the striatum, and 11C-FLB 457 to study possibly impaired mesocortical dopaminergic transmission in the cortex. To demonstrate differences of glucose metabolism, more than 2 × 41 patients/controls are needed. We expect to find that symptoms of cognitive and motivational reward deficits are attributable to changes in the frontal lobe and striatal glucose metabolism in the majority of patients, and that changes of D2-receptor availability and impaired dopaminergic transmission in the striatum and prefrontal cortex are contributing factors. CONCLUSIONS: This project is designed to generate entirely new and objective evidence of stress-induced cerebral illness, and to provide a basis for in-depth research and for a more rational management of this strenuous disorder. FUNDING: Private, industrial and public funds. TRIAL REGISTRATION: Clinicaltrails.gov/NCT03334045.

Plasma Cholinesterase Levels of Nepalese Farmers Following Exposure to Organophosphate Pesticides.

BACKGROUND: Farmers in developing countries use highly toxic organophosphate pesticides. Thus, the aim of this study was to compare plasma cholinesterase (PChE) enzyme activity before and after exposure to organophosphate pesticides in a real-life setting. METHODS: This was a prospective study conducted on 25 farmers spraying organophosphate pesticide in their farm. The PChE level was measured and clinical signs and symptoms of toxicity were asked before and immediately after spraying. RESULTS: The mean level of PChE before and after spraying was 1.41 and 1.29 IU/L, respectively (8.51% decreased). Farmers reported more clinical signs and symptoms of intoxication after spraying pesticides. CONCLUSIONS: Increase in acute intoxication signs/symptoms and decrease in PChE indicate a serious public health problem among farmers who use organophosphate pesticides. Appropriate training to the farmers is needed to reduce exposure to organophosphate pesticide.

Sex differences in risk and heritability estimates on primary knee osteoarthritis leading to total knee arthroplasty: a nationwide population based follow up study in Danish twins.

BACKGROUND: Symptomatic knee osteoarthritis is a highly age and sex associated complex disease. Little is known about the causes behind this age and sex associated increase, or if genetic and environmental factors impacts differently by gender. Our study examined the risk and heritability of primary knee osteoarthritis leading to total knee arthroplasty and whether these differences were attributable to sex and age differences in heritability. METHODS: All twins of known zygosity from The Danish Twin Register alive in 1997 were examined in a nationwide population based follow-up study collecting information on all twins recorded in The Danish Knee Arthroplasty from 1997 to follow-up in 2010. Our main outcomes were the cumulative incidence, probandwise concordance rates, heritability, within pair correlations in monozygotic and dizygotic twin pairs and the genetic and environmental influence estimated in models taking into account that individuals may not have had a total knee arthroplasty at follow up. RESULTS: 92,748 twins were eligible for analyses and 576 twins had a record of primary knee osteoarthritis in The Danish Knee Arthroplasty Register at follow-up comprising 358 female and 218 male twin cases. The risk increased particular after the age of 50 years displaying significant sex differences in the elderly. In the sex stratified analyses a discrete genetic component was found in females, but in males no genetic component could be detected. In both genders common and unique environmental factors were highly significant. In the sex-adjusted analysis an additive genetic component of 18 % (0; 62), a shared environmental component of 61 % (25; 97) and an individual environmental component of 21 % (6; 36) accounted for the variation in liability to primary total knee arthroplasty. CONCLUSION: The risk of primary total knee arthroplasty increases significantly after the age of 50 years, in particular in females, displaying significant sex differences in the elderly. After sex-adjustment 82 % of the variation in liability to primary total knee arthroplasty was attributable to common and unique environmental factors; the remaining 18 % of this variation was attributable to additive genetic factors indicating a pivotal impact of environmental factors on this disease.

[Specific bronchial and nasal provocations with work-related allergens]. / Specifikke bronkiale og nasale provokationer for erhvervsallergener.

Specific inhalation challenge (SIC) is the golden standard for identifying specific causes of work-related asthma and rhinoconjunctivitis. Few centres offer SIC as it requires experience, resources and acute treatment facilities. Prior to SIC treatment should be carefully reduced. A control challenge is performed on a separate day. Many new asthma causes have been identified with SIC. SIC provides the basis for optimal treatment and advice.