Current available therapies control Myasthenia gravis (MG) reasonably well, but Health Related Quality of life (HRQOL) remains lower than expected. The aim was provide insights in how HRQOL in MG ...stands across borders and time, compare the scores to general population controls and other chronic disorders and assess the impact of potential predictors for quality of life such as a) clinical characteristics b) antibodies c) thymoma and d) treatment in a population-based cohort.
We designed a population-based cross-sectional study including 858 patients, 373 from Norway and 485 from the Netherlands. The Short Form Health Survey 36 (SF-36) and a cross-cultural validated questionnaire were used. Data were in addition compared to the general population, other chronic diseases and previous studies.
Mean physical composite score was 59.4 and mental composite score 69.0 with no differences between the countries. The mean HRQOL score was lower in patients with bulbar and generalized symptoms (p < 0.001) compared to sex and age adjusted healthy controls, but not in patients with ocular symptoms or patients in remission. Multivariate analysis revealed that female gender, generalized symptoms and use of secondary immunosuppressive drugs at the time of testing were risk factors for reduced HRQOL.
Remission and absence of generalized symptoms were favorable factors for HRQOL in MG patients. Historically, the HRQOL levels have not changed since 2001 and no new clinical predictors could be detected in this exhaustive population-based study. Further studies should explore the impact of non clinical factors like ethnic variations, socio-economic and hormonal factors on HRQOL.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Obesity increases the risk for a number of solid malignant tumours. However, it is not clear whether body mass index (BMI) and height are associated with the risk of primary tumours of the central ...nervous system (CNS).
In a large population study (The Nord-Trøndelag Health Study (HUNT Study)) of 74 242 participants in Norway, weight and height were measured. During follow-up, incident CNS tumours were identified by individual linkage to the Norwegian Cancer Registry. Sex- and age-adjusted and multivariable Cox regression analyses were used to evaluate BMI and height in relation to the risk of meningioma, glioma and schwannoma.
A total of 138 meningiomas, 148 gliomas and 39 schwannomas occurred during 23.5 years (median, range 0-25) of follow-up. In obese women (BMI ≥ 30 kg m(-2)), meningioma risk was 67% higher (hazard ratio (HR)=1.68, 95% confidence interval (CI): 0.97-2.92, P-trend=0.05) than in the reference group (BMI 20-24.9 kg m(-2)), whereas no association with obesity was observed in males. There was no association of BMI with glioma risk, but there was a negative association of overweight/obesity (BMI ≥ 25 kg m(-2)) with the risk of schwannoma (HR=0.48, 95% CI: 0.23-0.99). However, the schwannoma analysis was based on small numbers. Height was not associated with the risk for any tumour subgroup.
These results suggest that BMI is positively associated with meningioma risk in women, and possibly, inversely associated with schwannoma risk.
Acquired brain injury (ABI) often leads to persisting somatic, cognitive, and social impairments. Cognitive impairments of processing speed, sustained attention, and working memory are frequently ...reported and may negatively affect activities of daily living and quality of life. Rehabilitation efforts aiming to retrain these cognitive functions have often consisted of computerized training programs. However, few studies have demonstrated effects that transfer beyond the trained tasks. There is a growing optimism regarding the potential usefulness of virtual reality (VR) in cognitive rehabilitation. The research literature is sparse, and existing studies are characterized by considerable methodological weaknesses. There is also a lack of knowledge about the acceptance and tolerability of VR as an intervention method for people with ABI. The present study aims to investigate whether playing a commercially available VR game is effective in training cognitive functions after ABI and to explore if the possible effects transfer into everyday functioning.
One hundred participants (18-65 years), with a verified ABI, impairments of processing speed/attention, and/or working memory, and a minimum of 12 months post injury will be recruited. Participants with severe aphasia, apraxia, visual neglect, epilepsy, and severe mental illness will be excluded. Participants will be randomized into two parallel groups: (1) an intervention group playing a commercial VR game taxing processing speed, working memory, and sustained attention; (2) an active control group receiving psychoeducation regarding compensatory strategies, and general cognitive training tasks such as crossword puzzles or sudoku. The intervention period is 5 weeks. The VR group will be asked to train at home for 30 min 5 days per week. Each participant will be assessed at baseline with neuropsychological tests and questionnaires, after the end of the intervention (5 weeks), and 16 weeks after baseline. After the end of the intervention period, focus group interviews will be conducted with 10 of the participants in the intervention group, in order to investigate acceptance and tolerability of VR as a training method.
This study will contribute to improve understanding of how VR is tolerated and experienced by the ABI population. If proven effective, the study can contribute to new rehabilitation methods that persons with ABI can utilize in a home setting, after the post-acute rehabilitation has ended.
Objectives – To describe the functional outcome and health‐related quality of life (HRQL) 10 years after moderate‐to‐severe traumatic brain injury (TBI).
Material and methods – A retrospective, ...population‐based study of 62 survivors of working‐age with moderate‐to‐severe TBI injured in 1995/1996, and hospitalized at the Trauma Referral Center in Eastern Norway. Functional status was measured by the Glasgow Outcome Scale‐Extended (GOS‐E). HRQL was assessed by the SF‐36 questionnaire.
Results – The mean current‐age was 40.8 years. The frequency of epilepsy was 19% and the depression rate 31%. A majority had good recovery (48%) or moderate disability (44%). Employment rate was 58%. Functional and employment status were associated with initial injury severity in contrast to HRQL. Study patients had significantly lower scores in all SF‐36 dimensions when compared with the general Norwegian population.
Conclusion – At 10‐years follow‐up, our study population is still in their most productive years and affected domains should be considered in long‐term follow‐up and intervention programs.
•In obese subjects, bone material strength (BMSi) was inversely associated with body mass index.•One year after Roux-en-Y gastric bypass (RYGB), BMSi improved despite an increase in bone turnover and ...decrease in aBMD.•Changes in BMSi was comparable in participants with and without type 2 diabetes (T2D).•In subjects with T2D, a larger decrease in HbA1c was associated with a larger increase in BMSi after RYGB.
Obesity and type 2 diabetes (T2D) are associated with an increased risk of skeletal fractures despite a normal areal bone mineral density (aBMD) and low bone turnover, possibly due to reduced bone material strength. Roux-en-Y gastric bypass (RYGB) enables a substantial and persistent weight loss and resolution of obesity related comorbidities such as T2D. However, the procedure induces a decrease in aBMD and increased bone turnover and fracture rate. To our knowledge, changes in bone material strength after RYGB have not been explored. This study aimed to evaluate changes in factors influencing bone quality; bone material strength, aBMD and bone turnover markers, in a population with morbid obesity undergoing RYGB and whether these changes differed in participants with and without T2D. We also sought to assess factors associated with bone material strength and bone mineral density in obese subjects before and after RYGB.
We examined 34 participants before and one year after RYGB, of whom 13 had T2D. Bone material strength index (BMSi) was evaluated by impact microindentation, aBMD and body composition by Dual energy X-ray absorptiometry, levels of bone turnover markers and calciotropic hormones were estimated from fasting serum samples. Participants with and without T2D were comparable before surgery, with the exception of glycosylated hemoglobin (HbA1c).
Preoperatively, BMSi was inversely associated with BMI, βunadjusted -1.1 (-1.9 to -0.28), R2=0.19, p=0.010, and this association remained significant after adjusting for age and gender. After RYGB the participants had lost a mean±SD of 33.9±10.9kg, 48.7±14.2 % of total body fat, increased physical activity, unchanged vitamin D levels, and all but one of the 13 participants with T2D were in diabetes remission. BMSi increased from 78.1±8.5 preoperatively to 82.0±6.4 one year after RYGB, corresponding to an increase of 4.0±9.8 in absolute units or 6.3±14.0 %, p=0.037. The increase was comparable in participants with and without T2D. In subjects with T2D, a larger decrease in HbA1c was associated with a larger increase in BMSi βunadjusted -9.2 (-16.5 to -1.9), R2=0.47, p=0.019. Bone turnover markers (CTX-1 and PINP) increased by 195.1±133.5 % and 109.5±70.6 %, respectively. aBMD decreased by 3.9±5.5 % in the lumbar spine, 8.2±4.6 % in the femoral neck, 11.6±4.9 % in total hip and 9.4±3.8 % in total body.
Our findings indicate that bone material strength improves despite an increase in bone turnover and a decrease in aBMD one year after RYGB. Trends were statistically comparable in participants with and without T2D. However, improved glucose control was associated with improved bone material strength in participants with T2D.
Aims/hypothesis The risk of dying of cardiovascular disease (CVD) before the age of 40 years is increased nearly 20-fold in patients with type 1 diabetes compared with non-diabetic persons. The aim ...of this study was to evaluate the prevalence of CVD risk factors in a population-based study of children and adolescents with type 1 diabetes. Methods CVD risk factors were examined according to the American Diabetes Association criteria in 2005. Of 26 paediatric clinics in Norway, 25 participated with 1,658 patients, 85% of those eligible. Mean age was 13.1 years and mean diabetes duration 5.7 years. Results HbA₁c was above the target level in 71.4%. A positive family history of early CVD and/or diabetes was found in 33% of participants. LDL-cholesterol was >2.6 mmol/l in 34.5% and HDL-cholesterol was <1.1 mmol/l in 6.9% of participants. Blood pressure was above the 90th percentile by age, sex and height in 7% and above the 95th percentile in 4% of participants. Four per cent of participants were obese, 3% of those >=12 years of age reported smoking and 1% of all participants had persistent microalbuminuria. Only 0.2% of the patients were receiving statin and 0.3% anti-hypertensive treatments. Dietary habits and physical activity level were evaluated in some patients. Almost all had higher intake of dietary fat and lower intake of fibre than recommended. A large part was less active and watched more TV than recommended. Conclusions/interpretation Of the participants, 86% had at least one, 45% at least two and 15% at least three CVD risk factors. Few patients were treated with statins and anti-hypertensive drugs.
Objective: To investigate longitudinal changes in cortical and subcortical volumes in patients with mild traumatic brain injury (MTBI) and to evaluate whether such changes were associated with ...self-reported post-concussive symptoms, global functional outcomes and neuropsychological functioning.
Methods: This was a prospecitve, longitudinal cohort study of patients with complicated (i.e presence of intracranial abnormalities on the day of injury CT) and uncomplicated MTBI (i.e, absence of intracranial abnormalities). Magnetic resonance imaging (MRI) was performed at approximately 4 weeks and 12 months. We utilized a 3T MRI system, cortical reconstruction and volumetric segmentation by FreeSurfer software. We included 33 patients with uncomplicated and 29 with complicated MTBI, who were aged 16-65 years.
Results: 12 months after MTBI, significant within-group volume reductions were detected in the left accumbens area and right caudate nucleus for both patients groups, but no significant differences between the groups were revealed. No associations between volumetric variables and post-concussive symptoms or global functioning were found. The left temporal thickness was significantly associated with executive functioning.
Conclusion: Structural subcortical alterations occur after complicated and uncomplicated MTBIs but these findings were not associated with symptoms burden or functional outcomes. Nonetheless, worse executive functioning was found in patients with shrinkage of the left temporal lobe.
Background and purpose
The influence of environmental factors in myasthenia gravis (MG) is unknown. The aim of this cross‐sectional population‐based study was to investigate if smoking and ...socio‐economic status (SES) were associated with MG in the Norwegian population.
Methods
Subjects were 491 MG patients identified in Norway at the time of the study (point prevalence 12.7/100 000). A questionnaire covering smoking habits and markers of SES (education and occupation) was mailed to all patients. Population data were obtained from Statistics Norway.
Results
A total of 375 (76.6%) patients completed the questionnaire (236 women, mean age 59 ± 18 years), of which 193 reported to be early onset MG (EOMG, onset ≤40 years, 155 women). Compared with the general population, current smoking was more prevalent amongst MG patients risk ratio (RR) 1.5; 95% confidence interval (CI) 1.1–1.9, most of whom had EOMG. Female MG patients had higher education compared with the general population (RR 4.5; 95% CI 3.2–6.2). Male MG patients were similar to the general population regarding both education and occupation, except for a subset of late onset MG who had shorter education (RR 1.9; 95% CI 1.1–3.2) and had worked in crafts and related trades. About half of working age MG patients received disability pension, a finding significantly related to low educational level and a more severe disease course (P < 0.001).
Conclusion
This is the first report indicating that smoking and SES may affect MG. Further studies investigating their role as potential risk factors are warranted.
Background
Kidney disease after out‐of‐hospital cardiac arrest (OHCA) is incompletely described. We examined the occurrence of acute kidney injury (AKI) in OHCA patients and impact of AKI, with or ...without renal replacement therapy (RRT), on 6‐month mortality and neurological outcome.
Methods
Prospective study at Oslo University Hospital, Oslo, Norway. Adult resuscitated comatose OHCA patients treated with targeted temperature management at 33°C for 24 h were included. AKI and chronic kidney disease (CKD) were classified according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Main outcomes were 6‐month mortality and good neurological outcome defined as Cerebral Performance Category 1–2.
Results
Among 245 included patients (84% males, mean age 61 years), 11 (4%) had previously known CKD and 112 (46%) developed AKI. Overall 6‐month outcome revealed that 112 (46%) died and 123 (50%) had good neurological outcome. Compared with no kidney disease, the presence of AKI was significantly associated with 6‐month mortality (odds ratio (OR) 3.17, 95% confidence interval (CI) 1.95–5.43, P < 0.001) and good neurological outcome (OR 0.28, 95% CI 0.16–0.48, P < 0.001). Six‐month mortality (50 vs. 61%, P = 0.401) and frequency of good neurological outcome (44 vs. 35%, P = 0.417) were not statistically different in AKI patients with or without RRT, also after excluding patients where RRT was withheld due to futility.
Conclusions
Kidney disease occurred in about half of patients successfully resuscitated from OHCA. Presence of AKI, but not RRT, was associated with unfavourable 6‐month outcome.
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