Abstract Background Numerous treatment guidelines recommend that long-term use of benzodiazepines (BZD) should be avoided primarily due to development of tolerance and a risk for BZD dependence. ...Despite this, long-term BZD use remains a controversial subject in clinical patient care with “for and against” debates. However, there is no explicit understanding of what is meant by long-term BZD use in real world. The aim of this study was to assess different definitions, usage patterns, prevalence and other characteristics of long-term BZD use based on published register-based studies. Synthesis of these characteristics is essential to derive a meaningful definition of long-term BZD. Methods Systematic review of register-based studies on long-term BZD use published in 1994–2014. Results Fourty-one studies met our predetermined inclusion criteria. The length of BZD use defined as “long-term” varied in these studies ranging from one month to several years. The most common definition was six months or longer during a year. The prevalence of long-term BZD use in the general population was estimated to be about 3%. The relative proportion of long-term BZD users (all definitions) in adult BZD users ranged from 6% to 76% (mean 24%; 95% CL 13–36%). The estimates were higher in studies only on the elderly (47%; 95% CL 31–64%). Long-term use involved typically steady treatment with low BZD doses. However, in elderly patients long-term BZD use and exceeding recommended doses was relatively common. Several characteristics associated with long-term use were found. Conclusions Long-term BZD use is common and a clinical reality. Uniform definitions for “long-term”, which is in line with population-based evidence, is needed to have more comparable results between studies. Our systematic review suggests that duration of BZD treatment over six months, the most common definition for long-term BZD use in the included studies. As also recommended previously, it is a useful starting point for further analyses on disadvantages but also potential advantages associated with long-term BZD use.
A cross-sectional observational study.
To investigate whether there is a difference in findings of lumbar Modic changes in low-field (0.3 T) magnetic resonance imaging (MRI) compared with high-field ...(1.5 T).
It is a challenge to give patients with low back pain a specific diagnosis. Modic changes as seen on MRI have been reported to be a possible source of pain. However, it is unclear whether the diagnosis is independent on the field strength.
Twenty patients with Modic changes, 11 women and 9 men (mean age, 53.6 yr; range, 29-81 yr), with or without sciatica, seen in a Danish outpatient low back pain clinic were included. All patients obtained MRI scans on both a high-field and a low-field MRI scanner. Two radiologists evaluated all lumbar endplates independently, using a standardized evaluation protocol. Kappa statistics were used to analyze the interobserver reproducibility. We used paired t test to analyze the difference between low- and high-field MRI.
The total number of Modic changes diagnosed with high-field MRI was significantly higher than that with low-field MRI. However, 3 to 4 times as many Modic type 1 changes were found with low-field MRI compared with high-field MRI. Contrarily, with high-field MRI type 2 changes were diagnosed twice as often.
There was a significant difference between low- and high-field MRI regarding the overall prevalence of any Modic change, but this had opposite directions for types 1 and 2: type 2 dominated in high field and conversely in high field corrected. The type of MRI unit should be taken into consideration when diagnosing patients with Modic changes
Cardiac biomarker release after exercise is well documented in endurance sports, but neither the impact of intermittent high‐intensity exercise nor the reproducibility has yet been established. ...Floorball, a popular sport in Scandinavia, involves intermittent periods of high‐intensity exercise. This study aimed to determine the prevalence and reproducibility of elevated cardiac marker levels among elite floorball players after two games. Twenty‐three healthy male elite floorball players of median age 19 years (range 16–34 years) participated in two standard games. Blood was drawn at three time points: pregame, immediately after, and 2 h after the game. Creatine kinase MB (CK‐MB), myoglobin, and high‐sensitivity cardiac troponin T (hs‐cTnT) were measured. The results showed significantly elevated median postgame values in all markers. In both games, hs‐cTnT exceeded the cutoff for myocardial damage (≥ 14 ng/L) 2 h postgame in the same six players. The major findings were that postgame cardiac hs‐cTnT values among elite floorball players were significantly elevated and reproducible. The findings imply that extended investigations should incorporate evaluation of myocardial function and myocardial perfusion during exercise to seek the clinical significance and underlying mechanisms of elevated cardiac troponin after high‐intensity exercise.
To identify novel prebiotics that could be used to maintain persistence of three representative probiotic strains in vivo. Test mice were treated with prebiotics soybean oligosaccharide (SOS), ...fructooligosaccharide (FOS) or inulin, followed by probiotics Lactobacillus acidophilus LAFTI® L10 (L10), Bifidobacterium lactis LAFTI® B94 (B94) or Lactobacillus casei L26 LAFTI® (L26). Faecal samples were then collected and analysed using selective medium and PCR analysis to determine the presence of the probiotic strains. In contrast to the control groups, in mice fed prebiotics, the survival and retention time of the test probiotics was increased extensively. SOS and FOS prolonged the retention period of L10 from 24 to 30 h. Of the three prebiotics, FOS gave the best result with B94, prolonging the retention period from 3 to >=10 days. Of the three prebiotics, inulin gave the best result for L26, prolonging the retention period from 2 to >=6 days. The prebiotics SOS, FOS and inulin significantly enhance survival and prolong the retention period of L10, B94 and L26 in vivo. Our results demonstrate the potential use of FOS, inulin and SOS as prebiotics in conjunction with the probiotic strains L10, B94 and L26 for new synbiotic products.
Three batches of Cheddar cheeses (Batch 1, with only starter lactococci; Batch 2, with lactococci and
Lactobacillus acidophilus 4962,
Lb. casei 279,
Bifidobacterium longum 1941; Batch 3, with ...lactococci and
Lb. acidophilus LAFTI
® L10,
Lb. paracasei LAFTI
® L26,
B. lactis LAFTI
®B94) were manufactured in triplicate to study the survival and influence of probiotic bacteria on proteolytic patterns and production of organic acid during ripening period of 6 months at 4
°C. All probiotic adjuncts survived manufacturing process and maintained their viability of >7.5
log
10
cfu
g
−1 at the end of ripening. The number of lactococci decreased by one to two log cycles, but their counts were not significantly different
(
P
>
0.05
)
in control and probiotic cheeses. No significant differences were observed in composition (fat, protein, moisture, salt content), but acetic acid concentration was higher in probiotic cheeses. Assessment of proteolysis during ripening showed no significant differences
(
P
>
0.05
)
in the level of water-soluble nitrogen (primary proteolysis), but the levels of secondary proteolysis indicated by the concentration of free amino acids were significantly higher
(
P
<
0.05
)
in probiotic cheeses. SDS-PAGE results on hydrolysis of
α
s-CN after 6 months were consistently higher in probiotic cheeses (19.28%, 46.99% and 63.42% in Batch 1, Batch 2 and Batch 3, respectively). Proteolytic activity, however, remained relatively low for all cheeses due to the low temperature of ripening (4
°C). Results demonstrated that Cheddar cheeses can be an effective vehicle for delivery of probiotic organisms.
Objectives
Despite the stable incidence of mental disorders in Finland and Europe, mental health-related occupational disability has been increasing. We unveiled the paths to permanent psychiatric ...disability, recovery, or death, by analysing sequences of labour market participation.
Methods
The RETIRE register database includes information regarding all persons (
n
= 42,170) awarded an ICD-10 psychiatric disability pension between 2010 and 2015 in Finland. We identified clusters of typical paths of pre-retirement labour market history. Controlling for major mental disorders, age, and sex, we evaluated factors associated with returning to work (RTW), or death, over a 5-year follow-up period.
Results
Only 10.5% of the disabled subjects returned to work within the follow-up. Half of them ended up with a permanent disability pension. Seven distinguishable paths to disability were identified. Subjects in the cluster characterized by steady employment were relatively often females, lost their work ability due to affective disorders, and had the highest rate of returning to work (16.3%). Mortality was highest (9%) among the cluster characterized by long-term unemployment. Distributions of major diagnostic groups, as well as age and sex, differed between clusters. After their adjustment in the analysis of RTW or death, the identified labour market history paths prior to losing work ability remained as important independent prognostic factors for both outcomes.
Conclusions
The complex retirement process involves identifiable clinical and contextual associating factors. Labour market history patterns associate with varying prognoses after psychiatric retirement. Prolonged unemployment appears as a predictor of relatively poor prognoses, whereas employment indicates the opposite.
Cheddar cheeses were produced with starter lactococci and
Bifidobacterium longum 1941,
B. lactis LAFTI
® B94,
Lactobacillus casei 279,
Lb. paracasei LAFTI
® L26,
Lb. acidophilus 4962 or
Lb. ...acidophilus LAFTI
® L10 to study the survival of the probiotic bacteria and the influence of these organisms on proteolytic patterns and production of organic acid during ripening period of 6 months at 4
°C. All probiotic adjuncts survived the manufacturing process of Cheddar cheese at high levels without alteration to the cheese-making process. After 6 months of ripening, cheeses maintained the level of probiotic organisms at >8.0
log
10
cfu
g
−1 with minimal effect on moisture, fat, protein and salt content. Acetic acid concentration was higher in cheeses with
B. longum 1941,
B. lactis LAFTI
® B94,
Lb. casei 279 and
Lb. paracasei LAFTI
® L26. Each probiotic organism influenced the proteolytic pattern of Cheddar cheese in different ways.
Lb. casei 279 and
Lb. paracasei LAFTI
® L26 showed higher hydrolysis of casein. Higher concentrations of free amino acids (FAAs) were found in all probiotic cheeses. Although
Bifidobacterium sp. was found to be weakly proteolytic, cheeses with the addition of those strains had highest concentration of FAAs. These data thus suggested that
Lb. acidophilus 4962,
Lb. casei 279,
B. longum 1941,
Lb. acidophilus LAFTI
® L10,
Lb. paracasei LAFTI
® L26 and
B. lactis LAFTI
® B94 can be applied successfully in Cheddar cheese.
The viability of
Lactobacillus acidophilus LAFTI
® L10,
Bifidobacterium lactis LAFTI
® B94, and
L. paracasei LAFTI
® L26 and their proteolytic activities were assessed in yoghurt at different ...termination pH of 4.45, 4.50, 4.55, and 4.60 in the presence of
L. delbrueckii ssp
. bulgaricus Lb1466 and
Streptococcus thermophilus St1342 during 28 days of storage at 4
°C. All strains achieved the recommended level of 6.00
log
cfu
g
−1 of the product with
L. acidophilus LAFTI
® L10 and
L. paracasei LAFTI
® L26 exceeding the number to 8.00 and 7.00
log
cfu
g
−1, respectively. Lactobacilli strains showed a good cellular stability maintaining constant concentration throughout storage period regardless of termination pH. On the other hand, the cell counts of
B. lactis LAFTI
® B94 decreased by one log cycle at the end of storage. The presence of probiotic organisms enhanced proteolysis significantly in comparison with the control batch containing
L. delbrueckii ssp
. bulgaricus Lb1466 and
S. thermophilus St1342 only. The proteolytic activity varied due to termination pH, but also appeared to be strain related. The increased proteolysis improved survival of
L. delbrueckii ssp
. bulgaricus Lb1466 during storage resulting in lowering of pH and production of higher levels of organic acids, which might have caused the low cell counts for
B. lactis LAFTI
® B94.
Surveillance for healthcare-associated infections such as healthcare-associated urinary tract infections (HA-UTI) is important for directing resources and evaluating interventions. However, ...traditional surveillance methods are resource-intensive and subject to bias.
To develop and validate a fully automated surveillance algorithm for HA-UTI using electronic health record (EHR) data.
Five algorithms were developed using EHR data from 2979 admissions at Karolinska University Hospital from 2010 to 2011: (1) positive urine culture (UCx); (2) positive UCx + UTI codes (International Statistical Classification of Diseases and Related Health Problems, 10th revision); (3) positive UCx + UTI-specific antibiotics; (4) positive UCx + fever and/or UTI symptoms; (5) algorithm 4 with negation for fever without UTI symptoms. Natural language processing (NLP) was used for processing free-text medical notes. The algorithms were validated in 1258 potential UTI episodes from January to March 2012 and results extrapolated to all UTI episodes within this period (N = 16,712). The reference standard for HA-UTIs was manual record review according to the European Centre for Disease Prevention and Control (and US Centers for Disease Control and Prevention) definitions by trained healthcare personnel.
Of the 1258 UTI episodes, 163 fulfilled the ECDC HA-UTI definition and the algorithms classified 391, 150, 189, 194, and 153 UTI episodes, respectively, as HA-UTI. Algorithms 1, 2, and 3 had insufficient performances. Algorithm 4 achieved better performance and algorithm 5 performed best for surveillance purposes with sensitivity 0.667 (95% confidence interval: 0.594–0.733), specificity 0.997 (0.996–0.998), positive predictive value 0.719 (0.624–0.807) and negative predictive value 0.997 (0.996–0.997).
A fully automated surveillance algorithm based on NLP to find UTI symptoms in free-text had acceptable performance to detect HA-UTI compared to manual record review. Algorithms based on administrative and microbiology data only were not sufficient.
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