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Stryhn L, Mejldal A, Guala M, Støving R, Stenager E, Skøt L, Mellentin A. Comorbid alcohol and cannabis use disorders increase mortality in patients with eating disorders. Eur Psychiatry 2022. [PMCID: PMC9567466 DOI: 10.1192/j.eurpsy.2022.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Alcohol and cannabis use disorders are the most frequent comorbid substance use disorders (SUDs) among patients with eating disorders (EDs). EDs and SUDs involving alcohol and cannabis are independently associated with excess mortality. Objectives To investigate the impact of comorbid alcohol use disorder (AUD) and cannabis use disorder (CUD) on mortality in anorexia nervosa (AN), bulimia nervosa (BN), and unspecified eating disorder (USED) compared with matched control subjects. Methods This retrospective cohort study was conducted using Danish nationwide registers. The risk of mortality among ED patients with/without AUD and/or CUD was compared to matched control subjects with/without AUD and/or CUD using hazard ratios (HRs). Results Of the 20,759 included ED patients, 4.7% and 4.3% had AUD and CUD, respectively. The corresponding figures for the 83,036 control subjects were 1.0% (AUD) and 1.3% (CUD). ED patients without SUDs exhibited an increased risk of mortality compared to control subjects without SUDs (adjusted HR 2.9, P<.001). Mortality risk was higher among ED patients with AUD (adjusted HR 11.8, P<.001) or CUD (adjusted HR 4.6, P<.001) compared to control subjects without AUD/CUD. In addition, patients with AN, BN, and USED, who had comorbid AUD and/or CUD, exhibited an elevated risk of mortality compared to control subjects without AUD/CUD (AN: adjusted HR 11.3, P<.001; BN: adjusted HR 5.9, P<.001; USED: adjusted HR 10.9, P<.001). Conclusions Comorbid AUD and/or CUD increase mortality risk in patients with EDs. In order to reduce mortality in ED patients, prevention and treatment of AUD and CUD is important. Disclosure No significant relationships.
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Hansen T, Waldorff F, Andersen K, Stenager E. Homebased screening for cognitive impairment due to dementia. Eur Psychiatry 2022. [PMCID: PMC9566945 DOI: 10.1192/j.eurpsy.2022.1677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Dementia develops slowly and insidiously and causes cognitive impairment. The diagnosis is pivotal for relevant treatment and care. However, 50,000 people are estimated to have undiagnosed dementia in Denmark, while 36,000 are diagnosed. The municipalities offers a home visit to the population at the ages of 75 and 80 years to assess the need of care and prevent sickness. These home visits are well established and might offer an unused opportunity to detect cognitive impairment and dementia. Objectives To assess impaired cognition at home visits in order to initiate clinical examination for dementia. Methods A feasibility study with the use of Brief Assessment of Impaired Cognition Questionnaire (BASIC-Q) (sensitivity 0.92, specificity 0.97) at home visits. It is expected to include 1000 participants without a dementia diagnosis at the ages of 75 and 80 years. Participants will be included in a period of 12 moths (in the year of 2022), in a number of municipalities. If the screening for cognitive impairment is positive, the participant is motivated for clinical examination at the general practitioner. Follow-up through registers and general practitioners. Results Preliminary results will be presented at the conference. Conclusions Assessment of cognition might give an opportunity to start medication and social support early in the elderly with impaired cognition and undiagnosed dementia. Disclosure No significant relationships.
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Jakobsen S, Christiansen E, Andersen P, Lauritsen J, Stenager E. Incidence rates of suicide attempts and self-harm in Europe. What can we learn? A systematic review and meta-analysis. Eur Psychiatry 2022. [PMCID: PMC9567207 DOI: 10.1192/j.eurpsy.2022.2179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Definitions used for suicide attempts and self-harm have been discussed for many years and is used differently in European countries, sometimes even interchangeably. Therefore, it is difficult to compare relevant rates across nations.
Objectives
This study aims at estimating the rate of suicide attempts and self-harm in chosen European countries in the more recent years when distinguishing between applied definitions.
Methods
A systematic search for relevant articles published between 2010-2020 will be performed in databases such as PubMed, Embase, PsycINFO, and Web of Science. Only articles in English or Danish will be included. Data will be collected for all age groups above 15 years of age. The prevalence of suicide attempts and self-harm will be calculated by a random effect model. Subgroup analyses will be performed to compare the rates according to age.
Results
from the performed systematic review and meta-study will be presented at the conference.
Conclusions
The conclusion will be presented when results have been analysed.
Disclosure
No significant relationships.
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Borg J, Stenager E, Wang Y, Svendstrup Christensen L, Goos R, Lund Henriksen F. Cardiac arrest survivors – Psychiatric comorbidity and cognitive impairment. Eur Psychiatry 2022. [PMCID: PMC9568054 DOI: 10.1192/j.eurpsy.2022.1595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
In 2019 there were 1,760 patients in Denmark’s hospitals who experienced cardiac arrest (IHCA patients = In Hospital Cardiac Arrest patients). Of these patients about 70% survived. There is only limited knowledge about the mental and cognitive state of cardiac arrest survivors. However, it seems, that cardiac arrest survivors, perform mentally and cognitively worse compared to the background population. The mental and cognitive difficulties can lead to reduced quality of life for both those affected and their relatives.
Objectives
Because the above-mentioned area has limited knowledge, further studies are needed to shed more light into the problem.
Methods
To find out if the patients can be included in the study, the patient journals will be studied. After that there will be performed an interview-survey-based study, in which IHCA patients’ possible symptoms of depression, anxiety, PTSD and suicide risk, the patients’ quality of life and any cognitive disorder, shortly after and three months after cardiac arrest, will be examined. The study will also, if possible, focus on the patients’ relatives and on the eventual difficulties they may experience in the aftermath of a relative surviving a cardiac arrest. The above-mentioned will be done using already existing relevant psychiatric and neuropsychological examination tools. In relation to the patients’ relatives, however, a separate survey tool, that has been developed, will be used.
Results
It is an ongoing study. Results are expected in 2023.
Conclusions
In the long run the study hopefully can contribute to establishing relevant help, counseling and rehabilitation for the patients and relatives affected.
Disclosure
No significant relationships.
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Petersen B, Stenager E, Mogensen CB, Erlangsen A. Response to letter regarding Tobacco smoking. J Intern Med 2020; 288:607. [PMID: 32367596 DOI: 10.1111/joim.13068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 11/27/2022]
Affiliation(s)
- B Petersen
- From the, Psychiatric Research Unit, Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - E Stenager
- From the, Psychiatric Research Unit, Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - C B Mogensen
- Acute Medicine Research Unit, Department of Regional Health Research, University Hospital of Southern Denmark, University of Southern Denmark, Abenraa, Denmark
| | - A Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen, Denmark.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center of Mental Health Research, Australian National University, Canberra, ACT, Australia
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6
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Thrue C, Riemenschneider M, Hvid LG, Stenager E, Dalgas U. Time matters: Early-phase multiple sclerosis is accompanied by considerable impairments across multiple domains. Mult Scler 2020; 27:1477-1485. [DOI: 10.1177/1352458520936231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Impairments across multiple domains are a disabling consequence of multiple sclerosis (MS). Originating from preventive medical strategies, the “time matters”-perspective has become a focal point when treating MS. In particular, early detection of physical and cognitive deficits, along with deficits in patient-reported outcomes seems crucial to further optimize both pharmacological and non-pharmacological MS treatment strategies. Therefore, this topical review investigates the level of impairments across multiple domains (physical function, cognitive function, and patient-reported outcomes) in the early stage of MS (⩽5 years since diagnosis, including clinically isolated syndrome (CIS)), when compared to matched healthy controls. Even at early disease stages, studies show impairments corresponding to 8%–34% and small-to-large numerical effect sizes (0.35–2.85) in MS/CIS patients across domains. This evidence call for early screening programs along with early interventions targeting the multiple impaired domains. This further highlights the importance of preventive initiatives preserving and/or restoring physical and cognitive reserve capacity if possible.
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Affiliation(s)
- C Thrue
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - M Riemenschneider
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - LG Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - E Stenager
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark/Department of Neurology, MS-Clinic of Southern Jutland (Sønderborg, Esbjerg, Kolding), Sønderborg, Denmark
| | - U Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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Abstract
OBJECTIVE To assess the association between specific heart diseases and suicide. DESIGN Nationwide retrospective cohort study. PARTICIPANTS A total of 7 298 002 individuals (3 640 632 males and 3 657 370 females) aged ≥15 years and living in Denmark during 1980-2016. MAIN OUTCOME MEASURES Incidence rate ratios (IRR) with 95% confidence intervals. In multivariate analysis, we adjust for sex, period, age group, living status, income level, Charlson Comorbidity Index, psychiatric disorders prior to heart disease and self-harm prior to heart disease. RESULTS Excess suicide rate ratios were found for following disorders: heart failure (IRR: 1.48; 95% CI: 1.38-1.58); cardiomyopathy (IRR: 1.41; 95% CI: 1.16-1.70); acute myocardial infarction (IRR: 1.28; 95% CI: 1.21-1.36); cardiac arrest with successful resuscitation (IRR: 4.75; 95% CI: 3.57-6.33); atrial fibrillation and flutter (IRR: 1.42; 95% CI: 1.32-1.52); angina pectoris (IRR: 1.19; 95% CI: 1.12-1.26); and ventricular tachycardia (IRR: 1.53; 95% CI: 1.20-1.94). A higher rate of suicide was noted during the first 6 months after the diagnosis of heart failure (IRR: 2.38; 95% CI: 2.04-2.79); acute myocardial infarction (IRR: 2.24; 95% CI: 1.89-2.66); atrial fibrillation and flutter (IRR: 2.70; 95% CI: 2.30-3.18); and angina pectoris (IRR: 1.83; 95% CI: 1.53-2.19) when compared to later. CONCLUSION Several specific disorders were found to be associated with elevated rates of suicide. Additionally, we found temporal associations with higher suicide rates in the first time after diagnosis. Our results underscore the importance of being attentive towards psychological distress in individuals with heart disease.
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Affiliation(s)
- B D Petersen
- From the, Psychiatric Research Unit, Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - E Stenager
- From the, Psychiatric Research Unit, Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - C B Mogensen
- Acute Medicine Research Unit, Department of Regional Health Research, University of Southern Denmark, University Hospital of Southern Denmark, Abenraa, Denmark
| | - A Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen, Denmark.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center of Mental Health Research, Australian National University, Canberra, ACT, Australia
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Hoang H, Stenager E, Stenager E. The Risk of Depression and Anxiety in the Post-diagnostic Period of Multiple Sclerosis Measured by Screening Instruments and Structured Interviews. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2017.01.2252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
ObjectiveTo examine the risk of depression and anxiety in MS patients in the post-diagnostic period by using clinical screening instruments and a diagnostic structured clinical interview.MethodA population of 134 MS patients was examined for the risk of depression and anxiety in the post-diagnostic period of MS using the clinical screening instruments Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS). Within six weeks of diagnosis, patients with cut-off > 12 for BDI and > 7 for HADS were offered a clinical structured interview using the Schedules for Clinical Assessment in Neuropsychiatry/SCAN Version 2.1.ResultsThe prevalence of depressive symptoms and depression in the post-diagnostic period of MS was 49.2% when using the screening instruments, but only 15.2% when using the SCAN interview. For anxiety, the prevalence was 3.4% for both the screening instruments and the SCAN interview in the post-diagnostic period of MS.ConclusionMS patients have a risk of depression and anxiety in the post-diagnostic period of MS, but it is crucial to consider which tools to use in a clinical setting to investigate depression and anxiety in MS patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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9
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Bruun H, Huniche L, Stenager E, Mogensen CB, Pedersen R. Hospital ethics reflection groups: a learning and development resource for clinical practice. BMC Med Ethics 2019; 20:75. [PMID: 31651308 PMCID: PMC6813973 DOI: 10.1186/s12910-019-0415-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/09/2019] [Indexed: 11/13/2022] Open
Abstract
Background An ethics reflection group (ERG) is one of a number of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the significance of ERGs in psychiatric and general hospital departments in Denmark. Methods This is a qualitative action research study, including systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. Short written descriptions of the ethical challenges presented in the ERGs also informed the analysis of significance. Results A recurring ethical challenge for clinicians, in a total of 63 cases described and assessed in 3 ethical reflection groups, is to strike a balance between respect for patient autonomy, paternalistic responsibility, professional responsibilities and institutional values. Both in psychiatric and general hospital departments, the study participants report a positive impact of ERG, which can be divided into three categories: 1) Significance for patients, 2) Significance for clinicians, and 3) Significance for ward managers. In wards characterized by short-time patient admissions, the cases assessed were retrospective and the beneficiaries of improved dialogue mainly future patients rather than the patients discussed in the specific ethical challenge presented. In wards with longer admissions, the patients concerned also benefitted from the dialogue in the ERG. Conclusion This study indicates a positive significance and impact of ERGs; constituting an interdisciplinary learning resource for clinicians, creating significance for themselves, the ward managers and the organization. By introducing specific examples, this study indicates that ERGs have significance for the patients discussed in the specific ethical challenge, but mostly indirectly through learning among clinicians and development of clinical practice. More research is needed to further investigate the impact of ERGs seen from the perspectives of patients and relatives.
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Affiliation(s)
- H Bruun
- Focused Research Unit in Psychiatry, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - L Huniche
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - E Stenager
- Focused Research Unit in Psychiatry, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - C B Mogensen
- Focused Research Unit in Emergency Medicine, Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - R Pedersen
- Center for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
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10
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Pankiewicz-Dulacz M, Stenager E, Chen M, Stenager EN. Risk factors of major infections in schizophrenia. A nationwide Danish register study. J Psychosom Res 2019; 121:60-67. [PMID: 31023486 DOI: 10.1016/j.jpsychores.2019.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Risk of infections is elevated in patients with schizophrenia. Predicting their occurrence is essential, as infections in this group of patients are associated with prolonged hospital admission and increased mortality. The objective of the current investigation was to identify the potential risk factors of major infection after diagnosis with schizophrenia. METHODS This national prospective observational cohort study included 7788 people with schizophrenia born in Denmark between 1975 and 1990. Socio-demographic, psychiatric and health related data were obtained from Danish national registers. The Cox regression model was used for data analyses. Crude and adjusted hazard ratios (HRs) with 95% confidence intervals (95%CIs) are presented. RESULTS The most significant risk factors associated with the development of major infections included young age, female gender, medical comorbidity and substance abuse. A history of treatment with antipsychotics preceding the diagnosis was negatively associated with such morbidity. CONCLUSION This study reports several factors that might increase the risk of infections in individuals with schizophrenia. Early intervention towards infections should be considered in the subpopulation of schizophrenia patients who are at increased risk of infections.
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Affiliation(s)
- M Pankiewicz-Dulacz
- The Focused Research Unit of Psychiatry, Department of Psychiatry, Aabenraa, Denmark; University of Southern Denmark, Winsløwparken 19.3, Odense C-DK 5000, Department of Regional Health Research, Faculty of Health Sciences, Denmark.
| | - E Stenager
- University of Southern Denmark, Winsløwparken 19.3, Odense C-DK 5000, Department of Regional Health Research, Faculty of Health Sciences, Denmark; The Focused Research Group of Neurology, Department of Neurology, Hospital of Southern Jutland, Sønderborg, Denmark.
| | - M Chen
- University of Southern Denmark, Winsløwparken 19.3, Odense C-DK 5000, Department of Regional Health Research, Faculty of Health Sciences, Denmark; Department of Clinical Microbiology, Hospital of Southern Jutland, Sønderborg, Denmark.
| | - E N Stenager
- The Focused Research Unit of Psychiatry, Department of Psychiatry, Aabenraa, Denmark; University of Southern Denmark, Winsløwparken 19.3, Odense C-DK 5000, Department of Regional Health Research, Faculty of Health Sciences, Denmark.
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11
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Løge-Hagen JS, Sæle A, Juhl C, Bech P, Stenager E, Mellentin AI. Prevalence of depressive disorder among patients with fibromyalgia: Systematic review and meta-analysis. J Affect Disord 2019; 245:1098-1105. [PMID: 30699852 DOI: 10.1016/j.jad.2018.12.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/16/2018] [Accepted: 12/01/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND It is acknowledged that fibromyalgia (FM) as a medical (rheumatological) disorder and major depressive disorder (MDD) as a mental disorder often co-occurs, but the inconsistency is prevailing at study-level and no overall estimate of the co-occurrence exist. AIMS This systematic review and meta-analysis aimed to estimate the overall point- and life-time prevalence of MDD among FM patients based on structured clinical interviews (SCI); and to estimate the point-prevalence of MDD among FM patients based on screening symptom scales (SSS). METHOD The electronical databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and PsycINFO were searched for papers that reported on prevalence of MDD among FM patients. Eligible studies were included in a random effects meta-analysis pooling the prevalence of depression. RESULTS The literature search identified 11 eligible studies for the meta-analysis. For SCI, the overall pooled point-prevalence (PP) was 25% (95% CI 19 to 31%), and life-time prevalence (LP) was 65% (95% CI 59 to 71%). When estimating the PP with self-administered SSS the overall pooled PP was 45% (95% CI 32 to 59%), and a single clinician-administered SSS yielded a PP of 23% (95% CI 10 to 41%). There was low inconsistency for the SCI and high inconsistency for the SSS. CONCLUSION One fourth of all FM patients had MDD, and more than half experienced MDD during their life-time according to clinician-administered instruments. Prevalence of MDD was almost twice as high when using self-administered symptom scales and may be likely to overestimate the co-occurrence.
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Affiliation(s)
- J S Løge-Hagen
- Psychiatric Research Unit, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - A Sæle
- Psychiatric Research Unit, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - C Juhl
- Department of Sports Science and Clinical Biomechanics, Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark; Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - P Bech
- Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Copenhagen, Denmark
| | - E Stenager
- Psychiatric Research Unit, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark; Psychiatric Research Unit, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark
| | - A I Mellentin
- Psychiatric Research Unit, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
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12
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Bruun H, Lystbaek SG, Stenager E, Huniche L, Pedersen R. Ethical challenges assessed in the clinical ethics Committee of Psychiatry in the region of Southern Denmark in 2010-2015: a qualitative content analyses. BMC Med Ethics 2018; 19:62. [PMID: 29914461 PMCID: PMC6006832 DOI: 10.1186/s12910-018-0308-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/04/2018] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this article is to give more insight into what ethical challenges clinicians in mental healthcare experience and discuss with a Clinical Ethics Committee in psychiatry in the Region of Southern Denmark. Ethical considerations are an important part of the daily decision-making processes and thereby for the quality of care in mental healthcare. However, such ethical challenges have been given little systematic attention – both in research and in practices. Methods A qualitative content analysis of 55 written case-reports from the Clinical Ethics Committee. The Committee offers clinicians in mental healthcare structured ethical analyses of ethical challenges and makes a thorough written case-report. Results The ethical challenges are grouped into three overarching topics: 1. Clinicians and their relation to patients and relatives. 2. Clinicians and institutional aspects of mental healthcare 3. Clinicians and mental healthcare in a wider social context. Through presentation of illustrative examples the complexity of daily clinical life in mental healthcare becomes evident, as well as typical interests, values and arguments. Conclusions This qualitative study indicates that difficult ethical challenges are an inherent part of mental healthcare that requires time, space and competence to be dealt with adequately.
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Affiliation(s)
- H Bruun
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark. .,Psychiatric hospitals, the Region of Southern Denmark, Toldbodgade 45, 5000, Odense, Denmark.
| | - S G Lystbaek
- Psychiatric hospitals, the Region of Southern Denmark, Toldbodgade 45, 5000, Odense, Denmark
| | - E Stenager
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Psychiatric hospitals, the Region of Southern Denmark, Toldbodgade 45, 5000, Odense, Denmark
| | - L Huniche
- User Perspectives, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - R Pedersen
- Center for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
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Affiliation(s)
- N. Asgari
- Department of Regional Health Research; University of Southern Denmark; Odense Denmark
- Department of Molecular Medicine; University of Southern Denmark; Odense Denmark
| | - S. T. Lillevang
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | - H. P. B. Skejoe
- Department of Radiology; Aleris-Hamlet Hospital; Copenhagen Denmark
| | - M. Falah
- Department of Neurology; Regionhospital Holstebro; Holstebro Denmark
| | - E. Stenager
- Department of Regional Health Research; University of Southern Denmark; Odense Denmark
- Department of Neurology; Sonderborg Denmark
| | - K. O. Kyvik
- OPEN; Odense Patient data Explorative Network; Odense University Hospital; Odense Denmark
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
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14
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Langeskov-Christensen D, Feys P, Baert I, Riemenschneider M, Stenager E, Dalgas U. Performed and perceived walking ability in relation to the Expanded Disability Status Scale in persons with multiple sclerosis. J Neurol Sci 2017; 382:131-136. [DOI: 10.1016/j.jns.2017.09.049] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/06/2017] [Accepted: 09/30/2017] [Indexed: 11/28/2022]
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15
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Søndergård S, Vaegter HB, Erlangsen A, Stenager E. Ten-year prevalence of mental disorders in patients presenting with chronic pain in secondary care: A register linkage cohort study. Eur J Pain 2017; 22:346-354. [PMID: 28971547 DOI: 10.1002/ejp.1124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Prevalence rates of mental disorders in patients with chronic pain vary and may be overestimated when assessed by screening instruments only. Objectives were to estimate the 10-year prevalence of different mental disorders diagnosed by psychiatrists in patients with chronic pain compared with the Danish general population. METHODS Patients (n = 7197) consulted in the interdisciplinary Pain Clinic South at Odense University Hospital, Denmark, from 2005 to 2015 were included. Data from the Pain Clinic were linked to the Danish National Patient Register-Psychiatry and the Danish Civil Registration System. Age and gender standardized prevalence ratios (SPR) were calculated. RESULTS In all, 17.8% of patients with chronic pain had been diagnosed with a mental disorder. The most frequent diagnoses were adjustment disorders (subcategory of anxiety disorders) (8.9%), depression (6.1%), personality disorders (3.8%), and substance abuse disorders (3.5%). Women and men with chronic pain had higher rates of anxiety disorders (SPR 3.1; 95% CI 2.9-3.4) and depression (SPR 2.5; 95% CI 2.3-2.8), whereas men had higher rates of substance abuse disorders (SPR 1.6; 95% CI 1.3-1.9) than found for the general population. CONCLUSIONS Although depression and anxiety were noted more frequently among patients with chronic pain than the general population, prevalence rates were lower than previously reported. The most frequent diagnoses were adjustment disorders. SIGNIFICANCE Prevalence rates of anxiety and depression diagnosed by psychiatrists in patients with chronic pain were found to be lower than previous findings using screening instruments. Adjustment disorders were the most frequent disorders diagnosed, as this study is the first to investigate.
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Affiliation(s)
- S Søndergård
- Research Unit in Mental Health, Institute for Regional Health Services, University of Southern Denmark, Aabenraa, Denmark
| | - H B Vaegter
- Pain Research Group, Pain Centre South, Odense University Hospital, Denmark.,Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - A Erlangsen
- Research Unit in Mental Health, Institute for Regional Health Services, University of Southern Denmark, Aabenraa, Denmark.,Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Denmark.,Department of Mental Health, Bloomberg Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - E Stenager
- Research Unit in Mental Health, Institute for Regional Health Services, University of Southern Denmark, Aabenraa, Denmark
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Gammelgaard I, Stenager E, Eplov L, Petersen K. Personal experiences of recovery facilitated by participation in an individual placement and support intervention. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionIndividual placement and support (IPS) is an evidence-based intervention where IPS consultants support people with severe mental illness in achieving competitive employment. IPS is a recovery-oriented intervention, but vast evidence regarding its ability to influence recovery-oriented outcomes challenges this position.AimTo investigate how an IPS-intervention influences the personal recovery process in people with severe mental illness.MethodA qualitative phenomenological study including interview of 12 participants in an IPS-intervention. Analysis was made using a four-step phenomenological analysis method.ResultsIPS contributed to personal recovery in a number of ways: The IPS consultants’ ability to create an equal, acknowledging and safe relationship where participants’ needs were taking into consideration in the search and support for job or education was found valuable. In combination with employment, the role of the IPS consultant contributed to normalization and stabilisation of participants’ daily lives, changed their behaviours and beliefs about maintaining new achievements, personal goals and dreams.ConclusionIndividual placement and support provides opportunities to gain personal goals and contributes to stabilisation and normalization of participants’ daily lives. This study supports the notion that the individual placement and support positively influences personal recovery in people with severe mental illness.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Andersen AD, Binzer M, Stenager E, Gramsbergen JB. Cerebrospinal fluid biomarkers for Parkinson's disease - a systematic review. Acta Neurol Scand 2017; 135:34-56. [PMID: 26991855 DOI: 10.1111/ane.12590] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 12/14/2022]
Abstract
Diagnosis of Parkinson's disease (PD) relies on clinical history and physical examination, but misdiagnosis is common in early stages. Identification of biomarkers for PD may allow early and more precise diagnosis and monitoring of dopamine replacement strategies and disease modifying treatments. Developments in analytical chemistry allow the detection of large numbers of molecules in plasma or cerebrospinal fluid, associated with the pathophysiology or pathogenesis of PD. This systematic review includes cerebrospinal fluid biomarker studies focusing on different disease pathways: oxidative stress, neuroinflammation, lysosomal dysfunction and proteins involved in PD and other neurodegenerative disorders, focusing on four clinical domains: their ability to (1) distinguish PD from healthy subjects and other neurodegenerative disorders as well as their relation to (2) disease duration after initial diagnosis, (3) severity of disease (motor symptoms) and (4) cognitive dysfunction. Oligomeric alpha-synuclein might be helpful in the separation of PD from controls. Through metabolomics, changes in purine and tryptophan metabolism have been discovered in patients with PD. Neurofilament light chain (NfL) has a significant role in distinguishing PD from other neurodegenerative diseases. Several oxidative stress markers are related to disease severity, with the antioxidant urate also having a prognostic value in terms of disease severity. Increased levels of amyloid and tau-proteins correlate with cognitive decline and may have prognostic value for cognitive deficits in PD. In the future, larger longitudinal studies, corroborating previous research on viable biomarker candidates or using metabolomics identifying a vast amount of potential biomarkers, could be a good approach.
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Affiliation(s)
- A. D. Andersen
- Department of Neurology; Hospital of Southern Jutland; Sønderborg Denmark
- Institute of Regional Health Research; University of Southern Denmark; Odense Denmark
- Focused Research Group in Neurology; Hospital of Southern Jutland; Sønderborg Denmark
| | - M. Binzer
- Institute of Regional Health Research; University of Southern Denmark; Odense Denmark
- Focused Research Group in Neurology; Hospital of Southern Jutland; Sønderborg Denmark
| | - E. Stenager
- Institute of Regional Health Research; University of Southern Denmark; Odense Denmark
- Focused Research Group in Neurology; Hospital of Southern Jutland; Sønderborg Denmark
- The Multiple Sclerosis Clinic of Southern Jutland; (Vejle, Sonderborg, Esbjerg) Denmark
| | - J. B. Gramsbergen
- Institute of Molecular Medicine, Neurobiological Research; University of Southern Denmark; Odense Denmark
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Birkbak J, Stuart EA, Lind BD, Qin P, Stenager E, Larsen KJ, Wang AG, Nielsen AC, Pedersen CM, Winsløv JH, Langhoff C, Mühlmann C, Nordentoft M, Erlangsen A. Psychosocial therapy and causes of death after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching. Psychol Med 2016; 46:3419-3427. [PMID: 27654845 DOI: 10.1017/s0033291716001872] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychosocial therapy after deliberate self-harm might be associated with reduced risk of specific causes of death. METHOD In this matched cohort study, we included patients, who after an episode of deliberate self-harm received psychosocial therapy at a Suicide Prevention Clinic in Denmark between 1992 and 2010. We used propensity score matching in a 1:3 ratio to select a comparison group from 59 046 individuals who received standard care. National Danish registers supplied data on specific causes of death over a 20-year follow-up period. RESULTS At the end of follow-up, 391 (6.9%) of 5678 patients in the psychosocial therapy group had died, compared with 1736 (10.2%) of 17 034 patients in the matched comparison group. Lower odds ratios of dying by mental or behavioural disorders [0.54, 95% confidence interval (CI) 0.37-0.79], alcohol-related causes (0.63, 95% CI 0.50-0.80) and other diseases and medical conditions (0.61, 95% CI 0.49-0.77) were noted in the psychosocial therapy group. Also, we found a reduced risk of dying by suicide as well as other external causes, however, not by neoplasms and circulatory system diseases. Numbers needed to treat were 212.9 (95% CI 139.5-448.4) for mental or behavioural disorders as a cause of death, 111.1 (95% CI 79.2-210.5) for alcohol-related causes and 96.8 (95% CI 69.1-161.8) for other diseases and medical conditions. CONCLUSIONS Our findings indicate that psychosocial therapy after deliberate self-harm might reduce long-term risk of death from select medical conditions and external causes. These promising results should be tested in a randomized design.
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Affiliation(s)
- J Birkbak
- Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark
| | - E A Stuart
- Department of Mental Health,Johns Hopkins Bloomberg School of Public Health,Baltimore, MD,USA
| | - B D Lind
- Department of Psychiatry,Clinic of Suicide Prevention and Treatment for Adults,Region of Southern Denmark,Denmark
| | - P Qin
- National Centre for Suicide Research and Prevention, University of Oslo,Oslo,Norway
| | - E Stenager
- Psychiatric Research Unit,Aabenraa,University of Southern Denmark,Odense,Denmark
| | - K J Larsen
- Department of Child and Adolescent Psychiatry,Clinic of Suicide Prevention and Treatment for Children and Adolescents,Region of Southern Denmark,Denmark
| | - A G Wang
- Competence Centre for Suicide Prevention,Amager,Capital Region of Denmark,Denmark
| | - A C Nielsen
- Competence Centre for Suicide Prevention,Copenhagen,Capital Region of Denmark,Denmark
| | - C M Pedersen
- Clinic for Suicide Prevention, Aarhus University Hospital Risskov,Aarhus,Central Denmark Region,Denmark
| | - J-H Winsløv
- Unit for Suicide Prevention,Aalborg University Hospital,North Denmark Region,Denmark
| | - C Langhoff
- Clinic for Suicide Prevention,Herning,Central Denmark Region,Denmark
| | - C Mühlmann
- Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark
| | - M Nordentoft
- Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark
| | - A Erlangsen
- Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark
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19
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Jensen HB, Nielsen JL, Ravnborg M, Dalgas U, Aagaard P, Stenager E. Effect of slow release-Fampridine on muscle strength, rate of force development, functional capacity and cognitive function in an enriched population of MS patients. A randomized, double blind, placebo controlled study. Mult Scler Relat Disord 2016; 10:137-144. [PMID: 27919481 DOI: 10.1016/j.msard.2016.07.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 06/25/2016] [Accepted: 07/27/2016] [Indexed: 11/16/2022]
Abstract
DESIGN This study was conducted as a randomized, double blind, placebo-controlled parallel group trial preceded by open label enrichment phase. OBJECTIVES The objectives of this study were 1) to examine the effect of SR-Fampridine treatment on muscle strength in terms of maximal voluntary contraction (MVC) and rate of force development (RFD) of the lower extremities and 2) to replicate previously published data on the effect of slow release-Fampridine (SR-Fampridine) on the functional capacity of the lower limbs, the upper limb and cognitive function, in persons with multiple sclerosis (pwMS). METHODS Previously identified responders to SR-Fampridine were randomized to SR- Fampridine or placebo treatment for four weeks. On days 0 and 26-28 participants underwent testing by isokinetic dynamometry, Nine Hole Peg Test (9-HPT), Symbol Digit Modalities Test (SDMT), Six Spot Step Test (SSST), Timed 25 Foot Walk Test (T25FW) and 5-Times Sit-to-Stand (5-STS). RESULTS A statistical significant effect of SR-Fampridine on MVC was demonstrated during knee extension, knee flexion and hip flexion of the weakest leg, as well as on RFD during knee extension and knee flexion of the weakest leg. Furthermore, a significant effect of SR-Fampridine on T25FW, SSST and 5-STS was demonstrated. CONCLUSION Gold standard dynamometry assessment of muscle strength showed improved MVC and RFD in persons with MS treated with SR-Fampridine compared to placebo. Furthermore, previous findings on the effects of SR-Fampridine on functional capacity of the lower limbs were replicated. ClinicalTrials.gov identifier: NCT01656148.
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Affiliation(s)
- H B Jensen
- Institute of Regional Health Research, University of Southern Denmark, Denmark; MS-clinic of Southern Jutland (Sønderborg, Vejle, Esbjerg), Department of Neurology, Sønderborg Hospital, Denmark.
| | - J L Nielsen
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - M Ravnborg
- Department of Neurology, Odense University Hospital, Denmark
| | - U Dalgas
- Department of Public Health, Section of Sport Science, Aarhus University, Denmark
| | - P Aagaard
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - E Stenager
- Institute of Regional Health Research, University of Southern Denmark, Denmark; MS-clinic of Southern Jutland (Sønderborg, Vejle, Esbjerg), Department of Neurology, Sønderborg Hospital, Denmark
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20
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Hansen T, Skytthe A, Stenager E, Petersen HC, Brønnum-Hansen H, Kyvik KO. Concordance for multiple sclerosis in Danish twins: an update of a nationwide study. Mult Scler 2016; 11:504-10. [PMID: 16193885 DOI: 10.1191/1352458505ms1220oa] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The occurrence of multiple sclerosis (MS) in twins has not previously been studied in complete nationwide data sets. The existence of almost complete MS and twin registries in Denmark ensures that essentially unbiased samples of MS cases among twins can be obtained. In this population-based study, virtually all Danish MS cases among twins born before 1983 with onset of MS after 1948 and diagnosis before 1 January 1997 were identified. Of 13 286 MS cases, 178 were twins and, of these 164 twin pairs were discordant and seven were concordant. We found significantly higher proband-wise concordance among monozygotic twins than dizygotic twins, with estimated proband-wise concordances of 24% (95% confidence interval (CI): 5-39%) for monozygotic and 3% (95% CI: 0-8%) for dizygotic twins. Thus, a monozygotic twin whose co-twin has MS has a 24% risk of developing the disease, while the corresponding risk for a dizygotic twin is only 3%. Our results largely confirm previously published concordance estimates and indicate that genetic factors are of importance in susceptibility to MS.
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Affiliation(s)
- T Hansen
- Department of Epidemiology and Biostatistics, National Institute of Public Health, Oster Farimagsgade 5, DK-1399 København K, Denmark.
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Sørensen PS, Sellebjerg F, Lycke J, Färkkilä M, Créange A, Lund CG, Schluep M, Frederiksen JL, Stenager E, Pfleger C, Garde E, Kinnunen E, Marhardt K. Minocycline added to subcutaneous interferon β-1a in multiple sclerosis: randomized RECYCLINE study. Eur J Neurol 2016; 23:861-70. [DOI: 10.1111/ene.12953] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/26/2015] [Indexed: 11/27/2022]
Affiliation(s)
- P. S. Sørensen
- Danish Multiple Sclerosis Center; Department of Neurology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - F. Sellebjerg
- Danish Multiple Sclerosis Center; Department of Neurology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - J. Lycke
- Department of Neurology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - M. Färkkilä
- Department of Neurology; University Central Hospital; Helsinki Finland
| | - A. Créange
- Service de Neurologie; Hôpital Henri Mondor; Université Paris Est Créteil; Créteil France
| | - C. G. Lund
- Department of Neurology; Oslo University Hospital; Oslo Norway
| | - M. Schluep
- Service de Neurologie; Département des Neurosciences Cliniques; Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
| | - J. L. Frederiksen
- Department of Neurology; Glostrup Esbjerg, Sonderborg, and Vejle, and University of Copenhagen; Copenhagen Denmark
| | - E. Stenager
- Department of Neurology; Esbjerg Hospital; Sonderborg Hospital; Vejle Hospital; Odense Denmark
| | - C. Pfleger
- Department of Neurology; Aalborg Hospital; Aalborg Denmark
| | - E. Garde
- Danish Research Centre for Magnetic Resonance; Centre for Functional and Diagnostic Imaging and Research; Hvidovre Hospital; University of Copenhagen; Copenhagen Denmark
| | - E. Kinnunen
- Department of Neurology; HUS Hyvinkään Hospital; Hyvinkää Finland
| | - K. Marhardt
- Merck Serono Global Medical Affairs; Merck GmbH; Vienna Austria
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Binzer S, Stenager E, Binzer M, Kyvik KO, Hillert J, Imrell K. Genetic analysis of the isolated Faroe Islands reveals SORCS3 as a potential multiple sclerosis risk gene. Mult Scler 2015; 22:733-40. [DOI: 10.1177/1352458515602338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/21/2015] [Indexed: 11/15/2022]
Abstract
Background: In search of the missing heritability in multiple sclerosis (MS), additional approaches adding to the genetic discoveries of large genome-wide association studies are warranted. Objective: The objective of this research paper is to search for rare genetic MS risk variants in the genetically homogenous population of the isolated Faroe Islands. Methods: Twenty-nine Faroese MS cases and 28 controls were genotyped with the HumanOmniExpressExome-chip. The individuals make up 1596 pair-combinations in which we searched for identical-by-descent shared segments using the PLINK-program. Results: A segment spanning 63 SNPs with excess case-case-pair sharing was identified (0.00173 < p > 0.00212). A haplotype consisting of 42 of the 63 identified SNPs which spanned the entire the Sortilin-related vacuolar protein sorting 10 domain containing receptor 3 ( SORCS3) gene had a carrier frequency of 0.34 in cases but was not present in any controls ( p = 0.0008). Conclusion: This study revealed an oversharing in case-case-pairs of a segment spanning 63 SNPs and the entire SORCS3. While not previously associated with MS, SORCS3 appears to be important in neuronal plasticity through its binding of neurotrophin factors and involvement in glutamate homeostasis. Although additional work is needed to scrutinise the genetic effect of the SORCS3-covering haplotype, this study suggests that SORCS3 may also be important in MS pathogenesis.
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Affiliation(s)
- S Binzer
- Institute of Regional Health Research, University of Southern Denmark, Denmark/Hospital of Southern Jutland, Denmark/Odense Patient data Explorative Network (OPEN), University of Southern Denmark, Denmark/ Torshavn National Hospital, Faroe Islands
| | - E Stenager
- Institute of Regional Health Research, University of Southern Denmark, Denmark/Hospital of Southern Jutland, Denmark/ MS Clinic of Southern Jutland (Sønderborg, Esbjerg, Vejle), Department of Neurology, Denmark
| | - M Binzer
- Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - KO Kyvik
- Department of Clinical Research, University of Southern Denmark, Denmark/Odense Patient data Explorative Network (OPEN), University of Southern Denmark, Denmark
| | - J Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - K Imrell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Kjølhede T, Dalgas U, Gade AB, Bjerre M, Stenager E, Petersen T, Vissing K. Acute and chronic cytokine responses to resistance exercise and training in people with multiple sclerosis. Scand J Med Sci Sports 2015; 26:824-34. [DOI: 10.1111/sms.12504] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 12/20/2022]
Affiliation(s)
- T. Kjølhede
- Section of Sport Science; Department of Public Health; Aarhus University; Aarhus Denmark
| | - U. Dalgas
- Section of Sport Science; Department of Public Health; Aarhus University; Aarhus Denmark
| | - A. B. Gade
- Section of Sport Science; Department of Public Health; Aarhus University; Aarhus Denmark
| | - M. Bjerre
- The Medical Research Laboratory; Department of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - E. Stenager
- Institute of Regional Health Research; University of Southern Denmark; Odense Denmark
- The Multiple Sclerosis Clinic of Southern Jutland (Sønderborg, Vejle, Esbjerg); Department of Neurology; Sygehus Sønderjylland; Sønderborg Denmark
| | - T. Petersen
- The Multiple Sclerosis Clinic; Department of Neurology; Aarhus University Hospital; Aarhus Denmark
| | - K. Vissing
- Section of Sport Science; Department of Public Health; Aarhus University; Aarhus Denmark
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24
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Binzer S, Imrell K, Binzer M, Kyvik KO, Hillert J, Stenager E. High inbreeding in the Faroe Islands does not appear to constitute a risk factor for multiple sclerosis. Mult Scler 2014; 21:996-1002. [DOI: 10.1177/1352458514557305] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/06/2014] [Indexed: 11/16/2022]
Abstract
Background: Large population-based genome-wide association studies have identified several multiple sclerosis (MS) genetic risk variants, but the existing missing heritability warrants different strategies. Isolated populations offer an alternative way of searching for rare genetic variants and evaluating the possible role of consanguinity in the development of MS. Studies of consanguinity and MS risk have yielded conflicting results. Objectives: In this study we investigated the role of consanguinity on MS risk in the relatively isolated Faroe Islands, which have a presumed high level of inbreeding. Methods: A total of 29 cases and 28 matched controls were genotyped and assessed for inbreeding coefficients, number of runs of homozygosity (ROH) at different lengths and observed number of homozygotes as measures of relatedness. Parametric and non-parametric statistical models were applied. Results: Both cases and controls exhibited considerable relatedness demonstrated by very high inbreeding coefficients, large number of observed homozygotes and many long ROH. However, apart from the number of ROH ≥ 2.5 mega base pairs, no significant differences between the two groups were observed. Conclusions: Overall, no significant difference between cases and controls were found, indicating that consanguinity in itself does not appear to be an important risk factor for MS in the population of the Faroe Islands.
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Affiliation(s)
- S Binzer
- Institute of Regional Health Services Research, University of Southern Denmark, Denmark/MS Clinic of Southern Jutland (Sønderborg, Esbjerg, Vejle), Department of Neurology, Denmark/Torshavn National Hospital, Torshavn, Faroe Islands Odense Patient data explorative network (OPEN)
| | - K Imrell
- Karolinska Institute, Clinical Neuroscience, Division of Neurology, Department of Clinical Neuroscience, Sweden
| | - M Binzer
- Institute of Regional Health Services Research, University of Southern Denmark, Denmark
| | - K. O Kyvik
- Institute of Regional Health Services Research, University of Southern Denmark, Denmark/Odense Patient data Explorative Network (OPEN), Odense University Hospital, Denmark
| | - J Hillert
- Karolinska Institute, Clinical Neuroscience, Division of Neurology, Department of Clinical Neuroscience, Sweden
| | - E Stenager
- Institute of Regional Health Services Research, University of Southern Denmark, Denmark/MS Clinic of Southern Jutland (Sønderborg, Esbjerg, Vejle), Department of Neurology, Denmark
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Dalgas U, Stenager E, Sloth M, Stenager E. The effect of exercise on depressive symptoms in multiple sclerosis based on a meta-analysis and critical review of the literature. Eur J Neurol 2014; 22:443-e34. [DOI: 10.1111/ene.12576] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 08/25/2014] [Indexed: 01/27/2023]
Affiliation(s)
- U. Dalgas
- Section of Sport Science; Department of Public Health; Aarhus University; Aarhus Denmark
| | - E. Stenager
- MS Clinic of Southern Jutland (Sønderborg, Esbjerg, Vejle); Department of Neurology; Soenderborg Hospital; Soenderborg Denmark
- Institute of Regional Health Research; University of Southern Denmark; Odense Denmark
| | - M. Sloth
- Section of Sport Science; Department of Public Health; Aarhus University; Aarhus Denmark
| | - E. Stenager
- Institute of Regional Health Research; University of Southern Denmark; Odense Denmark
- Focused Research Group in Psychiatry; Abenra Denmark
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Jensen H, Ravnborg M, Mamoei S, Dalgas U, Stenager E. Changes in cognition, arm function and lower body function after slow-release Fampridine treatment. Mult Scler 2014; 20:1872-80. [PMID: 24852920 DOI: 10.1177/1352458514533844] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to evaluate the effect of slow-release (SR) Fampridine on multiple outcome measures reflecting different domains, and to compare the responsiveness of the Six Spot Step Test (SSST) and the Timed 25 Foot Walk (T25FW). METHODS For this study 108 participants were included. On day 0 they were tested with the T25FW, the SSST, the 9-Hole Peg Test (9-HPT), the 5 Times Sit-To-Stand test (5-STS) and the Symbol Digit Modalities Test (SDMT). Four weeks of treatment with SR Fampridine 10 mg BID was commenced. Participants were tested again after 26-28 days of treatment. RESULTS Mean changes observed were: SSST -3.4±6.4 s (p<0.001), T25FW -1.2±3.7 s (p<0.001), 9-HPT -1.2±6.0 s (p<0.001), 5- STS -3.4±7.2 s (p<0.001) and SDMT 1.4±4.8 a.u. (p=0.003). Change on the SSST differed significantly from T25FW (SSST 17.0±19.6% vs. T25FW 11.2±17.1%, p=0.0013). Some 48.6% were found to have a meaningful change on the SSST compared with 25.7% on the T25FW. The response to treatment with SR Fampridine did not correlate with age, sex, Expanded Disability Status Scale and disease duration. CONCLUSION SR Fampridine treatment has significant effects on different domains including upper and lower body and cognition. Furthermore, the SSST is more responsive to the effect of SR Fampridine than is the T25FW. ClinicalTrials.gov identifier: NCT01656148.
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Affiliation(s)
- Hb Jensen
- Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, 5000 Odense C, Denmark; and MS-clinic of Southern Jutland (Sønderborg, Vejle, Esbjerg), Sønderborg Hospital, Denmark
| | | | - S Mamoei
- MS-clinic of Southern Jutland (Sønderborg, Vejle, Esbjerg), Sønderborg Hospital, Denmark
| | - U Dalgas
- Section of Sport Science, Aarhus University, Denmark
| | - E Stenager
- Institute of Regional Health Research, University of Southern Denmark, Denmark/MS-clinic of Southern Jutland (Sønderborg, Vejle, Esbjerg), Sønderborg Hospital, Denmark
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Skjerbæk AG, Næsby M, Lützen K, Møller AB, Jensen E, Lamers I, Stenager E, Dalgas U. Endurance training is feasible in severely disabled patients with progressive multiple sclerosis. Mult Scler 2013; 20:627-30. [PMID: 24057428 DOI: 10.1177/1352458513505351] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study tested whether upper-body endurance training (ET) is feasible and can be performed at sufficient intensity to induce cardiovascular adaptations in severely disabled patients with progressive multiple sclerosis (MS). Eleven progressive MS patients (6.5 ≤ EDSS ≤ 8.0) scheduled for a four-week inpatient rehabilitation program were randomized to a control group (CON, n = 5) that received standard individualized MS rehabilitation or an intervention group (EXE, n = 6) that in addition received 10 sessions of predominantly upper-body ET. One patient dropped out of the EXE group (drop-out rate: 1/6~17%) and no adverse events were recorded. The EXE group completed on average 9.3±0.8 sessions (~96.0±5%). During the ET sessions an average heart rate of 93.9±9.3beats*min(-1) were sustained corresponding to 91.6±6.8% of the maximal pre-intervention heart rate. In the EXE group a trend toward a time*group interaction was seen for VO2peak (p = 0.06). ET is feasible in severely disabled patients with progressive MS and it can probably be performed at sufficient intensity to induce cardiovascular adaptations.
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Nielsen NM, Pasternak B, Stenager E, Koch-Henriksen N, Frisch M. Multiple sclerosis and risk of Parkinson's disease: a Danish nationwide cohort study. Eur J Neurol 2013; 21:107-11. [PMID: 24053187 DOI: 10.1111/ene.12255] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 07/26/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Case reports have observed a co-occurrence of multiple sclerosis (MS) and Parkinson's disease (PD) and it has been hypothesized that MS lesions could affect dopaminergic pathways causing parkinsonism. Our aim was to examine the association between MS and PD in a historically prospective cohort study using Danish nationwide register data. METHODS Multiple sclerosis patients identified in the Multiple Sclerosis Registry were followed for PD from 1977 to 2011 in the National Patient Register. As measures of relative risk, ratios of observed to expected incidence rates of first hospitalization for PD amongst persons with MS were used, i.e. standardized incidence ratios (SIRs) with 95% confidence intervals (CIs). RESULTS Amongst 15,557 MS patients 26 cases of PD were observed versus 26.51 expected, reflecting no overall increased risk of PD (SIR 0.98, 95% CI 0.67-1.44). Similar estimates were seen for female (SIR 0.99, 95% CI 0.58-1.67) and male MS patients (SIR 0.97, 95% CI 0.55-1.72). Likewise, no increased risk of PD amongst MS patients was observed in a robustness analysis backdating the date of diagnosis of PD by 5 years to account for the time lag between disease onset and first hospital contact with PD (SIR 0.57, 95% CI 0.32-1.00). CONCLUSION Our data do not suggest an increased risk of PD amongst patients with MS.
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Affiliation(s)
- N M Nielsen
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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Koch-Henriksen N, Stenager E, Laursen B. The use of epidemiological multiple sclerosis registers in research: the Danish MS Registry. Acta Neurol Scand 2013:7-12. [PMID: 23278650 DOI: 10.1111/ane.12022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The claim of detection of several environmental risk factors for multiple sclerosis (MS), some of them new, makes the research of population-based MS registers for critical review or confirmation of alleged associations more relevant than ever before. AIMS To present examples of the use and important contributions from the Danish MS Registry (DMSR) over decades. METHODS The DMSR has through more than six decades registered virtually all patients with MS in Denmark, using multiple sources of notification and has been used for descriptive epidemiology, follow-up studies, studies of comorbidity and 'historical prospective' studies of proposed risk factors for MS. RESULTS Based on research from DMSR, we have found that female incidence of multiple sclerosis in Denmark has increased considerably; that patients with MS loose their working ability and their spouses/partners at a much higher rate than the background population; that patients with MS have a considerable excess mortality which seem to have decreased over several centuries decades - not centuries, also before the era of disease modifying treatment; that fewer patients with MS than expected from the population get diagnosed with or die from cancer; that infectious mononucleosis increases the risk of MS; that head trauma and a number of occupational exposures, for example, nurses, utility workers, exposure to solvents do not carry an enhanced risk of MS. CONCLUSION The DMSR has, as an example of long-lasting population-based registers, proven to be an effective tool for studying MS epidemiology. In future, the need for this kind of registers will continue, as biology or immunology cannot stand alone.
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Affiliation(s)
| | | | - B. Laursen
- National Institute for Institute of Regional Health Research; University of Southern Denmark Public Health; Copenhagen; Denmark
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Bazelier MT, van S, Bentzen J, Vestergaard P, Uitdehaag BMJ, Leufkens HGM, Stenager E, de V. Multiple sclerosis and fracture risk: traditional meta-analysis versus mega-analysis of individual patient data. ACTA ACUST UNITED AC 2013. [DOI: 10.13172/2053-079x-1-1-692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Rossen C, Buus N, Stenager E. 468 – A qualitative study of mentally ill iraqi refugees’ relatives’ experiences of their caring role and of receiving assistance from the community mental health services. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)75793-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Norgaard M, Nielsen RB, Jacobsen JB, Gradus JL, Stenager E, Koch-Henriksen N, Lash TL, Sorensen HT. The Authors Reply. Am J Epidemiol 2012. [DOI: 10.1093/aje/kwr443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mason K, Thygesen LC, Stenager E, Brønnum-Hansen H, Koch-Henriksen N. Evaluating the use and limitations of the Danish National Patient Register in register-based research using an example of multiple sclerosis. Acta Neurol Scand 2012; 125:213-7. [PMID: 21699500 DOI: 10.1111/j.1600-0404.2011.01558.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Danish National Patient Register, Landspatientregistret (LPR), is a register of all hospital discharges and outpatient treatments in Denmark. AIMS It is increasingly used in research so it is important to understand to what extent this can be used as an accurate source of information. Virtually all patients in Denmark with multiple sclerosis (MS) are reported to the Combined MS Registry (DMSR), so this was used as the standard which the LPR was compared against. METHODS All residents of Denmark are assigned a unique Civil Register (CPR) number; this was used to compare data between registers. The LPR completeness was estimated by the proportion of cases from the DMSR that could be retrieved from the LPR. The LPR validity was estimated by the proportion of cases, listed in the LPR and DMSR, in whom the MS diagnosis could be confirmed as definite/probable/possible by the DMSR. RESULTS We found that 86.9% of those who were DMSR listed with an approved MS diagnosis were also listed in the LPR with a MS diagnosis. The diagnosis was valid in 96.3% of patients listed in the LPR when compared against the DMSR. CONCLUSIONS The low completeness reduces the usefulness of the LPR in epidemiological MS research, in particular incidence studies. The study also found that the completeness of the LPR could be increased to 92.8% by including LPR records from other departments in addition, but this reduced the validity of the LPR to 95.1%. However, these results cannot uncritically be applied to registration of other diseases in the LPR.
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Affiliation(s)
- K Mason
- The University of Manchester, UK
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Asgari N, Nielsen C, Stenager E, Kyvik KO, Lillevang ST. HLA, PTPN22 and PD-1 associations as markers of autoimmunity in neuromyelitis optica. Mult Scler 2011; 18:23-30. [DOI: 10.1177/1352458511417480] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Neuromyelitis optica (NMO) is a disease with autoimmune characteristics. A genetic autoimmune dependency for NMO has not been clarified in detail. Objective: To investigate immunogenetic aspects of NMO. Methods: Forty-one patients with NMO and 42 patients with multiple sclerosis (MS) were diagnosed in a population-based Caucasian cohort. HLA DQA1, DQB1, and DRB1 alleles were determined. Polymorphisms in programmed death 1 (PD-1) PD-1.3 G/A and protein tyrosine phosphatase non-receptor 22 (PTPN22) 1858 C/T were genotyped. Results: In the NMO group 15% had other autoimmune disorders and 39% had family occurrence of autoimmunity, comparable to MS. A higher frequency of a family history (17%) of NMO and MS was found in the NMO group ( p < 0.026). The frequency of HLA-DQB1*0402 allele was increased in NMO ( p after Bonferroni correction, cp < 0.035) and the HLA-DRB1*15 and DQB1*06 alleles were increased in MS ( cp < 0.0027, cp < 0.01), compared to controls. No associations of the PTPN22 1858 T were detected. The PD-1.3A allele was increased both in NMO ( p < 0.0023) and in MS patients ( p < 0.028) compared to controls. Conclusion: Patients with NMO had frequent co-existence of autoimmunity and family occurrence of NMO and MS. The PD-1.3A allele was associated with NMO. The data suggest genetic autoimmune dependency of NMO.
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Affiliation(s)
- N Asgari
- The Multiple Sclerosis Clinic of Southern Jutland, (Sonderborg, Vejle, Esbjerg), Denmark
- Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark
| | - C Nielsen
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - E Stenager
- The Multiple Sclerosis Clinic of Southern Jutland, (Sonderborg, Vejle, Esbjerg), Denmark
- Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark
| | - KO Kyvik
- Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark
| | - ST Lillevang
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
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Abstract
BACKGROUND Epidemiologic studies have suggested different prevalence of neuromyelitis optica (NMO) in different ethnic groups. However, data on the incidence and prevalence of NMO in Caucasians are scarce. OBJECTIVE To estimate the incidence and prevalence of NMO in a predominantly Caucasian population based on the Wingerchuk 2006 criteria. METHODS The study was a population-based retrospective case series with longitudinal follow-up. Patients with multiple sclerosis (MS), optic neuritis (ON), acute transverse myelitis (TM), and NMO from the 4 neurology and 3 ophthalmology departments in the Region of Southern Denmark having been diagnosed between 1998 and 2008 were investigated. Patients were included based on 1) episodes of ON or TM and 2) an initial brain MRI not diagnostic for MS. An immunofluorescence assay was used to determine aquaporin-4 (AQP-4) antibodies. RESULTS A total of 477 patients with MS, TM, or ON were evaluated: 163 fulfilled the inclusion criteria, 42 (26%) qualified for the diagnosis of NMO, 26 (62.0%) of these were AQP4 antibody positive. All except one were Caucasian, the female:male ratio was 2.8:1, and mean age at onset was 35.6 years (range 15-64 years). The clinical presentation was heterogeneous including TM, longitudinally extensive TM, ON, and brainstem syndromes. The yearly incidence rate of NMO in the population was estimated to be 0.4 per 10(5) person-years (95% confidence interval [CI] 0.30-0.54) and the prevalence was 4.4 per 10(5) (95% CI 3.1-5.7). CONCLUSIONS Despite being a rare disease, NMO is more common in a Caucasian population than earlier believed.
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Affiliation(s)
- N Asgari
- Institute of Regional Health Services Research, University of Southern Denmark, Winsloews Vej 9B, DK-5000 Odense C, Denmark
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Asgari N, Owens T, Frøkiaer J, Stenager E, Lillevang ST, Kyvik KO. Neuromyelitis optica (NMO)--an autoimmune disease of the central nervous system (CNS). Acta Neurol Scand 2011; 123:369-84. [PMID: 20880299 DOI: 10.1111/j.1600-0404.2010.01416.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In the past 10 years, neuromyelitis optica (NMO) has evolved from Devic's categorical clinical description into a broader disease spectrum. Serum IgG antibodies have been identified in NMO patients with the water channel aquaporin-4 (AQP4) as their main target antigen. AQP4 antibodies/NMO-IgG have been shown to be a highly specific and moderately sensitive serum biomarker for NMO. The immunopathology of NMO lesions supports that anti-AQP4 antibodies/NMO-IgG are involved in the pathogenesis of NMO. In vitro studies have demonstrated that human NMO-IgG induce necrosis and impair glutamate transport in astrocytes. Certain ethnic groups, notably of Asian and African origin, seem to be more susceptible to NMO than others. The genetic background for these putative differences is not known, a weak human leucocyte antigen association has been identified. AQP4 gene variants could represent a genetic susceptibility factor for different clinical phenotypes within the NMO spectrum. Experimental models have been described including a double-transgenic myelin-specific B- and T-cell mouse. NMO-like disease has been induced with passive transfer of human anti-AQP4 antibodies to the plasma of mice with pre-established experimental autoimmune encephalomyelitis or by intrathecal administration to naive mice. NMO may be characterized as a channelopathy of the central nervous system with autoimmune characteristics.
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Affiliation(s)
- N Asgari
- Multiple Sclerosis Clinic of Southern Jutland, Sønderborg, Vejle, Esbjerg hospitals, and Institute of Molecular Medicine, University of Southern Denmark, Odense C, Denmark.
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Abstract
Background: Fatigue occurs in the majority of patients with multiple sclerosis (MS) and therapeutic possibilities are few. Exercise therapy is a therapeutic option but no studies have systematically reviewed the existing literature evaluating the effect of exercise therapy on MS fatigue. Objective: To determine the effect of exercise therapy on MS fatigue by systematically reviewing the literature. Methods: A comprehensive literature search (PubMed, SweMed +, Embase, Cochrane, CINAHL, PEDro, Sport Discuss and Bibliotek.dk) was conducted. Results: Studies evaluating the effect of exercise therapy on MS fatigue show heterogeneous results and only few studies have evaluated MS fatigue as the primary outcome. The heterogeneous findings seem to be related to the selected study population, which in many studies are non-fatigued. Most studies that have included fatigued patients with MS show positive effects, although it is not clear whether any exercise modalities are superior to others because there are no comparative studies regarding different exercise interventions. Conclusion: Exercise therapy has the potential to induce a positive effect on MS fatigue, but findings are heterogeneous probably because many studies have applied non-fatigued study populations. Furthermore, only few studies have evaluated MS fatigue as the primary outcome measure, emphasizing the need for future studies within this field.
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Affiliation(s)
- AK Andreasen
- Department of Neurology, Rigshospitalet, Denmark
| | - E Stenager
- MS-clinic of Southern Jutland (Soenderborg, Vejle, Esbjerg). Department of Neurology, Soenderborg Hospital, Denmark
- Institute of Regional Health Services, University of Southern Denmark, Denmark
| | - U Dalgas
- Department of Sport Science, Aarhus University, Denmark
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Christiansen E, Stenager E. Risk for attempted suicide in children and youths after contact with somatic hospitals: a Danish register based nested case-control study. J Epidemiol Community Health 2010; 66:247-53. [PMID: 20947873 DOI: 10.1136/jech.2009.103887] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND A range of studies have found an association between some somatic diseases and increased risk of suicide and attempted suicide. These studies are mostly analyses of adult populations and illnesses related to adulthood. OBJECTIVES To study the risk of attempted suicide in children and youths with a somatic diagnosis, and to assess a possible association from a somatic perspective. METHODS From a cohort of 403 431 individuals (born 1983-89), 3465 children and youths who had attempted suicide were identified. Each case was matched with 20 population controls. 72 765 children and youths constituted the case-control population. All data were obtained from national population registers and analysed in a nested case-control design. RESULTS Contact of children and youths with a somatic hospital is correlated with increased risk of attempted suicide; the risk peaks in the time immediately after contact. Risk factors were treatment for injury caused by violence, epilepsy, asthma and malformation for males; and spontaneous and medical abortions, treatment for injury caused by violence, epilepsy, asthma, insulin dependent diabetes mellitus and malformation for females. Not all the mentioned diagnoses were significant in the adjusted model. CONCLUSIONS Based on the results of the study a strategy to minimise the risk of attempted suicide among children and youths must be implemented. The strategy should mainly focus on children at high risk-that is, children from families with low socioeconomic status, and children with a psychiatric history, a history of previous suicide attempts and with an unstable somatic disease subsequently causing many admissions.
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Affiliation(s)
- E Christiansen
- Clinic of Suicide Prevention and Treatment for Children and Adolescents, Department of Child and Adolescent Psychiatry, Odense University Hospital, Bjergegade 15, 1st floor, DK-5000 Odense C, Denmark.
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Dalgas U, Stenager E, Jakobsen J, Petersen T, Overgaard K, Ingemann-Hansen T. Muscle fiber size increases following resistance training in multiple sclerosis. Mult Scler 2010; 16:1367-76. [DOI: 10.1177/1352458510377222] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To test the hypothesis that lower body progressive resistance training (PRT) leads to an increase of the muscle fiber cross-sectional area (CSA) and a shift in the proportion of fiber types in patients with multiple sclerosis (MS). Methods: The present study was a two-arm, randomized controlled trial (RCT). Thirty-eight MS patients (Expanded Disability Status Scale (EDSS) 3—5.5) were randomized to a PRT group (Exercise, n = 19) or a control group (Control, n = 19). The Exercise group performed a biweekly 12-week lower body PRT program [five exercises progressing from 15RM (Repetition Maximum) towards 8RM], whereas the Control group maintained their usual daily activity level during the trial period. Muscle biopsies from vastus lateralis were taken before (pre) and after the trial (post). Thigh volume (TV) was estimated from anthropometric measurements. Isokinetic muscle strength of the knee extensors (KE) and flexors (KF) were evaluated at slow (90°/s) and fast (180°/s) angular velocities. Results: In the Exercise group the mean CSA of all muscle fibers (7.9 ± 15.4% vs. -3.5 ± 9.0%, p = 0.03) and of type II muscle fibers (14.0 ± 19.4% vs. -2.6 ± 15.5%, p = 0.02) increased in comparison with the Control group. No changes occurred in the proportion of fiber types in the Exercise group. Neither was there any change in total TV. Isokinetic strength at KE180, KF90 and KF180 improved significantly after PRT when compared with the control group (10.2—21.3%, p ≤ 0.02). Conclusions: We conclude that progressive resistance training induces a compensatory increase of muscle fiber size in patients with the central nervous system disorder, multiple sclerosis.
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Affiliation(s)
- U Dalgas
- Department of Sport Science, University of Aarhus, Denmark, Department of Neurology, Soenderborg Hospital, Denmark, Department of Neurology, Aarhus University Hospital, Denmark,
| | - E Stenager
- Department of Neurology, Soenderborg Hospital, Denmark
| | - J Jakobsen
- Department of Neurology, Aarhus University Hospital, Denmark
| | - T Petersen
- Department of Neurology, Aarhus University Hospital, Denmark
| | - K Overgaard
- Department of Sport Science, University of Aarhus, Denmark
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Dalgas U, Kant M, Stenager E. Krafttraining bei schubförmig verlaufender Multipler Sklerose. Akt Neurol 2010. [DOI: 10.1055/s-0030-1248526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dalgas U, Stenager E, Jakobsen J, Petersen T, Hansen HJ, Knudsen C, Overgaard K, Ingemann-Hansen T. Fatigue, mood and quality of life improve in MS patients after progressive resistance training. Mult Scler 2010; 16:480-90. [DOI: 10.1177/1352458509360040] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fatigue occurs in the majority of multiple sclerosis patients and therapeutic possibilities are few. Fatigue, mood and quality of life were studied in patients with multiple sclerosis following progressive resistance training leading to improvement of muscular strength and functional capacity. Fatigue (Fatigue Severity Scale, FSS), mood (Major Depression Inventory, MDI) and quality of life (physical and mental component scores, PCS and MCS, of SF36) were scored at start, end and follow-up of a randomized controlled clinical trial of 12 weeks of progressive resistance training in moderately disabled (Expanded Disability Status Scale, EDSS: 3—5.5) multiple sclerosis patients including a Control group ( n = 15) and an Exercise group ( n = 16). Fatigue (FSS > 4) was present in all patients. Scores of FSS, MDI, PCS—SF36 and MCS—SF36 were comparable at start of study in the two groups. Fatigue improved during exercise by —0.6 (95% confidence interval (CI) —1.4 to 0.4) a.u. vs. 0.1 (95% CI —0.4 to 0.6) a.u. in controls ( p = 0.04), mood improved by —2.4 (95% CI —4.1 to 0.7) a.u. vs. 1.1 (—1.2 to 3.4) a.u. in controls ( p = 0.01) and quality of life (PCS—SF36) improved by 3.5 (95% CI 1.4—5.7) a.u. vs. —1.0 (95% CI —3.4—1.4) a.u. in controls ( p = 0.01). The beneficial effect of progressive resistance training on all scores was maintained at follow-up after further 12 weeks. Fatigue, mood and quality of life all improved following progressive resistance training, the beneficial effect being maintained for at least 12 weeks after end of intervention.
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Affiliation(s)
- U. Dalgas
- Department of Sport Science, University of Aarhus, Denmark, , Department of Neurology, Soenderborg Hospital, Denmark, Department of Neurology, Aarhus University Hospital, Denmark
| | - E. Stenager
- Department of Neurology, Soenderborg Hospital, Denmark
| | - J. Jakobsen
- Department of Neurology, Aarhus University Hospital, Denmark
| | - T. Petersen
- Department of Neurology, Aarhus University Hospital, Denmark
| | - HJ Hansen
- Department of Neurology, Aarhus University Hospital, Denmark
| | - C. Knudsen
- Department of Sport Science, University of Aarhus, Denmark
| | - K. Overgaard
- Department of Sport Science, University of Aarhus, Denmark
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Binzer S, Imrell K, Binzer M, Vang S, Rogvi-Hansen B, Hillert J, Stenager E. Multiple sclerosis in a family on the Faroe Islands. Acta Neurol Scand 2010. [DOI: 10.1111/j.1600-0404.2010.01358.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
BACKGROUND John Kurtzke has proposed that multiple sclerosis (MS) on the Faroe Islands occurred as a result of the spread of a transmittable agent brought to the country during World War II. AIM Kurtzke's theory has been opposed earlier and in this study, we present a family from the Faroe Islands containing a total of 14 family members with MS which show further inconsistencies with the theory. The present study is to our knowledge, the first description of familial incidences of MS on the Faroe Islands. METHODS Medical histories were gathered from 12 family members and 6 of the 8 living MS cases were human leukocyte antigen (HLA)-typed. RESULTS Seven family members had primary progressive MS (PPMS), while five had relapsing remitting MS. The HLA-DR15 allele was carried by the three cases with the most aggressive form of MS and they shared a common haplotypes. The HLA types carried by the remaining cases varied. CONCLUSION This research questions Kurtzke's theory as three of the cases do not conform to the epidemic cohorts described. Furthermore, there appears to be a higher than usual prevalence of PPMS. The high degree of heterogeneity of the HLA types carried indicates that HLA alleles do not independently explain the risk of developing MS.
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Affiliation(s)
- S Binzer
- Brighton and Sussex Medical School, Brighton, United Kingdom.
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Dalgas U, Stenager E, Jakobsen J, Petersen T, Hansen HJ, Knudsen C, Overgaard K, Ingemann-Hansen T. Resistance training improves muscle strength and functional capacity in multiple sclerosis. Neurology 2009; 73:1478-84. [DOI: 10.1212/wnl.0b013e3181bf98b4] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Dalgas U, Ingemann-Hansen T, Stenager E. Physical Exercise and MS Recommendations. Int MS J 2009; 16:5-11. [PMID: 19413920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 09/05/2008] [Indexed: 05/27/2023]
Abstract
The use of physical exercise programmes in the rehabilitation of patients with multiple sclerosis (MS) has been a controversial issue for many years. During the last decade, however, evidence from a number of studies has suggested that exercise is a safe and efficient way to induce improvements in a number of physiological functions, which ultimately can lead to functional improvements that have a positive effect on a patients daily life. The purpose of this review is, based on the existing research, to provide clinicians with some easily administrable recommendations for the application of exercise in the rehabilitation strategy of MS.
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Affiliation(s)
- U Dalgas
- Department of Sport Science, University, of Aarhus, Dalgas Avenue 4, 8000 Aarhus C, Denmark. Phone: +45 27 11 91 21; Fax: +45 89 42 48 97 E-mail:
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Pfleger CCH, Koch-Henriksen N, Stenager E, Flachs EM, Johansen C. Head injury is not a risk factor for multiple sclerosis: a prospective cohort study. Mult Scler 2009; 15:294-8. [DOI: 10.1177/1352458508099475] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The idea of physical trauma being involved in the causation of multiple sclerosis (MS) had been discussed since the earliest description of the illness. Despite the ongoing debate, the proposed association between physical and especially head trauma and MS failed to be proved or to be refuted conclusively. Objective To determine whether head trauma is associated with an increased risk of developing MS. Method A cohort of 150,868 subjects, 95,111 men, and 55,757 women registered in the National Danish Patient Registry with hospital admission for cerebral concussion, contusion, or skull fracture between 1977 and 1992, aged under 55, was selected. This trauma cohort was linked with the Danish MS Registry and followed up to the end of 1999 to retrieve subjects who had onset of MS after the year of the head trauma. We calculated the expected number of subjects, who, under a null-hypothesis, would subsequently develop MS, by using population age-, year-, and sex-specific MS-incidence densities from the Danish MS Registry. Results For men and women combined, the observed to expected number of MS cases (possible cases included) with onset after the head injury was 182/193.6 (standardized incidence ratio [SIR], 0.94; 95% CI, 0.81–1.09) and for possible MS excluded, 171/164.7 (SIR, 1.04; 95% CI, 0.89–1.21). In an analysis of a sub-cohort of 16,425 subjects with severe trauma (contusion, traumatic cerebral hemorrhage, and base or skull fracture), the observed to expected numbers, including possible MS, were 15/15.3 (SIR, 0.98; 95% CI, 0.55–1.62) and with possible MS excluded, 13/12.9 (SIR, 1.01; 95% CI, 0.53–1.73). As for the total group and for any of the subgroups and for men and women separately, none of the SIRs differed statistically significantly from unity. Neither were there any trends, which could be missed by type II errors. Conclusion Head injury of any severity does not affect the risk of acquiring MS later in life.
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Affiliation(s)
- CCH Pfleger
- Department of Neurology, Århus University Hospital, Aalborg, Denmark
| | - N Koch-Henriksen
- Department of Neurology, Århus University Hospital, Aalborg, Denmark; The Danish Multiple Sclerosis Registry, Copenhagen, Denmark
| | - E Stenager
- The Danish Multiple Sclerosis Registry, Copenhagen, Denmark; Department of Neurology, Sønderborg Hospital, Region of Southern Denmark, Sønderborg, Denmark
| | - EM Flachs
- The Danish Multiple Sclerosis Registry, Copenhagen, Denmark; The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - C Johansen
- The Danish Institute of Cancer Epidemiology, The Danish Cancer Society, Copenhagen, Denmark
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Hesse D, Frederiksen JL, Koch-Henriksen N, Schreiber K, Stenager E, Heltberg A, Ravnborg M, Bendtzen K, Sellebjerg F, Sorensen PS. Methylprednisolone does not restore biological response in multiple sclerosis patients with neutralizing antibodies against interferon-β. Eur J Neurol 2009; 16:43-7. [DOI: 10.1111/j.1468-1331.2008.02336.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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48
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Dalgas U, Stenager E, Ingemann-Hansen T. Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance- and combined training. Mult Scler 2007; 14:35-53. [PMID: 17881393 DOI: 10.1177/1352458507079445] [Citation(s) in RCA: 279] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This review summarizes the existing knowledge regarding the effects of physical exercise in patients suffering from multiple sclerosis (MS). Furthermore, recommendations are given regarding exercise prescription for MS patients and for future study directions. Previously, MS patients were advised not to participate in physical exercise. During recent years, it has been increasingly acknowledged that exercise benefits MS patients. The requirement for exercise in MS patients is emphasized by their physiological profile, which probably reflects both the effects of the disease per se and the reversible effects of an inactive lifestyle. To date the effects of exercise have only been studied in moderately impaired MS patients with an EDSS score of less than 7. Evidence exists for recommending participation in endurance training at low to moderate intensity, as the existing literature demonstrates that MS patients can both tolerate and benefit from this training modality. Also, resistance training of moderate intensity seems to be well tolerated and to have beneficial effects on MS patients, but the methodological quality of the existing evidence is in general low and the number of studies is limited. Only two studies have evaluated the effects of combined resistance- and endurance training, making solid conclusions regarding this training modality impossible.
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Affiliation(s)
- U Dalgas
- Department of Sport Science, University of Aarhus, Aarhus N, Denmark.
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Brønnum-Hansen H, Stenager E, Hansen T, Koch-Henriksen H. Survival and mortality rates among Danes with MS. Int MS J 2006; 13:66-71. [PMID: 16635423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 01/18/2006] [Indexed: 05/08/2023]
Abstract
Long-term survival and trends in overall and cause-specific excess mortality among people with MS have been studied using the Danish Multiple Sclerosis Registry, which contains information about all Danish MS patients since the mid-20th Century. A total of 4254 deaths among approximately 10,000 people with MS, representing more than 200,000 person-years of observation, have been analysed. Overall, mortality was almost three times higher and life expectancy 10 years less among people with MS than for the general population. However, excess mortality has declined significantly since 1950.
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Koch-Henriksen N, Sørensen PS, Christensen T, Frederiksen J, Ravnborg M, Jensen K, Heltberg A, Kristensen O, Stenager E, Petersen T, Hansen T. A randomized study of two interferon- beta treatments in relapsing–remitting multiple sclerosis. Neurology 2006; 66:1056-60. [PMID: 16510769 DOI: 10.1212/01.wnl.0000204018.52311.ec] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To investigate whether the efficacy of interferon-beta (IFNβ) treatment of relapsing–remitting MS (RR-MS) was influenced by type, dose, and frequency of administration.Methods: From June 1996 through October 1997, the authors offered participation to all Danish RR-MS patients who met the following criteria: definite MS, at least two relapses within 2 years, age 18 to 55, and an Expanded Disability Status Scale (EDSS) score of ≤5.5. The study was multicenter, controlled, open-label, randomized, head-to-head comparing IFNβ-1a 22 μg once a week (n = 143) with IFNβ-1b 250 μg every other day (n = 158), both subcutaneously, for 24 months. Patients who declined randomization were offered treatment with IFNβ-1b 250 μg every other day (n = 120). The primary end-points were the annualized relapse rate, the time to first relapse, and neutralizing antibody formation. The secondary endpoint was time to sustained progressionResults: The annual relapse rates were virtually equal in the two arms of the randomized study (IFNβ-1a: 0.70; IFNβ-1b: 0.71); so were the time to first relapse and the time to sustained progression. In the nonrandomized patients (IFNβ-1b), the annual relapse rate was not significantly different, but the time to progression was shorter.Conclusion: In this study, 250 μg interferon-beta-1b administered every other day did not prove clinically superior to once-a-week administration of 22 μg interferon-beta-1a.
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Affiliation(s)
- N Koch-Henriksen
- Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen, Denmark.
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