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Heltveit-Olsen SR, Sundvall PD, Gunnarsson R, Snaebjörnsson Arnljots E, Kowalczyk A, Godycki-Cwirko M, Platteel TN, Koning HAM, Groen WG, Åhrén C, Grude N, Verheij TJM, Hertogh CMPM, Lindbaek M, Hoye S. Methenamine hippurate to prevent recurrent urinary tract infections in older women: protocol for a randomised, placebo-controlled trial (ImpresU). BMJ Open 2022; 12:e065217. [PMID: 36319057 PMCID: PMC10098264 DOI: 10.1136/bmjopen-2022-065217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/31/2023] Open
Abstract
INTRODUCTION Methenamine hippurate is a urinary antiseptic used as preventive treatment for recurrent urinary tract infections (UTIs) in some Scandinavian countries. However, the scientific evidence for the preventive effect and safety for longer-term use is limited. The aim of this study is to assess whether methenamine hippurate can reduce the incidence of UTIs in older women with recurrent UTIs. METHODS AND ANALYSIS The ImpresU consortium is a collaboration between Norway, Sweden, Poland and the Netherlands. The study is a randomised, controlled, triple-blind phase IV clinical trial. Women ≥70 years with recurrent UTIs are screened for eligibility in a general practice setting. We aim to include 400 women in total, with 100 recruited from each collaborating country. The participants are randomised to treatment with methenamine hippurate 1 g or placebo tablets two times per day for a treatment period of 6 months, followed by a drug-free follow-up period of 6 months. The primary outcome is number of antibiotic treatments for UTIs during the treatment period. The secondary outcomes include number of antibiotic treatments for UTIs during the follow-up period and self-reported symptom of severity and duration of UTI episodes. Differences in complications between the treatment groups are measured as safety outcomes. We also aim to investigate whether strain characteristics or phylogenetic subgroups of Escherichia coli present in the urine culture at inclusion have a modifying effect on the outcomes. ETHICS AND DISSEMINATION Ethical approvals are obtained in all participating countries. The results will be communicated in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04077580); EudraCT: 2018-002235-15.
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Affiliation(s)
- Silje Rebekka Heltveit-Olsen
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Pär-Daniel Sundvall
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Borås, Sweden
| | - Ronny Gunnarsson
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Borås, Sweden
| | - Egill Snaebjörnsson Arnljots
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Borås, Sweden
| | - Anna Kowalczyk
- Centre for Family and Community Medicine, Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland
| | - Maciek Godycki-Cwirko
- Centre for Family and Community Medicine, Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland
| | - Tamara N Platteel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hilde A M Koning
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wim G Groen
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands
| | - Christina Åhrén
- Institute of Biomedicine, Department of Infectious Diseases and Centrum for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
- Swedish Strategic Program against Antimicrobial Resistance (Strama), Region Västra Götaland, Gothenburg, Sweden
| | - Nils Grude
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Medical Microbiology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Theo J M Verheij
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands
| | - Morten Lindbaek
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sigurd Hoye
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Ramsey NF, Koning HAM, Welles P, Cahn W, van der Linden JA, Kahn RS. Excessive recruitment of neural systems subserving logical reasoning in schizophrenia. Brain 2002; 125:1793-807. [PMID: 12135970 DOI: 10.1093/brain/awf188] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [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: 11/13/2022] Open
Abstract
Schizophrenic patients generally perform poorly on tasks that address executive functions. According to several imaging studies, the dorsolateral prefrontal cortex is hypoactive in schizophrenic patients during these tasks. It is not, however, clear whether this finding is associated more with impaired performance than with the illness itself, as performance has not been taken into account. We examined brain activity associated with executive function in schizophrenia using an experimental fMRI design that reveals performance effects, enabling correction for performance differences between groups. As this approach has not been reported before, and because brain function can be affected by medication, the effect of antipsychotic medication was also investigated. A task was used that requires logical reasoning, alongside a closely matched control task. Performance was accounted for by including individual responses in fMRI image analyses, as well as in group-wise analysis. Effects of medication were addressed by comparing medication-naïve patients and patients on atypical antipsychotic medication with healthy controls in two separate experiments. Imaging data were analysed with a novel, performance-driven method, but also with a method that is similar to that used in earlier studies, which reported hypofrontality. A modest reduction in performance was found in both patient groups. Brain activity associated with logical reasoning was correlated positively with performance in all groups. In patients on medication, activity did not differ from that in controls after correcting for difference in performance. In contrast, performance-corrected activity was significantly elevated in medication-naïve patients. This study indicates that schizophrenia may be associated with excessive recruitment of brain systems during logical reasoning. Considering the fact that performance was reduced in the patients, we argue that the efficiency of neural communication may be affected by the illness. It appears that in patients on atypical antipsychotic medication, this neural inefficiency is normalized. The study shows that performance is an important factor in the interpretation of differences between schizophrenic patients and controls. The reported association between performance and brain activity is relevant to clinical imaging studies in general.
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Affiliation(s)
- N F Ramsey
- Functional Imaging Section, Department of Psychiatry, University Medical Center of Utrecht, Utrecht, The Netherlands
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