Substance Use Within Trials of Psychological Interventions for Psychosis: Sample Inclusion, Secondary Measures, and Intervention Effectiveness

INTRODUCTION

Current clinical guidelines recommend that patients with co-occurring psychosis and alcohol or substance use disorders (A/SUD) receive evidenced-based treatment for both disorders, including psychological intervention for psychosis. However, the efficacy of such treatments for individuals with co-occurring psychosis and A/SUD is unclear.

STUDY DESIGN

Randomized controlled trials (RCTs) of psychological interventions for psychosis were systematically reviewed, to investigate how alcohol and substance use has been accounted for across sample inclusion and secondary measures. Findings from trials including individuals with co-occurring alcohol or substance use issues were then narratively summarized using the Synthesis Without Meta-Analysis guidelines, to indicate the overall efficacy of psychological interventions for psychosis, for this comorbid population.

STUDY RESULTS

Across the 131 trials identified, 60.3% of trials excluded individuals with alcohol or substance use issues. Additionally, only 6.1% measured alcohol or substance use at baseline, while only 2.3% measured alcohol or substance use as a secondary outcome. Across trials explicitly including individuals with alcohol or substance use issues, insufficient evidence was available to conclude the efficacy of any individual psychological intervention. However, preliminary findings suggest that psychoeducation (PE) and metacognitive therapy (MCT) may be proposed for further investigation.

CONCLUSION

Overall, co-occurring alcohol and substance use issues have been largely neglected across the recent RCTs of psychological interventions for psychosis; highlighting the challenges of making treatment decisions for these individuals using the current evidence base.

Ten Years of Improving Glycemic Control in Pediatric Diabetes Care: Data From the Norwegian Childhood Diabetes Registry

OBJECTIVE

To evaluate, from 2013 to 2022, how HbA1c, the incidence of acute complications, and use of diabetes technology changed at the national level in Norway and how glycemic control was associated with use of diabetes technology, carbohydrate counting, or participation in a quality improvement project.

RESEARCH DESIGN AND METHODS

This longitudinal observational study was based on 27,214 annual registrations of 6,775 children from the Norwegian Childhood Diabetes Registry from 2013 to 2022. Individuals aged >18 years, those with diabetes other than type 1, and those without HbA1c measurements were excluded. The outcome measure was HbA1c. The predictor variables in the adjusted linear mixed-effects model were 1) the use of diabetes technology, 2) the use of carbohydrate counting for meal bolusing, and 3) whether the patient's diabetes team participated in a quality improvement project.

RESULTS

Mean HbA1c decreased from 8.2% (2013) to 7.2% (2021), and the proportion of youth reaching an HbA1c <7.0% increased from 13% (2013) to 43% (2022). Insulin pump use increased from 65% (2013) to 91% (2022). Continuous glucose monitoring (CGM) use increased from 34% (first recorded in 2016) to 97% (2022). Insulin pump, CGM, and carbohydrate counting were associated with lower HbA1c and higher achievement of glycemic targets. Girls had a higher mean HbA1c than boys. Mean HbA1c levels were lower in clinics that participated in a quality improvement project for the following 4 years after the project.

CONCLUSIONS

Diabetes technology, carbohydrate counting, and systematic quality improvement in pediatric departments led to improved glycemic control.

The Relationship Between Self-Reported Childhood Maltreatment and Mental Health in Substance Use Disorders: A 6-Year Retrospective Analysis

OBJECTIVE

This longitudinal cohort study aims to investigate the relationship between self-reported childhood maltreatment (CM) and the retrospective trajectory of substance use, mental health, and satisfaction with life in individuals with substance use disorders.

METHODS

One hundred eleven treatment-seeking individuals with substance use disorder were recruited from clinical settings and monitored prospectively for 6 years. The participants' substance use, mental health, and satisfaction with life were assessed using standardized measures. Cluster analysis divided the cohort into two groups-low CM and high CM-based on their scores on the Childhood Trauma Questionnaire Short Form at year 6. Mixed-effects linear models were fitted to assess the association between longitudinal scores on drug use, mental health, and satisfaction with life and CM group.

RESULTS

Most participants (92%) reported at least 1 CM. Out of all participants, 36% were categorized into the high-CM group, while 59% were categorized into the low-CM group. CM group was not associated with the amount of substance or alcohol use. CM group was significantly associated with the longitudinal course of mental health and life satisfaction.

CONCLUSIONS

This study underscores the association between self-reported CM and mental health and life satisfaction in patients with substance use disorder. Our results may imply an increased risk of adverse outcomes in patients with high levels of CM, while bearing in mind that both current and retrospective mental health and substance use problems can influence the accuracy of recalling CM.

Personality traits as predictors of recovery among patients with substance use disorder

INTRODUCTION

Substance use disorder (SUD) is often considered a chronic illness in which prolonged recovery, in terms of abstinence, is uncommon. Personality has been found to predict recovery, but not much is known about its long-term predictive ability as the majority of previous studies have had short follow-up periods (≥ one year). The current longitudinal cohort study therefore investigated whether personality traits predict short- (STR) as well as long-term recovery (LTR) in SUD patients.

METHODS

Treatment-seeking patients with SUD (n = 123) completed the NEO Personality Inventory - Revised. STR and LTR categories were defined as scoring <8 on the Alcohol Use Disorders Identification Test - C and <2 on the Drug Use Disorder Identification Test - C at the one-year and 6-8-year follow-up, respectively. Whether personality traits predicted outcome was investigated by two-tailed independent samples t-tests, α < 0.05. Additional analysis was conducted with latent growth curve model.

RESULTS

Neuroticism (inversely, p = .004, d = 0.55) and Extraversion (p = .04, d = 0.38) predicted STR (n = 114). Although not significant the effect size for Conscientiousness was above the cut-off for a practical significant effect (d = 0.31). No traits predicted LTR category. Still, the effect sizes for LTR regarding Neuroticism (d = 0.36), Extraversion (d = 0.21) and Conscientiousness (d = 0.27) indicated that these traits have relevance for LTR. The latent growth curve model indicated that these traits predicted the short-term use of drugs and long-term use of alcohol in this cohort dominated by patients suffering from severe poly-SUD.

CONCLUSION

Personality traits predict recovery. The effect sizes indicate that more studies with larger samples on personality traits and LTR are required to understand their possible influences on the recovery process.

Exercise training and high-sensitivity cardiac troponin-I in patients with heart failure with reduced ejection fraction

AIMS

The aims of this sub-study of the SMARTEX trial were (1) to evaluate the effects of a 12-week exercise training programme on serum levels of high sensitivity cardiac troponin I (hs-cTnI) in patients with moderate chronic heart failure (CHF), in New York Heart Association class II-III with reduced ejection fraction (HFrEF) and (2) to explore the associations with left ventricular remodelling, functional capacity and filling pressures measured with N-terminal pro brain natriuretic peptide (NT-proBNP).

METHODS AND RESULTS

In this sub-study, 196 patients were randomly assigned to high intensity interval training (HIIT, n = 70), moderate continuous training (MCT, n = 59) or recommendation of regular exercise (RRE), (n = 67) for 12 weeks. To reveal potential difference between structured intervention and control, HIIT and MCT groups were merged and named supervised exercise training (SET) group. The RRE group constituted the control group (CG). To avoid contributing factors to myocardial injury, we also evaluated changes in patients without additional co-morbidities (atrial fibrillation, hypertension, diabetes mellitus, and chronic obstructive pulmonary disease). The relationship between hs-cTnI and left ventricular end-diastolic diameter (LVEDD), VO2peak, and NT-proBNP was analysed by linear mixed models. At 12 weeks, Hs-cTnI levels were modestly but significantly reduced in the SET group from median 11.9 ng/L (interquartile ratio, IQR 7.1-21.8) to 11.5 ng/L (IQR 7.0-20.7), P = 0.030. There was no between-group difference (SET vs. CG, P = 0.116). There was a numerical but not significant reduction in hs-cTnI for the whole population (P = 0.067) after 12 weeks. For the sub-group of patients without additional co-morbidities, there was a significant between-group difference: SET group (delta -1.2 ng/L, IQR -2.7 to 0.1) versus CG (delta -0.1 ng/L, IQR -0.4 to 0.7), P = 0.007. In the SET group, hs-cTnI changed from 10.9 ng/L (IQR 6.0-22.7) to 9.2 ng/L (IQR 5.2-20.5) (P = 0.002), whereas there was no change in the CG (6.4 to 5.8 ng/L, P = 0.64). Changes in hs-cTnI (all patients) were significantly associated with changes in; LVEDD, VO2peak, and NT-proBNP, respectively.

CONCLUSIONS

In patients with stable HFrEF, 12 weeks of structured exercise intervention was associated with a modest, but significant reduction of hs-cTnI. There was no significant difference between intervention group and control group. In the sub-group of patients without additional co-morbidities, this difference was highly significant. The alterations in hs-cTnI were associated with reduction of LVEDD and natriuretic peptide concentrations as well as improved functional capacity.

How Much Training Is Enough? Low-Dose, High-Frequency Simulation Training and Maintenance of Competence in Neonatal Resuscitation

INTRODUCTION

Facemask ventilation is a crucial, but challenging, element of neonatal resuscitation.In a previously reported study, instructor-led training using a novel neonatal simulator resulted in high-level ventilation competence for health care providers (HCPs) involved in newborn resuscitation. The aim of this study was to identify the optimal frequency and dose of simulation training to maintain this competence level.

METHODS

Prospective observational study of HCPs training through 9 months. All training was logged. Overall ventilation competence scores were calculated for each simulation case, incorporating 7 skill elements considered important for effective ventilation.Overall scores and skill elements were analyzed by generalized linear mixed effects models using frequency (number of months of 9 where training occurred and total number of training sessions in 9 months) and dose (total number of cases performed) as predictors. Training loads (frequency + dose) predictive of high scores were projected based on estimated marginal probabilities of successful outcomes.

RESULTS

A total of 156 HCPs performed 4348 training cases. Performing 5 or more sessions in 9 months predicted high global competence scores (>28/30). Frequency was the best predictor for 4 skill elements; success in maintaining airway patency and ventilation fraction was predicted by performing training in, respectively, 2 and 3 months of 9, whereas for avoiding dangerously high inflating pressures and providing adequate mask seal, 5 and 6 sessions, respectively, over the 9 months, predicted success. Skills reflecting global performance (successful resuscitation and valid ventilations) and ventilation rate were more dose-dependent.

CONCLUSIONS

Training frequency is important in maintaining neonatal ventilation competence. Training dose is important for some skill elements. This offers the potential for individualized training schedules.

Identification of diagnostic and prognostic biomarkers of PD using a multiplex proteomics approach

Given the complexity of Parkinson's disease (PD), achieving acceptable diagnostic and prognostic accuracy will require the support of a panel of diverse biomarkers. We used Proximity extension assays to measure a panel of 92 proteins in CSF of 120 newly diagnosed PD patients and 45 control subjects without neurological disease. From 75 proteins detectable in the CSF of >90% of the subjects, regularized regression analysis identified four proteins (β-NGF, CD38, tau and NCAN) as downregulated in newly diagnosed PD patients (age at diagnosis 67.2 ± 9.4 years) compared to controls (age 65.4 ± 10.9 years). Higher tau (β -0.82 transformed MMSE points/year, 95% CI -1.37 to -0.27, P = 0.005) was also linked to faster cognitive decline over the first ten years after PD diagnosis. These findings provide insights into multiple aspects of PD pathophysiology and may serve as the foundation for identifying new biomarkers and therapeutic targets.

Illuminating the daily life experiences of adolescents with and without ADHD: protocol for an ecological momentary assessment study

INTRODUCTION

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk of a range of difficulties, among which emotion regulation, peer and co-occurring mental health problems are prominent challenges. To better support adolescents with ADHD, ecologically valid interventions that can be embedded in daily life to target the most proximal antecedents of these challenges are needed. Ecological momentary assessment (EMA) designs are ideally suited to meeting this need.

METHODS AND ANALYSES

In the mental health in the moment ADHD study, we will use an EMA design to capture the daily life experiences of approximately 120 adolescents aged 11-14 years with a clinical diagnosis of ADHD and the same number of age-matched and gender-matched peers without a diagnosis of ADHD. We will combine this with comprehensive information gathered from online surveys. Analysing the data using techniques such as dynamic structural equation modelling, we will examine, among other research questions, the role of emotion regulation and peer problems in mediating the links between characteristics of ADHD and commonly co-occurring outcomes such as anxiety, depression and conduct problems. The results can help inform interventions to support improved peer functioning and emotion regulation for adolescents with ADHD.

ETHICS AND DISSEMINATION

This study received a favourable ethical opinion through the National Health Service ethical review board and the University of Edinburgh PPLS Research Ethics panel. The results will be disseminated through journal publications, conferences and seminar presentations and to relevant stakeholders, such as those with ADHD, their families and clinicians.

Understanding inequalities in access to adult mental health services in the UK: a systematic mapping review

BACKGROUND

Population groups experience differential access to timely and high-quality mental healthcare. Despite efforts of recent UK policies to improve the accessibility of mental health services, there remains a lack of comprehensive understanding of inequalities in access to services needed to do this. This systematic mapping review aimed to address this gap by identifying which population groups continue to be poorly served by access to adult mental health services in the UK, how access has been measured, and what research methods have been applied.

METHODS

Seven electronic databases were searched from January 2014 up to May 2022. Primary research studies of any design were included if they examined access to adult NHS mental health services in the UK by population groups at risk of experiencing inequalities. Study characteristics, measures of access, inequalities studied, and key findings were extracted. A best-fit framework approach was used, applying Levesque's Conceptual Framework for Healthcare Access to synthesise measures of access, and applying a template derived from Cochrane Progress-Plus and NHS Long Term Plan equality characteristics to synthesise key findings associated with inequalities.

RESULTS

Of 1,929 publications retrieved, 152 studies of various types were included. The most frequently considered dimensions of inequality were gender, age, and ethnicity, whilst social capital, religion, and sexual orientation were least frequently considered. Most studies researched access by measuring "healthcare utilisation", followed by studies that measured "healthcare seeking". Key barriers to access were associated with individuals' "ability to seek" (e.g. stigma and discrimination) and "ability to reach" (e.g. availability of services). Almost half of the studies used routinely collected patient data, and only 16% of studies reported patient and public involvement.

CONCLUSIONS

Little appears to have changed in the nature and extent of inequalities, suggesting that mental health services have not become more accessible. Actions to reduce inequalities should address barriers to population groups' abilities to seek and reach services such as stigma-reducing interventions, and re-designing services and pathways. Significant benefits exist in using routinely collected patient data, but its limitations should not be ignored. More theoretically informed research, using a holistic measurement of access, is needed in this area.

REVIEW REGISTRATION

https://doi.org/10.17605/OSF.IO/RQ5U7 .

Predicting Participation Willingness in Ecological Momentary Assessment of General Population Health and Behavior: Machine Learning Study

BACKGROUND

Ecological momentary assessment (EMA) is widely used in health research to capture individuals' experiences in the flow of daily life. The majority of EMA studies, however, rely on nonprobability sampling approaches, leaving open the possibility of nonrandom participation concerning the individual characteristics of interest in EMA research. Knowledge of the factors that predict participation in EMA research is required to evaluate this possibility and can also inform optimal recruitment strategies.

OBJECTIVE

This study aimed to examine the extent to which being willing to participate in EMA research is related to respondent characteristics and to identify the most critical predictors of participation.

METHODS

We leveraged the availability of comprehensive data on a general young adult population pool of potential EMA participants and used and compared logistic regression, classification and regression trees, and random forest approaches to evaluate respondents' characteristic predictors of willingness to participate in the Decades-to-Minutes EMA study.

RESULTS

In unadjusted logistic regression models, gender, migration background, anxiety, attention deficit hyperactivity disorder symptoms, stress, and prosociality were significant predictors of participation willingness; in logistic regression models, mutually adjusting for all predictors, migration background, tobacco use, and social exclusion were significant predictors. Tree-based approaches also identified migration status, tobacco use, and prosociality as prominent predictors. However, overall, willingness to participate in the Decades-to-Minutes EMA study was only weakly predictable from respondent characteristics. Cross-validation areas under the curve for the best models were only in the range of 0.56 to 0.57.

CONCLUSIONS

Results suggest that migration background is the single most promising target for improving EMA participation and sample representativeness; however, more research is needed to improve prediction of participation in EMA studies in health.

Inflammatory Biomarkers in Newly Diagnosed Patients With Parkinson Disease and Related Neurodegenerative Disorders

BACKGROUND AND OBJECTIVES

Neuroinflammation contributes to Parkinson disease (PD) pathology, and inflammatory biomarkers may aid in PD diagnosis. Proximity extension assay (PEA) technology is a promising method for multiplex analysis of inflammatory markers. Neuroinflammation also plays a role in related neurodegenerative diseases, such as dementia with Lewy bodies (DLB) and Alzheimer disease (AD). The aim of this work was to assess the value of inflammatory biomarkers in newly diagnosed patients with PD and in patients with DLB and AD.

METHODS

Patients from the Norwegian ParkWest and Dementia Study of Western Norway longitudinal cohorts (PD, n = 120; DLB, n = 15; AD, n = 27) and 44 normal controls were included in this study. A PEA inflammation panel of 92 biomarkers was measured in the CSF. Disease-associated biomarkers were identified using elastic net (EN) analysis. We assessed the discriminatory power of disease-associated biomarkers using receiver operating characteristic (ROC) curve analysis and estimated the optimism-adjusted area under the curve (AUC) using the bootstrapping method.

RESULTS

EN analysis identified 9 PEA inflammatory biomarkers (ADA, CCL23, CD5, CD8A, CDCP1, FGF-19, IL-18R1, IL-6, and MCP-2) associated with PD. Seven of the 9 biomarkers were included in a diagnostic panel, which was able to discriminate between those with PD and controls (optimism-adjusted AUC 0.82). Our 7-biomarker PD panel was also able to distinguish PD from DLB and from AD. In addition, 4 inflammatory biomarkers were associated with AD and included in a panel, which could distinguish those with AD from controls (optimism-adjusted AUC 0.87). Our 4-biomarker AD panel was also able to distinguish AD from DLB and from PD.

DISCUSSION

In our exploratory study, we identified a 7-biomarker panel for PD and a 4-biomarker panel for AD. Our findings indicate potential inflammation-related biomarker candidates that could contribute toward PD-specific and AD-specific diagnostic panels, which should be further explored in other larger cohorts.

Testing for Within × Within and Between × Within Moderation using Random Intercept Cross-Lagged Panel Models

Random-Intercept Cross-Lagged Panel Models allow for the decomposition of measurements into between- and within-person components and have hence become popular for testing developmental hypotheses. Here, we describe how developmental researchers can implement, test and interpret interaction effects in such models using an empirical example from developmental psychopathology research. We illustrate the analysis of Within × Within and Between × Within interactions utilising data from the United Kingdom-based Millennium Cohort Study within a Bayesian Structural Equation Modelling framework. We provide annotated Mplus code, allowing users to isolate, estimate and interpret the complexities of within-person and between person dynamics as they unfold over time.

Aerobic high-intensity interval exercise training in patients with angina and no obstructive coronary artery disease: feasibility and physiological effects

Aims

Patients with chest pain and normal coronary angiogram [angina with normal coronary arteries (ANOCA)] constitute a therapeutic problem with considerable functional limitation and reduced quality of life. The aims of the current pilot study were to (i) explore if a structured aerobic high-intensity interval training (HIT) program for 12 weeks was feasible in patients with ANOCA, and (ii) to assess mechanisms related to symptoms in this population.

Methods and results

Sixteen patients with ANOCA underwent a 3-month aerobic HIT program with one-to-one monitored exercise sessions on treadmill in a 4 min × 4 manner, three times a week. Four patients served as controls. Coronary flow velocity reserve (CFVR) transthoracic Doppler, flow-mediated vasodilation (FMD) and VO_2max was measured at baseline and after 12 weeks. The average attendance to training sessions was 82.3% ± 10.1 (56-94). CFVR in the training group increased from 2.50 ± 0.48 to 3.04 ± 0.71 (P < 0.001) whereas FMD increased from 4.19 ± 2.42% to 8.28 ± 2.85% (P < 0.001). Improvement in CFVR correlated with the relative improvement in FMD (R = 0.45, P = 0.047). This was associated with an increase in VO_2max from 28.75 ± 6.51 mL/kg/min to 31.93 ± 6.46 mL/kg/min (P < 0.001).

Conclusion

A 3-month program of monitored HIT was feasible, with high adherence resulting in improved functional capacity in patients with ANOCA. CFVR improved and this improvement was associated with improved FMD.

ClinicalTrialsgov Identifier

NCT02905630.

LONG-TERM CHANGES IN VISUAL FUNCTION AND EN FACE OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN FOVEA-OFF RETINAL DETACHMENT: A 2-Year Prospective Study

PURPOSE

To investigate the long-term changes in visual function and outer retinal abnormalities on en face optical coherence tomography after fovea-off rhegmatogenous retinal detachment and to assess associations between functional outcomes and outer retinal abnormalities.

METHODS

Prospective, observational study. The following data were collected at 1, 3, 6, 12, and 24 months after retinal reattachment: Best-corrected visual acuity, metamorphopsia (M-CHARTS), aniseikonia (New Aniseikonia Test), altered ellipsoid zone reflectivity, outer retinal folds, macular detachment demarcation, and subfoveal fluid.

RESULTS

Thirty-eight patients were included. Best-corrected visual acuity improved significantly from 1 to 12 months and from 12 to 24 months (P < 0.001; P = 0.022). Vertical and horizontal metamorphopsia improved significantly from 1 to 12 months (P < 0.001; P = 0.002), and at 24 months, scores of ≥0.2° were present in 54% and 42% of patients, respectively. The degree of aniseikonia did not change. Best-corrected visual acuity and aniseikonia scores were positively associated with outer retinal fold (r 0.4, P = 0.009; r 0.4, P = 0.048). A gradual normalization of outer retinal reflectivity took place during 24 months.

CONCLUSION

Visual acuity improved significantly during the second year after reattachment surgery for fovea-off rhegmatogenous retinal detachment, in parallel with normalization of outer retinal abnormalities on en face optical coherence tomography. Metamorphopsia did not improve after 12 months, and aniseikonia remained unchanged.

Personality and substance use disorder: Characteristics as measured by NEO-personality inventory–revised

The present study investigates the personality characteristics of a cohort of patients with Substance Use Disorders. The included participants (n = 123) were recruited from specialized treatment for addictions in Norway. The personality scores in the current sample were compared to the Norwegian norm sample with t-tests. Age and gender differences in personality scores were assessed by bivariate correlation analyses and t-tests, respectively. The sample had higher scores on Neuroticism and lower scores on Conscientiousness, Agreeableness, Extraversion, and Openness compared to the norm sample (p < 0.01). The effect sizes of the differences between the current sample and the Norwegian norm sample were large for Neuroticism and Conscientiousness. Older participants scored higher on Agreeableness and its facets A1: Trust and A2: Straightforwardness and lower on the facet E5: Excitement-Seeking (p < 0.01). No significant (p < 0.01) gender differences in NEO-PI-R scores were found. In conclusion, the current results support previous findings regarding personality traits associated with SUD. The clinical relevance of the findings is discussed.

Association of redox and inflammation-related biomarkers with prognosis in IgA nephropathy: A prospective observational study

BACKGROUND

IgA nephropathy (IGAN) has a variable prognosis. Risk stratification tools are usually based on clinical parameters combined with histologic Oxford-MEST-C score. Circulating redox- and inflammation-related biomarkers may be related to histological changes in IGAN. Therefore, we studied the performance of these biomarkers in predicting the rate of GFR-loss in IGAN.

METHODS

This was an observational prospective study. Fifty-seven stable patients with IGAN were examined at baseline and after a mean observational time of 5.9 ± 1.1 years. The main outcome measure was eGFR-loss per year with predefined groups, stable (<1.5 ml/min/1,73 m²/year, intermediate (between 1.5 and 2.5), and progressive (>2.5).

RESULTS

Fifteen patients were in the progressive, 11 in the intermediate, and 31 in the stable groups. Positive relationships were detected between eGFR-loss per year and baseline nitrate, oxidized free cysteine, parathyroid hormone, APRIL, TNFR1, CD30, chitinase 3, and LIF-5. The progressive group had elevated concentrations of these markers plus AOPP and osteopontin. Through ROC analysis, it was observed that AOPP, oxidized free cysteine, TNFR1, osteopontin, and LIF-5 had the best ability to identify progressive vs. non-progressive diseases. The combination of urinary albumin/creatinine ratio with AOPP and TNFR1 significantly improved the ability to identify progressive eGFR decline with ROC AUC 95% (adjusted 85%).

CONCLUSIONS

We found prognostic biomarkers related to the rate of eGFR-loss in IGAN. These biomarkers may help identify patients at risk of progressive disease. AOPP, oxidized free cysteine, TNFR1, and osteopontin are promising prognostic biomarkers in IGAN, however, further validation studies are needed.

Within-person Relations between Domains of Socio-emotional Development during Childhood and Adolescence

Adolescence is a critical period in the development of mental health with nearly 1 in 5 adolescents suffering from mental health problems and more than 40 percent of these experiencing at least one co-occurring mental health disorder. This study investigates whether there are differences in the relations between key dimensions of child and adolescent mental health in adolescence compared to childhood. Mental health and related socio-emotional traits were measured longitudinally at ages 4, 7, 8, 9, 11, 13, and 16 in the Avon Longitudinal Study of Parents and Children (N = 11279) using the Strengths and Difficulties Questionnaires. Graphical Vector Autoregression models were used to analyse the temporal within-person relations between conduct problems, emotional problems, hyperactivity/inattention, peer problems and prosociality across childhood (ages 4 to 9) and adolescence (11 to 16). Results suggest that adolescence is characterised by an increase in the number and strength of temporal relations between socio-emotional difficulties. In particular, in adolescence there were bidirectional connections between peer problems and emotional problems, between conduct problems and hyperactivity/inattention and between prosociality and conduct problems as well as hyperactivity/inattention. In childhood, conduct problems and prosociality were reciprocally related. Results also suggested peer problems as a potential mediating factor between conduct and emotional problems in childhood. Overall, this study suggests that different domains of socio-emotional development influence each other over development. Adolescence is characterised by an increase in temporal connections, which may be one factor underlying the increased vulnerability to the onset of mental health problems during that period.

Reduced LVEDD following a 12 week exercise training program in patients with symptomatic chronic heart failure is associated with reduction in serum levels of Troponin I

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Norwegian University of Science and Technology Danish Research Council

Background

Exercise training (ET) exerts many beneficial effects on the cardiovascular system, and longitudinal observational data from epidemiological studies suggest that higher physical activity is associated with lower concentrations of cardiac troponins. We have previously shown that ET can reduce Left Ventricle End-diastolic diameter (LVEDD), and improve exercise capacity.

Purpose

Our aim was to explore the relationship between changes in LVEDD and changes in high-sensitive plasma troponin I (hs-TnI) levels in patients with symptomatic heart failure undergoing a 12 week structured exercise training program in the randomized multicenter SMARTEX trial.

Methods

This was a post hoc analysis in 199 patients with symptomatic HF with LVEF &lt;35% and NYHA II-III that were randomly assigned to High Intensity Interval Training (HIIT, n = 73), Moderate Continuous Training (MCT, n = 59) or Recommendation of Regular Exercise, (RRT, n = 67) for 12 weeks. Log-transformed Hs-TnI measurements and clinical data acquired before (BL) and after a 12 week exercise training intervention (12 weeks) and at 1 year follow-up (1 year) were analysed using a linear mixed model. For Troponin analysis the STAT Troponin-I from Abbott Diagnostics was used.

Nakagawa’s marginal R2 and conditional R2 were used to evaluate variance explained by fixed effects only and by fixed and random effects together, respectively.

Changes of LVEDD between baseline and 12 weeks and baseline and 52 weeks were evaluated using linear mixed model. The outcome variable were measures of LVEDD, while age, sex, visit and training group and their interaction [visit × training group]  were included as fixed effects. Patient id and training center were random effects. Covariance structure was compound symmetry.

Linear association between log-transformed TnI and LVEDD baseline was evaluated using Pearson correlation coefficient (R).

Results

Serum was available for hs-TnI analyses in 199 patients. In the HIIT group there was a sustained significant reduction in LVEDD at both 12 and 52 weeks.

In the MCT group this reduction was statistically significant at 52 weeks only.

Mixed model analysis predicts that each 1 mm decrease in LVEDD is associated with 1.2% decrease in TnI levels (95% CI: 0.6 – 1.9%, p &lt;0.001). Neither time nor training group were associated with changes of TnI (overall test p = 0.739 and p = 0.987, respectively).

Dynamics of TnI is highly patient-specific with Intraclass correlation coefficient (ICC) = 0.86. Mixed model explains 87% variation of the data (conditional R2), however, only 7% is attributed to the fixed effects (marginal R2).

At baseline, TnI and LVEDD have modest but statistically significant correlation (R = 0.2, p= 0.004).

Conclusions

A reduction of LVEDD following a 12-week exercise-training program is associated with a reduction in plasma troponin levels, in patients with mild to moderate chronic heart failure. Abstract Figure.

Awareness of age-related changes in Norwegian individuals 50+. Short form questionnaire validation

BACKGROUND

A questionnaire assessing awareness of positive and negative age-related changes (AARC gains and losses) was developed in the US and Germany, and validated for the UK and Brazilian populations. In this study, we validated the short-form measure (AARC-10 SF) in the Norwegian population aged 50 and over. In addition, the relationship between cognitive variables and AARC was examined.

METHODS

Cross-sectional analyses of data from 1,510 participants in the ongoing online PROTECT Norge study were used to explore and confirm the two-factor structure of AARC gains and AARC losses; reliability; measurement invariance across different population groups defined by sex, education level, employment, and in middle age, early old age, and advanced old age. We explored the relationship between AARC and demographic variables (defined in the same way as the population groups).

RESULTS

We confirmed the two-factor structure (gains and losses) of the Norwegian translation of the AARC-10 SF. We did not find mutual correlations between related items in gains and losses, except for the physical health item from the gains dimension, which was positively correlated with all items of the losses dimension. Age, sex, marital status, employment, and university education predicted AARC gains and losses.

CONCLUSION

The Norwegian translation of the AARC-10 SF captures individuals' positive and negative self-perceptions of age-related changes in their mental, physical, and cognitive health.

Butterfly glioblastoma: Clinical characteristics, treatment strategies and outcomes in a population-based cohort

Background

Butterfly glioblastoma is a rare subgroup of glioblastoma with a bihemispheric tumor crossing the corpus callosum, and is associated with a dismal prognosis. Prognostic factors are previously sparsely described and optimal treatment remains uncertain. We aimed to analyze clinical characteristics, treatment strategies, and outcomes from butterfly glioblastoma in a real-world setting.

Methods

This retrospective population-based cohort study included patients diagnosed with butterfly glioblastoma in Western Norway between 01/01/2007 and 31/12/2014. We enrolled patients with histologically confirmed glioblastoma and patients with a diagnosis based on a typical MRI pattern. Clinical data were extracted from electronic medical records. Molecular and MRI volumetric analyses were retrospectively performed. Survival analyses were performed using the Kaplan–Meier method and Cox proportional hazards regression models.

Results

Among 381 patients diagnosed with glioblastoma, 33 patients (8.7%) met the butterfly glioblastoma criteria. Median overall survival was 5.5 months (95% CI 3.1–7.9) and 3-year survival was 9.1%. Hypofractionated radiation therapy with or without temozolomide was the most frequently used treatment strategy, given to 16 of the 27 (59.3%) patients receiving radiation therapy. Best supportive care was associated with poorer survival compared with multimodal treatment [adjusted hazard ratio 5.11 (95% CI 1.09–23.89)].

Conclusion

Outcome from butterfly glioblastoma was dismal, with a median overall survival of less than 6 months. However, long-term survival was comparable to that observed in non-butterfly glioblastoma, and multimodal treatment was associated with longer survival. This suggests that patients with butterfly glioblastoma may benefit from a more aggressive treatment approach despite the overall poor prognosis.

Analyzing dynamic change in children's socioemotional development using the strengths and difficulties questionnaire in a large United Kingdom longitudinal study

Many children who suffer from one mental health issue also suffer from at least one co-occurring disorder and a range of developmental psychopathology theories, including developmental cascade and network models, have been proposed to explain this widespread co-occurrence. Autoregressive latent trajectory models with structured residuals (ALT-SR) and multilevel graphical vector autoregression (GVAR) are recently proposed complementary approaches that can help operationalize and test these theories and provide new insights into the reciprocal relations between multiple mental health domains to advance the understanding of the development of co-occurring mental health problems. This study uses ALT-SR and multilevel GVAR models to analyze the temporal, contemporaneous, and between-person relations between key dimensions of child mental health: emotional problems, peer problems, conduct problems, hyperactivity/inattention, and prosociality as measured by the parent-reported Strengths and Difficulties Questionnaire (SDQ) in 17,478 children from the U.K. Millennium Cohort study at ages 3, 5, 7, 11, 14, and 17 years. Children's strengths and difficulties in different domains of psychosocial functioning were dynamically associated with each other over- and within-time. The ALT-SR highlighted that hyperactivity/inattention plays a central role in affecting other domains over developmental time, while the GVAR model highlighted comparably strong bidirectional relations between conduct problems and prosociality as well as between emotional problems and peer problems. This study confirms that mental health difficulties influence one another dynamically over time. The complementary techniques of ALT-SR and GVAR models offer different insights into co-occurring mental health problems and hold promise for supporting the building of more comprehensive developmental psychopathological theories that acknowledge the interconnectedness of different domains of mental health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The impact of common genetic variants in cognitive decline in the first seven years of Parkinson's disease: A longitudinal observational study

INTRODUCTION

Cognitive impairment is a common feature of Parkinson's disease and is a significant determinant of patients' quality of life and dependence. The pattern and progression of cognitive symptoms vary greatly between individuals, and genetic biomarkers may help to predict the severity and trajectory of cognitive impairment in groups of patients.

METHODS

The study included 171 patients from a longitudinal population-based incident Parkinson's disease study from South Western Norway. All participants were followed from the time of diagnosis for up to seven years, undertaking repeated batteries of clinical and neuropsychological tests, measuring global cognitive impairment, executive function, attention, verbal learning and memory, and visuospatial skills. We used linear mixed regression analyses to explore associations between the function in specific cognitive domains over time and common genetic variants in APOE, MAPT, COMT and BDNF.

RESULTS

The COMT¹⁵⁸Val/Val allele wasassociatedwith faster decline in executive function (p = 0.028), verbal learning and memory (p = 0.029), and visuospatial skills (p = 0.027). The BDNF, MAPT and APOE genotypes were not significantly associated with longitudinal changes in individual cognitive domains, however carriers of the APOE-ε4 allele were shown to be at increased risk of mild cognitive impairment and dementia within the study period (OR3.03; p = 0.006).

CONCLUSIONS

This population-based study of newly diagnosed patients provides new evidence that COMTVal¹⁵⁸Met effects cognitive outcomes limited to discrete domains and APOE-ε4 status predicts a poor overall cognitive prognosis. Together, these data contribute to our understanding of the biology underlying the heterogeneity observed in the progression of PD.

Increased VO2 peak after a structured exercise-training program is associated with reduced levels of cardiac myosin binding protein C in patients with symptomatic chronic heart failure

Background

Cardiac myosin-binding protein C (cMyC), a cardiac contractile protein, is a novel biomarker of myocardial injury, rising earlier and disappearing faster than cardiac troponins. It is a promising biomarker for use in triage of patients with chest pain presenting in the emergency department. It also has prognostic significance in patients with heart failure. However, the effects of systematic exercise training on plasma levels of cMyC has previously not been evaluated.

Purpose

The aim of this study was to assess the effect of a 12-week exercise training program on changes in plasma levels of cMyC in patients with chronic symptomatic heart failure with reduced ejection fraction (HFrEF). The changes in plasma levels of cMyC in an intervention group, performing structured exercise programs, were compared to those in a control group, instructed to perform regular recommended exercise (RRE) according to current guidelines.

Methods

This was a post hoc analysis of the SMARTEX-HF trial in 215 patients with symptomatic HF with Left Ventricular Ejection Fraction (LVEF) &lt;35% and NYHA II-III. The patients were randomly assigned to High Intensity Interval Training (HIIT, n=77), Moderate Continuous Training (MCT, n=65) or RRE, (n=73) for 12 weeks. HIIT and MCT groups constituted the intervention group (IG). Measurements and clinical data were acquired before and after the 12-week intervention.

Statistical analysis

We divided the patients in two groups with Δ VO2Peak above and below the median of the sample. The absolute changes of cMyC were then compared between the two groups.

Mann-Whitney U test was used to compare continuous variables between the groups. Chi-squared test and Fisher exact test were used to compare categorical variables, as appropriate. A two-tailed p&lt;0.05 was considered significant.

Results

There were no differences in changes of cMyC plasma levels, measured at baseline and after the intervention, between patients in the IG and RRE-group (p=0.580).

When dividing the entire study population according to Δ VO2Peak higher or lower than median value 0.48 ml/kg/min, we found a statistically significant greater reduction of cMyC values after 12 weeks of exercise training for those with higher than median Delta VO2Peak values compared to those with lower values (p=0.012). This finding was even stronger for the percentage change in cMyC levels (p=0.004 between groups).

Conclusion

In patients with symptomatic chronic HFrEF performing a structured 12-week exercise training program, a greater increase in Δ VO2Peak is significantly associated with a reduction in cMyC, suggesting cMyC may provide a dynamic measure of cardiorespiratory state.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Central Norwegian Health authority,Norwegian University of Science and Technology Baseline characteristicsBoxplot cMyC vs peak VO2

P14.62 Overall survival from glioblastoma: partial resection versus biopsy

BACKGROUND

Maximal safe resection is standard of care in patients with glioblastoma. Partial resection or biopsy are alternative surgical approaches when macroscopic complete resection is unachievable. Survival benefit from partial resection remains uncertain. We aimed to evaluate overall survival from glioblastoma in patients having undergone partial resection compared to biopsy.

MATERIAL AND METHODS

We retrospectively identified all patients with histologically confirmed glioblastoma having undergone partial resection or biopsy in Western Norway between 1.1.2007 and 31.12.2014. Clinical characteristics and radiology reports were extracted from electronic medical records. Categorical data were compared by chi square test or Fishers exact test, and continuous data by non-parametric tests. Kaplan Meier method and log rank test were used for survival analyses.

RESULTS

We identified 158 patients diagnosed with glioblastoma and having undergone biopsy or partial resection. Biopsy was performed in 52 patients (32.9%) and partial resection in 106 patients (67.1%). Median age (range) was 62.5 (18.1–82.3) in the biopsy group and 62.2 (27.9–85.1) in the partial resection group (p=0.90). Median Charlson comorbidity score was four in both groups. Multifocality was observed in 46.2% of patients in the biopsy group, compared to 27.4% of patients in the partial resection group (p=0.02). Deep-seated tumour localisation was also more frequent in the biopsy group than in the partial resection group, seen in 17.3% vs 5.7% of the patients (p=0.04). There was no difference in chemoradiotherapy (CRT) treatment between the groups. CRT according to the Stupp protocol, less intensive CRT and best supportive care was performed in 36.5%, 50.0% and 13.5% of patients in the biopsy group, compared to 45.3%, 49.1% and 5.7% in the partial resection group (p=0.20). Median overall survival in the biopsy group was 8.1 months (95% CI 5.2–11.1) compared to 11.1 months (95% CI 9.4–12.8) in the partial resection group (p=0.19). Median survival in the biopsy group was 13.8 months (95% CI 10.1–17.5), 6.5 months (95% CI 3.6–9.4), and 3.5 months (95% CI 0.0–7.7) for patients receiving CRT according to Stupp protocol, less-intensive CRT and best supportive care, respectively (p&lt;0.001). The corresponding numbers in the partial resection group were 15.1 months (95% CI 13.2–16.9), 9.1 months (95% CI 7.5–10.6), and 1.5 month (95% CI 0.0–4.7) (p&lt;0.001).

CONCLUSION

Median overall survival was slightly longer in patients having undergone partial resection compared to biopsy, however not statistically significant. Prospective studies are needed to evaluate the survival benefit from partial resection.

STRUCTURAL PATHOLOGY AFTER RETINAL DETACHMENT: Multicolor Confocal Scanning Laser Ophthalmoscopy Versus Color Fundus Photography

PURPOSE

To compare pathology detection using multicolor confocal scanning laser ophthalmoscopy with color fundus photography following macula-off rhegmatogenous retinal detachment.

METHODS

Postsurgery multicolor confocal scanning laser ophthalmoscopy and color fundus photography images from 30 rhegmatogenous retinal detachment patients were examined by 10 masked graders. Imaging was performed with the Heidelberg Spectralis HRA and the digital retinal camera Basler acA2500-14gc GigE. Swept-source optical coherence tomography was used as verification modality. Detection rates of ellipsoid zone disruption, foveal ellipsoid zone rosette, outer retinal folds, intraretinal cysts, subretinal fluid layer, subretinal fluid blebs, retinal striae, and retinal detachment line were compared. Intermodality and intergrader agreement were estimated.

RESULTS

Overall pathology detection was significantly higher for multicolor confocal scanning laser ophthalmoscopy multicolor confocal scanning laser ophthalmoscopy (adjusted odds ratio = 7.39; 95% confidence interval, 1.64-33.30; P = 0.009). The intermodality and intergrader agreement on overall pathology detection were moderate. The intermodality agreement was 0.49 (95% confidence interval, 0.48-0.51; P < 0.0001) (Gwet's AC1). Intergrader agreement was 0.53 (95% confidence interval, 0.52-0.54; P < 0.0001) for multicolor confocal scanning laser ophthalmoscopy and 0.58 (95% confidence interval, 0.57-0.59; P < 0.0001) (Fleiss kappa) for color fundus photography.

CONCLUSION

Multicolor confocal scanning laser ophthalmoscopy imaging is superior to color fundus photography in detecting and delineating structural retinal abnormalities following rhegmatogenous retinal detachment and can be a helpful tool in the visualization of retinal remodeling processes in patients recovering from rhegmatogenous retinal detachment surgery.

Longitudinal effects of breast feeding on parent-reported child behaviour

OBJECTIVE

Shorter breastfeeding duration has been linked to a range of difficulties in children. However, evidence linking shorter breastfeeding duration to child behavioural problems has been inconclusive. Owing to an almost exclusive focus on early childhood in previous research, little is known about breastfeeding effects on behaviour throughout childhood and adolescence. This study examines the longitudinal effect of breast feeding on parent-reported behaviour in children aged 3-14.

DESIGN

Data come from the Millennium Cohort Study, a large, prospective, UK birth cohort study.

PARTICIPANTS

11 148 children, their parents and teachers.

METHODS

This study maps the effect of breastfeeding duration on parent-reported child behaviour longitudinally, using latent growth curve modelling and on teacher-reported child behaviour using multiple regression analyses. Breastfeeding duration was assessed through parent interviews when the child was 9 months old. Children's behavioural development was measured using parent-reported Strengths and Difficulties Questionnaires (SDQ) at 3, 5, 7, 11 and 14 years and teacher-reported SDQs at 7 and 11 years.

RESULTS

Breast feeding was associated with fewer parent-reported behavioural difficulties at all ages even after adjusting for potential confounders (<2 months: B=-0.22, 95% CI -0.39 to -0.04; 2-4 months: B=-0.53, 95% CI -0.75 to -0.32; 4-6 months: B=-1.07, 95% CI -1.33 to -0.81; >6 months: B=-1.24, 95% CI -1.44 to -1.04; B=adjusted mean difference of raw SDQ scores at age 3, reference: never breast fed).

CONCLUSION

This study provides further evidence supporting links between breastfeeding duration and children's socioemotional behavioural development. Potential implications include intervention strategies encouraging breast feeding.

Association of SNCA Parkinson's Disease Risk Polymorphisms With Disease Progression in Newly Diagnosed Patients

Objectives: To evaluate the impact of SNCA polymorphisms originally identified as risk factors for Parkinson's disease (PD) on the clinical presentation and progression of the disease in a large cohort of population-based patients with incident PD.

Methods: Four hundred thirty-three patients and 417 controls from three longitudinal cohorts were included in the study. Disease progression was recorded annually for up to 9 years using the Unified Parkinson's Disease Rating Scale (UPDRS) or Mini-Mental State Examination. Genotypes for five variants within the SNCA locus (rs2870004, rs356182, rs5019538, rs356219, and rs763443) were determined. We studied the association between each variant and disease progression using linear mixed-effects regression models.

Results: The clinical profile of the patients with PD at the point of diagnosis was highly uniform between genotype groups. The rs356219-GG genotype was associated with a higher UPDRS II score than A-allele carriers (β = 1.52; 95% confidence interval 0.10–2.95; p = 0.036), but no differences were observed in the rate of progression of the UPDRS II scores. rs356219-GG was also associated with a faster annual change in Mini-Mental State Examination score compared with A-carriers (β = 0.03; 95% confidence interval 0.00–0.06; p = 0.043).

Conclusions: We show that the known PD-risk variant rs356219 has a minor effect on modifying disease progression, whereas no differences were associated with rs2870004, rs356182, rs5019538, and rs763443. These findings suggest that SNCA variants associated with PD risk may not be major driving factors to the clinical heterogeneity observed for PD.

Twenty years of endophthalmitis: Incidence, aetiology and clinical outcome

PURPOSE

To review the incidence, aetiology and outcomes of endophthalmitis during a 20-year period in a Norwegian university hospital.

METHODS

Single-centre retrospective review. Medical records of all patients admitted to Stavanger University Hospital with suspected endophthalmitis between January 1999 and December 2018 were reviewed.

RESULTS

We identified 84 eyes of 81 patients. Postoperative endophthalmitis (PE) was seen in 64 eyes (76%), endogenous endophthalmitis in thirteen eyes (15%), trauma in four eyes (5%) and three eyes (4%) had keratitis-associated endophthalmitis. Administration of intravitreal injections (IVI) was the most common cause (30%), followed by cataract surgery (CS) (21%). Of 40238 IVI, 23 PE cases were identified (incidence, 0.057%; 95% confidence interval [CI] 0.036-0.086%). Of 39697 CS, 12 PE cases were identified (incidence, 0.030%; 95%CI 0.016-0.053%). After introduction of intracameral cefuroxime PE incidence after CS decreased from 0.10% in 1999-2003 to 0.015% in 2004-2018 (p = 0.003). Eighty-four per cent of organisms were Gram-positive. Coagulase-negative staphylococci accounted for 54% of culture-proven cases, and 89% of post-IVI culture-proven cases. Thirty eyes (36%) either regained their previous vision or lost ≤1 Early Treatment Diabetic Retinopathy Study line. One third of endophthalmitis cases had a favourable visual outcome of logMAR 0.2 or better.

CONCLUSION

PE after IVI occurred in 1 in 1750 procedures, and was the most common cause of PE. The incidence of PE after CS has decreased >sixfold since 2003, to 1 in 6700 surgeries. A high proportion of low-virulence bacterial species may have contributed to the favourable visual outcome.

EN FACE IMAGING OF OUTER RETINAL PATHOLOGY AFTER RETINAL DETACHMENT

PURPOSE

To explore the potentials of multicolor (MC) confocal scanning laser ophthalmoscopy (cSLO) to detect structural retinal pathology after macula-off rhegmatogenous retinal detachment (RRD) and to describe their appearances.

METHODS

Thirty MC cSLO images of 30 eyes after RRD repair were prospectively studied for the presence of RRD-related pathology. All MC cSLO findings were verified using swept source optical coherence tomography. Positive percent agreements were calculated using swept source optical coherence tomography as reference.

RESULTS

Eight RRD-related structural pathologies were identified and characterized: ellipsoid zone (EZ) disruption, foveal EZ rosette, outer retinal fold, retinal detachment line, subretinal fluid blebs, subretinal fluid layer, retinal striae, and intraretinal cysts. Multicolor cSLO positive percent agreements were as follows: EZ disruption: 79%, foveal EZ rosette: 73%, outer retinal fold: 67%, retinal detachment line: 84%, subretinal fluid blebs: 0.70%, subretinal fluid layer: 50%, intraretinal cysts: 60%, and retinal striae: 100%.

CONCLUSION

En face MC cSLO imaging detected and delineated RRD-related structural pathology in high agreement with cross-sectional swept source optical coherence tomography and can supplement optical coherence tomography in the documentation and monitoring of outer retinal remodeling processes after macula-off RRD. Foveal EZ rosette is a new finding of the foveal EZ.

Links between perinatal risk factors and maternal psychological distress: A network analysis

INTRODUCTION

This paper explores a range of perinatal risk factors that may increase maternal vulnerability to postnatal psychological distress in a sample of 17 531 women participating in the Millennium Cohort Study, a diverse British, longitudinal birth cohort study.

MATERIAL AND METHODS

Using a graphical network modeling framework, this study models the links between postnatal psychological distress and perinatal risk factors, while controlling for sociodemographic factors and history of depression and anxiety. Postnatal psychological distress was assessed at 9 months postpartum using the Rutter Malaise Inventory.

RESULTS

Results of the graphical network models indicate that lower levels of happiness about the pregnancy (Edge weight [w] = 0.084, 95% CI = 0.069-0.100, b = 0.095), smoking during pregnancy (w = 0.026, 95% CI = -0.009-0.060, b = 0.029), infection during pregnancy (w = 0.071, 95% CI = 0.024-0.118, b = 0.090), hyperemesis gravidarum (w = 0.068, 95% CI = 0.013-0.123, b = 0.083), baby in special care (w = 0.048, 95% CI = -0.004-0.099, b = 0.062), not being white (w = 0.101, 95% CI = 0.062-0.140, b = 0.118), being from a more deprived area (w = -0.028, 95% CI = -0.051 to -0.005, b = -0.039), lower income (w = -0.025, 95% CI = -0.055-0.005, b = -0.036), and history of depression or anxiety (w = 0.574, 95% CI = 0.545-0.603, b = 0.764) were associated with increased psychological distress.

CONCLUSIONS

Some perinatal risk factors may be directly associated with postnatal psychological distress, but many risk factors appear to be primarily associated with demographic factors. This emphasizes the importance of taking a holistic approach when evaluating an individual's risk of developing postnatal psychological distress.

Plasma levels of troponin I is reduced after a 12 week exercise training program in patients with uncomplicated heart failure. A substudy of the SMARTEX-HF study

Background

Low-level elevation of cardiac troponins has been associated with adverse outcome, and concentrations even within the normal range provide independent information concerning risk in heart failure (HF). Exercise training exerts many beneficial effects on the cardiovascular system, and longitudinal observational data from epidemiological studies suggest that higher physical activity (PA) is associated with lower concentrations of cardiac troponins.

Purpose

Our aim was to compare changes in plasma troponin I (TnI) levels (Abbott Diagnostics) in patients with symptomatic heart failure undergoing a 12 week structured exercise training program (Intervention group, IG) with changes in controls on a recommendation of regular exercise (RRE); control group, (CG) in a randomized clinical trial.

Methods

This was a post hoc analysis of the SMARTEX-HF trial in 199 patients with symptomatic HF with LVEF &lt;35% and NYHA II-III. The patients were randomly assigned to High Intensity Interval Training (HIIT, n=73), Moderate Continuous Training (MCT, n=59) or RRE, (n=67) for 12 weeks. HIIT and MCT groups constituted the intervention group (IG). Measurements and clinical data acquired before and after the 12-week exercise training intervention were analysed.

Statistical analysis

Changes of TnI levels from baseline to 12 weeks are presented as medians and interquartile ranges. One-sample Wilcoxon sign rank test was used to determine if for a specific group of patients, the median change of troponin levels was equal to zero. In addition, Mann-Whitney U test was used to compare reductions of TnI between two groups.

Results

After 12 weeks plasma levels of TnI were reduced for all patients (median 11.9 to 11.4 ng/L, p=0.032) and there was no difference between the study groups (p=0.072). However, when the groups were studied separately, reduction of plasma levels of TnI was statistically significant in the IG only (12.5 to 11.7 ng/L, p=0.011), (CG 11.4 to 10.7 ng/L, p=0.955).

For the study cohort restricted to patients without additional complicating factors (i.e. no atrial fibrillation, no history of hypertension, diabetes or chronic obstructive pulmonary disease, n=77), difference in changes of plasma levels of TnI between IG (n=54) and CG (n=23) was found to be statistically significant (p=0.004). IG changed from 11.3 to 9.5 ng/L (p=0.002), (CG 12.6 to 12.7 ng/L, p=0.467).

Conclusions

A 12 weeks exercise-training program was associated with a reduction of plasma TnI levels in patients with mild to moderate HFrEF without additional complicating factors.

Figure 1

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Western Norway Regional; Health Authority [Grant Number 911 715]. St. Olavs Hospital; Faculty of Medicine, Norwegian University of Science and Technology; Norwegian Health Association

Circulating inflammation-related factors are correlated with systemic redox status in IgA nephropathy; a case-control study

BACKGROUND

IgA nephropathy (IGAN) is characterized by oxidative stress and inflammation. In the present study, we explored the relationship of redox status vs. that of circulating inflammation-related factors with other biomarkers in patients with IGAN.

METHODS

This is a case-control study comparing patients with IGAN (Stage 1-4) to healthy controls. Forty patients and 40 controls were matched for age and sex. Two circulating dynamic redox parameters were analysed: oxidized free cysteine (Cys) and nitrate. Thirty-seven inflammation-related factors were measured in serum.

RESULTS

The patients had elevated levels of oxidized free Cys and nitrate, indicating the presence of oxidative stress. Nine circulating inflammation-related factors were higher in the serum of patients than in that of controls. The most important factors were APRIL, MMP-3, osteopontin, TNFR1 and TWEAK. Inflammation-related factors were positively correlated with oxidized free Cys, nitrate, creatinine and parathyroid hormone (PTH) in the patients. The correlation coefficients of Latent Inflammatory Factor vs. oxidized free Cys and nitrate were r = 0.43 (p = 0.007) and r = 0.51 (p = 0.001), respectively. This finding persisted after adjusting for the glomerular filtration rate.

CONCLUSIONS

Patients with IGAN had disturbed redox status. Several circulating inflammation-related factors were elevated, suggesting activation of the non-canonical NF-kB pathway. There was a positive relationship between systemic redox status and the level of inflammation-related factors, partially independent of GFR. The present findings raise the question of whether circulating oxidized free Cys and/or nitrate may be employed as prognostic biomarkers for IGAN in the future.

Pentraxin 3 in primary percutaneous coronary intervention for ST elevation myocardial infarction is associated with early irreversible myocardial damage : Kinetic profile, relationship to interleukin 6 and infarct size

Background

The inflammatory marker long pentraxin 3 (PTX3) has been shown to be a strong predictor of 30-day and one-year mortality after acute myocardial infarction. The aim of this study was to evaluate the kinetic profile of PTX3 and its relationship with interleukin 6 (IL-6), high-sensitive C-reactive protein (hs-CRP) and infarct size.

Methods

PTX3, IL-6 and hs-CRP were measured at predefined time points, at baseline (before percutaneous coronary intervention (PCI)), at 12 and 72 hours after PCI in 161 patients with first-time ST elevation myocardial infarction (STEMI).

Results

PTX3 and IL-6 levels increased in the early phase, followed by a gradual decrease between 12 and 72 hours. There were statistically significant correlations between PTX3 and IL-6 in general, for all time points and for changes over time (0–72 hours). In a linear mixed model, PTX3 predicted IL-6 (p < 0.001). PTX3 is also correlated with hs-CRP in general, and at each time point post PCI, except at baseline. PTX3, IL-6 and hs-CRP were all significantly correlated with infarct size in general, and at the peak time point for maximum troponin I. In addition, there was a modest correlation between IL-6 levels at baseline and infarct size at 72 hours after PCI (ρ = 0.23, p = 0.006).

Conclusions

PTX3 had a similar kinetic profile to IL-6, with an early increase and decline, and was statistically significantly correlated with markers of infarct size in STEMI patients post primary PCI. Baseline levels of IL-6 only predicted infarct size at 72 hours post PCI.

Cerebrospinal fluid cytokines and chemokines in children with Lyme neuroborreliosis; pattern and diagnostic utility

BACKGROUND

Lyme neuroborreliosis (LNB) is characterized by cerebrospinal fluid (CSF) inflammation with several cytokines/chemokines and B-lymphocytes. Clinically, LNB in children may be difficult to discriminate from non-Lyme aseptic meningitis (NLAM). We aimed to identify CSF cytokine/chemokine patterns in children with LNB, NLAM and controls and elucidate the diagnostic value of these cytokines/chemokines alone or in combination to discriminate between LNB and NLAM.

METHODS

Children with symptoms suggestive of LNB were included prospectively and categorized as LNB, NLAM or controls (no pleocytosis). Cytokines/chemokines in CSF were measured by multiplex bead assays and levels were compared between the three groups by nonparametric statistical tests. Previous results from the same children on the established biomarker, CXCL13, were included in the statistical analyses. The diagnostic properties of cytokines/chemokines to discriminate between LNB and NLAM were determined by receiver operating characteristic curve analyses with estimates of area under curve (AUC). To explore diagnostic properties of combinations of cytokines/chemokines, prediction models based on logistic regression were used.

RESULTS

We included 195 children with LNB (n = 77), NLAM (n = 12) and controls (n = 106). Children with LNB had higher CSF levels of CCL19, CCL22 and CXCL13 compared to NLAM and controls, whereas INFγ was higher in NLAM than in LNB and controls. CXCL13 was the superior single cytokine/chemokine to discriminate LNB from NLAM (AUC 0.978). The combination CXCL13/CCL19 (AUC 0.992) may possibly improve the specificity for LNB, especially for children with moderate CXCL13 levels.

CONCLUSIONS

The intrathecal immune reaction in LNB is characterized by B cell associated chemokines. Whether the combination CXCL13/CCL19 further improves discrimination between LNB and NLAM beyond the diagnostic improvements by CXCL13 alone needs to be tested in new studies.

Public knowledge and expectations about dispatcher assistance in out-of-hospital cardiac arrest

AIM

To assess the factors associated with the knowledge and expectations among the general public about dispatcher assistance in out-of-hospital cardiac arrest incidents.

BACKGROUND

In medical dispatch centres, emergency calls are frequently operated by specially trained nurses as dispatchers. In cardiac arrest incidents, efficient communication between the dispatcher and the caller is vital for prompt recognition and treatment of the cardiac arrest.

DESIGN

A cross-sectional observational survey containing six questions and seven demographic items.

METHOD

From January-June 2017 we conducted standardized interviews among 500 members of the general public in Norway. In addition to explorative statistical methods, we used multivariate logistic analysis.

RESULTS

Most participants expected cardiopulmonary resuscitation instructions, while few expected "help in deciding what to do." More than half regarded the bystanders present to be responsible for the decision to initiate cardiopulmonary resuscitation. Most participants were able to give the correct emergency medical telephone number. The majority knew that the emergency call would not be terminated until the ambulance arrived at the scene. However, only one-third knew that the emergency telephone number operator was a trained nurse.

CONCLUSION

The public expect cardiopulmonary resuscitation instructions from the emergency medical dispatcher. However, the majority assume it is the responsibility of the bystanders to make the decision to initiate cardiopulmonary resuscitation or not. Based on these findings, cardiopulmonary resuscitation training initiatives and public campaigns should focus more on the role of the emergency medical dispatcher as the team leader of the first resuscitation team in cardiac arrest incidents.

Dopaminergic and Opioid Pathways Associated with Impulse Control Disorders in Parkinson's Disease

Introduction

Impulse control disorders (ICDs) are frequent non-motor symptoms in Parkinson’s disease (PD), with potential negative effects on the quality of life and social functioning. ICDs are closely associated with dopaminergic therapy, and genetic polymorphisms in several neurotransmitter pathways may increase the risk of addictive behaviors in PD. However, clinical differentiation between patients at risk and patients without risk of ICDs is still troublesome. The aim of this study was to investigate if genetic polymorphisms across several neurotransmitter pathways were associated with ICD status in patients with PD.

Methods

Whole-exome sequencing data were available for 119 eligible PD patients from the Norwegian ParkWest study. All participants underwent comprehensive neurological, neuropsychiatric, and neuropsychological assessments. ICDs were assessed using the self-report short form version of the Questionnaire for Impulsive-Compulsive Disorders in PD. Single-nucleotide polymorphisms (SNPs) from 17 genes were subjected to regression with elastic net penalization to identify candidate variants associated with ICDs. The area under the curve of receiver-operating characteristic curves was used to evaluate the level of ICD prediction.

Results

Among the 119 patients with PD included in the analysis, 29% met the criteria for ICD and 63% were using dopamine agonists (DAs). Eleven SNPs were associated with ICDs, and the four SNPs with the most robust performance significantly increased ICD predictability (AUC = 0.81, 95% CI 0.73–0.90) compared to clinical data alone (DA use and age; AUC = 0.65, 95% CI 0.59–0.78). The strongest predictive factors were rs5326 in DRD1, which was associated with increased odds of ICDs, and rs702764 in OPRK1, which was associated with decreased odds of ICDs.

Conclusion

Using an advanced statistical approach, we identified SNPs in nine genes, including a novel polymorphism in DRD1, with potential application for the identification of PD patients at risk for ICDs.

Bayesian estimation of HIV-1 dynamics in vivo

Statistical analysis of viral dynamics in HIV-1 infected patients undergoing structured treatment interruptions were performed using a novel model that accounts for treatment efficiency as well as total CD8+ T cell counts. A brief review of parameter estimates obtained in other studies is given, pointing to a considerable variation in the estimated values. A Bayesian approach to parameter estimation was used with longitudinal measurements of CD4+ and CD8+ T cell counts and HIV RNA. We describe an estimation procedure which uses spline approximations of CD8+ T cells dynamics. This approach reduces the number of parameters that must be estimated and is especially helpful when the CD8+ T cells growth function has a delayed dependence on the past. Seven important parameters related to HIV-1 in-host dynamics were estimated, most of them treated as global parameters across the group of patients. The estimated values were mainly in keeping with the estimates obtained in other reports, but our paper also introduces the estimates of some new parameters which supplement the current knowledge. The method was also tested on a simulated data set.