Published in 2020

Long-term exposure to air pollution and stroke incidence: A Danish Nurse cohort study

Amini, H., Dehlendorff, C., Lim, Y. H., Mehta, A., Jørgensen, J. T., Mortensen, L. H., Westendorp, R., Hoffmann, B., Loft, S., Cole-Hunter, T., Bräuner, E. V., Ketzel, M., Hertel, O., Brandt, J., Solvang Jensen, S., Christensen, J. H., Geels, C., Frohn, L. M., Backalarz, C., Simonsen, M. K. & Andersen, Z. J., 1 sep. 2020, I: Environment International. 142, s. 105891 105891.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Ambient air pollution has been linked to stroke, but few studies have examined in detail stroke subtypes and confounding by road traffic noise, which was recently associated with stroke. Here we examined the association between long-term exposure to air pollution and incidence of stroke (overall, ischemic, hemorrhagic), adjusting for road traffic noise. In a nationwide Danish Nurse Cohort consisting of 23,423 nurses, recruited in 1993 or 1999, we identified 1,078 incident cases of stroke (944 ischemic and 134 hemorrhagic) up to December 31, 2014, defined as first-ever hospital contact. The full residential address histories since 1970 were obtained for each participant and the annual means of air pollutants (particulate matter with diameter < 2.5 µm and < 10 µm (PM
2.5 and PM
10), nitrogen dioxide (NO
2), nitrogen oxides (NOx)) and road traffic noise were determined using validated models. Time-varying Cox regression models were used to estimate hazard ratios (HR) (95% confidence intervals (CI)) for the associations of one-, three, and 23-year running mean of air pollutants with stroke adjusting for potential confounders and noise. In fully adjusted models, the HRs (95% CI) per interquartile range increase in one-year running mean of PM
2.5 and overall, ischemic, and hemorrhagic stroke were 1.12 (1.01-1.25), 1.13 (1.01-1.26), and 1.07 (0.80-1.44), respectively, and remained unchanged after adjustment for noise. Long-term exposure to ambient PM
2.5 was associated with the risk of stroke independent of road traffic noise.

Originalsprog Engelsk
Artikelnummer 105891
Tidsskrift Environment International
Vol/bind 142
Sider (fra-til) 105891
ISSN 0160-4120
DOI
Status Udgivet - 1 sep. 2020

BACKGROUND/OBJECTIVES: To investigate the associations between indicators of obesity and fat distribution, such as body mass index (BMI), fat mass, and skinfold measures during preschool age, and attained height at school entry.

SUBJECTS/METHODS: The Healthy Start primary intervention study comprised 1100 obesity-prone preschool children from the greater Copenhagen area, with a mean [standard deviation (SD)] age of 4.0 (1.1) years at baseline. Anthropometry was measured by trained health professionals at baseline (preschool age) and follow-up height at school entry was gathered by school nurses. Prospective associations between body fat measures and later attained height were examined using generalized linear models with adjustments for potential confounders.

RESULTS: Greater adiposity at preschool age was directly associated with a higher attained height at follow-up at school-age, when adjusting for confounders. A baseline difference of one BMI unit was associated with a greater attained height of 0.8 cm [(95% confidence interval (CI) 0.5; 1.2]. Furthermore, a difference of 1 mm in the sum of four skinfolds measured at baseline was associated with a greater attained height of 0.1 cm (95% CI 0.03; 0.2) at follow-up. Children with overweight or obesity at baseline attained a significantly higher height of 2.9 (95% CI 1.6; 4.1) cm at follow-up after full adjustment than normal weight children.

CONCLUSIONS: Our results supports that greater adiposity at preschool age is associated with greater tallness. Although a greater height is assumed to be desirable, accelerated growth in childhood may in itself be a risk factor for obesity later in life.

Originalsprog Engelsk
Tidsskrift European Journal of Clinical Nutrition
Vol/bind 74
Udgave nummer 3
Sider (fra-til) 465-471
Antal sider 7
ISSN 0954-3007
DOI
Status Udgivet - mar. 2020

Low-Dose Naltrexone for the Treatment of Fibromyalgia: Investigation of Dose-Response Relationships

Bruun-Plesner, K., Blichfeldt-Eckhardt, M. R., Vaegter, H. B., Lauridsen, J. T., Amris, K. & Toft, P., 1 okt. 2020, I: Pain medicine (Malden, Mass.). 21, 10, s. 2253-2261 9 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVE: This study explores dose-response relationships when treating fibromyalgia with low-dose naltrexone.

DESIGN: A single-blinded clinical trial was carried out using the "up-and-down" method.

SUBJECTS: Subjects included women with a diagnosis of fibromyalgia aged 18-60 years who had been referred to treatment at a public pain clinic at a Danish university hospital.

METHODS: The test doses were in the range 0.75-6 mg, and the dosing interval was 0.75 mg. The method was sequential and allowed predicting the dose effective in 50% (ED50) and 95% (ED95) of the subjects when the dose had shifted direction 10 times, and six pairs of "up-and-down" data were available.

RESULTS: A total of 27 subjects were included in the study; two subjects were withdrawn. After inclusion of 25 evaluable subjects, the dose estimates were calculated as 3.88 mg for ED50 and 5.40 mg for ED95. As a secondary outcome, the effects on 10 common fibromyalgia symptoms were evaluated. A high interindividual variation was observed both in the symptom presentation at baseline and in which symptoms were reduced by low-dose naltrexone.

CONCLUSIONS: This study is the first to explore dose-response relationships in the treatment of fibromyalgia with low-dose naltrexone. Future placebo-controlled randomized clinical trials are needed, and according to our findings, 4.5 mg, which has previously been used, seems to be a relevant test dose. We recommend that future studies include additional nonpain fibromyalgia symptoms as outcome measures.

Originalsprog Engelsk
Tidsskrift Pain medicine (Malden, Mass.)
Vol/bind 21
Udgave nummer 10
Sider (fra-til) 2253-2261
Antal sider 9
ISSN 1526-2375
DOI
Status Udgivet - 1 okt. 2020

Bibliografisk note

© The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

BACKGROUND: We aimed to synthesise qualitative studies exploring medication-related experiences of polypharmacy among patients with multimorbidity.

METHODS: We systematically searched PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature in February 2020 for primary, peer-reviewed qualitative studies about multimorbid patients' medication-related experiences with polypharmacy, defined as the use of four or more medications. Identified studies were appraised for methodological quality by applying the Critical Appraisal Skills Programme checklist for qualitative research, and data were extracted and synthesised by the meta-aggregation approach.

RESULTS: We included 13 qualitative studies, representing 499 patients with polypharmacy and a wide range of chronic conditions. Overall, most Critical Appraisal Skills Programme items were reported in the studies. We extracted 140 findings, synthesised these into 17 categories, and developed five interrelated syntheses: (1) patients with polypharmacy are a heterogeneous group in terms of needing and appraising medication information; (2) patients are aware of the importance of medication adherence, but it is difficult to achieve; (3) decision-making about medications is complex; (4) multiple relational factors affect communication between patients and physicians, and these factors can prevent patients from disclosing important information; and (5) polypharmacy affects patients' lives and self-perception, and challenges with polypharmacy are not limited to practical issues of medication-taking.

DISCUSSION: Polypharmacy poses many challenges to patients, which have a negative impact on quality of life and adherence. Thus, when dealing with polypharmacy patients, it is crucial that healthcare professionals actively solicit individual patients' perspectives on challenges related to polypharmacy. Based on the reported experiences, we recommend that healthcare professionals upscale communicative efforts and involve patients' social network on an individualised basis to facilitate shared decision-making and treatment adherence in multimorbidpatients with polypharmacy.

Originalsprog Engelsk
Tidsskrift BMJ Open
Vol/bind 10
Udgave nummer 9
Sider (fra-til) e036158
ISSN 2044-6055
DOI
Status Udgivet - 6 sep. 2020

Bibliografisk note

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Motion-Based Technology for People With Dementia Training at Home: Three-Phase Pilot Study Assessing Feasibility and Efficacy

Petersen, J. D., Larsen, E. L., la Cour, K., von Bülow, C., Skouboe, M., Christensen, J. R. & Waldorff, F. B., 26 aug. 2020, I: JMIR mental health. 7, 8, s. e19495

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Persons with dementia tend to be vulnerable to mobility challenges and hence face a greater risk of fall and subsequent fractures, morbidity, and mortality. Motion-based technologies (MBTs), also called sensor-based technologies or virtual reality, have the potential for assisting physical exercise and training as a part of a disease management and rehabilitation program, but little is known about its' use for people with dementia.

OBJECTIVE: The purpose of this pilot study was to investigate the feasibility and efficacy of MBT physical training at home for people with dementia.

METHODS: A 3-phase pilot study: (1) baseline start-up, (2) 15 weeks of group training at a local care center twice a week, and (3) 12 weeks of group training reduced to once a week, supplemented with individual MBT training twice a week at home. A total of 26 people with dementia from a municipality in Southern Denmark were eligible and agreed to participate in this study. Three withdrew from the study, leaving 23 participants for the final analysis. Feasibility was measured by the percentage of participants who trained with MBT at home, and their completion rate of total scheduled MBT sessions. Efficacy was evaluated by physical function, measured by Sit-to-Stand (STS), Timed-Up-and-Go (TUG), 6-minute Walk Test (6MW), and 10-meter Dual-task Walking Test (10MDW); cognitive function was measured by Mini-Mental State Examination (MMSE) and Neuropsychiatric Inventory-Questionnaire (NPI-Q); and European Quality of Life 5 dimensions questionnaire (EQOL5) was used for measuring quality of life. Descriptive statistics were applied accordingly. Wilcoxon signed-rank and rank-sum tests were applied to explore significant differences within and between the groups.

RESULTS: As much as 12 of 23 participants (52%) used the supplemental MBT training at home. Among them, 6 (50%) completed 75% or more scheduled sessions, 3 completed 25% or less, and 3 completed between 25% and 75% of scheduled sessions. For physical and cognitive function tests, supplementing with MBT training at home showed a tendency of overall stabilization of scores among the group of participants who actively trained with MBT; especially, the 10MDW test even showed a significant improvement from 9.2 to 7.1 seconds (P=.03). We found no positive effect on EQOL5 tests.

CONCLUSIONS: More than half of the study population with dementia used MBT training at home, and among them, half had an overall high adherence to the home training activity. Physical function tended to remain stable or even improved among high-adherence MBT individuals. We conclude that MBT training at home may be feasible for some individuals with dementia. Further research is warranted.

Originalsprog Engelsk
Tidsskrift JMIR mental health
Vol/bind 7
Udgave nummer 8
Sider (fra-til) e19495
ISSN 2368-7959
DOI
Status Udgivet - 26 aug. 2020

Mucoide cyster på fingrene

Bartels, E. M., 2020, I: Ugerskrift for Læger. v02200110

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Originalsprog Dansk
Tidsskrift Ugerskrift for Læger
Vol/bind v02200110
ISSN 0041-5782
Status Udgivet - 2020

Multi-frequency bioimpedance: a non-invasive tool for muscle-health assessment of adults with cerebral palsy

Pingel, J., Harrison, A., Von Walden, F., Hjalmarsson, E. & Bartels, E. M., sep. 2020, I: Journal of muscle research and cell motility. 41, 2-3, s. 211-219 9 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Muscle contracture development is a major complication for individuals with cerebral palsy (CP) and has lifelong implications. In order to recognize contracture development early and to follow up on preventive interventions aimed at muscle health development, non-invasive, and easy to use methods are needed. The aim of the present study was to assess whether multi-frequency Bioimpedance (mfBIA) can be used to detect differences between skeletal muscle of individuals with CP and healthy controls. The mfBIA technique was applied to the medial gastrocnemius muscle of n = 24 adults with CP and n = 20 healthy controls of both genders. The phase angle (PA) and the centre frequency (fc) were significantly lower in individuals with CP when compared to controls; PA: - 25% for women and - 31.8% for men (P < 0.0001); fc: - 5.6% for women and - 5.2% for men (P < 0.009). The reactance (Xc) and the extracellular resistance (Re) of skeletal muscle from individuals with CP were significantly higher when compared to controls; Xc: + 9.9% for women and + 28.9% for men (P < 0.0001); Re: + 39.7% for women and + 91.2% for men (P < 0.0001). The present study shows that several mfBIA parameters differ significantly between individuals with CP and healthy controls. Furthermore, these changes correlated significantly with the severity of CP, as assessed using the GMFCS scale. The present data indicate that mfBIA shows promise in terms of being a useful diagnostic tool, capable of characterizing muscle health and its development in individuals with cerebral palsy.

Originalsprog Engelsk
Tidsskrift Journal of muscle research and cell motility
Vol/bind 41
Udgave nummer 2-3
Sider (fra-til) 211-219
Antal sider 9
ISSN 0142-4319
DOI
Status Udgivet - sep. 2020

Muscle function assessed by the non-invasive method acoustic myography (AMG) in a Danish group of healthy adults

Bartels, E. M., Olsen, J. K., Littrup Andersen, E., Danneskiold-Samsøe, B., Bliddal, H., Kristensen, L. E. & Harrison, A. P., 2020, ScienceDirect.

Publikation: AndetUdgivelser på nettet - Net-publikationForskningpeer review

Originalsprog Engelsk
Publikationsdato 2020
Udgiver ScienceDirect
Status Udgivet - 2020

Neonatal vitamin D levels and cognitive ability in young adulthood

Specht, I. O., Janbek, J., Thorsteinsdottir, F., Frederiksen, P. & Heitmann, B. L., aug. 2020, I: European Journal of Nutrition. 59, 5, s. 1919-1928 10 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

PURPOSE: Intelligence has a strong influence on life capability, and thus, identifying early modifiable risk factors related to cognitive ability is of major public health interest. During pregnancy, vitamin D is transported from the mother to the fetus through the placenta in the form of 25-hydroxyvitamin D (25(OH)D). Levels of 25(OH)D have in some studies been associated with childhood neurodevelopment; however, results from all studies are not in agreement. We investigated if neonatal 25(OH)D3 concentrations were associated with Børge Priens IQ test score (BPP) in young adulthood.

METHODS: In this nested cohort study, 25(OH)D3 concentrations were measured in dried blood spots from 818 newborns. We followed the children for their IQ BPP test scores in the Danish Conscription Register, which holds information on test results from the BPP test on individuals who have been recruited for Danish mandatory military draft board examination. Using general linear models, we investigated the crude and adjusted relationship between quintiles of 25(OH)D3 concentrations and BPP IQ test results.

RESULTS: The study population consisted of 95.8% men, with a mean age of 19.4 years. The median and range of the neonatal 25(OH)D3 levels were 26.2 nmol/L (0-104.7 nmol/L). The overall Wald test did not show an association between neonatal 25(OH)D3 levels and BPP IQ scores (p = 0.23); however, individuals within the 3rd (BPP IQ = 101.0, 98.0-103.9) and 4th (BPP IQ = 101.2, 99.1-104.3) quintiles had slightly higher BPP IQ scores than individuals from the first quintile (BPP IQ = 97.6, 94.6-100.6).

CONCLUSIONS: Our results support the hypothesis that individuals with the lowest levels of neonatal vitamin D might have slightly lower BPP. However, more studies are needed with larger study populations to confirm our results.

Originalsprog Engelsk
Tidsskrift European Journal of Nutrition
Vol/bind 59
Udgave nummer 5
Sider (fra-til) 1919-1928
Antal sider 10
ISSN 1436-6207
DOI
Status Udgivet - aug. 2020

Neonatal vitamin D status and myopia in young adult men

Specht, I. O., Jacobsen, N., Frederiksen, P. & Heitmann, B. L., 2020, I: Acta Ophthalmologica. 98, 5, s. 500-505 6 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

PURPOSE: The prevalence of myopia is increasing worldwide, and modifiable risk factors are thus important to identify. Season of birth has been associated with later myopia risk. Neonatal vitamin D status is highly dependent on season of birth due to maternal sun exposure late in gestation. We hypothesize that prenatal exposure to low levels of vitamin D can interfere with visual development in term-born infants and that this might contribute to adult visual dysfunction. The aim of this study was thus to compare neonatal vitamin D levels from stored dried blood spots taken shortly after birth among young term-born men with myopia (cases) and random controls with emmetropia.

METHODS: In this case-control study, we analysed neonatal 25(OH)D3 levels of 457 myopic male cases and 1280 emmetropic male controls assessed for myopia at the mandatory Danish conscript examination. Data were analysed using logistic regression analysis and results presented as crude and adjusted for potential confounders namely maternal age, maternal ethnicity, maternal and paternal education and season of birth.

RESULTS: We did not observe a seasonal variation in myopia risk, neither did we observe increased odds of myopia in relation to low neonatal 25(OH)D3 levels.

CONCLUSION: The rapid increase in myopia does not seem related to neonatal vitamin D status.

Originalsprog Engelsk
Tidsskrift Acta Ophthalmologica
Vol/bind 98
Udgave nummer 5
Sider (fra-til) 500-505
Antal sider 6
ISSN 1755-375X
DOI
Status Udgivet - 2020

Bibliografisk note

© 2020 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Neonatal Vitamin D Status and Risk of Asthma in Childhood: Results from the D-Tect Study

Thorsteinsdottir, F., Cardoso, I., Keller, A., Stougaard, M., Frederiksen, P., Cohen, A. S., Maslova, E., Jacobsen, R., Backer, V. & Heitmann, B. L., 21 mar. 2020, I: Nutrients. 12, 3, 842.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: low vitamin D status in pregnancy can influence the offspring's lung function and contribute to childhood asthma development. The objective of this study was to examine the influence of neonatal vitamin D status on the development of asthma among children age 3-9 years in a large population sample.

METHOD: in a case-cohort study utilizing a Danish biobank and register data we examined the association between neonatal 25-hydroxyvitamin D3 (25(OH)D3) concentrations and incidence of asthma among children aged 3-9 years. Cases of asthma (n = 911) were randomly selected among all cases of asthma in the Danish National Patient Register from children born between 1992 and 2002. The sub-cohort (n = 1423) was randomly selected among all children born in the same period. We used a weighted Cox proportional hazard model assessing the hazard of first asthma diagnoses by quintiles of 25(OH)D3.

RESULTS: the median 25(OH)D3 (interquartile range) for asthma cases was 23 nmol/L (14-35) and the sub-cohort 25 nmol/L (14-40). The hazard ratio for developing asthma between ages 3 and 9 years was lower for children in the fifth quintile of neonatal 25(OH)D3 compared to children in the first quintile, both in the unadjusted (0.61 95% CI: 0.46-0.80) and adjusted (0.55 95% CI: 0.39-0.77) analyses.

CONCLUSION: the results from our study suggest that higher neonatal vitamin D concentration may reduce the risk of developing childhood asthma at ages 3-9 years, indicating that neonatal vitamin D status as a proxy of vitamin D status during the prenatal period is important for normal immune- and lung development.

Originalsprog Engelsk
Artikelnummer 842
Tidsskrift Nutrients
Vol/bind 12
Udgave nummer 3
ISSN 2072-6643
DOI
Status Udgivet - 21 mar. 2020

Neuromuscular Exercises Improve Shoulder Function More Than Standard Care Exercises in Patients With a Traumatic Anterior Shoulder Dislocation: A Randomized Controlled Trial

Eshoj, H. R., Rasmussen, S., Frich, L. H., Hvass, I., Christensen, R., Boyle, E., Jensen, S. L., Søndergaard, J., Søgaard, K. & Juul-Kristensen, B., jan. 2020, I: Orthopaedic Journal of Sports Medicine. 8, 1, s. 2325967119896102

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Background: There is an important gap in knowledge about the effectiveness of nonoperative treatment (exercise) for patients with traumatic primary and recurrent anterior shoulder dislocations (ASDs).

Purpose/Hypothesis: The purpose of this study was to assess the efficacy and safety of physical therapist-supervised, shoulder instability neuromuscular exercise (SINEX) versus self-managed, home-based, standard care shoulder exercise (HOMEX) in patients with traumatic ASDs. The hypothesis was that SINEX would have a larger effect and fewer adverse events compared with HOMEX.

Study Design: Randomized controlled trial; Level of evidence, 2.

Methods: A total of 56 participants with radiographically verified, trauma-initiated primary or recurrent ASDs and self-reported decreased shoulder function were randomized to 12 weeks of either SINEX or HOMEX. The SINEX program consisted of 7 exercises, individually progressing from basic (2 × 20 repetitions each day) to elite (2 × 10 repetitions, 3 times weekly). The HOMEX program included 5 shoulder exercises performed 3 times weekly (2 × 10 repetitions). The primary outcome was the Western Ontario Shoulder Instability Index (WOSI) score, ranging from 0 (best possible) to 2100. The between-group minimal clinically important difference at 12 weeks was 250 points. Secondary outcomes included WOSI subdomain scores, patient-reported ratings of kinesiophobia and pain, objective shoulder function, patient satisfaction, and number of adverse events.

Results: The between-group mean difference in the WOSI total score at 12 weeks significantly favored SINEX over HOMEX (-228.1 [95% CI, -430.5 to -25.6]). SINEX was furthermore superior to HOMEX in most of the secondary outcomes (3/4 subdomains of the WOSI and pain level during the past 7 days as well as clinical signs of anterior shoulder instability). Also, although not statistically significant, less than half the proportion of the SINEX patients compared with the HOMEX patients (3/27 [11%] vs 6/24 [25%], respectively; P = .204) underwent or were referred for shoulder stabilizing surgery. Satisfaction with both exercise programs was high, and no serious adverse events were reported.

Conclusion: Neuromuscular shoulder exercise (SINEX) was superior to standard care exercise (HOMEX) in patients with traumatic ASDs. Further long-term follow-ups on treatment effects are needed.

Registration: NCT02371928 (ClinicalTrials.gov identifier).

Originalsprog Engelsk
Tidsskrift Orthopaedic Journal of Sports Medicine
Vol/bind 8
Udgave nummer 1
Sider (fra-til) 2325967119896102
ISSN 2325-9671
DOI
Status Udgivet - jan. 2020

Bibliografisk note

© The Author(s) 2020.

Novel insights into cerebral palsy

Bartels, E. M., Korbo, L. & Harrison, A. P., sep. 2020, I: Journal of muscle research and cell motility. 41, 2-3, s. 265-267 3 s.

Publikation: Bidrag til tidsskriftKommentar/debatForskningpeer review

Cerebral palsy (CP) is a neurodevelopmental disorder characterized by abnormalities of muscle tone, movement and motor skills, and is attributed to injury to the developing brain. CP affects about 1 in 500 neonates. CP shows clinical features which evolve with age, and these may over time lead to deterioration of motor function although the lesion to the developing brain is non-progressive. The underlying causes for CP remain unclear. Based on recent research we are able to give a physiological explanation on the appearance and development of the condition. The damage to the central nervous system causes a change in collagen structure, with a higher level of deposition of collagen around the muscles, increasing throughout life. Assuming this premise is correct, the question is, will it by any treatment be possible to delay or prevent this collagen accumulation in the CP muscles, thereby giving CP patients a better prognosis in the future.

Originalsprog Engelsk
Tidsskrift Journal of muscle research and cell motility
Vol/bind 41
Udgave nummer 2-3
Sider (fra-til) 265-267
Antal sider 3
ISSN 0142-4319
DOI
Status Udgivet - sep. 2020

Nutrients, Diet, and Other Factors in Prenatal Life and Bone Health in Young Adults: A Systematic Review of Longitudinal Studies

Jensen, K. H., Riis, K. R., Abrahamsen, B. & Händel, M. N., 19 sep. 2020, I: Nutrients. 12, 9, s. 1-19 19 s., 2866.

Publikation: Bidrag til tidsskriftReviewForskningpeer review

Optimizing skeletal health in early life has potential effects on bone health later in childhood and in adulthood. We aimed to evaluate the existing evidence that maternal exposures during pregnancy have an impact on the subsequent bone health among offspring in young adults aged between 16 and 30 years. The protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42019126890). The search was conducted up to 2 April 2019. We included seven observational prospective cohort studies that examined the association between maternal dietary factors, vitamin D concentration, age, preeclampsia, and smoking with any bone indices among offspring. The results indicated that high concentrations of maternal vitamin D; low fat intake; and high intakes of calcium, phosphorus, and magnesium may increase the bone mineral density in offspring at age 16. Evidence also suggests that the offspring of younger mothers may have a higher peak bone mass. It remains inconclusive whether there is an influence of preeclampsia or maternal smoking on bone health among young adults. Our assessment of internal validity warrants a cautious interpretation of these results, as all of the included studies were judged to have serious risks of bias. High-quality studies assessing whether prenatal prognostic factors are associated with bone health in young adults are needed.

Originalsprog Engelsk
Artikelnummer 2866
Tidsskrift Nutrients
Vol/bind 12
Udgave nummer 9
Sider (fra-til) 1-19
Antal sider 19
ISSN 2072-6643
DOI
Status Udgivet - 19 sep. 2020

Outcome domains reported in calcium pyrophosphate deposition studies: A scoping review by the OMERACT CPPD working group

Cai, K., Fuller, A., Hensey, O., Grossberg, D., Christensen, R., Shea, B., Singh, J. A., Abhishek, A., Tedeschi, S. & Dalbeth, N., aug. 2020, I: Seminars in Arthritis and Rheumatism. 50, 4, s. 719-727 9 s.

Publikation: Bidrag til tidsskriftReviewForskningpeer review

INTRODUCTION: Although calcium pyrophosphate deposition (CPPD) is common, there are no validated outcome domains and/or measurements for CPPD studies. The aim of this work was to identify domains that have been reported in prior clinical studies in CPPD, to inform the development of a core set of domains for CPPD studies.

METHODS: We performed a scoping literature review for clinical studies in CPPD, searching in Medline (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases; published from January 1, 1946 to January 7, 2020. All reported outcomes and study design data were extracted and mapped to the core areas and domains as defined by the OMERACT Filter 2.1.The protocol was registered on PROSPERO (CRD: 42019137075; 09-07-2019).

FINDINGS: There were 112 papers identified, comprising of 109 observational studies and three randomized controlled trials. Most studies reported clinical presentations of OA with CPPD or acute CPP crystal arthritis. Outcomes that mapped to 22 domains were identified; the most frequently reported measures mapped to the following domains/sub-domains: imaging (joint damage on imaging tests - 59 studies; joint calcification on imaging tests - 28 studies), joint pain (26 studies), response to treatment (23 studies), side effects of treatment (15 studies), inflammation in the joint fluid or blood (ESR or C-reactive protein - 12 studies; synovial fluid markers - 4 studies; other blood markers - 2 studies), overall function (14 studies), joint swelling (12 studies) and range of joint movement (10 studies). Very few studies mapped to domains related to life impact, societal/resource use or longevity.

CONCLUSION: There is substantial variability in outcomes reported in CPPD studies. Outcomes that map to imaging manifestations, joint pain and response to treatment domains are most often reported.

Originalsprog Engelsk
Tidsskrift Seminars in Arthritis and Rheumatism
Vol/bind 50
Udgave nummer 4
Sider (fra-til) 719-727
Antal sider 9
ISSN 0049-0172
DOI
Status Udgivet - aug. 2020

Bibliografisk note

Copyright © 2020 Elsevier Inc. All rights reserved.

Patient, physiotherapist and surgeon endorsement of the core domain set for total hip and total knee replacement in Germany: a study protocol for an OMERACT initiative

Prill, R., Singh, J. A., Seeber, G. H., Nielsen, S. M., Goodman, S., Michel, S., Kopkow, C., Schulz, R., Choong, P. & Hommel, H., 28 jun. 2020, I: BMJ Open. 10, 6, s. e035207

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

INTRODUCTION: There is a lack of harmonising measures for clinical trials on total joint replacement (TJR) that would allow for results from TJR studies to be compared or pooled. The Outcome Measures in Rheumatology (OMERACT) TJR core domain set is already endorsed among patients and physicians in the USA and Australia. Physiotherapists use different types of measurements compared to orthopaedic surgeons while both make substantial contributions to research in the field of TJR. To achieve consensus on core measurements sets, patients, physiotherapists and orthopaedic surgeons need to achieve consensus on the core domains for TJR trials.

METHODS AND ANALYSIS: For this multistage study, first, the OMERACT TJR core domain set survey will be translated to German and validated according to WHO guidelines. Next, the TJR core domain set will be considered for endorsement in different German stakeholder groups including patients, physiotherapists and orthopaedic surgeons.

ETHICS AND DISSEMINATION: Ethical approval for this protocol was given by the ethics committee of the Brandenburg University of Technology Cottbus-Senftenberg (BTU-CS, EK 2019-2). This article is based on the protocol version 2.5 from 6 May 2020. Anonymous data will be presented only. We will publish the results in peer-reviewed publications and at international conferences.

TRIAL REGISTRATION NUMBER: German Clinical Trials Registry (DRKS00016015).

Originalsprog Engelsk
Tidsskrift BMJ Open
Vol/bind 10
Udgave nummer 6
Sider (fra-til) e035207
ISSN 2044-6055
DOI
Status Udgivet - 28 jun. 2020

Patients With Persistent Low Back Pain and Nerve Root Involvement: To Operate, Or Not To Operate, That Is The Question

Petersen, T., Juhl, C. B. & Fournier, G. L., apr. 2020, I: Spine. 45, 7, s. 483-490 8 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

STUDY DESIGN: Prospective cohort study.

OBJECTIVE: The aims of this study were to evaluate the outcome of surgical and nonsurgical treatment for patients with lumbar herniated disc (LHD) or lumbar spinal stenosis (LSS) after 2 years and to identify predictors for nonsuccess.

SUMMARY OF BACKGROUND DATA: Studies regarding the clinician's ability to identify patients with a poor prognosis are not in concurrence and further studies are warranted.

METHODS: This study included 390 patients with LHD or LSS referred for surgical evaluation after unsuccessful conservative treatment. Nonsuccess was defined as a Roland-Morris Disability score above 4 (0-23) or a Numeric Rating Scale back and leg pain score above 20 (0-60). Uni- and multivariate logistic regression analyses were used to investigate potential predictive factors including sociodemographic characteristics, history findings, levels of pain and disability, and magnetic resonance imaging findings.

RESULTS: Rates of nonsuccess at 2 years were approximately 30% in surgically treated patients with LHD, approximately about 60% in patients with LSS for disability, and 30% and 40%, respectively for pain. For the main outcome variable, disability, in the final multiple logistic regression model, nonsuccess after surgery was associated with male sex (odds ratio [OR] 2.04, 95% confidence interval [CI]: 1.02-4.11, P = 0.04), low level of education (OR 2.60, 95% CI: 1.28-5.29, P = 0.01), high pain intensity (OR 3.06, 95% CI: 1.51-6.21, P < 0.01), and widespread pain (OR 3.59, 95% CI: 1.36-9.46, P = 0.01).

CONCLUSION: The results indicate that the prognosis for patients referred for surgery with persistent LHD or LSS and unsuccessful conservative treatment is substantially better when surgery is performed as opposed to not performed. The predictive value of the variables male sex, low level of education, high pain intensity, and widespread pain location found in our study are partly in accordance with results of previous studies. Thus, our results warrant further investigation until firm conclusions can be made.

LEVEL OF EVIDENCE: 3.

Originalsprog Engelsk
Tidsskrift Spine
Vol/bind 45
Udgave nummer 7
Sider (fra-til) 483-490
Antal sider 8
ISSN 0362-2436
DOI
Status Udgivet - apr. 2020

Patients with Rheumatoid Arthritis Acquire Sustainable Skills for Home Monitoring: A Prospective Dual-country Cohort Study (ELECTOR Clinical Trial I)

Skougaard, M., Bliddal, H., Christensen, R., Ellegaard, K., Nielsen, S. M., Zavada, J., Oreska, S., Krogh, N. S., Holm, C. C., Hetland, M. L., Vencovsky, J., Røgind, H., Taylor, P. C. & Gudbergsen, H., 1 maj 2020, I: Journal of Rheumatology. 47, 5, s. 658-667 10 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVE: In an eHealth setting, to investigate intra- and interrater reliability and agreement of joint assessments and Disease Activity Score using C-reactive protein (DAS28-CRP) in patients with rheumatoid arthritis (RA) and test the effect of repeated joint assessment training.

METHODS: Patients with DAS28-CRP ≤ 5.1 were included in a prospective cohort study (clinicaltrials.gov: NCT02317939). Intrarater reliability and agreement of patient-performed joint counts were assessed through completion of 5 joint assessments over a 2-month period. All patients received training on joint assessment at baseline; only half of the patients received repeated training. A subset of patients was included in an appraisal of interrater reliability and agreement comparing joint assessments completed by patients, healthcare professionals (HCP), and ultrasonography. Cohen's κ coefficients and intraclass correlation coefficients (ICC) were used for quantifying of reliability of joint assessments and DAS28-CRP. Agreement was assessed using Bland-Altman plots.

RESULTS: Intrarater reliability was excellent with ICC of 0.87 (95% CI 0.83-0.90) and minimal detectable change of 1.13. ICC for interrater reliability ranged between 0.69 and 0.90 (good to excellent). Patients tended to rate DAS28-CRP slightly higher than HCP. In patients receiving repeated training, a mean difference in DAS28-CRP of -0.08 was observed (limits of agreements of -1.06 and 0.90). After 2 months, reliability between patients and HCP was similar between groups receiving single or repeated training.

CONCLUSION: Patient-performed assessments of joints and DAS28-CRP in an eHealth home-monitoring solution were reliable and comparable with HCP. Patients can acquire the necessary skills to conduct a correct joint assessment after initial and thorough training. [clinicaltrials.gov (NCT02317939)].

Originalsprog Engelsk
Tidsskrift Journal of Rheumatology
Vol/bind 47
Udgave nummer 5
Sider (fra-til) 658-667
Antal sider 10
ISSN 0315-162X
DOI
Status Udgivet - 1 maj 2020

OBJECTIVE: To investigate the association between pain and perfusion in bone marrow lesions with and without cysts assessed dynamic contrast-enhanced (DCE)-MRI in patients with knee osteoarthritis.

SUBJECTS AND METHODS: In a cross-sectional setting, perfusion in bone marrow lesions was assessed using 3 Tesla MRI and correlated (Spearman's rank correlation) to pain using the knee injury and osteoarthritis outcome score (KOOS). Bone marrow lesions were assessed across the whole knee with DCE-MRI using heuristic variable and non-contrast-enhanced-MRI using MRI osteoarthritis knee score.

RESULTS: Data were available from 107 participants. The participants had a mean age of 60.8 years, mean BMI of 34.5 kg/m2, mean KOOS-pain of 63.7 (0-100 scale), and mean bone marrow lesion sum score of 6.5 (0-45 scale). The bivariate association between KOOS-pain and the heuristic perfusion variable time to peak in bone marrow lesions containing subchondral cysts showed a statistically significant correlation (r = 0.40; p = 0.002). The perfusion variables were not correlated with KOOS-pain in bone marrow lesions without cysts.

CONCLUSION: In this cross-sectional study, the rate of perfusion (TTP) in bone marrow lesions containing subchondral cysts was associated with pain in patients with knee OA. DCE-MRI has a potential to be used for separating subtypes of OA.

Originalsprog Engelsk
Tidsskrift Skeletal Radiology
Vol/bind 49
Udgave nummer 5
Sider (fra-til) 757-764
Antal sider 8
ISSN 0364-2348
DOI
Status Udgivet - maj 2020

Population characteristics as important contextual factors in rheumatological trials: an exploratory meta-epidemiological study from an OMERACT Working Group

Nielsen, S. M., Storgaard, H., Ellingsen, T., Shea, B. J., Wells, G. A., Welch, V. A., Furst, D. E., de Wit, M., Voshaar, M., Juhl, C. B., Boers, M., Escorpizo, R., Woodworth, T. G., Boonen, A., Bliddal, H., March, L. M., Tugwell, P. & Christensen, R., okt. 2020, I: Annals of the Rheumatic Diseases. 79, 10, s. 1269-1276 8 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVES: To explore whether trial population characteristics modify treatment responses across various interventions, comparators and rheumatic conditions.

METHODS: In this meta-epidemiological study, we included trials from systematic reviews available from the Cochrane Musculoskeletal Group published up to 23 April 2019 in Cochrane Library with meta-analyses of five or more randomised controlled trials (RCTs) published from year 2000. From trial reports, we extracted data on 20 population characteristics. For characteristics with sufficient data (ie, available for ≥2/3 of the trials), we performed multilevel meta-epidemiological analyses.

RESULTS: We identified 19 eligible systematic reviews contributing 187 RCTs (212 comparisons). Only age and sex were explicitly reported in ≥2/3 of the trials. Using information about the country of the trials led to sufficient data for five further characteristics, that is, 7 out of 20 (35%) protocolised characteristics were analysed. The meta-regressions showed effect modification by economic status, place of residence, and, nearly, from healthcare system (explaining 4.8%, 0.9% and 1.5% of the between-trial variation, respectively). No effect modification was demonstrated from age, sex, patient education/health literacy or predominant religion.

CONCLUSIONS: This study demonstrates the scarce reporting of most population characteristics, hampering investigation of their impact with meta-research. Our sparse results suggest that place of residence (ie, continent of the trial), economic status (based on World Bank classifications) and healthcare system (based on WHO index for health system performance) may be important in explaining the variation in treatment response across trials. There is an urgent need for consistent reporting of important population characteristics in trials.

PROSPERO REGISTRATION NUMBER: CRD42019127642.

Originalsprog Engelsk
Tidsskrift Annals of the Rheumatic Diseases
Vol/bind 79
Udgave nummer 10
Sider (fra-til) 1269-1276
Antal sider 8
ISSN 0003-4967
DOI
Status Udgivet - okt. 2020

Bibliografisk note

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