Twelve months effect of self-referral to inpatient treatment on patient activation, recovery, symptoms and functioning: A randomized controlled study.

OBJECTIVE: To investigate the effect of having a contract for self-referral to inpatient treatment (SRIT) in patients with severe mental disorders. METHODS: A randomized controlled trial with 53 adult patients; 26 participants received a SRIT contract, which they could use to refer themselves into a Community Mental Health Centre up to five days for each referral without contacting a doctor in advance. Outcomes were assessed after 12 months with the self-report questionnaires Patient Activation Measure (PAM-13), Recovery Assessment Scale (RAS), and the Behavior and Symptom Identification Scale (BASIS-32) and analyzed using linear mixed and regression models. RESULTS: There was no significant effect on PAM-13 (estimated mean difference (emd) -0.41, 95% CI (CI):-7.49-6.67), nor on the RAS (emd 0.02, CI:-0.27-0.31) or BASIS-32 (0.09, CI:-0.28-0.45). An exploratory post hoc analysis showed effect of SRIT in those with low PAM below ≤47 (p=0.049). CONCLUSION: There were no group differences after 12 months, but both groups maintained their baseline levels. PRACTICE IMPLICATIONS: SRIT contracts can be recommended as it supports the rights to self-determination, promote user participation in decision-making in own treatment without any indication of adverse effects.

Cardiorespiratory fitness in 16 025 adults aged 18-91 years and associations with physical activity and sitting time.

Our aim was to provide up-to-date cardiorespiratory fitness reference data for adults of all ages and to investigate associations between cardiores-piratory fitness and leisure time physical activity as well as sitting time. In the Danish Health Examination Survey 2007-2008, cardiorespiratory fitness was estimated in 16 025 individuals aged 18-91 years from validated cycle ergometer exercise tests. Level of leisure time physical activity (sedentary, light, moderate, and vigorous) and daily sitting time in hours was obtained from a self-administered questionnaire. Men had 20-33% higher cardiorespiratory fitness than women, depending on age, and cardiorespiratory fitness decreased by 0.26 and 0.23 mL/min/kg per year in men and women, respectively. Cardiorespiratory fitness was higher among participants who reported a high level of physical activity in leisure time compared with participants who were sedentary. Among sedentary or lightly physically active participants, inverse associations between total daily sitting time and cardiorespiratory fitness were found, while there was no association between sitting time and cardiorespiratory fitness among moderately or vigorously physically active participants. These data on cardiorespiratory fitness can serve as useful reference material. Although reluctant to conclude on causality, sitting time might impact cardiorespiratory fitness among individuals with low levels of leisure time physical activity.

A maximal cycle test with good validity and high repeatability in adults of all ages.

In 11 680 individuals (18-85 years) maximal oxygen consumption (VO2max) was estimated indirectly in a maximal cycle test using a prediction model developed in a young population (15-28 years). A subsample of 182 individuals (23-77 years) underwent 2 maximal cycle tests with VO2max estimated indirectly in both tests and measured directly in one test. Agreement between the direct measurement and the indirect estimate of VO2max and repeatability of the indirect estimates of VO2max were examined by Bland-Altman plots, limits of agreement (LOA) and coefficient of repeatability (CR). The indirect method (mean VO2max=3 132 ml · min(-1)) underestimated VO2max as compared to the direct method (mean VO2max=3 190 ml · min(-1)) in men (bias: 58 ml · min(-1) (95% LOA-450 and 565)) and overestimated VO2max in women (mean VO2max=2 328 vs. 2 258 ml · min(-1), bias: - 70 ml · min(-1) (95% LOA-468 and 328)). The mean difference between the 2 indirect estimates was non-significant (men: - 11.9 ml · min(-1), women: 18.3 ml · min(-1)) with a CR of 279 ml · min(-1) (8.9%) in men and 274 ml · min(-1) (11.7%) in women. The validity of the indirect method was good despite minor sex-specific bias. Owing to this bias we suggest a new prediction model of VO2max. The maximal cycle test was highly repeatable.

Prevalence of all relevant eating disorders in patients waiting for bariatric surgery: a comparison between patients with and without eating disorders.

OBJECTIVE: To study the prevalence of all relevant eating disorders in 157 obese patients waiting for bariatric surgery. Another aim was to explore for possible differences between gender, and those with and without ED. The dependent variables were: socio-demographic characteristics, BMI, obesity onset, and obesity-related somatic diseases. METHODS: ED was assessed using the self-report questionnaire, "Eating Disorders in Obesity" (EDO). The patients answered a questionnaire that targeted socio-demographic and health information. RESULTS: Subgroups were based on the patients responses to items on the EDO: 1 patient (0.6%) with Bulimia Nervosa (BN), 6 (3.8%) with Eating Disorder Not Otherwise Specified (EDNOS), 21 (13.4%) with Binge Eating Disorder (BED), and 23 (14.6%) with Binge Eating (BE). The patients in the EDNOS group were those who lacked one criterion of the BN diagnosis. The patients in the BE group lacked one criterion of the BED diagnosis. Twenty-eight (17.8%) fulfilled the DSM-IV-TR criteria for ED. When patients with BE were added, 51 patients (32.5%) were identified with ED or sub-threshold ED. In the explorative part of the study, no gender differences in socio-demographic variables, BMI, obesity onset, and obesity-related somatic diseases emerged. With the exception of age, no differences were found in these variables between those with and without ED. CONCLUSION: Employing all relevant eating disorders and binge eating symptoms (BE) for this population identified patients with pathological eating behaviors, which are not detected in previous studies measuring only BED and BE.

Short communication: salivary secretion during meals in lactating dairy cattle.

Four multiparous Holstein cows in midlactation were used in a 4 x 4 Latin square to evaluate whether source of forage influenced salivary secretion during eating in lactating dairy cows. The forages were allocated separately from the pelleted concentrates. Cows were offered 1 of 4 forages each period: barley silage, alfalfa silage, long-stemmed alfalfa hay, or chopped barley straw. Saliva secretion was measured during the morning meal by collecting masticates through the rumen cannula at the cardia of each cow. Rate of salivation (213 g/min) was not affected by forage source. However, the forage sources differed in eating rate (g of DM/min), which led to differences in ensalivation of forages (g of saliva/g of DM and g of saliva/g of NDF). On the basis of DM, ensalivation (g of saliva/g of DM) was greatest for straw (7.23) and similar for barley silage, alfalfa silage, and alfalfa hay (4.15, 3.40, and 4.34 g/g of DM, respectively). Higher ensalivation of straw could be accounted for by its higher neutral detergent fiber (NDF) content; ensalivation of NDF (g of saliva/g of NDF) was actually greatest for long-stemmed alfalfa hay (12.4) and similar for the other chopped forages (8.9). Cows consumed concentrate about 3 to 12 times faster than the various forages (DM basis), and ensalivation of concentrate was much lower (1.12 g of saliva/g of DM) than for forages. Feed characteristics such as particle size, DM, and NDF content affect salivary output during eating by affecting the eating rate. Slower eating rate and greater time spent eating may help prevent ruminal acidosis by increasing the total daily salivary secretion in dairy cows.

Comparison of the effect of multiple short-duration with single long-duration exercise sessions on glucose homeostasis in type 2 diabetes mellitus.

AIMS/HYPOTHESIS: We evaluated and compared the effects on glycaemic control of two different exercise protocols in elderly men with type 2 diabetes mellitus. METHODS: Eighteen patients with type 2 diabetes mellitus carried out home-based bicycle training for 5 weeks. Patients were randomly assigned to one of two training programmes at 60% of maximal oxygen uptake: three 10 min sessions per day (3 x 10) or one 30 min session per day (1 x 30). Plasma insulin, C-peptide and glucose concentrations were measured during a 3 h oral glucose tolerance test (OGTT). Insulin sensitivity index (ISI(composite)), pre-hepatic insulin secretion rates (ISR) and change in insulin secretion per unit change in glucose concentrations (B(total)) were calculated. RESULTS: Cardiorespiratory fitness increased in response to training in both groups. In group 3 x 10 (n = 9) fasting plasma glucose (p = 0.01), 120 min glucose OGTT (p = 0.04) and plasma glucose concentration areas under the curve at 120 min (p < 0.04) and 180 min (p = 0.07) decreased. These parameters remained unchanged in group 1 x 30 (n = 9). No significant changes were found in ISI(composite), ISR and B(total) in either of the exercise groups. In a matched time-control group (n = 10), glycaemic control did not change. CONCLUSIONS/INTERPRETATION: Moderate to high-intensity training performed at 3 x 10 min/day is preferable to 1 x 30 min/day with regard to effects on glycaemic control. This is in spite of the fact that cardiorespiratory fitness increased similarly in both exercise groups. A possible explanation is that the energy expenditure associated with multiple short daily sessions may be greater than that in a single daily session.

Validation of the M.D. Anderson Symptom Inventory Brain Tumor Module (MDASI-BT).

BACKGROUND: Symptom occurrence has been shown to predict treatment course and survival in patients with solid tumors. Primary brain tumor (PBT) patients are unique in the occurrence of neurologic symptoms. Currently, no instrument exists that measures both neurologic and cancer-related symptoms. METHODS: Patients diagnosed with PBT participated in this study. Data was collected at one point in time and included demographic and clinical factors, and the M.D. Anderson Symptom Inventory-Brain Tumor Module (MDASI-BT). The study evaluated the reliability and validity of the MDASI-BT in primary brain tumor patients. RESULTS: Two hundred and one patients participated in this study. Mean symptom severity of items as well as cluster analysis was used to reduce the number of total items to 22 (13 core, 9 brain tumor items). Regression analysis showed more than half (56%) of the variability in symptom severity was explained by brain module items. The MDASI-BT measures six underlying constructs including affective, cognitive, focal neurologic deficit, constitutional, generalized symptom, and a gastrointestinal related factor. The internal consistency (reliability) of the instrument was 0.91. The MDASI-BT was sensitive to disease severity based on performance status (P<0.001), tumor recurrence (P<0.01), and mean symptom interference (P<0.001). CONCLUSIONS: The 22 item MDASI-BT demonstrated validity and reliability in patients with PBT. This instrument can be used to identify symptom occurrence throughout the disease trajectory and to evaluate interventions designed for symptom management.

Host immune reactions and worm kinetics during the expulsion of Ascaris suum in pigs.

Pigs single inoculated with Ascaris suum eggs expel the majority of larvae between days 14 and 21 post inoculation (p.i.), but the role of the immune system in expulsion is unclear. To investigate the dynamics of immune responses before, during and after the expulsion of A. suum larvae, pigs inoculated with 10 000 A. suum eggs were sequentially necropsied. Ascaris suum gradually moved distally from days 10-14 p.i. and only a few larvae were left by day 21 p.i. Pronounced increases in mucosal A. suum-specific IgA antibody secreting cells (ASCs) were already found by day 10 p.i. especially in the proximal jejunum, while only small increases in parasite-specific IgM ASCs were observed by day 21 p.i. in both proximal and distal jejunum. No mucosal IgG ASC responses could be detected. Increases in systemic A. suum-specific IgG1, IgM and to a lesser extent IgA antibodies were observed, while IgG2 remained almost unchanged. The levels of eosinophils and mast cells in the small intestinal mucosa did not change throughout infection. The results demonstrate that both systemic and mucosal A. suum-specific effector mechanisms are strongly stimulated in A. suum single infections and indicate that mucosal IgA may be an important mediator in the expulsion of A. suum.

Comparative studies of experimental oral inoculation of pigs with Ascaris suum eggs or third stage larvae.

This experimental study was designed to compare the acquired resistance in pigs to Ascaris suum eggs following 4-weekly oral immunizations with either 200 A. suum infective eggs or 50 A. suum third stage larvae (L3). The two immunized groups (n = 7) together with an unimmunized control group (n = 7) of pigs were challenged orally with 50 infective A. suum eggs per kilogram bodyweight on day 19 after the last immunization. Seven days post-challenge the group immunized with eggs showed signs of resistance as evidenced by reduced lung larval counts compared with the challenge control group. Such significant resistance was not observed in the L3-immunized group. However, a markedly increased inflammatory liver reaction and white spot formation was demonstrated in the L3-immunized pigs after challenge compared with both control animals and egg-immunized pigs. On the day of challenge only the egg-immunized pigs mounted an anti-Ascaris antibody response both in serum and in lung lavage fluid. Ascaris-antigen induced increased histamine release from peripheral leucocytes following both immunization and challenge could only be demonstrated in the egg-immunized pigs. On day 7 post-challenge local IgA-anti-Ascaris antibodies were further demonstrated in bile of the egg-immunized group and in the small intestine of both immunized groups. In conclusion, oral A. suum egg immunization of pigs induced a significant reduction in lung larval counts upon challenge. In contrast, oral L3 immunization seemed to prime the pigs as observed by the presence of stunted lung larval growth and increased liver reaction post-challenge with A. suum eggs.

Yr32 for resistance to stripe (yellow) rust present in the wheat cultivar Carstens V.

Stripe or yellow rust of wheat, caused by Puccinia striiformis f. sp. tritici, is an important disease in many wheat-growing regions of the world. A number of major genes providing resistance to stripe rust have been used in breeding, including one gene that is present in the differential tester Carstens V. The objective of this study was to locate and map a stripe rust resistance gene transferred from Carstens V to Avocet S and to use molecular tools to locate a number of genes segregating in the cross Savannah/Senat. One of the genes present in Senat was predicted to be a gene that is present in Carstens V. For this latter purpose, stripe rust response data from both seedling and field tests on a doubled haploid population consisting of 77 lines were compared to an available molecular map for the same lines using a non-parametric quantitative trait loci (QTL) analysis. Results obtained in Denmark suggested that a strong component of resistance with the specificity of Carstens V was located in chromosome arm 2AL, and this was consistent with chromosome location work undertaken in Australia. Since this gene segregated independently of Yr1, the only other stripe rust resistance gene known to be located in this chromosome arm, it was designated Yr32. Further QTLs originating from Senat were located in chromosomes 1BL, 4D, and 7DS and from Savannah on 5B, but it was not possible to characterize them as unique resistance genes in any definitive way. Yr32 was detected in several wheats, including the North American differential tester Tres.

Inheritance and localisation of resistance to Mycosphaerella graminicola causing septoria tritici blotch and plant height in the wheat (Triticum aestivum L.) genome with DNA markers.

Resistance to the disease septoria tritici blotch of wheat (Triticum aestivum L.), caused by the fungus Mycosphaerella graminicola (Fuckel.) J. Schrot in Cohn (anamorph Septoria tritici Roberge in Desmaz.) was investigated in a doubled-haploid (DH) population of a cross between the susceptible winter wheat cultivar Savannah and the resistant cultivar Senat. A molecular linkage map of the population was constructed including 76 SSR loci and 244 AFLP loci. Parents and DH progeny were tested for resistance to single isolates of M. graminicola in a growth chamber at the seedling stage, and to an isolate mixture at the adult plant stage, in field trials. A gene located at or near the Stb6 locus mapping to chromosome 3A provided seedling resistance to IPO323. Two complementary genes, mapping to chromosome 3A, one of which was the IPO323 resistance gene, were needed for resistance to the Danish isolate Risø97-86. In addition, a number of minor loci influenced the expression of resistance in the growth chamber. In the field, four QTLs for resistance to septoria tritici blotch were detected. Two QTLs, located on chromosomes 3A and 6B explained 18.2 and 67.9% of the phenotypic variance in the mean over two trials. Both these QTLs were also detected at the seedling stage with isolate Risø97-86, whereas isolate IPO323 only detected the QTL on 3A. Additionally, two QTLs identified in adult plants on chromosomes 2B and 7B were not detected at the seedling stage. Four QTLs were detected for plant height located on chromosomes 2B, 3A, 3B and on a linkage group not assigned to a chromosome. The major QTLs on 3A and on the unassigned linkage group were consistent over two trials, and the QTL on 3A seemed to be linked to a QTL for septoria tritici blotch resistance.

Alternative migration routes of Ascaris suum in the pig.

Experiments were conducted to investigate possible alternative routes of extraintestinal migration of Ascaris suum larvae in the pig. Pigs were infected with A. suum via injection of newly hatched larvae into cecal veins (i.v.), into cecal lymph nodes (LN), or intraperitoneally (i.p.), and control animals were inoculated orally with infective eggs (p.o.). Two pigs per inoculation route were necropsied on days 1, 4, and 13 postinoculation. The numbers of liver lesions and the percentage of larvae recovered was considerably greater in pigs inoculated i.v. or p.o. on each necropsy day. However, irrespective of inoculation route, at least a proportion of larvae passed through the livers and were able to complete migration to the small intestine by day 13. The results indicate that larval penetration of the intestinal wall is not necessary for liver-lung migration and that passage through the liver may be favorable for migrating A. suum larvae, although a delayed arrival in the small intestine cannot be ruled out for larvae following alternative routes.

Interval cancers in the Norwegian breast cancer screening program: frequency, characteristics and use of HRT.

Breast cancers diagnosed between screening examinations among women who attend a breast cancer screening program are defined as interval cancers. The Norwegian Breast Cancer Screening Program started as a pilot project in 1996, and data from the first 2-year interval are available. Our study quantifies interval cancers in the pilot project and explores characteristics and factors that may be associated with interval cancer. Interval cancers in the screening population were identified through the Cancer Registry of Norway. The frequency of invasive interval cancer was calculated as cases per 10,000 screened and as observed/expected ratio. Characteristics of the interval cancers were compared to screening-detected and clinical cancers. Breast density was assessed in a blinded review of 3 categories of screening mammograms. Information on hormone replacement therapy (HRT) use was collected from a questionnaire. The frequency of invasive interval cancers was 18.2 (15.9-20.7) per 10,000 screened and the observed/expected ratio was 0.49 (0.43-0.56). The frequency in the second year of the interval was higher than reported from other programs. The median tumor size of the interval cancers was 19.5 mm and 44.0% of the patients had affected axillary lymph nodes. The interval cancer cases had higher proportions of dense breasts and reported use of HRT compared to screen normal and screening-detected cases. The reported frequency of interval cancers is similar to comparable programs. The interval cancers differed significantly from the cancers detected in the first screening round and were more similar to clinical cancers. Interval cancer was associated with dense breasts and use of HRT. Screening programs must keep these associations in focus.

Prevalence and risk factors of adenomyosis at hysterectomy.

BACKGROUND: The present study was performed to evaluate the prevalence and possible associated risk factors for adenomyosis. METHODS: Medical records were retrieved and histo-pathological material re-examined for 549 consecutive women undergoing hysterectomy in a two-year period from 1990-1991. RESULTS: The prevalence of adenomyosis in the study varied from 10.0-18.2%, depending on different diagnostic criteria. The presence of endometrial hyperplasia at the time of hysterectomy was the only variable significantly associated with adenomyosis (OR = 3.0; 95% CI: 1.2-8.3). No statistically significant association was found between adenomyosis and previous caesarean section, endometrial curettage or evacuation of the uterus. Furthermore, we did not see any significant association between adenomyosis and pain-related symptoms, indication for hysterectomy, age, parity or number of myometrial samples. CONCLUSIONS: Our study stresses the need for precise diagnostic criteria for adenomyosis, and furthermore indicates that endometrial hyperplasia and adenomyosis may have a common aetiology.

Regional immune responses with stage-specific antigen recognition profiles develop in lymph nodes of pigs following Ascaris suum larval migration.

The early life-cycle of the pig round worm, Ascaris suum, involves well-defined larval development in the liver, lungs and finally the small intestine. Distinct regional immune responses to larval antigens of A. suum were observed in the draining lymph nodes of immunized and challenged pigs during larval migration. This was reflected in a transient enlargement of the stimulated lymph nodes, due to increases in numbers of B cells and CD4 T cells, and the production of A. suum-specific antibody by antibody secreting cell (ASC) cultures. Larval antigen recognition pattern of antibodies in serum, bile and draining lymph node ASC culture supernatant (ASC-probes) was examined by immunoblotting. This revealed distinct organ-specific recognition patterns of larval-specific antigens by the draining lymph nodes at different times after challenge. In particular, an early larval 42 kDa antigen was recognized specifically by ASC-probes of the liver lymph nodes at 7 but not 14 days postchallenge (pc) which was not detected in other lymph nodes, serum or bile of the same pig. Similarly, a late larval antigen of 34 kDa was uniquely detected by lung and jejunal ASC-probes at 14 days pc. These observations demonstrate how development of distinct regional immune responses in tissues with different antigen stimulation can be monitored with ASC-probes and flow cytometry.

A Model of the Effect of Pseudothecia on Genetic Recombination and Epidemic Development in Populations of Mycosphaerella graminicola.

ABSTRACT It is generally agreed that ascospores are the origin of primary infections for the disease septoria tritici blotch of wheat caused by the fungus Mycosphaerella graminicola (anamorph Septoria tritici). The epidemic during the growing season was previously ascribed to the asexual pycni-diospores dispersed over short distances by rain splash, but recent observations suggest that the airborne ascospores also may play a role. As a consequence, the composition of the pathogen population over the growing season may change through genetic recombination. In an attempt to resolve the relative importance of the two spore types to the epidemic over the growing season, a model simulating disease caused by both types of spores was constructed and analyzed. The conclusion from the analysis of this model is that sexual recombination will affect the genetic composition of the population during a growing season. A considerable proportion of spores released at the end of the growing season may be sexual descendants of the initial population. However, ascospores are unlikely to affect the severity of the epidemic during the growing season. This is due to the much longer latent period for pseudothecia compared with pycnidia, resulting in ascospores being produced too late to influence the epidemic.

Risk of Hodgkin's disease and other cancers after infectious mononucleosis.

BACKGROUND: Infectious mononucleosis, which is caused by the Epstein-Barr virus, has been associated with an increased risk for Hodgkin's disease. Little is known, however, about how infectious mononucleosis affects long-term risk of Hodgkin's disease, how this risk varies with age at infectious mononucleosis diagnosis, or how the risk for Hodgkin's disease varies in different age groups. In addition, the general cancer profile among patients who have had infectious mononucleosis has been sparsely studied. METHODS: Population-based cohorts of infectious mononucleosis patients in Denmark and Sweden were followed for cancer occurrence. The ratio of observed-to-expected numbers of cancers (standardized incidence ratio [SIR]) served as a measure of the relative risk for cancer. SIRs of Hodgkin's disease in different subsets of patients were compared with the use of Poisson regression analysis. All statistical tests including the trend tests were two-sided. RESULTS: A total of 1381 cancers were observed during 689 619 person-years of follow-up among 38 562 infectious mononucleosis patients (SIR = 1. 03; 95% confidence interval [CI] = 0.98-1.09). Apart from Hodgkin's disease (SIR = 2.55; 95% CI = 1.87-3.40; n = 46), only skin cancers (SIR = 1.27; 95% CI = 1.13-1.43; n = 291) occurred in statistically significant excess. In contrast, the SIR for lung cancer was reduced (SIR = 0.71; 95% CI = 0.58-0.86; n = 102). The SIR for Hodgkin's disease remained elevated for up to two decades after the occurrence of infectious mononucleosis but decreased with time since diagnosis of infectious mononucleosis (P: for trend <.001). The SIR for Hodgkin's disease tended to increase with age at diagnosis of infectious mononucleosis (P: for trend =.05). Following infectious mononucleosis, the SIR for Hodgkin's disease at ages 15-34 years was 3.49 (95% CI = 2.46-4.81; n = 37), which was statistically significantly higher than the SIR for any other age group (P: for difference =.001). CONCLUSION: The increased risk of Hodgkin's disease after the occurrence of infectious mononucleosis appears to be a specific phenomenon.

Effects of bile on the in vitro hatching, exsheathment, and migration of Ascaris suum larvae.

This study reports on the in vitro egg hatching, exsheathment, migratory activity, and sensitivity to anthelmintics of Ascaris suum larvae in cultures with or without bovine bile. Three methods for egg hatching and/or incubation were used: an object-glass method, a glass-bead method, and an incubation method. An agar migration assay (AMA) was developed to test the migratory activity of Ascaris larvae following hatching. Bile appeared to be an important stimulatory factor for both egg hatching and larval mobility in the incubation method. Incubation in low concentrations of bile (2%, 5%, or 10%) stimulated both egg hatching and larval migration, whereas concentrations of at least 20% impaired egg hatching and larval migration. Furthermore, 5% bile seemed to promote exsheathment of A. suum larvae.