Salivary uric acid across child development and associations with weight, height, and body mass index.

Introduction: Obesity during childhood is a serious and growing chronic disease with consequences for lifelong health. In an effort to advance research into the preclinical indicators of pediatric obesity, we examined longitudinal assessments of uric acid concentrations in saliva among a cohort of healthy children from age 6-months to 12-years (n's per assessment range from 294 to 727). Methods: Using data from a subsample of participants from the Family Life Project (an Environmental influences on Child Health Outcomes Program cohort), we: (1) characterized salivary uric acid (sUA) concentrations from infancy to early adolescence by sex and race; (2) assessed changes in sUA levels across development; and (3) evaluated associations between sUA concentrations and measures of child weight, height, and body mass index (BMI). Across four assessments conducted at 6-, 24-, 90-, and 154-months of age, 2,000 saliva samples were assayed for UA from 781 participants (217 participants had sUA data at all assessments). Results: There were no significant differences in sUA concentrations by sex at any assessment, and differences in sUA concentrations between White and non-White children varied by age. At the 90- and 154-month assessments, sUA concentrations were positively correlated with measures of child weight, height, and BMI (90-month: weight- ρ(610) = 0.13, p < 0.01; height- ρ(607) = 0.10, p < 0.05; BMI- ρ(604) = 0.13, p < 0.01; 154-month: weight- ρ(723) = 0.18, p < 0.0001; height- ρ(721) = 0.10, p < 0.01; BMI- ρ(721) = 0.17, p < 0.0001). Group based trajectory modeling identified two groups of children in our sample with distinct patterns of sUA developmental change. The majority (72%) of participants showed no significant changes in sUA across time ("Stable" group), while 28% showed increases in sUA across childhood with steep increases from the 90- to 154-month assessments ("Increasing" group). Children in the Increasing group exhibited higher sUA concentrations at all assessments (6-month: t(215) = -5.71, p < 0.001; 24-month: t(215) = -2.89, p < 0.01; 90-month: t(215) = -3.89, p < 0.001; 154-month: t(215) = -19.28, p < 0.001) and higher weight at the 24- and 90-month assessments (24-month: t(214) = -2.37, p < 0.05; 90-month: t(214) = -2.73, p < 0.01). Discussion: Our findings support the potential utility of sUA as a novel, minimally-invasive biomarker that may help advance understanding of the mechanisms underlying obesity as well as further surveillance and monitoring efforts for pediatric obesity on a large-scale.

Lifespan data on postural balance in multiple standing positions.

BACKGROUND: Maintaining balance is important throughout life. The Nintendo Wii Balance Board (WBB) can give reliable quantitative measures of postural balance, but reference data are lacking. Furthermore, one-leg standing balance across the adult lifespan is not fully described. The aim of the study was (1) to provide reference data on postural balance in multiple standing positions using a WBB, (2) to determine an age cut-off for the ability to stand on one-leg in men and women. METHODS: This was a cross-sectional study and data was collected in two cities in Denmark (Aalborg and Odense) and Norway (Oslo and Ålesund) during spring and summer of 2016. Postural balance was assessed in individuals across the adult lifespan in three different bases of support positions (hip-wide and narrow two-legged stance, and one-legged stance) using a WBB. Reference data were analyzed and presented in 10-year intervals. RESULTS: A total of 354 individuals aged 20-99 years were recruited. Reference data were presented in percentiles stratified by gender for the following age categories: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, and 80+. Data showed that the difference between men and women's balance was larger at older age with men performing worst. The cut-off ability to stand on one-leg was 72.5 years without statistical evidence of gender difference. CONCLUSION: This study reports reference data for postural balance across the entire adult lifespan using a WBB. More than half of the individuals over 72.5 years of age were unable to stand balanced on one-leg.

Psoriasis and risk of myocardial infarction before and during an era with biological therapy: a population-based follow-up study.

BACKGROUND: Attention towards cardiovascular disease prevention in patients with moderate to severe psoriasis increased with the introduction of biological therapy. OBJECTIVE: To determine the risk of myocardial infarction (MI) following hospital-diagnosed psoriasis compared with the general population, in eras before and following the introduction of biological therapy. METHODS: We conducted a cohort study in Denmark utilising nationwide prospectively collected data from population-based registries. For the early era cohort, we identified subjects with first time hospital-diagnosed psoriasis between 1995 and 2002, and, for the late era cohort, those diagnosed between 2006 and 2013. Comparison cohorts from the general population were matched (10:1) on sex and birth year. All individuals were followed from date of psoriasis diagnosis (index date for matched controls) until incidence of MI, death, emigration or end of study (1 January 2002 for the early era cohort; 1 January 2013 for the late era cohort). We computed the cumulative MI incidence at 5 years of follow-up, and used Cox regression to compute HRs of MI comparing psoriasis subjects with general population subjects. RESULTS: For the early era, we identified 4302 psoriatic subjects and 43 791 general population subjects; and for the late era, 4577 psoriatic subjects (4% received biologic therapy) and 46 376 general population subjects. The cumulative incidence of MI among psoriatic subjects in the early era was 2.5% and it was 2.2% in the late era. The HRs comparing MI risk in the psoriasis and general population cohorts were 1.40 (95% CI: 1.09-1.80), for the early era, and 1.39 (95% CI: 1.10-1.75) for the late era, adjusting for educational level and use of cardiovascular drugs. CONCLUSION: The increased risk of MI among patients with hospital-diagnosed psoriasis, relative to the general population, remained unchanged during the initial years of increased attention towards cardiovascular disease prevention and availability of biologic therapy.

How food marketers can sell smaller portions: Consumer insights and product innovation.

Food portion size has been shown to be an important driver of energy intake. Despite the well acknowledged role of portion control in weight management, large portion sizes remain ubiquitous in the marketplace. Moving consumers towards consumption of smaller portion sizes will require changes in consumer behavior as well as changes in products available to consumers in a variety of settings. This special supplement presents cutting edge research aimed at understanding consumer behavior around portion size and innovations in product design that may promote the selection and consumption of smaller portion sizes. We identify further research that will be needed to translate basic behavioral findings into real world settings and to viable product development.

Opportunities and barriers for smaller portions in food service: lessons from marketing and behavioral economics.

This paper uses the frameworks and evidence from marketing and behavioral economics to highlight the opportunities and barriers for portion control in food service environments. Applying Kahneman's 'thinking fast and slow' concepts, it describes 10 strategies that can be effective in 'tricking' the consumer's fast cognitive system to make better decisions and in triggering the slow cognitive system to help prevent the fast system from making bad decisions. These strategies include shrinking defaults, elongating packages, increasing the visibility of small portions, offering more mixed virtue options, adding more small sizes, offering 'right-sized' standard portions, using meaningful size labels, adopting linear pricing, using temporal landmarks to push smaller portions and facilitating pre-commitment. For each of these strategies, I discuss the specific cost and revenue barriers that a food service operator would face if the strategy were adopted.

[Distress symptoms in hospice patients]. / Belastende symptomer hos patienter i hospice.

A number of symptoms cause physical or mental distress and suffering in the terminal and dying patient. In this prospective study of 117 patients (96% with a cancer diagnosis) in a Danish hospice all symptoms causing distress were assessed daily in three degrees of severity. The ten most frequently recorded symptoms were: fatigue, pain, weakness, dyspnoea, immobility/paresis, anorexia, general malaise, nausea/vomiting, oedema and amnesia. Fatigue was registered on 60.9% of the admission days, pain on 27.3%, dyspnoea on 19.2% and nausea/vomiting on 8.5%. The prevalence of pain, dyspnoea, nausea/vomiting, thirst and anxiety did not increase during the last seven days of life. Unconsciousness occurred in 23% of the patients during the last 24 hours and in 5% on the day before.

Dementia of depression or depression of dementia in stroke?

This study describes the correlation between changes in mood symptoms assessed by the Hamilton Depression Rating Scale (HDRS) and intellectual impairment assessed by the Brief Cognitive Rating Scale (BCRS) and Mattis Dementia Rating Scale (MDRS) in 166 unselected 1-year survivors after stroke, in whom post-stroke depression (PSD) has previously been described and validated. The course of intellectual impairment associated with PSD was compared with the course of intellectual impairment in non-PSD patients. In general, improvement in mood symptoms was correlated with an improvement in intellectual function. However, in 53 PSD patients improvement in intellectual performance was absent, despite the fact that the patients reported being significantly less distressed by dementia symptoms. Antidepressive medication did not lead to any improvement in MDRS score. No evidence was found to support the hypothesis of 'dementia of depression'. To the contrary, the findings indicate 'depression of dementia'.

Incidence of post-stroke depression during the first year in a large unselected stroke population determined using a valid standardized rating scale.

This study describes the development of post-stroke depression (PSD) prospectively during the first year post-stroke in 285 unselected stroke patients. An appropriate unselected population-based control group without cerebral pathology is included for comparison. Psychiatric assessment with the Hamilton Depression Rating Scale (HDRS) was undertaken unmodified. PSD was defined as HDRS > or = 13. The one-year incidence of PSD among the 209 survivors able to communicate reliably at 1 month was 41%. Most cases develop within the first months following stroke (79%), the frequency of new cases of PSD at one year being 5%, a level comparable to that in the control group. Depressed and nondepressed stroke patients consistently scored 4 points greater on total HDRS than in the corresponding controls.

Pathoanatomic correlation between poststroke pathological crying and damage to brain areas involved in serotonergic neurotransmission.

BACKGROUND AND PURPOSE: The aim of the study was to correlate the severity of poststroke pathological crying with lesion size and location. METHODS: Twelve selected stroke patients were ranked in terms of overall clinical severity of the syndrome of pathological crying, and the size and location of the stroke lesion(s) were determined by magnetic resonance imaging. RESULTS: The patients with the clinically most severe pathological crying had relatively large bilateral pontine lesions without lesions in the hemispheres. The intermediate group had bilateral central hemispheric lesions, and the clinically least affected patients had mainly unilateral large subcortical lesions. CONCLUSIONS: Poststroke pathological crying may be attributable to stroke-induced partial destruction of the serotonergic raphe nuclei in the brain stem or their ascending projections to the hemispheres.

Arthroscopic repair of the ruptured meniscus: one to 6.3 years follow up.

Forty-nine patients underwent arthroscopic meniscal repair. Twenty-three had an isolated tear of the medial meniscus, four an isolated tear of the lateral meniscus, two a tear of the medial meniscus combined with a rupture of the medial collateral ligament, and 20 a tear of the anterior cruciate ligament (ACL) and a tear of one or both menisci. At the time of repair of the menisci, seven had undergone reconstruction of their ACL, whereas 13 had been treated conservatively for their ACL rupture. Seven of 10 retears were in patients with a conservatively treated ACL tear, and three were in patients with an isolated tear of a meniscus. Thirty-five patients without retears were reexamined after 5.5 years (1-6.3 years). The average Lysholm knee score before the trauma was 98 (range 75-100), and at follow-up it was 87 (range 29-100). The average Tegner's activity score before the trauma was 6 (range 3-9), and at follow-up it was 5 (range 0-9). When there is no retear, the clinical results of arthroscopic repair of the menisci are excellent. In those patients who had isolated lesions of the menisci, there were very few retears, 11% in this study. ACL deficiency of the knee greatly increases the risk of retear. In this study 46% of patients with persistent instability after an untreated ACL rupture incurred retears. There were no retears in the patients who underwent ACL reconstruction concomitant with the meniscal repair.

Citalopram for post-stroke pathological crying.

Post-stroke pathological crying is a distressing condition in which episodes occur in response to minor stimuli without associated mood changes. There is preliminary evidence of disturbed serotoninergic neurotransmission in such cases. We investigated the effect of the selective serotonin reuptake inhibitor citalopram on uncontrolled crying in stroke patients in a double-blind placebo-controlled crossover study. 16 consecutive patients (median age 58.5 years, range 40-83) entered the 9-week study a median of 168 days (range 6-913) post stroke and were treated with citalopram 10-20 mg daily for 3 weeks. Crying history was determined from semistructured interviews and from diaries kept by the patients. Psychiatric assessment was made with the Hamilton depression scale (HDS), and unwanted effects were measured with the UKU side-effect scale. In 13 patients in whom frequency of crying could be assessed, the number of daily crying episodes decreased by at least 50% in all cases during citalopram treatment vs 2 patients during placebo treatment (p < 0.005, McNemar's test), the effect being rapid (1-3 days) and pronounced in 11 (73%). There was a concomitant significant decrease in depression rating from HDS 8.9 to 5.3 (p < 0.005, Wilcoxon's test). Citalopram was well tolerated, the few side-effects being mild and transient. We conclude that serotoninergic neurotransmission plays an important part in post-stroke pathological crying and that citalopram is an effective and well-tolerated treatment.

Myocardial ischaemia and spinal analgesia in patients with angina pectoris.

We have studied prospectively myocardial ischaemic events by Holter monitoring of ST-segment depression in patients with angina pectoris given spinal analgesia for minor surgery compared with a reference day of normal daily activities. Monitoring was undertaken continuously for 24 h on both days, starting just before anaesthesia on the day of surgery. On the reference day, seven of 14 patients had 27 ischaemic events with mean max ST-depression of 0.15 mV and total duration of 143 min, compared with 10 of 14 patients with 70 ischaemic events with mean max ST-depression of 0.22 mV and total duration of 1078 min (P < 0.01 for all). On the day of surgery, the first ischaemic event occurred a mean 338 min (range 75-480 min) after spinal analgesia, and the duration of all first events was 480 min. On this day, the first ischaemic event was associated with increased heart rate (103 beat min-1 (range 66-131 beat min-1) compared with 92 (60-122) beat min-1 during all events (P = 0.011)). In patients with angina pectoris, myocardial ischaemia did not occur immediately after the onset of spinal analgesia, but several hours later, corresponding to the cessation of block. This could be explained by increased cardiac pre- and afterload, probably further aggravated by the volume load.

[Helicobacter pylori and gastrointestinal tract diseases]. / Helicobacter pylori og sykdommer i fordøyelseskanalen.

We review the bacteriological, epidemiological and pathogenetic aspects of Helicobacter pylori and related diseases of the gastrointestinal tract. It is concluded that H. pylori seems to be at least one of several etiological factors for diseases such as chronic gastritis and duodenal ulcer. It may also be an important cofactor in the development of gastric carcinoma.

Suture of the torn anterior cruciate ligament. 5-year follow-up of 60 cases using an instrumental stability test.

60 patients were examined 5 (2-9) years after simple suture of acute rupture of the anterior cruciate ligament. In the follow-up the patients were examined clinically and by instrumental testing of stability (Acufex Knee Signature System). 10 knees had had a ligament reconstruction during the follow-up period, 28 knees were stable, and 22 unstable. By the Lysholm knee-score, function was rated excellent or good in both stable and unstable knees and the Tegner activity score dropped insignificantly. A positive correlation was found between the measured laxity and the clinical tests. Instrumental stability testing seems to be a reliable supplementary tool in the diagnosis of anterior cruciate ligament insufficiency. Ligament repair by simple suture was not better than reported results on conservative treatment.

Conservative treatment for acute rupture of the Achilles tendon.

Sixty-six patients with acute ruptures of the Achilles tendon were treated by immobilisation in a plaster cast for 12 weeks. Fifty-seven were followed up for a mean time of 70 months. Four re-ruptures occurred shortly after the initial treatment. Most patients had no or only slight complaints, three had moderate and one severe, problems. The activity level dropped slightly from 5.3 to 5.03 (Tegner score). The results are satisfactory with a low complication rate. The method is an alternative to operative repair, especially in patients declining operation and in those in whom operation or anaesthesia is contraindicated.

[Accidental falls in homes for the aged]. / Faldulykker på plejehjem.

Accidental falls among residents of homes for the elderly have only received scanty notice in the literature. During a period of 15 months, 296 falls among 1,856 residents of homes for the elderly were analyzed prospectively. The age-specific incidences for falls and fractures of the neck of the femur which are treated in hospital were found to be higher for residents of homes for the elderly as compared with elderly persons living at home in the age group 65-85 years. Residents of homes for the elderly who constitute 7% of all ages over 65 years are responsible for 21% of all accidental falls and 32% of all the lower limb fractures treated in hospital.

Treatment of unstable Colles' fractures by external fixation.

Twenty-six patients with unstable comminuted fracture of the distal part of the radius were treated with external fixation using Hoffmanns external fixation device. The average follow-up was 29 months. The anatomical results were 85% good or excellent, 10% fair and 5% poor. Functionally, 60% were good or excellent, 25% fair and 15% poor. There were three major complications and nine minor complications, the overall complication rate being 60%, though only 15% were major. The method is recommended when dealing with fractures of type VII and VIII, but not as a general routine.

"Pure alexia" without hemianopia or colour anomia.

We report a case of "pure alexia" without hemianopia or colour anomia, caused by a small subcortical haematoma in the dorso-lateral part of the occipital lobe, not affecting the splenium of the corpus callosum. It is argued that the reading disorder was due to a visual-verbal disconnection in spite of the fact that this typically is caused by a lesion in the medial part of the left occipital lobe including the splenium.