eHealth technology use and eHealth literacy after percutaneous coronary intervention.

AIMS: Electronic health (eHealth) sources have great potential to improve patients' access to health information for self-management of secondary prevention after percutaneous coronary intervention (PCI). It remains unclear, however, whether patients are health-related digitally active and whether they have sufficient eHealth literacy. This study aimed to determine the extent to which patients after PCI are health-related digitally active at baseline, 2 and 6 months after PCI, and to determine the association between patients' eHealth literacy and their health-related digital activity. METHODS AND RESULTS: This multicentre cohort study included patients at three large referral PCI centres in Norway (n = 1970). Data were collected from medical records, national registries, and patients' self-reports. The eHealth Literacy Scale (eHEALS) assessed patients' eHealth literacy. At baseline, 67% had used the internet to find health information. The mean eHEALS score was 25.71 (standard deviation 6.22), illustrating a lower level of eHealth literacy. There were substantial associations between eHealth literacy and use of the internet to find health information [coefficient 10.90, 95% confidence interval (CI) 8.05-14.57]. At the 2-month follow-up, there were substantial associations between baseline eHealth literacy and use of the internet to find information about health, prevention, illness, or treatment [odds ratio (OR) 1.19, 95% CI 1.14-1.24] and use of health applications (OR 1.15, 95% CI 1.08-1.22). CONCLUSION: This study provides evidence that patients' level of eHealth literacy after PCI is associated to how patients use, and can make use of, eHealth technology for health information. REGISTRATION: ClinicalTrials.gov (NCT03810612).

Elements in Mental Health Interventions Associated with Effects on Emotion Regulation in Adolescents: A Meta-Analysis.

PURPOSE: Adolescence is a sensitive period for developing mental health problems. Interventions targeting emotion regulation have shown promising transdiagnostic effects for this group, but optimization efforts are called for. In the current study, we used an element-based approach to identify potentially active ingredients in interventions measuring emotion regulation, to guide further optimization. METHODS: We coded practice elements in 30 studies based on a systematic review of mental health interventions measuring emotion regulation in adolescents (N = 2,389 participants, mean age 13-17 years). Using a three-level modeling approach, we then investigated the difference in effect on emotion regulation between studies of interventions with and without these practice elements. RESULTS: We identified 75 practice elements and 15 element categories used in the included interventions. Results showed significantly stronger effects on emotion regulation when interventions included the practice elements Setting goals for treatment (difference in d = 0.40, 95% CI [0.09, 0.70], p = .012) and Psychoeducation about acceptance (difference in d = 0.58, 95% CI [0.09, 1.07], p = .021). Furthermore, a total of 11 elements and four overall categories were identified as potentially active ingredients, based on an effect size difference of > 0.20 between interventions with and without the elements. CONCLUSION: The results can direct experimental research into the selection of practices that are most likely key to mechanisms of change in interventions addressing emotion regulation for adolescents. The challenge of measuring emotion regulation is discussed.

PTSD or not PTSD? Comparing the proposed ICD-11 and the DSM-5 PTSD criteria among young survivors of the 2011 Norway attacks and their parents.

BACKGROUND: The conceptualization of post-traumatic stress disorder (PTSD) in the upcoming International Classification of Diseases (ICD)-11 differs in many respects from the diagnostic criteria in the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5). The consequences of these differences for individuals and for estimation of prevalence rates are largely unknown. This study investigated the concordance of the two diagnostic systems in two separate samples at two separate waves. METHOD: Young survivors of the 2011 Norway attacks (n = 325) and their parents (n = 451) were interviewed at 4-6 months (wave 1) and 15-18 months (wave 2) after the shooting. PTSD was assessed with the UCLA PTSD Reaction Index for DSM-IV adapted for DSM-5, and a subset was used as diagnostic criteria for ICD-11. RESULTS: In survivors, PTSD prevalence did not differ significantly at any time point, but in parents, the DSM-5 algorithm produced significantly higher prevalence rates than the ICD-11 criteria. The overlap was fair for survivors, but amongst parents a large proportion of individuals met the criteria for only one of the diagnostic systems. No systematic differences were found between ICD-11 and DSM-5 in predictive validity. CONCLUSIONS: The proposed ICD-11 criteria and the DSM-5 criteria performed equally well when identifying individuals in distress. Nevertheless, the overlap between those meeting the PTSD diagnosis for both ICD-11 and DSM-5 was disturbingly low, with the ICD-11 criteria identifying fewer people than the DSM-5. This represents a major challenge in identifying individuals suffering from PTSD worldwide, possibly resulting in overtreatment or unmet needs for trauma-specific treatment, depending on the area of the world in which patients are being diagnosed.

Longitudinal relationship between diabetes-specific emotional distress and follow-up HbA1c in adults with Type 1 diabetes mellitus.

AIM: To examine whether diabetes-specific emotional distress was related to follow-up glycaemic control in adults with Type 1 diabetes mellitus. METHODS: Adults with Type 1 diabetes mellitus completed the Diabetes Distress Scale and reported sociodemographic information when attending a clinical consultation at a university endocrinology unit. Blood samples to determine baseline HbA1c were taken during consultations. All respondents' HbA1c measurements registered from January 2009 to December 2011 were collected from medical records. The relationship between baseline diabetes-specific emotional distress and HbA1c was examined with linear mixed-effects models in 175 patients with complete data. RESULTS: After controlling for confounders, baseline diabetes-specific emotional distress and glycaemic control were significantly associated (fixed-effect coefficient 0.40, P < 0.001) and the regimen-related distress subscale had the strongest association with glycaemic control (fixed-effect coefficient 0.47, P < 0.001). The two-item measure of diabetes-specific distress had a weaker but still significant association with glycaemic control (fixed-effect coefficient 0.31, P < 0.001). None of these relationships was significant after adjusting for the baseline HbA1c . CONCLUSIONS: People with elevated baseline diabetes-specific emotional distress are at risk of prolonged suboptimum glycaemic control; therefore, elevated diabetes-specific emotional distress, especially regimen-related distress, might be an important marker for prolonged suboptimum glycaemic control, and might indicate a need for special attention regarding patient self-management.

A 12-year population-based study of freezing of gait in Parkinson's disease.

INTRODUCTION: Freezing of gait (FOG) is a potentially disabling motor problem in Parkinson's disease (PD) with uncertain etiology. Longitudinal studies of FOG in PD are scarce. We determined the prevalence, incidence, and associated clinical risk factors and concomitants of FOG during prospective long-term follow-up of a population-based PD cohort. METHODS: A community-based prevalent cohort of 232 PD patients was followed prospectively over 12 years. Reassessments were conducted at 4 and 8 years, and then annually. FOG, as well as severity of parkinsonism, motor complications, and psychotic symptoms were assessed by the Unified PD Rating Scale, and cognitive impairment by the Mini-Mental State Examination. Generalized estimating equations were applied to investigate baseline risk factors and concomitants of FOG over time. RESULTS: The point prevalence of FOG at baseline was 27% (95% confidence interval (95%-CI) 22-33%). By study end, 63% (95%-CI 56-69%) of patients had developed FOG. The incidence rate of FOG was 124.2 (95%-CI 101.5-152.1) per 1000 person-years. Motor fluctuations (odds ratio (OR) 3.45; p = 0.036) and higher levodopa dose (OR 1.30/100 mg, p = 0.009) at baseline were independent risk factors of incident FOG. Prevalent FOG over time was additionally associated with features thought to reflect extrastrial, non-dopaminergic pathologies, including PIGD (postural instability/gait difficulty, OR 6.30/10 points, p < 0.001) and psychosis (OR 1.85; p = 0.016). CONCLUSION: These findings demonstrate that FOG affects the majority of patients in the general PD population and provide support to the hypothesis that alterations in both basal ganglia and extrastriatal brain areas are involved in the pathogenesis of FOG in PD.

Self-harm induced somatic admission after discharge from psychiatric hospital - a prospective cohort study.

BACKGROUND: Few studies have examined rate and predictors of self-harm in discharged psychiatric patients. AIMS: To investigate the rate, coding, timing, predictors and characteristics of self-harm induced somatic admission after discharge from psychiatric acute admission. METHOD: Cohort study of 2827 unselected patients consecutively admitted to a psychiatric acute ward during three years. Mean observation period was 2.3 years. Combined register linkage and manual data examination. Cox regression was used to investigate covariates for time to somatic admission due to self-harm, with covariates changing during follow-up entered time dependently. RESULTS: During the observation period, 10.5% of the patients had 792 somatic self-harm admissions. Strongest risk factors were psychiatric admission due to non-suicidal self-harm, suicide attempt and suicide ideation. The risk was increased throughout the first year of follow-up, during readmission, with increasing outpatient consultations and in patients diagnosed with recurrent depression, personality disorders, substance use disorders and anxiety/stress-related disorders. Only 49% of the somatic self-harm admissions were given hospital self-harm diagnosis. CONCLUSIONS: Self-harm induced somatic admissions were highly prevalent during the first year after discharge from acute psychiatric admission. Underdiagnosing of self-harm in relation to somatic self-harm admissions may cause incorrect follow-up treatments and unreliable register data.

Sperm counts and endocrinological markers of spermatogenesis in long-term survivors of testicular cancer.

BACKGROUND: The objective of this study was to assess markers of spermatogenesis in long-term survivors of testicular cancer (TC) according to treatment, and to explore correlations between the markers and associations with achieved paternity following TC treatment. METHODS: In 1191 TC survivors diagnosed between 1980 and 1994, serum-follicle stimulating hormone (s-FSH; n=1191), s-inhibin B (n=441), and sperm counts (millions per ml; n=342) were analysed in a national follow-up study in 1998-2002. Paternity was assessed by a questionnaire. RESULTS: At median 11 years follow-up, 44% had oligo- (<15 millions per ml; 29%) or azoospermia (15%). Sperm counts and s-inhibin B were significantly lower and s-FSH was higher after chemotherapy, but not after radiotherapy (RT), when compared with surgery only. All measures were significantly more abnormal following high doses of chemotherapy (cisplatin (Cis)>850 mg, absolute cumulative dose) compared with lower doses (Cis ≤ 850 mg). Sperm counts were moderately correlated with s-FSH (-0.500), s-inhibin B (0.455), and s-inhibin B : FSH ratio (-0.524; all P<0.001). All markers differed significantly between those who had achieved post-treatment fatherhood and those with unsuccessful attempts. CONCLUSION: The RT had no long-term effects on the assessed markers of spermatogenesis, whereas chemotherapy had. At present, the routine evaluation of s-inhibin B adds little in the initial fertility evaluation of TC survivors.

Vinorelbine and gemcitabine vs vinorelbine and carboplatin as first-line treatment of advanced NSCLC. A phase III randomised controlled trial by the Norwegian Lung Cancer Study Group.

BACKGROUND: Platinum-based doublet chemotherapy is the standard first-line treatment for advanced non-small cell lung cancer (NSCLC), but earlier studies have suggested that non-platinum combinations are equally effective and better tolerated. We conducted a national, randomised study to compare a non-platinum with a platinum combination. METHODS: Eligible patients had stage IIIB/IV NSCLC and performance status (PS) 0-2. Patients received up to three cycles of vinorelbine 60 mg m(-2) p.o.+gemcitabine 1000 mg m(-2) i.v. day 1 and 8 (VG) or vinorelbine 60 mg m(-2) p.o. day 1 and 8+carboplatin area under the curve=5 (Calvert's formula) i.v. day 1 (VC). Patients ≥75 years received 75% of the dose. Endpoints were overall survival, health-related quality of life (HRQoL), toxicity, and the use of radiotherapy. RESULTS: We randomised 444 patients from September 2007 to April 2009. The median age was 65 years, 58% were men and 25% had PS 2. Median survival was VG: 6.3 months; VC: 7.0 months, P=0.802. Vinorelbine plus carboplatin patients had more grade III/IV nausea/vomiting (VG: 4%, VC: 12%, P=0.008) and grade IV neutropenia (VG: 7%, VC: 19%, P<0.001). Infections, HRQoL and the use of radiotherapy did not differ significantly between the treatment groups. CONCLUSION: The two regimens yielded similar overall survival. The VG combination had only a slightly better toxicity profile.

Lower treatment intensity and poorer survival in metastatic colorectal cancer patients who live alone.

BACKGROUND: Socioeconomic status (SES) and social support influences cancer survival. If SES and social support affects cancer treatment has not been thoroughly explored. METHODS: A cohort consisting of all patients who were initially diagnosed with or who developed metastatic colorectal cancer (mCRC, n=781) in three Scandinavian university hospitals from October 2003 to August 2006 was set up. Clinical and socioeconomic data were registered prospectively. RESULTS: Patients living alone more often had synchronous metastases at presentation and were less often treated with combination chemotherapy than those cohabitating (HR 0.19, 95% CI 0.04-0.85, P=0.03). Surgical removal of metastases was less common in patients living alone (HR 0.29, 95% CI 0.10-0.86, P=0.02) but more common among university-educated patients (HR 2.22, 95% CI 1.10-4.49, P=0.02). Smoking, being married and having children did not influence treatment or survival. Median survival was 7.7 months in patients living alone and 11.7 months in patients living with someone (P<0.001). Living alone remained a prognostic factor for survival after correction for age and comorbidity. CONCLUSION: Patients living alone received less combination chemotherapy and less secondary surgery. Living alone is a strong independent risk factor for poor survival in mCRC.

Time-dependent effect analysis of antipsychotic treatment in a naturalistic cohort study of patients with schizophrenia.

OBJECTIVE: Evidence based treatment of schizophrenia as well as antipsychotic drug utility patterns have changed considerably in recent years and the present study aims to investigate the current level of unplanned hospital readmissions in a cohort of patients with schizophrenia, and to determine the risk-reducing effects of current antipsychotic drug treatment. METHOD: An open cohort study included all consecutively discharged patients with schizophrenia in a 3-year period (n=277). The treatment-dependent variables were entered in a multivariate Cox survival analyses with time to unplanned readmission as the dependent variable. RESULTS: 11.2% of patients were readmitted within 30 days of discharge, and 44.8% were readmitted within 12 months. Antipsychotic monotherapy reduced the risk of readmission by 74.9%. Treatment in CMHC also had a risk-reducing effect. The prescription rate of clozapine in this sample was 10.1%. DISCUSSION: The over-all level of unplanned readmissions was in correspondence with the findings of others. Current antipsychotic drug treatment independently offers strong protection against unplanned readmissions. There may be a potential for further optimalizing antipsychotic drug treatment according to treatment guidelines. CONCLUSIONS: Unplanned readmissions are very common for patients with schizophrenia but antipsychotic drug treatment is associated with a strong risk-reducing effect in this regard.

Cognitive impairments after critical illness.

BACKGROUND: Cognitive impairments are common after critical illness. Aetiology and effects of cognitive impairments in this setting are not fully revealed. The aim of this study was to investigate the effect of critical illness and intensive care unit (ICU) treatment on cerebral function. METHODS: Adult ICU patients with no previous history of cerebral disorders were included. Non-delirious patients scoring ≥ 24 on mini-mental state examination on ICU discharge were explored neuropsychologically using the Cambridge Neuropsychological Test Automated Battery (CANTAB) to classify cognitive impairments. Tests were repeated at 3 and 12 months. Results were compared with a normal reference population and a surgical comparison group. RESULTS: We included 55 patients. Eighteen of 28 patients were cognitively impaired, and it was not possible to classify 27 patients. The ICU survivors tested with CANTAB scored significantly lower than the reference population. They also scored worse than a surgical comparison group but significantly on only one of 10 measures. At 3 months follow-up, included patients scored significantly worse on one of 10 reported CANTAB measures. There were no differences at 12 months. We found no associations between age, co-morbidity, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment score, presence of cardiovascular disease, duration of ventilatory support and length of ICU stay, and cognitive impairments. Having a cognitive impairment did not affect other outcome measures such as mortality, health-related quality of life, and institutionalization. CONCLUSIONS: Cognitive impairments are common after critical illness and may be caused by the critical illness in itself. Incidences are high after ICU discharge (64%) but drops rapidly during the first 3 months after discharge.

What predicts mortality in Parkinson disease?: a prospective population-based long-term study.

OBJECTIVE: To identify independent risk factors of mortality in a community-based Parkinson disease (PD) cohort during prospective long-term follow-up. METHODS: A community-based prevalent sample of 230 patients with PD from southwestern Norway was followed prospectively with repetitive assessments of motor and nonmotor symptoms from 1993 to 2005. Information on vital status until October 20, 2009, was obtained from the National Population Register in Norway. Cox proportional hazards models were applied to identify independent predictors of mortality during follow-up. Chronological age, Unified Parkinson's Disease Rating Scale (UPDRS) motor score, levodopa equivalent dose, probable REM sleep behavior disorder, psychotic symptoms, dementia, and use of antipsychotics were included as time-dependent variables, and age at onset (AAO) and sex as time-independent variables. RESULTS: Of 230 patients, 211 (92%) died during the study period. Median survival time from motor onset was 15.8 years (range 2.2-36.6). Independent predictors of mortality during follow-up were AAO (hazard ratio [HR] 1.40 for 10-years increase, p = 0.029), chronological age (HR 1.51 for 10-years increase, p = 0.043), male sex (HR 1.63, p = 0.001), UPDRS motor score (HR 1.18 for 10-point increase, p < 0.001), psychotic symptoms (HR 1.45, p = 0.039), and dementia (HR 1.89, p = 0.001). CONCLUSIONS: This population-based long-term study demonstrates that in addition to AAO, chronological age, motor severity, and dementia, psychotic symptoms independently predict increased mortality in PD. In contrast, no significant impact of antipsychotic or antiparkinsonian drugs on survival was observed in our PD cohort. Early prevention of motor progression and development of psychosis and dementia may be the most promising strategies to increase life expectancy in PD.

Randomised comparison of percutaneous left ventricular assist device with open-chest cardiac massage and with surgical assist device during ischaemic cardiac arrest.

AIMS: A percutaneous left ventricular assist device can maintain blood flow to vital organs during ventricular fibrillation and may improve outcomes in ischaemic cardiac arrest. We compared haemodynamic and clinical effects of a percutaneous left ventricular assist device with a larger device deployed via endovascular prosthesis and with open-chest cardiac massage during ischaemic cardiac arrest. METHODS: Eighteen swine were randomised into three groups. After thoracotomy, coronary ischaemia and ventricular fibrillation was induced. Cardiac output was measured with transit-time flowmetry. Tissue perfusion was measured with microspheres. Defibrillation was performed after 20 min. RESULTS: Cardiac output with cardiac massage was 1129 mL min⁻¹ vs. 1169 mL min⁻¹ with the percutaneous- and 570 mL min⁻¹ with the surgical device (P < 0.05 surgical vs. others). End-tidal CO2 was 3.3 kPa with cardiac massage vs. 3.2 kPa with the percutaneous- and 2.3 kPa with the surgical device (P < 0.05 surgical vs. others). Subepicardial perfusion was 0.33 mL min⁻¹ g⁻¹ with cardiac massage vs. 0.62 mL min⁻¹ g⁻¹ with both devices (P < 0.05 devices vs. massage), cerebral perfusion was comparable between groups (all reported values after 3 min cardiac arrest, all P<0.05 vs. baseline, all P = NS for 3 min vs. 15 min). Return of spontaneous circulation was achieved in 5/6 subjects with cardiac massage vs. 6/6 with the percutaneous- and 4/6 with the surgical device (P = NS). CONCLUSION: The percutaneous device improved myocardial perfusion, maintained cerebral perfusion and systemic circulation with similar rates of successful defibrillation vs. cardiac massage. Increased delivery was not obtained with the surgical device during cardiac arrest.

Analysis of vestibular schwannoma size in multiple dimensions: a comparative cohort study of different measurement techniques.

OBJECTIVES: In this volumetric study of the vestibular schwannoma, we evaluated the accuracy and reliability of several approximation methods that are in use, and determined the minimum volume difference that needs to be measured for it to be attributable to an actual difference rather than a retest error. We also found empirical proportionality coefficients for the different methods. DESIGN/SETTING AND PARTICIPANTS: Methodological study with investigation of three different VS measurement methods compared to a reference method that was based on serial slice volume estimates. These volume estimates were based on: (i) one single diameter, (ii) three orthogonal diameters or (iii) the maximal slice area. Altogether 252 T1-weighted MRI images with gadolinium contrast, from 139 VS patients, were examined. MAIN OUTCOME MEASURES: The retest errors, in terms of relative percentages, were determined by undertaking repeated measurements on 63 scans for each method. Intraclass correlation coefficients were used to assess the agreement between each of the approximation methods and the reference method. The tendency for approximation methods to systematically overestimate/underestimate different-sized tumours was also assessed, with the help of Bland-Altman plots. RESULTS: The most commonly used approximation method, the maximum diameter, was the least reliable measurement method and has inherent weaknesses that need to be considered. This includes greater retest errors than area-based measurements (25% and 15%, respectively), and that it was the only approximation method that could not easily be converted into volumetric units. Area-based measurements can furthermore be more reliable for smaller volume differences than diameter-based measurements. CONCLUSIONS: All our findings suggest that the maximum diameter should not be used as an approximation method. We propose the use of measurement modalities that take into account growth in multiple dimensions instead.

Cognitive dysfunction and health-related quality of life after a cardiac arrest and therapeutic hypothermia.

BACKGROUND: Evidence-based treatment protocols including therapeutic hypothermia have increased hospital survival to over 50% in unconscious out-of-hospital cardiac arrest survivors. In this study we estimated the incidence of cognitive dysfunctions in a group of cardiac arrest survivors with a high functional outcome treated with therapeutic hypothermia. Secondarily, we assessed the cardiac arrest group's level of cognitive performance in each tested cognitive domain and investigated the relationship between cognitive function and age, time since cardiac arrest and health-related quality of life (HRQOL). METHODS: We included 26 patients 13-28 months after a cardiac arrest. All patients were scored using the Cerebral Performance Category scale (CPC) and Mini-Mental State Examination (MMSE). Twenty-five of the patients were tested for cognitive function using the Cambridge Neuropsychological Test Automated Battery (CANTAB). These patients were tested using four cognitive tests: Motor Screening Test, Delayed Matching to Sample, Stockings of Cambridge and Paired Associate Learning from CANTAB. All patients filled in the Short Form-36 for the assessment of HRQOL. RESULTS: Thirteen of 25 (52%) patients were classified as having a cognitive dysfunction. Compared with the reference population, there was no difference in the performance in motor function and delayed memory but there were significant differences in executive function and episodic memory. We found no associations between cognitive function and age, time since cardiac arrest or HRQOL. CONCLUSION: Half of the patients had a cognitive dysfunction with reduced performance on executive function and episodic memory, indicating frontal and temporal lobe affection, respectively. Reduced performance did not affect HRQOL.

Fear of hypoglycaemia in mothers and fathers of children with Type 1 diabetes is associated with poor glycaemic control and parental emotional distress: a population-based study.

AIMS: To analyse, in a population-based study, the association between parental fear of hypoglycaemia and (i) the prevalence of hypoglycaemia and diabetes treatment factors in children with Type 1 diabetes and (ii) emotional distress in mothers and fathers. METHODS: Mothers (n = 103) and fathers (n = 97) of 115 children with Type 1 diabetes (1-15 years old) participated in the study. In addition to demographic and disease-specific data, the participants completed the Hypoglycaemia Fear Survey-Parent version (HFS-P) (worry and behaviour subscales) and the Hopkins Symptom Checklist-25 items (HSCL-25) to measure emotional distress. RESULTS: A higher HFS-P worry score was associated with higher glycated haemoglobin (HbA(1c)), a higher frequency (>or= 7) of what parents experienced as problematic hypoglycaemic events during the past year and co-morbid disease in the child. A higher HFS-P behaviour score was associated with children receiving insulin injections compared with using an insulin pump and a higher frequency (>or= 7 per day) of blood glucose measurements. The mothers had higher scores than the fathers in both the worry and behaviour subscales. The mothers' and the fathers' HFS-P worry scores correlated significantly with their HSCL-25 scores. CONCLUSIONS: The association between a higher level of hypoglycaemic-related fear and parental emotional distress and poorer glycaemic control in the child emphasizes the need for programmes to support and guide parents. The results suggest that future interventions should target both the parents' fear and appropriate ways to prevent hypoglycaemia in children with Type 1 diabetes.

A population-based evaluation of the seventh edition of the TNM system for lung cancer.

Our study describes the new seventh edition of the TNM system for lung cancer in a national population and its clinical implications. We classified 1,885 operated patients with lung cancer, reported to the Cancer Registry of Norway (Oslo, Norway) from 2001 to 2005, according to the sixth and the seventh edition of the TNM system. We compared survival differences adjusting for known prognostic factors. Furthermore, we evaluated the overall predictive ability of both editions using Harrell's concordance index. Survival curves by stage for each of the editions were similar; however, a better description of stage IIIB was observed in the seventh edition. Survival rates of T1b and T2a tumours were similar (log rank p = 0.94). The concordance index was 0.68 for both editions, indicating no overall difference in their predictive accuracy. In the seventh edition, 211 (29%) stage IB patients migrated to stage II and 161 (48%) patients migrated from stage IIB to IIA. Stage migrations could change the treatment for up to 326 (17.3%) of the study patients. The seventh edition did not improve the overall predictive ability of the TNM system; however, the new classification implies changes in treatment for nearly one-fifth of the cases. The implications of the seventh TNM edition for the outcomes of patients should be studied further.

Effect of iron supplementation on iron status during the first week after blood donation.

INTRODUCTION: Frequent blood donations may lead to a negative iron balance. Iron depletion may be prevented by iron supplementation after whole blood donations. The aim of this study was to compare the short time changes in iron status after donation in two groups randomized to iron supplementation or no additional iron. A second objective was to evaluate the effect of iron supplementation in donors having HFE-variants compared to HFE wild types. METHODS: Subjects of both genders (199 women, 200 men) were randomised to receive iron supplementation or no additional iron after donation. Iron status, defined by the concentration of haemoglobin, serum ferritin, soluble transferrin receptor, concentration of haemoglobin in reticulocytes (CHr) and percent hypochrome mature red blood cells, was determined at the start of donation and 8 +/- 2 days after donation. HFE genotyping was performed at reappearance. RESULTS: There was a significant difference between the two study groups on all the iron status parameters. CHr was an efficient, early marker of ongoing synthesis of haemoglobin. Heterozygosity for the HFE variants C282Y and H63D had no statistically significant influence on the iron status. The donor's baseline serum ferritin value may be basis for an individual iron supplementation regimen, as donors with serum ferritin >50 microg/l do not seem to utilize the iron supplementation, but prefer endogenous iron to restore the loss of haemoglobin. CONCLUSION: Iron supplementation had a significant positive impact on the restoration of iron status one week after donation.

The effect of blood donation frequency on iron status.

INTRODUCTION: The effects of blood donation on iron status in donors without iron supplementation were studied. Analysing interactions between donations and iron status markers may predict these effects. MATERIALS AND METHODS: Haemoglobin (Hb) and serum ferritin were analysed in 893 donors over 1 year. Serum transferrin receptor (sTfR) was measured at the first and last donation. RESULTS: Prolonged intervals prevented decrease in Hb in women and in ferritin for both genders. In women, a high TfR-F index (sTfR/log ferritin) predicted fall in Hb. CONCLUSION: Adjusting the donation intervals is a way to prevent iron deficiency in blood donors.