Validation of the Danish SARC-F in Hospitalized, Geriatric Medical Patients.

OBJECTIVES: Validation of the Danish version of the SARC-F (Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls) for hospitalized geriatric medical patients, compared against the original EWGSOP (European Working Group on Sarcopenia in Older People) and revised EWGSOP2 definition for sarcopenia. Additionally, investigation of the ability of SARC-F to individually identify low strength/function and muscle mass. DESIGN: Cross-sectional analysis of data from an RCT. SETTING: Hospital, Medical Department. PARTICIPANTS: 122 geriatric medical patients (65.6% women) ≥ 70 years of age with mixed medical conditions. MEASUREMENTS: SARC-F screening, diagnostic assessment of sarcopenia (hand-grip strength, muscle mass measured by dual-frequency bio-impedance analysis, and 4-m usual gait speed). RESULTS: The prevalence of risk of sarcopenia (SARC-F ≥ 4) was 48.3%, while it was diagnosed in 65.8% and 21.7%, with EWGSOP and EWGSOP2, respectively. The sensitivity, specificity, positive predictive value, negative predictive value according to EWGSOP were 50.0 %, 53.7 %, 67.2% and 36.1%, while they were 53.8 %, 53.2 %, 24.1% and 80.6%, according to EWGSOP2 (all participants). The ability of SARC-F to predict reduced strength, function, and muscle mass was modest. There was a significant negative linear, yet weak, relationship between total SARC-F score and hand-grip strength (R2=0.033) and 4-m gait speed (R2=0.111), but not muscle mass (R2=0.004). CONCLUSION: SARC-F does not seem to be a suitable screening tool for identifying and excluding non-sarcopenic geriatric patients. Furthermore, the SARC-F score was more strongly correlated with reduced muscle strength and physical function than with low muscle mass.

Prevalence of muscle dysfunction concomitant with osteoporosis in a home-dwelling Danish population aged 65-93 years - The Copenhagen Sarcopenia Study.

INTRODUCTION: As life expectancy increases, a growing percentage of older individuals with age-related diseases such as osteoporosis and sarcopenia are expected. Patients with both conditions, i.e. patient with osteosarcopenia, are suggested to have a higher risk of fall and fracture compared to individuals with either condition. AIM: To investigate the potential relationship between low bone mineral density (BMD) and muscle dysfunction in a Danish cohort of older home-dwelling individuals. Furthermore, to examine the prevalence of osteosarcopenia and alterations in prevalence depending on cut-off values chosen. METHOD: Measures of BMD, relative appendicular lean mass and hand grip strength were assessed in 529 individuals aged 65+ from the population-based cross-sectional Copenhagen Sarcopenia Study (CSS). Osteoporosis was diagnosed according to the World Health Organization guidelines. Sarcopenia was diagnosed in accordance with the guidelines from the European Working Group on Sarcopenia in Older People (EWGSOP2) with application of cut-off values from the EWGSOP2 paper compared to cut-off values derived from a local cohort (CSS). RESULTS: 19.2% had osteoporosis (66 women and 35 men), whereas 2.7% (6 women and 8 men) and 4.2% (7 women and 15 men) had sarcopenia with application of EWGSOP2 and CSS cut-off values, respectively. Using the EWGSOP2 cut-off values, 1.5% (4 women and 4 men) were diagnosed with osteosarcopenia compared to 1.4% (4 women and 3 men) using CSS cut-off values. In the osteoporosis sub-population, 8% (EWGSOP2) and 7% (CSS) had sarcopenia and within the sarcopenia sub-population, 61.5% (EWGSOP2) and 33.3% (CSS) had osteoporosis. At all sites, BMD was lower among individuals with sarcopenia and sarcopenia increased the risk of osteoporosis (odds ratios: EWGSOP2: 7.3 (p < 0.001) and CSS: 2.2 (ns)). CONCLUSION: Osteosarcopenia was present in 1.5% of a group of healthy home-dwelling older individuals. Notably, individuals with sarcopenia had lower BMD and a higher risk of osteoporosis, whereas the opposite (prevalence of sarcopenia in individuals with osteoporosis) was not as frequent. Our data indicate that screening for sarcopenia and osteoporosis should be performed simultaneously in older individuals at high risk of falls and fractures. However, further studies with outcome-related results are needed to identify optimal measures of osteosarcopenia and cut-off values for sarcopenia.

Leaching of dissolved phosphorus from tile-drained agricultural areas.

We investigated leaching of dissolved phosphorus (P) from 45 tile-drains representing animal husbandry farms in all regions of Denmark. Leaching of P via tile-drains exhibits a high degree of spatial heterogeneity with a low concentration in the majority of tile-drains and few tile-drains (15% in our investigation) having high to very high concentration of dissolved P. The share of dissolved organic P (DOP) was high (up to 96%). Leaching of DOP has hitherto been a somewhat overlooked P loss pathway in Danish soils and the mechanisms of mobilization and transport of DOP needs more investigation. We found a high correlation between Olsen-P and water extractable P. Water extractable P is regarded as an indicator of risk of loss of dissolved P. Our findings indicate that Olsen-P, which is measured routinely in Danish agricultural soils, may be a useful proxy for the P leaching potential of soils. However, we found no straight-forward correlation between leaching potential of the top soil layer (expressed as either degree of P saturation, Olsen-P or water extractable P) and the measured concentration of dissolved P in the tile-drain. This underlines that not only the source of P but also the P loss pathway must be taken into account when evaluating the risk of P loss.

Management of latent tuberculous infection in Norway in 2009: a descriptive cross-sectional study.

SETTING: Despite a steep increase in the number of individuals treated for latent tuberculous infection (LTBI), few data are available on how treatment is implemented. OBJECTIVE: To obtain baseline information on initiation and completion of treatment for LTBI in Norway in 2009. DESIGN: A descriptive cross-sectional study. RESULTS: All 721 patients treated for LTBI in 2009 in Norway were included, of whom 607 (84%) completed treatment. The treatment regimen generally consisted of 3 months of rifampicin and isoniazid. The three main reasons for starting treatment were: 1) countries of origin with high tuberculosis (TB) prevalence, 2) a positive tuberculin skin test, and 3) a positive interferon gamma release assay. The use of directly observed treatment varied by health region and age. The majority of the 34 medical specialists interviewed saw a need for new national guidelines to improve the selection of high-risk patients with LTBI. CONCLUSIONS: Management of LTBI is in accordance with current guidelines, with a high completion rate. More targeted selection of which patients should be offered preventive treatment is required, and new guidelines and tools to enhance risk assessment are necessary.

Description of nine nutrient loss models: capabilities and suitability based on their characteristics.

In EUROHARP, an EC Framework V project, which started in 2002 with 21 partners in 17 countries across Europe, a detailed intercomparison of contemporary catchment-scale modelling approaches was undertaken to characterise the relative importance of point and diffuse pollution of nutrients in surface freshwater systems. The study focused on the scientific evaluation of different modelling approaches, which were validated on three core catchments (the Ouse, UK; the Vansjo-Hobøl, Norway; and the Enza, Italy), and the application of each tool to three additional, randomly chosen catchments across Europe. The tools involved differ profoundly in their complexity, level of process representation and data requirements. The tools include simple loading models, statistical, conceptual and empirical model approaches, and physics-based (mechanistic) models. The results of a scientific intercomparison of the characteristics of these different model approaches are described. This includes an analysis of potential strengths and weaknesses of the nutrient models.

Evaluation of the difference of eight model applications to assess diffuse annual nutrient losses from agricultural land.

The capability of eight nutrient models to predict annual nutrient losses (nitrogen and phosphorus) at catchment scale have been studied in the EUROHARP project. The methodologies involved in these models differ profoundly in their complexity, level of process representation and data requirements. This evaluation is focused on model performance in three core catchments: the Vansjø-Hobøl (Norway), the Ouse (Yorkshire, UK) and the Enza (Italy). These three different model applications have been evaluated by comparing calculated annual nutrient loads (total N or nitrate and total P), based on observed flow and total nitrogen or nitrate and total phosphorus concentrations, and the annual nutrient loads that were simulated by the eight nutrient models. Four statistics have been applied for this purpose: the root mean squared error (RMSE), the mean absolute error (MAE), the mean error (ME), and Nash-Sutcliffe's model efficiency (NS). The results show that all model approaches can predict the calculated annual discharges. Depending on the observed statistics (RMSE, MAE, ME and NS) the scores of the model application differed, therefore no overall 'best model' could be identified. Although the water and nutrient loads from (sub)catchments can be predicted, the modelled pathways of nutrients within agricultural land and the nutrient losses to surface waters from agricultural land vary among the catchments and among those model approaches which are able to make this distinction.

Ensemble modelling of nutrient loads and nutrient load partitioning in 17 European catchments.

An ensemble of nutrient models was applied in 17 European catchments to analyse the variation that appears after simulation of net nutrient loads and partitioning of nutrient loads at catchment scale. Eight models for N and five models for P were applied in three core catchments covering European-wide gradients in climate, topography, soil types and land use (Vansjø-Hobøl (Norway), Ouse (Yorkshire, UK) and Enza (Italy)). Moreover, each of the models was applied in 3-14 other EUROHARP catchments in order to inter-compare the outcome of the nutrient load partitioning at a wider European scale. The results of the nutrient load partitioning show a variation in the computed average annual nitrogen and phosphorus loss from agricultural land within the 17 catchments between 19.1-34.6 kg N ha(-1) and 0.12-1.67 kg P ha(-1). All the applied nutrient models show that the catchment specific variation (range and standard deviation) in the model results is lowest when simulating the net nutrient load and becomes increasingly higher for simulation of the gross nutrient loss from agricultural land and highest for the simulations of the gross nutrient loss from other diffuse sources in the core catchments. The average coefficient of variation for the model simulations of gross P loss from agricultural land is nearly twice as high (67%) as for the model simulations of gross N loss from agricultural land (40%). The variation involved in model simulations of net nutrient load and gross nutrient losses in European catchments was due to regional factors and the presence or absence of large lakes within the catchment.

Comparative study of model prediction of diffuse nutrient losses in response to changes in agricultural practices.

This article presents a comparative study of modelled changes in nutrient losses from two European catchments caused by modifications in agricultural practices. The purpose was not to compare the actual models used, but rather to assess the uncertainties a manager may be faced with after receiving decision support from consultants using different models. Seven modelling teams were given the same data about two catchments and their management characteristics and were asked to model the same changes in management practices using the model of their own choice. This can potentially cause accumulated 'errors' due to differences in the modelling teams' interpretation of relevant processes and definitions of boundary conditions (inputs). The study was carried out within the framework of the EUROHARP project, which aimed at harmonising procedures for quantifying diffuse losses of nitrogen and phosphorus from agriculture. Models are important for assessing river basin management plans (RBMPs) as required e.g. under the EC Water Framework Directive and Action Plans under the EC Nitrates Directive. This article illustrates some challenges with respect to interpreting such modelling results. The selected management scenarios include changes in fertiliser application levels, changes in livestock numbers and changes in land-use and crop rotation systems. Seven models were applied for the same scenarios in the Enza catchment in Italy and the Zelivka catchment in the Czech Republic. All models had been calibrated and validated with respect to historical data of climatic conditions, water quality and discharge measurements. The modelling results reveal a variation in predicted effects of the management scenarios, causing different conclusions with respect to choice of best management practice for reducing nutrient losses. The study demonstrates that it is important that care is taken by modellers and involved decision makers throughout the entire modelling process, both with regard to a common understanding of the problem definition, understanding of boundary conditions, and uncertainty of outputs and interpretation of results.

Phosphorus losses from agricultural areas in river basins: effects and uncertainties of targeted mitigation measures.

In this paper we show the quantitative and relative importance of phosphorus (P) losses from agricultural areas within European river basins and demonstrate the importance of P pathways, linking agricultural source areas to surface water at different scales. Agricultural P losses are increasingly important for the P concentration in most European rivers, lakes, and estuaries, even though the quantity of P lost from agricultural areas in European catchments varies at least one order of magnitude (<0.2 kg P ha(-1) to >2.1 kg P ha(-1)). We focus on the importance of P for the implementation of the EU Water Framework Directive and discuss the benefits, uncertainties, and side effects of the different targeted mitigation measures that can be adopted to combat P losses from agricultural areas in river basins. Experimental evidence of the effects of some of the main targeted mitigation measures hitherto implemented is demonstrated, including: (i) soil tillage changes, (ii) treatment of soils near ditches and streams with iron to reduce P transport from source areas to surface waters, (iii) establishment of buffer zones for retaining P from surface runoff, (iv) restoration of river-floodplain systems to allow natural inundation of riparian areas and deposition of P, and (v) inundation of riparian areas with tile drainage water for P retention. Furthermore, we show how river basin managers can map and analyze the extent and importance of P risk areas, exemplified by four catchments differing in size in Norway, Denmark, and the Netherlands. Finally, we discuss the factors and mechanisms that may delay and/or counteract the responses of mitigation measures for combating P losses from agricultural areas when monitored at the catchment scale.

Buffer zones as a sink for sediment and phosphorus between the field and stream: Danish field experiences.

Rill erosion, surface runoff and storage of sediment and phosphorus in buffer zones were investigated during three winters on ca. 140 arable field slope units in twenty places in Denmark covering all landscape types, climate gradients and dominant soil types. The dominant soils are Alfisols and Spodosols, with textural composition typically ranging from sand to loam. The average slope is 7% (range: 2-20%) and median buffer zone width was 8.3 m (range: 0.6-125 m). The geometric mean annual rill erosion was 0.33 m3 ha(-1) equalling to 495 kg sediment ha(-1) and 0.25 kg P ha(-1). The deposition of sediment on the field, in the buffer zone and delivery of soil to the stream was surveyed within the 140 slope units following three winters. Deposition of sediment in the buffer zone was observed in 31% (1997/98), 31% (1998/99) and 29% (1999/2000) of the slope units. Delivery of soil across the edge of the stream was observed in 23% (1997/98), 17% (1998/99) and 25% (1999/2000) of the 140 slope units. Median dissolved P concentration in surface runoff was 0.18 mg Pl(-1) (range: 0.029-16.294 mg Pl(-1)). A probability model was developed to predict the efficiency of different widths of buffer zones.

Analysis of the hydrology and flow of nitrogen in 17 Danish catchments.

In the search for tools for evaluating the effects of national action plans combating diffuse nutrient pollution causing eutrophication of surface waters, a study of the nitrogen (N) flow in 17 Danish agricultural catchments was carried out. Data on N input and N harvest for the agricultural year of 1993/1994 was obtained from questionnaire surveys facilitating the set up of N balances. Net export of N from the catchments measured at the outlet was obtained from time-series of stream water chemistry and discharge from 1993-1997. N leaching from the root zone of each field was calculated using an empirical model. A physically based lumped rainfall-runoff model was used for separating the hydrograph time-series into three runoff components: baseflow, interflow and overland flow. Large regional variations in net N input were found ranging from 62 kg N ha(-1) yr(-1) in the loamy eastern part of the country dominated by cereal production to 137 kg N ha(-1) yr(-1) in the western part characterised by less fertile sandy soils and dominated by animal husbandry. N leaching from the root zone showed a corresponding variation with regional averages ranging from 34.5 kg N ha(-1) yr(-1) to 90.9 kg N ha(-1) yr(-1). No similar regional pattern could however be found regarding net N export, and no relationship could be established between net N export and root zone N leaching. This finding was ascribed to a varying and in some catchments very high (>80%) N retention during subsurface transport to the stream. The hydrological modelling revealed that loamy catchments had a high proportion of quick flow (overland flow + interflow), whereas baseflow dominated the sandy catchments. Further, a highly significant relationship between N retention and proportion of quick flow was found emphasising the importance of understanding the hydrological pathways. This should be taken into consideration when evaluating the N loading of surface waters resulting from a given agricultural practice and the effects of possible changes in this practice.

[Intervention for apoplexy patients discharged from hospital. Physical training: a literature review]. / Opfølgende indsats til apopleksipatienter efter udskrivelse fra hospital. Fysisk traening: et litteraturstudium.

Stroke is among the leading causes of disability in Denmark. Rehabilitation services are in the process of being reorganised into dedicated stroke units. There is a general tendency toward reduction of length of in-patient treatment. The literature on outpatient rehabilitation services following primary rehabilitation on an inpatient basis was reviewed. The results of 16 randomised studies indicate that: 1) Continued rehabilitation after discharge can improve functional capacity of disabled stroke survivors; 2) Home-based rehabilitation is as effective as hospital-based outpatient rehabilitation; 3) Early supported discharge (ESD) services can reduce length of hospital stay but the relative advantages and drawbacks remain unclear. Ongoing rehabilitation by teams specialised in stroke rehabilitation seems to be crucial. More research, including evaluation of home-based rehabilitation services, is called for and existing outpatient rehabilitation services should be evaluated scientifically.

[Intervention for apoplexy patients discharged from hospital. Psychosocial support: a literature review]. / Opfølgende indsats til apopleksipatienter efter udskrivelse fra hospital. Psykosocial støtte: en litteraturoversigt.

Psychosocial support has been suggested as a way of easing stroke survivors' and their carers' adjustment to a life with disability. The literature on psychosocial support services following primary rehabilitation in hospital was reviewed. Eleven controlled studies evaluating the effect of psychosocial support interventions after discharge from hospital were identified. The studies differed widely with respect to design, intervention and evaluation methods. The results suggest that psychosocial support after discharge can improve psychological well being and quality of life for stroke survivors and their families and improve the social activity of patients. The effect was achieved by using different types of intervention such as providing information, counselling and support from stroke clubs. Psychosocial support for carers was effective as well. Future research should elucidate this area, including evaluation of psychosocial support as a tertiary prevention strategy.

[Can readmission after apoplexy be prevented? Post-hospital follow-up intervention for apoplexy patients]. / Kan genindlaeggelse af apopleksiramte forebygges? Resultater af et randomiseret interventionsstudium. Posthospital opfølgende indsats til apopleksipatienter.

INTRODUCTION: The aim of this study was to evaluate two models of an organised postdischarge follow-up service for stroke survivors in comparison with standard aftercare. METHODS: One hundred and fifty-five stroke patients discharged to their homes with lasting impairment were randomised as follows: 54 to follow-up home visits by a physician (INT1-HVP), 53 to instruction by a physiotherapist in their home (INT2-PI), and 48 to standard aftercare (control). Six months after discharge, data on readmission were collected. RESULTS: The readmission rate over the six-month period was 26% in the INT1-HVP group, 34% in the INT2-PI group, and 44% for the controls (p = 0.028). Multivariate analysis of the readmission risk showed a significant, favourable effect of intervention in interaction with the length of hospital stay (p = 0.0332), which indicates that the effect of intervention was strongest for patients with a long inpatient rehabilitation. DISCUSSION: Follow-up intervention after discharge seems to be a way of preventing readmission, especially for patients with a long inpatient rehabilitation.

Can readmission after stroke be prevented? Results of a randomized clinical study: a postdischarge follow-up service for stroke survivors.

BACKGROUND AND PURPOSE: About 50% of stroke survivors are discharged to their homes with lasting disability. Knowledge, however, of the importance of follow-up services that targets these patients is sparse. The purpose of the present study was to evaluate 2 models of follow-up intervention after discharge. The study hypothesis was that intervention could reduce readmission rates and institutionalization and prevent functional decline. We report the results regarding readmission. METHODS: This randomized study included 155 stroke patients with persistent impairment and disability who, after the completion of inpatient rehabilitation, were discharged to their homes. The patients were randomized to 1 of 2 follow-up interventions provided in addition to standard care or to standard aftercare. Fifty-four received follow-up home visits by a physician (INT1-HVP), 53 were provided instructions by a physiotherapist in their home (INT2-PI), and 48 received standard aftercare only (controls). Baseline characteristics for the 3 groups were comparable. Six months after discharge, data were obtained on readmission and institutionalization. RESULTS: The readmission rates within 6 months after discharge were significantly lower in the intervention groups than in the control group (INT1-HVP 26%, INT2-PI 34%, controls 44%; P=0.028). Multivariate analysis of readmission risk showed a significant favorable effect of intervention (INT1-HVP or INT2-PI) in interaction with length of hospital stay (P=0.0332), indicating that the effect of intervention was strongest for patients with a prolonged inpatient rehabilitation. CONCLUSIONS: Readmission is common among disabled stroke survivors. Follow-up intervention after discharge seems to be a way of preventing readmission, especially for patients with long inpatient rehabilitation.

Ketorolac (Toradol) as an analgesic in swine following transluminal coronary angioplasty.

Post-procedure pain is a common complication in swine following survival angioplastic procedures. Ketorolac and buprenorphine have been used to control pain in these animals. Time from completion of procedure-extubation to onset of feeding was used as an indicator for analgesic effect. The onset of feeding following extubation occurs within 6 to 20 h in animals given ketorolac compared to 30 plus hours in animals given buprenorphine.

[Patients' acceptance of poly-soft and paper-pack X-ray film packets]. / Patienters accept af poly-soft og paper-pack røntgenfilmpakninger.

Two types of Kodak dental x-ray film packets are manufactured, paper-pack (PP) from paper, and poly-soft (PS) from vinyl. They differ in dimensions as PP measures 31.4 X 42.1 mm compared to PS measuring 33.0 x 44.3 mm. The edges of PP are rounded, while those of PS have welded, thin and sharp edges. Patients acceptance of the two types was tested among 25 adult patients during exposures for full mouth surveys. For each patient half PP and PS were used in a random sequence. The patients were asked to rate any feeling of discomfort or pain and to compare the feeling after each pair of film packets. The scores were compared by Wilcoxon's matched-pairs signed-ranks test. The results revealed with a statistical significance at the 1% level, that the patients felt more discomfort when the poly-soft packet was used. No affections of image quality were noticed. In spite of the higher level of discomfort resulting from the use of PS it seems justified to recommend this type due to its superior hygienic qualities.

[Diagnosis of penicillin allergy. Results of a clinical investigation program]. / Diagnostik af penicillinallergi. Resultater af et klinisk undersøgelsesprogram.

Investigations concerning penicillin allergy (PA) from abroad suggest that considerable overdiagnosing occurs. The absence of standardized commercially available preparations for skin testing and the time necessary for thorough testing are also contributory causes. Fifty patients with suspected PA were investigated with a programme consisting, in serial order, of RAST for IgE to penicillin V and G, a cutaneous test with a commercially available test preparation (Penkit), first with a prick followed by intracutaneous testing and finally with oral provocation. If a positive reaction occurred, the test was discontinued. Six patients (12%) had positive RAST or cutaneous reactions, (1 positive to RAST, 2 to prick and three not until the intracutaneous test), while no patients with negative RAST and cutaneous tests reacted to oral provocation. No generalized allergic reactions occurred during testing. It did not prove possible to predict which patients would react positively on the basis of the case histories. This investigation thus demonstrates that PA is also considerably overdiagnosed in Denmark and that a programme of investigation such as this is suitable for testing for PA and, finally, that the programme of investigation can scarcely be simplified.

[Penicillin allergy]. / Penicillinallergi.

Patients are often labelled "allergic to penicillin" without adequate reason. Since penicillins are frequently the drugs of choice, this label should not be accepted lightly. The allergic reactions to penicillins are of immediate, accelerated, or delayed-type hypersensitivity. The most serious reactions are those of acute- and accelerated-type, which are both IgE mediated. Ideally, patients suspected of being allergic to penicillins should be tested in succession with RAST, skin testing, and per-oral provocation. Patients with serious infections and documented penicillin allergy should undergo desensitisation. Patients with penicillin allergy have a slightly increased risk of reactions to cephalosporins.

Multifocal invasive carcinoma of the vulva in a 25-year-old woman with Bowenoid papulosis.

This case report documents malignant progression associated with wart virus infection of the vulva in a 25-year-old female. The initial condition of Bowenoid papulosis and carcinoma in situ of the vulva was diagnosed on colposcopic biopsies performed to investigate chronic pruritus and superficial dyspareunia. This condition failed to resolve with local ablative therapy and progressed over a period of 8 months to multifocal invasive carcinoma of the vulva requiring radical surgery. Deoxyribonucleic acid hybridization studies on the operative specimen revealed the presence of human papilloma virus type 16. The role of human papilloma virus in the aetiology of Bowenoid papulosis and neoplasia of the vulva is discussed.